Association between ion shift index and prognosis in severe trauma patients without isolated head injury |
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| Affiliation: | 1. Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea;2. Department of Emergency Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, Republic of Korea;1. OhioHealth/Doctors Hospital, Department of Orthopedics, Columbus, OH 43228, United States;2. OhioHealth Orthopedic Trauma and Reconstructive Surgeons, Grant Medical Center, Columbus, OH 43215, United States;1. Department of Surgery; School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;2. Standford Children''s Health, Palo Alto, California, USA;3. Department of Surgery; School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;4. Department of Medicine; School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana;5. Department of Surgery; School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;6. Department of Surgery, University of Washington, Seattle, WA, USA, Global Injury Control Section, Harborview Injury Prevention and Research Center;1. Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA 68198;2. Division of Trauma Surgery, Overland Park Regional Medical Center, Overland Park, KS, USA 66215;1. 202 Field Hospital, Dawberry Fields road, Kings Norton, Birmingham;2. Clinical Trials Unit, Clinical Sciences Research Laboratories, University Hospitals Coventry and Warwickshire, Coventry, UK;1. Experimental Surgery and Simulation Center, Division of Gastrointestinal Surgery, Pontificia Universidad Católica de Chile, Chile;2. Trauma Surgery and Emergency Medicine Department, Hospital Dr. Sótero del Río, Chile |
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| Abstract: | IntroductionThis study aimed to investigate the ion shift index (ISI) as a prognostic factor of severe trauma. We hypothesized that the initial ISI measured in the emergency department (ED) is associated with discharge survival in severe non-isolated head injury (IHI) patients.Materials and methodsThis retrospective observational study included severe trauma patients with available medical records from January 2017 to December 2018 but excluded those with IHI. Logistic regression analysis was conducted to identify the risk factors for mortality in non-IHI patients, and adjustments were performed for relevant covariates. An area under the receiver operating characteristics curve (AUROC) analysis was performed to examine the primary outcome of our study, which was mortality at hospital discharge in severe non-IHI trauma patients.ResultsOf the 483 severe non-IHI trauma patients included in the study, 86 patients (17.8 %) died. The multiple logistic regression analysis demonstrated ISI (odds ratio OR], 2.300; 95% CI, 1.183–4.470) was significantly associated with mortality in the non-IHI group. Additionally, trauma and injury severity score (TRISS; OR, 0.538; 95% CI, 0.447–0.649), lactate (OR, 1.410; 95% CI, 1.252–1.588), creatinine (OR, 1.554; 95% CI, 1.221–1.979), and activated partial thromboplastin time (aPTT; OR, 1.050; 95% CI, 1.021–1.080) were independently associated with mortality at hospital discharge. The AUROC values for TRISS, lactate, aPTT, creatinine, and ISI were as follows: 0.892 (95% CI, 0.861–0.918), 0.838 (95% CI, 0.803–0.870), 0.754 (95% CI, 0.712–0.792), 0.650 (95% CI, 0.606–0.693), and 0.848 (95% CI, 0.813–0.879), respectively. The AUROC for the multiple logistic regression model with ISI was 0.942 (95% CI, 0.917–0.962). In a model in which TRISS was omitted, the addition of ISI to other predictors significantly improved the AUROC to 0.900 (95% CI, 0.869-0.925) (p=0.039).ConclusionThe initial ISI in the ED after trauma was associated with mortality in severe non-IHI trauma patients. In conjunction with other prognostic indicators, it could be used as an early prognostic marker, particularly if TRISS is unavailable. |
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