Skip to main content
Top
Published in: BMC Emergency Medicine 1/2021

Open Access 01-12-2021 | Thoracotomy | Research

Factors associated with survival in adult patients with traumatic arrest: a retrospective cohort study from US trauma centers

Authors: Abdel-Badih Ariss, Rana Bachir, Mazen El Sayed

Published in: BMC Emergency Medicine | Issue 1/2021

Login to get access

Abstract

Background

Traumatic arrests increasingly affect young adults worldwide with low reported survival rates. This study examines factors associated with survival (to hospital discharge) in traumatic arrests transported to US trauma centers.

Methods

This retrospective cohort study used the US National Trauma Databank 2015 dataset and included patients who presented to trauma centers with “no signs of life”. Univariate and bivariate analyses were done. Factors associated with survival were identified using multivariate regression analyses.

Results

The study included 5980 patients with traumatic arrests. Only 664 patients (11.1%) survived to hospital discharge. Patients were predominantly in age group 16–64 (84.6%), were mostly males (77.8%) and white (55.1%). Most were admitted to Level I (55.5%) or Level II trauma centers (31.6%). Injuries were mostly blunt (56.7%) or penetrating (39.3%). The median of the injury severity score (ISS) was 19 (interquartile range [IQR]: 9–30). Factors associated with decreased survival included: Age group ≥ 65 (Ref: 16–24), male gender, self-inflicted and other or undetermined types of injuries (Ref: assault), injuries to head and neck, injuries to torso and ISS ≥ 16 (Ref: < 16) and ED thoracotomy. While factors associated with increased survival included: All injury mechanisms (with the exception of motor vehicle transportation) (Ref: firearm), injuries to extremities or spine and back and all methods of coverage (Ref: self-pay).

Conclusion

Patients with traumatic arrests have poor outcomes with only 11.1% surviving to hospital discharge. Factors associated with survival in traumatic arrests were identified. These findings are important for devising injury prevention strategies and help guide trauma management protocols to improve outcomes in traumatic arrests.

Level of evidence

Level III.
Literature
2.
go back to reference Rhee P, Joseph B, Pandit V, Aziz H, Vercruysse G, Kulvatunyou N, Friese RS. Increasing trauma deaths in the United States. Ann Surg. 2014;260:13–21.CrossRef Rhee P, Joseph B, Pandit V, Aziz H, Vercruysse G, Kulvatunyou N, Friese RS. Increasing trauma deaths in the United States. Ann Surg. 2014;260:13–21.CrossRef
3.
go back to reference Shimazu S, Shatney CH. Outcomes of trauma patients with no vital signs on hospital admission. J Trauma. 1983;23:213–6.CrossRef Shimazu S, Shatney CH. Outcomes of trauma patients with no vital signs on hospital admission. J Trauma. 1983;23:213–6.CrossRef
4.
go back to reference Battistella FD, Nugent W, Owings JT, Anderson JT. Field triage of the pulseless trauma patient. Arch Surg. 1999;134:742–5; discussion 745–6. Battistella FD, Nugent W, Owings JT, Anderson JT. Field triage of the pulseless trauma patient. Arch Surg. 1999;134:742–5; discussion 745–6.
5.
go back to reference Ahmed N, Greenberg P, Johnson VM, Davis JM. Risk stratification of survival in injured patients with cardiopulmonary resuscitation within the first hour of arrival to trauma centre: retrospective analysis from the national trauma data bank. Emerg Med J. 2017;34:282–8.CrossRef Ahmed N, Greenberg P, Johnson VM, Davis JM. Risk stratification of survival in injured patients with cardiopulmonary resuscitation within the first hour of arrival to trauma centre: retrospective analysis from the national trauma data bank. Emerg Med J. 2017;34:282–8.CrossRef
6.
go back to reference Hopson LR, Hirsh E, Delgado J, Domeier RM, McSwain NE Jr, Krohmer J, National Association of EMS Physicians Standards and Clinical Practice Committee, American College of Surgeons Committee on Trauma. Guidelines for withholding or termination of resuscitation in prehospital traumatic cardiopulmonary arrest: a joint position paper from the National Association of EMS Physicians Standards and Clinical Practice Committee and the American College of Surgeons Committee on Trauma. Prehosp Emerg Care. 2003;7:141–6. Hopson LR, Hirsh E, Delgado J, Domeier RM, McSwain NE Jr, Krohmer J, National Association of EMS Physicians Standards and Clinical Practice Committee, American College of Surgeons Committee on Trauma. Guidelines for withholding or termination of resuscitation in prehospital traumatic cardiopulmonary arrest: a joint position paper from the National Association of EMS Physicians Standards and Clinical Practice Committee and the American College of Surgeons Committee on Trauma. Prehosp Emerg Care. 2003;7:141–6.
7.
go back to reference National Association of EMS Physicians, American College of Surgeons Committee on Trauma. Withholding of resuscitation for adult traumatic cardiopulmonary arrest. Prehosp Emerg Care. 2013;17:291. National Association of EMS Physicians, American College of Surgeons Committee on Trauma. Withholding of resuscitation for adult traumatic cardiopulmonary arrest. Prehosp Emerg Care. 2013;17:291.
8.
go back to reference Kleber C, Giesecke MT, Lindner T, Haas NP, Buschmann CT. Requirement for a structured algorithm in cardiac arrest following major trauma: epidemiology, management errors, and preventability of traumatic deaths in Berlin. Resuscitation. 2014;85:405–10.CrossRef Kleber C, Giesecke MT, Lindner T, Haas NP, Buschmann CT. Requirement for a structured algorithm in cardiac arrest following major trauma: epidemiology, management errors, and preventability of traumatic deaths in Berlin. Resuscitation. 2014;85:405–10.CrossRef
9.
go back to reference Moore HB, Moore EE, Burlew CC, Biffl WL, Pieracci FM, Barnett CC, Bensard DD, Jurkovich GJ, Fox CJ, Sauaia A. Establishing benchmarks for resuscitation of traumatic circulatory arrest: success-to-rescue and survival among 1708 patients. J Am Coll Surg. 2016;223:42–50.CrossRef Moore HB, Moore EE, Burlew CC, Biffl WL, Pieracci FM, Barnett CC, Bensard DD, Jurkovich GJ, Fox CJ, Sauaia A. Establishing benchmarks for resuscitation of traumatic circulatory arrest: success-to-rescue and survival among 1708 patients. J Am Coll Surg. 2016;223:42–50.CrossRef
10.
go back to reference Lai C-Y, Tsai S-H, Lin F-H, et al. Survival rate variation among different types of hospitalized traumatic cardiac arrest: a retrospective and nationwide study. Medicine (Baltimore). 2018;97:e11480.CrossRef Lai C-Y, Tsai S-H, Lin F-H, et al. Survival rate variation among different types of hospitalized traumatic cardiac arrest: a retrospective and nationwide study. Medicine (Baltimore). 2018;97:e11480.CrossRef
12.
go back to reference Huber-Wagner S, Lefering R, Qvick M, Kay MV, Paffrath T, Mutschler W, Kanz K-G, Working Group on Polytrauma of the German Trauma Society (DGU).Outcome in 757 severely injured patients with traumatic cardiorespiratory arrest. Resuscitation. 2007;75:276–85. Huber-Wagner S, Lefering R, Qvick M, Kay MV, Paffrath T, Mutschler W, Kanz K-G, Working Group on Polytrauma of the German Trauma Society (DGU).Outcome in 757 severely injured patients with traumatic cardiorespiratory arrest. Resuscitation. 2007;75:276–85.
13.
go back to reference Chen Y-C, Wu K-H, Hsiao K-Y, Hung M-S, Lai Y-C, Chen Y-S, Chang C-Y. Factors associated with outcomes in traumatic cardiac arrest patients without prehospital return of spontaneous circulation. Injury. 2019;50:4–9.CrossRef Chen Y-C, Wu K-H, Hsiao K-Y, Hung M-S, Lai Y-C, Chen Y-S, Chang C-Y. Factors associated with outcomes in traumatic cardiac arrest patients without prehospital return of spontaneous circulation. Injury. 2019;50:4–9.CrossRef
14.
go back to reference American College of Surgeons Committee on Trauma. (2015). ACS NTDB National Trauma Data Standard: Data Dictionary (2016 Admissions). American College of Surgeons Committee on Trauma. (2015). ACS NTDB National Trauma Data Standard: Data Dictionary (2016 Admissions).
15.
go back to reference Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. J Trauma. 1987;27:370–8.CrossRef Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. J Trauma. 1987;27:370–8.CrossRef
16.
go back to reference American College of Surgeons Committee on Trauma. National trauma databank user manual: NTDB research data set admission year 2006–2015. Chicago: American College of Surgeons; 2015. American College of Surgeons Committee on Trauma. National trauma databank user manual: NTDB research data set admission year 2006–2015. Chicago: American College of Surgeons; 2015.
18.
go back to reference Pickens JJ, Copass MK, Bulger EM. Trauma patients receiving CPR: predictors of survival. J Trauma. 2005;58:951–8.CrossRef Pickens JJ, Copass MK, Bulger EM. Trauma patients receiving CPR: predictors of survival. J Trauma. 2005;58:951–8.CrossRef
19.
go back to reference Tisherman SA. Salvage techniques in traumatic cardiac arrest: thoracotomy, extracorporeal life support, and therapeutic hypothermia. Curr Opin Crit Care. 2013;19(6):594–8.PubMed Tisherman SA. Salvage techniques in traumatic cardiac arrest: thoracotomy, extracorporeal life support, and therapeutic hypothermia. Curr Opin Crit Care. 2013;19(6):594–8.PubMed
20.
go back to reference Crewdson K, Lockey D. Mortality in traumatic cardiac arrest. Resuscitation. 2017;113:e21.CrossRef Crewdson K, Lockey D. Mortality in traumatic cardiac arrest. Resuscitation. 2017;113:e21.CrossRef
21.
go back to reference Loberg JA, Hayward RD, Fessler M, Edhayan E. Associations of race, mechanism of injury, and neighborhood poverty with in-hospital mortality from trauma: a population-based study in the Detroit metropolitan area. Medicine (Baltimore). 2018;97:e12606.CrossRef Loberg JA, Hayward RD, Fessler M, Edhayan E. Associations of race, mechanism of injury, and neighborhood poverty with in-hospital mortality from trauma: a population-based study in the Detroit metropolitan area. Medicine (Baltimore). 2018;97:e12606.CrossRef
22.
go back to reference Pape M, Giannakópoulos GF, Zuidema WP, et al. Is there an association between female gender and outcome in severe trauma? A multi-center analysis in the Netherlands. Scand J Trauma Resusc Emerg Med. 2019;27:16.CrossRef Pape M, Giannakópoulos GF, Zuidema WP, et al. Is there an association between female gender and outcome in severe trauma? A multi-center analysis in the Netherlands. Scand J Trauma Resusc Emerg Med. 2019;27:16.CrossRef
23.
go back to reference Barnard E, Yates D, Edwards A, Fragoso-Iñiguez M, Jenks T, Smith JE. Epidemiology and aetiology of traumatic cardiac arrest in England and Wales—a retrospective database analysis. Resuscitation. 2017;110:90–4.CrossRef Barnard E, Yates D, Edwards A, Fragoso-Iñiguez M, Jenks T, Smith JE. Epidemiology and aetiology of traumatic cardiac arrest in England and Wales—a retrospective database analysis. Resuscitation. 2017;110:90–4.CrossRef
24.
go back to reference Beck B, Bray JE, Cameron P, Straney L, Andrew E, Bernard S, Smith K. Predicting outcomes in traumatic out-of-hospital cardiac arrest: the relevance of Utstein factors. Emerg Med J. 2017;34:786–92.CrossRef Beck B, Bray JE, Cameron P, Straney L, Andrew E, Bernard S, Smith K. Predicting outcomes in traumatic out-of-hospital cardiac arrest: the relevance of Utstein factors. Emerg Med J. 2017;34:786–92.CrossRef
25.
go back to reference Stockinger ZT, McSwain NE Jr. Additional evidence in support of withholding or terminating cardiopulmonary resuscitation for trauma patients in the field. J Am Coll Surg. 2004;198:227–31.CrossRef Stockinger ZT, McSwain NE Jr. Additional evidence in support of withholding or terminating cardiopulmonary resuscitation for trauma patients in the field. J Am Coll Surg. 2004;198:227–31.CrossRef
26.
go back to reference Evans CCD, Petersen A, Meier EN, Buick JE, Schreiber M, Kannas D, Austin MA. Resuscitation Outcomes Consortium Investigators Prehospital traumatic cardiac arrest: management and outcomes from the resuscitation outcomes consortium epistry-trauma and PROPHET registries. J Trauma Acute Care Surg. 2016;81:285–93.CrossRef Evans CCD, Petersen A, Meier EN, Buick JE, Schreiber M, Kannas D, Austin MA. Resuscitation Outcomes Consortium Investigators Prehospital traumatic cardiac arrest: management and outcomes from the resuscitation outcomes consortium epistry-trauma and PROPHET registries. J Trauma Acute Care Surg. 2016;81:285–93.CrossRef
27.
go back to reference Hoyert DL, Kochanek KD, Murphy SL. Deaths: final data for 1997. Natl Vital Stat Rep. 1999;47:1–104.PubMed Hoyert DL, Kochanek KD, Murphy SL. Deaths: final data for 1997. Natl Vital Stat Rep. 1999;47:1–104.PubMed
28.
go back to reference Burt CW, Fingerhut LA. Injury visits to hospital emergency departments: United States, 1992–95. Vital and Health Statistics. 1998; Series 13, Data from the National Health Survey; no. 131; DHHS publication; no. (PHS) 98-1792. Burt CW, Fingerhut LA. Injury visits to hospital emergency departments: United States, 1992–95. Vital and Health Statistics. 1998; Series 13, Data from the National Health Survey; no. 131; DHHS publication; no. (PHS) 98-1792.
29.
go back to reference Beaman V, Annest JL, Mercy JA, Kresnow MJ, Pollock DA. Lethality of firearm-related injuries in the United States population. Ann Emerg Med. 2000;35:258–66.CrossRef Beaman V, Annest JL, Mercy JA, Kresnow MJ, Pollock DA. Lethality of firearm-related injuries in the United States population. Ann Emerg Med. 2000;35:258–66.CrossRef
30.
go back to reference Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006;60:S3-11.PubMed Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006;60:S3-11.PubMed
31.
go back to reference The ATLS Subcommittee, American College of Surgeons’, Committee on Trauma, and the International ATLS working group. Advanced trauma life support (ATLS®): The ninth edition. J Trauma Acute Care Surg. 2013;74:1363–6. The ATLS Subcommittee, American College of Surgeons’, Committee on Trauma, and the International ATLS working group. Advanced trauma life support (ATLS®): The ninth edition. J Trauma Acute Care Surg. 2013;74:1363–6.
32.
go back to reference Brown JB, Rosengart MR, Billiar TR, Peitzman AB, Sperry JL. Geographic distribution of trauma centers and injury-related mortality in the United States. J Trauma Acute Care Surg. 2016;80:42–9; discussion 49–50. Brown JB, Rosengart MR, Billiar TR, Peitzman AB, Sperry JL. Geographic distribution of trauma centers and injury-related mortality in the United States. J Trauma Acute Care Surg. 2016;80:42–9; discussion 49–50.
33.
go back to reference Branas CC, MacKenzie EJ, Williams JC, Schwab CW, Teter HM, Flanigan MC, Blatt AJ, ReVelle CS. Access to trauma centers in the United States. JAMA. 2005;293:2626–33.CrossRef Branas CC, MacKenzie EJ, Williams JC, Schwab CW, Teter HM, Flanigan MC, Blatt AJ, ReVelle CS. Access to trauma centers in the United States. JAMA. 2005;293:2626–33.CrossRef
34.
go back to reference Greene WR, Oyetunji TA, Bowers U, Haider AH, Mellman TA, Cornwell EE, Siram SM, Chang DC. Insurance status is a potent predictor of outcomes in both blunt and penetrating trauma. Am J Surg. 2010;199:554–7.CrossRef Greene WR, Oyetunji TA, Bowers U, Haider AH, Mellman TA, Cornwell EE, Siram SM, Chang DC. Insurance status is a potent predictor of outcomes in both blunt and penetrating trauma. Am J Surg. 2010;199:554–7.CrossRef
Metadata
Title
Factors associated with survival in adult patients with traumatic arrest: a retrospective cohort study from US trauma centers
Authors
Abdel-Badih Ariss
Rana Bachir
Mazen El Sayed
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Thoracotomy
Published in
BMC Emergency Medicine / Issue 1/2021
Electronic ISSN: 1471-227X
DOI
https://doi.org/10.1186/s12873-021-00473-9

Other articles of this Issue 1/2021

BMC Emergency Medicine 1/2021 Go to the issue