Outcomes of severely injured pregnant trauma patients: a multicenter analysis

Kyrillos G Awad; Jeffry Nahmias; Negaar Aryan; Alexa N Lucas; Nicole Fierro; Navpreet K Dhillon; Eric J Ley; Jennifer Smith; Sigrid Burruss; Alden Dahan; Arianne Johnson; William Ganske; Walter L Biffl; Dunya Bayat; Matthew Castelo; Diane Wintz; Kathryn B Schaffer; Dennis J Zheng; Areti Tillou; Raul Coimbra; Rahul Tuli; Jarrett E Santorelli; Brent Emigh; Morgan Schellenberg; Kenji Inaba; Thomas K Duncan; Graal Diaz; Erika Tay-Lasso; Danielle C Zezoff; Areg Grigorian

doi:10.1007/s13304-024-01817-3

Outcomes of severely injured pregnant trauma patients: a multicenter analysis

Updates Surg. 2024 Mar 30. doi: 10.1007/s13304-024-01817-3. Online ahead of print.

Authors

Kyrillos G Awad¹, Jeffry Nahmias², Negaar Aryan², Alexa N Lucas², Nicole Fierro³, Navpreet K Dhillon³, Eric J Ley³, Jennifer Smith⁴, Sigrid Burruss⁴, Alden Dahan⁵, Arianne Johnson⁶, William Ganske⁶, Walter L Biffl⁷, Dunya Bayat⁷, Matthew Castelo⁷, Diane Wintz⁸, Kathryn B Schaffer⁸, Dennis J Zheng⁹, Areti Tillou¹⁰, Raul Coimbra¹⁰, Rahul Tuli¹⁰, Jarrett E Santorelli¹¹, Brent Emigh¹², Morgan Schellenberg¹³, Kenji Inaba¹³, Thomas K Duncan¹⁴, Graal Diaz¹⁴, Erika Tay-Lasso², Danielle C Zezoff², Areg Grigorian¹⁵

Affiliations

¹ Department of Surgery, Desert Regional Medical Center, Palm Springs, CA, USA.
² Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA.
³ Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁴ Division of Trauma and Critical Care, Harbor-UCLA Hospital, Torrance, CA, USA.
⁵ Department of Trauma, Acute Care Surgery, Surgical Critical Care, Loma Linda Medical Center, Loma Linda, CA, USA.
⁶ Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA.
⁷ Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA.
⁸ Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA.
⁹ Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
¹⁰ Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Moreno Valley, CA, USA.
¹¹ Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, San Diego School of Medicine, University of California, San Diego, CA, USA.
¹² The Warren Alpert Medical School of Brown University, Providence, RI, USA.
¹³ Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
¹⁴ Department of Trauma, Ventura County Medical Center, Ventura, CA, USA.
¹⁵ Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA. agrigori@uci.edu.

PMID: 38554224
DOI: 10.1007/s13304-024-01817-3

Abstract

Nearly 10% of pregnant women suffer traumatic injury. Clinical outcomes for pregnant trauma patients (PTPs) with severe injuries have not been well studied. We sought to describe outcomes for PTPs presenting with severe injuries, hypothesizing that PTPs with severe injuries will have higher rates of complications and mortality compared to less injured PTPs. A post-hoc analysis of a multi-institutional retrospective study at 12 Level-I/II trauma centers was performed. Patients were stratified into severely injured (injury severity score [ISS] > 15) and not severely injured (ISS < 15) and compared with bivariate analyses. From 950 patients, 32 (3.4%) had severe injuries. Compared to non-severely injured PTPs, severely injured PTPs were of similar maternal age but had younger gestational age (21 vs 26 weeks, p = 0.009). Penetrating trauma was more common in the severely injured cohort (15.6% vs 1.4%, p < 0.001). The severely injured cohort more often underwent an operation (68.8% vs 3.8%, p < 0.001), including a hysterectomy (6.3% vs 0.3%, p < 0.001). The severely injured group had higher rates of complications (34.4% vs 0.9%, p < 0.001), mortality (15.6% vs 0.1%, p < 0.001), a higher rate of fetal delivery (37.5% vs. 6.0%, p < 0.001) and resuscitative hysterotomy (9.4% vs. 0%, p < 0.001). Only approximately 3% of PTPs were severely injured. However, severely injured PTPs had a nearly 40% rate of fetal delivery as well as increased complications and mortality. This included a resuscitative hysterotomy rate of nearly 10%. Significant vigilance must remain when caring for this population.

Keywords: Fetal delivery; Fetus; Mortality; Pregnant trauma; Resuscitative hysterotomy; Severe trauma.