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1.
Gerodontology ; 36(4): 358-364, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31274224

RESUMO

OBJECTIVE: To assess the prevalence and surgical treatment of facial fractures in a Swiss population aged 65 and over. BACKGROUND: The knowledge of the characteristics of geriatric trauma may help to prevent injuries and better allocate clinical resources for the management of multimorbid patients. MATERIAL AND METHODS: This study retrospectively evaluated a cohort of 181 patients who presented at the Bern University Hospital in Switzerland from May 2012 to September 2016. Data on age, gender, aetiology and type of trauma, treatment and complications, co-morbidities and associated injuries were obtained. RESULTS: Women were most frequently affected (55.2%). Mean age was 80 years. Zygomatic complex fractures were the most frequent type of fractures (37%), followed by isolated orbital fractures (27.6%). Falls were the most common cause of trauma (76.1%). Thirty-five per cent of all patients were taking anticoagulation or platelet aggregation medication. Hospitalisation was required in 88.4%, whereby 92.3% of the patients underwent surgical treatment. Surgery had to be performed immediately in three cases to treat compression of the optic nerve. Median hospital length of stay was 4 days, with 68% of patients returning to a domestic environment and 32% being transferred to another institution for further treatment. CONCLUSION: The most common cause of facial injuries is a fall while standing in a domestic environment. Midface fractures were the most common type of fractures.


Assuntos
Traumatismos Faciais , Fraturas Cranianas , Fraturas Zigomáticas , Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estudos Retrospectivos
2.
BMC Med ; 11: 83, 2013 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-23531202

RESUMO

BACKGROUND: Diuretics are among the most commonly prescribed medications and, due to their mechanisms of action, electrolyte disorders are common side effects of their use. In the present work we investigated the associations between diuretics being taken and the prevalence of electrolyte disorders on admission as well as the impact of electrolyte disorders on patient outcome. METHODS: In this cross sectional analysis, all patients presenting between 1 January 2010 and 31 December 2011 to the emergency room (ER) of the Inselspital, University Hospital Bern, Switzerland were included. Data on diuretic medication, baseline characteristics and laboratory data including electrolytes and renal function parameters were obtained from all patients. A multivariable logistic regression model was performed to assess the impact of factors on electrolyte disorders and patient outcome. RESULTS: A total of 8.5% of patients presenting to the ER used one diuretic, 2.5% two, and 0.4% three or four. In all, 4% had hyponatremia on admission and 12% hypernatremia. Hypokalemia was present in 11% and hyperkalemia in 4%. All forms of dysnatremia and dyskalemia were more common in patients taking diuretics. Loop diuretics were an independent risk factor for hypernatremia and hypokalemia, while thiazide diuretics were associated with the presence of hyponatremia and hypokalemia. In the Cox regression model, all forms of dysnatremia and dyskalemia were independent risk factors for in hospital mortality. CONCLUSIONS: Existing diuretic treatment on admission to the ER was associated with an increased prevalence of electrolyte disorders. Diuretic therapy itself and disorders of serum sodium and potassium were risk factors for an adverse outcome.


Assuntos
Diuréticos/administração & dosagem , Diuréticos/efeitos adversos , Medicina de Emergência/estatística & dados numéricos , Desequilíbrio Hidroeletrolítico/induzido quimicamente , Desequilíbrio Hidroeletrolítico/epidemiologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Suíça/epidemiologia
3.
Am J Emerg Med ; 31(4): 657-60, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23246111

RESUMO

PURPOSES: The aim of the study was to describe the prevalence, demographic, and clinical characteristics and etiologies of hypercalcemia in emergency department patients. BASIC PROCEDURES: In this retrospective cross-sectional descriptive study, all patients admitted between April 1, 2008, and March 31, 2011, to the emergency department of Inselspital, University Hospital Bern, were screened for the presence of hypercalcemia, defined as a serum calcium exceeding 2.55 mmol/L after correction for serum albumin. Demographic, laboratory, and outcome data were gathered. A detailed medical record review was performed to identify causes of hypercalcemia. MAIN FINDINGS: During the study period, 14 984 patients (19% of all admitted patients) received a measurement of serum calcium. Of these, 116 patients (0.7%) presented with hypercalcemia. Median serum calcium was 2.72 mmol/L (first quartile, 2.64; third quartile, 2.88), with 4.3 mmol/L being the maximum serum calcium value observed. Underlying malignancy in 44% of patients and hyperparathyroidism in 20% (12% secondary and 8% primary) were the leading causes of hypercalcemia. Twenty-six percent of patients presented with symptomatic hypercalcemia. Weakness was the most common symptom of hypercalcemia, followed by nausea and disorientation. PRINCIPAL CONCLUSIONS: Hypercalcemia is a rare but harmful electrolyte disorder in emergency department patients. Unspecific symptoms such as a change in mental state, weakness, or gastrointestinal symptoms should prompt physicians to order serum calcium measurements, at least in patients with known malignancy or renal insufficiency.


Assuntos
Hipercalcemia/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Hipercalcemia/diagnóstico , Hipercalcemia/etiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Suíça/epidemiologia , Adulto Jovem
4.
Emerg Med J ; 30(10): 846-50, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23100321

RESUMO

PRINCIPALS: Most people enjoy sexual intercourse without complications, but a significant, if small, number need to seek emergency medical help for related health problems. The true incidence of these problems is not known. We therefore assessed all admissions to our emergency department (ED) in direct relation to sexual intercourse. METHODS: All data were collected prospectively and entered into the ED's centralised electronic patient record database (Qualicare, Switzerland) and retrospectively analysed. The database was scanned for the standardised key words: 'sexual intercourse' (German 'Geschlechtsverkehr') or 'coitus' (German 'Koitus'). RESULTS: A total of 445 patients were available for further evaluation; 308 (69.0%) were male, 137 (31.0%) were female. The median age was 32 years (range 16-71) for male subjects and 30 years (range 16-70) for female subjects. Two men had cardiovascular emergencies. 46 (10.3%) of our patients suffered from trauma. Neurological emergencies occurred in 55 (12.4%) patients: the most frequent were headaches in 27 (49.0%), followed by subarachnoid haemorrhage (12, 22.0%) and transient global amnesia (11, 20.0%). 154 (97.0%) of the patients presenting with presumed infection actually had infections of the urogenital tract. The most common infection was urethritis (64, 41.0%), followed by cystitis (21, 13.0%) and epididymitis (19, 12.0%). A sexually transmitted disease (STD) was diagnosed in 43 (16.0%) of all patients presenting with a presumed infection. 118 (43.0%) of the patients with a possible infection requested testing for an STD because of unsafe sexual activity without underlying symptoms. CONCLUSIONS: Sexual activity is mechanically dangerous, potentially infectious and stressful for the cardiovascular system. Because information on ED presentation related to sexual intercourse is scarce, more efforts should be undertaken to document all such complications to improve treatment and preventative strategies.


Assuntos
Coito , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/etiologia , Feminino , Cefaleia/etiologia , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Estudos Retrospectivos , Distribuição por Sexo , Suíça , Infecções Urinárias/etiologia , Ferimentos e Lesões/etiologia , Adulto Jovem
5.
BMJ Open Sport Exerc Med ; 9(2): e001615, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37397265

RESUMO

Objectives: Sledging is a popular and traditional winter sport in Switzerland. This study examines injury patterns of patients who presented to a tertiary trauma centre in Switzerland following sledging trauma, focusing on sex differences. Methods: Retrospective single-centre study over 10 winters (2012-2022), including all patients experiencing sledging-related trauma. Injury history was collected and analysed from the patient data and demographic information. The Abbreviated Injury Scale and the Injury Severity Score (ISS) were used to classify injury types and severity. Results: 193 patients were identified with sledging injuries. The median age was 46 (IQR 28-65), and 56% were female. The most frequent mechanism of injury was a fall (70%), followed by collision (27%) and other fall on slopes (6%). Lower extremities (36%), trunk (20%) and head/neck (15%) were the most frequently injured body areas. Fourteen per cent of patients were admitted with head injuries, whereas females were significantly more likely to present with head injuries than males (p=0.047). Males were significantly more often admitted with fractures to the upper extremities than females (p=0.049). The median ISS was 4 (IQR 1-5), without significant differences between males and females (p=0.290). The hospital admission rate was 28.5% for sledging-related injuries. The median length of stay for patients admitted to the hospital was 5 (IQR 4-8) days. The total cost for all patients was CHF1 292 501, with a median of CHF1009 per patient (IQR CHF458-CHF5923). Conclusion: Sledging injuries are common and may result in serious injuries. The lower extremities, trunk and head/neck are frequently injured and could be specifically protected with safety devices. Multiple injuries were statistically more frequent in women compared with men. Males were significantly more often admitted with fractures to the upper extremities, and females were more likely to sustain head injuries. The findings can help to develop data-driven measures to prevent sledging accidents in Switzerland.

6.
Eur J Trauma Emerg Surg ; 49(4): 1683-1691, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36066583

RESUMO

PURPOSE: The aim of this study was to assess the impact of pre-injury stimulant use (amphetamine, cocaine, methamphetamine and/or ecstasy) on outcomes after isolated severe traumatic brain injury (TBI). METHODS: Retrospective 2017 TQIP study, including adult trauma patients (≥16 years old) who underwent drug and alcohol screening on admission and sustained an isolated severe TBI (head AIS ≥3). Patients with significant extracranial trauma (AIS ≥3) were excluded. Epidemiological and clinical characteristics, procedures and outcome variables were collected. Patients with isolated stimulant use were matched 1:1 for age, gender, mechanism of injury, head AIS and overall comorbidities, with patients with negative toxicology and alcohol screen. Outcomes in the two groups were compared with univariable and multivariable regression analysis. RESULTS: 681 patients with isolated TBI and stimulant use were matched with 681 patients with negative toxicology and alcohol screen. The incidence of hypotension and CGS <9 was similar in the two groups. In multivariable regression analysis, stimulant use was not independently associated with mortality (OR 0.95, 95% CI 0.61-1.49). However, stimulant use was associated with longer hospital length of stay (HLOS) (RC 1.13, 95%CI 1.03-1.24). CONCLUSION: Pre-injury stimulant use is common in patients admitted for severe TBI, but was not independently associated with mortality when compared to patients with negative toxicology. However, stimulant use was associated with a significant longer HLOS.


Assuntos
Lesões Encefálicas Traumáticas , Metanfetamina , Adolescente , Adulto , Humanos , Etanol , Tempo de Internação , Metanfetamina/efeitos adversos , Estudos Retrospectivos , Cocaína/efeitos adversos
7.
BMJ Open ; 13(3): e072649, 2023 03 29.
Artigo em Inglês | MEDLINE | ID: mdl-36990482

RESUMO

INTRODUCTION: Computerised diagnostic decision support systems (CDDS) suggesting differential diagnoses to physicians aim to improve clinical reasoning and diagnostic quality. However, controlled clinical trials investigating their effectiveness and safety are absent and the consequences of its use in clinical practice are unknown. We aim to investigate the effect of CDDS use in the emergency department (ED) on diagnostic quality, workflow, resource consumption and patient outcomes. METHODS AND ANALYSIS: This is a multicentre, outcome assessor and patient-blinded, cluster-randomised, multiperiod crossover superiority trial. A validated differential diagnosis generator will be implemented in four EDs and randomly allocated to a sequence of six alternating intervention and control periods. During intervention periods, the treating ED physician will be asked to consult the CDDS at least once during diagnostic workup. During control periods, physicians will not have access to the CDDS and diagnostic workup will follow usual clinical care. Key inclusion criteria will be patients' presentation to the ED with either fever, abdominal pain, syncope or a non-specific complaint as chief complaint. The primary outcome is a binary diagnostic quality risk score composed of presence of an unscheduled medical care after discharge, change in diagnosis or death during time of follow-up or an unexpected upscale in care within 24 hours after hospital admission. Time of follow-up is 14 days. At least 1184 patients will be included. Secondary outcomes include length of hospital stay, diagnostics and data regarding CDDS usage, physicians' confidence calibration and diagnostic workflow. Statistical analysis will use general linear mixed modelling methods. ETHICS AND DISSEMINATION: Approved by the cantonal ethics committee of canton Berne (2022-D0002) and Swissmedic, the Swiss national regulatory authority on medical devices. Study results will be disseminated through peer-reviewed journals, open repositories and the network of investigators and the expert and patients advisory board. TRIAL REGISTRATION NUMBER: NCT05346523.


Assuntos
Hospitalização , Projetos de Pesquisa , Humanos , Estudos Cross-Over , Serviço Hospitalar de Emergência , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Multicêntricos como Assunto
8.
J Trauma Acute Care Surg ; 92(5): 862-872, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-34554141

RESUMO

BACKGROUND: Increasing life expectancy has led to higher incidence of fragility fractures of the pelvis. These demographic changes may have a direct impact on fracture patterns. The goal of this study was (1) to evaluate demographical trends in patients with pelvic ring injuries at a tertiary Swiss trauma center and (2) to analyze the influence on fracture patterns. METHODS: We performed a retrospective cross-sectional study including 958 patients (mean ± SD age, 57 ± 21 years; 48% women) with a pelvic ring injury between 2007 and 2017. Fractures were classified according to Tile, Young and Burgess or Rommens and Hofmann (fragility fractures) using conventional and computer tomography imaging. Low-energy fractures were defined as fractures resulting from fall from standing height or less. Fracture classifications, age, sex, Injury Severity Score, and trauma mechanism were compared using analysis of variance or χ2 test. Cluster analysis was performed to identify groups with similarities in fracture patterns and demographic parameters. RESULTS: From 2007 to 2017, the frequency of pelvic ring injuries increased by 115% (increase per decade), and mean age increased by 15% (p = 0.031). A trimodal age distribution was found; highest increase for fractures occurred in the older (265%) patient group. Low-energy fracture was the most common trauma mechanism (43% of all fractures, an increase of 249%). Changes in fracture pattern showed a disproportioned increase of lateral compression (LC) fractures (LC type 1 in 64%) or partially stable fracture (B2, with 39%). In patient older than 65 years, the strongest increase was found for nondisplaced posterior fractures with an overall prevalence of 62%. Five clusters were found with the most frequent cluster representing older female patients with low-energy fracture (LC, Tile type B) in 30%. CONCLUSION: The current results corroborate the trend of increasing frequency of fragility fractures in an aging society. The demographic shift has a direct impact on fracture pattern with a disproportionate increase in partially stable compression fracture of the pelvis. LEVEL OF EVIDENCE: Prognostic/Epidemiologic, Level III.


Assuntos
Fraturas Ósseas , Centros de Traumatologia , Adulto , Idoso , Estudos Transversais , Etnicidade , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Suíça/epidemiologia , Tomografia Computadorizada por Raios X/efeitos adversos
9.
BMJ Open Sport Exerc Med ; 8(1): e001281, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35450112

RESUMO

Objectives: Outdoor rock climbing has become popular in recent years. However, few data have been published on climbing accidents in Switzerland, even though the Swiss Alps are a major climbing resort.To analyse data on accidents related to outdoor climbing treated in the Emergency Department (ED) of University Hospital Bern, Switzerland. Methods: A retrospective database search for accidents related to outdoor climbing was conducted in the clinical reporting system E.care of the ED of University Hospital Bern for the period April 2012-December 2018. Results: 78 patients were treated after an accident related to outdoor climbing, which accounted for 1 per 3571 (0.028%) of all ED visits during this period. Mean age was 35.8±10.4 years. 76% of patients were male. Falls were the most common mechanism of injury (64%), followed by rock or ice falling on the climber (21%). Injuries affected multiple body regions (38%) or only the lower limbs (22%). Most injuries were fractures (68%). Mean ISS was 7.5 (1-38), and grade 3 UIAA MedCom injuries were most common (45%). 11 cases of polytrauma occurred and one fatality. 44 patients needed inpatient admission. Mean duration of inpatient stay was 7 days. Mean costs per patient were 12 283 CHF. Conclusions: Accidents related to outdoor climbing accounted for a small number of patients seen in the University ED Bern. Further research should be on a nationwide basis, with collection of specific climbing data like use of a helmet and experience of climbing to inform injury prevention strategies. This should shed further light on this topic, as would a prospective study using the International Alpine Trauma Register.

10.
AJR Am J Roentgenol ; 196(3): W285-9, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21343476

RESUMO

OBJECTIVE: We assessed the diagnostic accuracy and time effectiveness of the Statscan low-dose full-body digital x-ray machine in the evaluation of ventriculoperitoneal (VP) shunt dysfunction. SUBJECTS AND METHODS: Twenty-five consecutive adults scheduled for a radiographic shunt series with the Statscan were prospectively selected (group 1). Another 21 consecutive patients who underwent conventional x-ray scanning served as controls (group 2) for blinded analysis. RESULTS: Image quality was sufficient for diagnosis in both groups (95.6% vs 95.1%). The quality of VP shunt delineation and contrast of anatomic structures was good or optimal in both groups (p > 0.05). The scan time was significantly lower for group 1 (p < 0.001). All images for group 2 exhibited overlapping of anatomic structures (25% of total coverage), whereas no technically determined overlapping occurred in group 1. CONCLUSION: The Statscan digital x-ray machine allows accurate assessment of VP shunt continuity at lower radiation dosages and in less time than conventional x-ray techniques.


Assuntos
Intensificação de Imagem Radiográfica/instrumentação , Derivação Ventriculoperitoneal , Imagem Corporal Total/instrumentação , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
11.
Phys Sportsmed ; 48(2): 179-185, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31532694

RESUMO

Background: Rhabdomyolysis is a potentially fatal condition that can be triggered by a variety of inciting events, including excessive muscular exertion.The purpose of this study was to investigate the causes of creatine kinase elevation (CK≥1000U/L) to determine what percentage result from exRML, the etiology, and kinetics of CK levels, as well as the complications of exRML and comorbidities that may predispose an individual to this condition.Methods: We performed a cross-sectional analysis of the emergency department database for patients with CK≥1000U/L between 2012 and 2017. In total, there were 1957 cases of rhabdomyolysis diagnosed based on laboratory data and documentation. Trauma was the most common cause for rhabdomyolysis (n = 726/1957; 37.1%, respectively).Results: ExRML was identified in 2.1% (n = 42/1957) of the total cases. Patients with ExRML were significantly younger (30.1 ± 10.6 years) with a significantly higher maximal level of CK compared to the non-exertional causes of rhabdomyolysis, (CK = 16,884.4 ± 41,645.6U/L; both p < 0.005). The far majority of cases were sport or exercise related (n = 35/42; 83.3%), with strength training at the gym making up the largest group of athletes (n = 16/42; 38.1%). The main complication amongst the ExRML group was acute kidney insufficiency, which was observed in 42.9% of patients. The CK levels of the patients in the ExRML cohort steadily decreased after initiation of aggressive hydration.Conclusion: ExRML may be more prevalent than the current literature predicts, which is important to recognize as it has the potential to cause kidney failure, irregular heart rhythm, and death. Therefore, physicians and active individuals should be sensitized to the signs and symptoms that may lead to earlier recognition and proper treatment in exercising individuals.


Assuntos
Creatina Quinase/sangue , Treinamento Resistido/efeitos adversos , Rabdomiólise/sangue , Rabdomiólise/etiologia , Injúria Renal Aguda/etiologia , Adulto , Idoso , Estudos Transversais , Feminino , Hidratação , Humanos , Masculino , Pessoa de Meia-Idade , Esforço Físico , Rabdomiólise/terapia , Ferimentos e Lesões/sangue , Ferimentos e Lesões/complicações , Adulto Jovem
12.
Oman Med J ; 33(1): 55-60, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29468000

RESUMO

OBJECTIVES: We sought to identify a simplified approach for the rapid differential diagnosis of patients presenting with acute scrotum. METHODS: A total of 440 patients referred to the emergency department of the University Hospital of Bern, Switzerland, with acute scrotum between 2003 and 2013 were retrospectively analyzed. Simple and multiple binary logistic regression analyses were used to evaluate clinical and laboratory parameters that may help to distinguish between genital/paragenital infection and acute testicular torsion. RESULTS: Over half (58.4%; 257/440) of the patients were diagnosed with genital/paragenital infection, 11.8% (52/440) with chronic testicular pain, 9.5% (42/440) with acute testicular torsion, 4.3% (19/440) with a testicular cancer, and 2.5% (11/440) with symptomatic distal ureterolithiasis. In multivariate analysis, a positive Prehn's sign was predictive of testicular torsion, whereas fever, dysuria, high leucocyte counts in blood and/or urine, high blood C-reactive protein, and burning pain were predictive of genital/paragenital infection. Color Doppler ultrasound did not help to distinguish between torsion and infection. CONCLUSIONS: An accurate diagnostic pathway helps to correctly distinguish between the possible causes of acute scrotum. However, none of the examinations performed could reliably distinguish between acute torsion and other causes of acute scrotum. Therefore, immediate surgical exploration of the testis is mandatory if torsion cannot be ruled out.

13.
BMJ Open ; 8(1): e020230, 2018 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-29331979

RESUMO

OBJECTIVES: To (1) compare timely but preliminary and definitive but delayed radiological reports in a large urban level 1 trauma centre, (2) assess the clinical significance of their differences and (3) identify clinical predictors of such differences. DESIGN, SETTING AND PARTICIPANTS: We performed a retrospective record review for all 2914 patients who presented to our university affiliated emergency department (ED) during a 6-week period. In those that underwent radiological imaging, we compared the patients' discharge letter from the ED to the definitive radiological report. All identified discrepancies were assessed regarding their clinical significance by trained raters, independent and in duplicate. A binary logistic regression was performed to calculate the likelihood of discrepancies based on readily available clinical data. RESULTS: 1522 patients had radiographic examinations performed. Rater agreement on the clinical significance of identified discrepancies was substantial (kappa=0.86). We found an overall discrepancy rate of 20.35% of which about one-third (7.48% overall) are clinically relevant. A logistic regression identified patients' age, the imaging modality and the anatomic region under investigation to be predictive of future discrepancies. CONCLUSIONS: Discrepancies between radiological diagnoses in the ED are frequent and readily available clinical factors predict their likelihood. Emergency physicians should reconsider their discharge diagnosis especially in older patients undergoing CT scans of more than one anatomic region.


Assuntos
Erros de Diagnóstico , Serviços Médicos de Emergência/normas , Serviço Hospitalar de Emergência , Radiografia/métodos , Centros de Traumatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Radiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Universidades , Adulto Jovem
14.
BMJ Open Sport Exerc Med ; 4(1): e000428, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30364432

RESUMO

BACKGROUND: The number of people conducting cycling and skating sports in Switzerland is rising; likewise, we notice an increase in patients visiting our emergency department for adults due to push scooter accidents. In 2001, our emergency department published the first article worldwide on push scooter-related injuries. Nearly two decades later, we want to review the interim period-collect data, compare it with other studies and evaluate the current impact of push scooter accidents in our adult patient population. OBJECTIVE: To investigate data on the incidence, severity, treatment and approximate costs of push scooter-related injuries in adults who presented to our emergency department from 2000 to 2017. MATERIALS AND METHODS: For this descriptive retrospective study, data were collected in the Department of Emergency Medicine at Inselspital (University Hospital), Berne, Switzerland, from October 2000 to September 2017. We used two clinical reporting systems during that period: Qualicare from 2000 to April 2012 and Ecare from May 2012 to 2017. RESULTS: 165 patients were included, aged 16-80 years. The accidents were mainly classified as unspecified falls in 139 cases (84.24%). 21 patients (12.73%) were wearing a helmet at the time of the accident, while the remaining 144 (87.27%) were not. The most common injuries suffered were fractures in 73 patients (44.24%). 92 patients (55.76%) sustained an impact to the head. The most common treatment was surgery in the operating theatre (59 patients, 35.76%). The mean total cost per case was SFr7566.65 (emergency room visit, hospital stay and outpatient controls for the initial case). CONCLUSION: The incidence of push scooter-related injuries in adults in our patient population is small but rising. Nevertheless, the resulting injuries are potentially life-threatening and can lead to persistent medical impairment.

15.
PLoS One ; 11(2): e0148196, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26863216

RESUMO

BACKGROUND: Forced displacement related to persecution and violent conflict has reached a new peak in recent years. The primary aim of this study is to provide an initial overview of the acute and chronic health care problems of asylum seekers from the Middle East, with special emphasis on asylum seekers from Syria. METHODS: Our retrospective data analysis comprised adult patients presenting to our emergency department between 01.11.2011 and 30.06.2014 with the official resident status of an "asylum seeker" or "refugee" from the Middle East. RESULTS: In total, 880 patients were included in the study. Of these, 625 (71.0%) were male and 255 (29.0%) female. The median age was 34 (range 16-84). 222 (25.2%) of our patients were from Syria. The most common reason for presentation was surgical (381, 43.3%), followed by medical (321, 36.5%) and psychiatric (137, 15.6%). In patients with surgical presentations, trauma-related problems were most common (n = 196, 50.6%). Within the group of patients with medical presentation, acute infectious diseases were most common (n = 141, 43.9%), followed by neurological problems (n = 70, 21.8%) and gastrointestinal problems (n = 47, 14.6%). There were no differences between Syrian and non-Syrian refugees concerning surgical or medical admissions. The most common chronic disorder of unclear significance was chronic gastrointestinal problems (n = 132, 15%), followed by chronic musculoskeletal problems (n = 108, 12.3%) and chronic headaches (n = 78, 8.9%). Patients from Syria were significantly younger and more often suffered from a post-traumatic stress disorder than patients of other nationalities (p<0.0001, and p = 0.05, respectively). CONCLUSION: Overall a remarkable number of our very young group of patients suffered from psychiatric disorders and unspecified somatic symptoms. Asylum seekers should be carefully evaluated when presenting to a medical facility and physicians should be aware of the high incidence of unspecified somatic symptoms in this patient population.In general, there is no major difference between asylum seekers from Syria when compared to other nationalities of asylum seekers from the Middle East.


Assuntos
Doenças Transmissíveis/diagnóstico , Gastroenteropatias/diagnóstico , Cefaleia/diagnóstico , Doenças Musculoesqueléticas/diagnóstico , Refugiados , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Ferimentos e Lesões/diagnóstico , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/fisiopatologia , Feminino , Gastroenteropatias/epidemiologia , Gastroenteropatias/fisiopatologia , Cefaleia/epidemiologia , Cefaleia/fisiopatologia , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/epidemiologia , Doenças Musculoesqueléticas/fisiopatologia , Estudos Retrospectivos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Suíça/epidemiologia , Síria/etnologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/patologia
16.
PLoS One ; 11(3): e0152822, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27031106

RESUMO

BACKGROUND: Major trauma remains one of the principle causes of disability and death throughout the world. There is currently no satisfactory risk assessment to predict mortality in patients with major trauma. The aim of our study is to examine whether S-100 B protein concentrations correlate with injury severity and survival in patients with major trauma, with special emphasis on patients without head injury. METHODS: Our retrospective data analysis comprised adult patients admitted to our emergency department between 1.12. 2008 and 31.12 2010 with a suspected major trauma. S-100 B concentrations were routinely assessed in major trauma patients. RESULTS: A total of 27.7% (378) of all patients had major trauma. The median ISS was 24.6 (SD 8.4); 16.6% (63/378) of the patients died. S-100 B concentrations correlated overall with the ISS (p<0.0001). Patients who died had significantly higher S-100 B concentrations than survivors (8.2 µg/l versus 2.2 µg/l, p<0.0001). Polytraumatised patients with and without head trauma did not differ significantly with respect to S-100 B concentration (3.2 µg/l (SD 5.3) versus 2.9 µg/l (SD 3.8), respectively, p = 0.63) or with respect to Injury Severity Score (24.8 (SD 8.6) versus 24.2 (SD 8.1), respectively, p = 0.56). S-100 B concentrations correlated negatively with survival (p<0.0001) in all patients and in both subgroups (p = 0.001 and p = 0.006, respectively). CONCLUSIONS: S-100 concentrations on admission correlate positively with greater injury severity and decreased survival in major trauma patients, independently of the presence of a head injury. S-100 B protein levels at admission in patients with major trauma may therefore be used to assess outcome in all polytraumatised patients. These measurements should be subject to further evaluation.


Assuntos
Lesões Encefálicas , Traumatismo Múltiplo , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Adulto , Biomarcadores/sangue , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/sangue , Traumatismo Múltiplo/mortalidade , Taxa de Sobrevida
17.
Swiss Med Wkly ; 145: w14208, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26594854

RESUMO

QUESTIONS UNDER STUDY: Many persons are travelling all over the world; the elderly with pre-existing diseases also travel to places with less developed health systems. Reportedly, fewer than 0.5% of all travellers need repatriation. We aimed to analyse and examine people who are injured or ill while abroad, where they travelled to and by what means they were repatriated. METHODS: Retrospective cross-sectional study with adult patients repatriated to a single level 1 trauma centre in Switzerland (2000-2011). RESULTS: A total of 372 patients were repatriated, with an increasing trend per year. Of these, 67% were male; the median age was 56 years. Forty-nine percent sustained an injury, and 13% had surgical and 38% medical pathologies. Patients with medical conditions were older than those with injuries or surgical emergencies (p <0.001). Seventy-three percent were repatriated from Europe. For repatriation from Africa trauma was slightly more frequent (53%, n = 17) than illnesses, whereas for most other countries illnesses and trauma were equally distributed. Injured patients had a median Injury Severity Score of 8. The majority of illnesses involved the nervous system (38%), mainly stroke. Forty-five percent were repatriated by Swiss Air Ambulance, 26% by ground ambulance, 18% by scheduled flights with or without medical assistance and two patients injured near the Swiss boarder by helicopter. The 28-day mortality was 4%. CONCLUSIONS: The numbers of travellers repatriated increased from 2000 to 2011. About half were due to illnesses and half due to injuries. The largest group were elderly Swiss nationals repatriated from European countries. As mortality is relatively high, special consideration to this group of patients is warranted.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Internacionalidade , Mortalidade , Transferência de Pacientes/estatística & dados numéricos , Viagem/estatística & dados numéricos , Adulto , Idoso , Resgate Aéreo/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Socioeconômicos , Suíça , Centros de Traumatologia/estatística & dados numéricos
18.
PLoS One ; 10(6): e0129562, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26110771

RESUMO

BACKGROUND: Primary hyperventilation is defined as a state of alveolar ventilation in excess of metabolic requirements, leading to decreased arterial partial pressure of carbon dioxide. The primary aim of this study was to characterise patients diagnosed with primary hyperventilation in the ED. METHODS: Our retrospective cohort study comprised adult (≥16 years) patients admitted to our ED between 1 January 2006 and 31 December 2012 with the primary diagnosis of primary (=psychogenic) hyperventilation. RESULTS: A total of 616 patients were eligible for study. Participants were predominantely female (341 [55.4%] female versus 275 [44.6%] male respectively, p <0.01). The mean age was 36.5 years (SD 15.52, range 16-85). Patients in their twenties were the most common age group (181, 29.4%), followed by patients in their thirties (121, 19.6%). Most patients presented at out-of-office hours (331 [53.7%]. The most common symptom was fear (586, 95.1%), followed by paraesthesia (379, 61.5%) and dizziness (306, 49.7%). Almost a third (187, 30.4%) of our patients had previously experienced an episode of hyperventilation and half (311, 50.5%) of patients had a psychiatric co-morbidity. CONCLUSION: Hyperventilation is a diagnostic chimera with a wide spectrum of symptoms. Patients predominantly are of young age, female sex and often have psychiatric comorbidities. The severity of symptoms accompanied with primary hyperventilation most often needs further work-up to rule out other diagnosis in a mostly young population. In the future, further prospective multicentre studies are needed to evaluate and establish clear diagnostic criteria for primary hyperventilation and possible screening instruments.


Assuntos
Tontura/complicações , Serviço Hospitalar de Emergência , Medo/psicologia , Hiperventilação/diagnóstico , Parestesia/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Tontura/diagnóstico , Tontura/psicologia , Feminino , Humanos , Hiperventilação/complicações , Hiperventilação/psicologia , Masculino , Pessoa de Meia-Idade , Parestesia/diagnóstico , Parestesia/psicologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Avaliação de Sintomas , Adulto Jovem
19.
Intern Emerg Med ; 9(3): 335-9, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24326466

RESUMO

To systematically investigate putative causes of non-coronary high-sensitive troponin elevations in patients presenting to a tertiary care emergency department. In this cross-sectional analysis, patients who received serial measurements of high-sensitive troponin T between 1 August 2010 and 31 October 2012 at the Department of Emergency Medicine were included. The following putative causes were considered to be associated with non-acute coronary syndrome-related increases in high-sensitive troponin T: acute pulmonary embolism, renal insufficiency, aortic dissection, heart failure, peri-/myocarditis, strenuous exercise, rhabdomyolysis, cardiotoxic chemotherapy, high-frequency ablation therapy, defibrillator shocks, cardiac infiltrative disorders (e.g., amyloidosis), chest trauma, sepsis, shock, exacerbation of chronic obstructive pulmonary disease, and diabetic ketoacidosis. During the study period a total of 1,573 patients received serial measurements of high-sensitive troponin T. Of these, 175 patients were found to have acute coronary syndrome leaving 1,398 patients for inclusion in the study. In 222 (30 %) of patients, no putative cause described in the literature could be attributed to the elevation in high-sensitive troponin T observed. The most commonly encountered mechanism underlying the troponin T elevation was renal insufficiency that was present in 286 patients (57 %), followed by cerebral ischemia in 95 patients (19 %), trauma in 75 patients (15 %) and heart failure in 41 patients (8 %). Non-acute coronary syndrome-associated elevation of high-sensitive troponin T levels is commonly observed in the emergency department. Renal insufficiency and acute cerebral events are the most common conditions associated with high-sensitive troponin T elevation.


Assuntos
Troponina T/sangue , Idoso , Estudos Transversais , Emergências , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio , Estudos Prospectivos
20.
Swiss Med Wkly ; 144: w13910, 2014 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-24526344

RESUMO

QUESTIONS UNDER STUDY: Patient characteristics and risk factors for death of Swiss trauma patients in the Trauma Audit and Research Network (TARN). METHODS: Descriptive analysis of trauma patients (≥16 years) admitted to a level I trauma centre in Switzerland (September 1, 2009 to August 31, 2010) and entered into TARN. Multivariable logistic regression analysis was used to identify predictors of 30-day mortality. RESULTS: Of 458 patients 71% were male. The median age was 50.5 years (inter-quartile range [IQR] 32.2-67.7), median Injury Severity Score (ISS) was 14 (IQR 9-20) and median Glasgow Coma Score (GCS) was 15 (IQR 14-15). The ISS was >15 for 47%, and 14% had an ISS >25. A total of 17 patients (3.7%) died within 30 days of trauma. All deaths were in patients with ISS >15. Most injuries were due to falls <2 m (35%) or road traffic accidents (29%). Injuries to the head (39%) were followed by injuries to the lower limbs (33%), spine (28%) and chest (27%). The time of admission peaked between 12:00 and 22:00, with a second peak between 00:00 and 02:00. A total of 64% of patients were admitted directly to our trauma centre. The median time to CT was 30 min (IQR 18-54 min). Using multivariable regression analysis, the predictors of mortality were older age, higher ISS and lower GCS. CONCLUSIONS: Characteristics of Swiss trauma patients derived from TARN were described for the first time, providing a detailed overview of the institutional trauma population. Based on these results, patient management and hospital resources (e.g. triage of patients, time to CT, staffing during night shifts) could be evaluated as a further step.


Assuntos
Sistema de Registros , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Acidentes por Quedas/mortalidade , Acidentes de Trânsito/mortalidade , Adulto , Fatores Etários , Idoso , Traumatismos em Atletas/mortalidade , Traumatismos Craniocerebrais/mortalidade , Feminino , Escala de Coma de Glasgow , Humanos , Escala de Gravidade do Ferimento , Traumatismos da Perna/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Traumatismos da Coluna Vertebral/mortalidade , Suíça/epidemiologia , Traumatismos Torácicos/mortalidade , Fatores de Tempo , Tomografia Computadorizada por Raios X , Reino Unido
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