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2.
J Oral Maxillofac Surg ; 78(11): 2042.e1-2042.e5, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33131549

RESUMO

PURPOSE: Self-inflicted gunshot wounds to the face are one of the most challenging clinical scenarios encountered by oral and maxillofacial surgeons. Knowledge is lacking regarding which factors might influence survival after these devastating injuries, especially pertaining to psychiatric history and substance use. The purpose of the present study was to evaluate the risk factors that might influence the survival of subjects with self-inflicted gunshot wounds to the face. MATERIALS AND METHODS: A retrospective cohort study was designed to analyze the data from subjects presenting to the University of Louisville Trauma Center with self-inflicted gunshot wounds to the face from February 2010 to September 2019. The predictor variables included demographic (eg, age, gender, race), medical and psychiatric history, and toxicology test results. The primary outcome variable was death before hospital discharge. Descriptive, bivariate, and logistic regression models were computed. RESULTS: The sample included 120 subjects, with an age range of 16 to 85 years old (average age, 43.5 years); 90.8% were male, and 56.7% had survived their suicide attempt. Of the 120 patients, 35% had a history of depression, 23.3% tested positive for benzodiazepines, and 33% had a social history positive for smoking, alcohol use, and/or drug use. Depression was the single largest predictor of mortality. Patients with depression were significantly more likely to survive their injuries than were patients without depression (odds ratio, 0.230; P = .003). The presence of benzodiazepines in toxicology tests was also a significant predictor of mortality (odds ratio, 0.297; P = .018); patients testing positive were more likely to survive than were patients with negative test results or positive test results for other drugs. CONCLUSIONS: Subjects who attempt suicide via self-inflicted gunshot wounds to the face were more likely to survive their injury if they had a reported history of depression or test results positive for a benzodiazepine.


Assuntos
Automutilação , Ferimentos por Arma de Fogo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tentativa de Suicídio , Centros de Traumatologia , Adulto Jovem
3.
BMJ Open ; 10(10): e041772, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33082198

RESUMO

OBJECTIVES: Assess the impacts of the COVID-19 pandemic on service delivery by frontline healthcare providers in acute care medical and emergency department settings and identify strategies used to cope with pandemic-related physical and mental health demands. DESIGN: Rapid clinical ethnography of patient-provider encounters during an initial pandemic 'surge' conducted by a team of clinician-researchers using a structured protocol for qualitative data collection and analysis. SETTING: Level 1 trauma centre at Harborview Hospital in Seattle Washington in April 2020. PARTICIPANTS: Frontline clinical providers serving as participant observers during performance of their clinical duties recorded observations and summaries of conversations with other providers and patients. RESULTS: We identified four different kinds of impacts: procedural, provider, patient and overall. Each impact highlighted two or more levels of a socioecological model of services delivery: (1) the epidemiology of COVID-19, (2) outer setting, (3) inner or organisational setting and (4) individual patient and provider. Despite significant changes in procedures that included COVID-19 screening of all admitted patients, social distancing and use of personal protective equipment, as well as changes in patient and provider behaviour, the overall impact of the pandemic on the emergency department and acute care service delivery was minimal. This is attributed to having a smaller surge than expected, a quick response by the healthcare system to anticipated demands for service delivery and protection of patients and providers, adequate supplies and high provider morale. CONCLUSIONS: Although limited to one setting in one healthcare system in one community, the findings offer some important lessons for healthcare systems that have yet to be impacted as well as systems that have been more severely impacted. Each of the socioecological framework levels was found to impact service delivery to patients, and variations at each of these levels account for variations in that quality of care globally.


Assuntos
Atitude do Pessoal de Saúde , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Pesquisa Qualitativa , Centros de Traumatologia/estatística & dados numéricos , Humanos , Washington/epidemiologia
4.
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
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5718-5721, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019273

RESUMO

Manually documented trauma flow sheets contain critical information regarding trauma resuscitations in the emergency department (ED). The American College of Surgeons (ACS) has enforced certain thresholds on trauma surgeons' arrival time to the trauma bay. Due to the complex and fast-paced ED environment, this information can be easily overlooked or erroneously recorded, affecting compliance with ACS standards. This paper is a retrospective study conducted at a Level I trauma center equipped with an RFID system to investigate an automated solution to evaluate and improve the accuracy of measuring trauma surgeons' response time to the highest level (red) trauma activations.Clinical Relevance- Demonstration of timely response to trauma activations is required for ACS verification. As real-time location systems become more prevalent, they may improve a hospital's ability to report accurate response times for trauma team activations.


Assuntos
Dispositivo de Identificação por Radiofrequência , Serviço Hospitalar de Emergência , Ressuscitação , Estudos Retrospectivos , Centros de Traumatologia
6.
Can J Surg ; 63(5): E422-E430, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33009903

RESUMO

BACKGROUND: Failure to rapidly identify bleeding in trauma patients leads to substantial morbidity and mortality. We aimed to develop and validate a simple bedside score for identifying bleeding patients requiring escalation of care beyond initial resuscitation. METHODS: We included patients with major blunt or penetrating trauma, defined as those with an Injury Severity Score greater than 12 or requiring trauma team activation, at The Ottawa Hospital from September 2014 to September 2017. We used logistic regression for derivation. The primary outcome was a composite of the need for massive transfusion, embolization or surgery for hemostasis. We prespecified clinical, laboratory and imaging predictors using findings from our prior systematic review and survey of Canadian traumatologists. We used an AIC-based stepdown procedure based on the Akaike information criterion and regression coefficients to create a 5-variable score for bedside application. We used bootstrap internal validation to assess optimism-corrected performance. RESULTS: We included 890 patients, of whom 133 required a major intervention. The main model comprised systolic blood pressure, clinical examination findings suggestive of hemorrhage, lactate level, focused assessment with sonography in trauma (FAST) and computed tomographic imaging. The C statistic was 0.95, optimism-corrected to 0.94. A simplified Canadian Bleeding (CAN-BLEED) score was devised. A score cut-off of 2 points yielded sensitivity of 97.7% (95% confidence interval [CI] 93.6 to 99.5) and specificity 73.2% (95% CI 69.9 to 76.3). An alternative version that included mechanism of injury rather than CT had lower discriminative ability (C statistic = 0.89). CONCLUSION: A simple yet promising bleeding score is proposed to identify highrisk patients in need of major intervention for traumatic bleeding and determine the appropriateness of early transfer to specialized trauma centres. Further research is needed to evaluate the performance of the score in other settings, define interrater reliability and evaluate the potential for reduction of time to intervention.


Assuntos
Hemorragia/diagnóstico , Modelos Biológicos , Triagem/métodos , Ferimentos não Penetrantes/complicações , Ferimentos Penetrantes/complicações , Adulto , Transfusão de Sangue/estatística & dados numéricos , Canadá/epidemiologia , Tomada de Decisão Clínica , Embolização Terapêutica/estatística & dados numéricos , Feminino , Hemorragia/epidemiologia , Hemorragia/etiologia , Hemorragia/terapia , Hemostasia Cirúrgica/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Transferência de Pacientes/estatística & dados numéricos , Estudos Prospectivos , Reprodutibilidade dos Testes , Medição de Risco/métodos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos não Penetrantes/terapia , Ferimentos Penetrantes/terapia
7.
Einstein (Sao Paulo) ; 18: eAO5448, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32965298

RESUMO

OBJECTIVE: To characterize the processes of brain death diagnosis and organ donation in a reference trauma center. METHODS: Observational and cross-sectional study with patients notified with brain death at a reference trauma center. Data were obtained through the collection of medical records and brain death declaration forms. RESULTS: One hundred fity-nine patients were notified with brain death, mostly male (82.6%), young adults (97.61%) and victims of brain traumatic injury (93.7%). Median of the total time interval for the diagnosis of brain death was 20.75 hours, with no difference between organ donors and non-donors. We had excessive time intervals on brain death declaration, but without statistical effect on organ donation numbers. CONCLUSION: We had low efficacy in brain death declaration based on longer time intervals, with no impact on organ donation.


Assuntos
Morte Encefálica , Transplante de Órgãos , Obtenção de Tecidos e Órgãos , Estudos Transversais , Humanos , Masculino , Estudos Retrospectivos , Doadores de Tecidos , Centros de Traumatologia , Adulto Jovem
8.
Am Surg ; 86(9): 1106-1112, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32967437

RESUMO

INTRODUCTION: Preinjury alcohol use and older age have independently been associated with poor outcomes. This study examined whether higher levels of blood alcohol concentration (BAC) correlated with an increased likelihood of poor outcomes in older trauma patients. METHODS: This was a retrospective cohort study of injured patients ≥65 years with BAC testing presenting to a Level 1 trauma center between 2015 and 2018. Patients were stratified by BAC at 4 thresholds of intoxication: BAC ≧10 mg/dL, BAC ≧80 mg/dL, BAC ≧150 mg/dL, and BAC ≧200 mg/dL. Propensity score matching using inverse probability of treatment weighting was used to estimate outcomes. Logistic and Poisson regression models were performed for each threshold of the BAC level with the matched cohort to assess clinical outcomes. RESULTS: Of all older patients (n = 3112), 32.5% (n = 1012) had BAC testing. In the matched cohort of 883 patients (76.7 ± 8.2 years; 48.1% female), 111 (12.5%) had BAC ≧10 mg/dL, 83 (74.8%) had BAC ≧80 mg/dL, 60 (54.1%) had BAC ≧150 mg/dL, and 37 (33.3%) had BAC ≧200 mg/dL. Falls (60.5%) and motor vehicle crashes (28.9%) were the most common mechanisms of injury. Median (IQR) of Injury Severity Score (ISS) was 5 (1-10). The risk of severe injury (ISS ≧15) was similar between alcohol-positive and alcohol-negative patients (9.9% vs 15.0%, P = .151). BAC ≧10 g/dL was not associated with length of stay, intensive care unit admission, or in-hospital complication, nor was any of the other 3 analyzed BAC thresholds. CONCLUSION: Overall, any detectable BAC along and increasing thresholds of BAC was not associated with poor in-hospital outcomes of older patients after trauma. Alcohol screening was low in this population, and intoxication may bias injury assessment, leading to mistriage of older trauma patients.


Assuntos
Intoxicação Alcoólica/sangue , Concentração Alcoólica no Sangue , Medição de Risco/métodos , Centros de Traumatologia , Ferimentos e Lesões/sangue , Idoso , Intoxicação Alcoólica/complicações , Feminino , Seguimentos , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , North Carolina/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/prevenção & controle
9.
Medicine (Baltimore) ; 99(39): e22279, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991428

RESUMO

PURPOSE: The aim of this study was to have a comprehensive evaluation of the effect of trauma care systems on the mortality of injured adult patients. MATERIALS AND METHODS: This protocol established in this study has been reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Web of Science, PubMed, EMBASE, Scopus, and the Cochrane Library were searched for all clinical trials evaluating the effect of trauma care systems on the mortality of injured adult patients until July 31, 2020. We will use a combination of Medical Subject Heading and free-text terms with various synonyms to search based on the eligibility criteria. Two investigators independently reviewed the included studies and extracted relevant data. The odds ratio (OR) and 95% confidence intervals (CIs) were used as effect estimate. I-square (I) test, substantial heterogeneity, sensitivity analysis, and publication bias assessment will be performed accordingly. Stata 15.0 and Review Manger 5.3 are used for meta-analysis and systematic review. RESULTS: The results will be published in a peer-reviewed journal. CONCLUSION: The results of this review will be widely disseminated through peer-reviewed publications and conference presentations. This evidence may also provide a comprehensive evaluation of the effect of trauma care systems on the mortality of injured adult patients. REGISTRATION NUMBER: INPLASY202080058.


Assuntos
Revisão da Pesquisa por Pares/métodos , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/mortalidade , Adulto , Ensaios Clínicos como Assunto , Humanos , Viés de Publicação , Sensibilidade e Especificidade , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia
10.
S Afr Med J ; 110(7): 667-670, 2020 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-32880345

RESUMO

BACKGROUND: Trauma in pregnancy poses a unique challenge to clinicians. Literature on this topic is limited in South Africa (SA). OBJECTIVES: To review our institution's experience with the management of trauma in pregnancy in a developing-world setting. METHODS: This study was based at Grey's Hospital, Pietermaritzburg, SA. All pregnant patients who were admitted to our institution following trauma between December 2012 and December 2018 were identified from the Hybrid Electronic Medical Registry (HEMR). RESULTS: During the 6-year study period, 2 990 female patients were admitted by the Pietermaritzburg Metropolitan Trauma Service (PMTS), of whom 89 were pregnant. The mean age of these patients was 25.64 (range 17 - 43) years. The mechanism of injury was road traffic crash (RTC) in 39, stab wounds (SW) in 19, assault other than SW or gunshot wounds (GSW) in 19, GSW in 8, snake bite in 5, impalement in 1, dog bite in 1, hanging in 1, sexual assault in 1 and a single case of a patient being hit by a falling object. A subset of patients sustained >1 mechanism of injury. Thirty patients were managed operatively. The mean time of gestation was 19.16 (5 - 36) weeks. Three patients died, and there were 16 fetal deaths (including 3 lost after the mother's death). Forty-five fetuses were recorded as surviving at discharge, while 25 fetal outcomes were not specifically recorded. There were 2 threatened miscarriages and/or patients with vaginal bleeding, 1 positive pregnancy test with no recorded outcome and no premature births as a result of trauma. CONCLUSIONS: Trauma in pregnancy is relatively uncommon and mostly due to a RTC or deliberately inflicted trauma. Fetal outcome is largely dependent on the severity of the maternal injury, with injuries requiring laparotomy leading to a high fetal mortality rate.


Assuntos
Complicações na Gravidez/epidemiologia , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Feminino , Morte Fetal , Humanos , Gravidez , Complicações na Gravidez/cirurgia , África do Sul/epidemiologia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Centros de Traumatologia , Ferimentos e Lesões/cirurgia , Adulto Jovem
12.
Unfallchirurg ; 123(11): 862-869, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-32986217

RESUMO

BACKGROUND: As part of the COVID-19 pandemic, political decisions were made to reduce social interaction and to reduce the number of infections. The aim was to create capacities for the in-hospital care of the patients. OBJECTIVE: The aim of the study was to check whether a reduction in the number of trauma patients compared to the mean of the previous 3 years could be observed. MATERIAL AND METHODS: We retrospectively analyzed all patients who presented in the emergency admission from 1 March to 15 April 2020 with the mean of the patients from the previous 3 years 2017-2019. The age of the patients, time of presentation, diagnoses, whereabouts of the patients, inpatient or outpatient, number and duration of the operative care and required capacity on the normal ward and intensive care units (ICU) were recorded. The injury mechanism was also examined. RESULTS: A total of 4967 patients between 1 March and 15 April were included. On average over the 3 previous years, a total of 1348 patients, i.e. 29.3 patients per day were counted in our emergency room. In 2020 a total of 923, i.e. 20 patients per day (p < 0.01) were counted. On average 227 (24.6%) were admitted to hospital compared to 311.5 (23.1%) in 2020. On average 143 operations were performed compared to 136 in 2020. The days on the ward were reduced from 2442 on average for the previous years, in 2020 to 1172 days by 52.1% (p < 0.01). The number of days on the ICU was 450 days on average in previous years and 303 days in 2020 (-32.7%, p < 0.01). CONCLUSION: The number of patients in the emergency admission was significantly reduced in the observation period in 2020 compared to the mean of the previous 3 years. This directly made resources available for the care of COVID-19 patients.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Centros de Traumatologia/estatística & dados numéricos , Betacoronavirus , Humanos , Pandemias , Estudos Retrospectivos
13.
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
14.
J Orthop Trauma ; 34(9): e343-e348, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32815849

RESUMO

OBJECTIVES: To compare orthopaedic trauma volume and mechanism of injury before and during statewide social distancing and stay-at-home directives. DESIGN: Retrospective. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: One thousand one hundred thirteen patients sustaining orthopaedic trauma injuries between March 17 and April 30 of years 2018, 2019, and 2020. INTERVENTION: Statewide social distancing and stay-at-home directives. MAIN OUTCOME MEASUREMENTS: Number of consults, mechanism of injury frequency, and type of injury frequency. RESULTS: During the COVID-19 pandemic, orthopaedic trauma consult number decreased. Injuries due to gunshot wounds increased and those due to automobile versus pedestrian accidents decreased. Time-to-presentation increased and length of stay decreased. Operative consults remained unchanged. CONCLUSIONS: Orthopaedic trauma injuries continued to occur during the COVID-19 pandemic at an overall decreased rate, however, with a different distribution in mechanism and type of injury. 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 , Isolamento Social , Centros de Traumatologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Idoso , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Adulto Jovem
15.
Rev Col Bras Cir ; 47: e20202533, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32844914

RESUMO

PURPOSE: to trauma quality indicators as a tool to identify opportunities of improvement in elderly trauma patient's' treatment. METHODS: prospective analysis of data collected between 2014-2015, and stored in the iTreg software (by Ecossistemas). Trauma victims, aged older than 60 years and trauma quality indicators were assessed, based on those supported by SBAIT in 2013: (F1) Acute subdural hematoma drainage after 4 hours from admission, in patients with GCS<9; (F2) emergency room transference without definitive airway and GCS <9; (F3) Re-intubation within 48 hours from extubation; (F4) Admission-laparotomy time greater than 60 min. in hemodynamically uinstable patients with abdominal bleeding; (F5) Unprogrammed reoperation; (F6) Laparotomy after 4 hours from admission; (F7) Unfixed femur diaphyseal fracture; (F8) Non-operative treatment for abdominal gunshot; (F9) Admission-tibial exposure fracture treatment time greater than 6 hours; (F10) Surgery after 24 from admission. The indicators, treatments, adverse effects and deaths were analyzed, using the SPSS software, and the chi-squared and Fisher tests were used to calculate the statistical relevance. RESULTS: from the 92 cases, 36 (39,1%) had complications and 15 (16,3%) died. The adequate use of quality indicator's were substantially different among those who survived (was of 12%) compared to those who died (55,6%). The incidence of complications was of 77,8% (7/9) in patients with compromised indicators and 34,9% (28/83) in those without (p=0.017). CONCLUSIONS: trauma quality indicators are directly related with the occurrence of complications and deaths, in elderly trauma patients.


Assuntos
Extubação , Hematoma Subdural Agudo/cirurgia , Laparotomia , Centros de Traumatologia/normas , Ferimentos e Lesões/cirurgia , Idoso , Atenção , Feminino , Cirurgia Geral , Hemorragia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
16.
Malawi Med J ; 32(1): 24-30, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32733656

RESUMO

Introduction: Globally, the burden of interpersonal violence and its significant impact on mortality, morbidity and disability makes it a major public health problem which necessitates intervention. This article examines characteristics of victims of interpersonal violence and violent events in Malawi. The focus is on a population that has been traditionally neglected in literature. Methods: Queen Elizabeth Central Hospital (QECH) maintains a trauma registry with data that is prospectively collected. Patients offered trauma care after interpersonal violence from May 2013 to May 2015 were evaluated. Results: There were 1431 patients with violent events recorded at the Adult Emergency Trauma Centre (AETC) with a male predominance of 79.5%. The dominant age group was young adults between 25-29 years old (22%). Most attacks occurred during cold and dry season (46.9%) and most common location was on the road (37.2%). Alcohol use by victims was recorded in 10.5% of cases. Soft tissue injuries were the most common injuries sustained (74.1%). Most patients were treated as outpatients (80.9%). There were two deaths. At multivariate analysis, women had a lower risk of interpersonal violence as compared to men, (OR 0.82 [0.69-0.98]). Victims' use of alcohol was associated with increased risk of assault (OR 1.63 [1.27-2.10]). As compared to other places, odds of being assaulted were higher at home (OR 1.62 [1.27-2.06]) but lower at work (OR 0.68 [0.52-0.89) and on the road (OR 0.82 [0.65-1.03]). Odds of being assaulted were higher in the cold and dry season as compared to hot and dry season, (OR 1.26 [1.08-1.47]). Conclusion: Young males were most involved in interpersonal violence. Location of injury and seasonal variation were significant factors associated with interpersonal violence and most commonly sustained injuries were soft tissue injuries. These findings will help in identifying targeted interventions for interpersonal violence in Malawi and other low-and-middle-income countries (LMICs).


Assuntos
Violência Doméstica/estatística & dados numéricos , Relações Interpessoais , Centros de Traumatologia/estatística & dados numéricos , Violência/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Intoxicação Alcoólica/epidemiologia , Feminino , Humanos , Malaui/epidemiologia , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Distribuição por Sexo , Fatores Sexuais , Violência/classificação , Adulto Jovem
18.
Am J Nurs ; 120(9): 36-43, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32858696

RESUMO

Optimal management of trauma-related hemorrhagic shock begins at the point of injury and continues throughout all hospital settings. Several procedures developed on the battlefield to treat this condition have been adopted by civilian health care systems and are now used in a number of nonmilitary hospitals. Despite the important role nurses play in caring for patients with trauma-related hemorrhagic shock, much of the literature on this condition is directed toward paramedics and physicians. This article discusses the general principles underlying the pathophysiology and clinical management of trauma-related hemorrhagic shock and updates readers on nursing practices used in its management.


Assuntos
Serviços Médicos de Emergência/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Choque Hemorrágico/terapia , Centros de Traumatologia/organização & administração , Hemorragia/terapia , Hemostáticos/uso terapêutico , Humanos , Traumatismo Múltiplo/complicações , Choque Hemorrágico/enfermagem , Gestão da Qualidade Total
19.
Plast Reconstr Surg ; 146(2): 332-338, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740583

RESUMO

BACKGROUND: Local health care facilities are often unequipped to treat complex upper extremity injuries, and patients are therefore transferred to designated trauma centers. This study describes the characteristics of patients transferred to a Level I trauma center for hand and upper extremity injuries and to investigate the accuracy of the provided diagnosis at the time of referral. METHODS: Adult patients transferred from outside facilities to the authors' Level I trauma center by means of direct contract with the on-call fellow for the care of hand and upper extremity injuries were identified. Patient- and injury-related information was prospectively collected at the time of referral before patient transfer, and again following diagnostic evaluation by a hand surgeon at the authors' institution. RESULTS: Sixty-three patients were transferred to the authors' hand surgery service from outside facilities after direct contact with the on-call fellow. Most patients were referred by emergency medicine physicians [n = 47 (76 percent)], followed by midlevel emergency department providers (physician assistant or nurse practitioner) [n = 12 (19 percent)] or hand surgeons [n = 3 (5 percent)]. Six patients were transferred directly from a Level I trauma center. Twenty-one transferred patients (33 percent) had an inaccurate diagnosis at the time of referral. Factors associated with an inaccurate diagnosis included trauma level of the referring hospital and diagnoses of infection or dysvascularity. CONCLUSIONS: The diagnostic accuracy for hand injuries transferred from outside facilities by means of provider-to-provider communication is imperfect, and some injuries are misdiagnosed. Hand surgeons should continue to improve the triage and transfer process for patients with acute hand surgery injuries. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.


Assuntos
Traumatismos do Braço/diagnóstico , Traumatismos da Mão/diagnóstico , Sobremedicalização/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Triagem/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Encaminhamento e Consulta/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Adulto Jovem
20.
Plast Reconstr Surg ; 146(2): 366-370, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740589

RESUMO

Computed tomographic scans are frequently obtained following craniomaxillofacial fracture reconstruction. The additive radiation from such scans is not trivial; cumulative radiation exposure poses stochastic health risks. In this article, the authors postulate that a low-dose computed tomography protocol provides adequate image quality for postoperative evaluation of reconstructed craniomaxillofacial fractures. This study included patients for whom a computed tomographic scan was indicated following craniomaxillofacial fracture repair at a Level I trauma center. Postoperative craniomaxillofacial computed tomography was performed using a low-dose protocol, rather than standard protocols. A craniomaxillofacial surgeon and a radiologist interpreted the images to determine whether they were of sufficient quality. It was decided a priori that any inadequate low-dose computed tomography would require repeated scanning using standard protocols. The primary endpoint was the need for repeated computed tomography. In addition, the clarity of clinically significant anatomical landmarks on the images was graded on a five-point Likert scale. Twenty patients were scanned postoperatively using the low-dose protocol. Mean radiation dose (total dose-length product) from the low-dose protocol was 71 mGy · cm versus 532 mGy · cm for the preoperative computed tomographic scans that were obtained using conventional protocols (p < 0.001). All 20 low-dose computed tomographic scans were determined to provide satisfactory image quality. No patients required repeated computed tomography secondary to poor image quality. Low-dose computed tomography received high image-quality scores. A low-dose computed tomography protocol that delivers approximately 7.5-fold less radiation than the standard protocols was found to be adequate for postoperative evaluation of craniomaxillofacial fractures. Larger prospective studies may be warranted. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Assuntos
Fixação de Fratura , Cuidados Pós-Operatórios/métodos , Doses de Radiação , Fraturas Cranianas/cirurgia , Tomografia Computadorizada por Raios X/métodos , Humanos , Projetos Piloto , Cuidados Pós-Operatórios/efeitos adversos , Fraturas Cranianas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/efeitos adversos , Centros de Traumatologia , Resultado do Tratamento
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