Ahmed, Omar Z; Burd, Randall S
The management of critically ill pediatric patients with trauma poses many challenges because of the infrequency and diversity of severe injuries and a paucity of high-level evidence to guide care for these uncommon events. This article discusses recent recommendations for early resuscitation and blood component therapy for hypovolemic pediatric patients with trauma. It also highlights the specific types of injuries that lead to severe injury in children and presents challenges related to their management. Copyright © 2017 Elsevier Inc. All rights reserved.
Tuna, M; Latifi, R; El-Menyar, A; Al Thani, H
Enteral nutrition (EN) is a widely used, standard-of-care technique for nutrition support in critically ill and trauma patients. To review the current techniques of gastrointestinal tract access for EN. For this traditional narrative review, we accessed English-language articles and abstracts published from January 1988 through October 2012, using three research engines (MEDLINE, Scopus, and EMBASE) and the following key terms: "enteral nutrition," "critically ill," and "gut access." We excluded outdated abstracts. For our nearly 25-year search period, 44 articles matched all three terms. The most common gut access techniques included nasoenteric tube placement (nasogastric, nasoduodenal, or nasojejunal), as well as a percutaneous endoscopic gastrostomy (PEG). Other open or laparoscopic techniques, such as a jejunostomy or a gastrojejunostomy, were also used. Early EN continues to be preferred whenever feasible. In addition, evidence is mounting that EN during the early phase of critical illness or trauma trophic feeding has an outcome comparable to that of full-strength formulas. Most patients tolerate EN through the stomach, so postpyloric tube feeding is not needed initially. In critically ill and trauma patients, early EN through the stomach should be instituted whenever feasible. Other approaches can be used according to patient needs, available expertise, and institutional guidelines. More research is needed in order to ensure the safe use of surgical tubes in the open abdomen.
Jensen, Søren Marker; Do, Hien Quoc; Rasmussen, Søren W.
BACKGROUND: Handling critically ill patients is a complex task for Emergency Department (ED) personnel. Initial treatment is of major importance and requires adequately experienced ED doctors to initiate and decide for the right medical or surgical treatment. Our aim was, with regard to clinical...... presentation, management and mortality to describe adult non-trauma patients that upon ED arrival elicited emergency team calls. METHODS: An observational study of adult patients (≥ 18 years) admitted to a regional ED with conditions that elicited acute team activation and additional emergency team...... consultation calls for non-ED specialist physicians. Emergency team calls were two-tiered with 'orange' and 'red' calls. Additionally, intensive care unit (ICU) admission charts were reviewed to identify the total number of adult non-trauma and non-cardiac arrest patients admitted to the ICU from the ED during...
Matsushima, Kazuhide; Goldwasser, Eleanor R; Schaefer, Eric W; Armen, Scott B; Indeck, Matthew C
The care of the critically ill trauma patients is provided by intensivists with various base specialties of training. The purpose of this study was to investigate the impact of intensivists' base specialty of training on the disparity of care process and patient outcome. We performed a retrospective review of an institutional trauma registry at an academic level 1 trauma center. Two intensive care unit teams staffed by either board-certified surgery or anesthesiology intensivists were assigned to manage critically ill trauma patients. Both teams provided care, collaborating with a trauma surgeon in house. We compared patient characteristics, care processes, and outcomes between surgery and anesthesiology groups using Wilcoxon tests or chi-square tests, as appropriate. We identified a total of 620 patients. Patient baseline characteristics including age, sex, transfer status, injury type, injury severity score, and Glasgow coma scale were similar between groups. We found no significant difference in care processes and outcomes between groups. In a logistic regression model, intensivists' base specialty of training was not a significant factor for mortality (odds ratio, 1.46; 95% confidence interval; 0.79-2.80; P = 0.22) and major complication (odds ratio, 1.11; 95% confidence interval, 0.73-1.67; P = 0.63). Intensive care unit teams collaborating with trauma surgeons had minimal disparity of care processes and similar patient outcomes regardless of intensivists' base specialty of training. Copyright © 2013 Elsevier Inc. All rights reserved.
Voils, Stacy A; Shahin, Mohamed H; Garrett, Timothy J; Frye, Reginald F
Incidence of venous thromboembolism (VTE) in critically ill patients remains unacceptably high despite widespread use of thromboprophylaxis. A systems biology approach may be useful in understanding disease pathology and predicting response to treatment. Metabolite profile under specific environmental conditions provides the closest link to phenotype, but the relationship between metabolomics and risk of VTE in critically ill patients is unknown. In this study, metabolomics signatures are compared in patients with and without VTE. Multicenter case-control study using prospectively collected data from the Inflammation and Host Response to Injury program, with pathway and in silico gene expression analyses. Eight level 1 US trauma centers. Critically ill adults with blunt trauma who developed VTE within the first 28 days of hospitalization compared to patients without VTE (N-VTE). None. Patients included in the study (n = 20 VTE, n = 20 N-VTE) were mean age of 34 years, injury severity score of 35, and VTE diagnosed a median of 10.5 days after admission. Global metabolomics revealed two kynurenine metabolites, N-formylkynurenine (AUC = 0.77; 95% CI: 0.59-0.89) and 5-hydroxy-N-formylkynurenine (AUC = 0.80; 95% CI:0.63-0.90) significantly discriminated VTE and N-VTE; ratio between N-formylkynurenine/5-hydroxy-N-formylkynurenine improved predictive power (AUC = 0.87; 95% CI: 0.74-0.95). In the pathway analysis, tryptophan was the only significant metabolic pathway including N-formylkynurenine and 5-hydroxy-N-formylkynurenine (p < 0.001), and 8 proteins directly or indirectly interacted with these metabolites in the interaction network analysis. Of the 8 genes tested in the in silico gene expression analyses, KYNU (p < 0.001), CCBL1 (p < 0.001), and CCBL2 (p = 0.001) were significantly different between VTE and N-VTE, controlling for age and sex. Two novel kynurenine metabolites in the tryptophan pathway associated with
Wong David T
but the study arm began to correct sooner at 24 hours compared to 48 hours for the control arm. Conclusion We analyzed the use of sodium acetate as an alternative to normal saline or lactated ringers during resuscitation of critically ill trauma patients at a single center. Our data shows that the hemodynamic profile remained favorable, without evidence of instability at any point during the study period. Normalization of hyperchloremia and metabolic acidosis occurred faster in the patients who received sodium acetate.
Fuentes, Eva; Shields, Jean-Francois; Chirumamilla, Nandan; Martinez, Myriam; Kaafarani, Haytham; Yeh, Daniel Dante; White, Benjamin; Filbin, Michael; DePesa, Christopher; Velmahos, George; Lee, Jarone
Emergency department (ED) overcrowding remains a significant problem in many hospitals, and results in multiple negative effects on patient care outcomes and operational metrics. We sought to test whether implementing a quality improvement project could decrease ED LOS for trauma patients requiring an ICU admission from the ED, specifically by directly admitting critically ill trauma patients from the ED CT scanner to an ICU bed. This was a retrospective study comparing patients during the intervention period (2013-2014) to historical controls (2011-2013). Critically ill trauma patients requiring a CT scan, but not the operating room (OR) or Interventional Radiology (IR), were directly admitted from the CT scanner to the ICU, termed the "One-way street (OWS)". Controls from the 2011-2013 Trauma Registry were matched 1:1 based on the following criteria: Injury Severity Score; mechanism of injury; and age. Only patients who required emergent trauma consult were included. Our primary outcome was ED LOS, defined in minutes. Our secondary outcomes were ICU LOS, hospital LOS and mortality. Paired t test or Wilcoxon signed rank test were used for continuous univariate analysis and Chi square for categorical variables. Logistic regression and linear regressions were used for categorical and continuous multivariable analysis, respectively. 110 patients were enrolled in this study, with 55 in the OWS group and 55 matched controls. Matched controls had lower APACHE II score (12 vs. 15, p = 0.03) and a higher GCS (14 vs. 6, p = 0.04). ED LOS was 229 min shorter in the OWS group (82 vs. 311 min, p < 0.0001). The time between CT performed and ICU disposition decreased by 230 min in the OWS arm (30 vs. 300 min, p < 0.001). There was no difference in ED arrival to CT time between groups. Following multivariable analysis, mortality was primarily predicted by the APACHE II score (OR 1.29, p < 0.001), and not ISS, mechanism of injury, or age. After controlling for APACHE
Skinner, D L; Laing, G L; Rodseth, R N; Ryan, L; Hardcastle, T C; Muckart, D J J
This study describes the incidence and outcomes of blunt cardiac injury (BCI) in a single trauma intensive care unit (TICU), together with the spectrum of thoracic injuries and cardiac abnormalities seen in BCI. We performed a retrospective observational study of 169 patients with blunt thoracic trauma admitted from January 2010 to April 2013. BCI was diagnosed using an elevated serum troponin in the presence of either clinical, ECG or transthoracic echocardiography (TTE) abnormalities in keeping with BCI. The mechanism of injury, associated thoracic injuries and TTE findings in these patients are reported. The incidence of BCI among patients with blunt thoracic trauma was 50% (n=84). BCI patients had higher injury severity scores (ISS) (median 37 [IQR 29-47]; p=0.001) and higher admission serum lactate levels (median 3.55 [IQR 2.4-6.2], p=0.008). In patients with BCI, the median serum TnI level was 2823ng/L (IQR 1353-6833), with the highest measurement of 64950ng/L. TTEs were performed on 38 (45%) patients with BCI, of whom 30 (79%) had abnormalities. Patients with BCI had a higher mortality (32% vs. 16%; p=0.028) and trended towards a longer length of stay (17.0 days [standard deviation (SD) 13.5] vs. 13.6 days [SD 12.0]; p=0.084). BCI was associated with an increased mortality and a trend towards a longer length of stay in this study. It is a clinically relevant diagnosis which requires a high index of suspicion. Screening of high risk patients with significant blunt thoracic trauma for BCI with serum troponins should be routine practise. Patients diagnosed with BCI should undergo more advanced imaging such as TTE or TOE to exclude significant cardiac structural injury. Copyright © 2014 Elsevier Ltd. All rights reserved.
T Carter Chiasson
Full Text Available BACKGROUND: Critically ill trauma patients with severe injuries are at high risk for venous thromboembolism (VTE and bleeding simultaneously. Currently, the optimal VTE prophylaxis strategy is unknown for trauma patients with a contraindication to pharmacological prophylaxis because of a risk of bleeding. METHODS AND FINDINGS: Using decision analysis, we estimated the cost effectiveness of three VTE prophylaxis strategies-pneumatic compression devices (PCDs and expectant management alone, serial Doppler ultrasound (SDU screening, and prophylactic insertion of a vena cava filter (VCF -- in trauma patients admitted to an intensive care unit (ICU with severe injuries who were believed to have a contraindication to pharmacological prophylaxis for up to two weeks because of a risk of major bleeding. Data on the probability of deep vein thrombosis (DVT and pulmonary embolism (PE, and on the effectiveness of the prophylactic strategies, were taken from observational and randomized controlled studies. The probabilities of in-hospital death, ICU and hospital discharge rates, and resource use were taken from a population-based cohort of trauma patients with severe injuries (injury severity scores >12 admitted to the ICU of a regional trauma centre. The incidence of DVT at 12 weeks was similar for the PCD (14.9% and SDU (15.0% strategies, but higher for the VCF (25.7% strategy. Conversely, the incidence of PE at 12 weeks was highest in the PCD strategy (2.9%, followed by the SDU (1.5% and VCF (0.3% strategies. Expected mortality and quality-adjusted life years were nearly identical for all three management strategies. Expected health care costs at 12 weeks were Can$55,831 for the PCD strategy, Can$55,334 for the SDU screening strategy, and Can$57,377 for the VCF strategy, with similar trends noted over a lifetime analysis. CONCLUSIONS: The attributable mortality due to PE in trauma patients with severe injuries is low relative to other causes of mortality
Dziadzko, Volha; Dziadzko, Mikhail A; Johnson, Margaret M; Gajic, Ognjen; Karnatovskaia, Lioudmila V
Post-intensive care syndrome (PICS), which encompasses profound psychological morbidity, affects many survivors of critical illness. We hypothesize that acute psychological stress during the intensive care unit (ICU) confinement likely contributes to PICS. In order to develop strategies that mitigate PICS associated psychological morbidity, it is paramount to first characterize acute ICU psychological stress and begin to understand its causative and protective factors. A structured interview study was administered to adult critical illness survivors who received ≥48h of mechanical ventilation in medical and surgical ICUs of a tertiary care center, and their families. Fifty patients and 44 family members were interviewed following ICU discharge. Patients reported a high level of psychological distress. The families' perception of patient's stress level correlated with the patient's self-estimated stress level both in daily life (rho=0.59; ppsychological stress during an ICU stay; the presence of family, and physician's attention are categorized as important mitigating factors. Patients and families identified several practical recommendations which may help assuage the psychological burden of the ICU stay. Copyright © 2017 Elsevier Inc. All rights reserved.
Daniel Dante Yeh
Full Text Available Background: Excessive crystalloid administration is common and associated with negative outcomes in critically ill trauma patients. Continuous furosemide infusion (CFI to remove excessive fluid has not been previously described in this population. We hypothesized that a goal-directed CFI is more effective for fluid removal than intermittent bolus injection (IBI diuresis without excess incidence of hypokalemia or renal failure. Materials and Methods: CFI cases were prospectively enrolled between November 2011 and August 2012, and matched to historic IBI controls by age, gender, Injury Severity Score (ISS, and net fluid balance (NFB at diuresis initiation. Paired and unpaired analyses were performed to compare groups. The primary endpoints were net fluid balance, potassium and creatinine levels. Secondary endpoints included intensive care unit (ICU and hospital length of stay (LOS, ventilator-free days (VFD, and mortality. Results: 55 patients were included, with 19 cases and 36 matched controls. Mean age was 54 years, mean ISS was 32.7, and mean initial NFB was +7.7 L. After one day of diuresis with CFI vs. IBI, net 24 h fluid balance was negative (−0.55 L vs. +0.43 L, P = 0.026 only for the CFI group, and there was no difference in potassium and creatinine levels. Cumulative furosemide dose (59.4mg vs. 25.4mg, P < 0.001 and urine output (4.2 L vs. 2.8 L, P < 0.001 were also significantly increased with CFI vs. IBI. There were no statistically significant differences in ICU LOS, hospital LOS, VFD, or mortality. Conclusions: Compared to IBI, goal-directed diuresis by CFI is more successful in achieving net negative fluid balance in patients with fluid overload with no detrimental side effects on renal function or patient outcome.
Objectives: The benefit of an early enteral nutrition start in critical ill patients is widely accepted. However, limited published data focus on trauma patients. This study aimed to investigate the effect of early enteral nutrition initiation on length of stay and mortality in an intensive care unit (ICU), as well as explore if enteral ...
in trauma patients can be used. However, some modifications have been made to adapt it to unstable trauma patients, where reawakening the patient is not an option because of the need for emergency airway control (Figure 3).4. Anaesthetists working in high-volume trauma centers should determine their own algorithm, ...
Mohr, Nicholas M; Pelaez Gil, Carlos A; Harland, Karisa K; Faine, Brett; Stoltze, Andrew; Pearson, Kent; Ahmed, Azeemuddin
The purpose of the study was to test the hypothesis that prehospital oral chlorhexidine administered to intubated trauma patients will decrease the Clinical Pulmonary Infection Score (CPIS) during the first 2 days of hospitalization. Prospective interventional concurrent-control study of all intubated adult trauma patients transported by air ambulance to a 711-bed Midwestern academic trauma center over a 1-year period. Patients transported by 2 university-based helicopters were treated with oral chlorhexidine after intubation, and the control group was patients transported by other air transport services. Sixty-seven patients were enrolled, of which 23 received chlorhexidine (9 patients allocated to the intervention were not treated). The change in CPIS score was no different between the intervention and control groups by intention to treat (1.06- vs 1.40-point reduction, P = .520), and no difference was observed in tracheal colonization (29.0% vs 36.7%, P = .586). No differences were observed in the rate of clinical pneumonia (8.7% vs 8.6%, P = .987) or mortality (P = .196) in the per-protocol chlorhexidine group. The prehospital administration of oral chlorhexidine does not reduce the CPIS score over the first 48 hours of admission for intubated trauma patients. Further study should explore other prehospital strategies of reducing complications of critical illness. Copyright © 2015 Elsevier Inc. All rights reserved.
Mauritz, M.W.; Goossens, P.J.J.; Draijer, N.; van Achterberg, T.
Background: Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. Objective: To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. Methods: We
Mauritz, M.W.; Goossens, P.J.J.; Draijer, N.; Achterberg, T. van
BACKGROUND: Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. OBJECTIVE: To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. METHODS: We
Maria W. Mauritz
Full Text Available Background: In the Netherlands, most patients with severe mental illness (SMI receive flexible assertive community treatment (FACT provided by multidisciplinary community mental health teams. SMI patients with comorbid posttraumatic stress disorder (PTSD are sometimes offered evidence-based trauma-focused treatment like eye movement desensitization reprocessing or prolonged exposure. There is a large amount of evidence for the effectiveness of narrative exposure therapy (NET within various vulnerable patient groups with repeated interpersonal trauma. Some FACT-teams provide NET for patients with comorbid PTSD, which is promising, but has not been specifically studied in SMI patients. Objectives: The primary aim is to evaluate NET in SMI patients with comorbid PTSD associated with repeated interpersonal trauma to get insight into whether (1 PTSD and dissociative symptoms changes and (2 changes occur in the present SMI symptoms, care needs, quality of life, global functioning, and care consumption. The second aim is to gain insight into patients’ experiences with NET and to identify influencing factors on treatment results. Methods: This study will have a mixed methods convergent design consisting of quantitative repeated measures and qualitative semi-structured in-depth interviews based on Grounded Theory. The study population will include adult SMI outpatients (n=25 with comorbid PTSD and receiving NET. The quantitative study parameters will be existence and severity of PTSD, dissociative, and SMI symptoms; care needs; quality of life; global functioning; and care consumption. In a longitudinal analysis, outcomes will be analyzed using mixed models to estimate the difference in means between baseline and repeated measurements. The qualitative study parameters will be experiences with NET and perceived factors for success or failure. Integration of quantitative and qualitative results will be focused on interpreting how qualitative results
Knapp, Sandra J; Sole, Mary Lou; Byers, Jacqueline Fowler
The aim of this study was to evaluate impact of the EPICS Family Bundle on stress and coping. Critical care nurses frequently deal with family stress, but may be without knowledge and skills needed to assist families to cope. A non-equivalent control group design was used, with a convenience sample of 84 family members of critically ill patients. During the control phase, participants completed tools measuring stress and coping. The intervention included use of the EPICS Family Bundle. After implementation, participants completed the same tools as those administered during the control phase. Outcomes were analyzed using independent-sample t-tests. The experimental group had a significantly higher coping score on two subscales; and although not statistically significant, it was also improved on an additional four. After implementation of the intervention, families experienced improved coping. The study may have lacked sufficient power to detect all differences. Copyright © 2013 Elsevier Inc. All rights reserved.
Chan, Jeffrey C Y
Differences in illness perception about hand injury may partly explain the variation in health behaviours such as adherence to post-operative therapy, coping strategy, emotional response and eventual clinical outcome. This study examined the illness perception of patients with hand injuries in the acute trauma setting.
Center. As glomerular hyperfiltration is unlikely in the setting of renal impairment, subjects were excluded if the estimated glomerular filtration ...trauma (3 points), and SOFA score of 4 or less (1 point). eGFR, estimated glomerular filtration rate; GNR, gram-negative rod; MVC, motor vehicle...confirmed with the comparator test, a timedurine creatinine concentration fromwhich to determine the glomerular filtration rate.Once the diagnosis ofARC
Fuster-Lluch, Oscar; Zapater-Hernández, Pedro; Gerónimo-Pardo, Manuel
The pharmacokinetic profile of intravenous acetaminophen administered to critically ill multiple-trauma patients was studied after 4 consecutive doses of 1 g every 6 hours. Eleven blood samples were taken (predose and 15, 30, 45, 60, 90, 120, 180, 240, 300, and 360 minutes postdose), and urine was collected (during 6-hour intervals between doses) to determine serum and urine acetaminophen concentrations. These were used to calculate the following pharmacokinetic parameters: maximum and minimum concentrations, terminal half-life, area under serum concentration-time curve from 0 to 6 hours, mean residence time, volume of distribution, and serum and renal clearance of acetaminophen. Daily doses of acetaminophen required to obtain steady-state minimum (bolus dosing) and average plasma concentrations (continuous infusion) of 10 μg/mL were calculated (10 μg/mL is the presumed lower limit of the analgesic range). Data are expressed as median [interquartile range]. Twenty-two patients were studied, mostly young (age 44 [34-64] years) males (68%), not obese (weight 78 [70-84] kg). Acetaminophen concentrations and pharmacokinetic parameters were these: maximum concentration 33.6 [25.7-38.7] μg/mL and minimum concentration 0.5 [0.2-2.3] μg/mL, all values below 10 μg/mL and 8 below the detection limit; half-life 1.2 [1.0-1.9] hours; area under the curve for 6 hours 34.7 [29.7-52.7] μg·h/mL; mean residence time 1.8 [1.3-2.6] hours; steady-state volume of distribution 50.8 [42.5-66.5] L; and serum and renal clearance 28.8 [18.9-33.7] L/h and 15 [11-19] mL/min, respectively. Theoretically, daily doses for a steady-state minimum concentration of 10 μg/mL would be 12.2 [7.8-16.4] g/day (166 [112-202] mg/[kg·day]); for an average steady-state concentration of 10 μg/mL, they would be 6.9 [4.5-8.1] g/day (91 [59-111] mg/[kg·day]). In conclusion, administration of acetaminophen at the recommended dosage of 1 g per 6 hours to critically ill multiple-trauma patients yields
Chan, Jeffrey C Y; Ong, Joshua C Y; Avalos, Gloria; Regan, Padraic J; McCann, Jack; Groarke, AnnMarie; Kelly, John L
Differences in illness perception about hand injury may partly explain the variation in health behaviours such as adherence to post-operative therapy, coping strategy, emotional response and eventual clinical outcome. This study examined the illness perception of patients with hand injuries in the acute trauma setting. The disability and severity of injury were assessed using the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and the Hand Injury Severity Score (HISS). The revised Illness Perception Questionnaire (IPQ-R) was used to explore patients' illness beliefs and perception on hand injury. Fifty seven patients were recruited over the 2 month period. The IPQ-R showed good internal reliability (Cronbach's alpha, 0.68-0.86). There was no correlation between the DASH or HISS scores and the various components of the IPQ-R scores, suggesting that illness perceptions were not influenced by the recent trauma experience. Patients with dominant hand injuries and females reported significantly higher subjective disability. Younger patients believed their injury would last for a limited duration but reported a significantly higher number of related symptoms. Overall, the cohort was optimistic about their treatment and duration of recovery (high treatment control score and low time line score). Beliefs of negative consequences, chronic/cyclical duration and low illness coherence were linked with negative emotional response. High illness identity was associated with perception of pessimistic outcome (high consequences score) and negative emotional response. The lack of correlations suggests that illness perceptions of patients do not necessarily relate to the recent trauma experience or the severity of their hand injury. Patients in this cohort were optimistic about treatment and their recovery. There was some evidence to suggest that patients with severe injury were over-optimistic about recovery. These findings suggest that there could be a role for
Full Text Available Specialized trauma teams have been shown to improve outcomes in critically injured patients. At our institution, an the American College of Surgeons Committee on trauma level I Trauma center, the trauma team activation (TTA criteria includes both physiologic and anatomic criteria, but any attending physician can activate the trauma team at their discretion outside criteria. As a result, the trauma team has been activated for noninjured patients meeting physiologic criteria secondary to nontraumatic hemorrhage. We present two cases in which the trauma team was activated for noninjured patients in hemorrhagic shock. The utilization of the TTA protocol and subsequent management by the trauma team are reviewed as we believe these were critical factors in the successful recovery of both patients. Beyond the primary improved survival outcomes of severely injured patients, trauma center designation has a “halo effect” that encompasses patients with nontraumatic hemorrhage.
A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the border trial.
Santamaria, Nick; Gerdtz, Marie; Sage, Sarah; McCann, Jane; Freeman, Amy; Vassiliou, Theresa; De Vincentis, Stephanie; Ng, Ai Wei; Manias, Elizabeth; Liu, Wei; Knott, Jonathan
The prevention of hospital acquired pressure ulcers in critically ill patients remains a significant clinical challenge. The aim of this trial was to investigate the effectiveness of multi-layered soft silicone foam dressings in preventing intensive care unit (ICU) pressure ulcers when applied in the emergency department to 440 trauma and critically ill patients. Intervention group patients (n = 219) had Mepilex(®) Border Sacrum and Mepilex(®) Heel dressings applied in the emergency department and maintained throughout their ICU stay. Results revealed that there were significantly fewer patients with pressure ulcers in the intervention group compared to the control group (5 versus 20, P = 0·001). This represented a 10% difference in incidence between the groups (3·1% versus 13·1%) and a number needed to treat of ten patients to prevent one pressure ulcer. Overall there were fewer sacral (2 versus 8, P = 0·05) and heel pressure ulcers (5 versus 19, P = 0·002) and pressure injuries overall (7 versus 27, P = 0·002) in interventions than in controls. The time to injury survival analysis indicated that intervention group patients had a hazard ratio of 0·19 (P = 0·002) compared to control group patients. We conclude that multi-layered soft silicone foam dressings are effective in preventing pressure ulcers in critically ill patients when applied in the emergency department prior to ICU transfer. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.
Kuzmanovska, Biljana; Cvetkovska, Emilija; Kuzmanovski, Igor; Jankulovski, Nikola; Shosholcheva, Mirjana; Kartalov, Andrijan; Spirovska, Tatjana
Rhabdomyolysis is a syndrome of injury of skeletal muscles associated with myoglobinuria, muscle weakness, electrolyte imbalance and often, acute kidney injury as severe complication. of this study is to detect the incidence of rhabdomyolysis in critically ill patients in the surgical intensive care unit (ICU), and to raise awareness of this medical condition and its treatment among the clinicians. A retrospective review of all surgical and trauma patients admitted to surgical ICU of the University Surgical Clinic "Mother Teresa" in Skopje, Macedonia, from January 1 st till December 31 st 2015 was performed. Patients medical records were screened for available serum creatine kinase (CK) with levels > 200 U/l, presence of myoglobin in the serum in levels > 80 ng/ml, or if they had a clinical diagnosis of rhabdomyolysis by an attending doctor. Descriptive statistical methods were used to analyze the collected data. Out of totally 1084 patients hospitalized in the ICU, 93 were diagnosed with rhabdomyolysis during the course of one year. 82(88%) patients were trauma patients, while 11(12%) were surgical non trauma patients. 7(7.5%) patients diagnosed with rhabdomyolysis developed acute kidney injury (AKI) that required dialysis. Average values of serum myoglobin levels were 230 ng/ml, with highest values of > 5000 ng/ml. Patients who developed AKI had serum myoglobin levels above 2000 ng/ml. Average values of serum CK levels were 400 U/l, with highest value of 21600 U/l. Patients who developed AKI had serum CK levels above 3000 U/l. Regular monitoring and early detection of elevated serum CK and myoglobin levels in critically ill surgical and trauma patients is recommended in order to recognize and treat rhabdomyolysis in timely manner and thus prevent development of AKI.
Lee, Bih-O; Chaboyer, Wendy; Wallis, Marianne
This study aimed to elucidate the illness representations of patients with traumatic injury and to examine what extent their illness representations change over time. Traumatic injury has attracted global concern because it is the major reason for death and disability in people under 45 years old. One model, the Common Sense Model of Illness Representation (CSMIR), has the potential to help individuals adjust to changes in health status such as traumatic injury. Longitudinal study design. This study was conducted using a and collected data prior to hospital discharge and at three and six months after hospital discharge. One individual question form and the Chinese Illness Perception Questionnaire Revised (IPQ-R) (Trauma) were used to collect demographic data, clinical data and illness representations. A total of 114 participants completed the survey three times. The overall response rate was 79.7%. Six subscales of the Chinese (Trauma): identity, emotional representations, consequences, controllability, illness coherence and causes of the Chinese IPQ-R (Trauma) changed significantly over time. Two subscales, Timeline (acute/chronic) and Timeline Cyclical, did not change significantly. Based on these findings, there may be a window of opportunity to provide appropriate interventions to individuals with traumatic injury at each time point. The results of this study have implications for nursing practice and further nursing research. Understanding illness representation in patients with traumatic injury may help nurses to provide anticipatory guidance and to design nursing interventions before and after hospital discharge, ultimately to improve health outcomes of those patients.
By necessity, critically ill patients admitted to intensive care units (ICUs) have a high level of dependency, which is linked to a variety of negative feelings, such as powerlessness. However, the term dependency is not well defined in the critically ill patients. The concept of “dependency” in critically ill patients was analyzed using a meta-synthesis approach. An inductive process described by Deborah Finfgeld-Connett was used to analyze the data. Overarching themes emerged that reflected critically ill patients’ experience and meaning of being in dependency were (a) antecedents: dependency in critically ill patients was a powerless and vulnerable state, triggered by a life-threatening crisis; (b) attributes: the characteristic of losing “self” was featured by dehumanization and disembodiment, which can be alleviated by a “self”-restoring process; and (c) outcomes: living with dependency and coping with dependency. The conceptual model explicated here may provide a framework for understanding dependency in critically ill patients. PMID:28462328
Full Text Available By necessity, critically ill patients admitted to intensive care units (ICUs have a high level of dependency, which is linked to a variety of negative feelings, such as powerlessness. However, the term dependency is not well defined in the critically ill patients. The concept of “dependency” in critically ill patients was analyzed using a meta-synthesis approach. An inductive process described by Deborah Finfgeld-Connett was used to analyze the data. Overarching themes emerged that reflected critically ill patients’ experience and meaning of being in dependency were (a antecedents: dependency in critically ill patients was a powerless and vulnerable state, triggered by a life-threatening crisis; (b attributes: the characteristic of losing “self” was featured by dehumanization and disembodiment, which can be alleviated by a “self”-restoring process; and (c outcomes: living with dependency and coping with dependency. The conceptual model explicated here may provide a framework for understanding dependency in critically ill patients.
Nash, Sara Siris; Kent, Laura K; Muskin, Philip R
This article explores the role of psychodynamics as it applies to the understanding and treatment of medically ill patients in the consultation-liaison psychiatry setting. It provides historical background that spans the eras from Antiquity (Hippocrates and Galen) to nineteenth-century studies of hysteria (Charcot, Janet, and Freud) and into the twentieth century (Flanders Dunbar, Alexander, Engle, and the DSM). The article then discusses the effects of personality on medical illness, treatment, and patients' ability to cope by reviewing the works of Bibring, Kahana, and others. The important contribution of attachment theory is reviewed as it pertains the patient-physician relationship and the health behavior of physically ill patients. A discussion of conversion disorder is offered as an example of psychodynamics in action. This article highlights the important impact of countertransference, especially in terms of how it relates to patients who are extremely difficult and "hateful," and explores the dynamics surrounding the topic of physician-assisted suicide, as it pertains to the understanding of a patient's request to die. Some attention is also given to the challenges surrounding the unique experience of residents learning how to treat medically ill patients on the consultation-liaison service. Ultimately, this article concludes that the use and understanding of psychodynamics and psychodynamic theory allows consultation-liaison psychiatrists the opportunity to interpret the life narratives of medically ill patients in a meaningful way that contributes importantly to treatment.
Joseph, Bellal; Zangbar, Bardiya; Pandit, Viraj; Kulvatunyou, Narong; Haider, Ansab; O'Keeffe, Terence; Khalil, Mazhar; Tang, Andrew; Vercruysse, Gary; Gries, Lynn; Friese, Randall S; Rhee, Peter
Geriatric patients are at higher risk for adverse outcomes after injury because of their altered physiological reserve. Mortality after trauma laparotomy remains high; however, outcomes in geriatric patients after trauma laparotomy have not been well established. The aim of our study was to identify factors predicting mortality in geriatric trauma patients undergoing laparotomy. A retrospective study was performed of all trauma patients undergoing a laparotomy at our level 1 trauma center over a 6-y period (2006-2012). Patients with age ≥55 y who underwent a trauma laparotomy were included. Patients with head abbreviated injury scale (AIS) score ≥ 3 or thorax AIS ≥ 3 were excluded. Our primary outcome measure was mortality. Significant factors in univariate regression model were used in multivariate regression analysis to evaluate the factors predicting mortality. A total of 1150 patients underwent a trauma laparotomy. Of which 90 patients met inclusion criteria. The mean age was 67 ± 10 y, 63% were male, and median abdominal AIS was 3 (2-4). Overall mortality rate was 23.3% (21/90) and progressively increased with age (P = 0.013). Age (P = 0.02) and lactate (P = 0.02) were the independent predictors of mortality in geriatric patients undergoing laparotomy. Mortality rate after trauma laparotomy increases with increasing age. Age and admission lactate were the predictors of mortality in geriatric population undergoing trauma laparotomies. Published by Elsevier Inc.
Meisler, Rikke; Thomsen, A B; Abildstrøm, H
Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage.......Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage....
Chang, Nam Sik; Kim, Jin Hwan; Kim, Jong Chul; Park, Cheong Hee; Cho, Jun Sik; Rhee, Byung Chull; Kim, Yong Baek
Ultrasound B-scan examination of traumatized eve is safe, cheap and easy diagnostic method for visualization of the posterior pole of the eye. Ophthalmoscopic visualization of the fundus of traumatized eye can be obscured by corneal opacity, anterior chamber hyphema, cataractous change of the lens, or hemorrhage of the citreous. Ultrasound B-scan examination of the posterior pole is imperative in such cases to detect any intraocular damage and the presence of a foreign body. So we performed ultrasound B-scan examination of traumatized eye seventy eight patients and analyzed those findings. All cases were confirmed by follow up examination of ophthalmoscopy and ultrasound, or surgery. The results were as follows; 1. The most common cause of the ocular injury was traffic accidents (19 patients, 24.4%),male was more commonly injured (63 patients, 80.8). and the most common age group was their 4th decade. 2. Summary of sonographically detected intraocular lesions were as follows; 1) Corneal opacity (44 patients)-hyphema 15, traumatic cataract 24, vitreous hemorrhage 31, retinal detachment 20, intraocular foreign body 4, etc. 2) Hyphemal (16 patients)-hyphema 16, vitreous hemorrhage 11, tretinal detachment 5, etc. 3) Traumatic cataract with no corneal or lens opacity (6 patients)-vitreous hemorrhage with or without retinal detachment 3, normal vitreous and retina 3. 4) Vitreous opacity(12 patients)-vitreous hemorrhage 12, retinal detachment 4, intraocular foreign body 3, etc. In all seventy eight patients with ocular trauma , we could demonstrate characteristic findings for each intraocular lesion. So we recognized the important role and high diagnostic accuracy of ultrasound B-scan examination for the evaluation of the posterior pole of traumatized eye
Chang, Nam Sik; Kim, Jin Hwan; Kim, Jong Chul; Park, Cheong Hee; Cho, Jun Sik; Rhee, Byung Chull; Kim, Yong Baek [Chungnam National University Hospital, Deajeon (Korea, Republic of)
Ultrasound B-scan examination of traumatized eve is safe, cheap and easy diagnostic method for visualization of the posterior pole of the eye. Ophthalmoscopic visualization of the fundus of traumatized eye can be obscured by corneal opacity, anterior chamber hyphema, cataractous change of the lens, or hemorrhage of the citreous. Ultrasound B-scan examination of the posterior pole is imperative in such cases to detect any intraocular damage and the presence of a foreign body. So we performed ultrasound B-scan examination of traumatized eye seventy eight patients and analyzed those findings. All cases were confirmed by follow up examination of ophthalmoscopy and ultrasound, or surgery. The results were as follows; 1. The most common cause of the ocular injury was traffic accidents (19 patients, 24.4%),male was more commonly injured (63 patients, 80.8). and the most common age group was their 4th decade. 2. Summary of sonographically detected intraocular lesions were as follows; 1) Corneal opacity (44 patients)-hyphema 15, traumatic cataract 24, vitreous hemorrhage 31, retinal detachment 20, intraocular foreign body 4, etc. 2) Hyphemal (16 patients)-hyphema 16, vitreous hemorrhage 11, tretinal detachment 5, etc. 3) Traumatic cataract with no corneal or lens opacity (6 patients)-vitreous hemorrhage with or without retinal detachment 3, normal vitreous and retina 3. 4) Vitreous opacity(12 patients)-vitreous hemorrhage 12, retinal detachment 4, intraocular foreign body 3, etc. In all seventy eight patients with ocular trauma , we could demonstrate characteristic findings for each intraocular lesion. So we recognized the important role and high diagnostic accuracy of ultrasound B-scan examination for the evaluation of the posterior pole of traumatized eye.
This article proposes a focused, novel sub-set of the cognitive behavioral therapy approach to hypnotherapy for physically ill patients, based upon the illness/non-illness psychotherapeutic model for physically ill patients. The model is based on three logical rules used in differentiating illness from non-illness: duality, contradiction, and complementarity. The article discusses the use of hypnotic interventions to help physically ill and/or disabled patients distinguish between illness and non-illness in their psychotherapeutic themes and attitudes. Two case studies illustrate that patients in this special population group can be taught to learn the language of change and to use this language to overcome difficult situations. The model suggests a new clinical mode of treatment in which individuals who are physically ill and/or disabled are helped in coping with actual motifs and thoughts related to non-illness or non-disability.
Slooter, A J C; Van De Leur, R R; Zaal, I J
Delirium is common in critically ill patients and associated with increased length of stay in the intensive care unit (ICU) and long-term cognitive impairment. The pathophysiology of delirium has been explained by neuroinflammation, an aberrant stress response, neurotransmitter imbalances, and
Joseph, Bellal; Khalil, Mazhar; Zangbar, Bardiya; Kulvatunyou, Narong; Orouji, Tahereh; Pandit, Viraj; O'Keeffe, Terence; Tang, Andrew; Gries, Lynn; Friese, Randall S; Rhee, Peter; Davis, James W
Domestic violence is an extremely underreported crime and a growing social problem in the United States. However, the true burden of the problem remains unknown. To assess the reported prevalence of domestic violence among trauma patients. A 6-year (2007-2012) retrospective analysis of the prospectively maintained National Trauma Data Bank. Trauma patients who experienced domestic violence and who presented to trauma centers participating in the National Trauma Data Bank were identified using International Classification of Diseases, Ninth Revision diagnosis codes (995.80-995.85, 995.50, 995.52-995.55, and 995.59) and E codes (E967.0-E967.9). Patients were stratified by age into 3 groups: children (≤18 years), adults (19-54 years), and elderly patients (≥55 years). Trend analysis was performed on April 10, 2014, to assess the reported prevalence of domestic violence over the years. Trauma patients presenting to trauma centers participating in the National Trauma Data Bank. To assess the reported prevalence of domestic violence among trauma patients. A total of 16 575 trauma patients who experienced domestic violence were included. Of these trauma patients, 10 224 (61.7%) were children, 5503 (33.2%) were adults, and 848 (5.1%) were elderly patients. The mean (SD) age was 15.9 (20.6), the mean (SD) Injury Severity Score was 10.9 (9.6), and 8397 (50.7%) were male patients. Head injuries (46.8% of patients) and extremity fractures (31.2% of patients) were the most common injuries. A total of 12 515 patients (75.1%) were discharged home, and the overall mortality rate was 5.9% (n = 980). The overall reported prevalence of domestic violence among trauma patients was 5.7 cases per 1000 trauma center discharges. The prevalence of domestic violence increased among children (14.0 cases per 1000 trauma center discharges in 2007 to 18.5 case per 1000 trauma center discharges in 2012; P = .001) and adults (3.2 cases per 1000 discharges in 2007 to 4.5 cases per
Nystrup, Kristin Brønnum; Stensballe, Jakob; Bøttger, Morten
Haemorrhage is a leading cause of death in paediatric trauma patients. Predefined massive transfusion protocols (MTP) have the potential to significantly reduce mortality by treating haemorrhagic shock and coagulopathy, in adhering to the principles of haemostatic resuscitation with rapid...... administration of balanced ratios of packed red blood cells (RBC), fresh frozen plasma (FFP) and platelets (PLT).Because of their substantial physiological reserve, initial vital signs may not be good predictors of early haemorrhage in paediatric patients. Determining the triggers for MTP activation...... in paediatric trauma patients is challenging, and the optimal blood product ratio that will increase survival in massively bleeding paediatric trauma patients has yet to be determined. To date, only a few small descriptive studies and case reports have investigated the use of predefined MTP in paediatric trauma...
Moliner Velázquez, S; Rubio Haro, R; De Andrés Serrano, C; De Andrés Ibáñez, J
Regional analgesia intrinsically, based on its physiological effects, is routinely used for the perioperative treatment of pain associated with surgical procedures. However, in other areas such as the non-surgical treatment of acute pain for patients in a critical condition, it has not been subjected to specific prospective studies. If we confine ourselves to the physiological effects of the nerve block, in a situation of stress, the indications for regional anaesthesia in this group of patients extend to the management of a wide variety of medical as well as postsurgical conditions, of trauma patients and of other painful procedures performed in the patient's bed. The critical patient certainly must be analyzed individually as their own primary conditions is of vital importance, as well as any associated conditions they have developed that can potentially increase the risk of systemic toxicity or morbidity, such as, coagulopathies, infection, immunosuppressive states, sedation and problems associated with mechanical ventilation. This review aims to assess the role of regional analgesia in critically ill patients, placing it within the algorithm decision tree of the professional responsible for patients in critical care units, all based on the evidence of potential benefits according to the published literature. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.
Lee, Jong Dae; Park, Moo Kyun; Lee, Byung Don; Park, Ji Yun; Lee, Tae Kyung; Sung, Ki-Bum
This study evaluates the otolith function of patients with head trauma, postulating that otolith dysfunction is a cause of nonspecific dizziness after head trauma. We prospectively enrolled 28 patients referred within 3 months after head trauma between March 2007 and December 2009. Pure tone audiometry, caloric testing and otolith function tests, including cervical vestibular evoked myogenic potential (cVEMP) and subjective visual vertical (SVV) tests, were performed on all patients. The relationship between otolith function and otologic symptoms was analyzed. Of the 28 patients with head trauma, 18 complained of dizziness and 12 experienced hearing loss, including 6 patients who complained of both. On defining otolith dysfunction as an abnormal cVEMP or abnormal SVV, a significant difference in otolith dysfunction existed between the groups with and without dizziness [72 (13/18) vs. 20% (2/10)]. In contrast, no significant difference in otolith dysfunction was detected between the abnormal and normal hearing groups. A significant number of the patients who complained of nonspecific dizziness after trauma had abnormal otolith function. After trauma, when patients complain of dizziness, vestibular function tests, including otolith function tests, should be considered.
Slooter, A J C; Van De Leur, R R; Zaal, I J
Delirium is common in critically ill patients and associated with increased length of stay in the intensive care unit (ICU) and long-term cognitive impairment. The pathophysiology of delirium has been explained by neuroinflammation, an aberrant stress response, neurotransmitter imbalances, and neuronal network alterations. Delirium develops mostly in vulnerable patients (e.g., elderly and cognitively impaired) in the throes of a critical illness. Delirium is by definition due to an underlying condition and can be identified at ICU admission using prediction models. Treatment of delirium can be improved with frequent monitoring, as early detection and subsequent treatment of the underlying condition can improve outcome. Cautious use or avoidance of benzodiazepines may reduce the likelihood of developing delirium. Nonpharmacologic strategies with early mobilization, reducing causes for sleep deprivation, and reorientation measures may be effective in the prevention of delirium. Antipsychotics are effective in treating hallucinations and agitation, but do not reduce the duration of delirium. Combined pain, agitation, and delirium protocols seem to improve the outcome of critically ill patients and may reduce delirium incidence. © 2017 Elsevier B.V. All rights reserved.
Full Text Available Introduction: The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care. Methods: We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443. The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions (“trauma center need” as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need. Results: Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need. Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Conclusion: Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the
Dahl, B; Schiødt, F V; Ott, P
in the circulation can lead to a condition resembling multiple organ dysfunction syndrome (MODS), and we have previously demonstrated that the level of Gc-globulin is decreased after severe trauma. The purpose of the present study was to determine whether the plasma levels of gelsolin were altered in the early phase...... after trauma. Twenty-three consecutive trauma patients were studied. Plasma samples were assayed for gelsolin by immunonephelometry with polyclonal rabbit antihuman gelsolin prepared in our own laboratory. The median time from injury until the time the first blood sample was taken was 52 min (range 20......-110) and the median Injury Severity Score (ISS) was 20 (range 4-50). The gelsolin level on admission was reduced significantly in the trauma patients compared with normal controls. The median level was 51 mg/L (7-967) vs. 207 mg/L (151-621), P
Tisherman, Samuel A; Kaplan, Lewis; Gracias, Vicente H; Beilman, Gregory J; Toevs, Christine; Byrnes, Matthew C; Coopersmith, Craig M
Providing optimal care for critically ill and injured surgical patients will become more challenging with staff shortages for surgeons and intensivists. This white paper addresses the historical issues behind the present situation, the need for all intensivists to engage in dedicated critical care per the intensivist model, and the recognition that intensivists from all specialties can provide optimal care for the critically ill surgical patient, particularly with continuing involvement by the surgeon of record. The new acute care surgery training paradigm (including trauma, surgical critical care, and emergency general surgery) has been developed to increase interest in trauma and surgical critical care, but the number of interested trainees remains too few. Recommendations are made for broadening the multidisciplinary training and practice opportunities in surgical critical care for intensivists from all base specialties and for maintaining the intensivist model within acute care surgery practice. Support from academic and administrative leadership, as well as national organizations, will be needed.
Joosse, Pieter; de Jong, Willem-Jan J.; Reitsma, Johannes B.; Wendt, Klaus W.; Schep, Niels W.; Goslings, J. Carel
The Emergency Trauma Score has been developed for early estimation of mortality risk in adult trauma patients with an Injury Severity Score of 16 or higher. Emergency Trauma Score combines four early predictors available at the trauma resuscitation room: age, Glasgow Coma Scale, base excess, and
Joosse, Pieter; de Jong, Willem-Jan J.; Wendt, Klaus W.; Schep, Niels W.; Goslings, J. Carel; Reitsma, J.
Objectives: The Emergency Trauma Score has been developed for early estimation of mortality risk in adult trauma patients with an Injury Severity Score of 16 or higher. Emergency Trauma Score combines four early predictors available at the trauma resuscitation room: age, Glasgow Coma Scale, base
Johnston, Matthew; Safcsak, Karen; Cheatham, Michael L; Smith, Chadwick P
Obesity incidence in the trauma population is increasing. Abdominal compartment syndrome has poor outcomes when left untreated. Surgeons may treat obese patients differently because of concern for increased morbidity and mortality. We studied the effects of body mass index (BMI) on resource utilization and outcome. An Institutional Review Board-approved retrospective review of trauma patients requiring temporary abdominal closure (TAC) was performed. Patients were stratified as follows: Group 1-BMI = 18.5 to 24.9 kg/m(2), Group 2-BMI = 25 to 29.9 kg/m(2), Group 3-BMI = 30 to 39.9 kg/m(2), Group 4-BMI ≥ 40 kg/m(2). Demographic data, illness severity as defined by Injury Severity Score, Acute Physiology and Chronic Health Evaluation Score Version II and Simplified Acute Physiology Score Version II scores, resource utilization, fascial closure rate, and survival were collected. About 380 patients required TAC. Median age of Group 1 was significantly lower than Groups 2 and 3 (P = 0.001). Severity of illness did not differ. Group 4 had a longer intensive care unit stay compared with Groups 1 and 2 (P = 0.005). Group 4 required mechanical ventilation longer than Group 1 (P = 0.027). Hospital stay, fascial closure, and survival were equivalent. Obese trauma patients with TAC have a longer intensive care unit stay and more ventilator days, but there is no difference in survival or type of closure. TAC can be used safely in trauma patients with a BMI ≥ 30 kg/m(2).
Helling, H; Stephan, B; Pindur, G
Activation of coagulation and inflammatory response including the complement system play a major role in the pathogenesis of critical illness. However, only limited data are available addressing the relationship of both pathways and its assessment of a predictive value for the clinical outcome in intense care medicine. Therefore, parameters of the coagulation and complement system were studied in patients with septicaemia and multiple trauma regarded as being exemplary for critical illness. 34 patients (mean age: 51.38 years (±16.57), 15 females, 19 males) were investigated at day 1 of admittance to the intensive care unit (ICU). Leukocytes, complement factors C3a and C5a were significantly (p complement system as part of the inflammatory response is a significant mechanism in septicaemia, whereas loss and consumption of blood components including parts of the coagulation and complement system is more characteristic for multiple trauma. Protein C in case of severe reduction might be of special concern for surviving in sepsis. Activation of haemostasis was occurring in both diseases, however, overt DIC was not confirmed in this study to be a leading mechanism in critically ill patients. MOF score, lactate, C1-inhibitor and prothrombin time have been the only statistically significant predictors for lethal outcome suggesting that organ function, microcirculation, haemostasis and inflammatory response are essential elements of the pathomechanism and clinical course of diseases among critically ill patients.
Rackley, Sandra; Bostwick, J Michael
In medically ill patients, given the many entities the phenotype of depression may represent, clinicians must be prepared to cast their diagnostic nets widely, not settling for the obvious but frequently incorrect choice of major depressive episode and throwing antidepressants at it willy nilly. Having chosen the correct diagnosis from among a broad differential of depression “look-alikes,” clinicians can draw upon a broad swath of treatment modalities including medications, psychotherapy, social supports, and spiritual interventions. Working as a psychiatrist in the medical arena requires the curiosity and analytic skills of a detective and the breadth of knowledge of a polymath adapting therapeutic tools from across the biopsychosociospiritual spectrum to the specific needs of the patient.
Full Text Available The need of energy increases by 40% in patients with a head trauma, when compared to people who are living a normal life. This ratio reaches to 200% in some cases. It is important to give a nutrition support which can satisfy the energy need resulted from the hypermetabolic and hypercatabolic states and that is enough to help to fix the immunologic state and achieve a better result in healing the injury. When oral nutrition is not possible in the patient with a head trauma, their energy need is satisfied through enteral and parenteral nutrition. Though parenteral nutrition had held an important role in feeding patients with head trauma, enteral nutrition is applied much more widely today. Enteral and parenteral nutrition both has their own advantages and disadvantages. In the clinical and laboratory studies that had been held, it was found that enteral nutrition improved the systemic immunity, decreased the incidence of the major infectious complications, decreased the metabolic response to trauma, protected the intestinal mucosa, and protected the ecologic balance of the microflora. In this article, it is investigated through the importance of the feeding in patients with a head trauma and reasons to chose enteral nutrition
Vervoort, Vera M; Vriezekolk, Johanna E; Olde Hartman, Tim C; Cats, Hans A; van Helmond, Toon; van der Laan, Willemijn H; Geenen, Rinie; van den Ende, Cornelia H
The disease impact and economic burden of fibromyalgia (FM) are high for patients and society at large. Knowing potential determinants of economic costs may help in reducing this burden. Cognitive appraisals (perceptions) of the illness could affect costs. The present study estimated costs of illness in FM and examined the association between these costs and illness perceptions. Questionnaire data of FM severity (FIQ), illness perceptions (IPQ-R-FM), productivity losses (SF-HLQ) and health care use were collected in a cohort of patients with FM. Costs were calculated and dichotomised (median split). Univariate and hierarchic logistic regression models examined the unique association of each illness perception with 1) health care costs and 2) costs of productivity losses. Covariates were FM severity, comorbidity and other illness perceptions. 280 patients participated: 95% female, mean age 42 (SD=12) years. Annualised costs of FM per patient were €2944 for health care, and €5731 for productivity losses. In multivariate analyses, a higher disease impact (FIQ) and two of seven illness perceptions (IPQ-R-FM) were associated with high health care costs: 1) high scores on 'cyclical timeline' reflecting a fluctuating, unpredictable course and 2) low scores on 'emotional representations', thus not perceiving a connection between fibromyalgia and emotions. None of the variables was associated with productivity losses. Our study indicates that perceiving a fluctuating course and low emotional representation, which perhaps reflects somatic fixation, are associated with health care costs in FM. Future studies should examine whether targeting these illness perceptions results in reduction of costs.
Tammelin, E; Handolin, L; Söderlund, T
Injuries are often missed during the primary and secondary surveys in trauma patients. Studies have suggested that a formal tertiary survey protocol lowers the number of missed injuries. Our aim was to determine the number, severity, and consequences of injuries missed by a non-formalized trauma tertiary survey, but detected within 3 months from the date of injury in trauma patients admitted to a trauma intensive care unit. We conducted a cohort study of trauma patients admitted to a trauma intensive care unit between 1 January and 17 October 2013. We reviewed the electronic medical records of patients admitted to the trauma intensive care unit in order to register any missed injuries, their delay, and possible consequences. We classified injuries into four types: Type 0, injury detected prior to trauma tertiary survey; Type I, injury detected by trauma tertiary survey; Type II, injury missed by trauma tertiary survey but detected prior to discharge; and Type III, injury missed by trauma tertiary survey and detected after discharge. During the study period, we identified a total of 841 injuries in 115 patients. Of these injuries, 93% were Type 0 injuries, 3.9% were Type I injuries, 2.6% were Type II injuries, and 0,1% were Type III injuries. Although most of the missed injuries in trauma tertiary survey (Type II) were fractures (50%), only 2 of the 22 Type II injuries required surgical intervention. Type II injuries presumably did not cause extended length of stay in the intensive care unit or in hospital and/or morbidity. In conclusion, the missed injury rate in trauma patients admitted to trauma intensive care unit after trauma tertiary survey was very low in our system without formal trauma tertiary survey protocol. These missed injuries did not lead to prolonged hospital or trauma intensive care unit stay and did not contribute to mortality. Most of the missed injuries received non-surgical treatment. © The Finnish Surgical Society 2016.
Background: Chest trauma is an important trauma globally accounting for about 10% of trauma admission and 25‑50% of trauma death. Different types and severity of ... Data were collected and were analyzed using WINPEPI Stone Mountain, Georgia: USD Inc; 1995 statistical software. Results: A total 149 patients with ...
Laudanski, Krzysztof; Wyczechowska, Dorota
Mechanical trauma is one of the most important causes of morbidity in the developed world. The response of the immune system to mechanical insult is of paramount importance for the patient's recovery. Shortly after trauma, the indiscriminate systemic inflammatory response syndrome (SIRS) is mediated by circulating monocytes (M Øs) and other innate immunity components. Then acquired immunity, limited to the offending pathogen and the site of injury, gradually preponderates. SIRS is followed by the compensatory anti-inflammatory response syndrome (CARS), where the initial inflammatory response is quenched by anti-inflammatory mediators. This precisely regulated process of immune system activation in response to trauma can be easily deviated, resulting in multiorgan failure (MOF) and increased mortality. Excessive activation of inflammatory M Øs in the SIRS phase, premature or exorbitant CARS, a predominance of macrophages (Macs) in the blood stream and peripheral tissues, as well as a depletion of dendritic cells are often seen in trauma patients and contribute to the development of MOF. Here we explore several mechanisms of pathological MØ; activation in patients with severe mechanical traumatic injury without accompanying sepsis.
Van Ittersum, M. W.; van Wilgen, C. P.; Hilberdink, W. K. H. A.; Groothoff, J. W.; van der Schans, C. P.
Objective: Former studies in chronic diseases showed the importance of patients' beliefs and perceptions. The Revised Illness Perception Questionnaire was developed to assess these illness perceptions. Our goal was to investigate psychometric properties of the IPQ-R for Fibromyalgia Dutch language version (IPQ-R FM-Dlv) and to describe illness perceptions of participants with FM. Methods: 196 patients completed the IPQ-R FM-Dlv. Internal consistency, domain structure and inter domain correlat...
Connorton, Ellen; Perry, Melissa J.; Hemenway, David; Miller, Matthew
Objective Peacekeepers, relief workers and military members experience multiple traumas, and trauma is believed to increase risk for psychiatric distress. We examined whether combat and/or peacekeeping or relief work was associated with subsequent mental illness. Methods Using data from the US National Co-morbidity Survey Replication (NCS-R) (n = 2,383), we estimated whether combat, peacekeeping or relief work were associated with increased prevalence of mental illness through bivariate cross-tabulations and multivariate logistic regression. Results Combat was associated with increased subsequent post-traumatic stress disorder (PTSD), alcohol or drug issues more than peacekeeping or relief work. Conclusions Combat, alone or combined with peacekeeping/relief work, appears to be a risk factor for subsequent PTSD and issues with drugs and alcohol. Peacekeeping/relief work without combat does not appear to be associated with these diagnoses. PMID:22173283
Vervoort, V.M.; Vriezekolk, J.E.; Olde Hartman, T.C.; Cats, H.A.; Helmond, T. van; Laan, W.H. van der; Geenen, R.; Ende, C.H.M. van den
OBJECTIVES: The disease impact and economic burden of fibromyalgia (FM) are high for patients and society at large. Knowing potential determinants of economic costs may help in reducing this burden. Cognitive appraisals (perceptions) of the illness could affect costs. The present study estimated
Nielsen, Signe Tellerup; Krogh-Madsen, Rikke; Møller, Kirsten
glucose (BG). This is taken advantage of in the treatment of patients with T2DM, for whom GLP-1 analogs have been introduced during the recent years. Infusion of GLP-1 also lowers the BG level in critically ill patients without causing severe hypoglycemia. The T2DM and critical illness share similar...
Nov 1, 2014 ... A compulsory medico-legal post-mortem examination is carried out with respect to all deaths. The patients were admitted to the unit ... Statistical analysis was performed using Stata®, GraphPad Software® and R® for Windows®. The data were found to be normally distributed using a Shapiro-Wilk test.
Murthi, Sarah B; Stansbury, Lynn G; Dutton, Richard P; Edelman, Bennett B; Scalea, Thomas M; Hess, John R
In 2008, we reviewed the practical interface between transfusion medicine and the surgery and critical care of severely injured patients. Reviewed topics ranged from epidemiology of trauma to patterns of resuscitation to the problems of transfusion reactions. In the interim, trauma specialists have adopted damage control resuscitation and become much more knowledgeable and thoughtful about the use of blood products. This new understanding and the resulting changes in clinical practice have raised new concerns. In this update, we focus on which patients need damage control resuscitation, current views on the optimal form of damage control resuscitation with blood products, the roles of newer blood products, and appropriate transfusion triggers in the postinjury setting. We will also review the role of new technology in patient assessment, therapy and monitoring.
Full Text Available Background : Head injury, severe acidosis, hypothermia, massive transfusion and hypoxia often complicate traumatic coagulopathy. First line investigations such as prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen level, platelet count and D-dimer levels help in the initial assessment of coagulopathy in a trauma victim. Aim : To study the coagulation profile in patients of orthopedic trauma. Settings and Design : Prospective study. Patients and Methods : Patients with head injury, severe acidosis, massive transfusion and severe hypoxia were excluded from the study. Coagulation parameters were evaluated at three intervals, at the time of admission, intra operatively and in the postoperative period. Statistical Analysis : Chi-square test was used for analysis of categorical variables. For comparison between groups, two- way ANOVA was used. Results and Conclusions : Of the 48 patients studied, 38 (80% had normal DIC scores upon admission and only 10 (20% had mild DIC scores at the time of admission. The median Injury Severity Score was 34 and they did not correlate with DIC scores. Fibrinogen levels alone were significantly different, increased progressively (mean pre op, intra op and post op levels 518 ± 31,582 ± 35 and 643 ± 27 respectively; P ≤ 0.02 since the time of admission in these patients. All the other parameters remained unchanged. Further large scale prospective studies would be required to correlate elevated fibrinogen levels with the type of trauma or surgery.
Fairchild, Berry; Webb, Travis P; Xiang, Qun; Tarima, Sergey; Brasel, Karen J
Sarcopenia describes a loss of muscle mass and resultant decrease in strength, mobility, and function that can be quantified by CT. We hypothesized that sarcopenia and related frailty characteristics are related to discharge disposition after blunt traumatic injury in the elderly. We reviewed charts of 252 elderly blunt trauma patients who underwent abdominal CT prior to hospital admission. Data for thirteen frailty characteristics were abstracted. Sarcopenia was measured by obtaining skeletal muscle cross-sectional area (CSA) from each patient's psoas major muscle using Slice-O-Matic(®) software. Dispositions were grouped as dependent and independent based on discharge location. χ (2), Fisher's exact, and logistic regression were used to determine factors associated with discharge dependence. Mean age 76 years, 49 % male, median ISS 9.0 (IQR = 8.0-17.0). Discharge destination was independent in 61.5 %, dependent in 29 %, and 9.5 % of patients died. Each 1 cm(2) increase in psoas muscle CSA was associated with a 20 % decrease in dependent living (p psoas major muscle CSA is related to discharge destination in elderly trauma patients and can be obtained from the admission CT. Lower psoas muscle CSA is related to loss of independence upon discharge in the elderly. The early availability of this variable during the hospitalization of elderly trauma patients may aid in discharge planning and the transition to dependent living.
Full Text Available Prolonged stay in Intensive Care Unit (ICU can cause muscle weakness, physical deconditioning, recurrent symptoms, mood alterations and poor quality of life.Physiotherapy is probably the only treatment likely to increase in the short- and long-term care of the patients admitted to these units. Recovery of physical and respiratory functions, coming off mechanical ventilation, prevention of the effects of bed-rest and improvement in the health status are the clinical objectives of a physiotherapy program in medical and surgical areas. To manage these patients, integrated programs dealing with both whole-body physical therapy and pulmonary care are needed.There is still limited scientific evidence to support such a comprehensive approach to all critically ill patients; therefore we need randomised studies with solid clinical short- and long-term outcome measures. Resumo: Uma estadia prolongada na Unidade de Cuidados Intensivos (UCI pode causar fraqueza muscular, descondicionamento físico, sintomas recorrentes, alterações de humor e má qualidade de vida.A fisioterapia é, provavelmente, o único tratamento com potencial para aumentar nos cuidados a curto e longo prazo aos pacientes internados nestas unidades. A recuperação das funções físicas e respiratórias, retirar a ventilação mecânica, prevenção de efeitos do repouso na cama e melhoria do estado de saúde são objectivos clínicos de um programa de fisioterapia nas áreas médicas e cirúrgicas. Para tratar estes pacientes, são necessários programas integrados que englobem tanto a fisioterapia global como os cuidados respiratórios necessários.A evidência científica para apoiar esta abordagem abrangente para todos os doentes críticos é ainda limitada; portanto, são necessários estudos aleatorizados com medidas de resultados a curto e longo prazo. Keywords: Rehabilitation, Mechanical ventilation, Physiotherapy, Weaning, Palavras-chave: Reabilitação, Ventilação mec
Full Text Available Prolonged stay in Intensive Care Unit (ICU can cause muscle weakness, physical deconditioning, recurrent symptoms, mood alterations and poor quality of life. Physiotherapy is probably the only treatment likely to increase in the short- and long-term care of the patients admitted to these units. Recovery of physical and respiratory functions, coming off mechanical ventilation, prevention of the effects of bed-rest and improvement in the health status are the clinical objectives of a physiotherapy program in medical and surgical areas. To manage these patients, integrated programs dealing with both whole-body physical therapy and pulmonary care are needed. There is still limited scientific evidence to support such a comprehensive approach to all critically ill patients; therefore we need randomised studies with solid clinical short- and long-term outcome measures. Resumo: Uma estadia prolongada na Unidade de Cuidados Intensivos (UCI pode causar fraqueza muscular, descondicionamento físico, sintomas recorrentes, alterações de humor e má qualidade de vida. A fisioterapia é, provavelmente, o único tratamento com potencial para aumentar nos cuida-dos a curto e longo prazo aos pacientes internados nestas unidades. A recuperação das funções físicas e respiratórias, retirar a ventilação mecânica, prevenção de efeitos do repouso na cama e melhoria do estado de saúde são objectivos clínicos de um programa de fisioterapia nas áreas médicas e cirúrgicas. Para tratar estes pacientes, são necessários programas integrados que englobem tanto a fisioterapia global como os cuidados respiratórios necessários. A evidência científica para apoiar esta abordagem abrangente para todos os doentes críticos é ainda limitada; portanto, são necessários estudos aleatorizados com medidas de resultados a curto e longo prazo. Keywords: Rehabilitation, Mechanical ventilation, Physiotherapy, Weaning, Palavras chave: Reabilitação, Ventilação mec
Salzberger, B; Rauscher, C
The complexity and diversity of the human intestinal microbiome has only recently been characterized. The multiple metabolic and immunologic effects of the bacterial flora have demonstrated the symbiosis between the microbiome and its host. This symbiosis is disturbed in a multitude of diseases, especially in critically ill patients. A review of the changes in the intestinal microbiome of critically ill patients and the use of probiotics. Nonsystematic literature search in PubMed on the topics: (1) changes in the intestinal microbiome in critically ill patients, (2) interventions using probiotics in critically ill patients, and (3) use of fecal transplantation in Clostridium difficile colitis. Trauma, sepsis, systemic inflammatory response syndrome, and other conditions lead to shifts in the composition of the intestinal microbiome, which are correlated with clinical outcome. The most obvious change is a profound loss of obligate anaerobe bacteria, leading also to metabolic changes. Probiotics have been used in several studies and show efficacy in the reduction of infectious complication but not in overall mortality. C. difficile colitis as the model disease for a disturbed microbiome can be treated effectively by transfer of donor feces, which also restores the diversity of the microbiome. Taking into account the successful intervention of fecal transplantation on the intestinal microbiome, new products developed using the current knowledge of the intestinal microbiome could be more effective.
van Ittersum, M.W.; van Wilgen, C.P.; Hilberdink, W.K.; Groothoff, J.W.; van der Schans, C.P.
OBJECTIVE: Former studies in chronic diseases showed the importance of patients' beliefs and perceptions. The Revised Illness Perception Questionnaire was developed to assess these illness perceptions. Our goal was to investigate psychometric properties of the IPQ-R for Fibromyalgia Dutch language
Van Ittersum, M. W.; van Wilgen, C. P.; Hilberdink, W. K. H. A.; Groothoff, J. W.; van der Schans, C. P.
Objective: Former studies in chronic diseases showed the importance of patients' beliefs and perceptions. The Revised Illness Perception Questionnaire was developed to assess these illness perceptions. Our goal was to investigate psychometric properties of the IPQ-R for Fibromyalgia Dutch language
To emphasize that the management of wounds represents a significant component within the overall supportive and palliative care of patients with advanced illness. It is also intended to clarify the linguistics that are commonly used around patients with wounds. New paradigms for wound management, wound outcomes, and goal setting have been defined and graphically depicted. Recent studies show that wounds may be used as prognostic factors for patients with advanced illness. Data from recent studies also demonstrate that marginal levels of wound healing are possible for all wound classes affecting patients with advanced illness. When indicated, time-limited trials of wound healing strategies should be facilitated by the Wound Bed Preparation Paradigm. Wound palliation may be guided through the use of the Toronto Symptom Assessment System for Wounds (TSAS-W). Wound management must continue to evolve as a tenet within the overall supportive and palliative care of patients with advanced illness.
Christensen, Richard C; Hodgkins, Candace C; Garces, Lorrie K; Estlund, Kathleen L; Miller, M David; Touchton, Reginald
This paper examines an empirical investigation of the lifetime prevalence of trauma (defined as sexual and/or physical abuse) in a cohort of adults enrolled in a federally funded initiative that provides treatment for homeless persons suffering the effects of comorbid substance use and serious mental illness, and considers the impact of this information on clinical programming. Data collected from homeless individuals with co-occurring disorders admitted to the Seeking Treatment and Recovery (STAR) Program during a one year period (n=78) were analyzed for a history of trauma events. Of those individuals evaluated, 79.5% (62/78) acknowledged a history of either physical and/or sexual abuse at some time in their lifetimes. Of this population, 100% of the homeless women (27/27) with co-occurring disorders had experienced a life-altering traumatic event while 68.6% (35/51) of the homeless men also reported trauma histories. We describe the trauma-based interventions made in the STAR Program that have the potential for replication in other initiatives committed to serving homeless individuals with co-occurring disorders.
Ryan, Mark Leo; Maxwell, Angela C; Manning, Lisa; Jacobs, Jonathan D; Bachier-Rodriguez, Marielena; Feliz, Alexander; Williams, Regan F
Hemorrhage is a major cause of preventable death secondary to traumatic injury. Diagnosis often requires multiple blood draws, which are psychologically stressful in pediatric patients. The Pronto device is a pulse co-oximeter that measures the total hemoglobin level using multiple wavelengths of light. The purpose of this study was to evaluate the accuracy of the noninvasive hemoglobin measurements relative to current invasive and point of care testing methods in pediatric trauma patients. We performed a prospective observational trial involving patients younger than 17 years presenting to a Level I pediatric trauma center. Following admission, blood was sampled from each patient for testing using an i-Stat device (point-of-care hemoglobin) and a complete blood count within our core laboratory (invasive hemoglobin). Noninvasive hemoglobin analysis was performed within 15 minutes of phlebotomy. Data were evaluated using Spearman correlation and Bland-Altman analysis. Over 2 years, 114 patients had attempted noninvasive hemoglobin measurements, with a success rate of 89%. Mean ± SD age was 9.2 ± 5.1 years. Ninety percent of admissions were for blunt injury, 3% penetrating, 5% near drowning, and 1% burns. Mean invasive hemoglobin was 12.6 ± 1.9 g/dL, mean point-of-care hemoglobin was 12.2 ± 2.0 g/dL, and mean noninvasive hemoglobin was 12.3 ± 1.6 g/dL. Noninvasive hemoglobin values were strongly correlated with both invasive and point of care measurements (R = 0.672 and R = 0.645, respectively; p venipuncture, noninvasive hemoglobin monitoring may be a valuable adjunct in the initial evaluation and monitoring of pediatric trauma patients. Diagnostic test study, level II.
Müller, F S; Meyer, O W; Chocano-Bedoya, P; Schietzel, S; Gagesch, M; Freystaetter, G; Neuhaus, V; Simmen, H-P; Langhans, W; Bischoff-Ferrari, H A
Malnutrition is an established risk factor for adverse clinical outcomes. Our aim was to assess nutritional status among geriatric trauma patients. We enrolled 169 consecutive patients (⩾70 years) admitted to the Geriatric Traumatology Centre (University Hospital Zurich, Switzerland). On admission to acute care, nutritional status was assessed with the mini nutritional assessment (score23.5=normal). At the same examination, we assessed mental (Geriatric Depression Scale; GDS) and cognitive function (Mini-Mental State Examination; MMSE), frailty status (Fried Scale), and number of comorbidities and medications. Further, discharge destination was documented. All analyses were adjusted for age and gender. A total of 7.1% of patients were malnourished and 49.1% were ARM. Patients with reduced mental health (GDS⩾5: 30.5 vs 11.5%; P=0.004), impaired cognitive function (MMSE⩽26: 23.6±0.5 vs 26.0±0.6; P=0.004), prevalent frailty (32.5 vs 8%; Pnutritional status (M+ARM). Further, M+ARM patients were twice as likely to be discharged to destinations different to home (odds ratio=2.08; confidence interval 1.07-4.05). In this consecutive sample of geriatric trauma patients, 56.2% had an M+ARM upon admission to acute care, which was associated with indicators of worse physical, mental and cognitive health and predicted a more than twofold greater odds of being discharged to a destination other than home.
Full Text Available Oral Myiasis is a rare disease that is mostly reported in developing countries. It is primarily caused by the invasion of the human body by fly larvae. The phenomenon is well-documented in the skin, especially among animals. This case report describes the presentation of Oral Myiasis caused by Musca Nebulo (common house fly, in a 28-year-old patient, with recent maxillofacial trauma. The patient was treated by manual removal of the larvae, after topical application of turpentine oil, followed by surgical debridement and oral therapy with Ivermectin.
Magnone, S; Ghirardi, A; Ceresoli, M; Ansaloni, L
Centralization of trauma patients has become the standard of care. Unfortunately, overtriage can overcome the capability of Trauma Centres. This study aims to analyse the association of different mechanisms of injury with severe or major trauma defined as Injury Severity Score (ISS) greater than 15 and an estimation of overtriage upon our Trauma Centre. A retrospective review of our prospective database was undertaken from March 2014 to August 2016. Univariate and multivariable logistic regression models were used to estimate the association between covariates (gender, age, and mechanisms of injury) and the risk of major trauma. The trauma team (TT) treated 1575 patients: among the 1359 (86%) were triaged only because of dynamics or mechanism of trauma. Overtriage according to an ISS < 15, was 74.6% on all trauma team activation (TTA) and 83.2% among the TTA prompted by the mechanism of injury. Patients aged 56-70 years had an 87% higher risk of having a major trauma than younger patients (OR 1.87, 95% CI 1.29-2.71) while for patients aged more than 71 years OR was 3.45, 95% CI 2.31-5.15. Car head-on collision (OR 2.50, 95% CI 1.27-4.92), intentional falls (OR 5.61, 95% CI 2.43-12.97), motorbike crash (OR 1.67, 95% CI 1.06-2.65) and pedestrian impact (OR 2.68, 95% CI 1.51-4.74) were significantly associated with a higher risk of major trauma in a multivariate analysis. Significant association with major trauma was demonstrated in the multivariate analysis of different mechanisms of trauma in patients triaged only for dynamics. A revision of our field triage protocol with a prospective validation is needed to improve overtriage that is above the suggested limits.
Babić, Dragan; Babić, Romana; Vasilj, Ivan; Avdibegović, Esmina
The stigmatization of mentally ill patients has negative labelling, marginalization and exclusion of people simply because they have a mental illness. Stigma has negative consequences for the individual and his family, as well as for psychiatry as a profession and the entire community. Stigma weakens the mentally ill, reinforcing a sense of alienation, which has negative consequences on the course of the illness. The media can inform the public about the treatment of mentally ill patients by conveying correct information, who can then act positively towards improving the quality of treatment. Stigma and self-stigma create a feeling of low self-esteem and fear of rejection, due to which mentally ill people avoid the media and very rarely speak publicly about their illness. The realization of information rights is very delicate and it is reflected through two opposing but substantially equivalent human rights: 1. Right to information, 2. Right to privacy. Which of the two rights will get advantage depends on the circumstances of each case and journalism ethics. The relationship of psychiatry with the media and especially the media with psychiatry must be extremely correct and professional, based on facts, and not on the pursuit of media sensationalism. The media can significantly reduce the current level of stigmatization of the mentally ill by adequate and correct reports, and thereby facilitate their role in family and society. Lack of knowledge and understanding of mental illness contributes to stigmatization. Education of patients, their families and journalists is crucial if we want to better understand people with mental illness and reduce stigma.
van Ittersum, M W; van Wilgen, C P; Hilberdink, W K H A; Groothoff, J W; van der Schans, C P
Former studies in chronic diseases showed the importance of patients' beliefs and perceptions. The Revised Illness Perception Questionnaire was developed to assess these illness perceptions. Our goal was to investigate psychometric properties of the IPQ-R for Fibromyalgia Dutch language version (IPQ-R FM-Dlv) and to describe illness perceptions of participants with FM. 196 patients completed the IPQ-R FM-Dlv. Internal consistency, domain structure and inter domain correlations were calculated and compared to the IPQ-R English language version. Scores were compared with chronic fatigue syndrome (CFS), rheumatoid arthritis (RA), and coronary heart disease (CHD). Most psychometric properties were comparable to those of the original IPQ-R. Participants showed a lack of understanding of their illness, expected their FM to be chronic and to have a lot of negative consequences on functioning. In 17 out of 24 domains significant differences were found between FM and CFS, RA, and CHD patients. The IPQ-R FM-Dlv showed acceptable psychometric properties, although some aspects need closer examination. Illness perceptions of FM patients on the Dutch questionnaire were non-comparable to CFS, RA, and CHD patients on the English questionnaire. The IPQ-R FM-Dlv can be used to assess illness perceptions of Dutch FM patients.
Koleszar, Juliann C; Childs, Benjamin R; Vallier, Heather A
The goals of this study were to determine the frequency of trauma recidivism and to identify risk factors. The authors hypothesized that substance abuse and mental illness would be associated with recidivism. They performed a retrospective review of 879 patients who were treated surgically for high-energy fractures over a period of 4 years. Recidivism was defined as presentation to the trauma center for a new, unrelated injury. A recurrent recidivist was a repeat patient who returned for more than 1 additional injury. The study identified 164 (18.7%) patients who returned with a new injury. Mean age of recidivists was 37.1 years vs 40.7 years for nonrecidivists (P=.025). Of the recidivists, 80% were male, and this group was more likely to be unmarried (76.2% vs 67.2%, P=.044) and unemployed (40.4% vs 19.6%, Precidivism is common, occurring overall in 18.7% of the study sample within a mean of 2.9 years. Factors associated with recidivism included age younger than 40 years, unmarried status, substance use, unemployment, and lack of insurance coverage. The greatest independent risk factors for recidivism were Medicaid insurance or no insurance and a history of a gunshot wound or assault. [Orthopedics. 2016; 39(5):300-306.]. Copyright 2016, SLACK Incorporated.
During the management of critical illness, optimal nutritional support is an important key for achieving positive clinical outcomes. Compared to healthy people, critically ill patients have higher energy expenditure, thereby their energy requirements and risk of malnutrition being increased. Assessing individual nutritional requirement is essential for a successful nutritional support, including the adequate energy supply. Methods to assess energy requirements include indirect calorimetry (IC) which is considered as a reference method, and the predictive equations which are commonly used due to the difficulty of using IC in certain conditions. In this study, a literature review was conducted on the energy metabolic changes in critically ill patients, and the implications for the estimation of energy requirements in this population. In addition, the issue of optimal caloric goal during nutrition support is discussed, as well as the accuracy of selected resting energy expenditure predictive equations, commonly used in critically ill patients.
Pessoa, Renata Fittipaldi; Nácul, Flávio Eduardo
Delirium is a frequent finding in the critically ill patient. Although it is associated with increased morbidity and mortality, it is often not recognized by intensive care doctors. This review will address the main issues regarding delirium in critically ill patients. Definition, incidence, mortality, risk factors, diagnosis, and treatment of delirium in the critically ill. Deliriumis defined as a disturbance of consciousness, attention, cognition and perception that occurs frequently in critically ill patients. It occurs in as many as 80% of mechanically ventilated ICU patients. Risk factors for delirium include acute systemic illnesses, older age, pre-existing cognitive impairment, sleep deprivation, and medications with anticholinergic activity. Although new assessment tools are available for rapidly and accurately measuring deliriumin critically ill patients, healthcare professionals still do not regularly monitor for this condition. In recent years, the emphasis in the approach to delirium has shifted to systematic screening and prevention. Haloperidol remains the standard treatment for delirium, but there is some evidence for the efficacy of risperidone.
1509. 10. Corwin, H.L.; Krantz, S.B. Anemia of the critically ill: “Acute” anemia of chronic disease . Crit. Care Med. 2000, 28, 3098–3099. 11. Berlin... anemia and normal or elevated ferritin levels. Plasma Cp oxidase activity in burn and trauma patients were markedly lower than controls on admission...thermally injured patients and the prevalence of anemia in critically injured patients [10,12]. In addition, we observed low iron binding capacity, serum
Nijboer, Johanna M. M.; Wullschleger, Martin E.; Nielsen, Susan E.; McNamee, Anitia M.; Lefering, Rolf; ten Duis, Hendrik-Jan; Schuetz, Michael A.
Background: The allocation of a trauma network in Queensland is still in the developmental phase. In a search for indicators to improve trauma care both locally as state-wide, a study was carried out comparing trauma patients in Queensland to trauma patients in Germany, a country with 82.4 million
Faintuch, J; Machado, F K; Freire, A N; Reis, J R; Machado, M; Pinto, L P; Ramos, S M; Loebens, M; Jovchelevich, V; Pinotti, H W
Total parenteral nutrition with lipids is a well-accepted modality of metabolic support in seriously ill trauma patients. Intolerance to lipid administration is unusual when dosage limits are not exceeded, and few hematologic disturbances have been recorded with modern fat emulsions. In the course of intravenous alimentation of six adults admitted for traumatic lesions, eosinophilia with or without leukocytopenia was noticed after periods of four days to five weeks. Principal clinical events and hematologic derangements were documented in this population. Sepsis was not always present in the patients by the time of the complication, and in those that did require antibiotics and other drugs, the prescription remained unchanged along the episode. Discontinuation of the nutritional regimen with lipids was followed by normalization of the hematologic profile, suggesting that an acute or sub-acute allergic reaction was responsible. The appearance of skin rash in two occasions reinforces this hypothesis, and the possibility of hemophagocytosis merits consideration in two of the cases who displayed reversible acute leukocytopenia. It is concluded that blood cell aberrations are possible during intravenous feeding with lipids in trauma subjects, but tend to respond to suppression of the lipid-containing nutritional prescription.
Bapat, Usha; Kedlaya, Prashanth G; Gokulnath
Dialysis therapy is extremely stressful as it interferes with all spheres of daily activities of the patients. This study is aimed at understanding the perceived illness intrusion among patients on hemodialysis (HD) and to find the association between illness intrusion and patient demo-graphics as well as duration of dialysis. A cross sectional study involving 90 patients with chronic kidney disease (CKD) stage V, on HD was performed during the period from 2005 to 2006. The subjects included were above 18 years of age, willing, stable and on dialysis for at least two months. Patients with psychiatric co-morbidity were excluded. A semi-structured interview schedule covering sociodemographics and a 13 item illness intrusion checklist covering the various aspects of life was carried out. The study patients were asked to rate the illness intrusion and the extent. The data were analyzed statistically. The mean age of the subjects was 50.28 + - 13.69 years, males were predominant (85%), 73% were married, 50% belonged to Hindu religion, 25% had pre-degree education, 25% were employed and 22% were housewives. About 40% and 38% of the study patients belonged to middle and upper socio-economic strata respectively; 86% had urban background and lived in nuclear families. The mean duration on dialysis was 24 + - 29.6 months. All the subjects reported illness intrusion to a lesser or greater extent in various areas including: health (44%), work (70%) finance (55%), diet (50%) sexual life (38%) and psychological status (25%). Illness had not intruded in areas of relationship with spouse (67%), friends (76%), family (79%), social (40%) and religious functions (72%). Statistically significant association was noted between illness intrusion and occupation (P= 0.02). (author)
Full Text Available Dialysis therapy is extremely stressful as it interferes with all spheres of daily acti-vities of the patients. This study is aimed at understanding the perceived illness intrusion among pa-tients on hemodialysis (HD and to find the association between illness intrusion and patient demo-graphics as well as duration of dialysis. A cross sectional study involving 90 patients with chronic kidney disease (CKD stage V, on HD was performed during the period from 2005 to 2006. The subjects included were above 18 years of age, willing, stable and on dialysis for at least two months. Patients with psychiatric co-morbidity were excluded. A semi-structured interview schedule covering socio-demographics and a 13 item illness intrusion checklist covering the various aspects of life was ca-rried out. The study patients were asked to rate the illness intrusion and the extent. The data were ana-lyzed statistically. The mean age of the subjects was 50.28 ± 13.69 years, males were predominant (85%, 73% were married, 50% belonged to Hindu religion, 25% had pre-degree education, 25% were employed and 22% were housewives. About 40% and 38% of the study patients belonged to middle and upper socio-economic strata respectively; 86% had urban background and lived in nuclear fami-lies. The mean duration on dialysis was 24 ± 29.6 months. All the subjects reported illness intrusion to a lesser or greater extent in various areas including: health (44%, work (70% finance (55%, diet (50% sexual life (38% and psychological status (25%. Illness had not intruded in areas of rela-tionship with spouse (67%, friends (76%, family (79%, social (40% and religious functions (72%. Statistically significant association was noted between illness intrusion and occupation (P= 0.02.
Bandana Pokharel; Anupama Pokharel
Introduction: Social support is the perception that one is cared for, has assistance available from significant others and its benefit is by buffering stress by influencing the ability to adjust and live with illness. Social support can uplift the quality and subjective wellbeing of people. The objective of this study was to examine the perceived social support and factors influencing it among mentally ill patients. Methods: A descriptive cross-sectional study was carried out. Ninety cas...
Grandim Balarama Gupta Vinit
Full Text Available Myiasis is a rare disease primarily caused by the invasion of tissue by larvae of certain dipteran flies. Oral myiasis is still more "rare" and "unique" owing to the fact that oral cavity rarely provides the necessary habitat conducive for a larval lifecycle. Common predisposing factors are poor oral hygiene, halitosis, trauma, senility, learning disabilities, physically and mentally challenged conditions. Oral myiasis can lead to rapid tissue destruction and disfigurement and requires immediate treatment. Treatment consists of manual removal of maggots from the oral cavity after application of chemical agents. Good sanitation, personal and environmental hygiene and cleanliness and special care for debilitated persons are the best methods to prevent oral myiasis. This case report describes the presentation of oral myiasis caused by musca nebulo (common house fly in a 40-year-old male patient, with recent maxillofacial trauma. The patient was treated by manual removal larvae by topical application of turpentine oil, followed by surgical debridement of the wound and open reduction and internal fixation of the fracture.
HIV infection, a major health problem worldwide, has been reported to be prevalent in trauma patients, thus presents an occupational hazard to health care workers who care for these patients. The purpose of this study was to establish the prevalence of HIV among trauma patients in our setting and to compare the outcome ...
Nov 19, 2007 ... residue, bacteria, and plaque; massaging the gums with a toothbrush, dental floss, or water irrigator ... an invasion of the patient's privacy.3 Oral hygiene care practices for a critically ill patient include assessment of the oral cavity, brushing the teeth, moisturising the lips and mouth and suctioning the mouth ...
Woll, Michael M; Maerz, Linda L
The elderly population is rapidly increasing in number. Therefore, geriatric trauma is becoming more prevalent. All practitioners caring for geriatric trauma patients should be familiar with the structural and functional changes naturally occurring in the aging heart, as well as common preexisting cardiac diseases in the geriatric population. Identification of the shock state related to cardiac dysfunction and targeted assessment of perfusion and resuscitation are important when managing elderly patients. Finally, management of cardiac dysfunction in the trauma patient includes an appreciation of the inherent effects of trauma on cardiac function. Copyright © 2016 Elsevier Inc. All rights reserved.
Kaewlai, Rathachai; de Moya, Marc A.; Santos, Antonio; Asrani, Ashwin V.; Avery, Laura L.; Novelline, Robert A.
Trauma patients with thoracic aortic injury (TAI) suffer blunt cardiac injury (BCI) at variable frequencies. This investigation aimed to determine the frequency of BCI in trauma patients with TAI and compare with those without TAI. All trauma patients with TAI who had admission electrocardiography (ECG) and serum creatine kinase-MB (CK-MB) from January 1999 to May 2009 were included as a study group at a level I trauma center. BCI was diagnosed if there was a positive ECG with either an eleva...
Laupland, Kevin B
Fever, commonly defined by a temperature of >or=38.3 degrees C (101 degrees F), occurs in approximately one half of patients admitted to intensive care units. Fever may be attributed to both infectious and noninfectious causes, and its development in critically ill adult medical patients is associated with an increased risk for death. Although it is widespread and clinically accepted practice to therapeutically lower temperature in patients with hyperthermic syndromes, patients with marked hyperpyrexia, and selected populations such as those with neurologic impairment, it is controversial whether most medical patients with moderate degrees of fever should be treated with antipyretic or direct cooling therapies. Although treatment of fever may improve patient comfort and reduce metabolic demand, fever is a normal adaptive response to infection and its suppression is potentially harmful. Clinical trials specifically comparing fever management strategies in neurologically intact critically ill medical patients are needed.
Full Text Available Introduction: Many traumatic pneumothoraces (PTX are not seen on initial chest radiograph (CR(occult PTX but are detected only on computed tomography (CT. Although CR remains the first toolfor detecting PTX, most trauma patients with significant thoracoabdominal injuries will receive both CTand CR. The primary objective of this study was to retrospectively determine the effectiveness of CR fordetecting PTX in trauma patients. Our hypotheses were that CR is a sensitive indicator of PTX on CT,that chest pain and shortness of breath are good predictors of PTX on CR, and that we could determineother predictors of PTX on CR.Methods: All trauma patients presenting to our Level I trauma center with a CT-diagnosed PTX over a2-year period who had both a CR and a chest CT were included. The CT reading was considered thegold standard for PTX diagnosis. Electronic medical records were searched using key words fordiagnoses, symptoms, demographics, and radiologic results. We recorded the official radiologistreadings for both CR and CT (positive or negative and the size of the PTX on CT (large, moderate,small, or tiny. The outcome variable was dichotomized based on presence or absence of PTXdetected on CR. Descriptive statistics and v2 tests were used for univariate analysis. A regressionanalysis was performed to determine characteristics predictive of a PTX on CR, and 1 variable wasadded to the model for every 10 positive CRs. With equal-size groups, this study has the power of 80%to detect a 10% absolute difference in single predictors of PTX on CR with 45 subjects in each group.Results: There were 134 CT-documented PTXs included in the study. Mean age was 42, and 74%were men. For 66 (49% patients, PTX was detected on CR (sensitivity¼50%. The CR detected 30%of small PTX, 35% of moderate PTX, and 33% of large PTX. Comparing patients with and without PTXon CR, there were no significant differences in shortness of breath or chest pain. There no
Ernst, Amy A; McIntyre, William A; Weiss, Steven J; Berryman, Chad
Many traumatic pneumothoraces (PTX) are not seen on initial chest radiograph (CR) (occult PTX) but are detected only on computed tomography (CT). Although CR remains the first tool for detecting PTX, most trauma patients with significant thoracoabdominal injuries will receive both CT and CR. The primary objective of this study was to retrospectively determine the effectiveness of CR for detecting PTX in trauma patients. Our hypotheses were that CR is a sensitive indicator of PTX on CT, that chest pain and shortness of breath are good predictors of PTX on CR, and that we could determine other predictors of PTX on CR. All trauma patients presenting to our Level I trauma center with a CT-diagnosed PTX over a 2-year period who had both a CR and a chest CT were included. The CT reading was considered the gold standard for PTX diagnosis. Electronic medical records were searched using key words for diagnoses, symptoms, demographics, and radiologic results. We recorded the official radiologist readings for both CR and CT (positive or negative) and the size of the PTX on CT (large, moderate, small, or tiny). The outcome variable was dichotomized based on presence or absence of PTX detected on CR. Descriptive statistics and χ(2) tests were used for univariate analysis. A regression analysis was performed to determine characteristics predictive of a PTX on CR, and 1 variable was added to the model for every 10 positive CRs. With equal-size groups, this study has the power of 80% to detect a 10% absolute difference in single predictors of PTX on CR with 45 subjects in each group. There were 134 CT-documented PTXs included in the study. Mean age was 42, and 74% were men. For 66 (49%) patients, PTX was detected on CR (sensitivity = 50%). The CR detected 30% of small PTX, 35% of moderate PTX, and 33% of large PTX. Comparing patients with and without PTX on CR, there were no significant differences in shortness of breath or chest pain. There no relationships between PTX detected
Chiumello, D; Gotti, M; Vergani, G
Fever, which is arbitrary defined as an increase in body temperature above 38.3°C, can affect up to 90% of patients admitted in intensive care unit. Induction of fever is mediated by the release of pyrogenic cytokines (tumor necrosis factor α, interleukin 1, interleukin 6, and interferons). Fever is associated with increased length of stay in intensive care unit and with a worse outcome in some subgroups of patients (mainly neurocritically ill patients). Although fever can increase oxygen consumption in unstable patients, on the contrary, it can activate physiologic systems that are involved in pathogens clearance. Treatments to reduce fever include the use of antipyretics. Thus, the reduction of fever might reduce the ability to develop an efficient host response. This balance, between harms and benefits, has to be taken into account every time we decide to treat or not to treat fever in a given patient. Among the antipyretics, paracetamol is one of the most common used. Paracetamol is a synthetic, nonopioid, centrally acting analgesic, and antipyretic drug. Its antipyretic effect occurs because it inhibits cyclooxygenase-3 and the prostaglandin synthesis, within the central nervous system, resetting the hypothalamic heat-regulation center. In this clinical review, we will summarize the use of paracetamol as antipyretic in critically ill patients (sepsis, trauma, neurological, and medical). Copyright © 2016 Elsevier Inc. All rights reserved.
Full Text Available Jeff Gadsden, Alicia Warlick Department of Anesthesiology, Duke University, Durham, NC, USA Abstract: Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform. Specific populations that have shown benefits (including morbidity and mortality advantages with regional analgesic techniques include those with fractured ribs, femur and hip fractures, and patients undergoing digital replantation. Acute compartment syndrome is a potentially devastating sequela of soft-tissue injury that complicates high-energy injuries such as proximal tibia fractures. The use of regional anesthesia in patients at risk for compartment syndrome is controversial; although the data is sparse, there is no evidence that peripheral nerve blocks delay the diagnosis, and these techniques may in fact facilitate the recognition of pathologic breakthrough pain. The benefits of regional analgesia are likely most influential when it is initiated as early as possible, and the performance of nerve blocks both in the emergency room and in the field has been shown to provide quality pain relief with an excellent safety profile. Keywords: trauma, injury, nerve block, regional anesthesia, outcomes
Mhanna, Maroun J; Elsheikh, Ibrahim S; Super, Dennis M
We sought to investigate the risk factors and outcome of Ventilator Associated Tracheitis (VAT) according to the Center for Disease Control (CDC) definition in pediatric trauma patients who were ventilated for ≥48 hr. In a retrospective cohort study, medical records of all pediatric trauma patients admitted to our Pediatric Intensive Care Unit (PICU) between April 2002 and April 2007 were reviewed. Medical records were reviewed for patients' demographics, Trauma Injury Severity Score (TISS), Glasgow Coma Scale (GCS), type of trauma, and other potential risk factors prior to the development of VAT (such as hyperglycemia, rate of re-intubation and tracheotomy, presence of chest tubes and central lines, urinary tract infection, seizures, need for cardiopulmonary resuscitation, use of total parental nutrition, transfusion, use of H(2) blockers, steroids, and pressors/inotropes). Medical records were also reviewed for days of mechanical ventilation, PICU length of stay, and PICU mortality. During the study period, 217 trauma patients were admitted to the PICU, 113 patients met our inclusion criteria and 21.2% (24/113) developed VAT. On average patients with VAT (in comparison to patients without VAT), had a higher TISS score on admission [38.6 ± 16.9 vs. 24.2 ± 10.6; respectively (P VAT. We conclude that the severity of illness and use of pressors/inotropes are associated with VAT in pediatric trauma patients. We also conclude that VAT is associated with an increase in days of mechanical ventilation and PICU length of stay in pediatric trauma patients. Copyright © 2012 Wiley Periodicals, Inc.
Boyko, Yuliya; Holst, René; Jennum, Poul
Critically ill patients have abnormal circadian and sleep homeostasis. This may be associated with higher morbidity and mortality. The aims of this pilot study were (1) to describe melatonin secretion in conscious critically ill mechanically ventilated patients and (2) to describe whether melatonin...... secretion and sleep patterns differed in these patients with and without remifentanil infusion. Eight patients were included. Blood-melatonin was taken every 4th hour, and polysomnography was carried out continually during a 48-hour period. American Academy of Sleep Medicine criteria were used for sleep...... scoring if sleep patterns were identified; otherwise, Watson's classification was applied. As remifentanil was periodically administered during the study, its effect on melatonin and sleep was assessed. Melatonin secretion in these patients followed a phase-delayed diurnal curve. We did not observe any...
Fung Kon Jin, P.H.P.; Geene, A.R. van; Linnau, K.F.; Jurkovich, G.J.; Ponsen, K.J.; Goslings, J.C.
Introduction: While computed tomography (CT) scan usage in acute trauma patients is currently part of the standard complete diagnostic workup, little is known regarding the time factors involved when CT scanning is added to the standard workup. An analysis of the current time factors and intervals in a high-volume, streamlined level-1 trauma center can potentially expose points of improvement in the trauma resuscitation phase. Materials and methods: During a 5-week period, data on current time factors involved in CT scanned trauma patients were prospectively collected. All consecutive trauma patients seen in the Emergency Department following severe trauma, or inter-hospital transfer following initial stabilizing elsewhere, and that underwent CT scanning, were included. Patients younger than 16 years of age were excluded. For all eligible patients, a complete time registration was performed, including admission time, time until completion of trauma series, time until CT imaging, and completion of CT imaging. Subgroup analyses were performed to differentiate severity of injury, based on ISS, and on primary or transfer presentations, surgery, and ICU admittance. Results: Median time between the arrival of the patient and completion of the screening X-ray trauma series was 9 min. Median start time for the first CT scan was 82 min. The first CT session was completed in a median of 105 min after arrival. Complete radiological workup was finished in 114 min (median). In 62% of all patients requiring CT scanning, a full body CT scan was obtained. Patients with ISS >15 had a significant shorter time until CT imaging and time until completion of CT imaging. Conclusion: In a high-volume level-1 trauma center, the complete radiological workup of trauma patients stable enough to undergo CT scanning, is completed in a median of 114 min. Patients that are more severely injured based on ISS were transported faster to CT, resulting in faster diagnostic imaging.
Full Text Available Background: Drug abuse has been known as a growing contributing factor to all types of trauma in the world. The goal of this article is to provide insight into demographic and substance use factors associated with trauma and to determine the prevalence of drug abuse in trauma patients. Methods: Evidence of substance abuse was assessed in trauma patients presenting to Sina trauma hospital over a 3-month period. They were interviewed and provided urine samples to detect the presence of drug/metabolites of opium, morphine, cannabis and heroin by “Morphine Check” kits. Demographic data, mechanisms of injury, history of smoking and drug abuse were recorded. Results: A total of 358 patients with a mean age of 28.4 years were studied. The Patients were predominantly male (94.7%. There was a history of smoking in 136 cases (38%. 58 cases (16.2% reported to abuse drugs (91.5% opium. The commonest route of administration was smoke inhalation (37.2%. Screening by Morphine Check test revealed 95 samples to be positive (26.5%. The preponderance of test-positive cases was among young people (of 20-30 years of age with a history of smoking. Victims of violence and those with penetrating injuries also showed a higher percentage of positive screens (P=0.038 and P<0.001, respectively. Conclusion: These results suggest that drug abuse is a contributing factor to trauma especially in violent injuries and among the young. Regarding the considerable prevalence of drug abuse among trauma patients, it’s highly recommended that all trauma patients be screened for illicit drugs
Allingstrup, Mikkel; Wetterslev, Jørn; Ravn, Frederikke B
Background: Critical illness is associated with uncontrolled inflammation and vascular damage which can result in multiple organ failure and death. Antithrombin III (AT III) is an anticoagulant with anti-inflammatory properties but the efficacy and any harmful effects of AT III supplementation...... in critically ill patients are unknown. This review was published in 2008 and updated in 2015. Objectives: To examine: 1. The effect of AT III on mortality in critically ill participants. 2. The benefits and harms of AT III. We investigated complications specific and not specific to the trial intervention......, bleeding events, the effect on sepsis and disseminated intravascular coagulation (DIC) and the length of stay in the intensive care unit (ICU) and in hospital in general. Search methods: We searched the following databases from inception to 27 August 2015: Cochrane Central Register of Controlled Trials...
Nedergaard, H K; Haberlandt, T; Reichmann, P D
BACKGROUND: Our aim was to explore which outcomes are most important to patients following ICU-discharge, and to explore whether intensive care unit (ICU)-nurses and anesthesiologists are aware of patients' priorities. METHODS: First, interviews with adult ICU-survivors were conducted until data...... lack of physical strength, fatigue, and decreased walking distance as the three most important outcomes following critical illness. Physicians had a higher focus on these physical impairments than ICU-nurses....
Full Text Available Abstract Objective To measure energy expenditure of acutely ill elderly patients in hospital and following discharge in the community. Design Sixty-three consecutive hospitalised acutely ill elderly patients were recruited. Eight patients were studied to assess the reliability of the Delta Tract Machine as a measure of energy expenditure; 35 patients had their energy expenditure studied in hospital on two occasions and 20 patients had their energy expenditure measured in hospital and at 6 weeks in the community Results Men had higher basal energy expenditure (BMR values compared to women however the difference was not statistically significant [Men, mean (SD 1405 (321 Kcal, women 1238 (322 kcal; mean difference (95% CI 166 kcal (-17 to 531, p = 0.075]. After adjusting for age, gender and body mass index both medication and C-reactive protein (CRP, concentrations showed significant correlation with measured energy expenditure in hospital, (r = -0.36, "p Conclusion Tissue inflammation and medications were associated with change in measured energy expenditure in acutely ill patients.
Conclusion: The results of our study indicate that most of the geriatric victims were admitted to the medical centers with traumatic causes. Thus, it is necessary to increase our social sensitivity to trauma and the ways in can be prevented in the geriatric age group. Key words: Trauma; Geriatric; Forensic case; Injury.
Lee, Bih-O; Chien, Chi-Sheng; Hung, Chang-Chiao; Chou, Pi-Ling
The aim of this study was to evaluate the effectiveness of a nursing intervention in changing the illness perceptions of injured patients. Illness perceptions have been found to be among the important patient outcomes after an injury. Research has suggested that a designed intervention might be an effective means of shaping injured patients' illness perceptions. An experimental study design was employed. A total of 82 injured patients completed this study, with 42 in the experimental group and 40 in the control group. Data were collected from 2011-2013. A trained nurse practitioner delivered an in-hospital nursing intervention according to self-regulatory theory. The outcome measure was the change in illness perceptions of injury among the patients as measured by the Chinese Illness Perception Questionnaire Revised-Trauma (the Chinese IPQ-R-Trauma), which comprises eight subscales. The experimental and control groups were followed up via telephone survey 3 months after discharge. The generalized estimating equations were used to analyse the data. The results showed statistically significant differences on two subscales of the Chinese IPQ-R-Trauma, Identity and Controllability, before and after the intervention. Results for the remaining six subscales did not change significantly. The findings indicate that the intervention resulted in a decrease in injury-related physical symptoms and in increases in positive perceptions among patients about controlling their postinjury condition. This nursing intervention led to changes in patients' illness perceptions and potentially improved the patients' self-regulation after their injuries. Future research can be conducted to enhance the effectiveness of the intervention protocol. © 2015 John Wiley & Sons Ltd.
Brown, Carlos V R; Ali, Sadia; Fairley, Romeo; Lai, Bryan K; Arthrell, Justin; Walker, Melinda; Tips, Gaylen
Inpatient falls lead to an injury in 30 per cent of cases and serious injury in 5 per cent. Increasing staffing and implementing fall prevention programs can be expensive and require a significant use of resources. We hypothesized that trauma patients have unique risk factors to sustain a fall while hospitalized. This is a retrospective cohort study from 2005 to 2010 of all trauma patients admitted to an urban Level I trauma center. Patients who fell while hospitalized were compared with patients who did not fall to identify risk factors for sustaining an inpatient fall. There were 16,540 trauma patients admitted during the study period and 128 (0.8%) fell while hospitalized. Independent risk factors for a trauma patient to fall while hospitalized included older age (odds ratio [OR], 1.02 [1.01 to 1.03], P hospitalized sustained an injury in 17 per cent of cases and a serious injury in 5 per cent. Inpatient falls in hospitalized trauma patients are uncommon. Risk factors include older age, male gender, blunt mechanism, lower Glasgow Coma Score, and the need for intensive care unit admission or mechanical ventilation. Trauma patients with these risk factors may require higher staffing ratios and should be enrolled in a formal fall prevention program.
Kemple, Mary; O'Toole, Sinead; O'Toole, Conor
To explore sleep quality in patients with chronic illness in primary care. Many people suffer from chronic illness with the numbers increasing. One common issue arises from problems that people have with their quality of sleep: a largely under-researched topic. This study exploring poor quality sleep allowed patients to describe their daily struggles with poor sleep in their own lives. This allowed the development of a deeper understanding of what it means to sleep poorly and find out how participants cope with not sleeping well. A qualitative approach enabling a deep exploration of patient's experiences of sleep quality was used. Interviews were conducted with a purposive sample of nine participants from a primary care clinic. Analysis utilised an interpretative approach. Data analysed produced four recurrent themes that were grouped into two categories. First, themes that identified the recognition by participants that 'something was wrong' were abrupt beginning and impact on their life. Second, themes that identified that the participants considered there was 'nothing wrong' were I am fine and I just carry on. Data revealed that poor quality sleep can have a profound effect on quality of life. Participants lived without good quality sleep for years. They had come to accept two seemingly irreconcilable ideas that not being able to sleep is an enduring problem with a distinct starting point, and paradoxically, this is not a problem that deserves much professional attention. Important original data were generated on the impact of poor quality sleep indicating that chronically disturbed sleep can increase the disease burden on patients with chronic illness. The results of this study suggest healthcare professionals need to understand how sleep quality issues impact on patient's experience of chronic illness. Data from this study will help nurses and other health professionals to deepen their understanding of the profound impact of poor quality sleep on patients with
Meizoso, Jonathan P; Valle, Evan J; Allen, Casey J; Ray, Juliet J; Jouria, Jassin M; Teisch, Laura F; Shatz, David V; Namias, Nicholas; Schulman, Carl I; Proctor, Kenneth G
We test the hypothesis that prehospital interventions (PHIs) performed by skilled emergency medical service providers during ground or air transport adversely affect outcome in severely injured trauma patients. Consecutive trauma activations (March 2012 to June 2013) transported from the scene by air or ground emergency medical service providers were reviewed. PHI was defined as intubation, needle decompression, tourniquet, cricothyroidotomy, or advanced cardiac life support. In 3,733 consecutive trauma activations (71% blunt, 25% penetrating, 4% burns), age was 39 years, 74% were male, Injury Severity Score (ISS) was 5, and Glasgow Coma Score (GCS) was 15, with 32% traumatic brain injury (TBI) and 7% overall mortality. Those who received PHI (n = 130, 3.5% of the trauma activations) were more severely injured: ISS (26 vs. 5), GCS (3 vs. 15), TBI (57% vs. 31%), Revised Trauma Score (RTS, 5.45 vs. 7.84), Trauma and Injury Severity Score (TRISS, 1.32 vs. 4.89), and mortality (56% vs. 5%) were different (all p blunt injury, high ISS, and long prehospital times (all p blunt trauma, and air transport were similar, but mortality was significantly lower (43% vs. 23%, p= 0.021). In our urban trauma system, PHIs are associated with a lower incidence of mortality in severely injured trauma patients and do not delay transport to definitive care. Prognostic/epidemiologic study, level III; therapeutic study, level IV.
Andrew A. Rosenthal
Full Text Available We present two separate cases of young male patients with congenital kidney anomalies (horseshoe and crossed fused renal ectopia identified following blunt abdominal trauma. Despite being rare, ectopic and fusion anomalies of the kidneys are occasionally noted in a trauma patient during imaging or upon exploration of the abdomen. Incidental renal findings may influence the management of traumatic injuries to preserve and protect the patient’s renal function. Renal anomalies may be asymptomatic or present with hematuria, flank or abdominal pain, hypotension, or shock, even following minor blunt trauma or low velocity impact. It is important for the trauma clinician to recognize that this group of congenital anomalies may contribute to unusual symptoms such as gross hematuria after minor trauma, are readily identifiable during CT imaging, and may affect operative management. These patients should be informed of their anatomical findings and encouraged to return for long-term follow-up.
Background: Neck trauma is a great surgical challenge, because there are multi organ and systems involved. Objective: To study the clinical presentation, management and outcome of twenty patients presented to Khartoum ENT Hospital with neck trauma. Methods: This is a prospective study conducted in Khartoum ENT ...
Thomsen Annemarie B
Full Text Available Abstract Introduction Exsanguination due to uncontrolled bleeding is the leading cause of potentially preventable deaths among trauma patients. About one third of trauma patients present with coagulopathy on admission, which is associated with increased mortality and will aggravate bleeding in a traumatized patient. Thrombelastographic (TEG clot strength has previously been shown to predict outcome in critically ill patients. The aim of the present study was to investigate this relation in the trauma setting. Methods A retrospective study of trauma patients with an injury severity qualifying them for inclusion in the European Trauma Audit and Research Network (TARN and a TEG analysis performed upon arrival at the trauma centre. Results Eighty-nine patients were included. The mean Injury Severity Score (ISS was 21 with a 30-day mortality of 17%. Patients with a reduced clot strength (maximal amplitude Conclusion Low clot strength upon admission is independently associated with increased 30-day mortality in trauma patients and it could be speculated that targeted interventions based on the result of the TEG analysis may improve patient outcome. Prospective randomized trials investigating this potential are highly warranted.
Padgett, Deborah K; Hawkins, Robert Leibson; Abrams, Courtney; Davis, Andrew
In-depth interviews were conducted with 13 formerly homeless mentally ill women to capture their individual life trajectories of mental illness, substance abuse, and trauma in their own words. Cross-case analyses produced 5 themes: (a) betrayals of trust, (b) graphic or gratuitous nature of traumatic events, (c) anxiety about leaving their immediate surroundings (including attending group treatment programs), (d) desire for one's own space, and (e) gender-related status loss and stigmatization. Findings suggest formerly homeless mentally ill women need (and want) autonomy, protection from further victimization, and assistance in restoring status and devalued identity. Avenues for intervention include enhanced provider training, addressing experiences of betrayal and trauma, and more focused attention to current symptoms rather than previous diagnoses. (c) 2007 APA, all rights reserved
Dennis, Bradley M; Vella, Michael A; Gunter, Oliver L; Smith, Melissa D; Wilson, Catherine S; Patel, Mayur B; Nunez, Timothy C; Guillamondegui, Oscar D
The Rural Trauma Team Development Course (RTTDC) is designed to teach knowledge and skills for the initial assessment and stabilization of trauma patients in resource-limited environments. The effect of RTTDC training on transfers from nontrauma centers to definitive care has not been studied. We hypothesized that RTTDC training would decrease referring hospital emergency department (ED) length of stay (LOS), time to call for transfer, pretransfer computed tomography (CT) imaging rate, and mortality rate. We conducted a pre/post analysis of trauma patients who were transferred from rural, nontrauma hospitals from 2012 to 2014. Patients from six rural hospitals that participated in an RTTDC course were compared with a control group of similar centers that did not participate in the course. Primary outcome evaluated was referring hospital ED LOS, which was estimated using a difference-in-differences regression model. Secondary outcomes were time to transfer call, pretransfer CT imaging rates, and mortality. Two hundred fifty-three patients were available for study (RTTDC group, n = 130; control group, n = 123). Demographics, CT imaging, and mortality rates were similar between the two groups. In the primary outcome, the RTTDC group experienced an overall 61-minute reduction in referring hospital LOS (p = 0.02) compared with the control group. The RTTDC group also showed a 41-minute reduction (p = 0.03) in time to call for transfer compared with controls. There were no differences in the secondary outcomes of pretransfer CT scanning rates or mortality. Rural Trauma Team Development Course training shortens ED LOS at rural, nontrauma hospitals by more than 1 hour without increasing mortality. Future educational and research efforts should focus on decreasing unnecessary imaging prior to transfer as well as opportunities to improve mortality rates. This study suggests an important role for RTTDC training in the care of rural trauma patients and may allow trauma centers
Rugeles, Saúl J; Ochoa Gautier, Juan B; Dickerson, Roland N; Coss-Bu, Jorge A; Wernerman, Jan; Paddon-Jones, Douglas
Calculation of energy and protein doses for critically ill patients is still a matter of controversy. For more than 40 years of nutrition support, the total amount of nutrients to be delivered to these patients has been calculated based on expert recommendations, and this calculation is based on the administration of nonprotein calories in one attempt to ameliorate catabolic response and avoid the weight loss. New evidence suggests protein delivery is the most important intervention to improve clinical and metabolic outcomes. This article describes the metabolic rationale and the new evidence supporting a change in the approach of metabolic support of the critically ill, proposing a physiological-based intervention supported by the recognition of ancillary characteristics of the metabolic response to trauma and injury. A moderate dose of calories around 15 kcal/kg/d with a delivery of protein of 1.5 g/kg/d appears to be the new recommendation for many hypercatabolic patients in the first week following injury.
Varshney, Upkar; Vetter, Ron
Medication adherence has been studied for some time; however most research has focused on able-bodied patients or the elderly living independently. What has not been studied nearly as much is medication adherence for people with psychiatric or mental illnesses. In this paper, we present a framework that includes the specific challenges in medication adherence for patients with mental illness, algorithms and protocols for evaluating adherence, and some on-going work in developing effective solutions. The architectural framework and associated algorithms leverage the context-aware computing capabilities available on many mobile devices. The system is designed to be able to collect and offer situation-aware information on medication use and adherence for healthcare professionals and other designated persons.
Haines, Krista L; Jung, Hee Soo; Zens, Tiffany; Turner, Scott; Warner-Hillard, Charles; Agarwal, Suresh
End-of-life and palliative care are important aspects of trauma care and are not well defined. This analysis evaluates the racial and socioeconomic disparities in terms of utilization of hospice services for critically ill trauma patients. Trauma patients ≥15 years old from 2012 to 2015 were queried from the National Trauma Databank. Chi-square and multivariate logistic regression analyses for disposition to hospice were performed after controlling for age, gender, comorbidities, injury severity, insurance, race, and ethnicity. Negative binomial regression analysis with margins for length of stay (LOS) was calculated for all patients discharged to hospice. Chi-square analysis of 2 966 444 patient's transition to hospice found patients with cardiac disease, bleeding and psychiatric disorders, chemotherapy, cancer, diabetes, cirrhosis, respiratory disease, renal failure, cirrhosis, and cerebrovascular accident (CVA) affected transfer ( P care than Caucasian patients (OR: 0.65, 0.60, 0.73; P care and significantly affect LOS. Our data demonstrate prominent racial and socioeconomic disparities exist, with uninsured and minority patients being less likely to receive hospice services and having a delay in transition to hospice care when compared to their insured Caucasian counterparts.
Osterballe, Lene; Helgstrand, Frederik; Hillingsø, Jens; Henriksen, Birthe; Svendsen, Lars Bo
Development of a hepatic pseudoaneurysm (HPA) is a well-known, yet rare complication after liver trauma. We found 135 cases reported in the literature since 1965. Ruptured HPAs may have severe consequences with sudden massive haemorrhage and death. A clear strategy towards diagnosis and management of HPA post liver trauma is needed and outlined in this paper. We recommend early detection and definitive treatment before enlargement and rupture.
Rapsang, Amy Grace; Shyam, Devajit Chowlek
Trauma is a major cause of morbidity and mortality; hence severity scales are important adjuncts to trauma care in order to characterize the nature and extent of injury. Trauma scoring models can assist with triage and help in evaluation and prediction of prognosis in order to organise and improve trauma systems. Given the wide variety of scoring instruments available to assess the injured patient, it is imperative that the choice of the severity score accurately match the application. Even though trauma scores are not the key elements of trauma treatment, they are however, an essential part of improvement in triage decisions and in identifying patients with unexpected outcomes. This article provides the reader with a compendium of trauma severity scales along with their predicted death rate calculation, which can be adopted in order to improve decision making, trauma care, research and in comparative analyses in quality assessment. Copyright © 2013 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.
Objective: To determine the prognostic value and reliability of revised trauma score (RTS) in polytraumatized patients. Subjects and Methods: Thirty adult patients of road traffic accidents sustaining multisystem injuries due to high energy blunt trauma were managed according to the protocols of advanced trauma life support (ATLS) and from their first set of data RTS was calculated. Score of each patient was compared with his final outcome at the time of discharge from the hospital. Results: The revised trauma score was found to be a reliable predictor of prognosis of polytraumatized patients but a potentially weak predictor for those patients having severe injury involving a single anatomical region. The higher the RTS the better the prognosis of polytrauma patient and vice versa. Revised trauma score <8 turned out to be an indicator of severe injury with high mortality and morbidity and overall mortality in polytraumatized patients was 26.66%. However, RTS-6 was associated with 50% mortality. Conclusion: The revised trauma score is a reliable indicator of prognosis of polytraumatized patients. Therefore, it can be used for field and emergency room triage. (author)
Ford, Dee; Zapka, Jane; Gebregziabher, Mulugeta; Yang, Chengwu; Sterba, Katherine
We investigated illness perceptions among critically ill patients or their surrogates in a university medical ICU using a prospective survey. We hypothesized that these would vary by demographic, personal, and clinical measures. Patients (n = 23) or their surrogates (n = 77) were recruited. The Illness Perception Questionnaire-Revised (IPQ-R) measured six domains of illness perception: timeline-acute/chronic, consequences, emotional impact, personal control, treatment efficacy, and illness comprehension. Multiple variable linear regression models were developed with IPQ-R scores as the outcomes. African Americans tended to perceive the illness as less enduring and reported more confidence in treatment efficacy (P < .01 for each). They also tended to report the illness as less serious, having less emotional impact, and having greater personal control (P = .0002 for each). Conversely, African Americans reported lower illness comprehension (P = .002). Faith/religion was associated with positive illness perceptions, including less concern regarding consequences (P = .02), less emotional impact (P = .03), and more confidence in treatment efficacy (P < .01). Lower patient quality of life (QOL) precritical illness was associated with negative perceptions, including greater concern about illness duration and consequences as well as perception of less personal control and less confidence in treatment efficacy (P < .01 for each). These variables were independently associated with illness perceptions after controlling for race, faith/religion, and survival to hospital discharge, whereas clinical measures were not. Illness perceptions among critically ill patients and surrogates are influenced by patient/surrogate factors, including race, faith, and precritical illness QOL, rather than clinical measures. Clinicians should recognize the variability in illness perceptions and the possible implications for patient/surrogate communication.
Elitsa G. Deliverska
Full Text Available Management of the multiply injured patient requires a co-ordinated multi-disciplinary approach in order to optimise patients’ outcome. A working knowledge of the sort of problems these patients encounter is therefore vital to ensure that life-threatening injuries are recognised and treated in a timely pattern and that more minor associated injuries are not omitted. This article outlines the management of polytraumatized patients using the Advanced Trauma Life Support (ATLS principles and highlights the areas of specific involvement of the engaged medical team. Advanced Trauma Life Support is generally regarded as the gold standard and is founded on a number of well known principles, but strict adherence to protocols may have its drawbacks when facial trauma co-exists. These can arise in the presence of either major or minor facial injuries, and oral and maxillofacial surgeons need to be aware of the potential problems.
Mahmood, Kamran; Eldeirawi, Kamal; Wahidi, Momen M
The influence of gender on mortality and other outcomes of critically ill patients is not clear. Different studies have been performed in various settings and patient populations often yielding conflicting results. We wanted to assess the relationship of gender and intensive care unit (ICU) outcomes in the patients included in the Acute Physiology and Chronic Health Evaluation (APACHE) IV database (Cerner Corporation, USA). We performed a retrospective review of the data available in the APACHE IV database. A total of 261,255 consecutive patients admitted to adult ICUs in United States from 1 January 2004 to 31 December 2008 were included. Readmissions were excluded from the analysis. The primary objective of the study was to assess the relationship of gender with ICU mortality. The secondary objective was to evaluate the association of gender with active therapy, mechanical ventilation, length of stay in the ICU, readmission rate and hospital mortality. The gender-related outcomes for disease subgroups including acute coronary syndrome, coronary artery bypass graft (CABG) surgery, sepsis, trauma and chronic obstructive pulmonary disease (COPD) exacerbation were assessed as well. ICU mortality was 7.2% for men and 7.9% for women, odds ratio (OR) for death for women was 1.07 (95% confidence interval (CI): 1.04 to 1.1). There was a statistically significant interaction between gender and age. In patients women had a reduced ICU mortality compared with men, after adjustment for acute physiology score, ethnicity, co-morbid conditions, pre-ICU length of stay, pre-ICU location and hospital teaching status (adjusted OR 0.83, 95% CI: 0.76 to 0.91). But among patients ≥ 50 years of age, there was no significant difference in ICU mortality between men and women (adjusted OR 1.02, 95% CI: 0.98 to 1.06). Among the critically ill patients, women less than 50 years of age had a lower ICU mortality compared to men, while 50 years of age or older women did not have a significant
Arash Forouzan; Kambiz Masoumi; Hassan Motamed; Alireza Teimouri; Hassan Barzegari; Behzad Zohrevandi; Fatemeh Rasouli
Introduction: Traumatic brain injuries are among the most important causes of mortality and disability. Since there is a lot of controversy regarding discharge of head trauma patients, especially those with mild traumatic brain injuries, this study was designed aiming to evaluate traumatic brain injuries from an epidemiologic point of view. Methods: In this retrospective cross-sectional study, patients with isolated head trauma, and all those who underwent computed tomography (CT) were includ...
Meyer, Martin; Ostrowski, S R; Windeløv, N A
A balanced transfusion of red blood cells, fresh frozen plasma and platelets are recommended for massively bleeding trauma patients. Fibrinogen concentrates could potentially lessen or replace the need for fresh frozen plasma and/or platelet transfusions.......A balanced transfusion of red blood cells, fresh frozen plasma and platelets are recommended for massively bleeding trauma patients. Fibrinogen concentrates could potentially lessen or replace the need for fresh frozen plasma and/or platelet transfusions....
Smyth, Rachel; Parton, Felicity; Trikha, Paul
Decision making within orthopaedic centres predominantly occurs at the trauma meeting, where all decisions are made as a part of the multidisciplinary process. This is an essential handover process. Difficulties occur when teaching and detailed case discussions detract from the actual decision making process, leading to failure in documentation and implementing treatment plans. An audit was carried out in a busy district general hospital (DGH), assessing the quality of trauma meeting documentation in patient records, and assessing whether the introduction of a proforma document would improve this. Prospective clinical reviews were performed on all patients discussed in the trauma meeting over a one month period. Following the initial audit cycle a proforma was introduced, and the audit process was repeated at a two month and six month interval. The quality of the entries were assessed and compared to the Academy of Medical Royal Colleges Standards for the clinical structure and content of patient records, and The Royal College of Surgeons (RCS) of England Guidelines for Clinicians on Medical Records and Notes. Sixty three patient records during a one month period from 1 August 2014 found that only 16% had any documentation of the trauma meeting, none of which met the standard set at the beginning of the audit. Following the introduction of the proforma, 102 patient records were reviewed from October 2014, showing 70% had documentation of the trauma meeting. This improved further to 84% in February 2015. The proforma has provided an effective means of documenting and communicating management plans, and in turn also improved the trauma patient pathway to theatre or discharge.
Boucher, Nathan A; Siddiqui, Ejaz A; Koenig, Harold G
Religion is an important part of many patients' cultural perspectives and value systems that influence them during advanced illness and toward the end of life when they directly face mortality. Worldwide violence perpetrated by people identifying as Muslim has been a growing fear for people living in the US and elsewhere. This fear has further increased by the tense rhetoric heard from the recent US presidential campaign and the new presidential administration. For many, this includes fear of all Muslims, the second-largest religious group in the world with 1.6 billion adherents and approximately 3.5 million in the US alone. Patient-centered care requires health professionals to look past news headlines and unchecked social media so they can deliver high-quality care to all patients. This article explores areas of importance in the context of advanced illness for practitioners of Islam. These include the conditions needed for prayer, the roles of medical treatment and religious authority, the importance of modesty, the religious concordance of clinicians, the role of family in medical decision making, advance care planning, and pain and symptom management. Initial recommendations to optimize care for Muslim patients and their families, informed by the described tenets of Muslim faith, are provided for clinicians and health systems administrators. These include Islamic cultural awareness training for staff, assessment of patients and families to determine needs, health education and decision-making outreach, and community health partnerships with local Islamic institutions.
Kiss, Thomas; Bölke, Alisa; Spieth, Peter M
Transportation of a patient between medical facilities without interruption of the medical treatment can be a challenging task. This review aims to define the term "interhospital transport" and give a general overview of the steps for organizing a transfer. Furthermore we discuss the team qualification, equipment standards and how to manage adverse events before and during transport by means of patient triage. The advanced interhospital transport of the critically ill patient can be defined as follows: "transportation of a patient between medical facilities without interruption of the medical treatment and monitoring due to the underlying disease by means of specific medical, technical equipment and knowledge with the objective of improved patient care." Several organizational steps come along with patients transfer: the hospital of origin has to identify transfer-eligible patients and be willing to release the patient. It has to identify a destination hospital and negotiate the transfer; the patient has to be transportable, the patient/relatives must agree; the transporting unit has to have the infrastructure and acknowledge to transport the patient; the insurance company or the family has to guarantee for the additional costs. Relocation team members need a specific training that focus on typical critical events that happen during transport. Technical equipment (ventilator, stretcher, monitor, defibrillator, external pacemaker, blood-gas analyzer) facilitates smooth patient transition from one facility to a distant one. The use of checklists is associated with a reduction of incidents during the transport.
Song, Jun-Mi; Min, Jung-Ah; Huh, Hyu-Jung; Chae, Jeong-Ho
The aim of this study was to investigate the differences in spirituality among adult patients with depressive disorders, who had suffered various types of abuse or neglect in childhood. A total of 305 outpatients diagnosed with depressive disorders completed questionnaires on socio-demographic variables, childhood trauma history, and spirituality. We used the Childhood Trauma Questionnaire-Short Form (CTQ-SF) to measure five different types of childhood trauma (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-Sp-12) to assess spirituality. Depressive symptoms and total CTQ-SF scores showed a negative correlation with spirituality. In the regression model, being older and belonging to a religion significantly predicted greater spirituality. Depressive symptoms significantly predicted lower spirituality. From among the five types of childhood trauma assessed by the CTQ-SF, only emotional neglect significantly predicted lower spirituality. A history of childhood emotional neglect was significantly related to lower spirituality, especially in the case of the Meaning aspect of spirituality. This finding suggests the potential harmful influence of childhood emotional neglect on the development of spirituality in psychiatric patients. Investigating different aspects of childhood trauma might be important in order to develop a more comprehensive psychiatric intervention that aids in the development of spirituality. Copyright © 2016 Elsevier Inc. All rights reserved.
Increasing temperatures are associated with increased attendances. Soccer matches and their outcomes have no significant effect on IPV-related attendances. Conclusion: Temporal and weather factors can help predict which trauma unit shifts will be busiest. Keywords: trauma unit, assault, motor vehicle collision, weather, ...
Egea-Guerrero, J J; Freire-Aragón, M D; Serrano-Lázaro, A; Quintana-Díaz, M
Traumatic injuries represent a major health problem all over the world. In recent years we have witnessed profound changes in the paradigm of severe trauma patient resuscitation, new concepts regarding acute coagulopathy in trauma have been proposed, and there has been an expansion of specific commercial products related to hemostasis, among other aspects. New strategies in severe trauma management include the early identification of those injuries that are life threatening and require surgical hemostasis, tolerance of moderate hypotension, rational intravascular volume replacement, prevention of hypothermia, correction of acidosis, optimization of oxygen carriers, and identification of those factors required by the patient (fresh frozen plasma, platelets, tranexamic acid, fibrinogen, cryoprecipitates and prothrombin complex). However, despite such advances, further evidence is required to improve survival rates in severe trauma patients. Copyright © 2014 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.
Young, Andrew Joseph; Meyers, Kenneth Sadler; Wolfe, Luke; Duane, Therese Marie
Our goal was to determine the characteristics of trauma transfer patients with repeat imaging. A retrospective trauma registry review was performed to evaluate trauma patients who were transferred from referring institutions between January 2005 and December 2009. Patients were divided into those who had a duplicate computed tomography (CT) scan versus those who did not. There were 2678 patients included of whom 559 (21%) had at least one repeat CT scan, whereas 2119 (79%) did not have any repeat CT scans. Those with repeat CT scans were older (42.3 ± 27.3 years vs 37.3 ± 25.6 years), had a higher Injury Severity Score (ISS) (13.7 ± 8.7 vs 11.9 ± 8.8), and more likely to have blunt trauma (odds ratio, 4.7; confidence interval, 2.3 to 9.6) (P for all < 0.0007). Those with CT scans done only at the referring facility were younger, had a lower ISS, and shorter lengths of stay (P for all < 0.0003). ISS and age were independent predictors for repeat CT scans. Transfer patients had imaging repeated one-fifth of the time. The younger, less injured patient went without repeat imaging suggesting that they may have been adequately cared for at the outside institution.
Rezvanfar, M.R.; Dalvandy, M.; Emami, A.R.; Rafiee, M.; Eshratee, B.
To analyze the relation between serum glucose concentration and hospital outcome across the critically ill patients. A single-centre, retrospective study was performed at surgical and medical intensive care unit. Admission glucose, mean morning glucose, mean glucose, maximal glucose and time-averaged glucose levels were calculated for each patient. The time-averaged hyperglycemia was defined as the area under the curve above the upper limit of normal, divided by the total length of stay. Of 300 patients with a median stay of 16 days, the mortality rate was 32%. Mean fasting glucose was 121 mg/dl in survivors versus 160 mg/dl in non survivors (P=0.001). Mean admission glucose was 127 mg/dl in survivors versus 142 mg/dl in non survivors (0.03). Median time-averaged hyperglycemia was 4 mg/dl in survivors versus 17.5 mg/dl in non survivors (P < 0.006). The area under the receiver operator characteristic (ROC) curve was 0.59 for time-averaged glucose and 0.73 for mean fasting glucose. Whereas time-averaged hyperglycemia is a useful assessment for glucose control in critically ill patients, it has no priority to admission glucose and mean fasting glucose for outcome prediction. (author)
Nielsen, Klaus; Hansen, Christian Muff; Rasmussen, Lars Simon
, however, there are no such firm recommendations regarding airway management and the GCS score may be less useful. The aim of this study was to describe the authors' experience with airway management in unconscious non-trauma patients in the prehospital setting with a physician-manned Mobile Emergency Care......-trauma patients registered in the database during 2006 were included. The ambulance patient charts and medical records were scrutinised to assess outcome and the need for tracheal intubation during the first 24 h after admittance into hospital.ResultsA total of 557 unconscious non-trauma patients were examined...... and 129 patients (23%) were tracheally intubated by the MECU physician before or during transport to the hospital. Intubation was done in most patients with cardiac arrest, severe stroke or respiratory failure. Of the remaining 428 patients, 364 (85%) regained consciousness before being transported...
Jordan, Benjamin C; Brungardt, Joseph; Reyes, Jared; Helmer, Stephen D; Haan, James M
The specific contribution of dementia towards mortality in trauma patients is not well defined. The purpose of the study was to evaluate dementia as a predictor of mortality in trauma patients when compared to case-matched controls. A 5-year retrospective review was conducted of adult trauma patients with a diagnosis of dementia at an American College of Surgeons-verified level I trauma center. Patients with dementia were matched with non-dementia patients and compared on mortality, ICU length of stay, and hospital length of stay. A total of 195 patients with dementia were matched to non-dementia controls. Comorbidities and complications (11.8% vs 12.4%) were comparable between both groups. Dementia patients spent fewer days on the ventilator (1 vs 4.5, P = 0.031). The length of ICU stay (2 days), hospital length of stay (3 days), and mortality (5.1%) were the same for both groups (P > 0.05). Dementia does not appear to increase the risk of mortality in trauma patients. Further studies should examine post-discharge outcomes in dementia patients. Copyright © 2017 Elsevier Inc. All rights reserved.
Fenton, Stephen J; Sandoval, Kristin N; Stevens, Austin M; Scaife, Eric R
Angiography is a common treatment used in adults with blunt abdominal trauma and/or severe pelvic fractures. The Committee on Trauma of the American College of Surgeons has recently advocated for this resource to be urgently available at pediatric trauma centers; however, its usefulness in the pediatric setting is unclear. The purpose of this study was to determine the incidence of angiography in the treatment of blunt abdominal trauma among injured children. An analysis was performed using an established public use data set of children (younger than 18 years) treated at 20 participating trauma centers for blunt torso trauma through the Pediatric Emergency Care Applied Research Network. Patients who underwent angiography of the abdomen or pelvis were identified and analyzed. Of the 12,044 children evaluated for blunt abdominal trauma included within the data set, 973 sustained abdominopelvic injuries. Of these, only 26 (3%) underwent angiography. The median age was 14 years, 65% were males, with a mortality rate of 19%. Overall, 29 angiographic procedures were performed: 21 abdominal, 8 pelvic, with 3 patients undergoing both abdominal and pelvic. Eleven patients underwent embolization of a bleeding vessel, all of which were related to the spleen. No hepatic, renal, or pelvic vessels required embolization. The median time to angiography from emergency department evaluation was 7.3 hours. In addition to angiography, 50% also required surgical intervention, of which 31% underwent a laparotomy. Thirty-five percent of these patients required blood product transfusion, and 42% were admitted to the intensive care unit. The emergent use of angiography with embolization is uncommon in pediatric patients with blunt abdominal injuries. The requirement that pediatric trauma centers have access to interventional radiology within 30 minutes may be unnecessary. Epidemiologic study, level III; therapeutic study, level IV.
Full Text Available Severe sepsis and septic shock are leading causes of morbidity and mortality in critically ill patients in and outside Intensive Care Units. Early hemodynamic and respiratory support, along with prompt appropriate antimicrobial therapy and source control of the infectious process are cornerstone management strategies to improve survival. Antimicrobial therapy should be as much appropriate as possible, since inappropriate initial antimicrobial therapy is associated with poorer outcome in different clinical settings. When prescribing antibiotic therapy, drug’s characteristics, along with dosing, pharmacokinetics, and pharmacodynamic properties related to the drug and to the clinical scenario should be well kept in mind in order to achieve maximal success.
Department of Surgery, Cardiothoracic Surgery Unit, 1Department of Anaesthesia, University of Uyo Teaching Hospital,. Uyo, Akwa Ibom State, Nigeria ... presentation beyond 24 h post trauma and severe chest injury with bilateral chest .... was validated and used on surgical intensive care unit admission in 2000. Other ...
Hamner, Chad E; Groner, Jonathon I; Caniano, Donna A; Hayes, John R; Kenney, Brian D
The epidemiology of pediatric blunt intraabdominal arterial injury is ill defined. We analyzed a multiinstitutional trauma database to better define injury patterns and predictors of outcome. The American College of Surgeons National Trauma Database was evaluated for all patients younger than 16 years with blunt intraabdominal arterial injury from 2000 to 2004. Injury distribution, operative treatment, and variables associated with mortality were considered. One hundred twelve intraabdominal arterial injuries were identified in 103 pediatric blunt trauma patients. Single arterial injury (92.2%) occurred most frequently: renal (36.9%), mesenteric (24.3%), and iliac (23.3%). Associated injuries were present in 96.1% of patients (abdominal visceral, 75.7%; major extraabdominal skeletal/visceral, 77.7%). Arterial control was obtained operatively (n = 46, 44.7%) or by endovascular means (n = 6, 5.8%) in 52 patients. Overall mortality was 15.5%. Increased mortality was associated with multiple arterial injuries (P = .049), intraabdominal venous injury (P = .011), head injury (P = .05), Glasgow Coma Score less than 8 (P cardiac arrest (P Trauma Score [P Injury Severity Score [P = .001], and TRISS [P = .002]). Blunt intraabdominal arterial injury in children usually affects a single vessel. Associated injuries appear to be nearly universal. The high mortality rate is influenced by serious associated injuries and is reflected by overall injury severity scores.
Connorton, Ellen; Perry, Melissa J; Hemenway, David; Miller, Matthew
Peacekeepers, relief workers, and military members experience multiple traumas, and trauma is believed to increase risk for psychiatric distress. We examined whether combat and/or peacekeeping or relief work was associated with subsequent mental illness. Using data from the US National Co-morbidity Survey Replication (n = 2383), we estimated whether combat, peacekeeping, or relief work was associated with increased prevalence of mental illness through bivariate cross-tabulations and multivariate logistic regression. Combat was associated with increased subsequent posttraumatic stress disorder (PTSD) and alcohol or drug issues more than peacekeeping or relief work. Combat, alone or combined with peacekeeping/relief work, appears to be a risk factor for subsequent PTSD and issues with drugs and alcohol. Peacekeeping/relief work without combat does not appear to be associated with these diagnoses. We found an association between combat and subsequent PTSD and drug and alcohol issues. Absent combat, peacekeeping, or relief work were not associated with mental illness. Previous diagnoses and trauma exposure may increase potential for subsequent mental health problems.
Farooq, Anum; Yousaf, Aasma
To determine the relationship between childhood trauma (physical, sexual, emotional abuse and neglect) and alexithymia in patients with conversion disorder, and to identify it as a predictor of alexithymia in conversion disorder. An analytical study. Multiple public sector hospitals in Lahore, from September 2012 to July 2013. Eighty women with conversion disorder were recruited on the basis of DSM IV-TR diagnostic criteria checklist to screen conversion disorder. Childhood abuse interview to measure childhood trauma and Bermond Vorst Alexithymia Questionnaire, DSM-IV TR Dianostic Criteria Checklist, and Childhood Abuse Interview to assess alexithymia were used, respectively. The mean age of the sample was 18 ±2.2 years. Thirty-six cases had a history of childhood trauma, physical abuse was the most reported trauma (f = 19, 23.8%) in their childhood. Patients with conversion disorder has a significant association with alexithymia (p conversion disorder. Strategies should be devised to reduce this disorder among women in Pakistani society.
Jennings, Fiona L; Mitchell, Marion
Trauma patient management is complex and challenging for nurses in the Intensive Care Unit. One strategy to promote quality and evidence based care may be through utilising specialty nursing experts both internal and external to the Intensive Care Unit in the form of a nursing round. Inter Specialty Trauma Nursing Rounds have the potential to improve patient care, collaboration and nurses' knowledge. The purpose of this quality improvement project was to improve trauma patient care and evaluate the nurses perception of improvement. The project included structured, weekly rounds that were conducted at the bedside. Nursing experts and others collaborated to assess and make changes to trauma patients' care. The rounds were evaluated to assess the nurse's perception of improvement. There were 132 trauma patients assessed. A total of 452 changes to patient care occurred. On average, three changes per patient resulted. Changes included nursing management, medical management and wound care. Nursing staff reported an overall improvement of trauma patient care, trauma knowledge, and collaboration with colleagues. Inter Specialty Trauma Nursing Rounds utilizes expert nursing knowledge. They are suggested as an innovative way to address the clinical challenges of caring for trauma patients and are perceived to enhance patient care and nursing knowledge. Copyright © 2017 Elsevier Ltd. All rights reserved.
Stephen R Odom
Full Text Available Context: We noted a bimodal relationship between mortality and shock index (SI, the ratio of heart rate to systolic blood pressure. Aims: To determine if extremes of SI can predict mortality in trauma patients. Settings and Designs: Retrospective evaluation of adult trauma patients at a tertiary care center from 2000 to 2012 in the United States. Materials and Methods: We examined the SI in trauma patients and determined the adjusted mortality for patients with and without head injuries. Statistical Analysis Used: Descriptive statistics and multivariable logistic regression. Results: SI values demonstrated a U-shaped relationship with mortality. Compared with patients with a SI between 0.5 and 0.7, patients with a SI of 1.3 had an odds ratio of death of 3.1. (95% CI 1.6–5.9. Elevated SI is associated with increased mortality in patients with isolated torso injuries, and is associated with death at both low and high values in patients with head injury. Conclusion: Our data indicate a bimodal relationship between SI and mortality in head injured patients that persists after correction for various co-factors. The distribution of mortality is different between head injured patients and patients without head injuries. Elevated SI predicts death in all trauma patients, but low SI values only predict death in head injured patients.
O'Connor, Enda D
Neuromuscular weakness, a frequent complication of prolonged bed rest and critical illness, is associated with morbidity and mortality. Mobilisation physiotherapy has widespread application in patients hospitalised with non-critical illness.
Rossi Ferrario S
Full Text Available Silvia Rossi Ferrario,1 Ines Giorgi,2 Paola Baiardi,3 Laura Giuntoli,4 Gianluigi Balestroni,1 Paola Cerutti,1 Marina Manera,2 Paola Gabanelli,2 Valentina Solara,5 Roberta Fornara,6 Michela Luisetti,1 Pierangela Omarini,1 Giovanna Omarini,1 Giulio Vidotto4 1Psychology Unit, Istituti Clinici Scientifici Maugeri SpA SB, Veruno, NO, Italy; 2Psychology Unit, 3Scientific Direction, Istituti Clinici Scientifici Maugeri SpA SB, Pavia, Italy; 4Department of General Psychology, University of Padova, Padova, Italy; 5Department of Neurology, ALS Centre, “Maggiore della Carita`” University Hospital, Novara, Italy; 6Psychology Unit, SS Trinità Hospital, Borgomanero, NO, Italy Purpose: Interest in assessing denial is still present, despite the criticisms concerning its definition and measurement. We tried to develop a questionnaire (Illness Denial Questionnaire, IDQ assessing patients’ and caregivers’ denial in relation to their illness/disturbance. Patients and methods: After a preliminary study, a final version of 24 dichotomous items (true/false was selected. We hypothesized a theoretical model with three dimensions: denial of negative emotions, resistance to change, and conscious avoidance, the first two composing the actual Denial and the last representing an independent component of the illness denial behavior. The IDQ was administered to 400 subjects (219 patients and 181 caregivers together with the Anxiety–Depression Questionnaire – Reduced form (AD-R, in order to assess concurrent validity. Confirmatory factor analysis (CFA, internal consistency indices (Cronbach’s α and McDonald’s ω, and test–retest analysis were performed. Results: CFA and internal consistency indices (Cronbach’s α: 0.87–0.96 indicated a clear and meaningful three-factor structure of IDQ, for both patients and caregivers. Further analyses showed good concurrent validity, with Denial and its subscale negatively associated with anxiety and depression and
Sanei Taheri, M.; Hemadi, H.; Sajadinasab, M.; Sharifi, G.; Jalali, A. H.; Shakiba, M.
To determine the frequency of computed tomography (CT) findings in patients with mild head trauma. Patients and Methods: In this cross-sectional study conducted between September 2005 and April 2006, 708 patients with mild head trauma as defined by a Glasgow Coma Score (GCS) of 13-15, were underwent standard clinical examination and cranial CT. Results The mean±SD age of our patients was 26.8±19.03 years (range: 1 month to 89 years). 489 (68.9%) patients were male and 219 (30.8%) were female. GSC was 13 in 1%. 14 in 4.6% and 15 in 94.4% of patients. The most common mechanism of trauma was car accident and falling down, each of which happened for 132 patients (18.6%). The most common findings on CT were subgaleal hematomas in 213(30%) and intracranial lesions were seen in 41 patients(5.8%) :among them 37 were male. Among intracranial lesions, the most common finding was epidural hematoma in 18 patients followed by hemorrhagic contusion in 13 patients. lntracranial lesions were observed in 28.6% of patients with GCS of 13: in 15.25% with GCS of 14 and in 5.1% with GCS of 15 (P=.002). conclusion: Many of patients with GCS equal to 15 after head trauma have considerable intracranial and minor focal neurologic signs revealed by careful physical examination could be a good marker of these lesions
Full Text Available Background: Malnutrition is an important factor in the survival of critically ill patients. The purpose of the present study was to assess the nutritional status of patients in the intensive care unit (ICU on the days of admission and discharge via a detailed nutritional assessment. Methods: Totally, 125 patients were followed up from admission to discharge at 8ICUs in Shiraz, Iran. The patients’ nutritional status was assessed using subjective global assessment (SGA, anthropometric measurements, biochemical indices, and body composition indicators. Diet prescription and intake was also evaluated. Results: Malnutrition prevalence significantly increased on the day of discharge (58.62% compared to the day of admission (28.8% according to SGA (P<0.001. The patients’ weight, mid-upper-arm circumference, mid-arm muscle circumference, triceps skinfold thickness, and calf circumference decreased significantly as well (P<0.001. Lean mass weight and body cell mass also decreased significantly (P<0.001. Biochemical indices showed no notable changes except for magnesium, which decreased significantly (P=0.013. A negative significant correlation was observed between malnutrition on discharge day and anthropometric measurements. Positive and significant correlations were observed between the number of days without enteral feeding, days delayed from ICU admission to the commencement of enteral feeding, and the length of ICU stay and malnutrition on discharge day. Energy and protein intakes were significantly less than the prescribed diet (26.26% and 26.48%, respectively. Conclusion: Malnutrition on discharge day increased in the patients in the ICU according to SGA. Anthropometric measurements were better predictors of the nutritional outcome of our critically ill patients than were biochemical tests.
Gauss, Tobias; Campion, Sébastien; Kerever, Sébastien; Eurin, Mathilde; Raux, Mathieu; Harrois, Anatole; Paugam-Burtz, Catherine; Hamada, Sophie
Early recognition of low fibrinogen concentrations in trauma patients is crucial for timely haemostatic treatment and laboratory testing is too slow to inform decision-making. To develop a simple clinical tool to predict low fibrinogen concentrations in trauma patients on arrival. Retrospective cohort study. Three designated level 1 trauma centres in the Paris Region, from January 2011 to December 2013. Patients admitted in accordance with national triage guidelines for major trauma and plasma fibrinogen concentration testing on admission. Construction of a clinical score [Fibrinogen on Admission in Trauma (FibAT) score] in a derivation cohort to predict fibrinogen plasma concentration 1.5 g l or less after multiple regressions. One point was given for each predictive factor. The score was the sum of all. Validation was performed in a separate validation cohort. Predictive accuracy of FibAT score. In total, 2936 patients were included, 2124 in the derivation cohort and 812 in the validation cohort. In the derivation cohort, a multivariate logistic model identified the following predictive factors for plasma fibrinogen concentrations 1.5 g l or less: age less than 33 years, prehospital heart rate more than 100 beats per minute, prehospital SBP less than 100 mmHg, blood lactate concentration on admission more than 2.5 mmol l, free intraabdominal fluid on sonography, decrease in haemoglobin concentration from prehospital to admission of more than 2 g dl, capillary haemoglobin concentration on admission less than 12 g dl and temperature on admission less than 36°C. The FibAT score had an area under the receiver operating characteristic curve of 0.87 [95% confidence interval (0.86 to 0.91)] in the derivation cohort and of 0.82 (95% confidence interval (0.86 to 0.91)] in the validation cohort to predict a low plasma fibrinogen. The FibAT score accurately predicts plasma fibrinogen levels 1.5 g l or less on admission in trauma patients. This easy-to-use score
Full Text Available Trauma patients with thoracic aortic injury (TAI suffer blunt cardiac injury (BCI at variable frequencies. This investigation aimed to determine the frequency of BCI in trauma patients with TAI and compare with those without TAI. All trauma patients with TAI who had admission electrocardiography (ECG and serum creatine kinase-MB (CK-MB from January 1999 to May 2009 were included as a study group at a level I trauma center. BCI was diagnosed if there was a positive ECG with either an elevated CK-MB or abnormal echocardiography. There were 26 patients (19 men, mean age 45.1 years, mean ISS 34.4 in the study group; 20 had evidence of BCI. Of 52 patients in the control group (38 men, mean age 46.9 years, mean ISS 38.7, eighteen had evidence of BCI. There was a significantly higher rate of BCI in trauma patients with TAI versus those without TAI (77% versus 35%, P<0.001.
Werman, Howard A; Erskine, Timothy; Caterino, Jeffrey; Riebe, Jane F; Valasek, Tricia
The geriatric population is unique in the type of traumatic injuries sustained, physiological responses to those injuries, and an overall higher mortality when compared to younger adults. No published, evidence-based, geriatric-specific field destination criteria exist as part of a statewide trauma system. The Trauma Committee of the Ohio Emergency Medical Services (EMS) Board sought to develop specific criteria for geriatric trauma victims. A literature search was conducted for all relevant literature to determine potential, geriatric-specific, field-destination criteria. Data from the Ohio Trauma Registry were used to compare elderly patients, defined as age >70 years, to all patients between the ages of 16 to 69 years with regards to mortality risk in the following areas: (1) Glasgow Coma Scale (GCS) score; (2) systolic blood pressure (SBP); (3) falls associated with head, chest, abdominal or spinal injury; (4) mechanism of injury; (5) involvement of more than one body system as defined in the Barell matrix; and (6) co-morbidities and motor vehicle collision with one or more long bone fracture. For GCS score and SBP, those cut-off points with equal or greater risk of mortality as compared to current values were chosen as proposed triage criteria. For other measures, any criterion demonstrating a statistically significant increase in mortality risk was included in the proposed criteria. The following criteria were identified as geriatric-specific criteria: (1) GCS score trauma; (2) SBP trauma. In addition, these data suggested that elderly patients with specific co-morbidities be given strong consideration for evaluation in a trauma center. The state of Ohio is the first state to develop evidence-based geriatric-specific field-destination criteria using data from its state-mandated trauma registry. Further analysis of these criteria will help determine their effects on over-triage and under-triage of geriatric victims of traumatic injuries and the impact on the
Full Text Available Citrate anticoagulation has risen in interest so it is now a real alternative to heparin in the ICUs practice. Citrate provides a regional anticoagulation virtually restricted to extracorporeal circuit, where it acts by chelating ionized calcium. This issue is particularly true in patients ongoing CRRT, when the “continuous” systemic anticoagulation treatment is per se a relevant risk of bleeding. When compared with heparin most of studies with citrate reported a longer circuit survival, a lower rate of bleeding complications, and transfused packed red cell requirements. As anticoagulant for CRRT, the infusion of citrate is prolonged and it could potentially have some adverse effects. When citrate is metabolized to bicarbonate, metabolic alkalosis may occur, or for impaired metabolism citrate accumulation leads to acidosis. However, large studies with dedicated machines have indeed demonstrated that citrate anticoagulation is well tolerated, safe, and an easy to handle even in septic shock critically ill patients.
With increasing survival rates from acute medical or surgical emergencies a new form of peripheral neuropathy, CIP, has been recognized. CIP can be seen only in patients who are considered to be critically ill; therefore, it invariably occurs in the ICU. Typically, initial symptoms begin with transient (hours to a few days) septic encephalopathy followed by generalized weakness, manifested in weaning failure, limb weakness and hyporeflexia. Diagnosis is confirmed by an EMG. CIP should be considered in any elderly patient with sepsis and prolonged respiratory muscle weakness. Prognosis is poor in severe cases, in which the EMG also shows severe axonal degeneration. In milder forms, fair to good recovery is expected within weeks. Management includes treatment of sepsis, normalization of failing organ function, physical therapy and proper nutrition.
O'Brien, Betsy S; Sher, Leo
Military Sexual Trauma (MST) is defined as sexual harassment and or sexual assault experienced by a military service member. It is much more widespread and common than reported. It is associated with pre-combat traumatic experiences and pathologic sequelae including mental and medical illness. An electronic search of the major behavioral science databases was conducted to retrieve studies detailing the social, epidemiological and clinical characteristics of MST and its relationship to psychiatric and medical illness. Studies indicate that military sexual trauma is related to an increase in psychiatric pathology, including posttraumatic stress disorder (PTSD), substance abuse and dependence, depression, anxiety, eating disorders and suicidal behavior. MST is also related to an increase in medical illness, primarily pain-related symptoms involving multiple organ systems, including gastrointestinal, neurological, genitourinary and musculoskeletal. MST is associated with an increased prevalence of mental and physical illness. Although there are some gender differences in the reported rates of MST and there may be some variables, such as prior traumatic experiences, that may make an individual more vulnerable to the psychiatric and medical sequela of MST, it is clear that MST is a major healthcare issue that affects both sexes and warrants further attention and an increase in clinical resources devoted to it. Some preventive measures for decreasing the prevalence of MST may include increasing education and legal prosecution of perpetrators in the military, and increasing access to mental health services for individuals who have suffered from MST.
Pajenda, Sahra; Mechtler, Karl; Wagner, Ludwig
Critically ill patients in intensive care face hazardous conditions. Among these, acute kidney injury (AKI) is frequently seen as a result of sepsis. Early diagnosis of kidney injury is of the utmost importance in the guidance of interventions or avoidance of treatment-induced kidney injury. On these grounds, we searched for markers that could indicate proximal tubular cell injury. Urine samples of 90 patients admitted to the intensive or intermediate care unit were collected over 2 to 5 days. The biomarker neprilysin (NEP) was investigated in urine using several methods such as dot blot, ELISA and immunofluorescence of urinary casts. Fifty-five healthy donors acted as controls. NEP was highly significantly elevated in the urine of patients who suffered AKI according to the KDIGO criteria in comparison to healthy controls. It was also found to be elevated in ICU patients without overt signs of AKI according to serum creatinine changes, however they were suffering from potential nephrotoxic insults. According to our findings, urinary NEP is indicative of epithelial cell alterations at the proximal tubule. This was elaborated in ICU patients when ghost fragments and NEP + microvesicles were observed in urinary sediment cytopreparations. Furthermore, NEP + immunofluorescence of healthy kidney tissue showed staining at the proximal tubules. NEP, a potential marker for proximal tubular epithelia, can be measured in urine. This does not originate from leakage of elevated serum levels, but indicates proximal tubular cell alterations such as brush border severing, which can heal in most cases.
Full Text Available The care of critically ill patients in the intensive care unit (ICU is a primary component of modern medicine. ICUs create potential for recovery in patients who otherwise may not have survived. However, they may suffer from problems associated with of nosocomial infections. Nosocomial infections are those which manifest in patients 48 hours after admission to hospital. Nosocomial infections are directly related to diagnostic, interventional or therapeutic procedures a patient undergoes in hospital, and are also influenced by the bacteriological flora prevailing within a particular unit or hospital. Urinary tract infections are the most frequent nosocomial infection, accounting for more than 40% of all nosocomial infections. Critical care units increasingly use high technology medicine for patient care, hemodynamic monitoring, ventilator support, hemodialysis, parenteral nutrition, and a large battery of powerful drugs, particularly antibiotics to counter infection. It is indeed a paradox that the use of high-tech medicine has brought in its wake the dangerous and all too frequent complication of nosocomial infections
Stevens, Penelope; Kepros, John P; Mosher, Benjamin D
Clinical staff members all recognize the importance of attaining high patient satisfaction scores. Although there are many variables that contribute to patient satisfaction, implementation of a dog visitation program has been shown to have positive effects on patient satisfaction in total joint replacement patients. This innovative practice had not previously been studied in trauma patients. The purpose of this quasi-experimental study was to determine whether dog visitation to trauma inpatients increased patient satisfaction scores with the trauma physicians. A team consisting of a dog and handler visited 150 inpatients on the trauma service. Patient satisfaction was measured using a preexisting internal tool for patients who had received dog visitation and compared with other trauma patients who had not received a visit. This study demonstrated that patient satisfaction on four of the five measured scores was more positive for the patients who had received a dog visit.
Bakvis, Patricia; Spinhoven, Philip; Giltay, Erik J; Kuyk, Jarl; Edelbroek, Peter M; Zitman, Frans G; Roelofs, Karin
Several studies have indicated that psychogenic nonepileptic seizures (PNES) are associated with psychological trauma, but only a few studies have examined the associations with neurobiologic stress systems, such as the hypothalamus-pituitary-adrenal (HPA) axis and its end-product cortisol. We tested several relevant HPA-axis functions in patients with PNES and related them to trauma history. Cortisol awakening curve, basal diurnal cortisol, and negative cortisol feedback (using a 1 mg dexamethasone suppression test) were examined in 18 patients with PNES and 19 matched healthy controls (HCs) using saliva cortisol sampling on two consecutive days at 19 time points. Concomitant sympathetic nervous system (SNS) activity was assessed by analyzing saliva alpha-amylase (sAA). Patients with PNES showed significantly increased basal diurnal cortisol levels compared to HCs. This effect was driven mainly by patients reporting sexual trauma who showed a trend toward higher cortisol levels as compared to patients without a sexual trauma report. Importantly, the increased basal diurnal cortisol levels in patients were not explained by depression, medication, or smoking, or by current seizures or group differences in SNS activity. This is the first study showing that basal hypercortisolism in patients with PNES is independent of the acute occurrence of seizures. In addition, basal hypercortisolism was more pronounced in traumatized patients with PNES as compared to nontraumatized patients with PNES. These findings suggest that HPA-axis activity provides a significant neurobiologic marker for PNES.
Full Text Available Virginie Vitrat,1 Serge Hautefeuille,2 Cécile Janssen,1 David Bougon,2 Michel Sirodot,2 Leonardo Pagani1,3 1Antimicrobial Stewardship Program, Infectious Diseases Unit, 2Intensive Care Unit, Annecy-Genevois Hospital Center (CHANGE, Annecy, France; 3Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy Abstract: Critically ill patients with infection in the intensive care unit (ICU would certainly benefit from timely bacterial identification and effective antimicrobial treatment. Diagnostic techniques have clearly improved in the last years and allow earlier identification of bacterial strains in some cases, but these techniques are still quite expensive and not readily available in all institutions. Moreover, the ever increasing rates of resistance to antimicrobials, especially in Gram-negative pathogens, are threatening the outcome for such patients because of the lack of effective medical treatment; ICU physicians are therefore resorting to combination therapies to overcome resistance, with the direct consequence of promoting further resistance. A more appropriate use of available antimicrobials in the ICU should be pursued, and adjustments in doses and dosing through pharmacokinetics and pharmacodynamics have recently shown promising results in improving outcomes and reducing antimicrobial resistance. The aim of multidisciplinary antimicrobial stewardship programs is to improve antimicrobial prescription, and in this review we analyze the available experiences of such programs carried out in ICUs, with emphasis on results, challenges, and pitfalls. Any effective intervention aimed at improving antibiotic usage in ICUs must be brought about at the present time; otherwise, we will face the challenge of intractable infections in critically ill patients in the near future. Keywords: ICU, antimicrobial therapies, antimicrobial stewardship, pharmacokinetics, pharmacodynamics, antimicrobial resistance, early diagnosis
Ihle, C; Bahrs, C; Freude, T; Bickel, M; Spielhaupter, I; Wintermeyer, E; Stollhof, L; Grünwald, L; Ziegler, P; Pscherer, S; Stöckle, U; Nussler, A
Background: The prevalence of malnutrition in hospitalised patients is reported to be between 16 and 55 % across disciplines. Within hospital care, screening for malnutrition is required. However, in orthopaedics and trauma surgery, there is still no generally accepted recommendation for the methods for such a data survey. In the present study, the following aspects are to be investigated with the help of two established scores: (1) the prevalence of malnutrition in the patient population of geriatric trauma care, and (2) the correlation between methods of data survey. Material and Methods: Between June 2014 and June 2015, a consecutive series of hospitalised trauma patients were studied prospectively with two validated screening instruments to record nutritional status. The study was carried out at a municipal trauma surgery hospital, which is a first level interregional trauma centre as well as a university hospital. The Nutritional Risk Screening (NRS) and the Mini Nutritional Assessment (MNA Short and Long Form) were used. All patients were divided into three age groups: 80 years. The prevalence of malnutrition in geriatric trauma patients and the correlation between the screening instruments were determined. For a better comparison, prescreening and main assessment were applied to all patients. For statistical evaluation, both quantitative and semi-quantitative parameters were used. Furthermore, the Kolmogorov-Smirnov test, Spearman's correlation analysis and the chi-square test were applied. These tests were two-sided and had a level of significance of 5 %. The present study was partially funded by the Oskar-Helene-Heim Foundation. Results: 521 patients (43.8 % women, 56.2 % men), with a mean age of 53.96 ± 18.13 years, were statistically evaluated within the present study. Depending on the method of the data survey, malnutrition (NRS≥3) in geriatric trauma patients varied from 31.3 % (65-80 years) to 60 % (> 80 years). With MNA, 28
Hewitt, Nicky; Bucknall, Tracey; Faraone, Nardene M
Critically ill patients require regular body position changes to minimize the adverse effects of bed rest, inactivity and immobilization. However, uncertainty surrounds the effectiveness of lateral positioning for improving pulmonary gas exchange, aiding drainage of tracheobronchial secretions and preventing morbidity. In addition, it is unclear whether the perceived risk levied by respiratory and haemodynamic instability upon turning critically ill patients outweighs the respiratory benefits of side-to-side rotation. Thus, lack of certainty may contribute to variation in positioning practice and equivocal patient outcomes. To evaluate effects of the lateral position compared with other body positions on patient outcomes (mortality, morbidity and clinical adverse events) in critically ill adult patients. (Clinical adverse events include hypoxaemia, hypotension, low oxygen delivery and global indicators of impaired tissue oxygenation.) We examined single use of the lateral position (i.e. on the right or left side) and repeat use of the lateral position (i.e. lateral positioning) within a positioning schedule. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 5), MEDLINE (1950 to 23 May 2015), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1937 to 23 May 2015), the Allied and Complementary Medicine Database (AMED) (1984 to 23 May 2015), Latin American Caribbean Health Sciences Literature (LILACS) (1901 to 23 May 2015), Web of Science (1945 to 23 May 2015), Index to Theses in Great Britain and Ireland (1950 to 23 May 2015), Trove (2009 to 23 May 2015; previously Australasian Digital Theses Program (1997 to December 2008)) and Proquest Dissertations and Theses (2009 to 23 May 2015; previously Proquest Digital Dissertations (1980 to 23 May 2015)). We handsearched the reference lists of potentially relevant reports and two nursing journals. We included randomized and quasi-randomized trials examining effects of
Holm Burén, Lars Andreas; Daugaard, Morten; Larsen, Jens Rolighed
Introduction: A formalized trauma response team is designed to optimize the quality and progress of patient care for severely injured patients in order to reduce mortality and morbidity. The goal of this study was to determine over- and undertriage and to evaluate if a physicianmanned pre-hospita...
E. P. Rodionov
Full Text Available During the Napoleonic wars, balloon evacuation of the wounded was the first to be made in the history when Paris was being defended. In the USA, casualty helicopters are being used in 20% of cases on evacuating the victims from the accident scene and in 80% during interhospital transportation. Russia also shows an ambiguous approach to employing air medical service — from the wide use of air transportation in the country’s regions that are difficult of access to its almost complete refusal in the regions with the well-developed transportation system. Long-distance transportation of critically ill patients by chartered or commercial planes is the reality of our time. In each region, continuing specialized teams of qualified medical workers who have a good knowledge of altitude pathophysiology and handle the obligatorily certified equipment should be created on the basis of large-scale medical centers.
Alekseev, V S; Ivanov, V A; Alekseev, S V; Vaniukov, V P
The work presents an analysis of condition severity of 139 casualties with isolated and combined spleen injuries on admission to a surgical hospital. The assessment of condition severity was made using the traditional gradation and score scale VPH-SP. The degree of the severity of combined trauma of the spleen was determined by the scales ISS. The investigation showed that the scale ISS and VPH-SP allowed objective measurement of the condition severity of patients with spleen trauma. The score assessment facilitated early detection of the severe category of the patients, determined the diagnostic algorithm and the well-timed medical aid.
Blunt trauma. (n = 17). 3 (17.6%). 2. 14 (82.4%). 0. Table 2. Types of complications according to Clavien-Dindo classification. Clavien-Dindo Grading. Postoperative Complications (number). I. Wound Sepsis (3), Ileus (1). II. Pneumonia (2). III a. Nil. III b. Empyema of chest (1)*. IV a. Acute Kidney Injury (1), Respiratory Failure ...
Nov 4, 2017 ... and via a password protected mobile application program within 6 hours. The alcohol levels were reported in grams. TRAUMA. Serum alcohol levels ..... restricts advertising on alcohol consumption.22 In addition, the South African Department of Health has published the. MiniDrug MasterPlan 23 which ...
Full Text Available Remifentanil has a unique pharmacokinetic profile, with a rapid onset and offset of action and a plasmatic metabolism. Its use can be recommended even in patients with renal impairment, hepatic dysfunction or poor cardiovascular function. A potential protective cardiac preconditioning effect has been suggested. Drug-related adverse effects seem to be comparable with other opioids. In cardiac surgery, many randomized controlled trials demonstrated that the potential benefits of the use of remifentanil not only include a profound protection against intraoperative stressful stimuli, but also rapid postoperative recovery, early weaning from mechanical ventilation, and extubation. Remifentanil shows ideal properties of sedative agents being often employed for minimally invasive cardiologic techniques, such as transcatheter aortic valve implantation and radio frequency treatment of atrial flutter, or diagnostic procedures such as transesophageal echocardiography. In intensive care units remifentanil is associated with a reduction in the time to tracheal extubation after cessation of the continuous infusion; other advantages could be more evident in patients with organ dysfunction. Effective and safe analgesia can be provided in case of short and painful procedures (i.e. chest drain removal. In conclusion, thanks to its peculiar properties, remifentanil will probably play a major role in critically ill cardiac patients.
Kolva, Elissa; Rosenfeld, Barry; Pessin, Hayley; Breitbart, William; Brescia, Robert
Context Anxiety in terminal cancer is linked to diminished quality of life, yet overall it is poorly understood with regard to prevalence and relationship to other aspects of psychological distress. Objectives This study examines anxiety in terminally ill cancer patients, including the prevalence of anxiety symptoms, the relationship between anxiety and depression, differences in anxiety between participants receiving inpatient palliative care and those receiving outpatient care, and characteristics that distinguish highly anxious from less anxious patients. Methods Participants were 194 patients with terminal cancer. Approximately half (n = 103) were receiving inpatient care in a palliative care facility and half (n = 91) were receiving outpatient care in a tertiary care cancer center. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression, and was administered along with measures of hopelessness, desire for hastened death, and social support. Results Moderately elevated anxiety symptoms were found in 18.6% of participants (n = 36) and 12.4% (n = 24) had clinically significant anxiety symptoms. Level of anxiety did not differ between the two treatment settings. However, participants receiving palliative care reported significantly higher levels of depression and desire for hastened death. A multivariate prediction model indicated that belief in an afterlife, social support, and anxiolytic and antidepressant use were unique, significant predictors of anxiety. Conclusion Severity of anxiety symptoms did not differ between the study sites, suggesting that anxiety may differ from depression and desire for hastened death in the course that it takes over the duration of terminal cancer. PMID:21565460
Wang, Hsiang-I; Yiang, Giou-Teng; Hsu, Chin-Wang; Wang, Jen-Chun; Lee, Chien-Hsing; Chen, Yu-Long
Thyroid storm, an endocrine emergency, remains a diagnostic and therapeutic challenge. It is recognized to develop as a result of several factors, including infection, surgery, acute illness, and rarely, trauma. Recognition of thyroid storm in a trauma patient is difficult because the emergency physician usually focuses on managing more obvious injuries. We present a case of trauma-related thyroid storm and review the previous literature on posttraumatic thyroid storm to delineate risk factors of the disease. The case occurred in a 32-year-old man after a motorcycle accident. Careful investigation of patient history and risk factors of trauma-related thyroid storms and utilization of the scoring system may facilitate early diagnosis. Traumatically induced thyroid storm usually responds to medical treatment developed for hyperthyroidism. Surgical intervention may be needed for patients who failed medical treatment or those with direct thyroid gland injuries. The outcome is usually fair under appropriate management. We present a case of trauma-related thyroid storm to illustrate the diagnostic and therapeutic approach with a summary of the previous literature. Emergency physicians should be aware of the clinical presentation and risk factors of patients with trauma-related thyroid storm to reduce the rate of misdiagnosis and prevent catastrophic outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.
Helping Patients With Physical Illness Cope With Hospitalization: Implication For The Nurses And Medical Social Workers In Meeting The Physical And ... their illness, allaying the fear and anxiety of the patients about outcomes of medical treatments (surgical operation and death), providing support for patients' ...
Full Text Available The purpose of this study was to evaluate the incidence of trauma victims of age 60 years and older who required maxillofacial intervention. The study analyses the pattern of injuries and the various factors that predict the treatment plan of these patients. A retrospective study was carried out in 1820 trauma patients who reported to the Sri. Ramachandra Dental College and Hospital and required maxillofacial intervention, over a period of 5 years (October 2000 and September 2005. Of the total trauma victims, 185 patients were found to be aged 60 years more. In the majority of the patients, the injury was due to road traffic accidents (79.4%. Males (72.4% sustained more injuries than females (27.6%. Soft tissue injuries were seen in 49.1% of the patients, while 14% had mandibular fractures. People in their early 60s were injured more often than their older counterparts. The findings of this study highlight the present situation with regard to maxillofacial trauma in patients aged 60 years and older and its management in this part of the country.
Schäfer, Nadine; Driessen, Arne; Fröhlich, Matthias
level I trauma centres with academic interest and research in the field of coagulopathy an online survey was conducted addressing local management practice for bleeding trauma patients including algorithms for detection, management and monitoring coagulation disorders and immediate interventions. Each......BACKGROUND: Uncontrolled haemorrhage is still the leading cause of preventable death after trauma and the primary focus of any treatment strategy should be related to early detection and control of blood loss including haemostasis. METHODS: For assessing management practices across six European...
Stein, Philipp; Kaserer, Alexander; Spahn, Gabriela H; Spahn, Donat R
Trauma remains one of the major causes of death and disability all over the world. Uncontrolled blood loss and trauma-induced coagulopathy represent preventable causes of trauma-related morbidity and mortality. Treatment may consist of allogeneic blood product transfusion at a fixed ratio or in an individualized goal-directed way based on point-of-care (POC) and routine laboratory measurements. Viscoelastic POC measurement of the developing clot in whole blood and POC platelet function testing allow rapid and tailored coagulation and transfusion treatment based on goal-directed, factor concentrate-based algorithms. The first studies have been published showing that this concept reduces the need for allogeneic blood transfusion and improves outcome. This review highlights the concept of goal-directed POC coagulation management in trauma patients, introduces a selection of POC devices, and presents algorithms which allow a reduction in allogeneic blood product transfusion and an improvement of trauma patient outcome. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Crosta, Maria Luigia; De Simone, Clara; Di Pietro, Salvatore; Acanfora, Mariateresa; Caldarola, Giacomo; Moccia, Lorenzo; Callea, Antonino; Panaccione, Isabella; Peris, Ketty; Rinaldi, Lucio; Janiri, Luigi; Di Nicola, Marco
Psoriasis is a chronic inflammatory skin disease with a complex etiology, involving the immune system, genetic factors, and external/internal triggers, with psychosomatic aspects. The aim of the study was to investigate childhood trauma and resilience in a psoriatic sample compared with healthy controls. Correlations between childhood trauma, resilience, quality of life, clinical data and psoriatic features were also evaluated. Seventy-seven psoriatic patients and seventy-six homogeneous healthy controls were enrolled. We used the Psoriasis Area and Severity Index (PASI) to assess the severity of psoriasis and the Skindex-29 to measure health-related quality of life. The psychometric battery included the Childhood Trauma Questionnaire (CTQ) and the Connor-Davidson Resilience Scale (CD-Risc) to assess trauma exposure and resilience, respectively. Psoriatic patients showed a significant prevalence of childhood trauma and a lower resilience level compared to healthy controls. Associations between traumatic experiences, low resilience and reduced quality of life in psoriatic subjects were also observed. A multidisciplinary approach is helpful to investigate clinical aspects, trigger factors and psychophysiological stress response in psoriatic subjects. Improving resilience with an early psychological intervention focused on self-motivation and strengthening of self-efficacy could facilitate the management of psoriasis. Copyright © 2018 Elsevier Inc. All rights reserved.
Serin, Gediz Murat; Derinsu, Ufuk; Sari, Murat; Gergin, Ozgül; Ciprut, Ayça; Akdaş, Ferda; Batman, Cağlar
Temporal bone fracture, which involves the otic capsule, can lead to complete loss of auditory and vestibular functions, whereas the patients without fractures may experience profound sensorineural hearing loss due to cochlear concussion. Cochlear implant is indicated in profound sensorineural hearing loss due to cochlear trauma but who still have an intact auditory nerve. This is a retrospective review study. We report 5 cases of postlingually deafened patients caused by cochlear trauma, who underwent cochlear implantation. Preoperative and postoperative hearing performance will be presented. These patients are cochlear implanted after the cochlear trauma in our department between 2001 and 2006. All patients performed very well with their implants, obtained open-set speech understanding. They all became good telephone users after implantation. Their performance in speech understanding was comparable to standard postlingual adult patients implanted. Cochlear implantation is an effective aural rehabilitation in profound sensorineural hearing loss caused by temporal bone trauma. Preoperative temporal bone computed tomography, magnetic resonance imaging, and promontorium stimulation testing are necessary to make decision for the surgery and to determine the side to be implanted. Surgery could be challenging and complicated because of anatomical irregularity. Moreover, fibrosis and partial or total ossification within the cochlea must be expected. Copyright 2010. Published by Elsevier Inc.
Traver, G A; Tyler, M L; Hudson, L D; Sherrill, D L; Quan, S F
To compare turning by an oscillating bed to standard 2-hour turning. Outcomes were survival, length of stay (LOS), duration of mechanical ventilation, and incidence of pneumonia. One hundred and three intensive care patients were randomly assigned to standard turning or turning by an oscillating bed. Data, collected at baseline, daily for 7 days, and then three times weekly until study discharge, included demographics, initial Acute Physiology and Chronic Health Evaluation (APACHE II) score, ventilatory/gas exchange parameters, indicators of pneumonia, nursing measures, and chest roentgenograph. There were no significant differences for LOS, duration of ventilation, nor incidence of pneumonia. Higher survival for subjects on the oscillating bed reached borderline significance (P = .056) for subjects with APACHE II greater than or equal to 20. Longitudinal data were analyzed using the random effects model. No differences in ventilatory or gas exchange parameters were identified. Among subjects who developed pneumonia there was a significantly higher respiratory score (nursing acuity scale) for subjects on the oscillating bed. In selected critically ill patients oscillating therapy may improve survival and improve airway clearance. The frequency and degree of turning needed to prevent complications and improve outcome remains unclear. These newer beds should be used with discrimination so as to not increase hospital costs unnecessarily.
Shinall, Myrick C; Guillamondegui, Oscar D
Evidence suggests that religiousness is associated with more aggressive end-of-life (EOL) care among terminally ill patients. The effect of religion on care in more acutely life-threatening diseases is not well studied. This study examines the association of religious affiliation and request for chaplain visit with aggressive EOL care among critically injured trauma patients. We conducted a retrospective review of all trauma patients surviving at least 2 days but dying within 30 days of injury over a 3-year period at a major academic trauma center. Time until death was used as a proxy for intensity of life-prolonging therapy. Controlling for social factors, severity of injury, and medical comorbidities, religious affiliation was associated with a 43 % increase in days until death. Controlling for these same variables, chaplain request was associated with a 24 % decrease in time until death. These results suggest that religious patients receive more aggressive, and ultimately futile, EOL care and that pastoral care may reduce the amount of futile care consumed.
M. Kamran Athar
Full Text Available Anemia is common in critically ill patients. As a consequence packed red blood cell (PRBC transfusions are frequent in the critically ill. Over the past two decades a growing body of literature has emerged, linking PRBC transfusion to infections, immunosuppression, organ dysfunction, and a higher mortality rate. However, despite growing evidence that risk of PRBC transfusion outweighs its benefit, significant numbers of critically ill patients still receive PRBC transfusion during their intensive care unit (ICU stay. In this paper, we summarize the current literature concerning the impact of anemia on outcomes in critically ill patients and the potential complications of PRBC transfusions.
Moussavi, Nushin; Davoodabadi, Abdol Hossein; Atoof, Fatemeh; Razi, Seyed Ebrahim; Behnampour, Mehdi; Talari, Hamid Reza
Background: Computerized Tomography (CT) scan is gaining more importance in the initial evaluation of patients with multiple trauma, but its effect on the outcome is still unclear. Until now, no prospective randomized trial has been performed to define the role of routine chest CT in patients with blunt trauma. Objectives: In view of the considerable radiation exposure and the high costs of CT scan, the aim of this study was to assess the effects of performing the routine chest CT on the outcome as well as complications in patients with blunt trauma. Patients and Methods: After approval by the ethics board committee, 100 hemodynamically stable patients with high-energy blunt trauma were randomly divided into two groups. For group one (control group), only chest X-ray was requested and further diagnostic work-up was performed by the decision of the trauma team. For group two, a chest X-ray was ordered followed by a chest CT, even if the chest X-ray was normal. Injury severity, total hospitalization time, Intensive Care Unit (ICU) admission time, duration of mechanical ventilation and complications were recorded. Data were evaluated using t-test, Man-Whitney and chi-squared test. Results: No significant differences were found regarding the demographic data such as age, injury severity and Glasgow Coma Scale (GCS). Thirty-eight percent additional findings were seen in chest CT in 26% of the patients of the group undergoing routine chest CT, leading to 8% change in management. The mean of in-hospital stay showed no significant difference in both groups with a P value of 0.098. In addition, the mean ICU stay and ventilation time revealed no significant differences (P values = 0.102 and 0.576, respectively). Mortality rate and complications were similar in both groups. Conclusions: Performing the routine chest CT in high-energy blunt trauma patients (with a mean injury severity of 9), although leading to the diagnosis of some occult injuries, has no impact on the outcome
Full Text Available Estimate the effectiveness of brief interventions in reducing trauma recidivism in hospitalized trauma patients who screened positive for alcohol and/or illicit drug use.Dynamic cohort study based on registry data from 1818 patients included in a screening and brief intervention program for alcohol and illicit drug use for hospitalized trauma patients. Three subcohorts emerged from the data analysis: patients who screened negative, those who screened positive and were offered brief intervention, and those who screened positive and were not offered brief intervention. Follow-up lasted from 10 to 52 months. Trauma-free survival, adjusted hazard rate ratios (aHRR and adjusted incidence rate ratios (aIRR were calculated, and complier average causal effect (CACE analysis was used.We found a higher cumulative risk of trauma recidivism in the subcohort who screened positive. In this subcohort, an aHRR of 0.63 (95% CI: 0.41-0.95 was obtained for the group offered brief intervention compared to the group not offered intervention. CACE analysis yielded an estimated 52% reduction in trauma recidivism associated with the brief intervention.The brief intervention offered during hospitalization in trauma patients positive for alcohol and/or illicit drug use can halve the incidence of trauma recidivism.
interpersonal violence. Part I. Alcohol and substance abuse. Dan J Stein, Dorothy Boshoff, Hester Abrahams,. Felicity Daniels, Annalene Traut, Jan H de Bruyn,. Johan van der Spuy. Background. Patients presenting with fresh trauma frequentty have evidence of substance abuse. Nevertheless, few South African studies ...
South African Family Practice. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 54, No 3 (2012) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Anaesthesia for trauma patients. M Ortega-Gonzalez. Abstract. No Abstract.
Injured. In the meantime, in SA, better care of the injured must be a higher priority for a health system traditionally vertically orientated to HIV/. AIDS and TB. Effective ... the common trauma patient. L Wallis, MB ChB, MD, DIMCRCSEd, Dip Sport Med, FRCS (Edin), FRCP (Edin), FRCEM, FCEM (SA), FEMSSA, FIFEM. Division ...
Background: The aim of this study was to describe our cohort of pediatric trauma patients and to analyze their physiological data. The intention was to highlight the difficulty in using systolic blood pressure (SBP) readings in this population and to investigate the role of base excess (BE) in predicting clinical outcomes in ...
Full Text Available Background: Assault is a common mechanism of injury among female trauma victims. This paper identifies risk factors for assault in female victims and explores the interplay between identified predictors of assault and their combined contribution to female violent victimization. Materials and Methods: A retrospective analysis of all female trauma patients was performed using the Illinois Department of Public Health Trauma Registry from 1999-2003. Patients with assault listed as their mechanism of injury were compared to patients with other mechanisms of injury. Bivariate and multivariate analyses were performed using STATA statistical software to identify independent risk factors for assault. Finally, interaction affects were studied among these identified risk factors. Results: Female victims of assault were more likely to be African American (OR 1.32, P < 0.001, lack insurance (OR 1.79, P < 0.001, and to have tested positive for drugs (OR 1.32, P < 0.001 than women with other mechanisms of injury. In addition to the independent effects of these variables, patient drug use and lack of insurance demonstrated interaction effects (OR 1.67, P = 0.02. Conclusion: In this study, women of color, the uninsured, and those using drugs were disproportionately represented among assault victims, highlighting further evidence of trauma disparities. Most significantly, this study demonstrates that predictors of assault in women frequently coexist and both independently and in combination may increase the risk for female violent victimization.
Bruce, Matt; Laporte, Dionne
Prevalence of childhood trauma is elevated among individuals with severe mental illness (SMI) compared to the general population and associated with poor prognosis, substance misuse, lower treatment compliance and violence. Antisocial personality disorder (ASPD) typologies (childhood vs adult onset) also represent possible mediating mechanisms to explain risk of violence among men with SMI. The current study aimed to explore an explanatory pathway linking childhood traumatic exposure, antisocial personality typologies and risk of violent behaviour among adult male inpatients with SMI. A total of 162 male inpatients with SMI were examined using a cross-sectional survey design. Information was extracted from medical files, interviews and official criminal records. Fifty-two participants (32.1%) reported experiencing a childhood trauma before 15. This group was 2.8 times more likely to engage in violent acts within the past 6months than those without such a history. Furthermore, those with childhood onset ASPD (early starters) were more likely to report childhood trauma and engage in violence compared to adult onset ASPD (late starters) and those without antisocial histories. Multivariate analyses revealed that early starter ASPD was the only variable that independently predicted violence and mediated the relationship between childhood trauma and recent violent acts. A significant subset of men reporting trauma and antisocial conduct from childhood (early starter ASPD) is at considerably elevated risk of engaging in violent behaviours. Assessment of antisocial typologies in men with SMI may assist effective and defensible case prioritisation, resource allocation and treatment planning. Copyright © 2014 Elsevier B.V. All rights reserved.
Starnino, Vincent R
Studies have identified spirituality to be a helpful resource for dealing with various types of trauma experiences. This coincides with a heightened focus on the role of spirituality within trauma-related theory (e.g., spiritual coping, meaning-making, and posttraumatic growth). Little remains known, however, about the relationship between trauma and spirituality among people with severe psychiatric disorders. Meanwhile, a high percentage of those with psychiatric disabilities are known to have trauma histories, whereas a majority self-identify as spiritual and/or religious. Two cases from a hermeneutic phenomenological qualitative study of people with co-occurring psychiatric disabilities and trauma histories are highlighted. Themes related to trauma and spirituality are discussed in-depth. Study participants drew upon a variety of spiritual coping strategies (e.g., prayer, meditation, spiritual readings) to help deal with trauma experiences. Participants additionally experienced spiritual struggles-a detailed account is given of a participant who was able to work through such struggles by shifting to a less self-blaming spiritual worldview (e.g., shifted from believing in a "punishing God" to viewing oneself as part of "oneness with humanity"). The study also examined the meaning-making process and shows how concepts such as global and appraised meaning-making are applicable to people with psychiatric disabilities. Finally, unique challenges related to posttraumatic growth are discussed (e.g., intrusive ruminations and "voices" with spiritual themes). This study offers useful examples of how spirituality and trauma can impact one another, and how people with psychiatric disabilities draw upon spirituality to cope as they strive for recovery. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Seibel, Katharina; Valeo, Sara Celestina; Xander, Carola; Adami, Sandra; Duerk, Thorsten; Becker, Gerhild
Consumerism in health care defines patients as self-determined, rational customers. Yet, it is questionable whether vulnerable patients, such as the terminally ill, also fulfill these criteria. Vulnerable contexts and the patient's perspective on being a customer remain relatively unexplored. The present study addresses this research gap by analyzing terminally ill patients' views on being customers. To explore the ways in which patients in palliative care refer to themselves as patients/customers, and how the patients' concepts of self-determination are related to their attitudes toward the patient/customer role. Qualitative interviews were conducted. Data were analyzed in three steps: narrative analysis, thematic content analysis, and typology construction. Researchers recruited 25 patients via the Department of Palliative Care, University Medical Center Freiburg, Germany. In many ways, palliative patients contradict the image of a self-determined customer. The palliative patient role is characterized by the concept of relational self-determination rather than an unrestricted self-determination. Self-attribution as a customer still occurs when positively associated with a person-centered, individualized treatment. Thus, the customer and patient role overlap within the palliative care setting because of the focus on the individual. The idealized customer role cannot be arbitrarily applied to all medical fields. Palliative patients are dependent on the physician, regardless of whether the customer or patient role is preferred. Hence, self-determination must be understood in relational terms, and physicians must recognize their crucial role in promoting patients' self-determination in the context of shared decision-making.
Wooley, Jennifer A; Btaiche, Imad F; Good, Kelley L
Acute renal failure (ARF) is rarely an isolated process but is often a complication of underlying conditions such as sepsis, trauma, and multiple-organ failure in critically ill patients. As such, concomitant clinical conditions significantly affect patient outcome. Poor nutritional status is a major factor in increasing patients' morbidity and mortality. Malnutrition in ARF patients is caused by hypercatabolism and hypermetabolism that parallel the severity of illness. When dialytic intervention is indicated, continuous renal replacement therapy (CRRT) is a commonly used alternative to intermittent hemodialysis because it is well tolerated by hemodynamically unstable patients. This paper reviews the metabolic and nutritional alterations associated with ARF and provides recommendations regarding the nutritional, fluid, electrolyte, micronutrient, and acid-base management of these patients. The basic principles of CRRT are addressed, along with their nutritional implications in critically ill patients. A patient case is presented to illustrate the clinical application of topics covered within the paper.
Loggers, S A I; Koedam, T W A; Giannakopoulos, G F; Vandewalle, E; Erwteman, M; Zuidema, W P
Trauma is a great contributor to mortality worldwide. One of the challenges in trauma care is early identification and management of bleeding. The circulatory status of blunt trauma patients in the emergency room is evaluated using hemodynamic (HD) parameters. However, there is no consensus on which parameters to use. In this study, we evaluate the used terms and definitions in the literature for HD stability and compare those to the opinion of Dutch trauma team members. A systematic review was performed to collect the definitions used for HD stability. Studies describing the assessment and/or treatment of blunt trauma patients in the emergency room were included. In addition, an online survey was conducted amongst Dutch trauma team members. Out of a total of 222, 67 articles were found to be eligible for inclusion. HD stability was defined in 70% of these articles. The most used parameters were systolic blood pressure and heart rate. Besides the variety of parameters, a broad range of corresponding cut-off points is noted. Despite some common ground, high inter- and intra-variability is seen for the physicians that are part of the Dutch trauma teams. All authors acknowledge HD stability as the most important factor in the assessment and management of blunt trauma patients. There is, however, no consensus in the literature as well as none-to-fair consensus amongst Dutch trauma team members in the definition of HD stability. A trauma team ready to co-operate with consensus-based opinions together with a valid scoring system is in our opinion the best method to assess and treat seriously injured trauma patients.
strengthen TB information, education and counselling. Key words: Tuberculosis, patients, illness perception, quality of life, Gezira, Sudan ... Tuberculosis (TB) persists as a global public health problem of a serious magnitude requiring urgent ..... Petrie KJ, Jago LA, Devcich DA. The role of illness perceptions in patients with ...
Eduardo Ariel Ramos Gómez
Full Text Available La rehabilitación en oftalmología tiene como función fundamental lograr el máximo aprovechamiento posible del resto visual. El traumatismo ocular es considerado una de las entidades nosológicas frecuentes que conllevan a una rehabilitación visual. Las causas que provocan este tipo de trauma son variadas y dentro de estas, las agresiones con intención de provocar daños con secuelas son muy frecuentes. Es objetivo de esta revisión puntualizar la importancia de la rehabilitación en pacientes con traumatismo ocular e incentivar el buen accionar de todos los oftalmólogos en cuanto a su atención.The main goal of rehabilitation in ophthalmology is to use as much as possible the residual vision. Ocular trauma is considered one of the common diseases that imply visual rehabilitation. The causes of eye injuries are varied; among them assaults with intent to cause damage are the most common. The objective of this article was to point out the importance of rehabilitation in patients with ocular trauma and to encourage all the ophthalmologists to act accordingly.
Medam, Sophie; Zieleskiewicz, Laurent; Duclos, Gary; Baumstarck, Karine; Loundou, Anderson; Alingrin, Julie; Hammad, Emmanuelle; Vigne, Coralie; Antonini, François; Leone, Marc
The aim of this study was to compare septic shock directly associated-mortality between severe trauma patients and nontrauma patients to assess the role of comorbidities and age. We conducted a retrospective study in an intensive care unit (ICU) (15 beds) of a university hospital (928 beds). From January 2009 to May 2015, we reviewed 2 anonymized databases including severe trauma patients and nontrauma patients. We selected the patients with a septic shock episode. Among 385 patients (318 nontrauma patients and 67 severe trauma patients), the ICU death rate was 43%. Septic shock was directly responsible for death among 35% of our cohort, representing 123 (39%) nontrauma patients and 10 (15%) trauma patients (P septic shock associated-mortality, whereas severe trauma was a protective factor (OR: 0.26; 95% CI [0.08-0.78], P = 0.01). From these independent risk factors, we determined the probability of septic shock associated-mortality. The receiver-operating characteristics curve has an area under the curve at 0.76 with sensitivity of 55% and specificity of 86%. Trauma appears as a protective factor, whereas the severity of organ failure has a major role in the mortality of septic shock. However, because of the study's design, unmeasured confounding factors should be taken into account in our findings. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.
Kellman, Robert M; Losquadro, William D
Airway management in patients with maxillofacial trauma is complicated by injuries to routes of intubation, and the surgeon is frequently asked to secure the airway. Airway obstruction from hemorrhage, tissue prolapse, or edema may require emergent intervention for which multiple intubation techniques exist. Competing needs for both airway and surgical access create intraoperative conflicts during repair of maxillofacial fractures. Postoperatively, edema and maxillomandibular fixation place the patient at risk for further airway compromise.
Measuring trauma and stressful events in childhood and adolescence among patients with first-episode psychosis: initial factor structure, reliability, and validity of the Trauma Experiences Checklist.
Cristofaro, Sarah L; Cleary, Sean D; Ramsay Wan, Claire; Broussard, Beth; Chapman, Colby; Haggard, Patrick J; Jananeh, Sara; Myers, Neely L; Compton, Michael T
Past trauma and stressful events, especially in childhood and adolescence, are common among individuals with serious mental illnesses like schizophrenia. Traumatic experiences are thought to be a socio-environmental risk factor not only for poorer outcomes, but also potentially for the onset of these disorders. Because improved measurement tools are needed, we developed and studied, among 205 first-episode psychosis patients, the factor structure, internal consistency reliability, and initial validity of the Trauma Experiences Checklist (TEC), our measure of trauma and stressful events during childhood/adolescence. We assessed validity of subscales using correlations with Childhood Trauma Questionnaire-Short Form, Parental Harsh Discipline, Violence Exposure, and TEC-Informant Version scores. Exploratory factor analysis resulted in two internally consistent subscales (Cronbach's α=0.79 and 0.80, respectively), interpersonal abuse and family stress, and violence, death, and legal involvement. Scores from the former subscale were substantially associated with CTQ-SF physical, emotional, and sexual abuse (r=0.42-0.57, all pchildhood and adolescence. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Prognostic Value And Daily Trend Of Interleukin-6, Neutrophil CD64 Expression, C-Reactive Protein And Lipopolysaccharide-Binding Protein In Critically Ill Patients: Reliable Predictors Of Outcome Or Not?
Full Text Available Background: Severe sepsis and/or trauma complicated by multiple organ dysfunction syndrome are the leading causes of death in critically ill patients. The aim of this prospective single-centre study was to assess the prognostic value and daily trend of interleukin-6 (IL-6, neutrophil CD64 expression, C-reactive protein (CRP and lipopolysaccharide-binding protein (LBP regarding outcome in critically ill patients with severe trauma and/or severe sepsis. Outcome measure was hospital mortality.
Wafaisade, Arasch; Lefering, Rolf; Bouillon, Bertil; Böhmer, Andreas B; Gäßler, Michael; Ruppert, Matthias
Evidence on prehospital administration of the antifibrinolytic tranexamic acid (TXA) in civilian trauma populations is scarce. The aim was to study whether prehospital TXA use in trauma patients was associated with improved outcomes. The prehospital database of the ADAC (General German Automobile Club) Air Rescue Service was linked with the TraumaRegister of the German Trauma Society to reidentify patients documented in both registries. Primarily admitted trauma patients (2012 until 2014) who were treated with TXA during the prehospital phase were matched with patients who had not received prehospital TXA, applying propensity score-based matching. The matching yielded two identical cohorts (n = 258 in each group), since there were no significant differences in demographics or injury characteristics (mean Injury Severity Score 24 ± 14 [TXA] vs. 24 ± 16 [control]; p = 0.46). The majority had sustained blunt injury (90.3 % vs. 93.0 %; p = 0.34). There were no differences with respect to prehospital therapy, including rates of intubation, chest tube insertion or both administration of i.v. fluids and catecholamines. During ER treatment, the TXA cohort received fewer numbers of red blood cells and plasma units, but without reaching statistical significance. Incidences of organ failure, sepsis or thromboembolism showed no significant differences as well, although data were incomplete for these parameters. Early mortality was significantly lower in the TXA group (e.g., 24-h mortality 5.8 % [TXA] vs. 12.4 % [control]; p = 0.01), and mean time to death was 8.8 ± 13.4 days vs. 3.6 ± 4.9 days, respectively (p = 0.001). Overall hospital mortality was similar in both groups (14.7 % vs. 16.3 %; p = 0.72). The most pronounced mortality difference was observed in patients with a high propensity score, reflecting severe injury load. This is the first civilian study, to our knowledge, in which the effect of prehospital TXA use in trauma patients has been examined. TXA was
Hemmila, Mark R; Jakubus, Jill L; Maggio, Paul M; Wahl, Wendy L; Dimick, Justin B; Campbell, Darrell A; Taheri, Paul A
Major postoperative complications are associated with a substantial increase in hospital costs. Trauma patients are known to have a higher rate of complications than the general surgery population. We used the National Surgical Quality Improvement Program (NSQIP) methodology to evaluate hospital costs, duration of stay, and payment associated with complications in trauma patients. Using NSQIP principles, patient data were collected for 512 adult patients admitted to the trauma service for > 24 hours at a Level 1 trauma center (2004-2005). Patients were placed in 1 of 3 groups: no complications (none), >or=1 minor complication (minor, eg, urinary tract infection), or >or=1 major complication (major, eg, pneumonia). Total hospital charges, costs, payment, and duration of stay associated with each complication group were determined from a cost-accounting database. Multiple regression was used to determine the costs of each type of complication after adjusting for differences in age, sex, new injury severity score, Glasgow coma scale score, maximum head abbreviated injury scale, and first emergency department systolic blood pressure. A total of 330 (64%) patients had no complications, 53 (10%) had >or= 1 minor complication, and 129 (25%) had >or= 1 major complication. Median hospital charges increased from $33,833 (none) to $81,936 (minor) and $150,885 (major). The mean contribution to margin per day was similar for the no complication and minor complication groups ($994 vs $1,115, P = .7). Despite higher costs, the patients in the major complication group generated a higher mean contribution to margin per day compared to the no complication group ($2,168, P costs when adjusted for confounding variables was $19,915 for the minor complication group (P costs associated with traumatic injury provides a window for assessing the potential cost reductions associated with improved quality care. To optimize system benefits, payers and providers should develop integrated
McLaughlin, Cory; Zagory, Jessica A; Fenlon, Michael; Park, Caron; Lane, Christianne J; Meeker, Daniella; Burd, Randall S; Ford, Henri R; Upperman, Jeffrey S; Jensen, Aaron R
The classic "trimodal" distribution of death has been described in adult patients, but the timing of mortality in injured children is not well understood. The purpose of this study was to define the temporal distribution of mortality in pediatric trauma patients. A retrospective cohort of patients with mortality from the National Trauma Data Bank (2007-2014) was analyzed. Categorical comparison of 'dead on arrival', 'death in the emergency department', and early (≤24h) or late (>24h) inpatient death was performed. Secondary analyses included mortality by pediatric age, predictors of early mortality, and late complication rates. Children (N=5463 deaths) had earlier temporal distribution of death compared to adults (n=104,225 deaths), with 51% of children dead on arrival or in ED compared to 44% of adults (p<0.001). For patients surviving ED resuscitation, children and adolescents had a shorter median time to death than adults (1.2 d and 0.8 days versus 1.6 days, p<0.001). Older age, penetrating mechanism, bradycardia, hypotension, tube thoracostomy, and thoracotomy were associated with early mortality in children. Injured children have higher incidence of early mortality compared to adults. This suggests that injury prevention efforts and strategies for improving early resuscitation have potential to improve mortality after pediatric injury. Level III: Retrospective cohort study. Copyright © 2017 Elsevier Inc. All rights reserved.
Sefrioui, I; Amadini, R; Mauro, J; El Fallahi, A; Gabbrielli, M
Exceptional circumstances like major incidents or natural disasters may cause a huge number of victims that might not be immediately and simultaneously saved. In these cases it is important to define priorities avoiding to waste time and resources for not savable victims. Trauma and Injury Severity Score (TRISS) methodology is the well-known and standard system usually used by practitioners to predict the survival probability of trauma patients. However, practitioners have noted that the accuracy of TRISS predictions is unacceptable especially for severely injured patients. Thus, alternative methods should be proposed. In this work we evaluate different approaches for predicting whether a patient will survive or not according to simple and easily measurable observations. We conducted a rigorous, comparative study based on the most important prediction techniques using real clinical data of the US National Trauma Data Bank. Empirical results show that well-known Machine Learning classifiers can outperform the TRISS methodology. Based on our findings, we can say that the best approach we evaluated is Random Forest: it has the best accuracy, the best area under the curve, and k-statistic, as well as the second-best sensitivity and specificity. It has also a good calibration curve. Furthermore, its performance monotonically increases as the dataset size grows, meaning that it can be very effective to exploit incoming knowledge. Considering the whole dataset, it is always better than TRISS. Finally, we implemented a new tool to compute the survival of victims. This will help medical practitioners to obtain a better accuracy than the TRISS tools. Random Forests may be a good candidate solution for improving the predictions on survival upon the standard TRISS methodology.
Insight and illness perception are two concepts of interest in the study of factors related to clinical outcome in patients with psychosis. Insight implies a risk of emotional distress for the patient. Illness perceptions, regardless of their accuracy, might be favorable or not to illness. Literature provides evidence of significant correlates of these factors with clinical outcome, but they are rarely included in a single study. 1) assessing insight and illness perception in a sample of Mexican patients who have experienced psychosis and, 2) analyzing how insight and illness perception relate to each other and how they relate to clinical status (i.e., positive, negative, and general psychopathology, depression, and anxiety). Sixty-one participants (55.7% females) were recruited from a public psychiatric hospital; insight and illness perceptions were assessed with the SUMD and the Brief-IPQ, respectively. Clinical status was assessed with the PANSS, CDS and BAI scales. Participants showed good insight, favorable illness perceptions for the cognitive and comprehension dimensions, but unfavorable for the emotional dimension. Clinical status of sample was characterized by mild symptoms. Poor insight related to positive symptoms and general psychopathology. Cognitive and emotional perceptions of illness were significantly associated to most clinical status parameters, whereas comprehension showed no significant results. The study not only replicates the significant association on insight and illness perception with clinical outcome, but shows how their patterns of interactions are different, reinforcing the idea that they are two distinct factors worthy of being habitually acknowledged in research and clinical practice.
Dencker, Annemarie; Rix, Bo Andreassen; Bøge, Per
OBJECTIVE: Research indicates that health personnel caring for seriously ill patients with dependent children aged 0 to 18 years often avoid discussing with them the challenges of being a family with a parent in treatment. Children of seriously ill patients risk serious trauma and emotional diffi...... backing for addressing children of seriously ill patients and time spent on it; and (3) the need for future HP training programmes to include how to implement procedures and how to address all barriers.......OBJECTIVE: Research indicates that health personnel caring for seriously ill patients with dependent children aged 0 to 18 years often avoid discussing with them the challenges of being a family with a parent in treatment. Children of seriously ill patients risk serious trauma and emotional......, drawing on the theoretical framework of Maturana's domains. RESULTS: The study found structural barriers (eg, lack of space in the medical recording system, professional code, time pressure, and lack of training) and emotional barriers (eg, the painful nature of the situation and the perceived need...
DeAndrade, James; Pedersen, Mark; Garcia, Luis; Nau, Peter
Sarcopenia is an independent risk factor for adverse outcomes in critically ill patients. The impact of sarcopenia on morbidity and length of stay in a trauma population has not been completely defined. This project evaluated the influence of sarcopenia on patients admitted to the trauma service. A retrospective review of 778 patients presenting as a trauma alert at a single institution from 2012-2014 was completed. Records were abstracted for comorbidities and hospital complications. The Hounsfield Unit Area Calculation was collected from admission computed tomography scans. Criteria for sarcopenia were based on the lowest 25th percentile of muscle density measurements. Relationships to patient outcomes were evaluated by univariate and multivariable regression or analyses of variance, when applicable. A total of 432 (55.6%) patients suffered a complication. Sarcopenia was associated with overall complications (P sarcopenia into a novel length of stay calculator showed increased prognostic ability for prolonged length of stay over Abbreviated Injury Scale alone (P = 0.0002). Sarcopenia is an independent risk factor for adverse outcomes and increased length of stay in trauma patients. Prognostic algorithms incorporating sarcopenia better predict hospital length of stay. Identification of patients at risk may allow for targeted interventions early in the patient's hospital course. Copyright © 2017 Elsevier Inc. All rights reserved.
Hoffstetter, P.; Herold, T.; Daneschnejad, M.; Zorger, N.; Jung, E.M.; Feuerbach, S.; Schreyer, A.G.
Purpose: whole-body CT scans for patients with multiple trauma represent an increasingly accepted first diagnostic tool. The multidetector approach in particular provides appropriate diagnostic algorithms for detecting nearly all relevant traumatic findings in a short time with a high grade of sensitivity and specificity. Non-trauma-associated additional findings are commonly depicted based on these CT examinations. The aim of this study is to evaluate the number and quality of these additional findings in consecutive patients with multiple trauma. Materials and methods: between 3/04 and 8/06 we scanned 304 patients according to our dedicated multiple trauma protocol. The examination protocol includes a head scan without intravenous contrast followed by a whole-body scan including the neck, thorax and abdomen acquired by a 16-row CT Scanner (Siemens, Sensation 16). The CT scans were retrospectively analyzed by two radiologists with respect to non-trauma-associated findings. Lesions were assessed according to their clinical relevance (highly relevant, moderately relevant, not relevant). For patients with highly relevant findings, additional follow-up research was performed. Results: The average age was 43 years (range 3 - 92). 236 of the patients were male (77.6%), 68 female (22.4%). 153 patients (50.3%) had additional non-trauma-associated findings. In 20 cases (6.6%) lesions with high clinical relevance were detected (e.g. carcinoma of the kidney or the ovary). In 71 patients (23.4%) findings with moderate relevance were described. In 63 patients (20.7%) additional findings without major relevance were diagnosed. Conclusion: Whole-body CT scans of patients randomized by a trauma show a considerable number of non-trauma-associated additional findings. In about 30% of cases, these findings are clinically relevant because further diagnostic workup or treatment in the short or medium-term is needed. The results of these analyses emphasize the diagnostic value of CT
Olufajo, Olubode A; Metcalfe, David; Yorkgitis, Brian K; Cooper, Zara; Askari, Reza; Havens, Joaquim M; Brat, Gabriel A; Haider, Adil H; Salim, Ali
Although trauma patients are frequently discharged against medical advice (AMA), the fate of these patients remains mostly unknown. Patients with traumatic injuries were identified in the California State Inpatient Database, 2007 to 2011. Readmission characteristics of patients discharged AMA were compared with patients discharged home. There were 203,756 (75.65%) patients discharged home and 4,480 (1.66%) discharged AMA. Compared with those discharged home, patients discharged AMA had significantly higher 30-day readmission rates (17.12% vs 6.75%), rates of multiple readmissions (3.83% vs 1.12%), and likelihood of being readmitted at different hospitals (44.83% vs 33.82%) (all P < .001). The commonest reasons for readmission in patients discharged AMA were psychiatric conditions [adjusted odds ratio: 1.67 (1.21 to 2.27)]. Discharge AMA is associated with multiple readmissions and higher rates of readmissions at different hospitals. Early identification of vulnerable patients and improved modalities to prevent discharge AMA among these patients may reduce the negative outcomes associated with discharge AMA among trauma patients. Copyright © 2016 Elsevier Inc. All rights reserved.
Frostholm, Lisbeth; Oernboel, Eva; Christensen, Kaj S
OBJECTIVE: Little is known about whether illness perceptions affect health outcomes in primary care patients. The aim of this study was to examine if patients' illness perceptions were associated with their self-rated health in a 2-year follow-up period. METHODS: One thousand seven hundred eighty......-five primary care patients presenting a new or recurrent health problem completed an adapted version of the illness perception questionnaire and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) at baseline and 3, 12, and 24 months' follow-up. Linear regressions were performed for (1) all...... patients, (2) patients without chronic disorders presenting physical disease, and (3) patients presenting medically unexplained symptoms (MUS). RESULTS: Negative illness perceptions were associated with poor physical and mental health at baseline. They most strongly predicted changes in health status...
Langton, Joanne E; Brent, Gregory A
Altered thyroid function tests as a consequence of illness have been recognized for many years, yet the cause and clinical implications remains uncertain. The routine testing of thyroid function in hospitalized patients should be discouraged, as the results are less predictive of primary thyroid disease than in ambulatory patients. Clinicians should be aware of the methods used for thyroid function testing, as the effect of illness on thyroid function varies among the different tests. The most commonly used free T4 assays likely are influenced significantly by nonthyroidal illness. Advances in understanding the basic mechanisms of thyroid hormone metabolism and thyroid hormone action have given insights into the changes in thyroid function tests as a consequence of nonthyroidal illness. In the future, thyroid hormone receptor isoform-specific agonists and antagonists may allow for more specific treatment of select patients with nonthyroidal illness syndrome.
Jain, Venu; Chari, Radha; Maslovitz, Sharon; Farine, Dan; Bujold, Emmanuel; Gagnon, Robert; Basso, Melanie; Bos, Hayley; Brown, Richard; Cooper, Stephanie; Gouin, Katy; McLeod, N Lynne; Menticoglou, Savas; Mundle, William; Pylypjuk, Christy; Roggensack, Anne; Sanderson, Frank
Physical trauma affects 1 in 12 pregnant women and has a major impact on maternal mortality and morbidity and on pregnancy outcome. A multidisciplinary approach is warranted to optimize outcome for both the mother and her fetus. The aim of this document is to provide the obstetric care provider with an evidence-based systematic approach to the pregnant trauma patient. Significant health and economic outcomes considered in comparing alternative practices. Published literature was retrieved through searches of Medline, CINAHL, and The Cochrane Library from October 2007 to September 2013 using appropriate controlled vocabulary (e.g., pregnancy, Cesarean section, hypotension, domestic violence, shock) and key words (e.g., trauma, perimortem Cesarean, Kleihauer-Betke, supine hypotension, electrical shock). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English between January 1968 and September 2013. Searches were updated on a regular basis and incorporated in the guideline to February 2014. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). This guideline is expected to facilitate optimal and uniform care for pregnancies complicated by trauma. Summary Statement Specific traumatic injuries At this time, there is insufficient evidence to support the practice of disabling air bags for pregnant women. (III) Recommendations Primary survey 1. Every female of reproductive age with significant injuries should be considered pregnant until proven otherwise by a definitive pregnancy test or ultrasound scan. (III
Grasso, Rosario Francesco; Quattrocchi, Carlo Cosimo; Crucitti, Pierfilippo; Carboni, Giampiero; Coppola, Roberto; Zobel, Bruno Beomonte
A 71-year-old man affected by cardio- and cerebrovascular disease experienced an accidental fall and trauma to the fronto-temporal area of the head. A few weeks later a growing mass appeared on his scalp. A diagnosis of superficial temporal artery pseudoaneurysm was made following CT and color Doppler ultrasound. His clinical condition favoured a conservative approach by ultrasound-guided compression and subsequent surgical resection. A conservative approach should be considered the treatment of choice in critically ill patients affected by superficial temporal artery pseudoaneurysm
Medellín-Garibay, Susanna E; Ortiz-Martín, Belén; Rueda-Naharro, Aída; García, Benito; Romano-Moreno, Silvia; Barcia, Emilia
The objectives of this study were to characterize the population pharmacokinetics of vancomycin in trauma patients and to propose dosing schemes to optimize therapy. Trauma patients from Hospital Universitario Severo Ochoa (Spain) receiving intravenous vancomycin and routine therapeutic drug monitoring were included. Concentrations and time data were retrospectively collected, and population modelling was performed with NONMEM 7.2; internal and external validations were performed to probe the final model. Finally, several simulations were executed to propose dosing guidelines to reach expected vancomycin concentrations. A total of 118 trauma patients were included; the population was 45% males, with a mean age of 77 years (range 37-100 years) and a mean total body weight (TBW) of 72 kg (range 38-110 kg). The pharmacokinetics of vancomycin was best described by a two-compartment open model; creatinine clearance (CLCR) was related to vancomycin clearance (0.49 ± 0.04 L/h), being diminished by the presence of furosemide (0.34 ± 0.05 L/h). TBW influenced both the central volume of distribution (V1 = 0.74 ± 0.1 L/kg) and peripheral volume of distribution (V2 = 5.9 ± 2 L/kg), but patients with age >65 years showed a larger V1 (1.07 ± 0.1 L/kg). Bootstrapping was performed to internally validate the stability of the final model. External validation was developed using an alternate population of 40 patients with the same characteristics. The validated model was compared with population pharmacokinetic models previously published and showed better predictive performance for trauma patients than the current one. This final model allowed us to propose a new practical dose guideline to reach higher trough concentrations (15-20 mg/L) and AUC0-24/MIC ratios of more than 400 after 4 days of vancomycin treatment. A new population model was described for trauma patients to optimize vancomycin therapy, showing precise predictive performance to be applied for therapeutic drug
Chilcot, Joseph; Wellsted, David; Farrington, Ken
Patients with end-stage renal disease are required to limit fluid and salt intake. We examined illness representations [common-sense model (CSM)] among a sample of hemodialysis (HD) patients, investigating whether fluid-adherent patients held illness representations different from those of nonadherent patients. We also explored the utility of illness perceptions in predicting fluid nonadherence after controlling for clinical parameters, including residual renal function (KRU). Illness perceptions were assessed [Revised Illness Perception Questionnaire (IPQ-R)] in 99 HD patients. Clinical parameters were collected and averaged over a 3-month period prior to and including the month of IPQ-R assessment. Depression scores, functional status, and comorbidity were also collected. Fluid nonadherence was defined using interdialytic weight gain (IDWG) and dry weight (ideal weight). Patients in the upper quartile of percent weight gain were defined as nonadherent (IDWG> or =3.21% dry weight). Nonadherent patients had timeline perceptions significantly lower than those of adherent patients. Logistic regression models were computed in order to identify predictors of fluid nonadherence. After several demographic and clinical variables, including age, gender, and KRU, had been controlled for, lower consequence perceptions predicted nonadherence. Illness representations appear to predict fluid nonadherence among HD patients. Extending the CSM to investigate specific perceptions surrounding treatment behaviors may be useful and merits attention in this setting. 2010 Elsevier Inc. All rights reserved.
Sánchez-Izquierdo Riera, J A; Montejo González, J C
The hypermetabolism that develops in patients with severe polytraumatism has led to the need for an aggressive metabolic-nutritional support from the start. Parenteral Nutrition is the preferred technique in many instances, due to the doubts on the effectiveness of enteral nutrition in the control of the metabolic response and to problems of gastrointestinal tolerance derived from its administration. However, the role of enteral nutrition as an important factor which limits the development of bacterial translocation and the chain of events leading to multiorganic failure appears to be more and more well-established and is an important argument for justifying the early administration of enteral nutrition in these patients. In accordance with the accumulated experience of several authors over the past few years, enteral nutrition may be administered early in polytraumatized patients. This is not only accompanied by the evidence of acceptable gastrointestinal tolerance to the diet, but also by additional advantages compared to parenteral nutrition, such as the maintenance of trophism and immunocompetence of the digestive mucosa, the reduction of septic complications and also greater nutritional effectiveness which can be evaluated by the behaviour of the seric proteins used as nutritional evolution markers. The interest of the different diet formulae which exist at present, for example diets enriched with branched-chain amino acids, diets with added fibre, peptidic diets, specific pulmonary diets or "euglycaemic diets" is evaluated in this review. All these diets may mean an increase in the effectiveness and/or tolerance of enteral nutrition in polytraumatized patients, and also contribute to the handling of specific problems such as "stress" hyperglycaemia or the withdrawal of mechanical ventilation support. The use of specific nutrients for the digestive mucosa, such as glutamine or short chain fatty acids seems to be an important factor in the reduction of
Berben, S.A.A.; Kemps, H.H.; Grunsven, P.M. van; Mintjes-de Groot, J.; Dongen, R.T. van; Schoonhoven, L.
Pain management for trauma patients is a neglected aspect in the chain of emergency care in general practices, ambulance services, mobile trauma teams and in hospital emergency departments. The aim of the guideline 'Pain management for trauma patients in the chain of emergency care' is to provide
transport and to track changes in numerous casualties in an austere environment from a remote location. Within that context, to evaluate the MWVSM...sensors accurately track vital signs and allow for appropriate triage compared to a gold standard bedside monitor in trauma patients. METHODS A...Meizoso JP, Nissan JJ, Schulman CI, Perez EA, Lasko D, Neville HL, Proctor KG, Sola JE: Injury Patterns Associated with Pediatric Bicycle Accidents
Full Text Available Introduction: Traumatic brain injuries are among the most important causes of mortality and disability. Since there is a lot of controversy regarding discharge of head trauma patients, especially those with mild traumatic brain injuries, this study was designed aiming to evaluate traumatic brain injuries from an epidemiologic point of view. Methods: In this retrospective cross-sectional study, patients with isolated head trauma, and all those who underwent computed tomography (CT were included using convenience sampling. Demographic data and final diagnosis of the patients were extracted from their medical profile, and were analyzed using SPSS 21 and appropriate statistical tests. Results: 786 patients with the mean age of 24 ± 16.8 years (range: 0.5 – 75 were evaluated (67.8% male. 42 patients (5.3% had abnormal CT scan and were hospitalized. 7 of them (16.7% of hospitalized, 3.3% of low-risk, and 0.9% of all patients were in the group categorized as low-risk regarding probability of brain injuries. 12 (1.5% participants needed surgery, 2 of which (0.9% were initially categorized as low-risk. Vomiting was significantly more in patients with abnormal CT scan (45.2% compared to those who had normal CT scan (19.6% (p = 0.0001. No significant difference was detected between the 2 groups in other symptoms. Conclusion: The results of this study indicate that by making decisions based on clinical findings alone, there is a probability of about 3.3% error in management of head trauma patients. In addition, 0.9% of the patients initially categorized as low-risk, needed surgical intervention in the end.
Vliet, L.M. van; Lindenberger, E.; Weert, J.C.M. van
This article aims to provide more insight into effective communication with older people with serious illness and their surrogates/caregivers. To do so, if focusses on specific skills in three core functions of communication (i) empathic behavior, (ii) information provision and (iii) enabling
van Tiel, D.; van Vliet, K. P.; Moerman, C. J.
The aim of this study was to explore sex differences in illness beliefs and behavior in patients with suspected coronary artery disease (CAD). Twenty-eight patients, 16 women and 12 men, were interviewed. The results show that both men and women think of CAD as a 'men's disease' and have equal
This prospective study was designed to evaluate the complications of percutaneous tube thoracostomy (PTT) performed for chest trauma in our institution and to determine predictive factors. One hundred and thirty-four primary PTTs were performed in 128 patients for blunt (83) and penetrating (45) chest traumas. Failure was defined as undrained hemothorax or pneumothorax, post-tube removal complications and empyema. Univariate and multivariate hazard analyses were used to assess the association between potential risk factors and complications. The overall complication rate was 25% including 30 (23%) failures and nine (7%) improper placement with iatrogenic injuries to the lung (n = 4) or subclavian vein (n = 1). Complications were managed with 18 repeat PTTs and ten early thoracotomies for clotted hemothorax (two), persistent air leak (two), fluid collection (three) or a combination (three) at a mean delay of 6.5 +/- 2.4 days. Failure of additional PTT required late decortication for empyema (three) or decortication (three) at a mean delay of 23 +/- 7 days. One patient died postoperatively, the only death directly related to PTT failure among the four (3.1%) deaths that occurred in this study. Hospital length of stay was significantly increased in patients with PTT failure (24 +/- 19 vs. 15 +/- 8 days in uncomplicated PTT, P = 0.004). By univariate analysis, polytraumatism (relative risk (RR) 2.7, P < 0.05), the need for assisted ventilation (RR 2.7, P = 0.003) and tube insertion by emergency physicians (RR 8.7, P < 0.0001) were significantly associated with increased incidence of complications in blunt trauma. Multivariate analysis identified the performance of the procedure by operators other than thoracic surgeons and residents trained in thoracic surgery as the only independent risk factor in both blunt and penetrating trauma (RR 58 and 71, respectively, P < 0.00001). PTT is associated with significant morbidity and extended hospitalizations, partly related to
Post, Robert M.; Altshuler, Lori L.; Kupka, Ralph; McElroy, Susan L.; Frye, Mark A.; Rowe, Michael; Grunze, Heinz; Suppes, Trisha; Keck, Paul E.; Nolen, Willem A.
Background: Patients with bipolar disorder from the US have more early-onset illness and a greater familial loading for psychiatric problems than those from the Netherlands or Germany (abbreviated here as Europe). We hypothesized that these regional differences in illness burden would extend to the
Kortesniemi, M; Kiljunen, T; Kangasmaeki, A
Multi-slice CT provides an efficient imaging modality for trauma imaging. The purpose of this study was to provide absorbed and effective dose data from CT taking into account the patient size and compare such doses with the standard CT dose quantities based on standard geometry. The CT examination data from abdominal and thoracic scan series were collected from 36 trauma patients. The CTDI vol , DLP w and effective dose were determined, and the influence of patient size was applied as a correction factor to calculated doses. The patient size was estimated from the patient weight as the effective radius based on the analysis from the axial images of abdominal and thoracic regions. The calculated mean CTDI vol , DLP w and effective dose were 15.2 mGy, 431 mGy cm and 6.5 mSv for the thorax scan, and 18.5 mGy, 893 mGy cm and 14.8 mSv for the abdomen scan, respectively. The doses in the thorax and abdomen scans taking the patient size into account were 34% and 9% larger than the standard dose quantities, respectively. The use of patient size in dose estimation is recommended in order to provide realistic data for evaluation of the radiation exposure in CT, especially for paediatric patients and smaller adults
Kortesniemi, M.; Kiljunen, T.; Kangasmäki, A.
Multi-slice CT provides an efficient imaging modality for trauma imaging. The purpose of this study was to provide absorbed and effective dose data from CT taking into account the patient size and compare such doses with the standard CT dose quantities based on standard geometry. The CT examination data from abdominal and thoracic scan series were collected from 36 trauma patients. The CTDIvol, DLPw and effective dose were determined, and the influence of patient size was applied as a correction factor to calculated doses. The patient size was estimated from the patient weight as the effective radius based on the analysis from the axial images of abdominal and thoracic regions. The calculated mean CTDIvol, DLPw and effective dose were 15.2 mGy, 431 mGy cm and 6.5 mSv for the thorax scan, and 18.5 mGy, 893 mGy cm and 14.8 mSv for the abdomen scan, respectively. The doses in the thorax and abdomen scans taking the patient size into account were 34% and 9% larger than the standard dose quantities, respectively. The use of patient size in dose estimation is recommended in order to provide realistic data for evaluation of the radiation exposure in CT, especially for paediatric patients and smaller adults.
Frequency and correlates of comorbid psychiatric illness in patients with heroin use disorder admitted to Stikland Opioid Detoxification Unit, South Africa. ... use disorders (World Health Organization's Alcohol Smoking Substance Involvement Screening Tool), and legal and social problems (Maudsley Addiction Profile).
Vellinga, Namkje A. R.; Boerma, E. Christiaan; Koopmans, Matty; Donati, Abele; Dubin, Arnaldo; Shapiro, Nathan I.; Pearse, Rupert M.; Machado, Flavia R.; Fries, Michael; Akarsu-Ayazoglu, Tulin; Pranskunas, Andrius; Hollenberg, Steven; Balestra, Gianmarco; van Iterson, Mat; van der Voort, Peter H. J.; Sadaka, Farid; Minto, Gary; Aypar, Ulku; Hurtado, F. Javier; Martinelli, Giampaolo; Payen, Didier; van Haren, Frank; Holley, Anthony; Pattnaik, Rajyabardhan; Gomez, Hernando; Mehta, Ravindra L.; Rodriguez, Alejandro H.; Ruiz, Carolina; Canales, Héctor S.; Duranteau, Jacques; Spronk, Peter E.; Jhanji, Shaman; Hubble, Sheena; Chierego, Marialuisa; Jung, Christian; Martin, Daniel; Sorbara, Carlo; Tijssen, Jan G. P.; Bakker, Jan; Ince, Can; Koopmans, M.; van Iterson, M.; van der Voort, P. H. J.; Bakker, J.; van Bommel, J.; Ruiz, C.; Hernandez, G.; Machado, F. R.; Bafi, A. T.; Dubin, A.; Kanoore Edul, V. S.; Canales, H. S.; Hurtado, F. J.; Lacuesta, G.; Baz, M.; Hollenberg, S. M.; Patel, U.; Shapiro, N. I.; Gomez, H.; Simon, P.; Pinsky, M.; Sadaka, F. G.; Krause, K.; Mehta, R.; Jung, C.; Fries, M.; Pearse, R. M.; Smith, A.; Martin, D. S.; Meale, P.; Jhanji, S.; Minto, G.; Lai, C.; Ferguson, C.; McMillan, H.; Quintrell, T.; Sair, M.; Martinelli, G.; Lombrano, M.; Hubble, S. M. A.; Thorn, C.; Rodriguez, A. H.; Martin-Loeches, I.; van Haren, F. M. P.; Pranskunas, A.; Pilvinis, V.; Donati, A.; Sorbara, C.; Forti, A.; Comin, A.; Chierego, M. L.; Pellis, T.; Holley, A.; Paratz, J.; Duranteau, J.; Harrois, A.; Payen, D.; Legrand, M.; Bucher, E.; Pattnaik, R.; Dondorp, A. M.; Herdman, M. T.; Aypar, U.; Ayhan, B.; Ayazoglu-Akarsu, T.
Microcirculatory alterations are associated with adverse outcome in subsets of critically ill patients. The prevalence and significance of microcirculatory alterations in the general ICU population are unknown. We studied the prevalence of microcirculatory alterations in a heterogeneous ICU
Goldhaber, Samuel Z; Leizorovicz, Alain; Kakkar, Ajay K
The efficacy and safety of prolonging prophylaxis for venous thromboembolism in medically ill patients beyond hospital discharge remain uncertain. We hypothesized that extended prophylaxis with apixaban would be safe and more effective than short-term prophylaxis with enoxaparin....
. 5 AIr Med J2000; 900 1140-1144. World literature concerning the outcome of critically ill obstetric and gynaecological patients is scarce. Those studies that are available have included heterogeneous populations where the pregnancy is often ...
Full Text Available Abstract Introduction The treatment of complex liver injuries remains a challenge. Nonoperative treatment for such injuries is increasingly being adopted as the initial management strategy. We reviewed our experience, at a University teaching hospital, in the nonoperative management of grade IV liver injuries with the intent to evaluate failure rates; need for angioembolization and blood transfusions; and in-hospital mortality and complications. Methods This is a retrospective analysis conducted at a single large trauma centre in Brazil. All consecutive, hemodynamically stable, blunt trauma patients with grade IV hepatic injury, between 1996 and 2011, were analyzed. Demographics and baseline characteristics were recorded. Failure of nonoperative management was defined by the need for surgical intervention. Need for angioembolization and transfusions, in-hospital death, and complications were also assessed Results Eighteen patients with grade IV hepatic injury treated nonoperatively during the study period were included. The nonoperative treatment failed in only one patient (5.5% who had refractory abdominal pain. However, no missed injuries and/or worsening of bleeding were observed during the operation. None of the patients died nor need angioembolization. No complications directly related to the liver were observed. Unrelated complications to the liver occurred in three patients (16.7%; one patient developed a tracheal stenosis (secondary to tracheal intubation; one had pleural effusion; and one developed an abscess in the pleural cavity. The hospital length of stay was on average 11.56 days. Conclusions In our experience, nonoperative management of grade IV liver injury for stable blunt trauma patients is associated with high success rates without significant complications.
Kahramansoy, Nurettin; Erkol, Hayri; Kurt, Feyzi; Gürbüz, Necla; Bozgeyik, Murat; Kıyan, Aysu
There is a grey zone about the epidemiology of trauma in eastern Turkey. The present study was aimed at obtaining data on this subject. Trauma patients who applied to the emergency department (ED) between January 2006 and December 2007 were analyzed. There were 6183 patients, of whom 87% were male. The mean age was 26.2 ± 13.6 years. Assault was the most common cause (63.2%). Motor vehicle injury (MVI) and fall were encountered at frequencies of 21.2% and 6.5%, respectively. The most frequently injured body regions were head-neck and extremities. The majority of patients were managed and discharged from the ED (89.8%) with no consultation (81.8%). Interestingly, the discharge rate of assault cases was 98.7%. Patients were hospitalized (4.2%) mostly for MVI (32.6%) and fall (19%); however, hospitalization rates for firearm and piercing/cutting injury (36.1% and 16.7%) were significantly high. Among the transported patients (5.3%), the rates of MVI and fall were high (41.5% and 24.3%, respectively). In groups, for burn and firearm injuries, these were 42.1% and 24.1%, respectively. Forty-eight patients (0.8%) died, mostly from MVI by number, but by self-infliction and firearm by rate (8.3% and 6%). Assault cases caused an excessive trauma patient density in the ED, as 98.7% were discharged from the ED. Further studies are needed regarding the high rate of assault cases.
Zakrison, Tanya L; Rattan, Rishi; Milian Valdés, Davel; Ruiz, Xiomara; Gelbard, Rondi; Cline, John; Turay, David; Luo-Owen, Xian; Namias, Nicholas; George, Jessica; Yeh, Dante; Pust, Daniel; Williams, Brian H
A recent EAST-supported, multicenter trial demonstrated a similar rate of intimate partner and sexual violence (IPSV) between male and female trauma patients, regardless of mechanism. Our objective was to perform a subgroup analysis of our affected male cohort as this remains an understudied group in the trauma literature. We conducted a recent EAST-supported, cross-sectional, multicenter trial over one year (03/15-04/16) involving four Level I trauma centers throughout the United States. We performed universal screening of adult trauma patients using the validated HITS (Hurt, Insult, Threaten, Scream) and SAVE (sexual violence) screening surveys. Risk factors for male patients were identified. Chi-squared test compared categorical variables with significance at pintimate partner violence, 14.1% for IPSV and 6.5% for sexual violence. On categorical analysis of the HITS screen, the proportion of men that were physically hurt was 4.8% compared to 4.3% for women (p = 0.896). A total of 4.8% of men screened positive for both intimate partner and sexual violence. The total proportion of men who presented with any history of intimate partner violence, sexual violence or both (IPSV) was 15.8%. More men affected by penetrating trauma screened positive for IPSV (p intimate partner and sexual violence, with one out of every six men experiencing some form of violence. Men are at similar risk for physical abuse as women when this intimate partner violence occurs. IPSV is associated with penetrating trauma in men. Support programs for this population may potentially impact associated mental illness, substance abuse, trauma recidivism and even societal-level violence. III STUDY TYPE: Diagnostic.
Hartl, Wolfgang H; Jauch, Karl-Walter
The aim of this study was to describe the evolution and nature of self-destructive metabolic responses observed in critically ill patients, and to analyze therapeutic principles on how best to avoid or diminish these responses. We electronically identified articles through a search of PubMed and Google Scholar. Metabolic reactions associated with surgical injury or infections comprise hyperglycemia, insulin resistance, increased hepatic glucose production, and muscle protein breakdown. From an evolutionary perspective, these responses have been necessary and successful to overcome spontaneously survivable insults (minor surgical trauma). If prolonged and exaggerated, however, these reactions may become self-destructive, causing secondary metabolic damage. There is overwhelming evidence that extreme metabolic responses have not been selected by evolution, but are brought about by modern medicine enabling survival of severe, otherwise lethal insults and giving patients the chance to develop such exaggerated self-destructive metabolic reactions. Poorly adapted metabolic responses to severe insults, however, may have persisted because of unavoidable evolutionary constraints. Self-destructive metabolic responses cannot be prevented by adjuvant therapies such as artificial nutrition, which may only help to ameliorate secondary metabolic damage. Minor surgical trauma is associated with a beneficial adaptive metabolic response. After a severe insult, however, emergence of self-destructive responses will be unavoidable if the patient survives the acute phase. Effective treatment is only possible by an aggressive therapy of underlying pathologies (such as shock, trauma or infection) thereby interrupting secondary metabolic trigger mechanisms at an early stage. Copyright © 2014 Elsevier Inc. All rights reserved.
VanDeMark, Nancy R.; Russell, Lisa A.; O'Keefe, Maura; Finkelstein, Norma; Noether, Chanson D.; Gampel, Joanne C.
Children exposed to parental substance abuse, mental illness, and violence face profound challenges, including increased risk for emotional and behavioral problems, substance abuse, and victimization. In this article, we describe the characteristics of a sample of children of women entering treatment. These children had been exposed to domestic…
Geerlings, S. E.; Rommes, J. H.; van Toorn, D. W.; Bakker, J.
A 19-year-old male patient developed thrombocytopenia and leukopenia due to acute folate deficiency while recovering from a multiple organ failure syndrome. Risk factors for acute folate deficiency are extensive tissue damage due to sepsis, trauma or surgery and acute renal failure requiring renal
Trichomonal disease typically involves the genital and occasionally respiratory tracts. Although exposure of the upper respiratory tract to infected genital secretions is not uncommon with contemporary sexual practices, trichomonal sinus disease has been rarely described. The present report describes the case of a healthy 17-year-old male admitted to an intensive care unit following multiple trauma, who developed purulent sinusitis on the 4th day of hospitalization. Numerous trichomonads were noted on microscopic examination of sinus aspirate. Further investigation revealed orofacial sexual exposure of the patient to a partner with trichomoniasis. The patient's sinusitis resolved following a course of parenteral metronidazole-containing antibiotics.
Evans, Heather L; Warner, Keir; Bulger, Eileen M; Sharar, Sam R; Maier, Ronald V; Cuschieri, Joseph
We reported similar rates of ventilator-associated pneumonia (VAP) previously in trauma patients intubated either in a pre-hospital (PH) venue or the emergency department. A subset of PH intubations with continuous quality assessment was re-examined to identify the intubation factors associated with VAP. The subgroup was derived from an existing data set of consecutive adult trauma patients intubated prior to Level I trauma center admission July 2007-July 2008. Intubation details recorded included bag-valve mask ventilation (BVM) and the presence of material in the airway. The diagnosis of VAP was made preferentially by quantitative bronchoalveolar lavage (BAL) cultures (≥ 10⁴ colony-forming units indicating infection). Baseline data, injury characteristics, and circumstances of intubation of patients with and without VAP were compared by univariable analysis. Detailed data were available for 197 patients; 32 (16.2%) developed VAP, on average 6.0±0.7 days after admission. Baseline characteristics were similar in the groups, but diabetes mellitus was more common in the VAP group (4 [12.5%] vs. 5 [3.0%]; p=0.02). There was a higher rate of blunt injury in the VAP patients (28 [87.5%] vs. 106 [64.2%]; p=0.01) and higher injury severity scores (33.1±2.8 vs. 23.0±1.0; p=0.0002) and chest Abbreviated Injury Scores (2.6±0.3 vs. 1.5±0.1; p=0.002). Lower Glasgow Coma Scale scores (7.9±0.9 vs. 9.9±0.4; p=0.04) and greater use of BVM (18 [56.3%] vs. 56 [34.0%]; p=0.02) were observed in patients who developed VAP. Among aspirations, 10 (31.3%) of patients with emesis developed VAP compared with only 4 (12.5%) with blood in the airway (p=0.003). Aspiration, along with depressed consciousness and greater injury severity, may predispose trauma patients to VAP. Prospective studies should focus on the quality and timing of aspiration relative to intubation to determine if novel interventions can prevent aspiration or decrease the risk of VAP after aspiration.
Olival Cirilo Lucena da Fonseca Neto
e apenas um foi E. Apenas três pacientes não foram reoperados (média de 1,7 cirurgias por paciente. Em 46,15%, ocorreu hipertensão intra-abdominal sendo necessário colocação de bolsa de Bogotá. O tempo de internamento variou de 30 à 365 dias (média = 53,4 dias. Ocorreu apenas um óbito. CONCLUSÃO: A pancreatite traumática é de elevada morbimortalidade, e uma das complicações mais importantes relacionada ao trauma pancreático, sendo o seu diagnóstico precoce junto com o acompanhamento multidisciplinar intensivo, o fator que poderá interferir favoravelmente na evolução desses pacientes.BACKGROUND: Pancreatic lesion is uncommon after closed or penetrating abdominal trauma, being related between 0,2 to 12% in severe closed abdominal traumas and in 5 to 7% of penetrating traumas. The majority of pancreatic lesions occur in young men and is associated with an increased incidence of trauma in adjacent organs and major vascular structures. AIM: To evaluate morbimortality rates, evolution and handling of patients with pancreatic trauma. METHODS: A prospective study of patients admitted to the trauma unit was made. Thirteen adults (>13 years-old were divided into two groups one composed of severe and the other composed of non-severe patients according to clinical criterion in the moment of identification of trauma using the Balthazars' criteria (A, B, C, D and E. The type of external trauma (opened or closed, classification of pancreatic trauma, number of organs reached by trauma, number of reoperations, type of nutritional support and period of time in the hospital were also analyzed. Presence of compartmental abdominal syndrome and necessity to close trauma temporarily were studied and compared to morbimortality in patients. RESULTS: All patients were male, with an average age of 28,6 years (13 to 60 years of age, presenting postoperatory traumatic pancreatitis. Seven patients, showed penetrating wounds due to firearms; three had closed abdomen; two had
Collins, S.; van Hilten, J.J.; Marinus, J.J.; Zuurmond, W.W.A.; de Lange, J.J.; Perez, R.S.G.M.
Collins S, van Hilten JJ, Marinus J, Zuurmond WW, de Lange JJ, Perez RS. Development of a symptoms questionnaire for complex regional pain syndrome and potentially related illnesses: the Trauma Related Neuronal Dysfunction Symptoms Inventory. Objective: To develop a questionnaire to evaluate
Full Text Available Background. The aims of this study were to evaluate the complications that occur after trauma and the characteristics of individuals who develop complications, to identify potential risk factors that increase their incidence, and finally to investigate the relationship between complications and mortality. Methods. We did a population-based retrospective study of trauma patients admitted to ICUs of a level I trauma center. Logistic regression analyses were performed to determine independent predictors for complications. Results. Of the 11,064 patients studied, 3,451 trauma patients developed complications (31.2%. Complications occurred significantly more in younger male patients. Length of stay was correlated with the number of complications (R=0.435,P<0.0001. The overall death rate did not differ between patients with or without complications. The adjusted odds ratio (OR of developing complication for patients over age 75 versus young adults was 0.7 (P<0.0001. Among males, traumatic central nervous system (CNS injury was an important predictor for complications (adjusted OR 1.24. Conclusions. Complications after trauma were found to be associated with age, gender, and traumatic CNS injury. Although these are not modifiable factors, they may identify subjects at high risk for the development of complications, allowing for preemptive strategies for prevention.
Conclusion: The illness perceptions of the TB patients might influence their adherence to treatment. The poor quality of life of the TB patients in the different areas of quality of life such as daily activities and work, calls for programmes to strengthen TB information, education and counselling. Key words: Tuberculosis, patients, ...
Joseph, Bellal; Khalil, Mazhar; Pandit, Viraj; Orouji Jokar, Tahereh; Cheaito, Ali; Kulvatunyou, Narong; Tang, Andrew; O'Keeffe, Terence; Vercruysse, Gary; Green, Donald J; Friese, Randall S; Rhee, Peter
Organ donation after cardiac death (DCD) is not optimal but still remains a valuable source of organ donation in trauma donors. The aim of this study was to assess national trends in DCD from trauma patients. A 12-year (2002 to 2013) retrospective analysis of the United Network for Organ Sharing database was performed. Outcome measures were the following: proportion of DCD donors over the years and number and type of solid organs donated. DCD resulted in procurement of 16,248 solid organs from 8,724 donors. The number of organs donated per donor remained unchanged over the study period (P = .1). DCD increased significantly from 3.1% in 2002 to 14.6% in 2013 (P = .001). There was a significant increase in the proportion of kidney (2002: 3.4% vs 2013: 16.3%, P = .001) and liver (2002: 1.6% vs 2013: 5%, P = .041) donation among DCD donors over the study period. DCD from trauma donors provides a significant source of solid organs. The proportion of DCD donors increased significantly over the last 12 years. Copyright © 2015 Elsevier Inc. All rights reserved.
Lund, Helle; Kofoed, Steen Christian; Hillingsø, Jens Georg
Hypovolaemic shock is a major course of death in trauma patients. The mortality in patients in profound shock at the time of arrival is extremely high and we wanted to investigate the outcome of patients undergoing laparotomy at the Trauma Care Unit (TCU).......Hypovolaemic shock is a major course of death in trauma patients. The mortality in patients in profound shock at the time of arrival is extremely high and we wanted to investigate the outcome of patients undergoing laparotomy at the Trauma Care Unit (TCU)....
Johnson-Obaseki, Stephanie; Veljkovic, Andrea; Javidnia, Hedyeh
In the setting of critical care, the most common indications for tracheostomy include: prolonged intubation, to facilitate weaning from mechanical ventilation, and for pulmonary toileting. In this setting, tracheostomy can be performed either via open surgical or percutaneous technique. Advantages for percutaneous dilatational tracheostomy (PDT) include: simplicity, smaller incision, less tissue trauma, lower incidence of wound infection, lower incidence of peristomal bleeding, decreased morbidity from patient transfer, and cost-effectiveness. Despite many studies comparing surgical tracheostomy (ST) versus PDT, there remains no consensus on which of these techniques minimizes complications in critically ill patients. To provide an updated meta-analysis to answer the following question: Is there a difference in complication rates between ST and PDT in the setting of critically ill patients? Our secondary outcome of interest was to examine the difference in procedure time in the ST versus PDT groups. We conducted a literature search using the following databases: Ovid MEDLINE, Embase, Google Scholar, and Cochrane Database of Systematic Reviews. Studies from 1985 until October 2014 published in French or English languages in peer-reviewed journals were included. With regard to rates of mortality, intraoperative hemorrhage, and postoperative hemorrhage, there was no statistically significant difference between the two techniques. Evaluation of infections rates and operative time, however, revealed a statistically significant difference, favoring PDT over ST. In critically ill patients, PDT appears to be a safe and efficient alternative to open ST. NA Laryngoscope, 126:2459-2467, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.
Loftus, Tyler J; Mira, Juan C; Ozrazgat-Baslanti, Tezcan; Ghita, Gabriella L; Wang, Zhongkai; Stortz, Julie A; Brumback, Babette A; Bihorac, Azra; Segal, Mark S; Anton, Stephen D; Leeuwenburgh, Christiaan; Mohr, Alicia M; Efron, Philip A; Moldawer, Lyle L; Moore, Frederick A; Brakenridge, Scott C
Sepsis is a common, costly and morbid cause of critical illness in trauma and surgical patients. Ongoing advances in sepsis resuscitation and critical care support strategies have led to improved in-hospital mortality. However, these patients now survive to enter state of chronic critical illness (CCI), persistent low-grade organ dysfunction and poor long-term outcomes driven by the persistent inflammation, immunosuppression and catabolism syndrome (PICS). The Sepsis and Critical Illness Research Center (SCIRC) was created to provide a platform by which the prevalence and pathogenesis of CCI and PICS may be understood at a mechanistic level across multiple medical disciplines, leading to the development of novel management strategies and targeted therapies. Here, we describe the design, study cohort and standard operating procedures used in the prospective study of human sepsis at a level 1 trauma centre and tertiary care hospital providing care for over 2600 critically ill patients annually. These procedures include implementation of an automated sepsis surveillance initiative, augmentation of clinical decisions with a computerised sepsis protocol, strategies for direct exportation of quality-filtered data from the electronic medical record to a research database and robust long-term follow-up. This study has been registered at ClinicalTrials.gov, approved by the University of Florida Institutional Review Board and is actively enrolling subjects. Dissemination of results is forthcoming. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Nov 4, 2017 ... patients with the mentioned indications undergoing rib fracture fixation within 3 days had significant decreases in respiratory failure, duration of mechanical ventilation, and need for tracheostomy, as well as significantly better daily incentive spirometry readings. Rib fracture fixation in a South African public.
Nov 4, 2017 ... asymptomatic patients may harbor isolated diaphragm injuries that may go undetected, and later develop a diaphragm hernia. To overcome this, it was initially proposed by Stylianos et al.2 that all left side TA stab wounds should undergo a laparotomy to rule out a diaphragm injury. During the mid 1990s, ...
Nov 4, 2017 ... Standard demographic data was analysed. Patients were classified according to severity of head injury and age. We defined a severe TBI as Glasgow Coma Scale (GCS) ≤ 8, moderate as GCS 9–12 and mild as GCS 13–15, in line with accepted international standards. We divided the cohort according to.
Bücker, J; Kozicky, J; Torres, I J; Kauer-Sant'anna, M; Silveira, L E; Bond, D J; Lam, R W; Yatham, L N
Both bipolar disorder (BD) and childhood trauma are associated with cognitive impairment. People with BD have high rates of childhood trauma, which confer greater overall disease severity, but, it is unknown if childhood trauma is associated with greater neurocognitive impairment in BD patients early in the course of their illnesses. In this study, we investigated the impact of childhood trauma on specific cognitive dysfunction in patients who recently recovered from their first episode of mania. Data were available for 64 patients and 28 healthy subjects matched by age, gender and pre-morbid IQ, recruited from a large university medical center. History of childhood trauma was measured using the Childhood Trauma Questionnaire. Cognitive function was assessed through a comprehensive neuropsychological test battery. Trauma was associated with poorer cognitive performance in patients on cognitive measures of IQ, auditory attention and verbal and working memory, and a different pattern was observed in healthy subjects. We had a modest sample size, particularly in the group of healthy subjects with trauma. Childhood trauma was associated with poorer cognition in BD patients who recently recovered from a first episode of mania compared to healthy subjects. The results require replication, but suggest that the co-occurrence of trauma and bipolar disorder can affect those cognitive areas that are already more susceptible in patients with BD. Copyright © 2012 Elsevier B.V. All rights reserved.
Francisco Jose Rodrigues de Moura Filho
Full Text Available Objective: To describe thorax computed tomography findings in patients assisted in the emergency unit of Institute Dr Jose Frota (IJF. Materials and Methods: Descriptive study analyzing 160 consecutive contrast-enhanced thorax computed tomography of patients victims of thoracic trauma admitted to the emergency unit of IJF, between November 1st, 2014 and January 31st, 2015. Results: Abnormal findings were observed in 91,2 % of the patients. Among them, the following findings were most frequently observed: fractures (48%, hemothorax (43%, atelectasis (37%, pneumothorax (26% and lung contusions (17% Rupture of the esophagus was seen in three patients. Conclusion: We recognize that the findings encountered in our study are of similar prevalence to the ones reported in the literature and that CT scan is essencial to quickly diagnose these findings.
Full Text Available Isolated grade 5 renal trauma in a hemodynamically stable patient is rare. It is therefore unsurprising there are conflicting recommendations on management of these injuries from authorities including the AUA, EAU and SIU. We present a 26-year-old male with flank pain following a 3-m fall whilst bicycle riding off a ramp, who was found to have an isolated grade 5 renal injury (shattered kidney. He was managed with early angio-embolization and subsequent nephrectomy due to ongoing bleeding. Further reports of clinician experience with this type of renal injury are needed to clarify best practice in management.
Full Text Available Aim: Thoracic surgery is a branch, the efficiency of which is unquestionable for war. And during the civil war in Syria, thoracic surgery specialists have been feeling this efficiency so closely. So we want to share our experiences on patients sent from this region. Material and Method: The cases comprised of 41 patients in total, 33 men and 8 women, between the ages of 16-75, who were brought from Syria between the dates of August 2012 %u2013 November 2013. The files of the patients were received from archive. Results: Except 11 isolated thorax trauma patients, it was determined thorax and abdomen injuries at 9 patients (21.9%, thorax and extremity injuries at 8 patients (19.5%, thorax and vertebra injuries at 3 patients (7.3%, thorax, abdomen and cranium injuries at 5 patients (12.1%, thorax, abdomen and eye injuries at one patient (2.4%, thorax, abdomen and vertebra injuries at 3 patients (7.3%, thorax, abdomen and extremity injuries at one patient (2.4%. Discussion: Thoracic surgery is a lifesaving branch in case of fast and effectual medical intervention to injuries during war.
Pagels, Agneta A; Söderquist, Birgitta Klang; Heiwe, Susanne
To explore the impact of chronic kidney disease (CKD) on individual illness representations, including symptoms and causal attributions. Fifty-four patients responded to the Illness Perception Questionnaire (IPQ-R) and a further seven patients undertook cognitive interviews regarding the IPQ-R. All respondents had CKD stage 2-5, not undergoing renal replacement therapy. Those in earlier CKD stages and those with fewer symptoms perceived a significantly different understanding of their condition than those in more advanced disease stages or with more symptoms. Behavioural and psychological attributions were commonly referred to as contributing causes to CKD. These attributions were associated to negative illness representations. An uncertainty assessing symptoms attributed to CKD was indicated, especially in earlier disease stages. Illness representations differ with CKD stages and symptom burden. The patients in earlier disease stages or with fewer symptoms did not hold as strong beliefs about their illness as being a threat as those in advanced stages or with more symptoms. Self-blame emerged as a common causal attribution. Patients did not always relate symptoms to CKD, therefore this study identifies a gap in patients' disease knowledge, especially in earlier stages of the condition. © 2015 European Dialysis and Transplant Nurses Association/European Renal Care Association.
Kizza, I B; Muliira, J K
This study aimed to describe the perceived barriers, enablers and acute pain assessment practices of nurses caring for critically ill adult patients in a resource-limited setting. Acute pain is a common problem among critically ill adult patients, and nurses' play a central role in its control. Very few studies have examined nurses' acute pain assessment practices in resource-limited settings. A descriptive and cross-sectional design was used. A total of 170 nurses working in a Ugandan hospital were enrolled. Data were collected using a questionnaire measuring various aspects of pain assessment for critically ill adult patients. The majority of nurses had poor pain assessment practices. The most commonly performed pain assessment practices were documenting assessment findings, discussing pain assessment and management during nurse-to-nurse reports, and assessing for analgesics need before wound care. The main barriers to pain assessment were workload; lack of education and familiarity with assessment tools; poor documentation and communication of pain assessment priorities. The only reported enabler was physician's prescriptions for analgesia. Pain assessment practices were significantly associated with perceived workload and priority given to pain assessment. Pain assessment practices of nurses caring for critically ill adult patients in a resource-limited setting are affected by several barriers. Interventions to reduce barriers and enhance enablers of acute pain assessment are needed to improve pain management in critically ill adult patients. To be effective, the interventions have to be holistic and implemented by professional bodies and employers of nurses. © 2015 International Council of Nurses.
Viviers, Petrus J
Seeding of splenic tissue to extra-abdominal sites is a relatively infrequent consequence of open abdominal trauma. Immunological function of these small foci of ectopic splenic tissue is unknown and their use in determining the splenic function may be limited. In this case report, a patient is described who had previously undergone an emergency splenectomy. The absence of Howell-Jolly bodies on the blood smear in a patient who had previously undergone surgical splenectomy raised the suspicion of splenosis. The immunological features as well as non-invasive evaluation of these ill-defined splenic tissue sites are discussed.
Full Text Available Introduction: Head injury has been recognized as a major public health problem and is a frequent cause of death and disability in young people and makes considerable demands on health services. Motor vehicle accidents are the major causes of traumatic brain injury (TBI that its occurrence has been increasing in our country in recent years. Objective: We decided to study head injury in our region to evaluate the Epidemiological, clinical and radiological features of this health problem. Materials and methods: We reviewed 200 TBI-patients records in Ali ebn abitaleb hospital of Rafsanjan from November 2012 – September 2013. A Questionnaire including Age, Sex, Job, Cause of trauma, GCS, Brain CT Scan findings and clinical symptoms for every head trauma patient; was completed. Data were analyzed by SPSS software. We used Chi-square test and P-Value less than 0.05 was considered significant. Results: From the total of 200 patients, 73.5% were males and 26.5% were females. The most common age group was 20-24 years. Majority of patients were students. Traffic accidents were the major cause of injuries (64.5% and 35.5% of them were motorcyclist. The most frequent finding of Brain CT scan was skull fracture and subdural hematoma. 25% of patient had severe head injury. In clinical symptoms in conscious patients, headache, nausea, vomiting and vertigo was common. Conclusion: This study showed that we should pay more attention to traumatic brain injury young patients who are the most active potential forces of our society. Traffic accident s are the major reason for head injuries. Pay attention to prevention of this accident can perform important role in decreasing of head injuries.
Kritayakirana, Kritaya; M Maggio, Paul; Brundage, Susan; Purtill, Mary-Anne; Staudenmayer, Kristan; A Spain, David
Background : Damage control surgery and the open abdomen technique have been widely used in trauma. These techniques are now being utilized more often in non-trauma patients but the outcomes are not clear. We hypothesized that the use of the open abdomen technique in non-trauma patients 1) is more often due to peritonitis, 2) has a lower incidence of definitive fascial closure during the index hospitalization, and 3) has a higher fistula rate. Methods : Retrospective case series of patients t...
Zalewski, Maureen; Cyranowski, Jill M; Cheng, Yu; Swartz, Holly A
Independently, maternal depression and maternal history of childhood abuse confer risk for impaired parenting. These associations may be compounded when depressed mothers with histories of childhood abuse are faced with the challenge of parenting offspring who themselves struggle with mental health problems. This study examined the relationships among maternal history of childhood abuse, maternal depression, and parenting style in the context of parenting a psychiatrically ill child, with an emphasis on examining maternal emotional abuse and neglect. We hypothesized that maternal childhood emotional abuse would be associated with maladaptive parenting strategies (lower levels of maternal acceptance and higher levels of psychological control), independent of maternal depression severity and other psychosocial risk factors. Ninety-five mother-child dyads (children ages 7-18) were recruited from child mental health centers where children were receiving treatment for at least one internalizing disorder. Participating mothers met DSM-IV criteria for major depressive disorder. Mothers reported on their own childhood abuse histories and children reported on their mothers' parenting. Regression analyses demonstrated that maternal childhood emotional abuse was associated with child reports of lower maternal acceptance and greater psychological control, controlling for maternal depression severity, and other psychosocial risk factors. When treating psychiatrically ill children, it is important for a child's clinician to consider mothers' childhood abuse histories in addition to their history of depression. These mothers appear to have additional barriers to effective parenting. © 2013 Wiley Periodicals, Inc.
Rationale: Adrenal insufficiency occurs with varying frequency in critically ill patients. It is usually associated with a high mortality and poor clinical outcome. Objective: To determine the incidence of adrenal failure in patients with severe sepsis and septic shock admitted to our intensive care unit. Design: Prospective ...
Oral hygiene care includes a combination of nursing activities that are often placed very low on the priority care list for a critically ill patient. This may have detrimental implications for the patient. A literature review was done to identify and describe the available evidence related to the beneficial effects of oral hygiene care ...
Itenov, Theis S; Berthelsen, Rasmus Ehrenfried; Jensen, Jens-Ulrik
these patients. DESIGN: Observational study with development and validation of a risk prediction model. SETTING: Nine academic ICUs in Denmark. PARTICIPANTS: Development cohort of critically ill patients with AKI at ICU admission from the Procalcitonin and Survival Study cohort (n = 568), validation cohort...
Dybdal, Bitten; Svane, Christian; Hesselfeldt, Rasmus
BACKGROUND: Mortality may be higher for admissions at odd hours than during daytime, although for trauma patients results are conflicting. The objective of this study was to assess whether diurnal differences in mortality among severely injured trauma patients in Denmark were present. METHODS......: This observational cohort study was conducted between 1 December 2009 and 30 April 2011 involving one level 1 trauma centre and seven local emergency departments in eastern Denmark. Patients were consecutively included if received by a designated trauma team. Night-time patients (20:00-07:59) were compared...
Rosenthal, David; Kochupura, Paul V; Wellons, Eric D; Burkett, Allison B; Methodius-Rayford, Walaya C
retrieve; they also had fewer cases of significant tilt (>20%) than the GT filters, but the difference was not statistically significant. GT and Celect IVCFs placed at the ICU bedside under IVUS guidance in multiple-trauma patients was simple, safe, and avoided transporting critically ill patients out of the ICU. Further investigation of the single sheath IVUS technique and the role of retrievable IVCFs in multi-trauma patients is warranted.
White-Chu, E Foy; Reddy, Madhuri
Pressure ulcers can be challenging to prevent, particularly in patients with advanced illnesses. This review summarizes the relevant literature since 2011. Through a MEDLINE and CINAHL database search from January 1, 2011 to June 1, 2012, a total of 14 abstracts were found addressing the prevention of pressure ulcers in persons with advanced illness. Search terms included pressure ulcer, prevention, and control. Advanced illness was defined as patients transitioning from curative to supportive and palliative care. Ten original studies and four review articles specifically addressed pressure ulcer prevention. There were four articles that specifically addressed patients with advanced illness. The studies varied in quality. One systematic review, one randomized controlled trial, three prospective trials, two retrospective trials, one cost-effectiveness analysis, one quality improvement project, one comparative descriptive design, and four review articles were found. The interventions for pressure ulcer prevention were risk assessment, repositioning, surface selection, nutritional support and maintenance of skin integrity with or without incontinence. The quality of pressure ulcer prevention studies in persons with advanced illness is poor. Increased number and higher quality studies are needed to further investigate this important topic for these fragile patients.
Laursen, Jannie; Andresen, Kristoffer; Rosenberg, Jacob
Aims and Objective. To investigate the relatives' satisfaction and involvement on a general surgery ward regarding the critically ill patient. Introduction. Relatives to critically ill patients are affected both physically and mentally during the hospitalization of a family member. Research has...... shown that relatives do not always receive the attention they need from health professionals. There is a lack of studies that focus on relatives' satisfaction and involvement during their family members' hospitalization. Design. A mixed methods design was chosen. Methods. A quantitative study...... was conducted with 27 relatives to critically ill patients. All participated in a questionnaire and out of the 27 relatives, six participated in qualitative in-depth interviews. Results. The questionnaire revealed that relatives were dissatisfied with care and involvement. For further exploration...
Robert S Green
Full Text Available Context: Trauma patients requiring procedural sedation and analgesia (PSA may have increased risk of adverse events (AEs and poor outcomes. Aims: To determine the incidence of AEs in adult major trauma patients who received PSA and to evaluate their postprocedural outcomes. Settings and Design: Retrospective analysis of adult patients (age >16 who received PSA between 2006 and 2014 at a Canadian academic tertiary care center. Materials and Methods: We compared the incidence of PSA-related AEs in trauma patients with nontrauma patients. Postprocedural outcomes including Intensive Care Unit admission, length of hospital stay, and mortality were compared between trauma patients who did or did not receive PSA. Statistical Analysis Used: Descriptive statistics and multivariable logistic regression. Results: Overall, 4324 patients received PSA during their procedure, of which 101 were trauma patients (107 procedures. The majority (77% of these 101 trauma patients were male, relatively healthy (78% with American Society of Anesthesiologists Physical Status [ASA-PS] 1, and most (85% of the 107 procedures were orthopedic manipulations. PSA-related AEs were experienced by 45.5% of the trauma group and 45.9% of the nontrauma group. In the trauma group, the most common AEs were tachypnea (23% and hypotension (20%. After controlling for age, gender, and ASA-PS, trauma patients were more likely than nontrauma patients to develop hypotension (odds ratio 1.79; 95% confidence interval 1.11-2.89. Conclusion: Although trauma patients were more likely than nontrauma patients to develop hypotension during PSA, their outcomes were not worse compared to trauma patients who did not have PSA.
Oyebola Olubodun Adekola
Full Text Available Critically ill patients have poor physiological reserves, and are at increased risk of cardiopulmonary complications such as hypoxia, hypotension, arrhythmias and cardiac arrest when undergoing airway management. This study audited airway management in critically ill patients. Patients Method: A Prospective observational study in 120 critically ill adult patients who required endotracheal intubation over a one year period. Induction was with IV midazolam (0.15mg/kg, and suxamethonium (1.5mg/kg. Data collected included immediate complications (complications during intubation, and early complications (complications on days one to seven of tube insertion. Results: The median age was 32 years, males constituted 68 (56.6% and female 52 (43.4%. One hundred and fifty-eight intubation attempts were recorded, one attempt to success in 93 (77.5%, and 2 attempts in 22 (18.33%. Difficult intubation occurred in 17 (10.49%, of whom 5 subjects had more than 3 intubation attempts, and 2 had surgical tracheostomy performed. The intubation aids used included stylet in 86.67%, bougie (3.33%, and laryngeal mask airway (1.67%. There was a significant association between the number of attempts at intubation, and trauma, bleeding, oesophageal intubation, aspiration or cardiac arrest, P<0.05. Tubal blockade occurred in 65 (36.31% subjects after a median duration of 38.5 hours. Conclusion: This study elicited the need to review the airway management of critically ill patients in our institution, provide different airway and intubating devices during difficult intubation, and ensure appropriate training in airway skills.
Sonesson, Linda; Boffard, Kenneth; Lundberg, Lars; Rydmark, Martin; Karlgren, Klas
European surgeons are frequently subspecialized and trained primarily in elective surgical techniques. As trauma leaders, they may occasionally have to deal with complex polytrauma, advanced management techniques, differing priorities, and the need for multidisciplinary care. There is a lack of expertise, experience, and a low trauma volume, as well as a lack of research, with limited support as to the decision-making and teaching challenges present. We studied what experienced trauma experts describe as the challenges that are specific to the advanced surgical decision-making required, whether civilian, humanitarian, or military. Design-based research using combined methods including interviews, reviews of authentic trauma cases, and video-recorded resuscitations performed at a high-volume civilian academic trauma center. Several educational dilemmas were identified: (1) thinking physiologically, (2) the application of damage control resuscitation and surgery, (3) differing priorities and time management, (4) impact of environment, (5) managing limited resources, (6) lack of general surgical skills, (7) different cultural behavior, and (8) ethical issues. The challenges presented, and the educational domains identified, constitute a basis for improved development of education and training in complex surgical decision-making. This study contributes new knowledge about the mindset required for decision-making in patients with complex multisystem trauma and competing priorities of care. This is, especially important in countries having a low intensity of trauma in both military and civilian environments, and consequential limited skills, and lack of expertise. Guidelines focused on the same decision-making process, using virtual patients and blended learning, can be developed.
Full Text Available Obstetric patients admitted to an Intensive Care Unit (ICU present a challenge to an intensivist because of normal physiological changes associated with pregnancy and puerperium, the specific medical diseases peculiar to pregnancy and the need to take care of both the mother and the foetus. Most common causes of admission to an ICU for obstetric patients are eclampsia, severe preeclampsia, haemorrhage, congenital and valvular heart disease, septic abortions, severe anemia, cardiomyopathy and non-obstetric sepsis. The purpose of this review is to present the recent concepts in critical care management of obstetric patients with special focus mainly on ventilatory strategies, treatment of shock and nutrition. The details regarding management of individual diseases would not be discussed as these would be beyond the purview of this article. In addition, some specific issues of importance while managing such patients would also be highlighted.
Frewen, Paul A.; Oremus, Carolina; Lanius, Ruth A.; McKinnon, Margaret C.
Background Although preliminary work suggests that dissociative symptoms may impact neuropsychological performance in trauma-exposed populations, the relation between dissociation and cognitive performance has not been explored in patients with depression. Objective The present study examined dissociative symptoms in relation to neuropsychological performance in participants with a primary diagnosis of recurrent major depressive disorder (MDD) and a history of trauma exposure. Method Twenty-three participants with MDD and 20 healthy controls who did not differ in age, sex, education, or IQ were assessed. In addition to a standardized neuropsychological battery assessing frontotemporally mediated cognitive processes, participants completed clinical measures assessing dissociative symptoms, illness severity, and past history of trauma exposure. Results Among participants with MDD, greater severity of derealization was associated with reduced performance on measures of delayed visuospatial recall and recognition on a task of verbal memory recognition. In addition, more severe depersonalization was associated with slower processing speed and a response style lending itself toward better performance in a less active environment. Conclusions These findings point toward dissociative symptoms as a transdiagnostic factor associated with neuropsychological dysfunction in patients with depression and a history of trauma. Limitations and recommendations for future research are discussed. PMID:26927902
Full Text Available Background: Although preliminary work suggests that dissociative symptoms may impact neuropsychological performance in trauma-exposed populations, the relation between dissociation and cognitive performance has not been explored in patients with depression. Objective: The present study examined dissociative symptoms in relation to neuropsychological performance in participants with a primary diagnosis of recurrent major depressive disorder (MDD and a history of trauma exposure. Method: Twenty-three participants with MDD and 20 healthy controls who did not differ in age, sex, education, or IQ were assessed. In addition to a standardized neuropsychological battery assessing frontotemporally mediated cognitive processes, participants completed clinical measures assessing dissociative symptoms, illness severity, and past history of trauma exposure. Results: Among participants with MDD, greater severity of derealization was associated with reduced performance on measures of delayed visuospatial recall and recognition on a task of verbal memory recognition. In addition, more severe depersonalization was associated with slower processing speed and a response style lending itself toward better performance in a less active environment. Conclusions: These findings point toward dissociative symptoms as a transdiagnostic factor associated with neuropsychological dysfunction in patients with depression and a history of trauma. Limitations and recommendations for future research are discussed.
Rondi, Céline; Berney, Alexandre
The use of social media as a communication tool is rapidly growing in the community, and more specifically in patients, through illness blogs. This has been true for several years in North America, but is becoming a reality in Europe as well. We report here the first results of studies on the putative psychological benefits and risks of illness blogs for their authors. We also explore the possible impact of blogging on the patient-caregiver relationship. Social media are expected to have a growing influence in certain areas of health care. Physicians should therefore stay informed about them, take advantage of their benefits, and anticipate their risks.
Thompson, Lee; Hill, Michael; Davies, Caroline; Shaw, Gary; Kiernan, Matthew D
Major trauma is often life threatening and the leading cause of death in the United Kingdom (UK) for adults aged less than 45 years old. This study aimed to identify pre-hospital factors associated with patient outcomes for major trauma within one Regional Trauma Network. Secondary analysis of pre-hospital audit data and patient outcome data from the Trauma Audit Research Network (TARN) was undertaken. The primary outcome used in analysis was 'Status at Discharge' (alive/deceased). Independent variables considered included 'Casualty Characteristics' such as mechanism of injury (MOI), age, and physiological measurements, as well as 'Response Characteristics' such as response timings and skill mix. Binary Logistic Regression analysis using the 'forward stepwise' method was undertaken for physiological measures taken at the scene. The study analysed 1033 major trauma records (mean age of 38.5 years, SD 21.5, 95% CI 37-40). Adults comprised 82.6% of the sample (n = 853), whilst 12.9% of the sample were children (n = 133). Men comprised 68.5% of the sample (n = 708) in comparison to 28.8% women (n = 298). Glasgow Coma Score (GCS) (p < 0.000), Respiration Rate (p < 0.001) and Age (p < 0.000), were all significant when associated with the outcome 'Status at Discharge' (alive/deceased). Isolated bivariate associations provided tentative support for response characteristics such as existing dispatching practices and the value of rapid crew arrival. However, these measurements appear to be of limited utility in predictive modelling of outcomes. The complexity of physiological indices potentially complicate their predictive utility e.g. whilst a Systolic Blood Pressure (SBP) of < 90 mmHg serves as a trigger for bypass to a Major Trauma Centre, the utility of this observation is nullified in cases of Traumatic Brain Injury. Analysis suggested that as people age, outcomes from major trauma significantly worsened. This finding is consistent with existing research
Fellner, F.A.; Krieger, J.; Floery, D.; Lechner, N.
Patients with severe, life-threatening trauma require a fast and accurate clinical and imaging diagnostic workup during the first phase of trauma management. Early whole-body computed tomography has clearly been proven to be the current standard of care of these patients. A similar imaging quality can be achieved in the multiple trauma setting compared with routine imaging especially using rapid, latest generation computed tomography (CT) scanners. This article encompasses a detailed view on the use of CT in patients with life-threatening trauma. A special focus is placed on radiological procedures in trauma units and on the methods for CT workup in routine cases and in challenging situations. Another focus discusses the potential of dose reduction of CT scans in multiple trauma as well as the examination of children with severe trauma. Various studies have demonstrated that early whole-body CT positively correlates with low morbidity and mortality and is clearly superior to the use of other imaging modalities. Optimal trauma unit management means a close cooperation between trauma surgeons, anesthesiologists and radiologists, whereby the radiologist is responsible for a rapid and accurate radiological workup and the rapid communication of imaging findings. However, even in the trauma setting, aspects of patient radiation doses should be kept in mind. (orig.) [de
Mikhail A. Nekrasov
Full Text Available Background: Mental illness (MI markedly affects a person’s daily living and leads to disability, reduced duration of active life and, finally, tremendous economic losses incurred by the state and society. Moreover, it has an adverse impact on the patient’s immediate social surroundings. The aim of the research was to study various aspects of mentally ill patients’ daily living and their social environment in order to optimize psychosocial rehabilitation programs and therapies. Methods: One thousand forty two mentally ill people and 580 persons from their social environment participated in an anonymous social survey. The survey was carried out using specially developed structured questionnaires. The results showed that MI changes the quality of life of mentally ill people (MIP: impaired well-being (84.4%, curbing of interests (36.0%, increased emotional sensitivity (39.0%, low self-esteem (75.4%, problems in family relations (78.0%, dramatic loss of sexual activity (72.3%, and in 75.8% patients – stigmatizing effect of their MI. The presence of a mentally-ill member in a family significantly affected the life and inner world of people close to that member, and modified their professional activity (38.8%, daily living (56.8% and emotional state (36.2%. Conclusion: To improve application of psychosocial rehabilitation methods, an attempt was made to conduct a comprehensive medical and social study of the mentally ill and their social environment.
Kuppens, Kevin; Neels, Hedwig; van Wilgen, C. Paul; Roussel, Nathalie; Heyrman, Annette; Lambrecht, Luc; van Ittersum, Miriam W.; Nijs, Jo
Objective: Illness perceptions, i.e. how patients think about their illness in terms of identity, cause and consequences, are important, as negative illness perceptions are associated with maladaptive illness behavior, more dysfunctioning, poor treatment adherence and treatment outcome. As illness
Ringdal, Kjetil G; Lossius, Hans Morten; Jones, J Mary
ABSTRACT: INTRODUCTION: No worldwide, standardised definitions exist for documenting, reporting, and comparing data from severely injured trauma patients. This study evaluated the feasibility of collecting the data variables of the international consensus-derived Utstein Trauma Template. METHODS......: Trauma centres from three different continents were invited to submit Utstein Trauma Template core data during a defined period, for up to 50 consecutive trauma patients. Directly admitted patients with a New Injury Severity Score (NISS) equal to or above 16 were included. Main outcome variables were...... was 27 (IQR 20-38), and blunt trauma predominated (91.1%). Of the 36 Utstein variables, 13 (36%) were collected by all participating centres. Eleven (46%) centres applied definitions of the survival outcome variable that were different from those of the template. Seventeen (71%) centres used...
Coccolini, Federico; Montori, Giulia; Catena, Fausto; Kluger, Yoram; Biffl, Walter; Moore, Ernest E; Reva, Viktor; Bing, Camilla; Bala, Miklosh; Fugazzola, Paola; Bahouth, Hany; Marzi, Ingo; Velmahos, George; Ivatury, Rao; Soreide, Kjetil; Horer, Tal; Ten Broek, Richard; Pereira, Bruno M; Fraga, Gustavo P; Inaba, Kenji; Kashuk, Joseph; Parry, Neil; Masiakos, Peter T; Mylonas, Konstantinos S; Kirkpatrick, Andrew; Abu-Zidan, Fikri; Gomes, Carlos Augusto; Benatti, Simone Vasilij; Naidoo, Noel; Salvetti, Francesco; Maccatrozzo, Stefano; Agnoletti, Vanni; Gamberini, Emiliano; Solaini, Leonardo; Costanzo, Antonio; Celotti, Andrea; Tomasoni, Matteo; Khokha, Vladimir; Arvieux, Catherine; Napolitano, Lena; Handolin, Lauri; Pisano, Michele; Magnone, Stefano; Spain, David A; de Moya, Marc; Davis, Kimberly A; De Angelis, Nicola; Leppaniemi, Ari; Ferrada, Paula; Latifi, Rifat; Navarro, David Costa; Otomo, Yashuiro; Coimbra, Raul; Maier, Ronald V; Moore, Frederick; Rizoli, Sandro; Sakakushev, Boris; Galante, Joseph M; Chiara, Osvaldo; Cimbanassi, Stefania; Mefire, Alain Chichom; Weber, Dieter; Ceresoli, Marco; Peitzman, Andrew B; Wehlie, Liban; Sartelli, Massimo; Di Saverio, Salomone; Ansaloni, Luca
Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.
Linder, Fredrik; Holmberg, Lina; Eklöf, Hampus; Björck, Martin; Juhlin, Claes; Mani, Kevin
To evaluate trauma triage criteria in terms of compliance, undertriage, and overtriage and identify risk factors for mistriage. In a retrospective cohort study, all consecutive trauma patients at a University Hospital in Sweden in 2012 were included. Patients were stratified into three groups on the basis of trauma team activation (full trauma team, limited trauma team, and no trauma team). Case records were reviewed for mechanism of injury, vital signs, and injuries. Compliance with alert criteria was evaluated and injury severity score combined with the Matrix method was used for assessment of overtriage and undertriage. A total of 1424 trauma patients were included in the study. Seventy-three (5.1%) patients activated a full trauma team, 732 (51.4%) a limited trauma team, and 619 (43.5%) did not activate any trauma team. Undertriage was 2.7% [95% confidence interval (CI): 1.9-3.8%] and overtriage was 34.2% (95% CI: 23.5-46.3%) in the complete cohort. Compliance with 'trauma triage criteria' was assessed by comparing actual alerts with what was estimated to be the correct alert levels on the basis of prehospital case records. Compliance with full trauma team criteria was 80% (68-88%), limited trauma team was 54% (51-58%), and no trauma team was 79% (76-82%). Assuming full compliance with trauma criteria, the Matrix method resulted in an undertriage of 2.3% (95% CI: 1.6-3.3%) and an overtriage of 42.6% (95% CI: 32.4-53.2%). The overtriage and undertriage in this study is in line with the recommendations of the American College of Surgeons Committee on Trauma. However, better compliance with trauma alert criteria would result in fewer trauma team activations without affecting patient safety.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or
Häske, David; Böttiger, Bernd W; Bouillon, Bertil; Fischer, Matthias; Gaier, Gernot; Gliwitzky, Bernhard; Helm, Matthias; Hilbert-Carius, Peter; Hossfeld, Björn; Meisner, Christoph; Schempf, Benjamin; Wafaisade, Arasch; Bernhard, Michael
Suitable analgesic drugs and techniques are needed for the acute care of the approximately 18 200-18 400 seriously injured patients in Germany each year. This systematic review and meta-analysis of analgesia in trauma patients was carried out on the basis of randomized, controlled trials and observational studies. A systematic search of the literature over the 10-year period ending in February 2016 was carried out in the PubMed, Google Scholar, and Springer Link Library databases. Some of the considered trials and studies were included in a meta-analysis. Mean differences (MD) of pain reduction or pain outcome as measured on the Numeric Rating Scale were taken as a summarizing measure of treatment efficacy. Out of 685 studies, 41 studies were considered and 10 studies were included in the meta-analysis. Among the drugs and drug combinations studied, none was clearly superior to another with respect to pain relief. Neither fentanyl versus morphine (MD -0.10 with a 95% confidence interval of [-0.58; 0.39], p = 0.70) nor ketamine versus morphine (MD -1.27 [-3.71; 1.16], p = 0.31), or the combination of ketamine and morphine versus morphine alone (MD -1.23 [-2.29; -0.18], p = 0.02) showed clear superiority regarding analgesia. Ketamine, fentanyl, and morphine are suitable for analgesia in spontaneously breathing trauma patients. Fentanyl and ketamine have a rapid onset of action and a strong analgesic effect. Our quantitative meta-analysis revealed no evidence for the superiority of any of the three substances over the others. Suitable monitoring equipment, and expertise in emergency procedures are prerequisites for safe and effective analgesia by healthcare professionals..
Halpern, Casey H; Milby, Andrew H; Guo, Wensheng; Schuster, James M; Gracias, Vicente H; Stein, Sherman C
Meta-analytic costeffectiveness analysis. Our goal was to compare the results of different management strategies for trauma patients in whom the cervical spine was not clinically evaluable due to impaired consciousness, endotracheal intubation, or painful distracting injuries. We performed a structured literature review related to cervical spine trauma, radiographic clearance techniques (plain radiography, flexion/extension, CT, and MRI), and complications associated with semirigid collar use. Meta-analytic techniques were used to pool data from multiple sources to calculate pooled mean estimates of sensitivities and specificities of imaging techniques for cervical spinal clearance, rates of complications from various clearance strategies and from empirical use of semirigid collars. A decision analysis model was used to compare outcomes and costs among these strategies. Slightly more than 7.5% of patients who are clinically unevaluable have cervical spine injuries, and 42% of these injuries are associated with spinal instability. Sensitivity of plain radiography or fluoroscopy for spinal clearance was 57% (95% CI: 57%-60%). Sensitivities for CT and MRI alone were 83% (82%-84%) and 87% (84%-89%), respectively. Complications associated with collar use ranged from 1.3% (2 days) to 7.1% (10 days) but were usually minor and short-lived. Quadriplegia resulting from spinal instability missed by a clearance test had enormous impacts on longevity, quality of life, and costs. These impacts overshadowed the effects of prolonged collar application, even when the incidence of quadriplegia was extremely low. As currently used, neuroimaging studies for cervical spinal clearance in clinically unevaluable patients are not cost-effective compared with empirical immobilization in a semirigid collar.
et al.,15 that absence of prenatal care was a predictor of maternal mortality in critically ill obstetric patients, the booking status in this study was not a predictor of mortality. This could be because the delay in recognition of the need for ICU care and delays in presentation could have removed the otherwise expected beneficial ...
More than half (57.5%) were married while about a third (36.3%) were widowed. Children of subjects constituted the largest percentage (78.2%) of caregivers. The three most common psychiatric illnesses were Depression (41%), Dementia (27%) and Schizophrenia (15%). A large proportion (61.8%) of the patients attended ...
Objectives: To document mortality among critically ill obstetric and gynaecological patients requiring intensive care unit (ICU) admission and to investigate whether any poor prognostic features could allow for earlier and more aggressive intervention. Study design: A retrospective study of all obstetric apd gynaecological ...
Cohen, Alexander T.; Spiro, Theodore E.; Büller, Harry R.; Haskell, Lloyd; Hu, Dayi; Hull, Russell; Mebazaa, Alexandre; Merli, Geno; Schellong, Sebastian; Spyropoulos, Alex C.; Tapson, Victor; Cohen, A. T.; Haskell, L.; Hu, D.; Hull, R.; Mebazaa, A.; Merli, G.; Schellong, S.; Spiro, T.; Spyropoulos, A. C.; Tapson, V.; Francis, C.; Kobayashi, S.; Leizorovicz, A.; Lowe, G.; Roberts, R.; Brandges, D.; Kolbach, D.; Limburg, M. L.; Mac Gillavry, M. R.; Otten, H. M.; Peters, R. G. J.; Prins, M. [=Martin H.; Robben, S.; Voorend, M.; Hemmrich, M.; Li, L.; Meng, I.; Mühlhofer, E.; Beckmann, H.; Desanctis, Y.; Duszczyszyn, A.; Fielding, L.; Twomey, T.; Müller, K.; Byra, W.; Nessel, C.; Atkinson, Sarah; Bottaro, F. J.; Caberlotto, O.; Grand, B.; Hendler, H.; Hojman, M.; Mykietiuk, A.; Salerno, R.; Baker, R.; Carroll, P.; Chong, B.; Colquhoun, D.; Gan, E.; Hall, S.; Jackson, D.; Leyden, M.; Salem, H.; Serisier, D.; Balcke, P.; Bauer, B.; Bauer, N. C.; Erlacher, L.; Fortunat, W.; Grafl, E.; Keil, F.; Kirchmair, P.; Pilger, E.; Schönherr, H.-R.; Siostrzonek, P.; Weidinger, F.; Weltermann, A.; Wenisch, C.; Blockmans, D.; Delobbe, A.; Hendrickx, K.; Jacquy, C.; Soupart, A.; Striekwold, H.; van Hoof, M.-E.; Vanden Abeele, A.; van Roey, G.; van Zandweghe, L.; Bizzacchi, J. M. A.; Cavalheiro, C.; Chamone, D.; Fiss, E.; Garicochea, B.; Lopes, A. C.; Rocha Moreira, R. C.; van Bellen, B.; Dimov, D.; Ivanov, Y.; Lyubenov, L.; Milanov, S.; Mincheva, V.; Nenkova, S.; Popov, D.; Taseva, M.; Bergeron, C.; Boulanger, J.-M.; Buck, B.; Daneault, N.; Desai, H.; Dube, F.; Kutsogiannis, D. J.; Miron, M.-J.; Moddel, G.; Shuaib, A.; Silver, F.; Stotts, G.; Verreault, S.; Bugedo, G.; Torres, H.; Chen, K.-N.; Chen, P.; Chen, R. C.; Chen, Y.; Gai, L.; Gao, Q.; Guo, S.; Hu, T.; Hua, Q.; Li, H.; Li, J.; Li, W.; Li, Y.-S.; Liu, C.; Liu, J.; Liu, Y.; Qi, G.; Qin, X.; Shen, C.; Sun, S.; Sun, Y.; Wan, Q.; Wang, C.; Wang, H.; Wang, Y.; Wu, C.; Wu, J.; Wu, S.; Xian, S.; Xiu, Q.; Xu, B.; Yan, X.; Yang, K.; Yang, L.; Yang, Y.; Zhang, D. P.; Zhang, J.; Zhang, S.; Zhao, Y.; Zhao, Z.; Zhou, Y.; Botero, R.; Cedano, J. E.; Fajardo, D.; Gómez, L. F.; Jaramillo, C. F.; Rada, R.; Uribe, L. G.; Velásquez, J. C.; Bergovec, M.; Hajnsek, S.; Knezevic, A.; Samarzija, M.; Steiner, R.; Zupancic-Salek, S.; Fiksa, J.; Gorican, K.; Linhart, A.; Macel, I.; Mayer, O.; Prochazka, V.; Sedlacek, J.; Avnstrøm, S.; Nielsen, H.; Nielsen, T.; Østergaard, O. V.; Tuxen, C.; Kolbassova, O.; Lember, M.; Marandi, T.; Uuetoa, T.; Karmakoski, J.; Lassila, R.; Aquilanti, S.; Bergmann, J.-F.; Brisot, D.; Debourdeau, P.; Duchemin, A.; Farge-Bancel, D.; Fournier, C.; Galinier, M.; Lacroix, P.; Lambert, M.; Le Jeunne, C.; Lorcerie, B.; Mahe, I.; Marquette, C.-H.; Mismetti, P.; Mottier, D.; Proust, A.; Quere, I.; Rihani, R.; Schmidt, J.; Stephan, D.; Vital-Durand, D.; Barth, J.; Beyer-Westendorf, J.; Borst, M.; Dormann, A.; Drouven, F.-M.; Espinola-Klein, C.; Heintges, T.; Hindahl, H.; Klotz, T.; Lawall, H.; Leschke, M.; Milstrey, H.-R.; Möbius-Winkler, S.; Mühlbauer, B.; Niederau, C.; Petermann, W.; Pohl, C.; Ringe, J.-D.; Sanner, B.; Scharrer, I.; Schmidt-Lucke, J. A.; Schöffauer, I.; Stoelben, E.; Theelen, W.; Veltkamp, R.; vom Dahl, J.; Apsokardos, S.; Babalis, D.; Bassaris, H.; Karafoulidou, A.; Katsivas, A.; Panoutsopoulos, G.; Patsilinakos, S.; Skoutelis, A.; Toubis, M.; Vlastos, F.; Wong, L. K. S.; Wong, R. S. M.; Frankfurter, Z.; Nagy, F.; Jakab, G.; Kondakor, I.; Nikl, J.; Nyirati, G.; Szakacs, Z.; Szegedi, N.; Avvaru, G.; Bhairappa, S.; Cheviri, A. N.; Gadkari, M.; Grant, P.; Kuchimanchi, K.; Kumar, K. P.; Mahajan, A.; Naik, A.; Oomman, A.; Raghu, C.; Ramanathan, R. M. P. L.; Talwar, D.; Whig, J.; Kalim, H.; Machfoed, M. H.; Tambunan, K. L.; Elias, M.; Elias, N.; Hayek, T.; Lishner, M.; Oren, S.; Osamah, H.; Sthoeger, Z.; Telman, G.; Zeltser, D.; Zimlichman, R.; Ageno, W.; Agnelli, G.; Berrettini, M.; Bondi, M.; Buzzoni, R.; Castaman, G.; de Blasio, A.; de Gaudenzi, E.; Falanga, A.; Fontanella, A.; Giorgi Pierfranceschi, M.; Landolfi, R.; Lodigiani, C.; Morra, E.; Parise, P.; Pini, M.; Pizzini, A.; Poggio, R.; Quintavalla, R.; Siragusa, S.; Violi, F.; Ando, S.; Fujimoto, K.; Fukui, K.; Funada, J.; Hataji, O.; Ibata, H.; Ichinose, T.; Ikefuji, H.; Imai, S.; Ito, K.; Kani, H.; Kato, M.; Momiyama, Y.; Nishi, S.; Mekaru, S.; Mio, T.; Nagaoka, M.; Nakagawa, H.; Nakamura, Y.; Okazaki, O.; Oshiro, K.; Ozawa, T.; Saito, T.; Sakagami, S.; Shimizu, A.; Shiohira, Y.; Tanaka, E.; Uchiyama, T.; Utsugisawa, K.; Tsuji, T.; Wada, A.; Yamada, N.; Bang, S.-M.; Chung, C.-S.; Kang, D. W.; Kim, Y.-K.; Lee, Y.-S.; YeunOh, D.; Yoon, B.-W.; Aizsilniece, I.; Krievins, D.; Kupcs, U.; Pontaga, N.; Rozitis, V.; Stukena, I.; Alekniene, B.; Bagdonas, A.; Basijokiene, V.; Butkiene, Z.; Griskeviciene, V.; Gumbrevicius, G.; Norviliene, R.; Petrauskiene, R.; Stonkus, S.; Vitkauskas, A.; Muller, P.; Rauh, S.; Chin, S. P.; Sim, K. H.; Wan Azman, B. W. A.; Cardoza Amador, J. I.; Gallegos Martínez, J.; Gómez Lara, M.; González Garza, J.; Hernández Gaeta, D. E.; Herver Cabrera, M. J.; Nares Ochoa, F.; Perea Sánchez, R. A.; Romero López, C.; Tanaka Chávez, A.; Vázquez López, M. Á; Velasco Rodríguez, V. M.; Dees, A.; de Kreuk, A. M.; Fijnheer, R.; ten Cate, H.; Jackson, S.; Ockelford, P.; Simpson, D.; Ghanima, W. K.; Schjesvold, F. H.; Stokstad, I.; Torp, R.; Aziz, Z.; Rizvi, N.; Tayyab, G. N.; Arrieta Días, F.; Castillo Leon, R.; Cotrina, R.; Moncada Vilela, Z.; Salas Pérez, M.; Salazar Candiotti, O. C.; Ulloa Pérez, V. R.; Biedrzycka, M.; Bojarska-Los, M.; Goch, A.; Gorska, M.; Gutowska-Jablonska, M.; Jahnz-Rozyk, K.; Krysiak, W.; Mirek-Bryniarska, E.; Ogorek, M.; Sydor, A.; Szczeklik, A.; Walasek, L.; Wrzesinski, K.; Zechowicz, T.; Bettencourt, P.; Ducla Soares, J.; Ferreira, A.; Ferreira, F.; Gomes, F.; Martins, A.; Mello e Silva, A.; Providência, L.; Rodrigues, T.; Santos, F.; Aroutynov, G.; Ershova, O.; Fedorova, T.; Glezer, M. G.; Khatkova, S.; Moiseev, V.; Shilkina, N.; Sotnikov, A.; Chua, G.; Gan, H. W.; Ng, A. W. K.; Ong, T. H.; Tan, R. S.; Tang, O. T.; Gaspar, L.; Kovar, F.; Spisak, V.; Stevlik, J.; Szentivanyi, M.; Flezar, M.; Gorjup, V.; Jereb, M.; Sok, M.; Tratar, G.; Zvan, B.; Adler, D.; Bloy, B.; Dreosti, L. M.; Engelbrecht, J. M.; Janse van Rensburg, H.; Koegelenberg, C. F. N.; Nortje, H.; Quinton, S.; Rabie, W. J.; Rapoport, B. L.; Roodt, A.; Smith, C.; Steenkamp, F. W. F. J.; van Nieuwenhuizen, E.; van Zyl, L.; Bisbe, J.; Castro, A.; Cereto Castro, F.; Conget, F.; Guil, M.; Monreal, M.; Nieto Rodríguez, J.-A.; Tirado Miranda, R.; Tolosa, C.; Trujillo Santos, J.; Villalta, J.; Bertholds, E.; Cwikiel, M.; Laska, A.-C.; Östergren, J.; Själander, A.; Svensson, P.; Timberg, I.; Torstensson, I.; Wiklund, P. G.; Banyai, M.; Baumgartner, I.; Imhof, A.; Jeanneret, C.; Nussbaumer, P.; Schifferli, J. A.; Chuang, K. Y.-C.; Guo, B.-F.; Lee, J. T.; Lin, Y.-H.; Shyu, K.-G.; Permpikul, C.; Pothirat, C.; Wattanathum, A.; Goker, E.; Ilerigelen, B.; Kucukoglu, S.; Nalbantgil, S.; Sirin, H.; Yilmaz, U.; Genyk, S.; Goncharova, Y.; Karpenko, O.; Korzh, O.; Koval, V.; Legkonogov, O.; Perepeliuk, M.; Polyakov, A.; Ryabichenko, T.; Skrebkov, V.; Sorkin, V.; Svyshchenko, Y.; Tseluyko, V.; Vakaliuk, I.; Vatutin, M.; Voronkov, L.; Cohen, A.; Durairaj, R.; Elliott, M.; Kesteven, P.; Luckit, J. K.; Rafferty, P.; Scully, M.; Albrecht, C. R.; Anderson, S.; Benninghoff, M.; Bidair, M.; Birch, T. A.; Brensilver, J.; Chastain, S.; Chen, D.; Comerota, A. J.; Concha, M.; Conrad, S. A.; Cox, M. J.; Daboul, N. Y.; Dexter, J.; Dietrich, D. W.; Fei, R. H.; Fontes, M. L.; French, W. J.; Gonzales, E.; Hazelrigg, M. R.; Heller, B. N.; Heyder, A. M.; Hill, G. T.; Jaffer, A. K.; Jetty, P.; Johnson, G.; Kaatz, S.; Kazimir, M.; Lavender, R. C.; Lawton, C. B.; Lerner, R.; Light, R. W.; Ling, T. G.; Mahal, S.; Manos, P.; Masson, J.; Maynor, K.; McLafferty, R. B.; Mehra, P.; Merli, G. J.; Minkowitz, H. S.; Murray, R. M.; Nadar, V.; Nathanson, A.; Patton, W. F.; Peberdy, M.; Plautz, M.; Pokharel, P.; Quintana, O. E.; Rajamani, K.; Rastogi, P.; Reiter, W. M.; Reyes, J. A.; Schuller, D.; Seibert, A.; Sharma, A.; Simmons, J.; Soff, G. A.; Stein, R. W.; Stoltz, S.; Suen, J.; Thurm, C.; Toe, W.; Updegrove, J. D.; Ward, J. A.; Waxman, K.; Welker, J.; Whittier, F. C.; Wright, P. E.; Wun, T.; Yusen, R. D.; Ziedalski, T. M.
Background The clinically appropriate duration of thromboprophylaxis in hospitalized patients with acute medical illnesses is unknown. In this multicenter, randomized, double-blind trial, we evaluated the efficacy and safety of oral rivaroxaban administered for an extended period, as compared with
disorders. Hence, as suggested by Clarke and colleagues (1989) 9, patients should not be assessed for mental disorders after ruling out a physical illness .... ns. Table 3: Frequency of the psychiatric disorders. Psychiatric disorder. Prevalence in study sample (N =258). Major depression. 33.7% (87). Anxiety disorder.
Background: Stress ulcer prophylaxis is an integral part of the care of the critically ill. Agents that alter gastric pH may predispose these patients to gastric colonisation, with subsequent pneumonia and/or sepsis. Cytoprotective agents such as sucralfate preserve gastric acidity and may be protective. Objective: To determine ...
Thim, Troels; Krarup, Niels Henrik; Grove, Erik Lerkevang; Løfgren, Bo
This systematic approach to the immediate assessment and treatment of the critically ill or injured patient is applicable in all clinical emergencies. The aim of the ABCDE approach is to facilitate immediate life-saving treatment and thus buy time for definite diagnosis and treatment by breaking down complex clinical situations into manageable parts. Application of the ABCDE approach may improve treatment quality.
Berg, D.P.G. van den; Bont, P.A.J.M. de; Vleugel, B.M. van der; Roos, C.J.A.M. de; Jongh, A. de; Minnen, A. van; Gaag, M. van der
Objectives: Most clinicians refrain from trauma treatment for patients with psychosis because they fear symptom exacerbation and relapse. This study examined the negative side effects of trauma-focused (TF) treatment in patients with psychosis and posttraumatic stress disorder (PTSD). Methods:
trauma patients 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Colin F. Mackenzie, MBChB, Yulei Wang, MS, Peter...Medical Electronics, Jupiter , FL) in our 13-bay trauma resuscitation unit from the networked patient monitors (GE-Marquette-Solar-7000/8000, GE Healthcare
Duus, B R; Hauch, O; Damm, P
The value of peritoneal lavage (PL) in the evaluation of 82 patients with equivocal signs after abdominal trauma was studied. The closed technique using an Intracatch (R) was employed. Fifty-four patients had blunt trauma, the predictive value of a positive PL was 86% and the predictive value of ...
Lisette Schoonhoven; T. Meijs; Sivera Berben; A. van Vugt; P. van Grunsven
The aim of this study was to give insight in the prevalence of pain, and the (effect of) pain management according to the national emergency medical services analgesia protocol in trauma patients in the Netherlands. The retrospective document study included adult and alert trauma patients. Data
van den Berg, D.P.G.; de Bont, P.A.J.M.; van der Vleugel, B.M.; de Roos, C.; de Jongh, A.; van Minnen, A.; van der Gaag, M.
Objectives: Most clinicians refrain from trauma treatment for patients with psychosis because they fear symptom exacerbation and relapse. This study examined the negative side effects of trauma-focused (TF) treatment in patients with psychosis and posttraumatic stress disorder (PTSD). Methods:
Russell, Derek W; Janz, David R; Emerson, William L; May, Addison K; Bernard, Gordon R; Zhao, Zhiguo; Koyama, Tatsuki; Ware, Lorraine B
Hyperoxia is common early in the course of resuscitation of critically ill patients. It has been associated with mortality in some, but not all, studies of cardiac arrest patients and other critically ill cohorts. Reasons for the inconsistency are unclear and may depend on unmeasured patient confounders, the timing and duration of hyperoxia, population characteristics, or the way that hyperoxia is defined and measured. We sought to determine whether, in a prospectively collected cohort of mechanically ventilated patients with traumatic injuries with and without head trauma, higher maximum partial pressure of arterial oxygen (PaO2) within 24 hours of admission would be associated with increased risk of in-hospital mortality. Critically ill patients with traumatic injuries undergoing invasive mechanical ventilation enrolled in the Validating Acute Lung Injury biomarkers for Diagnosis (VALID) study were included in this study. All arterial blood gases (ABGs) from the first 24 hours of admission were recorded. Primary analysis was comparison of the highest PaO2 between hospital survivors and non-survivors. A total of 653 patients were evaluated for inclusion. Of these, 182 were not mechanically ventilated or did not have an ABG measured in the first 24 hours, leaving 471 patients in the primary analysis. In survivors, the maximum PaO2 was 141 mmHg (median, interquartile range 103 - 212) compared to 148 mmHg (IQR 105 - 209) in non-survivors (p = 0.82). In the subgroup with head trauma (n = 266), the maximum PaO2 was 133 mmHg (IQR 97 - 187) among survivors and 152 mmHg (108 - 229) among nonsurvivors (p = 0.19). After controlling for age, injury severity score, number of arterial blood gases, and fraction of inspired oxygen, maximum PaO2 was not associated with increased mortality (OR 1.27 for every fold increase of PaO2 (95% CI 0.72 - 2.25). In mechanically ventilated patients with severe traumatic injuries, hyperoxia in the first 24 hours of admission was not associated
Full Text Available Direct trauma to the airway is a rare injury which can lead to disastrous consequences due to compounding effect of bleeding, aspiration of blood, airway obstruction and severe sympathetic stimulation. Here we are presenting two cases of open tracheal injury in two adult males following assault with sharp weapon. Two different techniques of securing the airways were employed depending upon the severity and urgency of the situation. In the first case, orotracheal intubation helped the surgeon to repair airway around the endotracheal tube whereas in the second patient this stenting effect was absent as he was intubated through the distal cut-end of trachea in the face of airway emergency.
Full Text Available Ambulance crew’s choosing of appropriate destination hospital for trauma patients can affect survival and morbidity outcomes. Aim of the present study is to devise a decision-making algorithm in order to allow the best choice of destination hospital for trauma patients and to apply it on an electronic device able to facilitate the decision made by ambulance staff. The method used was analysis of literature data, context and workload with a retrospective observational study. A comparison between the destination hospitals actually chosen and those that could have been chosen with the Piacenza trauma algorithm has been applied. The data shows a 9.5% (P>0.10 more advantageous change in appropriateness in the choice of medical facility and a 1.4% increase in admissions to the Emergency Department of the provincial hospital. The creation and use of a medical protocol and its consequent installation on an electronic device (tablet that can be shared over a computer platform could help medical staff make appropriate pre-hospital choices as regards the destination hospital for trauma patients.
Giannousi, Zoe; Manaras, Irene; Georgoulias, Vassilis; Samonis, George
The Revised-Illness Perception Questionnaire (IPQ-R) assesses illness perceptions according to Leventhal's self-regulatory model. The aim of this paper is to present findings on the reliability and validity of the IPQ-R in a population of Greek cancer patients. A total of 206 patients completed a Greek translation of the IPQ-R and the Greek version of the Beck Depression Inventory (BDI). The scale's reliability was investigated by examining its internal consistency (Cronbach's alpha) and its test-retest reliability. Structural validity was examined through factor analyses. Predictive validity was tested by regressing BDI scores on IPQ subscale scores. Inter-relationships between IPQ-R dimensions were also examined by computing Pearson's Correlation Coefficients. Cronbach's alpha showed satisfactory internal consistency for the IPQ-R subscales. Paired samples' t-test showed good test-retest reliability. Factor analysis of the IPQ-R items revealed that the Greek version reflects the structure of the original with the only difference being that the 'Consequences' and 'Emotional Representations' subscales loaded on one factor. Factor analysis of the causal dimension items revealed a different structure of Causal Representations than that of the original questionnaire yielding three main factors: Psychological Attributions, Behavioral, and External Factors. Multiple regression analyses showed that Consequences, Emotional Representations, Illness Identity, and Psychological Attributions were the best predictors for depression. Translation of the IPQ-R has good reliability and similar structure to that of the original. Difficulties to confirm the structure of Causal Representations may represent cultural differences in understanding illness causation. (c) 2009 John Wiley & Sons, Ltd.
Kamkar, Mohammad Zaman; Sanagoo, Akram; Zargarani, Fatemeh; Jouybari, Leila; Marjani, Abdoljalal
Background: Metabolic syndrome is commonly associated with cardiovascular diseases and psychiatric mental illness. Hence, we aimed to assess the metabolic syndrome among severe mental illness (SMI). Materials and Methods: The study included 267 patients who were referred to the psychiatric unit at 5th Azar Education Hospital of Golestan University of Medical Sciences in Gorgan, Iran. Results: The mean waist circumference, systolic and diastolic blood pressure, triglyceride and fasting blood glucose levels were significantly higher in the SMI with metabolic syndrome, but the high density lipoprotein (HDL)-cholesterol was significantly lower. The prevalence of metabolic syndrome in SMI patients was 20.60%. There were significant differences in the mean of waist circumference, systolic (except for women) and diastolic blood pressure, triglyceride, HDL-cholesterol and fasting blood glucose in men and women with metabolic syndrome when compared with subjects without metabolic syndrome. The prevalence of metabolic syndrome in SMI women was higher than men. The most age distribution was in range of 30-39 years old. The most prevalence of metabolic syndrome was in age groups 50-59 years old. The prevalence of metabolic syndrome was increased from 30 to 59 years old. Conclusion: The prevalence of metabolic syndrome in patients with SMI in Gorgan is almost similar to those observed in Asian countries. The prevalence of metabolic syndrome was lower than western countries. These observations may be due to cultural differences in the region. It should be mention that the families of mental illness subjects in our country believe that their patients must be cared better than people without mental illness. These findings of this study suggest that mental illness patients are at risk of metabolic syndrome. According to our results, risk factors such as age and gender differences may play an important role in the presence of metabolic syndrome. In our country, women do less
Munarriz, Ricardo; Talakoub, Lily; Somekh, Nir N; Lehrfeld, Todd; Chudnovsky, Aleksander; Flaherty, Elizabeth; Goldstein, Irwin
Perineal trauma can occur in both genders, however, data supporting the relationship between sexual dysfunction and blunt perineal trauma in women is lacking. This study reviewed the patient characteristics of women with sexual dysfunction who also had a history of blunt perineal trauma. A neurogenic form of sexual dysfunction has been implicated, with primary complaints of orgasm disorder and abnormalities noted on genital sensory testing. Further research in this area is needed.
Barak, Michal; Bahouth, Hany; Leiser, Yoav; Abu El-Naaj, Imad
According to the Advanced Trauma Life Support recommendations for managing patients with life-threatening injuries, securing the airway is the first task of a primary caregiver. Airway management of patients with maxillofacial trauma is complex and crucial because it can dictate a patient's survival. Securing the airway of patients with maxillofacial trauma is often extremely difficult because the trauma involves the patient's airway and their breathing is compromised. In these patients, mask ventilation and endotracheal intubation are anticipated to be difficult. Additionally, some of these patients may not yet have been cleared of a cervical spine injury, and all are regarded as having a full stomach and having an increased risk of regurgitation and pulmonary aspiration. The requirements of the intended maxillofacial operation may often preclude the use of an oral intubation tube, and alternative methods for securing the airway should be considered before the start of the surgery. In order to improve the clinical outcome of patients with maxillofacial trauma, cooperation between maxillofacial surgeons, anesthesiologists, and trauma specialists is needed. In this review, we discuss the complexity and difficulties of securing the airway of patients with maxillofacial trauma and present our approach for airway management of such patients.
Bahouth, Hany; Leiser, Yoav; Abu El-Naaj, Imad
According to the Advanced Trauma Life Support recommendations for managing patients with life-threatening injuries, securing the airway is the first task of a primary caregiver. Airway management of patients with maxillofacial trauma is complex and crucial because it can dictate a patient's survival. Securing the airway of patients with maxillofacial trauma is often extremely difficult because the trauma involves the patient's airway and their breathing is compromised. In these patients, mask ventilation and endotracheal intubation are anticipated to be difficult. Additionally, some of these patients may not yet have been cleared of a cervical spine injury, and all are regarded as having a full stomach and having an increased risk of regurgitation and pulmonary aspiration. The requirements of the intended maxillofacial operation may often preclude the use of an oral intubation tube, and alternative methods for securing the airway should be considered before the start of the surgery. In order to improve the clinical outcome of patients with maxillofacial trauma, cooperation between maxillofacial surgeons, anesthesiologists, and trauma specialists is needed. In this review, we discuss the complexity and difficulties of securing the airway of patients with maxillofacial trauma and present our approach for airway management of such patients. PMID:26161411
Baudin, G; Godin, O; Lajnef, M; Aouizerate, B; Berna, F; Brunel, L; Capdevielle, D; Chereau, I; Dorey, J M; Dubertret, C; Dubreucq, J; Faget, C; Fond, G; Gabayet, F; Laouamri, H; Lancon, C; Le Strat, Y; Tronche, A M; Misdrahi, D; Rey, R; Passerieux, C; Schandrin, A; Urbach, M; Vidalhet, P; Llorca, P M; Schürhoff, F
Childhood trauma (CT) and cannabis use are both environmental and modifier risk factors for schizophrenia. However, little is known about how they interact in schizophrenia. We examined the main effect of each of these two environmental factors on the clinical expression of the disease using a large set of variables, and we tested whether and how cannabis and CT interact to influence the course and the presentation of the illness. A sample of 366 patients who met the DSM-IV-TR criteria for schizophrenia was recruited through the FACE-SCZ (Fondamental Advanced Centre of Expertise - Schizophrenia) network. Patients completed a large standardized clinical evaluation including Structured Clinical Interview for DSM Disorders-I (SCID-I), Positive and Negative Symptoms Scale (PANSS), Columbia-Suicide Severity Rating Scale (C-SSRS), Global Assessment of Functioning (GAF), Short-Quality of Life-18 (S-QoL-18), and Medication Adherence Rating Scale (MARS). We assessed CT with the Childhood Trauma Questionnaire and cannabis status with SCID-I. CT significantly predicted the number of hospitalizations, GAF, and S-QoL-18 scores, as well as the PANSS total, positive, excitement, and emotional distress scores. Cannabis use disorders significantly predicted age of onset, and MARS. There was no significant interaction between CT and cannabis use disorders. However, we found evidence of a correlation between these two risk factors. CT and cannabis both have differential deleterious effects on clinical and functional outcomes in patients with schizophrenia. Our results highlight the need to systematically assess the presence of these risk factors and adopt suitable therapeutic interventions. Copyright © 2016 Elsevier B.V. All rights reserved.
Background Blunt thoracic trauma is one of the critical injury mechanisms in multiply injured trauma victims. Although these patients present a plethora of potential structural damages to vital organs, it remains debated which injuries actually influence outcome and thereby should be addressed initially. Hence, the aim of this study was to identify the influence of critical structural damages on mortality. Methods All patients in the database of the TraumaRegister DGU® (TR-DGU) from 2002–2011 with AIS Chest ≥ 2, blunt trauma, age of 16 or older and an ISS ≥ 16 were analyzed. Outcome parameters were in-hospital mortality as well as ventilation time in patients surviving the initial 14 days after trauma. Results 22613 Patients were included (mean ISS 30.5 ± 12.6; 74.7% male; Mean Age 46.1 ± 197 years; mortality 17.5%; mean duration of ventilation 7.3 ± 11.5; mean ICU stay 11.7 ± 14.1 days). Only a limited number of specific injuries had a significant impact on survival. Major thoracic vessel injuries (AIS ≥5), bilateral lung contusion, bilateral flail chest, structural heart injury (AIS ≥3) significantly influence mortality in study patients. Several extrathoracic factors (age, blood transfusion, systolic blood pressure and extrathoracic severe injuries) were also predictive of increased mortality. Most injuries of the thoracic wall had no or only a moderate effect on the duration of ventilation. Injuries to the lung (laceration, contusion or pneumothoraces) had a moderate prolonging effect. Cardiac injuries and severe injuries to the thoracic vessels induced a substantially prolonged ventilation interval. Conclusions We demonstrate quantitatively the influence of specific structural damages of the chest on critical outcome parameters. While most injuries of the chest wall have no or only limited impact in the study collective, injuries to the lung overall show adverse outcome. Injuries to the heart or thoracic vessels have a
Binder, Harald; Lang, Nikolaus; Tiefenboeck, Thomas M; Bukaty, Adam; Hajdu, Stefan; Sarahrudi, Kambiz
Traumatic injuries to the cervical spine are frequently accompanied by cervical spinal cord injuries-often necessitating tracheostomy. The purpose of this study was to evaluate patient characteristics and outcomes after undergoing anterior cervical spine fusion (ACSF) with tracheostomy. All patients with cervical spine injury (CSI) who underwent ACSF and tracheostomy between December 1992 and June 2014 were included in this retrospective data analysis. The study group consisted of 32 men (84 %) and six women (16 %), with an average age of 47 ± 20 years. Blunt trauma to the cervical spine was the cause of CSI in all 38 patients. The mean Injury Severity Score (ISS) was 30.50 ± 6.25. Eighteen patients sustained severe concomitant injuries related to the spinal injury. In 15 patients (39.5 %), traumatic brain injury (TBI) with fractures of the cranium and/or intracranial lesions were observed. The mean Glasgow Coma Scale (GCS) score was 11 ± 4.5 (range 3-15). Two tracheostomies (5.3 %) were performed simultaneously with ACSF. The remaining 36 were performed with an average "delay" of 15 ± ten days. We observed no difference in time to tracheostomy among patients initially presenting with an American Spinal Injury Association (ASIA) score of either A, B, C or D. Only two patients (5.3 %) were identified as having an infection at the site of ACSF after placement of a tracheostomy. There were no deaths directly related to airway difficulties in our cohort. Our data show that tracheostomy is safely performed after an average of 15 days post-ACSF, thereby being associated with a very low rate of complications. However, future prospective randomised studies are needed to identify the optimal timing of tracheostomy placement after ACSF. IV; retrospective case series.
Luis Muñiz Luna
Full Text Available ABSTRACT Objective: To determine the epidemiology of spine trauma in patients with polytrauma. Methods: The database of the service of polyfractured patients was reviewed from January to December 2015, 334 patients in total. Among them, 56 had spinal injury, of which 38 patients were included in the study. Results: Of the patients with polytraumatism, 16.77% had spinal cord injury. Mechanism of injury: fall 63.16%, traffic accidents 21.05%, running over 10.53%. Injury conditions: occupational 36.84%, at home 23.68%, traffic accident 15.79%, public road 13.16%, motorcycle accident 5.26%, of which 13.16% had consumed alcoholic beverages. Total with neurological injury 23.68%, incomplete lesion 18.42%. Injured vertebral segment: lumbar 76.32%, thoracic 31.58%, and cervical 7.89%. Associated injuries: upper limbs 47.37%, lower limbs 42.11%, pelvis 36.84%, thorax 34.21%, craniofacial 31.58%, abdomen 21.05%. Treatment: instrumentation 71.05%, orthoses 26.32%. Infection rate of 22.22%. Conclusions: The most common mechanism of injury was falls in the working environment, almost one fourth presented neurological damage, the most affected segment was the lumbar associated with injury of the lower limbs in 50%, with one fourth of patients that undergone intervention presenting infection. It is in the workplace, at home and in the transit where preventive measures must be reinforced to reduce the incidence of injuries in working age patients.
Stadhouder, Agnita; Buckens, Constantinus F M; Holtslag, Herman R; Oner, F Cumhur
Valid outcome assessment tools specific for spinal trauma patients are necessary to establish the efficacy of different treatment options. So far, no validated specific outcome measures are available for this patient population. The purpose of this study was to assess the current state of outcome measurement in spinal trauma patients and to address the question of whether this group is adequately served by current disease-specific and generic health-related quality-of-life instruments. A number of widely used outcome measures deemed most appropriate were reviewed, and their applicability to spinal trauma outcome discussed. An overview of recent movements in the theoretical foundations of outcome assessment, as it pertains to spinal trauma patients has been attempted, along with a discussion of domains important for spinal trauma. Commonly used outcome measures that are recommended for use in trauma patients were reviewed from the perspective of spinal trauma. The authors further sought to select a number of spine trauma-relevant domains from the WHO's comprehensive International Classification of Functioning, Disability and Health (ICF) as a benchmark for assessing the content coverage of the commonly used outcome measurements reviewed. The study showed that there are no psychometrically validated outcome measurements for the spinal trauma population and there are no commonly used outcome measures that provide adequate content coverage for spinal trauma domains. Spinal trauma patients are currently followed either as a subset of the polytrauma population in the acute and early postacute setting or as a subset of neurological injury in the long-term revalidation medicine setting.
Music's power to improve the 'human condition' has been acknowledged since ancient times. Something as counter-intuitive as weeping in response to music can ameliorate suffering for a time even for terminally ill patients. Several benefits-including catharsis, communication, and experiencing vitality-can be associated with grieving in response to "sad" music. In addressing the potential rewards of such an activity for terminally ill patients, this author combines concepts from philosopher Jerrold R. Levinson's article, entitled "Music and Negative Emotion," an illustration from a major motion picture, and supporting research from medical reports and aesthetic writings. Carefully offering this experience is recommended for patients who retain the capacity to express preference.
Skorpil, N.E.; van den Bergh, B.; Heymans, M.W.; Forouzanfar, T.
This study was designed to investigate retrospectively the incidence of venous thromboembolism (VTE) and the need for thromboembolism prophylaxis in patients undergoing surgery for oral and maxillofacial trauma. Data were obtained from all patients treated under general anaesthesia for maxillofacial
Stefanie Porkert; Eva Lehner-Baumgartner; Julia Valencak; Robert Knobler; Elisabeth Riedl; Constanze Jonak
The Revised Illness Perception Questionnaire (IPQ-R) has been shown to assess illness perception reproducibly in primary cutaneous T-cell lymphomas (CTCL). Illness perception reflects patients' individual concepts of understanding and interpretation of the disease, influencing illness behaviour and health-related quality of life (HRQOL). This study investigated the clinical relevance of the relationships between illness perception, illness behaviour, and HRQOL in CTCL and cutaneous B-cell lym...
Leeper, Christine M; Lin, Elizabeth; Hoffman, Marcus; Fombona, Anisleidy; Zhou, Tianhua; Kutcher, Matthew; Rosengart, Matthew; Watson, Gregory; Billiar, Timothy; Peitzman, Andrew; Zuckerbraun, Brian; Sperry, Jason
Older adult trauma patients are at increased risk of poor outcome, both immediately after injury and beyond hospital discharge. Identifying patients early in the hospital stay who are at increased risk of death after discharge can be challenging. Retrospective analysis was performed using our trauma registry linked with the social security death index from 2010 to 2014. Age was categorized as 18 to 64 and 65 years or older. We calculated mortality rates by age category then selected elderly patients with mechanism of injury being a fall for further analysis. Computed Tomography Abbreviated Assessment of Sarcopenia for Trauma (CAAST) was obtained by measuring psoas muscle cross-sectional area adjusted for height and weight. Kaplan-Meier survival analysis was performed, and proportional hazards regression modeling was used to determine independent risk factors for in-hospital and out-of-hospital mortality. A total of 23,622 patients were analyzed (16,748, aged 18-64 years; and 6,874, aged 65 or older). In-hospital mortality was 1.96% for ages 18 to 64 and 7.19% for age 65 or older (p older (p older group included injury characteristics such as ISS, admission vitals, and head injury. Predictors of postdischarge mortality for age 65or older included skilled nursing before admission, disposition, and mechanism of injury being a fall. A total of 57.5% (n = 256) of older patients who sustained a fall met criteria for sarcopenia. Sarcopenia was the strongest predictor of out-of-hospital mortality in this cohort with a hazard ratio of 4.77 (95% confidence interval, 2.71-8.40; p older adults. The CAAST measurement is an efficient and inexpensive measure that can allow clinicians to target older trauma patients at risk of poor outcome for early intervention and/or palliative care services. Prognostic and epidemiologic study, level III.
O'Brien, Jo-Anne; Fothergill-Bourbonnais, Frances
Little is known about the patients' experience of trauma resuscitation in the emergency department. Therefore, the purpose of this study was to determine (1) patients' perspectives of the experience of trauma resuscitation in the emergency department; (2) if patients have perceptions of vulnerability during trauma resuscitation in the emergency department; and (3) if there are factors that influence the patients' experience. A qualitative study of 7 patients using interpretive phenomenology was conducted in a Level I lead trauma hospital in Ontario, Canada. Inclusion criteria included age >/=18 years; trauma code initiated in the emergency department; Glasgow Coma Scale score >/=13; Revised Trauma Score >/=10; and physically and cognitively capable of participating in an interview in English. The sample included 4 men and 3 women. One-on-one semistructured tape-recorded interviews were conducted on the in-patient Trauma Unit between day 2 and 7 after trauma resuscitation. Follow-up interviews were conducted 7 to 12 months after the initial interview. Four themes were revealed in the data analysis: "I remember," "I was scared," "I felt safe," and "I will be okay." The findings revealed that initial perceptions of vulnerability subsided as a sense of feeling safe became prominent. System factors, such as a clearly identifiable trauma team leader, and caring behaviors, such as touch and tone of voice, were important and contributed to the overall belief that it was a positive experience. Both system factors and nursing interventions were important in contributing to the patients' feelings of being safe during trauma resuscitation in the emergency department. The fact that pain was felt or that family was not present, for example, seemed less important to patients than the perception that they were in capable hands and believed they were "safe."
Bar, Amir; Cies, Jeff; Stapleton, Kathleen; Tauber, Danna; Chopra, Arun; Shore, Paul M
Despite a paucity of supporting literature, acetazolamide is commonly used in critically ill children with metabolic alkalosis (elevated plasma bicarbonate [pHco-3] and pH). The objective of this study was to assess the change in 18 hours after initiation of acetazolamide therapy. Retrospective study. PICU of an urban, tertiary-care children's hospital. Mechanically ventilated children (≤ 17 yr) with metabolic alkalosis (pHco-3 ≥ 35 mmol/L). None. Of 153 consecutively screened patients, 61 patients (29 female patients) were enrolled: 18 cardiac patients (after congenital heart disease repair) and 43 noncardiac patients. The cardiac patients were younger than the noncardiac patients (median [interquartile range] age, 0.6 mo [0.3-2.5 mo] vs 7.4 mo [2.8-39.9 mo]; p metabolic alkalosis in critically ill children with congenital heart disease. Further study is required to determine why these cardiac patients respond differently to acetazolamide than noncardiac patients and whether this response impacts important clinical outcomes, for example, weaning mechanical ventilation.
Petrosoniak, Andrew; Hicks, Christopher
Trauma resuscitation is a complex and dynamic process that requires a high-performing team to optimize patient outcomes. More than 30 years ago, Advanced Trauma Life Support was developed to formalize and standardize trauma care; however, the sequential nature of the algorithm that is used can lead to ineffective prioritization. An improved understanding of shock mandates an updated approach to trauma resuscitation. This article proposes a resequenced approach that (1) addresses immediate threats to life and (2) targets strategies for the diagnosis and management of shock causes. This updated approach emphasizes evidence-based resuscitation principles that align with physiologic priorities. Copyright © 2017 Elsevier Inc. All rights reserved.
Correia, Isabel Araújo Marques; Sousa, Vítor; Pinto, Luis Marques; Barros, Ezequiel
Tracheotomy is one of the most frequent surgical procedures performed in critically ill patients hospitalized at intensive care units. The ideal timing for a tracheotomy is still controversial, despite decades of experience. To determine the impact of performing early tracheotomies in critically ill patients on duration of mechanical ventilation, intensive care unit stay, overall hospital stay, morbidity, and mortality. Retrospective and observational study of cases subjected to elective tracheotomy at one of the intensive care units of this hospital during five consecutive years. The patients were stratified into two groups: early tracheotomy group (tracheotomy performed from day one up to and including day seven of mechanical ventilation) and late tracheotomy group (tracheotomy performed after day seven). The outcomes of the groups were compared. In the early tracheotomy group, there was a statistically significant reduction in duration of mechanical ventilation (6 days vs. 19 days; p<0.001), duration of intensive care unit stay (10 days vs. 28 days; p=0.001), and incidence of ventilator-associated pneumonia (1 case vs. 44 cases; p=0.001). Early tracheotomy has a significant positive impact on critically ill patients hospitalized at this intensive care unit. These results support the tendency to balance the risk-benefit analysis in favor of early tracheotomy. Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.
Full Text Available According to the Advanced Trauma Life Support recommendations for managing patients with life-threatening injuries, securing the airway is the first task of a primary caregiver. Airway management of patients with maxillofacial trauma is complex and crucial because it can dictate a patient’s survival. Securing the airway of patients with maxillofacial trauma is often extremely difficult because the trauma involves the patient’s airway and their breathing is compromised. In these patients, mask ventilation and endotracheal intubation are anticipated to be difficult. Additionally, some of these patients may not yet have been cleared of a cervical spine injury, and all are regarded as having a full stomach and having an increased risk of regurgitation and pulmonary aspiration. The requirements of the intended maxillofacial operation may often preclude the use of an oral intubation tube, and alternative methods for securing the airway should be considered before the start of the surgery. In order to improve the clinical outcome of patients with maxillofacial trauma, cooperation between maxillofacial surgeons, anesthesiologists, and trauma specialists is needed. In this review, we discuss the complexity and difficulties of securing the airway of patients with maxillofacial trauma and present our approach for airway management of such patients.
Appel, Philip W; Tsemberis, Sam; Joseph, Herman; Stefancic, Ana; Lambert-Wacey, Dawn
The Housing First approach used by Pathways to Housing, Inc., was used to enhance residential independence and treatment retention of homeless, seriously mentally ill methadone patients. The Keeping Home project first secured scattered-site apartments and assertive community treatment services and then addressed patients' service needs. Three years post-implementation, methadone treatment retention for 31 Keeping Home patients versus 30 comparison participants (drawn from an administrative database) was 51.6% vs. 20% (p < .02); apartment/independent housing retention was 67.7% vs. 3% or 13% (both p's < .01). Although results firmly support Keeping Home, future research needs to address study's possible database limitations.
van Hasselt, Fenneke M; Oud, Marian J T; Loonen, Anton J M
Patients with severe mental illness have an accumulation of risk factors for physical diseases like cardiovascular diseases, metabolic syndrome, diabetes mellitus and COPD. These patients receive suboptimal care in the Netherlands. A major barrier to optimal care is the lack of collaboration between mental health professionals and general practitioners. An improvement could be made if all medical professionals actively supported these high-risk patients in taking adequate care of their health needs. This improvement can only be made if general practitioners and mental health professionals collaborate in a timely and structured manner.
Oranye, Nelson Ositadimma; Arumugam, Utharas; Ahmad, Nora; Arumugam, Marian E
Introductio n: In Malaysia, nurses form a significant part of the clinical mental health team, but the current level of training in mental health results in suboptimal nursing care delivery. For this study 220 registered nurses and medical assistants working with the mentally ill completed a structured questionnaire. The purpose of this study was to explore perceived competence in mental healthcare and the training needs of nurses working with mentally ill patients in inpatient mental healthcare facilities. The skills perceived as important for practicing in mental health varied among the nurse participants. Post basic training in mental health was significantly related to perceived competence in patient mental state assessment (p=0.036), risk assessment for suicide (p=0.024), violence (p=0.044) and self-harm (p=0.013). There is little emphasis on psychosocial skills in current post basic mental health training in Malaysia.
de Koning, M.E.; Gareb, Barzi; El Moumni, M.; Scheenen, M. E.; van der Horn, H. J.; Timmerman, M. E.; Spikman, J. M.; van der Naalt, J.
Objective: To identify the frequency, nature and profile of complaints for trauma patients with and without mild traumatic brain injury (mTBI), and to assess their relation to anxiety and depression. Methods: A prospective cohort study in a level-one trauma centre was conducted. Mild traumatic brain
Windeløv, Nis Agerlin; Ostrowski, Sisse Rye; Johansson, Per Ingemar
OBJECTIVE AND DESIGN: To elucidate whether platelets differentiate cytokine release following trauma, we prospectively measured three major platelet-derived cytokines in 213 trauma patients on hospital arrival. METHODS: We measured plasma levels of the anti-inflammatory β-thromboglobulins (βTGs),...
Fruchtenicht, Ana Valéria Gonçalves; Poziomyck, Aline Kirjner; Kabke, Geórgia Brum; Loss, Sérgio Henrique; Antoniazzi, Jorge Luiz; Steemburgo, Thais; Moreira, Luis Fernando
To systematically review the main methods for nutritional risk assessment used in critically ill cancer patients and present the methods that better assess risks and predict relevant clinical outcomes in this group of patients, as well as to discuss the pros and cons of these methods according to the current literature. The study consisted of a systematic review based on analysis of manuscripts retrieved from the PubMed, LILACS and SciELO databases by searching for the key words "nutritional risk assessment", "critically ill" and "cancer". Only 6 (17.7%) of 34 initially retrieved papers met the inclusion criteria and were selected for the review. The main outcomes of these studies were that resting energy expenditure was associated with undernourishment and overfeeding. The high Patient-Generated Subjective Global Assessment score was significantly associated with low food intake, weight loss and malnutrition. In terms of biochemical markers, higher levels of creatinine, albumin and urea were significantly associated with lower mortality. The worst survival was found for patients with worse Eastern Cooperative Oncologic Group - performance status, high Glasgow Prognostic Score, low albumin, high Patient-Generated Subjective Global Assessment score and high alkaline phosphatase levels. Geriatric Nutritional Risk Index values Nutritional Index score was associated with abnormal nutritional status in critically ill cancer patients. Among the reviewed studies that examined weight and body mass index alone, no significant clinical outcome was found. None of the methods reviewed helped to define risk among these patients. Therefore, assessment by a combination of weight loss and serum measurements, preferably in combination with other methods using scores such as Eastern Cooperative Oncologic Group - performance status, Glasgow Prognostic Score and Patient-Generated Subjective Global Assessment, is suggested given that their use is simple, feasible and useful in such
Lee, Jay Wook
Disturbances in fluid and electrolytes are among the most common clinical problems encountered in the intensive care unit (ICU). Recent studies have reported that fluid and electrolyte imbalances are associated with increased morbidity and mortality among critically ill patients. To provide optimal care, health care providers should be familiar with the principles and practice of fluid and electrolyte physiology and pathophysiology. Fluid resuscitation should be aimed at restoration of normal...
Jang, Ji Young; Shim, Hongjin; Lee, Seung Hwan; Lee, Jae Gil
The authors designed this study to determine how serum selenium and zinc affect the outcomes of critically ill surgical patients. The medical records of 162 patients admitted to a surgical intensive care unit (ICU) from October 2010 to July 2012 and managed for more than 3 days were retrospectively investigated. Overall, the mean patient age was 61.2 ± 15.0 years, and the median ICU stay was 5 (3-115) days. The mean Acute Physiologic and Chronic Health Evaluation II score was 18.0 ± 8.0. Eighteen (11.1%) of the study subjects died in ICU. mean selenium levels were 83.5 ± 23.8 ng/dL in the survivor group and 83.3 ± 29.6 ng/dL in the nonsurvivor group, and corresponding mean zinc levels were 46.3 ± 21.7 and 65.6 ± 41.6 μg/dL, respectively. Mean selenium concentrations were significantly different in patients with and without shock (77.9 ± 25.4 and 87.2 ± 23.1 ng/dL, P = .017). Furthermore, mean serum selenium was lower in patients with sepsis than in traumatic or simply postoperative patients (P selenium and zinc levels on critically ill surgical patients, a large-scale prospective study is needed. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.
Full Text Available Abstract Background Recognizing infection is crucial in immunocompromised patients with organ dysfunction. Our objective was to assess the diagnostic accuracy of procalcitonin (PCT in critically ill immunocompromised patients. Methods This prospective, observational study included patients with suspected sepsis. Patients were classified into one of three diagnostic groups: no infection, bacterial sepsis, and nonbacterial sepsis. Results We included 119 patients with a median age of 54 years (interquartile range [IQR], 42-68 years. The general severity (SAPSII and organ dysfunction (LOD scores on day 1 were 45 (35-62.7 and 4 (2-6, respectively, and overall hospital mortality was 32.8%. Causes of immunodepression were hematological disorders (64 patients, 53.8%, HIV infection (31 patients, 26%, and solid cancers (26 patients, 21.8%. Bacterial sepsis was diagnosed in 58 patients and nonbacterial infections in nine patients (7.6%; 52 patients (43.7% had no infection. PCT concentrations on the first ICU day were higher in the group with bacterial sepsis (4.42 [1.60-22.14] vs. 0.26 [0.09-1.26] ng/ml in patients without bacterial infection, P 0.5 ng/ml had 100% sensitivity but only 63% specificity for diagnosing bacterial sepsis. The area under the receiver operating characteristic (ROC curve was 0.851 (0.78-0.92. In multivariate analyses, PCT concentrations > 0.5 ng/ml on day 1 independently predicted bacterial sepsis (odds ratio, 8.6; 95% confidence interval, 2.53-29.3; P = 0.0006. PCT concentrations were not significantly correlated with hospital mortality. Conclusion Despite limited specificity in critically ill immunocompromised patients, PCT concentrations may help to rule out bacterial infection.
Robinson, Rebecca L; Kroenke, Kurt; Mease, Philip; Williams, David A; Chen, Yi; D'Souza, Deborah; Wohlreich, Madelaine; McCarberg, Bill
This study was designed to describe burden of illness and treatment patterns, and to examine the patient, physician, and care factors associated with the treatment choices of individuals receiving new prescriptions for fibromyalgia (FM). This is a baseline assessment of the Real-World Examination of Fibromyalgia: Longitudinal Evaluation of Costs and Treatments (REFLECTIONS), a prospective observational study. Baseline data (including a physician survey, a patient visit form, and computer-assisted telephone interviews) were collected from July 2008 through May 2010 in 58 care settings in the United States, including Puerto Rico. Patients (N = 1,700) were mostly female (94.6%) and white (82.9%). Mean age was 50.4 years and mean duration of illness was 5.6 years. Mean Fibromyalgia Impact Questionnaire total score was 54.4 (range 0-80), and Brief Pain Inventory average pain severity level was 5.5 (range 0-10). Patients reported high annual health care use and numerous work limitations related to FM. Patients were taking 182 unique types of medications prescribed for FM, including duloxetine (26.8%), nonsteroidal anti-inflammatory drugs (26.6%), pregabalin (24.5%), opioids (24.2%), tramadol (15.3%), benzodiazepines (15.2%), cyclobenzaprine (12.9%), milnacipran (8.9%), and others. Most patients took more than one medication concurrently (77.8%). Type of current medications used was most strongly associated with medication history and physician specialty. Burden of illness was high for patients with FM, and treatment patterns were highly variable. Importantly, the treatments with the most evidence to support their use were not always the most frequently chosen. Wiley Periodicals, Inc.
Yuan-Ming Tsai; Kuan-Hsun Lin; Tsai-Wang Huang; Chun-Ying Chen; Zhi-Jie Hong; Sheng-Der Hsu
Background: Blunt chest trauma is associated with a high risk of mortality. Respiratory complications may necessitate prolonged ventilation and result in death. The present study aimed to investigate possible signs of trauma and the prognosis of trauma patients with thoracic injuries and identify risk factors for mortality. Patients and Methods: A retrospective study was performed to investigate the clinical characteristics and treatment outcomes of trauma patients with blunt chest injuries ...
Misiak, Błażej; Szmida, Elżbieta; Karpiński, Paweł; Loska, Olga; Sąsiadek, Maria M; Frydecka, Dorota
We investigated methylation of DNA repetitive sequences (LINE-1 and BAGE) in peripheral blood leukocytes from first-episode schizophrenia (FES) patients and healthy controls (HCs) with respect to childhood adversities. Patients were divided into two subgroups based on the history of childhood trauma - FES(+) and FES(-) subjects. The majority of HCs had a negative history of childhood trauma - HCs(-) subjects. FES(+) patients had significantly lower LINE-1 methylation in comparison with FES(-) patients or HC(-) subjects. Emotional abuse and total trauma score predicted lower LINE-1 methylation in FES patients, while general trauma score was associated with lower BAGE methylation in HCs. Childhood adversities might be associated with global DNA hypomethylation in adult FES patients.
Molfino, Alessio; Alessandri, Francesco; Mosillo, Paola; Dell'Utri, Donatella; Farcomeni, Alessio; Amabile, Maria Ida; Laviano, Alessandro
Phosphatase and tensin homologue (PTEN) reduces insulin sensitivity. Since critically ill patients present insulin resistance, we aimed at assessing the role of PTEN expression on glucose homeostasis and clinical outcome in patients admitted to an intensive care unit (ICU) and receiving artificial nutrition. Observational, single-center study conducted in one ICU in Rome, Italy on adult patients hospitalized for trauma. Plasma glucose levels and its variability were recorded in patients receiving artificial nutrition. PTEN expression was measured by western blotting analysis and the associations between PTEN, plasma glucose levels and variability, and calories administered were investigated. Parametric and non-parametric tests were used, as appropriate. Twenty consecutive patients (13 men and 7 women, mean age of 37.3 ± 12.7 years) were studied. No correlation between plasma glucose and PTEN was documented (r = -0.15, P = 0.55), neither between glycemic variability and PTEN expression (r = -0.00, P = 0.99). However, total kcal/day administered and PTEN expression significantly correlated (r = 0.56, P = 0.01). Also, patients with PTEN levels below the median received less kcal/day than those with PTEN above the median (P = 0.048). This association was more pronounced when normalized per body weight (P = 0.03) and after adjusting for the average of insulin daily administered (P = 0.02). PTEN expression might significantly contribute to glucose homeostasis and disposal in critically ill patients receiving artificial nutrition. Larger samples are necessary to confirm our observation. NCT01796847 (www.clinicaltrials.gov) submitted on February 11, 2013. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Full Text Available Background: Early experiences of traumatic events (TEs may be associated with subsequent eating disturbance. However, few studies have investigated overall exposure and trauma-type frequency in various types of eating disorders (EDs. Objective: This study aimed to investigate the prevalence and type of TEs in a nationally representative sample of Swedish ED patients. Method: Data from a database (Stepwise for specialized ED care were used. Trauma history was assessed as a part of the routine, initial assessment. Participants over the age of 18 with a diagnosed DSM-IV ED were included (N=4,524. Results: The number of patients having experienced at least one TE was 843 (18.6%, and 204 (24.2% reported at least one additional trauma. Sexual trauma was the most common form of TE (6.3%. There was no difference in overall traumatic exposure or in type of experienced trauma between the ED diagnostic subgroups (AN, BN, EDNOS, and BED. Overall traumatic exposure was linked to self-reported severity of ED symptoms, more secondary psychosocial impairment, psychiatric comorbidity, and negative self-image. Conclusions: Trauma history in ED patients merits attention. Results are partly in line with and partly in contrast to previous research. Measurement of trauma history has varied substantially in research on EDs, and this study adds to the indistinct literature on trauma history in ED.
Frankenfield, D C; Omert, L A; Badellino, M M; Wiles, C E; Bagley, S M; Goodarzi, S; Siegel, J H
Indirect calorimetry is the preferred method for determining caloric requirements of patients, but availability of the device is limited by high cost. A study was therefore conducted to determine whether clinically obtainable variables could be used to predict metabolic rate. Patients with severe trauma or sepsis who required mechanical ventilation were measured by an open-circuit indirect calorimeter. Several clinical variables were obtained simultaneously. Measurements were repeated every 12 hours for up to 10 days. Twenty-six trauma and 30 sepsis patients were measured 423 times. Mean resting energy expenditure was 36 +/- 7 kcal/kg (trauma) vs 45 +/- 8 kcal/kg (sepsis) (p types.
Full Text Available Introduction: The early detection of injury in multiple trauma patients can lead to decreased mortality, length of stay, and improved clinical status of the patient. It is shown that there is a relation between increased level of serum amylase and pancreatic injury in trauma patients. The aim of this study is to evaluate serum amylase level in hospital outcomes of patients with abdominal blunt trauma. Methods: This study was a cross-sectional survey that was conducted at the emergency room of Imam Reza (AS Medical and Educational Center in Tabriz, Iran, during a year (April 2014-April 2015 on 101 patients with blunt abdominal trauma. Serum amylase levels were measured 6 hours after injury. The outcome of patients during hospitalization including the need for laparotomy and mortality were followed. Data were analyzed by SPSS software. P < 0.050 was considered significant. Results: A significant relationship between elevated serum amylase level by laparotomy and mortality was observed (P < 0.001. 15 patients had serum amylase higher than 100 U/L. All patients with abnormal serum amylase died. Conclusion: Determination of serum amylase level can be valuable in the prognosis of patients with blunt abdominal trauma, especially in determining mortality and proceed to laparotomy. However, studies with larger research community are required to investigate the precise role of amylase in the diagnosis and prognosis of patients with blunt abdominal trauma.
Jiao, Juan; Vincent, Ann; Cha, Stephen S; Luedtke, Connie A; Kim, Chul H; Oh, Terry H
The objective of this study was to evaluate both precipitating factors in patients with fibromyalgia and any differences in clinical presentation, symptom severity, and quality-of-life between those with and without precipitating physical trauma or infection. In a retrospective cross-sectional study, the authors compared patient characteristics and fibromyalgia symptom severity and quality-of-life with the Fibromyalgia Impact Questionnaire and the Short Form-36 Health Survey in patients seen in a fibromyalgia treatment program. Of 939 patients, 27% reported precipitating factors (trauma, n = 203; infection, n = 53), with the rest having idiopathic fibromyalgia (n = 683). Patients with precipitating trauma were more likely to have worse Fibromyalgia Impact Questionnaire physical function than patients with idiopathic onset (P = 0.03). Compared with patients with idiopathic onset and precipitating trauma, patients with precipitating infection were more likely to have worse Short Form-36 Health Survey physical component summary (P = 0.01 and P = 0.003) but better role emotional (P = 0.04 and P = 0.005), mental health index (P = 0.02 and P = 0.007), and mental component summary (P = 0.03 and P = 0.004), respectively. One-fourth of this study's patients with fibromyalgia had precipitating physical trauma or infection. Patients with precipitating infection had different sociodemographic characteristics, clinical presentation, and quality-of-life from the idiopathic and trauma groups. Further studies are needed to look into the relationships between precipitating events and fibromyalgia.
Savola, Olli; Pyhtinen, Juhani; Leino, Tuomo K; Siitonen, Simo; Niemelä, Onni; Hillbom, Matti
Serum protein S100B determinations have been recently suggested as markers of traumatic brain injury. However, little is known about the effects of extracranial injuries on S100B levels in trauma patients. We studied 224 patients with head trauma (54 of whom also had extracranial injuries), 155 patients with various types of extracranial injuries, and 8 healthy pilots exposed to high Gz forces. The head trauma patients had either no brain injury (n = 35), mild brain injury (n = 165), or moderate to severe brain injury (n = 24). The extracranial injuries were divided into small and large injuries. Serum protein S100B levels were determined from samples taken within 6 hours after the trauma event. The head trauma patients had a significantly higher median S100B (0.17 microg/L) than the patients with extracranial injuries (0.07 microg/L) (p head trauma did not significantly affect S100B levels (0.07 microg/L). Above the cutoff level of 0.13 microg/L, there were 61% of the head trauma patients and 26% of those with extracranial injuries (Pearson chi test, p head trauma patients with moderate to severe brain injury exceeded this cutoff in 67% of the cases. Exposure to high Gz forces did not influence serum S100B levels in healthy individuals. We conclude that serum S100B is a sensitive marker of brain injury, which correlates with the severity of the injury. Large extracranial injuries also elevate S100B levels. However, S100B has a high negative predictive power, and the finding of a normal S100B value shortly after trauma should thus exclude significant brain injury with a high accuracy.
Choi, Seung Joon; Kim, Eun Young; Kim, Hyung Sik; Choi, Hye-Young; Cho, Jinseong; Yang, Hyuk Jun; Chung, Yong Eun
The aims of this study were to analyze cumulative effective dose (cED) and to assess lifetime attributable risk (LAR) of cancer due to radiation exposure during computed tomography (CT) examinations in adolescent trauma patients. Between January 2010 and May 2011, the adolescent patients with trauma were enrolled in this study. Numbers of CT examinations and body regions examined were collated, and cEDs were calculated using dose-length product values and conversion factors. Lifetime attributable risk for cancer incidence and cancer-associated mortality were quantified based on the studies of survivors of the atomic bombs on Japan. Data were stratified according to severity of trauma: minor trauma, injury severity score of less than 16; and major trauma, injury severity score of 16 or greater. A total of 698 CT scans were obtained on the following regions of 484 adolescent patients: head CT, n = 647; rest of the body, n = 41; and thorax, n = 10. Mean cED per patient was 3.4 mSv, and mean LARs for cancer incidence and mortality were 0.05% and 0.02%, respectively. The majority of patients (98.4%) experienced minor trauma, and their mean cED and LARs for cancer incidence and mortality (3.0 mSv and 0.04% and 0.02%, respectively) were significantly lower than those of patients with major trauma (24.3 mSv and 0.31% and 0.15%, respectively, all P values CT examinations performed for the initial assessment of minor trauma was found to be relatively low in adolescent patients. However, adolescent patients with major trauma were exposed to a substantial amount of radiation during multiple CT examinations.
Aim: The aim of this study was to investigate the medical and forensic importance of thorax computed tomography in stable patients with blunt chest trauma. Material and Methods: Fifty patients with blunt chest injury were retrospectively evaluated with chest radiography and thorax computed tomography in the first 24 hours after trauma. Patient demographics, thoracic lesions, management options, and forensic assessment were rewieved. Results: The most common lesion of the study was ri...
Jansen, Jens Einar; Pedersen, Marlene Buch; Trauelsen, Anne Marie
. To examine this, we conducted in-depth interviews with 15 service users with a diagnosis of a first-episode nonaffective psychosis who had reported 1 or more childhood traumas in self-report measures. Therewas an unexpected discrepancy between the number of traumas reported in self-report measures......Persons with schizophrenia spectrum disorders often report high levels of childhood trauma, which often exacerbates symptoms and impede the process of recovery. However, little is known about how these traumas are experienced by service users and how they are integrated in their life stories...... and in semistructured interviews, and many of the traumas did not seem integrated in their personal narratives. The analyses further revealed that although participants often described complicated and traumatic childhood environments, they still felt supported by their families; they reported a range of ways in which...
Kumar, Sunil; Prakash, Puneet; Joshi, Mohit Kumar; Rathi, Vinita
CECT scan is considered essential for selective non-operative management (SNOM) of patients with abdominal trauma. However, CECT has its own hazards and limitations. We evaluated the safety and efficacy of selective non-operative management of patients with abdominal trauma without the mandatory use of CECT scan in a prospective study. Patients with peritonitis and ongoing intra-abdominal bleed were excluded. Consenting FAST positive, hemodynamically stable patients with blunt and penetrating abdominal trauma between 18 and 60 years of age were included and admitted for SNOM and detailed ultrasonography of the abdomen (in all) with or without CECT abdomen (selectively). Eighty-four patients with abdominal trauma were admitted during the study period. Twenty-two patients did not satisfy the inclusion criteria and 18 required immediate laparotomy based on primary survey. Remaining 44 patients were admitted for SNOM: mean ± SD age of these patients was 27 ± 8.7 years; 40 (89 %) were males. Thirty-five patients (79.54 %) sustained blunt trauma (RTI = 16, Fall = 16, others = 3) while nine patients (20.45 %) sustained penetrating trauma. SNOM without CECT was successful in 36 (81.82 %) patients. Five (11.36 %) patients underwent delayed emergency laparotomy based on clinical and detailed USG evaluation. CECT was not done in these patients. Three patients underwent CECT for various reasons; however, they were managed with SNOM. Thus, SNOM without abdominal CECT was successful in 36 (81.82 %) patients. SNOM failed in five patients but abdominal USG was sufficient. SNOM can be practised safely in patients of abdominal trauma with limited use of CECT scan.
Florea, Bogdan; Beniczky, Simona Alexandra; Demény, Helga; Beniczky, Sándor
to investigate the semiology of subtle motor phenomena in critically ill patients, with- versus without nonconvulsive status epilepticus (NCSE). 60 consecutive comatose patients, in whom subtle motor phenomena were observed in the intensive care unit (ICU), were analysed prospectively. The semiology of the subtle phenomena was described from video-recordings, blinded to all other data. For each patient, the type, location and occurrence-pattern/duration were described. EEGs recorded in the ICU were classified using the Salzburg criteria for NCSE. only 23% (14/60) of the patients had NCSE confirmed by EEG. None of the semiological features could distinguish between patients with NCSE and those without. In both groups, the following phenomena were most common: discrete myoclonic muscle twitching and discrete tonic muscle activation. Besides these, automatisms and eye deviation were observed in both groups. subtle motor phenomena in critically ill patients can raise the suspicion of NCSE. Nevertheless, EEG is needed to confirm the diagnosis, since none of the semiological features are specific. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
Mechanic, D; Meyer, S
This paper examines conceptions of trust among three groups of respondents diagnosed with either breast cancer, Lyme disease or mental illness. Interviews were carried out using an open-ended interview guide to explore how patients made assessments of trust in their doctors and health care plans. The guide followed a conceptual approach that asked questions about competence, agency/fiduciary responsibility, control, disclosure and confidentiality. Respondents were given ample opportunity to raise other areas of concern. The data were organized using the NUDIST software package for the analysis of non-numerical and unstructured qualitative data. Patients viewed trust as an iterative process and commonly tested their physicians against their knowledge and expectations. Interpersonal competence, involving caring, concern and compassion, was the most common aspect of trust reported, with listening as a central focus. Most patient comments referred to learnable skills and not simply to personality characteristics. Technical competence also received high priority but was often assessed by reputation or interpersonal cues. Patients were much concerned that doctors be their agents and fight for their interests with health care plans. Disclosure and confidentiality were less common concerns; most patients anticipated that doctors would be honest with them and respect their confidences. Patients' responses also appeared to vary by their disease, their socio-demographic characteristics, their involvement with self-help groups, and how their illness conditions unfolded.
Ritter, Cristiane; Tomasi, Cristiane D; Dal-Pizzol, Felipe; Pinto, Bernardo Bollen; Dyson, Alex; de Miranda, Aline S; Comim, Clarissa M; Soares, Márcio; Teixeira, Antonio L; Quevedo, João; Singer, Mervyn
Delirium is a common occurrence in critically ill patients and is associated with an increase in morbidity and mortality. Septic patients with delirium may differ from a general critically ill population. The aim of this investigation was to study the relationship between systemic inflammation and the development of delirium in septic and non-septic critically ill patients. We performed a prospective cohort study in a 20-bed mixed intensive care unit (ICU) including 78 (delirium = 31; non-delirium = 47) consecutive patients admitted for more than 24 hours. At enrollment, patients were allocated to septic or non-septic groups according to internationally agreed criteria. Delirium was diagnosed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) during the first 72 hours of ICU admission. Blood samples were collected within 12 hours of enrollment for determination of tumor necrosis factor (TNF)-α, soluble TNF Receptor (STNFR)-1 and -2, interleukin (IL)-1β, IL-6, IL-10 and adiponectin. Out of all analyzed biomarkers, only STNFR1 (P = 0.003), STNFR2 (P = 0.005), adiponectin (P = 0.005) and IL-1β (P < 0.001) levels were higher in delirium patients. Adjusting for sepsis and sedation, these biomarkers were also independently associated with delirium occurrence. However, none of them were significant influenced by sepsis. STNFR1, STNFR2, adiponectin and IL-1β were associated with delirium. Sepsis did not modify the relationship between the biomarkers and delirium occurrence.
Nedergaard, Helene Korvenius; Jensen, Hanne Irene; Stylsvig, Mette
and long-term cognitive function. DISCUSSION: If non-sedation can improve long-term cognitive function, it could be an approach worth considering for a larger group of critically ill patients. TRIAL REGISTRATION: The study has been approved by the relevant scientific ethics committee and is registered......BACKGROUND: The effects of non-sedation on cognitive function in critically ill patients on mechanical ventilation are not yet certain. This trial is a substudy of the NONSEDA trial where critically ill patients are randomized to non-sedation or to sedation with a daily wake-up attempt during...... trauma, status epilepticus, patients treated with therapeutic hypothermia and patients with severe hypoxia). The experimental intervention will be non-sedation supplemented with pain management during mechanical ventilation. The control intervention will be sedation with a daily wake-up attempt...
Johnstone, Benjamin; Velakoulis, Dennis; Yuan, Cheng Yi; Ang, Anthony; Steward, Chris; Desmond, Patricia; O'Brien, Terence J
Exposure to early life childhood trauma has been implicated as resulting in a vulnerability to epileptic and psychogenic nonepileptic seizures (PNES), hippocampal atrophy, and psychiatric disorders. This study aimed to explore the relationships between childhood trauma, epilepsy, PNES, and hippocampal volume in patients admitted to a video-electroencephalogram monitoring (VEM) unit. One hundred thirty-one patients were recruited from the Royal Melbourne Hospital VEM unit. The diagnostic breakdown of this group was: temporal lobe epilepsy (TLE) (32), other epilepsy syndromes (35), PNES (47), other nonepileptic syndromes (5), both epilepsy and PNES (6), and uncertain diagnosis (6). All patients completed a questionnaire assessing exposure to childhood trauma, the Childhood Trauma Questionnaire (CTQ), as well as questionnaires assessing psychiatric symptomatology (SCL-90-R), Anxiety and Depression (HADS), quality of life (QOLIE-98) and cognition (NUCOG). Volumetric coronal T1 MRI scans were available for 84 patients. Hippocampal volumes were manually traced by a blinded operator. The prevalence of childhood trauma in patients with PNES was higher than in patients with other diagnoses (p=0.005), and the group with PNES overall scored significantly higher on the CTQ (p=0.002). No association was found between CTQ scores and hippocampal volumes; however, patients with a history of sexual abuse were found to have smaller left hippocampal volumes than patients who had not (p=0.043). Patients reporting having experienced childhood trauma scored lower on measures of quality of life and higher on measures of psychiatric symptomatology. Patients with PNES report having experienced significantly more childhood trauma than those with epileptic seizures, and in both groups there was a relationship between a history of having experienced sexual abuse and reduced left hippocampal volume. Patients with PNES and those with epilepsy who have a history of childhood trauma have overall
Hajibandeh, Shahab; Hajibandeh, Shahin
The initial diagnostic evaluation and management of trauma patients is mainly based on Advanced Trauma Life Support (ATLS) guidelines worldwide. Based on ATLS principles, conventional diagnostics such as conventional radiography (CR) and focused abdominal sonography in trauma (FAST) should precede selective use of CT. Whole-body CT (WBCT) is highly accurate and allows detection of life threatening injuries with good sensitivity and specificity. WBCT is faster than conventional diagnostics and saves more time in management of trauma patients. This study aims to review studies investigating the effect of WBCT on mortality in trauma patients. Literatures were found by searching keywords in Medline, PubMed and Cochrane library. The relevant articles were selected by two independent reviewers based on title, abstract and introduction sections. Full-texts of selected articles were reviewed and those investigating effect of WBCT on mortality in trauma patients were included. Searching the keywords in Medline and PubMed resulted in 178 and 167 articles, respectively. Nine studies met the inclusion criteria and were reviewed. These included 8 retrospective and 1 prospective cohort studies. Mortality was measured as mortality rate or standardised mortality ratio (SMR) in the included studies. Unlike previous systematic reviews, this review indicates that use of WBCT in blunt trauma patients is associated with reduced overall mortality rate and that WBCT can potentially improve the probability of survival in haemodynamically stable and unstable blunt trauma patients. High quality RCTs are required to describe a causal relationship between WBCT and mortality in trauma patients. © 2015 KUMS, All rights reserved.
van Minnen, A; van der Vleugel, B M; van den Berg, D P G; de Bont, P A J M; de Roos, C; van der Gaag, M; de Jongh, A
This study presents secondary analyses of a recently published trial in which post-traumatic stress disorder (PTSD) patients with psychosis (n = 108) underwent 8 sessions of trauma-focused treatment, either prolonged exposure (PE) or eye movement desensitisation and reprocessing (EMDR) therapy. 24.1% fulfilled the criteria for the dissociative subtype, a newly introduced PTSD subtype in DSM-5. Treatment outcome was compared for patients with and without the dissociative subtype of PTSD. Patients with the dissociative subtype of PTSD showed large reductions in clinician-administered PTSD scale (CAPS) score, comparable with patients without the dissociative subtype of PTSD. It is concluded that even in a population with severe mental illness, patients with the dissociative subtype of PTSD do benefit from trauma-focused treatments without a pre-phase of emotion regulation skill training and should not be excluded from these treatments. © The Royal College of Psychiatrists 2016.
Secombe, Paul; Harley, Simon; Chapman, Marianne; Aromataris, Edoardo
The objective of this review is to identify effective enteral nutritional regimens targeting protein and calorie delivery for the critically ill obese patient on morbidity and mortality.More specifically, the review question is:In the critically ill obese patient, what is the optimal enteral protein and calorie target that improves mortality and morbidity? The World Health Organization (WHO) defines obesity as abnormal or excessive fat accumulation that may impair health, or, empirically, as a body mass index (BMI) ≥ 30 kg/m. Twenty-eight percent of the Australian population is obese with the prevalence rising to 44% in rural areas, and there is evidence that rates of obesity are increasing. The prevalence of obese patients in intensive care largely mirrors that of the general population. There is concern, however, that this may also be rising. A recently published multi-center nutritional study of critically ill patients reported a mean BMI of 29 in their sample, suggesting that just under 50% of their intensive care population is obese. It is inevitable, therefore, that the intensivist will care for the critically ill obese patient.Managing the critically ill obese patient is challenging, not least due to the co-morbid diseases frequently associated with obesity, including diabetes mellitus, cardiovascular disease, dyslipidaemia, sleep disordered breathing and respiratory insufficiency, hepatic steatohepatitis, chronic kidney disease and hypertension. There is also evidence that metabolic processes differ in the obese patient, particularly those with underlying insulin resistance, itself a marker of the metabolic syndrome, which may predispose to futile cycling, altered fuel utilization and protein catabolism. These issues are compounded by altered drug pharmacokinetics, and the additional logistical issues associated with prophylactic, therapeutic and diagnostic interventions.It is entirely plausible that the altered metabolic processes observed in the obese
Anthony, Chris A; Volkmar, Alexander; Shah, Apurva S; Willey, Mike; Karam, Matt; Marsh, J Lawrence
Communication with orthopedic trauma patients is traditionally problematic with low response rates (RRs). The purpose of this investigation was to (1) evaluate the feasibility of communicating with orthopedic trauma patients postoperatively, utilizing an automated mobile phone messaging platform; and (2) assess the first 2 weeks of postoperative patient-reported pain and opioid use after lower extremity orthopedic trauma procedures. This was a prospective investigation at a Level 1 trauma center in the United States. Adult patients who were capable of mobile phone messaging and were undergoing common, lower extremity orthopedic trauma procedures were enrolled in the study. Patients received a daily mobile phone message protocol inquiring about their current pain level and amount of opioid medication they had taken in the past 24 h starting on postoperative day (POD) 3 and continuing through POD 17. Our analysis considered (1) Patient completion rate of mobile phone questions, (2) Patient-reported pain level (0-10 scale), and (3) Number and percentage of daily prescribed opioid medication patients reported taking. Twenty-five patients were enrolled in this investigation. Patients responded to 87.5% of the pain and opioid medication inquiries they received over the 2-week study period. There were no differences in RRs by patient age, sex, or educational attainment. Patient-reported pain decreased over the initial 2-week study period from an average of 4.9 ± 1.7 on POD 3 to 3 ± 2.2 on POD 16-17. Patients took an average of 68% of their maximum daily narcotic prescription on POD 3 compared with 35% of their prescribed pain medication on POD 16-17. We found that in orthopedic trauma patients, an automated mobile phone messaging platform elicited a high patient RR that improved upon prior methods in the literature. This method may be used to reliably obtain pain and medication utilization data after trauma procedures.
Full Text Available Aim: To assess the various epidemiological parameters that influence the causation of trauma as well as the consequent morbidity and mortality in the pediatric age group. Materials and Methods: A prospective study of 791 patients of less than 12 years age, was carried out over a period of 1 year (August 2009 to July 2010, and pediatric trauma trends, with regards to the following parameters were assessed: Age group, sex, mode of trauma, type of injury, place where the trauma occurred and the overall mortality as well as mortality. Results: Overall trauma was most common in the school-going age group (6-12 years, with male children outnumbering females in the ratio of 1.9:1. It was observed that orthopedic injuries were the most frequent (37.8% type of injuries, whereas fall from height (39.4%, road traffic accident (27.8% and burns (15.2% were the next most common modes of trauma. Home was found out to be the place where maximum trauma occurred (51.8%. Maximum injuries happened unintentionally (98.4%. Overall mortality was found out to be 6.4% (n = 51. Conclusions: By knowing the epidemiology of pediatric trauma, we conclude that majority of pediatric injuries are preventable and pediatric epidemiological trends differ from those in adults. Therefore, preventive strategies should be made in pediatric patients on the basis of these epidemiological trends.
Full Text Available Background: The incidence of trauma has been high and has gained attention worldwide. The energy involved in trauma results in specific tissue damage. Such tissue damage generally leads to pain. The high pain intensity possibly is consequence of trauma due to transfer energy to the body from external force and absorbed in wide area. This pain affected patients’ physical and psychological function, in which well known as pain interference. Objective: The aim of this review is to describe the pain intensity and pain interference among trauma patients. Method: A systematic search of electronic databases (CINHAL, ProQuest, Science Direct, and Google scholar was conducted for quantitative and qualitative studies measuring pain intensity and pain interference. The search limited to hospitalized trauma patients in adult age. Results: The search revealed 678 studies. A total of 10 descriptive studies examined pain intensity and pain interference and met inclusion criteria. The pain intensity and pain interference was assessed using Brief Pain Inventory (BPI. Pain intensity of hospitalized trauma patients were moderate to severe. These including 6 studies in orthopedic trauma, one study in musculoskeletal, two in studies in combinational between orthopedic and musculoskeletal, and two studies in burn injury. Moreover, the patients also reported pain was relentless & unbearable. In accordance, data showed that pain interference was moderate to severe from six studies. These studies result in vary of functional interference. However, those studies examined pain interference on sleep, enjoyment of life, mood, relationship with other, walking, general activity, and walking. Conclusion: The evidence from 10 studies included in this review indicates that hospitalized trauma patients perceived moderate to severe pain intensity and pain interference. Further research is needed to better evaluate the pain of hospitalized trauma patients.
Ashraf F. Hefny
Conclusion: Bleeding into the subcutaneous plane in closed degloving injury can cause severe hypovolemic shock. It is important for the clinicians managing trauma patients to be aware this serious injury.
Kelly, B; Burnett, P; Pelusi, D; Badger, S; Varghese, F; Robertson, M
This exploratory study investigated factors associated with the wish to hasten death among a sample of terminally ill cancer patients. Semi-structured interviews conducted on a total of 72 hospice and home palliative care patients were subjected to qualitative analysis using QSR-NUDIST. The main themes to emerge suggested that patients with a high wish to hasten death had greater concerns with physical symptoms and psychological suffering, perceived themselves to be more of a burden to others, and experienced higher levels of demoralization, while also reporting less confidence in symptom control, fewer social supports, less satisfaction with life experiences and fewer religious beliefs when compared with patients who had a moderate or no wish to hasten death. The implications of these findings will be discussed.
Meyer, Anna Sina P; Meyer, Martin A S; Sørensen, Anne Marie
BACKGROUND: Viscoelastic hemostatic assays may provide means for earlier detection of trauma-induced coagulopathy (TIC). METHODS: This is a prospective observational study of 182 trauma patients admitted to a Level 1 trauma center. Clinical data, thrombelastography (TEG), and rotational thromboel......BACKGROUND: Viscoelastic hemostatic assays may provide means for earlier detection of trauma-induced coagulopathy (TIC). METHODS: This is a prospective observational study of 182 trauma patients admitted to a Level 1 trauma center. Clinical data, thrombelastography (TEG), and rotational...... ratio greater than 1.2 (TIC patients) as well as transfusion needs (no red blood cells [RBCs], 1-9 RBCs, and ≥10 RBC in 6 hours). Correlations were analyzed by Spearman's correlation. RESULTS: TIC patients had lower amplitudes than non-TIC patients in ROTEM/TEG as follows: EXTEM, INTEM, and FIBTEM: A5.......001) (CK, 16 [15-17] vs. 27 [25-30]; rTEG, 11 [11-11] vs. 18 [17-20]; EXTEM, 11 [11-11] vs. 29 [26-31]; and INTEM 13[12-13] vs. 25 [22-29]). CONCLUSION: Early amplitudes were lower in TIC patients, had significant correlations with MA/MCF, and differentiated between nontransfused and patients receiving one...
Hyun Oh Park
Full Text Available Background: Ventilator-associated pneumonia (VAP is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU. This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. Methods: We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score. Results: Forty-six patients (45.5% had at least 1 episode of VAP, 10 (21.7% of whom died in the ICU. Of the 55 (54.5% patients who did not have pneumonia, 9 (16.4% died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029. Conclusion: Severe pulmonary contusion (pulmonary lung contusion score 6–12 is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.
Townsend, Laura L; Esquivel, Micaela M; Uribe-Leitz, Tarsicio; Weiser, Thomas G; Maggio, Paul M; Spain, David A; Tennakoon, Lakshika; Staudenmayer, Kristan
We hypothesized that psychiatric diagnoses would be common in hospitalized trauma patients in the United States and when present, would be associated with worse outcomes. The Nationwide Inpatient Sample (NIS, 2012) was used to determine national estimates for the number of patients admitted with an injury. Psychiatric diagnoses were identified using diagnosis codes according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A total of 36.5 million patients were admitted to hospitals in the United States in 2012. Of these, 1.3 million (4%) were due to trauma. Psychiatric conditions were more common in patients admitted for trauma versus those admitted for other reasons (44% versus 34%, P drug and alcohol abuse predominated (41%), whereas dementia and related disorders (48%) were the most common in adults ≥65 y. Mortality was lower for trauma patients with a psychiatric diagnosis compared to those who did not in both unadjusted and adjusted analysis (1.9% versus 2.8%; odds ratio: 0.56, P < 0.001). Psychiatric conditions are present in almost half of all hospitalized trauma patients in the United States; however, the types of conditions varied with age. The frequency of psychiatric conditions in the trauma population suggests efforts should be made to address this component of patient health. Copyright © 2017 Elsevier Inc. All rights reserved.
Monteleone, Alessio Maria; Monteleone, Palmiero; Serino, Ismene; Scognamiglio, Pasquale; Di Genio, Monica; Maj, Mario
Exposure to trauma during childhood is a risk factor for eating disorders (EDs) in adulthood. The biological mechanisms underlying such increased risk seem to involve the endogenous stress response system (i.e., the hypothalamic-pituitary-adrenal [HPA] axis), which undergoes trauma-induced functional changes that may persist later in life. In the present study, we examined the effects of childhood trauma experiences on HPA-axis activity, comparing saliva cortisol awakening response (CAR) in adult patients with anorexia nervosa (AN) or bulimia nervosa (BN) with CAR in adult healthy controls. Twenty-three patients with symptomatic AN, 21 patients with symptomatic BN, and 29 healthy women collected saliva samples at awakening and again after 15, 30, and 60 min. Participants also completed the Childhood Trauma Questionnaire and eating-related psychopathological rating scales. According to the Childhood Trauma Questionnaire, 13 individuals with AN and 12 individuals with BN, but none of the healthy women, reported childhood maltreatment. Compared with the control group, the non-maltreated AN patient group exhibited an enhanced CAR, whereas the group of non-maltreated BN patients showed a normal CAR. Moreover, both AN and BN patient groups with childhood maltreatment exhibited statistically significant blunting of CAR compared with non-maltreated groups. The present findings add to the evidence supporting the concept that there is a dysregulation of HPA-axis activity in symptomatic patients with EDs and suggest that childhood trauma exposure may contribute to such dysregulation. © 2014 Wiley Periodicals, Inc.
Murphy, Margaret; Curtis, Kate; Lam, Mary K; Palmer, Cameron S; Hsu, Jeremy; McCloughen, Andrea
Simulation has been promoted as a platform for training trauma teams. However, it is not clear if this training has an impact on health service delivery and patient outcomes. This study evaluates the association between implementation of a simulation based multidisciplinary trauma team training program at a metropolitan trauma centre and subsequent patient outcomes. This was a retrospective review of trauma registry data collected at an 850-bed Level 1 Adult Trauma Centre in Sydney, Australia. Two concurrent four-year periods, before and after implementation of a simulation based multidisciplinary trauma team training program were compared for differences in time to critical operations, Emergency Department (ED) length of stay (LOS) and patient mortality. There were 2389 major trauma patients admitted to the hospital during the study, 1116 in the four years preceding trauma team training (the PREgroup) and 1273 in the subsequent 4 years (the POST group). There were no differences between the groups with respect to gender, body region injured, incidence of polytrauma, and pattern of arrival to ED. The POST group was older (median age 54 versus 43 years, p team training was associated with a reduction in time to critical operation while overall ED length of stay increased. Simulation is promoted as a platform for training teams; but the complexity of trauma care challenges efforts to demonstrate direct links between multidisciplinary team training and improved outcomes. There remain considerable gaps in knowledge as to how team training impacts health service delivery and patient outcomes. Retrospective comparative therapeutic/care management study, Level III evidence. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.
Introduction Although a plethora of studies have delineated the relationship between childhood trauma and onset, symptom severity, and course of depression and anxiety disorders, there has been little evidence that childhood trauma may lead to interpersonal problems among adult patients with depression and anxiety disorders. Given the lack of prior research in this area, we aimed to investigate characteristics of interpersonal problems in adult patients who had suffered various types of abuse and neglect in childhood. Methods A total of 325 outpatients diagnosed with depression and anxiety disorders completed questionnaires on socio-demographic variables, different forms of childhood trauma, and current interpersonal problems. The Childhood Trauma Questionnaire (CTQ) was used to measure five different forms of childhood trauma (emotional abuse, emotional neglect, physical abuse, physical neglect, and sexual abuse) and the short form of the Korean-Inventory of Interpersonal Problems Circumplex Scale (KIIP-SC) was used to assess current interpersonal problems. We dichotomized patients into two groups (abused and non-abused groups) based on CTQ score and investigated the relationship of five different types of childhood trauma and interpersonal problems in adult patients with depression and anxiety disorders using multiple regression analysis. Result Different types of childhood abuse and neglect appeared to have a significant influence on distinct symptom dimensions such as depression, state-trait anxiety, and anxiety sensitivity. In the final regression model, emotional abuse, emotional neglect, and sexual abuse during childhood were significantly associated with general interpersonal distress and several specific areas of interpersonal problems in adulthood. No association was found between childhood physical neglect and current general interpersonal distress. Conclusion Childhood emotional trauma has more influence on interpersonal problems in adult patients with
Fruchtenicht, Ana Valéria Gonçalves; Poziomyck, Aline Kirjner; Kabke, Geórgia Brum; Loss, Sérgio Henrique; Antoniazzi, Jorge Luiz; Steemburgo, Thais; Moreira, Luis Fernando
Objective To systematically review the main methods for nutritional risk assessment used in critically ill cancer patients and present the methods that better assess risks and predict relevant clinical outcomes in this group of patients, as well as to discuss the pros and cons of these methods according to the current literature. Methods The study consisted of a systematic review based on analysis of manuscripts retrieved from the PubMed, LILACS and SciELO databases by searching for the key words “nutritional risk assessment”, “critically ill” and “cancer”. Results Only 6 (17.7%) of 34 initially retrieved papers met the inclusion criteria and were selected for the review. The main outcomes of these studies were that resting energy expenditure was associated with undernourishment and overfeeding. The high Patient-Generated Subjective Global Assessment score was significantly associated with low food intake, weight loss and malnutrition. In terms of biochemical markers, higher levels of creatinine, albumin and urea were significantly associated with lower mortality. The worst survival was found for patients with worse Eastern Cooperative Oncologic Group - performance status, high Glasgow Prognostic Score, low albumin, high Patient-Generated Subjective Global Assessment score and high alkaline phosphatase levels. Geriatric Nutritional Risk Index values Nutritional Index score was associated with abnormal nutritional status in critically ill cancer patients. Among the reviewed studies that examined weight and body mass index alone, no significant clinical outcome was found. Conclusion None of the methods reviewed helped to define risk among these patients. Therefore, assessment by a combination of weight loss and serum measurements, preferably in combination with other methods using scores such as Eastern Cooperative Oncologic Group - performance status, Glasgow Prognostic Score and Patient-Generated Subjective Global Assessment, is suggested given that
Xhaard, Aliénor; Epelboin, Loic; Schnell, David; Vincent, François; Levy, Vincent; Malphettes, Marion; Azoulay, Elie; Darmon, Michaël
Although recent studies have demonstrated an improvement in the prognosis of critically ill cancer patients, little is known regarding the prognosis of patients with non-aggressive underlying malignancies. The aims of this study were to assess the prognosis of critically ill patients with chronic lymphocytic leukemia (CLL) and to evaluate risk factors for hospital mortality. In retrospective mono-center cohort study, consecutive adult patients with CLL requiring ICU admission from 1997 to 2008 were included. Sixty-two patients of 67 years (62-75) were included. Median time interval between CLL diagnosis and ICU admission was 6.7 years (2.6-10.8). Nine patients (15 %) had stage C disease at the time of ICU admission, and seven patients (11 %) had Richter syndrome. Most ICU admissions were related to bacterial or fungal pulmonary infections (n = 47; 76 %). ICU, in-hospital, and 90-day mortality were 35 % (n = 22), 42 % (n = 26), and 58 % (n = 36), respectively. Only three factors were independently associated with in-hospital mortality: oxygen saturation lower than 95 % when breathing room air (odds ratio (OR) 5.80; 95 % confidence interval (CI) 1.23-27.33), need for vasopressors (OR 27.94; 95 % CI 5.37-145.4), and past history of infection (OR 6.62; 95 % CI 1.34-32.68). The final model did not change when disease-related variables (Binet classification, Richter syndrome, long-term steroids) or treatment-related variables (fludarabine, rituximab, or alemtuzumab) were included. Acute pulmonary infections remain the leading cause of ICU admission in patients with CLL. The severity at ICU admission and past history of infection were the only factors associated with hospital mortality. Neither disease characteristics nor previous cancer treatments were associated with outcome.
Nayebaghayee, Hossein; Afsharian, Tahmineh
Background: The study aimed to assess the relationship between computed tomography (CT) scan findings and Glasgow Coma Scale (GCS) score with the purpose of introducing GCS scoring system as an acceptable alternative for CT scan to clinically management of brain injuries in head trauma patients. Materials and Methods: This study was conducted on hospitalized patients with the complaints of head trauma. The severity of the head injury was assessed on admission by the GCS score and categorized ...
Mohr, Nicholas M; Vakkalanka, J Priyanka; Harland, Karisa K; Bell, Amanda; Skow, Brian; Shane, Dan M; Ward, Marcia M
Telemedicine has been proposed as one strategy to improve local trauma care and decrease disparities between rural and urban trauma outcomes. This study was conducted to describe the effect of telemedicine on management and clinical outcomes for trauma patients in North Dakota. Cohort study of adult (age ≥18 years) trauma patients treated in North Dakota Critical Access Hospital (CAH) Emergency Departments (EDs) from 2008 to 2014. Records were linked to a telemedicine network's call records, indicating whether telemedicine was available and/or used at the institution at the time of the care. Multivariable generalized estimating equations were developed to identify associations between telemedicine consultation and availability and outcomes such as transfer, timeliness of care, trauma imaging, and mortality. Of the 7,500 North Dakota trauma patients seen in CAH, telemedicine was consulted for 11% of patients in telemedicine-capable EDs and 4% of total trauma patients. Telemedicine utilization was independently associated with decreased initial ED length of stay (LOS) (30 min, 95% confidence interval [CI] 14-45 min) for transferred patients. Telemedicine availability was associated with an increase in the probability of interhospital transfer (adjusted odds ratio [aOR] 1.2, 95% CI 1.1-1.4). Telemedicine availability was associated with increased total ED LOS (15 min, 95% CI 10-21 min), and computed tomography scans (aOR 1.6, 95% CI 1.3-1.9). ED-based telemedicine consultation is requested for the most severely injured rural trauma patients. Telemedicine consultation was associated with more rapid interhospital transfer, and telemedicine availability is associated with increased radiography use and transfer. Future work should evaluate how telemedicine could target patients likely to benefit from telemedicine consultation.
Andrea Regina Martin
Full Text Available OBJECTIVE: To study the factors that influence the perception of acute pain and the consequences of this experience in patients suffering from mild trauma. METHOD: Descriptive qualitative study conducted in an emergency service in southern Brazil. Data was collected in October 2013, through semi-structured interviews with 29 individuals who reported pain after physical trauma, regardless of the triggering factor. To process the data, we used a Content Analysis technique, subject modality. RESULTS: Two categories emerged: Factors that influence the perception of pain resulting from trauma and, Consequences of acute pain due to trauma. The acute pain sensation was influenced by biological, emotional, spiritual and socio-cultural factors and induced biological and emotional consequences for individuals. CONCLUSION: The health professionals need to consider the factors that influence soreness and its consequences for the proper assessment and management of pain resulting from trauma.
AWARD NUMBER: W81XWH-14-1-0376 TITLE: Acute Pancreatitis as a Model to Predict Transition of Systemic Inflammation to Organ Failgure in Trauma...COVERED 22 Sep 2016 - 21 Sep 2017 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Acute Pancreatitis as a Model to Predict Transition of Systemic...Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Trauma, extensive burns, bacterial infections, and acute pancreatitis (AP) are common
Bedreag Ovidiu Horea; Rogobete Alexandru Florin; Sarandan Mirela; Cradigati Alina Carmen; Nartita Radu; Sandesc Dorel; Papurica Marius
A patient with multiple traumas is usually found in severe haemorrhagic shock. In 40% of the cases, the patient with multiple traumas and haemorrhagic shock cannot recover due to secondary injuries and complications associated with the shock. In this paper we present the case of a male patient 30 years old, who suffered a car accident. The patient is admitted in our hospital with haemorrhagic shock due to femur fracture, acute cranial-cerebral trauma and severe thoracic trauma with bleeding s...
Meisinger, Quinn C; Brown, Michele A; Dehqanzada, Zia A; Doucet, Jay; Coimbra, Raul; Casola, Giovanna
The pregnant abdominal trauma patient presents a unique diagnostic challenge. This study aimed to evaluate the accuracy of abdominal sonography for the detection of clinically important injuries in pregnant abdominal trauma patients. A retrospective review was performed of a trauma center database from 2001 to 2011. Medical records were reviewed to determine initial abdominal imaging test results and clinical course. Sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for detection of traumatic injury were calculated. Of 19,128 patients with suspected abdominal trauma, 385 (2 %) were pregnant. Of these, 372 (97 %) received ultrasound as the initial abdominal imaging test. All 13 pregnant patients who did not receive ultrasound received abdominal CT. Seven pregnant patients underwent both ultrasound and CT. Seven ultrasound examinations were positive, leading to one therapeutic Cesarean section and one laparotomy. One ultrasound was considered false positive (no injury was seen on subsequent CT). There were 365 negative ultrasound examinations. Of these, 364 were true negative (no abdominal injury subsequently found). One ultrasound was considered false negative (a large fetal subchorionic hemorrhage seen on subsequent dedicated obstetrical ultrasound). Sensitivity and positive predictive value were 85.7 %. Specificity and negative predictive value were 99.7 %. Abdominal sonography is an effective and sufficient imaging examination in pregnant abdominal trauma patients. When performed as part of the initial assessment using an abbreviated trauma protocol with brief modifications for pregnancy, ultrasound minimizes diagnostic delay, obviates radiation risk, and provides high sensitivity for injury in the pregnant population.
Hereditary angioedema (HAE) is a rare genetic disease characterized by long-term recurrent attacks of subcutaneous or submucosal edema in different parts of the body. A comprehensive review of the literature on burden of illness for patients with HAE is presented. A Boolean search was performed using MEDLINE and EMBASE databases and the Internet. Articles discussing aspects of the burden of illness in HAE were selected. Topics focused on the course of the disease, nature of attacks, treatment, quality of life, and costs. Hereditary angioedema is associated with a significant and multifaceted disease burden. Diagnosis is often delayed for years, with patients receiving ineffective treatment and unnecessary medical procedures before diagnosis. HAE attacks are painful, unpredictable, and debilitating and often require emergency medical attention. Attacks can affect a patient's daily activities, including work or schooling. Depression and anxiety are prevalent in patients with HAE. Recent advances in treatment provide patients with effective and well-tolerated prophylactic and on-demand therapeutic options. However, end points specific to HAE that better measure the impact of treatment on disease burden are lacking. Furthermore, there is a notable paucity of literature directed toward physicians who are instrumental in diagnosing and treating patients with HAE (eg, emergency department). More publications are broadening the understanding of HAE. However, important gaps remain. Effective management of HAE requires a more comprehensive understanding of the disease burden so that disease management can be individualized to meet specific patient needs. Copyright © 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Hall, Andrea; McKenna, Brian; Dearie, Vikki; Maguire, Tessa; Charleston, Rosemary; Furness, Trentham
Background Practicing with trauma informed care (TIC) can strengthen nurses? knowledge about the association of past trauma and the impact of trauma on the patient?s current mental illness. An aim of TIC is to avoid potentially re-traumatising a patient during their episode of care. A TIC education package can provide nurses with content that describes the interplay of neurological, biological, psychological, and social effects of trauma that may reduce the likelihood of re-traumatisation. Al...
Full Text Available Aim: Spinal trauma is one of the most important causes of trauma-related morbidity worldwide. Spinal injuries are often caused by traffic accidents (40%, falls (20-30%, sports injuries (10-20%, and firearm injuries. The aim of this study is to stress incidence and injury mechanism of spinal traumas and types of spinal traumas in our province by retrospectively reviewing 91 patients. Material and Method: 91 patients applied to the emergency department and neurosurgery clinic of Elazig Education and Research Hospital with spinal trauma between 2010 and 2013. Traffic accidents were classified as in-vehicle or out-of-vehicle accidents and falls were classified according to height as follows: falls from a height≤1 m and those from a height>1 m. Result: 36 patients were admitted due to falls from a height>1 m, 18 patients were admitted due to falls from a height≤1 m, 20 patients were admitted due to in-vehicle traffic accidents, 14 patients were admitted due to out-of-vehicle traffic accidents, 2 patients were admitted due to sports injuries and one patient was admitted due to assault. Thirty-one patients underwent surgery due to neurological deficit and/or radiological instability. Fifty-eight patients were managed with conservative approach. One patient died during the pre-operative period. Discussion: The aim of this study was to indicate incidence of spinal trauma, mechanism of injury, and types of spinal trauma in our province as an epidemiological study .
Hidaka, Seigo; Goto, Koji; Hagiwara, Satoshi; Iwasaka, Hideo; Noguchi, Takayuki
Objectives of the prospective, open-label study were to investigate pharmacokinetics of doripenem and determine appropriate doripenem regimens during continuous hemodiafiltration (CHDF) in critically ill patients with renal failure (creatinine clearance times during one dosing interval were measured in order to calculate pharmacokinetic parameters and clearance via hemodiafiltration. Mean half-life (+/-standard deviation) of doripenem was 7.9+/-3.7 hours. Total body clearance of doripenem was 58.0+/-12.7 ml/min, including clearance of 13.5+/-1.6 ml/min via CHDF. An IV dose of 250 mg of doripenem every 12 hours during CHDF provided adequate plasma concentrations for critically ill patients with renal failure, without resulting in accumulation upon steady-state. Thus, under the conditions tested, CHDF appeared to have little effect on doripenem clearance. Therefore, the blood level of doripenem can be satisfactorily controlled by adjustment of doripenem dose and dosing interval, in accordance with residual renal function in patients receiving CHDF.
Wardell, Stephan; Wall, Alastair; Bryce, Rhonda; Gjevre, John A; Laframboise, Karen; Reid, John Kilpatrick
Obesity rates are increasing worldwide, particularly in North America. The impact of obesity on the outcome of critically ill patients is unclear. A prospective observational cohort study of consecutive patients admitted to a tertiary critical care unit in Canada between January 10, 2008 and March 31, 2009 was conducted. Exclusion criteria were age care unit (ICU) admission. Coprimary end points were ICU mortality and a composite of ICU mortality, reintubation, ventilator-associated pneumonia, line sepsis and ICU readmission. Subjects were stratified as obese or nonobese, using two separate metrics: body mass index (BMI) ≥ 30 kg/m(2) and a novel measurement of 75th percentile for waist-to-height ratio (WHR). Among 449 subjects with a BMI ≥ 18.5 kg/m(2), both BMI and WHR were available for comparative analysis in 348 (77.5%). Neither measure of obesity was associated with the primary end points. BMI ≥ 3 0 kg/m(2) was associated with a lower odds of six-month mortality than the BMI Obesity was not necessarily associated with worse outcomes in critically ill patients.
Lotzin, Annett; Haupt, Lena; von Schönfels, Julia; Wingenfeld, Katja; Schäfer, Ingo
The high occurrence of childhood trauma in individuals with alcohol dependence is well-recognized. Nevertheless, researchers have rarely studied which types of childhood trauma often co-occur and how these combinations of different types and severities of childhood trauma are related to the patients' current addiction-related problems. We aimed to identify childhood trauma profiles in patients with alcohol dependence and examined relations of these trauma profiles with the patients' current addiction-related problems. In 347 alcohol-dependent patients, 5 types of childhood trauma (sexual abuse, physical abuse, emotional abuse, emotional neglect, and physical neglect) were measured using the Childhood Trauma Questionnaire. Childhood trauma profiles were identified using cluster analysis. The patients' current severity of addiction-related problems was assessed using the European Addiction Severity Index. We identified 6 profiles that comprised different types and severities of childhood trauma. The patients' trauma profiles predicted the severity of addiction-related problems in the domains of psychiatric symptoms, family relationships, social relationships, and drug use. Childhood trauma profiles may provide more useful information about the patient's risk of current addiction-related problems than the common distinction between traumatized versus nontraumatized patients. Copyright © 2016 by the Research Society on Alcoholism.
Chan, M; Al-Buali, W; Charyk Stewart, T; Singh, R N; Kornecki, A; Seabrook, J A; Fraser, D D
A retrospective registry review. To determine the incidence of cervical spine (CS) injuries and collar complications in severely injured paediatric trauma patients. Regional Trauma Centre, Children's Hospital. A retrospective review of 365 paediatric severe trauma patients (0-17 years), defined as an Injury Severity Score (ISS)≥12, admitted to the paediatric intensive care unit (PICU). Clinically significant CS injuries occurred in 5% (n=18/365) of trauma patients, in 9% (n=13/149) of traumatic brain injury (TBI) patients and in 11% (n=6/56) of in-hospital trauma deaths. CS injuries were suspected before imaging in 33% (n=6/18) of patients based on either motor/sensory impairment or shock. CS injuries were deemed unstable in 61% (n=11/18) of patients. Patients with CS injuries had higher ISS, and longer PICU and hospital stays (Pcollar complications occurred in 10% of patients, mainly identified by day 6 and consisting of either erythema or ulcers. Patients with CS collar complications were older and more likely to have TBI, lower Glasgow Coma Scale (GCS) scores, longer PICU and hospital stays, and increased days to CS clearance (Pcollar complications were associated with a lower GCS and longer CS clearance times. Attention to CS collar management protocols and earlier CS clearance with computed tomography/magnetic resonance imaging in obtunded patients might reduce CS collar complications.
Kao, Mary J; Nunez, Hector; Monaghan, Sean F; Heffernan, Daithi S; Adams, Charles A; Lueckel, Stephanie N; Stephen, Andrew H
A proportion of trauma patients present for evaluation in a delayed fashion after injury, likely due to a variety of medical and nonmedical reasons. There has been little investigation into the characteristics and outcomes of trauma patients who present delayed. We hypothesize that trauma patients who present in a delayed fashion are a unique population at risk of increased trauma-related complications. This was a retrospective review from 2010-2015 at a Level I trauma center. Patients were termed delayed if they presented >24 hours after injury. Patients admitted within 24 hours of their injury were the comparison group. Charts were reviewed for demographics, mechanism, comorbidities, complications and outcomes. A subgroup analysis was done on patients who suffered falls. During the 5-y period, 11,705 patients were admitted. A total of 588 patients (5%) presented >24 h after their injury. Patients in the delayed group were older (65 versus 55 y, P fashion have unique characteristics and are more likely to suffer negative outcomes including substance withdrawal. Future goals will include exploring strategies for early intervention, such as automatic withdrawal monitoring and social work referral for all patients who present in a delayed fashion. Copyright © 2016 Elsevier Inc. All rights reserved.
In current clinical practice, vital signs such as heart rate, blood pressure, oxygen saturation level, respiratory rate and temperature are continuously measured for critically ill patients. Monitored by medical devices, each vital sign provides information about basic body functions and allows...... the estimation of physiological condition, text-based electronic health records (EHR) were collected, and time-labeled entries were extracted through algorithms from Natural Language Processing (NLP). The combination of EWS and NLP enabled the development of a system which could present and quantify...... between systolic and diastolic blood pressures during the first two hours of admission. The final study dealt with classification of diabetes mellitus (DM) in ischemic stroke patients, where current findings indicate that one third of patients have unrecognized DM. A support vector machine was trained...
Thachil, Jecko; Warkentin, Theodore E
A low platelet count is a frequently encountered haematological abnormality in patients treated in intensive treatment units (ITUs). Although severe thrombocytopenia (platelet count classical view for thrombocytopenia in this setting is consumption associated with thrombin-mediated platelet activation, but other concepts, including platelet adhesion to endothelial cells and leucocytes, platelet aggregation by increased von Willebrand factor release, red cell damage and histone release, and platelet destruction by the complement system, have recently been described. The management of severe thrombocytopenia is platelet transfusion in the presence of active bleeding or invasive procedure, but the risk-benefit of prophylactic platelet transfusions in this setting is uncertain. In this review, the incidence and mechanisms of thrombocytopenia in patients with ITU, its prognostic significance and the impact on organ function is discussed. A practical approach based on the authors' experience is described to guide management of a critically ill patient who develops thrombocytopenia. © 2016 John Wiley & Sons Ltd.
This article reports the implementation and impact of a standardized systematic evidence-based predictive score for the initial assessment of acutely ill medical patients. The Simple Clinical Score (SCS) was introduced in the A&E department and the medical floor of the authors\\' hospital between June 2007 and July 2008. The SCS was well received by the staff - 67% felt it greatly improved patient assessment and was very valuable for ensuring appropriate placement of the patient after admission and improved the quality of care. This article describes the change process, the pilot evaluation and the training programme undertaken during the implementation of the SCS. It is hoped that this experience will be of value to other project teams who are undertaking similar initiatives.
This article reports the implementation and impact of a standardized systematic evidence-based predictive score for the initial assessment of acutely ill medical patients. The Simple Clinical Score (SCS) was introduced in the A&E department and the medical floor of the authors\\' hospital between June 2007 and July 2008. The SCS was well received by the staff - 67% felt it greatly improved patient assessment and was very valuable for ensuring appropriate placement of the patient after admission and improved the quality of care. This article describes the change process, the pilot evaluation and the training programme undertaken during the implementation of the SCS. It is hoped that this experience will be of value to other project teams who are undertaking similar initiatives.
Granda-Cameron, Clara; Houldin, Arlene
The purpose of this concept analysis of good death was to examine the attributes of a good death and explore the changes of the concept over time and its impact on terminally ill patients. The method used for this analysis was the Rodgers' evolutionary method. A literature search was completed using Medline Ovid and Journal Storage (JSTOR).The findings describe the evolution of the good death concept over time from the prehistoric era followed by premodern, modern, and postmodern times. In addition, information is presented about surrogate terms, attributes, antecedents, and consequences associated with good death followed by analysis and discussion of the findings. General attributes of a good death include pain and symptom management, awareness of death, patient's dignity, family presence, family support, and communication among patient, family, and health care providers.
Oksan, Derinoz; Ayfer, Keles
We reviewed the charts of 25 patients who underwent powered intraosseous line insertion between July 1, 2008 and August 31, 2010 to determine its users, indications, procedural details, success rates, and complications. Intraosseous (IO) line was inserted in the anteromedial aspect of the proximal tibia in all patients. The first attempt was successful in 80%, and the median duration for insertion of the IO line was 4 hours. Extravasation was the most common complication. Ninety-six percent of the physicians had undergone prior training in IO insertion. Because of its high success and short procedure time, IO access should be the first alternative to failed vascular access in critically ill children. Training in IO should be extended to all who care for pediatric patients in inpatient as well as in prehospital and emergency department settings.
Massive hemorrhage remains a major cause of traumatic deaths. The ideal fluid resuscitative strategy is much debated. Research has provided inconsistent results regarding which fluid strategy is ideal; the optimum fluid type, timing, and volume remains elusive. Aggressive large-volume resuscitation has been the mainstay based on controlled hemorrhage animal models. For uncontrolled hemorrhagic shock, liberal fluid resuscitative strategies exacerbate the lethal triad, invoke resuscitative injury, and increase mortality while more restrictive fluid strategies tend to ameliorate trauma-induced coagulopathy and favor a greater chance of survival. This article discusses the current evidence regarding liberal and restrictive fluid strategies for trauma. Copyright © 2016 Elsevier Inc. All rights reserved.
Kritayakirana, Kritaya; M Maggio, Paul; Brundage, Susan; Purtill, Mary-Anne; Staudenmayer, Kristan; A Spain, David
Background: Damage control surgery and the open abdomen technique have been widely used in trauma. These techniques are now being utilized more often in non-trauma patients but the outcomes are not clear. We hypothesized that the use of the open abdomen technique in non-trauma patients 1) is more often due to peritonitis, 2) has a lower incidence of definitive fascial closure during the index hospitalization, and 3) has a higher fistula rate. Methods: Retrospective case series of patients treated with the open abdomen technique over a 5-year period at a level-I trauma center. Data was collected from the trauma registry, operating room (OR) case log, and by chart review. The main outcome measures were number of operations, definitive fascial closure, fistula rate, complications, and length of stay. Results One hundred and three patients were managed with an open abdomen over the 5-year period and we categorized them into three groups: elective (n = 31), urgent (n = 35), and trauma (n = 37). The majority of the patients were male (69%). Trauma patients were younger (39 vs 53 years; P < 0.05). The most common indications for the open abdomen technique were intraabdominal hypertension in the elective group (n = 18), severe intraabdominal infection in the urgent group (n = 19), and damage control surgery in the trauma group (n = 28). The number of abdominal operations was similar (3.1–3.7) in the three groups, as was the duration of intensive care unit (ICU) stay (average: 25–31 days). The definitive fascial closure rates during initial hospitalization were as follows: 63% in the elective group, 60% in the urgent group, and 54% in the trauma group. Intestinal fistula formation occurred in 16%, 17%, and 11%, respectively, in the three groups, with overall mortality rates of 35%, 31%, and 11%. Conclusion: Intra-abdominal infection was a common reason for use of the open abdomen technique in non-trauma patients. However, the definitive fascial closure and fistula rates
Full Text Available Background : Damage control surgery and the open abdomen technique have been widely used in trauma. These techniques are now being utilized more often in non-trauma patients but the outcomes are not clear. We hypothesized that the use of the open abdomen technique in non-trauma patients 1 is more often due to peritonitis, 2 has a lower incidence of definitive fascial closure during the index hospitalization, and 3 has a higher fistula rate. Methods : Retrospective case series of patients treated with the open abdomen technique over a 5-year period at a level-I trauma center. Data was collected from the trauma registry, operating room (OR case log, and by chart review. The main outcome measures were number of operations, definitive fascial closure, fistula rate, complications, and length of stay. Results : One hundred and three patients were managed with an open abdomen over the 5-year period and we categorized them into three groups: elective (n = 31, urgent (n = 35, and trauma (n = 37. The majority of the patients were male (69%. Trauma patients were younger (39 vs 53 years; P < 0.05. The most common indications for the open abdomen technique were intraabdominal hypertension in the elective group (n = 18, severe intraabdominal infection in the urgent group (n=19, and damage control surgery in the trauma group (n = 28. The number of abdominal operations was similar (3.1−3.7 in the three groups, as was the duration of intensive care unit (ICU stay (average: 25−31 days. The definitive fascial closure rates during initial hospitalization were as follows: 63% in the elective group, 60% in the urgent group, and 54% in the trauma group. Intestinal fistula formation occurred in 16%, 17%, and 11%, respectively, in the three groups, with overall mortality rates of 35%, 31%, and 11%. Conclusion : Intra-abdominal infection was a common reason for use of the open abdomen technique in non-trauma patients. However, the definitive fascial closure and
Brown, Carlos V R; Daigle, Jacob B; Foulkrod, Kelli H; Brouillette, Brandee; Clark, Adam; Czysz, Clea; Martinez, Marnie; Cooper, Hassie
After mechanical ventilation, extubation failure is associated with poor outcomes and prolonged hospital and intensive care unit (ICU) stays. We hypothesize that specific and unique risk factors exist for failed extubation in trauma patients. The purpose of this study was to identify the risk factors in trauma patients. We performed an 18-month (January 2008-June 2009) prospective, cohort study of all adult (8 years or older) trauma patients admitted to the ICU who required mechanical ventilation. Failure of extubation was defined as reintubation within 24 hours of extubation. Patients who failed extubation (failed group) were compared with those who were successfully extubated (successful group) to identify independent risk factors for failed extubation. A total of 276 patients were 38 years old, 76% male, 84% sustained blunt trauma, with an mean Injury Severity Score = 21, Glasgow Coma Scale (GCS) score = 7, and systolic blood pressure = 125 mm Hg. Indications for initial intubation included airway (4%), breathing (13%), circulation (2%), and neurologic disability (81%). A total of 17 patients (6%) failed extubation and failures occurred a mean of 15 hours after extubation. Independent risk factors to fail extubation included spine fracture, airway intubation, GCS at extubation, and delirium tremens. Patients who failed extubation spent more days in the ICU (11 vs. 6, p = 0.006) and hospital (19 vs. 11, p = 0.002). Mortality was 6% (n = 1) in the failed group and 0.4% (n = 1) in the successful extubation group. Independent risk factors for trauma patients to fail extubation include spine fracture, initial intubation for airway, GCS at extubation, and delirium tremens. Trauma patients with these four risk factors should be observed for 24 hours after extubation, because the mean time to failure was 15 hours. In addition, increased complications, extended need for mechanical ventilation, and prolonged ICU and hospital stays should be expected for trauma patients
Full Text Available Objective. To determine whether the inferior vena cava (IVC measurement by bedside ultrasound (US-IVC predicts improvement in renal function in patients with acute kidney injury (AKI. Design. Prospective observational study. Setting. Medical intensive care unit. Patients. 33 patients with AKI were included. Intervention. US-IVC was done on admission. The patients’ management was done by the primary teams, who were unaware of the US-IVC findings. Two groups of patients were identified. Group 1 included patients who were managed in concordance with their US-IVC (potential volume responders who had a positive fluid balance at 48 h after admission and potential volume nonresponders who had an even or negative fluid balance at 48 hours after admission. Group 2 included patients in whom the fluid management was discordant with their US-IVC. Measurements and Main Results. At 48 hours, Group 1 patients had a greater improvement in creatinine [85% versus 31%, p=0.0002], creatinine clearance (78±93% versus 8±64%, p=0.002, and urine output (0.86±0.54 versus 0.45±0.36 ml/Kg/h, p=0.03. Conclusion. In critically ill patients with AKI, concurrence of fluid therapy with IVC predicted fluid management, as assessed by bedside ultrasound, was associated with improved renal function at 48 hours. This trial is registered with ClinicalTrials.gov registration number: NCT02064244.
Guveli, Hulya; Guveli, Murat Emin; Sen, Fatma; Oflaz, Serap; Gurdal, Necla; Tambas, Makbule; Kucucuk, Seden; Aydıner, Adnan; Ozkan, Mine
Early identification of patients coping poorly is important for compliance with treatment and control of distress. This study aims to investigate the effect of the childhood trauma experience on the type of reaction and adjustment that the person exhibits to the cancer among the patients with breast cancer. This cross-sectional study enrolled 310 patients with breast cancer. The effect of the childhood trauma and the psychological condition on the adjustment to cancer was investigated by assessing the adjustment to cancer, the experiences of childhood trauma and psychological status of the subjects using mental adjustment to cancer scale (MAC), childhood trauma questionnaire (CTQ28), Beck Depression Inventory (BDI) and Beck anxiety inventory (BAI). Majority of the subjects (77.4%) showed positive adjustment to cancer. Fighting spirit (63.9%) was the most commonly seen mechanism of adjustment to cancer. Of the subjects, 54.5% suffered at least one of the childhood trauma types. Among the patients, 47.1% had depression and 58.4% had anxiety. In the multivariate logistic regression analysis, emotional neglect and depression, respectively, have an effect on both positive and negative adjustment to cancer. Our study demonstrated that childhood trauma, especially emotional neglect, affects coping and adjustment among the patients with breast cancer. It is necessary to determine the childhood experiences to ensure the development of psychosocial interventions that will increase the adjustment and quality of life after the diagnosis of the cancer.
Conclusions: Both uncertainty in illness and mood state were related to coping style. These data suggest that nurses should be trained to offer appropriate guidance to help decrease patients' uncertainty in illness and relieve their negative emotions.
Objective: To examine the relationship between illness representations, coping behaviour and adaptive outcome in patients with Addison's disease (AD). Design: Cross-sectional. Following Leventhal's self-regulation model (Leventhal, Meyer & Nerenz, 1980), it was hypothesized that illness
Ciesla, David J; Pracht, Etienne E; Tepas, Joseph J; Namias, Nicholas; Moore, Frederick A; Cha, John Y; Kerwin, Andrew; Langland-Orban, Barbara
A regional trauma system must establish and monitor acceptable overtriage and undertriage rates. Although diagnoses from discharge data sets can be used with mortality prediction models to define high-risk injury, retrospective analyses introduce methodological errors when evaluating real-time triage processes. The purpose of this study was to determine if major trauma patients identified using field criteria correlated with those retrospectively labeled high risk and to assess system performance by measuring triage accuracy and trauma center utilization. A statewide database was queried for all injury-related International Classification of Diseases, 9th Revision, code discharges from designated trauma centers and nontrauma centers for 2012. Children and burn patients were excluded. Patients assigned a trauma alert fee were considered field-triage(+). The International Classification Injury Severity Score methodology was used to estimate injury-related survival probabilities, with an International Classification Injury Severity Score less than 0.85 considered high risk. Triage rates were expressed relative to the total population; the proportion of low- and high-risk patients discharged from trauma centers defined trauma center utilization. There were 116,990 patients who met study criteria, including 11,368 (10%) high-risk, 70,741 field-triage(-) patients treated in nontrauma centers and 28,548 field-triage(-) and 17,791 field-triage(+) patients treated in trauma centers. Field triage was 86% accurate, with 10% overtriage and 4% undertriage. System triage was 66% accurate, with 32% overtriage and 2% undertriage. Overtriage patients more often, and undertriage patients less often, had severe injury characteristics than appropriately triaged patients. Trauma system performance assessed using retrospective administrative data provides a convenient measure of performance but must be used with caution. Residual mistriage can partly be attributed to error introduced by
Bessette, Russell W; Carter, Randy L
Despite significant investments of federal and state dollars to transition patient medical records to an all-electronic system, a chasm still exists between health care quality and payment for it. A major reason for this gap is the difficulty in evaluating health care outcomes based on claims data. Since both payers and patients may not appreciate how illness complexity impacts treatment outcomes, it is difficult to determine fair provider compensation. Chronic kidney disease (CKD) typifies these problems and is often associated with comorbidities that impact cost, health, and work productivity. Thus, the objective of this study was to evaluate an illness complexity score (ICS) based on a linear regression of select blood values that might assist in predicting average monthly reimbursements in CKD patients. A second objective was to compare the results of this ICS prediction to results obtained by prediction of average monthly reimbursement using CKD stage. A third objective was to analyze the relationship between the change in ICS, estimated glomerular filtration rate (eGFR), and CKD stage over time to average monthly reimbursement. We calculated parsimonious values for select variables associated with CKD patients and compared the ICS to ordinal staging of renal disease. Data from 177 de-identified patients over 13 months was collected, which included 15 blood chemistry observations along with complete claims data for all medical expenses. To test for the relationship between average blood chemistry values, stages of CKD, age, and average monthly reimbursement, we modeled an association through a linear regression function of age, eGFR, and the Z-scores calculated from average monthly values of phosphorus, parathyroid hormone, glucose, hemoglobin, bicarbonate, albumin, creatinine, blood urea nitrogen, potassium, calcium, sodium, alkaline phosphatase, alanine aminotransferase, and white blood cells. The results of our study demonstrated that the association
Full Text Available Background: Initial assessment of hemodynamic parameters and timely management of patients regarding hypovolemic shock occurrence is the most essential clinical action in trauma patients and shock index (SI has considerable accuracy associated with wide application. Therefore, this study is planned to evaluate the relationship of the shock index and clinical outcome in patients with multiple trauma referring to Shahid Sadoughi Hospital of Yazd in 2011. Methods: The present study was a descriptive cross-sectional study carried out on 334 patients with multiple trauma referring to Emergency Center of Shahid Sadoughi Hospital of Yazd in 2011. Patients were divided into two separate groups based on Shock index score (≥ 0.9 as abnormal SI and < 0.9 as normal SI.Finally, data were analyzed using Chi-square and independent sample t-test in SPSS ver.19. Results: There was significant difference between the two groups in terms of mean of and gender distribution (P= 0.001. There was also a significant difference between patients with head and neck trauma and pelvic injuries in terms of frequency distribution (P< 0.05. Hemodynamic parameters were also significantly different in the two studied groups (P< 0.001. Also, with regard to the frequency distribution of intensive care unit admission (ICU and mortality rate, there was significant difference in the two groups. Conclusion: Shock index has considerable predictive value in patients with multiple trauma and can be used in initial management and assessment of patients with multiple trauma before any other diagnostic procedures since it is easily calculated. Shock index can also rapidly diagnose the real condition of trauma patient in primary hours and prevent secondary unpleasant clinical outcomes.
Full Text Available Hasan Kara,1 Aysegul Bayir,1 Ahmet Ak,1 Murat Akinci,1 Necmettin Tufekci,1 Selim Degirmenci,1 Melih Azap21Department of Emergency Medicine, Selçuk University, Konya, Turkey; 2Department of Emergency Medicine, Konya Numune Hospital, Konya, TurkeyPurpose: Trauma is a common cause of admission to the hospital emergency department. The purpose of this study was to evaluate the cause of admission, clinical characteristics, and outcomes of patients aged ≥65 years admitted to an emergency department in Turkey because of blunt trauma.Materials and methods: Medical records were retrospectively reviewed for 568 patients (314 women and 254 men aged ≥65 years who were admitted to an emergency department of a tertiary care hospital.Results: Trauma was caused by low-energy fall in 379 patients (67%, traffic accident in 79 patients (14%, high-energy fall in 69 patients (12%, and other causes in 41 patients (7%. The most frequent sites of injury were the lower extremity, thorax, upper extremity, and head. The femur was the most frequent fracture site. After evaluation in the emergency department, 377 patients (66% were hospitalized. There were 31 patients (5% who died. Risk of hospitalization after trauma was significantly associated with trauma to the lower extremity, thorax, and spine; fractures of the femur and rib; and intracranial injury.Conclusion: Emergency department admission after trauma in patients aged $65 years is common after low-energy falls, and most injuries occur to the extremities. It is important to focus on prevention of falls to decrease the frequency of trauma in the elderly.Keywords: fall, femur, fracture, injury
Tuma, Mazin A; Stansbury, Lynn G; Stein, Deborah M; McQuillan, Karen A; Scalea, Thomas M
Induced hypothermia after cardiac arrest is an accepted neuroprotective strategy. However, its role in cardiac arrest during acute trauma care is not yet defined. To characterize recent experience with this technique at our center, we undertook a detailed chart review of acute trauma patients managed with induced hypothermia after cardiac arrest. From Trauma Registry records, we identified all adult patients (older than 17 years) admitted to our Level I trauma center from July 1, 2008, through June 30, 2010, who experienced cardiac arrest during acute trauma care and were managed via our induced hypothermia protocol. This requires maintenance of core body temperature between 32°C and 34°C for 24 hours after arrest. Patient clinical records were then reviewed for selected factors. Six acute trauma patients (3 male and 3 female; median age, 53 years) with cardiac arrest managed per protocol were identified. All injuries were due to blunt impact, and five of six injuries were motor-vehicle-associated. Median Injury Severity Score was 27; median prearrest Glasgow Coma Scale (GCS) score was 15. One patient arrested prehospital and the other 5 in-hospital. Median duration of arrest was 8 minutes. All were comatose after arrest. One death occurred, in the patient with a prehospital cardiac arrest. Two patients were discharged to chronic care facilities with GCS11-tracheostomy; three were discharged to active rehabilitation care facilities with GCS score of 14 to 15. There were no obvious complications related to cooling. Mild induced hypothermia can be beneficial in a selected group of trauma patients after cardiac arrest. Prospective trials are needed to explore the effects of targeted temperature management on coagulation in this patient group.
Furness, Nicholas D; Bradford, Oliver J; Paterson, Maurice P
Tablets are becoming commonplace in the health care setting. Patients often request to view their radiographs after sustaining trauma. This can be challenging, especially if patients are immobile. The authors performed a prospective, questionnaire-based study to assess inpatient desire to view radiographs on tablets and whether viewing images affected patient-rated outcomes of understanding and satisfaction. Enabling trauma patients to view their images on a tablet is a worthwhile practice because it improves patient involvement in decision making, satisfaction, perceived understanding, and overall experience. Copyright 2013, SLACK Incorporated.
Grassi, Luigi; Caruso, Rosangela; Costantini, Anna
Communication is the corner stone of the relationship with the patient in all medical settings with the main aims of creating a good inter-personal relationship, exchanging information, and making treatment-related decisions. In a rapidly changing cultural and social context, the paternalistic approach of doctors knowing the best and deciding what should be done for a patient has been replaced by a shared decision-making approach, with patients being advised to educate themselves, ask questions and influence the course of the discussion with their doctors. Thus, a need for an improvement in the communication skills of physicians is extremely important for patients affected by serious physical illness (e.g. cancer, HIV infection, multiple sclerosis, amyotrophic lateral sclerosis). Certain attitudes, behaviour and skills (e.g. capacity to impart confidence, being empathetic, providing a 'human touch', relating on a personal level, being forthright, being respectful, and being thorough) are part of effective communication. However, some specific aspects influencing doctor-patient communication and relationships, such as personality variables, coping and attachment styles, as well as cultural factors, should also be taken in to account. The development of training curricula to help doctors acquire proper skills in communication is mandatory, since research has shown that training in communication may facilitate the effectiveness of a doctor-patient relationship and the patient's satisfaction with care and give a general sense of humanity, which is easily lost in a biotechnologically oriented medicine. © 2015 S. Karger AG, Basel.
Carrie E Bearden
Full Text Available Despite converging evidence that major depressive illness is associated with both memory impairment and hippocampal pathology, findings vary widely across studies and it is not known whether these changes are regionally specific. In the present study we acquired brain MRIs (magnetic resonance images from 31 unmedicated patients with MDD (major depressive disorder; mean age 39.2±11.9 years; 77% female and 31 demographically comparable controls. Three-dimensional parametric mesh models were created to examine localized alterations of hippocampal morphology. Although global volumes did not differ between groups, statistical mapping results revealed that in MDD patients, more severe depressive symptoms were associated with greater left hippocampal atrophy, particularly in CA1 (cornu ammonis 1 subfields and the subiculum. However, previous treatment with atypical antipsychotics was associated with a trend towards larger left hippocampal volume. Our findings suggest effects of illness severity on hippocampal size, as well as a possible effect of past history of atypical antipsychotic treatment, which may reflect prolonged neuroprotective effects. This possibility awaits confirmation in longitudinal studies.
Bakvis, P.; Spinhoven, P.; Giltay, E.J.; Kuyk, J.; Edelbroek, P.M.; Zitman, F.G.; Roelofs, K.
Purpose: Several studies have indicated that psychogenic nonepileptic seizures (PNES) are associated with psychological trauma, but only a few studies have examined the associations with neurobiologic stress systems, such as the hypothalamus-pituitary-adrenal (HPA) axis and its end-product cortisol.
Jun 1, 2015 ... diagnosis of Road Traffic Accident or trauma of all aetiologies that presented to the hospital between. January 2005 ... indicate that there were 13,572 road traffic accidents recorded in Ghana in 2011, with 13,272 people ..... 1st Ed. Salt Lake City: WB. Saunders 2002; P12-17. 8. Surgical Care at the District ...
evised trauma scores (RTS) (P= 0.002,), HIV seropositivity (P= 0.0012) and CD4+ count (P= 0.001) were significantly found to be associated with increased LOS. Mortality rate was 10.8% and was significantly associated with; the body region ...
Results: Of the 192 adults (71.9% White and 67.2% female) referred for psychological services, 75.5% were diagnosed with mood disorders, 17.2% with anxiety disorders, 22.4% with substance-related disorders and 20.9% with cluster B personality disorders or traits. A total of 145 (75.5%) reported past trauma exposure.
It has been four years since I wrote an editorial in the SAMJ relating to the problems of trauma in. South Africa (SA). I was more optimistic, naïve perhaps, and looking for meaningful change. In the face of the daily carnage from road accidents and interpersonal violence, I asked, 'is 2011 the year we will stand up.
Shumate, Robert; Portnof, Jason; Amundson, Melissa; Dierks, Eric; Batdorf, Robert; Hardigan, Patrick
The purpose of this study was to analyze maxillofacial trauma sustained by patients at least 75 years old. With the injury patterns identified, treatment recommendations for the contemporary oral and maxillofacial surgeon are made. This study was a retrospective case series using data from 2 level 1 trauma centers. The variables of interest included age at traumatic event, gender, mechanism of trauma, concomitant injuries, radiographic studies performed, management of maxillofacial injuries, and disposition. Numerical analysis was completed with statistical software. One hundred seventy-six patients at least 75 years old who sustained facial trauma were identified. Ground-level falls caused most cases of maxillofacial trauma in the geriatric population. The median age at the time of trauma was 83 and 85 years for men and women, respectively. The most common injuries were midface fractures. Intracranial hemorrhage was the most common concomitant injury, and all but 1 patient underwent computed tomography of at least the head after their traumatic event. Most maxillofacial injuries were treated without operative repair. The information gained from this study suggests that oral and maxillofacial surgeons should counsel geriatric patients on the risk of falls and encourage the prevention of potential hazards for falls in their homes. Copyright © 2017. Published by Elsevier Inc.
Full Text Available Abstract Background Early enteral nutrition is recommended in cases of critical illness. It is unclear whether this recommendation is of most benefit to extremely ill patients. We aim to determine the association between illness severity and commencement of enteral feeding. Methods One hundred and eight critically ill patients were grouped as “less severe” and “more severe” for this cross-sectional, retrospective observational study. The cut off value was based on Acute Physiology and Chronic Health Evaluation II score 20. Patients who received enteral feeding within 48 h of medical intensive care unit (ICU admission were considered early feeding cases otherwise they were assessed as late feeding cases. Feeding complications (gastric retention/vomiting/diarrhea/gastrointestinal bleeding, length of ICU stay, length of hospital stay, ventilator-associated pneumonia, hospital mortality, nutritional intake, serum albumin, serum prealbumin, nitrogen balance (NB, and 24-h urinary urea nitrogen data were collected over 21 days. Results There were no differences in measured outcomes between early and late feedings for less severely ill patients. Among more severely ill patients, however, the early feeding group showed improved serum albumin (p = 0.036 and prealbumin (p = 0.014 but worsened NB (p = 0.01, more feeding complications (p = 0.005, and prolonged ICU stays (p = 0.005 compared to their late feeding counterparts. Conclusions There is a significant association between severity of illness and timing of enteral feeding initiation. In more severe illness, early feeding was associated with improved nutritional outcomes, while late feeding was associated with reduced feeding complications and length of ICU stay. However, the feeding complications of more severely ill early feeders can be handled without significantly affecting nutritional intake and there is no eventual difference in length of hospital stay or mortality
Daleboudt, G M N; Broadbent, E; Berger, S P; Kaptein, A A
This study investigated the illness perceptions of patients with systemic lupus erythematosus (SLE) and whether perceptions are influenced by type of treatment for proliferative lupus nephritis. In addition, the illness perceptions of SLE patients were compared with those of patients with other chronic illnesses. Thirty-two patients who had experienced at least one episode of proliferative lupus nephritis were included. Patients were treated with either a high or low-dose cyclophosphamide (CYC) regimen (National Institutes of Health [NIH] vs. Euro-Lupus protocol). Illness perceptions were measured with the Brief Illness Perception Questionnaire (B-IPQ) and a drawing assignment. The low-dose CYC group perceived their treatment as more helpful than the high-dose CYC group. In comparison with patients with asthma, SLE patients showed more negative illness perceptions on five of the eight illness perception domains. Drawings of the kidney provided additional information about perceptions of treatment effectiveness, kidney function and patients' understanding of their illness. Drawing characteristics showed associations with perceptions of consequences, identity, concern and personal control. These findings suggest that the type of treatment SLE patients with proliferative lupus nephritis receive may influence perceptions of treatment effectiveness. In addition, patients' drawings reveal perceptions of damage caused by lupus nephritis to the kidneys and the extent of relief provided by treatment. The finding that SLE is experienced as a more severe illness than other chronic illnesses supports the need to more frequently assess and aim to improve psychological functioning in SLE patients.
Gruartmoner, G; Mesquida, J; Baigorri, F
Hemodynamic resuscitation seeks to correct global macrocirculatory parameters of pressure and flow. However, current evidence has shown that despite the normalization of these global parameters, microcirculatory and regional perfusion alterations can persist, and these alterations have been independently associated with a poorer patient prognosis. This in turn has lead to growing interest in new technologies for exploring regional circulation and microcirculation. Near infra-red spectroscopy allows us to monitor tissue oxygen saturation, and has been proposed as a noninvasive, continuous and easy-to-obtain measure of regional circulation. The present review aims to summarize the existing evidence on near infra-red spectroscopy and its potential clinical role in the resuscitation of critically ill patients in shock. Copyright © 2013 Elsevier España, S.L. and SEMICYUC. All rights reserved.
Murata, A; Kikuchi, M; Mishima, S; Sakaki, S; Goto, H; Matsuoka, T; Tanaka, H; Yukioka, T; Shimazaki, S
It remains difficult to treat severely ill patients, especially those who have sepsis and subsequent multiple organ dysfunction syndrome. We propose the hypothesis that the pathophysiology in the sequential sepsis and multiple organ dysfunction syndrome may be strongly related to the imbalance between inflammatory cytokines and antiinflammatory cytokines induced for the host defense to active neutrophils and endothelial cells. Thus we attempted to develop cytokine modulation therapy to normalize the cytokine balance in the host defense system. In this review, we elucidate the relationship between cytokine imbalance and SIRS/CARS in patients with severe burn injury. Furthermore, we examine the possible usage of G-CSF to amplify neutrophil function, and clarify the reasons why various innovative therapies against sepsis have failed.
Kralik, Stephen F.; Finke, Whitney; Wu, Isaac C.; Ho, Chang Y. [Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Indianapolis, IN (United States); Hibbard, Roberta A.; Hicks, Ralph A. [Indiana University School of Medicine, Department of Pediatrics, Section of Child Protection Programs, Indianapolis, IN (United States)
Pediatric head trauma, including abusive head trauma, is a significant cause of morbidity and mortality. The purpose of this research was to identify and evaluate radiologic interpretation errors of head CTs performed on abusive and non-abusive pediatric head trauma patients from a community setting referred for a secondary interpretation at a tertiary pediatric hospital. A retrospective search identified 184 patients <5 years of age with head CT for known or potential head trauma who had a primary interpretation performed at a referring community hospital by a board-certified radiologist. Two board-certified fellowship-trained neuroradiologists at an academic pediatric hospital independently interpreted the head CTs, compared their interpretations to determine inter-reader discrepancy rates, and resolved discrepancies to establish a consensus second interpretation. The primary interpretation was compared to the consensus second interpretation using the RADPEER trademark scoring system to determine the primary interpretation-second interpretation overall and major discrepancy rates. MRI and/or surgical findings were used to validate the primary interpretation or second interpretation when possible. The diagnosis of abusive head trauma was made using clinical and imaging data by a child abuse specialist to separate patients into abusive head trauma and non-abusive head trauma groups. Discrepancy rates were compared for both groups. Lastly, primary interpretations and second interpretations were evaluated for discussion of imaging findings concerning for abusive head trauma. There were statistically significant differences between primary interpretation-second interpretation versus inter-reader overall and major discrepancy rates (28% vs. 6%, P=0.0001; 16% vs. 1%, P=0.0001). There were significant differences in the primary interpretation-second interpretation overall and major discrepancy rates for abusive head trauma patients compared to non-abusive head trauma
Kralik, Stephen F.; Finke, Whitney; Wu, Isaac C.; Ho, Chang Y.; Hibbard, Roberta A.; Hicks, Ralph A.
Pediatric head trauma, including abusive head trauma, is a significant cause of morbidity and mortality. The purpose of this research was to identify and evaluate radiologic interpretation errors of head CTs performed on abusive and non-abusive pediatric head trauma patients from a community setting referred for a secondary interpretation at a tertiary pediatric hospital. A retrospective search identified 184 patients <5 years of age with head CT for known or potential head trauma who had a primary interpretation performed at a referring community hospital by a board-certified radiologist. Two board-certified fellowship-trained neuroradiologists at an academic pediatric hospital independently interpreted the head CTs, compared their interpretations to determine inter-reader discrepancy rates, and resolved discrepancies to establish a consensus second interpretation. The primary interpretation was compared to the consensus second interpretation using the RADPEER trademark scoring system to determine the primary interpretation-second interpretation overall and major discrepancy rates. MRI and/or surgical findings were used to validate the primary interpretation or second interpretation when possible. The diagnosis of abusive head trauma was made using clinical and imaging data by a child abuse specialist to separate patients into abusive head trauma and non-abusive head trauma groups. Discrepancy rates were compared for both groups. Lastly, primary interpretations and second interpretations were evaluated for discussion of imaging findings concerning for abusive head trauma. There were statistically significant differences between primary interpretation-second interpretation versus inter-reader overall and major discrepancy rates (28% vs. 6%, P=0.0001; 16% vs. 1%, P=0.0001). There were significant differences in the primary interpretation-second interpretation overall and major discrepancy rates for abusive head trauma patients compared to non-abusive head trauma
Shizgal, H.M.; Martin, M.F.
The caloric requirement of the critically ill septic patient was determined by measuring body composition, by multiple isotope dilution, before and at 2-wk intervals while receiving total parenteral nutrition (TPN) in 86 septic and 57 nonseptic malnourished patients. All patients received a TPN solution containing 25% dextrose and 2.75% crystalline amino acids. The body composition of the nonseptic patients, who received 51.9 +/- 1.5 kcal/kg.day, improved significantly, while that of the septic patients, receiving 46.8 +/- 1.1 kcal/kg.day was only maintained. The relationship between caloric intake and the restoration of a malnourished body cell mass (BCM) was determined for each group by correlating, using multiple linear regression, the mean daily change in the BCM with the caloric intake and the nutritional state, as determined by body composition. According to the resultant regressions, an intake of 35.1 and 50.7 kcal/kg.day was required to maintain the BCM of the septic and nonseptic patients, respectively. To restore a depleted BCM, caloric intakes in excess of this amount are required
Darelys Baños Sánchez
Full Text Available The insertion of intravenous catheters has converted itself in an indispensable procedure in Pediatric Intensive Care Units. The objective is caracterizing the morbimortality associated with intravenous boarding in very ill pediatrics’ patients. Descriptive, longitudinal prospective study, during 2016, in the Intensive Care Unit of the Pepe Portilla Pediatric Hospital, Pinar of the Río, The Universe: It got constituted for 182 patients admitted in the period of study and they required intravenous boarding. The information got from patient's charts and the unit's record of continuous morbility itself, and it was processed with SPSS statistical parcel for Windows, the test of hypothesis of proportions and the percentages were utilized. The intravenous boarding was accomplished to the 51.12% of the admitted patients, 31.46% for femoral road and 60.83% to patients under one year old. Principal use was the administration of medications (100%, the 56.59% had the boarding over 10 days, the 12.08% of patients presented complications, infection was more frequent. The conclusions are high incidence of the application of intravenous boarding exists; infection for catheter is the correlated complication more frequent.
de Mestral, Charles; Iqbal, Sameena; Fong, Nancy; LeBlanc, Joanne; Fata, Paola; Razek, Tarek; Khwaja, Kosar
Background A multidisciplinary tracheostomy team was created in 2005 to follow critically ill patients who had undergone a tracheostomy until their discharge from hospital. Composed of a surgeon, surgical resident, respiratory therapist, speech-language pathologist and clinical nurse specialist, this team has been meeting twice a week for rounds involving patients who transitioned from the intensive care unit (ICU) to the medical and surgical wards. Our objective was to assess the impact of this multidisciplinary team on downsizing and decannulation times, on the incidence of speaking valve placement and on the incidence of tracheostomy-related complications on the ward. Methods This study was conducted at a tertiary care, level-1 trauma centre and teaching hospital and involved all patients who had received a tracheostomy during admission to the ICU from Jan. 1 to Dec. 31, 2004 (preservice group), and from Jan. 1 to Dec. 31, 2006 (postservice group). We compared the outcomes of patients who required tracheostomies in a 12-month period after the team was created with those of patients from a similar time frame before the establishment of the team. Results There were 32 patients in the preservice group and 54 patients in the post-service group. Under the new tracheostomy service, there was a decrease in incidence of tube blockage (5.5% v. 25.0%, p = 0.016) and calls for respiratory distress (16.7% v. 37.5%, p = 0.039) on the wards. A significantly larger proportion of patients also received speaking valves (67.4% v. 19.4%, p tracheostomy team was associated with fewer tracheostomy-related complications and an increase in the use of a speaking valve. PMID:21443833
Madani, Amin; Gips, Amanda; Razek, Tarek; Deckelbaum, Dan L; Mulder, David S; Grushka, Jeremy R
Effective management of trauma patients is heavily dependent on sound judgment and decision-making. Yet, current methods for training and assessing these advanced cognitive skills are subjective, lack standardization, and are prone to error. This qualitative study aims to define and characterize the cognitive and interpersonal competencies required to optimally manage injured patients. Cognitive and hierarchical task analyses for managing unstable trauma patients were performed using qualitative methods to map the thoughts, behaviors, and practices that characterize expert performance. Trauma team leaders and board-certified trauma surgeons participated in semistructured interviews that were transcribed verbatim. Data were supplemented with content from published literature and prospectively collected field notes from observations of the trauma team during trauma activations. The data were coded and analyzed using grounded theory by 2 independent reviewers. A framework was created based on 14 interviews with experts (lasting 1-2 hours each), 35 field observations (20 [57%] blunt; 15 [43%] penetrating; median Injury Severity Score 20 [13-25]), and 15 literary sources. Experts included 11 trauma surgeons and 3 emergency physicians from 7 Level 1 academic institutions in North America (median years in practice: 12 [8-17]). Twenty-nine competencies were identified, including 17 (59%) related to situation awareness, 6 (21%) involving decision-making, and 6 (21%) requiring interpersonal skills. Of 40 potential errors that were identified, root causes were mapped to errors in situation awareness (20 [50%]), decision-making (10 [25%]), or interpersonal skills (10 [25%]). This study defines cognitive and interpersonal competencies that are essential for the management of trauma patients. This framework may serve as the basis for novel curricula to train and assess decision-making skills, and to develop quality-control metrics to improve team and individual performance
Sudhir B. Sharma
Full Text Available Retropharyngeal abscess most commonly occurs in children. When present in adults the clinical features may not be typical, and associated immunosuppression or local trauma can be part of the presentation. We present a case series of five adult patients who developed foreign body ingestion trauma associated retropharyngeal abscess. The unusual pearls of each case, along with their outcomes, are discussed. Pertinent information for the emergency medicine physician regarding retropharyngeal abscess is presented as well.
Nelson Mesquita Junior
Full Text Available BACKGROUND: Deep vein thrombosis is a common disease among people who are immobilized. Immobility is inherent to paraplegia and leads to venous stasis, which is one of the factors covered by Virchow's triad describing its development. Trauma is the primary cause of paraplegia and is currently increasing at a rate of 4% per year. OBJECTIVE: To determine the prevalence of deep vein thrombosis in paraplegic patients whose paraplegia was caused by traumas, using color Doppler ultrasonography for diagnosis. METHODS: This was a cross-sectional observational study of 30 trauma-induced paraplegia patients, selected after analysis of medical records at the neurosurgery department of a University Hospital in Curitiba, Brazil, and by a proactive survey of associations that care for the physically disabled. The prevalence of deep vein thrombosis was analyzed using 95% confidence intervals. RESULTS: Spinal cord trauma was the cause of paraplegia in 29 patients. The most common cause of trauma was gunshot wounding, reported by 17 patients. Deep vein thrombosis was diagnosed by color Doppler ultrasonography in 14 patients in the sample. The most often affected vein was the posterior tibial, in 11 patients. The left lower limb was involved three times more often than the right. Edema was observed in 25 individuals, cyanosis in 14, ulcers in 8 and localized increase in temperature in 13. CONCLUSIONS: Deep vein thrombosis was prevalent, occurring in 46.7% of the patients.
Johannesdottir, Bergros K; Mogensen, Brynjolfur; Gudbjartsson, Tomas
Emergency thoracotomy (ET) can be life-saving in highly selected trauma patients, especially after penetrating chest trauma. There is little information on the outcome of ET in European trauma centres. Here we report our experience in Iceland. This was a retrospective analysis of all patients who underwent ET in Iceland between 2005 and 2010. Patient demographics, mechanism, and location of major injury (LOMI) were registered, together with signs of life (SOL), the need for cardiopulmonary resuscitation (CPR), and transfusions. Based on physiological status from injury at admission, the severity score (ISS), revised trauma score (RTS), and probability of survival (PS) were calculated. Of nine ET patients (all males, median age 36years, range 20-76) there were five long-term survivors. All but one made a good recovery. There were five blunt traumas (3 survivors) and four penetrating injuries (2 survivors). The most frequent LOMI was isolated thoracic injury (n=6), but three patients had multiple trauma. Thoracotomy was performed in five patients, sternotomy in two, and two underwent both procedures. One patient was operated in the ambulance and the others were operated after arrival. Median ISS and NISS were 29 (range 16-54) and 50 (range 25-75), respectively. Median RTS was 7 (range 0-8) with estimated PS of 85% (range 1-96%). Median blood loss was 10L (range 0.9-55). A median of 23 units of packed red blood cells were transfused (range 0-112). For four patients, CPR was required prior to transport; two others required CPR in the emergency room. Three patients never had SOL and all of them died. ET is used infrequently in Iceland and the number of patients was small. More than half of them survived the procedure. This is especially encouraging considering how severely injured the patients were. Copyright © 2012 Elsevier Ltd. All rights reserved.
Scalea Thomas M
Full Text Available Abstract Background The utility of esophagogastroduodenoscopy (EGD performed at the time of percutaneous endoscopic gastrostomy (PEG is unclear. We examined whether EGD at time of PEG yielded clinically useful information important in patient care. We also reviewed the outcome and complication rates of EGD-PEG performed by trauma surgeons. Methods Retrospective review of all trauma patients undergoing EGD with PEG at a level I trauma center from 1/01–6/03. Results 210 patients underwent combined EGD with PEG by the trauma team. A total of 37% of patients had unsuspected upper gastrointestinal lesions seen on EGD. Of these, 35% had traumatic brain injury, 10% suffered multisystem injury, and 47% had spinal cord injury. These included 15 esophageal, 61 gastric, and six duodenal lesions, mucosal or hemorrhagic findings on EGD. This finding led to a change in therapy in 90% of patients; either resumption/continuation of H2 -blockers or conversion to proton-pump inhibitors. One patient suffered an upper gastrointestinal bleed while on H2-blocker. It was treated endoscopically. Complication rates were low. There were no iatrogenic visceral perforations seen. Three PEGs were inadvertently removed by the patient (1.5%; one was replaced with a Foley, one replaced endoscopically, and one patient underwent gastric repair and open jejunostomy tube. One PEG leak was repaired during exploration for unrelated hemorrhage. Six patients had significant site infections (3%; four treated with local drainage and antibiotics, one requiring operative debridement and later closure, and one with antibiotics alone. Conclusion EGD at the time of PEG may add clinically useful data in the management of trauma patients. Only one patient treated with acid suppression therapy for EGD diagnosed lesions suffered delayed gastrointestinal bleeding. Trauma surgeons can perform EGD and PEG with acceptable outcomes and complication rates.
Cui, Li-Hong; Li, Chao; Wang, Xiao-Hui; Yan, Zhi-Hui; He, Xing; Gong, San-Dong
To compare the therapeutic effects of different doses of intravenous esomeprazole on treating trauma patients with stress ulcer bleeding. A total of 102 trauma patients with stress ulcer bleeding were randomly divided into 2 groups: 52 patients were assigned to the high-dose group who received 80 mg intravenous esomeprazole, and then 8 mg/h continuous infusion for 3 days; 50 patients were assigned to the conventional dose group who received 40 mg intravenous esomeprazole sodium once every 12 h for 72 h. Compared with the conventional dose group, the total efficiency of the high-dose group and conventional dose group was 98.08% and 86.00%, respectively (p esomeprazole have good hemostatic effects on stress ulcer bleeding in trauma patients. The high-dose esomeprazole is better for hemostasis.
Full Text Available Russell W Bessette1, Randy L Carter2,3 1Department of Health Sciences, Institute for Healthcare Informatics, 2Department of Biostatistics, 3Population Health Observatory, University at Buffalo, State University of New York, Buffalo, NY, USA Background: Despite significant investments of federal and state dollars to transition patient medical records to an all-electronic system, a chasm still exists between health care quality and payment for it. A major reason for this gap is the difficulty in evaluating health care outcomes based on claims data. Since both payers and patients may not appreciate how illness complexity impacts treatment outcomes, it is difficult to determine fair provider compensation. Objectives: Chronic kidney disease (CKD typifies these problems and is often associated with comorbidities that impact cost, health, and work productivity. Thus, the objective of this study was to evaluate an illness complexity score (ICS based on a linear regression of select blood values that might assist in predicting average monthly reimbursements in CKD patients. A second objective was to compare the results of this ICS prediction to results obtained by prediction of average monthly reimbursement using CKD stage. A third objective was to analyze the relationship between the change in ICS, estimated glomerular filtration rate (eGFR, and CKD stage over time to average monthly reimbursement. Methods: We calculated parsimonious values for select variables associated with CKD patients and compared the ICS to ordinal staging of renal disease. Data from 177 de-identified patients over 13 months was collected, which included 15 blood chemistry observations along with complete claims data for all medical expenses. To test for the relationship between average blood chemistry values, stages of CKD, age, and average monthly reimbursement, we modeled an association through a linear regression function of age, eGFR, and the Z-scores calculated from average
Renata Matos da Silva
Full Text Available OBJECTIVE: To identify which noninvasive ventilation (NIV masks are most commonly used and the problems related to the adaptation to such masks in critically ill patients admitted to a hospital in the city of São Paulo, Brazil. METHODS: An observational study involving patients ≥ 18 years of age admitted to intensive care units and submitted to NIV. The reason for NIV use, type of mask, NIV regimen, adaptation to the mask, and reasons for non-adaptation to the mask were investigated. RESULTS: We evaluated 245 patients, with a median age of 82 years. Acute respiratory failure was the most common reason for NIV use (in 71.3%. Total face masks were the most commonly used (in 74.7%, followed by full face masks and near-total face masks (in 24.5% and 0.8%, respectively. Intermittent NIV was used in 82.4% of the patients. Adequate adaptation to the mask was found in 76% of the patients. Masks had to be replaced by another type of mask in 24% of the patients. Adequate adaptation to total face masks and full face masks was found in 75.5% and 80.0% of the patients, respectively. Non-adaptation occurred in the 2 patients using near-total facial masks. The most common reason for non-adaptation was the shape of the face, in 30.5% of the patients. CONCLUSIONS: In our sample, acute respiratory failure was the most common reason for NIV use, and total face masks were the most commonly used. The most common reason for non-adaptation to the mask was the shape of the face, which was resolved by changing the type of mask employed.
Full Text Available Background: No evidence-based guidelines or protocols to treat the infection-related symptoms in cancer patients with terminal stages have been established. Materials and Methods: We retrospectively analyzed all the patients with terminal stage cancer who died between April 2009 and March 2010. The patients' background, the prevalence of infection and clinical outcomes, pathogens isolated, antibiotics used, and whether blood cultures and some of examinations were performed or not were evaluated. Results: A total of 62 (44 males and 18 females patients were included in this study. The median age was 73 years (35-98 years. The most common cancer was that of the lung (n =59, 95.2%. A total of 32 patients were diagnosed with the following infections: Infection of respiratory tract in 27 (84.4%, of urinary tract in 4 (12.5%, and cholangitis in 1 (3.1%. Two cases (6.3% had pneumonia complicated with urinary tract infection. Blood cultures and antibiotic therapies were performed in 28 and 30 cases, respectively. Four (14.3% positive cultures were isolated from the blood obtained from 28 individual patients. As for clinical course, 3 (10% of them experienced improved symptoms after antibiotic therapy. Twenty-seven (90% patients were not confirmed as having any symptom improvement. Conclusions: Blood cultures and antibiotic therapy were limited, and might not be effective in terminally ill cancer patients with lung cancer. We suggest that administering an antibiotic therapy without performing a blood culture would be one of choices in those with respiratory tract infections if patients' life expectancy is short.
Patanwala, Asad E; Abarca, Jacob; Huckleberry, Yvonne; Erstad, Brian L
To compare the effectiveness of common laxatives in producing a bowel movement in patients admitted to a medical intensive care unit (MICU). Retrospective medical record review. MICU of an academic medical center. Ninety-five patients admitted to the MICU from July 1-October 31, 2004. Fifty patients satisfied the inclusion criteria. Patient-specific data such as age, weight, sex, length of MICU stay, Acute Physiology and Chronic Health Evaluation (APACHE) II score, dietary intake, opioid intake, laxative intake, and bowel movements were recorded during the first 96 hours of admission. Logistic regression analysis was used to compare patients who did and did not have a bowel movement. Of the 50 patients, 25 did not have a bowel movement during the first 96 hours of MICU admission. Patients given a stimulant laxative (senna, bisacodyl) and/or an osmotic laxative (lactulose, milk of magnesia) were more likely to have a bowel movement (odds ratio [OR] 26.6, 95% confidence interval [CI] 3.2-221, p=0.002). Opioid intake, expressed as logarithmic morphine equivalents, was negatively associated with occurrence of a bowel movement (OR 0.76, 95% CI 0.59-0.97, p=0.027). Disease severity, as determined by APACHE II score, was also negatively associated with a bowel movement (OR 0.84, 95% CI 0.7-0.99, p=0.04). Critically ill patients have a high frequency of constipation, and opioid therapy is a significant risk factor. Routine administration of stimulant or osmotic laxatives should be considered for this patient population.
Ana Mavarez-Martinez MD
Full Text Available Many trauma patients present with a combination of cranial and thoracic injury. Anesthesia for these patients carries the risk of intraoperative hemodynamic instability and respiratory complications during mechanical ventilation. Massive air leakage through a lacerated lung will result in inadequate ventilation and hypoxemia and, if left undiagnosed, may significantly compromise the hemodynamic function and create a life-threatening situation. Even though these complications are more characteristic for the early phase of trauma management, in some cases, such a scenario may develop even months after the initial trauma. We report a case of a 25-year-old patient with remote thoracic trauma, who developed an intraoperative tension pneumothorax and hemodynamic instability while undergoing an elective cranioplasty. The intraoperative patient assessment was made even more challenging by unexpected massive blood loss from the surgical site. Timely recognition and management of intraoperative pneumothorax along with adequate blood replacement stabilized the patient and helped avoid an unfavorable outcome. This case highlights the risks of intraoperative pneumothorax in trauma patients, which may develop even months after injury. A high index of suspicion and timely decompression can be life saving in this type of situation.
Full Text Available 【Abstract】 Objective: Thoracic injuries are respon- sible for 25% of deaths of blunt traumas. Chest X-ray (CXR is the first diagnostic method in patients with blunt trauma. The aim of this study was to detect the accuracy of CXR versus chest computed tomograpgy (CT in hemodynami- cally stable patients with blunt chest trauma. Methods: Study was conducted at the emergency department of Sina Hospital from March 2011 to March 2012. Hemodynamically stable patients with at least 16 years of age who had blunt chest trauma were included. All patients underwent the same diagnostic protocol which consisted of physical examination, CXR and CT scan respectively. Results: Two hundreds patients (84% male and 16% female were included with a mean age of (37.9±13.7 years. Chin J Traumatol 2013;16(6:351-354 Rib fracture was the most common finding of CXR (12.5% and CT scan (25.5%. The sensitivity of CXR for hemothorax, thoracolumbar vertebra fractures and rib fractures were 20%, 49% and 49%, respectively. Pneumothorax, foreign body, emphysema, pulmonary contusion, liver hematoma and ster- num fracture were not diagnosed with CXR alone. Conclusion: Applying CT scan as the first-line diag- nostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome. Key words: Radiography; Thoracic injuries; Tomography, X-ray computed
Malhotra, Ajay; Durand, David; Wu, Xiao; Geng, Bertie; Abbed, Khalid; Nunez, Diego B; Sanelli, Pina
To determine the utility of cervical spine MRI in blunt trauma evaluation for instability after a negative non-contrast cervical spine CT. A review of medical records identified all adult patients with blunt trauma who underwent CT cervical spine followed by MRI within 48 h over a 33-month period. Utility of subsequent MRI was assessed in terms of findings and impact on outcome. A total of 1,271 patients with blunt cervical spine trauma underwent both cervical spine CT and MRI within 48 h; 1,080 patients were included in the study analysis. Sixty-six percent of patients with a CT cervical spine study had a negative study. Of these, the subsequent cervical spine MRI had positive findings in 20.9%; 92.6% had stable ligamentous or osseous injuries, 6.0% had unstable injuries and 1.3% had potentially unstable injuries. For unstable injury, the NPV for CT was 98.5%. In all 712 patients undergoing both CT and MRI, only 1.5% had unstable injuries, and only 0.42% had significant change in management. MRI for blunt trauma evaluation remains not infrequent at our institution. MRI may have utility only in certain patients with persistent abnormal neurological examination. • MRI has limited utility after negative cervical CT in blunt trauma. • MRI is frequently positive for non-specific soft-tissue injury. • Unstable injury missed on CT is infrequent.
Reece Albert S
Full Text Available Abstract Background Trauma plays an important role in the experience of many patients with substance use disorder, but is relatively under-studied particularly in Australia. The present survey examined the lifetime prevalence of various forms of trauma including driving careers in the context of relevant medical conditions. Methods A survey was undertaken in a family medicine practice with a special interest in addiction medicine in Brisbane, Australia. Results Of 350 patients surveyed, 220 were substance dependent, and 130 were general medical patients. Addicted patients were younger (mean ± S.D. 33.72 ± 8.14 vs. 44.24 ± 16.91 years, P Conclusion This study shows that despite shorter driving histories, addicted patients have worse driving careers and general trauma experience than the comparison group which is not explained by associated medical conditions. Trauma is relevant to addiction management at both the patient and policy levels. Substance dependence policies which focus largely on prevention of virus transmission likely have too narrow a public health focus, and tend to engender an unrealistically simplistic and trivialized view of the addiction syndrome. Reduction of drug driving and drug related trauma likely require policies which reduce drug use per se, and are not limited to harm reduction measures alone.
Cantini Ardila, Jorge Ernesto; Mendoza, Miguel Ángel Rivera; Ortega, Viviana Gómez
Background and Purpose Sphenoid bone fractures and sphenoid sinus fractures have a high morbidity due to its association with high-energy trauma. The purpose of this study is to describe individuals with traumatic injuries from different mechanisms and attempt to determine if there is any relationship between various isolated or combined fractures of facial skeleton and sphenoid bone and sphenoid sinus fractures. Methods We retrospectively studied hospital charts of all patients who reported to the trauma center at Hospital de San José with facial fractures from December 2009 to August 2011. All patients were evaluated by computed tomography scan and classified into low-, medium-, and high-energy trauma fractures, according to the classification described by Manson. Design This is a retrospective descriptive study. Results The study data were collected as part of retrospective analysis. A total of 250 patients reported to the trauma center of the study hospital with facial trauma. Thirty-eight patients were excluded. A total of 212 patients had facial fractures; 33 had a combination of sphenoid sinus and sphenoid bone fractures, and facial fractures were identified within this group (15.5%). Gender predilection was seen to favor males (77.3%) more than females (22.7%). The mean age of the patients was 37 years. Orbital fractures (78.8%) and maxillary fractures (57.5%) were found more commonly associated with sphenoid sinus and sphenoid bone fractures. Conclusions High-energy trauma is more frequently associated with sphenoid fractures when compared with medium- and low-energy trauma. There is a correlation between facial fractures and sphenoid sinus and sphenoid bone fractures. A more exhaustive multicentric case-control study with a larger sample and additional parameters will be essential to reach definite conclusions regarding the spectrum of fractures of the sphenoid bone associated with facial fractures. PMID:24436756
Sierink, Joanne C; Joosse, Pieter; de Castro, Steve Mm; Schep, Niels Wl; Goslings, J Carel
In our level I trauma center, it is considered common practice to repeat blood haemoglobin measurements in patients within 2 h after admission. However, the rationale behind this procedure is elusive and can be considered labour-intensive, especially in patients in whom haemorrhaging is not to be expected. The aim of this study was to assess the value of the repeated Hb measurement (r-Hb) within 2 h in adult trauma patients without evidence of haemodynamic instability. The local trauma registry was used to identify all trauma patients without evidence of haemodynamic instability from January 2009 to December 2010. Patients in whom no initial blood Hb measurement (i-Hb) was done on admission, referrals, and patients without risk for traumatic injuries or haemorrhage based upon mechanism of injury (e.g. inhalation or drowning injury) were excluded. A total of 1,537 patients were included in the study, 1,246 of which did not present with signs of haemodynamic instability. Median Injury Severity Score (ISS) was 5 (interquartile range (IQR) 1 to 13), 22% of the patients were multitrauma patients (ISS > 15). A normal i-Hb was found in 914 patients (73%). Of the 914 patients with a normal i-Hb, 639 (70%) had a normal r-Hb, while in 127 patients (14%), an abnormal r-Hb was found. In none of these patients, the abnormal r-Hb led to new diagnoses. In 148 patients (16%), no repeated Hb measurement was done without clinical consequences. We conclude that repeated blood Hb measurement within 2 h after admission in stable, adult trauma patients with a normal initial Hb concentration does not add value to a trauma patient's evaluation.
Xie, Peng; Wu, Kai; Zheng, Yingjun; Guo, Yangbo; Yang, Yuling; He, Jianfei; Ding, Yi; Peng, Hongjun
Childhood trauma has long-term adverse effects on physical and psychological health. Previous studies demonstrated that suicide and mental disorders were related to childhood trauma. In China, there is insufficient research available on childhood trauma in patients with mental disorders. Outpatients were recruited from a psychiatric hospital in southern China, and controls were recruited from local communities. The demographic questionnaire, the Childhood Trauma Questionnaire-Short Form (CTQ-SF), and the Social Support Rating Scale (SSRS) were completed by all participants, and the Self-rating Idea of Suicide Scale (SIOSS) were completed only by patients. Prevalence rates of childhood trauma were calculated. Kruskal-Wallis test and Dunnett test were used to compare CTQ-SF and SSRS scores between groups. Logistic regression was used to control demographic characteristics and examine relationships between diagnosis and CTQ-SF and SSRS scores. Spearman's rank correlation test was conducted to analyze relationships between suicidal ideation and childhood trauma and suicidal ideation and social support. The final sample comprised 229 patients with depression, 102 patients with bipolar, 216 patient with schizophrenia, and 132 healthy controls. In our sample, 55.5% of the patients with depression, 61.8% of the patients with bipolar disorder, 47.2% of the patients with schizophrenia, and 20.5% of the healthy people reported at least one type of trauma. In patient groups, physical neglect (PN) and emotional neglect (EN) were most reported, and sexual abuse (SA) and physical abuse (PA) were least reported. CTQ-SF and SSRS total scores, and most of their subscale scores in patient groups were significantly different from the control group. After controlling demographic characteristics, mental disorders were associated with higher CTQ-SF scores and lower SSRS scores. CTQ-SF scores and number of trauma types were positively correlated with the SIOSS score. Negative correlations
Full Text Available Objective: The aim of this study was to determine the mortality rate and factors affecting the mortality of trauma patients in general intensive care unit (ICU of a state hospital. Material and Method: Data of trauma patients hospitalized between January 2012 and March 2013 in ICU of Konya Numune Hospital were retrospectively analyzed. Demographic characteristics and clinical data of patients were recorded. Patients were divided into two groups as survivors and dead. Mortality rate and factors affectin mortality were examined. Results: A total of 108 trauma patients were included in the study. The mortality rate of overall group was 19.4%. Median age of the patients was 44.5 years and 75.9% of them were males. Median Glasgow Coma Scale of death group was lower (5 (3-8 vs. 15 (13-15, p<0.0001, median APACHE II score was higher (20 (15-26 vs. 10 (8-13, p<0.0001 and median duration of ICU stay was longer (27 (5-62,5 vs. 2 (1-5, p<0.0001 than those in the survival group. The most common etiology of trauma was traffic accidents (47.2% and 52.7% of patients had head trauma. The rate of patients with any fracture was significantly higher in the survival group (66.7% vs. 33.3%, p=0.007. The rate of erythrocyte suspension, fresh frozen plasma, trombocyte suspension and albumin were 38.9%, 27.8%, 0.9% and 8.3%, respectively in all group. The number of patients invasive mechanically ventilated was 27.8% and median length of stay of these patients were 5 (1.75-33.5 days. The rate of operated patients was 42.6%. The rate of tracheostomy, renal replacement therapy, bronchoscopy and percutaneous endoscopic gastrostomy enforcements were higher in the death group. The advanced age (p=0.016, OR: 1.054; 95% CI: 1.010-1100 and low GCS (p<0.0001, OR: 0.583; 95% CI: 0.456-0.745 were found to be independent risk factors the ICU mortality of trauma patients in logistic regression analysis. Conclusion: We believe that the determination of these risk factors affecting
Sosa Martin, Gimel; Morales Portuondo, Kelvis; Baez Franco, Zenia
Pancreas is an intra-abdominal organ in retroperitoneal location chow trauma is uncommon. Degree classification helps in more effective treatment practice and in decrease of complications appeared s consequence of traumas or the surgical treatment, which may be simple or involves large resections. The case of a patient with closed abdominal trauma of 3 days course. Diagnostic and clinic and complementary examinations were carried out being necessary surgical treatment. The aim of present paper was to expose the clinical elements, complementary results and surgical findings in this patient, as well as to motivate the suspicion of this affection in abdominal trauma. (author)
Jonovska, Suzana; Jengić, Vesna Sendula; Zupancić, Bozidar; Klarić, Miro; Klarić, Branka; Marinović, Marin; Stemberger, Cristophe; Kozomara, Davorin; Martinović, Zeljko
The main aim of this study was to establish the relationships between several psychosocial characteristics in children and adolescents differently treated for isolated long tubular bones' fractures. Examined variables were: self-esteem, basic emotional reactions toward illness or injury including depression and anxiety, as well as perception of quality of life and social support during the treatment. Whole sample comprehends 135 patients, both gender, 10-18 years of age, treated for mentioned fractures in period 2003-2005 at the Departments of Pediatric Surgery of 3 hospitals: University Hospital Centre in Rijeka and Clinical Children's Hospital in Zagreb, both in Croatia and University Hospital in Mostar, BiH. 73 patients were treated conservatively (CT), 40 of them underwent Elastic Stable Intramedullary Nailing (ESIN) and 22 of them underwent other surgical techniques (OST). Basic methods of work were: interview to collect data for half-structured socio-demographical questionnaire, evaluation of medical records and self-reported questionnaires including: Rosenberg Self-esteem Scale (RSS), Children Depression Inventory (CDI), Spielberg State Trait Anxiety Inventory (STAI), Short Form 36 Health Survey (SF-36) and Test of Perception of Social Support (TPSS). RSS, CDI and STAI were administered to the patients at baseline and after 6 months of the trauma, while SF-36 and TPSS after 1 month of the trauma. Results of this study point to close and strong relationships between examined variables, mostly statistically significant at level p self-esteem increased and depression and anxiety decreased during the time in all patients (with different dynamics regarding the type of treatment); higher perception of social support enhanced that effect. Perception of quality of life in whole sample in summary measures was statistically significant at level p self-esteem and negatively with depression and anxiety, thus connection with perception of social support was statistically
van Wilgen, C. Paul; van Ittersum, Miriam W.; Kaptein, Ad A.; van Wijhe, Marten; van, Wijhe M.
Objective. In the last decade, illness perceptions have been identified as mportant in the treatment of fibromyalgia (FM). The aim of the present study was to examine illness perceptions and use of the revised Illness Perception Questionnaire in patients with FM (IPQ-R-FM) and their relationship to
Rodriguez, Jose Luis; Rodriguez, Sonia Pilar; Manzano, Ana Cristina
A case of a 3 years old female patient, who suffered blunt lumbar trauma (horse kick) with secondary kidney trauma, is reported. Imaging findings are described. Renal trauma classification and imaging findings are reviewed
Lee, Soo Eon; Jahng, Tae-Ahn; Kim, Hyun-Jib
Study Design?Retrospective study. Objective?Minor trauma, even from a simple fall, can often cause cervical myelopathy, necessitating surgery in elderly patients who may be unaware of their posterior longitudinal ligament ossification (OPLL). The aim of this study is to determine the influence of trauma on the neurologic course in patients who have undergone surgery for cervical OPLL. Methods?Patients who underwent surgery due to OPLL were divided by trauma history and compared (34 in the tra...
Schuppen, J. van; Olthof, D.C.; Wilde, J.C.H.; Beenen, L.F.M.; Rijn, R.R. van; Goslings, J.C.
Introduction: Blunt abdominal trauma (BAT) is an important but often unrecognized cause of death in children. Imaging plays a vital role in the early detection of abdominal trauma. The exact role of imaging in the management of BAT in children is still under research. The aim of this study was to assess diagnostic accuracy of a step-up imaging strategy, where the decision to observe or to perform an intervention depends on the vital parameters of the patient, in combination with the presence or absence of free fluid at Focused Assessment with Sonography for Trauma (FAST) and the findings on CT (performed selectively), for pediatric patients presenting to the ED with a blunt abdominal trauma. Methods: Consecutive patients aged ≤16 years admitted between January 2008 and December 2012 to a Dutch level 1 trauma centre were included in this retrospective study. Sensitivity, negative predictive value (NPV) and the negative likelihood ratio (LR−) of the imaging strategy were calculated. Results: The cohort consisted of 122 patients; 66 (54%) patients were discharged home after primary survey, 51 (41%) patients were admitted and observed, 3 (2%) patients underwent transarterial embolization and 2 (2%) patients underwent surgery. Treatment failed in 1 patient, initially selected for observation. The sensitivity of the imaging strategy was 0.833 (0.446–0.990). The NPV and LR− were 0.991 (0.963–1.000) and 0.167 (0.028–0.997), respectively. Conclusion: The step-up imaging strategy that is applied in our academic level 1 trauma centre has a high sensitivity and a high negative predictive value. No clinically relevant injuries were missed without doing unnecessary harm, e.g. radiation or an intervention
Full Text Available Background: Blunt abdominal trauma is one of the causes of mortality in emergency department. Free fluid in the abdomen due to intra-abdominal blunt trauma can be determined by the surface probe of ultrasound. Since the importance of this free fluid in hemodynamic stable patients with blunt trauma is associated with the unknown outcome for surgeons, this study was performed to evaluate the role of ultrasound surface probe as a screening method in evaluating the patients with blunt abdominal trauma. Materials and Methods: A descriptive-analytical study was done on 45 patients with blunt abdominal trauma and hemodynamic stability. The patients were evaluated twice during the three-hours, including repeated ultrasound surface probe and clinical examinations. Computerized tomography was also performed. The patients were divided based on the amount of the free fluid in the abdomen during the evaluations into two groups: Fixed or increased, and decreased free fluid. The results of the different evaluated methods were compared using the sensitivity and specificity. Results: From 17 patients with CT abnormalities, free fluid increased in 14 patients (82.4%. Free fluid was decreased in three patients who were discharged well from the surgery service without any complication. Surface probe in prognosis detection had a sensitivity of 82.4% and specificity of 92.9%. The percentage of false positive and negative ultrasound compared with CT scan was 7.1% and 17.6%. Also, positive and negative predictive value of the ultrasound with surface probe was 87.5% and 89.7% respectively. Conclusion: The use of the ultrasound with surface probe in the diagnosis of free fluid in blunt abdominal trauma in hemodynamic stable patients can be considered as a useful screening method.
Schuppen, J. van [Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands); Olthof, D.C. [Trauma Unit Department of Surgery, Academic Medical Centre, Amsterdam (Netherlands); Wilde, J.C.H. [Department of Paediatric Surgery, Emma' s Children Hospital/Academic Medical Centre, Amsterdam (Netherlands); Beenen, L.F.M.; Rijn, R.R. van [Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands); Goslings, J.C., E-mail: email@example.com [Trauma Unit Department of Surgery, Academic Medical Centre, Amsterdam (Netherlands)
Introduction: Blunt abdominal trauma (BAT) is an important but often unrecognized cause of death in children. Imaging plays a vital role in the early detection of abdominal trauma. The exact role of imaging in the management of BAT in children is still under research. The aim of this study was to assess diagnostic accuracy of a step-up imaging strategy, where the decision to observe or to perform an intervention depends on the vital parameters of the patient, in combination with the presence or absence of free fluid at Focused Assessment with Sonography for Trauma (FAST) and the findings on CT (performed selectively), for pediatric patients presenting to the ED with a blunt abdominal trauma. Methods: Consecutive patients aged ≤16 years admitted between January 2008 and December 2012 to a Dutch level 1 trauma centre were included in this retrospective study. Sensitivity, negative predictive value (NPV) and the negative likelihood ratio (LR−) of the imaging strategy were calculated. Results: The cohort consisted of 122 patients; 66 (54%) patients were discharged home after primary survey, 51 (41%) patients were admitted and observed, 3 (2%) patients underwent transarterial embolization and 2 (2%) patients underwent surgery. Treatment failed in 1 patient, initially selected for observation. The sensitivity of the imaging strategy was 0.833 (0.446–0.990). The NPV and LR− were 0.991 (0.963–1.000) and 0.167 (0.028–0.997), respectively. Conclusion: The step-up imaging strategy that is applied in our academic level 1 trauma centre has a high sensitivity and a high negative predictive value. No clinically relevant injuries were missed without doing unnecessary harm, e.g. radiation or an intervention.
Golden, Jamie; Dossa, Avafia; Goodhue, Catherine J; Upperman, Jeffrey S; Gayer, Christopher P
Pediatric trauma uses a substantial amount of resources. Quick and cost-effective measures that can be used to identify children with clinically relevant injuries are essential to resource allocation and optimization of patient care. Admission hematocrit is rapid and inexpensive, causes minimal harm, and can potentially aid in critical decision making. We hypothesize that admission hematocrit predicts the need for transfusion in pediatric blunt trauma patients. Records of trauma patients age 0 year to 17 years (2005-2013) who presented to a pediatric Level 1 trauma center were retrospectively reviewed. Data collected include demographics, computed tomographic scan findings, need for an intervention secondary to bleeding (blood transfusion, angioembolization, or operation), and admission hematocrit. We found a significant decrease in admission hematocrit between patients requiring a transfusion and patients who did not (27% vs. 36%, p hematocrit values remained significantly lower in the patients requiring a transfusion up to 67 hours after admission (p = 0.04). A cutoff admission hematocrit of 35% or less has a sensitivity of 94% and a negative predictive value of 99.9% in identifying children who need a transfusion after blunt trauma. An admission hematocrit of 35% or less provides a reliable screening test because of its low false negative rate and high specificity for identifying patients at an increased risk of bleeding after injury. Admission hematocrit could be widely implemented to identify patients who may need a transfusion with low expense and minimal harm for our pediatric patients and may be able to alter the entire course of their trauma resuscitation. Epidemiologic/prognostic study, level III.
Larsen, Jens Ivar; Andersen, Ulla A; Becker, Thomas
different geographical areas - Asia (Japan), Africa (Nigeria) and Western Europe (Switzerland, Germany and Denmark) - and to search for possible transcultural differences in these correlations, which would also reflect the differences between low-income areas in Africa (Nigeria) and high-income areas...... in Europe and Japan.Method:Patients with International Classification of Diseases (ICD-10) F2 diseases (schizophrenia spectrum disorders) and F3 diseases (affective disorders) admitted to one Nigerian, one Japanese, two Swiss, two German and six Danish centres during 1 year were included. Physical diseases...... Europe, Nigeria and Japan) within the same ranges (however, the Japanese results should be interpreted conservatively owing to the limited sample size). Overweight among the mentally ill were marked in Nigeria. A parallelism of the incidence of overweight, CVD and diabetes with the occurrence...
The presence of acid-base disturbances, especially metabolic acidosis may negatively affect the outcome of critically ill patients. Lactic acidosis is the most frequent etiology and has largest impact on the prognosis. Since lactate measurement might not have always been available at bedside, it had been regarded as one of the unmeasured anions. Therefore, anion gap and strong ion gap has been used to as a surrogate of lactate concentration. From this perspective, the relationship between either anion gap or strong ion gap and mortality has been explored. Then, lactate became routinely measurable at bedside and the direct comparison between directly measured lactate and these surrogate parameters can be possible. Currently available evidence suggests that directly measured lactate has larger prognostic ability for mortality than albumin-corrected anion gap and strong ion gap without lactate. In this commentary, the rationale and possible clinical implications of these findings are discussed.
Yamashita, Ryoko; Arao, Harue; Takao, Ayumi; Masutani, Eiko; Morita, Tatsuya; Shima, Yasuo; Kizawa, Yoshiyuki; Tsuneto, Satoru; Aoyama, Maho; Miyashita, Mitsunori
Unfinished business often causes psychological issues after bereavement. Providing care for families of terminally ill patients with cancer to prevent unfinished business is important. To clarify the prevalence and types of unfinished business in families of end-of-life patients with cancer admitted to palliative care units (PCUs), explore depression and grief associated with unfinished business, and explore the factors affecting unfinished business. We conducted a cross-sectional, anonymous, self-report questionnaire survey with 967 bereaved families of patients with cancer admitted to PCUs. The questionnaire assessed the presence or the absence of unfinished business, content of unfinished business, depression, grief, process of preparedness, condition of the family and patient, and the degree of involvement of health care professionals. Questionnaires were sent to 967 families, and 73.0% responded. In total, 26.0% of families had some unfinished business, with improvement of the patient-family relationship being a common type of unfinished business. Families with unfinished business had significantly higher depression and grief scores after bereavement compared with those without. Factors that influenced the presence or the absence of unfinished business were preparedness for the patient's death (P = 0.001), discussion between the patient and family about the disease trajectory and way to spend daily life (P business. Health care professionals should coordinate the appropriate timing for what the family wishes to do, with consideration of family dynamics, including the family's preparedness, communication pattern, and relationships. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Full Text Available Background Patients receiving cancer treatment start lifestyle changes mostly at the end of the treatment during the rehabilitation period. Most often, the first step is a dietary change and physical exercises built into the daily routine. Patients who do this in groups led by qualified therapists and based on professional counseling can build more effective and more permanent changes into their life. To develop a complex rehabilitation program which, in the short term, aims to familiarize patients with a lifestyle which harmonizes the physical, mental, spiritual and social spheres of life and, in the long term, to build it into their everyday life in order to ameliorate the physical and mental state and reduce the psychological symptoms and the isolation of patients. The physical component focuses on diet and exercise. The psycho-social-spiritual support focuses on discovering inner sources of strength, developing active coping mechanisms and helping to achieve more open communication. Participants and procedure In February and March 2011, 8 patients treated for malignant tumors participated in the model program. The components of the model program were psychotherapy, physiotherapy, cancer consultation, nutrition counseling, creative activities and walking. Results During the period of the model program the isolation of the patients decreased and their social support and ability of coping with the illness ameliorated. They reported an ease in anxiety and depression in their everyday activities. According to feedback, their communication with each other, with the staff and with their relatives became more open. Altogether this had advantageous effects on the functioning of the ward and the mood of the staff. Conclusions The rehabilitation program confirmed that beside individual psycho-social support, beneficial and economic psycho-social support can be provided for the patients in group form along with the most effective assignment of the
Hiesmayr, M; Hölzenbein, T; Valentini, L; Sautner, T; Karner, J; Roth, E
Several studies have shown that exogenous human growth hormone (HGH) exerts an anabolic effect on protein metabolism in surgical patients with mild or moderate catabolism. However, contradictory results have been demonstrated in polytrauma patients where HGH did not improve protein metabolism. Aim of this study was to evaluate whether the pharmacokinetics of recombinant biosynthetic human GH (r-HGH) are altered in critically ill patients. After an overnight fast, r-HGH was infused at a rate of 460 micrograms/h/kg/bw during 120 min to five intensive care unit (ICU) patients. The patients were catabolic (nitrogen balance -11 +/- 0.5), showed normal liver function, and only one patient had a slightly impaired kidney function (creatinine > 1.5 mg/dl). Endogenous GH secretion was suppressed by continuous infusion of 50 micrograms/m2/h somatostatin. From plasma GH curves, elimination half life (t1/2kle), whole body clearance (Cltot) and steady state distribution space (DS) were calculated in an open two compartment model. Additionally, the effects of r-HGH infusion on plasma insulin, glucagon and amino acid concentrations were evaluated. T1/2kle was 19.6 +/- 2.3 min, Cltot 2.9 +/- 0.4 ml/kg/bw/min and DS 76.4 +/- 3.8 ml/kg/bw for 90 min. The plasma levels of total amino acids including the branched chain amino acids valine, leucine and isoleucine and of glutamine were significantly higher during r-HGH infusion than during the basal and somatostatin periods. In conclusion, the elimination of r-HGH in catabolic ICU patients is not different from that of healthy volunteers.
Gormican, Erin K; Hussein, Zahra S
Screening, brief intervention, and referral to treatment (SBIRT) is an important and effective strategy among injury prevention measures aimed at reducing risky alcohol use (). The trauma patient population is at significant risk for alcohol-related trauma recidivism () and is therefore a priority group in which to implement SBIRT. Vancouver General Hospital (VGH) implemented SBIRT on its 2 inpatient trauma units in the fall of 2014. The alcohol use disorders screening test (AUDIT-C) was chosen as the screening tool for nurses to complete with new patients. A brief intervention was conducted by the trauma social workers in the cases where a patient scored positive on the AUDIT-C. To evaluate the implementation and effectiveness of SBIRT on the 2 inpatient trauma units at VGH and to provide recommendations for improvement, a telephone survey of past trauma patients and a review of the screening process were undertaken in May 2016. Patient follow-up was conducted via a telephone survey. Of the 79 patients who met the follow-up criteria, a total of 19 were successfully contacted. Results from the survey showed that the majority of patients did not recall being screened with the AUDIT-C and were either unsure or did not recall receiving a brief intervention by the social worker. Despite these findings, a rescreening with the AUDIT-C tool revealed that 68% of patients who participated in the survey had a lower score than when they were inpatients. Recommendations for improvement include optimizing the timing of SBIRT with trauma inpatients and implementing a follow-up system. The literature suggests that following up with patients to provide an SBIRT "booster" increases the effectiveness of brief interventions (C. ).
Alhinai, Mustafa Y
On June 6(th) 2007, a tropical Cyclone Gonu striked the coastline of Oman. The purpose of this study is to compare number of patients and pattern of illnesses between disaster (June 2007) and peace times (June 2006/2008). Descriptive comparative analysis of all patients who visited primary health centers in Wilayat A'Seeb during the index days. Electronic database collected from the Health Centers (HC) were grouped into four groups; infection-related, trauma-related, acute non trauma-related, and miscellaneous group. Data were analyzed to find difference of patient influx and disease patterns between disaster and peace times. HC visits during the index days decreased from 9006 in 2006 to 8687 in 2007 then increased to 8786 in 2008. Neither between years variation nor between disaster and peace times difference was found to be statistically significant. The proportion of patient visited the HC due to infection-related illnesses changed from 30% in 2006, 31% in 2007, and 24% in 2008 (pTropical Cyclone Gonu caused statistically significant increase in percentages of infectious and trauma-related visits. The overall ratios of total visits did not differ from peace times.
Post, Robert M; Altshuler, Lori L; Kupka, Ralph; McElroy, Susan L; Frye, Mark A; Rowe, Michael; Grunze, Heinz; Suppes, Trisha; Keck, Paul E; Leverich, Gabriele S; Nolen, Willem A
Evidence suggests that patients with bipolar disorder from the United States have an earlier age of onset and a more difficult course of illness than those from Germany and the Netherlands. These characteristics were related to a greater family burden of psychiatric illness and the experience of more psychosocial adversity in childhood. We hypothesized that this greater illness burden would extend to the offspring of the US patients. 968 outpatients (average age 41) with bipolar illness gave informed consent for participation in a treatment outcome network and filled out a detailed questionnaire about their illness and family history of illness, including whether their offspring had a diagnosis of depression, bipolar disorder, alcohol or substance abuse, suicide attempt or "other" illness. Of those with children, 356 were from the US and 132 were from Europe. Compared to the Europeans, offspring of patients from the US had significantly (pV. All rights reserved.
Hinzpeter, R.; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Boehm, T. [Kantonsspital Graubuenden, Department of Radiology, Chur (Switzerland); Boll, D. [University Hospital Basel, Department of Radiology and Nuclear Medicine, Basel (Switzerland); Constantin, C. [Spital Wallis, Department of Radiology, Visp (Switzerland); Del Grande, F. [Ospedale Regionale di Lugano, Department of Radiology, Lugano (Switzerland); Fretz, V. [Kantonsspital Winterthur, Institute of Radiology and Nuclear Medicine, Winterthur (Switzerland); Leschka, S. [Kantonsspital St Gallen, Division of Radiology and Nuclear Medicine, Gallen (Switzerland); Ohletz, T. [Kantonsspital Aarau, Department of Radiology, Aarau (Switzerland); Broennimann, M. [University Hospital Bern, Department of Diagnostic, Interventional and Pediatric Radiology, Bern (Switzerland); Schmidt, S. [Lausanne University Hospital, Department of Diagnostic and Interventional Radiology, Lausanne (Switzerland); Treumann, T. [Luzerner Kantonsspital, Institute of Radiology, Luzern 16 (Switzerland); Poletti, P.A. [Geneva University Hospital, Department of Radiology, Geneve (Switzerland)
To identify imaging algorithms and indications, CT protocols, and radiation doses in polytrauma patients in Swiss trauma centres. An online survey with multiple choice questions and free-text responses was sent to authorized level-I trauma centres in Switzerland. All centres responded and indicated that they have internal standardized imaging algorithms for polytrauma patients. Nine of 12 centres (75 %) perform whole-body CT (WBCT) after focused assessment with sonography for trauma (FAST) and conventional radiography; 3/12 (25 %) use WBCT for initial imaging. Indications for WBCT were similar across centres being based on trauma mechanisms, vital signs, and presence of multiple injuries. Seven of 12 centres (58 %) perform an arterial and venous phase of the abdomen in split-bolus technique. Six of 12 centres (50 %) use multiphase protocols of the head (n = 3) and abdomen (n = 4), whereas 6/12 (50 %) use single-phase protocols for WBCT. Arm position was on the patient's body during scanning (3/12, 25 %), alongside the body (2/12, 17 %), above the head (2/12, 17 %), or was changed during scanning (5/12, 42 %). Radiation doses showed large variations across centres ranging from 1268-3988 mGy*cm (DLP) per WBCT. Imaging algorithms in polytrauma patients are standardized within, but vary across Swiss trauma centres, similar to the individual WBCT protocols, resulting in large variations in associated radiation doses. (orig.)
Ordoñez, Carlos A; Herrera-Escobar, Juan P; Parra, Michael W; Rodriguez-Ossa, Paola A; Mejia, David A; Sanchez, Alvaro I; Badiel, Marisol; Morales, Monica; Rojas-Mirquez, Johanna C; Garcia-Garcia, Maria P; Pino, Luis F; Puyana, Juan C
Dynamic and efficient resuscitation strategies are now being implemented in severely injured hemodynamically unstable (HU) patients as blood products become readily and more immediately available in the trauma room. Our ability to maintain aggressive resuscitation schemes in HU patients allows us to complete diagnostic imaging studies before rushing patients to the operating room (OR). As the criteria for performing computed tomography (CT) scans in HU patients continue to evolve, we decided to compare the outcomes of immediate CT versus direct admission to the OR and/or angio suite in a retrospective study at a government-designated regional Level I trauma center in Cali, Colombia. During a 2-year period (2012-2013), blunt and penetrating trauma patients (≥ 15 years) with an Injury Severity Score (ISS) greater than 15 who met criteria of hemodynamic instability (systolic blood pressure [SBP] 100 beats/min and/or ≥ 4 U of packed red blood cells transfused in the trauma bay) were included. Isolated head trauma and patients who experienced a prehospital cardiac arrest were excluded. The main study outcome was mortality. We reviewed 171 patients. CT scans were performed in 80 HU patients (47%) immediately upon arrival (CT group); the remaining 91 patients (53%) went directly to the OR (63 laparotomies, 20 thoracotomies) and/or 8 (9%) to the angio suite (OA group). Of the CT group, 43 (54%) were managed nonoperatively, 37 (46%) underwent surgery (15 laparotomies, 3 thoracotomies), and 2 (5%) underwent angiography (CT OA subgroup). None of the mortalities in the CT group occurred in the CT suite or during their intrahospital transfers. There was no difference in mortality between the CT and OA groups in HU patients. CT scan was attainable in 47% of HU patients and avoided surgery in 54% of the cases. Furthermore, CT scan was helpful in deciding definitive/specific surgical management in 46% scanned HU patients who necessitated surgery after CT. Therapy
Bores, Sam A; Pajerowski, William; Carr, Brendan G; Holena, Daniel; Meisel, Zachary F; Mechem, C Crawford; Band, Roger A
The optimal approach to prehospital care of trauma patients is controversial, and thought to require balancing advanced field interventions with rapid transport to definitive care. We sought principally to examine any association between the amount of prehospital IV fluid (IVF) administered and mortality. We conducted a retrospective cohort analysis of trauma registry data patients who sustained penetrating trauma between January 2008 and February 2011, as identified in the Pennsylvania Trauma Systems Foundation registry with corresponding prehospital records from the Philadelphia Fire Department. Analyses were conducted with logistic regression models and instrumental variable analysis, adjusted for injury severity using scene vital signs before the intervention was delivered. There were 1966 patients identified. Overall mortality was 22.60%. Approximately two-thirds received fluids and one-third did not. Both cohorts had similar Trauma and Injury Severity Score-predicted mortality. Mortality was similar in those who received IVF (23.43%) and those who did not (21.30%) (p = 0.212). Patients who received IVF had longer mean scene times (10.82 min) than those who did not (9.18 min) (p < 0.0001), although call times were similar in those who received IVF (24.14 min) and those who did not (23.83 min) (p = 0.637). Adjusted analysis of 1722 patients demonstrated no benefit or harm associated with prehospital fluid (odds ratio [OR] 0.905, 95% confidence interval [CI] 0.47-1.75). Instrumental variable analysis utilizing variations in use of IVF across different Emergency Medical Services (EMS) units also found no association between the unit's percentage of patients that were provided fluids and mortality (OR 1.02, 95% CI 0.96-1.08). We found no significant difference in mortality or EMS call time between patients who did or did not receive prehospital IVF after penetrating trauma. Published by Elsevier Inc.
Hajjar, Ludhmila Abrahão; Auler Junior, Jose Otávio Costa; Santos, Luciana; Galas, Filomena
Anemia is one of the most common abnormal findings in critically ill patients, and many of these patients will receive a blood transfusion during their intensive care unit stay. However, the determinants of exactly which patients do receive transfusions remains to be defined and have been the subject of considerable debate in recent years. Concerns and doubts have emerged regarding the benefits and safety of blood transfusion, in part due to the lack of evidence of better outcomes resulting from randomized studies and in part related to the observations that transfusion may increase the risk of infection. As a result of these concerns and of several studies suggesting better or similar outcomes with a lower transfusion trigger, there has been a general tendency to decrease the transfusion threshold from the classic 10 g/dL to lower values. In this review, we focus on some of the key studies providing insight into current transfusion practices and fueling the current debate on the ideal transfusion trigger.
K.D. Strang; D.L. van Imhoff (Diederik); E.M.M. van Lieshout (Esther); S.K. D'Amours (Scott); O.J.F. van Waes (Oscar)
markdownabstractBackground: Abdominal Compartment Syndrome (ACS) is an uncommon but deleterious complication after trauma laparotomy. Early recognition of patients at risk of developing ACS is crucial for their outcome. The aim of this study was to compare the characteristics of patients who
Wang, Zheng; Xue, Zhimin; Pu, Weidan; Yang, Bo; Li, Li; Yi, Wenyin; Wang, Peng; Liu, Chang; Wu, Guowei; Liu, Zhening; Rosenheck, Robert A
There has been considerable interest in identifying and addressing the specific needs of early-episode patients diagnosed with schizophrenia in the hope that by addressing such needs early, chronic disabilities can be avoided. One hundred twenty-eight early-episode and 571 chronic patients were compared on socio-demographic characteristics, clinical symptoms and history of childhood trauma. Symptoms were measured with the Positive and Negative Syndrome Scale (PANSS), and trauma with the short version of the Childhood Trauma Questionnaire. First-episode patients scored 9.3% higher than chronic patients on the PANSS positive symptom scale and 16.3% lower on the negative symptom scale. More first episode patients reported childhood sexual abuse (P = 0.033); however, fewer reported childhood emotional neglect (P = 0.01). Childhood trauma was associated with positive symptoms, specifically with hallucinations in first-episode patients (r = 0.174; P = 0.049). Moreover, fewer parents of first episode patients were living alone (P = 0.008). On multiple logistic regression, the first-episode patients were younger (odds ratio = 0.92), had higher PANSS positive symptom scores (odds ratio 1.04) and lower negative symptom scores (odds ratio 0.948 recalculate). More positive symptoms, fewer negative symptoms, less isolated parents and greater risk of childhood sexual abuse might warrant attention in first episode schizophrenia and perhaps should be a focus for the development of targeted interventions. © 2012 Wiley Publishing Asia Pty Ltd.
Full Text Available Establishing the etiology of tachycardia in a trauma patient is often difficult. Pediatric trauma patients present an even tougher challenge. Cardiac contusion should be suspected when other more common traumatic injuries that produce hypoxia and blood loss are excluded. The diagnosis of cardiac contusion is notoriously difficult to make largely due to the controversy over the definition of the disease, and the lack of a true gold standard confirmatory test. Atrioventricular nodal reentrant tachycardia (AVNRT is a common form of supraventricular tachycardia (SVT that can also present a diagnostic challenge to emergency physicians. While electrophysiologic studies are the gold standard for confirming the diagnosis, there are certain aspects of the history, electrocardiogram (ECG, and responses to cardiac maneuvers that strongly suggest the diagnosis. We present the case of a pediatric trauma patient that presented with new onset AVNRT masquerading as cardiac contusion.
Full Text Available Background : This study was designed to evaluate the use of laxative prophylaxis for constipation in intensive care unit (ICU and the impact of early versus late bowel movement on patient′s outcome. Methods : The study was a prospective, randomized controlled trial in critically ill ventilated adult patients, who were expected to stay on ventilator for >72 h. Control group did not receive any intervention for bowel movement for the first 72 h, whereas interventional group received prophylactic dose of lactulose 20 cc enterally every 12 h for the first 72 h. The parameters measured during the study were admission diagnosis, age, gender, comorbid conditions, admission Simplified Acute Physiologic Score (SAPS II, sedative and narcotic agents with doses and duration, timing and tolerance of nutrition, daily assessment of bowel movement, total use of prokinetic, doses of suppositories, and enema for first bowel movement, total number of days on ventilator, weaning failures, extubation or tracheostomy, ICU length of stay, and death or discharge. Results : A total of 100 patients were enrolled, 50 patients in each control and interventional group. Mean age was 38.8 years, and both groups had male predominance. Mean SAPS II score for both was 35. Mean dose of Fentanyl (323.8 ± 108.89 mcg/h in control and 345.83 ± 94.43 mcg/h in interventional group and mean dose of Midazolam (11.1 ± 4.04 mg/h in control and 12.4 ± 3.19 mg/h in interventional group. There were only two (4% patients in control, while nine (18% patients in interventional group who had bowel movement in <72 h (P < 0.05. Mean ventilator days were 16.19, and 17.36 days in control and interventional groups, respectively. Subgroup analysis showed that the patients who moved bowel in <5 days in both groups had mean ventilator days of 18.5, whereas it was 15.88 days for the patients who moved bowel after 5 days in both groups (P< 0.05. Mean ICU days for control was 21.15 ± 10.44 and 20
Bruder, Eric A; Ball, Ian M; Ridi, Stacy; Pickett, William; Hohl, Corinne
trials in patients undergoing emergency endotracheal intubation for critical illness, including but not limited to trauma, stroke, myocardial infarction, arrhythmia, septic shock, hypovolaemic or haemorrhagic shock, and undifferentiated shock states. We included single (bolus) dose etomidate for emergency airway intervention compared to any other rapid-acting intravenous bolus single-dose induction agent. Refinement of our initial search results by title review, and then by abstract review was carried out by three review authors. Full-text review of potential studies was based on their adherence to our inclusion and exclusion criteria. This was decided by three independent review authors. We reported the decisions regarding inclusion and exclusion in accordance with the PRISMA statement.Electronic database searching yielded 1635 potential titles, and our grey literature search yielded an additional 31 potential titles. Duplicate titles were filtered leaving 1395 titles which underwent review of their titles and abstracts by three review authors. Sixty seven titles were judged to be relevant to our review, however only eight met our inclusion criteria and seven were included in our analysis. We included eight studies in the review and seven in the meta-analysis. Of those seven studies, only two were judged to be at low risk of bias. Overall, no strong evidence exists that etomidate increases mortality in critically ill patients when compared to other bolus dose induction agents (odds ratio (OR) 1.17; 95% confidence interval (CI) 0.86 to 1.60, 6 studies, 772 participants, moderate quality evidence). Due to a large number of participants lost to follow-up, we performed a post hoc sensitivity analysis. This gave a similar result (OR 1.15; 95% CI 0.86 to 1.53). There was evidence that the use of etomidate in critically ill patients was associated with a positive adrenocorticotropic hormone (ACTH) stimulation test, and this difference was more pronounced at between 4 to 6
Larsen, Jens I; Andersen, Ulla A; Becker, Thomas; Bickel, Graziella G; Bork, Bernhard; Cordes, Joachim; Frasch, Karel; Jacobsen, Bent A; Jensen, Signe O Wallenstein; Kilian, Reinhold; Lauber, Christoph; Mogensen, Birthe; Nielsen, Jørgen A; Rössler, Wulf; Tsuchiya, Kenji J; Uwakwe, Richard; Munk-Jørgensen, Povl
People with psychiatric diseases have a severely increased risk for physical morbidity and premature death from physical diseases. The aims of the study were to investigate the occurrence of cardiovascular diseases (CVD), diabetes (DM) and obesity in schizophrenia and depression in three different geographical areas - Asia (Japan), Africa (Nigeria) and Western Europe (Switzerland, Germany and Denmark) - and to search for possible transcultural differences in these correlations, which would also reflect the differences between low-income areas in Africa (Nigeria) and high-income areas in Europe and Japan. Patients with International Classification of Diseases (ICD-10) F2 diseases (schizophrenia spectrum disorders) and F3 diseases (affective disorders) admitted to one Nigerian, one Japanese, two Swiss, two German and six Danish centres during 1 year were included. Physical diseases in accordance with ICD-10 were also registered. Psychiatric and physical comorbidity were calculated and standardized rate ratio incidences of background populations were our primary measures. Incidence rate ratios were increased for both CVD, DM and overweight in both F2 and F3 in all cultures (Western Europe, Nigeria and Japan) within the same ranges (however, the Japanese results should be interpreted conservatively owing to the limited sample size). Overweight among the mentally ill were marked in Nigeria. A parallelism of the incidence of overweight, CVD and diabetes with the occurrence in background populations was seen and was most marked in overweight. Overweight, CVD and DM were increased in schizophrenia spectrum disorders and affective disorders in all three cultures investigated (Western Europe, Nigeria and Japan). Lifestyle diseases were also seen in Nigeria and Japan. The results from this study indicate that cultural background might be seen as an important factor in dealing with lifestyle diseases among people with a severe mental illness, as it is in the general population.
Hadi Darvishi Khezri
Full Text Available Background: Ventilator-associated pneumonia (VAP is a type of lung infection that typically affects critically ill patients undergoing mechanical ventilation (MV in the intensive care unit (ICU. Patients with type 2 diabetes mellitus (T2DM are considered to be more susceptible to several types of infections including community-acquired pneumonia. However, it is not clear whether T2DM is a risk factor for the development of VAP. The purpose of this study was to determine the risk of VAP for diabetic and nondiabetic mechanically ventilated trauma patients. Materials and Methods: This study is a secondary analysis of a prospective observational study of the history of T2DM in the ICU over a period of 1 year at Imam Khomeini Hospital in Iran. A total of 186 critically ill trauma patients who required at least 48 h of MV were monitored for the occurrence of VAP by their clinical pulmonary infection score (CPIS until ICU discharge, VAP diagnosis, or death. Results: Forty-one of the 186 patients developed VAP. The median time from hospitalization to VAP was 29.09 days (95% CI: 26.27-31.9. The overall incidence of VAP was 18.82 cases per 1,000 days of intubation (95% CI: 13.86-25.57. Risk of VAP in diabetic patients was greater than nondiabetic patients after adjustments for other potential factors [hazard ratio (HR: 10.12 [95% confidence interval (CI: 5.1-20.2; P < 0.0001]. Conclusion: The findings show that T2DM is associated with a significant increase in the occurrence of VAP in mechanically ventilated adult trauma patients.
Full Text Available Objectives: Using whole-body multislice computed tomography (MSCT excessively or with irrelevant indications can be seen in many centers. The aim of this study was to analyze retrospectively the MSCT findings in trauma patients admitted to the emergency department. Methods: Records of the patients who have applied to the emergency department due to blunt trauma in a 12 month period and whose whole body MSCT images have been taken, were evaluated using the “Nucleus Medical Information System”. Results: The most frequent type of trauma was traffic accidents in 61.4%, falling down from the height in 22.4%, and motorcycle accidents in 11.4% of patients. Of the patients, 25.2% were discharged from the emergency, while 73.8% were hospitalized. At least one CT findings associated with trauma was present in 61.4% of our patients. Pathological findings in MSCT were most frequently detected in the head and face (35.3% and thoracic (28.6% regions, respectively. The most common finding in the head and face region was fractures. The most common pathological findings in the thoracic region were pulmonary contusion and rib fractures. A significant relationship was detected between trauma type and spinal MSCT result (p < 0.001. In a large percentage of the patients, MSCT findings were normal in the abdominal region and genitourinary system. Vertebral fractures were most frequently detected in the thoracolumbar region. Conclusions: In our study, our rate of negative CT was found to be 38.6%, which is a higher ratio compared to other studies conducte on this topic. Keywords: Emergency, Trauma, Whole-body multislice computed tomography
Paulo Roberto Lima Carreiro
Full Text Available OBJECTIVE: Show the steps of a Trauma Registry (TR implementation in a Brazilian public hospital and evaluate the initial data from the database.METHODS: Descriptive study of the a TR implementation in João XXIII Hospital (Hospital Foundation of the state of Minas Gerais and analysis of the initial results of the first 1,000 patients.RESULTS: The project was initiated in 2011 and from January 2013 we began collecting data for the TR. In January 2014 the registration of the first 1000 patients was completed. The greatest difficulties in the TR implementation were obtaining funds to finance the project and the lack of information within the medical records. The variables with the lowest completion percentage on the physiological conditions were: pulse, blood pressure, respiratory rate and Glasgow coma scale. Consequently, the Revised Trauma Score (RTS could be calculated in only 31% of cases and the TRISS methodology applied to 30.3% of patients. The main epidemiological characteristics showed a predominance of young male victims (84.7% and the importance of aggression as a cause of injuries in our environment (47.5%, surpassing traffic accidents. The average length of stay was 6 days, and mortality 13.7%.CONCLUSION: Trauma registries are invaluable tools in improving the care of trauma victims. It is necessary to improve the quality of data recorded in medical records. The involvement of public authorities is critical for the successful implementation and maintenance of trauma registries in Brazilian hospitals.
Rehn, M; Weaver, A E; Eshelby, S; Røislien, J; Lockey, D J
The current management of severely injured patients includes damage control resuscitation strategies that minimise the use of crystalloids and emphasise earlier transfusion of red blood cells (RBC) to prevent coagulopathy. In 2012, London's air ambulance (LAA) became the first UK civilian pre-hospital service to routinely carry RBC to the trauma scene. To investigate the effect of pre-hospital RBC transfusion (phRTx) on overall blood product consumption. A retrospective trauma database study compares before implementation with after implementation of phRTx in exsanguinating trauma patients transported directly to one major trauma centre. Pre-hospital deaths were excluded. Univariate and multivariate Poisson regression analyses on data subject to multiple imputation were conducted. We included 137 and 128 patients in the before and after the implementation of phRTx groups, respectively. LAA transfused 304 RBC units (median 2, inter quartile range 1-3). We found a significant reduction in total RBC usage and reduced early use of platelets and fresh-frozen plasma (FFP) after the implementation of phRTx in both univariate (P Pre-hospital trauma transfusion practice is feasible and associated with overall reduced RBC, platelets and FFP consumption. © 2017 British Blood Transfusion Society.
Mielczarek, Marzena; Olszewski, Jurek
The article shows 2 cases of unusual presentation of acute acoustic trauma and blast injury due to occupational exposure. In the case of both patients the range of impaired frequencies in pure tone audiograms was atypical for this kind of causative factor. Both patients had symmetrical hearing before the accident (which was confirmed by provided results of hearing controls during their employment). A history of noise/blast exposure, the onset of symptoms directly after harmful exposure, symmetrical hearing before the trauma documented with audiograms, directed initial diagnosis towards acoustic/blast trauma, however, of atypical course. Acute acoustic and blast trauma and coexisting acoustic neuroma (AN) contributed to, and mutually modified, the course of sudden hearing loss. In the literature there are some reports pointing to a higher sensitivity to acoustic trauma in the case of patients with AN and, on the other hand, indicating noise as one of the causative factors in AN. Int J Occup Med Environ Health 2018;31(3):361-369. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.
Carreiro, Paulo Roberto Lima; Drumond, Domingos André Fernandes; Starling, Sizenando Vieira; Moritz, Mônica; Ladeira, Roberto Marini
Show the steps of a Trauma Registry (TR) implementation in a Brazilian public hospital and evaluate the initial data from the database. Descriptive study of the a TR implementation in João XXIII Hospital (Hospital Foundation of the state of Minas Gerais) and analysis of the initial results of the first 1,000 patients. The project was initiated in 2011 and from January 2013 we began collecting data for the TR. In January 2014 the registration of the first 1000 patients was completed. The greatest difficulties in the TR implementation were obtaining funds to finance the project and the lack of information within the medical records. The variables with the lowest completion percentage on the physiological conditions were: pulse, blood pressure, respiratory rate and Glasgow coma scale. Consequently, the Revised Trauma Score (RTS) could be calculated in only 31% of cases and the TRISS methodology applied to 30.3% of patients. The main epidemiological characteristics showed a predominance of young male victims (84.7%) and the importance of aggression as a cause of injuries in our environment (47.5%), surpassing traffic accidents. The average length of stay was 6 days, and mortality 13.7%. Trauma registries are invaluable tools in improving the care of trauma victims. It is necessary to improve the quality of data recorded in medical records. The involvement of public authorities is critical for the successful implementation and maintenance of trauma registries in Brazilian hospitals.
García-Soler, Patricia; Morales-Martínez, Antonio; Rosa-Camacho, Vanessa; Lillo-Muñoz, Juan Antonio; Milano-Manso, Guillermo
To determine the prevalence and risks factors of vitamin D deficiency, as well as its relationship with morbidity and mortality in a PICU. An observational prospective study in a tertiary children's University Hospital PICU conducted in two phases: i: cohorts study, and ii: prevalence study. The study included 340 critically ill children with ages comprising 6 months to 16 years old. Chronic kidney disease, known parathyroid disorders, and vitamin D supplementation. Total 25-hydroxyvitamin D [25(OH)D] was measured in the first 48hours of admission to a PICU. Parathormone, calcium, phosphate, blood gases, blood count, C-reactive protein, and procalcitonin were also analysed. A record was also made of demographic features, characteristics of the episode, and complications during the PICU stay. The overall prevalence rate of vitamin D deficiency was 43.8%, with a mean of 22.28 (95% CI 21.15-23.41) ng/ml. Patients with vitamin D deficiency were older (61 vs 47 months, P=.039), had parents with a higher level of academic studies (36.5% vs 20%, P=.016), were admitted more often in winter and spring, had a higher PRISM-III (6.8 vs 5.1, P=.037), a longer PICU stay (3 vs 2 days, P=.001), and higher morbidity (61.1% vs 30.4%, P<001) than the patients with sufficient levels of 25(OH)D. Patients who died had lower levels of 25(OH)D (14±8.81ng/ml versus 22.53±10.53ng/ml, P=.012). Adjusted OR for morbidity was 5.44 (95%CI; 2.5-11.6). Vitamin D deficiency is frequent in critically ill children, and it is related to both morbidity and mortality, although it remains unclear whether it is a causal relationship or it is simply a marker of severity in different clinical situations. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.
Strang, Steven G; Van Imhoff, Diederik L; Van Lieshout, Esther M M; D'Amours, Scott K; Van Waes, Oscar J F
Abdominal Compartment Syndrome (ACS) is an uncommon but deleterious complication after trauma laparotomy. Early recognition of patients at risk of developing ACS is crucial for their outcome. The aim of this study was to compare the characteristics of patients who developed high-grade intra-abdominal hypertension (IAH) (i.e., grade III or IV; intra-abdominal pressure, IAP >20 mm Hg) following an injury-related laparotomy versus those who did not (i.e., IAP ≤20 mm Hg). A retrospective analysis of consecutive trauma patients admitted to a level 1 trauma centre in Australia between January 1, 1995 and January 31, 2010 was performed. A comparison was made between characteristics of patients who developed high-grade IAH following trauma laparotomy versus those who did not. A total of 567 patients (median age 31 years) were included in this study. Of these patients 10.2% (58/567) developed high-grade IAH of which 51.7% (30/58) developed ACS. Patients with high-grade IAH were older (pgrade IAH received larger volumes of crystalloids (pgrade IAH suffered higher mortality rates (25.9% (15/58) vs. 12.2% (62/509); p=0.012). Of all patients who underwent a trauma laparotomy, 10.2% developed high-grade IAH, which increases the risk of mortality. Patients with acidosis, coagulopathy, and hypothermia were especially at risk. In these patients, the abdomen should be left open until adequate resuscitation has been achieved, allowing for definitive surgery. This is a level III retrospective study. Copyright © 2014 Elsevier Ltd. All rights reserved.
The objective of this study was to evaluate the association between severity of maxillofacial injuries determined by trauma scoring systems and its economic burden to patients in terms of cost and duration of hospitalization. Following ethical approval a retrospective chart review was undertaken at Meenakshi Ammal Dental College and Hospital to identify patients admitted with maxillofacial injuries between January 2006 and December 2008. Patients with incomplete records, associated injuries, debilitating systemic diseases and patients treated under local anesthesia were excluded. Details regarding the nature and severity of injury and treatment were recorded in addition to the total treatment cost and duration of hospitalization. Maxillofacial injury severity was scored using maxillofacial injury severity score (MFISS) and facial injury severity scale (FISS). The MFISS and FISS scores were correlated with two surrogate markers of the economic burden namely cost and duration of hospitalization. A total of 162 patients with maxillofacial injuries were identified (108 males, 54 females; mean age = 32.4 years). Road traffic accidents were the cause of injury in 114 patients (70.4%) and only 29 patients (17.9%) had medical insurance coverage. The mean MFISS and FISS scores were 14.04 (standard deviation [SD] = 9.19; range = 3-42) and 4.40 (SD = 3.17; range = 1-14), respectively. The mean cost and duration of hospitalization of the patients were Indian rupees (INR) 13877.28 (SD = 8252.59; range = INR 5250-42960) and 4.12 days (SD = 1.5; range = 2-8 days) respectively. Pearson's correlation between the MFISS and FISS scores and the cost and duration of hospitalization, revealed statistically significant correlations (MFISS vs. cost - R = 0.862, P maxillofacial injury severity measured by MFISS and FISS scores are predictable indicators of the economic burden to the patients.
Eltorai; P. Thomas; Yang; Daniels; Born
Context According to the american medical association (AMA) and the national institutes of health (NIH), the recommended readability of patient education materials should be no greater than a sixth-grade reading level. The online patient education information produced by the american academy of orthopaedic surgeons (AAOS) may be too complicated for some patients to understand. This study evaluated whether the AAOS’s online trauma-related patient education materials meet recommend...
Burykin, Anton; Buchman, Timothy
We studied changes in cardio-respiratory synchronization and dynamics of cardiovascular system during transition from mechanical ventilation to spontaneous respiration in critically ill patients. This observational study exploits a standard clinical practice---the spontaneous breathing trial (SBT). The SBT consists of a period of mechanical ventilation, followed by a period of spontaneous breathing, followed by resumption of mechanical ventilation. We collected continuous respiratory, cardiac (EKG), and blood pressure signals of mechanically ventilated patients before, during and after SBT. The data were analyzed by means of spectral analysis, phase dynamics, and entropy measures. Mechanical ventilation appears to affect not only the lungs but also the cardiac and vascular systems. Spontaneous cardiovascular rhythms are entrained by the mechanical ventilator and are drawn into synchrony. Sudden interruption of mechanical ventilation causes gross desynchronization, which is restored by reinstitution of mechanical ventilation. The data suggest (1) therapies intended to support one organ system may propagate unanticipated effects to other organ systems and (2) sustained therapies may adversely affect recovery of normal organ system interactions.
servative definition requiring both an anatomic or clinical syn- drome and a pathogen .8 The design of this study was similar, and many patients enrolled...Naturalloganthm u Using llospllallength of "ay did nut pass the goodness of fit test. wa-. used to tran,form total body surface area due to
Zaidi, N.; Javed, N.; Rahman, M. U.
Objective: To explore the prevalence of anxiety among young cardiac patients visiting tertiary care hospital, Rawalpindi. Study Design: Observational cross-sectional study. Place and Duration of Study: Rawalpindi Institute of Cardiology (RIC), from 27th Jun to 30th Sep 2016. Material and Methods: After ethical clearance and approval of the supervisor of Rawalpindi Institute of Cardiology, data were collected from the OPD patients of Rawalpindi Institute of Cardiology over a period of one month. Patients were briefed about the nature of study and after informed written consent, information was collected through face to face interviews by trained data collectors using General anxiety Disorder (GAD) scale. SPSS-21 was used for data analysis. Results: A total 237 patients were interviewed and male to female ratio was 1.4:1 (140:97). Age ranged from 20-40 years with mean of 32 ± 5.2 years. Overall prevalence of anxiety was 25.5 percent. There was not statistically significant difference observed in anxiety levels between male (23, 9 percent) and females (25, 11 percent), (p-value: 1.000). The participants were divided into 4 age groups and group 4 (36-40 years) was most affected group. However, none of the group showed statistically association with age groups. A statistically significant relationship is found with unemployment and anxiety (OR: 2.8, p-value: <.005). However there was no relationship between duration of cardiac illness and anxiety (p-value: .588). Conclusion: Moderate level of anxiety was most prevalent among the 30-40 years age group. (author)
McCoy, C Eric; Menchine, Michael; Sampson, Sehra; Anderson, Craig; Kahn, Christopher
We determine the association between emergency medical services (EMS) out-of-hospital times and mortality in trauma patients presenting to an urban Level I trauma center. We conducted a secondary analysis of a prospective cohort registry of trauma patients presenting to a Level I trauma center during a 14-year period (1996 to 2009). Inclusion criteria were patients sustaining traumatic injury who presented to an urban Level I trauma center. Exclusion criteria were extrication, missing or erroneous out-of-hospital times, and intervals exceeding 5 hours. The primary outcome was inhospital mortality. EMS out-of-hospital intervals (scene time and transport time) were evaluated with multivariate logistic regression. There were 19,167 trauma patients available for analysis, with 865 (4.5%) deaths; 16,170 (84%) injuries were blunt, with 596 (3.7%) deaths, and 2,997 (16%) were penetrating, with 269 (9%) deaths. Mean age and sex for blunt and penetrating trauma were 34.5 years (68% men) and 28.1 years (90% men), respectively. Of those with Injury Severity Score less than or equal to 15, 0.4% died, and 26.1% of those with a score greater than 15 died. We analyzed the relationship of scene time and transport time with mortality among patients with Injury Severity Score greater than 15, controlling for age, sex, Injury Severity Score, and Revised Trauma Score. On multivariate regression of patients with penetrating trauma, we observed that a scene time greater than 20 minutes was associated with higher odds of mortality than scene time less than 10 minutes (odds ratio [OR] 2.90; 95% confidence interval [CI] 1.09 to 7.74). Scene time of 10 to 19 minutes was not significantly associated with mortality (OR 1.19; 95% CI 0.66 to 2.16). Longer transport times were likewise not associated with increased odds of mortality in penetrating trauma cases; OR for transport time greater than or equal to 20 minutes was 0.40 (95% CI 0.14 to 1.19), and OR for transport time 10 to 19 minutes was
Gogol, M; van den Heuvel, D; Lüttje, D; Püllen, R; Reingräber, A C; Schulz, R-J; Veer, A; Wittrich, A
For the care of the elderly, specific geriatric care facilities in hospitals and specialized rehabilitation centers have been established in the last 20 years throughout Germany. In addition, trauma surgery departments in hospitals and clinics also provide comprehensive care for trauma patients. The present requirements catalog was developed with the aim to ensure the standardization and quality assurance of these care facilities. Thus, the structural basics and, in particular, the structured cooperation between geriatrics and trauma surgery are described and defined in terms of structure, process, and outcome quality. The Bundesverband Geriatrie, the Deutsche Gesellschaft für Geriatrie, and the Deutsche Gesellschaft für Gerontologie und Geriatrie offer documentation for external and internal use and evaluation of the structures and processes for certification of geriatric trauma centers. Prerequisite for certification is to meet the technical requirements defined in the requirements catalogue or documents derived from it, and proof of a quality management system according to ISO 9001.
Cai, Shi-Qi; Hu, Jun-Wu; Liu, Dong; Bai, Xiang-Jun; Xie, Jie; Chen, Jia-Jun; Yang, Fan; Liu, Tao
This study aims to assess the influence of tracheostomy timing on outcomes among trauma patients, including mortality, medical resource utility and incidence of pneumonia. A systematic review of the literature was conducted by internet search. Data were extracted from selected studies and analyzed using Stata to compare outcomes in trauma patients with early tracheostomy (ET) or late tracheostomy (LT)/prolonged intubation (PI). 20 studies met our inclusion criteria with 3305 patients in ET group and 4446 patients in LT/PI group. Pooled data revealed that mortality was not lower in trauma patients with ET compared to those with LT/IP. However, ET was found to be associated with a significantly reduced length of ICU and hospital stay, shorter MV duration and lower risk of pneumonia. Evidence of this meta-analysis supports the dimorphism in some clinical outcomes of trauma patients with different tracheostomy timing. Additional well-designed randomized controlled trials (RCTs) are needed to confirm it in future. Copyright © 2017 Elsevier Ltd. All rights reserved.
Shere-Wolfe Roger F
Full Text Available Abstract Background Care of the polytrauma patient does not end in the operating room or resuscitation bay. The patient presenting to the intensive care unit following initial resuscitation and damage control surgery may be far from stable with ongoing hemorrhage, resuscitation needs, and injuries still requiring definitive repair. The intensive care physician must understand the respiratory, cardiovascular, metabolic, and immunologic consequences of trauma resuscitation and massive transfusion in order to evaluate and adjust the ongoing resuscitative needs of the patient and address potential complications. In this review, we address ongoing resuscitation in the intensive care unit along with potential complications in the trauma patient after initial resuscitation. Complications such as abdominal compartment syndrome, transfusion related patterns of acute lung injury and metabolic consequences subsequent to post-trauma resuscitation are presented. Methods A non-systematic literature search was conducted using PubMed and the Cochrane Database of Systematic Reviews up to May 2012. Results and conclusion Polytrauma patients with severe shock from hemorrhage and massive tissue injury present major challenges for management and resuscitation in the intensive care setting. Many of the current recommendations for “damage control resuscitation” including the use of fixed ratios in the treatment of trauma induced coagulopathy remain controversial. A lack of large, randomized, controlled trials leaves most recommendations at the level of consensus, expert opinion. Ongoing trials and improvements in monitoring and resuscitation technologies will further influence how we manage these complex and challenging patients.
M. W. Barentsz
Full Text Available Purpose. To analyse the technical success of pelvic embolization in our institution and to assess periprocedural hemodynamic status and morbidity/mortality of all pelvic trauma patients who underwent pelvic embolization. Methods. A retrospective analysis of patients with a pelvic fracture due to trauma who underwent arterial embolization was performed. Clinical data, pelvic radiographs, contrast-enhanced CT-scans, and angiographic findings were reviewed. Subsequently, the technical success and peri-procedural hemodynamic status were evaluated and described. Results. 19 trauma patients with fractures of the pelvis underwent arterial embolization. Initially, 10/19 patients (53% were hemodynamically unstable prior to embolization. Technical success of embolization was 100%. 14/19 patients (74% were stable after embolization, and treatment success was high as 74%. Conclusion. Angiography with subsequent embolization should be performed in patients with a pelvic fracture due to trauma and hemodynamic instability, after surgical intervention or with a persistent arterial blush indicative of an active bleeding on CT.
Johansson, Pär I; Sørensen, Anne Marie Møller; Larsen, Claus F
admission and 68, 71, and 75%, respectively, of patients transfused within 24 hours received the respective blood products within the first 2 hours. In patients transfused within 24 hours, the median number of blood products at 2 hours was 5 units of RBCs, 5 units of plasma, and 2 units of PLT concentrates......BACKGROUND: Hemorrhage accounts for most preventable trauma deaths, but still the optimal strategy for hemostatic resuscitation remains debated. STUDY DESIGN AND METHODS: This was a prospective study of adult trauma patients admitted to a Level I trauma center. Demography, Injury Severity Score...... (ISS), transfusion therapy, and mortality were registered. Hemostatic resuscitation was based on a massive transfusion protocol encompassing transfusion packages and thromboelastography (TEG)-guided therapy. RESULTS: A total of 182 patients were included (75% males, median age 43 years, ISS of 17, 92...
Invariably the mentally ill person encounters rejectionand humiliation that are in some way tantamount to a "second illness." The combination either disrupts or puts beyond reach the usual personal and social life stages of marriage, family life, raising children, sexual relationships, the choice of treatment, affordable housing, ...
Roberts, Derek J; Ball, Chad G; Feliciano, David V; Moore, Ernest E; Ivatury, Rao R; Lucas, Charles E; Fabian, Timothy C; Zygun, David A; Kirkpatrick, Andrew W; Stelfox, Henry T
To review the history of the innovation of damage control (DC) for management of trauma patients. DC is an important development in trauma care that provides a valuable case study in surgical innovation. We searched bibliographic databases (1950-2015), conference abstracts (2009-2013), Web sites, textbooks, and bibliographies for articles relating to