May 2014 Paul Jones, MD MacTraumatic: Predicting Early Death in Trauma Patients.

Slides:

Advertisements

Similar presentations

Blood pressure measurement in primary care

Advertisements

Get to Goal, Achieve Control

Figure legends to the Supplemental Figures Supplemental Figure 1: Frequency distribution of the Glasgow Coma Score (GCS) of 405 alcohol intoxicated patients.

March 2004; Revised July 2006, November 2010

Branko N Huisa M.D. Assistant Professor of Neurology UNM Stroke Center.

Journal Club: AKI and timing of RRT in Post-op ITU Patients

Rachel Hawes RVI Northern trauma network conference March 2014 Major Haemorrhage Policy for Trauma.

US cost-effectiveness of simvastatin in 20,536 people at different levels of vascular disease risk: randomised placebo-controlled trial UK Medical Research.

CMR of Non-ischemic Dilated and Restrictive Cardiomyopathies

CRASH2 Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage.

Winning hearts and minds Tranexamic acid and life threatening bleeding.

Is it useful to control blood pressure faster in hypertensive patients? Based on: Gradman AH et al. Hypertension. 2013;61:

UK Renal Registry 17th Annual Report Figure 5.1. Trend in one year after 90 day incident patient survival by first modality, 2003–2012 cohorts (adjusted.

Thrombolysis for stroke in older people.

Trauma Associated Severe Hemorrhage (TASH)-Score: Probability of Mass Transfusion as Surrogate for Life Threatening Hemorrhage after Multiple Trauma The.

TXA in trauma patients: who should we treat and when?

Tranexamic acid safely reduces mortality in bleeding trauma patients Here we present the evidence.

1 SECOND AUSTRALIAN NATIONAL BLOOD PRESSURE STUDY (ANBP-2) Enalapril/ACEI vs. HCTZ, n = 6,083 Randomized, open-label (blinded endpoint review) All CV events.

Targeted Temperature Management TTM-trial investigators

Recombinant Factor VIIa as Adjunctive Therapy for Bleeding Control in Severely Injured Trauma Patients: Two Parallel Randomized, Placebo-Controlled, Double-

Systemic inflammatory response syndrome score at admission independently predicts mortality and length of stay in trauma patients. by R2 黃信豪.

Blood Pressure Reduction Among Acute Stroke Patients A Randomized Controlled Clinical Trial Jiang He, Yonghong Zhang, Tan Xu, Weijun Tong, Shaoyan Zhang,

Uncontrolled Hypertension, Systolic and Diastolic Blood Pressure and Development of Symptomatic Peripheral Arterial Disease in the Women’s Health Study.

A Major Problem for the Health Service p Worldwide injury is a major public health problem p The commonest cause of death between the ages of 1 and 40.

OVBIAGELE B, DIENER H-C, YUSUF S, ET AL., PROFESS INVESTIGATORS. LEVEL OF SYSTOLIC BLOOD PRESSURE WITHIN THE NORMAL RANGE AND RISK OF RECURRENT STROKE.

Corticosteroid Randomisation After Significant Head Injury.

Ambulatory blood pressure as a predictor of cardiovascular risk: What’s new?

Prevalence of Clinically Important Traumatic Brain Injuries in Children With Minor Blunt Head Trauma and Isolated Severe Injury Mechanisms Nigrovic LE,

1 CBS Journal Club CBS Journal Club Christopher Sharpe MD, FRCPC R6 Transfusion Medicine May 3, 2011.

A large randomised controlled trial among trauma patients with significant haemorrhage, of the effects of antifibrinolytic treatment on death and transfusion.

Carol Hawley1, Magdy Sakr2, Sarah Scapinello, Jesse Salvo, Paul Wren, Helga Magnusson, Harald Bjorndalen 1 Warwick Medical School 2 University Hospitals.

The TRial Of Preventing HYpertension (TROPHY) TROPHY.

Jamaica Conference 3/30/15 Sariah Khormaee TRANEXAMIC ACID (TXA): The promise of a nearly perfect drug for the bleeding trauma patient.

To assess the prognostic value of variability in home-measured blood pressure (BP) and heart rate (HR) in a general population. Objective: Methods: BP.

Emergency Trauma Score as a predictor of mortality in clinical practice. A. Fischinger, M. Tomaževič, M. Cimerman, A. Kristan Dept. of Traumatology. University.

The effect of heart rate reduction with ivabradine on renal function in patients with chronic heart failure: an analysis from SHIFT Systolic Heart failure.

A Global Perspective on Blood Pressure Treatment and Control in a Referred Cohort of Hypertensive Patients Bramlage P, et al. J Clin Hyper. doi: /j x.

Influence of background treatment with mineralocorticoid receptor antagonists on ivabradine's effects in patients with chronic heart failure Systolic Heart.

Interobserver Reliability of Acute Kidney Injury Network (AKIN) criteria A single center cohort study Figure 2 The acute kidney injury network (AKIN) criteria.

Background There are 12 different types of medications to lower blood sugar levels in patients with type 2 diabetes. It is widely agreed upon that metformin.

Heart rate in heart failure: Heart rate in heart failure: risk marker or risk factor? A subanalysis of the SHIFT trial on behalf of the Investigators M.

Which Beta-Blocker is Best for Patients with Heart Failure? Summary and Comment by Joel M. Gore, MD Published in Journal Watch Cardiology December 17,

Applying CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage 2) in a Pre- Hospital Wilderness Context Paul B. Jones PGY1.

To establish whether a difference in SBP between arms is associated with peripheral or cardiovascular (CV) disease, and with an increased risk of CV or.

Tranexamic Acid: A Cost Effective Medication to Decrease Death From Acute Blood Loss in Trauma Patients Brandon M. Smith Pacific University School of Physician.

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y j 내과 R2 이지영.

Blood Pressure and Age in Controlling Hypertension

Volume 376, Issue 9734, Pages (July 2010)

Circ Cardiovasc Qual Outcomes

Fan et al. Am J Nephrol 2017;45: (DOI: / )

CRASH 2 Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2):

Volume 376, Issue 9734, Pages (July 2010)

Systematic reviews and meta-analysis

MARFAN SARTAN Trial design: Marfan patients were randomized to losartan (n = 153) vs. placebo (n = 150). The dose of losartan was 50 mg for those

Why double blind, controlled randomized trials?

Q&A – studying medicine or health-related topics at university

Tranexamic acid safely reduces mortality in bleeding trauma patients

Trauma scoring systems and databases

ASCORE : An up-to-date cardiovascular risk score for hypertensive patients reflecting. contemporary clinical practices developed. using the ASCOT trial.

China PEACE risk estimation tool for in-hospital death from acute myocardial infarction: an early risk classification tree for decisions about fibrinolytic.

DENERHTN Trial design: Patients with resistant hypertension were randomized to renal denervation plus standardized stepped-care antihypertensive treatment.

Baseline Demographic Characteristics of Adults With Diagnosed Heart Failure and Eligible to Receive Lipid-Lowering Therapy Alan S. Go, et al.

Blood transfusion balance: Too much, not enough, or just right

Use of L’Abbé and pooled calibration plots to assess the relationship between severity of illness and effectiveness in studies of corticosteroids for.

Tranexamic acid safely reduces mortality in bleeding trauma patients

Tranexamic acid in hip fracture surgery: a randomized controlled trial

Numbers of excess or lower than expected deaths for each place of death. Numbers of excess or lower than expected deaths for each place of death. Separate.

Subgroup analyses according to various characteristics in matched patients. Subgroup analyses according to various characteristics in matched patients.

Average change in blood pressure (BP) from recruitment to 6-month postrecruitment in intervention and control patients >50 years included due to having.

Presentation transcript:

May 2014 Paul Jones, MD MacTraumatic: Predicting Early Death in Trauma Patients

OBJECTIVE Does the simplified prognostic model developed by Perel et al. using Age, SBP and GCS accurately predict early death in HHS Trauma Registry patients?

Fig 4 Chart to predict death in trauma patients*. Perel P et al. BMJ 2012;345:bmj.e5166 ©2012 by British Medical Journal Publishing Group * Excludes Middle and Low income countries

METHODS MY INCLUSION CRITIERA –Age > 15 years old <82 –SBP < 90 mm Hg –HR > 110 –Or both

METHODS Search HHS Trauma Registry between January 1, 2009 and March 31, 2013 Total Trauma Registry Patients = 2871 –Meeting Inclusion Criteria: Total n = 246

METHODS PREDICTORS: –Age –Systolic Blood Pressure (SBP) –Glasgow Coma Scale (GCS) OUTCOME: –Early Mortality Observed Risk of Death Predicted Risk of Death

Baseline characteristics 1. = 15% mortality 2.TARN = 12% mortality 3. HHS = 13% morality

RESULTS

Fig 5 Internal and external calibration of simple chart. Perel P et al. BMJ 2012;345:bmj.e5166 ©2012 by British Medical Journal Publishing Group

Conclusions The simplified model accurately predicts early death in the HHS Trauma Registry. There was strong agreement between the predicted risk of death and the observed deaths in the HHS Trauma Registry.

References 1. Perel P, Prieto-Merino D, Shakur H, Clayton T, Lecky F, Bouamra O, et al. Predicting early death in patients with traumatic bleeding: development and validation of prognostic model. BMJ 2012;345:e Moons, Karel G. M. ; Royston, Patrick ; Vergouwe, Yvonne ; et al. Prognosis and prognostic research: what, why, and how? BMJ Feb 23;338:b375. doi: /bmj.b Royston P, Moons KGM, Altman DG, Vergouwe Y. Prognosis and prognostic research: developing a prognostic model. BMJ 2009;338:b Altman DG, Vergouwe Y, Royston P, Moons KG. Prognosis and prognostic research: validating a prognostic model. BMJ May 28;338:b605. doi: /bmj.b605.

Thank You Erich Hanel Angela Coates Kristen O’Brien David Prieto-Merino

BACKGROUND A large randomized placebo controlled trial among trauma patients with, or at risk of, significant haemorrhage, of the effects of antifibrinolytic treatment on death and transfusion requirement Double blind RCT, London School of Hygiene and Tropical Medicine 274 Hospitals, 40 Countries, adult trauma patients

BACKGROUND Perel et al. developed and validated a prognostic model to predict early death in patients with traumatic bleeding 1. Initially they developed a prognostic model development with 20,127 trauma patients with, or at risk of, significant bleeding, within 8 hours of injury in CRASH-2 trial. They then externally validated their prognostic model with 14,220 selected trauma patients from the Trauma Audit and Research Network (TARN) in the UK.

Systolic blood pressure < 90 mm Hg or heart rate >110 beats per min or both or who were considered to be at risk of significant hemorrhage and who were within 8 hours of injury. CRASH-2 INCLUSIONS