Factors associated with survival in Adult Patients with Traumatic Arrest: A Retrospective Cohort Study from US Trauma Centers

Abstract

Background: Traumatic arrests (TA) increasingly affect young adults worldwide with low reported survival rates. This study examines factors associated with survival (to hospital discharge) in traumatic arrests transported to US trauma centers. Methods: This retrospective cohort study used the US National Trauma Databank 2015 dataset and included patients who presented to trauma centers with “no signs of life”. Univariate and bivariate analyses were done. Factors associated with survival were identified using multivariate regression analyses. Results: The study included 5,980 patients with traumatic arrests. Only 664 patients (11.1%) survived to hospital discharge. Patients were predominantly in age group 16-64 (84.6%), were mostly males (77.8%) and white (55.1%). Most were admitted to Level I (55.5%) or Level II trauma centers (31.6%). Injuries were mostly blunt (56.7%) or penetrating (39.3%). Mean ISS was 23.71 (± 20.79). Factors associated with decreased survival included: Age group ≥65 (Ref: 16-24), male gender, self-inflicted and other or undetermined types of injuries (Ref: assault), injuries to head & neck, injuries to torso and injury severity score (ISS) ≥ 16 (Ref: <16). While factors associated with increased survival included: All injury mechanisms (with the exception of Motor Vehicle Transportation (MVT)) (Ref: firearm), injuries to extremities or spine & back and all methods of coverage (Ref: self-pay).Conclusion: Patients with traumatic arrests have poor outcomes with only 11.1 % surviving to hospital discharge. Factors associated with survival in traumatic arrests were identified. These findings are important for devising injury prevention strategies and help guide trauma management protocols to improve outcomes in traumatic arrests. Level of evidence: Level III

Prehospital advanced airway management of emergency medical service‐witnessed traumatic out‐of‐hospital cardiac arrest patients: analysis of nationwide trauma registry

“…We are aware of several studies showing that prehospital AAM is not beneficial for improving mortality in trauma patients. 2,13,18 Tsur et al 19 showed prehospital definitive airway did not benefit the improvement of survival. However, the survival rates in their series were 77.6% for secured airway patients and 78.0% for failed definitive airway patients.…”

“…Furthermore, we undertook a subgroup analysis using conditional logistic regression analysis based on body regions where the severe injury occurred, as physiological impact could differ depending on the injury site (severe head injury, severe torso (chest or abdominal) injury, severe extremity/spine injury). 13 Severe injury was defined as AIS ≥ 3. The same analyses were applied for each respective subgroup.…”

“…Our results suggest that AAM for selected trauma OHCA patients seems justifiable. We are aware of several studies showing that prehospital AAM is not beneficial for improving mortality in trauma patients 2,13,18 . Tsur et al 19 .…”