Central Venous Catheterization before Versus after Computed Tomography in Hemodynamically Unstable Patients with Major Blunt Trauma: Clinical Characteristics and Factors for Decision Making

Kim, Ji Hun; Ha, Sang Ook; Park, Young Sun; Yi, Jeong Hyeon; Hur, Sun Beom; Lee, Ki Ho

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자료유형: 학술저널

저자정보: Kim, Ji Hun (Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center) Ha, Sang Ook (Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center) Park, Young Sun (Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center) Yi, Jeong Hyeon (Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center) Hur, Sun Beom (Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center) Lee, Ki Ho (Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center)

저널정보: 대한외상학회 Journal of trauma and injury : JTI Journal of trauma and injury : JTI 제31권 제3호

발행연도: 2018.1

수록면: 135 - 142 (8page)

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Purpose: When hemodynamically unstable patients with blunt major trauma arrive at the emergency department (ED), the safety of performing early whole-body computed tomography (WBCT) is concerning. Some clinicians perform central venous catheterization (CVC) before WBCT (pre-computed tomography [CT] group) for hemodynamic stabilization. However, as no study has reported the factors affecting this decision, we compared clinical characteristics and outcomes of the pre- and post-CT groups and determined factors affecting this decision. Methods: This retrospective study included 70 hemodynamically unstable patients with chest or/and abdominal blunt injury who underwent WBCT and CVC between March 2013 and November 2017. Results: Univariate analysis revealed that the injury severity score, intubation, pulse pressure, focused assessment with sonography in trauma positivity score, and pH were different between the pre-CT (34 patients, 48.6%) and post-CT (all, p<0.05) groups. Multivariate analysis revealed that injury severity score (ISS) and intubation were factors affecting the decision to perform CVC before CT (p=0.003 and p=0.043). Regarding clinical outcomes, the interval from ED arrival to CT (p=0.011) and definite bleeding control (p=0.038), and hospital and intensive care unit lengths of stay (p=0.018 and p=0.053) were longer in the pre-CT group than in the post-CT group. Although not significant, the pre-CT group had lower survival rates at 24 hours and 28 days than the post-CT group (p=0.168 and p=0.226). Conclusions: Clinicians have a tendency to perform CVC before CT in patients with blunt major trauma and high ISS and intubation.

#Blunt trauma #Computed tomography #Central venous catheterization #Injury severity score

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