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2017 ; 2
(1
): e000070
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Prognostic predictors of early mortality from exsanguination in adult trauma: a
Malaysian trauma center experience
#MMPMID29766083
Huei TJ
; Mohamad Y
; Lip HTC
; Md Noh N
; Imran Alwi R
Trauma Surg Acute Care Open
2017[]; 2
(1
): e000070
PMID29766083
show ga
BACKGROUND: Trauma mortality due to exsanguination is the second most common
cause of death. The objective of this study is to investigate the predictors for
early death from exsanguination. METHODS: A prognostic study was done to identify
predictors of early mortality due to exsanguination. Data were extracted from our
Trauma Surgery Registry database of Sultanah Aminah Hospital, Johor Bahru,
Malaysia. All patients who were treated from May 1, 2011 to April 31, 2014 by the
trauma team were included. Adult trauma patients included from the Trauma Surgery
Registry were divided into two groups for analysis: early death from
exsanguination and death from non-exsanguination/survivors. Univariate and
multivariate analysis was performed to look for significant predictors of death
from exsanguination. Variables analyzed were demography, mechanism of injury,
organ injury scale, physiological parameters (systolic blood pressure (SBP),
respiratory rate, heart rate, temperature), Glasgow Coma Scale (GCS), Revised
Trauma Score (RTS), New Injury Severity Score (NISS), Trauma and Injury Severity
Score (TRISS) and cause of death. RESULTS: A total of 2208 patients with an
average age of 36 (±16) years were included. Blunt trauma was the majority with
90.5%, followed by penetrating injuries (9.2%). The overall mortality is 239 out
of 2208 (10.8%). Seventy-eight patients (32.6%) died due to central nervous
system injury, 69 due to sepsis (28.9%) and 58 due to exsanguination (24.3%).
After multivariate analysis, age (OR 1.026 (1.009 to 1.044), p=0.002), SBP (OR
0.985 (0.975 to 0.995), p=0.003) and temperature (OR 0.203 (0.076 to 0.543),
p=0.001) were found to be the significant physiological parameters.
Intra-abdominal injury and NISS were significant anatomic mortality predictors
from exsanguination (p<0.001). Patients with intra-abdominal injury had four
times higher risk of mortality from exsanguination (OR 3.948 (2.331 to 6.686),
p<0.001). DISCUSSION: In a Malaysian trauma center, age, SBP, core body
temperature, intra-abdominal injury and NISS were significant predictors of early
death from exsanguination. LEVEL OF EVIDENCE: II.