CLINICS

Clinics (Sao Paulo). 2017 August; 72(8): 461-468.
doi:10.6061/clinics/2017(08)02

Copyright © 2017 CLINICS

Independent early predictors of mortality in polytrauma patients: a prospective, observational, longitudinal study

Luiz Guilherme V. da Costa I II * , Maria José C. Carmona I , Luiz M. Malbouisson I , Sandro Rizoli III , Joel Avancini Rocha-Filho I , Ricardo Galesso Cardoso II , José Otávio C. Auler-Junior I

Divisao de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

Grupo de Resgate e Atendimento as Urgencias (GRAU), Secretaria de Estado da Saude, Sao Paulo, SP, BR

University of Toronto Trauma and Acute Care Service, St Michael’s Hospital, Toronto, Canada

*Corresponding author. E-mail: lgvc76@yahoo.com.br

received December 6, 2016; revised January 26, 2017; accepted March 14, 2017.

Abstract

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.

Keywords: Multiple Trauma, Indicators, Mortality, Shock, Brain Injuries, Anoxia


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