J Korean Soc Traumatol.  2018 Dec;31(3):135-142. 10.20408/jti.2018.022.

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

• Kim JH
• Ha SO
• Park YS
• Yi JH
• Hur SB
• Lee KH

• KMID: 2437276
• DOI: http://doi.org/10.20408/jti.2018.022

Abstract

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.

Keyword

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

MeSH Terms

Blood Pressure
Catheterization, Central Venous*
Central Venous Catheters*
Decision Making*
Emergency Service, Hospital
Hemodynamics
Hemorrhage
Humans
Hydrogen-Ion Concentration
Injury Severity Score
Intensive Care Units
Intubation
Multivariate Analysis
Retrospective Studies
Survival Rate
Thorax
Wounds, Nonpenetrating