Registry-Based Mortality Analysis Reveals a High Proportion of Patient Decrees and Presumed Limitation of Therapy in Severe Geriatric Trauma
Abstract
:1. Introduction
2. Experimental Section
Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
- Oyeniyi, B.; Fox, E.; Scerbo, M.; Tomasek, J.; Wade, C.; Holcomb, J. Trends in 1029 Trauma Deaths at a Level 1 Trauma Center. Injury 2018, 48, 5–12. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Faid, M.; Gleicher, D. Progress in the prevention of injuries in the WHO European Region Germany. World Health Organ. Eur. 2010, 80, 1–4. [Google Scholar]
- Störmann, P.; Wagner, N.; Köhler, K.; Auner, B.; Simon, T.-P.; Pfeifer, R.; Horst, K.; Pape, H.-C.; Hildebrand, F.; Wutzler, S.; et al. Monotrauma is associated with enhanced remote inflammatory response and organ damage, while polytrauma intensifies both in porcine trauma model. Eur. J. Trauma Emerg. Surg. 2020, 46, 31–42. [Google Scholar] [CrossRef] [PubMed]
- Malone, D.L.; Dunne, J.; Tracy, J.K.; Putnam, A.T.; Scalea, T.M.; Napolitano, L.M. Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. J. Trauma 2003, 52, 898–907. [Google Scholar] [CrossRef] [PubMed]
- Bouillon, B.; Kanz, K.G.; Lackner, C.K.; Mutschler, W.; Sturm, J. Die bedeutung des Advanced Trauma Life Support® (ATLS®) im schockraum. Unfallchirurg 2004, 107, 844–850. [Google Scholar] [CrossRef]
- Hack, J.; Buecking, B.; Lopez, C.L.; Ruchholtz, S.; Kühne, C.A. Patientenverfügung, Vorsorgevollmacht und gesetzliche Betreuung im unfallchirurgischen Alltag: Zahlen aus einem alterstraumatologischen Zentrum. Z. Gerontol. Geriatr. 2016, 49, 721–726. [Google Scholar] [CrossRef]
- Bundesgesundheitsministerium Patientenverfügung. Available online: https://www.bundesgesundheitsministerium.de/patientenverfuegung.html (accessed on 19 August 2020).
- Marzi, I. Quality improvement in trauma care. Eur. J. Trauma Emerg. Surg. 2013, 39, 1–2. [Google Scholar] [CrossRef] [Green Version]
- World Health Organization. Global status report on noncommunicable diseases. World Health Organ. 2010, 53, 1689–1699. [Google Scholar] [CrossRef]
- Klauber, J.; Gerardts, M.; Friedrich, J.; Wasem, J. Krankenhaus-Report Schwerpunkt: Patientensicherheit, 1st ed.; Schattauer: Stuttgart, Germany, 2014; ISBN 9783794567966. [Google Scholar]
- Öhrn, A. Measures of Patient Safety: Studies of Swedish Reporting Systems and Evaluation of an Intervention Aimed at Improved Patient Safety Culture; Linkoping University: Linkoping, Sweden, 2012; ISBN 9789173930437. [Google Scholar]
- Verbraucherschutz, B. für J. und Sozialgesetzbuch (SGB V) Fünftes Buch Gesetzliche Krankenversicherung. Available online: https://www.sozialgesetzbuch-sgb.de/sgbv/1.html (accessed on 17 April 2020).
- Tosic, B.; Ruso, J.; Filipovic, J. Quality Management in Health Care Principles and Methods. In Proceedings of the 3rd International Conference on Quality of Life, Kopaonik, Serbia, 28 November 2018; pp. 1–589. [Google Scholar]
- Nast-Kolb, D.; Ruchholtz, S. Qualitätsmanagement der frühen klinischen Behandlung schwerverletzter Patienten. Unfallchirurg 1999, 102, 337. [Google Scholar] [CrossRef] [Green Version]
- Wegscheider, K. Medizinische Register. In Bundesgesundheitsblatt-Gesundheitsforsch. Gesundheitsschutz; Springer: Berlin, Germany, 2004; Volume 47, pp. 416–421. [Google Scholar] [CrossRef]
- Workman, T.A. Engaging Patients in Information Sharing and Data Collection: The Role of Patient-Powered Registries and Research Networks; Agency for Healthcare Research and Quality (US): Rockville, MD, USA, 2013. [Google Scholar]
- DGU Traumaregister Das TraumaRegister DGU®. Available online: http://www.traumaregister-dgu.de/index.php?id=142 (accessed on 19 August 2020).
- Lefering, R.; Höfer, C. Jahresbericht 2019—TraumaRegister DGU®. Sekt. Notfall- Intensivmed. Schwerverletztenversorgung der Dtsch. Gesellschaft für Unfallchirurgie e.V. AUC Akad. Unfallchirurgie GmbH 2019, 2, 1–68. [Google Scholar]
- Haasper, C.; Junge, M.; Ernstberger, A.; Brehme, H.; Hannawald, L.; Langer, C.; Nehmzow, J.; Otte, D.; Sander, U.; Krettek, C.; et al. Die Abbreviated Injury Scale (AIS). Unfallchirurgie 2010, 113, 366–372. [Google Scholar] [CrossRef] [PubMed]
- Baker, S.P.; O’Neill, B.; Haddon, W.B.L. The Injury Severity Score. J. Trauma Inj. Infect. Crit. Care 1974, 14, 187–196. [Google Scholar] [CrossRef]
- Lefering, R.; Huber-Wagner, S.; Nienaber, U.; Maegele, M.; Bouillon, B. Update of the trauma risk adjustment model of the TraumaRegister DGUTM: The Revised Injury Severity Classification, version II. Crit. Care 2014, 18, 1–12. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- von Elm, E.; Altmann, D.G.; Egger, M.; Pocock, S.C.; Gøtzsche, P.C.; Vandenbroucke, J.P. Das Strengthening the Reporting of Observational Studies in Epidemiology (STROBE-) Statement. Internist 2008, 49, 688–693. [Google Scholar] [CrossRef] [Green Version]
- Benchimol, E.I.; Smeeth, L.; Guttmann, A.; Harron, K.; Moher, D.; Petersen, I.; Sørensen, H.T.; von Elm, E.; Langan, S.M. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement. PLoS Med. 2015, 12, e1001885. [Google Scholar] [CrossRef]
- Pape, H.C.; Hildebrand, F.; Ruchholtz, S. (Eds.) Management des Schwerverletzten; Springer: Berlin/Heidelberg, Germany, 2018; ISBN 978-3-662-54980-3. [Google Scholar]
- Marzi, I.R.S. Praxisbuch Polytrauma. Vom Unfall bis zur Rehabilitation; Deutscher Ärzte-Verlag: Köln, Germany, 2012; ISBN 978-3-7691-0479-0. [Google Scholar]
- Malkomes, P.; Störmann, P.; El Youzouri, H.; Wutzler, S.; Marzi, I.; Vogl, T.; Bechstein, W.O.; Habbe, N. Characteristics and management of penetrating abdominal injuries in a German level I trauma center. Eur. J. Trauma Emerg. Surg. 2019, 45, 315–321. [Google Scholar] [CrossRef]
- Kuhn-Régnier, S.; Stickel, M.; Link, B.C.; Fischer, H.; Babst, R.; Beeres, F.J.P. Trauma care in German-speaking countries: Have changes in the curricula led to changes in practice after 10 years? Eur. J. Trauma Emerg. Surg. 2019, 45, 309–314. [Google Scholar] [CrossRef]
- Yoong, S.; Kothari, R.; Brooks, A. Assessment of sensitivity of whole body CT for major trauma. Eur. J. Trauma Emerg. Surg. 2019, 45, 489–492. [Google Scholar] [CrossRef]
- Lansink, K.W.W.; Gunning, A.C.; Leenen, L.P.H. Cause of death and time of death distribution of trauma patients in a Level I trauma centre in the Netherlands. Eur. J. Trauma Emerg. Surg. 2013, 39, 375–383. [Google Scholar] [CrossRef]
- Yogi, R.R.; Sammy, I.; Paul, J.F.; Nunes, P.; Robertson, P.; Ramcharitar Maharaj, V. Falls in older people: Comparing older and younger fallers in a developing country. Eur. J. Trauma Emerg. Surg. 2018, 44, 567–571. [Google Scholar] [CrossRef]
- Nolan, J.P. Cardiac arrest: The science and practice of resuscitation medicine. Resuscitation 1997, 33, 283–284. [Google Scholar] [CrossRef]
- Zwingmann, J.; Lefering, R.; Feucht, M.; Südkamp, N.P.; Strohm, P.C.; Hammer, T. Outcome and predictors for successful resuscitation in the emergency room of adult patients in traumatic cardiorespiratory arrest. Crit. Care 2016, 20, 1–10. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Konesky, K.L.; Guo, W.A. Revisiting traumatic cardiac arrest: Should CPR be initiated? Eur. J. Trauma Emerg. Surg. 2018, 44, 903–908. [Google Scholar] [CrossRef] [PubMed]
- Lefering, R.; Bouillon, B.; Neugebauer, E. Traumascores: Ist der New ISS dem ISS überlegen? Zurück Zuk. 2003, 2003, 256–257. [Google Scholar] [CrossRef]
- Davis, R.A.; Cunningham, P.S. Prognostic factors in severe head injury. Surg Gynecol Obs. 1984, 159, 597–604. [Google Scholar]
- Oder, W. Zeitschrift für Erkrankungen des Nervensystems. J. Neurol. Neurochir. Psychiatr. 2013, 14, 55–63. [Google Scholar]
- Schmidt, B.R.; Moos, R.M.; Könü-Leblebicioglu, D.; Bischoff-Ferrari, H.A.; Simmen, H.P.; Pape, H.C.; Neuhaus, V. Higher age is a major driver of in-hospital adverse events independent of comorbid diseases among patients with isolated mild traumatic brain injury. Eur. J. Trauma Emerg. Surg. 2019, 45, 191–198. [Google Scholar] [CrossRef]
- Bäckström, D.; Larsen, R.; Steinvall, I.; Fredrikson, M.; Gedeborg, R.; Sjöberg, F. Deaths caused by injury among people of working age (18–64) are decreasing, while those among older people (64+) are increasing. Eur. J. Trauma Emerg. Surg. 2018, 44, 589–596. [Google Scholar] [CrossRef]
Median | (IQR) | % | ||
---|---|---|---|---|
Age (y) | 69 | (38–83) | Sex (male) | 71.1 |
ISS (pts) | 25 | (17–34) | AIShead ≥4 | 41.0 |
ISSrecalculated (pts) | 25 | (20–38) | ISS ≥16 | 84.4 |
NISS (pts) | 36 | (24–57) | ISS ≥25 | 71.1 |
RISC II Score (%) | 65 | (29–88) | ISS ≥50 | 16.3 |
AIShead (pts) | 4 | (2–5) | ||
AISface/neck (pts) | 0 | (0–0) | Internal cause of death | 18.7 |
AISthorax (pts) | 0 | (0–3) | ||
AISabdomen (pts) | 0 | (0–0) | ||
AISextremities (pts) | 0 | (0–2) | ||
AISsoft tissue (pts) | 0 | (0–1) | ||
GCSpreclinical (pts) | 3 | (3–8) | ||
GCSER (pts) | 3 | (3–4) | ||
ICU (d) | 2 | (0–4) | ||
ETI (d) | 2 | (1–4) |
Treatment | % | Damage Control | % |
---|---|---|---|
Preclinical CPR | 29.1 | Massive blood transfusion | 17.9 |
ETI | 46.9 | ||
Chest tubing | 5.3 | Chest tubing | 16.2 |
TXA | 11.4 | ICP | 26.9 |
craniotomy | 30.4 | ||
Primary admission | 91.9 | secondary | 4.5 |
Laparotomy/Packing | 11.9 | ||
Clinical CPR | 32.1 | ECMO | 4.5 |
KAT | 46.2 | Spine surgery | 1.5 |
ETI | 31.1 | ||
Therapy limitation | 71.6 | ||
Patient decree | 12.7 | ||
In consensus with relevant | 64.9 |
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Schindler, C.R.; Woschek, M.; Verboket, R.D.; Sturm, R.; Söhling, N.; Marzi, I.; Störmann, P. Registry-Based Mortality Analysis Reveals a High Proportion of Patient Decrees and Presumed Limitation of Therapy in Severe Geriatric Trauma. J. Clin. Med. 2020, 9, 2686. https://doi.org/10.3390/jcm9092686
Schindler CR, Woschek M, Verboket RD, Sturm R, Söhling N, Marzi I, Störmann P. Registry-Based Mortality Analysis Reveals a High Proportion of Patient Decrees and Presumed Limitation of Therapy in Severe Geriatric Trauma. Journal of Clinical Medicine. 2020; 9(9):2686. https://doi.org/10.3390/jcm9092686
Chicago/Turabian StyleSchindler, Cora Rebecca, Mathias Woschek, René Danilo Verboket, Ramona Sturm, Nicolas Söhling, Ingo Marzi, and Philipp Störmann. 2020. "Registry-Based Mortality Analysis Reveals a High Proportion of Patient Decrees and Presumed Limitation of Therapy in Severe Geriatric Trauma" Journal of Clinical Medicine 9, no. 9: 2686. https://doi.org/10.3390/jcm9092686