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Modified Shock Index as an Indicator of Morbidity and Mortality in Trauma Patients
No full textINTRODUCTION:
The most frequent cause of shock in trauma victims is haemorrhage. Fluid changes within the body's fluid compartments, especially in the extracellular fluid compartment, make the trauma patient's reaction to blood loss more complicated. Even little bleeding can cause changes of fluid to the extracellular compartment after soft tissue damage. It is important to take these fluid changes into account while analysing the reaction to blood loss. Also take into account the pathophysiologic effects of resuscitation and reperfusion as well as the changes brought on by severe, persistent shock.
The goal of triage in the emergency department is to identify patients in critical condition who require immediate treatment and separate them from those who do not. An experienced nurse triages patient in most hospitals based on vital signs, age, level of consciousness, and presenting complaints. We are evaluating a simple marker that can be easily used to predict the outcome of emergency patients, which could be extremely useful in triage.
OBJECTIVES
PRIMARY OBJECTIVE:
To analyse the predictive value of Modified Shock Index in mortality and morbidity of Trauma patients.
SECONDARY OBJECTIVES:
1. To predict the MSI beyond which there is necessity for blood transfusion.
2.To arrive at the MSI beyond which mortality rate increases
3. To predict the MSI beyond which requirement of Intensive Care admission increases.
MATERIALS & METHODS:
STUDY DESIGN AND SETTING:
A prospective observational study conducted in the Emergency and Trauma Ward of Rajiv Gandhi Government General Hospital. The period of study is between June 2022 to December 2022.
ETHICS STATEMENT: This study was approved by the institutional human ethics committee and institutional review board of Madras Medical College. Data confidentiality was maintained and written informed consent was obtained from the patients.
STUDY POPULATION: The study participants were patients presenting with features of shock to the emergency department.
INCLUSION CRITERIA:
1. All patients of age >12 years, irrespective of their sex admitted following trauma.
2. Patients primarily received in RGGGH following trauma.
3. Acceptance of informed consent.
EXCLUSION CRITERIA:
1. Age <12 years.
2. Trauma patients who had underwent primary intervention in other hospitals.
3. Refusal for consent SAMPLE SIZE MSI 1.3 had higher odds of mortality as compared to other predictors according a study of Singh et al. Based on the above parameter with an alpha of 0.05 (2 sided) and power of 95% and assuming proportion of disease and correlation is 0.5 the estimated sample size using the sample size formula for Regression methods - Multiple logistic regression is 213. STUDY PROTOCOL All patients satisfying the Inclusion and Exclusion criteria were included in the study. Upon arrival, patients are examined after analysing the mode of trauma. Vital parameters including Heart Rate, Systolic Blood Pressure, Diastolic Blood Pressure are recorded immediately on arrival of patient in Emergency ward. Modified Shock Index on arrival is calculated. Patient is started on necessary blood products when warranted and closely
monitored with vital parameters, ECG, arterial blood gas analysis and other radiological investigations as per protocol on ATLS guidelines. Patients are reassessed after 6 hours with vital parameters and necessity for ICU admission is included. An analysis was made with the available values, cut off points, ICU stay and mortality of the patients.
CONCLUSION
Hemorrhagic shock is the type of shock most often seen in severe trauma patients, and its early identification is crucial to patient prognosis. This study shows both shock indices to offer good massive bleeding predicting capacity, and the results obtained are comparable to those of other studies that describe SI and MSI as potentially useful for the identification of hemorrhagic shock
MSI is a good predictor of morbidity and mortality in trauma and is easy to apply during initial management of severe trauma. The cut-off value derived for Modfied Shock Index in trauma patients in this study is 1.3, beyond which mortality and morbidity serially rises.
In our study patients with MSI >1.68 required blood transfusion and those patients with MSI 1.92 needed ICU care and mortality rate was high when MSI > 2.35
Significance of 24 hour Post Operative Lactate Levels in Predicting Mortality and Morbidity in Patients Undergoing Emergency Laparotomy in a Tertiary Centre
No full textINTRODUCTION:
Serum lactate levels had shown to increase in acute abdominal conditions like appendicitis and mesenteric ischemia and can used as a marker for mesenteric ischemia and appendicitis. Blood lactate levels had shown to have greater prognostic value than oxygen derived variables like oxygen delivery or oxygen uptake. Obtaining a lactate level is essential to identifying tissue hypo perfusion in patients who are not yet hypotensive but who are at risk for septic shock. The strategy of clearing lactate to normal values was assessed in the 2012 Surviving Sepsis Campaign Guidelines. The campaign suggests targeting resuscitation to normalize lactate in patients with elevated lactate levels as a marker of tissue hypo perfusion. Lactate clearance is percentage change in lactate level since admission. High lactate clearance to be associated with better outcome in critically ill patients and low mortality in comparison to low lactate clearance.
OBJECTIVES :
Primary objective: to compare the ability of the lactate levels to predict postoperative mortality.
Secondary objective: to compare the ability to predict postoperative morbidity like wound site infection, length of stay, lower respiratory tract infection, inotropic support, development of AKI, delirium, cardiac morbidity and need for re-exploration.
METHODOLOGY :
The study is done after obtaining a detailed history, complete general physical examination and systemic examination. The patients are subjected to relevant investigations like x-ray erect abdomen, CXR, USG , CT and routine investigations like Hb, TC, urea, creatinine, serum electrolytes. All investigations and surgical procedures were carried out with proper informed written consent as appropriately. Both Preoperative and Postoperative serum lactate analysis will be done, and the outcome analysis will be evaluated with mortality being the primary outcome. Patients will be followed upto 30 days postoperatively. They will be enquired about survival and complications through telephonic interview. The data regarding patient particulars, diagnosis, investigations, and surgical procedures is collected in a specially designed case recording form and transferred to a master chart subjected to statistical methods like mean, standard deviation, proportion, percentage calculation and wherever necessary chi square test for proportion are used.
RESULTS:
In the present study, 200 case of patients undergoing emergency abdominal surgeries for various etiology who came to RGGGH emergency department from November 2021 to August 2022 were included. Those patients who were more than 12 years of age were included in this study. There is a significant male preponderance (69.39%). Among those included in the study, 24.5% of patients were found to be hypertensive, 32% of patients were found to be diabetic and 9% of the patients were found to be CAD. Various etiologies including Intestinal obstruction, Perforation, SMA thrombosis, Appendicular perforations has been observed in this study. Based on the above values, both observed and expected values are calculated and entered in tables. By using the values, the Chi Square statistic is calculated. Degree of freedom is found to be 1. Based on the analysis, p-value is calculated to find the significance of the test. Based on the analysis of lactate values for patients with complications and without complications, the following observations are made Chi-square statistic is 18.3911. The p-value is 0.000018. Based on the analysis of lactate values for patients with mortality and without mortality, the following observations are made. Chi-square statistic is 6.4068. The p-value is 0.011369. Significant at p < 0.5
CONCLUSION:
Sepsis and septic shock remains a major challenge faced by surgeons in current days scenario. Lactate has been proven as an incredible tool to assess the outcomes of the patient and plan the management accordingly. Increased lactate levels post operatively poses significant high risk in mortality and morbidity of the patient and might help surgeons to as a guide to understand the nature of the disease and its prognosis. Those with normal post operative lactate levels are found to have lower risk of complications and mortality
Targeting TGF-Beta Receptor by Inhibition of DNA Methyl Transferases to treat Advanced Prostate Cancer
No full textPrevalence of Malnutrition in Patients with Gastric Cancer and Its Impact on Postoperative Outcomes (MaGiC study)
No full textA Cross Sectional study on the Prevalence of Comorbidities among the SARS-COV-2 Deaths Reported in Tertiary Care Centre
No full textINTRODUCTION:
The strength and power of a disease is always determined by its case fatality rate. The new SARS-COV-2 pandemic have been made significant panic with its mortality among subjects with underlying health conditions and age extremes.
OBJECTIVES:
The study was done with an objective to assess the impact of Covid-19 infection on the most frequent comorbidities encountered amongst those who have died due to this pathogen.
The study also wanted to identify the high-risk group in this pandemic and prioritising them for vaccination. And also, to estimate the most prevalent comorbidity in the study population.
METHODOLOGY:
The study was done as a retrospective observational study among subjects who deceased due to Covid-19 in a particular period. The study was done among 796 deceased subjects who were selected consecutively from deaths reported due to Covid-19 between June 2020 and June 2021 as reported by the Ministry of Health. Deaths with confirmed RT-PCR positive result for SARS-COV-2 and patients with age >15 years were included in the study.
Patients who recovered from SARS-COV-2 infection and reactive patients who were discharged and later expired due to other causes were excluded from the study. The available data generally included information about the age, gender, confirmed positive, the date of death and their underlying comorbidities. The data was entered into Microsoft excel and analysed using SPSS 23.
RESULTS:
The mean (SD) of age in years among the population was 60.35 (13.41) years. In the study 554 (69.6%) subjects who deceased due to Covid-19 were males and 242 (30.4%) were
females. Among the deceased Covid-19 patients showed that 616 (77.4%) subjects had presence of co-morbidities. The Frequency distribution of type of comorbidity observed in the deceased Covid-19 patients showed that Diabetes mellitus (DM) was present for 431 (70%), Systemic hypertension (SHT) 334 (54.2%), Coronary artery disease (CAD) 124 (20.1%) and Chronic kidney disease (CKD) 93(15.1%).I n the study subjects presence of comorbidity was significantly older than those without comorbidity [61.58 (11.93) vs. 56.15 (16.91)] The comorbid status with respect to age shows that majority of comorbidity were present in the age group of 61-80 years 303(49.2%) and 41-60 years (259 (42%)). The correlation between time spent in hospital before death with age, number of days of symptoms before admission, duration and number of comorbidities and comorbidity status were not significantly different.
CONCLUSION:
The study showed that male gender, older subjects were mostly deceased among the population. The study showed diabetes and hypertension to be the most prevalent
comorbidities and no significant difference in duration of hospital stay with the presence of comorbidities
A Comparative study on Severity of Postoperative Pain in Patients Undergoing Milligan Morgan Haemorrhoidectomy With and Without Lateral Anal Sphincterotomy
No full textA Randomised Control Trial on Flap Tacking Versus Non Flap Tacking in Incisional Hernia and Its Outcome on Seroma Formation at Stanley Medical College, Chennai
No full textA Comparative study Between Outcomes in Different Types of Patch Closure in Perforation Peritonitis
No full text
