• machine learning
• mortality
• pediatrics
• prediction
• trauma

Pelvic trauma has increased risk of mortality in the elderly. Our study aimed to analyze the impact of the additional burden of pelvic fractures in severely injured elderly.

This is a retrospective analysis of a prospectively maintained trauma registry from 2012 to 2018 at an American College of Surgeons (ACS) verified Level I Trauma Center. Trauma patients aged ≥ 65 years with ISS ≥ 16 and AIS severity score ≥ 3 in at least two body regions were divided in two groups: group I, consisted of elderly polytrauma patients without pelvic fractures, and group II elderly who had concomitant pelvic fractures. We used a double-adjustment method using propensity score matching (PSM) with subsequent covariate adjustment to minimize the effect of confounding factors, and give unbiased estimation of the impact of pelvic fractures. Balance assessment was conducted by computing absolute standardized mean differences (ASMDs) and ASMD < 0.10 reflects good balance between groups.

Of 12,774 patients admitted during this time, 411 (3.2%) elderly with a mean age of 77.75 ± 8.32 years met the inclusion criteria. Of this cohort, only 92 patients (22.4%) had pelvic fractures. Females outnumbered males (55 vs. 45%). Comparing characteristics of group I and group II using ASMDs, pelvic trauma patients were more likely to have higher systolic blood pressure (SBP), head injuries, lower extremity injuries, anticoagulant therapy, and cirrhosis. Fewer variables differed significantly after matching. We observed few instances of worse outcomes associated with pelvic trauma using PSM with and without covariate adjustment. Crude PSM without covariate adjustment, showed a significantly higher rate of deep vein thrombosis (DVT) for pelvic trauma (p < 0.001). Crude PSM also showed a significantly higher rate of ventilator-associated pneumonia (VAP) in group II (p = 0.006). PSM with covariate adjustment did not confirm differences on these outcomes. PSM both without and with covariate adjustment found lower ventilator days and ICU length of stay among patients with pelvic trauma. No significant differences were seen on 12 outcomes: death, acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), cardiac arrest with cardiopulmonary resuscitation (CPR), myocardial infarction (MI), pulmonary embolism (PE), unplanned intubation, unplanned admission to intensive care unit (ICU), catheter-associated urinary tract infection (CAUTI), and hospital length of stay.

At a Level I Trauma Center the additional burden of pelvic fractures in seriously injured elderly did not translate into higher mortality. PSM without covariate adjustment suggests worse rates among pelvic trauma patients for DVT and VAP but covariate adjustment removed statistical significance for both outcomes. Pelvic trauma patients had shorter time on ventilator and in the ICU. Whether similar analytic methods applied to patients from larger data sources would produce similar findings remains to be seen.

• Confounders
• Elderly
• Outcomes
• Pelvic fractures
• Propensity score matching
• Trauma

• Injury severity score
• Mortality
• Neutrophil
• Platelet
• Trauma

• animal trauma triage score
• feline
• illness severity score
• trauma

• Epidemiology
• Fragility fracture
• Pelvic fracture
• Pelvis
• Treatment

• Mortality
• Pelvic fractures
• Predictors
• Trauma registry

To evaluate the prognostic value of arterial blood gas (ABG) indices, especially base excess (BE), regarding the severity of traumatic injury.

A total number of 96 trauma patients with fractures of femur and pelvis were included in this study. Demographic characteristics and clinical information of samples were recorded. The results of ABG test and hemoglobin (Hb) were evaluated at two time intervals (on admission and 6 hours later). The outcome of the patients was evaluated at the end of the study (dead or alive). The ABG indices included O2 saturation (O2Sat), PH, PO2, PCO2, bicarbonate (HCO3) and base excess (BE). The mean of the hemodynamic and ABG indices were compared between those who were discharged and mortality cases. The confounders were compensated using a multivariate logistic regression model.

Overall 94 trauma patients with long and pelvic fractures were included. There were 69 (73.4%) men and 25 (26.6%) women among the patients with mean age of 37.43 ± 20.07 years. The mortality rate was 10 (10.6%). The most common mechanism of injury was motorcycle accident in 41 (43.6%) and car collision in 43 (45.7%) patients. We found that mortality was significantly associated with amount of FFP transfusion (p=0.005), but was not associated with amount of transfused packed cells (p=0.113). We also found that mortality was associated with lower BP after 6 hours of admission (p=0.001), higher HR on admission (p=0.036), lower HR after 6 hours (p=0.017), lower O2Sat on admission (p<0.001), higher PCO2 after 6 hours and lower BE on admission (p=0.025).    

The ABG indices including O2Sat, BE and PCO2 are considered prognostic determinants of outcome in trauma patients with long and pelvic fractures. These findings can be considered as fundamental studies to achieve new diagnostic methods.  

• Arterial blood gas (ABG)
• Femur
• Injuries
• Mortality
• Pelvis
• Prognosis
• hemodynamic indices

• Trauma
• aorta
• balloon occlusion
• hemorrhage
• resuscitation

• Computed tomography scan
• X-ray
• clinical signs
• multiple trauma
• pelvic fracture
• symptoms

• Elderly patients
• Epidemiology
• Incidence
• Mortality
• Pelvic fractures

• Nigeria
• Port Harcourt
• Trauma
• mortality
• surgical wards

• Brain Injuries, Traumatic/epidemiology
• Brain Injuries, Traumatic/mortality
• Burns/epidemiology
• Burns/mortality
• Cause of Death
• Female
• Hospitals, Teaching
• Humans
• Inpatients
• Male
• Nigeria/epidemiology
• Retrospective Studies
• Spinal Cord Injuries/epidemiology
• Spinal Cord Injuries/mortality
• Tertiary Care Centers
• Wounds and Injuries/epidemiology
• Wounds and Injuries/mortality

Geriatric trauma constitutes an increasingly recognized problem. Aging results in a progressive decline in cellular function which leads to a loose of their capacity to respond to injury. Some medications commonly used in this population can mask or blunt the response to injury. Falls constitute the most common cause of trauma and the leading cause of trauma-related deaths in this population. Falls are complicated by the widespread use of antiplatelets and anticoagulants, especially in patients with brain injury. Under-triage is common in this population. Evaluation of frailty could be helpful to solve this issue. Appropriate triaging and early aggressive management with correction of coagulopathy can improve outcome. Limitation of care and palliative measures must be considered in cases with a clear likelihood of poor prognosis.

• Geriatric trauma
• Elderly patients
• Severe trauma
• Triage
• Outcome

• Aging
• Geriatric
• Injury
• Trauma

• Age Factors
• Aged
• Emergency Service, Hospital
• Humans
• Resuscitation/methods
• Risk Factors
• Triage/methods
• Wounds and Injuries/diagnosis
• Wounds and Injuries/pathology
• Wounds and Injuries/physiopathology
• Wounds and Injuries/therapy

• D-dimer (DD)
• Extravasation
• Fibrin degradation products (FDP)
• Fibrinogen
• Pelvic fracture

• Adult
• Aged
• Aged, 80 and over
• Biomarkers/metabolism
• Blood Coagulation
• Blood Pressure
• Emergency Medicine
• Extravasation of Diagnostic and Therapeutic Materials/metabolism
• Female
• Fibrin Fibrinogen Degradation Products/metabolism
• Fibrinogen/metabolism
• Fractures, Bone/diagnosis
• Fractures, Bone/metabolism
• Heart Rate
• Humans
• Injury Severity Score
• Male
• Middle Aged
• Pelvic Bones/injuries
• ROC Curve
• Retrospective Studies
• Sensitivity and Specificity

There is no existing adequate blood transfusion needs determination tool that Emergency Medical Services (EMS) personnel can use for prehospital blood transfusion initiation. In this study, a simple and pragmatic prehospital blood transfusion needs scoring system was derived and validated.

Local trauma registry data were reviewed retrospectively from 2004 through 2013. Patients were randomly assigned to derivation and validation cohorts. Multivariate logistic regression was used to identify the independent approachable risks associated with early blood transfusion needs in the derivation cohort in which a scoring system was derived. Sensitivity, specificity, and area under the receiver operational characteristic (AUC) were calculated and compared using both the derivation and validation data.

A total of 24,303 patients were included with 12,151 patients in the derivation and 12,152 patients in the validation cohorts. Age, penetrating injury, heart rate, systolic blood pressure, and Glasgow coma scale (GCS) were risks predictive of early blood transfusion needs. An early blood transfusion needs score was derived. A score > 5 indicated risk of early blood transfusion need with a sensitivity of 83% and a specificity of 80%. A sensitivity of 82% and a specificity of 80% were also found in the validation study and their AUC showed no statistically significant difference (AUC of the derivation = 0.87 versus AUC of the validation = 0.86, P > 0.05).

An early blood transfusion scoring system was derived and internally validated to predict severe trauma patients requiring blood transfusion during prehospital or initial emergency department resuscitation.

• Blood transfusion
• Derivation
• Emergency department
• Needs
• Prehospital
• Score
• Trauma
• Validation