Systolic blood pressure below 110 mmHg is associated with increased mortality in penetrating major trauma patients: Multicentre cohort study
Trauma Audit and Research Network, Health Sciences Research Group, School of Community Based Medicine, Manchester Academic Health Sciences Centre, University of Manchester, Salford Royal Hospital, Stott Lane, Salford M6 8HD, UK. Resuscitation
(Impact Factor: 4.17).
11/2011; 83(4):476-81. DOI: 10.1016/j.resuscitation.2011.10.018
Non-invasive systolic blood pressure (SBP) measurement is a commonly used triaging tool for trauma patients. A SBP of <90mmHg has represented the threshold for hypotension for many years, but recent studies have suggested redefining hypotension at lower levels. We therefore examined the association between SBP and mortality in penetrating trauma patients.
We conducted a prospective cohort study in adult (≥16 years) penetrating trauma patients. Patients were admitted to hospitals belonging to the Trauma Audit and Research Network (TARN) between 2000 and 2009. The main outcome measure was the association between SBP and mortality at 30 days. Multivariate logistic regression models adjusted for the influence of age, gender, Injury Severity Score (ISS) and Glasgow Coma Score (GCS) on mortality were used.
3444 patients with a median age of 30 years (IQR 22.5-41.4), SBP of 126mmHg (IQR 107-142), ISS of 9 (IQR 9-14) and GCS of 15 (IQR 15-15), were analysed. Multivariable logistic regression analysis adjusted for age, gender, severity of injury and level of consciousness showed a cut-off for SBP at <110mmHg, after which increased mortality was observed. Compared with the reference group with SBP 110-129mmHg, mortality was doubled at SBP 90-109mmHg, was four-fold higher at 70-89mmHg and 10-fold higher at <70mmHg. SBP values ≥150mmHg were associated with decreased mortality.
We recommend that penetrating trauma patients with a SBP<110mmHg are triaged to resuscitation areas within dedicated, appropriately specialised, high-level care trauma centres.
Available from: I-Kuan Wang
- "A multivariate Cox regression analysis (Table
5) confirmed that hypotension, respiratory failure, coma, and QTc prolongation were significant risk factors for mortality after organophosphate poisoning. The associations between both hypotension
 and coma with mortality were not surprising because both are important vital signs, irrespective of the cause of disease. Similarly, it was not surprising to find an association between respiratory failure and mortality because respiratory failure is a prominent feature of acute organophosphate poisoning with an early central apnea followed by later pulmonary effects
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ABSTRACT: We investigated the mortality rates of patients with and without diabetes mellitus after acute large-dose exposure to organophosphate insecticides. All patients without diabetes mellitus were traced to examine the long-term risk of new-onset diabetes mellitus. Previous reports indicated that organophosphate exposure might increase the risk of new-onset diabetes mellitus.
We analyzed the records of 118 patients referred to Chang Gung Memorial Hospital for management of intentional organophosphate poisoning between 2000 and 2011. Patients were stratified by diabetes mellitus status. Demographic, clinical, laboratory and mortality data were analyzed.
Most patients were middle aged (53.45 +/- 16.20 years) and male (65.3%) and were referred to our hospital after a relatively short amount of time had elapsed since poisoning (median 3.0 hours). 18 (15.2%) of 118 patients died, including 15 (13.8%) of 109 patients without diabetes mellitus and 3 (33.3%) of 9 with diabetes mellitus. There was no significant difference in mortality between these groups (P = 0.117). In a multivariate Cox regression model, hypotension (P = 0.000), respiratory failure (P = 0.042), coma (P = 0.023), and corrected QT interval prolongation (P = 0.002) were significant risk factors for mortality. Conversely, diabetes mellitus status was not a significant variable in this model. At routine outpatient follow up a median of 1.25 months post exposure, random blood glucose measurements gave no evidence of new-onset diabetes in patients without pre-existing diabetes.
Diabetes mellitus status might not increase mortality risk following acute large-dose exposure to organophosphates, and the risk of new-onset diabetes mellitus also might be minimal in the short term. Larger prospective studies with formal testing for diabetes at later times post-exposure are required.
Available from: Tzung-Hai Yen
- "Finally, multivariate Cox regression analysis confirmed that hypotension (P = 0.000), respiratory failure (P = 0.042), coma (P = 0.023), and QTc prolongation (P = 0.002) were significant risk factors for mortality after organophosphate poisoning. The associations between both hypotension  and coma with mortality are not surprising, because both are important vital signs, irrespective of the cause of disease. Similarly, it is not surprising to find an association between respiratory failure and mortality because respiratory failure is a prominent feature of acute organophosphate poisoning with an early central apnea followed by later pulmonary effects . "
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ABSTRACT: In this study, we investigated the outcomes for patients with intentional organophosphate poisoning. Previous reports indicate that in contrast to normal heart rate-corrected QT intervals (QTc), QTc prolongation might be indicative of a poor prognosis for patients exposed to organophosphates.
We analyzed the records of 118 patients who were referred to Chang Gung Memorial Hospital for management of organophosphate poisoning between 2000 and 2011. Patients were grouped according to their initial QTc interval, i.e., normal (<0.44 s) or prolonged (>0.44 s). Demographic, clinical, laboratory, and mortality data were obtained for analysis.
The incidence of hypotension in patients with prolonged QTc intervals was higher than that in the patients with normal QTc intervals (P = 0.019). By the end of the study, 18 of 118 (15.2%) patients had died, including 3 of 75 (4.0%) patients with normal QTc intervals and 15 of 43 (34.9%) patients with prolonged QTc intervals. Using multivariate-Cox-regression analysis, we found that hypotension (OR = 10.930, 95% CI = 2.961-40.345, P = 0.000), respiratory failure (OR = 4.867, 95% CI = 1.062-22.301, P = 0.042), coma (OR = 3.482, 95% CI = 1.184-10.238, P = 0.023), and QTc prolongation (OR = 7.459, 95% CI = 2.053-27.099, P = 0.002) were significant risk factors for mortality. Furthermore, it was revealed that non-survivors not only had longer QTc interval (503.00±41.56 versus 432.71±51.21 ms, P = 0.002), but also suffered higher incidences of hypotension (83.3 versus 12.0%, P = 0.000), shortness of breath (64 versus 94.4%, P = 0.010), bronchorrhea (55 versus 94.4%, P = 0.002), bronchospasm (50.0 versus 94.4%, P = 0.000), respiratory failure (94.4 versus 43.0%, P = 0.000) and coma (66.7 versus 11.0%, P = 0.000) than survivors. Finally, Kaplan-Meier analysis demonstrated that cumulative mortality was higher among patients with prolonged QTc intervals than among those with normal QTc intervals (Log-rank test, Chi-square test = 20.36, P<0.001).
QTc interval helps predict mortality after intentional organophosphate poisoning.
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ABSTRACT: The aim of this paper is to investigate MFD estimation methods from traffic states observations. To eliminate all the experimental bias, traffic situations will be determined from a simulation tool that encompasses an equilibrium model (the LWR model). Three methods will be compared: (i) the analytical method that provides the upper bound of the MFD, (ii) the “production” method that requires vehicles trajectories and (iii) the “loop detector” method that aggregates flow, speed and occupancy observations. This latter method will be thoroughly examined to quantify the impact of loop detector positions (spatial distribution, distance from traffic signals …) and of heterogeneities in traffic states. Recommendations will finally be drawn to improve the global understanding on MFD and to better define methods to calibrate them.
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