Recovery to Normal Vital Functions and Acid-base Status After a Severe Trauma in Level I Versus Level II Trauma Centres

Overview

Journal Eur J Trauma Emerg Surg

Specialties Critical Care
Emergency Medicine

Date 2023 Dec 13

PMID 38093136

Authors

Roos J M Havermans

Mariska A C de Jongh

Alexander H van der Veen

Michael Edwards

Koen W W Lansink

Affiliations

Soon will be listed here.

Abstract

Purpose: In the Netherlands, approximately 70% of severely injured patients (ISS ≥ 16) are transported directly to a Level I trauma center. This study compared the time needed to return to normal vital parameters and normal acid-base status in severely injured patients and some in-hospital processes in Level I versus Level II trauma centers.

Methods: This retrospective cohort study included all adult severely injured patients or adult trauma patients admitted to the intensive care unit between 2015 and 2020 in a Dutch trauma region. The primary endpoint was time until normal vital parameters and acid-base status. Secondary endpoints were complication rate, hospital length of stay, emergency department length of stay, and time until a computed tomography (CT) scan.

Results: A total of 2345 patients were included. Patients admitted to a Level I trauma center had a significantly higher rate of normalization of vital parameters over time (HR 1.51). There was no significant difference in normalization rate of the acid-base status over time (HR 1.10). In Level I trauma centers, time spent at the emergency department and time until the CT scan was significantly shorter (respectively, β - 38 min and β - 77 min), and the complication rate was significantly lower (OR 0.35).

Conclusion: Severely injured patients admitted to a Level I trauma center require less time to normalize their vital functions. Level I centers are better equipped, resulting in better in-hospital processes with shorter time at the emergency department and shorter time until a CT scan.

References

Havermans R, de Jongh M, Bemelman M, van Driel A, Noordergraaf G, Lansink K . Trauma care before and after optimisation in a level I trauma Centre: Life-saving changes. Injury. 2019; 50(10):1678-1683. DOI: 10.1016/j.injury.2019.07.017. View

Demetriades D, Martin M, Salim A, Rhee P, Brown C, Chan L . The effect of trauma center designation and trauma volume on outcome in specific severe injuries. Ann Surg. 2005; 242(4):512-7. PMC: 1402347. DOI: 10.1097/01.sla.0000184169.73614.09. View

Herrera-Escobar J, Rios-Diaz A, Zogg C, Wolf L, Harlow A, Schneider E . The "mortality ascent": Hourly risk of death for hemodynamically unstable trauma patients at Level II versus Level I trauma centers. J Trauma Acute Care Surg. 2017; 84(1):139-145. DOI: 10.1097/TA.0000000000001706. View

Glance L, Osler T, Mukamel D, Dick A . Impact of trauma center designation on outcomes: is there a difference between Level I and Level II trauma centers?. J Am Coll Surg. 2012; 215(3):372-8. DOI: 10.1016/j.jamcollsurg.2012.03.018. View

Kaji A, Bosson N, Gausche-Hill M, Dawes A, Putnam B, Shepherd T . Patient Outcomes at Urban and Suburban Level I Versus Level II Trauma Centers. Ann Emerg Med. 2017; 70(2):161-168. DOI: 10.1016/j.annemergmed.2017.01.040. View

Gunning A, Lansink K, van Wessem K, Balogh Z, Rivara F, Maier R . Demographic Patterns and Outcomes of Patients in Level I Trauma Centers in Three International Trauma Systems. World J Surg. 2015; 39(11):2677-84. PMC: 4591196. DOI: 10.1007/s00268-015-3162-x. View

Salottolo K, Carrick M, Johnson J, Gamber M, Bar-Or D . A retrospective cohort study of the utility of the modified early warning score for interfacility transfer of patients with traumatic injury. BMJ Open. 2017; 7(5):e016143. PMC: 5623387. DOI: 10.1136/bmjopen-2017-016143. View

Xie X, Huang W, Liu Q, Tan W, Pan L, Wang L . Prognostic value of Modified Early Warning Score generated in a Chinese emergency department: a prospective cohort study. BMJ Open. 2018; 8(12):e024120. PMC: 6303659. DOI: 10.1136/bmjopen-2018-024120. View

Buist M, Bernard S, Nguyen T, Moore G, Anderson J . Association between clinically abnormal observations and subsequent in-hospital mortality: a prospective study. Resuscitation. 2004; 62(2):137-41. DOI: 10.1016/j.resuscitation.2004.03.005. View

10.

Bruijns S, Guly H, Bouamra O, Lecky F, Lee W . The value of traditional vital signs, shock index, and age-based markers in predicting trauma mortality. J Trauma Acute Care Surg. 2013; 74(6):1432-7. DOI: 10.1097/TA.0b013e31829246c7. View

11.

van der Wulp I, Rullmann H, Leenen L, van Stel H . Associations of the Emergency Severity Index triage categories with patients' vital signs at triage: a prospective observational study. Emerg Med J. 2010; 28(12):1032-5. DOI: 10.1136/emj.2010.096172. View

12.

Fullerton J, Price C, Silvey N, Brace S, Perkins G . Is the Modified Early Warning Score (MEWS) superior to clinician judgement in detecting critical illness in the pre-hospital environment?. Resuscitation. 2012; 83(5):557-62. DOI: 10.1016/j.resuscitation.2012.01.004. View

13.

Liu N, Holcomb J, Wade C, Salinas J . Inefficacy of standard vital signs for predicting mortality and the need for prehospital life-saving interventions in blunt trauma patients transported via helicopter: A repeated call for new measures. J Trauma Acute Care Surg. 2017; 83(1 Suppl 1):S98-S103. DOI: 10.1097/TA.0000000000001482. View

14.

Paladino L, Sinert R, Wallace D, Anderson T, Yadav K, Zehtabchi S . The utility of base deficit and arterial lactate in differentiating major from minor injury in trauma patients with normal vital signs. Resuscitation. 2008; 77(3):363-8. DOI: 10.1016/j.resuscitation.2008.01.022. View

15.

Juern J, Khatri V, Weigelt J . Base excess: a review. J Trauma Acute Care Surg. 2012; 73(1):27-32. DOI: 10.1097/TA.0b013e318256999d. View

16.

Rixen D, Raum M, Bouillon B, Lefering R, Neugebauer E . Base deficit development and its prognostic significance in posttrauma critical illness: an analysis by the trauma registry of the Deutsche Gesellschaft für unfallchirurgie. Shock. 2001; 15(2):83-9. DOI: 10.1097/00024382-200115020-00001. View

17.

Mitra B, Tullio F, Cameron P, Fitzgerald M . Trauma patients with the 'triad of death'. Emerg Med J. 2011; 29(8):622-5. DOI: 10.1136/emj.2011.113167. View

18.

Champion H, Sacco W, Copes W, GANN D, Gennarelli T, Flanagan M . A revision of the Trauma Score. J Trauma. 1989; 29(5):623-9. DOI: 10.1097/00005373-198905000-00017. View

19.

Daabiss M . American Society of Anaesthesiologists physical status classification. Indian J Anaesth. 2011; 55(2):111-5. PMC: 3106380. DOI: 10.4103/0019-5049.79879. View

20.

Caputo N, Kanter M, Fraser R, Simon R . Comparing biomarkers of traumatic shock: the utility of anion gap, base excess, and serum lactate in the ED. Am J Emerg Med. 2015; 33(9):1134-9. DOI: 10.1016/j.ajem.2015.04.085. View