Predictors for Emergency Hemostasis in Severe Trauma Patients

Document Type: Original Article

Authors

1 Department of Surgery, Faculty of Medicine, Prince of Songkla University,Songkhla, Thailand

2 Department of Surgery, Division of Trauma and Critical Care, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

Abstract

Background: Exsanguination is the main cause of death in trauma patients. Early determination that a patient requires an emergency operation is crucial for saving of life. We challenge the defining predictors that guide the intervention or emergency operation for hemorrhage control in severe trauma patients. Aims: The aim of this study was to define the predictors that guide the intervention or emergency operation to resuscitate severe trauma patients. Methods: This study was a retrospective study in trauma patients from Songklanagarind hospital. Data were retrospectively collected from a prospective collection registry that included 131 trauma patients who met the trauma activation criteria at Songklanagarind Hospital from January 2014 to December 2014. Emergency operation or intervention was defined as the procedures needed to improve hemostasis within 4 h. Categorical data were compared. Logistic regression was used to measure the relationship between dependent and one or more independent variables. Results: The study population was 81.7% male. The age range was 31–35 years. The most frequent mechanism was blunt injury (78%). The emergency hemostasis patients had 27 patients (20.6%). The factors relate to an emergency operation or intervention to improve the hemostasis within 4 h were focused assessment with sonography for trauma (FAST)‑positive (P < 0.001), male (P = 0.02), Injury Severity Score (ISS) ≥25 (P = 0.013), and penetrating injury (P = 0.016). The preventive factors to an emergency hemostasis were platelet ≥100,000 (P = 0.039) and age ≥50 (P = 0.005). Conclusion: The palate count, FAST, male, age, ISS, and penetrating injury are factors that relate to an emergency operation or intervention within the first 4 h.

Keywords


1. Hoyt DB, Coimbra R, Acosta J. Management of acute trauma. In: Townsend CM, Beauchamp RD, Evers BM, editors. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Philadelphia: Saunders Elsevier; 2008. p. 477‑520.

2. Trunkey DD. Trauma. Accidental and intentional injuries account for more years of life lost in the U.S. Than cancer and heart disease. Among the prescribed remedies are improved preventive efforts, speedier surgery and further research. Sci Am 1983;249:28‑35.

3. Demetriades D, Kimbrell B, Salim A, Velmahos G, Rhee P, Preston C, et al. Trauma deaths in a mature urban trauma system: Is “trimodal” distribution a valid concept? J Am Coll Surg 2005;201:343‑8.

4. Thomas J, Esposito KJ. Trauma. In: Mattox KL, editor. Epidemiology. United States: The McGraw‑Hill Companies, Inc.; 2013. p. 18‑35.

5. PannaA, Codner KJ. Initial assessment and management. In: Mattox KL, editor. Trauma. United States: The McGraw‑Hill Companies; 2013. p. 154‑66.

6. Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, et al. Schwartz’s Principles of Surgery. 10th ed. New York: McGraw-Hill Companies; 2015. p. 161‑222.

7. Jacobs RG, Howland WS, Goulet AH. Serial microhematocrit determinations in evaluating blood replacement. Anesthesiology 1961;22:342‑7.

8. Marino PL, editor. Hemorrhage and hypovolemia. In: The ICU Book. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.

9. Gibson JB, Maxwell RA, Schweitzer JB, Fabian TC, Proctor KG. Resuscitation from severe hemorrhagic shock after traumatic brain injury using saline, shed blood, or a blood substitute. Shock 2002;17:234‑44.

10. Jewelewicz DD, Cohn SM, Crookes BA, Proctor KG. Modified rapid deployment hemostat bandage reduces blood loss and mortality in coagulopathic pigs with severe liver injury. J Trauma 2003;55:275‑80.

11. Baradaran H, Salimi J, Nassaji‑Zavareh M, Khaji A, Rabbani A. Epidemiological study of patients with penetrating abdominal trauma in Tehran‑Iran. Acta Med Iran 2007;45:305‑8.

12. Lone GN, Peer GQ, Warn AK, Bhat AM, Warn NA. An experience with abdominal trauma in adults in Kashmir. JK Pract 2001;8:225‑30.

13. Smith J, Caldwell E, D’Amours S, Jalaludin B, Sugrue M. Abdominal trauma: A disease in evolution. ANZ J Surg 2005;75:790‑4.

14. Huang MS, Liu M, Wu JK, Shih HC, Ko TJ, Lee CH. Ultrasonography for the evaluation of hemoperitoneum during resuscitation: A simple scoring system. J Trauma 1994;36:173‑7.

15. Lichtveld RA, Panhuizen IF, Smit RB, Holtslag HR, van der Werken C. Predictors of death in trauma patients who are alive on arrival at hospital. Eur J Trauma Emerg Surg 2007;33:46‑51.

16. Gad MA, Saber A, Farrag S, Shams ME, Ellabban GM. Incidence, patterns, and factors predicting mortality of abdominal injuries in trauma patients. N Am J Med Sci 2012;4:129‑34.

17. Brown LM, Call MS, Margaret Knudson M, Cohen MJ; Trauma Outcomes Group, Holcomb JB, et al. A normal platelet count may not be enough: The impact of admission platelet count on mortality and transfusion in severely injured trauma patients. J Trauma 2011;71:S337‑42.