Extremity Trauma At a Level 1 Trauma Center
- Conditions
- Trauma BluntTrauma InjuryVascular Trauma
- Interventions
- Other: Packed Red Blood Cell Administration
- Registration Number
- NCT06402669
- Lead Sponsor
- Arrowhead Regional Medical Center
- Brief Summary
Blunt vascular trauma to the lower extremity has been associated with injuries to the anteroposterior tibial arteries or popliteal artery in the form of transection, occlusion, or intimal injury. With many blunt injuries resulting in orthopedic fractures, the incidence of limb loss increases substantial. Distal vascular injuries combined with complex orthopedic fractures are more likely to result in limb loss. A recent retrospective study showed two main predicative factors resulting in limb loss was a result of multi-segmental bone fractures and prolong ischemic time greater then 10 hours.
- Detailed Description
Extremity trauma continues to remain a notable cause for presentation to the emergency department for trauma-level care, with penetrating extremity injuries comprising 5 to 15% of trauma cases. In the setting of vascular extremity injury, appropriate care protocols must be established to prevent life threatening complications including infection, non-union, limb salvage failure, and death. The two primary mechanisms of extremity trauma include penetrating trauma involving projectile and stab injuries, as well as blunt trauma involving fractures and joint dislocations. While central or peripheral vascular injuries constitute 1-2% of traumatic injuries, they result in more than 20% of trauma-related mortality demonstrating the importance of timely and efficacious care of extremity trauma patients, with particular emphasis on vascular injury assessment. The health care facility settings in which patients present have significant implications in the level of care provided, as availability of diagnostic and therapeutic resources may be limited in some settings. In such circumstances, patients may be transferred to alternate care facilities for higher level of care, with timing of transfer playing a substantial role in successful trauma patient care.
While it is noted that the treatment of severely injured patients in higher level trauma centers allows for access to increased care resources and improved prognostic outcomes, the patient outcomes of trauma patients transferred from lower level to higher level trauma centers may not be as clear. With regards to interhospital patient transfers, there are established statewide trauma policies that guide "re-triage," which is defined as the urgent or emergent transfer of critically ill trauma patients from a non-trauma or lower level trauma facility to an upper level trauma center for higher level of care. The categories for re-triage consideration include perfusion, respiratory status, neurologic status, anatomic findings, and provider judgment. For example, anatomic findings that necessitate transfer to higher level of care facilities include extremity injury with neurovascular compromise. Important components of re-triage include early identification of patients who require higher levels of care as well as established transfer agreements between sending and receiving care facilities. Recognizing that patient transfers may impact overall health outcomes such that transferred extremity trauma patients may have worse clinical outcomes compared to non-transferred patients, the investigators aim to investigate the relationship between transfer status and patient outcomes through conducting a retrospective observational case-control review of extremity trauma patients.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 20000
- All patients aged 18 years or higher with blunt or penetrating extremity trauma injuries
- Pregnant females with blunt or penetrating extremity trauma injuries
- Catastrophic head injuries
- Individuals discharged from the hospital in the first 24 hours of being seen
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Direct Admission to Hospital Packed Red Blood Cell Administration Patients with blunt or penetrating trauma that are directly brought to level 1 trauma center Transferred from Outside Hospital Packed Red Blood Cell Administration Patients with blunt or penetrating trauma that are transferred from an outside hospital to admitting level 1 trauma center
- Primary Outcome Measures
Name Time Method Operative Cases Time frame is from admission to discharge and would be collected in the first 180 days. The total operative cases required for a patient
Length of total hospital stay Length of total hospital stay from admission in the hospital is defined as the time frame between admission and discharge. The time frame of collection until the event occurred was 180 days. The time spent hospitalized in days.
Mortality Measured in the first 30 days of admission Incidence of mortality associated with transfer status
Admission lactate levels he estimated period of time over which preoperative lactate levels are measured occur in the initial 2 hours after admission to the hospital Admission lactate levels were defined as the first measured lactate level on admission of an individual who presented as a trauma patient.
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (1)
Arrowhead Regional Medical Center
🇺🇸Colton, California, United States