Predictors of mortality for blunt trauma patients in intensive care: A retrospective cohort study [version 5; peer review: 2 approved]
Background Major trauma places substantial demand on critical care services, is a leading cause of death in under 40-year-olds and causes significant morbidity and mortality across all age groups. Various factors influence patient outcome and predefining these could allow prognostication. The aim of...
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2024-12-01
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| author | Ahilanandan Dushianthan Amy Addison Rebecca Egglestone Michael Jennings James Booker |
| author_facet | Ahilanandan Dushianthan Amy Addison Rebecca Egglestone Michael Jennings James Booker |
| author_sort | Ahilanandan Dushianthan |
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| description | Background Major trauma places substantial demand on critical care services, is a leading cause of death in under 40-year-olds and causes significant morbidity and mortality across all age groups. Various factors influence patient outcome and predefining these could allow prognostication. The aim of this study was to identify predictors of mortality from major trauma in intensive care. Methods This was a retrospective study of adult trauma patients admitted to general intensive care between January 2018 and December 2019. We assessed the impact on mortality of patient demographics, patterns of injury, injury scores (Glasgow Coma Score (GCS), Charlson’s comorbidity index (CCI), Acute Physiology and Health Evaluation II (APACHE II), Injury Severity Score (ISS) and Probability of Survival Score (Ps19)), number of surgeries and mechanism of injury using logistic regression. Results A total of 414 patients were included with a median age of 54 years (IQR 34–72). Overall mortality was 18.6%. The most common mechanism of injury was traffic collision (46%). Non-survivors were older, had higher ISS scores with lower GCS on admission and lower probability of survival scores. Factors independently predictive of mortality were age 70-80 (OR 3.267, p = 0.029), age >80 (OR 27.043, p < 0.001) and GCS < 15 (OR 8.728, p < 0.001). Ps19 was the best predictor of mortality (p <0.001 for each score category), with an AUROC of 0.90. Conclusions The significant mortality predictors were age, fall from <2 metres, injury of head or limbs, GCS <15 and Ps19. Contrary to previous studies, CCI and APACHE II did not significantly predict mortality. Although Ps19 was found to be the best current prognostic score, trauma prognostication would benefit from a single validated scoring system incorporating both physiological variables and injury patterns. |
| format | Article |
| id | doaj-art-6198d7f4283c48dba2a6385fc0c50ea9 |
| institution | Kabale University |
| issn | 2046-1402 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | F1000 Research Ltd |
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| spelling | doaj-art-6198d7f4283c48dba2a6385fc0c50ea92024-12-10T01:00:00ZengF1000 Research LtdF1000Research2046-14022024-12-0112174997Predictors of mortality for blunt trauma patients in intensive care: A retrospective cohort study [version 5; peer review: 2 approved]Ahilanandan Dushianthan0https://orcid.org/0000-0002-0165-3359Amy Addison1Rebecca Egglestone2Michael Jennings3https://orcid.org/0000-0001-7588-2827James Booker4General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UKFaculty of Medicine, University of Southampton, Tremona Road, Southampton, SO16 6YD, UKGeneral Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UKGeneral Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UKDepartment of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UKBackground Major trauma places substantial demand on critical care services, is a leading cause of death in under 40-year-olds and causes significant morbidity and mortality across all age groups. Various factors influence patient outcome and predefining these could allow prognostication. The aim of this study was to identify predictors of mortality from major trauma in intensive care. Methods This was a retrospective study of adult trauma patients admitted to general intensive care between January 2018 and December 2019. We assessed the impact on mortality of patient demographics, patterns of injury, injury scores (Glasgow Coma Score (GCS), Charlson’s comorbidity index (CCI), Acute Physiology and Health Evaluation II (APACHE II), Injury Severity Score (ISS) and Probability of Survival Score (Ps19)), number of surgeries and mechanism of injury using logistic regression. Results A total of 414 patients were included with a median age of 54 years (IQR 34–72). Overall mortality was 18.6%. The most common mechanism of injury was traffic collision (46%). Non-survivors were older, had higher ISS scores with lower GCS on admission and lower probability of survival scores. Factors independently predictive of mortality were age 70-80 (OR 3.267, p = 0.029), age >80 (OR 27.043, p < 0.001) and GCS < 15 (OR 8.728, p < 0.001). Ps19 was the best predictor of mortality (p <0.001 for each score category), with an AUROC of 0.90. Conclusions The significant mortality predictors were age, fall from <2 metres, injury of head or limbs, GCS <15 and Ps19. Contrary to previous studies, CCI and APACHE II did not significantly predict mortality. Although Ps19 was found to be the best current prognostic score, trauma prognostication would benefit from a single validated scoring system incorporating both physiological variables and injury patterns.https://f1000research.com/articles/12-974/v5intensive care critical care trauma mortality scoring systemseng |
| spellingShingle | Ahilanandan Dushianthan Amy Addison Rebecca Egglestone Michael Jennings James Booker Predictors of mortality for blunt trauma patients in intensive care: A retrospective cohort study [version 5; peer review: 2 approved] F1000Research intensive care critical care trauma mortality scoring systems eng |
| title | Predictors of mortality for blunt trauma patients in intensive care: A retrospective cohort study [version 5; peer review: 2 approved] |
| title_full | Predictors of mortality for blunt trauma patients in intensive care: A retrospective cohort study [version 5; peer review: 2 approved] |
| title_fullStr | Predictors of mortality for blunt trauma patients in intensive care: A retrospective cohort study [version 5; peer review: 2 approved] |
| title_full_unstemmed | Predictors of mortality for blunt trauma patients in intensive care: A retrospective cohort study [version 5; peer review: 2 approved] |
| title_short | Predictors of mortality for blunt trauma patients in intensive care: A retrospective cohort study [version 5; peer review: 2 approved] |
| title_sort | predictors of mortality for blunt trauma patients in intensive care a retrospective cohort study version 5 peer review 2 approved |
| topic | intensive care critical care trauma mortality scoring systems eng |
| url | https://f1000research.com/articles/12-974/v5 |
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