Factors Associated With Survival Following Blunt Chest Trauma in Older Patients

Harrington, David; Phillips, Benjamin; Machan, Jason T.; Zacharias, Nikolaos; Velmahos, George C.; Rosenblatt, Michael S.; Winston, Eleanor; Patterson, Lisa A.; Desjardins, Steven; Winchell, Robert J.; Brotman, Sheldon; Churyla, Andrei; Schulz, John; Maung, Adrian A.; Davis, Kimberly A.

doi:10.1001/archsurg.2010.71

Cited by 66 publications

(54 citation statements)

References 28 publications

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“…Trauma center status is associated with improved outcomes, and in our study, trauma centers placed the majority of the epidurals. 19,27 In our multivariate analyses we adjusted for trauma center status. Moreover, we performed a complete set of analyses limited only to patients treated in trauma centers, and the epidural effect was almost exactly the same, and there was significant benefit in patients with three or more rib fractures.…”

Section: Discussionmentioning

confidence: 99%

The effect of epidural placement in patients after blunt thoracic trauma

Gage

Rivara

Wang

et al. 2014

Journal of Trauma and Acute Care Surgery

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Section: Discussionmentioning

confidence: 99%

The effect of epidural placement in patients after blunt thoracic trauma

Gage

Rivara

Wang

et al. 2014

Journal of Trauma and Acute Care Surgery

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“…[1,3,9,11,17] Özellikle 65 yaş ve üzeri hasta grubunda mortalite daha çok oranda görülmekle birlikte, [8] çalışma grubumuzdaki mortalite görülen 8 hastadan sadece birinin yaşı 65 üzeri idi.…”

Section: Discussionunclassified

“…[2] Künt travma ile başvuran hastaların değerlendiril-mesinde, fiziksel inceleme ve direkt grafiler yanında bilgisayarlı tomografinin (BT) kullanımı son yıllarda giderek artmıştır. [6][7][8][9][10] Her ne kadar maliyet ve radyasyona maruz kalma gibi dezavantajları olsa da, oluşan travmanın etkilerinin daha iyi tanınması, gizli travmaların belirlenebilmesi, elde edilen bilgiler ışığında acil tedavinin yönlendirilmesi ve prognozun tahmin edilebilmesi BT'nin sağladığı genel avantajlardır. [9,10] Nonoperatif yönetim toraks travmaları ile başvuran hastalarda çoğunlukla yeterli olmaktadır.…”

unclassified

Factors Affecting Mortality in Blunt Thoracic Trauma

Hasbahçeci¹,

Özpek²,

Başak³

et al. 2013

Ulus Travma Acil Cerrahi Derg

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AMAÇKünt toraks travması, travma hastalarında sıklıkla toraks dışı yaralanmalarla birlikte görülmekte fakat mortaliteye etkisi tam olarak bilinmemektedir. GEREÇ VE YÖNTEMKünt toraks travmalı hastalar, klinik özellikler ve mortaliteye etki eden faktörler açısından değerlendirildi. BULGULARÇalışma grubu 76 hastadan (37,2±15 yıl) oluştu. Trafik kazası %63 oranıyla en sık görülen travma sebebiydi. Hastalarda görülen torasik yaralanmalar pnömotoraks (%54), kot kırığı (%42), hemotoraks (%22) ve akciğer kontüzyonu (%22) olarak saptandı. Ekstremite (%46) ve karın (%40) toraks dışı travmaların en sık görüldüğü bölgeler idi. Glasgow koma skoru, yaralanma şiddet skoru ve revize edilmiş travma skoru ortalamaları sırası ile 14±2,6, 19±13 ve 7,4±1,5 olarak hesaplandı. Sadece nonoperatif yönetim 37 (%48,7) hastada yeterli olurken, 37 (%48,7) hastada tüp torakostomi ve 2 (%2,6) hastada torakotomi gerekli oldu. Toplam 8 hastada (%10,5) mortalite görüldü. İlk başvuruda 90 mmHg'nin dü-şük sistolik kan basıncı değeri, yüzeyel ve apneik solunum ve travma skorlama sistemi sonuçlarının mortalite üzerinde anlamlı etkisi olduğu tespit edildi (p<0,05). SONUÇKünt toraks travmaları toraks dışı sistem yaralanmaları ile genellikle beraber görülmektedir. Toraks patolojisinin tipi ve sayısı ile mortalite arasında bir ilişki gösterilememiştir. Yüzeyel ve apneik solunum, 90 mmHg'den düşük sistolik kan basıncı ve travma skorlama sistemi sonuçları mortalite ile yakından ilişkilidir. Nonoperatif yönetim ve tüp torakostomi tedavi açısından çoğu hastada yeterli olmaktadır.

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“…Factors that are common in patients who died or survived with complications after attempted resuscitation included: blood loss,18 suffering from hypotension before cardiac arrest,19 emergency surgery performed outside of the normal working hours, suffering from severe underlying disease,20 suffering from severe conditions,16,21 and emergency surgery14,22 (especially trauma,16,20 cardiovascular surgery,19,22 abdominal aortic aneurysm,3 infant or elderly patients,20,23,24 myocardial ischemia,3 and delay in carrying out surgery) 23…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors for death and survival with or without complications in cardiac arrest patients receiving CPR within 24 hours of anesthesia for emergency surgery

Siriphuwanun¹,

Punjasawadwong²,

Lapisatepun³

et al. 2014

RMHP

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PurposeTo determine prognostic factors for death and survival with or without complications in cardiac arrest patients who received cardiopulmonary resuscitation (CPR) within 24 hours of receiving anesthesia for emergency surgery.Patients and methodsA retrospective cohort study approved by the Maharaj Nakorn Chiang Mai University Hospital Ethical Committee. Data used were taken from records of 751 cardiac arrest patients who received their first CPR within 24 hours of anesthesia for emergency surgery between January 1, 2003 and October 31, 2011. The reviewed data included patient characteristics, surgical procedures, American Society of Anesthesiologist (ASA) physical status classification, anesthesia information, the timing of cardiac arrest, CPR details, and outcomes at 24 hours after CPR. Univariate and polytomous logistic regression analyses were used to determine prognostic factors associated with the outcome variable. P-values of less than 0.05 were considered statistically significant.ResultsThe outcomes at 24 hours were death (638/751, 85.0%), survival with complications (73/751, 9.7%), and survival without complications (40/751, 5.3%). The prognostic factors associated with death were: age between 13–34 years (OR =3.08, 95% CI =1.03–9.19); ASA physical status three and higher (OR =6.60, 95% CI =2.17–20.13); precardiopulmonary comorbidity (OR =3.28, 95% CI =1.09–9.90); the condition of patients who were on mechanical ventilation prior to receiving anesthesia (OR =4.11, 95% CI =1.17–14.38); surgery in the upper abdominal site (OR =14.64, 95% CI =2.83–75.82); shock prior to cardiac arrest (OR =6.24, 95% CI =2.53–15.36); nonshockable electrocardiography (EKG) rhythm (OR =5.67, 95% CI =1.93–16.62); cardiac arrest occurring in postoperative period (OR =7.35, 95% CI =2.89–18.74); and duration of CPR more than 30 minutes (OR =4.32, 95% CI =1.39–13.45). The prognostic factors associated with survival with complications were being greater than or equal to 65 years of age (OR =4.30, 95% CI =1.13–16.42), upper abdominal site of surgery (OR =10.86, 95% CI =1.99–59.13), shock prior to cardiac arrest (OR =3.62, 95% CI =1.30–10.12), arrhythmia prior to cardiac arrest (OR =4.61, 95% CI =1.01–21.13), and cardiac arrest occurring in the postoperative period (OR =3.63, 95% CI =1.31–10.02).ConclusionThe mortality and morbidity in patients who received anesthesia for emergency surgery within 24 hours of their first CPR were high, and were associated with identifiable patient comorbidity, age, shock, anatomic site of operation, the timing of cardiac arrest, EKG rhythm, and the duration of CPR. EKG monitoring helps to identify cardiac arrest quickly and diagnose the EKG rhythm as a shockable or nonshockable rhythm, with CPR being performed as per the American Heart Association (AHA) CPR Guidelines 2010. The use of the fast track system in combination with an interdisciplinary team for surgery, CPR, and postoperative care helps to rescue patients in a short time.

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Factors Associated With Survival Following Blunt Chest Trauma in Older Patients

Cited by 66 publications

References 28 publications

The effect of epidural placement in patients after blunt thoracic trauma

The effect of epidural placement in patients after blunt thoracic trauma

Factors Affecting Mortality in Blunt Thoracic Trauma

Prognostic factors for death and survival with or without complications in cardiac arrest patients receiving CPR within 24 hours of anesthesia for emergency surgery

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