Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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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 (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)
  • Received : 2018.06.19
  • Accepted : 2018.09.28
  • Published : 2018.12.31
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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.

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References

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