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1.
Medicine (Baltimore) ; 99(50): e23647, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327346

RESUMO

This study aimed to describe the sport injuries of elite collegiate athletes, and to examine the influence of career length, past injuries, and psychological factors on the treatment period and willingness to pay (WTP) for treatment.A survey was conducted among students of the Department of Physical Education, Korea National Sport University. Results were interpreted through frequency analysis and multiple linear regression analysis.All students currently in training (n = 624, mean age 21 ±â€Š2 years) participated in this study. 12-month prevalence of sports injuries was 56%. The locations of the most common and severe injuries were the knee, ankle, and back. The most frequent types of common injury were sprain, ruptured ligament, and bruising. The location of injuries varied according to the sports discipline. The treatment period was influenced by sports discipline, career length, location, and type of injury, and fear of further injuries. Treatment period was associated with the reason for fear of injuries, and WTP was influenced by fear of further injuries.Our study suggests that specific management plans for athletes based on disciplines, past injuries, and their emotional responses to previous injuries are required for rehabilitation and return to sports following treatment.


Assuntos
Atletas/psicologia , Traumatismos em Atletas/psicologia , Traumatismos em Atletas/terapia , Esportes/estatística & dados numéricos , Estudantes/psicologia , Traumatismos em Atletas/classificação , Traumatismos em Atletas/economia , Estudos Transversais , Feminino , Humanos , Masculino , República da Coreia , Fatores Sexuais , Índices de Gravidade do Trauma , Adulto Jovem
2.
Chin J Traumatol ; 23(6): 363-366, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33214008

RESUMO

The treatment of severe trauma, especially multiple injuries, requires multidisciplinary collaboration. The current study aims to highlight the challenges of consultation mode for severe trauma in general hospitals and emphasizes the need to create a new temporary-sustainable team. It suggests developing an information consultation mode and enforcing the fine management to improve the quality and safety of the medical treatment. The management mode of a temporary-sustainable team will reduce the cost and improve the treatment efficiency. Overall, a temporary-sustainable team has significant advantages over a traditional multidisciplinary team for severe trauma treatment.


Assuntos
Escala de Gravidade do Ferimento , Colaboração Intersetorial , Traumatismo Múltiplo/terapia , Equipe de Assistência ao Paciente/organização & administração , Qualidade da Assistência à Saúde , Encaminhamento e Consulta , Índices de Gravidade do Trauma , Feminino , Humanos , Masculino , Segurança , Traumatologia/organização & administração , Resultado do Tratamento
3.
Afr Health Sci ; 20(2): 991-999, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33163068

RESUMO

Background: Unintentional injuries from burns comprise a significant proportion of public health morbidity in Nigeria. In order to understand the type and impact of burns on youth in Low-and-Middle-Income countries, the epidemiology of burns must be adequately assessed. Methods: This review describes the epidemiological patterns of burn occurrences in the pediatric populations and proposes interventions using the Haddon Matrix to address injuries in specific populations in Nigeria. A literature search was conducted using the Proquest, CINAHL, and PubMed databases at the Johns Hopkins University library (January 1, 1990 to August 14, 2018), on burns or thermal injury among pediatric populations in Nigeria. The review focused on the forms of injury, risk factors and potential interventions. Results: Ten studies were identified and the main risk factors for burns were socioeconomic status, overcrowding, and involving young girls in traditional cooking roles. The main types of injuries include scald injuries (50%) and fire burns (45%) affecting mainly children aged 14 and below with significant regional epidemiological variations. We created a novel intervention to develop countermeasures and reduce the number of pediatric burns based on biological, physical and sociocultural environment.. Conclusion: Interventions such as improved supervision of children, improved emergency infrastructure and culturally sensitive first aid education and treatment can help ensure a reduction in morbidity and mortality resulting from burns. Epidemiological studies can provide an accurate depiction of the burden of burn injuries in different regions of Nigeria.


Assuntos
Acidentes Domésticos/prevenção & controle , Queimaduras/etiologia , Queimaduras/prevenção & controle , Classe Social , Acidentes Domésticos/estatística & dados numéricos , Queimaduras/epidemiologia , Humanos , Lactente , Escala de Gravidade do Ferimento , Nigéria/epidemiologia , Fatores de Risco , Fatores Socioeconômicos , Índices de Gravidade do Trauma
4.
Neurology ; 95(12 Suppl 2): S11, 2020 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-33199570

RESUMO

OBJECTIVE: Evaluating the TBI incidence during the COVID-19 pandemic era compared with similar period in previous year. BACKGROUND: The emergence of SARS-CoV2 influenced the evolution of governmental and hospital policy worldwide, which might eventually impact many aspects. The incidence of many diseases in the Emergency Department (ED), especially traumatic brain injury (TBI), has been an area of interest. DESIGN/METHODS: Retrospective study comparing TBI incidence before and during COVID-19 pandemic era starting from the declaration of national pandemic date (March 16, 2020) until June 14, 2020 with the comparison of the same period in the previous year. RESULTS: There was an increase in admission rate due to TBI during COVID-19 pandemic compared with the previous year (157/752 (20.9%) vs 106/766 (13.8%), p < 0.001, respectively). While the range of age was similar between COVID-19 and non-COVID-19 era (37.9 ± 14.8 vs 38.6 ± 15.4 years, p = 0.712), male was higher in percentage to experience the injury (131/157 (83.4%) vs 67/106 (63.2%), p < 0.001). During the pandemic era, road traffic injury (97/157 (61.8%) vs 56/106 (52.8%), p = 0.149) as well as moderate-to-severe brain injury tended to increase (30/157 (19.1%) vs 17/106 (16.0%) p = 0.524) albeit statistically insignificant. Although the mortality rate was similar (12/157 (7.6%) vs 9/106 (8.5%), p = 0.804), higher hospitalization rate was observed in the pandemic era (81/157 (51.2%) vs 37/106 (34.9%) p = 0.008). CONCLUSIONS: TBI incidence remained increasing despite entering the COVID-19 era. These phenomena required further investigation and analysis that may possibly be unrelated with the COVID-19, but due to the change of the government policy and its impact, such as the more quiet road after national social distancing.


Assuntos
Lesões Encefálicas Traumáticas/epidemiologia , Serviço Hospitalar de Emergência , Hospitalização/tendências , Mortalidade/tendências , Acidentes de Trânsito/tendências , Adulto , Distribuição por Idade , Feminino , Humanos , Incidência , Indonésia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Índices de Gravidade do Trauma , Adulto Jovem
5.
Medicine (Baltimore) ; 99(42): e22412, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080675

RESUMO

In many German trauma centres, it is routine to perform abdominal follow-up sonography (AFS) 6 h after admission for patients with multiple trauma, even if the clinical course is uneventful and multi-slice computed tomography (MSCT) reveals no abdominal pathology. However, this approach is not recommended in the German Guidelines for trauma, and recent studies have questioned the value of AFS to these patients. The present study aimed to evaluate the revised German Guidelines for trauma with respect to the omission of AFS.We included patients with multiple injuries with no clinical signs of abdominal trauma and with normal abdominal MSCT. We collected clinical data of 370 consecutive patients who underwent AFS (Group A) and another 370 consecutive patients who did not undergo AFS (Group B).No abdominal injury was missed by the omission of AFS, and thus, no patient suffered from its omission or benefitted from the use of AFS. In our study population, the negative predictive value of normal MSCT results combined with no clinical signs of abdominal trauma was 100% (95% confidence interval: 99.5%-100.0%).This single-centre study conducted in a large German trauma centre demonstrates AFS to have no utility in the diagnosis of abdominal injury. Moreover, omission of AFS for conscious patients without clinical signs of abdominal trauma and with negative abdominal MSCT does not appear to have negative consequences in terms of missed abdominal injury.Therefore, AFS can be safely omitted in the majority of cases of polytrauma, which simplifies the imaging workup tremendously.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Traumatismo Múltiplo/diagnóstico por imagem , Guias de Prática Clínica como Assunto , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Alemanha , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Traumatologia , Índices de Gravidade do Trauma , Procedimentos Desnecessários
6.
BMC Neurol ; 20(1): 396, 2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33121453

RESUMO

BACKGROUND: Outcome prediction for patients with disorders of consciousness (DOC) is essential yet challenging. Evidence showed that patients with DOC lasting 1 year or longer after a brain injury were less likely to recover. However, the reasons why outcomes of DOC patients differ greatly remain unclear. With a variety of analytical methods and through quantitative behavioral assessments, we aimed to track the progression of a patient with severe brain injury, in order to advance our understanding of the underlying mechanisms of DOC. CASE PRESENTATION: We performed a longitudinal study for a 52-year-old male DOC patient who has remained in the state for 1.5 years with comprehensive rehabilitative therapies. The patient underwent 3 times of assessments of Coma Recovery Scale-Revised (CRS-R) and ultra-high-field 7 T magnetic resonance imaging (MRI). Both topologic properties and brain microstructure were analyzed to track disease progression. We observed dynamic increases of fiber densities with measurements at three time points (t1:1.5 M, t2:7.5 M t3:17.5 M). Specifically, fiber densities of the superior longitudinal fasciculus and arcuate fasciculus nerve fiber bundles improved mostly in the visual, verbal, and auditory subscales, which was consistent with the CRS-R scores. Moreover, the graph-theory analyses demonstrated that network topologic properties showed an improvement although the disease duration exceeded 1 year. CONCLUSIONS: DOC patients with a course longer than 1 year remain possible to improve, and including evaluation methods such as WM connectome analysis and graph theory could be potentially valuable for a more precise assessment of patients with a longer course of DOC.


Assuntos
Transtornos da Consciência/patologia , Transtornos da Consciência/fisiopatologia , Neuroimagem/métodos , Recuperação de Função Fisiológica/fisiologia , Doença Crônica , Transtornos da Consciência/diagnóstico por imagem , Progressão da Doença , Seguimentos , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Índices de Gravidade do Trauma
7.
Am J Surg ; 220(6): 1480-1484, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33046221

RESUMO

BACKGROUND: Base Deficit (BD) and lactate have been used as indicators of shock and resuscitation. This study was done to evaluate the utility of BD and lactate in identifying shock and resuscitative needs in trauma patients. METHODS: A prospective observational study was performed from 3/2014-12/2018. Data included demographics, admission systolic BP, ISS, BD, lactate, blood transfusion, and outcomes. BD and lactate were modeled continuously and categorically and compared. RESULTS: 2271 patients were included. BD and lactate were moderately correlated (r2 = 0.63 p < 0.001). On univariate regression, BD and lactate were associated with transfusion requirement and mortality (p < 0.001), but on multivariate regression, only BD was associated with transfusion requirement and mortality (OR = 1.2, p < 0.001; OR = 1.1, p < 0.001, respectively). BD discriminated better than lactate for hypotension, higher ISS, increased transfusion requirements and mortality. CONCLUSIONS: Admission BD and lactate levels are correlated following injury, but BD is superior to lactate in identifying shock, resuscitative needs and mortality in severely injured trauma patients.


Assuntos
Desequilíbrio Ácido-Base/sangue , Ácido Láctico/sangue , Ressuscitação , Choque/sangue , Choque/terapia , Ferimentos e Lesões/sangue , Ferimentos e Lesões/terapia , Biomarcadores/sangue , Transfusão de Sangue , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Estudos Prospectivos , Choque/mortalidade , Índices de Gravidade do Trauma , Ferimentos e Lesões/mortalidade
8.
Rev. cuba. estomatol ; 57(3): e2978, jul.-set. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1126524

RESUMO

RESUMEN Introducción: La utilización de herramientas pronósticas que permitan valorar la gravedad del trauma, la supervivencia y mortalidad de los lesionados, permite la estratificación de los pacientes y la toma de decisiones acertadas para el tratamiento más efectivo en el área hospitalaria. Objetivo: Realizar una revisión bibliográfica sobre las herramientas pronósticas más utilizadas en la atención de urgencia para detectar la gravedad del trauma maxilofacial. Métodos: Se realizó una revisión bibliográfica desde octubre de 2018 hasta enero de 2019. Fueron examinados libros y artículos publicados en revistas de impacto, en idioma español, inglés y portugués, con atención prioritaria a aquellos que tuvieran cinco años o menos. Se consultaron las bases de datos MEDLINE, EBSCO, PubMed, SciELO, ClinicalKey, utilizando los descriptores: "Trauma Severity Indices", "Maxillofacial Injuries", "Traumatology", "Indexes". Se recuperaron dos libros y 50 artículos, aunque la revisión se circunscribió solamente a los 33 que mejor describían los elementos estudiados. Análisis e integración de la información: El puntaje Cooter David, el de gravedad de lesiones maxilofaciales, la escala de severidad de lesiones faciales, la de severidad de fracturas faciales y el modelo ZS, son los principales instrumentos utilizados en el pronóstico de gravedad existentes de la región facial. Conclusiones: Constan en la literatura escalas, índices y puntajes para pronosticar la gravedad del trauma maxilofacial en la urgencia, cada una exhibe ventajas que las convierte en una herramienta coadyuvante de la atención del trauma; sin embargo, poseen también desventajas que complejizan su aplicación en el medio hospitalario. Entre las herramientas más utilizadas está la escala de severidad de lesiones faciales; fácil de aplicar en los servicios de urgencia, pero con deficiencias a la hora de tratar los componentes de tejido blando y óseo. En Cuba hay escasas evidencias de la utilización de estos instrumentos en la especialidad de cirugía maxilofacial(AU)


ABSTRACT Introduction: The usage of prognostic tools that allow assessing trauma severity, as well as injury survival and mortality, allows patient stratification and making right decisions for the most effective treatment in the hospital area. Objective: To carry out a bibliographic review about the prognostic tools most widely used in emergency care to identify maxillofacial trauma severity. Methods: A bibliographic review was carried out from October 2018 to January 2019. We examined books and articles published in high-impact magazines, in Spanish, English and Portuguese, with priority attention on those five years old or less. We consulted the MEDLINE, EBSCO, PubMed, SciELO, Clinical Key databases using the descriptors Trauma Severity Indices, Maxillofacial Injuries, Traumatology, and Indexes. Two books and 50 articles were retrieved, although the review was limited to only 33 which described best the elements studied. Information analysis and integration: The Cooter-David scoring system, the maxillofacial injury severity score, the facial injury severity scale, the facial fracture severity scale, and the ZS model are the main instruments used for existing severity forecast in the facial region. Conclusions: There literature includes scales, indexes and scoring systems for predicting the maxillofacial trauma severity in the emergency department, each one showing advantages that make them an adjunct tool for trauma care; however, they also have disadvantages that complicate their application in the hospital setting. The facial injury severity scale is among the most widely used tools, as far as it is easy to apply in the emergency services, but with deficiencies for treating soft tissue and bone components. In Cuba, there is little evidence about the use of these instruments in the specialty of maxillofacial surgery(AU)


Assuntos
Humanos , Índices de Gravidade do Trauma , Serviços Médicos de Emergência/métodos , Traumatismos Faciais/terapia , Traumatismos Maxilofaciais/etiologia , Publicações Periódicas como Assunto , Bases de Dados Bibliográficas , Sobrevivência
9.
Med. intensiva (Madr., Ed. impr.) ; 44(6): 325-332, ago.-sept. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194811

RESUMO

OBJETIVO: Evaluar la capacidad de los modelos TRISS y PS14 para predecir la probabilidad de supervivencia en nuestro sistema de salud y población. DISEÑO: Desarrollamos un estudio observacional retrospectivo durante un periodo de 66 meses. ÁMBITO: El estudio se llevó a cabo en una UCI especializada en traumatología en un hospital urbano de alta complejidad. PACIENTES: Se incluyeron en el estudio los pacientes mayores de 14 años con traumatismo grave (definido como ISS ≥ 16 y/o RTS < 12). VARIABLES DE INTERÉS: Se calculó el estadístico W (diferencia entre la mortalidad -hospitalaria o a los 30 días para los modelos TRISS o PS14 respectivamente- calculada y observada por cada 100 pacientes) y su nivel de significación para cada modelo. Se realizó un análisis por subgrupos. La calibración y discriminación se evaluaron por medio del test de Hosmer-Lemeshoy y cinturón GiViTI y curvas ROC respectivamente. RESULTADOS: Se incluyeron 1.240 pacientes. La supervivencia global al alta fue de 81,9%. El estadístico W para los modelos TRISS, TRISS2010 y PS14 fue respectivamente +6,72 (p < 0,01), +1,48 (p = 0,08) y +2,74 (p < 0,01). El AUROC para los citados modelos fue respectivamente 0,915, 0,919 y 0,914, sin que se encontraran diferencias significativas entre ellos. Tanto el test de Hosmer-Lemeshow como el cinturón de calibración GiViTI mostraron escasa calibración en los 3 modelos. CONCLUSIONES: Estos modelos son una herramienta adecuada para la evaluación de la calidad asistencial en una UCI de traumatismo. En nuestro centro las tasas de supervivencia fueron mayores de lo predicho por los modelos


OBJECTIVE: To evaluate the ability of the TRISS and PS14 models to predict mortality rates in our medical system and population. DESIGN: A retrospective observational study was carried out over a 66-month period. BACKGROUND: The study was conducted in the Trauma Intensive Care Unit (ICU) of a third level hospital. PATIENTS: All severe trauma patients (Injury Severity Score ≥ 16 and/or Revised Trauma Score < 12) aged > 14 years were included. Variables of interest: Medical care data were prospectively recorded. The "W" statistic (difference between expected and observed mortality for every 100 patients) and its significance were calculated for each model. Discrimination and calibration were evaluated by means of receiver operating characteristic (ROC) curves, and the Hosmer-Lemeshow test and GiViTI calibration belt, respectively. RESULTS: A total of 1240 patients were included. Survival at hospital discharge was 81.9%. The "W" scores for the TRISS, TRISS 2010 and PS14 models were +6.72 (P < .01), +1.48 (P = .08) and +2.74 (P < .01) respectively. Subgroup analysis revealed significant favorable results for some populations. The areas under the ROC curve for the TRISS, TRISS 2010 and PS14 models were 0.915, 0.919 and 0.914, respectively. There were no significant differences among them (P > .05). Both the Hosmer-Lemeshow test and GiViTI calibration belt demonstrated poor calibration for the three models. CONCLUSIONS: These models are suitable tools for assessing quality of care in a Trauma ICU, affording excellent discrimination but poor calibration. In our institution, survival rates higher than expected were observed


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Garantia da Qualidade dos Cuidados de Saúde/métodos , Índices de Gravidade do Trauma , Ferimentos e Lesões/mortalidade , Taxa de Sobrevida , Estudos Retrospectivos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/normas , Intervalos de Confiança , Ferimentos e Lesões/classificação
10.
Pan Afr Med J ; 36: 152, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874416

RESUMO

Introduction: fall injuries constitute a major public health concern worldwide, contributing to over 646,000 deaths every year. The aim of this study was to determine the nature and severity of fall injuries at a tertiary hospital in the Kingdom of Saudi Arabia (KSA). Methods: we conducted a cross-sectional study at the King Khalid Hospital and Prince Sultan Centre for Health Care in Al Kharj. We recruited the patients and followed them through the triage, admission and discharge processes. We analyzed the participant´s clinical notes on the electronic health record (EHR) to obtain information relevant to the study, including the nature, cause, mechanism of injury, demographic characteristics and prognostic factors captured through the injury severity score (ISS), the Glasgow coma scale (GCS) and the presence or absence of shock. Results: of 264 patients, most of the patients were children under the age of ten (25.7%), followed by young adults between the ages of twenty-one and thirty (18.2%). The ISS was associated with severe head, chest, skull, brain, scalp, rib, abdominal, pelvic and lower limb injuries. The GCS was associated with severe the head, chest, skull, brain and rib injuries (p<0.005). The degree of shock was also significantly associated with pelvic, head, chest, skull, brain, scalp, abdominal and upper limb injuries (p<0.05). Conclusion: fall injuries in our setting are severe. Training of staff should prioritize head, chest, skull, brain, abdominal and rib injury management. As a reference hospital, minor injuries are more likely to be managed at lower levels of care.


Assuntos
Acidentes por Quedas , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Acidentes por Quedas/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Arábia Saudita/epidemiologia , Choque/epidemiologia , Choque/etiologia , Centros de Atenção Terciária , Índices de Gravidade do Trauma , Ferimentos e Lesões/patologia , Adulto Jovem
11.
J Plast Reconstr Aesthet Surg ; 73(11): 1995-2000, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32948497

RESUMO

PURPOSE: Replantation of multidigit amputations is difficult to perform due to severe damage to the digits, prolonged operative time, and ischemia. This study aimed to report the clinical results of multidigit replantation. METHODS: A retrospective case series of 34 digits belonging to 12 consecutive patients who underwent multidigit replantation was conducted. Patients with injury in at least one or more amputated fingers proximal to the insertion of the flexor digitorum superficialis tendon were included. The mean follow-up duration was 18.1 months. The number of amputated digits, mechanism and zone of injury, survival rate, and clinical outcomes, including the range of motion, grip strength, and sensory recovery, at the final follow-up were reviewed and analyzed. RESULTS: The mean number of amputated digits per patient was 2.8. Complete survival was achieved in 27 of 31 digits (87.1%). The mean final percentage of total active motion of injured digits was 47.0%, and the mean percentage of grip strength was 45.9% of the contralateral uninjured side. The comparison between patients with two and three amputated digits showed that there was no significant difference in both survival rates and functional outcomes. CONCLUSIONS: The results showed that both the survival rates and functional outcomes of multidigit replantation were as good as those of single-digit replantation, and there was no significant difference for outcomes between patients with two and three amputated digits. These results suggested that all multidigit replantations should be performed regardless of the number of injured digits or amputation zones.


Assuntos
Amputação Traumática , Traumatismos dos Dedos/cirurgia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos , Recuperação de Função Fisiológica , Reimplante , Amputação Traumática/etiologia , Amputação Traumática/cirurgia , Feminino , Articulações dos Dedos/fisiopatologia , Força da Mão , Humanos , Masculino , Microcirurgia/efeitos adversos , Microcirurgia/métodos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Amplitude de Movimento Articular , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reimplante/efeitos adversos , Reimplante/métodos , Estudos Retrospectivos , Índices de Gravidade do Trauma
12.
Medicine (Baltimore) ; 99(38): e22004, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957318

RESUMO

BACKGROUND: Mannitol and hypertonic saline (HTS) are effective in reducing intracranial pressure (ICP) after severe traumatic brain injury (TBI). However, their efficacy on the ICP has not been evaluated rigorously. OBJECTIVE: To evaluate the efficacy of repeated bolus dosing of HTS and mannitol in similar osmotic burdens to treat intracranial hypertension (ICH) in patients with severe TBI. METHODS: The authors used an alternating treatment protocol to evaluate the efficacy of HTS with that of mannitol given for ICH episodes in patients treated for severe TBI at their hospital during 2017 to 2019. Doses of similar osmotic burdens (20% mannitol, 2 ml/kg, or 10% HTS, 0.63 ml/kg, administered as a bolus via a central venous catheter, infused over 15 minutes) were given alternately to the individual patient with severe TBI during ICH episodes. The choice of osmotic agents for the treatment of the initial ICH episode was determined on a randomized basis; osmotic agents were alternated for every subsequent ICH episode in each individual patient. intracranial pressure (ICP), mean arterial pressure (MAP), and cerebral perfusion pressure (CPP) were continuously monitored between the beginning of each osmotherapy and the return of ICP to 20 mm Hg. The duration of the effect of ICP reduction (between the beginning of osmotherapy and the return of ICP to 20 mm Hg), the maximum reduction of ICP and its time was recorded after each dose. Serum sodium and plasma osmolality were measured before, 0.5 hours and 3 hours after each dose. Adverse effects such as central pontine myelinolysis (CPM), severe fluctuations of serum sodium and plasma osmolality were assessed to evaluate the safety of repeated dosing of HTS and mannitol. RESULTS: Eighty three patients with severe TBI were assessed, including 437 ICH episodes, receiving 236 doses of HTS and 221 doses of mannitol totally. There was no significant difference between equimolar HTS and mannitol boluses on the magnitude of ICP reduction, the duration of effect, and the time to lowest ICP achieved (P > .05). The proportion of efficacious boluses was higher for HTS than for mannitol (P = .016), as was the increase in serum sodium (P = .038). The serum osmolality increased immediately after osmotherapy with a significant difference (P = .017). No cases of CPM were detected. CONCLUSION: Repeat bolus dosing of 10% HTS and 20% mannitol appears to be significantly and similarly effective for treating ICH in patients with severe TBI. The proportion of efficacious doses of HTS on ICP reduction may be higher than mannitol.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Diuréticos Osmóticos/uso terapêutico , Hipertensão Intracraniana/tratamento farmacológico , Hipertensão Intracraniana/etiologia , Manitol/uso terapêutico , Solução Salina Hipertônica/uso terapêutico , Adulto , Circulação Cerebrovascular/efeitos dos fármacos , Diuréticos Osmóticos/administração & dosagem , Diuréticos Osmóticos/efeitos adversos , Feminino , Humanos , Pressão Intracraniana/efeitos dos fármacos , Masculino , Manitol/administração & dosagem , Manitol/efeitos adversos , Pessoa de Meia-Idade , Solução Salina Hipertônica/administração & dosagem , Solução Salina Hipertônica/efeitos adversos , Índices de Gravidade do Trauma
13.
J Safety Res ; 74: 55-69, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32951796

RESUMO

INTRODUCTION: Although public buses have been demonstrated as a relatively safe mode of transport, the number of injuries to public bus passengers is far from negligible. Existing studies of public bus safety have focused primarily on injuries caused by collisions. Surprisingly, limited effort has been devoted to identifying factors that increase the severity of passenger injuries in non-collision incidents. METHOD: Our study therefore investigated the injury risk of public bus passengers involved in collision incidents and non-collision incidents comparatively, based on a police-reported dataset of 17,383 passengers injured on franchised public buses over a 10-year period in Hong Kong. A random parameters logistic model was established to estimate the likelihood of fatal and severe injuries to passengers as a function of various factors. RESULTS: Our results indicated substantial inconsistences in the effects of risk factors between models of non-collision injuries and collision injuries. The severity of passenger injuries tended to increase significantly when non-collision incidents occurred due to excessive speed of bus drivers, on double-decker buses, in less urbanized areas, in winter, in heavy rains, during daytime, and at night without street lighting. Elderly female passengers were also found more likely to be fatally or severely injured in non-collision incidents if they lost their balance while boarding, alighting from, or standing on a bus. In comparison, the following factors were associated with a greater likelihood of fatal or severe injuries in collision incidents: elderly female passengers, standing passengers who lost balance, buses out of driver control, double-decker buses, collisions with vehicles or objects, and less urbanized areas. Practical Applications: Based on our comparative analysis, more targeted countermeasures, namely "4E" (engineering, enforcement, emergency, and education) and "3A" (awareness, appreciation, and assistance), were recommended to mitigate collision injuries and non-collision injuries to public bus passengers, respectively.


Assuntos
Acidentes de Trânsito/prevenção & controle , Veículos Automotores , Índices de Gravidade do Trauma , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Hong Kong , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem
14.
Artigo em Inglês | MEDLINE | ID: mdl-32854407

RESUMO

Walking is a sustainable mode of transport which has well established health and environmental benefits. Unfortunately, hundreds of thousands of pedestrians lose their lives each year over the world due to involvement in road traffic crashes, and mid-blocks witness a significant portion of pedestrian fatalities. This study examined the direct and indirect effects of various contributing factors on the pedestrian injury severity in vehicle-pedestrian crashes at mid-blocks. Data of vehicle-pedestrian crashes during 2002-2009 were extracted from the NASS-GES, with pre-crash behaviors and injury severity included. The SEM path analysis method was applied to uncover the inter-relationships between the pedestrian injury severity and various explanatory variables. Both the direct and indirect effects of these explanatory variables on the pedestrian injury severity were calculated based on the marginal effects in the multinomial and ordered logit models. The results indicate some variables including number of road lanes and the age of pedestrian have indirect impacts on the injury severity through influencing the pre-crash behaviors. Although most indirect effects are relatively small compared with the direct effects, the results in this study still provide some valuable information to improve the overall understanding of pedestrian injury severity at mid-blocks.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Pedestres/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Adulto , Idoso , Feminino , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Características de Residência , Fatores de Risco , Envio de Mensagens de Texto , Índices de Gravidade do Trauma , Caminhada , Ferimentos e Lesões/epidemiologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-32785108

RESUMO

(1) Background: The COVID-19 pandemic poses substantial threats to Latinx farmworkers and other immigrants in food production and processing. Classified as essential, such workers cannot shelter at home. Therefore, knowledge and preventive behaviors are important to reduce COVID-19 spread in the community. (2) Methods: Respondents for 67 families with at least one farmworker (FWF) and 38 comparable families with no farmworkers (nonFWF) in North Carolina completed a telephone survey in May 2020. The survey queried knowledge of COVID-19, perceptions of its severity, self-efficacy, and preventive behaviors. Detailed data were collected to document household members' social interaction and use of face coverings. (3) Results: Knowledge of COVID-19 and prevention methods was high in both groups, as was its perceived severity. NonFWF had higher self-efficacy for preventing infection. Both groups claimed to practice preventive behaviors, though FWF emphasized social avoidance and nonFWF emphasized personal hygiene. Detailed social interactions showed high rates of inter-personal contact at home, at work, and in the community with more mask use in nonFWF than FWF. (4) Conclusions: Despite high levels of knowledge and perceived severity for COVID-19, these immigrant families were engaged in frequent interpersonal contact that could expose community members and themselves to COVID-19.


Assuntos
Infecções por Coronavirus/etnologia , Infecções por Coronavirus/prevenção & controle , Fazendeiros , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hispano-Americanos , Pandemias/prevenção & controle , Pneumonia Viral/etnologia , Pneumonia Viral/prevenção & controle , Betacoronavirus , Feminino , Comportamentos Relacionados com a Saúde , Habitação , Humanos , Masculino , North Carolina/epidemiologia , Autoeficácia , Índices de Gravidade do Trauma
16.
J Orthop Trauma ; 34(9): e336-e342, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32815848

RESUMO

OBJECTIVES: To evaluate the effect of the COVID-19 pandemic and the "shelter-in-place" order on orthopaedic trauma presenting to a community level II trauma center. It is hypothesized that the overall number of orthopaedic trauma encounters (OTEs), the number of OTEs related to both high and low severity injuries, and the proportion of OTEs related to high severity versus low severity injuries decreased compared with previous years. METHODS: A retrospective analysis was conducted of OTEs between 2016 and 2020. High and low severity OTEs were classified according to an algorithm created by the researchers. Data were statistically analyzed and compared with external data for traffic counts, motor vehicle accidents, and Transportation Security Administration checkpoints. RESULTS: A 45.1% decrease (P = 0.0005) was seen in OTEs from March and April 2016-2019 compared with 2020. The decrease began approximately 12 days before the shelter-in-place order. There was a 58.8% decrease in high severity injuries with a fracture (P = 0.013) and a 42.9% decrease in low severities injuries (P = 0.0003). The proportion of high to low severity OTEs was unchanged. CONCLUSIONS: The quantity of OTEs was significantly affected by the COVID-19 pandemic and Michigan shelter-in-place order. A decrease in both high and low severity OTEs was found; however, there was no statistically significant change in the ratio of high to low severity OTEs compared with previous years. Although it is difficult to determine what portion of the decrease in OTE is attributable to the shelter-in-place order versus the COVID-19 pandemic in general, data suggest both play a role. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of Levels of Evidence.


Assuntos
Betacoronavirus , Controle de Doenças Transmissíveis , Infecções por Coronavirus/prevenção & controle , Fraturas Ósseas/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Acidentes de Trânsito/estatística & dados numéricos , Algoritmos , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Isolamento Social , Centros de Traumatologia , Índices de Gravidade do Trauma
17.
Br J Anaesth ; 125(4): 505-517, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32747075

RESUMO

BACKGROUND: We aimed to study the associations between pre- and in-hospital tracheal intubation and outcomes in traumatic brain injury (TBI), and whether the association varied according to injury severity. METHODS: Data from the international prospective pan-European cohort study, Collaborative European NeuroTrauma Effectiveness Research for TBI (CENTER-TBI), were used (n=4509). For prehospital intubation, we excluded self-presenters. For in-hospital intubation, patients whose tracheas were intubated on-scene were excluded. The association between intubation and outcome was analysed with ordinal regression with adjustment for the International Mission for Prognosis and Analysis of Clinical Trials in TBI variables and extracranial injury. We assessed whether the effect of intubation varied by injury severity by testing the added value of an interaction term with likelihood ratio tests. RESULTS: In the prehospital analysis, 890/3736 (24%) patients had their tracheas intubated at scene. In the in-hospital analysis, 460/2930 (16%) patients had their tracheas intubated in the emergency department. There was no adjusted overall effect on functional outcome of prehospital intubation (odds ratio=1.01; 95% confidence interval, 0.79-1.28; P=0.96), and the adjusted overall effect of in-hospital intubation was not significant (odds ratio=0.86; 95% confidence interval, 0.65-1.13; P=0.28). However, prehospital intubation was associated with better functional outcome in patients with higher thorax and abdominal Abbreviated Injury Scale scores (P=0.009 and P=0.02, respectively), whereas in-hospital intubation was associated with better outcome in patients with lower Glasgow Coma Scale scores (P=0.01): in-hospital intubation was associated with better functional outcome in patients with Glasgow Coma Scale scores of 10 or lower. CONCLUSION: The benefits and harms of tracheal intubation should be carefully evaluated in patients with TBI to optimise benefit. This study suggests that extracranial injury should influence the decision in the prehospital setting, and level of consciousness in the in-hospital setting. CLINICAL TRIAL REGISTRATION: NCT02210221.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Intubação Intratraqueal/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índices de Gravidade do Trauma
18.
Br J Sports Med ; 54(19): 1136-1141, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32847810

RESUMO

Epidemiological studies of injury in elite and recreational golfers have lacked consistency in methods and definitions employed and this limits comparison of results across studies. In their sports-generic statement, the Consensus Group recruited by the IOC (2020) called for sport-specific consensus statements. On invitation by International Golf Federation, a group of international experts in sport and exercise medicine, golf research and sports injury/illness epidemiology was selected to prepare a golf-specific consensus statement. Methodological stages included literature review and initial drafting, online feedback from the consensus group, revision and second draft, virtual consensus meetings and completion of final version. This consensus statement provides golf-specific recommendations for data collection and research reporting including: (i) injury and illness definitions, and characteristics with golf-specific examples, (ii) definitions of golf-specific exposure measurements and recommendations for the calculation of prevalence and incidence, (iii) injury, illness and exposure report forms for medical staff and for golfers, and (iv) a baseline questionnaire. Implementation of the consensus methodology will enable comparison among golf studies and with other sports. It facilitates analysis of causative factors for injuries and illness in golf, and can also be used to evaluate the effects of prevention programmes to support the health of golfers.


Assuntos
Traumatismos em Atletas/epidemiologia , Métodos Epidemiológicos , Golfe/lesões , Traumatismos em Atletas/etiologia , Comportamento Competitivo , Coleta de Dados , Feminino , Inquéritos Epidemiológicos , Humanos , Incidência , Masculino , Condicionamento Físico Humano/efeitos adversos , Prevalência , Índices de Gravidade do Trauma
19.
Am Surg ; 86(8): 991-995, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32757761

RESUMO

BACKGROUND: The modified brain injury guidelines (mBIG) provide an algorithm for surgeons to manage some mild traumatic brain injury (TBI) with intracranial hemorrhage (ICH) without neurosurgical consultation or repeat imaging. Currently, antiplatelet use among patients with any ICH classifies a patient at the highest level, mBIG 3. This study assesses the risk of clinical progression among patients taking antiplatelet medications with mild TBI with ICH. METHODS: A retrospective analysis of patients with traumatic ICH over a 5-year period was conducted. Demographics, injury severity, and outcome data were collected for each patient. Patients taking antiplatelet agents were reclassified as if they were not taking these medications. Patients who would have met criteria for a lower classification (mBIG 1 or 2) without antiplatelet agents were designated mBIG 3 Antiplatelet and compared with all other mBIG 1 and 2 patients. RESULTS: 736 patients met the inclusion criteria. 158 patients were taking antiplatelet medications and 53 were reclassified as mBIG 3 Antiplatelet. When comparing mBIG 3 Antiplatelet to the 226 patients originally classified as mBIG 1 and 2, mBIG 3 Antiplatelet patients were more likely to undergo repeat head computed tomography (98.1% vs 76.6%; P < .001) and neurosurgical consultation (94.2% vs 76.5%; P < .001) but had no significant differences in outcomes. No mBIG 3 Antiplatelet patients had a worsening examination or needed operative intervention. DISCUSSION: This data suggests that antiplatelet medication use should not automatically classify a patient as mBIG 3. Adoption of this strategy would better utilize resources and avoid unnecessary costs without sacrificing care.


Assuntos
Concussão Encefálica/complicações , Tomada de Decisão Clínica/métodos , Hemorragia Intracraniana Traumática/etiologia , Inibidores da Agregação de Plaquetas/efeitos adversos , Índices de Gravidade do Trauma , Algoritmos , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Feminino , Humanos , Hemorragia Intracraniana Traumática/diagnóstico , Hemorragia Intracraniana Traumática/terapia , Masculino , Guias de Prática Clínica como Assunto , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
20.
Plast Reconstr Surg ; 146(2): 250e-251e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740632
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