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The consequences of high-risk behaviors: trauma during pregnancy.
J Trauma. 2007 Apr; 62(4):1015-20.JT

Abstract

BACKGROUND

Trauma during pregnancy places two lives at risk. Knowledge of risk factors for trauma during pregnancy may improve outcomes.

METHODS

We reviewed the charts of 188 such patients admitted to a Level I trauma center from 1996 to 2004. A comparison was made of injury severity and outcome from a cohort of nonpregnant female trauma patients selected with a similar temporal occurrence and age range.

RESULTS

Motor vehicle collisions comprised 160 cases, 67 using a restraint device. Of 84 patients tested, 45 tested positive for intoxicants, 16 positive for 2 or more intoxicants. A significant trend toward less testing through the study period was observed (p = 0.0002). Injury severity was assessed by Revised Trauma Score (RTS). RTS <11 or admission to operating room or intensive care units (OR/ICU) classified patients as severely injured. The six maternal fatalities had an RTS <11 or OR/ICU disposition. Fetal outcomes included 155 live in utero, 18 live births, and 15 fatalities correlating with injury severity by either criteria (p < 0.0001). Of the fetal fatalities, 7 occurred with RTS = 12, but only 3 fatalities occurred in the 147 cases not admitted to OR/ICU. Gestational age correlated (p < 0.0001) with fetal outcomes. The 18 live births had mean gestational ages of 35 +/- 4 weeks as compared with fetal fatalities at 20 +/- 9 weeks, and fetuses alive in utero at 22 +/- 9 weeks gestation. Coagulation tests prothrombin time (PT), international normalized ratio (INR) (both p < 0.008), and partial thromboplastin time (PTT) (p < 0.0001) correlated with maternal outcome. A matched cohort of nonpregnancy trauma cases during the same time frame indicated that, despite a significantly higher percentage of severely injured patients, fewer fatalities occurred. This might reflect a greater risk for the pregnant trauma patient.

CONCLUSIONS

This study of trauma in pregnancy cases revealed a high percentage with risk behaviors. There was a significant trend toward less intoxicant testing in recent years. Coagulation tests were the most predictive of outcomes. Lower gestational age correlated with fetal demise.

Authors+Show Affiliations

Department of Anesthesiology, University of Tennessee Graduate School of Medicine, TN, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17426561

Citation

Patteson, Stephen K., et al. "The Consequences of High-risk Behaviors: Trauma During Pregnancy." The Journal of Trauma, vol. 62, no. 4, 2007, pp. 1015-20.
Patteson SK, Snider CC, Meyer DS, et al. The consequences of high-risk behaviors: trauma during pregnancy. J Trauma. 2007;62(4):1015-20.
Patteson, S. K., Snider, C. C., Meyer, D. S., Enderson, B. L., Armstrong, J. E., Whitaker, G. L., & Carroll, R. C. (2007). The consequences of high-risk behaviors: trauma during pregnancy. The Journal of Trauma, 62(4), 1015-20.
Patteson SK, et al. The Consequences of High-risk Behaviors: Trauma During Pregnancy. J Trauma. 2007;62(4):1015-20. PubMed PMID: 17426561.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The consequences of high-risk behaviors: trauma during pregnancy. AU - Patteson,Stephen K, AU - Snider,Carolyn C, AU - Meyer,David S, AU - Enderson,Blaine L, AU - Armstrong,Janice E, AU - Whitaker,Gregory L, AU - Carroll,Roger C, PY - 2007/4/12/pubmed PY - 2007/6/1/medline PY - 2007/4/12/entrez SP - 1015 EP - 20 JF - The Journal of trauma JO - J Trauma VL - 62 IS - 4 N2 - BACKGROUND: Trauma during pregnancy places two lives at risk. Knowledge of risk factors for trauma during pregnancy may improve outcomes. METHODS: We reviewed the charts of 188 such patients admitted to a Level I trauma center from 1996 to 2004. A comparison was made of injury severity and outcome from a cohort of nonpregnant female trauma patients selected with a similar temporal occurrence and age range. RESULTS: Motor vehicle collisions comprised 160 cases, 67 using a restraint device. Of 84 patients tested, 45 tested positive for intoxicants, 16 positive for 2 or more intoxicants. A significant trend toward less testing through the study period was observed (p = 0.0002). Injury severity was assessed by Revised Trauma Score (RTS). RTS <11 or admission to operating room or intensive care units (OR/ICU) classified patients as severely injured. The six maternal fatalities had an RTS <11 or OR/ICU disposition. Fetal outcomes included 155 live in utero, 18 live births, and 15 fatalities correlating with injury severity by either criteria (p < 0.0001). Of the fetal fatalities, 7 occurred with RTS = 12, but only 3 fatalities occurred in the 147 cases not admitted to OR/ICU. Gestational age correlated (p < 0.0001) with fetal outcomes. The 18 live births had mean gestational ages of 35 +/- 4 weeks as compared with fetal fatalities at 20 +/- 9 weeks, and fetuses alive in utero at 22 +/- 9 weeks gestation. Coagulation tests prothrombin time (PT), international normalized ratio (INR) (both p < 0.008), and partial thromboplastin time (PTT) (p < 0.0001) correlated with maternal outcome. A matched cohort of nonpregnancy trauma cases during the same time frame indicated that, despite a significantly higher percentage of severely injured patients, fewer fatalities occurred. This might reflect a greater risk for the pregnant trauma patient. CONCLUSIONS: This study of trauma in pregnancy cases revealed a high percentage with risk behaviors. There was a significant trend toward less intoxicant testing in recent years. Coagulation tests were the most predictive of outcomes. Lower gestational age correlated with fetal demise. SN - 0022-5282 UR - https://www.unboundmedicine.com/medline/citation/17426561/The_consequences_of_high_risk_behaviors:_trauma_during_pregnancy_ L2 - https://doi.org/10.1097/01.ta.0000221554.95815.2e DB - PRIME DP - Unbound Medicine ER -