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Wu H, Ma X, Hao Y, Ji L, Zhu W, Mu W, Guo Y, Fan L. Nurses' knowledge, attitudes and practices regarding the application of the injury severity score in emergency departments: A cross-sectional multicentre study. J Clin Nurs 2024. [PMID: 38757751 DOI: 10.1111/jocn.17180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 03/30/2024] [Accepted: 04/10/2024] [Indexed: 05/18/2024]
Abstract
AIMS AND OBJECTIVES To investigate knowledge, attitudes, and practices regarding the application of the Injury Severity Score (ISS) among emergency department nurses in China and the factors influencing these variables. BACKGROUND ISS is the first trauma scoring method to be developed and the most widely used in clinical practice. The correct application of the ISS by emergency department nurses plays an important role in assisting in the diagnosis and treatment of trauma patients, and it is crucial to understand nurses' knowledge, attitudes and practices. DESIGN A cross-sectional multicentre study. METHODS Nurses from the emergency departments of 25 grade II and grade III hospitals in Gansu Province, China participated in this study. Data was collected online using a self-administered questionnaire. Student's t-test or analysis of variance was performed to compare the differences between the groups. Multiple logistic regression analysis identified factors influencing nurses' knowledge, attitudes and practices regarding applying ISS. A STROBE checklist was used to report findings. RESULTS Among 459 nurses, a good level of attitude and passing levels of knowledge and practice regarding applying the ISS were revealed. Nurses in higher hospital grades, who had been exposed to ISS and received training had higher levels of knowledge and practices. Previous exposure to the ISS and training related to it were factors that influenced nurses' attitudes. CONCLUSIONS Chinese emergency department nurses' knowledge, attitudes and practices of applying the ISS still need to be improved. Hospitals and nursing managers should provide training opportunities for nurses about ISS knowledge and practices, while grade II hospitals should pay more attention to training and continuing education in this area. RELEVANCE TO CLINICAL PRACTICE In hospitals, nursing managers may benefit from enhancing related education and training to promote the emergency department nurses' knowledge and practice of the ISS, by developing specific curricula and providing continuing education and training opportunities, while grade II hospitals should pay more attention to training and continuing education in this area. NO PATIENT OR PUBLIC CONTRIBUTIONS This study focused on emergency department nurses' knowledge, attitudes, and practices regarding the application of the ISS. The research questions and design were derived from clinical nursing practice, literature review, and expert panel review, and patients or the public are temporarily not involved.
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Affiliation(s)
- Hui Wu
- Nursing Administration Department, The First Hospital of Lanzhou University, Lanzhou, China
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Xiaoyan Ma
- Department of Spine Surgery, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Yaru Hao
- Nursing Administration Department, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Li Ji
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Wei Zhu
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Wenjing Mu
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Yue Guo
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Luo Fan
- Nursing Administration Department, The First Hospital of Lanzhou University, Lanzhou, China
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
- School of Nursing, Lanzhou University, Lanzhou, China
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Flaaten N, Moslim H, Tang E, Varrall R. Scapular fractures: A regional and rural perspective. Aust J Rural Health 2024; 32:388-393. [PMID: 38480988 DOI: 10.1111/ajr.13100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/30/2024] [Accepted: 02/27/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION Scapular fractures (SFs) have historically been associated with severe trauma and multiple injuries. Recent studies have demonstrated improved outcomes. However, SFs have never been studied from a strictly rural or Australian perspective. OBJECTIVE The study's objective was to assess whether associations still exist between a fractured scapula and trauma scores, mortality rates, and other commonly associated injuries in a regional Australian trauma centre. DESIGN The study design examined prospectively collected data from a regional hospital between the years 2012 to 2021 presenting to the emergency department with traumatic SFs. Primary outcomes of interest were mortality rate, method of injury, ISS scores, and associated injuries. FINDINGS One hundred and five patients had a SF. The median age was 49 with 93 (89%) being male. Most fractures were located in the body of the scapula (80%). The primary mechanism of injury was motorbike accidents (36%), falls (24%), and motor vehicle accidents (22%). Two patients died from their injuries (1.9%). Thirty-four percent demonstrated mild trauma scores, with 36% moderate, 28% severe, and 1.9% critical. Commonly observed associated injuries included chest wall fractures, vertebral fractures, thoracic injuries, brain injury, and abdominal trauma. DISCUSSION A minority of SFs were associated with severe or critical trauma, and overall, patients who sustained a SF had a low mortality rate. These findings suggest that patients from regional areas have similar outcomes to those from more urban centres in other parts of the world. CONCLUSION Given these results, a re-examination of whether SFs are a reliable marker of severe trauma should be considered.
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Affiliation(s)
- Nordan Flaaten
- University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
- Orthopedic Department, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Huissan Moslim
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Eric Tang
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Ruth Varrall
- University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
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Özensoy HS, Gürü S. A Retrospective Study to Compare the Glasgow Coma Score, Pediatric Trauma Score, and Injury Severity Score and Outcomes in 118 Pediatric Trauma Patients at a Single Emergency Center in Turkey. Med Sci Monit 2024; 30:e943501. [PMID: 38515009 PMCID: PMC10964724 DOI: 10.12659/msm.943501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 01/24/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The main causes of accidental trauma in children include road traffic accidents (RTAs) and falling from height (FFH). Rapid and accurate assessment of severity of injury is required to guide effective management. This retrospective study aimed to compare the Glasgow Coma Score (GCS), Pediatric Trauma Score (PTS), and Injury Severity Score (ISS) and outcomes for 118 pediatric trauma patients at a single Emergency Department (ED) in Turkey. MATERIAL AND METHODS Patients admitted to Ankara City Hospital due to high-energy trauma between November 1, 2019 and April 30, 2020 were analyzed retrospectively. Data for 118 patients with trauma by major mechanisms, aged 0-17, were collected. Demographic characteristics, trauma-related characteristics, outcomes, and GCS, PTS, and ISS values were compared. It was examined whether there was a relationship between trauma severity and prognosis. In this context, trauma severity was defined by these scores. RESULTS Of the 118 admitted patients, 66 (55.9%) were discharged from the ED, 33 (28%) were transferred to the intensive care unit (ICU), and 19 (16.1%) were admitted to non-ICU departments in the hospital. With hospitalization, patients with thoracic trauma (P<0.001; OR 11.1; 95% CI 3.0-40) and patients with abdominal trauma (P=0.003; OR 4.0; 95% CI 1.5-10.8) were discharged significantly less frequently than patients with other types of trauma. Patients with low ISS (P<0.001) and high PTS (P<0.001) were discharged more often. The relationship between diagnosis and hospitalization was significant (P<0.001). CONCLUSIONS RTA and FFH are the leading trauma mechanisms in children. Boys experience more trauma. ISS and PTS provide accurate predictions of severe and poor prognosis in pediatric trauma cases.
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Fallah N, Noonan VK, Thorogood NP, Kwon BK, Kopp MA, Schwab JM. Effect of body mass index on survival after spinal cord injury. Front Neurol 2024; 14:1269030. [PMID: 38344110 PMCID: PMC10853461 DOI: 10.3389/fneur.2023.1269030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/27/2023] [Indexed: 05/12/2024] Open
Abstract
Introduction Increased mortality after acute and chronic spinal cord injury (SCI) remains a challenge and mandates a better understanding of the factors contributing to survival in these patients. This study investigated whether body mass index (BMI) measured after acute traumatic SCI is associated with a change in mortality. Methods A prospective longitudinal cohort study was conducted with 742 patients who were admitted to the Acute Spine Unit of the Vancouver General Hospital between 2004 and 2016 with a traumatic SCI. An investigation of the association between BMI on admission and long-term mortality was conducted using classification and regression tree (CART) and generalized additive models (spline curves) from acute care up to 7.7 years after SCI (chronic phase). Multivariable models were adjusted for (i) demographic factors (e.g., age, sex, and Charlson Comorbidity Index) and (ii) injury characteristics (e.g., neurological level and severity and Injury Severity Score). Results After the exclusion of incomplete datasets (n = 602), 643 patients were analyzed, of whom 102 (18.5%) died during a period up to 7.7 years after SCI. CART identified three distinct mortality risk groups: (i) BMI: > 30.5 kg/m2, (ii) 17.5-30.5 kg/m2, and (iii) < 17.5 kg/m2. Mortality was lowest in the high BMI group (BMI > 30.5 kg/m2), followed by the middle-weight group (17.5-30.5 kg/m2), and was highest in the underweight group (BMI < 17.5 kg/m2). High BMI had a mild protective effect against mortality after SCI (hazard ratio 0.28, 95% CI: 0.09-0.88, p = 0.029), concordant with a modest "obesity paradox". Moreover, being underweight at admission was a significant risk factor for mortality up to 7.7 years after SCI (hazard ratio 5.5, 95% CI: 2.34-13.17, p < 0.001). Discussion Mortality risk (1 month to 7.7 years after SCI) was associated with differences in BMI at admission. Further research is needed to better understand the underlying mechanisms. Given an established association of BMI with metabolic determinants, these results may suggest unknown neuro-metabolic pathways that are crucial for patient survival.
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Affiliation(s)
- Nader Fallah
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Vanessa K. Noonan
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Nancy P. Thorogood
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Brian K. Kwon
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Marcel A. Kopp
- Department of Neurology and Experimental Neurology, Clinical and Experimental Spinal Cord Injury Research, Charité – Universitätsmedizin Berlin, Berlin, Germany
- QUEST-Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany
| | - Jan M. Schwab
- Department of Neurology and Experimental Neurology, Clinical and Experimental Spinal Cord Injury Research, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Spinal Cord Injury Division, The Ohio State University, Wexner Medical Center, Columbus, OH, United States
- Belford Center for Spinal Cord Injury, Departments of Physical Medicine and Rehabilitation and Neuroscience, The Ohio State University, Wexner Medical Center, Columbus, OH, United States
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Tsukuda M, Kumagai G, Wada K, Asari T, Nitobe Y, Tsuda E, Ishibashi Y. Association between injury severity scores and clinical outcomes in patients with traumatic spinal injury in an aging Japanese society. Medicine (Baltimore) 2023; 102:e35369. [PMID: 37773811 PMCID: PMC10545282 DOI: 10.1097/md.0000000000035369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023] Open
Abstract
The Injury Severity Score (ISS) is widely used to evaluate patients with multiple injuries. This study investigated the association between ISS and clinical outcomes of patients with spinal cord injury (SCI) in an aging Japanese population. This retrospective cohort study investigated patients admitted to a Japanese university hospital. In the study, 89 patients with traumatic SCI were included. Traumatic SCI was categorized as monotrauma or polytrauma, and the ISS was used to evaluate trauma severity. Spearman's correlation coefficient was used to estimate the correlation between ISS and the American Spinal Injury Association (ASIA) motor score, Barthel Index (activities of daily living assessment), and the European Quality of Life (QOL) scale (EQ5d) as an assessment of QOL at admission or the last follow-up with the adjustment for age, sex, and body mass index. Return to home and work were analyzed using the chi-squared test after the ISS was divided into three groups (<14, 14-19, and 20). The mean ISS was significantly higher for polytrauma than monotrauma. Significant negative correlations between the ISS and ASIA motor scores at the first visit (P < .001, r = -0.37) and the last follow-up (adjusted, P = .007, r = -0.30) were observed. The Barthel Index was also negatively correlated with ISS at the first visit (P = .04, r = -0.21) and at the last follow-up period (P < .001, r = -0.35). Moreover, ISS was significantly negatively correlated with EQ5d score at the last follow-up (P = .01, r = -0.28). The chi-squared test demonstrated that patients with an ISS of < 14 returned home (P = .03), while those with an ISS of < 19 returned to work (P = .02). ISS is associated with paralysis, activities of daily living, QOL, and lifestyle in patients with SCI and is an important initial injury assessment method.
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Affiliation(s)
- Manami Tsukuda
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Gentaro Kumagai
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kanichiro Wada
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Toru Asari
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yohshiro Nitobe
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Aydogdu HI, Koca Y, Cirakoglu E, Anolay NN. Is post-traumatic stress disorder related to the severity of physical trauma? Rev Assoc Med Bras (1992) 2023; 69:e20230439. [PMID: 37729370 PMCID: PMC10508949 DOI: 10.1590/1806-9282.20230439] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/27/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE Trauma can cause physical morbidity and even result in death. Besides, it can lead to serious mental problems as well. The most well-known mental health problem is post-traumatic stress disorder. Through this study, it was primarily aimed to find out whether the severity of physical trauma is effective on post-traumatic stress disorder and other risk factors if any. METHODS The reports of the patients who were transferred to the Turkish Council of Forensic Medicine Third Speciality Board between January 01, 2019, and December 31, 2020, for post-traumatic invalidity or disability evaluation and whose psychiatric examinations were performed were retrospectively analyzed in the electronic environment. RESULTS It was found that 34 (26.4%) of the patients had a diagnosis of post-traumatic stress disorder (under treatment for at least 6 months), while 76 (58.9%) of them did not have a psychiatric disease and 19 (14.7%) of them had mental disorders not associated with trauma (i.e., affective disorder, anxiety disorder, etc.). No significant correlation was found between trauma scores and post-traumatic stress disorder (p>0.05). CONCLUSION Based on the results of our study, post-traumatic stress disorder and the severity of physical trauma are not significantly correlated. Being of female gender, sustaining a non-accidental injury, and witnessing a fatal event stand out as significant risk factors.
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Affiliation(s)
- Halil Ilhan Aydogdu
- Giresun University, Faculty of Medicine, Department of Forensic Medicine – Giresun, Turkey
| | - Yasin Koca
- The Ministry of Justice Council of Forensic Medicine – Istanbul, Turkey
| | - Emre Cirakoglu
- The Ministry of Justice Council of Forensic Medicine – Istanbul, Turkey
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He Y, Liu X, Zhong S, Fu Q. Neutrophil-to-lymphocyte ratio in relation to trauma severity as prognosis factors in patients with multiple injuries complicated by multiple organ dysfunction syndrome: A retrospective analysis. Immun Inflamm Dis 2023; 11:e1031. [PMID: 37773708 PMCID: PMC10521378 DOI: 10.1002/iid3.1031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVE This study aimed to explore potential risk factors for the occurrence of multiple organ dysfunction syndrome (MODS) in patients with multiple injuries by evaluating neutrophil-to-lymphocyte ratio (NLR)-associated trauma severity. METHODS This retrospective case-control study included 95 patients with multiple injuries, who were admitted to our hospital (between January 2018 and December 2020). Clinical data including gender, age, underlying disease, number of injury sites (NIS), injury severity score (ISS), hemoglobin level within 24 h of admission (HL-24h), neutrophil count (NC), white blood cell count, platelet count (PC), NLR, d-dimer level, activated partial thromboplastin time (APTT), complicated shock within 24 h of admission (CS-24h), length of stay, as well as prognostic outcome was systematically analyzed. According to MODS occurrence, patients were divided into a MODS group (n = 27) and a non-MODS group (n = 68). The risk factors affecting patients with multiple injuries complicated by MODS were identified using univariate and multivariate logistic regression analyses. Candidate risk factors were further analyzed using receiver operating characteristic (ROC) curves. RESULTS Univariate analysis revealed a significant difference between the MODS and non-MODA groups in terms of NIS, ISS, HL-24h, PC, APTT, d-dimer level, CS-24h, NLR, NC, prognostic outcome, and other indicators (p < .05). Multivariate logistic regression analysis showed that d-dimer levels within 24 h of admission and ISS, NLR, and CS-24h were significantly associated with multiple injuries complicated by MODS. Compared with the non-MODS controls, the NLR in the MODS group showed a much higher level and tended to rise with the increase in ISS score, indicating a significant intergroup difference (p < .05). The ROC curve analysis results suggested that the NLR had good sensitivity and specificity for predicting the prognosis of patients with MODS with multiple injuries. CONCLUSION d-dimer level, ISS, NLR, and CS-24h are important risk factors for MODS in patients with multiple injuries. Notably, NLR expression may be a good indicator of injury severity and predictor of the occurrence of MODS in patients with multiple injuries. Therefore, assessment of injury severity and coagulation function, active resuscitation, as well as prevention of infection should be emphasized during treatment of multiple injuries, to reduce and prevent the risk of MODS in patients with multiple injuries.
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Affiliation(s)
- Yong‐Ming He
- Department of EmergencyShenzhen Longhua District Center HospitalShenzhenChina
| | - Xing Liu
- Department of EmergencyShenzhen Longhua District Center HospitalShenzhenChina
- Department of EmergencyThe Second People's Hospital of Futian DistrictShenzhenChina
| | - Si‐Yi Zhong
- Department of EmergencyThe Second People's Hospital of Futian DistrictShenzhenChina
- Department of Public HealthGuangdong Medical UniversityDongguanChina
| | - Qiu‐Hong Fu
- Department of EmergencyShenzhen Longhua District Center HospitalShenzhenChina
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Gilchrist SA, Stanfield J, Tan MAM, Hicks RC, Urevick A, Cabbage T, Bhattacharya SD. Changes in Pediatric Non-accidental Trauma Emergency Department Visits During and Following the COVID-19 Lockdown. Am Surg 2023; 89:3881-3883. [PMID: 37155157 PMCID: PMC10170259 DOI: 10.1177/00031348231173951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
A level 1 pediatric trauma registry database was examined for all non-accidental trauma (NAT) emergency department visits between 2016 and 2021, and average injury severity score assigned to those patients with physical injuries over 2019-2021. There was a decline in NAT visits in 2020 (267) from prior years (343 visits average over 2016-2019), with subsequent increase in 2021 (548). Injury severity score increased (ISS) in 2020 (7.3) when compared to 2019 (5.71), with a decline in average ISS in 2021 (5.42). This data highlights the potential for missed abuse during closures with increased detection following reopening. Our data regarding ISS demonstrates the pediatric population is at risk of more severe abuse during times of familial stress. We need increased awareness that periods of vulnerability to NAT exist, as seen during the COVID-19 pandemic.
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Affiliation(s)
- S. Austin Gilchrist
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, TN, USA
| | - Jennifer Stanfield
- Department of Pediatric Emergency Medicine, Erlanger Children’s Hospital, Chattanooga, TN, USA
| | - Martin Aaron M. Tan
- Department of Surgery, University of Tennessee College of Medicine, Memphis, TN, USA
| | - R. Chace Hicks
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, TN, USA
| | - Alexander Urevick
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, TN, USA
| | - Tanner Cabbage
- Department of Pediatrics, University of Tennessee College of Medicine, Chattanooga, TN, USA
| | - S. Dave Bhattacharya
- Department of Pediatric Surgery, University of Tennessee College of Medicine, Chattanooga, TN, USA
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Dalton SE, Sakowicz A, Charles AG, Stamilio DM. Major trauma in pregnancy: prediction of maternal and perinatal adverse outcomes. Am J Obstet Gynecol MFM 2023; 5:101069. [PMID: 37399890 DOI: 10.1016/j.ajogmf.2023.101069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Trauma, largely the consequence of motor vehicle crashes, is the leading cause of pregnancy-associated maternal mortality. Prediction of adverse outcomes has been difficult in pregnancy given the infrequent occurrence of traumatic events and anatomic considerations unique to pregnancy. The injury severity score, an anatomic scoring system with weighting dependent on severity and anatomic region of injury, is used in the prediction of adverse outcomes in the nonpregnant population but has yet to be validated in pregnancy. OBJECTIVE This study aimed to estimate the associations between risk factors and adverse pregnancy outcomes after major trauma in pregnancy and to develop a clinical prediction model for adverse maternal and perinatal outcomes. STUDY DESIGN This was a retrospective analysis of a cohort of pregnant patients who sustained major trauma and who were admitted to 1 of 2 level 1 trauma centers. Three composite adverse pregnancy outcomes were evaluated, namely adverse maternal outcomes and short- and long-term adverse perinatal outcomes, defined as outcomes occurring within the first 72 hours of the traumatic event or encompassing the entire pregnancy. Bivariate analyses were performed to estimate the associations between clinical or trauma-related variables and adverse pregnancy outcomes. Multivariable logistic regression analyses were performed to predict each adverse pregnancy outcome. The predictive performance of each model was estimated using receiver operating characteristic curve analyses. RESULTS A total of 119 pregnant trauma patients were included, 26.1% of whom met the severe adverse maternal pregnancy outcome criteria, 29.4% of whom met the severe short-term adverse perinatal pregnancy outcome definition, and 51.3% of whom met the severe long-term adverse perinatal pregnancy outcome definition. Injury severity score and gestational age were associated with the composite short-term adverse perinatal pregnancy outcome with an adjusted odds ratio of 1.20 (95% confidence interval, 1.11-1.30). The injury severity score was solely predictive of the adverse maternal and long-term adverse perinatal pregnancy outcomes with odds ratios of 1.65 (95% confidence interval, 1.31-2.09) and 1.14 (95% confidence interval, 1.07-1.23), respectively. An injury severity score ≥8 was the best cutoff for predicting adverse maternal outcomes with 96.8% sensitivity and 92.0% specificity (area under the receiver operating characteristic curve, 0.990±0.006). An injury severity score ≥3 was the best cutoff for the short-term adverse perinatal outcomes, which correlates with a 68.6% sensitivity and 65.1% specificity (area under the receiver operating characteristic curve, 0.755±0.055). An injury severity score ≥2 was the best cutoff for the long-term adverse perinatal outcomes, yielding a 68.3% sensitivity and 72.4% specificity (area under the receiver operating characteristic curve, 0.763±0.042). CONCLUSION For pregnant trauma patients, an injury severity score of ≥8 was predictive of severe adverse maternal outcomes. Minor trauma in pregnancy, defined in this study as an injury severity score <2, was not associated with maternal or perinatal morbidity or mortality. These data can guide management decisions for pregnant patients who present after trauma.
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Affiliation(s)
- Susan E Dalton
- Department of OB/GYN, Division of Maternal-Fetal Medicine, University of Utah Health, Salt Lake City, UT (Dr Dalton).
| | - Allie Sakowicz
- Department of OB/GYN, Division of Maternal-Fetal Medicine, Wake Forest University, Winston-Salem, NC (Drs Sakowicz and Stamilio)
| | - Anthony G Charles
- Department of General Surgery; Division of Critical Care and Trauma Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC (Dr Charles)
| | - David M Stamilio
- Department of OB/GYN, Division of Maternal-Fetal Medicine, Wake Forest University, Winston-Salem, NC (Drs Sakowicz and Stamilio)
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Wankhade BS, Alrais ZF, Alrais GZ, Hadi AMA, Naidu GAK, Abbas MS, Kheir ATYA, Hadad H, Sharma S, Sait M. Epidemiology and outcome of an acute kidney injuries in the polytrauma victims admitted at the apex trauma center in Dubai. Acute Crit Care 2023; 38:217-225. [PMID: 37313668 DOI: 10.4266/acc.2023.00388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/27/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Polytrauma from road accidents is a common cause of hospital admissions and deaths, frequently leading to acute kidney injury (AKI) and impacting patient outcomes. METHODS This retrospective, single-center study included polytrauma victims with an Injury Severity Score (ISS) >25 at a tertiary healthcare center in Dubai. RESULTS The incidence of AKI in polytrauma victims is 30.5%, associated with higher Carlson comorbidity index (P=0.021) and ISS (P=0.001). Logistic regression shows a significant relationship between ISS and AKI (odds ratio [OR], 1.191; 95% confidence interval [CI], 1.150-1.233; P<0.05). The main causes of trauma-induced AKI are hemorrhagic shock (P=0.001), need for massive transfusion (P<0.001), rhabdomyolysis (P=0.001), and abdominal compartment syndrome (ACS; P<0.001). On multivariate logistic regression AKI can be predicated by higher ISS (OR, 1.08; 95% CI, 1.00-1.17; P=0.05) and low mixed venous oxygen saturation (OR, 1.13; 95% CI, 1.05-1.22; P<0.001). The development of AKI after polytrauma increases length of stay (LOS)-hospital (P=0.006), LOS-intensive care unit (ICU; P=0.003), need for mechanical ventilation (MV) (P<0.001), ventilator days (P=0.001), and mortality (P<0.001). CONCLUSIONS After polytrauma, the occurrence of AKI leads to prolonged hospital and ICU stays, increased need for mechanical ventilation, more ventilator days, and a higher mortality rate. AKI could significantly impact their prognosis.
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Affiliation(s)
- Bhushan Sudhakar Wankhade
- Department of Surgical Intensive Care Medicine, Rashid Hospital, Oud Metha, Dubai, UAE
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Zeyad Faoor Alrais
- Department of Surgical Intensive Care Medicine, Rashid Hospital, Oud Metha, Dubai, UAE
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | | | | | | | - Mohammed Shahid Abbas
- Department of Surgical Intensive Care Medicine, Rashid Hospital, Oud Metha, Dubai, UAE
| | | | - Hasan Hadad
- Emergency Department, Emirates Hospital, Jumeirah, Dubai, UAE
| | - Sundareswaran Sharma
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Mohammad Sait
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
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Sakowicz A, Dalton S, McPherson JA, Charles AG, Stamilio DM. Accuracy and utilization patterns of intra-abdominal imaging for major trauma in pregnancy. Am J Obstet Gynecol MFM 2023; 5:100915. [PMID: 36882128 DOI: 10.1016/j.ajogmf.2023.100915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/18/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Imaging protocols for maternal major trauma during pregnancy are not standardized, and it is uncertain whether focused assessment with sonography for trauma (FAST) or computed tomography of the abdomen/pelvis (CTAP) is preferred for detecting intra-abdominal hemorrhage. OBJECTIVE To estimate the accuracy of the FAST exam compared to CTAP, validate imaging accuracy with clinical outcomes, and describe clinical factors associated with each imaging mode. STUDY DESIGN A retrospective cohort study of pregnant patients evaluated for major trauma at one of two Level 1 trauma centers between 2003 and 2019. We identified 4 imaging groups: no intra-abdominal imaging, FAST only, CTAP only, and both FAST and CTAP. The primary outcome was a composite maternal severe adverse pregnancy outcome, including death and intensive care unit admission. We estimated sensitivity, specificity, and positive and negative predictive values of FAST for hemorrhage with reference CTAP. We performed ANOVA and chi-squared tests to compare clinical factors and outcomes across imaging groups. Multinomial logistic regression was used to estimate associations between selected imaging mode and clinical factors. RESULTS Of 119 pregnant trauma patients, 31 (26.1%) experienced a maternal severe adverse pregnancy outcome. Intra-abdominal imaging modes included none in 37.0%, FAST only in 21.0%, CTAP only in 25.2%, and both modes in 16.8%. With CTAP as the reference, FAST exam had sensitivity, specificity, positive predictive value, and negative predictive value of 11%, 91%, 50%, and 55%, respectively. One patient had a maternal severe adverse pregnancy outcome with a positive FAST and negative CTAP and two patients with a positive CTAP did not have an adverse outcome. Use of CTAP with or without FAST exam was associated with a higher injury severity score, lower systolic blood pressure nadir, higher motor vehicle collision speed, and higher rates of hypotension, tachycardia, bone fracture, maternal severe adverse pregnancy outcome and fetal demise. The association of CTAP use with higher injury severity score, tachycardia, and lower systolic blood pressure nadir persisted in multivariable analysis. With each 1-point increase in the ISS, there was an 11% more likelihood of using CTAP over FAST exam for intra-abdominal imaging. CONCLUSION The sensitivity of FAST in detecting intra-abdominal hemorrhage in pregnant trauma patients is poor, and CTAP has a low false-negative rate. Providers appear to prefer CTAP to FAST in patients with the most severe trauma. CTAP with or without FAST is more accurate than FAST alone.
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Affiliation(s)
- Allie Sakowicz
- Department of Obstetrics & Gynecology, Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Susan Dalton
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, UT
| | - Jessica A McPherson
- Section of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Anthony G Charles
- Division of General and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David M Stamilio
- Section of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Wake Forest University School of Medicine, Winston-Salem, NC
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Adenuga A, Adeyeye A. Injury severity score as a predictor of mortality in patients with abdominal trauma at a tertiary Nigerian hospital. Niger J Clin Pract 2023; 26:223-228. [PMID: 36876612 DOI: 10.4103/njcp.njcp_559_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Background Abdominal trauma is a major cause of morbidity and mortality in low-and middle-income countries. Typical patients present late and very sick with early recognition key to improving outcome. There is a paucity of trauma data in this environment and trauma scoring systems which have been validated in the developed world are yet to find widespread use here. Aim This study aimed at evaluating role of injury severity score (ISS) in predicting mortality. Patients and Methods This is a retrospective observational study of patients with abdominal trauma who presented at the University of Ilorin Teaching Hospital from 2013 to 2019. Records were identified and data were extracted and analyzed using Statistical package for social sciences 23. Results A total of 87 patients were included in the study. There were 73 males and 14 females. The mean overall ISS in this study was 16.06 ± 7.9. Concerning morbidity, the area under the receiver operating characteristic curve in predicting morbidity was 0.843 (95% confidence interval 0.737-0.928). ISS had a strong sensitivity of 90% and specificity 55% at a cut-off of 14.50. Also, the area under the receiver operating characteristic curve in predicting mortality was 0.746 (95% confidence interval 0.588-0.908) and at a cut-off of 16.50; ISS had a specificity of 80% and sensitivity of 60%. The mean ISS of patients with mortality was 22.60 ± 10.5 while the survivors had a mean ISS of 14.7 ± 6.5 (P <.001). The mean ISS for patients who had morbidity was 22.8 ± 8.1 while those without morbidity had a mean ISS of 13.1 ± 5.7 (P <.05). Conclusion ISS was a good predictor of morbidity and mortality in abdominal trauma in patients in this study. A prospective study with standardized abdominal imaging would be needed to further validate this scoring tool.
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Affiliation(s)
- A Adenuga
- Department of Surgery, Cedarcrest Hospitals, Abuja, Nigeria
| | - A Adeyeye
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Salastekar NV, Duszak R , Jr, Santavicca S, Horný M, Balthazar P, Khaja A, Hughes DR, Hanna TN. Utilization of Chest and Abdominopelvic CT for Traumatic Injury From 2011 to 2018: Evaluation Using a National Commercial Database. AJR Am J Roentgenol 2023; 220:265-71. [PMID: 36000666 DOI: 10.2214/AJR.22.27991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND. Increases in the use of CT to evaluate patients presenting with trauma have raised concern about inappropriate imaging. The evolving utilization of CT for trauma evaluation may be impacted by injury severity. OBJECTIVE. The purpose of this study was to explore patterns in utilization of chest and abdominopelvic CT among trauma-related emergency department (ED) visits across the United States. METHODS. This retrospective study was conducted with national commercial claims information extracted from the MarketScan Commercial Database. Trauma-related ED encounters were identified from the 2011-2018 MarketScan database files and classified by injury severity score (minor, intermediate, and major injuries) on the basis of International Classification of Diseases codes. ED encounters were also assessed for chest CT, abdominopelvic CT, and single-encounter chest and abdominopelvic CT examinations. Utilization per 1000 trauma-related ED encounters was determined. Multivariable Poisson regression models were used to determine incidence rate ratios (IRRs) as a measure of temporal changes in utilization. RESULTS. From 2011 to 2018, 8,369,092 trauma-related ED encounters were identified (5,685,295 for minor, 2,624,944 for intermediate, and 58,853 for major injuries). Utilization of chest CT per 1000 trauma-related ED encounters increased from 4.9 to 13.5 examinations (adjusted IRR, 1.15 per year; minor injuries, from 2.2 to 7.7 [adjusted IRR, 1.17]; intermediate injuries, from 8.5 to 21.5 [adjusted IRR, 1.16]; major injuries, from 117.8 to 200.1 [adjusted IRR, 1.08]). Utilization of abdominopelvic CT per 1000 trauma-related ED encounters increased from 7.5 to 16.4 (adjusted IRR, 1.12; minor injuries, 4.8 to 12.2 [adjusted IRR, 1.13]; intermediate injuries, 10.6 to 21.7 [adjusted IRR, 1.13]; major injuries, 134.8 to 192.6 [adjusted IRR, 1.07]). Utilization of single-encounter chest and abdominopelvic CT per 1000 trauma-related ED encounters increased from 3.4 to 8.9 [adjusted IRR, 1.16; minor injuries, 1.1 to 4.6 [adjusted IRR, 1.18]; intermediate injuries, 6.4 to 16.4 [adjusted IRR, 1.16]; major injuries, 99.6 to 179.9 [adjusted IRR, 1.08]). CONCLUSION. National utilization of chest and abdominopelvic CT for trauma-related ED encounters increased among commercially insured patients from 2011 to 2018, particularly for single-encounter chest and abdominopelvic CT examinations and for minor injuries. CLINICAL IMPACT. Given concerns about increased cost and detection of incidental findings, further investigation is warranted to explore the potential benefit of single-encounter chest and abdominopelvic CT examinations of patients with minor injuries and to develop strategies for optimizing appropriateness of imaging orders.
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Wan V, Reddy S, Thomas A, Issa N, Posluszny J, Schwulst S, Shapiro M, Alam H, Bilimoria KY, Stey AM. How does Injury Severity Score derived from International Classification of Diseases Programs for Injury Categorization using International Classification of Diseases, Tenth Revision, Clinical Modification codes perform compared with Injury Severity Score derived from Trauma Quality Improvement Program? J Trauma Acute Care Surg 2023; 94:141-147. [PMID: 35647796 PMCID: PMC9708941 DOI: 10.1097/ta.0000000000003656] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Injury Severity Score (ISS) is a measurement of injury severity based on the Abbreviated Injury Scale. Because of the difficulty and expense of Abbreviated Injury Scale coding, there have been recent efforts in mapping ISS from administrative International Classification of Diseases ( ICD ) codes instead. Specifically, the open source and freely available International Classification of Diseases Programs for Injury Categorization (ICDPIC) in R (Foundation for Statistical Computing, Vienna, Austria) converts International Classification of Diseases, Ninth Revision, codes to ISS. This study aims to compare ICDPIC calculations versus manually derived Trauma Quality Improvement Program (TQIP) calculations for International Classification of Diseases, Tenth Revision ( ICD-10 ), codes. Moderate concordance was chosen as the hypothetical relationship because of previous work by both Fleischman et al. ( J Trauma Nurs. 2017;24(1):4-14) who found moderate to substantial concordance between ICDPIC and ISS and Di Bartolomeo et al. ( Scand J Trauma Resusc Emerg Med. 2010;18(1):17) who found none to slight concordance. Given these very different findings, we thought it reasonable to predict moderate concordance with the use of more detailed ICD-10 codes. METHODS This was an observational cohort study of 1,040,728 encounters in the TQIP registry for the year 2018. International Classification of Diseases Programs for Injury Categorization in R was used to derive ISS from the ICD-10 codes in the registry. The resulting scores were compared with the manually derived ISS in TQIP. RESULTS The median difference between ISS calculated by ICDPIC-2021 using ICD-10, Clinical Modification (ISS-ICDPIC), and manually derived ISS was -3 (95% confidence interval, -5 to 0), while the mean difference was -2.09 (95% confidence interval, -2.10 to -2.07). There was substantial concordance between ISS-ICDPIC and manually derived ISS ( κ = 0.66). The ISS-ICDPIC was a better predictor of mortality (area under the curve, 0.853 vs. 0.836) but a worse predictor of intensive care unit admission (area under the curve, 0.741 vs. 0.757) and hospital stay ≥10 days (AUC, 0.701 vs. 0.743). The ICDPIC has substantial concordance with TQIP for the firearm ( κ = 0.69), motor vehicle trauma ( κ = 0.71), and pedestrian ( κ = 0.73) injury mechanisms. CONCLUSION When TQIP data are unavailable, ICDPIC remains a valid way to calculate ISS after transition to ICD-10 codes. The ISS-ICDPIC performs well in predicting a number of outcomes of interest but is best served as a predictor of mortality. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Vivian Wan
- From the Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Yang YH, Zhang TN, Yang N, Xu W, Wang LJ, Gao SY, Liu CF. Functional status of pediatric patients with trauma and risk factors for mortality from a single center in China. Front Pediatr 2023; 11:1051759. [PMID: 37206974 PMCID: PMC10188922 DOI: 10.3389/fped.2023.1051759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction The influence of reduced functional status has become increasingly relevant because of the gradual decline in mortality rate over the recent years. Nonetheless, only a few studies investigating the functional status of patients with trauma at hospital discharge have been conducted. This study aimed to identify the risk factors influencing the mortality rate in pediatric trauma survivors at a pediatric intensive care unit and analyze their functional status using the Functional Status Scale (FSS). Methods A retrospective analysis was conducted at Shengjing Hospital of China Medical University. Children admitted to the pediatric intensive care unit between January 2015 and January 2020 who met the trauma diagnostic criteria were included. The FSS score and the Injury Severity Score (ISS) were recorded upon admission and discharge, respectively. Clinical data were compared between the survival and non-survival groups to identify the risk factors for poor prognosis. The risk factors for mortality were identified using multivariate and univariate analyses. Results A total of 246 children {59.8%, male; median [interquartile range (IQR)] age: 3 [1-7] years} were diagnosed with trauma (including head trauma, chest trauma, abdominal trauma, and extremity trauma). Of these patients, 207 were discharged, 11 dropped out mid-treatment, and 39 died (hospital mortality rate, 15.9%). Upon admission, the median FSS and trauma scores were 14 (IQR, 11-18) and 22 (IQR, 14-33) points, respectively. At discharge, the FSS score was 8 (IQR, 6-10) points. The patient clinical status improved with a ΔFSS score of -4 (IQR, -7, 0) points. At hospital discharge, 119 (48.3%), 47 (19.1%), 27 (11.0%), 12 (4.8%), and 2 (0.9%) survivors had good, mildly abnormal, moderately abnormal, severely abnormal, and very severely abnormal function, respectively. Reduced functional status in patients was categorized as follows: motor, 46.4%; feeding, 26.1%; sensory, 23.2%; mental, 18.4%; and communication, 17.9%. In the univariate analysis, ISS >25 points, shock, respiratory failure, and coma were independently associated with the mortality rate. Multivariate analysis revealed that the ISS was an independent risk factor for mortality. Conclusion The mortality rate of patients with trauma was high. ISS was an independent risk factor for mortality. Mildly reduced functional status remained at discharge and was reported in nearly half of the discharged patients. Motor and feeding functions were the most severely impacted domains.
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Affiliation(s)
- Yu-Hang Yang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tie-Ning Zhang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ni Yang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Xu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Li-Jie Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shan-Yan Gao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chun-Feng Liu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
- Correspondence: Chun-Feng Liu
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Dai G, Lu X, Xu F, Xu D, Li P, Chen X, Guo F. Early Mortality Risk in Acute Trauma Patients: Predictive Value of Injury Severity Score, Trauma Index, and Different Types of Shock Indices. J Clin Med 2022; 11:jcm11237219. [PMID: 36498793 PMCID: PMC9735436 DOI: 10.3390/jcm11237219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Objective: This study aimed to explore the predictive value of the Injury Severity Score (ISS), Trauma Index (TI) and different types of shock indices (SI) on the early mortality risk of acute trauma patients. Methods: Clinical data of acute trauma patients who met the inclusion and exclusion criteria of this study and were treated in the hospital from January 2020 to December 2020 were retrospectively collected, including gender, age, trauma mechanism, severe injury site, ISS, TI, admission vital signs, different types of shock indices (SI), death within 7 days, length of hospital stay, and Glasgow Outcome Score (GOS). The predictive value of the Injury Severity Score, Trauma Index, and different types of shock indices on the risk of early mortality in patients with acute trauma were compared using relevant statistical methods. Results: A total of 283 acute trauma patients (mean age 54.0 ± 17.9 years, 30.74% female) were included, and 43 (15.19%) of the patients died during 7 days of hospitalization. The admission ISS, TI, SI, MSI, and ASI in the survival group were significantly lower than those in the death group, and the difference was statistically significant (p < 0.05). Meanwhile, different trauma assessment tools included in the study have certain predictive value for early mortality risk of trauma patients. Conclusions: The TI indicates a better capability to predict the risk of early death in patients with acute trauma. As the most sensitive predictor, the SI has the greatest reference value in predicting the risk of early death in patients with traumatic shock.
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Affiliation(s)
| | | | | | | | | | - Xionghui Chen
- Correspondence: (X.C.); (F.G.); Tel.: +86-0512-67973243 (X.C. & F.G.)
| | - Fengbao Guo
- Correspondence: (X.C.); (F.G.); Tel.: +86-0512-67973243 (X.C. & F.G.)
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Shah A, Judge A, Griffin XL. Variation in timely surgery for severe open tibial fractures by time and place of presentation in England from 2012 to 2019 : a cohort study using data collected nationally by the Trauma Audit and Research Network. Bone Jt Open 2022; 3:941-952. [PMID: 36475361 PMCID: PMC9783273 DOI: 10.1302/2633-1462.312.bjo-2022-0130.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS Several studies have reported that patients presenting during the evening or weekend have poorer quality healthcare. Our objective was to examine how timely surgery for patients with severe open tibial fracture varies by day and time of presentation and by type of hospital. This cohort study included patients with severe open tibial fractures from the Trauma Audit and Research Network (TARN). METHODS Provision of prompt surgery (debridement within 12 hours and soft-tissue coverage in 72 hours) was examined, using multivariate logistic regression to derive adjusted risk ratios (RRs). Time was categorized into three eight-hour intervals for each day of the week. The models were adjusted for treatment in a major trauma centre (MTC), sex, age, year of presentation, injury severity score, injury mechanism, and number of operations each patient received. RESULTS We studied 8,258 patients from 175 hospitals. Patients presenting during the day (08:00 to 15:59; risk ratio (RR) 1.11, 95% confidence interval (CI) 1.02 to 1.20) were more likely to receive debridement within 12 hours, and patients presenting at night (16:00 to 23:59; RR 0.56, 95% CI 0.51 to 0.62) were less likely to achieve the target; triage to a MTC had no effect. Day of presentation was associated with soft-tissue coverage within 72 hours; patients presenting on a Thursday or Friday being less likely to receive this surgery within 72 hours (Thursday RR 0.88, 95% CI 0.81 to 0.97; Friday RR 0.89, 95% CI 0.81 to 0.98), and the standard less likely to be achieved for those treated in 'non-MTC' hospitals (RR 0.76, 95% CI 0.70 to 0.82). CONCLUSION Variations in care were observed for timely surgery for severe open tibial fractures with debridement surgery affected by time of presentation and soft-tissue coverage affected by day of presentation and type of hospital. The variation is unwarranted and highlights that there are opportunities to substantially improve the delivery and quality of care for patients with severe open tibial fracture.Cite this article: Bone Jt Open 2022;3(12):941-952.
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Affiliation(s)
- Anjali Shah
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK,Correspondence should be sent to Anjali Shah. E-mail:
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK,Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Xavier L. Griffin
- Barts Bone and Joint Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, UK,Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
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AVCI OZBALIK B, BINGOL TANRIVERDI T, OZCAN HG, GURA CELIK M. The Clinical Importance of Optic Nerve Sheath Diameter in Patients with Traumatic Brain Injury: Preliminary Report. Medeni Med J 2022; 37:320-326. [PMID: 36578149 PMCID: PMC9808856 DOI: 10.4274/mmj.galenos.2022.42966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective Traumatic brain injury (TBI) is a serious health problem that is related to an increased mortality. In cases of severe TBI, the prediction of prognosis is essential. The enlargement of the optic nerve sheath diameter (ONSD) shows an increased intracranial pressure and is associated with poor outcomes. In this study, we aimed to evaluate the prognostic value of ONSD in patients with severe TBI. Methods Forty-four patients with severe TBI were retrospectively enrolled in the study. The patients were divided into two groups: survivors (n=17) and non-survivors (n=27). Baseline characteristics, clinical data, Glasgow coma scale (GCS) on hospital admission, brain computed tomography (CT) results, injury severity score (ISS), and Marshall score were recorded for all patients. ONSD was calculated at 3 mm distance from the globe, immediately below the sclera. Results The ONSD on the initial CT was significantly higher in non-survivors compared with survivors (6.83±1.40 vs. 6.40±1.36, p<0.05). In addition, ISS and Marshall score were significantly higher, whereas GCS was significantly lower in non-survivors. ONSD was positively correlated with Marshall score (r=0.332, p<0.05). Receiver operating characteristics analysis demonstrated that ONSD ≥6.61 had a sensitivity of 70.4% and specificity of 64.7% for predicting mortality. It was shown that ONSD ≥6.61 had a 4.3-fold increased risk for in-hospital mortality (odds ratio: 4.35; 95% confidence interval: 1.195-15.865; p<0.05). Conclusions The enlargement of ONSD on initial CT was detected to be associated with increased in-hospital mortality in patients with severe TBI.
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Affiliation(s)
- Burcu AVCI OZBALIK
- Iskenderun State Hospital, Clinic of Anesthesiology and Reanimation, Hatay, Turkey,* Address for Correspondence: Iskenderun State Hospital, Clinic of Anesthesiology and Reanimation, Hatay, Turkey E-mail:
| | - Tugba BINGOL TANRIVERDI
- University of Health Sciences Turkey, Mehmet Akif Inan Training and Research Hospital, Clinic of Anesthesiology and Reanimation, Sanliurfa, Turkey
| | - Hafize Gulsah OZCAN
- Acibadem Ankara Hospital, Clinic of Anesthesiology and Reanimation, Ankara, Turkey
| | - Melek GURA CELIK
- Istanbul Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Clinic of Anesthesiology and Reanimation, Istanbul, Turkey
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Abstract
This study examined the opioid prescribing patterns at discharge in the trauma center of a major Canadian hospital and compared them to the guidelines provided by the Illinois surgical quality improvement collaborative (ISQIC), a framework that has been recognized as being associated with reduced risk. This was a retrospective chart review of patient data from the trauma registry between January 1, 2018, and October 31, 2019. A total of 268 discharge charts of naïve opioid patients were included in the analysis. A Morphine Milligram Equivalents per day (MME/day) was computed for each patient who was prescribed opioids and compared with standard practice guidelines. About 75% of patients were prescribed opioids. More males (75%) than females (25%) were prescribed opioids to patients below 65 years old (91%). Best practice guidelines were followed in most cases. Only 16.6% of patients were prescribed over 50 mg MME/day, the majority (80.9%) were prescribed opioids for =<3 days and only 1% for >7 days. Only 7.5% were prescribed extended-release opioids and none were strong like fentanyl. Patients received a multimodal approach with alternatives to opioids in 88.9% of cases and 82.9% had a plan for opioid discontinuation. However, only 23.6% received an acute pain service referral. The majority of the prescriptions provided adhered to the best practice guidelines outlined by the ISQIC framework. These results are encouraging with respect to the feasibility of implementing opioid prescription guidelines effectively. However, routine monitoring is necessary to ensure that adherence is maintained.
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Affiliation(s)
- Priyanka Premachandran
- School of Health Services Management, Ted Rogers School of Management, Ryerson University, Toronto, Ontario, Canada
| | - Pria Nippak
- School of Health Services Management, Ted Rogers School of Management, Ryerson University, Toronto, Ontario, Canada
- *Correspondence: Pria Nippak, School of Health Services Management, Ted Rogers School of Management, Ryerson University, 8th floor, 2068, Toronto, Ontario, Canada (e-mail: )
| | - Housne Begum
- School of Health Services Management, Ted Rogers School of Management, Ryerson University, Toronto, Ontario, Canada
| | - Julien Meyer
- School of Health Services Management, Ted Rogers School of Management, Ryerson University, Toronto, Ontario, Canada
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Lim NK, Park JH. The use of machine learning for investigating the role of plastic surgeons in anatomical injuries: A retrospective observational study. Medicine (Baltimore) 2022; 101:e30943. [PMID: 36221333 PMCID: PMC9542809 DOI: 10.1097/md.0000000000030943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
While plastic surgeons have been historically indispensable in the reconstruction of posttraumatic defects, their role in trauma centers worldwide has not been clearly defined. Therefore, we aimed to investigate the contribution of plastic surgeons in trauma care using machine learning from an anatomic injury viewpoint. We conducted a retrospective study reviewing the data for all trauma patients of our hospital from March 2019 to February 2021. In total, 4809 patients were classified in duplicate according to the 17 trauma-related departments while conducting the initial treatment. We evaluated several covariates, including age, sex, cause of trauma, treatment outcomes, surgical data, and severity indices, such as the Injury Severity Score and Abbreviated Injury Scale (AIS). A random forest algorithm was used to rank the relevance of 17 trauma-related departments in each category for the AIS and outcomes. Additionally, t test and chi-square test were performed to compare two groups, which were based on whether the patients had received initial treatment in the trauma bay from the plastic surgery department (PS group) or not (non-PS group), in each AIS category. The department of PS was ranked first in the face and external categories after analyzing the relevance of the 17 trauma-related departments in six categories of AIS, through the random forest algorithm. Of the 1108 patients in the face category of AIS, the PS group was not correlated with all outcomes, except for the rate of discharge to home (P < .0001). Upon re-verifying the results using random forest, we found that PS did not affect the outcomes. In the external category in AIS, there were 30 patients in the PS group and 56 patients in the non-PS group, and there was no statistically significant difference between the two groups when comparing the outcomes. PS has contributed considerably to the face and external regions among the six AIS categories; however, there was no correlation between plastic surgical treatment and the outcome of trauma patients. We investigated the plastic surgeons' role based on anatomical injury, using machine learning for the first time in the field of trauma care.
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Affiliation(s)
- Nam Kyu Lim
- Department of Plastic and Reconstructive Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
- Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Cheonan, Republic of Korea
- *Correspondence: Nam Kyu Lim, Department of Plastic and Reconstructive surgery, Dankook University College of Medicine, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam 31116, Republic of Korea (e-mail: )
| | - Jong Hyun Park
- Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Cheonan, Republic of Korea
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Leonardi L, Fonseca MK, Baldissera N, Cunha CEBDA, Petrillo YTM, Dalcin RR, Breigeiron R. Predictive factors of mortality in damage control surgery for abdominal trauma. Rev Col Bras Cir 2022; 49:e20223390. [PMID: 36074395 PMCID: PMC10578851 DOI: 10.1590/0100-6991e-20223390-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/17/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION damage control surgery (DCS) is well recognized as a surgical strategy for patients sustaining severe abdominal trauma. Literature suggests the indications, operative times, therapeutic procedures, laboratory parameters and intraoperative findings have a direct bearing on the outcomes. OBJECTIVE to analyze the clinical profile of patients undergoing DCS and determine predictors of morbidity and mortality. METHODS a retrospective cohort study was conducted on all patients undergoing DCS following abdominal trauma from November 2015 and December 2021. Data on subjects' demographics, baseline presentation, mechanism of injury, associated injuries, injury severity scores, laboratory parameters, operative details, postoperative complications, length of stay and mortality were assessed. A binary logistic regression analysis was performed to determine potential risk factors for mortality. RESULTS During the study period, 696 patients underwent trauma laparotomy. Of these, 8.9% (n=62) were DCS, with more than 80% due to penetrating mechanisms. Overall mortality was 59.6%. In the logistic regression stratified by survival, several variables were significantly associated with mortality, including hypotension, and altered mental status at admission, intraoperative cardiorespiratory arrest, need for resuscitative thoracotomy, metabolic acidosis, hyperlactatemia, coagulopathy, fibrinolysis, and severity of the trauma injury scores. CONCLUSION DCS may be appropriate in critically injured patients; however, it remains associated with significant morbidity and high mortality, even at specialized trauma care centers. From pre and postoperative clinical and laboratory parameters, it was possible to predict the risk of death in the studied sample.
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Affiliation(s)
- Luiza Leonardi
- - Hospital de Pronto Socorro de Porto Alegre, Residência Médica em Cirurgia Geral e Cirurgia do Trauma - Porto Alegre - RS - Brasil
| | - Mariana Kumaira Fonseca
- - Hospital de Pronto Socorro de Porto Alegre, Serviço de Cirurgia Geral e do Trauma - Porto Alegre - RS - Brasil
| | - Neiva Baldissera
- - Hospital de Pronto Socorro de Porto Alegre, Serviço de Cirurgia Geral e do Trauma - Porto Alegre - RS - Brasil
| | | | - Yuri Thomé Machado Petrillo
- - Hospital de Pronto Socorro de Porto Alegre, Residência Médica em Cirurgia Geral e Cirurgia do Trauma - Porto Alegre - RS - Brasil
| | - Roberta Rigo Dalcin
- - Hospital de Pronto Socorro de Porto Alegre, Serviço de Cirurgia Geral e do Trauma - Porto Alegre - RS - Brasil
| | - Ricardo Breigeiron
- - Hospital de Pronto Socorro de Porto Alegre, Serviço de Cirurgia Geral e do Trauma - Porto Alegre - RS - Brasil
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22
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Katzensteiner M, Ponschab M, Schöchl H, Oberladstätter D, Zipperle J, Osuchowski M, Schlimp CJ. Factor XIII Measurement and Substitution in Trauma Patients after Admission to an Intensive Care Unit. J Clin Med 2022; 11. [PMID: 35887938 DOI: 10.3390/jcm11144174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Trauma patients admitted to an intensive care unit (ICU) may potentially experience a deficiency of coagulation factor thirteen (FXIII). In this retrospective cohort study conducted at a specialized trauma center, ICU patients were studied to determine the dependency of FXIII activity levels on clinical course and substitution with blood and coagulation products. A total of 189 patients with a median injury severity score (ISS) of 25 (16−36, IQR) were included. Abbreviated injury scores for extremities (r = −0.38, p < 0.0001) but not ISS (r = −0.03, p = 0.45) showed a negative correlation with initial FXIII levels. Patients receiving FXIII concentrate presented with a median initial FXIII level of 54 (48−59)% vs. 88 (74−108)%, p < 0.0001 versus controls; they had fewer ICU-free days: 17 (0−22) vs. 22 (16−24), p = 0.0001; and received higher amounts of red blood cell units: 5 (2−9) vs. 4 (1−7), p < 0.03 before, and 4 (2−7) vs. 1 (0−2), p < 0.0001 after FXIII substitution. Matched-pair analyses based on similar initial FXIII levels did not reveal better outcome endpoints in the FXIII-substituted group. The study showed that a low initial FXIII level correlated with the clinical course in this trauma cohort, but a substitution of FXIII did not improve endpoints within the range of the studied FXIII levels. Future prospective studies should investigate the utility of FXIII measurement and lower threshold values of FXIII, which trigger substitution in trauma patients.
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23
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Canzi G, Aseni P, De Ponti E, Cimbanassi S, Sammartano F, Novelli G, Sozzi D. The Comprehensive Facial Injury (CFI) Score Is an Early Predictor of the Management for Mild, Moderate and Severe Facial Trauma. J Clin Med 2022; 11:jcm11123281. [PMID: 35743355 PMCID: PMC9225200 DOI: 10.3390/jcm11123281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 01/27/2023] Open
Abstract
Identifying groups of patients with homogeneous characteristics and comparable outcomes improves clinical activity, patients' management, and scientific research. This study aims to define mild, moderate, and severe facial trauma by validating two cut-off values of the Comprehensive Facial Injury (CFI) score and describing their foreseeable clinical needs to create a useful guide in patient management, starting from the first evaluation. The individual CFI score, overall surgical time, and length of hospitalization are calculated for a sample of 1400 facial-injured patients. Receiver Operating Characteristic (ROC) analysis and the corresponding Area Under the Curve (AUC) is tested, and a CFI score ≥4 is selected to discriminate patients undergoing surgical management under general anesthesia (Positive Predictive Value, PPV of 91.4%), while a CFI score ≥10 is selected to identify patients undergoing major surgical procedures (Negative Predictive Value, NPV of 91.7%). These results are enhanced by the consensual trend of Length of Stay outcome. The use of the CFI score allows us to distinguish between the "Mild facial trauma" with a low risk of hospitalization for surgical treatment, the "Moderate facial trauma" with a high probability of surgical treatment, and the "Severe facial trauma" that requires long-lasting surgery and hospital stay, with an increased incidence of Intensive Care Unit admission.
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Affiliation(s)
- Gabriele Canzi
- Maxillofacial Surgery Unit, Department of Emergency, ASST-GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Correspondence: ; Tel.: +39-0264447018; Fax: +39-0264447019
| | - Paolo Aseni
- Department of Emergency, ASST-GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy;
- Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milano, Via Giovanni Battista Grassi 74, 20157 Milan, Italy
| | - Elena De Ponti
- Department of Medical Physics, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy;
| | - Stefania Cimbanassi
- O.U. General Surgery—Trauma Team, Department of Emergency, ASST-GOM Niguarda, Niguarda Hospital, University of Milan, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.C.); (F.S.)
| | - Fabrizio Sammartano
- O.U. General Surgery—Trauma Team, Department of Emergency, ASST-GOM Niguarda, Niguarda Hospital, University of Milan, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.C.); (F.S.)
| | - Giorgio Novelli
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, St. Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; (G.N.); (D.S.)
| | - Davide Sozzi
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, ASST-Monza, St. Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy; (G.N.); (D.S.)
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24
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Hung CC, Shen PH, Wu JL, Cheng YW, Chen WL, Lee SH, Yeh TT. Association between 3D Printing-Assisted Pelvic or Acetabular Fracture Surgery and the Length of Hospital Stay in Nongeriatric Male Adults. J Pers Med 2022; 12:jpm12040573. [PMID: 35455689 PMCID: PMC9026420 DOI: 10.3390/jpm12040573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023] Open
Abstract
Pelvic and acetabular fractures are challenging for orthopedic surgeons, but 3D printing has many benefits in treating these fractures and has been applied worldwide. This study aimed to determine whether 3D printing can shorten the length of hospital stay (LHS) in nongeriatric male adult patients with these fractures. This is a single-center retrospective study of 167 nongeriatric male adult participants from August 2009 to December 2021. Participants were divided into two groups based on whether they received 3D printing assistance. Subgroup analyses were performed. Pearson’s correlation and multivariable linear regression models were used to analyze the LHS and the parameters. Results showed that 3D printing-assisted surgery did not affect LHS in the analyzed patients. The LHS was positively correlated with the Injury Severity Score (ISS). Initial hemoglobin levels were negatively associated with LHS in patients aged 18−40 and non-major trauma (ISS < 16) patients. In 40−60-year-old and non-major trauma patients, the duration from fracture to admission was significantly associated with LHS. This study indicates that 3D-assisted technology for pelvic or acetabular fracture surgery for nongeriatric male adults does not influence the LHS. More importantly, the initial evaluation of patients in the hospital was the main predictor of the LHS.
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Affiliation(s)
- Chun-Chi Hung
- Department of Orthopaedic Surgery, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan; (C.-C.H.); (P.-H.S.)
- Division of Traumatology, Department of Surgery, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan
| | - Pei-Hung Shen
- Department of Orthopaedic Surgery, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan; (C.-C.H.); (P.-H.S.)
| | - Jia-Lin Wu
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (J.-L.W.); (S.-H.L.)
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Orthopedics Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11600, Taiwan
| | - Yung-Wen Cheng
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan; (Y.-W.C.); (W.-L.C.)
| | - Wei-Liang Chen
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan; (Y.-W.C.); (W.-L.C.)
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan
- Department of Biochemistry, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Rd. Neihu Dist., Taipei City 11490, Taiwan
| | - Shih-Han Lee
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (J.-L.W.); (S.-H.L.)
- Department of Orthopedics, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Orthopedics Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan
| | - Tsu-Te Yeh
- Department of Orthopaedic Surgery, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan; (C.-C.H.); (P.-H.S.)
- Medical 3D Printing Center, Tri-Service General Hospital and National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd. Neihu Dist., Taipei City 11490, Taiwan
- Correspondence: ; Tel.: +886-2-87923311
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25
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Anantharaman V, Zuhary TM, Ying H, Krishnamurthy N. Characteristics of injuries resulting from falls from height in the construction industry. Singapore Med J 2022; 64:237-243. [PMID: 35139629 PMCID: PMC10144449 DOI: 10.11622/smedj.2022017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Falls from heights contribute to 34% of fatal accidents in Singapore. Of these, 51% of the accidents occur in the construction industry. This retrospective review, of all persons falling from heights in the construction industry from 2006 to 2012 and attending a major hospital, analysed injury patterns and related them to mechanisms and contributory factors. METHODS Information collected included injury and casualty characteristics, safety measures, pre-existing medical conditions and clinical outcomes. RESULTS Of 1,085 patients, 951 were male with a mean age of 39.8 years, mean height of 165.9 cm and mean weight of 69.7 kg. Most of the casualties fell between 0800 and 2000 hours. Among the severely injured patients, 2.4% had head injuries, 54.9% had chest injuries and 39.2% had abdominal and pelvic injuries. For these casualties, the mortality rate was 60.8%. For patients with less than major trauma, the commonest injuries were in the lower limbs (41.8%), upper limbs (40.8%) and spine (22.2%). All the casualties survived. Falls from scaffolding, formwork and platforms were the most common causes of severe injuries (41.1%). Safety helmets and harnesses were reported to be used in 1.8% and 4.1% of instances of falls, respectively. CONCLUSION Studying the patterns of injuries following falls at construction sites has the potential for injury prevention through safe practices, use of safety equipment and targeted training.
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Affiliation(s)
- Venkataraman Anantharaman
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Emergency Medicine Academic Medical Programme, SingHealth-Duke-NUS Academic Medical Centre, Singapore
| | - Thajudeen Mohammed Zuhary
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Emergency Medicine Academic Medical Programme, SingHealth-Duke-NUS Academic Medical Centre, Singapore
| | - Hao Ying
- Health Services Research Centre, Singapore Health Services, Singapore
| | - Natarajan Krishnamurthy
- Centre for Workplace Safety and Health, National Institute of Engineering, Mysuru, Karnataka, India
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26
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Chang YH, Cheng YY, Hou WH, Chien YW, Chang CH, Chen PL, Lu TH, Yovita Hendrati L, Li CY, Foo NP. Risk of Mortality in Association with Pregnancy in Women Following Motor Vehicle Crashes: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2022; 19:911. [PMID: 35055738 DOI: 10.3390/ijerph19020911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 02/04/2023]
Abstract
The aim of the study was to provide a systematic review and meta-analysis of studies examining the association between mortality risk and motor vehicle crashes (MVCs) in pregnant women compared with nonpregnant women. We used relevant MeSH terms to identify epidemiological studies of mortality risk in relation to MVCs from PubMed, Embase, and MEDLINE databases. The Newcastle–Ottawa Scale (NOS) was used for quality assessment. For comparison of mortality from MVCs between pregnant and nonpregnant women, the pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random effects model. The eight studies selected met all inclusion criteria. These studies included 14,120 injured victims who were pregnant at the time of the incident and 207,935 victims who were not pregnant. Compared with nonpregnant women, pregnant women had a moderate but insignificant decrease in mortality risk (pooled OR = 0.68, 95% CI = 0.38–1.22, I2 = 88.71%). Subgroup analysis revealed that the pooled OR significantly increased at 1.64 (95% CI = 1.16–2.33, I2 < 0.01%) for two studies with a similar difference in the mean injury severity score (ISS) between pregnant and nonpregnant women. Future studies should further explore the risk factors associated with MVCs in pregnant women to reduce maternal mortality.
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Song Y, Xu L, Jin X, Chen D, Jin X, Xu G. Effect of calcium and magnesium on inflammatory cytokines in accidentally multiple fracture adults: A short-term follow-up. Medicine (Baltimore) 2022; 101:e28538. [PMID: 35029924 PMCID: PMC8735799 DOI: 10.1097/md.0000000000028538] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/16/2021] [Indexed: 12/11/2022] Open
Abstract
Calcium (Ca) and magnesium (Mg), which play an important role in several cellular processes, is essential for normal development of the skeleton and maintenance of tissue homeostasis. Deficiency of these elements might delay bone fracture recovery or accelerates bone loss. We aimed to examine whether supplementation of trace element (TE) promotes fracture healing in accidentally fracturing adults by involvement of inflammatory mechanism.A short-term follow-up in clinic was performed. Totally, 117 subjects diagnosed with multiple fractures by traffic accidents were recruited in this study. Serum Ca and Mg levels were measured by inductively coupled plasma atomic emission spectrophotometry. Short-term changes such as serum C-reactive protein, interleukin (IL)-1β, IL-6, and tumor necrosis factor alpha in normal treatment and TE supplement groups were detected by enzyme-linked immunosorbent assay. Student t test and the Spearman correlation were performed to analyze the data.Significantly negative correlations between Ca (r = 0.7032; P < .001) and Mg (r = 0.2719; P < .05) and injury severity score were observed. Serum Ca and Mg were significantly increased at Day 5, 7, and 9 following TE supplements. After treatment, serum C-reactive protein, IL-1β, IL-6, and tumor necrosis factor alpha were significantly reduced whereas cytokine levels of the TE supplement group were found to be lower than that of the normal treatment group after Day 3.These findings suggest that Ca and Mg levels are associated with the injury severity of multiple fractures, and the supplement could reduce the inflammation, which may be beneficial for the bone recovery and disease process.
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Affiliation(s)
- Yongxing Song
- Department of Orthopedics, China Coast Guard Hospital of the People's Armed Police Force, Jiangnan Hospital Affiliated to Jiaxing University, Jiaxing, ZJ, China
| | - Long Xu
- Molecular Pathology Laboratory, Department of Pathology, Institute of Forensic Science, Jiaxing University Medical College, Jiaxing, ZJ, China
| | - Xin Jin
- Molecular Pathology Laboratory, Department of Pathology, Institute of Forensic Science, Jiaxing University Medical College, Jiaxing, ZJ, China
| | - Deqing Chen
- Molecular Pathology Laboratory, Department of Pathology, Institute of Forensic Science, Jiaxing University Medical College, Jiaxing, ZJ, China
| | - Xiuhui Jin
- Department of Immunology and Human Biology, University of Toronto, Toronto, ON, Canada
| | - Guangtao Xu
- Molecular Pathology Laboratory, Department of Pathology, Institute of Forensic Science, Jiaxing University Medical College, Jiaxing, ZJ, China
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Charles Sifford M, Dailey R, Reif R, Hutchison M, Mason C, Kimbrough K, Davis B, Bhavaraju A, Jensen HK, Robertson R, Taylor J, Beck W, Sexton K. CDC field triage criteria accurately predicts outcomes in high impact trauma. J Inj Violence Res 2022; 14:115-124. [PMID: 35137693 PMCID: PMC9115808 DOI: 10.5249/jivr.v14i1.1650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 01/26/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The precision of emergency medical services (EMS) triage criteria dictates whether an injured patient receives appropriate care. The trauma triage protocol is a decision scheme that groups patients into triage categories of major, moderate and minor. We hypothesized that there is a difference between trauma triage category and injury severity score (ISS). METHODS This retrospective, observational study was conducted to investigate a difference between trauma triage category and ISS. Bivariate analysis was used to test for differences between the subgroup means. The differences between the group means on each measure were analyzed for direction and statistical significance using ANOVA for continuous variables and chi square tests for categorical variables. Logistic and linear regressions were performed to evaluate factors predicting mortality, ICU length of stay. RESULTS With respect to trauma triage category, our findings indicate that minor and moderate triage categories are similar with respect to ISS, GCS, ICU LOS, hospital LOS, and mortality. However, after excluding for low impact injuries (falls), differences between the minor and moderate categories were evident when comparing to ISS, GCS, ICU LOS, and hospital LOS. Additionally, after excluding for low impact injures, ISS, ICU LOS, and hospital stay were found to correlate well with trauma triage category. CONCLUSIONS In this retrospective, observational study significant differences were not seen when comparing ISS with the trauma triage categories of moderate and minor during our initial analysis. However, a difference was found after excluding for low impact injuries. These findings suggest that CDC criteria accurately predicts outcomes in high impact trauma.
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Affiliation(s)
- Mason Charles Sifford
- a Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - R. Dailey
- a Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - R. Reif
- a Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - M. Hutchison
- b Metropolitan Emergency Medical Services, Little Rock, AR, USA.
| | - C. Mason
- b Metropolitan Emergency Medical Services, Little Rock, AR, USA.
| | - K. Kimbrough
- a Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - B. Davis
- a Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - A. Bhavaraju
- a Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - H. K Jensen
- a Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - R. Robertson
- a Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - J. Taylor
- a Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - W.C. Beck
- a Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Kevin Sexton
- a Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
,
Kevin W. Sexton: MD, Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR 72205. Tel: 501-686-7000; (Sexton KW.). https://orcid.org/0000-0002-1460-9867
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29
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Pavel B, Popescu MR, Skolozubova D, Flutur E, Voiculescu VM, Brezeanu AC. Early Low Level of Procalcitonin Is Associated with a Favorable Outcome in a Case of a Surviving Patient with 80% Body Surface Area Thermal Burn. Am J Case Rep 2021; 22:e934052. [PMID: 35642541 PMCID: PMC8635220 DOI: 10.12659/ajcr.934052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/22/2021] [Accepted: 09/28/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Burns covering a large skin surface area represent a life-threatening condition due to the release of cytokines and the activation of a systemic inflammatory response, as well as the potential for septic complications. Outcome for these patients is related to the burn surface, age, and coexisting diseases. Although some severity scores are available, such as the Abbreviated Burn Severity Index (ABSI), Baux score, R-Baux score, Boston score, and Belgian Outcome Burn Injury (BOBI) score, none can provide a solid picture of the final outcome. Recent studies claim that procalcitonin, a known sepsis marker, can assist in estimating a burn patient's chance of survival from the time of admission, and can also assist in estimating the chance of sepsis occurrence during hospitalization. CASE REPORT In this manuscript we report the case of a 28-year-old man who suffered burn injuries on approximately 80% of his body surface due to poor handling of a gasoline can in August 2018. Despite high severity index scores and early high values of C-reactive protein, we noticed a low level of early procalcitonin. In this case, as well in our previous experience, early low procalcitonin was associated with a favorable outcome. CONCLUSIONS Early procalcitonin values might prove to be a promising prognosis marker in some cases of extensive burns.
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Affiliation(s)
- Bogdan Pavel
- Division of Physiology and Neurosciences, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Anesthesia and Intensive Care, Clinical Emergency Hospital of Plastic Surgery and Burns, Bucharest, Romania
| | - Mihaela Roxana Popescu
- Division of Physiology and Neurosciences, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Cardiology, „Elias” Emergency Hospital, Bucharest, Romania
| | - Daria Skolozubova
- Division of Physiology and Neurosciences, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Elena Flutur
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | - Vlad Mihai Voiculescu
- Division of Physiology and Neurosciences, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Dermatology, „Elias” Emergency Hospital, Bucharest, Romania
| | - Ariana Cristina Brezeanu
- Division of Physiology and Neurosciences, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Plastic Surgery and Burns, Clinical Emergency Hospital of Plastic Surgery and Burns, Bucharest, Romania
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30
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Hazell GA, Pearce AP, Hepper AE, Bull AMJ. Injury scoring systems for blast injuries: a narrative review. Br J Anaesth 2021; 128:e127-e134. [PMID: 34774294 DOI: 10.1016/j.bja.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/10/2021] [Accepted: 10/03/2021] [Indexed: 11/25/2022] Open
Abstract
Injury scoring systems can be used for triaging, predicting morbidity and mortality, and prognosis in mass casualty incidents. Recent conflicts and civilian incidents have highlighted the unique nature of blast injuries, exposing deficiencies in current scoring systems. Here, we classify and describe deficiencies with current systems used for blast injury. Although current scoring systems highlight survival trends for populations, there are several major limitations. The reliable prediction of mortality on an individual basis is inaccurate. Other limitations include the saturation effect (where scoring systems are unable to discriminate between high injury score individuals), the effect of the overall injury burden, lack of precision in discriminating between mechanisms of injury, and a lack of data underpinning scoring system coefficients. Other factors influence outcomes, including the level of healthcare and the delay between injury and presentation. We recommend that a new score incorporates the severity of injuries with the mechanism of blast injury. This may include refined or additional codes, severity scores, or both, being added to the Abbreviated Injury Scale for high-frequency, blast-specific injuries; weighting for body regions associated with a higher risk for death; and blast-specific trauma coefficients. Finally, the saturation effect (maximum value) should be removed, which would enable the classification of more severe constellations of injury. An early accurate assessment of blast injury may improve management of mass casualty incidents.
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Affiliation(s)
- George A Hazell
- Centre for Blast Injury Studies, Imperial College London, London, UK.
| | - A Phill Pearce
- Department of General Surgery, The Royal London Hospital, Barts NHS Trust, London, UK
| | - Alan E Hepper
- Defence Science and Technology Laboratory, Porton Down, Salisbury, UK
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Imperial College London, London, UK
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Teke C, Kurtoğlu Çelik G, Yıldırım Ç, Şener A, Tanrıverdi F, Kahraman FA, Gökhan Ş. Assessment of the number of admissions for road traffic collisions and severity of injury in daylight saving time and permanent daylight saving time periods. Int J Clin Pract 2021; 75:e14798. [PMID: 34482615 DOI: 10.1111/ijcp.14798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/18/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM Permanent daylight saving time has been implemented in Turkey since 2016. The present study determines the characteristics of road traffic collisions in the short-term, trauma severity, and whether permanent daylight saving time has an impact on these parameters. MATERIALS AND METHODS Drivers admitted because of road traffic collisions to a tertiary care university hospital emergency service two weeks before and after the transition to wintertime in 2014 and 2015 and summertime in 2015 and 2016 as well as those admitted two weeks before and after the same period with permanent daylight saving time in 2016 and 2017 wintertime and 2017 and 2018 summertime were included in the study. Trauma severity was measured using the Injury Severity Score. RESULTS The study analysed the data of 710 patients. There was no statistically significant difference was found between admissions in the summertime and permanent daylight saving time periods in terms of gender, time of admission, week of admission, Injury Severity Score and outcome (P > .05 for all values). CONCLUSIONS In this study, we examined the short-term effects of daylight saving time on road traffic collisions, and demonstrated that it had no impact on the number or time of admission, trauma severity and patient outcomes. More comprehensive studies covering longer periods can be performed across the country.
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Affiliation(s)
- Cahit Teke
- Department of Emergency Medicine, Birecik State Hospital, Şanlıurfa, Turkey
| | - Gülhan Kurtoğlu Çelik
- Department of Emergency Medicine, School of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Department of Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | - Çağdaş Yıldırım
- Department of Emergency Medicine, School of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Department of Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | - Alp Şener
- Department of Emergency Medicine, School of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Department of Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | - Fatih Tanrıverdi
- Department of Emergency Medicine, School of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Department of Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | - Fatih Ahmet Kahraman
- Department of Emergency Medicine, School of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Department of Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | - Şervan Gökhan
- Department of Emergency Medicine, School of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Department of Emergency Medicine, Ankara City Hospital, Ankara, Turkey
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Soysal E, Horvat CM, Simon DW, Wolf MS, Tyler-Kabara E, Gaines BA, Clark RS, Kochanek PM, Bayır H. Clinical Deterioration and Neurocritical Care Utilization in Pediatric Patients With Glasgow Coma Scale Score of 9-13 After Traumatic Brain Injury: Associations With Patient and Injury Characteristics. Pediatr Crit Care Med 2021; 22:960-968. [PMID: 34038066 PMCID: PMC8570972 DOI: 10.1097/pcc.0000000000002767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To define the clinical characteristics of hospitalized children with moderate traumatic brain injury and identify factors associated with deterioration to severe traumatic brain injury. DESIGN Retrospective cohort study. SETTING Tertiary Children's Hospital with Level 1 Trauma Center designation. PATIENTS Inpatient children less than 18 years old with an International Classification of Diseases code for traumatic brain injury and an admission Glasgow Coma Scale score of 9-13. MEASUREMENTS AND RESULTS We queried the National Trauma Data Bank for our institutional data and identified 177 patients with moderate traumatic brain injury from 2010 to 2017. These patients were then linked to the electronic health record to obtain baseline and injury characteristics, laboratory data, serial Glasgow Coma Scale scores, CT findings, and neurocritical care interventions. Clinical deterioration was defined as greater than or equal to 2 recorded values of Glasgow Coma Scale scores less than or equal to 8 during the first 48 hours of hospitalization. Thirty-seven patients experienced deterioration. Children who deteriorated were more likely to require intubation (73% vs 26%), have generalized edema, subdural hematoma, or contusion on CT scan (30% vs 8%, 57% vs 37%, 35% vs 16%, respectively), receive hypertonic saline (38% vs 7%), undergo intracranial pressure monitoring (24% vs 0%), were more likely to be transferred to inpatient rehabilitation following hospital discharge (32% vs 5%), and incur greater costs of care ($25,568 vs $10,724) (all p < 0.01). There was no mortality in this cohort. Multivariable regression demonstrated that a higher Injury Severity Score, a higher initial international normalized ratio, and a lower admission Glasgow Coma Scale score were associated with deterioration to severe traumatic brain injury in the first 48 hours (p < 0.05 for all). CONCLUSIONS A substantial subset of children (21%) presenting with moderate traumatic brain injury at a Level 1 pediatric trauma center experienced deterioration in the first 48 hours, requiring additional resource utilization associated with increased cost of care. Deterioration was independently associated with an increased international normalized ratio higher Injury Severity Score, and a lower admission Glasgow Coma Scale score.
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Affiliation(s)
- Elif Soysal
- Department of Critical Care Medicine, University of Pittsburgh
- Department of Pediatrics, University of Pittsburgh
- Safar Center for Resuscitation Research, University of Pittsburgh
| | - Christopher M. Horvat
- Department of Critical Care Medicine, University of Pittsburgh
- Brain Care Institute, Children’s Hospital of Pittsburgh
| | - Dennis W. Simon
- Department of Critical Care Medicine, University of Pittsburgh
- Department of Pediatrics, University of Pittsburgh
- Safar Center for Resuscitation Research, University of Pittsburgh
| | - Michael S. Wolf
- Safar Center for Resuscitation Research, University of Pittsburgh
- Department of Pediatrics, Division of Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | - Robert S.B. Clark
- Department of Critical Care Medicine, University of Pittsburgh
- Department of Pediatrics, University of Pittsburgh
- Children’s Neuroscience Institute, Children’s Hospital of Pittsburgh
- Brain Care Institute, Children’s Hospital of Pittsburgh
- Safar Center for Resuscitation Research, University of Pittsburgh
| | - Patrick M. Kochanek
- Department of Critical Care Medicine, University of Pittsburgh
- Department of Pediatrics, University of Pittsburgh
- Children’s Neuroscience Institute, Children’s Hospital of Pittsburgh
- Brain Care Institute, Children’s Hospital of Pittsburgh
- Safar Center for Resuscitation Research, University of Pittsburgh
| | - Hülya Bayır
- Department of Critical Care Medicine, University of Pittsburgh
- Department of Environmental and Occupational Health, University of Pittsburgh
- Department of Pediatrics, University of Pittsburgh
- Children’s Neuroscience Institute, Children’s Hospital of Pittsburgh
- Brain Care Institute, Children’s Hospital of Pittsburgh
- Safar Center for Resuscitation Research, University of Pittsburgh
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Sahu MR, Mohanty MK, Sasmal PK, Radhakrishnan RV, Mohanty CR, Shaji IM, Naveen A, Parida M. Epidemiology and patterns of road traffic fatalities in India pre- and post-motor vehicle (Amendment) act 2019: An autopsy-based study. Int J Crit Illn Inj Sci 2021; 11:198-203. [PMID: 35070908 PMCID: PMC8725808 DOI: 10.4103/ijciis.ijciis_51_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 11/04/2022] Open
Abstract
Background Road traffic accidents (RTAs) are a preventable cause of death. The government of India enacted the motor vehicle amendment (MVA) act on September 01, 2019, to curtail the alarming trend of RTAs and their associated fatality. The study objective was to compare the epidemiology and pattern of fatal RTAs before and after the MVA Act 2019 of India. Methods An autopsy-based cross-sectional study was conducted at the Department of Forensic Medicine and Toxicology (FMT) of a tertiary-care hospital from March 2019 to February 2020. The sample comprised 75 fatal RTA victims who underwent postmortem at FMT. Patients were studied in two groups: One pre-MVA group (n = 47) and one Post-MVA group (n = 28). The data were obtained from medical records and inquest reports with autopsy correlation. Data pertaining to sociodemographic profile, mechanism, injury profile including injury-severity-score (ISS) and survival-time was recorded. Results There was a 40.4% decline in mortality among RTA victims (P = 0.057) in the post-MVA group. The case fatality rate also declined during post-MVA implementation months compared to pre-MVA months (1.61 vs. 1.96). A significant correlation was noted between the ISS and survival-time of victims (P < 0.001, r = -0.522). The mean age of patients was 39.87 ± 17.44 years. Heavy motor vehicles along with motorized two-wheeler were the most common offending-vehicle. The median ISS of all victims was 41 (33-57). Head injury was the most common cause of death (60%). Conclusion Study results signal-toward early triumph of the new MVA act, probably due to enhanced adherence to safety gears and constructive behavioral change.
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Affiliation(s)
- Manas Ranjan Sahu
- Department of Forensic Medicine and Toxicology, Critical Care All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Manoj Kumar Mohanty
- Department of Forensic Medicine and Toxicology, Critical Care All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prakash Kumar Sasmal
- Department of General Surgery, Critical Care All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | - Chitta Ranjan Mohanty
- Department of Trauma and Emergency, Critical Care All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ijas Muhammed Shaji
- Department of Trauma and Emergency, Critical Care All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Alagarasan Naveen
- Department of Forensic Medicine and Toxicology, Critical Care All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Madhusmita Parida
- Department of Anaesthesiology, Critical Care All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Jain M, Mohanty CR, Doki SK, Radhakrishnan RV, Khutia S, Patra SK, Biswas M. Traumatic spine injuries in Eastern India: A retrospective observational study. Int J Crit Illn Inj Sci 2021; 11:79-85. [PMID: 34395209 PMCID: PMC8318168 DOI: 10.4103/ijciis.ijciis_95_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/05/2020] [Accepted: 10/27/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Trauma is the leading cause of hospitalization globally, and trauma-induced spinal injuries can be devastating and permanent. The objective of this study was to describe the pattern, association, and outcome in patients with traumatic spine injury (TSI). Methods: A retrospective cross-sectional study was undertaken on patients with TSI who presented to the trauma and emergency department of a level 1 trauma center in eastern India between August 15, 2018, and August 14, 2019, by including 103 patients. Information pertaining to demography, mode of injury (MOI), fracture morphology, neurological grading, and associated spinal or other regional injuries was obtained. Correlation among injury severity score (ISS), neurological damage as per American Spinal Injury Association (ASIA), and morphological patterns was determined. Results: The median age was 39 years, and the gender ratio was 5.87:1. Fall from height (43.7%) was the most common MOI. The median ISS was 21, and the percentage of patients with polytrauma was 73% (ISS > 15). The cervical region (n = 30) was the most common site of injury, and multiple vertebral involvement (n = 32) was more common than isolated involvement. Type A pattern (53.4%) was the predominant type, followed by types C and B (29.1% and 15.5%, respectively) for primary spine injury, and type A was the predominant type for secondary spinal injury. Severe neurological damage (ASIA A-C) was noticed in 69 patients. The correlation between ISS and ASIA scores (Spearman's ρ = 0.561, P < 0.001) and between morphology type and ASIA score (Pearson's χ
2= 69.7, P < 0.001) was statistically significant. In total, 53 patients were managed surgically and 24 patients were managed by conservative measures. Conclusion: Our study found a predominantly younger population, multilevel involvement, significant neurological damage, multiple associated injuries, and higher ISS among the patients of TSI. The pattern in eastern India is different from previous reports from other parts of the country.
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Affiliation(s)
- Mantu Jain
- Department of Orthopedics, AIIMS, Bhubaneswar, Odisha, India
| | | | - Sunil Kumar Doki
- Department of Orthopedics, IMS and Sum Hospital, Bhubaneswar, Odisha, India
| | | | - Susanta Khutia
- Department of Orthopedics, AIIMS, Bhubaneswar, Odisha, India
| | - Saroj Kumar Patra
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
| | - Mridul Biswas
- Department of Orthopedics, AIIMS, Bhubaneswar, Odisha, India
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Khaja A, Horný M, Balthazar P, Hanna TN, Harkey P, Villalobos A, Duszak R Jr. Disproportionate Use in Minor Trauma Is Driving Emergency Department Cervical Spine Imaging: An Injury Severity Score-Based Analysis. J Am Coll Radiol 2021:S1546-1440(21)00568-8. [PMID: 34339664 DOI: 10.1016/j.jacr.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Clinical practice guidelines intended to reduce unnecessary cervical spine imaging have yielded mixed results. We aimed to assess evolving emergency department (ED) cervical spine imaging utilization in patients with trauma by injury severity. METHODS Using 2009 to 2018 IBM MarketScan Commercial Databases, we identified ED trauma encounters, associated cervical spine imaging, and related diagnosis codes. We classified encounters by injury severity (minor, intermediate, major) using an International Classification of Disease code-derived Injury Severity Score algorithm and studied evolving imaging utilization using multivariable Poisson regression models. RESULTS Of all 11,346,684 ED visits for trauma, 7,753,914 (68.3%), 3,524,250 (31.1%), and 68,520 (0.6%) involved minor, intermediate, and major injuries, respectively. Overall cervical spine imaging increased 5.7% annually (incidence rate ratio [IRR] 1.057, P < .001) with radiography decreasing 2.7% annually (IRR 0.973, P < .001) and CT increasing 10.5% annually (IRR 1.105, P < .001). Radiography utilization remained unchanged for minor injuries (IRR 0.994, P = .14) but decreased for intermediate (IRR 0.928 versus minor, P < .001) and major (IRR 0.931 versus minor, P < .001) injuries. Increases in CT utilization were greatest for minor injuries (IRR 1.109, P < .001) with smaller increases in intermediate (IRR 0.960 versus minor, P < .001) and major (IRR 0.987 versus minor, P = .022) injuries. CONCLUSIONS Recent increases in cervical spine imaging in commercially insured patients with trauma seen in the ED have been largely related to increases in CT for patients with only minor injuries, in whom imaging utilization has been historically low. Further study is necessary to assess appropriateness, implications on costs and population radiation dose, and factors influencing ordering decision making.
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Lakshmi VS, Cherian A, Adole P. Procalcitonin Assay Has No Role in the Routine Assessment of Severe Trauma Patients at Admission to the Emergency Department. Cureus 2021; 13:e16228. [PMID: 34268060 PMCID: PMC8262111 DOI: 10.7759/cureus.16228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction A key challenge in emergency departments (ED) is the early recognition of sepsis or the potential for sepsis in patients. Appropriate and accurate ED triage will ensure improved case management. This study analysed the association between ED findings at admission and outcomes in patients presenting with severe trauma. Methods This was a prospective study conducted at a tertiary level ED and included severely injured adult patients who presented to the ED within 24 hours of injury. Data collected included clinical findings and imaging reports at initial assessment, serum procalcitonin (PCT), length of ICU and hospital stay, the incidence of bloodstream and other infections, and patient outcome as discharge from care or death. Multiple logistic regression was used to assess the association between outcome variables and independent variables. Results A total of 155 patients were included in the study. Head and neck (61.9%), extremity (58%), and chest (45%) were more commonly injured. Injury Severity Score (ISS) >25, Glasgow Coma Scale (GCS) score <8, head and neck injuries, and extremity injuries were found to be significantly associated with mortality. Bloodstream infections were more common in the presence of lung contusions, abdominal injury, operative management, and blood transfusions. PCT levels at admission did not have a significant predictive value for mortality, bloodstream infections, other infectious complications, or length of ICU stay. Conclusions Head injuries were the most common cause of mortality in our study. In addition to the anatomical region involved, ISS and GCS have a significant association with mortality. PCT levels at ED admission do not have any prognostic value and need not be routinely analysed.
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Affiliation(s)
- Vijaya S Lakshmi
- Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Anusha Cherian
- Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Prashant Adole
- Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
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Schroeder GD, Canseco JA, Patel PD, Divi SN, Karamian BA, Kandziora F, Vialle EN, Oner FC, Schnake KJ, Dvorak MF, Chapman JR, Benneker LM, Rajasekaran S, Kepler CK, Vaccaro AR. Establishing the Injury Severity of Subaxial Cervical Spine Trauma: Validating the Hierarchical Nature of the AO Spine Subaxial Cervical Spine Injury Classification System. Spine (Phila Pa 1976) 2021; 46:649-657. [PMID: 33337687 PMCID: PMC8057527 DOI: 10.1097/brs.0000000000003873] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/06/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Global cross-sectional survey. OBJECTIVE The aim of this study was to validate the AO Spine Subaxial Cervical Spine Injury Classification by examining the perceived injury severity by surgeon across AO geographical regions and practice experience. SUMMARY OF BACKGROUND DATA Previous subaxial cervical spine injury classifications have been limited by subpar interobserver reliability and clinical applicability. In an attempt to create a universally validated scheme with prognostic value, AO Spine established a subaxial cervical spine injury classification involving four elements: injury morphology, facet injury involvement, neurologic status, and case-specific modifiers. METHODS A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. Respondents graded the severity of each variable of the classification system on a scale from zero (low severity) to 100 (high severity). Primary outcome was to assess differences in perceived injury severity for each injury type over geographic regions and level of practice experience. RESULTS A total of 189 responses were received. Overall, the classification system exhibited a hierarchical progression in subtype injury severity scores. Only three subtypes showed a significant difference in injury severity score among geographic regions: F3 (floating lateral mass fracture, P = 0.04), N3 (incomplete spinal cord injury, P = 0.03), and M2 (critical disk herniation, P = 0.04). When stratified by surgeon experience, pairwise comparison showed only two morphological subtypes, B1 (bony posterior tension band injury, P = 0.02) and F2 (unstable facet fracture, P = 0.03), and one neurologic subtype (N3, P = 0.02) exhibited a significant difference in injury severity score. CONCLUSION The AO Spine Subaxial Cervical Spine Injury Classification System has shown to be reliable and suitable for proper patient management. The study shows this classification is substantially generalizable by geographic region and surgeon experience, and provides a consistent method of communication among physicians while covering the majority of subaxial cervical spine traumatic injuries.Level of Evidence: 4.
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Affiliation(s)
| | - Jose A. Canseco
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Parthik D. Patel
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Srikanth N. Divi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Brian A. Karamian
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Frank Kandziora
- Center for Spinal Surgery and Neurotraumatology, Berufsgenossenschaftliche Unfallklinik, Frankfurt am Main, Germany
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Serna C, Serna JJ, Caicedo Y, Padilla N, Gallego LM, Salcedo A, Rodríguez-Holguín F, González-Hadad A, García A, Herrera MA, Parra MW, Ordoñez CA. Damage control surgery for splenic trauma: "preserve an organ - preserve a life". Colomb Med (Cali) 2021; 52:e4084794. [PMID: 34188324 PMCID: PMC8216056 DOI: 10.25100/cm.v52i2.4794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The spleen is one of the most commonly injured solid organs of the abdominal cavity and an early diagnosis can reduce the associated mortality. Over the past couple of decades, management of splenic injuries has evolved to a prefered non-operative approach even in severely injured cases. However, the optimal surgical management of splenic trauma in severely injured patients remains controversial. This article aims to present an algorithm for the management of splenic trauma in severely injured patients, that includes basic principles of damage control surgery and is based on the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia. The choice between a conservative or a surgical approach depends on the hemodynamic status of the patient. In hemodynamically stable patients, a computed tomography angiogram should be performed to determine if non-operative management is feasible and if angioembolization is required. While hemodynamically unstable patients should be transferred immediately to the operating room for damage control surgery, which includes splenic packing and placement of a negative pressure dressing, followed by angiography with embolization of any ongoing arterial bleeding. It is our recommendation that both damage control principles and emerging endovascular technologies should be applied to achieve splenic salvage when possible. However, if surgical bleeding persists a splenectomy may be required as a definitive lifesaving maneuver.
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Affiliation(s)
- Carlos Serna
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia
| | - José Julián Serna
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Fundación Valle del Lili., Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Natalia Padilla
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | | | - Alexander Salcedo
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Fundación Valle del Lili., Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili., Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Adolfo González-Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Alberto García
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia.,Fundación Valle del Lili., Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL - USA
| | - Carlos A Ordoñez
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery Division of Trauma and Acute Care Surgery. Cali, Colombia.,Fundación Valle del Lili., Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Universidad Icesi, Cali, Colombia
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Çağlar A, Sert ET, Mutlu H. Impact of chronic medical conditions on mortality in geriatric trauma, 10-year analysis of a single centre in Turkey. Acta Chir Belg 2021; 122:253-259. [PMID: 33719848 DOI: 10.1080/00015458.2021.1900523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The healthy and active lifestyle adopted by the elderly as a result of improvements in the standards of living may lead to an increase in the risk of injury. Comorbidities increase the risk of posttraumatic complications and mortality. The aim of this study was to investigate the impact of chronic medical conditions (CMCs) on the risk of mortality in geriatric trauma patients. METHODS All geriatric trauma patients admitted to emergency department over a 10-year period were retrospectively analysed. Patients were stratified by baseline characteristics, injury severity score (ISS), presence of CMCs, and in-hospital mortality. Multivariate logistic regression was used to determine variables significantly associated with in-hospital mortality. RESULTS 9455 patients included in the study. The median age was 74 (10) years and 57% of them were female. The presence of ≥1 CMC and ≥2 CMCs increased the risk of mortality 5.64 and 2.38 times respectively in mild traumas and 2.67 and 2.59 times respectively in moderate traumas. Age, ISS and penetrating traumas had a significant impact on the risk of mortality in all ISS groups. In severe traumas, only renal disease had an impact on the risk of mortality (OR = 2.58, 95%CI = 1.03-6.43, p = 0.042). All other CMCs, ≥1 CMC, and ≥2 CMCs had no impact on the risk of mortality. CONCLUSION The presence of CMCs in elderly patients with mild and moderate injuries increases the risk of mortality. Such patients should be diagnosed and treated more quickly and aggressively during the prehospital process and in the hospital.
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Affiliation(s)
- Ahmet Çağlar
- Department of Emergency Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - Ekrem Taha Sert
- Department of Emergency Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - Hüseyin Mutlu
- Department of Emergency Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey
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Pasquali GF, Kock KDS. Epidemiological profile of chest trauma and predictive factors for length of hospital stay in a hospital in Southern Brazil. Int J Burns Trauma 2021; 11:54-61. [PMID: 33824786 PMCID: PMC8012872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 01/26/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Thoracic trauma is one of the most common types, corresponding to 10% of the traumas admitted in emergency services. OBJECTIVE To analyse epidemiologic aspects of patients diagnosed with chest trauma in a hospital at the south of Brazil and its predictive factor for prolonged length of stay. METHODS We conducted a retrospective cohort involving patients who were victims of chest trauma. They were described by the International Classification of Diseases (ICD) from S20 to S29 admited in a regional hospital in Southern Brazil, from January 2008 to December 2018. The analysed variables were: sex, age, ICD, type of trauma, complication, need for intensive care unit (ICU), mechanical ventilation (MV) and oxygen therapy (O2), scores on Injury Severity Score (ISS) and Thoracic Trauma Severity Score (TTSS) and outcomes length of stay and death. RESULTS 121 patients were evaluated, with median age 47.0 (35-0-58.5) years, where 84.3% being of them were male. Blunt trauma had a higher prevalence with 85.1%, with the most frequent complication being spine fractures (30.4%), followed by rib fractures (23.2%) and pneumothorax (16.8%). There was need of ICU in 14%, use of O2 in 30.6% and need of MV in 5.8%. The median length of stay was 6.0 (4.0-10.5), and death as an outcome was found in only 1.7%. Relying on the TTSS, the median (p25-p75) found was 3.0 (2.0-5.0) points and the ISS score was 4.0 (0.0-9.0). If observing patients with a length of stay ≥ 6 days, there were an association with the female gender, need of ICU, O2 and MV, ISS scores, and TTSS scores in the categories who involved pleural commitment and minor PaO2/FiO2. CONCLUSION Most of the victims were male young adults with low mortality. The TTSS and ISS were found to be adequate predictors of prolonged length of stay.
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Affiliation(s)
| | - Kelser de Souza Kock
- University of Southern Santa Catarina (UNISUL), Medicine Course Tubarão, Santa Catarina, Brazil
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Wendling-Keim DS, Hefele A, Muensterer O, Lehner M. Trauma Scores and Their Prognostic Value for the Outcome Following Pediatric Polytrauma. Front Pediatr 2021; 9:721585. [PMID: 34540770 PMCID: PMC8446435 DOI: 10.3389/fped.2021.721585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/04/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose: The management and prognostic assessment of pediatric polytrauma patients can pose substantial challenges. Trauma scores developed for adults are not universally applicable in children. An accurate prediction of the severity of trauma and correct assessment of the necessity of surgical procedures are important for optimal treatment. Several trauma scores are currently available, but the advantages and drawbacks for use in pediatric patients are unclear. This study examines the value of the trauma scores Injury Severity Score (ISS), Pediatric Trauma Score (PTS), National Advisory Committee for Aeronautics (NACA), and Glasgow Coma Score (GCS) for the assessment of the polytraumatized child. Methods: In a retrospective study, 97 patients aged 0-17 years who presented with polytrauma and an ISS ≥16 in the trauma bay were included in the study. Patient records including radiological studies were analyzed. Pathological imaging findings and emergency surgery were assessed as outcome variables and the predictive value of the trauma scores were analyzed using receiver operator characteristic (ROC) curves. Statistical significance was set at an alpha level of P ≤ 0.05. Results: In this study, 35 of the 97 studied children had pathological cranial computed findings. These either underwent craniectomy or trepanation or a parenchymal catheter was placed for intracranial pressure monitoring. Abdominal trauma was present in 45 patients, 16 of which were treated surgically. Forty-three patients arrived with thoracic injuries, 10 of which received a thoracic drainage. One child underwent an emergency thoracotomy. Predictive accuracy for emergency surgery calculated using receiver-operator characteristic (ROC) curves was highest for ISS and NACA scores (0,732 and 0.683, respectively), and lower for GCS (0.246) and PTS (0.261). Conclusion: In our study cohort, initial ISS and NACA scores better predicted operative interventions and outcome than PTS or GCS for polytraumatized pediatric patients.
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Affiliation(s)
- Danielle S Wendling-Keim
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Anja Hefele
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Oliver Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Markus Lehner
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.,Department of Pediatric Surgery, Children's Hospital, Luzerner Kantonsspital, Lucerne, Switzerland
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Ordoñez CA, Parra MW, Caicedo Y, Padilla N, Rodríguez-Holguín F, Serna JJ, Salcedo A, García A, Orlas C, Pino LF, Del Valle AM, Mejia D, Salamea-Molina JC, Brenner M, Hörer T. REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients. Colomb Med (Cali) 2020; 51:e4064506. [PMID: 33795901 PMCID: PMC7968426 DOI: 10.25100/cm.v51i4.4422.4506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Noncompressible torso hemorrhage is one of the leading causes of preventable death worldwide. An efficient and appropriate evaluation of the trauma patient with ongoing hemorrhage is essential to avoid the development of the lethal diamond (hypothermia, coagulopathy, hypocalcemia, and acidosis). Currently, the initial management strategies include permissive hypotension, hemostatic resuscitation, and damage control surgery. However, recent advances in technology have opened the doors to a wide variety of endovascular techniques that achieve these goals with minimal morbidity and limited access. An example of such advances has been the introduction of the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), which has received great interest among trauma surgeons around the world due to its potential and versatility in areas such as trauma, gynecology & obstetrics and gastroenterology. This article aims to describe the experience earned in the use of REBOA in noncompressible torso hemorrhage patients. Our results show that REBOA can be used as a new component in the damage control resuscitation of the severely injured trauma patient. To this end, we propose two new deployment algorithms for hemodynamically unstable noncompressible torso hemorrhage patients: one for blunt and another for penetrating trauma. We acknowledge that REBOA has its limitations, which include a steep learning curve, its inherent cost and availability. Although to reach the best outcomes with this new technology, it must be used in the right way, by the right surgeon with the right training and to the right patient.
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Affiliation(s)
- Carlos A Ordoñez
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL - USA
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Natalia Padilla
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia
| | - José Julián Serna
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia
| | - Alexander Salcedo
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia
| | - Alberto García
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Claudia Orlas
- Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, USA.,Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, USA
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Hospital Universitario del Valle, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia
| | | | - David Mejia
- Hospital Pablo Tobon Uribe, Department of Surgery, Medellin, Colombia.,Universidad de Antioquia, Department of Surgery, Medellin, Colombia
| | - Juan Carlos Salamea-Molina
- Hospital Vicente Corral Moscoso, Division of Trauma and Acute Care Surgery. Cuenca, Ecuador.,Universidad del Azuay, Escuela de Medicina. Cuenca, Ecuador
| | - Megan Brenner
- University of California, Department of Surgery Riverside University Health Systems. Riverside, CA, USA
| | - Tal Hörer
- 15 Örebro University Hospital, Faculty of Medicine, Department of Cardiothoracic and Vascular Surgery, Örebro, Sweden
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Jain M, Radhakrishnan RV, Mohanty CR, Behera S, Singh AK, Sahoo SS, Guru S, Barik S. Clinicoepidemiological profile of trauma patients admitting to the emergency department of a tertiary care hospital in eastern India. J Family Med Prim Care 2020; 9:4974-4979. [PMID: 33209831 PMCID: PMC7652149 DOI: 10.4103/jfmpc.jfmpc_621_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/10/2020] [Accepted: 07/02/2020] [Indexed: 11/10/2022] Open
Abstract
Context: Trauma is an immediate cause of patients flowing to the emergency department of any hospital. Besides epidemiology, clinical profile and treatment strategy forms an important aspect to reflect the gap in the existing public sector health-care system and the requirement. Aims: To evaluate the clinicoepidemiological profile of trauma patients admitting to an apex trauma hospital in east India. Settings and Design: A prospective observational study was performed during the time period of December 2018 to July 2019 on trauma patients admitted to the Trauma and Emergency department. Methods and Material: Patient's demographic profile, injury type, mechanism, the vehicle involved in the accident, and transportation were recorded. Various trauma scores (clinical) and outcome measures were recorded. Statistical Analysis Used: Statistical analysis was done by R version 3.6.1. Results: Male: female ratio was 407:93 with the 21–30 age group predominantly. 2–6 PM was the most common time of injury and ambulance was the predominant mode of transport (58%). Road traffic injury (RTI) accounted for 75% victims; two-wheelers (68%) dominated over others. Thirty percent (drivers 18%, pillion riders 12%) were wearing helmet; 41% were wearing seat belts (drivers 34%, passenger 12%). Twenty-five percent of drivers consumed alcohol. The median ± Interquartile range of injury severity score (ISS), revised trauma and trauma score and injury severity score were 17 (11–26), 7.8 (4.1–7.8), and 98.41 (95.95–99.30), respectively. Extremity injury (54% fractures) and head injury (50%) were the frontrunners in the pattern of injury, with half of the victims were polytrauma (ISS > 15). Conclusions: The injury was prominently RTI and the trauma victims/patients were young male drivers on two wheelers. The focus should be directed to make use of safety measures among the youth.
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Affiliation(s)
- Mantu Jain
- Department of Orthopedics, AIIMS, Bhubaneswar, Odisha, India
| | | | | | | | - Arvind Kumar Singh
- Department of Community and Family Medicine, AIIMS, Bhubaneswar, Odisha, India
| | | | - Satyabrata Guru
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
| | - Sadananda Barik
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
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Anantha RV, Painter MD, Diaz-Garelli F, Nunn AM, Miller PR, Chang MC, Jason Hoth J. Undertriage Despite Use of Geriatric-Specific Trauma Team Activation Guidelines : Who Are We Missing? Am Surg 2020; 87:419-426. [PMID: 33026234 DOI: 10.1177/0003134820951450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Elderly trauma patients are at risk for undertriage, resulting in substantial morbidity and mortality. The objective of this study was to determine whether implementation of geriatric-specific trauma team activation (TTA) protocols appropriately identified severely-injured elderly patients. METHODS This single-center retrospective study evaluated all severely injured (injury severity score [ISS] >15), geriatric (≥65 years) patients admitted to our Level 1 tertiary-care hospital between January 2014 and September 2017. Undertriage was defined as the lack of TTA despite presence of severe injuries. The primary outcome was all-cause in-hospital mortality; secondary outcomes were mortality within 48 hours of admission and urgent hemorrhage control. A multivariable logistic regression analysis was performed to identify predictors of appropriate triage in this study. RESULTS Out of 1039 severely injured geriatric patients, 628 (61%) did not undergo TTA. Undertriaged patients were significantly older and had more comorbidities. In-hospital mortality was 5% and 31% in the undertriaged and appropriately triaged groups, respectively (P < .0001). One percent of undertriaged patients needed urgent hemorrhage control, compared to 6% of the appropriately triaged group (P < .0001). One percent of undertriaged patients died within 48 hours compared to 19% in the appropriately triaged group (P < .0001). Predictors of appropriate triage include GCS, heart rate, systolic blood pressure, lactic acid, ISS, shock, and absence of dementia, stroke, or alcoholism. DISCUSSION Geriatric-specific TTA guidelines continue to undertriage elderly trauma patients when using ISS as a metric to measure undertriage. However, undertriaged patients have much lower morbidity and mortality, suggesting the geriatric-specific TTA guidelines identify those patients at highest risk for poor outcomes.
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Affiliation(s)
- Ram V Anantha
- 6889 Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Matthew D Painter
- 6889 Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Franck Diaz-Garelli
- 12280 Wake Forest Clinical and Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andrew M Nunn
- 6889 Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Preston R Miller
- 6889 Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael C Chang
- 6889 Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - J Jason Hoth
- 6889 Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Heinrich M, Lany M, Anastasopoulou L, Biehl C, Szalay G, Brenck F, Heiss C. Evidence of Prolonged Monitoring of Trauma Patients Admitted via Trauma Resuscitation Unit without Primary Proof of Severe Injuries. J Clin Med 2020; 9:E2516. [PMID: 32759854 DOI: 10.3390/jcm9082516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/21/2020] [Accepted: 07/30/2020] [Indexed: 11/17/2022] Open
Abstract
Introductio: Although management of severely injured patients in the Trauma Resuscitation Unit (TRU) follows evidence-based guidelines, algorithms for treatment of the slightly injured are limited. Methods: All trauma patients in a period of eight months in a Level I trauma center were followed. Retrospective analysis was performed only in patients ≥18 years with primary TRU admission, Abbreviated Injury Scale (AIS) ≤ 1, Maximum Abbreviated Injury Scale (MAIS) ≤ 1 and Injury Severity Score (ISS) ≤3 after treatment completion and ≥24 h monitoring in the units. Cochran’s Q-test was used for the statistical evaluation of AIS and ISS changes in units. Results: One hundred and twelve patients were enrolled in the study. Twenty-one patients (18.75%) reported new complaints after treatment completion in the TRU. AIS rose from the Intermediate Care Unit (IMC) to Normal Care Unit (NCU) 6.2% and ISS 6.9%. MAIS did not increase >2, and no intervention was necessary for any patient. No correlation was found between computed tomography (CT) diagnostics in TRU and AIS change. Conclusions: The data suggest that AIS, MAIS and ISS did not increase significantly in patients without a severe injury during inpatient treatment, regardless of the type of CT diagnostics performed in the TRU, suggesting that monitoring of these patients may be unnecessary.
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Razik MA, Alslimah FA, Alghamdi KS, Altamimi MA, Alzhrani AA, Alqahtani NM, Alshalawi SM. The severity of fall injuries in Saudi Arabia: a cross-sectional study. Pan Afr Med J 2020; 36:152. [PMID: 32874416 PMCID: PMC7436634 DOI: 10.11604/pamj.2020.36.152.23944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction fall injuries constitute a major public health concern worldwide, contributing to over 646,000 deaths every year. The aim of this study was to determine the nature and severity of fall injuries at a tertiary hospital in the Kingdom of Saudi Arabia (KSA). Methods we conducted a cross-sectional study at the King Khalid Hospital and Prince Sultan Centre for Health Care in Al Kharj. We recruited the patients and followed them through the triage, admission and discharge processes. We analyzed the participant´s clinical notes on the electronic health record (EHR) to obtain information relevant to the study, including the nature, cause, mechanism of injury, demographic characteristics and prognostic factors captured through the injury severity score (ISS), the Glasgow coma scale (GCS) and the presence or absence of shock. Results of 264 patients, most of the patients were children under the age of ten (25.7%), followed by young adults between the ages of twenty-one and thirty (18.2%). The ISS was associated with severe head, chest, skull, brain, scalp, rib, abdominal, pelvic and lower limb injuries. The GCS was associated with severe the head, chest, skull, brain and rib injuries (p<0.005). The degree of shock was also significantly associated with pelvic, head, chest, skull, brain, scalp, abdominal and upper limb injuries (p<0.05). Conclusion: fall injuries in our setting are severe. Training of staff should prioritize head, chest, skull, brain, abdominal and rib injury management. As a reference hospital, minor injuries are more likely to be managed at lower levels of care.
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Affiliation(s)
- Mohamed Abdel Razik
- General Surgery Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | | | | | | | - Adel Ahmed Alzhrani
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Sasmal PK, Mohanty CR, Jain M, Radhakrishnan RV, Sahoo S, Krishna VS, Doki SK, Dungala RVMK. The effect of 'THE MOTOR VEHICLES (AMENDMENT) ACT, 2019' on the clinico-epidemiological profile of road traffic accident patients presenting to a tertiary care trauma centre in Bhubaneswar. J Family Med Prim Care 2020; 9:3682-3687. [PMID: 33102351 PMCID: PMC7567252 DOI: 10.4103/jfmpc.jfmpc_293_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/14/2020] [Accepted: 03/30/2020] [Indexed: 11/16/2022] Open
Abstract
CONTEXT Road traffic accidents (RTA) are a foremost rising cause of morbidity and mortality in developing countries like India. The Government of India enacted a new motor vehicle amendment act (MVA) on September 1st 2019 that permits heavy penalties for traffic rule offenders. AIMS To find out the early impact of "THE MOTOR VEHICLES (AMENDMENT) ACT, 2019". SETTINGS AND DESIGN A retrospective observational study was performed during the time period July to October 2019 on RTA patients admitted to the Trauma and Emergency department. METHODS AND MATERIALS Patients studied in two groups - One Pre MVA group (n = 371) and one Post MVA group (n = 415). The data were extracted from medical case records of the department and filled up in a structured format. Detailed demographic profile, including the use of safety measure and clinical variables such as the pattern of injury and injury severity scores, were recorded. STATISTICAL ANALYSIS USED Statistical analysis was done by R version 3.6.1. RESULTS There is a 41% drop in RTA victims post MVA implementation. Polytrauma reduced (25% vs 45.5%) significantly (P = 0.002) and so was Injury severity score (6.00 vs 13.00). More RTA victims were wearing helmets as compared to previous (42% vs 18%), and there was a steep decline in the alcohol driving (25% vs 10%) between the pre and post MVA group. A significant reduction noted in the under 18 yrs. Two-wheeler riders in the post MVA group compared to earlier (P = 0.016). CONCLUSIONS The study reveals that there is a commendable reduction in the injury severity, violation of safety gears, alcohol use and rash driving following the implementation of MVA September 2019. Primary care and family physician can play a crucial role in creating public awareness about the personal safety measures, which will help in strengthening of this law to reduce the incidence of RTA and the associated mortality and morbidity.
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Affiliation(s)
- Prakash K. Sasmal
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Chitta R. Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Mantu Jain
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Sangeeta Sahoo
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Vuppala S. Krishna
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sunil K. Doki
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, India
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Sae-Tae N, Lim A, Dureh N. Determinants of severe injury and mortality from road traffic accidents among motorcycle and car users in Southern Thailand. Int J Inj Contr Saf Promot 2020; 27:286-292. [PMID: 32498604 DOI: 10.1080/17457300.2020.1774616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study aimed to identify factors associated with severe injury and mortality from road traffic accidents (RTA) among motorcycle and car users in southern Thailand. The data were obtained from the Office of Disease Prevention and Control, Thailand, for years 2008-2013. Chi-squared tests were used to assess associations between determinants and outcomes and these associations were then estimated after adjusting for possible confounding with other factors using logistic regression. Severe injury and mortality contributed 11.6% and 5% to RTA of motorcycle users, and 14.3% and 7.5% for car users. Among motorcycle users, male gender, older age, and not wearing a helmet increased severe injury and mortality rates, whereas drivers had more severe injuries than passengers. Older car users had higher severe injury and mortality rates, whereas not fastening seat belts had higher mortality. Safety device use should be made mandatory for both drivers and passengers. Male motorcycle users and the elderly should be focused on.
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Affiliation(s)
- Natthika Sae-Tae
- Department of Mathematics and Computer Science, Faculty of Science and Technology, Prince of Songkla University, Pattani Campus, Pattani, Thailand.,Centre of Excellence in Mathematics, the Commission on Higher Education, Bangkok, Thailand
| | - Apiradee Lim
- Department of Mathematics and Computer Science, Faculty of Science and Technology, Prince of Songkla University, Pattani Campus, Pattani, Thailand.,Centre of Excellence in Mathematics, the Commission on Higher Education, Bangkok, Thailand
| | - Nurin Dureh
- Department of Mathematics and Computer Science, Faculty of Science and Technology, Prince of Songkla University, Pattani Campus, Pattani, Thailand
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Tamsen F, Sturup J, Thiblin I. Association between homicide injury severity and benzodiazepine influence. Forensic Sci Res 2020; 6:53-58. [PMID: 34007516 PMCID: PMC8110181 DOI: 10.1080/20961790.2020.1767867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There are case reports of offenders inflicting excessive injuries on their victims when under the influence of benzodiazepines. However, the potential association between benzodiazepine influence on the offender and victim injury severity in a general homicide population has not been studied. We investigated associations between offender positive testing for benzodiazepines or z-drugs (zolpidem, zopiclone and zaleplon) and victim injury severity. Data were drawn from 95 Swedish homicide cases from 2007–2009 in which offenders had known toxicology. There were no significant differences in injury severity between cases in which the offender tested positive vs. negative for benzodiazepines/z-drugs. Thus, the findings do not support the hypothesis that there is an association between benzodiazepine influence on the offender and victim injury severity in a general homicide population.Key points Some previous studies have linked benzodiazepines to aggression, violence and excessive homicide injuries. The present study analysed the association between homicide injury severity and benzodiazepine status of the offender. Offenders who tested positive for benzodiazepines did not inflict more severe injuries on their victims. These findings do not support the hypothesis that benzodiazepine influence generally causes offenders to inflict more severe injuries on homicide victims.
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Affiliation(s)
- Fredrik Tamsen
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Ingemar Thiblin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Forensic Medicine, Swedish National Board of Forensic Medicine, Stockholm, Sweden
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Cuevas-Østrem M, Røise O, Wisborg T, Jeppesen E. Geriatric Trauma - A Rising Tide. Assessing Patient Safety Challenges in a Vulnerable Population Using Norwegian Trauma Registry Data and Focus Group Interviews: Protocol for a Mixed Methods Study. JMIR Res Protoc 2020; 9:e15722. [PMID: 32352386 PMCID: PMC7226039 DOI: 10.2196/15722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/27/2019] [Accepted: 12/17/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Elderly trauma patients constitute a vulnerable group, with a substantial risk of morbidity and mortality even after low-energy falls. As the world's elderly population continues to increase, the number of elderly trauma patients is expected to increase. Limited data are available about the possible patient safety challenges that elderly trauma patients face. The outcomes and characteristics of the Norwegian geriatric trauma population are not described on a national level. OBJECTIVE The aim of this project is to investigate whether patient safety challenges exist for geriatric trauma patients in Norway. An important objective of the study is to identify risk areas that will facilitate further work to safeguard and promote quality and safety in the Norwegian trauma system. METHODS This is a population-based mixed methods project divided into 4 parts: 3 quantitative retrospective cohort studies and 1 qualitative interview study. The quantitative studies will compare adult (aged 16-64 years) and elderly (aged ≥65 years) trauma patients captured in the Norwegian Trauma Registry (NTR) with a date of injury from January 1, 2015, to December 31, 2018. Descriptive statistics and relevant statistical methods to compare groups will be applied. The qualitative study will comprise focus group interviews with doctors responsible for trauma care, and data will be analyzed using a thematic analysis to identify important themes. RESULTS The project received funding in January 2019 and was approved by the Oslo University Hospital data protection officer (No. 19/16593). Registry data have been extracted for 33,344 patients, and the analysis of these data has begun. Focus group interviews will be conducted from spring 2020. Results from this project are expected to be ready for publication from fall 2020. CONCLUSIONS By combining data from the NTR with interviews with doctors responsible for treatment and transfer of elderly trauma patients, we will provide increased knowledge about trauma in Norwegian geriatric patients on a national level that will form the basis for further research aiming at developing interventions that hopefully will make the trauma system better equipped to manage the rising tide of geriatric trauma. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/15722.
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Affiliation(s)
- Mathias Cuevas-Østrem
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
- Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Olav Røise
- Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torben Wisborg
- Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Elisabeth Jeppesen
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
- Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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