Scand J Trauma Resus
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Although significant efforts have been made to enhance trauma care, the mortality rate for traumatic cardiac arrest (TCA) remains exceedingly high. Therefore, our institution has implemented special measures to optimize the treatment of major trauma patients. These measures include a prehospital Medical Intervention Car (MIC) and a 'code red' protocol in the trauma resuscitation room for patients with TCA or shock. ⋯ However, a significant proportion of these patients still die due to circulatory failure shortly after. Our observations from patients who underwent clamshell thoracotomy or received echocardiographic evaluation in conjunction with current scientific findings led us to conclude that dysfunction of the heart itself may be the cause. Therefore, we propose discussing severe trauma-associated cardiac failure (STAC) as a new entity to facilitate scientific research and the development of specific treatment strategies, with the aim of improving the outcome of severe trauma.
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Scand J Trauma Resus · Jan 2024
Imposter or knight in shining armor? Pelvic circumferential compression devices (PCCD) for severe pelvic injuries in patients with multiple trauma: a trauma-registry analysis.
Pelvic Circumferential Compression Devices (PCCD) are standard in hemorrhage-control of unstable pelvic ring fractures (UPF). Controversial data on their usefulness exists. Aim of the study was to investigate whether prehospital application of PCCD can reduce mortality and transfusion requirements in UPF. ⋯ We observed PCCD overuse in general and underuse in UPF. Prehospital PCCD appears to be more a marker of injury severity and less triggered by presence of UPF. We found no salutary effect on survival or transfusion requirements. Inappropriate indication and technical flaw may have biased our results. TR-DGU does not contain data on these aspects. Further studies are necessary. Modular add-on questioners to the registry could offer one possible solution to overcome this limitation. We are concerned that PCCD use may be unfairly discredited by misinterpretation of the available evidence and strongly vote for a prospective trial.
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Scand J Trauma Resus · Jan 2024
Multicenter StudyInvestigating the effects of frailty on six-month outcomes in older trauma patients admitted to UK major trauma centres: a multi-centre follow up study.
Pre-injury frailty is associated with adverse in-hospital outcomes in older trauma patients, but the association with longer term survival and recovery is unclear. We aimed to investigate post discharge survival and health-related quality of life (HRQoL) in older frail patients at six months after Major Trauma Centre (MTC) admission. ⋯ Frailty is associated with increased mortality post trauma discharge and frail older trauma survivors had worse HRQoL and increased care needs at six months post-discharge. Pre-injury frailty is a predictor of poor longer-term HRQoL after trauma and recognition should enable early specialist pathways and discharge planning.
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Scand J Trauma Resus · Dec 2023
A classification system for identifying patients dead on ambulance arrival: a prehospital medical record review.
Patients dead before arrival of the ambulance or before arrival at hospital may be in- or excluded in mortality analyses, making comparison of mortality difficult. Often only physicians are allowed to declare death, thereby impeding uniform registration of prehospital death. Many studies do not report detailed definitions of prehospital mortality. Our aim was to define criteria to identify and categorize prehospital patients' vital status, and to estimate the proportion of these groups, primarily the proportion of patients dead on ambulance arrival. ⋯ We defined exhaustive and mutually exclusive criteria to define vital status, DOAA, OHCA, and Alive on Ambulance Arrival based on prehospital medical records. More than one out of four patients receiving an ambulance and registered dead on the same or the following day were dead already at ambulance arrival. Adding OHCA BLS where resuscitation was terminated without defibrillation or other treatment, increased the proportion of patients dead on ambulance arrival to 42%. We recommend reporting similar categories of vital status to improve valid comparisons of prehospital mortality rates.