Maternal death in the emergency department from trauma

Kathleen Brookfield, Victor H. Gonzalez-Quintero, James S. Davis, Carl I. Schulman

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Purpose: Trauma during pregnancy is among leading causes of non-pregnancy-related maternal death (MD). This study describes risk factors for MD from trauma during pregnancy in a large urban population. Methods: We queried an urban Level One Trauma Center registry for the medical records of pregnant women suffering trauma from 1990 to 2007. Associations were examined between maternal demographics, injury mode details, injury characteristics, and risk of maternal death upon arrival to the emergency room. Results: Overall, 351 patients were identified. Most traumas was caused by motor vehicle collision (71.8 %), accounting for 78.9 % of MD, followed by gun shot wound (10.3 %), stabbing (8.5 %), falls (4.3 %), and assaults (4 %). Abdominal and head injuries were more frequent in cases of MD compared with patients admitted to the hospital (33.3 vs. 25.1 % abdominal, 55.6 vs. 29.4 % head; p <0.001). A greater proportion of MDs were characterized by lack of restraint use (66.7 %) compared to women admitted to the hospital (47.7 %) and women discharged after observation (43.1 %); p = 0.014. ER deaths had more negative base excess scores than women who were admitted or discharged (-14 vs. -3 vs. -2; p <0.001), lower blood pH values (6.96 vs. 7.40 vs. 7.44; p <0.001), greater Injury Severity Scores (ISS) (44.4 vs. 11.49 vs. 2.66; p <0.001), and lower Revised Trauma Scores (RTS) (0.5 vs. 7.49 vs. 7.83; p <0.001). Conclusions: Lack of restraint use in the pregnant population is associated with increased MD. Although not validated in the pregnant population, the ISS and RTS were associated with maternal mortality outcomes.

Original languageEnglish (US)
Pages (from-to)507-512
Number of pages6
JournalArchives of Gynecology and Obstetrics
Volume288
Issue number3
DOIs
StatePublished - Sep 2013
Externally publishedYes

Fingerprint

Maternal Death
Hospital Emergency Service
Wounds and Injuries
Injury Severity Score
Abdominal Injuries
Pregnancy
Urban Population
Maternal Mortality
Trauma Centers
Firearms
Motor Vehicles
Craniocerebral Trauma
Population
Medical Records
Registries
Pregnant Women
Head
Mothers
Observation
Demography

Keywords

  • Injury Severity Score
  • Maternal mortality
  • Revised Trauma Score
  • Trauma in pregnancy

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Maternal death in the emergency department from trauma. / Brookfield, Kathleen; Gonzalez-Quintero, Victor H.; Davis, James S.; Schulman, Carl I.

In: Archives of Gynecology and Obstetrics, Vol. 288, No. 3, 09.2013, p. 507-512.

Research output: Contribution to journalArticle

Brookfield, Kathleen ; Gonzalez-Quintero, Victor H. ; Davis, James S. ; Schulman, Carl I. / Maternal death in the emergency department from trauma. In: Archives of Gynecology and Obstetrics. 2013 ; Vol. 288, No. 3. pp. 507-512.
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N2 - Purpose: Trauma during pregnancy is among leading causes of non-pregnancy-related maternal death (MD). This study describes risk factors for MD from trauma during pregnancy in a large urban population. Methods: We queried an urban Level One Trauma Center registry for the medical records of pregnant women suffering trauma from 1990 to 2007. Associations were examined between maternal demographics, injury mode details, injury characteristics, and risk of maternal death upon arrival to the emergency room. Results: Overall, 351 patients were identified. Most traumas was caused by motor vehicle collision (71.8 %), accounting for 78.9 % of MD, followed by gun shot wound (10.3 %), stabbing (8.5 %), falls (4.3 %), and assaults (4 %). Abdominal and head injuries were more frequent in cases of MD compared with patients admitted to the hospital (33.3 vs. 25.1 % abdominal, 55.6 vs. 29.4 % head; p <0.001). A greater proportion of MDs were characterized by lack of restraint use (66.7 %) compared to women admitted to the hospital (47.7 %) and women discharged after observation (43.1 %); p = 0.014. ER deaths had more negative base excess scores than women who were admitted or discharged (-14 vs. -3 vs. -2; p <0.001), lower blood pH values (6.96 vs. 7.40 vs. 7.44; p <0.001), greater Injury Severity Scores (ISS) (44.4 vs. 11.49 vs. 2.66; p <0.001), and lower Revised Trauma Scores (RTS) (0.5 vs. 7.49 vs. 7.83; p <0.001). Conclusions: Lack of restraint use in the pregnant population is associated with increased MD. Although not validated in the pregnant population, the ISS and RTS were associated with maternal mortality outcomes.

AB - Purpose: Trauma during pregnancy is among leading causes of non-pregnancy-related maternal death (MD). This study describes risk factors for MD from trauma during pregnancy in a large urban population. Methods: We queried an urban Level One Trauma Center registry for the medical records of pregnant women suffering trauma from 1990 to 2007. Associations were examined between maternal demographics, injury mode details, injury characteristics, and risk of maternal death upon arrival to the emergency room. Results: Overall, 351 patients were identified. Most traumas was caused by motor vehicle collision (71.8 %), accounting for 78.9 % of MD, followed by gun shot wound (10.3 %), stabbing (8.5 %), falls (4.3 %), and assaults (4 %). Abdominal and head injuries were more frequent in cases of MD compared with patients admitted to the hospital (33.3 vs. 25.1 % abdominal, 55.6 vs. 29.4 % head; p <0.001). A greater proportion of MDs were characterized by lack of restraint use (66.7 %) compared to women admitted to the hospital (47.7 %) and women discharged after observation (43.1 %); p = 0.014. ER deaths had more negative base excess scores than women who were admitted or discharged (-14 vs. -3 vs. -2; p <0.001), lower blood pH values (6.96 vs. 7.40 vs. 7.44; p <0.001), greater Injury Severity Scores (ISS) (44.4 vs. 11.49 vs. 2.66; p <0.001), and lower Revised Trauma Scores (RTS) (0.5 vs. 7.49 vs. 7.83; p <0.001). Conclusions: Lack of restraint use in the pregnant population is associated with increased MD. Although not validated in the pregnant population, the ISS and RTS were associated with maternal mortality outcomes.

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KW - Maternal mortality

KW - Revised Trauma Score

KW - Trauma in pregnancy

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