Independent early predictors of mortality in polytrauma patients: a prospective, observational, longitudinal study

Abstract

OBJECTIVES:Trauma is an important public health issue and associated with substantial socioeconomic impacts and major adverse clinical outcomes. No single study has previously investigated the predictors of mortality across all stages of care (pre-hospital, emergency room, surgical center and intensive care unit) in a general trauma population. This study was designed to identify early predictors of mortality in severely injured polytrauma patients across all stages of care to provide a better understanding of the physiologic changes and mechanisms by which to improve care in this population.METHODS:A longitudinal, prospective, observational study was conducted between 2010 and 2013 in São Paulo, Brazil. Patients submitted to high-energy trauma were included. Exclusion criteria were as follows: injury severity score <16, <18 years old or insufficient data. Clinical and laboratory data were collected at four time points: pre-hospital, emergency room, and 3 and 24 hours after hospital admission. The primary outcome assessed was mortality within 30 days. Data were analyzed using tests of association as appropriate, nonparametric analysis of variance and generalized estimating equation analysis (p<0.05). ClinicalTrials.gov: NCT01669577.RESULTS:Two hundred patients were included. Independent early predictors of mortality were as follows: arterial hemoglobin oxygen saturation (p<0.001), diastolic blood pressure (p<0.001), lactate level (p<0.001), Glasgow Coma Scale score (p<0.001), infused crystalloid volume (p<0.015) and presence of traumatic brain injury (p<0.001).CONCLUSION:Our results suggest that arterial hemoglobin oxygen saturation, diastolic blood pressure, lactate level, Glasgow Coma Scale, infused crystalloid volume and presence of traumatic brain injury are independent early mortality predictors.

Predictors of Hospital Mortality and the Related Burden of Disease in Severe Traumatic Brain Injury: A Prospective Multicentric Study in Brazil

“…This is the first prospective, a multicentric study assessing hospital mortality due to severe TBI in Brazil. The results were similar to our (16) and others (15, 22) previous single-center studies in Brazil and multicentric studies in Latin America (14, 23). The hospital mortality in the present study was similar in the three centers analyzed (range between 28.5 to 36.1%) and did not change significantly in comparison to the mortality registered in the city of Florianópolis, at the HGCR, between 1994 and 2003 (16).…”

Polytrauma Is Associated with Increased Three- and Six-Month Disability after Traumatic Brain Injury: A TRACK-TBI Pilot Study

“…1,2 Multi-system trauma is common in the setting of TBI, with reported incidences of up to 70% across large population-based cohorts. 3,4 In the trauma literature concurrent TBI is linked to poorer prognoses; 5,6 however, the impact of polytrauma on TBI outcomes remains understudied, especially in the civilian population. Proper outcome assessment tools are critical for capturing divergence in outcomes attributable to polytrauma after TBI.…”

Análise comparativa do perfil de vítimas de trauma contuso e penetrante atendidas na sala de emergência: estudo longitudinal

“…Um estudo brasileiro, que avaliou preditores de mortalidade de 200 vítimas de trauma múltiplo acompanhadas por 30 dias após admissão, reportou como fatores de risco para mortalidade hospitalar alteração nos valores da saturação periférica de oxigênio (p < 0,001) e pressão arterial sistólica (p = 0,017) (150) .…”

“…Logo, as repercussões fisiológicas, anatômicas e clínicas observadas podem ser diferentes para cada um dos tipos de trauma, e a região corpórea acometida também é determinante. A busca na literatura revelou inúmeros estudos sobre essas manifestações em segmentos corpóreos específicos (6)(7)(8)(9)(10)(11)(12)(13) .…”