Quality of life after multiple trauma: results from a patient cohort treated in a certified trauma network

Angerpointner, Katharina; Ernstberger, Antonio; Bosch, Katharina; Zeman, Florian; Koller, Michael; Kerschbaum, Maximilian

doi:10.1007/s00068-019-01160-y

“…Patients are often in the state of severe metabolic dysfunction and phys-iological disorders when visiting the doctor, and the body will release many cytokines, inflammatory factors, and stress hormones for compensatory adjustment. At this time, the systemic blood will be redistributed, accompanied by poor local microcirculation, gastrointestinal mucosa vasoconstriction, lactic acid increase, and tissue ischemia and hypoxia, inducing systemic inflammation [17,18]. Moreover, the release of massive inflammatory mediators will further damage the impaired vascular endothelial cells, which leads to platelet aggregation and the synthesis and release of other coagulation factors, aggravating microcirculation disorders and forming a vicious circle [19,20].…”

Section: Discussionmentioning

confidence: 99%

Effect of Massive Transfusion Protocol on Coagulation Function in Elderly Patients with Multiple Injuries

Li¹,

Zhang²,

Wei³

2021

Computational and Mathematical Methods in Medicine

View full text Add to dashboard Cite

Objective. To evaluate the effect of massive transfusion protocol on coagulation function in elderly patients with multiple injuries. Methods. In this retrospective cohort study, clinical data were collected from a total of 94 elderly patients with multiple injuries, including 44 cases who received routine transfusion protocol (control group) and 50 cases who concurrently received massive transfusion protocol in our hospital (research group). The changes in platelet parameters, coagulation function, and organ dysfunction scores at admission and 24 h after transfusion were compared between the two groups. The 24-hour plasma and red blood cell transfusion volume, length of stay, complications, and mortality of the two groups were analyzed statistically. Results. Twenty-four hours after blood transfusion, the hematocrit, platelets, and hemoglobin in the research group were higher than those in the control group, while the activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen, and scores of Marshall scoring system and Sequential Organ Failure Assessment were lower than those in the control group ( P < 0.01 ). The 24-hour plasma transfusion volume was higher, and the length of intensive care unit (ICU) stay and total length of stay were lower in the research group compared with the control group ( P < 0.01 ). No significant difference was found in the mortality rate between the research group and the control group (10.00% vs. 13.64%, P > 0.05 ). The incidence of complications in the research group was lower than that in the control group (12.00% vs. 31.82%, P < 0.05 ). Conclusion. Massive transfusion protocol for elderly patients with multiple injuries can improve their coagulation function and platelet parameters, alleviate organ dysfunction, shorten length of ICU stay, and decrease the incidence of complications, which is conducive to improving the prognosis of patients.

show abstract

“…Second, (major) trauma networks have matured. Especially, international studies handling QoL after MT from a regional trauma network perspective are scarce [7,9,10]. Most studies on QoL of MT patients included adult populations admitted to a single TC.…”

Section: Discussionmentioning

confidence: 99%

“…However, many MT patients also being admitted to non-Trauma Centers (NTC) [ 8 ]. Only a few cohorts have followed patients from a trauma network perspective [ 7 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Health-related quality of life and return to work 1 year after major trauma from a network perspective

Ditshuizen

¹

,

Lieshout

²

,

Beeck

³

et al. 2021

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Introduction Major trauma often results in long-term disabilities. The aim of this study was to assess health-related quality of life, cognition, and return to work 1 year after major trauma from a trauma network perspective. Methods All major trauma patients in 2016 (Injury Severity Score > 15, n = 536) were selected from trauma region Southwest Netherlands. Eligible patients (n = 365) were sent questionnaires with the EQ-5D-5L and questions on cognition, level of education, comorbidities, and resumption of paid work 1 year after trauma. Results A 50% (n = 182) response rate was obtained. EQ-US and EQ-VAS scored a median (IQR) of 0.81 (0.62–0.89) and 70 (60–80), respectively. Limitations were prevalent in all health dimensions of the EQ-5D-5L; 90 (50%) responders reported problems with mobility, 36 (20%) responders reported problems with self-care, 108 (61%) responders reported problems during daily activities, 129 (73%) responders reported pain or discomfort, 70 (39%) responders reported problems with anxiety or depression, and 102 (61%) of the patients reported problems with cognition. Return to work rate was 68% (37% full, 31% partial). A median (IQR) EQ-US of 0.89 (0.82–1.00) and EQ-VAS of 80 (70–90) were scored for fully working responders; 0.77 (0.66–0.85, p < 0.001) and 70 (62–80, p = 0.001) for partial working respondents; and 0.49 (0.23–0.69, p < 0.001) and 55 (40–72, p < 0.001) for unemployed respondents. Conclusion The majority experience problems in all health domains of the EQ-5D-5L and cognition. Return to work status was associated with all health domains of the EQ-5D-5L and cognition.

show abstract

“…Although tertiary hospitals are familiar with how to decrease mortality following injury, primary hospitals still have difficulty to handle the tough situation. The three top reasons demonstrated to cause death in multiple trauma patients are 2 , 3 , 4 , 5 : (1) missing the chance to treat patients within the so called “golden hour of shock”, (2) hemorrhagic shock, (3) multiple organ dysfunction syndrome (MODS). So, how to reasonably handle these three challenges are still the focuses of the clinical research.…”

Section: Discussionmentioning

confidence: 99%

Advantage of surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in multiple trauma management in a primary hospital

Chen

¹

,

Mu

²

,

Xie

³

et al. 2021

Chinese Journal of Traumatology

0

View full text Add to dashboard Cite

Purpose It is a challenge for the primary hospitals to manage multiple trauma patients. In this article, we explored the advantage of establishing a surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in the early management of multiple trauma. Methods This was a retrospective study and patients with multiple trauma in our hospital were collected and divided into two groups, based on time period and treat modes: group A (retrospective observation group) where patients were treated with the traditional treatment mode from January 2017 to December 2017 and group B (study group) where patients were treated in the SICU predominant by cardiothoracic surgeons from January 2018 to December 2018. Clinical data including demographics, injury severity score (ISS), causes of injury, time intervals from reception to entering SICU or operating room and mortality three days after injuries were collected. Data were analyzed by SPSS 20.0 software. Categorical variables were presented as number and/or frequency and continuous variables as mean ± SD. Results Altogether 406 patients were included in this study, including 217 patients in group A and 189 patients in group B. General data between the two groups revealed no significant difference: mean age (years) (35.51 ± 12.97 vs . 33.62 ± 13.61, p = 0.631), gender distribution (mean/female, 130/87 vs . 116/73, p = 0.589) and ISS (15.92 ± 7.95 vs . 16.16 ± 6.89, p = 0.698). Fall from height were the dominant mechanism of injury, with 135 cases in group A (71.4%) and 121 cases in group B (55.8%), followed by traffic accidents. Injury mechanism showed no significant differences between two groups ( p = 1.256). Introduction of the SICU significantly improved the care of trauma patients, regarding speed and mortality. Time intervals between reception and entering SICU or operating room was (108.23 ± 6.72) min and (45.67 ± 7.96) min in group A and B, respectively ( p = 0.001). Mortality three days after injuries was 13.89% and 5.53% in group A and B, respectively ( p = 0.005). Conclusion Establishing a SICU predominant by cardiothoracic surgeons can reduce the early mortality rates in multiple trauma patients.

show abstract

Quality of life after multiple trauma: results from a patient cohort treated in a certified trauma network

Cited by 11 publications

References 17 publications

Effect of Massive Transfusion Protocol on Coagulation Function in Elderly Patients with Multiple Injuries

Effect of Massive Transfusion Protocol on Coagulation Function in Elderly Patients with Multiple Injuries

Health-related quality of life and return to work 1 year after major trauma from a network perspective

Advantage of surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in multiple trauma management in a primary hospital

Contact Info

Product

Resources

About