https://nova.newcastle.edu.au/vital/access/ /manager/Index en-au 5 https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:13964 Wed 11 Apr 2018 16:27:43 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:18915 2). This study aimed to validate this definition on larger data set. We hypothesized that patients defined by the 2 × AIS score > 2 cutoff have worse outcomes and use more resources than those without 2 × AIS score > 2 and that this would therefore be a better definition of polytrauma. METHODS: Patients injured between 2009 and 2011, with complete documentation of AIS by New South Wales Trauma Registry and 16 years and older were selected. Age and sex were obtained in addition to outcomes of ISS, hospital length of stay (LOS), intensive care unit (ICU) admission, ICU LOS, and mortality. We compared demographic characteristics and outcomes between patients with ISS greater than 15 who did and did not meet the 2 × AIS score > 2 definition. We then undertook regression analyses (logistic regression for binary outcomes [ICU admission and death] and linear regression for hospital and ICU LOS) to compare outcomes for patients with and without 2 × AIS score > 2, adjusting for sex and age categories. RESULTS: In the adjusted analyses, patients with 2 × AIS score > 2 had twice the odds of being admitted to the ICU compared with those without 2 × AIS score > 2 (odds ratio, 2.5; 95% confidence interval [CI], 2.2–2.8) and 1.7 times the odds of dying (95% CI, 1.4–2.0; p < 0.001 for both models). Patients with 2 × AIS score > 2 also had a mean difference of 1.5 days longer stay in the hospital compared with those without 2 × AIS score > 2 (95% CI, 1.4–1.7) and 1.6 days longer ICU stay (95% CI, 1.4–1.8; p < 0.001 for all models). CONCLUSION: Patients with 2 × AIS score > 2 had higher mortality, more frequent ICU admissions, and longer hospital and ICU stay than those without 2 × AIS score > 2 and represents a superior definition to the definitions for polytrauma currently in use..]]> Wed 11 Apr 2018 14:43:36 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:27103 Wed 11 Apr 2018 09:32:03 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:48395 Wed 05 Jul 2023 14:46:29 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:52188  100.000/mm3 [n = 99 (57.9%)] and prothrombin time (PT)/activated partial thromboplastin time (aPTT) < 1.5 times the normal control [n = 85 (49.7%)] in patients needing spinal surgery. MRI [n = 160 (93.6%)] and spinal surgery [n = 158 (92.4%)] should be performed after intracranial, hemodynamic, and respiratory stabilization by most respondents. Corticosteroids [n = 103 (60.2%)], ISP/SCPP monitoring [n = 148 (86.5%)], and therapeutic hypothermia [n = 137 (80%)] were not utilized by most respondents. Conclusions: Our survey has shown a great worldwide variability in clinical practices for acute phase management of tSCI patients with polytrauma. These findings can be helpful to define future research in order to optimize the care of patients suffering tSCI.]]> Wed 04 Oct 2023 11:09:50 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:54517 Tue 27 Feb 2024 15:46:04 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:41114 Tue 26 Jul 2022 08:55:17 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:55715 3), we identified patients who had surgery that preceded MOF, determined whether the timing of these operation(s) were modifiable(M) or non-modifiable (non-M), and evaluated the change in physiological parameters as a result of surgery. Results: Of 716 polytrauma patients at-risk of MOF, 205/716 (29%) developed MOF, and 161/205 (79%) had surgery during their ICU admission. Of the surgical MOF patients, 147/161 (91%) had one or more operation(s) that preceded MOF, and 65/161 (40%) of them had operation(s) with modifiable timings. There were no differences in age (mean (SD) 52 (19) vs 53 (21)years), injury severity score (median (IQR) 34 (26–41)vs34 (25–44)), admission physiological and resuscitation parameters, between M and non-M-patients. M patients had longer ICU LOS (median (IQR) 18 (12–28)versus 11 (8–16)days, p < 0.0001) than non-M-patients, without difference in mortality (14%vs16%, p = 0.7347), or hospital LOS (median (IQR) 32 (18–52)vs27 (17–47)days, p = 0.3418). M-patients had less fluids and transfusions intraoperatively. Surgery did not compromise patient physiology. Conclusion: Operations preceding MOF are common in polytrauma and seem to be safe in maintaining physiology. The margin for improvement from optimizing surgical timing is modest, contrary to historical assumptions.]]> Tue 18 Jun 2024 12:53:52 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:53816 Tue 16 Jan 2024 15:12:54 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:54907  15, Abbreviated Injury Scale (AIS) Head < 3 and survived > 48 h. Demographics, physiological and shock resuscitation parameters were collected. The primary outcome was MOF defined by a Denver Score > 3. Secondary outcomes: intensive care unit length of stay (ICU LOS), ventilation days and mortality. Results: Three hundred and forty-seven patients met inclusion criteria (age 48 ± 20; ISS 30 ± 11, 248 (71%) were males and 23 (6.6%) patients died. The 74 (21%) MOF patients (maximum Denver Score: 5.5 ± 1.8; Duration; 5.6 ± 5.8 days) had higher ISS (32 ± 11 versus 29 ± 11) and were older (54 ± 19 versus 46 ± 20 years) than non-MOF patients. Mean daily Denver scores adjusted for age, sex, MOF and ISS did not change over time. Crystalloid usage decreased over the 10-year period (p value < 0.01) and PRBC increased (p value < 0.01). Baseline cumulative incidence of MOF at 28 days was 9% and competing risk analyses showed that incidence of MOF increased over time (subdistribution hazard ratio 1.14, 95% CI 1.04 to 1.23, p value < 0.01). Mortality risk showed no temporal change. ICU LOS increased over time (subdistribution hazard ratio 0.95, 95% CI 0.92 to 0.98, p value < 0.01). Ventilator days increased over time (subdistribution hazard ratio 0.94, 95% CI 0.9 to 0.97, p value < 0.01). Conclusion: The epidemiology of MOF continues to evolve. Our prospective cohort suggests an ageing population with increasing incidence of MOF, particularly in males, with little changes in injury or shock parameters, who are being resuscitated with less crystalloids, stay longer on ICU without improvement in survival.]]> Thu 21 Mar 2024 11:56:18 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:54906  15), the risk of dying is less than 10%. This group contains critical polytrauma patients (ISS 50–75), with high risks of death. We hypothesized that the reduction in trauma mortality was driven by reduction in moderate injury severity and that death from critical polytrauma remained persistently high. Methods: A 20-year retrospective analysis ending December 2021 of a Level-1 trauma center’s registry was performed on all trauma patients admitted with ISS > 15. Patients’ demographics, injury severity and outcomes were collected. Multivariate logistic regression analysis was performed. Mortality was examined for the entire study group and separately for the subset of critical polytrauma patients (ISS 50–75). Results: A total of 8462 severely injured (ISS > 15) trauma patients were identified during the 20-year period. Of these 238 (2.8%) were critical polytrauma patients (ISS 50–75). ISS > 15 mortality decreased from 11.3 to 9.4% over the study period (Adjusted OR 0.98, 0.97–0.99). ISS 50–75 mortality did not change significantly (46.2–60.0%), adjusted OR 0.96, 0.92–1.00). Conclusion: The improvement in trauma mortality over the past 20 years has not been experienced equally. The ISS50-75 critical polytrauma mortality is a practical group to capture. It could be a group for deeper study and reporting to drive improvement.]]> Thu 21 Mar 2024 11:55:42 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:7643 Sat 24 Mar 2018 08:36:03 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:15229 Sat 24 Mar 2018 08:26:06 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:21435 4 hours after injury or dead on arrival were excluded. Patient management followed advanced trauma life support and institutional guidelines. Collected data included patient demographics, mechanism of injury, vital signs, acid-base status, fluid resuscitation, trauma scores, fracture patterns, procedures, and outcomes. Potential predictors were identified using standard statistical tests: Univariate analysis, Pearson correlation (r), receiver operator characteristic, and decision tree analysis. Intervention: Observational study. Outcome Measures: PFRAB was determined based on angiography or computed tomography angiogram or laparotomy findings. Results: Of the 143 study patients, 15 (10%) had PFRAB. They were significantly older, more severely injured, more hypotensive, more acidotic, more likely to require transfusions in the ED, and had higher mortality rate than non-PFRAB patients. No single variable proved to be a strong predictor but some had a significant correlation with PFRAB. Useful predictors identified were worst base deficit (BD), receiver operator characteristic (0.77, cutoff: 6 mmol/L, r = 0.37), difference between any 2 measures of BD within 4 hours (ΔBD) >2 mmol/L, transfusion in ED (yes/no), and worst systolic blood pressure <104 mm Hg. Demographics, injury mechanism, fracture pattern, temperature, and pH had poor predictive value. Conclusions: BD <6 mmol/L, ΔBD >2 mmol/L, systolic blood pressure <104 mm Hg, and the need for transfusion in ED are independent predictors of PFRAB in the ED. These predictors can be valuable to triage blunt trauma victims for pelvic hemorrhage control with angiography.]]> Sat 24 Mar 2018 08:05:47 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:20344 15, ISS > 17 and a recently recommended AIS > 2 in at least two body regions (2 × AIS > 2). Purpose: To compare the outcomes of clinically defined polytrauma patients with those defined based on anatomical scores. Material and methods: A prospective observational study on all trauma team activation patients over a 7-month period presenting at a level-1 trauma centre were included in the study. The prospective data collection included AIS in each body region, ISS, ICU length of stay (LOS), multiple organ failure (MOF) and mortality. Results: 336 patients met inclusion criteria (age: 41 ± 20, 74% male, ISS: 15 ± 11, NISS: 19 ± 15, MOF: 3%, mortality: 4%, 25% ICU admission). ISS > 15: 13 deaths (10%), 71 (54%) required ICU admission and 10 (8%) developed MOF. ISS > 17 captured 11 deaths (11%), with 63 (62%) requiring ICU admission and 10 (10%) developing MOF. Defining as (2 × AIS > 2): 8 deaths (13% of the group), with 43 patients requiring ICU admission (67%) and 9 (14%) developing MOF. When examining the performance of these three approaches, the ISS > 15 and the ISS > 17 captured statistically the same amount of clinically defined polytrauma patients (p = 0.4106), while the 2 × AIS > 2 definition captured significantly more polytrauma patients than ISS > 15 (p = 0.0251) and ISS > 17 (p = 0.0019). Conclusion: 2 × AIS > 2 captured the greatest percentage of the worst outcomes and significantly larger % of the clinically defined polytrauma patients. 2 × AIS > 2 has higher accuracy and precision in defining polytrauma than ISS > 15 and ISS > 17. This simple, retrospectively also reproducible criteria warrants larger scale validation.]]> Sat 24 Mar 2018 08:02:56 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:18955 Sat 24 Mar 2018 07:58:57 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:18945 38 °C or <36 °C; Pulse >90 bpm; RR > 20/min or a PaCO₂ < 32 mmHg; WCC > 12.0 × 10⁹ L⁻¹, or <4.0 × 10⁹ L⁻¹, or the presence of >10 immature bands) collected from presentation, at 24 h intervals until 72 h post injury. Inclusion criteria were all patients generating a trauma team activation response age >16. Results: 336 patients met inclusion criteria. In 46% (155/336) serial SIRS scores could not be calculated due to missing data. Lowest rates of missing data observed on admission [3% (11/336)]. Stratified by ISS > 15 (132/336), in 7% (9/132) serial SIRS scores could not be calculated due to missing data. In 123 patients ISS > 15 with complete data, 81% (100/123) developed SIRS. For Abbreviated Injury Scale (AIS) > 2 in at least 2 body regions (64/336) in 5% (3/64) serial SIRS scores could not be calculated, with 92% (56/61) of patients with complete data developing SIRS. For Direct ICU admissions [25% (85/336)] 5% (4/85) of patients could not have serial SIRS calculated [mean ISS 15(±11)] and 90% (73/81) developed SIRS at least once over 72 h. Conclusion: Based on the experience of our level-1 trauma centre, the practicability of including SIRS into the definition of polytrauma as a surrogate for physiological derangement appears questionable even in prospective fashion.]]> Sat 24 Mar 2018 07:58:52 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:19721 15; age > 18 years, head Abbreviated Injury Scale [AIS] score < 3; and survival for >48 hours). Demographics, injury severity (ISS), physiologic parameters, MOF status based on the Denver score, and outcome data were prospectively collected. Univariate analysis and multivariate logistic modeling were performed; p < 0.05 was considered significant. Data are presented as percentage or mean (SD). RESULTS: A total of 140 patients met the inclusion criteria (age, 47 [21] years; ISS, 30 [11]; male, 69%), 21 patients (15%) developed MOF, and MOF associated mortality was 24% versus non-MOF mortality rate of 3%. Patients who developed MOF had longer ICU stays (19 [7] vs. 7 [5], p < 0.01) and had more ventilator days (18 [9] vs. 4 [4], p < 0.01). Prediction models were generated at two time points as follows: admission and 24 hours after injury. At admission, age (>65 years) and admission platelet count (<150 ✕ 10(9)/L) were significant predictors of MOF; at 24 hours after injury, MOF was predicted by age more than 65 years, admission platelet count less than 150 ✕ 10(9)/L, maximum creatinine of greater than 150 ✕ 10(9)/L and minimum bilirubin of greater than 10 ✕ 10(9)/L. Shock parameters and injury severity did not predict MOF. CONCLUSION: The incidence of MOF (15%) is lower than reported 15 years ago; MOF remains a major cause of ICU resource use and late mortality after injury. The independent predictors of MOF have fundamentally changed, likely owing to improvements in resuscitation and critical care. Current predictors are universally available at admission and 24 hours. LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III.]]> Sat 24 Mar 2018 07:53:43 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:18382 Sat 24 Mar 2018 07:52:42 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:53253 Mon 20 Nov 2023 10:57:40 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:18674 2 is a good marker of polytrauma-better than other ISS cutoffs, which could also indicate monotrauma. The selection of the most accurate physiological parameters is still underway, but they will most likely be descriptors of tissue hypoxia and coagulopathy.]]> Mon 20 Jul 2015 17:34:24 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:50236 Mon 10 Jul 2023 14:50:01 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:45160 Fri 28 Oct 2022 11:23:16 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:45408 Fri 28 Oct 2022 08:25:16 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:54924 Fri 22 Mar 2024 09:32:42 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:44476 Fri 14 Oct 2022 08:50:44 AEDT ]]>