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2 "Biomarkers"
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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
  • 2,976 View
  • 137 Download
AbstractAbstract PDFSupplementary 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
  • 6,593 View
  • 205 Download
  • 11 Citations
AbstractAbstract PDF
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  
  • Evaluation of the role of repeated inferior vena cava sonography in estimating first 24 h fluid requirement in resuscitation of major blunt trauma patients in emergency department Suez Canal University Hospital
    Rasha Mahmoud Ahmed, Bassant Sayed Moussa, Mohamed Amin Ali, Aml Ibrahiem Sayed Ahmed Abo El Sood, Gouda Mohamed El Labban
    BMC Emergency Medicine.2024;[Epub]     CrossRef
  • Prehospital Delta Shock Index Predicts Mortality and Need for Life Saving Interventions in Trauma Patients
    Philip W. Walker, James F. Luther, Stephen R. Wisniewski, Joshua B. Brown, Ernest E. Moore, Martin Schreiber, Bellal Joseph, Chad T. Wilson, Brian G. Harbrecht, Daniel G. Ostermayer, Bryan Cotton, Richard Miller, Mayur Patel, Christian Martin-Gill, Jason
    Prehospital Emergency Care.2024; : 1.     CrossRef
  • Association of Shock Index and Modified Shock Index with Mortality Rate in Emergency Department Trauma Patient
    Areej Zehra, Farah Ahmed, Yasmeen Fatima Zaidi, Umaima Khan, Rabia Rauf, Samina Mohyuddin
    Pakistan Journal of Health Sciences.2024; : 134.     CrossRef
  • Delta shock index predicts injury severity, interventions, and outcomes in trauma patients: A 10-year retrospective observational study
    Mohammad Asim, Ayman El-Menyar, Khalid Ahmed, Mushreq Al-Ani, Saji Mathradikkal, Abubaker Alaieb, Abdel Aziz Hammo, Ibrahim Taha, Ahmad Kloub, Hassan Al-Thani
    World Journal of Critical Care Medicine.2024;[Epub]     CrossRef
  • 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
  • Outcomes of Trauma Patients Present to the Emergency Department with a Shock Index of ≥1.0
    Sharfuddin Chowdhury, P. J. Parameaswari, Luke Leenen
    Journal of Emergencies, Trauma, and Shock.2022; 15(1): 17.     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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