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PubMed1990

Comparison of creatinine and inulin clearances in multiple trauma.

Creatinine clearance (Ccr) is a good predictor of renal dysfunction. However, numerous analytical interferences have been observed with the classical measurement of creatinine by Jaffé's procedure. This prospective study was conducted to compare 4 methods for determining creatinine; and also endogenous creatinine clearance with inulin clearance (Cin) to estimate the glomerular filtration rate. The 4 different techniques for measuring creatinine were: 1) 2 techniques using Jaffé's colorimetric reaction: one with rapid and the other with slow kinetics: 2) 2 more selective methods: enzymatic procedure and high performance liquid chromatography (HPLC). Measurements were performed in 13 multiple trauma patients after stabilization and in 5 comatose patients (control group) over a 3-day period, with strict 24-h urine collection. On the second day, inulin clearance and para-aminohippuric acid clearance (Cpah) were measured. Measurement of creatinine by Jaffé's procedure yields significantly higher levels than those obtained by the other methods. Higher levels of both plasma and urinary creatinine were observed in the multiple trauma patients with all the methods used. There were no significant differences in Ccr, Cin, Cpah between the multiple trauma patients and the control patients. The best correlations between inulin clearance and creatinine clearance were observed for Jaffé's rapid kinetics (r = 0.90) in the control group and for the enzymatic procedure in the multiple trauma group (r = 0.55). Plasma creatinine is not a useful indicator in multiple trauma. The correlation between creatinine clearance and inulin clearance is not very strong in multiple trauma, indicating that the relative evolution (not the absolute values) of creatinine clearance is of interest.

Adult↗
PubMed2005

[Evaluation of multiple trauma victims with 16-row multidetector CT (MDCT): a time analysis].

PURPOSE: Description and time analysis of a 16-row MDCT protocol in the evaluation of multiple trauma patients considering transport, time of scanning, patient positioning, image reconstruction, and image interpretation. MATERIALS AND METHODS: Between May and December 2004, 60 multiple trauma patients underwent 16-row MDCT (Sensation, Siemens, Erlangen, Germany). The protocol included serial scanning of the head, spiral scanning of the cervical spine and contrast-enhanced spiral scanning of the thorax/abdomen with multiplanar reformations (MPR) of the thoracic/lumbar spine and the pelvis. All time intervals including transport, patient positioning, scanning, duration of MPR, total time in the examination room, and time to first and final image interpretation were prospectively evaluated. Furthermore, patient characteristics, trauma profiles, and mortality rates were recorded. RESULTS: 46 male and 14 female patients (mean age 43.6 years) were enrolled in the study. Time analysis of 16-row MDCT revealed the following results (mean time standard deviation): Emergency room treatment and transport 19.2 +/- 6.7 min, patient positioning 16.5 +/- 6.5 min, scan duration 8.0 +/- 3.3 min, total time in examination room 24.5 +/- 7.2 min, image reconstruction including MPR 32.0 +/- 16.4 min, and time of first (16.4 +/- 4.7 min) and final image interpretation (82.5 +/- 30.4 min). Trauma profiles revealed thoracic injuries in 35/60 patients (58.3 %), head injuries in 23/60 patients (38.3 %), abdominal injuries in 15/60 patients (25.0 %), injuries of the cervical (9/60 patients, 15.0 %), thoracic (12/60 patients, 20.0 %), and lumbar spine (19/60 patients, 31.7 %), pelvic injuries in 13/60 patients (21.7 %), and injuries of extremities in 39/60 patients (65.0 %). The mortality rate was 21.7 %. CONCLUSION: MDCT provides fast and all-inclusive imaging of multiple trauma patients. With the use of 16-row MDCT technology scanning times of 8 minutes are realistic and first image interpretation can be performed 16 minutes after arrival of the patient in the examination room and 35 minutes after admission in the emergency room, respectively. The duration of all procedures done in the examination room is strongly influenced by positioning maneuvers, whereas final image interpretation depends on image reconstructions including MPR. Beside technical improvements, these circumstances provide the potential to further accelerate the diagnostic process in multiple trauma victims.

Abdominal Injuries↗
PubMed1993

Model for trauma outcomes management in patients with multiple trauma.

Critically injured patients with chest trauma generally sustain severe life-threatening injuries. Post-operative care tends to be complex, and all aspects of care from pre-hospital through rehabilitation must be coordinated and communicated to maximize patient outcomes. The Trauma Outcomes Management Model allows clinicians to assess, track, and analyze the relationship among interventions, outcomes, and the cost of care for each phase of the trauma care continuum. This article presents the design and utilization of trauma outcome guides in the Emergency and Critical Care departments.

Critical Care↗
PubMed1981

[Emergency laparoscopy in patients with multiple trauma (author's transl)].

In 83 patients with multiple trauma emergency laparoscopy spared the patient a formal laparotomy in 46%. 95% of the laparoscopies gave unequivocal clinical information. Emergency laparoscopy is less invasive and of special value in patients with multiple trauma and poor general condition.

Abdominal Injuries↗
PubMed2005

[Study on high mobility group-1 protein in patients with multiple trauma].

OBJECTIVE: To study the change in serum high mobility group-1 (HMG-1) protein in patients with multiple trauma and determine its relationship to severity of trauma and multiple organ dysfunction syndrome (MODS). METHODS: In 33 cases, HMG-1 levels were determined on 1, 3, 7 days after trauma respectively. The values of injury severity score (ISS), acute physiology and chronic health evaluation II (APACHE II) and systemic inflammatory response syndrome (SIRS) score were determined. Meanwhile, the occurrence of organ dysfunction was noted. RESULTS: The level of serum HMG-1 in patients with multiple trauma was much higher than that of normal controls, and also in those with organ dysfunction. HMG-1 and APACHE II were positively correlated (r=0.495, P=0.016). The level of serum HMG-1 and APACHE II value were much higher in patients with organ dysfunction than those of normal organ function, but there was no significant difference in SIRS score between the two groups (P=0.105). CONCLUSION: Serum HMG-1 increases in patients with trauma and is positively correlated with severity of trauma. Serial determination of HMG-1 is helpful to discover clinical infection earlier. HMG-1 can be used as a warning indicator of the onset of MODS.

APACHE↗
PubMed1995

Treatment results of patients with multiple trauma: an analysis of 3406 cases treated between 1972 and 1991 at a German Level I Trauma Center.

The quality and progress of treatment for 3406 multiple trauma patients was reviewed retrospectively. Two periods (1972 to 1981, the first decade, and 1982 to 1991, the second decade) were compared. Sixty-nine percent of patients with multiple trauma had cerebral injuries, 62% thoracic trauma, and 86% fractures (40% open fractures). Concerning injury combinations, there was an increase of head/extremity injuries and thoracic/extremity injuries, whereas all combinations with abdominal injuries decreased. The relation between severity of injury as well as number of injured body regions and the mortality rate was significant. In the second decade prehospital care became more aggressive with an increase in use of intravenous fluid resuscitation (from 80% to 98%), intubation (from 84% to 91%), and chest tube insertion (from 37% to 76%). Rescue times were progressively shortened. For initial clinical diagnosis of massive abdominal hemorrhage, ultrasound (89%) nearly replaced peritoneal lavage (10%) and led to earlier surgical approach. For diagnosis of head injury, CT scan was used more frequently. Primary stabilization of long bone fractures, especially of the lower limb, is recommended. Concerning complications, the change in volume therapy helped to nearly eliminate acute renal failure (from 8.4% to 3.7%), the modification of respirator treatment led to a decrease of pulmonary insufficiency (ARDS; from 18.2% to 12.0%), whereas the rate of multiple organ failure increased. The mortality rate declined from 37% in the first decade to 22% in the second decade. The incidence of lethal multiple organ failure increased from 13.8% in the first decade to 18.6% in the second decade, whereas the mortality rate of ARDS decreased from 32.4% to 15.9%. Further reduction of incidents of death is only possible with causal therapy of posttraumatic organ failure immediately after injury.

Accidents, Traffic↗
PubMed2001

Retrospective study of mechanical ventilation in treating multiple trauma accompanied with craniocerebral injury.

OBJECTIVE: To explore the importance of mechanic al ventilation (MV) in treating multiple trauma mainly accompanied with cerebral injury and improve the treatment level. METHODS: All 116 patients who suffered from multiple trauma accompanied with mainly cerebral injury were analyzed. Rank correlation and Chi-square test were made between MV with GCS, ISS, and whether shock or not. RESULTS: The MV was correlated with GCS, ISS scores, and whether shock or not markedly. Furthermore, when GCS or=35, the ratio of MV was about 85%. CONCLUSIONS: During the treatment of multiple trauma accompanied with cerebral injury, the principle of "early MV, early withdraw" and "individualism" should be insisted on. For patients accompanied with shock, the optimum PEEP is very important. Proper and active MV is of great importance and can improve the treatment level markedly.

Adolescent↗
PubMed1979

[A case of severe multiple trauma (author's transl)].

A case of severe multiple trauma sustained in a road accident is reported. The aim of the report is to show the determing role played by diagnostic and surgical methods and therapeutic possibilities available in the intensive care unit (shock treatment, controlled respiration, parenteral feeding, haemodialysis) in winning the five-months' battle for the life of the patient. Early haemodyalisis as supporting therapy in respiratory failure and conservation treatment of intestinal fistulae are important. Post-traumatic pancreatitis which is a not infrequent complicating feature of severe multiple trauma may present diagnostic difficulties.

Accidents, Traffic↗
PubMed1984

The prevention of superinfection in multiple trauma patients.

In a control group of 59 multiple trauma patients requiring prolonged intensive care, a conventional restrictive antibiotic policy was followed. Forty-eight patients (81%) developed 94 infections. Fifty-one patients received systemic antibiotic therapy with one or more drugs. The total quantity of systemic antibiotics used was very high (18.3 +/- 22.1 antibiotic days per patient). This policy resulted in a very high incidence of superinfections (24%) with multiply-resistant Gram-negative bacteria, mostly emerging from the digestive tract (secondary endogenous infections). Five patients died from infection. A novel technique of infection prevention, based on the maintenance of the colonization resistance and on selective decontamination of the digestive tract in combination with systematic antibiotic prophylaxis with cefotaxime, proved to be very effective. Out of 63 multiple trauma patients, intubated and ventilated for 5 days or more in the ICU, 10 (16%) developed 11 infections. Most infections occurring under this regimen were primary endogenous infections which were treated by continuation of cefotaxime. Only two patients (3%) developed a superinfection with cefotaxime-resistant Gram-negative bacteria. No patient died. This approach to infection prevention in the ICU, shows that prophylactic administration of antibiotics significantly reduced the infection rate of critically ill patients without the development of superinfection.

Adolescent↗
PubMed1989

Multiple trauma.

Explore the source record for details and available documents.

Humans↗
PubMedDate not supplied

Riboflavin status of nutritionally supported multiple-trauma accident patients.

This study evaluates riboflavin status of multiple-trauma accident patients receiving nutritional support. Riboflavin excretion, erythrocyte glutathione reductase (EGR-AC), erythrocyte riboflavin (ERC-B2), nitrogen balance and riboflavin, and nitrogen and energy intake were assessed periodically throughout the study. Mean intakes of nitrogen, energy, and riboflavin were less than recommended. All patients but one were in negative nitrogen balance; however, patients retained riboflavin except when nitrogen and energy intakes were very low. EGR-AC values were within normal range and did not reflect changes in riboflavin retention. ERC-B2 values were also within normal range but decreased over time in patients with the largest riboflavin excretion and most negative nitrogen balance. ERC-B2 in combination with riboflavin intake and excretion data may offer a suitable method for assessing riboflavin status in multiple-trauma patients.

Adult↗
PubMed2002

Influence on outcome of ventilator-associated pneumonia in multiple trauma patients with head trauma treated with selected digestive decontamination.

OBJECTIVE: Ventilator-associated pneumonia is said to be associated with an increased mortality or a prolonged intensive care unit stay. In multiple trauma, the use of selective digestive decontamination has been reported to decrease morbidity and mortality associated with pneumonia. We performed a study to evaluate the attributable morbidity and mortality of ventilator-associated pneumonia in multiple trauma patients with head trauma treated with selective digestive decontamination. DESIGN: Prospective, matched-paired, case-control study. SETTING: Intensive care unit at a tertiary university hospital. PATIENTS: During a 6-yr period, 324 consecutive multiple trauma patients with head trauma requiring mechanical ventilation for >48 hrs were prospectively followed for the development of VAP. Case-control matching criteria were as follows: 1) age difference within 5 yrs, 2) Glasgow coma scale within five categories, 3) injury severity score within 5 points, 4) APACHE II score within 5 points, 5) ventilation of control patients for at least as long as the cases. The selective digestive decontamination regimen was used in all patients (cases and controls): polymixin E, gentamicin, and amphotericin B. Systemic cefazolin (1 g three times a day) was given for the first 3 days of intensive care unit stay. MEASUREMENTS AND MAIN RESULTS: Analysis was performed on 58 pairs that were matched with 100% of success The most common isolates recovered were Staphylococcus aureus (39%) and Haemophilus influenzae (22%). High-risk pathogens were rarely isolated: Pseudomonas aeruginosa (5.1%), Acinetobacter species (8.6%), and methicillin-resistant S. aureus (6.7%). The duration of mechanical ventilation and intensive care unit stay were increased in case patients (11.6 +/- 1.7 and 22.7 +/- 2.9 days, respectively) compared with control patients (9.4 +/- 1.3 and 16.8 +/- 2.9 days, respectively; p <.0006). Mortality was similar in both case (17%) and control (24%) patients. CONCLUSION: Ventilator-associated pneumonia did not seem to increase mortality of multiple trauma patients with head trauma who received selective digestive decontamination. Whether or not this conclusion applied to trauma patients not receiving selective digestive decontamination should be evaluated in further studies.

Adolescent↗
PubMed1996

[Monitoring of multiple trauma in an emergency hospital unit].

In the monitoring of multiple trauma patients in the emergency hospital setting the use of monitors should be graduated. However, the use and interpretation of data from these monitors is becoming increasingly complex and can lead to errors and responses which may not be adopted. Clinical nomination and observation have their limits and the anaesthetist is faced with the added difficulties of interpretation of data from monitors and is pitfalls. The management of the patient is based on this human-machine relationship, which provides the basis for the therapeutic attitude and the treatment which ensues. Basic monitoring comprises a pulse oximeter, a capnograph, an ECG and a blood pressure monitor, 52% of incidents are detected by these instruments; 27% by SpO2, 24% by capnography. The pertinence is 82% for the oximeter when used alone and 55% for the capnography alone, although when the two are used together this increases to 88%. If the blood pressure monitor is added the pertinence increases to 93%, and to 95% if the FiO2 is monitored. The use of monitors of levels of haemoglobin or haematocrit must take into account the important variations in volaemia. The displayed values have a poor predictive value. The second level of monitoring comprises the use of a pulmonary artery catheter. The errors in measurement and interpretation are reviewed and finally, we consider the possible use of FOE transoesophageal echocardiography in the multiple trauma patient.

Blood Pressure Determination↗
PubMed2004

Health-related quality of life and disability in survivors of multiple trauma one year after intensive care unit discharge.

OBJECTIVE: To evaluate health-related quality of life and disability in multiple-trauma patients requiring intensive care unit management. DESIGN: A total of 87 survivors of multiple trauma, with a median age of 31 yrs and a median Injury Severity Score of 22, were enrolled in the present study. The Nottingham Health Profile, Glasgow Outcome Scale, and Rosser Disability Scale were used to assess the functional consequences of trauma 1 yr after intensive care unit discharge. RESULTS: A total of 64 of 87 patients had a problem in at least one of the six domains related to subjective health status. The most prevalent complaint was related to somatic subdimensions, but emotional functioning was also affected. Nottingham Health Profile part 2 showed that 63 of the survivors experienced problems in at least one of the daily activities. Of particular importance, inability to work was reported by 47% of the patients. Fifty-nine percent experienced moderate-to-severe disability as evaluated by Glasgow Outcome Scale and Rosser Disability Scale. High aggregate injury severity score along with severe head trauma were independent predictors of poor health-related quality of life and disability. CONCLUSIONS: The majority of survivors of major trauma exhibit considerable levels of disability and impairment in health-related quality of life. Global injury severity score and degree of brain trauma determine functional limitations. This information may help in organizing long-term rehabilitation of multiple-trauma patients.

Adolescent↗
PubMed1999

Early enteral feeding of patients with multiple trauma.

The case study illustrates the recovery of a patient with multiple trauma who was fed a peptide-based formula via the enteral route soon after the trauma. Although the clinical course might have been worse if D.H. had not received this treatment, his generally excellent recovery might be partly attributable to this therapy. Although stress hypermetabolism occurs in most patients with multiple trauma within 48 hours after injury, no known treatment can arrest or reverse this problem. However, the lethal catabolic and septic effects of stress hypermetabolism can be at least partly thwarted through delivery of enteral nutrients within 72 hours after trauma.

Adult↗
PubMed1991

[The prognostic value of the delayed cutaneous immune reaction following multiple trauma in comparison with other clinical parameters].

Infection is a frequent cause of morbidity and mortality after multiple trauma. Although impaired immune function has been assumed to be associated with the development of infection and sepsis in trauma victims, its predictive role is still controversial. In a prospective study, the predictive value of the immunological in vivo response to intradermally applied recall antigens was compared with serial determinations of routine parameters. PATIENTS AND METHODS. Using the commercially available Multitest device, the cutaneous delayed-type hypersensitivity (DTH) response to seven standardized recall antigens was sequentially tested at defined time intervals in 35 mechanically ventilated multiple-trauma patients (4 females, 31 males). Routine clinical and laboratory parameters (FiO2, lactate, creatinine, platelet count, absolute and differential white blood cell (WBC) count) were determined every day. Injury severity scores (ISS), infections, and intensive care unit (ICU) mortality were prospectively documented by the same investigator. RESULTS AND DISCUSSION. The overall ICU mortality was 23%. In survivors, the mean ISS was 29.5, in nonsurvivors 38.9 (P less than 0.05). Mortality significantly increased in association with sepsis. Interestingly, the DTH response and severity of the trauma did not show any interdependence. Immediately after ICU admission, DTH testing failed to correlate with either infection or mortality: most of the multiply traumatized patients were anergic on initial skin testing. In the early posttraumatic stage, the serum levels of creatinine or lactate, lymphocyte and promyelocyte counts, and FiO2 proved to be more reliable predictors. In the later course, however, a good correlation was found between sequential skin test results and the development of infection. Beginning on the 4th day after trauma, DTH scores below 5 mm defined a population with a high incidence of developing a clinically important septic episode. In conclusion, lactate, FiO2, and WBC counts are early indicators of an impending poor outcome, whereas the skin test response is not. In the later course, however, the sequentially determined DTH response may substantially contribute to the identification of multiple-trauma patients at increased risk of infection.

Female↗
PubMed2002

Is the screening portable pelvis film clinically useful in multiple trauma patients who will be examined by abdominopelvic CT? Experience with 397 patients.

The multiple trauma patient is usually initially imaged with a portable "trauma series" consisting of a lateral cervical spine film, a portable chest film, and a portable pelvis film (PPF). An investigation was performed to determine whether the screening PPF could be eliminated for multiple trauma patients being examined by abdominopelvic CT scan (APCT). A retrospective investigation analyzed all patients evaluated in our level I trauma center from 1 January to 31 December 2000 who were examined with a "trauma series" followed by an APCT scan within 8 h. The numbers and types of fractures diagnosed by PPF and by APCT were compared and correlated with clinical follow-up. Of 397 patients imaged by both PPF and APCT, 43 patients were diagnosed with 109 individual fractures by CT scan. The PPF did not detect 51 of the 109 individual fractures (47%) and failed to diagnose 9 of the 43 patients (21%) with a pelvic fracture. The PPF most often failed to detect sacral and iliac fractures. The four cases in which the PPF reported a fracture not listed in the APCT report were due to reporting errors or film artifacts. No soft tissue injuries were seen by PPF that were not also seen by APCT. We conclude that the screening PPF appears to be an unnecessary exam in multiple trauma patients about to be imaged by APCT scan.

Journal Article↗
PubMed2006

Significance of Elecsys S100 immunoassay for real-time assessment of traumatic brain damage in multiple trauma patients.

BACKGROUND: The neuroprotein S100 released into the circulation has been suggested as a reliable marker for primary brain damage. However, safe identification of relevant traumatic brain injury (TBI) may possibly be hampered by S100 release from peripheral tissue. The objective of this study was to measure early S100 levels using the Elecsys S100 immunoassay for real-time assessment of severe TBI in multiple trauma. METHODS: Consecutively admitted multiple trauma patients (injury severity score >or=16 points) were stratified according to the results of the initial cerebral computed tomography (CCT) examination. S100 serum levels were determined at admission and at 6, 12, 24, 48 and 72 h after trauma. Data were correlated to creatine phosphokinase (CK) and lactate dehydrogenase (LDH) serum levels. Using receiver operating characteristic (ROC) analysis, the discriminating power of S100 measurement was calculated for the detection of CCT+ findings. RESULTS: Median S100 levels of CCT+ patients (n=9; 37 years) decreased from 3.30 microg/L at admission to 0.41 microg/L 72 h after trauma. They revealed no significant differences to CCT- patients (n=18; 44 years), but remained elevated compared to controls. Median CK and LDH levels correlated with the corresponding S100 levels during the first 24 h after trauma. ROC analysis displayed a maximum area under the curve of only 0.653 at 12 h after trauma. No significant difference was calculated for the differentiation between CCT+ and CCT- patients. CONCLUSIONS: Measurements of S100 serum levels using the Elecsys S100 immunoassay are not reliable for the real-time detection of severe TBI in multiple trauma patients. Due to soft tissue trauma or bone fractures, S100 is mainly released from peripheral sources such as adipocytes or skeletal muscle cells.

Adult↗