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Education, Teaching, and Quality Improvement |

Maintaining Higher Hemoglobin Levels and Dedicated Trauma Management to Optimize Survivorship of Patients With Severe Head Injury

Benita Panigrahi, MD; Audrey Sharp, BA; Micheal Smith, BA; Akella Chendrasekhar, MD
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Richmond University Medical Center, Staten Island, NY


Chest. 2013;144(4_MeetingAbstracts):549A. doi:10.1378/chest.1698472
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Abstract

SESSION TITLE: Outcomes/Quality Control Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Management of brain injury involves preventing secondary injury. Secondary brain injury is associated with decreased brain oxygen delivery and oxygen content. Oxygen content predominantly determined by Hemoglobin [Hgb] concentration. Data are lacking on optimal Hgb level in head injured patients. The American College of Surgeons-Committee on Trauma [ACS-COT] recommends care of head injured patients by an organized Trauma service, often these patients are transferred to medical services for management. The efficacy of this process is unclear.

METHODS: We performed a retrospective descriptional analysis of 251patients who presented to our Level 1 Trauma Center with severe head injury [ (AIS) ≥ 3]. Patients were subdivided by management by the trauma service or medical service. We assessed daily average Hgb levels for each day of hospitalization for the first 7 days. The data were analyzed by one-way analysis of variance[ANOVA] for differences in survivorship. Patients with length of stay ≤ 1 day and pediatric patients with age < 16 years were excluded.

RESULTS: 158 patients were evaluated for the study. 135 patients [85.4%] survived to discharge and 23 patients [14.6%] died. The average Hgb of survivors was 12.8 ± 0.2 gm/dl versus 10.7 ± 0.4 for non-survivors [p=0.0001]. Conversely patients with an average Hgb of 12 gm/dl or greater had an improved survival [ 91.3 ± 3.6% versus 76.9 ± 4.3% for Hgb less than 12, p=0.01] As expected the age, AIS, and injury severity score [ISS] were higher for non-survivors. The hospital length of stay [HLOS] as well as the ICU length of stay [ICU-LOS] was equivalent. When we assessed the data by discharge service, we found that a greater percentage of patients who remained on the trauma service went on to survive as compared to being transferred to the medical service [89.5 ± 3.6% versus 69.0 ± 5.2%, respectively, p=0.008]. We also found that trauma service had a shorter HLOS as compared to medical service [6.6 ± 1.1 days versus 11.1 ± 1.5 days respectively, p=0.01], while ICU-LOS , AIS and ISS were equivalent.

CONCLUSIONS: An average hemoglobin of 12 gm/dl or greater and sustained management by a designated trauma service is associated with improved survival in patients with severe closed head injury

CLINICAL IMPLICATIONS: Resuscitation of a patient with severe head injury to a hemoglobin level of greater than 12 grams/dl and keeping the patient on a dedicated trauma service at a designated trauma center improves survival.

DISCLOSURE: The following authors have nothing to disclose: Benita Panigrahi, Audrey Sharp, Micheal Smith, Akella Chendrasekhar

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