Background
Methods
TraumaRegister DGU®
Patients
Statistical analysis
Results
Control group | CPR in the ER | |
---|---|---|
n = 36391 | n = 2108 | |
Age (years) | 48.1 ± 20.1 | 49.0 ± 21.0 |
ISS | 27.9 ± 11.0 | 42.0 ± 18.1 |
Male/female | 27.1 %/72.9 % | 29.9 %/70.1 % |
Trauma cause | ||
Car | 27.4 % | 29.2 % |
Motorcycle | 14,0 % | 13.8 % |
Bicycle | 8.4 % | 7.1 % |
Pedestrian | 7.8 % | 13,0 % |
High fall (≥3 m) | 19.1 % | 19.7 % |
Low fall | 14.5 % | 4.7 % |
Others | 8.9 % | 12.6 % |
Traffic accident | 41.5 % | 35.2 % |
Blunt trauma | 95.7 % | 92.1 % |
Penetrating trauma | 4.3 % | 7.9 % |
AIS head ≥3 | 56.8 % | 58.6 % |
AIS thorax ≥3 | 56.2 % | 73.6 % |
AIS abdomen ≥3 | 18.4 % | 31.8 % |
AIS extremities ≥3 | 33.9 % | 46.5 % |
Preclinical volume (ml) | 1107 ± 864 | 1601 ± 1155 |
Time from accident to hospital admission (min) | 68.4 ± 29.3 | 64.0 ± 27.2 |
Preclinical resuscitation | 2.6 % | 56.8 % |
Preclinical GCS ≤8 | 31.9 % | 70.6 % |
Preclinical shock (BP ≤90mmHG) | 17.0 % | 59.9 % |
Preclinical intubation | 49.6 % | 84.8 % |
Preclinical transfusion of catecholamines | 9.1 % | 53.3 % |
Preclinical thoracic drainage | 5.4 % | 18.0 % |
Mild hypotension on admission (BP ≤90mmHG) | 13.4 % | 63.6 % |
Blood transfusion: number of packed red blood cell units | 21.9 % | 63.6 % |
TASH score | 6.2 ± 5.0 | 13.8 ± 6.0 |
Hemoglobin ER | 12.1 ± 2.6 | 9.1 ± 3.6 |
Quick’s value ER | 79.1 ± 22.9 | 50.7 ± 28.0 |
INR ER | 1.28 ± 0.65 | 2.34 ± 2.02 |
Base excess ER | – 3.0 ± 4.5 | – 12.3 ± 9.1 |
Coagulopathy | 29.2 % | 70.8 % |
Mortality
Koef | SE |
p value | OR | 95 % CI | |
---|---|---|---|---|---|
Preclinical resuscitation | 1.747 | 0.107 |
<0.001
| 5.74 | 4.65–7.07 |
Preclinical catecholamines | 0.419 | 0.091 |
<0.001
| 1.52 | 1.27–1.82 |
Preclinical thorax drainage | 0.43 | 0.102 |
<0.001
| 1.54 | 1.26–1.88 |
Coagulopathy | 0.777 | 0.077 |
<0.001
| 2.18 | 1.87–2.53 |
Preclinical GCS ≤8 | 0.248 | 0.081 |
0.002
| 1.28 | 1.87–2.53 |
AIS thorax ≥3 | 0.23 | 0.08 |
0.004
| 1.26 | 1.08–1.47 |
AIS abdomen ≥3 | 0.205 | 0.078 |
0.009
| 1.23 | 1.05–1.43 |
AIS extremities ≥3 | 0.236 | 0.073 |
0.001
| 1.27 | 1.10–1.46 |
Preclinical shock (BP ≤90mmHG) | 0.301 | 0.078 |
<0.001
| 1.35 | 1.16–1.57 |
Mild hypotension on admission (BP ≤90mmHG) | 1.250 | 0.075 |
<0.001
| 3.49 | 3.02–4.04 |
Constant | -5.587 | 0.100 |
<0.001
| 0.004 |
Neurological outcome
Glasgow Outcome Scale | 1 Dead | 2 Vegetative state | 3 Severe disability | 4 Moderate disability | 5 Good recovery | Good and moderate outcome combined |
---|---|---|---|---|---|---|
No resuscitation (n = 35,447) | 16.4 % (5816) | 2.4 % (865) | 12.7 % (4495) | 25.4 % (9015) | 43.0 % (15,256) | 68.5 % (24,271) |
Prehospital resuscitation (n = 944) | 68.3 % (645) | 6.4 % (60) | 10.6 % (100) | 7.7 (73) | 7.0 % (66) | 14.7 % (139) |
ER resuscitation (n = 1197) | 74.4 % (891) | 1.3 % (15) | 5.1 % (61) | 9.7 % (116) | 9.5 % (114) | 19.2 % (230) |
Prehospital + ER resuscitation n = 911) | 95.2 % (867) | 0.7 % (6) | 1.4 % (13) | 1.3 % (12) | 1.4 % (13) | 2.7 % (25) |
GOS 4 + 5 (good and moderate outcome) in % | GOS 1–3 (severe disability, vegetative state, dead) in % | Total n = | ||
---|---|---|---|---|
ER resuscitation | 90.2 | 52.2 | 1197 |
p
< 0.001
|
Preclinical + ER resuscitation | 9.8 | 47.8 | 911 | |
Penetrating trauma | 8.9 | 7.8 | 163 |
p = 0.53 |
Blunt trauma | 91.1 | 92.2 | 1894 | |
Female patients | 27.2 | 30.1 | 628 |
p = 0.38 |
Male patients | 72.8 | 69.9 | 1483 | |
Type of injury | ||||
Car | 28.5 | 29.1 | 582 |
p = 0.26 |
Motorcycle | 14.6 | 13,6 | 275 | |
Bicycle | 6.9 | 7.1 | 142 | |
Pedestrian | 9.8 | 13.4 | 260 | |
Fall > 3 m | 17.9 | 20.1 | 397 | |
Fall < 3 m | 6.9 | 4.4 | 94 | |
Other | 15.4 | 12.2 | 253 | |
Severity of injury (AIS) | ||||
AIS head <3 | 56.0 | 39.5 | 881 |
p
< 0.001
|
AIS head ≥ 3 | 44.0 | 60.5 | 1241 | |
AIS thorax <3 | 31.5 | 25.7 | 560 |
p
= 0.05
|
AIS thorax ≥ 3 | 68.5 | 74.3 | 1562 | |
AIS abdomen <3 | 69.6 | 68.1 | 1449 |
p = 0.67 |
AIS abdomen ≥ 3 | 30.4 | 31.9 | 673 | |
AIS extremities <3 | 50.6 | 53.8 | 1134 |
p = 0.35 |
AIS extremities ≥ 3 | 49.4 | 46.2 | 988 | |
Preclinical RR >90 mmHG | 73.3 | 34.9 | 664 |
p
< 0.001
|
Preclinical RR ≤90 mmHG | 26.7 | 65.1 | 991 | |
ER RR >90 mmHG | 69.2 | 31.4 | 647 |
p
< 0.001
|
ER RR ≤90 mmHG | 30.8 | 68.6 | 1130 | |
No blood transfusion | 52.5 | 33.9 | 700 |
p
< 0.001
|
Blood transfusion | 47.5 | 66.1 | 1222 | |
≤10 blood transfusions | 79.8 | 72.8 | 1418 |
p
= 0.018
|
>10 blood transfusions | 20.2 | 27.2 | 505 | |
No coagulopathy | 57.8 | 24.1 | 471 |
p
< 0.001
|
Coagulopathy | 42.2 | 75.9 | ||
Preclinical GCS >8 | 70.2 | 23.8 | 593 |
p
< 0.001
|
Preclinical GCS ≤8 | 29.8 | 76.2 | 1420 | |
No acidosis | 57.7 | 20.2 | 313 |
p
< 0.001
|
Acidosis | 42.3 | 79.8 | 925 | |
Age in years | 45 ± 20 | 50 ± 21 | 2122 |
p
= 0.005
|
ISS | 30 ± 12 | 45 ± 18 | 2122 |
p
< 0.001
|
Preclinical volume in ml | 1302 ± 974 | 1645 ± 1173 | 1886 |
p
< 0.001
|
TASH score | 9.6 ± 6.3 | 14.6 ± 5.6 | 1047 |
p
< 0.001
|
Hemoglobin in the TR | 11.2 ± 2.9 | 8.8 ± 3.5 | 1777 |
p
< 0.001
|
Quick in the TR | 72 ± 25 | 47 ± 51 | 1449 |
p
< 0.001
|
INR in the TR | 1.40 ± 0.70 | 2.51 ± 2.14 | 1482 |
p
< 0.001
|
Base excess | -6.2 ± 7.1 | -13.2 ± 9.0 | 1238 |
p
< 0.001
|
Koef | SE |
p value | OR | 95%CI | |
---|---|---|---|---|---|
Preclinical resuscitation | 1.131 | 0.258 |
p
< 0.001
| 3.10 | 1.9–5.1 |
ISS (per point) | 0.048 | 0.007 |
p
< 0.001
| 1.05 | 1.04–1.06 |
GCS ≤8 preclinical | 1.357 | 0.186 |
p
< 0.001
| 3.886 | 2.7–5.6 |
RR ≤90mmHG in the ER | 0.909 | 0.181 |
p
< 0.001
| 2.481 | 1.74–3.54 |
Age ≥60 years | 1.317 | 0.199 |
p
< 0.001
| 3.732 | 2.53–5.52 |
Blood transfusion | 0.534 | 0.184 |
p
= 0.004
| 1.706 | 1.189–2.446 |
Coagulopathy | 0.537 | 0.177 |
p
= 0.002
| 1.711 | 1.210–2.420 |
Constant | 2.353 | 0.269 |
p
<0.001
| 0.95 |
Discussion
Mortality
Limitations
Conclusions
Key messages
-
Patients’ outcomes after severe trauma seems to be better than those reported in most previous studies.
-
Resuscitation in the ER is associated with better neurological outcomes compared with resuscitation in a preclinical context or in both the preclinical phase and the ER.
-
Among the survivors, patients who survived preclinical resuscitation had the highest rate of good or moderate outcome
-
These data might support algorithms and guidelines in the future dealing with the resuscitation of polytraumatised patients.