A mathematical program to predict survival and to support initial therapeutic decisions for trauma patients with long-bone and pelvic fractures.
OBJECTIVE
To test a mathematical program to monitor early haemodynamic patterns of patients with fractures, predict survival and support initial therapeutic decisions.


METHODS
A mathematical search and display program based on non-invasive haemodynamic monitoring was used to study 430 consecutively monitored patients with fractures during the first 48 h after admission to the emergency department of an inner city public hospital. We studied four types of fractures: simple extremity fractures, long-bone fractures, pelvic fractures and fractures incidental to severe trauma. The program continuously displayed haemodynamic patterns and predicted survival probability (SP), which was evaluated by the actual outcome at hospital discharge. The program also assessed the effectiveness of therapies according to haemodynamic responses.


RESULTS
The cardiac index, heart rate, mean arterial pressure, arterial saturation and transcutaneous oxygen tensions at the initial resuscitation were significantly higher in survivors than in non-survivors. After the first 48 h, the haemodynamic patterns were more influenced by fever, sepsis, complications and organ failures. The calculated survival probability averaged 81%+/-18% in the first 48 h for survivors and 72%+/-20% for non-survivors.


CONCLUSIONS
Early continuous non-invasive haemodynamic monitoring using the proposed information system is helpful in predicting outcome and guiding therapy for patients with fractures.
Lu
Kevin
K
Department of Surgery, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, 1200 N State Street, Los Angeles, CA 90033, USA.
Shoemaker
William C
WC
Wo
Charles C J
CC
Lee
Jackson
J
Demetriades
Demetrios
D
D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006620:Hip Fractures / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D006810:Humeral Fractures / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009102:Multiple Organ Failure / Q000401:mortality / Q000503:physiopathology; D011336:Probability; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D016019:Survival Analysis; D013978:Tibial Fractures / Q000401:mortality* / Q000503:physiopathology; D016896:Treatment Outcome