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1.
Am Surg ; 89(9): 3947-3949, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37259977

RESUMO

The leading cause of preventable traumatic death is uncontrolled bleeding. This study aimed to better identify those most likely to experience in-hospital mortality with increasing injury severity scoring (ISS). This is a single-center study of Trauma Registry data, from July 3, 2016, to February 24, 2022. The inclusion criteria were based upon age (≥18 years) and in-hospital mortality. 546 patients (mean age 58) were included in the analysis. There were several significant associations with increasing ISS among those who experienced in-hospital mortality, which included a rising shock index ratio, activation of the massive transfusion protocol, and, most notably, motorcycle trauma. This research reiterates the importance of the "Stop the Bleed" campaign as vital for training laypersons in the life-saving technique for hemorrhage control.


Assuntos
Motocicletas , Ferimentos e Lesões , Humanos , Pessoa de Meia-Idade , Adolescente , Escala de Gravidade do Ferimento , Mortalidade Hospitalar , Centros de Traumatologia , Transfusão de Sangue , Hemorragia , Ferimentos e Lesões/terapia , Estudos Retrospectivos
2.
Am Surg ; 89(9): 3975-3976, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37365878

RESUMO

Acute small bowel obstruction (SBO) is a common cause of emergency department visits in the United States, and it accounts for approximately 20% of emergency surgical operations.1 Its etiology is divided into intrinsic luminal obstruction or extrinsic compression of the bowel.2 Among the causes of SBO, by far the most common is intraperitoneal adhesions due to previous abdominal surgeries, which comprises about 60-70% of the cases.2 The abdominal cavity is subdivided into the peritoneal cavity and the retroperitoneal cavity; the division is marked by a thin covering of parietal peritoneum that encases all the intraperitoneal structures. Here, we present a rare case of an acute small bowel obstruction secondary to exposure of the retroperitoneal external iliac artery from a surgical procedure 20 years prior to presentation.


Assuntos
Hérnia Abdominal , Obstrução Intestinal , Humanos , Artéria Ilíaca/cirurgia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Hérnia Interna/complicações , Aderências Teciduais/complicações
3.
J Trauma Nurs ; 30(3): 150-157, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37144804

RESUMO

BACKGROUND: The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury algorithm is used to identify children at low risk of clinically significant traumatic brain injuries to reduce computed tomography (CT) exposure. Adapting PECARN rules based on population-specific risk stratification has been suggested to improve diagnostic accuracy. OBJECTIVE: This study sought to identify center-specific patient variables, beyond PECARN rules, that may enhance the identification of patients requiring neuroimaging. METHODS: This single-center, retrospective cohort study was conducted from July 1, 2016, to July 1, 2020, in a Southwestern U.S. Level II pediatric trauma center. The inclusion criteria were adolescents (10-15 years), Glasgow Coma Scale (13-15), with a confirmed mechanical blow to the head. Patients without a head CT were excluded. Logistic regression was performed to identify additional complicated mild traumatic brain injury predictor variables beyond the PECARN. RESULTS: There were 136 patients studied; 21 (15%) presented with a complicated mild traumatic brain injury. Relative to motorcycle collision or all-terrain vehicle trauma (odds ratio [OR] 211.75, 95% confidence interval, CI [4.51, 9931.41], p < .001), an unspecified mechanism (OR 42.0, 95% CI [1.30, 1350.97], p = .03) and consult activation (OR 17.44, 95% CI [1.75, 173.31], p = .01) were significantly associated with complicated mild traumatic brain injury. CONCLUSIONS: We identified additional factors associated with complex mild traumatic brain injury, including motorcycle collision and all-terrain vehicle trauma, unspecified mechanism, and consult activation that are not in the PECARN imaging decision rule. Adding these variables may aid in determining the need for appropriate CT scanning.


Assuntos
Experiências Adversas da Infância , Concussão Encefálica , Lesões Encefálicas Traumáticas , Traumatismos Craniocerebrais , Adolescente , Criança , Humanos , Concussão Encefálica/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico , Técnicas de Apoio para a Decisão , Estudos Retrospectivos , Serviço Hospitalar de Emergência , Lesões Encefálicas Traumáticas/diagnóstico por imagem
4.
Am Surg ; 89(8): 3490-3492, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36880603

RESUMO

This study aimed to evaluate non-survivors who were admitted to a level I trauma center but later died, in terms of predicting who would expire early vs late. This is a single-center study of Trauma Registry data, from July 3, 2016, to February 24, 2022. The inclusion criteria were based upon age (≥18 years) and in-hospital mortality. 546 patients (mean age 58) were included in the analysis. Trauma patients who may experience an earlier death were those with increasing injury severity scores, activation of massive transfusion protocol, comorbid advanced directive limiting care, COPD, personality disorder, and ED death location. Patients were more likely to experience later in-hospital mortality, including those with increasing ICU stays, and comorbid dementia.


Assuntos
Transfusão de Sangue , Ferimentos e Lesões , Humanos , Pessoa de Meia-Idade , Adolescente , Mortalidade Hospitalar , Escala de Gravidade do Ferimento , Hospitalização , Centros de Traumatologia , Ferimentos e Lesões/terapia , Estudos Retrospectivos
5.
Am Surg ; 89(8): 3563-3565, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36912455

RESUMO

The leading cause of preventable traumatic death is uncontrolled bleeding. This study aimed to better identify those most likely to experience in-hospital mortality with increasing injury severity scoring (ISS). This is a single-center study of Trauma Registry data, from July 3, 2016, to February 24, 2022. The inclusion criteria were based upon age (≥18 years) and in-hospital mortality. 546 patients (mean age 58) were included in the analysis. There were several significant associations with increasing ISS among those who experienced in-hospital mortality, which included a rising shock index ratio, activation of the massive transfusion protocol, and, most notably, motorcycle trauma. This research reiterates the importance of the "Stop the Bleed" campaign as vital for training laypersons in the life-saving technique for hemorrhage control.


Assuntos
Motocicletas , Ferimentos e Lesões , Humanos , Pessoa de Meia-Idade , Adolescente , Mortalidade Hospitalar , Transfusão de Sangue , Hemorragia , Centros de Traumatologia , Ferimentos e Lesões/terapia , Escala de Gravidade do Ferimento , Estudos Retrospectivos
6.
Am Surg ; 88(8): 1912-1915, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35438573

RESUMO

This research aims to evaluate the specific effects of end-stage renal disease on acutely injured trauma patients. This is a single-center study of Trauma Registry data, inclusive years July 1, 2016 to February 28, 2021. Patients were grouped by pre-existing comorbidity of chronic kidney disease (CKD) and those without. Overall, 7261 elderly trauma patients were included in the analysis; stratified groups identified 197 with CKD (3%) and 7064 without (97%). The Injury Severity Scores (ISSs) between the two groups were not significantly different. Elderly trauma patients with CKD typically stayed in the ICU and hospital longer with discharge to hospice, rehab, experienced an in-hospital mortality, and most likely experienced an in-hospital complication. For CKD and non-CKD cohorts, ISSs were similar. However, outcomes for the CKD cohort in the trauma setting were significantly worse, particularly in elderly patients with fall trauma and lower extremity fractures.


Assuntos
Falência Renal Crônica , Insuficiência Renal Crônica , Idoso , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Falência Renal Crônica/complicações , Insuficiência Renal Crônica/complicações , Estudos Retrospectivos
7.
Am Surg ; 88(8): 1925-1927, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35435732

RESUMO

This study aims at identifying the under-triage patients to improve the quality of care among those transferred into a level I trauma system. This is a single-center study of Trauma Registry data, inclusive years, from July 1, 2016 to January 31, 2021. Patients were grouped based upon under-triage, over-triage, and OK triage. The under-triage group was more likely to be older, partially activated, blunt, fall trauma patients with a higher GCS, higher ISS, and significant injuries found to the head/neck who experienced a longer length of stay at the referring facility and higher morbidity outcomes with diagnosed comorbidities of dementia and hypertension. There are distinct differences in under and over-triage groups within this trauma system, which gives insight into future education and outreach among interfacility transfers.


Assuntos
Triagem , Ferimentos e Lesões , Idoso , Humanos , Escala de Gravidade do Ferimento , Sistema de Registros , Estudos Retrospectivos , Centros de Traumatologia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia
8.
Am Surg ; 88(7): 1576-1579, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35437019

RESUMO

This study aims to assess chemical VTE prophylactic type and timing and associated outcomes within the elderly trauma population. This is a single center study of Trauma Registry data, inclusive years July 1, 2016, to February 28, 2021. The patients were grouped based upon discharge disposition. 7261 elderly trauma patients were included in the analysis. Late administration of VTE prophylaxis was associated with a discharge disposition to hospice. Administration of unfractionated heparin was most associated with in-hospital mortality. Xa inhibitors had the least impact on morbidity and mortality, with most likely associations in discharge to rehab or a skilled nursing facility. LMWH associated with a discharge to a rehab facility. The timing of administration and type of VTE prophylaxis may significantly affect the morbidity and mortality outcomes in elderly trauma.


Assuntos
Tromboembolia Venosa , Idoso , Anticoagulantes/uso terapêutico , Heparina/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Resultado do Tratamento , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle
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