- 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
- Application of Critical Pathway in Trauma Patients
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Hongjin Shim, Ji Yong Jang, Jae Gil Lee, Seonghwan Kim, Min Joung Kim, You Seok Park, Inchel Park, Seung Ho Kim
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J Trauma Inj. 2012;25(4):159-165.
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Abstract
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- PURPOSE
For trauma patients, an early-transport and an organized process which are not delayed in hospital stage are necessary. Our hospital developed a procedure, the trauma Critical Pathway (CP), through which a traumatic patient has the priority over other patients, which makes the diagnostic and the therapeutic processes faster than they are for other patients.
METHODS
The records of patients to whom Trauma CP were applied from January 1, 2011 through April 15. 2012. were reviewed. We checked several time intervals from ER visiting to decision of admission-department, to performing first CT, to applying angio-embolization, to starting emergency operation and to discharging from ER. In addition, outcomes such as duration of ICU stay, hospital stay and mortality were checked and analyzed.
RESULTS
The trauma CP was applied to a total of 143 patients, of whom, 48 patients were excluded due to pre-hospital death, ER death, transferring to other hospital and not severe injury. Thus 95 patients (male 64, 67.3%) were enrolled in this study. Fifty-nine patients(62.1%) were injured by the traffic accident. The mortality rate was 10.5% and the mean Revised Trauma Score (RTS) of the patients was 6.4+/-2.0. After visiting ER, decision making for admission was completed, on average, in 3 hours 10 seconds. The mean time intervals for the first CT, angio-embolization, surgery and discharge were 1 hour 20 minutes, 5 hours 16 minutes, 7 hours 26 minutes and 6 hours 13 minutes, respectively.
CONCLUSION
The trauma CP did not show the improvement of time interval outcome, as well as mortality rate. However, this test did show that the trauma CP might be able to reduce delays in procedures for managing trauma patients at the university-based hospitals. To find out the benefit of CP protocol, a large scaled data is required.
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Summary
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