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336: What is the Impact of Obesity on the Relative Risk of Cervical Spine Injury in Blunt Trauma Patients?
Research Forum Abstracts
336
What is the Impact of Obesity on the Relative Risk of Cervical Spine Injury in Blunt Trauma Patients?
Jones RS, Galli RL, Orledge J, Summers RL/University of Mississippi Medical Center, Jackson, MS
Study Objectives: The incidence of obesity has reached epidemic proportions in the United States. The impact of this comorbid condition on the likelihood of injury in the trauma patient is unknown. In this study, the relative risk of cervical spine injury was determined for a population of obese blunt trauma patients as compared to a nonobese cohort. Methods: A retrospective analysis of an electronic patient database at a Level 1 trauma center with a large referral base of patients with cervical spine injuries was conducted for the period from September 1, 2005 to December 31, 2007. In addition to standard demographic characteristics, information with regard to cervical spine injury and body mass index (BMI) were collected for each patient with blunt trauma who met the criteria for a trauma activation or trauma consultation due to significant injury. The patients were then divided into the categories of obese and nonobese based on the World Health Organization classification (BMI cutoff of 30). The relative risk of cervical spine injury in the obese group as compared to the nonobese group was determined using standard statistical methodologies. Results: For the 1687 patients in the database who met the blunt trauma inclusion criteria, measurements of the BMI and other information required for the study were available for only 657 of the subjects. The average age, male to female ratio and BMI were found to be very similar between the obese and nonobese groups (p ⬍ 0.05). Of these blunt trauma patients, 161 were determined to have a concurrent cervical spine injury. The statistically determined relative risk of sustaining a cervical spine injury for the obese patients was 0.67 as compared to the nonobese group. Conclusions: The relative risk of injury in obese patients who sustain blunt trauma has not been well characterized. This study suggests that obese patient have a lower risk of cervical spine injury as compared to their nonobese counterparts who are subjected to a similar severity of blunt trauma. One postulated explanation is that the cervical spine in obese patients is less mobile due to the abundance of subcutaneous fat and functions as an anatomic stabilizing factor. More study is necessary to clarify the influence of obesity on the incidence and mechanisms of traumatic injury.
337
Early Identification of Combat Casualties Who Are at High Risk for Death from Severe Trauma
Mehta SG, Spinella P, Cox ED, West S, Apocada A, Holcomb JB/Brooke Army Medical Center, Ft. Sam Houston, TX; Connecticut Childrens Medical Center, Hartford, CT; William Beaumont Army Medical Center, El Paso, TX; Institute of Surgical Research, Ft. Sam Houston, TX
Study Objectives: Trauma is the leading cause of death for ages 1 to 44 and the 5th leading cause of death in the U.S. Accounting for 34% out-of-hospital deaths and a hospital death rate of 3%, trauma is also the leading case of life years lost. Compared to civilian trauma, combat trauma injuries tend to be more severe with higher ISS and increased use blood product. We looked to define physiologic criteria to identify those who are at increased risk of death within the first 24 hours and hypothesized that traumatic combat deaths would use more blood products. Methods: From April 2006 - September 2007, patients who presented at a Combat Support Hospital (CSH) meeting predefined physiologic criteria were identified. The subjects were resuscitated in standard technique with crystalloids and blood products with recombinant activated factor VII (rFVIIa) use based on physician discretion. Results: The group that died had a significantly lower systolic blood pressure (SBP), Glascow Coma Score (GCS), and higer International Normalized Ratio (INR) and base deficit (BD) upon admission, Age, heart rate (HR), temperature (temp), and hemoglobin concentration ([Hb]) were similar between the two groups. There was no statistically significant difference in rFVIIa administration between the 2 groups (p⫽0.14). There were significantly more blood products used in the ED and operating room (OR) in the group that died with increased transfusion of pRBC, plasma and FFP/RBC ratio in the ED. Conclusions: Early identification of patients at high risk of death may help decreased blood product transfusion requirements for combat casualties with severe trauma requiring massive transfusion.
S144 Annals of Emergency Medicine
338
Incidental Pneumothorax Found after Blunt Abdominal Trauma
Robinson DJ, Oakes JL, Jones N, Burk K, Kingeter A, Kaden A, Roberts M/ University of Texas Houston, Houston, TX
Background: Pneumothorax (PTX), the second most common blunt chest injury, may be missed in the initial trauma workup as the most common initial screening modality, the supine chest radiograph (CXR), may not identify small PTX. The abdominal computed tomographic (CT) scan is often deployed as a second screening test for patients presenting with significant blunt abdominal trauma. Prior studies have reported incidental PTX detected by CT in patients with reported negative CXRs ranging from 2.7% to 64% depending on the age and severity of injuries of the cohort. Study Objectives: Identify the patient cohort of Incidental Pneumothorax after Blunt Abdominal Trauma (IPBAT), to define the incidence, predictors of IPBAT, and their outcomes. In this trial, blunt trauma patients diagnosed with AIS codes indicating chest trauma were excluded to better distinguish the PTXs as truly incidental. Methods: Retrospective query from a level 1 trauma center’s registry excluding patients with any AIS score of 450xxx (skeletal trauma). Final diagnoses, injury scores (AIS, ISS), demographics, hospital and ED length of stay were abstracted from the registry and EMR. Final radiology reports were used to determine the outcomes of the CXR and CT scans. An IPBAT was defined as a blunt abdominal trauma with no evidence of chest trauma on presentation (no chest pain, rib fractures, respiratory distress, or obvious thoracic trauma) with both a negative CXR and a positive PTX reported on CT. Results: From 2004-6, 1474 of 14978 (9.8%) trauma patients met the criteria for blunt trauma, with 104 ⫹IPBAT (7.1%), 1298 ⫺IPBAT (88.1%), and 72 excluded (4.9%). Queried variables including sex, age, ED length of stay, hospital length of stay, and mean AIS were not significantly different between ⫹IPBAT and ⫺IPBAT groups. The frequency and odds ratios computed for the most frequent diagnoses associated with ⫹IPBAT were: lung contusions (N⫽38, 5.3%, OR⫽4.38), splenic trauma (N⫽31, 4.3%, OR⫽1.54), pelvic fracture (N⫽45, 6.3%, OR ⫽1.26), and transverse process fracture (N⫽48, 6.7%, OR:1.17). For ⫺IPBATS, the highest frequency of injuries were: transverse process fracture (N⫽510, 7.5%), pelvic fracture (N⫽486, 7.2%), splenic trauma (N⫽283, 4.2%), and liver trauma (N⫽277, 4.1%). The mean ISS in the ⫹IPBAT group (24.63 95% CI [22.86-26.41]) was statistically higher than the ⫺IPBAT (15.27 95%CI [14.72-15.82]) Respiratory failure occurred more frequently in IPBATs 23/104 (22.1%) than ⫺IPBATs 78/1298 (6%) (p⬍0.01). Conclusion: In this trial, IPBAT were associated with higher mean ISS than in the non-IPBAT group. Although lung contusions were 4 times more likely and respiratory failure were significantly higher in the IPBAT cohort than in those without IPBAT in our study, we found no differences in the ED or hospital length of stay or outcomes. Further research to prospectively validate these results may prove helpful to the practicing emergency physician.
339
High Serum S100B Levels in Patients With Acute Bone Fractures Without Cerebral Injuries
Kim C, Lee K, Choe J, Kim S, Lee S, Oh J/Cung-Ang University Medical Center, Seoul, Republic of Korea
Study Objectives: The measurement of S-100 protein in serum is known as the chemical marker for head trauma, and research being conducted recently shows that it could increase after various neurologic disorder, cardiac arrest and heart surgery. Therefore, as the possibility of another repository of S-100 protein other than the central nervous system is suggested, this research was intended to figure out the status of the S-100 protein in patients with acute bone fractures without cerebral injury. Methods: Subjects are fracture patients who were hospitalized after visiting
Volume , . : October
336
What is the Impact of Obesity on the Relative Risk of Cervical Spine Injury in Blunt Trauma Patients?
Jones RS, Galli RL, Orledge J, Summers RL/University of Mississippi Medical Center, Jackson, MS
Study Objectives: The incidence of obesity has reached epidemic proportions in the United States. The impact of this comorbid condition on the likelihood of injury in the trauma patient is unknown. In this study, the relative risk of cervical spine injury was determined for a population of obese blunt trauma patients as compared to a nonobese cohort. Methods: A retrospective analysis of an electronic patient database at a Level 1 trauma center with a large referral base of patients with cervical spine injuries was conducted for the period from September 1, 2005 to December 31, 2007. In addition to standard demographic characteristics, information with regard to cervical spine injury and body mass index (BMI) were collected for each patient with blunt trauma who met the criteria for a trauma activation or trauma consultation due to significant injury. The patients were then divided into the categories of obese and nonobese based on the World Health Organization classification (BMI cutoff of 30). The relative risk of cervical spine injury in the obese group as compared to the nonobese group was determined using standard statistical methodologies. Results: For the 1687 patients in the database who met the blunt trauma inclusion criteria, measurements of the BMI and other information required for the study were available for only 657 of the subjects. The average age, male to female ratio and BMI were found to be very similar between the obese and nonobese groups (p ⬍ 0.05). Of these blunt trauma patients, 161 were determined to have a concurrent cervical spine injury. The statistically determined relative risk of sustaining a cervical spine injury for the obese patients was 0.67 as compared to the nonobese group. Conclusions: The relative risk of injury in obese patients who sustain blunt trauma has not been well characterized. This study suggests that obese patient have a lower risk of cervical spine injury as compared to their nonobese counterparts who are subjected to a similar severity of blunt trauma. One postulated explanation is that the cervical spine in obese patients is less mobile due to the abundance of subcutaneous fat and functions as an anatomic stabilizing factor. More study is necessary to clarify the influence of obesity on the incidence and mechanisms of traumatic injury.
337
Early Identification of Combat Casualties Who Are at High Risk for Death from Severe Trauma
Mehta SG, Spinella P, Cox ED, West S, Apocada A, Holcomb JB/Brooke Army Medical Center, Ft. Sam Houston, TX; Connecticut Childrens Medical Center, Hartford, CT; William Beaumont Army Medical Center, El Paso, TX; Institute of Surgical Research, Ft. Sam Houston, TX
Study Objectives: Trauma is the leading cause of death for ages 1 to 44 and the 5th leading cause of death in the U.S. Accounting for 34% out-of-hospital deaths and a hospital death rate of 3%, trauma is also the leading case of life years lost. Compared to civilian trauma, combat trauma injuries tend to be more severe with higher ISS and increased use blood product. We looked to define physiologic criteria to identify those who are at increased risk of death within the first 24 hours and hypothesized that traumatic combat deaths would use more blood products. Methods: From April 2006 - September 2007, patients who presented at a Combat Support Hospital (CSH) meeting predefined physiologic criteria were identified. The subjects were resuscitated in standard technique with crystalloids and blood products with recombinant activated factor VII (rFVIIa) use based on physician discretion. Results: The group that died had a significantly lower systolic blood pressure (SBP), Glascow Coma Score (GCS), and higer International Normalized Ratio (INR) and base deficit (BD) upon admission, Age, heart rate (HR), temperature (temp), and hemoglobin concentration ([Hb]) were similar between the two groups. There was no statistically significant difference in rFVIIa administration between the 2 groups (p⫽0.14). There were significantly more blood products used in the ED and operating room (OR) in the group that died with increased transfusion of pRBC, plasma and FFP/RBC ratio in the ED. Conclusions: Early identification of patients at high risk of death may help decreased blood product transfusion requirements for combat casualties with severe trauma requiring massive transfusion.
S144 Annals of Emergency Medicine
338
Incidental Pneumothorax Found after Blunt Abdominal Trauma
Robinson DJ, Oakes JL, Jones N, Burk K, Kingeter A, Kaden A, Roberts M/ University of Texas Houston, Houston, TX
Background: Pneumothorax (PTX), the second most common blunt chest injury, may be missed in the initial trauma workup as the most common initial screening modality, the supine chest radiograph (CXR), may not identify small PTX. The abdominal computed tomographic (CT) scan is often deployed as a second screening test for patients presenting with significant blunt abdominal trauma. Prior studies have reported incidental PTX detected by CT in patients with reported negative CXRs ranging from 2.7% to 64% depending on the age and severity of injuries of the cohort. Study Objectives: Identify the patient cohort of Incidental Pneumothorax after Blunt Abdominal Trauma (IPBAT), to define the incidence, predictors of IPBAT, and their outcomes. In this trial, blunt trauma patients diagnosed with AIS codes indicating chest trauma were excluded to better distinguish the PTXs as truly incidental. Methods: Retrospective query from a level 1 trauma center’s registry excluding patients with any AIS score of 450xxx (skeletal trauma). Final diagnoses, injury scores (AIS, ISS), demographics, hospital and ED length of stay were abstracted from the registry and EMR. Final radiology reports were used to determine the outcomes of the CXR and CT scans. An IPBAT was defined as a blunt abdominal trauma with no evidence of chest trauma on presentation (no chest pain, rib fractures, respiratory distress, or obvious thoracic trauma) with both a negative CXR and a positive PTX reported on CT. Results: From 2004-6, 1474 of 14978 (9.8%) trauma patients met the criteria for blunt trauma, with 104 ⫹IPBAT (7.1%), 1298 ⫺IPBAT (88.1%), and 72 excluded (4.9%). Queried variables including sex, age, ED length of stay, hospital length of stay, and mean AIS were not significantly different between ⫹IPBAT and ⫺IPBAT groups. The frequency and odds ratios computed for the most frequent diagnoses associated with ⫹IPBAT were: lung contusions (N⫽38, 5.3%, OR⫽4.38), splenic trauma (N⫽31, 4.3%, OR⫽1.54), pelvic fracture (N⫽45, 6.3%, OR ⫽1.26), and transverse process fracture (N⫽48, 6.7%, OR:1.17). For ⫺IPBATS, the highest frequency of injuries were: transverse process fracture (N⫽510, 7.5%), pelvic fracture (N⫽486, 7.2%), splenic trauma (N⫽283, 4.2%), and liver trauma (N⫽277, 4.1%). The mean ISS in the ⫹IPBAT group (24.63 95% CI [22.86-26.41]) was statistically higher than the ⫺IPBAT (15.27 95%CI [14.72-15.82]) Respiratory failure occurred more frequently in IPBATs 23/104 (22.1%) than ⫺IPBATs 78/1298 (6%) (p⬍0.01). Conclusion: In this trial, IPBAT were associated with higher mean ISS than in the non-IPBAT group. Although lung contusions were 4 times more likely and respiratory failure were significantly higher in the IPBAT cohort than in those without IPBAT in our study, we found no differences in the ED or hospital length of stay or outcomes. Further research to prospectively validate these results may prove helpful to the practicing emergency physician.
339
High Serum S100B Levels in Patients With Acute Bone Fractures Without Cerebral Injuries
Kim C, Lee K, Choe J, Kim S, Lee S, Oh J/Cung-Ang University Medical Center, Seoul, Republic of Korea
Study Objectives: The measurement of S-100 protein in serum is known as the chemical marker for head trauma, and research being conducted recently shows that it could increase after various neurologic disorder, cardiac arrest and heart surgery. Therefore, as the possibility of another repository of S-100 protein other than the central nervous system is suggested, this research was intended to figure out the status of the S-100 protein in patients with acute bone fractures without cerebral injury. Methods: Subjects are fracture patients who were hospitalized after visiting
Volume , . : October