Krishna Akella

1599: CONCOMITANT CHEST INJURY IN HEAD-INJURED PATIENTS ASSOCIATED WITH INCREASED MORBIDITY AND MORTALITY

www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: Traumatic Brain Injury (TBI) is the most common cause of death among trauma patients. Although isolated injury is well characterized in the literature, patients commonly present with combined injury. At our level 1 trauma center, we compared outcomes in patients with isolated head injury versus patients with head and chest injury. Methods: A retrospective data analysis was performed comparing patients with isolated head injury with patients with combined head and chest injury. Data obtained included age, Injury Severity Score (ISS), Revised Trauma Score (RTS), development of pneumonia, Hospital Length of Stay, ICU length of stay, ventilator days, and survival. Data were analyzed with one-way analysis of variance (ANOVA). Results: 199 patients were enrolled with average injury severity over 3, 99 with isolated head injury, 100 with combined head and chest injury. Mean age (years) of individuals with isolated head trauma was greater (53.8 vs. 45.8, 0.185). Overall complication rates were found to be greater in patients with combined injury with regard to incidence of pneumonia development (14% vs. 39%, p < 0.0001), hospital length of stay (days) (6.4 vs. 10.3, p = 0.01), ICU length of stay (days) (3.1 vs. 6.2, p = 0.006), ventilator days (1.3 vs. 4.2, p = 0.0006), and survival to hospital discharge (96.9% vs. 86.0%, p = 0.0142). Difference in ISS (p = 0.0615) and RTS (0.1647) were insignificant. Conclusions: Patients with combined head and chest injury had worse worse in-hospital morbidity including development of pneumonia, hospital length of stay, ICU length of stay, ventilator days and greater mortality than patients with isolated head trauma.

Initial Prealbumin Level and Ability to Normalize Prealbumin Are Highly Predictive of Increased Mortality and Morbidity in Elderly Trauma Patients

Prealbumin is a well characterized indicator of nutritional status more recently found to be an inverse inammatory marker. At our urban level 1 trauma center, we sought to study the relationship between malnutrition and outcomes in elderly trauma patients. Using prealbumin as a surrogate marker for nutritional status, we hypothesized that patients with reduced prealbumin on initial evaluation have worse outcomes, and in patients where initial prealbumin that was reduced, ability to correct is associated with improved outcomes. We performed a retrospective cohort study involving 200 consecutive patients over the age of 65 admitted to our trauma service. Based on initial prealbumin, patients were divided into 3 groups below 5 mg/dL, 5-10 mg/dL and greater than 10 mg/dL. Prealbumin was then re-assessed 4 days after admission and patients were again divided into 2 groups based on ability to normalize prealbumin. Data obtained included age, gender, revised trauma score (RTS), injury severity score (ISS), days on a ventilator, ICU length of stay (ICU-LOS), hospital length of stay (HLOS), survival, initial prealbumin, and ability to correct prealbumin within 4 days after admission. Of the 200 patients enrolled, patients were divided into 3 groups using initial prealbumin 71 patients below 5 mg/dL, 101 patients 5-10 mg/dL, and 28 patients greater than 10 mg/dL. There were 180 patients who were hospitalized for over a 4 day period. Normalization of prealbumin was achieved in 128 patients while 52 patients did not. Mean age was 79.2 years. RTS was found to be decreased in patients with initial prealbumin below 5 mg/dL in comparison to the other groups (11.3 vs. 11.8 vs. 11.8, p = 0.0002), with greater ISS (25.1 vs. 18.8 vs. 19.7, p < 0.0001), ICU LOS (days) (11.3 vs. 3.9 vs. 3.0, p < 0.0001), ventilator days (7.9 vs. 0.8 vs. 0.1, p < 0.0001), HLOS (days) (17.4 vs 7.8 vs. 7.1, p < 0.0001) and decreased survival (66% vs. 95% vs. 100%, p < 0.0001). Patients with prealbumin corrected within 4 days had lower ISS (19.9 vs. 29.2, p < 0.0001), as well as reduction in ventilator days (0.9 vs. 10.1, p < 0.0001), ICU LOS (days) (4.2 vs. 13.8, p < 0.0001), HLOS (days) (8.3 vs. 21.3, p < 0.0001) and improved survival (94% vs. 63%, p < 0.0001). Prealbumin is able to provide short term information regarding current nutritional status and response to therapy. Recent evidence suggest prealbumin may be a prognostic indicator for risk of malnutrition and inammation in critically ill trauma patients. In management of critically ill trauma patients, prealbumin can provide a valuable clinical indication of response to therapeutic intervention and potentially guide management strategy.

Evolution of venous thromboembolism risk assessment in trauma and surgical patients

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Bullet to the femoral head

A bullet being lodged in the femoral head is a unique trauma situation, which can be managed either operatively or non-operatively. We present two different scenarios of a bullet being lodged in the femoral head with a discussion of both operative and non-operative manage- ment as well as diagnostic considerations.