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Am J Surg ; 224(1 Pt B): 584-589, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35300857


BACKGROUND: The COVID-19 pandemic has led to decreased access to care and social isolation, which have the potential for negative psychophysical effects. We examine the impact of the pandemic on physical and mental health outcomes after trauma. METHODS: Patients in a prospective study were included. The cohort injured during the pandemic was compared to a cohort injured before the pandemic. We performed regression analyses to evaluate the association between the COVID-19 pandemic and physical and mental health outcomes. RESULTS: 1,398 patients were included. In adjusted analysis, patients injured during the pandemic scored significantly worse on the SF-12 physical composite score (OR 2.21; [95% CI 0.69-3.72]; P = 0.004) and were more likely to screen positive for depression (OR 1.46; [1.02-2.09]; P = 0.03) and anxiety (OR 1.56; [1.08-2.26]; P = 0.02). There was no significant difference in functional outcomes. CONCLUSIONS: Patients injured during the COVID-19 pandemic had worse mental health outcomes but not physical health outcomes.

COVID-19 , Ansiedade/epidemiologia , Ansiedade/etiologia , COVID-19/epidemiologia , Depressão/epidemiologia , Depressão/etiologia , Humanos , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Estudos Prospectivos , Qualidade de Vida/psicologia
J Trauma Acute Care Surg ; 92(2): 277-286, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34739001


BACKGROUND: Despite the ubiquity of rib fractures in patients with blunt chest trauma, long-term outcomes for patients with this injury pattern are not well described. METHODS: The Functional Outcomes and Recovery after Trauma Emergencies (FORTE) project has established a multicenter prospective registry with 6- to 12-month follow-up for trauma patients treated at participating centers. We combined the FORTE registry with a detailed retrospective chart review investigating admission variables and injury characteristics. All trauma survivors with complete FORTE data and isolated chest trauma (Abbreviated Injury Scale score of ≤1 in all other regions) with rib fractures were included. Outcomes included chronic pain, limitation in activities of daily living, physical limitations, exercise limitations, return to work, and both inpatient and discharge pain control modalities. Multivariable logistic regression models were built for each outcome using clinically relevant demographic and injury characteristic univariate predictors. RESULTS: We identified 279 patients with isolated rib fractures. The median age of the cohort was 68 years (interquartile range, 56-78 years), 59% were male, and 84% were White. Functional and quality of life limitations were common among survivors of isolated rib fractures even 6 to 12 months after injury. Forty-three percent of patients without a preexisting pain disorder reported new daily pain, and new chronic pain was associated with low resilience. Limitations in physical functioning and exercise capacity were reported in 56% and 51% of patients, respectively. Of those working preinjury, 28% had not returned to work. New limitations in activities of daily living were reported in 29% of patients older than 65 years. Older age, higher number of rib fractures, and intensive care unit admission were independently associated with higher odds of receiving regional anesthesia. Receiving a regional nerve block did not have a statistically significant association with any patient-reported outcome measures. CONCLUSION: Isolated rib fractures are a nontrivial trauma burden associated with functional impairment and chronic pain even 6 to 12 months after injury. LEVEL OF EVIDENCE: Prognostic/epidemiologic, level III.

Medidas de Resultados Relatados pelo Paciente , Fraturas das Costelas/complicações , Escala Resumida de Ferimentos , Idoso , Dor Crônica/etiologia , Tolerância ao Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Qualidade de Vida , Recuperação de Função Fisiológica , Sistema de Registros , Estudos Retrospectivos
Crit Care Clin ; 36(3): 531-546, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32473697


This article describes 2 relatively rare, but complex situations in pulmonary embolism (PE): clot-in-transit (CIT), incidental PE (IPE). CIT describes a venous thromboembolism that has become lodged in the right heart. CIT is associated with high mortality and presents unique challenges in management. Incidental PE (IPE) describes PE diagnosed on imaging performed for another indication. The treatment is complex because there is often a disconnect between the PE severity on imaging and lack of severity of the clinical presentation. We summarize the available literature and aid clinicians as they manage patients with PE across the clinical severity spectrum.

Anticoagulantes/normas , Guias de Prática Clínica como Assunto , Embolia Pulmonar/complicações , Embolia Pulmonar/fisiopatologia , Terapia Trombolítica/normas , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Feminino , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico , Tromboembolia Venosa/diagnóstico
Thromb Res ; 187: 139-147, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31991381


OBJECTIVES: Clot in transit (CIT) represents a rare and life-threatening manifestation of venous thromboembolism of which we have limited understanding. This study describes the risk factors, clinical characteristics, and outcomes associated with the development of CIT as well as death following CIT diagnosis. METHODS: We analyzed patients enrolled in our institutional Pulmonary Embolism Response Team (PERT) registry and compared 57 patients who had a CIT to 608 pulmonary embolism (PE) patients who did not have a CIT. We performed univariate and multivariate logistic regression to identify factors associated with CIT (vs PE without CIT) among patients who had an echocardiogram, as well as factors associated with 7-day death after CIT diagnosis. RESULTS: CIT was present in (57) 8.6% of patients who had an echocardiogram. Multivariate analysis showed heart failure (OR 2.8, 95% CI 1.2-6.5, P = 0.01), a pre-existing central venous catheter (OR 2.5, 95% CI 1.1-5.7, P = 0.03), and hypotension (OR 2.1, 95% CI 1.1-3.7, P = 0.02) to be independently associated with CIT. All-cause mortality by 7 days was higher in CIT patients (12.5% vs 5.1%, P = 0.02). CIT patients who died were more likely to have presented with hemodynamic collapse (57.1% vs 14.0%, P = 0.02), mental status change (100% vs 22.0%, P < 0.001), and to be intubated (100% vs 36.0%, P = 0.001). CONCLUSIONS: The presence of heart failure, a central venous catheter, and hypotension should alert physicians to patients who may require an echocardiogram to diagnose CIT. The mortality of CIT is high, even relative to a population with severe PE.

Embolia Pulmonar , Trombose , Tromboembolia Venosa , Ecocardiografia , Humanos , Embolia Pulmonar/complicações , Fatores de Risco , Tromboembolia Venosa/complicações