title: Predictors of mortality and prehospital monitoring limitations in blunt trauma patients.
abstract: This study aimed at determining predictors of in-hospital mortality and prehospital monitoring limitations in severely injured intubated blunt trauma patients. We retrospectively reviewed patients' charts. Prehospital vital signs, Injury Severity Score (ISS), initial Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), arterial blood gases, and lactate were compared in two study groups: survivors (n = 40) and nonsurvivors (n = 30). There were no significant differences in prehospital vital signs between compared groups. Nonsurvivors were older (P = 0.006), with lower initial GCS (P < 0.001) and higher ISS (P < 0.001), along with higher lactate (P < 0.001) and larger base deficit (BD; P = 0.006), whereas RTS (P = 0.001) was lower in nonsurvivors. For predicting mortality, area under the curve (AUC) was calculated: for lactate 0.82 (P < 0.001), for ISS 0.82 (P < 0.001), and for BD 0.69 (P = 0.006). Lactate level of 3.4 mmol/L or more was 82% sensitive and 75% specific for predicting in-hospital death. In a multivariate logistic regression model, ISS (P = 0.037), GCS (P = 0.033), and age (P = 0.002) were found to be independent predictors of in-hospital mortality. The AUC for regression model was 0.93 (P < 0.001). Increased levels of lactate and BD on admission indicate more severe occult hypoperfusion in nonsurvivors whereas vital signs did not differ between the groups.
authors.affiliation: Prehospital Unit, Center for Emergency Medicine, Community Health Center Maribor, Ulica Talcev 9, SI-2000 Maribor, Slovenia ; Medical Faculty, University of Maribor, Taborska Ulica 8, SI-2000 Maribor, Slovenia.
authors.forename: Matej
authors.identifier: 0000-0002-4505-557X
authors.initials: M
authors.lastname: Strnad
authors.affiliation: Prehospital Unit, Center for Emergency Medicine, Community Health Center Maribor, Ulica Talcev 9, SI-2000 Maribor, Slovenia.
authors.forename: Vesna Borovnik
authors.initials: VB
authors.lastname: Lesjak
authors.affiliation: Prehospital Unit, Center for Emergency Medicine, Community Health Center Maribor, Ulica Talcev 9, SI-2000 Maribor, Slovenia.
authors.forename: Vitka
authors.initials: V
authors.lastname: Vujanović
authors.affiliation: Prehospital Unit, Center for Emergency Medicine, Community Health Center Maribor, Ulica Talcev 9, SI-2000 Maribor, Slovenia.
authors.forename: Tine
authors.initials: T
authors.lastname: Pelcl
authors.affiliation: Medical Faculty, University of Maribor, Taborska Ulica 8, SI-2000 Maribor, Slovenia ; Faculty of Health Sciences, University of Maribor, Žitna Ulica 15, SI-2000 Maribor, Slovenia.
authors.forename: Miljenko
authors.initials: M
authors.lastname: Križmarić
mesh_terms: D000328:Adult; D000368:Aged; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017524:Slovenia / Q000453:epidemiology; D015996:Survival Rate; D055986:Vital Signs; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D055815:Young Adult