Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.12.006
Brazilian Journal of Anesthesiology
Clinical Research

Predictors of mortality of trauma patients admitted to the ICU: a retrospective observational study

Preditores de mortalidade de pacientes com trauma admitidos em UTI: estudo observacional retrospectivo

Matthaios Papadimitriou-Olivgeris, Eleftheria Panteli, Kyriaki Koutsileou, Maria Boulovana, Anastasia Zotou, Markos Marangos, Fotini Fligou

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Abstract

Background and objectives
: Worldwide, trauma is one of the leading causes of morbidity and mortality. The aim of the present study is to identify the predictors of mortality of trauma patients requiring Intensive Care Unit (ICU) admission.

Methods
This retrospective study was conducted in the ICU of our institution in Greece during a six-year period (2010–15).

Results
Among 326 patients, trauma was caused by road traffic accidents in .5%, followed by falls (21.1%) and violence (7.4%). Thirty-day mortality was 27.3%. Multivariate analysis showed that higher New Injury Severity Score (NISS), severe head/neck injury, acute kidney injury, septic shock and hemorrhagic shock were significantly associated with mortality while higher Revised Injury Severity Classification, version II (RISC II) and the administration of enteral nutrition were associated with survival. NISS showed the higher accuracy in predicting 30-day mortality followed by RISC II, while scores based only in physiological variables had lower predictive ability.

Conclusions
Increased mortality was strongly associated with the severity of the injury upon admission. Traumatic brain injury, septic shock and acute kidney injury have also been found among the strongest predictors of mortality. NISS can be considered as a statistically superior score in predicting mortality of severely injured patients.

Keywords

Road traffic accident;  Traumatic brain injury;  Sepsis;  New Injury Severity Score (NISS);  Revised Injury Severity Classification, version II (RISC II)

References

1 O. Brattstrom, F. Granath, P. Rossi, et al. Early predictors of morbidity and mortality in trauma patients treated in the intensive care unit Acta Anaesthesiol Scand., 54 (2010), pp. 1007-1017

2 European Association for Injury Prevention and Safety Promotion (EuroSafe) Injuries in the European Union, Summary of injury statisticsfor the years 2010-2012 (2014) Amsterdam, The Netherlands. Available at: http://www.eurosafe.eu.com/uploads/inline-files/IDB_Report_2014_final%202010-2012.pdf. (accessed September 11, 2017)

3 R. Pfeifer, I.S. Tarkin, B. Rocos, et al. Patterns of mortality and causes of death in polytrauma patients -- has anything changed? Injury, 40 (2009), pp. 907-911

4 A. Ulvik, T. Wentzel-Larsen, H. Flaatten Trauma patients in the intensive care unit: short- and long-term survival and predictors of 30-day mortality Acta Anaesthesiol Scand., 51 (2007), pp. 171-177

5 A. Frutiger, C. Ryf, C. Bilat, et al. Five years’ follow-up of severely injured ICU patients J Trauma., 31 (1991), pp. 1216-1225 discussion 25-26

6 J. Leitgeb, W. Mauritz, A. Brazinova, et al. Impact of concomitant injuries on outcomes after traumatic brain injury Arch Orthop Trauma Surg, 133 (2013), pp. 659-668

7 P.L. Chalya, J.M. Gilyoma, R.M. Dass, et al. Trauma admissions to the intensive care unit at a reference hospital in Northwestern Tanzania Scand J Trauma Resusc Emerg Med, 19 (2011), p. 61

8 P. Fueglistaler, F. Amsler, M. Schuepp, et al. Prognostic value of Sequential Organ Failure Assessment and Simplified Acute Physiology II Score compared with trauma scores in the outcome of multiple-trauma patients Am J Surg, 200 (2010), pp. 204-214

9 S.P. Baker, B. O’Neill, W Haddon Jr., et al. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care J Trauma, 14 (1974), pp. 187-196

10 C.R. Boyd, M.A. Tolson, W.S. Copes Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score J Trauma., 27 (1987), pp. 370-378

11 R. Lefering, S. Huber-Wagner, U. Nienaber, et al. Update of the trauma risk adjustment model of the TraumaRegister DGU: the Revised Injury Severity Classification, version II Crit Care., 18 (2014), p. 476

12 B.P. Smith, A.J. Goldberg, J.P. Gaughan, et al. A comparison of Injury Severity Score and New Injury Severity Score after penetrating trauma: A prospective analysis J Trauma Acute Care Surg., 79 (2015), pp. 269-274

13 C. Thanapaisal, P. Saksaen A comparison of the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Trauma-Injury Severity Score (TRISS) for outcome assessment in Srinagarind Intensive Care Unit trauma patients J Med Assoc Thai., 95 (2012), pp. S25-33

14 M. Singer, C.S. Deutschman, C.W. Seymour, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA, 315 (2016), pp. 801-810

15 A. Khwaja KDIGO clinical practice guidelines for acute kidney injury Nephron Clin Pract, 120 (2012), pp. c179-84

16 S. Di Saverio, G. Gambale, F. Coccolini, et al. Changes in the outcomes of severe trauma patients from 15-year experience in a Western European trauma ICU of Emilia Romagna region (1996-2010). A population cross-sectional survey study Langenbecks Arch Surg, 399 (2014), pp. 109-126

17 A.D. Trajano, B.M. Pereira, G.P. Fraga Epidemiology of in-hospital trauma deaths in a Brazilian university hospital BMC Emerg Med, 14 (2014), p. 22

18 E. Pikoulis, V. Filias, N. Pikoulis, et al. Patterns of injuries and motor-vehicle traffic accidents in Athens Int J Inj Contr Saf Promot, 13 (2006), pp. 190-193

19 H. Tohira, I. Jacobs, D. Mountain, et al. Systematic review of predictive performance of injury severity scoring tools Scand J Trauma Resusc Emerg Med, 20 (2012), p. 63

20 S.Y. Hwang, J.H. Lee, Y.H. Lee, et al. Comparison of the sequential organ failure assessment, acute physiology and chronic health evaluation II scoring system, and trauma and injury severity score method for predicting the outcomes of intensive care unit trauma patients Am J Emerg Med, 30 (2012), pp. 749-753

21 S.C.H. Kuo, P.J. Kuo, C.S. Rau, et al. The protective effect of helmet use in motorcycle and bicycle accidents: a propensity score-matched study based on a trauma registry system BMC Public Health, 17 (2017), p. 639

22 J. Fujinaga, A. Kuriyama, N. Shimada Incidence and risk factors of acute kidney injury in the Japanese trauma population: A prospective cohort study Injury (2017)

23 R. Pfeifer, M. Teuben, H. Andruszkow, et al. Mortality Patterns in Patients with Multiple Trauma: A Systematic Review of Autopsy Studies PloS One, 11 (2016), Article e0148844

24 H.I. Giamberardino, E.P. Cesario, E.R. Carmes, et al. Risk factors for nosocomial infection in trauma patients Braz J Infect Dis, 11 (2007), pp. 285-289

25 G. Papia, B.A. McLellan, P. El-Helou, et al. Infection in hospitalized trauma patients: incidence, risk factors, and complications J Trauma, 47 (1999), pp. 923-927

26 M. Prin, G. Li Complications and in-hospital mortality in trauma patients treated in intensive care units in the United States, 2013 Inj Epidemiol., 3 (2016), p. 18

27 F. Kolonitsiou, M. Papadimitriou-Olivgeris, A. Spiliopoulou, et al. Trends of Bloodstream Infections in a University Greek Hospital during a Three-Year Period: Incidence of Multidrug-Resistant Bacteria and Seasonality in Gram-negative Predominance Pol J Microbiol, 66 (2017), pp. 171-180

28 G. Elke, A.R. van Zanten, M. Lemieux, et al. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials Crit Care, 20 (2016), p. 117

29 Brain Trauma Foundation Guidelines for the Management of Severe Traumatic Brain Injury (4th Edition) (2016) Campbell, California

30 Y.H. Chiang, D.P. Chao, S.F. Chu, et al. Early enteral nutrition and clinical outcomes of severe traumatic brain injury patients in acute stage: a multi-center cohort study J Neurotrauma, 29 (2012), pp. 75-80

31 H. Pu, G.S. Doig, P.T. Heighes, M.J. Allingstrup Early Enteral Nutrition Reduces Mortality and Improves Other Key Outcomes in Patients With Major Burn Injury: A Meta-Analysis of Randomized Controlled Trials Crit Care Med, 46 (2018), pp. 2036-2042

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