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Overview of inpatient management in the adult trauma patient

Babak Sarani, MD, FACS, FCCM
Niels Martin, MD, FACS, FCCM
Section Editor
Eileen M Bulger, MD, FACS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Trauma remains the leading cause of death in those less than 44 years of age in the United States, and for those older than 45, trauma is one of the top five causes of death. The management of patients with traumatic injuries presents a variety of challenges. Patients have usually undergone multidisciplinary evaluation, resuscitation, and stabilization in the emergency department and possible operative intervention prior to inpatient admission. Patients remain at risk for complications due to unrecognized injuries or related to initial or ongoing management.

The general care and management of injured patients who require hospital admission is reviewed here. Initial evaluation and treatment in the emergency department is discussed separately. Specific injuries are discussed in separate topic reviews. (See "Prehospital care of the adult trauma patient" and "Initial evaluation and management of blunt abdominal trauma in adults" and "Initial evaluation and management of blunt thoracic trauma in adults" and "Initial evaluation and management of abdominal gunshot wounds in adults" and "Initial evaluation and management of abdominal stab wounds in adults" and "Initial evaluation and management of penetrating thoracic trauma in adults".)


Ongoing inpatient assessment and monitoring is critical to managing injured patients. This is particularly true in patients who have undergone damage control surgery or those with injuries that are being managed nonoperatively, such as blunt splenic, hepatic, duodenal, or pancreatic injury. Recognition of the full extent of traumatic injury requires an accurate history, skillful physical examination, and timely and judicious use of diagnostic studies.

Obtain a complete history — Patients with serious traumatic injuries often are unable to give details of their past medical history upon presentation to the emergency department, and collateral sources of information (eg, family or friends) may not be available initially. It is therefore incumbent upon the admitting clinician to obtain additional information about past medical history, outpatient medications, allergies, and any history of drug or alcohol use.

It is also important to obtain information about the circumstances that led to the injury since falls from a height or motor vehicle collisions may have been precipitated by medical causes such as cardiac dysrhythmia, hypoglycemia, or stroke and injuries from assault may be a result of domestic violence. In addition, self-inflicted injuries may be a manifestation of a psychological disorder that needs to be identified and treated.

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Literature review current through: Nov 2017. | This topic last updated: Dec 05, 2017.
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  1. MacKenzie EJ, Morris JA Jr, Edelstein SL. Effect of pre-existing disease on length of hospital stay in trauma patients. J Trauma 1989; 29:757.
  2. Soderstrom CA, Smith GS, Dischinger PC, et al. Psychoactive substance use disorders among seriously injured trauma center patients. JAMA 1997; 277:1769.
  3. Jurkovich GJ, Rivara FP, Gurney JG, et al. The effect of acute alcohol intoxication and chronic alcohol abuse on outcome from trauma. JAMA 1993; 270:51.
  4. Milzman DP, Soderstrom CA. Substance use disorders in trauma patients. Diagnosis, treatment, and outcome. Crit Care Clin 1994; 10:595.
  5. Biffl WL, Harrington DT, Cioffi WG. Implementation of a tertiary trauma survey decreases missed injuries. J Trauma 2003; 54:38.
  6. Hajibandeh S, Hajibandeh S, Idehen N. Meta-analysis of the effect of tertiary survey on missed injury rate in trauma patients. Injury 2015; 46:2474.
  7. Richards CF, Mayberry JC. Initial management of the trauma patient. Crit Care Clin 2004; 20:1.
  8. Committee on Trauma of the American College of Surgeons. Advanced Trauma Life Support: Course for Physicians, 5th ed, American College of Surgeons, Chicago, 1993, p. 17.
  9. Yeh DD, Imam AM, Truong SH, et al. Incidental findings in trauma patients: dedicated communication with the primary care physician ensures adequate follow-up. World J Surg 2013; 37:2081.
  10. Pfeifer R, Pape HC. Missed injuries in trauma patients: A literature review. Patient Saf Surg 2008; 2:20.
  11. Giannakopoulos GF, Saltzherr TP, Beenen LF, et al. Missed injuries during the initial assessment in a cohort of 1124 level-1 trauma patients. Injury 2012; 43:1517.
  12. Leeper WR, Leeper TJ, Vogt KN, et al. The role of trauma team leaders in missed injuries: does specialty matter? J Trauma Acute Care Surg 2013; 75:387.
  13. Kalemoglu M, Demirbas S, Akin ML, et al. Missed injuries in military patients with major trauma: original study. Mil Med 2006; 171:598.
  14. Brooks A, Holroyd B, Riley B. Missed injury in major trauma patients. Injury 2004; 35:407.
  15. Vles WJ, Veen EJ, Roukema JA, et al. Consequences of delayed diagnoses in trauma patients: a prospective study. J Am Coll Surg 2003; 197:596.
  16. Haste AK, Brewer BL, Steenburg SD. Diagnostic Yield and Clinical Utility of Abdominopelvic CT Following Emergent Laparotomy for Trauma. Radiology 2016; 280:735.
  17. Todd SR. Critical concepts in abdominal injury. Crit Care Clin 2004; 20:119.
  18. Enderson BL, Maull KI. Missed injuries. The trauma surgeon's nemesis. Surg Clin North Am 1991; 71:399.
  19. Rostas J, Cason B, Simmons J, et al. The validity of abdominal examination in blunt trauma patients with distracting injuries. J Trauma Acute Care Surg 2015; 78:1095.
  20. Sung CK, Kim KH. Missed injuries in abdominal trauma. J Trauma 1996; 41:276.
  21. Allen GS, Coates NE. Pulmonary contusion: a collective review. Am Surg 1996; 62:895.
  22. Cohn SM. Pulmonary contusion: review of the clinical entity. J Trauma 1997; 42:973.
  23. Wanek S, Mayberry JC. Blunt thoracic trauma: flail chest, pulmonary contusion, and blast injury. Crit Care Clin 2004; 20:71.
  24. Moore HB, Moore EE, Gonzalez E, et al. Hyperfibrinolysis, physiologic fibrinolysis, and fibrinolysis shutdown: the spectrum of postinjury fibrinolysis and relevance to antifibrinolytic therapy. J Trauma Acute Care Surg 2014; 77:811.
  25. CRASH-2 trial collaborators, Shakur H, Roberts I, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010; 376:23.
  26. Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg 2012; 147:113.
  27. Ouellet JF, Roberts DJ, Tiruta C, et al. Admission base deficit and lactate levels in Canadian patients with blunt trauma: are they useful markers of mortality? J Trauma Acute Care Surg 2012; 72:1532.
  28. Régnier MA, Raux M, Le Manach Y, et al. Prognostic significance of blood lactate and lactate clearance in trauma patients. Anesthesiology 2012; 117:1276.
  29. Callaway DW, Shapiro NI, Donnino MW, et al. Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients. J Trauma 2009; 66:1040.
  30. Dietch ZC, Edwards BL, Thames M, et al. Rate of lower-extremity ultrasonography in trauma patients is associated with rate of deep venous thrombosis but not pulmonary embolism. Surgery 2015; 158:379.
  31. Thorson CM, Ryan ML, Van Haren RM, et al. Venous thromboembolism after trauma: a never event?*. Crit Care Med 2012; 40:2967.
  32. Bandle J, Shackford SR, Kahl JE, et al. The value of lower-extremity duplex surveillance to detect deep vein thrombosis in trauma patients. J Trauma Acute Care Surg 2013; 74:575.
  33. http://www.east.org/resources/traumacast-detail/23 (Accessed on April 28, 2016).
  34. Goldberg SR, Anand RJ, Como JJ, et al. Prophylactic antibiotic use in penetrating abdominal trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73:S321.
  35. Smith BP, Fox N, Fakhro A, et al. "SCIP"ping antibiotic prophylaxis guidelines in trauma: The consequences of noncompliance. J Trauma Acute Care Surg 2012; 73:452.
  36. O'Donnell M, Weitz JI. Thromboprophylaxis in surgical patients. Can J Surg 2003; 46:129.
  37. Spain DA, Richardson JD, Polk HC Jr, et al. Venous thromboembolism in the high-risk trauma patient: do risks justify aggressive screening and prophylaxis? J Trauma 1997; 42:463.
  38. Geerts WH, Code KI, Jay RM, et al. A prospective study of venous thromboembolism after major trauma. N Engl J Med 1994; 331:1601.
  39. Velmahos GC, Kern J, Chan LS, et al. Prevention of venous thromboembolism after injury: an evidence-based report--part I: analysis of risk factors and evaluation of the role of vena caval filters. J Trauma 2000; 49:132.
  40. Meissner MH, Chandler WL, Elliott JS. Venous thromboembolism in trauma: a local manifestation of systemic hypercoagulability? J Trauma 2003; 54:224.
  41. Malinoski D, Ewing T, Patel MS, et al. Risk factors for venous thromboembolism in critically ill trauma patients who cannot receive chemical prophylaxis. Injury 2013; 44:80.
  42. Coleman JJ, Zarzaur BL, Katona CW, et al. Factors associated with pulmonary embolism within 72 hours of admission after trauma: a multicenter study. J Am Coll Surg 2015; 220:731.
  43. Ho KM, Rao S, Rittenhouse KJ, Rogers FB. Use of the Trauma Embolic Scoring System (TESS) to predict symptomatic deep vein thrombosis and fatal and non-fatal pulmonary embolism in severely injured patients. Anaesth Intensive Care 2014; 42:709.
  44. Rogers FB, Shackford SR, Horst MA, et al. Determining venous thromboembolic risk assessment for patients with trauma: the Trauma Embolic Scoring System. J Trauma Acute Care Surg 2012; 73:511.
  45. Zander AL, Van Gent JM, Olson EJ, et al. Venous thromboembolic risk assessment models should not solely guide prophylaxis and surveillance in trauma patients. J Trauma Acute Care Surg 2015; 79:194.
  46. Brakenridge SC, Henley SS, Kashner TM, et al. Comparing clinical predictors of deep venous thrombosis versus pulmonary embolus after severe injury: a new paradigm for posttraumatic venous thromboembolism? J Trauma Acute Care Surg 2013; 74:1231.
  47. Brakenridge SC, Toomay SM, Sheng JL, et al. Predictors of early versus late timing of pulmonary embolus after traumatic injury. Am J Surg 2011; 201:209.
  48. Hanson SJ, Faustino EV, Mahajerin A, et al. Recommendations for venous thromboembolism prophylaxis in pediatric trauma patients: A national, multidisciplinary consensus study. J Trauma Acute Care Surg 2016; 80:695.
  49. Ginzburg E, Cohn SM, Lopez J, et al. Randomized clinical trial of intermittent pneumatic compression and low molecular weight heparin in trauma. Br J Surg 2003; 90:1338.
  50. Brasel KJ, Borgstrom DC, Weigelt JA. Cost-effective prevention of pulmonary embolus in high-risk trauma patients. J Trauma 1997; 42:456.
  51. Geerts WH, Jay RM, Code KI, et al. A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma. N Engl J Med 1996; 335:701.
  52. Upchurch GR Jr, Demling RH, Davies J, et al. Efficacy of subcutaneous heparin in prevention of venous thromboembolic events in trauma patients. Am Surg 1995; 61:749.
  53. Fisher CG, Blachut PA, Salvian AJ, et al. Effectiveness of pneumatic leg compression devices for the prevention of thromboembolic disease in orthopaedic trauma patients: a prospective, randomized study of compression alone versus no prophylaxis. J Orthop Trauma 1995; 9:1.
  54. Rosenthal D, Wellons ED, Levitt AB, et al. Role of prophylactic temporary inferior vena cava filters placed at the ICU bedside under intravascular ultrasound guidance in patients with multiple trauma. J Vasc Surg 2004; 40:958.
  55. Dossett LA, Adams RC, Cotton BA. Unwarranted national variation in the use of prophylactic inferior vena cava filters after trauma: an analysis of the National Trauma Databank. J Trauma 2011; 70:1066.
  56. Barrera LM, Perel P, Ker K, et al. Thromboprophylaxis for trauma patients. Cochrane Database Syst Rev 2013; :CD008303.
  57. Olson EJ, Bandle J, Calvo RY, et al. Heparin versus enoxaparin for prevention of venous thromboembolism after trauma: A randomized noninferiority trial. J Trauma Acute Care Surg 2015; 79:961.
  58. Kidane B, Madani AM, Vogt K, et al. The use of prophylactic inferior vena cava filters in trauma patients: a systematic review. Injury 2012; 43:542.
  59. Haut ER, Garcia LJ, Shihab HM, et al. The effectiveness of prophylactic inferior vena cava filters in trauma patients: a systematic review and meta-analysis. JAMA Surg 2014; 149:194.
  60. Hemmila MR, Osborne NH, Henke PK, et al. Prophylactic Inferior Vena Cava Filter Placement Does Not Result in a Survival Benefit for Trauma Patients. Ann Surg 2015; 262:577.
  61. Rogers FB, Cipolle MD, Velmahos G, et al. Practice management guidelines for the prevention of venous thromboembolism in trauma patients: the EAST practice management guidelines work group. J Trauma 2002; 53:142.
  62. Hirsh J, Raschke R. Heparin and low-molecular-weight heparin: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126:188S.
  63. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:381S.
  64. Bandle J, Shackford SR, Sise CB, et al. Variability is the standard: the management of venous thromboembolic disease following trauma. J Trauma Acute Care Surg 2014; 76:213.
  65. Kakkos SK, Caprini JA, Geroulakos G, et al. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism in high-risk patients. Cochrane Database Syst Rev 2008; :CD005258.
  66. Kwiatt ME, Patel MS, Ross SE, et al. Is low-molecular-weight heparin safe for venous thromboembolism prophylaxis in patients with traumatic brain injury? A Western Trauma Association multicenter study. J Trauma Acute Care Surg 2012; 73:625.
  67. Saadeh Y, Gohil K, Bill C, et al. Chemical venous thromboembolic prophylaxis is safe and effective for patients with traumatic brain injury when started 24 hours after the absence of hemorrhage progression on head CT. J Trauma Acute Care Surg 2012; 73:426.
  68. Rostas JW, Manley J, Gonzalez RP, et al. The safety of low molecular-weight heparin after blunt liver and spleen injuries. Am J Surg 2015; 210:31.
  69. Kurtoglu M, Yanar H, Bilsel Y, et al. Venous thromboembolism prophylaxis after head and spinal trauma: intermittent pneumatic compression devices versus low molecular weight heparin. World J Surg 2004; 28:807.
  70. Brill JB, Calvo RY, Wallace JD, et al. Aspirin as added prophylaxis for deep vein thrombosis in trauma: A retrospective case-control study. J Trauma Acute Care Surg 2016; 80:625.
  71. Kwok CS, Arthur AK, Anibueze CI, et al. Risk of Clostridium difficile infection with acid suppressing drugs and antibiotics: meta-analysis. Am J Gastroenterol 2012; 107:1011.
  72. Hoen S, Mazoit JX, Asehnoune K, et al. Hydrocortisone increases the sensitivity to alpha1-adrenoceptor stimulation in humans following hemorrhagic shock. Crit Care Med 2005; 33:2737.
  73. Roquilly A, Mahe PJ, Seguin P, et al. Hydrocortisone therapy for patients with multiple trauma: the randomized controlled HYPOLYTE study. JAMA 2011; 305:1201.
  74. Berg GM, Spence M, Patton S, et al. Pressure ulcers in the trauma population: are reimbursement penalties appropriate? J Trauma Acute Care Surg 2012; 72:793.
  75. Tsuei BJ, Kearney PA. Hypothermia in the trauma patient. Injury 2004; 35:7.
  76. Shafi S, Elliott AC, Gentilello L. Is hypothermia simply a marker of shock and injury severity or an independent risk factor for mortality in trauma patients? Analysis of a large national trauma registry. J Trauma 2005; 59:1081.
  77. Dischinger PC, Mitchell KA, Kufera JA, et al. A longitudinal study of former trauma center patients: the association between toxicology status and subsequent injury mortality. J Trauma 2001; 51:877.
  78. Rudnick MR, Berns JS, Cohen RM, Goldfarb S. Contrast media-associated nephrotoxicity. Semin Nephrol 1997; 17:15.
  79. Deray G, Jacobs C. Radiocontrast nephrotoxicity. A review. Invest Radiol 1995; 30:221.
  80. Merten GJ, Burgess WP, Gray LV, et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA 2004; 291:2328.
  81. Biffl WL, Moore EE, Haenel JB. Nutrition support of the trauma patient. Nutrition 2002; 18:960.
  82. Cheatham ML, Safcsak K, Brzezinski SJ, Lube MW. Nitrogen balance, protein loss, and the open abdomen. Crit Care Med 2007; 35:127.
  83. Burlew CC, Moore EE, Cuschieri J, et al. Who should we feed? Western Trauma Association multi-institutional study of enteral nutrition in the open abdomen after injury. J Trauma Acute Care Surg 2012; 73:1380.
  84. Moore EE, Jones TN. Benefits of immediate jejunostomy feeding after major abdominal trauma--a prospective, randomized study. J Trauma 1986; 26:874.
  85. Dissanaike S, Pham T, Shalhub S, et al. Effect of immediate enteral feeding on trauma patients with an open abdomen: protection from nosocomial infections. J Am Coll Surg 2008; 207:690.
  86. Heyland DK, Dhaliwal R, Day AG, et al. REducing Deaths due to OXidative Stress (The REDOXS Study): Rationale and study design for a randomized trial of glutamine and antioxidant supplementation in critically-ill patients. Proc Nutr Soc 2006; 65:250.
  87. Todd SR, Gonzalez EA, Turner K, Kozar RA. Update on postinjury nutrition. Curr Opin Crit Care 2008; 14:690.
  88. Casaer MP, Hermans G, Wilmer A, Van den Berghe G. Impact of early parenteral nutrition completing enteral nutrition in adult critically ill patients (EPaNIC trial): a study protocol and statistical analysis plan for a randomized controlled trial. Trials 2011; 12:21.
  89. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Rice TW, Wheeler AP, et al. Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA 2012; 307:795.
  90. Byrnes MC, Reicks P, Irwin E. Early enteral nutrition can be successfully implemented in trauma patients with an "open abdomen". Am J Surg 2010; 199:359.
  91. Cothren CC, Moore EE, Ciesla DJ, et al. Postinjury abdominal compartment syndrome does not preclude early enteral feeding after definitive closure. Am J Surg 2004; 188:653.
  92. Kudsk KA, Tolley EA, DeWitt RC, et al. Preoperative albumin and surgical site identify surgical risk for major postoperative complications. JPEN J Parenter Enteral Nutr 2003; 27:1.
  93. Bochicchio GV, Joshi M, Bochicchio KM, et al. Early hyperglycemic control is important in critically injured trauma patients. J Trauma 2007; 63:1353.
  94. Bochicchio GV, Salzano L, Joshi M, et al. Admission preoperative glucose is predictive of morbidity and mortality in trauma patients who require immediate operative intervention. Am Surg 2005; 71:171.
  95. Yendamuri S, Fulda GJ, Tinkoff GH. Admission hyperglycemia as a prognostic indicator in trauma. J Trauma 2003; 55:33.
  96. Bochicchio GV, Bochicchio KM, Joshi M, et al. Acute glucose elevation is highly predictive of infection and outcome in critically injured trauma patients. Ann Surg 2010; 252:597.
  97. Kerby JD, Griffin RL, MacLennan P, Rue LW 3rd. Stress-induced hyperglycemia, not diabetic hyperglycemia, is associated with higher mortality in trauma. Ann Surg 2012; 256:446.
  98. Compton WM, Volkow ND. Major increases in opioid analgesic abuse in the United States: concerns and strategies. Drug Alcohol Depend 2006; 81:103.
  99. Mohseni S, Holzmacher J, Sjolin G, et al. Outcomes after resection versus non-resection management of penetrating grade III and IV pancreatic injury: A trauma quality improvement (TQIP) databank analysis. Injury 2017.
  100. van Haarst EP, van Bezooijen BP, Coene PP, Luitse JS. The efficacy of serial physical examination in penetrating abdominal trauma. Injury 1999; 30:599.
  101. Brooks AJ, Rowlands BJ. Blunt abdominal injuries. Br Med Bull 1999; 55:844.
  102. Al-Mulhim AS, Mohammad HA. Non-operative management of blunt hepatic injury in multiply injured adult patients. Surgeon 2003; 1:81.
  103. Rotondo MF, Schwab CW, McGonigal MD, et al. 'Damage control': an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 1993; 35:375.
  104. Schreiber MA. Damage control surgery. Crit Care Clin 2004; 20:101.
  105. Parr MJ, Alabdi T. Damage control surgery and intensive care. Injury 2004; 35:713.
  106. Chung SB, Lee SH, Kim ES, Eoh W. Incidence of deep vein thrombosis after spinal cord injury: a prospective study in 37 consecutive patients with traumatic or nontraumatic spinal cord injury treated by mechanical prophylaxis. J Trauma 2011; 71:867.
  107. Ho KM, Burrell M, Rao S, Baker R. Incidence and risk factors for fatal pulmonary embolism after major trauma: a nested cohort study. Br J Anaesth 2010; 105:596.
  108. Tuttle-Newhall JE, Rutledge R, Hultman CS, Fakhry SM. Statewide, population-based, time-series analysis of the frequency and outcome of pulmonary embolus in 318,554 trauma patients. J Trauma 1997; 42:90.
  109. O'Malley KF, Ross SE. Pulmonary embolism in major trauma patients. J Trauma 1990; 30:748.
  110. Spencer Netto F, Tien H, Ng J, et al. Pulmonary emboli after blunt trauma: timing, clinical characteristics and natural history. Injury 2012; 43:1502.
  111. Jeremitsky E, St Germain N, Kao AH, et al. Risk of pulmonary embolism in trauma patients: Not all created equal. Surgery 2013; 154:810.
  112. Watkins TR, Nathens AB, Cooke CR, et al. Acute respiratory distress syndrome after trauma: development and validation of a predictive model. Crit Care Med 2012; 40:2295.
  113. Cook A, Norwood S, Berne J. Ventilator-associated pneumonia is more common and of less consequence in trauma patients compared with other critically ill patients. J Trauma 2010; 69:1083.
  114. Rello J, Ollendorf DA, Oster G, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002; 122:2115.
  115. Cavalcanti M, Ferrer M, Ferrer R, et al. Risk and prognostic factors of ventilator-associated pneumonia in trauma patients. Crit Care Med 2006; 34:1067.
  116. Bihorac A, Delano MJ, Schold JD, et al. Incidence, clinical predictors, genomics, and outcome of acute kidney injury among trauma patients. Ann Surg 2010; 252:158.
  117. Eriksson M, Brattström O, Mårtensson J, et al. Acute kidney injury following severe trauma: Risk factors and long-term outcome. J Trauma Acute Care Surg 2015; 79:407.
  118. Qureshi SH, Rizvi SI, Patel NN, Murphy GJ. Meta-analysis of colloids versus crystalloids in critically ill, trauma and surgical patients. Br J Surg 2016; 103:14.
  119. Vogel JA, Liao MM, Hopkins E, et al. Prediction of postinjury multiple-organ failure in the emergency department: development of the Denver Emergency Department Trauma Organ Failure score. J Trauma Acute Care Surg 2014; 76:140.
  120. Vogel JA, Newgard CD, Holmes JF, et al. Validation of the Denver Emergency Department Trauma Organ Failure Score to Predict Post-Injury Multiple Organ Failure. J Am Coll Surg 2016; 222:73.
  121. Milzman DP, Boulanger BR, Rodriguez A, et al. Pre-existing disease in trauma patients: a predictor of fate independent of age and injury severity score. J Trauma 1992; 32:236.
  122. Winfield RD, Bochicchio GV. The critically injured obese patient: a review and a look ahead. J Am Coll Surg 2013; 216:1193.
  123. Liu T, Chen JJ, Bai XJ, et al. The effect of obesity on outcomes in trauma patients: a meta-analysis. Injury 2013; 44:1145.