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1.
J Surg Res ; 245: 163-167, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31419641

RESUMO

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


Assuntos
Cuidados de Suporte Avançado de Vida no Trauma/normas , Medição de Risco/métodos , Choque/classificação , Índices de Gravidade do Trauma , Ferimentos e Lesões/complicações , Adulto , Idoso , Transfusão de Sangue/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Choque/diagnóstico , Choque/etiologia , Choque/mortalidade , Análise de Sobrevida , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/terapia , Adulto Jovem
2.
Zhonghua Shao Shang Za Zhi ; 35(5): 326-332, 2019 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-31154729

RESUMO

Objective: To analyze the relationship between serum lactic acid value and risk of death in patients with extensive burn during shock stage and the related influencing factors. Methods: Clinical data of 127 patients (111 males and 16 females) with extensive burn admitted to Institute of Burn Research of the First Affiliated Hospital of Army Medical University from January 2009 to December 2013 and Department of Plastic Surgery and Burns of the Affiliated Hospital of Southwest Medical University from January 2016 to December 2018, who met the admission criteria, were retrospectively analyzed. The patients aged 21 to 62 years, with total burn area more than 50% total body surface area. All patients were treated with antishock therapy after admission. (1) According to the treatment outcome, the patients were divided into survival group (n=98) and death group (n=29). The gender, age, total burn area, partial-thickness burn area, full-thickness burn area, abbreviated burn severity index (ABSI), admission time after injury, number of patients with inhalation injury, number of patients with acute renal failure, and serum lactic acid values on admission and at post admission hour (PAH) 12, 24, 36, and 48 were recorded. (2) According to the optimal positive cut-off value of serum lactic acid 48 hours after admission, the patients were divided into high lactic acid group and normal lactic acid group. Age, gender, total burn area, indexes at PAH 48 including urea nitrogen, creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total serum bilirubin, alkaline phosphatase (ALP), albumin, white blood cell count, platelet count, lymphocyte count, prothrombin time (PT), hematocrit value, oxygenation index, respiratory index (RI), the alveolar-arterial oxygen partial pressure difference, mean arterial pressure (MAP) at PAH 48, the average urine volume within 48 hours after admission, the total volume of intravenous fluid infusion within 48 hours after admission, the volume of fluid infusion per kilogram of body mass within the first 24 hours after admission, the volume of fluid infusion per one percent of body surface area per kilogram of body mass within the first 24 hours after admission, the volume of urine per kilogram of body mass per hour within the first 24 hours after admission, and the percentage of hospital death were recorded. Data were processed with t test, chi-square test, and Fisher's exact probability test. Cox regression analysis was used to screen independent risk factors affecting the prognosis of patients. Receiver operating characteristic curve (ROC) of serum lactic acid value at PAH 48 of 127 patients was drawn to predict patients' death and determine the optimal positive cut-off value. Multivariate logistic regression analysis was used to screen independent risk factors causing increase of serum lactic acid. Results: (1) There were significantly statistical differences in total burn area, full-thickness burn area, and ABSI of patients between survival group and death group (t=6.257, 4.476, 5.727, P<0.01), while other indexes between the two groups were close. (2) The serum values of lactic acid of patients in death group on admission and at PAH 12, 24, 36, and 48 were (4.00±0.28), (4.50±0.26), (4.02±0.31), (3.48±0.22), (3.40±0.19) mmol/L, respectively, which were significantly higher than those in survival group [(3.30±0.21), (3.20±0.19), (2.33±0.17), (1.85±0.18), (1.50±0.09) mmol/L, t=14.552, 29.603, 38.133, 40.648, 74.973, P<0.05 or P<0.01]. (3) Cox regression analysis showed that the serum value of lactic acid at PAH 48 was the independent risk factor affecting the prognosis of patients, with risk ratio of 1.853 and 95% confidence interval of 1.342-2.559, P<0.01. (4) The total area under ROC of serum value of lactic acid at PAH 48 to predict death of 127 patients was 0.811, with 95% confidence interval of 0.699-0.924, P<0.01. The optimal positive cut-off value of serum value of lactic acid was 1.75 mmol/L, with sensitivity of 75.0% and specificity of 79.5% for predicting death. (5) There were significantly statistical differences in total burn area, ALT, AST, ALP, PT, total serum bilirubin, total volume of intravenous fluid infusion within 48 hours after admission, volume of fluid infusion per kilogram of body mass within the first 24 hours after admission, and percentage of hospital deaths of patients between high lactic acid group (n=34) and normal lactic acid group (n=93), t=3.592, 6.797, 10.367, 2.089, 2.880, 4.517, 2.984, 4.044, χ(2)=58.498, P<0.05 or P<0.01, while other indexes were close between the two groups. (6) Multivariate logistic regression analysis showed that AST and total serum bilirubin were independent risk factors for increase of serum lactic acid, with odds ratios of 1.021 and 1.064 and 95% confidence intervals of 1.001-1.040 and 1.001-1.132, P<0.05. Conclusions: Serum value of lactic acid at PAH 48 can independently predict the death of patients with extensive burns. Liver injury is an important risk factor causing hyperlacticemia during burn shock stage. Widespread increase of vascular permeability and large amount of fluid resuscitation are the core factors leading to aggravation of abdominal organ injury.


Assuntos
Queimaduras/sangue , Ácido Láctico/sangue , Choque/mortalidade , Adulto , Queimaduras/mortalidade , Feminino , Hidratação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Albumina Sérica , Índice de Gravidade de Doença , Resultado do Tratamento
3.
Cardiovasc J Afr ; 30(2): e1-e6, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31155635

RESUMO

INTRODUCTION: Acute circulatory failure is a life-threatening emergency whose prognosis depends on early management and aetiological diagnosis. The aim of our study was to assess the epidemiological, aetiological, therapeutic and prognostic aspects of acute circulatory failure in two cardiology departments in Dakar. METHODS: This was a longitudinal, multicentre, descriptive study over a period of six months from October 2014 to March 2015. We included all patients with acute circulatory failure (systolic blood pressure < 90 mmHg, oligoanuria, tachycardia, tachypnoea, onset of altered consciousness) either on admission or during hospitalisation during the study period. A long-term survival survey (six months to one year) was conducted on all included patients. RESULTS: Forty-four patients were enrolled. The average age was 54.9 years, ranging from 20 to 83 years. The gender ratio was 1.1. Acute circulatory failure occurred most often during hospitalisation (63%), with known cardiomyopathy in 47.7% of cases. Consciousness was impaired in 11 patients while oligoanuria was present in 27.3% of cases. Inflammatory syndrome was mostly found in 63.6% of cases and renal insufficiency and acute liver failure were reported in 45.5 and 29.5% of patients, respectively. Left ventricular dysfunction was the most common echocardiographic feature (70%). Acute circulatory failure was cardiogenic in most cases, with a predominance of advanced dilated cardiomyopathy (44.9%). Septic shock was found in 25% of patients, with pulmonary infection as the main location (20%). Nine per cent of patients had hypovolaemic shock. The most used inotropic drug was dobutamine in 79.5% of cases, followed by adrenaline (18.2%) and norepinephrine (4.5%). Intra-hospital mortality rate was high (52.3%) and one-year survival rate was 27.2%. Poor prognostic factors such as advanced age and renal impairment were associated with a higher overall mortality rate of 18 to 90%, with no statistical significance. CONCLUSIONS: Acute circulatory failure is a diagnostic and therapeutic emergency with a high mortality rate.


Assuntos
Serviço Hospitalar de Cardiologia , Choque/terapia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Fatores de Risco , Senegal , Choque/diagnóstico , Choque/mortalidade , Choque/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
4.
J Wound Care ; 28(6): 317-322, 2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31166860

RESUMO

OBJECTIVE: Self-inflicted burns typically result in extensive injuries requiring intensive care and attention in a specialised burn unit. Burn units should be familiar with the optimal management of self-inflicted burns, including the psychological and psychiatric treatment. This paper describes the experiences of managing these challenging injuries in a German burn centre. METHODS: A retrospective review of patients with self-inflicted burns admitted to the burn centre between 2000 and 2017. Demographics, details of injury, presence of psychiatric disorder, clinical course, operative management and patient outcomes were recorded and compared with a control group without self-inflicted burns. Outcome measures included graft take rate, complications and need for further surgery. RESULTS: There were a total of 2055 burn patient admissions, with 17 cases (0.8%) of self-inflicted burns. The mean age was 36±11 years with an mean percentage total body surface area (%TBSA) burned of 43.5±22.5% which was not significantly different from the control group (p=0.184). Schizophrenia and personality disorder were the most common diagnoses in the self-inflicted burns patients (n=11; 65%). Of these, four had sustained previous self-inflicted burns. Length of hospital stay was significantly longer in the self-inflicted burn group than in the control group (49.0±16.7 days, respectively, p=0.002). CONCLUSION: Attempted suicide by self-inflicted burns represents <1% of burn admissions. This population demonstrates a high incidence of prior psychiatric disorders. Successful treatment includes multidisciplinary management of acute medical, surgical, and psychiatric care.


Assuntos
Queimaduras/terapia , Hidratação , Transtornos Mentais/psicologia , Transplante de Pele , Tentativa de Suicídio , Escala Resumida de Ferimentos , Adolescente , Adulto , Idoso , Asfixia/mortalidade , Unidades de Queimados , Queimaduras/mortalidade , Queimaduras/psicologia , Estudos de Casos e Controles , Causas de Morte , Cuidados Críticos , Transtorno Depressivo Maior/psicologia , Feminino , Alemanha , Insuficiência Cardíaca/mortalidade , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Mortalidade , Insuficiência de Múltiplos Órgãos/mortalidade , Traumatismo Múltiplo/mortalidade , Transtornos da Personalidade/psicologia , Transtornos Psicóticos/psicologia , Estudos Retrospectivos , Esquizofrenia , Comportamento Autodestrutivo/terapia , Choque/mortalidade , Adulto Jovem
5.
Arch Cardiovasc Dis ; 112(6-7): 441-449, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31253558

RESUMO

Emergent implantation of temporary mechanical circulatory support using venoarterial ECMO (ECLS for extracorporeal Life Support) is increasingly adopted in various indications of acute circulatory failure refractory to optimal medical treatment. To implant such devices, but also to provide appropriate daily management, expertise and adapted technical platform are required. Organization, coordination and regulation of such program are not clearly established in our country. We propose a dedicated territorial organization to improve and facilitate management of these specific and most severe patients.


Assuntos
Prestação Integrada de Cuidados de Saúde/normas , Oxigenação por Membrana Extracorpórea/normas , Choque/terapia , Doença Aguda , Consenso , Prestação Integrada de Cuidados de Saúde/organização & administração , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/instrumentação , Oxigenação por Membrana Extracorpórea/mortalidade , França , Humanos , Modelos Organizacionais , Equipe de Assistência ao Paciente/normas , Choque/diagnóstico , Choque/mortalidade , Choque/fisiopatologia , Resultado do Tratamento
6.
J Pediatr Surg ; 54(5): 984-988, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30952455

RESUMO

BACKGROUND: Studies have demonstrated the superiority of the shock index, pediatric age-adjusted (SIPA) in predicting outcomes in pediatric blunt trauma patients. However, all have utilized SIPA calculated on emergency department (ED) arrival. We sought to evaluate the utility of SIPA at the trauma scene and describe changes in SIPA from the trauma scene to the ED. METHODS: We used 2014-2016 Trauma Quality Improvement Program Data to identify blunt trauma patients 1-15 years old with an injury severity score (ISS) > 15. We calculated SIPA using vitals obtained at the trauma scene and on ED arrival. Outcome measures included ISS, transfusion within 24 h, intensive care unit (ICU), hospital length of stay (LOS), ventilator days, and mortality. RESULTS: We identified 2917 patients, and 34.2% had a persistently elevated SI from the injury scene to ED arrival, whereas 17.9% had a persistently elevated SIPA. An elevated SIPA at the trauma scene was more predictive of greater ISS, LOS, and ventilator requirements. Furthermore, a SIPA that remained abnormal was associated with greater ISS, LOS, ICU admission, mechanical ventilation, and mortality. CONCLUSIONS: Prehospital SIPA values predict worse outcomes in pediatric trauma patients, and their change over time may have greater predictive utility than a single value alone. LEVEL OF EVIDENCE: II TYPE OF STUDY: Prognosis Study.


Assuntos
Choque/diagnóstico , Índices de Gravidade do Trauma , Ferimentos não Penetrantes/diagnóstico , Adolescente , Fatores Etários , Transfusão de Sangue , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Prognóstico , Estudos Retrospectivos , Choque/etiologia , Choque/mortalidade , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/mortalidade
7.
PLoS One ; 14(3): e0213491, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30897096

RESUMO

INTRODUCTION: Nigeria has one of the highest maternal mortality ratios in the world. The nurses and midwives being the first point of contact play a central role in addressing these problems. This study was conducted to assess the knowledge and utilization of the technologies (misoprostol, anti-shock garment and magnesium sulphate) in the reduction of maternal mortality amongst the Primary Health Care (PHC) nurses and midwives in Lagos State, Nigeria. In addition, the availability of the technologies in the flagship Primary Health Centres (PHCs) was assessed. METHODS: This was a cross-sectional study among all the nurses and midwives at the flagship PHCs in Lagos state and a total of 230 were eventually studied. Data was collected using a self-administered, structured questionnaire and a checklist. Descriptive and inferential statistics were applied. Level of significance was set at 5% (p<0.05). RESULTS: All the respondents were aware of the technologies but most (73.9%) had poor knowledge of them. Majority (74.8%) of the respondents had good knowledge of maternal mortality and its major causes. Most, 81.3% of the respondents have administered misoprostol, 37.0% magnesium sulphate while 52.2% have administered anti shock garment. Out of the 57 flagship PHCs, 27 (47.4%) had magnesium sulphate, 42 (73.7%) had misoprostol and 52 (91.2%) had anti-shock garments in their facilities. Respondents who were double qualified (nurse/midwife) had significantly better knowledge of maternal mortality and its major causes (p = 0.009) than the other cadres. Longer years of experience (p = 0.019), training in the use of misoprostol (p = 0.020) and training in the use of magnesium sulphate (p = 0.001) significantly improved knowledge of the technologies. CONCLUSION: Respondents had good knowledge of maternal mortality and its major causes and poor knowledge of the technologies for maternal mortality reduction, despite the trainings attended. Of the three technologies considered, misoprostol was the most commonly used. Periodic refresher courses for the training and retraining of PHC nurses and midwives on the technologies for maternal mortality reduction is recommended.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Sulfato de Magnésio/administração & dosagem , Mortalidade Materna , Misoprostol/administração & dosagem , Atenção Primária à Saúde , Choque , Inquéritos e Questionários , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tocologia , Nigéria/epidemiologia , Enfermeiras Obstétricas , Gravidez , Choque/tratamento farmacológico , Choque/mortalidade
8.
Emerg Med J ; 36(5): 293-297, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30910912

RESUMO

STUDY OBJECTIVES: The shock index (SI), defined as the ratio of the heart rate (HR) to the systolic blood pressure (BP), is used as a prognostic tool in trauma and in specific disease states. However, there is scarcity of data about the utility of the SI in the general emergency department (ED)population. Our goal was to use a large national database of EDs in the United States (US) to determine whether the likelihood of inpatient mortality and hospital admission was associated with initial SI at presentation. METHODS: Data from the National Hospital Ambulatory Medical Care Survey were retrospectively reviewed to obtain a weighted sample of all US ED visits between 2005 and 2010. All adults >18 years old who survived the ED visit were included, regardless of their chief complaint. Likelihood ratios (LR) were calculated for a range of SI values, in order to determine SI thresholds most predictive of hospital admission and inpatient mortality. +LRs >5 were considered to be clinically significant. RESULTS: A total of 526 455 251 adult patient encounters were included in the analysis. 56.9% were women, 73.9% were white and 53.2% were between the ages of 18 and 44 years. 88 326 638 (15.7%) unique ED visits resulted in hospital admission and 1 927 235 (2.6%) visits resulted in inpatient mortality. SI>1.3 was associated with a clinically significant increase in both the likelihood of hospital admission (+LR=6.64) and inpatient mortality (+LR=5.67). SI>0.7 and >0.9, the traditional cited cut-offs, were only associated with marginal increases (+LR= 1.13; 1.54 for SI>0.7 and +LR=1.95; 2.59 for SI>0.9 for hospital admission and inpatient mortality, respectively). CONCLUSIONS: In this largest retrospective study to date on SI in the general ED population, we demonstrated that initial SI at presentation to the ED could potentially be useful in predicting the likelihood of hospital admission and inpatient mortality, which could help guide rapid and accurate acuity designation, resource allocation and disposition.


Assuntos
Hospitalização/estatística & dados numéricos , Projetos de Pesquisa/normas , Choque/classificação , Choque/mortalidade , Adolescente , Adulto , Idoso , Estudos de Coortes , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Projetos de Pesquisa/estatística & dados numéricos , Estudos Retrospectivos , Choque/epidemiologia , Estados Unidos/epidemiologia
9.
J Forensic Leg Med ; 63: 52-55, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30870725

RESUMO

Clinical and pathological case files of lethal snakebites were reviewed from the Magway Region General Hospital, Magway, Myanmar, over a five-year period (January 2013 December 2017). A total of 2069 postmortem examinations were performed which included 84 cases of lethal snake bite (4.1%). The annual numbers ranged from 10 out of a total of 268 autopsies in 2013 (3.7%), to 31 out of a total of 501 autopsies in 2016 (6.2%). There were 54 males (64%) and 30 females (36%) (M:F = 1.9:1; age range 5-75yrs, mean 33yrs). The most common time for lethal envenomation was August (16/84-19%), the middle of the monsoon season. 45/84 (54%) had acute renal failure, 27/84 (32%) were shocked, and the remaining 12/84 (14%) had disseminated intravascular coagulation. Twenty cases (24%) died within 24 h after envenomation. Fang marks were identified on the legs (either right or left) in 73/84 cases (87%) and on the arms in five cases (6%). The predominant findings at autopsy were of acute renal injury (82/84-98%), pituitary haemorrhage/necrosis (36/84-43%), and adrenal gland haemorrhage (30/84-36%). Despite the reduction in fatalities over the years snakebite from Russell's viper in particular remains an important contributor to mortality in central Myanmar despite the availability of antivenom.


Assuntos
Mordeduras de Serpentes/mortalidade , Venenos de Serpentes/envenenamento , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/mortalidade , Adolescente , Doenças das Glândulas Suprarrenais/induzido quimicamente , Doenças das Glândulas Suprarrenais/mortalidade , Adulto , Distribuição por Idade , Idoso , Animais , Criança , Pré-Escolar , Coagulação Intravascular Disseminada/induzido quimicamente , Coagulação Intravascular Disseminada/mortalidade , Feminino , Hemorragia/induzido quimicamente , Hemorragia/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Mianmar/epidemiologia , Necrose , Doenças da Hipófise/induzido quimicamente , Doenças da Hipófise/mortalidade , Hipófise/patologia , Estudos Retrospectivos , Distribuição por Sexo , Choque/induzido quimicamente , Choque/mortalidade , Adulto Jovem
10.
J Hepatobiliary Pancreat Sci ; 26(4): 128-136, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30776194

RESUMO

BACKGROUND: Liver transplantation (LT) using grafts from donation after circulatory death (DCD) is evolving to standard of care in many countries. Various transplant centers have developed a protocol for DCD-LT. The existence of numerous protocols may cause inconsistencies. Knowledge of these differences may help improve the outcome of DCD-LT. METHODS: An internet-based survey was sent to 119 transplant surgeons among four countries: Belgium (BE), the Netherlands (NL), Spain (ES) and the United Kingdom (UK). RESULTS: Thirty-three percent of all respondents indicated having no specific age limit for DCD-LT donors, and if there was a limit, half of them ignored it. Calculation of donor warm ischemia time (dWIT) varied substantially between countries. In ES and the UK, the starting point of dWIT was defined as deterioration of saturation/blood pressure, while in NL, cardiac arrest was used as starting point. Seventy-eight percent of the respondents used a super-rapid sterno-laparotomy as procurement technique. Surgeons from NL and BE mainly used aortic perfusion (95% and 72%), while dual perfusion was more common in the UK (90%) and ES (91%). CONCLUSIONS: This study demonstrates major differences in approach to DCD-LT. To assure both donors and recipients a consistent standard of care, a consensus meeting on DCD-LT is highly recommended.


Assuntos
Guias como Assunto , Transplante de Fígado/normas , Choque , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/normas , Humanos , Complicações Pós-Operatórias , Choque/mortalidade
11.
Pediatr Emerg Care ; 35(2): 132-137, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30702541

RESUMO

OBJECTIVES: Compared with unadjusted shock index (SI) (heart rate/systolic blood pressure), age-adjusted SI improves identification of negative outcomes after injury in pediatric patients. We aimed to further evaluate the utility of age-adjusted SI to predict negative outcomes in pediatric trauma. METHODS: We performed an analysis of patients younger than 15 years using the National Trauma Data Bank. Elevated SI was defined as high normal heart rate divided by low-normal blood pressure for age. Our primary outcome measure was mortality. Secondary outcomes included need for a blood transfusion, ventilation, any operating room/interventional radiology procedures, and intensive care unit stay. Multiple logistic regressions were performed. RESULTS: Twenty-eight thousand seven hundred forty-one cases met the study criteria. The overall mortality rate was 0.7%, and 1.7% had an elevated SI. Patients with an elevated SI were more likely (P < 0.001) to require blood transfusion, ventilation, an operating room/interventional radiology procedure, or an intensive care unit stay. An elevated SI was the strongest predictor for mortality (odds ratio [OR] 22.0) in pediatric trauma patients compared with hypotension (OR, 12.6) and tachycardia (OR, 2.6). CONCLUSIONS: Elevated SI is an accurate and specific predictor of morbidity and mortality in pediatric trauma patients and is superior to tachycardia or hypotension alone for predicting mortality.


Assuntos
Índice de Gravidade de Doença , Choque/diagnóstico , Ferimentos e Lesões/complicações , Adolescente , Transfusão de Sangue/estatística & dados numéricos , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Morbidade , Respiração Artificial/estatística & dados numéricos , Choque/etiologia , Choque/mortalidade , Estados Unidos , Ferimentos e Lesões/mortalidade
12.
J Forensic Leg Med ; 62: 92-96, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30708197

RESUMO

The aim of this study was to collect all available data from 2009 to 2016 focusing on the epidemiological, clinical and pharmacological issues only related to acute intoxication fatalities in the Unit of Legal Medicine of the Department of Medicine and Surgery at the University of Parma. All death certificates and autopsy reports were retrieved from the archives and evaluated to identify cases in which only acute intoxication from xenobiotics could be defined as the cause of death, however statistical and descriptive analyses were applied to all the data. A more comprehensive analysis on all causes of death showed that out of 1005 total cases the most common is haemorrhagic shock/traumatic shock (36.5%), followed by cardiogenic shock with 27.4%; asphyxia ranks as the third cause of death (11.8%); concerning encephalic injuries, our data show 10.9% of cases, while acute intoxication by xenobiotics accounts for 5.7%. Data show that the majority of subjects are poly-abuser (75.4%); people not enrolled within a preventive treatment (59.4%) were more likely to commit suicide (28.1%), whereas only 6.2% in the sub-population in treatment (40.6%) committed suicide: therefore, data strongly suggest the evidence that joining a preventive programme can decrease the probability of extreme action. Access to a full case history may indeed save considerable time and expense in carrying out tests, but also valuable targeted samplings. The investigating officer should, therefore, submit as much information as possible about the case, as this may influence the type and extent of analysis undertaken, as well as the interpretation of analytical results.


Assuntos
Causas de Morte , Preparações Farmacêuticas/sangue , Envenenamento/mortalidade , Acidentes/mortalidade , Adulto , Distribuição por Idade , Idoso , Asfixia/mortalidade , Lesões Encefálicas/mortalidade , Depressores do Sistema Nervoso Central/sangue , Afogamento/mortalidade , Etanol/sangue , Feminino , Medicina Legal , Homicídio/estatística & dados numéricos , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Choque/mortalidade , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Suicídio/estatística & dados numéricos , Adulto Jovem
13.
Aust J Rural Health ; 27(1): 49-56, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30693995

RESUMO

OBJECTIVE: To identify the extent to which rurality influences the admission and mortality rates for acute circulatory complications among people with type 2 diabetes mellitus. DESIGN: Retrospective study. SETTING: All Victorian hospitals. PARTICIPANTS: State-wide hospital admissions from 1 July 2010 to 30 June 2015 using the Victorian Admitted Episodes Dataset. Data included patients with type 2 diabetes mellitus and diagnosis of acute cardiovascular events, acute cerebrovascular haemorrhage or infarction, acute peripheral vascular events or hypertensive diseases. MAIN OUTCOME MEASURE: Rates of admission and mortality were calculated for local government areas and Department of Health regions. Regression analysis identified the influence between admission rates and various predictor variables. RESULTS: In total, 5785 emergency hospital admissions occurred during the study period, with the highest and lowest mortality and admission rates occurring in rural areas. Moderately high admission rates were identified in urban areas. Cardiovascular events far outnumbered other acute circulatory admissions. Regression analysis identified a number of significant socioeconomic variables, primarily for metropolitan residents. Socioeconomic disadvantage was the only significant factor in rural areas. CONCLUSION: Victorian admission and mortality rates for acute circulatory complications are greatest in rural areas; yet, there is considerable heterogeneity in the admission rates within both rural and metropolitan areas. Furthermore, socioeconomic status is more influential than remoteness in determining emergency admissions. Further research needs to investigate the particular variables that lead to poorer outcomes rurally, investigate socioeconomic disadvantage in rural areas and have greater emphasis on peripheral vascular disease prevention.


Assuntos
Serviço Hospitalar de Admissão de Pacientes/estatística & dados numéricos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Serviços de Saúde Rural/estatística & dados numéricos , Choque/etiologia , Choque/terapia , Serviços Urbanos de Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Choque/mortalidade , Classe Social , Vitória , Adulto Jovem
14.
Burns ; 45(2): 479-483, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30600127

RESUMO

This study was conducted to determine the epidemiological and clinical characteristics of burn injuries, estimate the case fatality rate for burn patients, and determine the main determinants of the associated death among burn patients who were admitted to Baghdad Burn Hospital, Medical City Teaching Hospitals, Baghdad, Iraq during 2015. This study involved a retrospective review of medical records of all burn patients who were admitted to Baghdad Burn Hospital in 2015. Data were collected using a special form and included information on demographic characteristics and burn characteristics and outcomes. A total of 676 patients with burn were included in this study, who constituted 75% of admitted patients. The remaining was admitted for treatment of old scars. About one third of patients (37.0%) aged 21-30 years, 67.1% were males, 34.8% were military personnel, and 60.7% of the patients had primary school education. About 71.6% of patients were burned by flame and 23.4% were burned by hot fluid. Half of patients had a second degree burns. Almost half of patients had 11-20% of their body surface area affected. About 13% of patients died, mainly due to multiple organs failure (53.3%), septicemia (44.4%), and shock (2.2%). In conclusion, young adults and children, males, and low educated patients represent the majority of admitted burn cases in Iraq. Flame and scalds were the most important causes of burn. More than one tenth of patients died mostly due to septicemia and multi-organ failure.


Assuntos
Queimaduras/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Superfície Corporal , Unidades de Queimados , Queimaduras/mortalidade , Causas de Morte , Criança , Escolaridade , Feminino , Humanos , Iraque/epidemiologia , Masculino , Pessoa de Meia-Idade , Militares/estatística & dados numéricos , Mortalidade , Insuficiência de Múltiplos Órgãos/mortalidade , Estudos Retrospectivos , Sepse/mortalidade , Distribuição por Sexo , Choque/mortalidade , Índices de Gravidade do Trauma , Adulto Jovem
15.
Med Leg J ; 87(1): 38-41, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30489187

RESUMO

A 26-year-old unmarried female with a history of acute abdominal pain and bleeding per vagina was brought unresponsive to the hospital. She was in shock on arrival and could not be resuscitated. Death was registered as a medico-legal case. Further investigation by the police revealed that she had amenorrhoea for eight weeks and had tested positive for pregnancy. She had consumed abortion pills purchased from a local pharmacist without consulting a doctor and had developed acute abdominal pain after 48 h. Autopsy revealed a ruptured ectopic pregnancy (tubal type).


Assuntos
Gravidez Ectópica/mortalidade , Dor Abdominal/etiologia , Adulto , Autopsia/métodos , Feminino , Humanos , Gravidez , Choque/etiologia , Choque/mortalidade
16.
Cardiovasc Revasc Med ; 20(1): 11-15, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30217626

RESUMO

BACKGROUND/PURPOSE: Appropriate patient selection for mechanical circulatory support following percutaneous coronary intervention (PCI) remains a challenge. This study aims to evaluate the role of coronary perfusion pressure and other left ventricular hemodynamics to predict cardiovascular collapse following PCI. METHODS/MATERIALS: We retrospectively analyzed all patients who underwent PCI for acute coronary syndrome (ACS) from 2003 to 2016. Coronary perfusion pressure was calculated for each patient and defined as the difference in mean arterial pressure and left ventricular end diastolic pressure (LVEDP). Logistic regression analysis was performed to determine predictor of composite outcome of in-hospital mortality, myocardial infarction (MI), congestive heart failure (CHF), and cardiogenic shock. RESULTS: Nine hundred twenty-two patients were analyzed. Two-hundred twenty-eight (25%) presented with ST-elevation MI (STEMI) while 694 (75%) underwent PCI for unstable angina or non-Q-wave MI. The mean LVEDP was significantly higher in the STEMI patients (24 ±â€¯9 vs. 19 ±â€¯8 mm Hg, p < 0.05) and perfusion pressure significantly lower (68 ±â€¯24 vs. 74 ±â€¯18 mm Hg, p < 0.05). Eighty-seven (9.4%) reached the composite endpoint, and there was no difference between the STEMI and Not-STEMI groups. Neither LVEDP nor coronary perfusion pressure was a predictor of the composite outcome following multivariable logistic regression analysis for either STEMI or Not-STEMI patients. Increasing age, chronic renal insufficiency (CRI), CHF, and low left ventricular ejection fraction were predictors of the composite outcome for Not-STEMI patients, whereas only history of cerebrovascular accident and CRI were predictors for STEMI patients. CONCLUSIONS: In hemodynamically stable patients presenting with ACS, LVEDP and coronary perfusion pressure are not predictive of in-hospital cardiovascular collapse. SUMMARY: The authors retrospectively analyzed 922 patients from a single center who underwent percutaneous coronary intervention (PCI) for acute coronary syndromes to evaluate the role of coronary perfusion pressure and other left ventricular hemodynamics to predict cardiovascular collapse following PCI. They found that neither coronary perfusion pressure nor left ventricular end diastolic pressure was predictive of in-hospital cardiovascular collapse.


Assuntos
Síndrome Coronariana Aguda/terapia , Circulação Coronária , Hemodinâmica , Intervenção Coronária Percutânea/efeitos adversos , Choque/etiologia , Função Ventricular Esquerda , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/mortalidade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Choque/mortalidade , Choque/fisiopatologia , Choque/terapia , Volume Sistólico , Resultado do Tratamento , Pressão Ventricular
17.
Shock ; 51(1): 60-67, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-27984523

RESUMO

INTRODUCTION: The knowledge of the etiology and associated mortality of undifferentiated shock in the emergency department (ED) is limited. We aimed to describe the etiology-based proportions and incidence rates (IR) of shock, as well as the associated mortality in the ED. METHODS: Population-based cohort study at a University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. Patients aged ≥18 years living in the ED-catchment area (N = 225,000) with a first-time ED presentation with shock (n = 1,553) defined as hypotension (systolic blood pressure ≤100 mm Hg) and ≥1 organ failures were included. Discharge diagnoses defined the etiology and were grouped as follows: distributive septic shock (SS), distributive non-septic shock (NS), cardiogenic shock (CS), hypovolemic shock (HS), obstructive shock (OS), and other conditions (OC). Outcomes were etiology-based characteristics, annual IR per 100,000 person-years at risk (95% confidence intervals [CIs]), mortality at 0 to 7-, and 0 to 90 days (95% CIs) and hazard rates (HR) at 0 to 7, 8 to 90 days (95% CIs). Poisson and Cox regression models were used for analyses. RESULTS: Among 1,553 shock patients: 423 (27.2%) had SS, 363 (23.4%) NS, 217 (14.0%) CS, 479 (30.8%) HS, 14 (0.9%) OS, and 57 (3.7%) OC. The corresponding IRs were 16.2/100,000 (95% CI: 14.8-17.9), 13.9/100,000 (95% CI: 12.6-15.4), 8.3/100,000 (95% CI: 7.3-9.5), 18.4/100,000 (95% CI: 16.8-20.1), 0.5/100,000 (95% CI: 0.3-0.9), and 2.2/100,000 (95% CI: 1.7-2.8). SS IR increased from 8.4 to 28.5/100,000 during the period 2000 to 2011. Accordingly, the 7-, and 90-day mortalities of SS, NS, CS, and HS were 30.3% (95% CI: 25.9-34.7) and 56.2% (95% CI: 50.7-61.5), 12.7% (95% CI: 9.2-16.1) and 22.6% (95% CI: 18.1-27.7), 34.6% (95% CI: 28.2-40.9) and 52.3% (95% CI: 44.6-59.8), 19.2% (95% CI: 15.7-22.7), and 36.8% (95% CI: 33.3-43.3). SS (HR = 1.46 [95% CI: 1.03-2.07]), and CS (HR = 2.15 [95% CI: 1.47-3.13]) were independent predictors of death within 0 to 7 days, whereas SS was a predictor within 8 to 90 days (HR = 1.66 [95% CI: 1.14-2.42]). CONCLUSION: HS and SS are frequent etiological characteristics followed by NS and CS, whereas OS is a rare condition. We confirm the increasing trend of SS, as previously reported. Seven-day mortality ranged from 12.7% to 34.6%, while 90-day mortality ranged from 22.6% to 56.2%. The underlying etiology was an independent predictor of mortality.


Assuntos
Serviço Hospitalar de Emergência , Choque , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Choque/diagnóstico , Choque/etiologia , Choque/mortalidade , Choque/terapia , Taxa de Sobrevida
18.
Am J Emerg Med ; 37(3): 391-394, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29866414

RESUMO

BACKGROUND: The shock index is a rapid and simple tool used to predict mortality in patients with acute illnesses including sepsis, multiple trauma, and postpartum hemorrhage. However, its ability to predict mortality in geriatric patients with influenza in the emergency department (ED) remains unclear. This study was conducted to clarify this issue. METHODS: We conducted a retrospective case-control study, recruiting geriatric patients (≥ 65 years) with influenza visiting the ED of a medical center between January 01, 2010 and December 31, 2015. Demographic data, vital signs, shock index, past histories, subtypes of influenza, and outcomes were included for the analysis. We investigated the association between shock index ≥1 and 30-day mortality. RESULTS: In total, 409 geriatric ED patients with mean age of 79.5 years and nearly equal sex ratio were recruited. The mean shock index ±â€¯standard deviation was 0.7 ±â€¯0.22 and shock index ≥1 was accounted for in 7.1% of the total patients. Logistic regression showed that shock index ≥1 predicted mortality (odds ratio: 6.80; 95% confidence interval: 2.39-19.39). The area under the receiver operating characteristic was 0.62 and the result of the Hosmer-Lemeshow goodness-of-fit test was 0.23. The sensitivity, specificity, positive predictive value, and negative predictive value of a shock index ≥1 were 30.0%, 94.1%, 20.0%, and 96.4%. CONCLUSIONS: A shock index ≥1 has a high specificity, negative predictive value, and good reliability to predict 30-day mortality in geriatric ED patients with influenza.


Assuntos
Mortalidade Hospitalar , Influenza Humana/complicações , Influenza Humana/mortalidade , Índice de Gravidade de Doença , Choque/mortalidade , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Estudos de Casos e Controles , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Avaliação Geriátrica , Humanos , Modelos Logísticos , Masculino , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Choque/etiologia , Taiwan/epidemiologia
19.
Cardiovasc Interv Ther ; 34(2): 97-104, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29736670

RESUMO

Several recent studies suggested that the door-to-balloon time (DTBT) for patients with ST-segment elevation myocardial infarction (STEMI) should be as short as possible, despite the existing guideline for STEMI. This study aimed to evaluate the clinical outcomes of the STEMI patient cohort having the highest proportion of patients treated with a DTBT of ≤ 30 min ever reported. We evaluated 527 consecutive patients with STEMI who underwent percutaneous coronary intervention between 2007 and 2015. The mean age was 68.0 ± 12.7 years, and the mean DTBT was 44.4 ± 33.1 min. The patients were classified into four groups according to the DTBT, and the relationship between the DTBT and clinical outcome was investigated. DTBTs were ≤ 30 min in 146 patients (27.7%), 31-60 min in 297 patients (56.4%), 61-90 min in 60 patients (11.4%), and > 90 min in 24 patients (4.6%). In-hospital mortality rates were 0.7, 5.0, 11.7, and 12.5% for DTBTs of ≤ 30, 31-60, 61-90, and > 90 min, respectively. In multivariate analysis, a DTBT ≤ 30 min (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.01-0.91, p = 0.041), shock on arrival (OR 2.74, 95% CI 1.02-7.37, p = 0.046), and blood transfusion (OR 49.60, 95% CI 13.90-177.00, p < 0.001) were the independent predictors of in-hospital mortality. Patients with STEMI treated with a DTBT ≤ 30 min showed significantly better clinical outcomes than those treated with a DTBT > 30 min.


Assuntos
Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Tempo para o Tratamento , Idoso , Transfusão de Sangue , Feminino , Mortalidade Hospitalar , Humanos , Japão/epidemiologia , Masculino , Prognóstico , Estudos Retrospectivos , Choque/mortalidade
20.
Can J Cardiol ; 34(12): 1648-1654, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30527154

RESUMO

BACKGROUND: We sought to identify nontraditional risk factors coded in administrative claims data and evaluate their ability to improve prediction of long-term mortality in patients undergoing percutaneous mitral valve repair. METHODS: Patients undergoing transcatheter mitral valve repair using MitraClip implantation between September 28, 2010, and September 30, 2015 were identified among Medicare fee-for-service beneficiaries. We used nested Cox regression models to identify claims codes predictive of long-term mortality. Four groups of variables were introduced sequentially: cardiac and noncardiac risk factors, presentation characteristics, and nontraditional risk factors. RESULTS: A total of 3782 patients from 280 clinical sites received treatment with MitraClip over the study period. During the follow-up period, 1114 (29.5%) patients died with a median follow-up time period of 13.6 (9.6 to 17.3) months. The discrimination of a model to predict long-term mortality including only cardiac risk factors was 0.58 (0.55 to 0.60). Model discrimination improved with the addition of noncardiac risk factors (c = 0.63, 0.61 to 0.65; integrated discrimination improvement [IDI] = 0.038, P < 0.001), and with the subsequent addition of presentation characteristics (c = 0.67, 0.65 to 0.69; IDI = 0.033, P < 0.001 compared with the second model). Finally, the addition of nontraditional risk factors significantly improved model discrimination (c = 0.70, 0.68 to 0.72; IDI = 0.019, P < 0.001, compared with the third model). CONCLUSIONS: Risk-prediction models, which include nontraditional risk factors as identified in claims data, can be used to predict long-term mortality risk more accurately in patients who have undergone MitraClip procedures.


Assuntos
Procedimentos Cirúrgicos Cardíacos/instrumentação , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Medição de Risco , Idoso , Fibrilação Atrial/mortalidade , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Humanos , Hepatopatias/mortalidade , Masculino , Medicare , Análise Multivariada , Diálise Renal/mortalidade , Fatores de Risco , Choque/mortalidade , Estados Unidos/epidemiologia
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