Differences between blunt and penetrating trauma after resuscitation with hydroxyethyl starch

Casey J. Allen, Evan J. Valle, Jassin M. Jouria, Carl I Schulman, Nicholas Namias, Alan Livingstone, Kenneth G Proctor

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: The purpose of this study was to test the hypothesis that a single bolus of 6% hydroxyethyl starch (HES 450/0.7 in lactated electrolyte injection) during initial resuscitation has a differential effect in blunt and penetrating trauma patients.

Methods: Consecutive admissions to the trauma service were reviewed. Patients who died within 24 hours were excluded. Multivariate analysis defined individual predictors for the primary outcomes, acute kidney injury (AKI) and mortality within 90 days. Data were expressed as mean T SD, and significance was assessed at p < 0.05.

Results: Therewere 1,410 patients (76% male; mean ± SD, age 43 ± 18 years; 68% blunt trauma; mean ± SD Injury Severity Score [ISS] 14 ± 11; AKI, 4.4%; and mortality, 3.4%). HES (0.5-1.5 L) was administered to 216 patients (15.3%). After multiple logistic regression, HES remained a significant independent predictor of AKI after blunt trauma (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.24-5.19; area under the receiver operating characteristic curve [AUROC], 0.809) but not penetrating trauma (OR, 0.90; 95% CI, 0.23-3.60; AUROC, 0.849). In separate logistic regression models, HES was a significant predictor of mortality after blunt trauma (OR, 3.77; 95% CI, 0.91-0.97; AUROC, 0.921) but not penetrating trauma (OR, 0.72; 95% CI, 0.13-3.94; AUROC, 0.904).

Conclusion: HES is an independent risk factor for AKI and death after blunt, but not penetrating, trauma, which underscores a fundamental difference between these two injury types.

Original languageEnglish
Pages (from-to)859-864
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume77
Issue number6
DOIs
StatePublished - Jan 1 2014

Fingerprint

Resuscitation
Starch
Wounds and Injuries
Acute Kidney Injury
ROC Curve
Odds Ratio
Confidence Intervals
Logistic Models
Mortality
Injury Severity Score
Electrolytes
Multivariate Analysis
Injections

Keywords

  • Acute kidney injury
  • Hextend
  • Mechanism of injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Differences between blunt and penetrating trauma after resuscitation with hydroxyethyl starch. / Allen, Casey J.; Valle, Evan J.; Jouria, Jassin M.; Schulman, Carl I; Namias, Nicholas; Livingstone, Alan; Proctor, Kenneth G.

In: Journal of Trauma and Acute Care Surgery, Vol. 77, No. 6, 01.01.2014, p. 859-864.

Research output: Contribution to journalArticle

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abstract = "Background: The purpose of this study was to test the hypothesis that a single bolus of 6{\%} hydroxyethyl starch (HES 450/0.7 in lactated electrolyte injection) during initial resuscitation has a differential effect in blunt and penetrating trauma patients.Methods: Consecutive admissions to the trauma service were reviewed. Patients who died within 24 hours were excluded. Multivariate analysis defined individual predictors for the primary outcomes, acute kidney injury (AKI) and mortality within 90 days. Data were expressed as mean T SD, and significance was assessed at p < 0.05.Results: Therewere 1,410 patients (76{\%} male; mean ± SD, age 43 ± 18 years; 68{\%} blunt trauma; mean ± SD Injury Severity Score [ISS] 14 ± 11; AKI, 4.4{\%}; and mortality, 3.4{\%}). HES (0.5-1.5 L) was administered to 216 patients (15.3{\%}). After multiple logistic regression, HES remained a significant independent predictor of AKI after blunt trauma (odds ratio [OR], 2.54; 95{\%} confidence interval [CI], 1.24-5.19; area under the receiver operating characteristic curve [AUROC], 0.809) but not penetrating trauma (OR, 0.90; 95{\%} CI, 0.23-3.60; AUROC, 0.849). In separate logistic regression models, HES was a significant predictor of mortality after blunt trauma (OR, 3.77; 95{\%} CI, 0.91-0.97; AUROC, 0.921) but not penetrating trauma (OR, 0.72; 95{\%} CI, 0.13-3.94; AUROC, 0.904).Conclusion: HES is an independent risk factor for AKI and death after blunt, but not penetrating, trauma, which underscores a fundamental difference between these two injury types.",
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T1 - Differences between blunt and penetrating trauma after resuscitation with hydroxyethyl starch

AU - Allen, Casey J.

AU - Valle, Evan J.

AU - Jouria, Jassin M.

AU - Schulman, Carl I

AU - Namias, Nicholas

AU - Livingstone, Alan

AU - Proctor, Kenneth G

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N2 - Background: The purpose of this study was to test the hypothesis that a single bolus of 6% hydroxyethyl starch (HES 450/0.7 in lactated electrolyte injection) during initial resuscitation has a differential effect in blunt and penetrating trauma patients.Methods: Consecutive admissions to the trauma service were reviewed. Patients who died within 24 hours were excluded. Multivariate analysis defined individual predictors for the primary outcomes, acute kidney injury (AKI) and mortality within 90 days. Data were expressed as mean T SD, and significance was assessed at p < 0.05.Results: Therewere 1,410 patients (76% male; mean ± SD, age 43 ± 18 years; 68% blunt trauma; mean ± SD Injury Severity Score [ISS] 14 ± 11; AKI, 4.4%; and mortality, 3.4%). HES (0.5-1.5 L) was administered to 216 patients (15.3%). After multiple logistic regression, HES remained a significant independent predictor of AKI after blunt trauma (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.24-5.19; area under the receiver operating characteristic curve [AUROC], 0.809) but not penetrating trauma (OR, 0.90; 95% CI, 0.23-3.60; AUROC, 0.849). In separate logistic regression models, HES was a significant predictor of mortality after blunt trauma (OR, 3.77; 95% CI, 0.91-0.97; AUROC, 0.921) but not penetrating trauma (OR, 0.72; 95% CI, 0.13-3.94; AUROC, 0.904).Conclusion: HES is an independent risk factor for AKI and death after blunt, but not penetrating, trauma, which underscores a fundamental difference between these two injury types.

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KW - Acute kidney injury

KW - Hextend

KW - Mechanism of injury

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