A Model to Predict Duration of Ventilation and 30-Day Mortality in Patients with Traumatic Injuries
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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Learning Objectives Scoring systems are widely used in civilian practice to predict intensive care patient outcomes. Tools to predict outcomes from combat trauma are not available specifically prediction tools for aeromedical evacuation from theater. The objective was to identify pre-flight variables associated with an increased requirement for ventilation time and 30-day mortality. Methods This IRB-approved, retrospective cohort study included all patients evacuated from combat theaters by the U.S. Air Force Critical Care Air Transport Team CCATT between 2007 and 2011. Pre-flight physiological variables and treatments were assessed for associations and examined in stepwise regression models. The primary outcome was total ventilator time 72 hours vs 72 hours the secondary outcome was 30-day mortality. Receiver operating characteristic ROC curves were produced for both outcomes. Data are presented as percentages, median IQR, and odds ratio OR 95 CI. Results 1308 combat trauma patients 24 years, 98 male were included 72 blast, 17 penetrating, 9 blunt, and 2 burns. Pre-flight systolic blood pressure was 121 109-143 mmHg, pulse 100 84-116 bpm, and base deficit 0 -2-2. The median number of blood products administered pre-flight were 4 0-13 units packed red blood cells PRBC, and 3 0-12 units fresh frozen plasma. When modeling for ventilator time, injury severity score ISS OR 1.04 1.03-1.06, pre-flight PRBC units transfused OR 1.05 1.04-1.07, and pre-flight intubated status OR 11.9 8.53-16.89 were independently associated with increased ventilator days. A composite of the variables produced an AUC of 0.85 with 86 sensitivity and 56 specificity. Using mortality as the outcome, ISS OR 1.06 1.03-1.09, prothrombin time OR 2.13 1.18-4.47, pre-flight intubated status OR 9.2 1.88-166.11, and whole blood OR 3.18 1.38-7.04 were associated with death.
- Medicine and Medical Research