https://ogma.newcastle.edu.au/vital/access/ /manager/Index ${session.getAttribute("locale")} 5 https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:50479 72 hours with Injury Severity Score (ISS) of >15 were included. Patients were grouped based on number of repeat contrast studies received after initial imaging. Initial vital signs, resuscitation data, and laboratory parameters were collected. Primary outcome was AKI (Kidney Disease: Improving Global Outcomes criteria), and secondary outcomes included contrast-induced acute kidney injury (CI-AKI; >25% or >44 μmol/L increase in creatinine within 72 hours of contrast administration), multiple organ failure, length of stay, and mortality. Results: Six-hundred sixty-three multiple injury patients (age, 45.3 years [SD, 9.1 years]; males, 75%; ISS, 25 (interquartile range, 20–34); mortality, 5.4%) met the inclusion criteria. The incidence of AKI was 13.4%, and CI-AKI was 14.5%. Multivariate analysis revealed that receiving additional contrast doses within the first 72 hours was not associated with AKI (odds ratio, 1.33; confidence interval, 0.80–2.21; p = 0.273). Risk factors for AKI included higher ISS (p < 0.0007), older age (p = 0.0109), higher heart rate (p = 0.0327), lower systolic blood pressure (p = 0.0007), and deranged baseline blood results including base deficit (p = 0.0042), creatinine (p < 0.0001), lactate (p < 0.0001), and hemoglobin (p = 0.0085). Acute kidney injury was associated with worse outcomes (ICU length of stay: 8 vs. 3 days, p < 0.0001; mortality: 16% vs. 3.8%, p < 0.0001; MOF: 42% vs. 6.6%, p < 0.0001). Conclusion: There is a limited role of repeat contrast administration in AKI development in ICU-admitted multiple injury patients. The clinical significance of CI-AKI is likely overestimated, and it should not compromise essential secondary imaging from the ICU. Further prospective studies are needed to verify our results. Level of Evidence: Therapeutic/Care Management; Level III.]]> Wed 26 Jul 2023 18:08:25 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:53320 Wed 22 Nov 2023 09:57:30 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:48019 Wed 15 Feb 2023 10:48:01 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:41114 Tue 26 Jul 2022 08:55:17 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:37506 Thu 04 Feb 2021 16:30:11 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:47326 Thu 02 May 2024 15:17:59 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:20942 p = 0.020) and then further elevated after surgery (1 hour postoperative, 17.8 ± 2.0 U vs. preoperative, 13.8 ± 1.4 U, p = 0.008). Polytrauma patients were more hypercoagulable than nonpolytrauma at the preoperative sample time (17.7 ± 2.6 U vs. 10.7 ± 1.2 U, p = 0.040) and postoperative period (24.3 ± 3.4 U vs. 11.9 ± 1.4 U, p = 0.006). The OHP for patients undergoing open pelvic surgery (28.3 ± 3.0 U) was higher than both intramedullary nailing (16.2 ± 2.0 U) and percutaneous pelvic surgery (17.0 ± 1.7 U) on Day 5 (p < 0.05). Patients demonstrated a higher OHP than controls did at all time points, except at 6 weeks (patients, 10.8 ± 1.7 U vs. controls, 8.1 ± 0.5 U; p = 0.400). CONCLUSION: The OHP assay detected the hypercoagulable state following major orthopedic trauma and surgical intervention, which was present for 10 days postoperatively. The extent of hypercoagulability could be associated with polytrauma and the type of surgical intervention; however, further studies are needed to confirm this.]]> Sat 24 Mar 2018 08:06:06 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:17326 120) or Glasgow Coma Scale score <14 on arrival were excluded. Nausea, vomiting, and antiemetic use were recorded. RESULTS: Convenience sample of 196 trauma resuscitation patients (68% men; age, 42 ± 18 years, mean Injury Severity Score 8 ± 7) were interviewed over the 5-month study period, of a total 369 admitted trauma patients (53%). Seventy-five (38%) patients reported some degree of nausea, 57 (29%) moderate or severe nausea, and 15 (8%) vomited. Older age and female gender were associated with vomiting (p < 0.01). Seventy-nine patients (40%) received a prophylactic antiemetic. Of these, four became nauseous (5%), compared with 71 of 117 (61%) for patients not given an antiemetic (p < 0.0001). CONCLUSIONS: Prehospital nausea and vomiting are more common in our cohort of trauma patients than the reported rates in the literature for nontrauma patients transported to hospital by ambulance. Only 40% of patients receive prophylactic antiemetics, but those patients are less likely to develop symptoms.]]> Sat 24 Mar 2018 08:01:47 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:19658 15. Patients were identified from the trauma registry, and data for age, sex, mechanism of injury, ISS, survival to discharge, and length of stay were collected. Mortality was examined for patients with severe injury (ISS > 15) and patients with critical injury (ISS > 24) and compared for the three periods: 2002–2004 (without trauma specialist), 2005–2007 (with trauma specialist), and 2008–2011 (with specialist trauma service). Results: A total of 3,869 severely injured (ISS > 15) trauma patients were identified during the 10-year period. Of these, 2,826 (73%) were male, 1,513 (39%) were critically injured (ISS > 24), and more than 97% (3,754) were the victim of blunt trauma. Overall mortality decreased from 12.4% to 9.3% (relative risk, 0.75) from period one to period three and from 25.4% to 20.3% (relative risk, 0.80) for patients with critical injury. A 0.46% per year decrease (p = 0.018) in mortality was detected (odds ratio, 0.63; p < 0.001). For critically injured (ISS > 24), the trend was (0.61% per year; odds ratio, 0.68; p = 0.039). Conclusion: The introduction of a specialist trauma service decreased the mortality of patients with severe injury, the model of care should be considered to implement state- and nationwide in Australia. Level of Evidence: Epidemiologic study, level III.]]> Sat 24 Mar 2018 08:01:13 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:20767 3) were adjusted for admission risk factors (age, sex, body max index, Injury Severity Score [ISS], systolic blood pressure, and base deficit) using survival analysis. Results: A total of 1,643 patients from four institutions were evaluated. MOF incidence decreased over time (from 17% in 2003–2004 to 9.8% in 2009–2010). MOF-related death rate (33% in 2003–2004 to 36% in 2009–2010), intensive care unit stay, and mechanical ventilation duration did not change over the study period. Adjustment for admission risk factors confirmed the crude trends. MOF patients required much longer ventilation and intensive care unit stay, compared with non-MOF patients. Most of the MOF-related deaths occurred within 2 days of the MOF diagnosis. Lung and cardiac dysfunctions became less frequent (57.6% to 50.8%, 20.9% to 12.5%, respectively), but kidney and liver failure rates did not change (10.1% to 12.5%, 15.2% to 14.1%). Conclusion: Postinjury MOF remains a resource-intensive, morbid, and lethal condition. Lung injury is an enduring challenge and should be a research priority. The lack of outcome improvements suggests that reversing MOF is difficult and prevention is still the best strategy.]]> Sat 24 Mar 2018 08:00:21 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:18955 Sat 24 Mar 2018 07:58:57 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:20386 15, age > 18 years, head Abbreviated Injury Scale [AIS] score < 3, survival for >48 hours). Demographics, ISS, physiologic parameters, SOFA and Denver scores, and outcome data were prospectively collected. Sensitivity/specificity and receiver operating characteristic curve were calculated for both scores. Analysis was also completed for a Day 3 postinjury SOFA and Denver score. Results: A total of 140 patients met the inclusion criteria (mean [SD] age, 47 [21] years; ISS, 30; male, 69%; mortality rate, 6%; mean [SD] ICU LOS, 9 [7] days; mean [SD] ventilation period, 6 [7] days). There was no difference in the score performance predicting mortality. Day 3 SOFA score of 4 or greater outperformed the Denver score of greater than 3 when predicting ICU LOS and ventilator days (area under the curve, 0.83 vs. 0.69, 0.86 vs. 0.73, respectively). The SOFA score was more sensitive and the Denver score was more specific when predicting mortality, ICU LOS, and ventilator days. Conclusion: Both scores had similar performance predicting mortality; however, the Day 3 SOFA score outperforms the Denver score when predicting ICU LOS and ventilator days. Either score could be superior based on whether one is seeking to optimize specificity or sensitivity. It is important to note that these findings are in a non–head-injured population and that there are practical difficulties using the SOFA in head-injured patients.]]> Sat 24 Mar 2018 07:58:08 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:19806 Sat 24 Mar 2018 07:57:11 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:19109 Sat 24 Mar 2018 07:55:59 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:19721 15; age > 18 years, head Abbreviated Injury Scale [AIS] score < 3; and survival for >48 hours). Demographics, injury severity (ISS), physiologic parameters, MOF status based on the Denver score, and outcome data were prospectively collected. Univariate analysis and multivariate logistic modeling were performed; p < 0.05 was considered significant. Data are presented as percentage or mean (SD). RESULTS: A total of 140 patients met the inclusion criteria (age, 47 [21] years; ISS, 30 [11]; male, 69%), 21 patients (15%) developed MOF, and MOF associated mortality was 24% versus non-MOF mortality rate of 3%. Patients who developed MOF had longer ICU stays (19 [7] vs. 7 [5], p < 0.01) and had more ventilator days (18 [9] vs. 4 [4], p < 0.01). Prediction models were generated at two time points as follows: admission and 24 hours after injury. At admission, age (>65 years) and admission platelet count (<150 ✕ 10(9)/L) were significant predictors of MOF; at 24 hours after injury, MOF was predicted by age more than 65 years, admission platelet count less than 150 ✕ 10(9)/L, maximum creatinine of greater than 150 ✕ 10(9)/L and minimum bilirubin of greater than 10 ✕ 10(9)/L. Shock parameters and injury severity did not predict MOF. CONCLUSION: The incidence of MOF (15%) is lower than reported 15 years ago; MOF remains a major cause of ICU resource use and late mortality after injury. The independent predictors of MOF have fundamentally changed, likely owing to improvements in resuscitation and critical care. Current predictors are universally available at admission and 24 hours. LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III.]]> Sat 24 Mar 2018 07:53:43 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:18382 Sat 24 Mar 2018 07:52:42 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:21022 p = 0.003), 3 days (p = 0.003), and 5 days (p = 0.0014). Preoperative mtDNA levelswere greater with shorter time from injury to surgery (p = 0.0085). Postoperative mtDNA level negatively correlated with intraoperative crystalloid infusion (p = 0.0017). Major pelvic surgery (vs. minor) was associated with greater mtDNA release 5 days postoperatively (p < 0.05). Conclusion: This pilot of heterogeneous orthopedic trauma patients showed that the release of mtDNA and nDNA is sustained for 5 days following orthopedic trauma surgery. Postoperative, circulating DNA is not associated with markers of tissue necrosis but is associated with surgical invasiveness and is inversely related to intraoperative fluid administration. Sustained elevation of mtDNA levels could be of inflammatory origin and may contribute to postinjury dysfunctional inflammation.]]> Sat 24 Mar 2018 07:50:33 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:41100 Mon 25 Jul 2022 10:38:22 AEST ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:37467 Mon 11 Jan 2021 16:16:25 AEDT ]]> https://ogma.newcastle.edu.au/vital/access/ /manager/Repository/uon:52615 3, 12.7% (95% CI, 9.3-16.1%) in Denver score >3 with blunt injuries only, 28.6% (95% CI, 12-45.1%) in Denver score >8, 25.6% (95% CI, 10.4-40.7%) in Goris score >4, 29.9% (95% CI, 14.9-45%) in Marshall score >5, 20.3% (95% CI, 9.4-31.2%) in Marshall score >5 with blunt injuries only, 38.6% (95% CI, 33-44.3%) in SOFA score >3, 55.1% (95% CI, 49.7-60.5%) in SOFA score >3 with blunt injuries only, and 34.8% (95% CI, 28.7-40.8%) in SOFA score >5. Conclusion: The incidence of postinjury MOF varies largely because of lack of a consensus definition and study population. Until an international consensus is reached, further research will be hindered. Level of Evidence: Systematic Review and Meta-analysis; Level III.]]> Fri 10 Nov 2023 07:10:04 AEDT ]]>