Author/Authors :
Yucel, Neslihan Department of Emergency Medicine - Inonu University - School of Medicine - Malatya - Turkey , Ozturk Demir, Tuba Department of Emergency Medicine - Inonu University - School of Medicine - Malatya - Turkey , Derya, Serdar Department of Emergency Medicine - Inonu University - School of Medicine - Malatya - Turkey , Oguzturk, Hakan Department of Emergency Medicine - Inonu University - School of Medicine - Malatya - Turkey , Bicakcioglu, Murat Department of Anesthesiology and Reanimation - Inonu University - School of Medicine - Malatya - Turkey , Yetkin, Funda Department of Infectious Disease and Clinical Microbiology - Inonu University - School of Medicine - Malatya - Turkey
Abstract :
Introduction. The aim was to identify risk factors that infuence in-hospital mortality for patients with moderate-to-severe blunt
multiple trauma (BMT) who survive initial resuscitation. Methods. The prospective study involved 195 adult patients with BMT
who were admitted to a referral hospital’s emergency department (ED) between May 1, 2015, and May 31, 2016. Results. Forty-three
(22%) of the 195 patients died in hospital. Multivariate analysis identifed low blood pH (odds ratio [OR] 6.580, 95% confdence
interval [CI] 1.12-38.51), high serum lactate level (OR 1.041, 95% CI 1.01-1.07), high ISS (OR 1.109, 95% CI 1.06-1.16), high APACHE
II score (OR 1.189, 95% CI 1.07-1.33), traumatic brain injury (TBI) (OR 4.358, 95% CI 0.76-24.86), severe hemorrhage (OR 5.314,
95% CI 1.07-26.49), and coagulopathy (OR 5.916, 95% CI 1.17-29.90) as useful predictors of acute in-hospital mortality. High ISS
(OR 1.047, 95% CI 1.02-1.08), TBI (OR 8.922, 95% CI 2.57-31.00), sepsis (OR 4.956, 95% CI 1.99-12.36), acute respiratory distress
syndrome (ARDS) (OR 8.036, 95% CI 1.85-34.84), respiratory failure (OR 9.630, 95% CI 2.64-35.14), renal failure (OR 74.803, 95%
CI 11.34-493.43), and multiple organ failure [MOF] (OR 10.415, 95% CI 4.48-24.24) were risk factors for late in-hospital mortality.
High Glasgow Coma Scale (GCS) was a good predictor for survival at 2, 7, and 28 or more days of hospitalization (OR 0.708 and
95% CI 0.56-0.09; or 0.835 and 95% CI 0.73-0.95; or 0.798 and 95% CI 0.71-0.90, resp.). Conclusion. Several factors signal poor
short-term outcome for patients who present to the ED with moderate-to-severe BMT: low blood pH, high serum lactate level,
presence of TBI, severe hemorrhage, coagulopathy, organ failure (respiratory, renal, and MOF), and ARDS. For this patient group, ISS and APACHE II scores might be helpful for stratifying by mortality risk, and GCS might be a good predictor for survival.
Keywords :
Potential Risk Factors , Hospital Mortality , Patients , Blunt Multiple Trauma , patients
