- Usefulness of End-tidal Carbon Dioxide as a Predictor of Emergency Intervention in Major Trauma Patients
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Sung Ho Kim, Seunghwan Kim, Jae Gil Lee, Sung Phil Chung, Seung Ho Kim
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J Trauma Inj. 2014;27(4):133-138.
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 Abstract
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- PURPOSE
If the survival of patients suffering from severe blunt trauma is to be improved, appropriate interventions should be taken immediately. The purpose of this study is to evaluate the clinical utility of end-tidal carbon dioxide (ETCO2) as a surrogate marker for predicting both the need for intervention and the prognosis.
METHODS
This is a prospective observational study. Nasal cannula was applied to measure ETCO2, and the following parameters, which are known to be related to the prognosis for a patient, were recorded: injury severity score (ISS), revised trauma score (RTS), arterial blood gas (ABG), lactate, and hemoglobin (Hb). To evaluate the outcome, we investigated the details of emergent interventions and expired patients.
RESULTS
A total of 93 patients were enrolled in this study. Emergent intervention was significantly associated with systolic blood pressure (sBP, p-value=0.001), ETCO2 (p-value<0.001), serum lactate level (p-value<0.001), pH (p-value< 0.003), HCO3 (p-value=0.004), base excess (p-value<0.002), ISS (p-value<0.001) and RTS (p-value=0.005). In the multivariate logistic regression, only ETCO2 (odds ratio (OR): 0.897, 95% confidence interval (CI): 0.792-0.975, pvalue= 0.048) and ISS (OR: 1.132, 95% CI: 1.053-1.233, p-value=0.002) were associated with emergent intervention whereas ETCO2 (p-value=0.973) and ISS (p-value=0.511) were not statistically significant in predicting the survival of patients in the univariate analysis. An optimal ETCO cut-off of 29 mmHg on the ROC curve was determined, with the area under the ROC curve (AUC) being 0.824 (0.732-0.917)].
CONCLUSION
This study has revealed that ETCO2, which can be rapid and easily measured through a nasal cannula, and the ISS may be prognostic indicators of emergent interventions in Emergency Departments.
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Summary
- Effective Radiologic Doses and Lifetime Attributable Risks in Patients with Trauma Critical Pathway Activation
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Wonhyo Lee, Taeyoung Kong, Seunghwan Kim, Je Sung You, Yoo Seok Park, Jae Gil Lee, Sung Phil Chung
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J Trauma Inj. 2013;26(3):198-206.
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Abstract
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- PURPOSE
This study was performed to calculate and analyze the effective radiation doses from computed tomography (CT) and radiologic intervention in patients in the emergency department (ED) with trauma critical pathway (CP) activation and further to estimate the lifetime attributable risks (LARs) for the incidence of and mortality from cancers induced by the radiation dose.
METHODS
Through a retrospective electrical chart review of 104 injured patients who trauma critical pathway were activated from November 2012 to March 2013, we calculated effective radiologic doses by taking the product of the dose-linear product of the scan and the conversion coefficient. After a determination of the image results, we divided the patients into two groups, negative or positive, and calculated the effective dose for each group. With these results, we estimated the LARs for the incidence of and the mortality from cancers by using the table in the Biologic Effects of Ionizing Radiation (BEIR)-VII report.
RESULTS
A total of 76 patients were enrolled. The mean age was 49.0+/-8.5 years. The mean injury severity score (ISS) was 12.7+/-8.4. The cumulative effective dose (CED) for individual patients varied from 2.8 mSv to 238.8 mSv, and the mean was 47.6+/-39.9 mSv. The CED in patients with an ISS> or =16(63.2+/-26.6 mSv) was higher than that of patients whose ISS<16(33.5+/-23.1 mSv) (p<0.001). The CED in patients who were treated with surgery or intervention(69.0+/-45.2 mSv) was higher than that of patients who were treated conservatively(33.6+/-22.4 mSv) (p<0.001). The LARs for cancer incidence and mortality were 328.5+/-308.6 and 189.0+/-159.3 per 100,000 people, respectively.
CONCLUSION
The CED and the LAR for trauma CP-activated patients in the ED were significant, so efforts should be made to decrease the effective dose received by severely injured patients.
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Summary
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