Journal of Trauma and Injury

Original Articles

Outcomes and physiologic responses associated with ketamine administration after traumatic brain injury in the United States and Canada: a retrospective analysis: Austin J. Peters, Saad A. Khan, Seiji Koike, Susan Rowell, Martin Schreiber; J Trauma Inj. 2023;36(4):354-361. Published online November 7, 2023; DOI: https://doi.org/10.20408/jti.2023.0034

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Abstract PDF Supplementary Material: Purpose
Ketamine has historically been contraindicated in traumatic brain injury (TBI) due to concern for raising intracranial pressure. However, it is increasingly being used in TBI due to the favorable respiratory and hemodynamic properties. To date, no studies have evaluated whether ketamine administered in subjects with TBI is associated with patient survival or disability.
Methods
We performed a retrospective analysis of data from the multicenter Prehospital Tranexamic Acid Use for Traumatic Brain Injury trial, comparing ketamine-exposed and ketamine-unexposed TBI subjects to determine whether an association exists between ketamine administration and mortality, as well as secondary outcome measures.
Results
We analyzed 841 eligible subjects from the original study, of which 131 (15.5%) received ketamine. Ketamine-exposed subjects were younger (37.3±16.9 years vs. 42.0±18.6 years, P=0.037), had a worse initial Glasgow Coma Scale score (7±3 vs. 8±4, P=0.003), and were more likely to be intubated than ketamine-unexposed subjects (88.5% vs. 44.2%, P<0.001). Overall, there was no difference in mortality (12.2% vs. 15.5%, P=0.391) or disability measures between groups. Ketamine-exposed subjects had significantly fewer instances of elevated intracranial pressure (ICP) compared to ketamine-unexposed subjects (56.3% vs. 82.3%, P=0.048). In the very rare outcomes of cardiac events and seizure activity, seizure activity was statistically more likely in ketamine-exposed subjects (3.1% vs. 1.0%, P=0.010). In the intracranial hemorrhage subgroup, cardiac events were more likely in ketamine-exposed subjects (2.3% vs. 0.2%, P=0.025). Ketamine exposure was associated with a smaller increase in TBI protein biomarker concentrations.
Conclusions
Ketamine administration was not associated with worse survival or disability despite being administered to more severely injured subjects. Ketamine exposure was associated with reduced elevations of ICP, more instances of seizure activity, and lower concentrations of TBI protein biomarkers.; Summary

Usefulness of Shock Index to Predict Outcomes of Trauma Patient: A Retrospective Cohort Study: Myoung Jun Kim, Jung Yun Park, Mi Kyoung Kim, Jae Gil Lee; J Trauma Inj. 2019;32(1):17-25. Published online March 31, 2019; DOI: https://doi.org/10.20408/jti.2018.034

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6 Citations

Purpose

We investigated how prehospital, emergency room (ER), and delta shock indices (SI) correlate with outcomes including mortality in patients with polytrauma.

Methods

We retrospectively reviewed the medical records of 1,275 patients who visited the emergency department from January 2015 to April 2018. A total of 628 patients were enrolled in the study. Patients were divided into survivor and non-survivor groups, and logistic regression analysis was used to investigate independent risk factors for death. Pearson coefficient analysis and chi-square test were used to examine the significant relationship between SI and clinical progression markers.

Results

Of 628 enrolled patients, 608 survived and 27 died. Multivariate logistic regression analysis reveals “age” (p<0.001; OR, 1.068), “pre-hospital SI >0.9” (p<0.001; OR, 11.629), and “delta SI ≥0.3” (p<0.001; OR, 12.869) as independent risk factors for mortality. Prehospital and ER SIs showed a significant correlation with hospital and intensive care unit length of stay and transfusion amount. Higher prehospital and ER SIs (>0.9) were associated with poor clinical progression.

Conclusions

SI and delta SI are significant predictors of mortality in patients with polytrauma. Moreover, both prehospital and ER SIs can be used as predictive markers of clinical progression in these patients.

Summary

Citations

Citations to this article as recorded by

Shock Index for the Prediction of Interventions and Mortality in Patients With Blunt Thoracic Trauma
Mohammad Asim, Ayman El-Menyar, Talat Chughtai, Ammar Al-Hassani, Husham Abdelrahman, Sandro Rizoli, Hassan Al-Thani
Journal of Surgical Research.2023; 283: 438. CrossRef
Emergency Department Shock Index Outperforms Prehospital and Delta Shock Indices in Predicting Outcomes of Trauma Patients
Hamidreza Hosseinpour, Tanya Anand, Sai Krishna Bhogadi, Christina Colosimo, Khaled El-Qawaqzeh, Audrey L. Spencer, Lourdes Castanon, Michael Ditillo, Louis J. Magnotti, Bellal Joseph
Journal of Surgical Research.2023; 291: 204. CrossRef
Shock index as a predictor for mortality in trauma patients: a systematic review and meta-analysis
Malene Vang, Maria Østberg, Jacob Steinmetz, Lars S. Rasmussen
European Journal of Trauma and Emergency Surgery.2022; 48(4): 2559. CrossRef
Delta Shock Index Predicts Outcomes in Pediatric Trauma Patients Regardless of Age
Samer Asmar, Muhammad Zeeshan, Muhammad Khurrum, Jorge Con, Mohamad Chehab, Letitia Bible, Rifat Latifi, Bellal Joseph
Journal of Surgical Research.2021; 259: 182. CrossRef
Shock index as a predictor for short‐term mortality in helicopter emergency medical services: A registry study
Johannes Björkman, Lasse Raatiniemi, Piritta Setälä, Jouni Nurmi
Acta Anaesthesiologica Scandinavica.2021; 65(6): 816. CrossRef
Association between prehospital field to emergency department delta shock index and in-hospital mortality in patients with torso and extremity trauma: A multinational, observational study
Dae Kon Kim, Joo Jeong, Sang Do Shin, Kyoung Jun Song, Ki Jeong Hong, Young Sun Ro, Tae Han Kim, Sabariah Faizah Jamaluddin, Zsolt J. Balogh
PLOS ONE.2021; 16(10): e0258811. CrossRef

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