Assessment Of Trauma Research Articles

A narrative review on emerging issues about war-related trauma in perinatal women: good practice for assessment, prevention, and treatment.

Wars, in addition to causing death and destruction, have a negative impact on mental health, especially on perinatal women. The literature has identified psychological trauma as one of the most prevalent mental health issues associated with wars, but few studies have summarized how to assess, prevent, or treat this problem in perinatal women. To address this gap, the purpose of this study is to provide a narrative review of the current state of assessment, prevention, and treatment interventions of trauma among perinatal women living in war conditions or displaced as a result of a war. A literature search was performed in different research databases (e.g., Medline, PsycInfo). The search terms include a combination of trauma and stressor-related disorders and focused on diagnosis, prevention, and treatment. Most of the results were related to post traumatic stress disorder (PTSD) more than acute stress disorder, although there are not many assessments, and interventions (prevention or treatment) dedicated specifically to perinatal women affected by war conditions. Research in this area is still scarce. Recommendations for evidence-based practices in assessment and prevention and treatment interventions and future directions in research and clinical practice are provided. • The literature on trauma in perinatal women is sparse, and especially among perinatal women living in conditions of war. • This paper presents a narrative review of evidence-based assessment and treatment for perinatal women victims of war who experience trauma.

Should Trauma Assessment Include a Quaternary Survey to Screen for Mental Health and Social Issues?

Should Trauma Assessment Include a Quaternary Survey to Screen for Mental Health and Social Issues?

Narrative review of chest wall ultrasound: a practical approach.

Traditionally, literature on thoracic ultrasound has focused on the study of pleural and pulmonary pathology. However, given the superficial location of thoracic wall structures, ultrasound proves to be an excellent technique for their examination. This study aims to evaluate the clinical utility of thoracic ultrasound in diagnosing various thoracic wall pathologies and to illustrate the primary diagnoses that can be achieved. We performed a literature search in January 2024 in PubMed and Google Scholar for articles on thoracic ultrasound. Relevant articles were selected and synthesized in a narrative form. Thoracic ultrasound has emerged as a powerful diagnostic tool, especially when combined with a thorough clinical history. It allows for rapid, inexpensive, and safe resolution of a wide range of common clinical uncertainties across all levels of healthcare. In emergency contexts, it excels in the detection of rib fractures, demonstrating superior capability compared to traditional chest X-rays and similar efficacy to computed tomography (CT) scans. Additionally, thoracic ultrasound is highly effective in evaluating tumors, often providing accurate diagnoses without the need for further studies. It also aids in differentiating pathologies that may require more advanced imaging such as CT or magnetic resonance imaging (MRI). Moreover, thoracic ultrasound plays a valuable role in the initial assessment of infectious and degenerative conditions. Thoracic ultrasound is a versatile and efficient diagnostic tool for examining thoracic wall structures. Its applications are particularly valuable in trauma assessment, tumor evaluation, and the differentiation of various pathologies. The rapid, cost-effective, and safe nature of this technique highlights its potential as a primary diagnostic tool in a wide variety of clinical settings.

Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Optimizing Management and Minimizing Risk of Osteoporotic Vertebral Fractures - Perspectives of the AO Spine KF Trauma and Infection Group Key Opinion Leaders.

Literature review with clinical recommendations. To highlight important studies about osteoporotic spinal fractures (OF) that may be integrated into clinical practice based on the assessment of the AO Spine KF Trauma and Infection group key opinion leaders. 4 important studies about OF that may affect current clinical practice of spinal surgeons were selected and reviewed with the aim of providing clinical recommendations to streamline the journey of research into clinical practice. Recommendations were graded as strong or conditional following the GRADE methodology. 4 studies were selected. Article 1: a validation of the Osteoporotic Fracture (OF)-score to treat OF fractures. Conditional recommendation to incorporate the OF score in the management of fractures to improve clinical results. Article 2: a randomized multicenter study comparing romosozumab/alendronate vs alendronate to decrease the incidence of new vertebral fractures. Strong recommendation that the group receiving romosozumab/alendronate had a decreased risk of new OF when compared with the alendronate only group only. Article 3: a systematic literature review of spinal orthoses in the management of. Conditional recommendation to prescribe a spinal orthosis to decrease pain and improve quality of life. Article 4: post-traumatic deformity after OF. A conditional recommendation that middle column injury and pre-injury use of steroids may lead to high risk of post-traumatic deformity after OF. Management of patients with OF is still complex and challenging. This review provides some recommendations that may help surgeons to better manage these patients and improve their clinical practice.

Pediatric Trauma Assessment, Resuscitation, Anesthesia care and Beyond

Pediatric Trauma Assessment, Resuscitation, Anesthesia care and Beyond

Assessment of Maxillofacial Trauma Due to Road Traffic Accidents in an Insecure Environment at Sominé Dolo Hospital in Mopti (Mali) from 2019-2023

Introduction: Maxillofacial trauma represents a social issue that continues to grow. According to WHO, 1.2 million people lose their lives each year on the road, or more than 3,000 deaths per day. The aim of this study is to evaluate the epidemiological, clinical and therapeutic aspects of maxillofacial trauma related to road accidents at Sominé Dolo Hospital in Mopti. Patients and Method: From 2019 to 2023, we conducted a descriptive cross-sectional study with retrospective collection on cases of maxillofacial trauma due to road traffic accidents at Sominé Dolo hospital in Mopti. Results: The frequency was 85.59%, the age was 28.37 years and a sex ratio of 5. The Bandiagara region represented 34.6% and that of Mopti 49.76%. 2-wheeled vehicles accounted for 60%. Open fractures accounted for 67.8%, located at the mandibular level 40.10%. Contention associated with osteosynthesis was performed in 49.1%. Discussion: In our study, the hospital frequency of maxillofacial trauma following a road traffic accident is 85.60%. This high frequency in our country could be explained by the non-compliance with the highway code, the poor condition of the roads, the multiplication of means of transport and the security situation. Conclusion: The increasing frequency of maxillofacial trauma over the years is a reality in Mopti (Mali) and poses a public health problem. Only early appropriate treatment and peace can minimize the sometimes serious and difficult to correct after-effects.

Beyond Symptoms – A Cross-Sectional Study Exploring Functioning in Psychiatric Outpatients

Objective This study aimed to explore factors influencing functioning in psychiatric outpatients, both separately and in combination. The primary objectives were to determine predictors of functioning, assess their significance in a combined analysis, and quantify their collective predictive power. Method A sample of 137 psychiatric outpatients diagnosed with bipolar disorder, borderline personality disorder, or attention deficit hyperactivity disorder (ADHD) participated in this cross-sectional study, undergoing semi-structured diagnostic interviews for psychiatric and personality disorders. Participants also completed assessments of current functioning, personality traits (temperament and character), attachment style, and childhood trauma. Linear regression models were employed to analyse the relationships between these factors and level of functioning. Results The majority of temperament and character traits and attachment dimensions, as well as having a personality disorder, predicted impaired functioning, but comorbidity and childhood trauma did not. When all variables were taken into account in a multiple regression analysis, only the temperament and character traits Harm Avoidance and Self-directedness remained significantly predictive (p = .006 and .003, respectively). These two factors explain about one-third of the variance. Conclusions Personality traits—more specifically, the temperament trait Harm Avoidance and the character trait Self-directedness—are strong predictors of functioning among psychiatric outpatients. Interestingly, when accounting for these factors, traditionally associated variables, such as attachment, comorbidity, and childhood trauma, lost their significance as predictors. These findings underscore the pivotal role of specific personality traits in understanding and predicting the functioning of psychiatric patients.

Childhood trauma types in relation to antipsychotic effectiveness in schizophrenia spectrum disorders: A prospective, pragmatic, randomized controlled study

Treatment with antipsychotics (APs) for schizophrenia spectrum disorders (SSDs) is generally effective, however, a significant proportion does not respond favorably. Childhood trauma (CT) subtypes (physical, sexual, and emotional abuse, physical and emotional neglect) could influence treatment effectiveness; however, research is scarce. Heterogeneity in AP response could be explained by differentiating by CT subtype. The present study was based on the Bergen-Stavanger-Trondheim-Innsbruck (BeSt InTro) study. CTQ-SF assessed CT subtypes in SSDs (n = 98). CT subtypes were examined in relation to psychosis symptoms measured by PANSS during one year of treatment with APs, by means of linear mixed effects (LME) models. Results were significant for CT subtypes, where increased levels of sexual abuse and physical neglect were associated with increased mean levels of psychosis symptoms throughout the course of treatment from baseline to 52 weeks. AP effectiveness may thus be influenced by CT subtype in SSDs. The results support clinical guidelines recommending a focus on assessment and treatment of trauma in SSDs.

Recorded Rates of Trauma-Exposure in a Retrospective Epidemiologically Complete First-Episode Psychosis Cohort.

Trauma plays an important role in the development and maintenance of psychosis. However, it is still under-examined in daily clinical practice. The current study investigated the rates of recording of trauma-exposure in the clinical histories of a first-episode psychosis (FEP) cohort attending an early intervention psychosis service. This study used a retrospective chart review methodology in a 6-year epidemiologically complete FEP cohort attending an early intervention psychosis service. The Trauma and Life Events Checklist was used to define the rate and types of trauma-exposure reported in clinical histories. The relationships were examined between recorded trauma-exposure and positive and negative symptoms, depression and duration of untreated psychosis at first assessment. Trauma-exposure was frequently recorded within clinical histories. Childhood trauma-exposure was recorded in 47.4% of the sample, which is lower than may be expected. No significant relationships between the recorded trauma-exposure and symptom measures were found. A significant relationship was found between interpersonal stressors and positive symptoms, and work-related stress and negative symptoms, highlighting the importance of proximal stressful life events. This study found that clinicians were frequently recording trauma-exposure in daily practice. However, it was unclear whether the recording of trauma-exposure highlighted led to systematic diagnosis, assessment or treatment of trauma for people with psychosis. The importance of treatment and service planning to include information about trauma-exposure is discussed.

Relationships between serotonin 1A receptor DNA methylation, self-reported history of childhood abuse and gray matter volume in major depression

BackgroundEarly life adversity is a risk factor for psychopathology and is associated with epigenetic alterations in the 5-HT1A receptor gene promoter. The 5-HT1A receptor mediates neurotrophic effects, which could affect brain structure and function. We examined relationships between self-reported early childhood abuse, 5-HT1A receptor promoter DNA methylation, and gray matter volume (GMV) in Major Depressive Disorder (MDD). MethodsPeripheral DNA methylation of 5-HT1A receptor promoter CpG sites −681 and −1007 was assayed in 50 individuals with MDD, including 18 with a history of childhood abuse. T1-weighted structural magnetic resonance imaging (MRI) was performed. Voxel-based morphometry (VBM) was quantified in amygdala, hippocampus, insula, occipital lobe, orbitofrontal cortex, temporal lobe, parietal lobe, and at the voxel level. ResultsNo relationship was observed between DNA methylation and history of childhood abuse. We observed regional heterogeneity comparing −681 CpG site methylation and GMV (p = 0.014), with a positive relationship to GMV in orbitofrontal cortex (p = 0.035). Childhood abuse history was associated with higher GMV considering all ROIs simultaneously (p < 0.01). In whole-brain analyses, childhood abuse history was positively correlated with GMV in multiple clusters, including insula and orbitofrontal cortex (pFWE = 0.005), and negatively in intracalcarine cortex (pFWE = 0.001). LimitationsSmall sample size, childhood trauma assessment instrument used, and assay of peripheral, rather than CNS, methylation. ConclusionsThese cross-sectional findings support hypotheses of 5-HT1A receptor-related neurotrophic effects, and of increased regional GMV as a potential regulatory mechanism in the setting of childhood abuse. Orbitofrontal cortex was uniquely associated with both childhood abuse history and 5-HT1A receptor methylation.

The relationship between social environmental stressors and depressive symptoms among Chinese young adults: Above and beyond the effects of childhood trauma

Childhood trauma has been identified as an important etiological risk factor for depressive symptoms, but there are other modifiable social environmental factors that may be equally, if not more, important. This study aimed to improve our understanding of the social determinants of depressive symptoms among young people while taking childhood trauma into account. We analyzed survey data from a convenience sample of Chinese young adults aged between 18 to 24 (N = 205). Participants completed standardized assessments of childhood trauma (the Brief Betrayal Trauma Survey), depressive symptoms (the PHQ-9), and social environmental stressors (the Social Environmental Stress Questionnaire). Social environmental stressors had the strongest relationship with depressive symptoms (β = .416, p < .001), above and beyond the effects of childhood trauma. We also identified some specific modifiable and targetable social environmental stressors (e.g., school work and occupation issues, high expectations from others, sleep environment) that were positively correlated with depressive symptoms, even when the Bonferroni correction was applied. Although childhood trauma is a well-documented risk factor for mental health problems, there are modifiable factors associated with depressive symptoms, above and beyond the effects of childhood trauma. Educators, healthcare practitioners, social service providers, and policymakers can play a vital role in changing the trajectory of depression in the community.

Lower Extremity Traumatic Wound Management: Relative Significance of Negative Pressure Wound Therapy in the Orthopedic Setting.

Significance: Lower extremity traumatic wounds are associated with numerous perioperative challenges. Their etiologies determine the characteristics and extent of the injury. The timing of subsequent surgical intervention and wound healing optimization after lower extremity trauma are integral to successful perioperative lower extremity wound management. Recent Advances: Managing trauma to the lower extremities uses a multidisciplinary surgical approach. The objective of this review is to summarize lower limb trauma assessment, advancements in lower extremity trauma management, and the clinical applications of advanced wound care in lower limb traumatic wounds. The advent of lower limb reconstruction and the development of advanced wound care modalities have helped to improve the management of these complex injuries. Critical Issues: The extensive involvement of bone, soft tissues, nerves, and blood vessels of severe lower extremity trauma wounds presents a challenge for clinicians in both the acute care setting and during patient rehabilitation. If not properly managed, these injuries may be subject to a decline in limb function and may possibly result in limb loss. To reveal developing limb-threatening conditions, serial examinations should be performed. Future Directions: The majority of lower limb traumatic wound will benefit from the perioperative administration of an appropriate negative pressure wound therapy (NPWT)-based system, which can help to promote granulation tissue and remove wound exudate before definitive closure and/or reconstruction. NPWT should be included as an important adjunct in the surgical management of lower limb traumatic wounds.

Auditory System Injury on the Battlefield-Solutions for Point-of-Injury and Prolonged Casualty Care: A DOTmLPF-P Analysis.

"Good hearing" (DoDI 6030.03 6.5&6.6) is a combat multiplier, critical to service members' lethality and survivability on the battlefield. Exposure to an explosive blast or high-intensity continuous noise is common in operational settings with the potential to compromise both hearing and vestibular health and jeopardize safety and high-level mission performance. The Joint Trauma System Acoustic Trauma Clinical Practice Guideline was published in 2018, providing recommendations for the assessment and treatment of aural blast injuries and acoustic trauma in the forward deployed environment. Combat care capabilities responsive to current threat environments emphasize prolonged casualty care. Despite recommendations, auditory system health has not been assessed routinely or in its entirety on the battlefield. This is due primarily to the large footprint of an audiometric booth and to the heavy logistical burden of providing high-quality, comprehensive auditory system (including vestibular) examinations in the combat environment. The Defense Health Agency Hearing Center of Excellence has completed a Doctrine, Organization, Training, Materiel, Leadership & Education, Personnel, Facilities, and Policy (DOTmLPF-P) analysis of battlefield auditory system assessment and treatment, using 67 existing DoD documents and artifacts related to operational medicine. Our analysis found that acoustic trauma is generally not addressed in any of the DOTmLPF-P domains. We recommend that auditory system assessment and treatment be incorporated across the continuum of care on the battlefield. This should be addressed through Prolonged Field Care and Tactical Combat Casualty Care guidance and in all Tactical Combat Casualty Care training programs. Equipment sets should be modified to include boothless technology and associated materiel for auditory system assessment. Policy and Doctrine changes would be required to mandate and support the implementation of these services. Uniformed audiologists should be added to the organizational structure at role 3 or higher to provide direct patient care; consult with other health care providers and commanders; develop and support enforcement of noise hazard guidelines; track hearing readiness; and, when necessary, provide specialized hearing protection devices that can compensate for hearing loss. These recommendations aim to help the DoD bring about necessary assessments and interventions for acoustic trauma so that service members can have better hearing outcomes and maintain critical auditory system function on the battlefield.

A Call to Action: Extending the Research on Trauma Assessment and Treatment for Children With Intellectual Disabilities and Extensive Support Needs

A Call to Action: Extending the Research on Trauma Assessment and Treatment for Children With Intellectual Disabilities and Extensive Support Needs

2271 Older trauma in the emergency department

Abstract Aim Improve the care of patients aged 65+ presenting with trauma to the emergency department by ensuring earlier senior reviews (ST4+) and consideration of trauma calls and appropriate imaging. Method Staff survey to assess awareness of older trauma and its management. Data analysis and collection followed by use of PDSA cycles to implement change. Teaching session on primary survey assessment and management of older trauma. Development of older trauma standard operating procedure. Results Improvement was seen in both primary outcomes over a period of 8 months. Documentation of primary survey improved from 30% from the initial 5 weeks to 52% over the final 5 weeks on average. Senior doctor review or discussion improved from 30% average in the first 5 weeks to 80% averaged across the final 5 weeks. There was no evidence of effect on waiting times in the emergency department for these patients. Conclusion This quality improvement initiative has positively impacted the early assessment of older trauma patients, aiming to mitigate the likelihood of missed injuries and adverse outcomes. While we haven’t formally assessed more complex outcome data, a notable achievement is the initiation of a cultural shift among our frontline medical and nursing staff. This shift involves approaching older trauma patients with a heightened index of suspicion. Among the interventions, the most straightforward and reproducible was the implementation of regular educational emails. We anticipate continued progress and hope that this poster serves as inspiration for other departments. Encouraging a review of how they assess and treat this expanding cohort of vulnerable, complex, and potentially critically ill patients. Unfortunately, it is not uncommon that for our growing elderly population, a trip and fall can lead to fatal consequences. We aspire for this work to contribute towards broader efforts in changing that narrative.

Trends in Radiation at a Level I Trauma Center.

Introduction Following traumatic injury, patients often require imaging modalities that subject them to large amounts of radiation. The current protocol for imaging workup in trauma patients includes plain radiographs and computed tomography (CT). Although these imaging modalities have improved quality and efficiency in trauma interventions, it is essential to understand their potential limitations and adverse effects.The large amounts of radiation from these imaging tests have raised concern for particularly vulnerable populations, including children and adolescents. Objective To evaluate the trends in radiation exposure in trauma assessment and imaging seen at a Level I trauma center. Methods This retrospective analysis used a de-identified dataset from the trauma registry at Desert Regional Medical Center Level I Trauma Center in Palm Springs, CA. Total radiation amounts were calculated based on the type of diagnostic modality. An effective radiation dose was assigned to each examination (radiograph and CT scan) based on the values provided by the American College of Radiology. Results There was a statistically significant positive correlation between injury severity scoreand effective radiation dose from imaging workup. From 2016 to 2021, radiation amount and year were found to be negatively correlated. There was a larger, statistically significant amount of radiation dosage among adult trauma patients (16.32 mSv) when compared to pediatric (6.32 mSv) and geriatric (12.67 mSv) groups. Conclusion Our Level I trauma center has observed a decline in radiation exposure with our current trauma protocols in place. On average, adult patients received the highest effective radiation dose to pediatric and geriatric patients. CT scans and radiography are essential tools in initial trauma workup and should be used only in appropriate patients.

The Consequences of Misdiagnosing Race-Based Trauma Response in Black Men: A Critical Examination

ABSTRACT Mental illness is a significant public health concern prevalent in America. Over one in five U.S. adults are affected, yet less than half receive treatment. Among African Americans, only one in three seek treatment with statically lower rates among Black males. Therefore, an accurate diagnosis is crucial for appropriate treatment, while misdiagnosis leads to stigma, discrimination, and untreated illness. This paper examines the implications of misdiagnosing trauma responses in Black men, highlighting systemic biases that impede suitable care and perpetuate negative narratives. The authors propose a conceptual framework incorporating historical trauma, discrimination, and traumatic stress reactions, emphasizing the need for cultural competence and humility. This framework involves public narratives that influence perceptions and judgments, reviewing research evidence, advocating for competent trauma assessments, community empowerment, and future research directions. This paper underscores the importance of understanding and addressing the unique challenges Black men face in mental health diagnosis and treatment.

Evaluation of the role of repeated inferior vena cava sonography in estimating first 24 h fluid requirement in resuscitation of major blunt trauma patients in emergency department Suez Canal University Hospital

IntroductionThe assessment of hemodynamic status in polytrauma patients is an important principle of the primary survey of trauma patients, and screening for ongoing hemorrhage and assessing the efficacy of resuscitation is vital in avoiding preventable death and significant morbidity in these patients. Invasive procedures may lead to various complications and the IVC ultrasound measurements are increasingly recognized as a potential noninvasive replacement or a source of adjunct information.Aimof this studyThe study aimed to determine if repeated ultrasound assessment of the inferior vena cava (diameter, collapsibility (IVC- CI) in major trauma patients presenting with collapsible IVC before resuscitation and after the first hour of resuscitation will predict total intravenous fluid requirements at first 24 h.Patients & methodsThe current study was conducted on 120 patients presented to the emergency department with Major blunt trauma (having significant injury to two or more ISS body regions or an ISS greater than 15). The patients(cases) group (shocked group) (60) patients with signs of shock such as decreased blood pressure < 90/60 mmHg or a more than 30% decrease from the baseline systolic pressure, heart rate > 100 b/m, cold, clammy skin, capillary refill > 2 s and their shock index above0.9. The control group (non-shocked group) (60) patients with normal blood pressure and heart rate, no other signs of shock (normal capillary refill, warm skin), and (shock index ≤ 0.9). Patients were evaluated at time 0 (baseline), 1 h after resucitation, and 24 h after 1st hour for:(blood pressure, pulse, RR, SO2, capillary refill time, MABP, IVCci, IVCmax, IVCmin).ResultsAmong 120 Major blunt trauma patients, 98 males (81.7%) and 22 females (18.3%) were included in this analysis; hypovolemic shocked patients (60 patients) were divided into two main groups according to IVC diameter after the first hour of resuscitation; IVC repleted were 32 patients (53.3%) while 28 patients (46.7%) were IVC non-repleted. In our study population, there were statistically significant differences between repleted and non-repleted IVC cases regarding IVCD, DIVC min, IVCCI (on arrival) (after 1 h) (after 24 h of 1st hour of resuscitation) ( p-value < 0.05) and DIVC Max (on arrival) (after 1 h) (p-value < 0.001). There is no statistically significant difference (p-value = 0.075) between repleted and non-repleted cases regarding DIVC Max (after 24 h).In our study, we found that IVCci0 at a cut-off point > 38.5 has a sensitivity of 80.0% and Specificity of 85.71% with AUC 0.971 and a good 95% CI (0.938 – 1.0), which means that IVCci of 38.6% or more can indicate fluid responsiveness. We also found that IVCci 1 h (after fluid resuscitation) at cut-off point > 28.6 has a sensitivity of 80.0% and Specificity of 75% with AUC 0.886 and good 95% CI (0.803 – 0.968), which means that IVCci of 28.5% or less can indicate fluid unresponsiveness after 1st hour of resuscitation. We found no statistically significant difference between repleted and non-repleted cases regarding fluid requirement and amount of blood transfusion at 1st hour of resuscitation (p-value = 0.104).ConclusionRepeated bedside ultrasonography of IVCD, and IVCci before and after the first hour of resuscitation could be an excellent reliable invasive tool that can be used in estimating the First 24 h of fluid requirement in Major blunt trauma patients and assessment of fluid status.

Psychological Impacts of Natural Disaster

The Canadian Red Cross approved funding for the Psychologists’ Association of Alberta through its Alberta Wildfires 2016 Community Organization Partnership Program. Funding was used to directly resource psychological trauma assessment and treatment until June 2020. Outcome-informed practices were employed to empirically validate treatment employing the Outcome Rating Scale (ORS). Sixteen approved psychologists provided trauma-informed services to 349 clients over 3 years, with the ORS being completed at five-session intervals. Results indicated very low levels of functioning and well-being at intake. For adults, overall average functioning and well-being increased over the treatment period. By the 5th, 10th, and 15th sessions, there was an average reported increase in perceived well-being of 65%, 57%, and 100%, respectively. Treatment made a significant difference for clients. The resulting five primary recommendations are 1) to provide timely access to qualified assessment and treatment, 2) to conduct trauma-informed screening of referrals, 3) to identify and provide additional resources for vulnerable populations, 4) to tailor services to gender considerations, and 5) to take steps to reduce barriers to accessing assessment and treatment.

Early Point-of-Care Thromboelastometry Reduces Mortality in Patients with Severe Trauma and Risk of Transfusion: An Analysis Based on the TraumaRegister DGU®.

Background: Thromboelastometry like ROTEM® is a point-of-care method used to assess the coagulation status of patients in a rapid manner being particularly useful in critical care settings, such as trauma, where quick and accurate assessment of coagulation can guide timely and appropriate treatment. Currently, this method is not yet comprehensively available with sparse data on its effectiveness in resuscitation rooms. The aim of this study was to assess the effect of early thromboelastometry on the probability of mass transfusions and mortality of severely injured patients. Methods: The TraumaRegister DGU® was retrospectively analyzed for severely injured patients (2011 until 2020) with information available regarding blood transfusions and Trauma-Associated Severe Hemorrhage (TASH) score components. Patients with an estimated risk of mass transfusion >2% were included in a matched-pair analysis. Cases with and without use of ROTEM® diagnostic were matched based on risk categories for mass transfusion. A total of 1722 patients with ROTEM® diagnostics could be matched with a non-ROTEM® patient with an identical risk category. Adult patients (≥16) admitted to a trauma center in Germany, Austria, or Switzerland with Maximum Abbreviated Injury Scale severity ≥3 were included. Results: A total of 83,798 trauma victims were identified after applying the inclusion and exclusion criteria. For 7740 of these patients, the use of ROTEM® was documented. The mean Injury Severity Score (ISS) in patients with ROTEM® was 24.3 compared to 19.7 in the non-ROTEM® group. The number of mass transfusions showed no significant difference (14.9% ROTEM® group vs. 13.4% non-ROTEM® group, p = 0.45). Coagulation management agents were given significantly more often in the ROTEM® subgroup. Mortality in the ROTEM® group was 4.1% less than expected (estimated mortality based on RISC II 34.6% vs. observed mortality 30.5% (n = 525)). In the non-ROTEM® group, observed mortality was 1.6% less than expected. Therefore, by using ROTEM® analysis, the expected mortality could be reduced by 2.5% (number needed to treat (NNT) 40; SMR of ROTEM® group: 1:0.88; SMR of non-ROTEM® group: 1:0.96; p = 0.081). Conclusions: Hemorrhage is still one of the leading causes of death of severely injured patients in the first hours after trauma. Early thromboelastometry can lead to a more targeted coagulation management, but is not yet widely available. This study demonstrated that ROTEM® was used for the more severely injured patients and that its use was associated with a less than expected mortality as well as a higher utilization of hemostatic products.