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Independent early predictors of mortality in polytrauma patients: a prospective, observational, longitudinal study
Luiz Guilherme V da Costa1,2, Maria José C Carmona1, Luiz M Malbouisson1
1Divisao de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
Insights
Early trauma mortality predictors include oxygen saturation, blood pressure, lactate levels, Glasgow Coma Scale, crystalloid volume, and traumatic brain injury. These factors are crucial for understanding and improving care for severely injured patients.
Area of Science:
- Trauma Care
- Public Health
- Emergency Medicine
Background:
- Trauma represents a significant public health concern with considerable socioeconomic and clinical impacts.
- Previous studies have not comprehensively identified mortality predictors across all trauma care stages.
- Understanding early predictors is vital for improving outcomes in severely injured patients.
Purpose of the Study:
- To identify independent early predictors of mortality in severely injured polytrauma patients.
- To analyze mortality predictors across pre-hospital, emergency room, and intensive care unit stages.
- To enhance the understanding of physiologic changes and improve trauma care.
Main Methods:
- Prospective, observational study conducted from 2010-2013 in São Paulo, Brazil.
- Included 200 high-energy trauma patients (Injury Severity Score >= 16, age >= 18).
- Collected clinical and laboratory data at pre-hospital, ER, and 3/24 hours post-admission; analyzed using statistical tests (p<0.05).
Main Results:
- Identified key independent predictors of 30-day mortality.
- Significant predictors included: arterial hemoglobin oxygen saturation, diastolic blood pressure, lactate level, Glasgow Coma Scale score, infused crystalloid volume, and traumatic brain injury.
- All identified predictors were statistically significant (p<0.015).
Conclusions:
- Arterial hemoglobin oxygen saturation, diastolic blood pressure, lactate level, Glasgow Coma Scale, infused crystalloid volume, and traumatic brain injury are independent early mortality predictors.
- These findings can inform clinical decision-making and resource allocation in trauma care.
- Further research can build upon these predictors to refine trauma management protocols.
Objectives::
Trauma is an important public health issue and associated with substantial socioeconomic impacts and major adverse clinical outcomes. No single study has previously investigated the predictors of mortality across all stages of care (pre-hospital, emergency room, surgical center and intensive care unit) in a general trauma population. This study was designed to identify early predictors of mortality in severely injured polytrauma patients across all stages of care to provide a better understanding of the physiologic changes and mechanisms by which to improve care in this population.
Methods::
A longitudinal, prospective, observational study was conducted between 2010 and 2013 in São Paulo, Brazil. Patients submitted to high-energy trauma were included. Exclusion criteria were as follows: injury severity score <16, <18 years old or insufficient data. Clinical and laboratory data were collected at four time points: pre-hospital, emergency room, and 3 and 24 hours after hospital admission. The primary outcome assessed was mortality within 30 days. Data were analyzed using tests of association as appropriate, nonparametric analysis of variance and generalized estimating equation analysis (p<0.05). ClinicalTrials.gov: NCT01669577.
Results::
Two hundred patients were included. Independent early predictors of mortality were as follows: arterial hemoglobin oxygen saturation (p<0.001), diastolic blood pressure (p<0.001), lactate level (p<0.001), Glasgow Coma Scale score (p<0.001), infused crystalloid volume (p<0.015) and presence of traumatic brain injury (p<0.001).
Conclusion::
Our results suggest that arterial hemoglobin oxygen saturation, diastolic blood pressure, lactate level, Glasgow Coma Scale, infused crystalloid volume and presence of traumatic brain injury are independent early mortality predictors.
