Trauma management in the end-stage renal disease patient

More than 230,000 patients in the United States are being treated for end-stage renal disease (ESRD). This group of patients has not been evaluated for trauma resource use. When these patients are involved in trauma the need for dialysis and awareness of chronic disease processes must be considered in addition to their injuries. There were 4,894 patients admitted to a Level II trauma center over a 4-year period. Fifty-nine of these patients were considered to have ESRD before admission. The charts of these patients were reviewed and compared with those in the general trauma population. The average age of the ESRD patients was 58 years with an average Injury Severity Score of 8 as compared with 31 years of age and Injury Severity Score of 10.9 for the general trauma population. Thirty-four patients required hemodialysis within 48 hours of admission. Ten patients required mechanical ventilation. Eight patients in this study died. The complication and mortality rates among the ESRD patients were 50.8 per cent and 13.5 per cent respectively as compared with 16.3 and 4.7 per cent among the general trauma population. The trauma complication and mortality rates among ESRD patients are approximately three times greater than those in the general trauma population. Because of their coexisting medical problems and the need for dialysis trauma patients with ESRD should be cared for in trauma centers with dialysis capability and access to multidisciplinary services.