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2.
Am Surg ; 86(2): 83-89, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32167053

RESUMEN

The ACS NSQIP Surgical Risk Calculator is designed to estimate the chance of an unfavorable outcome after surgery. Our goal was to evaluate the accuracy of the calculator in our emergency general surgery population. Surgical outcomes were compared to predicted risk. The risk was calculated with surgeon adjustment scores (SASs) of 1 (no adjustment), 2 (risk somewhat higher), and 3 (risk significantly higher than estimate). Two hundred and twenty-seven patients met the inclusion criteria. An SAS of 1 or 2 accurately predicted risk of mortality (5.7% and 8.5% predicted versus 7.9% actual), whereas a risk adjustment of 3 indicated significant overestimation of mortality rate (14.8% predicted). There was good overall prediction performance for most variables with no clear preference for SAS 1, 2, or 3. Poor correlation was seen with SSI, urinary tract infection, and length of stay variables. The ACS NSQIP Surgical Risk Calculator yields valid predictions in the emergency general surgery population, and the data support its use to inform conversations about outcome expectations.


Asunto(s)
Urgencias Médicas , Medición de Riesgo/métodos , Procedimientos Quirúrgicos Operativos/mortalidad , Exactitud de los Datos , Humanos , Tiempo de Internación , Modelos Logísticos , Persona de Mediana Edad , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/mortalidad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Infecciones Urinarias/mortalidad , Heridas y Traumatismos/clasificación , Heridas y Traumatismos/mortalidad , Heridas y Traumatismos/cirugía
4.
Rev Lat Am Enfermagem ; 28: e3236, 2020.
Artículo en Inglés, Portugués, Español | MEDLINE | ID: mdl-32074207

RESUMEN

OBJECTIVE: To analyze the risk factors for death of trauma patients admitted to the intensive care unit (ICU). METHOD: Retrospective cohort study with data from medical records of adults hospitalized for trauma in a general intensive care unit. We included patients 18 years of age and older and admitted for injuries. The variables were grouped into levels in a hierarchical manner. The distal level included sociodemographic variables, hospitalization, cause of trauma and comorbidities; the intermediate, the characteristics of trauma and prehospital care; the proximal, the variables of prognostic indices, intensive admission, procedures and complications. Multiple logistic regression analysis was performed. RESULTS: The risk factors associated with death at the distal level were age 60 years or older and comorbidities; at intermediate level, severity of trauma and proximal level, severe circulatory complications, vasoactive drug use, mechanical ventilation, renal dysfunction, failure to perform blood culture on admission and Acute Physiology and Chronic Health Evaluation II. CONCLUSION: The identified factors are useful to compose a clinical profile and to plan intensive care to avoid complications and deaths of traumatized patients.


Asunto(s)
Mortalidad Hospitalaria , Unidades de Cuidados Intensivos/estadística & datos numéricos , Heridas y Traumatismos/mortalidad , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Índices de Gravedad del Trauma , Heridas y Traumatismos/clasificación , Adulto Joven
5.
Ann Emerg Med ; 75(3): 339-353, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31955941

RESUMEN

STUDY OBJECTIVE: Existing comorbidity indices such as the Charlson comorbidity index are dated yet still widely used. This study derives and validates up-to-date comorbidity indices for hospital-admitted injury patients, specific to mortality outcomes. METHODS: Injury-related hospital admissions data for 2 cohorts of patients in the Australian state of Victoria were linked to mortality data: July 2012 to June 2014 (161,334 patients) and July 2006 to June 2015 (614,762 patients). Logistic regression models were fitted, and results were used to derive binary and weighted comorbidity indices to predict mortality outcomes. The indices were validated with data from New South Wales (Australia). RESULTS: There were 11 comorbidity groups identified as associated with inhospital death (cohort 1), 13 with 30-day mortality, and 19 with 1-year mortality (cohort 2). The newly derived weights for comorbidities were very different from the Charlson comorbidity index weights for some conditions. The area under the curve statistics for inhospital death, 30-day mortality, and 1-year mortality were similar for the newly derived binary comorbidity indices (0.920, 0.923, and 0.910, respectively), the Charlson comorbidity index (0.915, 0.919, and 0.906, respectively), and the Elixhauser comorbidity measure (0.924, 0.923, and 0.908, respectively). The false-negative rates for the new binary indices (15.8%, 15.8%, and 16.3%, respectively) were statistically equal to those of the Charlson comorbidity index (17.4%, 16.3%, and 16.5%, respectively) and the Elixhauser comorbidity measure (15.2%, 14.8%, and 16.3%, respectively). CONCLUSION: The newly derived Australian Injury Comorbidity Indices, which are a binary representation of individual conditions associated with the outcome of interest, are useful in quantifying the effect of comorbidity among injury patients. They include a shorter list of conditions than existing indices such as the Charlson comorbidity index and Elixhauser comorbidity measure, are up to date, and consider the individual association of each condition over a summed score such as the Charlson comorbidity index. Indices that quantify the effect of comorbidities should consider the population, disease prevalence, and outcome of interest and require periodic updating.


Asunto(s)
Heridas y Traumatismos/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia , Niño , Preescolar , Comorbilidad , Femenino , Mortalidad Hospitalaria , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Heridas y Traumatismos/epidemiología , Adulto Joven
7.
Nat Med ; 26(1): 65-70, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31932800

RESUMEN

Temperatures that deviate from the long-term local norm affect human health, and are projected to become more frequent as the global climate changes1. There are limited data on how such anomalies affect deaths from injuries. In the present study, we used data on mortality and temperature over 38 years (1980-2017) in the contiguous USA and formulated a Bayesian spatio-temporal model to quantify how anomalous temperatures, defined as deviations of monthly temperature from the local average monthly temperature over the entire analysis period, affect deaths from unintentional (transport, falls and drownings) and intentional (assault and suicide) injuries, by age group and sex. We found that a 1.5 °C anomalously warm year, as envisioned under the Paris Climate Agreement2, would be associated with an estimated 1,601 (95% credible interval 1,430-1,776) additional injury deaths. Of these additional deaths, 84% would occur in males, mostly in adolescence to middle age. These would comprise increases in deaths from drownings, transport, assault and suicide, offset partly by a decline in deaths from falls in older ages. The findings demonstrate the need for targeted interventions against injuries during periods of anomalously warm temperatures, especially as these episodes are likely to increase with global climate change.


Asunto(s)
Cambio Climático , Heridas y Traumatismos/mortalidad , Accidentes por Caídas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Suicidio , Adulto Joven
8.
Medicine (Baltimore) ; 99(1): e18567, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31895799

RESUMEN

We investigated the epidemiological and clinical characteristics deaths from road traffic injury (RTI) in Beijing, and provided evidence useful for the prevention of fatal traffic trauma and for the treatment of traffic-related injuries.We retrospectively reviewed death cases provided by the Beijing Red Cross Emergency Center on road traffic injury deaths from 2008 to 2017. We analyzed population characteristics, time distribution, distribution of transportation modes, intervals to death, locations and injured body parts.From 2008 to 2017, there were 3327 deaths from RTI recorded by the Beijing Red Cross Emergency Center, with mainly males among these deaths. The average age at death was 46.19 ±â€Š17.43 years old (46.19, 0.43-100.24). In accidents with more detail recorded, pedestrians and people using nonmotorized transportation modes suffered the most fatalities (664/968, 68.60%). The most commonly injured body parts were the head (2569/3327, 77.22%), followed by the chest (180/3327, 5.41%), abdomen (130/3327, 3.91%), lower extremities (68/3327, 2.04%), pelvis (67/3327, 2.01%), spinal cord (31/3327, 0.93%), and upper extremities (26/3327, 0.78%). Burns accounted for 0.96% (32/3327), and unknown body parts were affected in 11.28% (365/3327). The average time interval from injury to death was 36.90 ±â€Š89.57 h (36.90, 0-720); 46.7% (1554/3327) died within 10 minutes after injury; 9.02% (300/3327) died between 10 min and 1 hour; 30.33% (1009/3327) died between 1 hour and 3 days; 13.95% (464/3327) died between 3 and 30 days.In Beijing, RTI is a significant cause of preventable death, particularly among pedestrians and users of non-motorized vehicles. Head trauma was the most lethal cause of RTI deaths. Our findings suggested that interventions to prevent collisions and reduce injuries, and improved trauma treatment process and trauma rescue system could address a certain proportion of avoidable RTI deaths.


Asunto(s)
Accidentes de Tránsito/mortalidad , Traumatismos Craneocerebrales/mortalidad , Peatones/estadística & datos numéricos , Heridas y Traumatismos/mortalidad , Adulto , Anciano , Beijing/epidemiología , Traumatismos Craneocerebrales/etiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Centros Traumatológicos/estadística & datos numéricos , Heridas y Traumatismos/etiología
9.
J Zoo Wildl Med ; 50(4): 966-971, 2020 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-31926529

RESUMEN

Determining the causes of mortality in endangered species is essential to understanding the possible reasons behind their decline and to facilitating the implementation of mitigating steps. The southern bent-winged bat (Miniopterus orianae bassanii) is a critically endangered Australian bat whose population numbers have decreased over the past 50 years. As part of a larger investigation to determine if disease could be a contributing factor to the decline, 27 southern bent-winged bats and one closely related eastern bent-winged bat (Miniopterus orianae oceanensis) that died during the study were necropsied and examined histologically. Trauma was the most common cause of death in the southern bent-winged bats, which mostly occurred at one site where fencing and other infrastructure was positioned around a key breeding cave. In response to these findings, management actions have been implemented to reduce this infrastructure-associated mortality of southern bent-winged bats. The single eastern bent-winged bat examined had a severe dermatitis caused by the mite Notoedres muris.


Asunto(s)
Quirópteros , Especies en Peligro de Extinción , Heridas y Traumatismos/veterinaria , Animales , Australia , Causas de Muerte , Heridas y Traumatismos/mortalidad , Heridas y Traumatismos/patología
10.
J Forensic Sci ; 65(1): 103-111, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31404476

RESUMEN

This study analyzes postmortem records from 260 homicide cases autopsied by the Department of Forensic Medicine in Rome from 2000 to 2014. The victims were mainly males (74%) and young (61% aged from 21 to 50 years). Although the victims were mostly Italians, the number of foreign victims (33%) has increased since 1990, primarily due to immigration. The offenders frequently used firearms (39%), particularly in multiple murders. An increase in blunt (20%) and sharp force (32%) weapons was also seen. The primary crime scene was residential (42%), and the head was the most frequently injured body region. Male victims occurred frequently in the context of organized crime (7.6%). In family or intimate-sexual relationships, women were the majority of victims (8%). Forensic pathologists play an important role during investigation. They should consider all the information available to them, including autopsy information, crime scene information, and crime investigation data.


Asunto(s)
Víctimas de Crimen/estadística & datos numéricos , Homicidio/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Emigrantes e Inmigrantes/estadística & datos numéricos , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Motivación , Distribución por Sexo , Suicidio/estadística & datos numéricos , Armas/estadística & datos numéricos , Heridas y Traumatismos/mortalidad , Adulto Joven
11.
J Surg Res ; 246: 269-273, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31614324

RESUMEN

BACKGROUND: A structured family meeting (FM) is recommended within 72 h of admission for trauma patients with high risk of mortality or disability. Multidisciplinary FMs (MDFMs) may further facilitate decision-making. We hypothesized that FM within three hospital days (HDs) or MDFM would be associated with increased use of comfort measures. MATERIALS AND METHODS: We reviewed all adult trauma deaths at an academic level 1 trauma center from December 2014 to December 2017. Death in the first 24 h or on nonsurgical services were excluded. Demographics, injury characteristics, FM characteristics, and outcomes such as length of stay (LOS) were recorded. Early FM was defined as occurring within three HDs; MDFM required attendance by two or more specialty teams. RESULTS: A total of 177 patients were included. Median LOS was 6 d (interquartile range 4-12). FMs were documented in 166 patients (94%), with 57% occurring early. MDFM occurred in 49 (28%), but usually occurred later (median HD 5 and interquartile range 2-8). Early FM was associated with reduced LOS (5 versus 11 d, P < 0.001), ventilator days (4 versus 9 d, P < 0.001), and deaths during a code (1.2% versus 13.2%, P < 0.001). MDFM was associated with higher use of comfort measures (88% versus 68%, P < 0.05). Of patients who transitioned to comfort care status (n = 130, 73.4%), code status change occurred earlier if an early FM occurred (5 versus 13 d, P < 0.001). CONCLUSIONS: MDFM is associated with increased comfort care measures, whereas early FM is associated with reduced LOS, ventilator days, death during a code, and earlier comfort care transition.


Asunto(s)
Toma de Decisiones , Familia , Planificación de Atención al Paciente , Cuidado Terminal/organización & administración , Heridas y Traumatismos/terapia , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/organización & administración , Cuidados Paliativos/estadística & datos numéricos , Transferencia de Pacientes/organización & administración , Transferencia de Pacientes/estadística & datos numéricos , Estudios Retrospectivos , Factores de Tiempo , Centros Traumatológicos/organización & administración , Centros Traumatológicos/estadística & datos numéricos , Índices de Gravedad del Trauma , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/mortalidad
12.
J Trauma Acute Care Surg ; 88(2): 219-229, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31804415

RESUMEN

BACKGROUND: We sought to examine patterns of readmission after nonoperative trauma, including rates of delayed operative intervention and mortality. METHODS: The Nationwide Readmissions Database (2013-2014) was queried for all adult trauma admissions and 30-day readmissions. Index admissions were classified as operative (OI) or nonoperative (NOI), and readmissions examined for major operative intervention (MOR). Multivariable regression modeling was used to evaluate risk for readmission requiring MOR and in-hospital mortality. RESULTS: Of 2,244,570 trauma admissions, there were 59,573 readmissions: 66% after NOI, and 35% after OI. Readmission rate was higher after NOI compared with OI (3.6% vs. 1.7% p < 0.001). Readmitted NOI patients were older, with a higher proportion of Injury Severity Score ≥15 and were readmitted earlier (NOI median 8 days vs. OI 11 days). Thirty-one percent of readmitted NOI patients required MOR and experienced higher overall mortality compared with OI patients with operative readmission (NOI 2.9% vs. OI 2%, p = 0.02). Intracranial hemorrhage was an independent risk factor for NOI readmission requiring MOR in both the overall (hazard ratio, 1.11; 95% confidence interval [CI], 1.01-1.22) and Injury Severity Score of 15 or greater cohorts (hazard ratio, 1.46; 95% CI, 1.24-1.7), with a predominance of nonspine neurosurgical procedures (20.3% and 55.1%, respectively). Operative readmission after NOI cost a median of $17,364 (interquartile range, US $11,481 to US $27,816) and carried a total annual cost of US $147 million (95% CI, US $141 million to $154 million). CONCLUSIONS: Nonoperative trauma patients have a higher readmission rate than operative index patients and nearly one third require operative intervention during readmission. Operative readmission carries a higher overall mortality rate in NOI patients and together accounts for nearly US $150 million in annual costs. LEVEL OF EVIDENCE: Epidemiological, level III.


Asunto(s)
Costos de Hospital/estadística & datos numéricos , Mortalidad Hospitalaria , Readmisión del Paciente/estadística & datos numéricos , Tiempo de Tratamiento/economía , Heridas y Traumatismos/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Tiempo , Tiempo de Tratamiento/estadística & datos numéricos , Estados Unidos , Heridas y Traumatismos/economía , Heridas y Traumatismos/mortalidad , Adulto Joven
13.
J Surg Res ; 246: 605-613, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31668435

RESUMEN

BACKGROUND: Platelet function tests such as thrombelastography platelet mapping and impedance aggregometry have demonstrated universal platelet dysfunction in trauma patients. In this study, we introduce the measurement of platelet contraction force as a test of platelet function. We hypothesize that force will correlate with established coagulation tests such as thrombelastography, demonstrate significant differences between healthy subjects and trauma patients, and identify critically ill trauma patients. METHODS: Blood samples were prospectively collected from level 1 trauma patients at initial presentation, assayed for force of and time to contraction and compared with thrombelastography. Blood from healthy subjects was assayed to establish a reference range. Results from trauma patients were compared with healthy controls and trauma patients that died. RESULTS: The study includes one hundred trauma patients with mean age 45 y, 74% were male, and median injury severity score of 14 ± 12. Patients that survived (n = 90) demonstrated significantly elevated platelet contraction force compared with healthy controls (n = 12) (6390 ± 2340 versus 4790 ± 470 µN, P = 0.043) and trauma patients that died (n = 10) (6390 ± 2340 versus 2860 ± 1830 µN, P = 0.0001). Elapsed time to start of platelet contraction was faster in trauma patients that survived compared with healthy controls (660 ± 467 versus 1130 ± 140 s, P = 0.0022) and those that died (660 ± 470 versus 1460 ± 1340 s, P < 0.0001). CONCLUSIONS: In contrast with all existing platelet function tests reported in the literature, which report platelet dysfunction in trauma patients, contractile force demonstrates hyperfunction in surviving trauma patients and dysfunction in nonsurvivors. Platelet contraction reflects platelet metabolic reserve and thus may be a potential biomarker for survival after trauma. Contractile force warrants further investigation to predict mortality in severely injured trauma patients.


Asunto(s)
Trastornos de las Plaquetas Sanguíneas/diagnóstico , Plaquetas/fisiología , Heridas y Traumatismos/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Coagulación Sanguínea/fisiología , Trastornos de las Plaquetas Sanguíneas/sangre , Trastornos de las Plaquetas Sanguíneas/etiología , Trastornos de las Plaquetas Sanguíneas/fisiopatología , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Pruebas de Función Plaquetaria/métodos , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Curva ROC , Tromboelastografía , Heridas y Traumatismos/sangre , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/mortalidad , Adulto Joven
14.
Eur J Vasc Endovasc Surg ; 59(3): 472-479, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31865031

RESUMEN

OBJECTIVE: The study compared transradial access (TRA) and transfemoral access (TFA) for splenic angio-embolisation (SAE), with a focus on technical success, intra-operative adjuncts, and complications. METHODS: This was a retrospective comparative study of all trauma patients undergoing SAE by TRA or TFA between February 2015 and February 2019 at a single institution. The medical records were queried for procedural and post-operative data, with comparisons made based on access site. Continuous variables were compared using a two tailed t test and categorical variables were compared using a chi square test. RESULTS: Over a four year period, there were 47 cases of SAE via TRA and 127 via TFA. Technical success was 95.7% during TRA and 98.4% during TFA (p = .30). Technical failures were a result of failed splenic artery cannulation after successful radial or femoral access. Time to splenic cannulation was shorter in the TRA group (19 min vs. 30 min; p = .008). Two or fewer catheters were used during TRA, whereas more than two catheters were needed during TFA (p < .001). There were no statistically significant differences in procedure length, fluoroscopy time, radiation dose, or contrast volume between groups. Nine patients (5.2%) developed access related complications, all in the TFA group (p = .12). Mortality rate was 2.3% (n = 4), with no statistical significance between groups (p = .71). CONCLUSION: While TFA is the conventional strategy for SAE, TRA is a safe and efficacious modality for SAE in trauma patients. Although larger studies are needed to establish the full efficacy of TRA for SAE at the multi-institutional level, this single centre study demonstrates the legitimacy of an alternative means for SAE in the trauma population.


Asunto(s)
Cateterismo Periférico , Embolización Terapéutica , Arteria Femoral , Arteria Radial , Arteria Esplénica , Heridas y Traumatismos/terapia , Adulto , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/mortalidad , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/mortalidad , Femenino , Arteria Femoral/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Punciones , Arteria Radial/diagnóstico por imagen , Estudios Retrospectivos , Factores de Riesgo , Arteria Esplénica/diagnóstico por imagen , Factores de Tiempo , Resultado del Tratamiento , Heridas y Traumatismos/diagnóstico por imagen , Heridas y Traumatismos/mortalidad
15.
Accid Anal Prev ; 134: 105324, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31648116

RESUMEN

OBJECTIVE: Side crashes between vehicles which usually lead to high casualties and property loss, rank first among total crashes in China. This paper aims to identify the factors associated with injury severity of side crashes at intersections and to provide suggestions for developing countermeasures to mitigate the levels of injuries. METHOD: In order to investigate the role of striking and struck vehicles in side crashes simultaneously, bivariate probit model was proposed and Bayesian approach was employed to evaluate the model, compared to the corresponding univariate probit model. DATA: Crash data from Beijing, China for the period 2009-2012 were used to carry out the statistical analysis. Based on the investigation with vehicles and data analysis on events, 130 intersection side crash cases were selected to form a specific dataset. Then, the influence of human, vehicles, roadway and environmental variables on crash severity was examined by means of bivariate probit regression within Bayesian framework. RESULTS: The effects of the factors on striking vehicle drivers and struck vehicle drivers were considered separately and simultaneously to find more targeted conclusions. The statistical analysis revealed vehicle type, lane number, no non-motorized lane and speeding have the corresponding influence on the injury severity of striking vehicles, while time of day and vehicle type of struck vehicles increased the likelihood of being injured. CONCLUSIONS: From the results it can be concluded that there indeed exists correlation between striking and struck vehicles in side crashes, although the correlation is not so strong. Importantly, Bayesian bivariate probit model can address the role of striking and struck vehicles in side crashes simultaneously and can accommodate the correlation clearly, which extends the range of univariate probit analysis. The general and empirical countermeasures are presented to improve the safety at intersections.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Heridas y Traumatismos/mortalidad , Teorema de Bayes , Beijing/epidemiología , Entorno Construido/estadística & datos numéricos , Humanos , Modelos Logísticos , Vehículos a Motor/clasificación , Vehículos a Motor/estadística & datos numéricos , Probabilidad
16.
Accid Anal Prev ; 134: 105325, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31706185

RESUMEN

Although mortality trends can be influenced by different ages, periods, and cohorts, few studies have demonstrated the age-period-cohort (APC) effect on road traffic injury (RTI) mortality. Moreover, APC effects in Korea have never been documented despite the high mortality rates from RTIs. This study aimed to describe the trends in mortality from RTIs and examine APC effects on RTI mortality in Korea. Using the national death certificate and census mid-year population estimates data during 1983-2017, trends in age-standardized mortality rates from RTIs were analyzed using Joinpoint regression. Intrinsic estimator regression models were used to estimate APC effects on RTI mortality. Consistent with the trend in period effects, RTI mortality increased sharply with the economic growth in the 1980s, decelerated after the implementation of road safety policies in the early 1990s, plummeted owing to the 1997-1998 financial crisis, and gradually decreased from the early 2000s. A J-shaped age effect indicated that the relative risk of road traffic death surged in people aged ≥65 years. Educational expansion from the mid-1950s turned an increasing birth cohort effect into a continuously decreasing trend after peaking around the 1938-1943 birth cohorts. The risk of road traffic death was relatively high among the Korean Generation Y, i.e., those born in 1978-1983. RTI mortality trends in Korea have been affected by diverse socioeconomic changes through cohort and period effects. Despite the recent favorable trend, RTI mortality remains high, especially among older people. Road safety policies to address the burden of RTIs require further improvement.


Asunto(s)
Accidentes de Tránsito/mortalidad , Heridas y Traumatismos/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , República de Corea/epidemiología , Adulto Joven
17.
J Surg Res ; 245: 163-167, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31419641

RESUMEN

BACKGROUND: The Advanced Trauma Life Support (ATLS) shock classification has been accepted as the conceptual framework for clinicians caring for trauma patients. We sought to validate its ability to predict mortality, blood transfusion, and urgent intervention. MATERIALS AND METHODS: We performed a retrospective review of trauma patients using the 2014 National Trauma Data Bank. Using initial vital signs data, patients were categorized into shock class based on the ATLS program. Rates for urgent blood transfusion, urgent operative intervention, and mortality were compared between classes. RESULTS: 630,635 subjects were included for analysis. Classes 1, 2, 3, and 4 included 312,404, 17,133, 31, and 43 patients, respectively. 300,754 patients did not meet criteria for any ATLS shock class. Of the patients in class 1 shock, 2653 died (0.9%), 3123 (1.0%) were transfused blood products, and 7115 (2.3%) underwent an urgent procedure. In class 2, 219 (1.3%) died, 387 (2.3%) were transfused, and 1575 (9.2%) underwent intervention. In class 3, 7 (22.6%) died, 10 (32.3%) were transfused, and 13 (41.9%) underwent intervention. In class 4, 15 (34.9%) died, 19 (44.2%) were transfused, and 23 (53.5%) underwent intervention. For uncategorized patients, 21,356 (7.1%) died, 15,168 (5.0%) were transfused, and 23,844 (7.9%) underwent intervention. CONCLUSIONS: Almost half of trauma patients do not meet criteria for any ATLS shock class. Uncategorized patients had a higher mortality (7.1%) than patients in classes 1 and 2 (0.9% and 1.3%, respectively). Classes 3 and 4 only accounted for 0.005% and 0.007%, respectively, of patients. The ATLS classification system does not help identify many patients in severe shock.


Asunto(s)
Atención de Apoyo Vital Avanzado en Trauma/normas , Medición de Riesgo/métodos , Choque/clasificación , Índices de Gravedad del Trauma , Heridas y Traumatismos/complicaciones , Adulto , Anciano , Transfusión Sanguínea/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Choque/diagnóstico , Choque/etiología , Choque/mortalidad , Análisis de Supervivencia , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/mortalidad , Heridas y Traumatismos/terapia , Adulto Joven
18.
J Surg Res ; 245: 198-204, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31421362

RESUMEN

BACKGROUND: Race and insurance status have been shown to predict outcomes in pediatric bicycle traumas. It is unknown how these factors influence outcomes in adult bicycle traumas. This study aims to evaluate the association, if any, between race and insurance status with mortality in adults. METHODS: This retrospective cohort study used the National Trauma Data Bank Research Data Set for the years 2013-2015. Multivariate logistic regression models were used to determine the independent association between patient race and insurance status on helmet use and on outcomes after hospitalization for bicycle-related injury. These models adjusted for demographic factors and comorbid variables. When examining the association between race and insurance status with outcomes after hospitalization, injury characteristics were also included. RESULTS: A study population of 45,063 met the inclusion and exclusion criteria. Multivariate regression demonstrated that black adults and Hispanic adults were significantly less likely to be helmeted at the time of injury than white adults [adjusted odds ratio of helmet use for blacks 0.25 (95% CI 0.22-0.28) and for Hispanics 0.33 (95% CI 0.30-0.36) versus whites]. Helmet usage was also independently associated with insurance status, with Medicare-insured patients [AOR 0.51 (95% CI 0.47-0.56) versus private-insured patients], Medicaid-insured patients [AOR 0.18 (95% CI 0.17-0.20)], and uninsured patients [AOR 0.29 (95% CI 0.27-0.32)] being significantly less likely to be wearing a helmet at the time of injury compared with private-insured patients. Although patient race was not independently associated with hospital mortality among adult bicyclists, we found that uninsured patients had significantly higher odds of mortality [AOR 2.02 (AOR 1.31-3.12)] compared with private-insured patients. CONCLUSIONS: Minorities and underinsured patients are significantly less likely to be helmeted at the time of bicycle-related trauma when compared with white patients and those with private insurance. Public health efforts to improve the utilization of helmets during bicycling should target these subpopulations.


Asunto(s)
Ciclismo/lesiones , Disparidades en Atención de Salud/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Heridas y Traumatismos/mortalidad , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Anciano , Conjuntos de Datos como Asunto , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Dispositivos de Protección de la Cabeza/estadística & datos numéricos , Hispanoamericanos/estadística & datos numéricos , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Puntaje de Gravedad del Traumatismo , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento , Estados Unidos/epidemiología , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/terapia , Adulto Joven
19.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1356-1362, 2019 Nov 10.
Artículo en Chino | MEDLINE | ID: mdl-31838804

RESUMEN

Objective: To describe the trends and potential reasons responsible for injury mortality among children under 18 years old in different stages of the China Children's Development Outlines (CCDO) for children from 1990 to 2017, in China. Methods: Data derived from the Global Burden of Disease 2017 (GBD2017) were used to analyze the change of injury mortality, among children under 18 years old, by sex and provinces. Results: Since 1990, the Chinese government had formulated and implemented three CCDOs on Children. Each CCDO proposed corresponding main targets and strategic measures based on the development of children under current situation, in each area, accordingly. The first two CCDOs failed to set clear targets for child injury prevention and control, but the third one did propose a quantifiable target. The injury mortality rate of children under 18 years old showed a declining trend in all periods of the three CCDOs, by 26.07%, 40.68% and 26.48%, respectively. Both boys and girls showed significant downward trend in these three stages. Mortality rate on child injury differed in these three stages in all the 31 provinces. Conclusion: Thanks to the contribution of CCDO in different stages that providing important policies and impetus for the prevention and control of child injury, the number of deaths caused by child injury kept reducing, from 1990 to 2017, in China.


Asunto(s)
Grupo de Ascendencia Continental Asiática/estadística & datos numéricos , Mortalidad del Niño/tendencias , Heridas y Traumatismos/mortalidad , Adolescente , Niño , Desarrollo Infantil , Preescolar , China/epidemiología , Femenino , Carga Global de Enfermedades , Humanos , Masculino , Salud Pública
20.
J Safety Res ; 70: 223-232, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31847999

RESUMEN

INTRODUCTION: Vehicles in transport sometimes leave the travel lane and encroach onto natural or artificial objects on the roadsides. These types of crashes are called run-off the road crashes, which account for a large proportion of fatalities and severe crashes to vehicle occupants. In the United States, there are about one million such crashes, with roadside features leading to one third of all road fatalities. Traffic barriers could be installed to keep vehicles on the roadways and to prevent vehicles from colliding with obstacles such as trees, boulder, and walls. The installation of traffic barriers would be warranted if the severity of colliding with the barrier would be less severe than colliding with other fix objects on the sides of the roadway. However, injuries and fatalities do occur when vehicle collide with traffic barriers. A comprehensive analysis of traffic barrier features is lacking due to the absence of traffic barrier features data. Previous research has focused on simulation studies or only a general evaluation of traffic barriers, without accounting for different traffic barrier features. METHOD: This study is conducted using an extensive traffic barrier features database for the purpose of investigating the impact of different environmental and traffic barrier geometry on this type of crash severity. This study only included data related to two-lane undivided roadway systems, which did not involve median barrier crashes. Crash severity is modeled using a mixed binary logistic regression model in which some parameters are fixed and some are random. RESULTS: The results indicated that the effects of traffic barrier height, traffic barrier offset, and shoulder width should not be separated, but rather considered as interactions that impact crash severity. Rollover, side slope height, alcohol involvement, road surface conditions, and posted speed limit are some factors that also impact the severity of these crashes. The effects of gender, truck traffic count, and time of a day were found to be best modeled with random parameters in this study. The effects of these risk factors are discussed in this paper. PRACTICAL APPLICATIONS: Results from this study could provide new guidelines for the design of traffic barriers based upon the identified roadway and traffic barrier characteristics.


Asunto(s)
Accidentes de Tránsito/prevención & control , Planificación Ambiental , Heridas y Traumatismos/prevención & control , Accidentes de Tránsito/mortalidad , Adulto , Consumo de Bebidas Alcohólicas , Bases de Datos Factuales , Etanol , Femenino , Humanos , Modelos Logísticos , Masculino , Vehículos a Motor , Factores de Riesgo , Seguridad , Viaje , Estados Unidos , Heridas y Traumatismos/mortalidad
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