TY - JOUR
T1 - Epidemiology and outcomes of non-compressible torso hemorrhage
AU - Kisat, Mehreen
AU - Morrison, Jonathan J.
AU - Hashmi, Zain G.
AU - Efron, David T.
AU - Rasmussen, Todd E.
AU - Haider, Adil H.
N1 - Funding Information:
Financial support for this work was provided by the National Institutes of Health/National Institute of General Medical Sciences K23GM093112-01 and American College of Surgeons , C. James Carrico Fellowship for the study of trauma and critical care (to A.H.H.). The authors declare no conflict of interest.
PY - 2013
Y1 - 2013
N2 - Background: Non-compressible torso hemorrhage (NCTH) is the leading cause of potentially preventable death in military trauma, but the civilian epidemiology is unknown. The aim of this study is to apply a military definition of NCTH, which incorporates anatomic and physiological criteria, to a civilian population treated at trauma centers in the US. Methods: Patients (age >16 y) from 197 Level 1 trauma centers (approximately 95% of all US Level 1 centers) in the National Trauma Data Bank 2007-2009 that sustained a named torso vessel injury, pulmonary injury, grade IV solid organ injury, or pelvic fracture with ring disruption were included. Of these, patients with a systolic blood pressure <90 mmHg were considered to have NCTH. Multivariable logistic regression was used to identify patient and injury factors associated with NCTH and mortality after adjusting for the following covariates: patient (age, gender, ethnicity, and insurance status), injury (Glasgow Coma Scale, injury type, Injury Severity Score, anatomic region), and clinical (major surgical procedure, need for transfusion, and intensive care unit admission) characteristics. Results: Of the 1.8 million patients in the 2007-2009 National Trauma Data Bank, 249,505 met the anatomic criteria for non-compressible torso injury (NCTI). Of these, 20,414 (8.2%) patients had associated hemorrhage. The rate of pulmonary and torso vessel injury was similar (53.4% and 50.6%, respectively), with solid organ injury identified in 27.0% of patients and pelvic injury in 8.9%. The overall mortality rate of patients with NCTI and NCTH was 6.8% and 44.6%, respectively. The most lethal injury was major torso vessel injury (OR 1.54, 95% CI 1.33-1.78), followed by pulmonary injury (OR 1.32, 95% CI 1.18-1.48). Lower mortality was found in patients with pelvic injury (OR 0.80, 95% CI 0.65-0.98). Conclusions: The military definition of NCTH can be usefully applied to civilians to identify patients with lethal injuries and high resource needs. Investigating the implications of NCTH on patient triage is recommended.
AB - Background: Non-compressible torso hemorrhage (NCTH) is the leading cause of potentially preventable death in military trauma, but the civilian epidemiology is unknown. The aim of this study is to apply a military definition of NCTH, which incorporates anatomic and physiological criteria, to a civilian population treated at trauma centers in the US. Methods: Patients (age >16 y) from 197 Level 1 trauma centers (approximately 95% of all US Level 1 centers) in the National Trauma Data Bank 2007-2009 that sustained a named torso vessel injury, pulmonary injury, grade IV solid organ injury, or pelvic fracture with ring disruption were included. Of these, patients with a systolic blood pressure <90 mmHg were considered to have NCTH. Multivariable logistic regression was used to identify patient and injury factors associated with NCTH and mortality after adjusting for the following covariates: patient (age, gender, ethnicity, and insurance status), injury (Glasgow Coma Scale, injury type, Injury Severity Score, anatomic region), and clinical (major surgical procedure, need for transfusion, and intensive care unit admission) characteristics. Results: Of the 1.8 million patients in the 2007-2009 National Trauma Data Bank, 249,505 met the anatomic criteria for non-compressible torso injury (NCTI). Of these, 20,414 (8.2%) patients had associated hemorrhage. The rate of pulmonary and torso vessel injury was similar (53.4% and 50.6%, respectively), with solid organ injury identified in 27.0% of patients and pelvic injury in 8.9%. The overall mortality rate of patients with NCTI and NCTH was 6.8% and 44.6%, respectively. The most lethal injury was major torso vessel injury (OR 1.54, 95% CI 1.33-1.78), followed by pulmonary injury (OR 1.32, 95% CI 1.18-1.48). Lower mortality was found in patients with pelvic injury (OR 0.80, 95% CI 0.65-0.98). Conclusions: The military definition of NCTH can be usefully applied to civilians to identify patients with lethal injuries and high resource needs. Investigating the implications of NCTH on patient triage is recommended.
KW - Critical care
KW - Hemorrhage
KW - Trauma epidemiology
KW - Trauma surgery
UR - http://www.scopus.com/inward/record.url?scp=84884672463&partnerID=8YFLogxK
U2 - 10.1016/j.jss.2013.05.099
DO - 10.1016/j.jss.2013.05.099
M3 - Article
AN - SCOPUS:84884672463
SN - 0022-4804
VL - 184
SP - 414
EP - 421
JO - Journal of Surgical Research
JF - Journal of Surgical Research
IS - 1
ER -