Background: Blunt thoracic trauma is responsible for 35% of trauma-related deaths in the United States and significantly contributes to morbidity and healthcare-related financial strain. The goal of this study was to evaluate factors influencing mortality in patients emergently admitted with the primary diagnosis of blunt chest wall trauma. Methods: Adults emergently admitted for blunt chest trauma were assessed using the National Inpatient Sample Database, 2004–2014. Data regarding demographics, comorbidities, and outcomes were collected. Relationships were determined using univariable and multivariable logistic regression models. Results: In total, 1120 adult and 1038 elderly patients emergently admitted with blunt chest trauma were assessed; 46.3% were female, and 53.6% were male. The average ages of adult and elderly patients were 46.6 and 78.9 years, respectively. Elderly and adult patients both displayed mortality rates of 1%. The regression model showed HLOS and several comorbidities as the main risk factors of mortality Every additional day of hospitalization increased the odds of mortality by 9% (OR = 1.09, 95% CI = 1.01–1.18, p = 0.033). Mortality and liver disease were significantly associated (OR = 8.36, 95% CI = 2.23–31.37, p = 0.002). Respiratory disease and mortality rates demonstrated robust correlations (OR = 7.46, 95% CI = 1.63–34.11, p = 0.010). Trauma, burns, and poisons were associated with increased mortality (OR = 3.72, 95% CI = 1.18–11.71, p = 0.025). The presence of platelet/white blood cell disease correlated to higher mortality. (OR = 4.42, 95% CI = 1.09–17.91, p = 0.038).

• Adult
• Aged
• Female
• Hospital Mortality
• Hospitals
• Humans
• Injury Severity Score
• Length of Stay
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors
• Thoracic Injuries/epidemiology
• Thoracic Wall/injuries
• Wounds, Nonpenetrating

• Cytokines
• Inflammation
• NF-kappaB
• Plasmin

• dynamical systems
• systems analysis
• control theory
• biomedical engineering
• medical research

• Blood Coagulation Disorders/drug therapy
• Blood Coagulation Disorders/etiology
• Blood Coagulation Factors/therapeutic use
• Humans
• Thrombin/metabolism

• Bleeding
• INR
• International normalized ratio
• Point-of-care testing

• Animal model
• coagulopathy
• hemorrhage
• platelets
• shock
• trauma

Acute traumatic coagulopathy can result in uncontrolled haemorrhage responsible for the majority of early deaths after adult trauma. Data on the frequency, transfusion practice and outcome of severe trauma haemorrhage in paediatric patients are inconsistent.

Datasets from paediatric trauma patients were retrieved from the registry of the German trauma society (TR-DGU^®) between 2009 and 2016. Coagulopathy was defined by a Quick’s value < 70% (INR (international normalized ratio) > 1.4) and/or thrombocytes ≤ 100 k upon emergency room admission. Children were grouped according to age in 4 different groups (A: 1–5, B: 6–10, C: 11–15 and D: 16–17 years). Prevalence of coagulopathy was assessed. Demographics, injury severity, haemostatic management including transfusions and mortality were described.

5351 primary admitted children ≤ 17 years with an abbreviated injury scale (AIS) ≥ 3 and complete datasets were included. The prevalence of coagulopathy was 13.7% (733/5351). The majority of the children sustained blunt trauma (more than 90% independent of age group) and a combination of traumatic brain injury (TBI) and any other trauma in more than 60% (A, C, D) and in 53.8% in group B. Coagulopathy occurred the most among the youngest (A: 18.2%), followed by all other age groups with approximately 13%. Overall mortality was the highest in the youngest (A: 40.9%) and among the youngest patients with traumatic brain injury (A: 71.4% and B: 47.1%). Transfusion of packed red blood cells (pRBCs) and fresh frozen plasma (FFPs) occurred almost in a 2:1 ratio (or less) across all age subgroups.

Traumatic haemorrhage in association with coagulopathy and severe shock is a major challenge in paediatric trauma across all age groups.

The online version of this article (10.1007/s00068-020-01398-x) contains supplementary material, which is available to authorized users.

• Coagulopathy
• Haemorrhage
• Mortality
• Paediatric trauma
• Transfusion

• coagulopathy
• hemorrhage
• rotational thromboelastometry (ROTEM)
• thromboelastography (TEG)
• trauma
• viscoelastic assay

• acute pancreatitis
• coagulation
• endothelial injury
• inflammation
• laboratory markers

• Acute Disease
• Animals
• Anticoagulants/therapeutic use
• Biomarkers
• Blood Coagulation
• Cell Communication
• Cytokines/metabolism
• Endothelium/metabolism
• Endothelium/pathology
• Hemostasis
• Humans
• Inflammation/metabolism
• Inflammation/pathology
• Inflammation Mediators/metabolism
• Microcirculation
• Pancreatitis/blood
• Pancreatitis/diagnosis
• Pancreatitis/drug therapy
• Pancreatitis/etiology
• Prognosis
• Severity of Illness Index
• Treatment Outcome

• Blood coagulation disorders
• emergency service
• hospital
• multiple trauma
• outcome assessment
• risk factors

• Emergency management
• Mortality
• Pelvic fracture
• Pelvic trauma, complex
• Registry

The management of trauma patients is often difficult. The American college of surgeons suggests using advanced trauma life support (ATLS) measures. ATLS is regarded as the gold standard for the resuscitation of cases with acute life threatening injuries.

To assess the change in base excess (BE) values and central venous pressure (CVP) one and six hours after injection of 1000 cc normal saline in trauma patients admitted to the ICU.

According to the inclusion and exclusion criteria, patients were randomly selected to participate in the project. Inclusion criteria included trauma patients admitted to the ICU with a CVP line and who had indication for hydration. In trauma patients, at the zero time period, BP, PR, RR and CVP were measured, and a blood gas test was used to assess Hb, pH, BE, PO₂, HCO₃ and PCO₂. Then 1000 cc of normal saline was injected, and after one and six hours, the same values were re-evaluated.

The mean age of the patients was 38.1 ± 3.9 (range 15 - 60). The mean duration of hospitalization was 7.4 ± 4.4 (range 1 - 21) days. The mean ISS for these patients was 14.33 ± 5.3. BE changes in both groups of patients, based on Hb primary division, showed a significant difference (P ≤ 0.05). The results showed that there was no significant relation between the measured ISS and the changes in base values (P ≥ 0.05).

According to our results, the infusion of one liter normal saline will cause a statistically significant decrease only in BD, after one hour, in patients with moderate to severe ISS. The changes in SBP, PR, CVP and also pH, HCO₃ and Hb were not statistically remarkable.

• Fluid Therapy
• Hemodilution
• Multiple Trauma

• coagulation
• fibrinolysis
• hemorrhage
• plasmin
• thrombin

• Hemorrhage
• International normalized ratio
• Mortality
• Trauma

Coagulopathy is a well-known consequence of trauma and is the most common cause of mortality in the young. However, its cause and management is still controversial. A new concept in the understanding of coagulopathy in trauma is the occurrence of Acute coagulopathy of trauma (ACoT). ACoT is associated with hypo perfusion and tissue trauma as seen in massive injury. The incidence of coagulopathy increases with injury scores and is associated with higher number of ventilator days, higher morbidity and mortality. The process of coagulation is better described by the cell based model with a central role for platelets rather than the older plasma based model. This shift in our understanding supports the theory that ACoT results from the endothelial release of thrombomodulin and activated protein C in the presence of hypoperfusion. This in turn leads on to a hyperfibrinolytic and hypocoagulable state. Viscoelastic hemostatic assays are replacing the older tests like prothrombin time in the assessment of coagulopathy. These tests are accurate, determine the need for transfusion and can be performed at the point of care. Damage control resuscitation includes newer concepts like permissive hypotension, increased use of plasma as a part of massive transfusion protocols and damage control surgery.

• Trauma
• Coagulopathy
• Massive transfusion
• Bleeding
• Thromboelastography

• Fluid Therapy
• blood gas analysis
• hemodilution
• multiple trauma

• Blood Coagulation Disorders/diagnosis
• Blood Coagulation Disorders/epidemiology
• Blood Coagulation Disorders/therapy
• Disease Management
• Drug Monitoring/methods
• Drug Monitoring/standards
• Europe/epidemiology
• Hemorrhage/diagnosis
• Hemorrhage/epidemiology
• Hemorrhage/therapy
• Humans
• Multiple Trauma/diagnosis
• Multiple Trauma/epidemiology
• Multiple Trauma/therapy
• Practice Guidelines as Topic/standards
• Randomized Controlled Trials as Topic/methods
• Randomized Controlled Trials as Topic/standards