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Ferrajão P, Batista CI, Elklit A. Polytraumatization, defense mechanisms, PTSD and complex PTSD in Indian adolescents: a mediation model. BMC Psychol 2023; 11:411. [PMID: 38001536 PMCID: PMC10675876 DOI: 10.1186/s40359-023-01456-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 11/19/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Adolescence is recognized as a particularly susceptible developmental period for experiencing multiple types of Adverse Childhood Experiences (ACE), increasing the vulnerability to higher levels of Post-Traumatic Stress Disorder (PTSD) and Complex PTSD symptoms. Some studies found that defense mechanisms play an important role on the association between ACE and psychological symptoms. METHODS We analyzed the associations between direct and indirect exposure to ACE and PTSD and Complex PTSD (affective dysregulation, negative self-concept and disturbances in relationships) through the mediation role of mature defense mechanisms: mature, neurotic, and immature defense mechanisms in Indian adolescents. A sample of 411 Indian adolescents (M = 14.2 years old; S.D. = 0.5) completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modelling employing Preacher and Hayes' procedures (2008). RESULTS Immature and neurotic defense mechanisms mediated the association between direct exposure to ACE with PTSD symptoms. Immature defense mechanisms were mediators of the relationship between direct exposure to ACE and Complex PTSD symptoms clusters. CONCLUSIONS Maladaptive defense mechanisms can disturb the process of self-regulation and emotion regulation capabilities in coping with traumatic experiences, leading to higher PTSD and Complex PTSD symptoms severity.
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Affiliation(s)
- Paulo Ferrajão
- Faculdade de Ciências Sociais e Tecnologia, Universidade Europeia, Quinta do Bom Nome, Estrada da Correia 53, Lisbon, 1500-210, Portugal.
| | - Carolina Isabel Batista
- Faculdade de Ciências Sociais e Tecnologia, Universidade Europeia, Quinta do Bom Nome, Estrada da Correia 53, Lisbon, 1500-210, Portugal
| | - Ask Elklit
- National Center for Psychotraumatology, University of Southern Denmark, Odense, Denmark
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Nhu NT, Kang JH, Yeh TS, Wu CC, Tsai CY, Piravej K, Lam C. Prediction of posttraumatic functional recovery in middle-aged and older patients through dynamic ensemble selection modeling. Front Public Health 2023; 11:1164820. [PMID: 37408743 PMCID: PMC10319009 DOI: 10.3389/fpubh.2023.1164820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/17/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Age-specific risk factors may delay posttraumatic functional recovery; complex interactions exist between these factors. In this study, we investigated the prediction ability of machine learning models for posttraumatic (6 months) functional recovery in middle-aged and older patients on the basis of their preexisting health conditions. Methods Data obtained from injured patients aged ≥45 years were divided into training-validation (n = 368) and test (n = 159) data sets. The input features were the sociodemographic characteristics and baseline health conditions of the patients. The output feature was functional status 6 months after injury; this was assessed using the Barthel Index (BI). On the basis of their BI scores, the patients were categorized into functionally independent (BI >60) and functionally dependent (BI ≤60) groups. The permutation feature importance method was used for feature selection. Six algorithms were validated through cross-validation with hyperparameter optimization. The algorithms exhibiting satisfactory performance were subjected to bagging to construct stacking, voting, and dynamic ensemble selection models. The best model was evaluated on the test data set. Partial dependence (PD) and individual conditional expectation (ICE) plots were created. Results In total, nineteen of twenty-seven features were selected. Logistic regression, linear discrimination analysis, and Gaussian Naive Bayes algorithms exhibited satisfactory performances and were, therefore, used to construct ensemble models. The k-Nearest Oracle Elimination model outperformed the other models when evaluated on the training-validation data set (sensitivity: 0.732, 95% CI: 0.702-0.761; specificity: 0.813, 95% CI: 0.805-0.822); it exhibited compatible performance on the test data set (sensitivity: 0.779, 95% CI: 0.559-0.950; specificity: 0.859, 95% CI: 0.799-0.912). The PD and ICE plots showed consistent patterns with practical tendencies. Conclusion Preexisting health conditions can predict long-term functional outcomes in injured middle-aged and older patients, thus predicting prognosis and facilitating clinical decision-making.
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Affiliation(s)
- Nguyen Thanh Nhu
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Jiunn-Horng Kang
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
- Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tian-Shin Yeh
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Epidemiology and Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, United States
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Chia-Chieh Wu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Yu Tsai
- Centre for Transport Studies, Department of Civil and Environmental Engineering, Imperial College London, London, United Kingdom
| | - Krisna Piravej
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Carlos Lam
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Yu JY, Heo S, Xie F, Liu N, Yoon SY, Chang HS, Kim T, Lee SU, Hock Ong ME, Ng YY, Do shin S, Kajino K, Cha WC. Development and Asian-wide validation of the Grade for Interpretable Field Triage (GIFT) for predicting mortality in pre-hospital patients using the Pan-Asian Trauma Outcomes Study (PATOS). THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 34:100733. [PMID: 37283981 PMCID: PMC10240358 DOI: 10.1016/j.lanwpc.2023.100733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/24/2023] [Accepted: 02/19/2023] [Indexed: 03/07/2023]
Abstract
Background Field triage is critical in injury patients as the appropriate transport of patients to trauma centers is directly associated with clinical outcomes. Several prehospital triage scores have been developed in Western and European cohorts; however, their validity and applicability in Asia remains unclear. Therefore, we aimed to develop and validate an interpretable field triage scoring systems based on a multinational trauma registry in Asia. Methods This retrospective and multinational cohort study included all adult transferred injury patients from Korea, Malaysia, Vietnam, and Taiwan between 2016 and 2018. The outcome of interest was a death in the emergency department (ED) after the patients' ED visit. Using these results, we developed the interpretable field triage score with the Korea registry using an interpretable machine learning framework and validated the score externally. The performance of each country's score was assessed using the area under the receiver operating characteristic curve (AUROC). Furthermore, a website for real-world application was developed using R Shiny. Findings The study population included 26,294, 9404, 673 and 826 transferred injury patients between 2016 and 2018 from Korea, Malaysia, Vietnam, and Taiwan, respectively. The corresponding rates of a death in the ED were 0.30%, 0.60%, 4.0%, and 4.6% respectively. Age and vital sign were found to be the significant variables for predicting mortality. External validation showed the accuracy of the model with an AUROC of 0.756-0.850. Interpretation The Grade for Interpretable Field Triage (GIFT) score is an interpretable and practical tool to predict mortality in field triage for trauma. Funding This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant Number: HI19C1328).
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Affiliation(s)
- Jae Yong Yu
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Digital & Smart Health Office, Tan Tock Seng Hospital, Singapore
| | - Sejin Heo
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Feng Xie
- Programme in Health Services and Systems Research, Duke–National University of Singapore Medical School, Singapore
- Department of Biomedical Data Science, Stanford University, Stanford, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, USA
| | - Nan Liu
- Programme in Health Services and Systems Research, Duke–National University of Singapore Medical School, Singapore
- Health Service Research Centre, Singapore Health Services, Singapore
- Institute of Data Science, National University of Singapore, Singapore
| | - Sun Yung Yoon
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Han Sol Chang
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Taerim Kim
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Marcus Eng Hock Ong
- Programme in Health Services and Systems Research, Duke–National University of Singapore Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Yih Yng Ng
- Digital & Smart Health Office, Tan Tock Seng Hospital, Singapore
| | - Sang Do shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Kentaro Kajino
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Moriguchi, Japan
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Digital Innovation Center, Samsung Medical Center, Seoul, South Korea
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Teixeira HM, DA-Silva AA, DA-Rocha AKC, Valderrama MR, Bernardelli RS, Silva VWM, Bahten LCVON. Analysis of primary care of victims of interpersonal and self inflicted violence during the COVID-19 pandemic. Rev Col Bras Cir 2023; 50:e20233423. [PMID: 37075464 PMCID: PMC10508655 DOI: 10.1590/0100-6991e-20233423-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 12/08/2022] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVES to analyze the epidemiological profile of aggression victims admitted at the emergency room on a trauma hospital during the COVID-19 pandemic, to compare these data in different restriction periods and with prepandemic data from the same service. METHODS cross-sectional study with probabilistic sampling using medical records of patients who were victims of aggression admitted at the hospital between June 2020 and May 2021. In addition to the epidemiological variables, other variables collected were the current restriction level, mechanism of aggression, resulting injuries and the Revised Trauma Score (RTS). The data was compared between the three restriction levels and the proportion of attendances during the study period was compared with the pre-pandemic study (December 2016 to February 2018). RESULTS the average age was 35.5 years, 86.1% of the patients were male and 61.6% of the attendances were due to blunt injury. The highest average of attendances per day occurred during the "yellow" restriction level (2.9), however there was no significant difference when comparing the restriction periods two by two. There was also no significant difference either in the analysis of the standardized residuals of the proportions of aggressions or the mechanism of aggression in the pre-pandemic and pandemic periods. CONCLUSIONS there was a predominance of attendances due to blunt trauma and in young male patients. There was no significant difference between the average daily attendance for aggression during the three restriction levels and between the proportion of attendances in the pre-pandemic and pandemic period.
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Affiliation(s)
- Heloísa Moro Teixeira
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
| | - Angel Adriany DA-Silva
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
| | | | | | - Rafaella Stradiotto Bernardelli
- - Pontifícia Universidade Católica do Paraná, Escola de Medicina e Ciências da Vida - Departamento de Bioestatística - Curitiba - PR - Brasil
| | | | - Luiz Carlos VON Bahten
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
- - Universidade Federal do Paraná, Departamento de Clínica Cirúrgica - Curitiba - PR - Brasil
- - Pontifícia Universidade Católica do Paraná, Escola de Medicina e Ciências da Vida - Departamento de Clínica Cirúrgica - Curitiba - PR - Brasil
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VON-Bahten LC, Zvicker AL, Silva AADA, Salviato BZ, Teixeira HM, Ando PK, Bernardelli RS. Influence of the COVID-19 pandemic on the epidemiological profile of the initial care of victims of falls. Rev Col Bras Cir 2023; 50:e20233422. [PMID: 36921132 PMCID: PMC10519699 DOI: 10.1590/0100-6991e-20233422-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/17/2022] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVE to assess the epidemiological profile of trauma patients from fall from the same level (FSL) and fall from an elevated level (FEL) during the COVID-19 pandemic, and to compare it with data from different levels of restriction (flags) and data prior to the pandemic. METHOD a cross-sectional study with a probability sample of the medical records of patients aged 18 years or older admitted to the emergency room due to falls, from June 2020 to May 2021. Epidemiological data, such as sex, age and injuries were analyzed, as well the current level of restriction. The three restriction periods were compared between then and the proportion of admissions due to falls was compared with the period from December 2016 to February 2018. RESULTS a total of 296 admissions were evaluated, 69.9% were victims of FSL and 30.1% of FEL. The mean age was 57.6 years, and 45.6% were over 60 years old. Admissions among men predominated, and 40.2% of patients required hospitalization. During the red flag period, there were proportionally more injuries to the head and neck (p=0.016), injuries to extremities (p=0.015) and neurological trauma (p<0.001). An average of 6.1, 6.3 and 5.2 admissions per day was obtained during the yellow, orange and red flag, respectively. There was a relative increase in falls when compared to the pre-pandemic period. CONCLUSIONS there was an absolute reduction in admissions of victims of falls in midst of the most restrictive period during the pandemic. However, when compared to pre-pandemic data, there was a relative increase in falls.
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Affiliation(s)
- Luiz Carlos VON-Bahten
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
- - Universidade Federal do Paraná, Departamento de Clínica Cirúrgica - Curitiba - PR - Brasil
- - Pontifícia Universidade Católica do Paraná, Escola de Medicina e Ciências da Vida - Departamento de Clínica Cirúrgica - Curitiba - PR - Brasil
| | - Aliana Lunardi Zvicker
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
| | - Angel Adriany DA Silva
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
| | | | - Heloísa Moro Teixeira
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
| | - Paula Kaori Ando
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
| | - Rafaella Stradiotto Bernardelli
- - Pontifícia Universidade Católica do Paraná, Escola de Medicina e Ciências da Vida - Departamento de Bioestatística - Curitiba - PR - Brasil
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VON-BAHTEN LUIZCARLOS, ZVICKER ALIANALUNARDI, SILVA ANGELADRIANYDA, SALVIATO BEATRIZZANUTTO, TEIXEIRA HELOÍSAMORO, ANDO PAULAKAORI, BERNARDELLI RAFAELLASTRADIOTTO. Influência da pandemia da COVID-19 no perfil epidemiológico do atendimento inicial de pacientes vítimas de quedas. Rev Col Bras Cir 2023. [DOI: 10.1590/0100-6991e-20233422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
RESUMO Objetivo: avaliar o perfil epidemiológico do trauma por quedas de mesmo nível (QMN) e quedas de nível elevado (QNE) durante a pandemia da COVID-19, realizar a comparação dos dados entre os níveis de restrição (bandeiras) e comparar com dados prévios à pandemia. Método: estudo transversal com amostragem probabilística de prontuários de pacientes com 18 anos ou mais admitidos na sala de emergência devido a quedas de junho de 2020 a maio de 2021. Foram avaliados dados epidemiológicos, como sexo, idade e lesões resultantes, além da bandeira vigente. Os três períodos de restrição foram comparados entre si e a proporção de atendimentos por quedas foi comparada com o período de dezembro de 2016 a fevereiro de 2018. Resultados: avaliou-se 296 atendimentos, sendo 69,9% vítimas de QMN e 30,1% de QNE. A média de idade foi 57,6 anos, sendo que 45,6% apresentavam idade superior a 60 anos. Sexo masculino predominou e 40,2% dos pacientes necessitaram internamento hospitalar. Durante a bandeira vermelha proporcionalmente ocorreram mais lesões em cabeça e pescoço (p=0,016), trauma em extremidades (p=0,015) e neurológico (p<0,001). Obteve-se uma média de 6,1, 6,3 e 5,2 atendimentos/dia durante a bandeira amarela, laranja e vermelha respectivamente. Ocorreu um aumento significativo da ocorrência de quedas quando comparado ao período prévio à pandemia. Conclusões: durante o período pandêmico, verificou-se uma redução absoluta de atendimentos de vítimas de quedas na bandeira mais restritiva. Porém, quando comparado ao período pré-pandêmico, verifica-se um aumento significativo das quedas.
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Affiliation(s)
- LUIZ CARLOS VON-BAHTEN
- Hospital Universitário Cajuru, Brasil; Universidade Federal do Paraná, Brazil; Pontifícia Universidade Católica do Paraná, Brazil
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Silva AADA, Ströher GR, Teixeira HM, Cordeiro MVG, Olandoski M, VON-Bahten LC. Impact of the COVID-19 pandemic on the epidemiology of traffic accidents: a cross-sectional study. Rev Col Bras Cir 2022; 49:e20223364. [PMID: 36515331 PMCID: PMC10578847 DOI: 10.1590/0100-6991e-20223364-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/20/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE to assess the epidemiological profile of traffic accident victims in the setting of the Coronavirus Disease 2019 (COVID-19) pandemic and analyze the admissions throughout the different levels of restriction (flags), as well as compare the results with the pre-pandemic period. METHODS a cross-sectional study was performed, with probability sampling, in a trauma center in Brazil. Medical records of patients involved in traffic accidents from June 2020 to May 2021 were evaluated. Aside from epidemiological characteristics, variables such as the current flag, the trauma mechanism, the resulting injuries, and the Revised Trauma Score (RTS) were also considered. Data were compared between three different flag periods and the proportion of consultations during the pandemic was compared with that from pre-pandemic time (December 2016 to February 2018). RESULTS it was observed that 62.2% of the patients were victims of motorcycle accidents, 77.5% were male, and the mean age was 33 ± 12.4 years. The mean and median RTS were 7.5 and 7.8, respectively. Statistical difference was stated when comparing the number of visits per day between the yellow and red flags (p=0.001) and orange and red flags (p=0.016). A significantly lower number of consultations for traffic accidents was observed in the pandemic when compared to the pre-pandemic period. CONCLUSIONS the epidemiological profile of the study consisted mostly of young men who were victims of motorcycle accidents. There was a lower incidence of admissions during red flag periods and a lower proportion of consultations throughout the survey when compared to the pre-pandemic period.
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Affiliation(s)
- Angel Adriany DA Silva
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
| | | | - Heloísa Moro Teixeira
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
| | | | - Marcia Olandoski
- - Pontifícia Universidade Católica do Paraná, Escola de Medicina e Ciências da Vida, Departamento de Bioestatística - Curitiba - PR - Brasil
| | - Luiz Carlos VON-Bahten
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
- - Universidade Federal do Paraná, Departamento de Clínica Cirúrgica - Curitiba - PR - Brasil
- - Pontifícia Universidade Católica do Paraná, Escola de Medicina e Ciências da Vida, Departamento de Clínica Cirúrgica - Curitiba - PR - Brasil
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Factors Associated with an Increase in On-Site Time of Pediatric Trauma Patients in a Prehospital Setting: A Nationwide Observational Study in Japan. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111658. [PMID: 36360384 PMCID: PMC9688461 DOI: 10.3390/children9111658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
The factors that prolong the on-site time in pediatric trauma cases in a prehospital setting are unknown. We investigated these factors using a national trauma registry in Japan. We identified pediatric trauma patients aged ≤18 years, from January 2004 to May 2019. We categorized cases into shorter (≤13 min) and longer (>13 min) prehospital on-site time groups. We performed multivariable logistic regression analysis with multiple imputations to assess the factors associated with longer prehospital on-site time. Overall, 14,535 patients qualified for inclusion. The median prehospital on-site time was 13 min. In the multivariable logistic regression analysis, the longer prehospital on-site time was associated with higher age; suicide (Odds ratio [OR] 1.27; 95% confidence interval [CI] 1.03−1.57); violence (OR 1.74; 95%CI 1.27−2.38); higher revised trauma score, abbreviated injury scale > 3 in the spine (OR 1.25; 95%CI 1.04−1.50), upper extremity (OR 1.26; 95%CI 1.11−1.44), and lower extremity (OR 1.25; 95%CI 1.14−1.37); immobilization (OR 1.16; 95%CI 1.06−1.27); and comorbid mental retardation (OR 1.56; 95%CI 1.11−2.18). In light of these factors, time in the field could be reduced by having more pediatric emergency physicians and orthopedic surgeons available.
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Rodrigues BC, Lemos MM, Gonçalves MR, Labbado JA, Bitencourt MR, Lemos MAS, Luziardi EM, Camargo M, Henrique Iora P, Bitencourt MR. Air Medical Transportation Provided by Norte Novo Regional Urgency Mobile Service: What Is the Current Scenario? Air Med J 2022; 41:190-195. [PMID: 35307142 DOI: 10.1016/j.amj.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim of this study was to investigate, describe, and analyze the Norte Novo regional air medical service provided by the Brazilian Emergency Medical Rescue Service. METHODS This was a retrospective and descriptive study with a quantitative approach of the incidents registered from November 2016 to December 2019. For general patient classification, descriptive statistics of the following variables were performed: sex, age/age group, type of diagnosis, city where the incident took place, city of destination, length of patient care, ventilatory support, use of sedation, and use of vasoactive drugs. All analyses were performed using the XLSTAT program (Version 19.4; Addinsoft, New York, NY), considering a significance level of 5%. RESULTS There were 1,677 responses divided into clinical (60.8%), traumatic (37.8%), organ transport (1.2%), and interhospital transference (0.2%). The most frequent diagnoses were acute myocardial infarction and stroke (clinical care) and polytrauma (trauma care). The average waiting time until the helicopter arrived at the scene was 25 minutes. CONCLUSION This study shows the importance and relevance of this air medical service for the area it covers. Further research is needed to address the profile of this service in our country, which will allow us to elucidate scenarios and develop strategies to assist the population and, thus, design training and simulation exercises for emergency service teams based on local realities.
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Affiliation(s)
| | - Mauricio Medeiros Lemos
- Parana Health Department, Maringá, Paraná, Brazil; Department of Health Promotion, Unicesumar, Maringá, Paraná, Brazil
| | | | | | - Mariá Romanio Bitencourt
- City Hall of Maringá, Paraná, Brazil; Department of Health Sciences, State University of Maringá, Maringá, Paraná, Brazil
| | | | | | | | - Pedro Henrique Iora
- Department of Medicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Marcos Rogério Bitencourt
- Parana Health Department, Maringá, Paraná, Brazil; Department of Health Sciences, State University of Maringá, Maringá, Paraná, Brazil
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Ying Y, Huang B, Zhu Y, Jiang X, Dong J, Ding Y, Wang L, Yuan H, Jiang P. Comparison of Five Triage Tools for Identifying Mortality Risk and Injury Severity of Multiple Trauma Patients Admitted to the Emergency Department in the Daytime and Nighttime: A Retrospective Study. Appl Bionics Biomech 2022; 2022:9368920. [PMID: 35251304 PMCID: PMC8896924 DOI: 10.1155/2022/9368920] [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: 11/20/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022] Open
Abstract
Effective triage tools are indispensable for doctors to make a prompt decision for the treatment of multiple trauma patients in emergency departments (EDs). The Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), standardized early warning score (SEWS), Modified Rapid Emergency Medicine Score (mREMS), and Revised Trauma Score (RTS) are five common triage tools proposed for trauma management. However, few studies have compared these tools in a multiple trauma cohort and investigated the influence of nighttime admission on the performance of these tools. This retrospective study was aimed at evaluating and comparing the performance of MEWS, NEWS, SEWS, mREMS, and RTS for identifying the mortality risk and trauma severity of patients with multiple trauma admitted to the ED during the daytime and nighttime. Retrospective data were collected from the medical records of patients with multiple trauma admitted in the daytime or nighttime to calculate scores for each triage tool. Logistic regression analysis was conducted on each triage tool for identifying in-hospital mortality and severe trauma (injury severity score > 15) in the daytime and nighttime. The performance of the tools was evaluated and compared by calculating area under the receiver operating characteristic curve (AUROC) of the retrospective logistic model of each tool. We collected data for 1,818 admissions, including 1,070 daytime and 748 nighttime admissions. A comparison of performance for identifying in-hospital mortality between daytime and nighttime yielded the following results (AUROC): MEWS (0.95 vs. 0.93, p = 0.384), NEWS (0.95 vs. 0.94, p = 0.708), SEWS (0.95 vs. 0.94, p = 0.683), mREMS (0.94 vs. 0.92, p = 0.286), and RTS (0.93 vs. 0.93, p = 0.87). Similarly, a comparison of performance for identifying trauma severity between daytime and nighttime yielded the following results (AUROC): MEWS (0.78 vs. 0.78, p = 0.95), NEWS (0.8 vs. 0.8, p = 0.885), SEWS (0.78 vs. 0.78, p = 0.818), mREMS (0.75 vs. 0.69, p = 0.019), and RTS (0.75 vs. 0.74, p = 0.619). All five scores are excellent triage tools (AUROC ≥ 0.9) for identifying in-hospital mortality for both daytime and nighttime admissions. However, they have only moderate effectiveness (AUROC < 0.9) at identifying severe trauma. The NEWS is the best triage tool for identifying severe trauma for both daytime and nighttime admissions. The MEWS, NEWS, SEWS, and RTS exhibited no significant differences in performance for identifying in-hospital mortality or severe trauma during the daytime or nighttime. However, the mREMS was better at identifying severe trauma during the daytime.
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Affiliation(s)
- Youguo Ying
- Emergency Department 1, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Boli Huang
- Department of Nursing, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Nursing Management Research Center of China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhu
- Department of Nursing, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaobin Jiang
- Emergency Department 1, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinxiu Dong
- Emergency Department 1, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanfen Ding
- Emergency Department 1, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Wang
- Emergency Department 1, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huimin Yuan
- Emergency Department 1, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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SILVA ANGELADRIANYDA, STRÖHER GABRIELAREDIVO, TEIXEIRA HELOÍSAMORO, CORDEIRO MARIAVICTÓRIAGUTIERREZ, OLANDOSKI MARCIA, VON-BAHTEN LUIZCARLOS. Impacto da pandemia da COVID-19 na epidemiologia dos acidentes de trânsito: um estudo transversal. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
RESUMO Introdução: avaliar o perfil epidemiológico das vítimas de acidentes de trânsito no contexto da pandemia da doença do coronavírus 2019 (COVID-19), analisar os atendimentos entre os níveis de restrição implementados (bandeiras) e comparar os dados com o período pré-pandêmico. Métodos: trata-se de um estudo transversal, com amostragem probabilística, realizado em um hospital de trauma no sul do Brasil utilizando prontuários de pacientes vítimas de acidente de trânsito entre junho de 2020 a maio de 2021. Além das variáveis epidemiológicas, coletou-se a bandeira vigente, o mecanismo de trauma, as lesões resultantes e o Revised Trauma Score (RTS). Os dados foram comparados entre as três bandeiras e a proporção de atendimentos do período pandêmico foi comparada com a do período pré-pandêmico (dezembro de 2016 a fevereiro de 2018). Resultados: observou-se que 62,2% dos pacientes foram vítimas de acidentes com motocicletas, 77,5% da amostra era do sexo masculino e que a média etária foi de 33 ± 12,4 anos. A média e mediana do RTS foram 7,5 e 7,8, respectivamente. Houve diferença significativa ao comparar o número de atendimentos ao dia entre as bandeiras amarela e vermelha (p=0,001) e laranja e vermelha (p=0,016). Constatou-se um número significativamente menor de atendimentos por acidentes de trânsito no período pandêmico quando comparado com o período pré-pandêmico. Conclusões: o perfil epidemiológico do estudo foi composto em sua maioria por homens jovens vítimas de acidentes com motocicleta. Houve menor incidência de admissões na bandeira vermelha e menor proporção de atendimentos no período da pesquisa quando comparado ao pré-pandêmico.
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Affiliation(s)
| | | | | | | | | | - LUIZ CARLOS VON-BAHTEN
- Hospital Universitário Cajuru, Brasil; Universidade Federal do Paraná, Brazil; Pontifícia Universidade Católica do Paraná, Brazil
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Yu Z, Xu F, Chen D. Predictive value of Modified Early Warning Score (MEWS) and Revised Trauma Score (RTS) for the short-term prognosis of emergency trauma patients: a retrospective study. BMJ Open 2021; 11:e041882. [PMID: 33722865 PMCID: PMC7959230 DOI: 10.1136/bmjopen-2020-041882] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES This study aimed to assess the predictive value of the Modified Early Warning Score (MEWS) and Revised Trauma Score (RTS) for emergency trauma patients who died within 24 hours. DESIGN A retrospective, single-centred study. SETTING This study was conducted at a tertiary hospital in Southern China. PARTICIPANTS A total of 1739 patients with acute trauma, aged 16 years or older who presented to the emergency department from 1 November 2016 to 30 November 2019, were included. INTERVENTIONS NONE None. OUTCOME 24-hour mortality was the primary outcome of trauma. RESULTS 1739 patients were divided into the survival group (1709 patients,98.27%), and the non-survival group (30 patients,1.73%). Crude OR and adjusted OR of MEWS were 1.99, 95% CI (1.73 to 2.29), and 2.00, 95% CI (1.74 to 2.31), p<0.001, respectively. Crude OR and adjusted OR of RTS were 0.62, 95% CI (0.55 to 0.69) and 0.61, 95% CI (0.55 to 0.68), p<0.001, respectively. The area under the curve of MEWS was significantly higher than that of RTS (p=0.005): 0.927, 95% CI (0.914 to 0.939) vs 0.799, 95% CI (0.779 to 0.817). CONCLUSIONS Both MEWS and RTS were independent predictors of the short-term prognosis in emergency trauma patients, MEWS had better predictive efficacy.
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Affiliation(s)
- Zhejun Yu
- Division of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng Xu
- Division of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Du Chen
- Division of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
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Rahmani F, Khajoei R, Abadi M, Dehesh T, Heydarpour N, Shokohian S. Predictive value of the glasgow coma scale, age, and arterial blood pressure and the new trauma score indicators to determine the hospital mortality of multiple trauma patients. ARCHIVES OF TRAUMA RESEARCH 2021. [DOI: 10.4103/atr.atr_72_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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14
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Verma D, Kumar N, Jain A, Gouda B, Kumawat S. Comparative evaluation of revised trauma score and injury severity score as prognosis predictor among polytrauma patients. ARCHIVES OF TRAUMA RESEARCH 2021. [DOI: 10.4103/atr.atr_54_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jiang X. An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity. PeerJ 2020; 8:e10242. [PMID: 33194421 PMCID: PMC7597630 DOI: 10.7717/peerj.10242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/05/2020] [Indexed: 11/20/2022] Open
Abstract
Background Rapid identification of trauma severity is essential for the timely triage of multiple trauma patients. Tools such as the modified early warning score (MEWS) are used for determining injury severity. Although the conventional MEWS is a good predictor of mortality, its performance assessing injury severity is moderate. This study hypothesized that adding an injury site severity-related score (e.g., abdomen score) may enhance the capability of the MEWS for identifying severe trauma. Method To validate the hypothesis, we propose an improved modified early warning score called MEWS-A, which incorporates an injury site-specific severity-related abdomen score to MEWS. The utility of MEWS and MEWS-A were retrospectively evaluated and compared for identifying trauma severity in adult multiple trauma patients admitted to the emergency department. Results We included 1,230 eligible multiple trauma patients and divided them into minor and severe trauma groups based on the injury severity score. Results of logistic regression and receiver operating characteristic (ROC) curve analyses showed that the MEWS-A had a higher area under the ROC curve (AUC: 0.81 95% CI [0.78-0.83]) than did the MEWS (AUC: 0.77 95% CI [0.74-0.79]), indicating that the MEWS-A is superior to the MEWS in identifying severe trauma. The optimal MEWS-A cut-off score is 4, with a specificity of 0.93 and a sensitivity of 0.54. MEWS-A ≥ 4 can be used as a protocol for decision-making in the emergency department. Conclusions Our study suggests that while the conventional MEWS is sufficient for predicting mortality risk, adding an injury site-specific score (e.g., abdomen score) can enhance its performance in determining injury severity in multiple trauma patients.
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Affiliation(s)
- Xiaobin Jiang
- Emergency Department 1, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Tseng IC, Chen IJ, Chou YC, Hsu YH, Yu YH. Predictors of Acute Mortality After Open Pelvic Fracture: Experience From 37 Patients From A Level I Trauma Center. World J Surg 2020; 44:3737-3742. [PMID: 32632642 PMCID: PMC7527368 DOI: 10.1007/s00268-020-05675-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Open pelvic fractures are caused by high-energy traumas and are accompanied by organ injuries. Despite improvements in pre-hospital care, the acute mortality rate following open pelvic fractures remains high. This study aimed to report experiences in managing open pelvic fractures, identify potential independent predictors that contribute to acute mortality in such patients, and generate a scoring formula to predict mortality rate. METHODS Open pelvic fracture patients managed during a 42-month period were retrospectively studied. Logistic regression analysis was used to determine predictors of acute mortality. Using the Youden index, threshold values of predictors were selected. Significant predictors were weighted to create a scoring formula. The area under the curve (AUC) was tested in this specific group. RESULTS The incidence of open pelvic fractures in all pelvic fractures was 4.9% (37/772), and the overall mortality rate was 21.6% (8/37). All the successfully resuscitated patients entered the reconstruction stage survived and underwent the complete treatment course. Univariate and multivariate logistic regression analyses revealed that the revised trauma score (RTS) was the single independent predictor of acute mortality. A scoring formula was generated following the statistical analysis. The probability of mortality was 0% and 100% when the score was above and below -2, respectively. This model predicted mortality with an AUC of 0.948 (95% confidence interval 0.881-1.000, P < 0.01). CONCLUSION The RTS may be a potential predictor of acute mortality in open pelvic fracture patients. Further work would be required to validate the clinical efficacy of the generated scoring formula.
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Affiliation(s)
- I-Chuan Tseng
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsin St. Kweish, 33302, Tao-Yuan, Taiwan
| | - I-Jung Chen
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsin St. Kweish, 33302, Tao-Yuan, Taiwan
| | - Ying-Chao Chou
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsin St. Kweish, 33302, Tao-Yuan, Taiwan
| | - Yung-Heng Hsu
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsin St. Kweish, 33302, Tao-Yuan, Taiwan
| | - Yi-Hsun Yu
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsin St. Kweish, 33302, Tao-Yuan, Taiwan.
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Guizzo WA, de-Souza BS, Weihermann V, da-Silva AB, Jabur GR, Menini-Stahlschmidt CM, Von-Bahten LC. Trauma in Curitiba: multifactorial assessment of victims admitted to a university hospital. Rev Col Bras Cir 2020; 47:e20202408. [PMID: 32555964 DOI: 10.1590/0100-6991e-20202408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/17/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to describe the epidemiological profile of trauma patients admitted to a referral hospital in Curitiba (PR). Also, to investigate trauma mechanisms and to evaluate trauma severity scores. METHODS descriptive observational cross-sectional study. Data were collected by applying a questionnaire to victims admitted in the emergency room from December 2016 to February 2018. RESULTS a total of 1354 trauma victims were included in the study, of which 60% were transported by SIATE and 40% by SAMU. Regarding gender, 70% of the patients were male. The mean age was 39.48 years. About the time and day of the calls, the largest proportion was concentrated on Friday night. In relation to the mechanism of trauma, in patients transported by SIATE, the most frequent in men was motorcycle collision (34.3%), while in women was same-level fall (21.42%). In SAMU, the most frequent mechanism regardless of gender was same-level fall (20.06% and 40.66%, respectively). Analyzing the severity scores, it was observed that 95.5% of the patients were classified as mild by the Glasgow Coma Scale. CONCLUSION the profile of trauma victims analyzed in this large study is quite similar to what other national smaller studies have already described: young men victims of traffic accidents. Therefore, the economically active population is the most affected, reflecting in high cost to society.
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Affiliation(s)
| | | | - Viktoria Weihermann
- Hospital Universitário Cajuru, Liga Acadêmica do Trauma - Curitiba - PR - Brasil
| | | | - Gabriel Ramos Jabur
- Hospital Universitário Cajuru, Serviço de Cirurgia Geral - Curitiba - PR - Brasil
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18
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Romeo ACDCB, Cardoso PLP, Correia-Jr GB, Joaquim-de-Carvalho MEA, Santos FM, Serafim DF, Dos Reis-Junior GS, Cunha AG. Undeclared civil war? Urban violence in major city in Brazil. ACTA ACUST UNITED AC 2020; 47:e20202506. [PMID: 32555969 DOI: 10.1590/0100-6991e-20202506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 03/29/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE Civil violence is responsible for 2.5% of deaths worldwide; it killed more people in the 21st century than the sum of all wars. This study describes violence victims treated at a trauma reference hospital in Salvador, Brazil and analyzes the impact of different types of interpersonal violence. METHODS Interpersonal violence victims admitted between July 2015 and July 2017 were included. The 1,296 patients (mean age: 30.3 years; 90% male) were divided into three groups according to the mechanism of interpersonal violence: 1) beating, 2) firearm injury and 3) stab wound (STW) injury. The groups were compared for the following variables: age, gender, trauma mechanism, Revised Trauma Score (RTS) at admission, need for intensive care unit (ICU) attention, length of hospital stay, need for transfusion of blood products and death. RESULTS Gunshot wounds (GSW) were the primary mechanism of injury (59%), followed by beating (24%) and STW (17%). Gunshot wound victims had a lower mean RTS upon admission, increased need for blood products and more Intensive Care Unit (ICU) admissions. Beating victims had the longest mean hospital stay (11.6 ± 19.6 days). The GSW group accounted for 77.4% of all deaths. The in-hospital mortality rate was significantly higher in the GSW group (12.7%) than in the beating group (5.4%) and in the STW group (4.9%). CONCLUSIONS Gunshot wound victims are more critical: they require longer ICU stays, more transfusions of blood products and exhibit increased mortality compared with STW and beating victims.
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Affiliation(s)
- Ana Celia D C B Romeo
- Escola Bahiana de Medicina e Saúde Pública, Programa de Pós Graduação - Salvador - BA - Brasil.,Universidade Federal da Bahia, Departamento de Anestesiologia e Cirurgia - Salvador - BA - Brasil
| | | | | | | | - Felipe Miranda Santos
- Universidade Federal da Bahia, Departamento de Anestesiologia e Cirurgia - Salvador - BA - Brasil
| | | | | | - André Gusmão Cunha
- Universidade Federal da Bahia, Departamento de Anestesiologia e Cirurgia - Salvador - BA - Brasil
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Aspelund AL, Patel MQ, Kurland L, McCaul M, van Hoving DJ. Evaluating trauma scoring systems for patients presenting with gunshot injuries to a district-level urban public hospital in Cape Town, South Africa. Afr J Emerg Med 2019; 9:193-196. [PMID: 31890483 PMCID: PMC6933194 DOI: 10.1016/j.afjem.2019.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/24/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction Trauma scoring systems are widely used in emergency settings to guide clinical decisions and to predict mortality. It remains unclear which system is most suitable to use for patients with gunshot injuries at district-level hospitals. This study compares the Triage Early Warning Score (TEWS), Injury Severity Score (ISS), Trauma and Injury Severity Score (TRISS), Kampala Trauma Score (KTS) and Revised Trauma Score (RTS) as predictors of mortality among patients with gunshot injuries at a district-level urban public hospital in Cape Town, South Africa. Methods Gunshot-related patients admitted to the resuscitation area of Khayelitsha Hospital between 1 January 2016 and 31 December 2017 were retrospectively analysed. Receiver Operating Characteristic (ROC) analysis were used to determine the accuracy of each score to predict all-cause in-hospital mortality. The odds ratio (with 95% confidence intervals) was used as a measure of association. Results In total, 331 patients were included in analysing the different scores (abstracted from database n = 431, excluded: missing files n = 16, non gunshot injury n = 10, <14 years n = 1, information incomplete to calculate scores n = 73). The mortality rate was 6% (n = 20). The TRISS and KTS had the highest area under the ROC curve (AUC), 0.90 (95% CI 0.83-0.96) and 0.86 (95% CI 0.79–0.94), respectively. The KTS had the highest sensitivity (90%, 95% CI 68-99%), while the TEWS and RTS had the highest specificity (91%, 95% CI 87–94% each). Conclusions None of the different scoring systems performed better in predicting mortality in this high-trauma burden area. The results are limited by the low number of recorded deaths and further studies are needed. Gunshot injuries most often occurs in young males. Trauma scores can be used to prognosticate patients in order to allocate appropriate resources. Accuracy-related data of trauma scores in entry-level hospitals is limited.
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Affiliation(s)
| | | | - Lisa Kurland
- Department of Research and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Sciences, Department of Emergency Medicine, Örebro, Sweden
| | - Michael McCaul
- Biostatistics Unit, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, South Africa
| | - Daniël Jacobus van Hoving
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
- Corresponding author at: PO Box 241, Cape Town 8000, South Africa.
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Pimentel SK, Almeida PAD, Shimizu GP, Carvalho FHD. Computerized Axial Tomography in patients with severe abdominal trauma: is it a justifiable risk? ACTA ACUST UNITED AC 2019; 46:e2064. [PMID: 30916209 DOI: 10.1590/0100-6991e-20192064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 12/11/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE to evaluate the evolution of severe abdominal trauma patients, for whom the massive transfusion protocol was triggered, and who were submitted to Computed Axial Tomography (CAT) in the emergency room (ER), in order to verify the patient's prognosis and the diagnostic efficiency of CAT in this scenario. METHODS retrospective, longitudinal and observational study performed at a referral center for trauma care in Curitiba, Parana, Brazil. We selected 60 severe abdominal trauma patients who had massive transfusion protocol activation and divided them into two groups: patients who underwent CAT at ER and patients who did not. We verified the diagnostic accuracy of CAT-scan examination and compared the number of deaths, hospitalization time, and transfused blood components in both groups. RESULTS considering the 60 patients, 66.67% received red blood cells at ER; 33.3% underwent CAT on admission due to hemodynamic improvement, and 66.7% did not perform the examination at the entrance. The percentage of deaths was 35% in both groups. Considering the two groups, the difference between the mean lengths of hospital stay was not statistically significant, as well as the difference between the mean numbers of transfused red blood cells. In the group that underwent CAT, 45% did not require exploratory laparotomy. CONCLUSION CAT could be rapidly performed in patients with hemodynamic instability on arrival at ER, sparing some patients from an unnecessary exploratory laparotomy and not significantly influencing mortality.
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Affiliation(s)
- Silvania Klug Pimentel
- Universidade Federal do Paraná, Departamento de Cirurgia. Curitiba, PR, Brasil.,Hospital do Trabalhador, Serviço de Cirurgia Geral, Curitiba, PR, Brasil
| | | | - Gustavo Pás Shimizu
- Universidade Federal do Paraná, Departamento de Cirurgia. Curitiba, PR, Brasil
| | - Fábio Henrique de Carvalho
- Universidade Federal do Paraná, Departamento de Cirurgia. Curitiba, PR, Brasil.,Hospital do Trabalhador, Serviço de Cirurgia Geral, Curitiba, PR, Brasil
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Brunello LFS, Bettega AL, Reis PGTDA, Tomasich FDS, Collaço IA, Guetter CR, Rezende TMDS, Nasr A. Influence of trauma origin site on admission rates of patients submitted to emergency laparotomy. ACTA ACUST UNITED AC 2018; 45:e1970. [PMID: 30379215 DOI: 10.1590/0100-6991e-20181970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 09/09/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE to evaluate the influence of the site of trauma occurrence on the trauma scores of patients submitted to emergency laparotomy. METHODS this is a retrospective, observational, analytical study. We included 212 patients who underwent exploratory laparotomies in the period of January 2015 and December 2017. We obtained information about the accident site and vital data of the patients based on data collection through electronic and physical records. We analyzed the trauma indices of patients from Curitiba and its Metropolitan Region and the place where the patient was rescued (physical establishment or public road). RESULTS among the 212 patients studied, 184 (86.7%) were brought by the Prehospital Care Service from the city of Curitiba, and 28 (13.3%), from the Metropolitan Region of Curitiba. Twenty-five patients (17.6%) were rescued in physical establishments, while 117 (82.4%) were rescued on public roads. We observed higher values of Injurity Severity Scores (ISS) in patients coming from the Metropolitan Region than in those coming from Curitiba (29.78 vs 22.46, P=0.009), but higher values of Trauma and Injury Severity Scores (TRISS) in patients from Curitiba than the ones from the Metropolitan Region (90.62 vs 81.30, P=0.015). Patients rescued in public roads presented lower Revised Trauma Scores (RTS) (6.96 vs 7.65, P=0.024) and TRISS (86.42 vs 97.21; P=0.012). CONCLUSION trauma victims from sites more distant from the referral center and rescued on public roads presented worse prognosis.
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Affiliation(s)
| | - Ana Luísa Bettega
- Hospital do Trabalhador, Serviço de Cirurgia Geral, Curitiba, PR, Brasil
| | | | | | | | | | | | - Adonis Nasr
- Hospital do Trabalhador, Serviço de Cirurgia Geral, Curitiba, PR, Brasil
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Clinical Outcome and Management for Geriatric Traumatic Injury: Analysis of 2688 Cases in the Emergency Department of a Teaching Hospital in Taiwan. J Clin Med 2018; 7:jcm7090255. [PMID: 30181469 PMCID: PMC6162823 DOI: 10.3390/jcm7090255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/23/2018] [Accepted: 09/03/2018] [Indexed: 01/06/2023] Open
Abstract
Geriatric traumatic injuries in emergency departments are frequent and associated with higher mortality rates and catastrophic functional outcomes. Several prediction scores have been established to manage traumatic patients, including the shock index (SI), revised trauma score (RTS), injury severity score (ISS), trauma injury severity score (TRISS), and new injury severity score (NISS). However, it was necessary to investigate the effectiveness and efficiency of care for the geriatric traumatic population. In addition, image studies such as computed tomography and magnetic resonance imaging play an important role in early diagnosis and timely intervention. However, few studies focus on this aspect. The association between the benefit of carrying out more image studies and clinical outcomes remains unclear. In this study, we included a total of 2688 traumatic patients and analyzed the clinical outcomes and predicting factors in terms of geriatric trauma via pre-hospital and in-hospital analysis. Our evaluation revealed that a shock index ≥1 may be not a strong predictor of geriatric trauma due to the poor physical response in the aging population. This should be modified in geriatric patients. Other systems, like RTS, ISS, TRISS, and NISS, were significant in terms of predicting the clinical outcome.
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Pastore Neto M, Gonçalves RV, Machado CJ, Resende V. Factors associated with changes in creatine phosphokinase (CPK) in trauma patients submitted to the "Red Wave", with evolution to rhabdomyolysis. Rev Col Bras Cir 2018; 45:e1604. [PMID: 29668808 DOI: 10.1590/0100-6991e-20181604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/22/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify and analyze factors associated with plasma creatine phosphokinase (CPK) levels in trauma victims with progression to rhabdomyolysis. METHODS we conducted a prospective, longitudinal study, with 50 patients submitted to the "Red Wave" protocol, with evolution to rhabdomyolysis after hospital admission. We studied the variables age, gender, trauma scores, mechanism and outcome, CPK at admission and final, intervals of days between laboratory evaluations, surgery and complications. We stratified CPK values in <500U/L, ≥500 - <1000 U/L, and ≥1000U/L, with calculation of the difference between the initial and final values. RESULTS at admission, 83% of patients (n=39) had CPK≥1000U/L, with predominance of blunt trauma and thoracic injury (p<0.05), as well as orthopedic fracture, acute renal failure and gastrointestinal bleeding, CPK being lower in those without acute renal injury, with a trend towards statistical significance. There were no differences in final CPK stratification. Factors that were independently associated with the greater CPK variation were, positively, hospitalization time greater than one week and compartment syndrome, and negatively, acute renal injury. CONCLUSION the CPK level of 1000U/L remains the lower limit, with importance for early intervention in worsening conditions such as digestive hemorrhage, acute renal injury and compartment syndrome, which implied greater absolute differences between initial and final CPK, in addition to blunt trauma, thoracic injury and orthopedic fracture.
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Affiliation(s)
- Mario Pastore Neto
- Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Carla Jorge Machado
- Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Vivian Resende
- Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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