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Bianchi D, Sethi NK, Velasco G, Qureshi UA, deWeber K. Care of The Older Fighter: Position Statement of the Association of Ringside Physicians. PHYSICIAN SPORTSMED 2024:1-7. [PMID: 38708547 DOI: 10.1080/00913847.2024.2344227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Abstract
Older Fighters are defined as combat sports athletes older than 35 years, based on heightened medical risks and historical classification. Age-related changes to the neurological, cardiopulmonary, endocrinological, thermoregulatory, osmoregulatory, and musculoskeletal systems increase these athletes' risks for injury and may prolong their recovery. These age-related risks warrant special considerations for competition, licensure, prefight medical clearance, in-fight supervision, post-fight examination, and counseling regarding training practices and retirement from combat sports. Neurological considerations include increased risk of intracranial lesions, intracranial hemorrhage, and sequelae from traumatic brain injury (TBI), warranting more comprehensive neurological evaluation and neuroimaging. Increased risk of myocardial ischemia and infarction warrant careful assessment of cardiac risk factors and scrutiny of cardiovascular fitness. Older fighters may take longer time to recover from musculoskeletal injury; post-injury clearance should be individualized.
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Affiliation(s)
- Davide Bianchi
- Medbase Cornavin Sports Center, SwissBoxing, Geneva, Switzerland
| | - Nitin K Sethi
- Associate Professor of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - George Velasco
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Uneeb A Qureshi
- United States Public Health Service, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kevin deWeber
- Program Director, SW Washington Sports Medicine Fellowship, Vancouver, WA USA
- Affiliate Associate Professor of Family Medicine, Oregon Health and Science University, Portland, OR, USA
- Clinical Assistant Professor of Family Medicine, University of Washington, Seattle, WA, USA
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Chockalingam K, A Rahman NA, Idris Z, Theophilus SC, Abdullah JM, Ghani ARI, Ali A. Door-to-Skin Time in Patient Undergoing Emergency Trauma Craniotomy. Malays J Med Sci 2023; 30:71-84. [PMID: 37655152 PMCID: PMC10467600 DOI: 10.21315/mjms2023.30.4.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 10/30/2022] [Indexed: 09/02/2023] Open
Abstract
Background Traumatic brain injury (TBI) is the third leading cause of death and disability worldwide in 2020. For patients with TBI with significant intracranial bleeds, urgent surgical intervention remains the mainstay treatment. This study aims to evaluate the time to definite surgical intervention since admission and its association with patient outcomes in a neurosurgery referral centre in Malaysia. Methods This retrospective study was conducted at Hospital Sultanah Aminah Johor Bahru from 1 January 2019 to 31 December 2019. All patients with TBI requiring urgent craniotomy were identified from the operating theatre registry, and the required data were extracted from their clinical notes, including the Glasgow Outcome Score (GCS) at discharge and 6 months later. Logistic regression was performed to identify the factors associated with poor outcomes. Results A total of 154 patients were included in this study. The median door-to-skin time was 605 (interquartile range = 494-766) min. At discharge, 105 patients (68.2%) had poor outcomes. At the 6-month follow-up, only 58 patients (37.7%) remained to have poor outcomes. Simple logistic regression showed that polytrauma, hypotensive episode, ventilation, severe TBI, and the door-to-skin time were significantly associated with poor outcomes. After adjustments for the clinical characteristics in the analysis, the likelihood of having poor outcomes for every minute delay in the door-to-skin time increased at discharge (adjusted odds ratio [AOR] = 1.005; 95% confidence interval [CI] = 1.002-1.008) and the 6-month follow-up (AOR = 1.008; 95% CI = 1.005-1.011). Conclusion The door-to-skin time is directly proportional to poor outcomes in patients with TBI. Concerted efforts from all parties involved in trauma care are essential in eliminating delays in surgical interventions and improving outcomes.
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Affiliation(s)
- Kumarappan Chockalingam
- Department of Neurosurgery, Hospital Sultanah Aminah Johor Bahru, Johor, Malaysia
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Noor Azman A Rahman
- Department of Neurosurgery, Hospital Sultanah Aminah Johor Bahru, Johor, Malaysia
| | - Zamzuri Idris
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | - Jafri Malin Abdullah
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Abdul Rahman Izaini Ghani
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Aisyah Ali
- Clinical Research Centre, Hospital Sultan Ismail, Johor, Malaysia
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Novoa Ferro M, Santos Armentia E, Silva Priegue N, Jurado Basildo C, Sepúlveda Villegas C, Del Campo Estepar S. Brain CT requests from emergency department: Reality. RADIOLOGIA 2022; 64:422-432. [DOI: 10.1016/j.rxeng.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/24/2020] [Indexed: 11/25/2022]
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Shao XL, Wang YZ, Chen XH, Ding WJ. Impact of failure mode and effects analysis-based emergency management on the effectiveness of craniocerebral injury treatment. World J Clin Cases 2022; 10:554-562. [PMID: 35097081 PMCID: PMC8771373 DOI: 10.12998/wjcc.v10.i2.554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/14/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Craniocerebral injuries encompass brain injuries, skull fractures, cranial soft tissue injuries, and similar injuries. Recently, the incidence of craniocerebral injuries has increased dramatically due to the increased numbers of traffic accidents and aerial work injuries, threatening the physical and mental health of patients.
AIM To investigate the impact of failure modes and effects analysis (FMEA)-based emergency management on craniocerebral injury treatment effectiveness.
METHODS Eighty-four patients with craniocerebral injuries, treated at our hospital from November 2019 to March 2021, were selected and assigned, using the random number table method, to study (n = 42) and control (n = 42) groups. Patients in the control group received conventional management while those in the study group received FMEA theory-based emergency management, based on the control group. Pre- and post-interventions, details regarding the emergency situation; levels of inflammatory stress indicators [Interleukin-6 (IL-6), C-reactive protein (CRP), and procalcitonin (PCT)]; incidence of complications; prognoses; and satisfaction regarding patient care were evaluated for both groups.
RESULTS For the study group, the assessed parameters [pre-hospital emergency response time (9.13 ± 2.37 min), time to receive a consultation (2.39 ± 0.44 min), time needed to report imaging findings (1.15 ± 4.44 min), and test reporting time (32.19 ± 6.23 min)] were shorter than those for the control group (12.78 ± 4.06 min, 3.58 ± 0.71 min, 33.49 ± 5.51 min, 50.41 ± 11.45 min, respectively; P < 0.05). Pre-intervention serum levels of IL-6 (78.71 ± 27.59 pg/mL), CRP (19.80 ± 6.77 mg/L), and PCT (3.66 ± 1.82 ng/mL) in the study group patients were not significantly different from those in the control group patients (81.31 ± 32.11 pg/mL, 21.29 ± 8.02 mg/L, and 3.95 ± 2.11 ng/mL respectively; P > 0.05); post-intervention serum indicator levels were lower in both groups than pre-intervention levels. Further, serum levels of IL-6 (17.35 ± 5.33 pg/mL), CRP (2.27 ± 0.56 mg/L), and PCT (0.22 ± 0.07 ng/mL) were lower in the study group than in the control group (30.15 ± 12.38 pg/mL, 3.13 ± 0.77 mg/L, 0.38 ± 0.12 ng/mL, respectively; P < 0.05). The complication rate observed in the study group (9.52%) was lower than that in the control group (26.19%, P < 0.05). The prognoses for the study group patients were better than those for the control patients (P < 0.05). Patient care satisfaction was higher in the study group (95.24%) than in the control group (78.57%, P < 0.05).
CONCLUSION FMEA-based craniocerebral injury management effectively shortens the time spent on emergency care, reduces inflammatory stress and complication risk levels, and helps improve patient prognoses, while achieving high patient care satisfaction levels.
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Affiliation(s)
- Xiao-Lan Shao
- Department of Emergency Surgery Ward 48, First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Ya-Zhou Wang
- Department of Emergency Surgery Ward 48, First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Xiong-Hui Chen
- Department of Emergency Surgery Ward 48, First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Wen-Juan Ding
- Department of Emergency Surgery Ward 48, First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
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Pradhan P, Pradhan A, Shrestha AP, Shrestha A, Paudel RC, Shrestha R. Impact of implementation of the national institute for health and clinical excellence (NICE) head injury guideline in a tertiary care center emergency department: A pre and post-intervention study. PLoS One 2021; 16:e0254754. [PMID: 34264993 PMCID: PMC8282013 DOI: 10.1371/journal.pone.0254754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/04/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Head injury, a common presentation to the emergency department (ED), is a substantial problem in developing countries like Nepal. The current national institute for health and clinical excellence (NICE) guideline revised in January 2014 focuses on effective clinical assessment and early management of head injuries according to their severity in all age groups. This study assessed the impact of implementing this guideline on the proportions of computed tomography (CT) head scans, guideline adherence, and confidence level of the attending physicians. METHODS We consecutively recruited 139 traumatic head injury (THI) patients in this prospective pre-post interventional study conducted in the ED of a tertiary care center. We implemented the NICE guideline into routine practice using multimodal intervention through physicians' education sessions, information sheets and guideline-dissemination. The pre and post-implementation CT head scan rates were compared. The post-implementation guideline adherence was assessed. Online Google form-questionnaires including 12 validated case scenarios were distributed to the attending physicians at the end of both phases to assess their confidence levels. RESULTS The implementation resulted in a statistically significant decrease in the proportion of CT head scan rates from 92.0% to 70.0% (p-value = 0.005). Following educational interventions, improved guideline adherence of 20.3 percentage points (p-value = 0.001) was observed. Nine ED attending physicians were enrolled in the study who showed statistically significant improvement in their confidence level following the intervention. The NICE guideline showed a sensitivity and specificity of 93.6% and 76.4% with 82.6% accuracy compared to that of clinical judgment (100%, 34.6%, and 58.1% respectively) in detecting intracranial lesions. CONCLUSION The implementation was successful in satisfying the aim of the NICE guideline by decreasing the proportion of CT head scans, improving guideline adherence and increasing the confidence of the attending physicians.
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Affiliation(s)
- Pratisha Pradhan
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Bagmati Province, Nepal
| | - Alok Pradhan
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Bagmati Province, Nepal
| | - Anmol Purna Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Bagmati Province, Nepal
| | - Abha Shrestha
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Bagmati Province, Nepal
| | - Ram Chandra Paudel
- Department of Radiodiagnosis and Imaging, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Bagmati Province, Nepal
| | - Roshana Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Bagmati Province, Nepal
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Novoa Ferro M, Santos Armentia E, Silva Priegue N, Jurado Basildo C, Sepúlveda Villegas CA, Del Campo Estepar S. Brain CT requests from emergency department: reality. RADIOLOGIA 2020; 64:S0033-8338(20)30123-5. [PMID: 33131785 DOI: 10.1016/j.rx.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 08/01/2020] [Accepted: 08/24/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the most common reasons for requesting brain CT studies from the emergency department and to calculate the prevalence of urgent acute pathology on this population group. MATERIAL AND METHODS We reviewed brain CT studies requested from the emergency department during October and November 2018. We recorded the following variables: age, sex, reason for requesting the study, CT findings, use of contrast agents and reasons for using them, and, in patients who had undergone previous head CT studies, whether the findings had changed. SPSS was used for statistical analyses. RESULTS A total of 507 urgent brain CT studies were done (41.4% in men, 58.6% in women; mean age, 65.4±20 years). The most common reason for requesting the study was head trauma (40.5%); only 15.6% of these studies showed acute posttraumatic intracranial lesions. The second most common reason was focal neurologic symptoms (16%); only 16% of these studies showed recent ischemic infarcts or acute bleeding. No pathological findings were reported in 43.2% of the studies. The most common abnormal finding was small vessel disease (20%). Space-occupying lesions (both benign and malignant) were found in 3.9% of all patients. CONCLUSIONS Most brain CT studies requested from the emergency department showed no findings that would modify the management of the patient. Overuse of urgent brain CT increases the radiology department's workload and exposes patients to radiation unnecessarily.
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Affiliation(s)
- M Novoa Ferro
- Hospital Povisa, Servicio de Radiodiagnóstico, Vigo, Pontevedra, España.
| | - E Santos Armentia
- Hospital Povisa, Servicio de Radiodiagnóstico, Vigo, Pontevedra, España
| | - N Silva Priegue
- Hospital Povisa, Servicio de Radiodiagnóstico, Vigo, Pontevedra, España
| | - C Jurado Basildo
- Hospital Povisa, Servicio de Radiodiagnóstico, Vigo, Pontevedra, España
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