Admission hyperglycemia is associated with different outcomes after blunt versus penetrating trauma

Jonathan P. Meizoso, Juliet J. Ray, Charles A. Karcutskie, Laura F. Teisch, Casey J. Allen, Nicholas Namias, Carl I Schulman, Kenneth G Proctor

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Stress-induced hyperglycemia is associated with worse outcomes after trauma; however, the effect of mechanism of injury has not been studied. To fill this gap, we tested the hypothesis that blunt and penetrating trauma evoke different glycemic responses which are associated with different outcomes. Materials and methods A retrospective cohort study comparing adults with blunt (n = 835) or penetrating trauma (n = 858) and admission glucose levels ≥ 106 mg/dL, ≥150 mg/dL, and ≥200 mg/dL at a level 1 trauma center from 02, 2011 to 08, 2013. Primary outcomes were mortality and infectious complications. Results For all patients, mean Injury Severity Score was 14 ± 12, with 10% (n = 162) infections and 6% (n = 102) mortality. Median admission glucose was 122 mg/dL (102-154 mg/dL). Hyperglycemia was associated with infections, length of stay, and mortality (all P < 0.01). Ten percent had an admission glucose ≥200 mg/dL, which was associated with infections after blunt trauma (odds ratio [OR], 2.28; 95% CI, 1.16-4.47; P = 0.017) but not penetrating trauma. Hyperglycemia was not an independent predictor of mortality in blunt trauma. In contrast, glucose ≥150 mg/dL (OR, 2.58; 95% CI, 1.13-5.89; P = 0.025) and ≥200 mg/dL (OR, 2.98; 95% CI, 1.27-6.98; P = 0.012) both predicted mortality in penetrating trauma patients. Conclusions This is the first study to show that hyperglycemia is associated with fundamentally different outcomes after blunt versus penetrating trauma. Patients who died were 4-8 times more likely to have hyperglycemia and penetrating, not blunt, trauma. Incorporation of hyperglycemia in injury scoring systems might improve outcome predictions after trauma.

Original languageEnglish (US)
Pages (from-to)83-89
Number of pages7
JournalJournal of Surgical Research
Volume206
Issue number1
DOIs
StatePublished - Nov 1 2016

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Hyperglycemia
Wounds and Injuries
Mortality
Glucose
Odds Ratio
Infection
Injury Severity Score
Trauma Centers
Length of Stay
Cohort Studies
Retrospective Studies

Keywords

  • Blunt trauma
  • Glucose
  • Hyperglycemia
  • Mortality
  • Penetrating trauma

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Admission hyperglycemia is associated with different outcomes after blunt versus penetrating trauma. / Meizoso, Jonathan P.; Ray, Juliet J.; Karcutskie, Charles A.; Teisch, Laura F.; Allen, Casey J.; Namias, Nicholas; Schulman, Carl I; Proctor, Kenneth G.

In: Journal of Surgical Research, Vol. 206, No. 1, 01.11.2016, p. 83-89.

Research output: Contribution to journalArticle

Meizoso, Jonathan P. ; Ray, Juliet J. ; Karcutskie, Charles A. ; Teisch, Laura F. ; Allen, Casey J. ; Namias, Nicholas ; Schulman, Carl I ; Proctor, Kenneth G. / Admission hyperglycemia is associated with different outcomes after blunt versus penetrating trauma. In: Journal of Surgical Research. 2016 ; Vol. 206, No. 1. pp. 83-89.
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abstract = "Background Stress-induced hyperglycemia is associated with worse outcomes after trauma; however, the effect of mechanism of injury has not been studied. To fill this gap, we tested the hypothesis that blunt and penetrating trauma evoke different glycemic responses which are associated with different outcomes. Materials and methods A retrospective cohort study comparing adults with blunt (n = 835) or penetrating trauma (n = 858) and admission glucose levels ≥ 106 mg/dL, ≥150 mg/dL, and ≥200 mg/dL at a level 1 trauma center from 02, 2011 to 08, 2013. Primary outcomes were mortality and infectious complications. Results For all patients, mean Injury Severity Score was 14 ± 12, with 10{\%} (n = 162) infections and 6{\%} (n = 102) mortality. Median admission glucose was 122 mg/dL (102-154 mg/dL). Hyperglycemia was associated with infections, length of stay, and mortality (all P < 0.01). Ten percent had an admission glucose ≥200 mg/dL, which was associated with infections after blunt trauma (odds ratio [OR], 2.28; 95{\%} CI, 1.16-4.47; P = 0.017) but not penetrating trauma. Hyperglycemia was not an independent predictor of mortality in blunt trauma. In contrast, glucose ≥150 mg/dL (OR, 2.58; 95{\%} CI, 1.13-5.89; P = 0.025) and ≥200 mg/dL (OR, 2.98; 95{\%} CI, 1.27-6.98; P = 0.012) both predicted mortality in penetrating trauma patients. Conclusions This is the first study to show that hyperglycemia is associated with fundamentally different outcomes after blunt versus penetrating trauma. Patients who died were 4-8 times more likely to have hyperglycemia and penetrating, not blunt, trauma. Incorporation of hyperglycemia in injury scoring systems might improve outcome predictions after trauma.",
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AU - Meizoso, Jonathan P.

AU - Ray, Juliet J.

AU - Karcutskie, Charles A.

AU - Teisch, Laura F.

AU - Allen, Casey J.

AU - Namias, Nicholas

AU - Schulman, Carl I

AU - Proctor, Kenneth G

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N2 - Background Stress-induced hyperglycemia is associated with worse outcomes after trauma; however, the effect of mechanism of injury has not been studied. To fill this gap, we tested the hypothesis that blunt and penetrating trauma evoke different glycemic responses which are associated with different outcomes. Materials and methods A retrospective cohort study comparing adults with blunt (n = 835) or penetrating trauma (n = 858) and admission glucose levels ≥ 106 mg/dL, ≥150 mg/dL, and ≥200 mg/dL at a level 1 trauma center from 02, 2011 to 08, 2013. Primary outcomes were mortality and infectious complications. Results For all patients, mean Injury Severity Score was 14 ± 12, with 10% (n = 162) infections and 6% (n = 102) mortality. Median admission glucose was 122 mg/dL (102-154 mg/dL). Hyperglycemia was associated with infections, length of stay, and mortality (all P < 0.01). Ten percent had an admission glucose ≥200 mg/dL, which was associated with infections after blunt trauma (odds ratio [OR], 2.28; 95% CI, 1.16-4.47; P = 0.017) but not penetrating trauma. Hyperglycemia was not an independent predictor of mortality in blunt trauma. In contrast, glucose ≥150 mg/dL (OR, 2.58; 95% CI, 1.13-5.89; P = 0.025) and ≥200 mg/dL (OR, 2.98; 95% CI, 1.27-6.98; P = 0.012) both predicted mortality in penetrating trauma patients. Conclusions This is the first study to show that hyperglycemia is associated with fundamentally different outcomes after blunt versus penetrating trauma. Patients who died were 4-8 times more likely to have hyperglycemia and penetrating, not blunt, trauma. Incorporation of hyperglycemia in injury scoring systems might improve outcome predictions after trauma.

AB - Background Stress-induced hyperglycemia is associated with worse outcomes after trauma; however, the effect of mechanism of injury has not been studied. To fill this gap, we tested the hypothesis that blunt and penetrating trauma evoke different glycemic responses which are associated with different outcomes. Materials and methods A retrospective cohort study comparing adults with blunt (n = 835) or penetrating trauma (n = 858) and admission glucose levels ≥ 106 mg/dL, ≥150 mg/dL, and ≥200 mg/dL at a level 1 trauma center from 02, 2011 to 08, 2013. Primary outcomes were mortality and infectious complications. Results For all patients, mean Injury Severity Score was 14 ± 12, with 10% (n = 162) infections and 6% (n = 102) mortality. Median admission glucose was 122 mg/dL (102-154 mg/dL). Hyperglycemia was associated with infections, length of stay, and mortality (all P < 0.01). Ten percent had an admission glucose ≥200 mg/dL, which was associated with infections after blunt trauma (odds ratio [OR], 2.28; 95% CI, 1.16-4.47; P = 0.017) but not penetrating trauma. Hyperglycemia was not an independent predictor of mortality in blunt trauma. In contrast, glucose ≥150 mg/dL (OR, 2.58; 95% CI, 1.13-5.89; P = 0.025) and ≥200 mg/dL (OR, 2.98; 95% CI, 1.27-6.98; P = 0.012) both predicted mortality in penetrating trauma patients. Conclusions This is the first study to show that hyperglycemia is associated with fundamentally different outcomes after blunt versus penetrating trauma. Patients who died were 4-8 times more likely to have hyperglycemia and penetrating, not blunt, trauma. Incorporation of hyperglycemia in injury scoring systems might improve outcome predictions after trauma.

KW - Blunt trauma

KW - Glucose

KW - Hyperglycemia

KW - Mortality

KW - Penetrating trauma

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