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Central Venous Catheterization before Versus after Computed Tomography in Hemodynamically Unstable Patients with Major Blunt Trauma: Clinical Characteristics and Factors for Decision Making
J Trauma Inj 2018;31(3):135-142
Published online December 31, 2018
© 2018 The Korean Society of Trauma.

Ji Hun Kim, M.D., Sang Ook Ha, M.D., Young Sun Park, M.D., Jeong Hyeon Yi, M.D., Sun Beom Hur, M.D., Ki Ho Lee, M.D.

Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Korea
Correspondence to: Sang Ook Ha, M.D.
Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, 22 Gwanpyeong-ro 170beon-gil, Donan-gu, Anyang 14068, Korea
Tel: +82-31-380-4158
Fax: +82-31-380-4131
E-mail: mdhso@hallym.or.kr
Received June 19, 2018; Revised September 11, 2018; Accepted September 28, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: When hemodynamically unstable patients with blunt major trauma arrive at the emergency department (ED), the safety of performing early whole-body computed tomography (WBCT) is concerning. Some clinicians perform central venous catheterization (CVC) before WBCT (pre-computed tomography [CT] group) for hemodynamic stabilization. However, as no study has reported the factors affecting this decision, we compared clinical characteristics and outcomes of the pre- and post-CT groups and determined factors affecting this decision.
Methods: This retrospective study included 70 hemodynamically unstable patients with chest or/and abdominal blunt injury who underwent WBCT and CVC between March 2013 and November 2017.
Results: Univariate analysis revealed that the injury severity score, intubation, pulse pressure, focused assessment with sonography in trauma positivity score, and pH were different between the pre-CT (34 patients, 48.6%) and post-CT (all, p<0.05) groups. Multivariate analysis revealed that injury severity score (ISS) and intubation were factors affecting the decision to perform CVC before CT (p=0.003 and p=0.043). Regarding clinical outcomes, the interval from ED arrival to CT (p=0.011) and definite bleeding control (p=0.038), and hospital and intensive care unit lengths of stay (p=0.018 and p=0.053) were longer in the pre-CT group than in the post-CT group. Although not significant, the pre-CT group had lower survival rates at 24 hours and 28 days than the post-CT group (p=0.168 and p=0.226).
Conclusions: Clinicians have a tendency to perform CVC before CT in patients with blunt major trauma and high ISS and intubation.
Keywords : Blunt trauma; Computed tomography; Central venous catheterization; Injury severity score


December 2018, 31 (3)
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