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1.
PLoS One ; 16(8): e0256610, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34415973

RESUMEN

The impacts of COVID-19 on travel demand, traffic congestion, and traffic safety are attracting heated attention. However, the influence of the pandemic on electric bike (e-bike) safety has not been investigated. This paper fills the research gap by analyzing how COVID-19 affects China's e-bike safety based on a province-level dataset containing e-bike safety metrics, socioeconomic information, and COVID-19 cases from 2017 to 2020. Multi-output regression models are adopted to investigate the overall impact of COVID-19 on e-bike safety in China. Clustering-based regression models are used to examine the heterogeneous effects of COVID-19 and the other explanatory variables in different provinces/municipalities. This paper confirms the high relevance between COVID-19 and the e-bike safety condition in China. The number of COVID-19 cases has a significant negative effect on the number of e-bike fatalities/injuries at the country level. Moreover, two clusters of provinces/municipalities are identified: one (cluster 1) with lower and the other (cluster 2 that includes Hubei province) higher number of e-bike fatalities/injuries. In the clustering-based regressions, the absolute coefficients of the COVID-19 feature for cluster 2 are much larger than those for cluster 1, indicating that the pandemic could significantly reduce e-bike safety issues in provinces with more e-bike fatalities/injuries.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Ciclismo/estadística & datos numéricos , COVID-19/epidemiología , Heridas y Lesiones/epidemiología , China/epidemiología , Análisis por Conglomerados , Humanos , Mortalidad , Análisis de Regresión , Estaciones del Año , Factores Socioeconómicos , Heridas y Lesiones/mortalidad
2.
Pan Afr Med J ; 38: 414, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34381558

RESUMEN

Introduction: trauma is the leading cause of mortality in individuals less than 45 years. The principles of Advanced Trauma Life Support (ATLS) which is used around the world in resuscitation of trauma patients have been considered to be safe. However, the outbreak of corona virus disease 2019 (COVID-19) has affected the processes and characteristics of acute trauma patients seen around the world. This study is intended to determine the impact of COVID-19 lockdown on the acute trauma patients seen in a Nigerian trauma centre. Methods: this is a cross-sectional observational study of trauma patients seen in the resuscitation room of the National Hospital trauma centre in Abuja, Nigeria, from 24th February,2020 to 3rd May, 2020. The participants were consecutive acute trauma patients who were grouped into two: five weeks preceding total lockdown and five weeks of total lockdown. Statistical analysis was done using the statistical package for social sciences (SPSS) version 24.0 while results were presented in tables and a figure. Results: a total of 229 patients were recruited into the study with age range 1 to 62 years, mean age of 28 ± 13 and male to female ratio of 3.87. The patient volume reduced by 41.31% during the lockdown. Though motor vehicular crash (MVC) was the predominant mechanism of injury in both groups making up 37.65% and 23.88% respectively, penetrating assault was more during the lockdown period (17.91% versus 6.17%). The lockdown was further associated with more delayed presentation (52.24% versus 48.15%), more referrals (53.73% versus 32.72%), less severe injury score (29.6% versus 56.7%) and no death in the resuscitation room (0% versus 1.85%). Conclusion: despite the reduction in the volume of trauma presentations by 41.31%, patients got the required care with less mortality. Efforts should be directed at sustaining access to acute trauma care in all circumstances to reduce preventable trauma deaths.


Asunto(s)
COVID-19 , Heridas y Lesiones/epidemiología , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Derivación y Consulta/estadística & datos numéricos , Factores de Tiempo , Centros Traumatológicos , Índices de Gravedad del Trauma , Heridas y Lesiones/mortalidad , Heridas y Lesiones/terapia , Adulto Joven
3.
Malawi Med J ; 33(1): 1-6, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-34422227

RESUMEN

Introduction: Injuries are a leading cause of morbidity and mortality worldwide, necessitating that we understand the local burden of injury to improve injury-related trauma care and patient outcomes. The characteristics, outcomes, and risk factors for mortality following stab wounds in Malawi are poorly delineated. Methods: This is a retrospective, descriptive analysis of patients presenting to Kamuzu Central Hospital in Lilongwe, Malawi, with stab wounds from February 2008 to May 2018. Univariate and bivariate analyses were performed to compare patient and injury characteristics based on mortality. We performed Poisson multivariate regression to predict the factors that increase the relative risk of mortality. Results: During the study, 32,297 patients presented with assault. Of those patients, 2,352 (7.3%) presented with stab wounds resulting in a 3.2% (n=74) overall mortality. The majority of wounds were to the head or cervical spine (n=1,043, 44.6%), while injuries to the chest (n=319, 13.7%) were less frequent. We found an increased relative risk of mortality in patients who presented with an injury to the chest (RR 3.95, 95% CI 1.79-8.72, p=0.001) and who were brought in by the police (RR 33.24, 95% CI 11.23-98.35, p<0.001). Conclusion: In this study, stab wounds accounted for 7.3% of all assault cases, with a 3.2% mortality. Though the commonest site of stab was the head, wounds to the chest conferred the highest relative risk of mortality. A multifaceted approach to reducing mortality is needed. Incorporating training of first responders in basic life support, including the police, may reduce stab-related mortality.


Asunto(s)
Mortalidad Hospitalaria , Heridas y Lesiones/mortalidad , Heridas Punzantes/epidemiología , Traumatismos Abdominales/epidemiología , Adulto , Traumatismos Craneocerebrales/epidemiología , Humanos , Puntaje de Gravedad del Traumatismo , Malaui/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Traumatismos Torácicos/epidemiología , Heridas Punzantes/mortalidad , Adulto Joven
4.
Nutrients ; 13(8)2021 Jul 22.
Artículo en Inglés | MEDLINE | ID: mdl-34444657

RESUMEN

Under stress conditions, the metabolic demand for nutrients increases, which, if not met, may slow down or indeed stop the wound from healing, thus, becoming chronic wounds. This study aims to perform a systematic review and meta-analysis of the effect of arginine and glutamine supplementation on wound healing. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for the systematic review and ten electronic databases were used. Five and 39 human studies met the inclusion criteria for arginine and glutamine, respectively. The overall meta-analysis demonstrated a significant effect of arginine supplementation on hydroxyproline content (MD: 4.49, 95% CI: 3.54, 4.45, p < 0.00001). Regarding glutamine supplementation, there was significant effect on nitrogen balance levels (MD: 0.39, 95% CI: 0.21, 0.58, p < 0.0001), IL-6 levels (MD: -5.78, 95% CI: -8.71, -2.86, p = 0.0001), TNFα levels (MD: -8.15, 95% CI: -9.34, -6.96, p < 0.00001), lactulose/mannitol (L/M) ratio (MD: -0.01, 95% CI: -0.02, -0.01, p < 0.00001), patient mortality (OR: 0.48, 95% CI: 0.32, 0.72, p = 0.0004), C-reactive protein (CRP) levels (MD: -1.10, 95% CI: -1.26, -0.93, p < 0.00001) and length of hospital stay (LOS) (MD: -2.65, 95% CI: -3.10, -2.21, p < 0.00001). Regarding T-cell lymphocytes, a slight decrease was observed, although it failed to reach significance (MD: -0.16, 95% CI: -0.33, 0.01, p = 0.07). Conclusion: The wound healing might be enhanced in one or at various stages by nutritional supplementation in the right dose.


Asunto(s)
Arginina/administración & dosificación , Suplementos Dietéticos , Glutamina/administración & dosificación , Cicatrización de Heridas/efectos de los fármacos , Heridas y Lesiones/tratamiento farmacológico , Arginina/efectos adversos , Suplementos Dietéticos/efectos adversos , Glutamina/efectos adversos , Humanos , Tiempo de Internación , Estado Nutricional , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Tiempo , Resultado del Tratamiento , Heridas y Lesiones/mortalidad , Heridas y Lesiones/patología , Heridas y Lesiones/fisiopatología
5.
J Trauma Acute Care Surg ; 91(3): 457-464, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-34432752

RESUMEN

BACKGROUND: In addition to reflecting gas exchange within the lungs, end-tidal carbon dioxide (ETCO2) also reflects cardiac output based on CO2 delivery to the pulmonary parenchyma. We hypothesized that low prehospital ETCO2 values would be predictive of hemorrhagic shock in intubated trauma patients. METHODS: A retrospective observational study of adult trauma patients intubated in the prehospital setting and transported to a single Level I trauma center from 2016 to 2019. Continuous prehospital ETCO2 data were linked with patient care registries. We developed a novel analytic approach that allows for reflection of prehospital ETCO2 over the entire prehospital course of care. The primary outcome was hemorrhagic shock on emergency department (ED) presentation, defined as either initial ED systolic blood pressure of 90 mm Hg or less or initial Shock Index (SI) > 0.9, and transfusion of at least one unit of blood product during their ED stay. Prehospital ETCO2 less than 25 mm Hg was evaluated for predictive value of hemorrhagic shock. RESULTS: Three hundred and seven patients (82% men, 34% penetrating injury, 42% in hemorrhagic shock on ED arrival, 27% mortality) were included in the study. Patients in hemorrhagic shock had lower median ETCO2 values (26.5 mm Hg vs. 32.5 mm Hg; p < 0.001) than those not in hemorrhagic shock. Patients with prehospital ETCO2 less than 25 mm Hg were 3.0 times (adjusted odds ratio = 3.0; 95% confidence interval, 1.1-7.9) more likely to be in hemorrhagic shock upon ED arrival than patients with ETCO2 ≥ 25 mm Hg. CONCLUSION: Intubated patients with hemorrhagic shock upon ED arrival had significantly lower prehospital ETCO2 values. Incorporating ETCO2 assessment into prehospital care for trauma patients could support decisions regarding prehospital blood transfusion, and triage to higher-level trauma centers, and trauma team activation. LEVEL OF EVIDENCE: Prognostic, level III.


Asunto(s)
Dióxido de Carbono/análisis , Servicios Médicos de Urgencia , Choque Hemorrágico/diagnóstico , Volumen de Ventilación Pulmonar , Heridas y Lesiones/mortalidad , Adulto , Transfusión Sanguínea , Femenino , Mortalidad Hospitalaria/tendencias , Humanos , Puntaje de Gravedad del Traumatismo , Modelos Logísticos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Curva ROC , Sistema de Registros , Estudios Retrospectivos , Choque Hemorrágico/terapia , Centros Traumatológicos , Triaje , Washingtón , Adulto Joven
6.
J Trauma Acute Care Surg ; 91(3): 496-500, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-34432755

RESUMEN

BACKGROUND: Helicopter emergency medical services (HEMSs) are used with increasing frequency for the transportation of injured patients from the scene and from treatment facilities to higher levels of care. Improved outcomes have been difficult to establish, and reports of overutilization and financial harm have been published. Our study was performed to evaluate statewide utilization for interfacility transfers (IFTs). METHODS: Data from the North Carolina state trauma registry from 2013 to 2017 were evaluated and ground, and helicopter IFTs were compared. RESULTS: Overall interfacility use of HEMSs peaked at 7,861 patient transports in 2016, and the percent of all IFTs fell from 17% to 13.3% over the study period. Helicopter emergency medical services patients were more likely to be male (69.8%) and younger (48.0 vs. 56.2 years), and have higher Injury Severity Scores (14.6 vs. 9.0) and higher mortality (10.5% vs. 2.8%) than ground emergency medical services (GEMSs) patients. When adjusted for age, sex, Injury Severity Score, and transport distance, HEMSs survival was significantly higher (odds ratio, 0.353; 95% CI, 0.308-0.404; p < 0.0001). Normal prehospital vital signs (VSs) and Glasgow Coma Scale score motor component (GCS-M) were associated with low mortality rates in both groups. Abnormal prehospital VSs and GCS-M were associated with an 11.8% mortality rate in HEMSs patients and 3.1% in GEMSs patients. Normal referring facility VSs and GCS-M did not confer similar protection with a mortality rate of 10.0% in HEMSs patients and 2.8% in GEMSs. Changes in prehospital to referring facility VSs did not demonstrate a low mortality group. Abbreviated Injury Scale and changes in VSs did not identify HEMSs transport benefit groups. CONCLUSION: The proportion of HEMSs transfers fell over the study period and, while associated with a 10.5% mortality rate, had an outcome benefit compared with GEMSs. These patients could not be sorted into risk categories for transportation choice based on VSs or GCS-M derangement or by changes thereof, and opportunities for system improvement were not identified. LEVEL OF EVIDENCE: Prognostic/epidemiological study, level III; Care Management, level IV.


Asunto(s)
Ambulancias Aéreas/estadística & datos numéricos , Aeronaves , Transporte de Pacientes/métodos , Centros Traumatológicos , Heridas y Lesiones/mortalidad , Adulto , Anciano , Femenino , Escala de Coma de Glasgow , Humanos , Puntaje de Gravedad del Traumatismo , Modelos Logísticos , Masculino , Persona de Mediana Edad , North Carolina/epidemiología , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Signos Vitales , Heridas y Lesiones/terapia
7.
Ulus Travma Acil Cerrahi Derg ; 27(4): 427-433, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34212990

RESUMEN

BACKGROUND: In this study, we aimed to evaluate the outcomes of patients transported by Helicopter Emergency Medical Services in East Azerbaijan Province. METHODS: This retrospective cross-sectional study was conducted on patients transported by the HEMS centre of Tabriz from August 2014 to March 2017. Records of the centre were used to collect data. Statistical analysis was performed by SPSS software version 20; the statistical significance level was considered below 0.05. RESULTS: In this study, 268 patients were transferred to Tabriz hospitals by 167 missions performed. The mean age of patients was 34.26±19.43, and 173 (65%) patients were male. The most common reason for call-out was the need for professional care (91.4%). The target of the majority of missions was on countryside routes. The mean distance of destinations was about 99.13±35.9 Kms, with a mean transference time of 54.68±14.17 minutes, while the mean estimated ground route time was 86.38±26.26 minutes. The most prevalent diagnosis was trauma; The Glasgow Coma Scale (GCS) and vital signs of the majority of patients were above 13 and stable, respectively. About 98 percent of patients received fluid therapy, and 71 percent were immobilized, and only 6 percent needed intubation. Also, 28 percent of patients needed Intensive Care Unit (ICU), 56 percent of whom passed away later. CONCLUSION: Our results suggest that Tabriz HEMS missions have reduced the patient transport time and also made the mortality rate closer to international standards.


Asunto(s)
Servicios Médicos de Urgencia/estadística & datos numéricos , Heridas y Lesiones , Adolescente , Adulto , Azerbaiyán/epidemiología , Estudios Transversales , Femenino , Escala de Coma de Glasgow , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Heridas y Lesiones/mortalidad , Heridas y Lesiones/terapia , Adulto Joven
8.
Transfusion ; 61 Suppl 1: S243-S251, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34269443

RESUMEN

BACKGROUND: In traumatic bleeding, transfusion practice has shifted toward higher doses of platelets and plasma transfusion. The aim of this systematic review was to investigate whether a higher platelet-to-red blood cell (RBC) transfusion ratio improves mortality without worsening organ failure when compared with a lower ratio of platelet-to-RBC. METHODS: Pubmed, Medline, and Embase were screened for randomized controlled trials (RCTs) in bleeding trauma patients (age ≥16 years) receiving platelet transfusion between 1946 until October 2020. High platelet:RBC ratio was defined as being the highest ratio within an included study. Primary outcome was 24 hour mortality. Secondary outcomes were 30-day mortality, thromboembolic events, organ failure, and correction of coagulopathy. RESULTS: In total five RCTs (n = 1757 patients) were included. A high platelet:RBC compared with a low platelet:RBC ratio significantly improved 24 hour mortality (odds ratio [OR] 0.69 [0.53-0.89]) and 30- day mortality (OR 0.78 [0.63-0.98]). There was no difference between platelet:RBC ratio groups in thromboembolic events and organ failure. Correction of coagulopathy was reported in five studies, in which platelet dose had no impact on trauma-induced coagulopathy. CONCLUSIONS: In traumatic bleeding, a high platelet:RBC improves mortality as compared to low platelet:RBC ratio. The high platelet:RBC ratio does not influence thromboembolic or organ failure event rates.


Asunto(s)
Recuento de Eritrocitos , Hemorragia/sangre , Recuento de Plaquetas , Heridas y Lesiones/sangre , Plaquetas/citología , Eritrocitos/citología , Hemorragia/mortalidad , Humanos , Heridas y Lesiones/mortalidad
9.
Transfusion ; 61 Suppl 1: S252-S263, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34269434

RESUMEN

BACKGROUND: Multiple thresholds are defined to identify patients at risk of death from hemorrhage, including massive transfusion (MT), critical administration threshold (CAT), and resuscitation intensity (RI). All fail to account for the use of whole blood (WB). We hypothesized that a definition including WB transfusion would better predict early mortality following trauma. METHODS: This is a retrospective review of all trauma patients with activation of the MT protocol from December 2018 to February 2020. Combinations of WB, RBCs, and fresh frozen plasma (FFP) units transfused during the initial hour of resuscitation were compared using receiver operating characteristic and area under the receiver curve (AUC) for 3- and 6-h mortality. WB massive transfusion (WB MT) score was defined as the sum of each unit RBC plus three times each unit of WB transfused within the first hour of resuscitation. RESULTS: There were 235 patients eligible for analysis with 60 resuscitated using ≥1 unit of WB. Overall, 27 and 29 patients died in the first 3 and 6 h, respectively. WB MT ≥7 had the greatest 3-h and 6-h mortality AUC values (0.78 and 0.79, respectively) when compared to MT, CAT, RI4+, and other attempted definitions using units of WB, RBC, and FFP. Compared to WB MT-, WB MT+ patients died at significantly higher rates at 3 h (28.9% vs. 3.1%, p < .001), 24 h (35.5% vs. 5.7%, p < .001), and 28 days (42.1% vs. 11.9%, p < .001). CONCLUSION: WB MT is the first measure of massive resuscitation to incorporate WB and better identifies early mortality than other definitions.


Asunto(s)
Transfusión Sanguínea/métodos , Hemorragia/terapia , Resucitación/métodos , Heridas y Lesiones/terapia , Adulto , Femenino , Hemorragia/sangre , Hemorragia/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Heridas y Lesiones/sangre , Heridas y Lesiones/mortalidad
10.
World J Emerg Surg ; 16(1): 38, 2021 07 13.
Artículo en Inglés | MEDLINE | ID: mdl-34256793

RESUMEN

BACKGROUND: Traumatic injury remains the leading cause of death, with more than five million deaths every year. Little is known about the comparative effectiveness in reducing mortality of trauma care systems at different stages of development. The objective of this study was to review the literature and examine differences in mortality associated with different stages of trauma system development. METHOD: A systematic review of peer-reviewed population-based studies retrieved from MEDLINE, EMBASE, and CINAHL. Additional studies were identified from references of articles, through database searching, and author lists. Articles written in English and published between 2000 and 2020 were included. Selection of studies, data extraction, and quality assessment of the included studies were performed by two independent reviewers. The results were reported as odds ratio (OR) with 95 % confidence intervals (CI). RESULTS: A total of 52 studies with a combined 1,106,431 traumatic injury patients were included for quantitative analysis. The overall mortality rate was 6.77% (n = 74,930). When patients were treated in a non-trauma centre compared to a trauma centre, the pooled statistical odds of mortality were reduced (OR 0.74 [95% CI 0.69-0.79]; p < 0.001). When patients were treated in a non-trauma system compared to a trauma system the odds of mortality rates increased (OR 1.17 [95% CI 1.10-1.24]; p < 0.001). When patients were treated in a post-implementation/initial system compared to a mature system, odds of mortality were significantly higher (OR 1.46 [95% CI 1.37-1.55]; p < 0.001). CONCLUSION: The present study highlights that the survival of traumatic injured patients varies according to the stage of trauma system development in which the patient was treated. The analysis indicates a significant reduction in mortality following the introduction of the trauma system which is further enhanced as the system matures. These results provide evidence to support efforts to, firstly, implement trauma systems in countries currently without and, secondly, to enhance existing systems by investing in system development. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019142842 .


Asunto(s)
Centros Traumatológicos/organización & administración , Heridas y Lesiones/mortalidad , Heridas y Lesiones/terapia , Hospitalización/estadística & datos numéricos , Humanos
11.
J Trauma Acute Care Surg ; 91(3): 559-565, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-34074996

RESUMEN

BACKGROUND: The COVID-19 pandemic reshaped the health care system in 2020. COVID-19 infection has been associated with poor outcomes after orthopedic surgery and elective, general surgery, but the impact of COVID-19 on outcomes after trauma is unknown. METHODS: We conducted a retrospective cohort study of patients admitted to Pennsylvania trauma centers from March 21 to July 31, 2020. The exposure of interest was COVID-19 (COV+) and the primary outcome was inpatient mortality. Secondary outcomes were length of stay and complications. We compared demographic and injury characteristics between positive, negative, and not-tested patients. We used multivariable regression with coarsened exact matching to estimate the impact of COV+ on outcomes. RESULTS: Of 15,550 included patients, 8,170 (52.5%) were tested for COVID-19 and 219 (2.7%) were positive (COV+). Compared with COVID-19-negative (COV-) patients, COV+ patients were similar in terms of age and sex, but were less often white (53.5% vs. 74.7%, p < 0.0001), and more often uninsured (10.1 vs. 5.6%, p = 0.002). Injury severity was similar, but firearm injuries accounted for 11.9% of COV+ patients versus 5.1% of COV- patients (p < 0.001). Unadjusted mortality for COV+ was double that of COV- patients (9.1% vs. 4.7%, p < 0.0001) and length of stay was longer (median, 5 vs. 4 days; p < 0.001). Using coarsened exact matching, COV+ patients had an increased risk of death (odds ratio [OR], 6.05; 95% confidence interval [CI], 2.29-15.99), any complication (OR, 1.85; 95% CI, 1.08-3.16), and pulmonary complications (OR, 5.79; 95% CI, 2.02-16.54) compared with COV- patients. CONCLUSION: Patients with concomitant traumatic injury and COVID-19 infection have elevated risks of morbidity and mortality. Trauma centers must incorporate an understanding of these risks into patient and family counseling and resource allocation during this pandemic. LEVEL OF EVIDENCE: Level II, Prognostic Study.


Asunto(s)
COVID-19/epidemiología , Tiempo de Internación/estadística & datos numéricos , Centros Traumatológicos/estadística & datos numéricos , Heridas y Lesiones/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/complicaciones , COVID-19/etnología , Prueba de COVID-19/estadística & datos numéricos , Comorbilidad , Femenino , Humanos , Masculino , Pacientes no Asegurados/estadística & datos numéricos , Persona de Mediana Edad , Pennsylvania/epidemiología , Estudios Retrospectivos , SARS-CoV-2 , Heridas y Lesiones/complicaciones , Heridas por Arma de Fuego/epidemiología
12.
Br J Anaesth ; 127(1): 102-109, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-34074525

RESUMEN

BACKGROUND: Frailty has been associated with increased incidence of postoperative delirium and mortality. We hypothesised that postoperative delirium mediates a clinically significant (≥1%) percentage of the effect of frailty on mortality in older orthopaedic trauma patients. METHODS: This was a single-centre, retrospective observational study including 558 adults 65 yr and older, who presented with an extremity fracture requiring hospitalisation without initial ICU admission. We used causal statistical inference methods to estimate the relationships between frailty, postoperative delirium, and mortality. RESULTS: In the cohort, 180-day mortality rate was 6.5% (36/558). Frail and prefrail patients comprised 23% and 39%, respectively, of the study cohort. Frailty was associated with increased 180 day mortality from 1.4% to 12.2% (11% difference; 95% confidence interval [CI], 8.4-13.6), which translated statistically into an 88.7% (79.9-94.3%) direct effect and an 11.3% (5.7-20.1%) postoperative delirium mediated effect. Prefrailty was also associated with increased 180 day mortality from 1.4% to 4.4% (2.9% difference; 2.4-3.4), which was translated into a 92.5% (83.8-99.9%) direct effect and a 7.5% (0.1-16.2%) postoperative delirium mediated effect. CONCLUSIONS: Frailty is associated with increased postoperative mortality, and delirium might mediate a clinically significant, but small percentage of this effect. Studies should assess whether, in patients with frailty, attempts to mitigate delirium might decrease postoperative mortality.


Asunto(s)
Delirio del Despertar/mortalidad , Fragilidad/mortalidad , Fragilidad/cirugía , Procedimientos Ortopédicos/mortalidad , Heridas y Lesiones/mortalidad , Heridas y Lesiones/cirugía , Anciano , Anciano de 80 o más Años , Delirio del Despertar/diagnóstico , Femenino , Anciano Frágil , Fragilidad/diagnóstico , Evaluación Geriátrica/métodos , Humanos , Masculino , Mortalidad/tendencias , Procedimientos Ortopédicos/tendencias , Estudios Retrospectivos , Factores de Tiempo , Heridas y Lesiones/diagnóstico
13.
Medicine (Baltimore) ; 100(22): e26258, 2021 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-34087916

RESUMEN

ABSTRACT: We aimed to study the epidemiological changes in geriatric trauma in Al-Ain City, United Arab Emirates, in the past decade to give recommendations on injury prevention.Trauma patients aged 65 years and above who were hospitalized at Al-Ain Hospital for more than 24 hours or died in the hospital after their arrival regardless of the length of stay were studied. Data were extracted from the Al-Ain Hospital trauma registry. Two periods were compared; March 2003 to March 2006 and January 2014 to December 2017. Studied variables which were compared included demography, mechanism of injury and its location, and clinical outcome.There were 66 patients in the first period and 200 patients in the second period. The estimated annual incidence of hospitalized geriatric trauma patients in Al-Ain City was 8.5 per 1000 geriatric inhabitants in the first period compared with 7.8 per 1000 geriatric inhabitants in the second period. Furthermore, mortality was reduced from 7.6% to 2% (P = 0.04). There was a significant increase in falls on the same level by14.9% (62.1%-77%, P = 0.02, Pearson χ2 test). This was associated with a significant increase of injuries occurring at home (55.4%-78.7% P = 0.0003, Fisher Exact test). There was also a strong trend in the reduction of road traffic collision injuries which was reduced by 10.8% (27.3%-16.5%, P = 0.07, Fisher Exact test).Although the incidence and severity of geriatric trauma did not change over the last decade, in-hospital mortality has significantly decreased over time. There was a significant increase in injuries occurring at homes and in falls on the same level. The home environment should be targeted in injury prevention programs so as to reduce geriatric injuries.


Asunto(s)
Accidentes por Caídas/prevención & control , Servicios de Salud para Ancianos/estadística & datos numéricos , Heridas y Lesiones/epidemiología , Heridas y Lesiones/prevención & control , Accidentes por Caídas/mortalidad , Accidentes por Caídas/estadística & datos numéricos , Accidentes de Tránsito/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Femenino , Escala de Coma de Glasgow/normas , Escala de Coma de Glasgow/estadística & datos numéricos , Servicios de Salud para Ancianos/tendencias , Mortalidad Hospitalaria/tendencias , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Puntaje de Gravedad del Traumatismo , Masculino , Estudios Prospectivos , Sistema de Registros , Emiratos Árabes Unidos/epidemiología , Heridas y Lesiones/mortalidad
14.
Arq. ciências saúde UNIPAR ; 25(2): 117-124, maio-ago. 2021.
Artículo en Portugués | LILACS | ID: biblio-1252364

RESUMEN

Introdução: o trauma é uma doença significativa em perda de anos de vida, contribuindo para alta morbidade e mortalidade. Seu evento em idosos pode ocasionar desfechos indesejáveis devido às condições fisiológicas do idoso. Objetivo: analisar as características e associação com o óbito de idosos traumatizados hospitalizados em uma unidade de terapia intensiva. Material e métodos: estudo transversal, com dados de prontuários de idosos hospitalizados por trauma em uma unidade de terapia intensiva geral. Foram incluídos pacientes com 60 anos ou mais de idade e admitidos por lesões. As variáveis coletadas relacionam-se às características sociodemográficas, da internação, de saúde, do trauma e do tratamento intensivo. Para identificação das principais características foi realizada análise descritiva, e para associação com o óbito foi realizado o teste de associação qui-quadrado. Resultados: observou-se predominância masculina (62,5%); idosos entre 60 e 79 anos (70,2%); com comorbidades (60,4%); politraumatizados (58,3%); trauma contuso (95,8%) tendo como principal causa externa as quedas (56,3%). A região do corpo mais afetada foi cabeça e pescoço (39,6%); e a gravidade do trauma foi leve (52,1%). Foram associados ao óbito a disfunção pulmonar (p=0,005), uso de nutrição enteral (p=0,027), drogas vasoativas (p=0,003) e ventilação mecânica (p<0,001). Conclusão: as informações sobre idosos hospitalizados por trauma em tratamento intensivo, sobretudo a observação de fatores associados ao óbito, são úteis para a composição de um perfil clínico capaz de direcionar para a assistência intensiva capaz de prevenir esse e demais desfechos indesejados durante a hospitalização.(AU)


Introduction: trauma is a significant disease in terms of loss of years of life, contributing to high morbidity and mortality. Its occurrence in the elderly can cause undesirable outcomes due to the physiological conditions of such a population. Objective: to analyze the characteristics and association with the death of traumatized elderly people hospitalized in an intensive care unit. Material and methods: cross-sectional study, with data collected from medical records of elderly hospitalized for trauma in a general intensive care unit. Patients aged 60 years' old and over, having been admitted for injuries, were included. The variables collected are related to sociodemographic, hospitalization, health, trauma, and intensive care characteristics. In order to identify the main characteristics, a descriptive analysis was performed. The chi-square association test was applied for the association with death. Results: the study presented predominance of male patients (62.5%); age ranging between 60 and 79 years' old (70.2%); with comorbidities (60.4%); polytrauma (58.3%); blunt trauma (95.8%) with falls being considered the main external cause (56.3%). The head and neck were the regions most frequently affected (39.6%), and the severity of the trauma being mild (52.1%). Lung dysfunction (p = 0.005), use of enteral nutrition (p = 0.027), vasoactive drugs (p = 0.003), and mechanical ventilation (p <0.001) were associated with death. Conclusion: information on elderly hospitalized for trauma in intensive care, especially the observation of factors associated with death, are useful for the composition of a clinical profile capable of guiding the patient to intensive care capable of preventing this and other undesirable outcomes during hospitalization.(AU)


Asunto(s)
Humanos , Anciano , Anciano de 80 o más Años , Heridas y Lesiones/complicaciones , Heridas y Lesiones/mortalidad , Hospitalización , Unidades de Cuidados Intensivos , Estudios Transversales/instrumentación
16.
J Trauma Acute Care Surg ; 91(1): 72-76, 2021 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-34144558

RESUMEN

BACKGROUND: Appropriate interfacility transfers are a key component of highly functioning trauma systems but transfer of unsalvageable patients can overburden the resources of higher-level centers. We sought to identify the occurrence and associated reasons for futile transfers within our trauma system. METHODS: Using prospectively collected data from our system database, a retrospective cohort study was conducted to identify patients who underwent interfacility transfer to our American College of Surgeons level I center. Adult patients from June 2017 to June 2019 who died, had comfort measures implemented, were discharged, or went to hospice care within 48 hours of admission without significant operation, procedure, or radiologic intervention were examined. Futility was defined as resulting in death or hospice discharge within 48 hours of transfer without major operative, endoscopic, or radiologic intervention. RESULTS: A total of 1,241 patients transferred to our facility during the study period. Four hundred seven patients had a length of stay less than or equal to 48 hours. Eighteen (1.5%) met the criteria for futility. The most common reason for transfer in the futile population was traumatic brain injury (56%) and need for neurosurgical capabilities (62%). Futile patients had a median age and Injury Severity Score of 75 and 21. The main transportation method was ground 9 (50%) with 8 (44.4%) being transported by helicopter and 1 (5.6%) being transported by both. Combining transport costs with hospital charges, each futile transfer was estimated to cost US $56,396 (interquartile range, 41,889-106,393) with a total cost exceeding US $1.7 million. With an estimated 33,000 interfacility transfers annually for trauma in the United States, the cost of futile transfers to the American trauma system would exceed 27 million dollars each year. CONCLUSION: Futile transfers represent a small but costly portion transfer volume. Identification of patients whose conditions preclude the benefit of transfer due to futility and development of appropriate support for referral will significantly improve appropriate allocation of health care resources. LEVEL OF EVIDENCE: Economic; Care management, level IV.


Asunto(s)
Costos de Hospital/normas , Inutilidad Médica , Transferencia de Pacientes/economía , Centros Traumatológicos/economía , Heridas y Lesiones/terapia , Anciano , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Transferencia de Pacientes/estadística & datos numéricos , Estudios Prospectivos , Estudios Retrospectivos , Centros Traumatológicos/estadística & datos numéricos , Resultado del Tratamiento , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/economía , Heridas y Lesiones/mortalidad
17.
J Trauma Acute Care Surg ; 91(1): 24-33, 2021 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-34144557

RESUMEN

BACKGROUND: Despite the widespread institution of modern massive transfusion protocols with balanced blood product ratios, survival for patients with traumatic hemorrhage receiving ultramassive transfusion (UMT) (defined as ≥20 U of packed red blood cells [RBCs]) in 24 hours) remains low and resource consumption remains high. Therefore, we aimed to identify factors associated with mortality in trauma patients receiving UMT in the modern resuscitation era. METHODS: An Eastern Association for the Surgery of Trauma multicenter retrospective study of 461 trauma patients from 17 trauma centers who received ≥20 U of RBCs in 24 hours was performed (2014-2019). Multivariable logistic regression and Classification and Regression Tree analysis were used to identify clinical characteristics associated with mortality. RESULTS: The 461 patients were young (median age, 35 years), male (82%), severely injured (median Injury Severity Score, 33), in shock (median shock index, 1.2; base excess, -9), and transfused a median of 29 U of RBCs, 22 U of fresh frozen plasma (FFP), and 24 U of platelets (PLT). Mortality was 46% at 24 hours and 65% at discharge. Transfusion of RBC/FFP ≥1.5:1 or RBC/PLT ≥1.5:1 was significantly associated with mortality, most pronounced for the 18% of patients who received both RBC/PLT and RBC/FFP ≥1.5:1 (odds ratios, 3.11 and 2.81 for mortality at 24 hours and discharge; both p < 0.01). Classification and Regression Tree identified that age older than 50 years, low initial Glasgow Coma Scale, thrombocytopenia, and resuscitative thoracotomy were associated with low likelihood of survival (14-26%), while absence of these factors was associated with the highest survival (71%). CONCLUSION: Despite modern massive transfusion protocols, one half of trauma patients receiving UMT are transfused with either RBC/FFP or RBC/PLT in unbalanced ratios ≥1.5:1, with increased associated mortality. Maintaining focus on balanced ratios during UMT is critical, and consideration of advanced age, poor initial mental status, thrombocytopenia, and resuscitative thoracotomy can aid in prognostication. LEVEL OF EVIDENCE: Prognostic, level III.


Asunto(s)
Transfusión de Componentes Sanguíneos/métodos , Hemorragia/terapia , Resucitación/métodos , Trombocitopenia/epidemiología , Heridas y Lesiones/terapia , Adulto , Factores de Edad , Transfusión de Componentes Sanguíneos/estadística & datos numéricos , Femenino , Escala de Coma de Glasgow , Hemorragia/diagnóstico , Hemorragia/etiología , Hemorragia/mortalidad , Mortalidad Hospitalaria , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Trombocitopenia/etiología , Trombocitopenia/terapia , Centros Traumatológicos/estadística & datos numéricos , Resultado del Tratamiento , Heridas y Lesiones/complicaciones , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/mortalidad
18.
Scand J Trauma Resusc Emerg Med ; 29(1): 71, 2021 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-34044857

RESUMEN

BACKGROUND: A threshold Injury Severity Score (ISS) ≥ 16 is common in classifying major trauma (MT), although the Abbreviated Injury Scale (AIS) has been extensively revised over time. The aim of this study was to determine effects of different AIS revisions (1998, 2008 and 2015) on clinical outcome measures. METHODS: A retrospective observational cohort study including all primary admitted trauma patients was performed (in 2013-2014 AIS98 was used, in 2015-2016 AIS08, AIS08 mapped to AIS15). Different ISS thresholds for MT and their corresponding observed mortality and intensive care (ICU) admission rates were compared between AIS98, AIS08, and AIS15 with Chi-square tests and logistic regression models. RESULTS: Thirty-nine thousand three hundred seventeen patients were included. Thresholds ISS08 ≥ 11 and ISS15 ≥ 12 were similar to a threshold ISS98 ≥ 16 for in-hospital mortality (12.9, 12.9, 13.1% respectively) and ICU admission (46.7, 46.2, 46.8% respectively). AIS98 and AIS08 differed significantly for in-hospital mortality in ISS 4-8 (χ2 = 9.926, p = 0.007), ISS 9-11 (χ2 = 13.541, p = 0.001), ISS 25-40 (χ2 = 13.905, p = 0.001) and ISS 41-75 (χ2 = 7.217, p = 0.027). Mortality risks did not differ significantly between AIS08 and AIS15. CONCLUSION: ISS08 ≥ 11 and ISS15 ≥ 12 perform similarly to a threshold ISS98 ≥ 16 for in-hospital mortality and ICU admission. This confirms studies evaluating mapped datasets, and is the first to present an evaluation of implementation of AIS15 on registry datasets. Defining MT using appropriate ISS thresholds is important for quality indicators, comparing datasets and adjusting for injury severity. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III.


Asunto(s)
Escala Resumida de Traumatismos , Heridas y Lesiones/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Puntaje de Gravedad del Traumatismo , Modelos Logísticos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Sistema de Registros , Estudios Retrospectivos , Centros Traumatológicos , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/mortalidad
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