Page 115 - JSOM Winter 2022

Univariate analysis showed nonsurvivors had a higher ISS [0.36%] versus 9 [0.2%]; p = .035), sepsis (9 [0.07%] versus
(34.7 versus 27.4, p = .010) and were more likely to have an 15 [0.33%]; p < .001), cardiac arrest (7 [0.05%] versus 14
explosion as the MOI (90% versus 33%; p = .035) (Table 1). [0.31%]; p < .001), acute kidney injury (AKI), and pulmonary
Spinal injury (Abbreviated Injury Score Body Region 6) was embolism (PE)/deep vein thrombosis (DVT) (39 [0.28%] ver-
more common in nonsurvivors as well (Table 1). sus 5 [0.11%]; p = .012) were all more common in nonsurvi-
vors versus survivors (Table 3).
Table 2 looks at initial presentation clinical variables and pa-
rameters. Survivors had higher mean GCS scores (12.8 ± 3.7 TABLE 3 Rates of Complications in Study Cohort
versus 8.5 ± 5.6; p < .001), higher mean temperature (100.6 ± Survivors, n Nonsurvivors,
1.7°F versus 94.5 ± 16.8°F; p < .001), lower maximum inter- Complications (%) n (%) p Value
national normalized ratio (INR) (1.5 ± 0.5 versus 1.9 ± 1.0; p Pneumonia 49 (0.36%) 15 (0.33%) .766
= .02), and lower Paco (44.5mmHg ± 5.3 versus 47.9mmHg Pneumothorax 36 (0.26%) 9 (0.2%) .389
2
± 5.5; p = .012) compared to nonsurvivors (Table 2). Addi- Pleural effusion 59 (0.43%) 12 (0.27%) .046
tionally, nonsurvivors had a higher minimum INR (1.3 ± 0.2
versus 1.1 ± 0.2; p < .001), lower platelet count (129.2 ± 103.8 Pulmonary edema 50 (0.36%) 9 (0.2%) .035
versus 200.9 ± 202; p = .016), lower pH (7.2 ± 0.1 versus 7.3 ± Sepsis 9 (0.07%) 15 (0.33%) <.001
0.1; p = .014), and higher mean base deficit (–9.1 ± 8.4 versus AKI 15 (0.11%) 18 (0.4%) <.001
–3 ± 7.4; p < .001) compared to survivors. Cardiac arrest 7 (0.05%) 14 (0.31%) <.001
PE/DVT 39 (0.28%) 5 (0.11%) .012
Table 2 also displays data on survival and blood product PE = pulmonary embolism, DVT = deep vein thrombosis.
transfusion. No data on time of transfusion from point of
injury were available. There was no difference in total IVF, The multivariate logistic regression model for mortality
whole blood, or packed red blood cells (pRBCs) between demonstrated an increased odds of death for increased ISS
survivors and nonsurvivors. However, nonsurvivors received (odds ratio [OR] = 1.05 [1.01, 1.11]), lowest measured Paco 2
more platelets and fresh frozen plasma (FFP) (Table 2). Differ- in the emergency department (ED) (OR = 1.20 [1.06, 1.35]),
ence in mean number of units for survivors and nonsurvivors lowest base deficit (OR = 0.92 [0.85, 0.99]), and lower best
was statistically significant for FFP (10.26 ± 15.6 versus 36.04 GCS (OR = 0.89 [0.79, 1.00]) for values recorded on initial
± 77.22; p = .042) and platelets (2.3 ± 5.04 versus 12 ± 29.2; evaluation in the ED.
p = .003).
To account for changes in clinical practice across time, we also
Complications in the first 24 hours were not associated with analyzed a death cohort. This is because as clinical practice
survival (Table 3). In fact, the incidence of pleural effusion (59 guidelines change and adapt, there could have been an impact
[0.43%] versus 12 [0.27%]; p = .046), pulmonary edema (50 on ARDS outcomes. We evaluated 175 patients who died from

TABLE 2 Mortality Analysis Based on Factors Captured in Emergency Department and Blood Products Used
Survivors Nonsurvivors
Factor N Mean ± SD N Mean ± SD p Value
Min respiratory rate 109 18.3 ± 6.6 28 19.7 ± 6.7 .260
Max respiratory rate 109 23.1 ± 8 28 22.8 ± 9.1 .777
Min systolic BP 136 104.7 ± 16.3 41 104 ± 20.6 .757
Min diastolic BP 136 54.5 ± 11 41 58.1 ± 11.6 .148
Min Sao 119 95.6 ± 5.6 28 95.1 ± 5.3 .421
2
Best GCS score 134 12.8 ± 3.7 45 8.5 ± 5.6 <.001
Max pulse rate 137 123.9 ± 21.5 44 129.3 ± 26.8 .075
Max temperature 135 100.6 ± 1.7 39 94.5 ± 16.8 <.001
Min INR 113 1.1 ± 0.2 30 1.3 ± 0.2 <.001
Max INR 113 1.5 ± 0.5 30 1.9 ± 1.0 .020
Min hematocrit 116 29 ± 5.4 30 31.2 ± 9.4 .198
Min platelet count 116 200.9 ± 202 30 129.2 ± 103.8 .016
Min pH 105 7.3 ± 0.1 29 7.2 ± 0.1 .014
Min base deficit 104 –3 ± 7.4 29 –9.1 ± 8.4 <.001
Max Paco 84 44.5 ± 5.3 23 47.9 ± 5.5 .012
2
Blood Products Used (Mean ± SD)
Whole blood 137 1.77 ± 5.97 45 9.68 ± 36.21 .654
PRBCs 137 16.71 ± 24.55 45 41.63 ± 78.01 .191
Platelets 137 2.3 ± 5.04 45 12 ± 29.2 .003
FFP 137 10.26 ± 15.6 46 36.04 ± 77.22 .042
Crystalloids in first 24 hours 137 5,110 ± 6,620 45 7,157 ± 10,135 .210
Colloids in first 24 hours 137 252 ± 526 45 1,816 ± 8,341 .216
SD = standard deviation, BP = blood pressure, GCS = Glasgow Coma Scale, Sao = oxygen saturation, INR = international normalized ratio,
2
Paco = partial pressure of carbon dioxide, PRBC = packed red blood cell, FFP = fresh frozen plasma.
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