Impact of blunt pulmonary contusion in polytrauma patients with rib fractures.

BACKGROUND: We investigated the impact of blunt pulmonary contusion (BPC) in patients with rib fractures. METHODS: Adult patients with rib fractures caused by blunt mechanisms were enrolled over 3 years at a Level 1 trauma center. BPC was defined according to percentage of lung affected as: moderate (1-19% contusion) or severe (≥20% contusion). RESULTS: In total, 1448 of the 7238 admitted patients had rib fractures. Of these, 321 (22.2%) had BPC: 236 moderate and 85 severe. Patients with BPC were more likely to be admitted to the ICU (moderate: OR 1.55, 95% CI 1.10-2.19; severe: OR 2.74, 95% CI 1.41-5.32). Significantly increased rates of pneumonia (OR 2.52, 95% CI 1.43-4.90) and empyema (OR 4.80, 95% CI 1.07-21.54) were found for moderate and severe BPC, respectively. CONCLUSIONS: ICU admission and infectious pulmonary complications were more likely with BPC. The presence of BPC on admission CT is also prognostic of increased resource utilization.

Outcomes of preinjury anticoagulation in patients with traumatic rib fractures.

BACKGROUND: Anticoagulant and antiplatelet agents (ACAP) have been shown to negatively affect trauma patients. METHODS: Outcomes in adults with rib fractures were reviewed. Pearson chi-square test was used for analysis. Multivariate logistic regression was used to adjust for potential confounders. RESULTS: Of the 1448 included patients, 149 (10.3%) took preinjury ACAP; these patients were significantly older than non-anticoagulated patients (72 vs. 54 years, P ≤ 0.05). There was no difference in pulmonary complications, ICU admissions or ICU LOS. The preinjury ACAP group had a significantly longer LOS (12.03 vs. 9.33 days, P = 0.004), fewer pulmonary contusions (15.43% vs. 22.94%, P = 0.037), and fewer thoracic drainage procedures (10.74% vs. 18.17%, P = 0.023). Multivariate adjustment for possible confounders revealed that patients taking warfarin had a significantly longer LOS (+7.38 days). After adjustment there was no difference in mortality. CONCLUSION: Preinjury ACAP use does not increase mortality or morbidity in patients with rib fractures. SUMMARY: We demonstrated that preinjury anticoagulation and antiplatelet agents do not increase mortality or morbidity in patients with rib fractures. However, they lead to a longer hospital length of stay, particularly in patients on warfarin.

Cryoballoon-to-Pulmonary Vein Occlusion Assessment via Capnography Technique: Where Does Occlusion Testing by End-Tidal CO2 Measurement "Fit" as a Predictor of Long-Term Efficacy?

INTRODUCTION: Parameters used to gauge the effectiveness of a cryoballoon lesion have been described that monitor the ablation at the time of balloon-to-pulmonary vein (PV) occlusion, during the cryoablation freeze, and at the thaw phase of the cryoablation. This study examines the balloon-to-PV occlusion step and monitors the completeness of occlusion using capnography to measure end-tidal CO2 (ETCO2). Specifically, the main objective was to determine if ETCO2 measurements can be used to quantify the amount of balloon-to-PV occlusion and to determine if acute ETCO2 parameters could predict long-term freedom from atrial fibrillation (AF). METHODS AND RESULTS: In a prospective study, 30 subjects were cryoballoon ablated for drug refractory symptomatic paroxysmal AF by pulmonary vein isolation method. During the balloon-to-PV occlusion and throughout the cryoablation, ETCO2 measurements were recorded. The subjects were followed for a 12-month period to monitor their freedom from AF. Five subjects had a recurrence of AF outside of a 90-day blanking period but before the 12-month endpoint. Between the 25 subjects that maintained normal sinus rhythm (NSR) and the 5 subjects that had recurrent AF (rAF), there were no statistical differences in procedural parameters, including: the number of cryoablations per PV, duration of each cryoablation, balloon nadir temperature, or balloon thaw time. Additionally, there were no statistical differences in baseline ETCO2 and in nadir ETCO2 between the two cohorts; however, when examining Δ ETCO2, the subjects in the NSR cohort had a significantly larger change compared to the rAF cohort (P<0.001). The largest change in ETCO2 during balloon-to-PV occlusion was observed during the cryoballoon ablation of the superior PVs; however, Δ ETCO2 did not solely predict long-term freedom from AF for the individual subject. CONCLUSION: Δ ETCO2 did tend to be larger in the NSR cohort compared to the rAF cohort; however, ETCO2 monitoring was more responsive in the superior PVs and less useful in the inferior PVs. Moreover, ETCO2 monitoring could not be used as a sole indicator of long-term efficacy. Suggesting that monitoring balloon-to-PV occlusion is a necessary first in cryoballoon ablation, but other parameters must be incorporated and observed as surrogates of a circumferential and transmural lesion formation with long-term durability.

Personality correlates of self-employed small business owners' success.

OBJECTIVE: Drawing on prior occupational choice research on entrepreneurs and self-employed business owners, we examined personality predictors of their occupational business success and work satisfaction. PARTICIPANTS AND PROCEDURES: A sample of 147 small business owners completed a web-based assessment of 14 work-related personality traits--adaptability, autonomy, competitiveness, dependability, emotional resilience, goal-setting, optimism, persistence, risk tolerance, self-promotion, networking, and tolerance for financial insecurity, work-based locus of control, and work drive--and three self-reported indices of business success--revenue growth, profit growth, and income growth--as well as multiple facets of individual satisfaction. Criterion variables included composite business success and overall satisfaction. RESULTS: Ten traits correlated with business success. The top four personality predictors of success--goal-setting, social networking, emotional resilience, and work drive--together accounted for 16% of the variance. Similarly, 12 of 14 personality traits were positively related to overall satisfaction. The top three personality predictors of satisfaction--optimism, work-based locus of control, and work drive--accounted for 29% of the variability in satisfaction. An expectancy analysis revealed that the percent of participants who reported at least a 20% increase in sales and profits the preceding year was 26% versus 54% for individual scoring in the lower and upper third of a personality composite measure. CONCLUSIONS: Results carry implications for future research, and have direct, practical applications for prospective and current entrepreneurs and self-employed owners of small businesses.

Auditory test result characteristics of subjects with and without tinnitus.

Tinnitus is the perception of sound that does not have an acoustic source in the environment. Ascertaining the presence of tinnitus in individuals who claim tinnitus for compensation purposes is very difficult and increasingly becoming a problem. This study examined the potential to observe differences in loudness and pitch matches between individuals who experience tinnitus versus those who do not. This study follows a previous pilot study we completed that included 12 subjects with and 12 subjects without tinnitus. The current study included 36 subjects with and 36 without tinnitus. Results of this study revealed no significant differences between groups with regard to decibel sensation level (SL) loudness matches and within-session loudness-match reliability. Between-group differences revealed that the tinnitus subjects had (1) greater decibel sound pressure level loudness matches, (2) better between-session loudness-match reliability, (3) better pitch-match reliability, and (4) higher frequency pitch matches. These findings support the data from our pilot study with the exception that decibel SL loudness matches were greater for the tinnitus subjects in the pilot study. Tinnitus loudness and pitch matching may have some value in an overall battery of tests for evaluating tinnitus claims.