Epidemiology and Outcomes of Non-compressible Torso Hemorrhage
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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Background Non-compressible torso hemorrhage NCTH is the leading cause of potentially preventable death in military trauma, but the civilian epidemiology is unknown. The aim of this study is to apply a military definition of NCTH, which incorporates anatomic and physiological criteria, to a civilian population treated at trauma centers in the US. Methods Patients age 16 y from 197 Level 1 trauma centers approximately 95 of all US Level 1 centers in the National Trauma Data Bank 2007-2009 that sustained a named torso vessel injury, pulmonary injury, grade IV solid organ injury, or pelvic fracture with ring disruption were included. Of these, patients with a systolic blood pressure 90 mmHg were considered to have NCTH. Multivariable logistic regression was used to identify patient and injury factors associated with NCTH and mortality after adjusting for the following covariates patient age, gender, ethnicity, and insurance status, injury Glasgow Coma Scale, injury type, Injury Severity Score, anatomic region, and clinical major surgical procedure, need for transfusion, and intensive care unit admission characteristics. Results Of the 1.8 million patients in the 2007-2009 National Trauma Data Bank, 249,505 met the anatomic criteria for non-compressible torso injury NCTI. Of these, 20,414 8.2 patients had associated hemorrhage. The rate of pulmonary and torso vessel injury was similar 53.4 and 50.6, respectively, with solid organ injury identified in 27.0 of patients and pelvic injury in 8.9. The overall mortality rate of patients with NCTI and NCTH was 6.8 and 44.6, respectively. The most lethal injury was major torso vessel injury OR 1.54, 95 CI 1.33e1.78, followed by pulmonary injury OR 1.32, 95 CI 1.18-1.48. Lower mortality was found in patients with pelvic injury OR 0.80, 95 CI 0.65-0.98.
- Medicine and Medical Research