Trauma Quality Indicators' usage limitations in severe trauma patients
Pedro DE Souza Lucarelli Antunes, Paula Ribeiro LibÓrio, Giovanna Mennitti Shimoda, Luca Giovanni Antonio Pivetta, JosÉ Gustavo Parreira, Jose Cesar Assef, Pedro DE Souza Lucarelli Antunes, Paula Ribeiro LibÓrio, Giovanna Mennitti Shimoda, Luca Giovanni Antonio Pivetta, JosÉ Gustavo Parreira, Jose Cesar Assef
Abstract
Purpose: to analyze the relation between Trauma Quality Indicators (QI) and death, as well as clinical adverse events in severe trauma patients.
Methods: analysis of data collected in the Trauma Register between 2014-2015, including patients with Injury Severity Score (ISS) > 16, reviewing the QI: (F1) Acute subdural hematoma drainage > 4 hours with Glasgow Coma Scale (GCS) <9; (F2) emergency room transference without definitive airway and GCS <9; (F3) Re-intubation within 48 hours; (F4) Admission-laparotomy time greater than 60 min in hemodynamically instable patients with abdominal bleeding; (F5) Unprogrammed reoperation; (F6) Laparotomy after 4 hours; (F7) Unfixed femur diaphyseal fracture; (F8) Non-operative treatment for abdominal gunshot; (F9) Admission-tibial exposure fracture treatment time > 6 hours; (F10) Surgery > 24 hours. T the chi-squared and Fisher tests were used to calculate statistical relevance, considering p<0.05 as relevant.
Results: 127 patients were included, whose ISS ranged from 17 to 75 (28.8 + 11.5). There were adverse events in 80 cases (63%) and 29 died (22.8%). Twenty-six patients had some QI compromised (20.6%). From the 101 patients with no QI, 22% died, and 7 of 26 patients with compromised QI (26.9%) (p=0.595). From the patients with no compromised QI, 62% presented some adverse event. From the patients with any compromised QI, 18 (65.4%) had some adverse event on clinical evolution (p=0.751).
Conclusion: the QI should not be used as death or adverse events predictors in severe trauma patients.
Source: PubMed