Independent Predictors of Mortality in Torso Trauma Injuries.

Roberto Bini,Fabrizio Sammartano,Osvaldo Chiara,Laura Briani,Stefano Granieri,Francesca Bindi,Federica Renzi,Caterina Accardo,Stefania Cimbanassi

doi:10.3390/jcm9103202

Abstract

Noncompressible torso injuries (NCTIs) represent a trauma-related condition with high lethality. This study’s aim was to identify potential prediction factors of mortality in this group of trauma patients at a Level 1 trauma center in Italy. Materials and Methods: A total of 777 patients who had sustained a noncompressible torso injury (NCTI) and were admitted to the Niguarda Trauma Center in Milan from 2010 to 2019 were included. Of these, 166 patients with a systolic blood pressure (SBP) <90 mmHg were considered to have a noncompressible torso hemorrhage (NCTH). Demographic data, mechanism of trauma, pre-hospital and in-hospital clinical conditions, diagnostic/therapeutic procedures, and survival outcome were retrospectively recorded. Results: Among the 777 patients, 69% were male and 90.2% sustained a blunt trauma with a median age of 43 years. The comparison between survivors and non-survivors pointed out a significantly lower pre-hospital Glasgow coma scale (GCS) and SBP (p < 0.001) in the latter group. The multivariate backward regression model identified age, pre-hospital GCS and injury severity score (ISS) (p < 0.001), pre-hospital SBP (p = 0.03), emergency department SBP (p = 0.039), performance of torso contrast enhanced computed tomography (CeCT) (p = 0.029), and base excess (BE) (p = 0.008) as independent predictors of mortality. Conclusions: Torso trauma patients who were hemodynamically unstable in both pre- and in-hospital phases with impaired GCS and BE had a greater risk of death. The detection of independent predictors of mortality allows for the timely identification of a subgroup of patients whose chances of survival are reduced.

Highlights

777 patients sustaining blunt and penetrating trauma with Noncompressible torso injuries (NCTIs) were consecutively admitted to our institution
We performed a retrospective study of patients suffering from NCTIs and noncompressible torso hemorrhage (NCTH) who were managed at the Niguarda Trauma Center from 2010 and 2019
Along with hypotension at arrival in the emergency department (ED), our findings describe a patient poorly perfused with ongoing bleeding

Summary

Introduction

In this scenario, NCTH is a trauma-related condition with an elevated risk of death. Hemorrhage accounts for 40% of civilian trauma-related deaths and more than 90% of military deaths from potentially non-lethal injuries [1]. Most early deaths are caused by hemorrhage and occur at a median of 2.6 h after admission [2]. While extremities injuries can be managed with both hemostatic gauzes and tourniquets, NCTHs need to be managed in operating or interventional rooms. The latter requires rapid identification of the source of bleeding and its timely treatment in a context suitable for the emergency

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