Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb 24:48:e20202769.
doi: 10.1590/0100-6991e-20202769. eCollection 2021.

Trauma Quality Indicators' usage limitations in severe trauma patients

[Article in English, Portuguese]
Pedro DE Souza Lucarelli Antunes  1 , Paula Ribeiro LibÓrio  1 , Giovanna Mennitti Shimoda  1 , Luca Giovanni Antonio Pivetta  2 , JosÉ Gustavo Parreira  1   2 , Jose Cesar Assef  1   2
Affiliations

Trauma Quality Indicators' usage limitations in severe trauma patients

[Article in English, Portuguese]
Pedro DE Souza Lucarelli Antunes et al. Rev Col Bras Cir. .

Abstract
in English, Portuguese

Purpose: to analyze the relation between Trauma Quality Indicators (QI) and death, as well as clinical adverse events in severe trauma patients.

Methods: analysis of data collected in the Trauma Register between 2014-2015, including patients with Injury Severity Score (ISS) > 16, reviewing the QI: (F1) Acute subdural hematoma drainage > 4 hours with Glasgow Coma Scale (GCS) <9; (F2) emergency room transference without definitive airway and GCS <9; (F3) Re-intubation within 48 hours; (F4) Admission-laparotomy time greater than 60 min in hemodynamically instable patients with abdominal bleeding; (F5) Unprogrammed reoperation; (F6) Laparotomy after 4 hours; (F7) Unfixed femur diaphyseal fracture; (F8) Non-operative treatment for abdominal gunshot; (F9) Admission-tibial exposure fracture treatment time > 6 hours; (F10) Surgery > 24 hours. T the chi-squared and Fisher tests were used to calculate statistical relevance, considering p<0.05 as relevant.

Results: 127 patients were included, whose ISS ranged from 17 to 75 (28.8 + 11.5). There were adverse events in 80 cases (63%) and 29 died (22.8%). Twenty-six patients had some QI compromised (20.6%). From the 101 patients with no QI, 22% died, and 7 of 26 patients with compromised QI (26.9%) (p=0.595). From the patients with no compromised QI, 62% presented some adverse event. From the patients with any compromised QI, 18 (65.4%) had some adverse event on clinical evolution (p=0.751).

Conclusion: the QI should not be used as death or adverse events predictors in severe trauma patients.

Objetivo:: analisar relação entre comprometimento de Filtros de Qualidade (FQ) com complicações e mortalidade entre vítimas de trauma grave.

Métodos:: análise dos dados coletados para o Registro de Trauma entre 2014 e 2015, sendo incluídos os traumatizados com Injury Severity Score (ISS) > 16 e analisados os FQ: (F1) drenagem de Hematoma Subdural Agudo (HSA) > 4 horas com Escala de Coma de Glasgow (ECG) <9, (F2) transferência da sala de emergência sem via aérea definitiva e com ECG<9, (F3) reintubação traqueal em até 48 horas, (F4) tempo entre admissão e laparotomia exploradora maior que 60 minutos em pacientes instáveis com foco abdominal, (F5) reoperação não programada, (F6) laparotomia > 4 horas, (F7) fratura de diáfise de fêmur não fixada, (F8) tratamento não operatório em Ferimento por Arma de Fogo (FAF) abdominal, (F9) tempo entre admissão e tratamento de fraturas expostas de tíbia > 6 horas, (F10) operação > 24 horas. Testes de Chi quadrado e Fisher para a análise estatística, considerando significativo p<0,05, foram usados.

Resultado:: foram incluídos 127 pacientes com ISS entre 17 a 75 (28,8 + 11,5). As complicações ocorreram em 80 casos (63%) e 29 morreram (22,8%). Vinte e seis pacientes apresentaram algum FQ comprometido (20,6%). Dos 101 doentes sem FQ comprometido, 22% faleceram, o que ocorreu em 7 dos 26 doentes com comprometimento dos FQ (26,9%) (p=0,595). Dos doentes sem FQ comprometido, 62% tiveram alguma complicação. Entre os pacientes com FQ comprometido, 18 (65,4%) tiveram complicações (p=0,751).

Conclusão:: os FQs não devem ser utilizados como preditor de mortes ou complicações evitáveis nas vítimas de traumas graves.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: no.

Figures

Graph 1
Graph 1. Patients’ severity bases on Injurity Severity Score (ISS).
Graph 2
Graph 2. Pattern of body region’s injuries in the patients, based on AIS.
Graph 3
Graph 3. Trauma Quality Indicators commitment distribution, based on occurrence.
Graph 4
Graph 4. Comparative analysis of death among patients with compromised Trauma Quality Indicators and those with no commitment. The graph shows death in 22% of patients with no QI commitment, as well as in 26.9% of patients with compromised QI. This difference was not statistically significant (p=0.595).
Graph 5
Graph 5. Assessment of complications and compromised of QIs.
See this image and copyright information in PMC

References

    1. Parreira JG, Matar MR, Tôrres ALB, Perlingeiro JAG, Solda SC, Assef JC. Análise comparativa entre as lesões identificadas em vítimas de queda de altura e de outros mecanismos de trauma fechado. Rev Col Bras Cir. 2014;41(4):272–277. - PubMed
    1. Wang ZG. An overview of recent developments in the management and research of trauma. Ann Acad Med Singapore. 1997;26(1):54–59. - PubMed
    1. Viano DC, King AI, Melvin JW, Weber K. Injury biomechanics research an essential element in the prevention of trauma. J Biomech. 1989;22(5):403–417. - PubMed
    1. Fraga GP. Programas de Qualidade no Atendimento ao Trauma. Medicina, Ribeirão Preto. 2007;40(3):321–328.
    1. Teasdale G, Jennet B. Assessment of Coma and Impaired Consciousness A Practical Scale. Lancet. 1974;2(7872):81–84. - PubMed