Central Venous Catheterization before Versus after Computed Tomography in Hemodynamically Unstable Patients with Major Blunt Trauma: Clinical Characteristics and Factors for Decision Making
Purpose When hemodynamically unstable patients with blunt major trauma arrive at the emergency department (ED), the safety of performing early whole-body computed tomography (WBCT) is concerning. Some clinicians perform central venous catheterization (CVC) before WBCT (pre-computed tomography [CT] g...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Korean Society of Traumatology
2018-12-01
|
| Series: | Journal of Trauma and Injury |
| Subjects: | |
| Online Access: | http://www.jtraumainj.org/upload/pdf/jti-31-135.pdf |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841558935705747456 |
|---|---|
| author | Ji Hun Kim Sang Ook Ha Young Sun Park Jeong Hyeon Yi Sun Beom Hur Ki Ho Lee |
| author_facet | Ji Hun Kim Sang Ook Ha Young Sun Park Jeong Hyeon Yi Sun Beom Hur Ki Ho Lee |
| author_sort | Ji Hun Kim |
| collection | DOAJ |
| description | Purpose When hemodynamically unstable patients with blunt major trauma arrive at the emergency department (ED), the safety of performing early whole-body computed tomography (WBCT) is concerning. Some clinicians perform central venous catheterization (CVC) before WBCT (pre-computed tomography [CT] group) for hemodynamic stabilization. However, as no study has reported the factors affecting this decision, we compared clinical characteristics and outcomes of the pre- and post-CT groups and determined factors affecting this decision. Methods This retrospective study included 70 hemodynamically unstable patients with chest or/and abdominal blunt injury who underwent WBCT and CVC between March 2013 and November 2017. Results Univariate analysis revealed that the injury severity score, intubation, pulse pressure, focused assessment with sonography in trauma positivity score, and pH were different between the pre-CT (34 patients, 48.6%) and post-CT (all, p<0.05) groups. Multivariate analysis revealed that injury severity score (ISS) and intubation were factors affecting the decision to perform CVC before CT (p=0.003 and p=0.043). Regarding clinical outcomes, the interval from ED arrival to CT (p=0.011) and definite bleeding control (p=0.038), and hospital and intensive care unit lengths of stay (p=0.018 and p=0.053) were longer in the pre-CT group than in the post-CT group. Although not significant, the pre-CT group had lower survival rates at 24 hours and 28 days than the post-CT group (p=0.168 and p=0.226). Conclusions Clinicians have a tendency to perform CVC before CT in patients with blunt major trauma and high ISS and intubation. |
| format | Article |
| id | doaj-art-a831820bc663457aa068eb815356730e |
| institution | Kabale University |
| issn | 1738-8767 2287-1683 |
| language | English |
| publishDate | 2018-12-01 |
| publisher | Korean Society of Traumatology |
| record_format | Article |
| series | Journal of Trauma and Injury |
| spelling | doaj-art-a831820bc663457aa068eb815356730e2025-01-06T01:08:03ZengKorean Society of TraumatologyJournal of Trauma and Injury1738-87672287-16832018-12-0131313514210.20408/jti.2018.022962Central Venous Catheterization before Versus after Computed Tomography in Hemodynamically Unstable Patients with Major Blunt Trauma: Clinical Characteristics and Factors for Decision MakingJi Hun Kim0Sang Ook Ha1Young Sun Park2Jeong Hyeon Yi3Sun Beom Hur4Ki Ho Lee5Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, KoreaDepartment of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, KoreaDepartment of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, KoreaDepartment of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, KoreaDepartment of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, KoreaDepartment of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, KoreaPurpose When hemodynamically unstable patients with blunt major trauma arrive at the emergency department (ED), the safety of performing early whole-body computed tomography (WBCT) is concerning. Some clinicians perform central venous catheterization (CVC) before WBCT (pre-computed tomography [CT] group) for hemodynamic stabilization. However, as no study has reported the factors affecting this decision, we compared clinical characteristics and outcomes of the pre- and post-CT groups and determined factors affecting this decision. Methods This retrospective study included 70 hemodynamically unstable patients with chest or/and abdominal blunt injury who underwent WBCT and CVC between March 2013 and November 2017. Results Univariate analysis revealed that the injury severity score, intubation, pulse pressure, focused assessment with sonography in trauma positivity score, and pH were different between the pre-CT (34 patients, 48.6%) and post-CT (all, p<0.05) groups. Multivariate analysis revealed that injury severity score (ISS) and intubation were factors affecting the decision to perform CVC before CT (p=0.003 and p=0.043). Regarding clinical outcomes, the interval from ED arrival to CT (p=0.011) and definite bleeding control (p=0.038), and hospital and intensive care unit lengths of stay (p=0.018 and p=0.053) were longer in the pre-CT group than in the post-CT group. Although not significant, the pre-CT group had lower survival rates at 24 hours and 28 days than the post-CT group (p=0.168 and p=0.226). Conclusions Clinicians have a tendency to perform CVC before CT in patients with blunt major trauma and high ISS and intubation.http://www.jtraumainj.org/upload/pdf/jti-31-135.pdfblunt traumacomputed tomographycentral venous catheterizationinjury severity score |
| spellingShingle | Ji Hun Kim Sang Ook Ha Young Sun Park Jeong Hyeon Yi Sun Beom Hur Ki Ho Lee Central Venous Catheterization before Versus after Computed Tomography in Hemodynamically Unstable Patients with Major Blunt Trauma: Clinical Characteristics and Factors for Decision Making Journal of Trauma and Injury blunt trauma computed tomography central venous catheterization injury severity score |
| title | Central Venous Catheterization before Versus after Computed Tomography in Hemodynamically Unstable Patients with Major Blunt Trauma: Clinical Characteristics and Factors for Decision Making |
| title_full | Central Venous Catheterization before Versus after Computed Tomography in Hemodynamically Unstable Patients with Major Blunt Trauma: Clinical Characteristics and Factors for Decision Making |
| title_fullStr | Central Venous Catheterization before Versus after Computed Tomography in Hemodynamically Unstable Patients with Major Blunt Trauma: Clinical Characteristics and Factors for Decision Making |
| title_full_unstemmed | Central Venous Catheterization before Versus after Computed Tomography in Hemodynamically Unstable Patients with Major Blunt Trauma: Clinical Characteristics and Factors for Decision Making |
| title_short | Central Venous Catheterization before Versus after Computed Tomography in Hemodynamically Unstable Patients with Major Blunt Trauma: Clinical Characteristics and Factors for Decision Making |
| title_sort | central venous catheterization before versus after computed tomography in hemodynamically unstable patients with major blunt trauma clinical characteristics and factors for decision making |
| topic | blunt trauma computed tomography central venous catheterization injury severity score |
| url | http://www.jtraumainj.org/upload/pdf/jti-31-135.pdf |
| work_keys_str_mv | AT jihunkim centralvenouscatheterizationbeforeversusaftercomputedtomographyinhemodynamicallyunstablepatientswithmajorblunttraumaclinicalcharacteristicsandfactorsfordecisionmaking AT sangookha centralvenouscatheterizationbeforeversusaftercomputedtomographyinhemodynamicallyunstablepatientswithmajorblunttraumaclinicalcharacteristicsandfactorsfordecisionmaking AT youngsunpark centralvenouscatheterizationbeforeversusaftercomputedtomographyinhemodynamicallyunstablepatientswithmajorblunttraumaclinicalcharacteristicsandfactorsfordecisionmaking AT jeonghyeonyi centralvenouscatheterizationbeforeversusaftercomputedtomographyinhemodynamicallyunstablepatientswithmajorblunttraumaclinicalcharacteristicsandfactorsfordecisionmaking AT sunbeomhur centralvenouscatheterizationbeforeversusaftercomputedtomographyinhemodynamicallyunstablepatientswithmajorblunttraumaclinicalcharacteristicsandfactorsfordecisionmaking AT kiholee centralvenouscatheterizationbeforeversusaftercomputedtomographyinhemodynamicallyunstablepatientswithmajorblunttraumaclinicalcharacteristicsandfactorsfordecisionmaking |