Abstract | BACKGROUND: METHODS: This was a retrospective cohort study of prospectively gathered data from the National Study on Cost and Outcomes of Trauma database, a multisite prospective study of injured patients aged 18 years to 84 years. Patients were treated at 69 participating hospitals (18 Level I trauma centers and 51 nontrauma centers) across the United States. Our analysis was limited to patients with a blunt mechanism of injury and a thoracic maximum Abbreviated Injury Scale (MAXAIS) score of 2 or greater. Excluded were patients who were not potential candidates for epidural placement, such as patients with significant head and spine injuries (head MAXAIS score > 2 or spine MAXAIS score > 2), significant neurologic impairment (best motor Glasgow Coma Scale [GCS] score < 4), unstable pelvic fractures, coagulopathy, or those who died within 48 hours. RESULTS: The National Study on Cost and Outcomes of Trauma database contains 5,043 patients, of whom 836 (16.5%) were identified as potential candidates for epidural placement. Of patients included in the study, 100 patients (12%) had epidural catheters placed. The likelihood of epidural catheter placement was significantly higher in trauma centers as compared with nontrauma centers (adjusted odds ratio, 3.06; 95% confidence interval [CI] 1.80-5.22). In the epidural group compared with those not receiving a catheter, the adjusted (including trauma center status) odds of death in patients with three or more rib fractures at 30, 90, and 365 days was 0.08 (95% CI, 0.01-0.43), 0.09 (95% CI, 0.02-0.42), and 0.12 (95% CI, 0.04-0.42), respectively. CONCLUSION: LEVEL OF EVIDENCE: Therapeutic study, level II.
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Authors | Alexis Gage, Frederick Rivara, Jin Wang, Gregory J Jurkovich, Saman Arbabi |
Journal | The journal of trauma and acute care surgery
(J Trauma Acute Care Surg)
Vol. 76
Issue 1
Pg. 39-45; discussion 45-6
(Jan 2014)
ISSN: 2163-0763 [Electronic] United States |
PMID | 24368355
(Publication Type: Journal Article, Multicenter Study)
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Topics |
- Abbreviated Injury Scale
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Analgesia, Epidural
(methods, mortality)
- Emergency Service, Hospital
- Female
- Glasgow Coma Scale
- Humans
- Male
- Middle Aged
- Retrospective Studies
- Rib Fractures
- Thoracic Injuries
(mortality)
- Trauma Centers
- Wounds, Nonpenetrating
(mortality)
- Young Adult
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