Evidence map›Paper›PMID 28930959›Full record

Trial reportThe journal of trauma and acute care surgery2017

Outcomes after concomitant traumatic brain injury and hemorrhagic shock: A secondary analysis from the Pragmatic, Randomized Optimal Platelets and Plasma Ratios trial.

Samuel M Galvagno, Erin E Fox, Savitri N Appana, Sarah Baraniuk, Patrick L Bosarge, Eileen M Bulger, Rachel A Callcut, Bryan A Cotton, Michael Goodman, Kenji Inaba and 7 more

Open access · greenAbstract readRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The journal of trauma and acute care surgery, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed
4.8field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 55 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors at 1 institution in 1 country.

Samuel M GalvagnoFrom the Division of Critical Care Medicine, Department of Anesthesiology (S.M.G.), University of Maryland Medical Center, Program in Trauma R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland; Division of Acute Care Surgery, Department of Surgery (E.E.F.), Center for Translational Injury Research (CeTIR); Department of Biostatistics (S.N.A.), School of Public Health, School of Public Health (S.B.), University of Texas-Houston Health Sciences Center, Houston, Texas; Division of Acute Care Surgery, Department of Surgery (P.L.B.), University of Alabama School of Medicine, Birmingham, Alabama; Department of Surgery (E.M.B.), University of Washington; Department of Trauma (E.M.B.), Harborview Medical Center, Seattle, Washington; Division of General Surgery (R.A.C.), University of California San Francisco, San Francisco, California; Division of Acute Care Surgery, Department of Surgery (B.A.C.), University of Texas Health Science Center, Houston, Texas; Department of Surgery (M.G.), University of Cincinnati School of Medicine, Cincinnati, Ohio; Department of Surgery (K.I.), University of Southern California Keck School of Medicine, Los Angeles, California; University of Arizona School of Medicine (T.O.), Tucson, Arizona; Division of Trauma, Critical Care, and Acute Care Surgery (M.A.S.), Oregon Health & Science, University School of Medicine Portland, Portland, Oregon; Department of Surgery (C.E.W., J.B.H.), University of Texas Health Science Center, Houston, Texas; Program in Trauma Francis X. Kelly (T.M.S.), and Department of Surgery, Program in Trauma (D.M.S.), R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland.
Erin E Fox
Savitri N Appana
Sarah Baraniuk
Patrick L Bosarge
Eileen M Bulger
Rachel A Callcut
Bryan A Cotton
Michael Goodman
Kenji Inaba
Terence O'Keeffe
Martin A Schreiber
Charles E Wade
Thomas M Scalea
John B Holcomb
Deborah M Stein
PROPPR Study Group
University of Maryland, Baltimore · US

Funding

Resuscitation Outcomes Consortium (ROC) Data Coordinating CenterU01HL077863 · NHLBI · UNIVERSITY OF WASHINGTON · PI MAY, SUSANNE · 2004 to 2015
$125.1M
SUMS)P50GM038529 · NIGMS · UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON · PI DIAL, ELIZABETH J · 1988 to 2008
$11.7M
Advancing Outcome Metrics in Trauma Surgery Through Utilization of Big DataK01ES026834 · NIEHS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI CALLCUT, RACHAEL A · 2015 to 2018
$889k
CIHR CRR-120612NHLBI NIH HHS U01 HL077863NIEHS NIH HHS K01 ES026834NIGMS NIH HHS P50 GM038529
6 · The paper itself

Abstract

backgroundOften the clinician is faced with a diagnostic and therapeutic dilemma in patients with concomitant traumatic brain injury (TBI) and hemorrhagic shock (HS), as rapid deterioration from either can be fatal. Knowledge about outcomes after concomitant TBI and HS may help prioritize the emergent management of these patients. We hypothesized that patients with concomitant TBI and HS (TBI + HS) had worse outcomes and required more intensive care compared with patients with only one of these injuries.

methodsThis is a post hoc analysis of the Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial. TBI was defined by a head Abbreviated Injury Scale score greater than 2. HS was defined as a base excess of -4 or less and/or shock index of 0.9 or greater. The primary outcome for this analysis was mortality at 30 days. Logistic regression, using generalized estimating equations, was used to model categorical outcomes.

resultsSix hundred seventy patients were included. Patients with TBI + HS had significantly higher lactate (median, 6.3; interquartile range, 4.7-9.2) compared with the TBI group (median, 3.3; interquartile range, 2.3-4). TBI + HS patients had higher activated prothrombin times and lower platelet counts. Unadjusted mortality was higher in the TBI + HS (51.6%) and TBI (50%) groups compared with the HS (17.5%) and neither group (7.7%). Adjusted odds of death in the TBI and TBI + HS groups were 8.2 (95% confidence interval, 3.4-19.5) and 10.6 (95% confidence interval, 4.8-23.2) times higher, respectively. Ventilator, intensive care unit-free and hospital-free days were lower in the TBI and TBI + HS groups compared with the other groups. Patients with TBI + HS or TBI had significantly greater odds of developing a respiratory complication compared with the neither group.

conclusionThe addition of TBI to HS is associated with worse coagulopathy before resuscitation and increased mortality. When controlling for multiple known confounders, the diagnosis of TBI alone or TBI+HS was associated with significantly greater odds of developing respiratory complications. LEVEL OF EVIDENCE: Prognostic study, level II.

Indexed as

Blood TransfusionCritical CareAbbreviated Injury ScaleAdultBlood Coagulation DisordersBrain Injuries, TraumaticFemaleHumansIncidenceLogistic ModelsMaleMiddle AgedShock, HemorrhagicTreatment Outcome

Identifiers

PMID28930959
PMCPMC5718977
OpenAlexW2919377965

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.