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1.
Am Surg ; 85(7): 700-707, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405411

RESUMO

The purpose of this study was to identify the risk factors for hospital readmission for child maltreatment after trauma, including admissions across different hospitals nationwide. The Nationwide Readmissions Database for 2010-2014 was queried for all patients younger than 18 years admitted for trauma. The primary outcome was readmission for child maltreatment. The secondary outcome was readmission for maltreatment presenting to a hospital different than the index admission hospital. A subgroup analysis was performed on patients without a diagnosis of maltreatment during the index admission. Multivariable logistic regression was performed for each outcome. There were 608,744 admissions identified and 44,569 (7.32%) involved maltreatment at the index admission. Readmission for maltreatment was found in 1,948 (0.32%) patients and 368 (18.89%) presented to a different hospital. The highest risk for readmission for maltreatment was found in patients with maltreatment identified at the index admission (odds ratios (OR) 9.48 [8.35-10.76]). The strongest risk factor for presentation to a different hospital was found with the lowest median household income quartile (OR 3.50 [2.63-4.67]). The subgroup analysis identified 647 (0.11%) children with readmission for maltreatment that was missed during the index admission. The strongest risk factor for this outcome was Injury Severity Score > 15 (OR 3.29 [2.68-4.03]). This study demonstrates that a significant portion of admissions for trauma in children and teenagers could be misrepresented as not involving maltreatment. These index admissions could be the only chance for intervention for child maltreatment. Identifying these at-risk individuals is critical to prevention efforts.


Assuntos
Maus-Tratos Infantis/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adolescente , Criança , Maus-Tratos Infantis/diagnóstico , Pré-Escolar , Feminino , Hospitais/estatística & dados numéricos , Humanos , Lactente , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
2.
Am Surg ; 85(7): 733-737, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405418

RESUMO

Several models exist to predict trauma center need in the prehospital setting; however, there is lack of simple clinical tools to predict the need for ICU admission and mortality in trauma patients. The aim of our study was to develop a simple clinical tool that can be used with ease in the prehospital or emergency setting and can reliably predict the need for ICU admission and mortality in trauma patients. We abstracted one year of National Trauma Data Bank for all patients aged ≥ 18 years. Transferred patients and those dead on arrival were excluded. Patient demographics, injury parameters, vital signs, and Glasgow Coma Scale (GCS) were recorded. Our primary outcome measures were mortality and ICU admission. Logistic regression analysis was performed using three variables (age > 55 years, shock index (SI) > 1, and GCS score) to determine the appropriate weights for predicting mortality. Appropriate weights derived from regression analysis were used to construct a simple SI, age, and GCS (SAG) score, and associated mortality and ICU admissions were calculated for three different risk groups (low, intermediate, and high). A total of 281,522 patients were included. The mean age was 47 ± 20 years, and 65 per cent were male. The overall mortality rate was 2.9 per cent, and the rate of ICU admission was 28.7 per cent. The SAG score was constructed using weights derived from regression analysis for age ≤ 55 years (4 points), SI < 1 (3 points), and GCS (3-15 points). The median [IQR] SAG score was 21 [18-22]. The area under the receiver operating curve [95% Confidence Interval (CI)] of the SAG score for predicting mortality and ICU admission was 0.873 [0.870-0.877] and 0.644 [0.642-0.647], respectively. Each 1-point increase in the SAG score was associated with 18 per cent lower odds of mortality (odds ratio [95% CI]: 0.822 [0.820-0.825]) and 10 per cent lower odds of ICU admission (odds ratio [95% CI]: 0.901 [0.899-0.902]). The SAG score is a simple clinical tool derived from variables that can be assessed with ease during the initial evaluation of trauma patients. It provides a rapid assessment and can reliably predict mortality and need for ICU admission in trauma patients. This simple tool may allow early resource mobilization possibly even before the arrival of the patient.


Assuntos
Mortalidade Hospitalar , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/estatística & dados numéricos , Índices de Gravidade do Trauma , Ferimentos e Lesões/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Admissão do Paciente/estatística & dados numéricos , Análise de Regressão , Estudos Retrospectivos , Ferimentos e Lesões/mortalidade , Adulto Jovem
3.
Am Surg ; 85(7): 752-756, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405422

RESUMO

To characterize both emergency room (ER) and hospital discharge dispositions of patients presenting with farm-related injuries. The 2012 National Trauma Data Bank was queried in August 2017 for injuries occurring on a farm. Patients were stratified by gender, age group, race, Injury Severity Score (ISS), and injury type. We performed logistic regression analysis to correlate parameters with likelihood of discharge home or death. P values < 0.05 were considered significant. Five thousand six hundred thirty-one patients were identified, the majority of whom were male (72%) and white (85%). The most common mechanisms of injury included animal-related (29%), followed by falls, vehicles, and other causes. The highest ISSs were seen in vehicular injuries (11% ISS of 25+) and the greatest fatality rate was seen in machinery injuries (4%). Four thousand seven hundred fifty-three (84%) patients were admitted to the hospital, and 4056 (72%) were discharged home from the ER or after hospitalization. One hundred thirty patients (2%) died of their farm-related injury. Most patients presenting to the ER with farm-related injuries survive, are admitted to the hospital, and are ultimately discharged home. Few patients die of their injuries. Animal injury is most common and machinery injury most lethal of farm trauma patients presenting to the ER.


Assuntos
Agricultura , Fazendas , Ferimentos e Lesões/etiologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trabalho/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
4.
Am Surg ; 85(7): 764-767, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405425

RESUMO

Patient physiology and crash characteristics are essential components of field triage for motor vehicle crashes. We aimed to identify prehospital information that predicted high injury severity or critical patient condition on hospital arrival. The association of demographics, shock index (SI), Glasgow Coma Scale, and 10 crash characteristics of trauma activations for motor vehicle crashes with injury severity score (ISS) ≥ 16 and a composite of hypotension, need for blood transfusions, or immediate operation was determined using univariate and multivariate analyses. A total of 133 of 498 patients (27%) had ISS ≥ 16; SI ≥ 0.9, Glasgow Coma Scale ≤ 8, speed ≥ 55 mph, seatbelt use, airbag deployment, ambulatory patient, severe vehicle damage, ejection, and extrication were associated with ISS ≥ 16. Only abnormal SI and high speed remained independent predictors for ISS ≥ 16 with Odds Ratio (OR) = 10.76 (95% confidence interval (CI), 1.14-101, P = 0.04) and OR = 10.37 (95% CI, 1.48-72.93, P = 0.02), respectively. SI ≥ 0.9 predicted the composite outcome with OR = 5.92 (95% CI, 2.32-15.08, P < 0.01). Many commonly reported crash characteristics did not predict clinically important outcomes. Improvements in road and vehicle safety may be resulting in lower injury severity despite major crash mechanisms.


Assuntos
Acidentes de Trânsito , Triagem/métodos , Ferimentos e Lesões/diagnóstico , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Feminino , Escala de Coma de Glasgow , Humanos , Hipotensão/diagnóstico , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Razão de Chances , Avaliação de Resultados (Cuidados de Saúde) , Cintos de Segurança , Choque/diagnóstico , Centros de Traumatologia/estatística & dados numéricos , Adulto Jovem
5.
Am Surg ; 85(7): 772-777, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405427

RESUMO

Trauma in pregnancy is a leading cause of poor fetal and obstetric outcomes. Trauma team activation (TTA) criteria include injury with ≥ 20 weeks gestational age (GA). A retrospective analysis was performed on pregnant patients evaluated at a Level 1 trauma center. Patients were characterized by TTA: full, partial, or non-TTA, and TTA criteria independent of pregnancy. Index trauma and delayed delivery hospitalization outcomes were examined. Bivariate analysis, t test, and logistic regression were used when appropriate. From 2010 to 2015, 216 full, 50 partial, and 50 non-TTAs presented. Independent of pregnancy, 79 per cent of patients did not meet the TTA criteria. Fourteen (4%) had a pregnancy-related complication during index hospitalization (eight fetal and two maternal deaths). Nine of ten deaths occurred in patients meeting TTA independent of pregnancy. Delivery complications were greater in the index (52%, 13/25) versus subsequent (5%, 17/155) hospitalizations and were predicted by the respiratory rate (P = 0.016) and injury severity score (P < 0.001). Poor delayed delivery outcomes were associated with earlier GA (P < 0.002) and longer index hospitalization (P < 0.024). Odds of complication are higher in patients meeting the physiologic and anatomic criteria criteria for TTA versus GA criteria alone, signifying overtriage. Trauma activation protocols should be adapted based on the physiologic and anatomic criteria criteria in pregnant patients.


Assuntos
Complicações na Gravidez/etiologia , Centros de Traumatologia/estatística & dados numéricos , Triagem/métodos , Ferimentos e Lesões , Adulto , Feminino , Idade Gestacional , Hospitalização/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Gravidez , Estudos Retrospectivos , Ferimentos e Lesões/classificação , Adulto Jovem
6.
Medicine (Baltimore) ; 98(34): e16951, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441892

RESUMO

Teaching status/academic ranking may play a role in the variations in trauma center (TC) outcomes. Our study aimed to determine the relationship between TC teaching status and injury-adjusted, all-cause mortality in a national sampling.Retrospective review of the National Sample Program (NSP) from the National Trauma Data bank (NTDB). TCs were categorized based on teaching status. Adjusted mortality was determined by observed/expected (O/E) mortality ratios, derived using TRauma Injury Severity Score methodology from the Injury Severity Score and Revised Trauma Score. Chi-square and t test analyses were utilized with a statistical significance defined as P <.05.Of the 94 TCs in the NSP, 46 were university, 38 were community teaching, and 10 were community nonteaching. For the University TCs, 62.8% were American College of Surgeons (ACS) level 1 and 81.2% state level 1. Of the community teaching TCs, 39.0% was ACS level 1 and 35.1% was state level 1. Of the community nonteaching TCs, 0% was ACS level 1 and 11.1% was state level 1. University TCs had a significantly higher O/E mortality rate than community teaching (0.75 vs 0.71; P = .04). There were no differences in O/E between community teaching and nonteaching TCs (0.71 vs 0.70; P = .70).Community teaching and nonteaching TCs have lower injury-adjusted, all-cause mortality rates than University Centers. Future studies should further investigate key differences between University TCs and community teaching TC to evaluate possible quality and performance improvement measures.


Assuntos
Hospitais Comunitários/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Avaliação de Resultados (Cuidados de Saúde)/estatística & dados numéricos , Centros de Traumatologia/normas , Ferimentos e Lesões/mortalidade , Adulto , Bases de Dados Factuais , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Estudos Retrospectivos , Centros de Traumatologia/classificação , Estados Unidos
7.
N Engl J Med ; 381(4): 328-337, 2019 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-31259488

RESUMO

BACKGROUND: Whether early placement of an inferior vena cava filter reduces the risk of pulmonary embolism or death in severely injured patients who have a contraindication to prophylactic anticoagulation is not known. METHODS: In this multicenter, randomized, controlled trial, we assigned 240 severely injured patients (Injury Severity Score >15 [scores range from 0 to 75, with higher scores indicating more severe injury]) who had a contraindication to anticoagulant agents to have a vena cava filter placed within the first 72 hours after admission for the injury or to have no filter placed. The primary end point was a composite of symptomatic pulmonary embolism or death from any cause at 90 days after enrollment; a secondary end point was symptomatic pulmonary embolism between day 8 and day 90 in the subgroup of patients who survived at least 7 days and did not receive prophylactic anticoagulation within 7 days after injury. All patients underwent ultrasonography of the legs at 2 weeks; patients also underwent mandatory computed tomographic pulmonary angiography when prespecified criteria were met. RESULTS: The median age of the patients was 39 years, and the median Injury Severity Score was 27. Early placement of a vena cava filter did not result in a significantly lower incidence of symptomatic pulmonary embolism or death than no placement of a filter (13.9% in the vena cava filter group and 14.4% in the control group; hazard ratio, 0.99; 95% confidence interval [CI], 0.51 to 1.94; P = 0.98). Among the 46 patients in the vena cava filter group and the 34 patients in the control group who did not receive prophylactic anticoagulation within 7 days after injury, pulmonary embolism developed in none of those in the vena cava filter group and in 5 (14.7%) in the control group, including 1 patient who died (relative risk of pulmonary embolism, 0; 95% CI, 0.00 to 0.55). An entrapped thrombus was found in the filter in 6 patients. CONCLUSIONS: Early prophylactic placement of a vena cava filter after major trauma did not result in a lower incidence of symptomatic pulmonary embolism or death at 90 days than no placement of a filter. (Funded by the Medical Research Foundation of Royal Perth Hospital and others; Australian New Zealand Clinical Trials Registry number, ACTRN12614000963628.).


Assuntos
Embolia Pulmonar/prevenção & controle , Filtros de Veia Cava , Ferimentos e Lesões/terapia , Adulto , Angiografia por Tomografia Computadorizada , Humanos , Incidência , Escala de Gravidade do Ferimento , Estimativa de Kaplan-Meier , Perna (Membro)/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/mortalidade , Risco , Falha de Tratamento , Ultrassonografia , Trombose Venosa/diagnóstico por imagem , Ferimentos e Lesões/mortalidade
8.
Am Surg ; 85(6): 567-571, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267895

RESUMO

In the past 30 years, opioid prescription rates have quadrupled and hospital admissions for overdose are rising. Previous studies have focused on alcohol use and trauma recidivism, however rarely evaluating recidivism and opioid use. We hypothesized there is an association between opioid use and trauma recidivism. This is a retrospective review of patients with multiple admissions for traumatic injury. Demographics, opioid toxicology screen (TS) results, and injury characteristics were collected. Statistical analysis was performed with chi-squared and Poisson regression models. One thousand six hundred forty-nine patients (age ≥18 years) had multiple trauma admissions. Seven hundred nine patients had TS data for both admissions. Thirty-one per cent (218) were TS positive on the 1st admission compared with 34 per cent (244) on their 2nd admission. Fifty-five per cent of patients who were TS positive on the 1st admission were positive on their 2nd admission, whereas 25 per cent who were TS negative on the 1st admission were subsequently positive on their 2nd admission (P < 0.0001). Patients who were TS positive on the subsequent admission were less severely injured than TS negative patients (Injury Severity Score > 15, 26.3% vs 22.3%, P = 0.04). The only significant risk factor for being TS positive on the 2nd admission was being TS positive on the 1st admission (relative risk = 2.18, P < 0.001). A previous history of opioid use is the strongest predictor of recurrent use in recidivists.


Assuntos
Analgésicos Opioides/efeitos adversos , Uso de Medicamentos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Ferimentos e Lesões/induzido quimicamente , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Analgésicos Opioides/uso terapêutico , Análise Química do Sangue , Estudos de Coortes , Intervalos de Confiança , Bases de Dados Factuais , Feminino , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/induzido quimicamente , Traumatismo Múltiplo/epidemiologia , Traumatismo Múltiplo/terapia , Determinação de Necessidades de Cuidados de Saúde , Transtornos Relacionados ao Uso de Opioides/complicações , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Distribuição por Sexo , Estatísticas não Paramétricas , Taxa de Sobrevida , Centros de Traumatologia/estatística & dados numéricos , Estados Unidos/epidemiologia , Ferimentos e Lesões/terapia , Adulto Jovem
9.
Am Surg ; 85(6): 572-578, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267896

RESUMO

Despite low mortality rates, self-inflicted stab wounds (SISWs) can result in significant morbidity and often reflect underlying substance abuse and mental health disorders. This study aimed to characterize demographics, comorbidities, and outcomes seen in self-inflicted stabbings and compare these metrics to those seen in assault stabbings. A Level I trauma center registry was queried for patients with stab injuries between January 2010 and December 2015. Classification was based on whether injuries were SISWs or the result of assault stab wounds (ASWs). Demographic, injury, and outcome measures were recorded. Differences between genders, ethnicities, individuals with and without psychiatric comorbidities, and SISW and ASW patients were assessed. Within the SIWS cohort, no differences were found when comparing age, gender, or race, including need for operative intervention. However, patients with psychiatric histories were less likely to have a positive toxicology test on arrival than those without psychiatric histories (22% vs. 0%, P = 0.04). When compared with 460 ASW patients, SISW were older (41 vs. 35, P < 0.001), more likely to be white (92% vs. 64%, P < 0.001), more likely to have a psychiatric history (15% vs. 4%, P < 0.001), require operative intervention (65% vs. 50%, P = 0.008), and be discharged to a psychiatric facility (47% vs. 0.2%, P < 0.001). SISW patients have higher rates of psychiatric illness and an increased likelihood to require operative intervention as compared with ASW patients. This population demonstrates an acute need for both inpatient and outpatient psychiatric care with early involvement of multidisciplinary teams for treatment and discharge planning.


Assuntos
Mortalidade Hospitalar , Sistema de Registros , Comportamento Autodestrutivo/psicologia , Centros de Traumatologia , Ferimentos Perfurantes/epidemiologia , Ferimentos Perfurantes/cirurgia , Adolescente , Adulto , Distribuição por Idade , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Incidência , Escala de Gravidade do Ferimento , Kentucky , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Distribuição por Sexo , Taxa de Sobrevida , Resultado do Tratamento , Ferimentos Perfurantes/prevenção & controle , Adulto Jovem
10.
Am Surg ; 85(6): 654-662, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267908

RESUMO

Resuscitative endovascular balloon occlusion of the aorta (REBOA) represents an innovative method by which noncompressible bleeding in the torso can be mitigated until definitive treatment can be obtained. To perform a systematic review of the literature on the use of the REBOA in trauma patients. An English and Spanish literature search was performed using MEDLINE, PubMed, and Scopus, from 1948 to 2018. Keywords used were aortic balloon occlusion, resuscitative endovascular balloon, REBOA, hemorrhage, and resuscitative endovascular balloon occlusion of the aorta. The eligilibility criteria included only original and human subject articles. Nontrauma patients, nonbleeding pathology, letters, single case reports, reviews, and pediatric patients were excluded. Two hundred forty-six articles were identified, of which 17 articles were included in this review. The total number of patients was 1340; 69 per cent were men and 31 per cent women. In 465 patients, the aortic zone location was described: 83 per cent the balloon was placed in aortic zone I and 16 per cent in zone III. Systolic blood pressure increased at an average of 52 mmHg before and after aortic occlusion. Although 32 patients (2.4%) presented clinical complications derived from the procedure, no mortality was reported. The trauma-related mortality rate was 58 per cent (776/1340). REBOA is a useful resource for the management of noncompressive torso hemorrhage with promising results in systolic blood pressure and morbidity. Indications for its use include injuries in zones 1 and 3, whereas it is not clear for zone 2 injuries. Additional studies are needed to define the benefits of this procedure.


Assuntos
Ruptura Aórtica/terapia , Oclusão com Balão/métodos , Ressuscitação/métodos , Lesões do Sistema Vascular/terapia , Ferimentos e Lesões/terapia , Aorta Torácica/lesões , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/mortalidade , Feminino , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Masculino , Ressuscitação/mortalidade , Medição de Risco , Taxa de Sobrevida , Ferimentos e Lesões/diagnóstico
11.
Accid Anal Prev ; 129: 230-240, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31176143

RESUMO

The single-vehicle crash has been recognized as a critical crash type due to its high fatality rate. In this study, a two-year crash dataset including all single-vehicle crashes in New Mexico is adopted to analyze the impact of contributing factors on driver injury severity. In order to capture the across-class heterogeneous effects, a latent class approach is designed to classify the whole dataset by maximizing the homogeneous effects within each cluster. The mixed logit model is subsequently developed on each cluster to account for the within-class unobserved heterogeneity and to further analyze the dataset. According to the estimation results, several variables including overturn, fixed object, and snowing, are found to be normally distributed in the observations in the overall sample, indicating there exist some heterogeneous effects in the dataset. Some fixed parameters, including rural, wet, overtaking, seatbelt used, 65 years old or older, etc., are also found to significantly influence driver injury severity. This study provides an insightful understanding of the impacts of these variables on driver injury severity in single-vehicle crashes, and a beneficial reference for developing effective countermeasures and strategies for mitigating driver injury severity.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Escala de Gravidade do Ferimento , Ferimentos e Lesões/epidemiologia , Adulto , Idoso , Ambiente Construído/estatística & dados numéricos , Feminino , Humanos , Análise de Classes Latentes , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , New Mexico/epidemiologia , Fatores de Risco , Cintos de Segurança/estatística & dados numéricos , Adulto Jovem
12.
Accid Anal Prev ; 129: 334-341, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31200121

RESUMO

In the Netherlands, cyclists have to share the bicycle path with light moped riders. These riders are allowed to ride 25 km/h and do not have to wear a helmet (Dutch regulation). Due to several trends such as traffic congestion and the introduction of the scooter model, light mopeds have become more popular, both among older and younger people. This has led to an increased traffic density on bicycle paths as well as concerns about the safety of cyclists. In response to these concerns, several Dutch cities would like to ban light moped riders (LMRs) from the bicycle path and let them ride on the carriageway. However, it is uncertain what the consequences would be for the safety of light moped riders. Moreover, it is not clear to what extent the shared use of bicycle paths leads to serious crashes between cyclists and LMRs. Therefore, an in-depth crash investigation study was carried out to gain more insight into the factors and circumstances that influence the occurrence and consequences of light moped crashes on bicycle paths. A dedicated team for in-depth road crash investigation collected and analyzed detailed information on 36 light moped crashes that occurred on an urban bicycle path. This resulted in a description of the course of events for every crash that was analyzed, including a list of factors that contributed to the occurrence of the crash and possible injuries. Crashes with a similar course of events and a comparable combination of contributory factors were grouped into (sub)types of light moped crashes. Six types of crashes were identified. Based on the contributory crash factors of the identified crash types, remedial measures can be developed to prevent similar crashes from occurring in the future. Moving the LMR to the carriageway is only advisable on 30 km/h roads. Alternative measures to improve the safety of both cyclists and light moped riders include: 1) removing obstacles such as poles from the bicycle path, 2) following guidelines on the minimum width of bicycle paths given traffic volumes, 3) improving sight distances at intersections, 4) traffic light control without conflicts between traffic flows, and 5) introducing a helmet law for light moped riders and their passengers.


Assuntos
Acidentes de Trânsito/prevenção & controle , Motocicletas/estatística & dados numéricos , Acidentes de Trânsito/classificação , Acidentes de Trânsito/estatística & dados numéricos , Ciclismo/lesões , Ciclismo/estatística & dados numéricos , Cidades , Planejamento Ambiental , Humanos , Escala de Gravidade do Ferimento , Motocicletas/legislação & jurisprudência , Países Baixos/epidemiologia , Medição de Risco , Ferimentos e Lesões/epidemiologia
13.
J Craniofac Surg ; 30(4): 1113-1117, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31166255

RESUMO

OBJECTIVES: To study the trigeminal nerve neuropathy prevalence after mandibular fractures and follow nerve recovery and to examine associations with clinical features. SUBJECTS: The files of 304 patients treated for 424 mandibular fractures in Hadassah Medical Center between 2001 and 2008 were analyzed. Twenty-five patients with paresthesia were examined by electro-diagnostic conduction test (quantitative sensory testing). RESULTS: The most common fracture sites were the symphysis (28.5%) and condyle (21.4%). A strong correlation between fracture severity and treatment modality was found. Nerve damage occurred in 13.4% of nondisplaced fractures and in 65.3% of >5 mm displaced fractures. Patients who were treated by open reduction internal fixation demonstrated the biggest difference in quantitative sensory testing values between the affected and nonaffected sides. C nerve fibers were the most damaged and least regenerated. There was correlation between damage perception and objective test results. CONCLUSIONS: There is a correlation between fracture type and displacement severity on neurologic deficit and prognosis. The objective neurosensory damage was manifested by higher nerve excitation threshold on the injured side. Patients should be informed on the prognosis of neurologic deficit according to fracture type.


Assuntos
Fraturas Mandibulares/complicações , Doenças do Nervo Trigêmeo/etiologia , Traumatismos do Nervo Trigêmeo/etiologia , Adulto , Eletrodiagnóstico , Feminino , Fixação Interna de Fraturas , Humanos , Escala de Gravidade do Ferimento , Israel/epidemiologia , Masculino , Fraturas Mandibulares/cirurgia , Pessoa de Meia-Idade , Redução Aberta , Doenças do Nervo Trigêmeo/diagnóstico , Doenças do Nervo Trigêmeo/epidemiologia , Traumatismos do Nervo Trigêmeo/diagnóstico , Traumatismos do Nervo Trigêmeo/epidemiologia , Escala Visual Analógica
14.
Am Surg ; 85(4): 370-375, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31043197

RESUMO

The effect of timing in patients requiring tracheostomy varies in the literature. The purpose of this study was to evaluate the impact of early tracheostomy on outcomes in trauma patients with and without traumatic brain injury (TBI). This study is a four-year review of trauma patients undergoing tracheostomy. Patients were divided into two groups based on TBI/non-TBI. Each group was divided into three subgroups based on tracheostomy timing: zero to three days, four to seven days, and greater than seven days postadmission. TBI patients were stratified by the Glasgow Coma Scale (GCS), and non-TBI patients were stratified by the Injury Severity Score (ISS). The primary outcome was ventilator-free days (VFDs). Significance was defined as P < 0.05. Two hundred eighty-nine trauma patients met the study criteria: 151 had TBI (55.2%) versus 138 (47.8%) non-TBI. There were no significant differences in demographics within and between groups. In TBI patients, statistically significant increases in VFDs were observed with GCS 13 to 15 for tracheostomies performed in four to seven versus greater than seven days (P = 0.005). For GCS <8 and 8 to 12, there were significant increases in VFDs for tracheostomies performed at days 1 to 3 and 4 to 7 versus greater than seven days (P ≪ 0.05 for both). For non-TBI tracheostomies, only ISS ≥ 25 with tracheostomies performed at zero to three days versus greater than seven days was associated with improved VFDs. Early tracheostomies in TBI patients were associated with improved VFDs. In trauma patients with no TBI, early tracheostomy was associated with improved VFDs only in patients with ISS ≥ 25. Future research studies should investigate reasons TBI and non-TBI patients may differ.


Assuntos
Traqueostomia/métodos , Ferimentos e Lesões/cirurgia , Adulto , Lesões Encefálicas Traumáticas/cirurgia , Estudos de Casos e Controles , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
15.
Am Surg ; 85(4): 390-396, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31043200

RESUMO

In the past, injuries to the adrenal glands due to blunt trauma were considered rare, and were reported to be associated with high Injury Severity Scores (ISSs) and high mortality. Recent reports have reported a much high incidence associated with lower ISS and lower mortality. The purpose of this study was to assess the incidence of adrenal gland injuries due to blunt trauma in a large state trauma registry and determine whether these injuries are associated with a higher ISS and increased risk for mortality. A retrospective review was performed on the New York State Trauma Registry comparing blunt injured adults with adrenal injuries to those who did not. Concurrent organ injuries, ISS, and inhospital mortality were compared. Three hundred thirty-nine patients with adrenal gland injuries were identified. Concurrent liver and kidney injuries were more prevalent in the adrenal injured group, and concurrent injuries to the small and large intestine and spleen were more prevalent in the nonadrenal injured group. There was no difference in ISS or mortality between the adrenal injured and nonadrenal injured populations. The results of this study are consistent with recent smaller studies which identified incidence rates which were higher than previously reported and that ISS and mortality risk were unchanged by the presence of blunt adrenal gland injuries. Adrenal gland injuries due to blunt trauma are not uncommon, with an incidence rate of 0.61 per cent. Adrenal gland injuries are not associated with higher ISS or an increased risk of mortality.


Assuntos
Traumatismos Abdominais/epidemiologia , Glândulas Suprarrenais/lesões , Ferimentos não Penetrantes/epidemiologia , Traumatismos Abdominais/diagnóstico , Adulto , Idoso , Feminino , Humanos , Incidência , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Ferimentos não Penetrantes/diagnóstico
16.
Forensic Sci Int ; 300: 151-156, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31108376

RESUMO

There are previous studies that have found associations between specific injury patterns and different victim-offender relationships (VORs) in homicides. We have used quantitative injury severity scores to further investigate this issue. The amount and severity of injuries were assessed in 178 Swedish homicide victims, retrospectively included from the years 2007-2009. We analyzed whether different injury measures could be used to predict the VOR. In addition to a deeper understanding of violent behavior, such associations may be of help to homicide investigators for offender profiling. The victims' injuries were assessed with eleven different methods. The cases with known VORs were divided into four categories: partner, relative, acquaintance, and stranger. The injury severities were then compared between these categories. No relevant differences were found. Thus, the current study does not support the claim that the VOR can be predicted from the injury severity in a general homicide population. These findings are in contrast to the results of some previous studies but confirm those of others.


Assuntos
Vítimas de Crime/estatística & dados numéricos , Criminosos/estatística & dados numéricos , Homicídio , Escala de Gravidade do Ferimento , Ferimentos e Lesões/mortalidade , Adulto , Feminino , Humanos , Relações Interpessoais , Masculino , Estudos Retrospectivos , Suécia/epidemiologia
17.
Scand J Trauma Resusc Emerg Med ; 27(1): 52, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31039800

RESUMO

BACKGROUND: Trauma triage based on prehospital information facilitates correct allocation of in-hospital resources. The Swedish national two-tier trauma team activation (TTA) criteria were revised in 2016. The current study aimed to evaluate the safety and efficacy of the new criteria. METHODS: Five centres covering trauma care for 1.2 million inhabitants registered all trauma patients prospectively in the Swedish trauma registry (SweTrau) prior to and after stepwise introduction of new TTA criteria within the cohort (a prospective stepped-wedge cohort study design; period August 2016-November 2017). Evaluation of full- and limited-TTA frequency, under- and overtriage were performed at equal duration before and after this change. RESULTS: The centres registered 1948 patients, 1882 (96.6%) of which were included in the study. With new criteria, frequency of full-TTA was unchanged, while limited-TTA decreased with 46.3% (from 988 to 531). 30-day trauma mortality was unchanged. The overtriage was 107/150 (71.3%) with former criteria, and 104/144 (72.2%) with new criteria, p = 0.866. Undertriage was 50/1037 (4.8%) versus 39/551 (7.1%), p = 0.063. Undertriage was consistently > 20% in patients with fall injury. Among patients with Injury Severity Score (ISS) > 15, 50/93 (53.8%) did not initiate full-TTA with former, vs 39/79 (49.4%) with new criteria, p = 0.565. Age > 60-years was a risk factor for undertriage (OR 2.89, p < 0.001), while low fall injuries indicated a trend (OR 2.70, p = 0.051). CONCLUSIONS: The newly implemented Swedish TTA criteria result in a reduction in limited TTA frequency, indicating an increased efficiency in use of resources. The over- and undertriage is unchanged compared to former criteria, thus upholding patient safety.


Assuntos
Sistema de Registros , Centros de Traumatologia/estatística & dados numéricos , Triagem/métodos , Ferimentos e Lesões/diagnóstico , Acidentes por Quedas/estatística & dados numéricos , Adulto , Feminino , Seguimentos , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Prospectivos , Fatores de Risco , Suécia/epidemiologia , Ferimentos e Lesões/epidemiologia , Adulto Jovem
18.
Isr Med Assoc J ; 5(21): 330-332, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31140225

RESUMO

BACKGROUND: Selective management of stable patients with anterior abdomen stab wounds (AASWs) has become a gold standard management approach throughout the world. Evidenced-based options for supporting selective management include clinical follow-up, local wound exploration with or without diagnostic peritoneal lavage, diagnostic laparoscopy, and abdominal computerized tomography. The presence of multiple AASWs might signify a more aggressive attack and limit the safety of a selective management approach. OBJECTIVES: To evaluate whether multiple AASWs are associated with an increased risk of intra-abdominal injury requiring emergency surgery. METHODS: We retrospectively reviewed all AASW patients admitted to Assaf Harofeh Medical Center, Zerifin, Israel, and Hillel Yaffe Medical Center in Hadera, Israel, from 2007 to 2015. Patients were divided into two groups based on the number of stab wounds: single or multiple. Data were coded for demographics, severity of injury, presence of intra-abdominal injury, laparotomy rate, length of hospital stay (LOS), length of stay in the intensive care unit (LICU), and survival. RESULTS: The study included 169 patients. Of these, 143 patients had a single AASW and 26 had multiple AASWs. There were no differences between the groups regarding demographics, severity of injury, intra-abdominal penetration, specific organ injury, LOS, or LICU. There was no difference in the percentage of patients requiring laparotomy. The overall mortality was 2.36% (4/169). There was no significant difference in the mortality rate between the groups (P = 0.11). CONCLUSIONS: The presence of multiple AASWs is not a risk factor for increased frequency and severity of intra-abdominal injury.


Assuntos
Traumatismos Abdominais , Ferimentos Perfurantes , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/terapia , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/estatística & dados numéricos , Israel/epidemiologia , Laparoscopia/métodos , Laparotomia/métodos , Laparotomia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Mortalidade , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/normas , Lavagem Peritoneal/métodos , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos , Ferimentos Perfurantes/diagnóstico , Ferimentos Perfurantes/mortalidade , Ferimentos Perfurantes/terapia
19.
Pediatr Surg Int ; 35(7): 793-801, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31076868

RESUMO

PURPOSE: Distribution and outcomes of traumatic injury of the esophagus (TIE) in pediatric versus adult populations are unknown. Our study sought to perform a descriptive analysis of TIE in children and adults. METHODS: We reviewed the National Trauma Data Bank (NTDB) for the years 2010-2015. Demographics, characteristics, and outcomes of pediatric (age < 16 years) and adult TIE patients were described and compared. RESULTS: Among 526,850 pediatric and 3,838,895 adult trauma patients, 90 pediatric (0.02%) and 1,411 (0.04%) adult TIE patients were identified. Demographics and esophageal injury severity did not differ. Children were more likely to sustain blunt trauma (63% versus 37%), with the most common mechanism being transportation-related accidents, were less-severely injured (median ISS 14 versus 22), and had fewer associated injuries (79% versus 95%) and complications (30% versus 51%) (all p < 0.001). Children had shorter hospitalizations (median 5 versus 10 days) and were more likely to be discharged home (84% versus 64%) (both p = 0.01). In-hospital mortality did not differ significantly between children and adults (10% versus 19%, p = 0.09). CONCLUSION: TIE in the pediatric population has unique characteristics compared to adults: it is more likely to be a result of blunt trauma, has lower injury burden, and has more favorable clinical outcomes.


Assuntos
Traumatismos Abdominais/epidemiologia , Esôfago/lesões , Traumatismo Múltiplo , Sistema de Registros , Traumatismos Torácicos/epidemiologia , Centros de Traumatologia/estatística & dados numéricos , Ferimentos não Penetrantes/epidemiologia , Traumatismos Abdominais/diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Mortalidade Hospitalar/tendências , Humanos , Incidência , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Tempo de Internação/tendências , Masculino , Traumatismos Torácicos/diagnóstico , Estados Unidos/epidemiologia , Ferimentos não Penetrantes/diagnóstico , Adulto Jovem
20.
Ulus Travma Acil Cerrahi Derg ; 25(3): 259-267, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31135949

RESUMO

BACKGROUND: Several scoring systems have been and continue to be developed in numerous countries with the goal of quickly and accurately assessing the severity of trauma injuries. The aim of this study was to identify factors that help to determine the gravity of damage and to minimize it, in order to reduce mortality and morbidity. It is important that the criteria set for the determination of the severity of trauma are objective, measurable, and comparable. This study was an assessment of the contribution of vital signs, hemogram values, and trauma severity scores recorded at initial admission in the prediction of mortality in patients with firearm trauma wounds. METHODS: This was a retrospective cohort study. Patients with gunshot injuries who were admitted to the emergency department (ED) of a single facility between December 2015 and March 2016 were included in the study. Statistical software was used to perform bivariate analyses using a t-test or the Mann-Whitney U test for continuous variables, depending on the distribution of variables, and logistic regression analysis was utilized to determine independent predictors of mortality after ED admission. A p value of <0.05 was considered statistically significant. RESULTS: A total of 418 patients were included. A statistically significant difference was found between the white blood cell count, respiratory rate, Glasgow Coma Scale score, Abbreviated Injury Scale score, and the Injury Severity Score (ISS) of the patients who survived and those who died (p<0.05). The analysis also indicated that a systolic blood pressure below 90 mmHg and a heart rate above 100 beats/minute were independent variables in terms of the expectation of mortality. CONCLUSION: The objective assessment of the ISS at admission to the ED is an important element in the calculation of hemoglobin requirements, mortality, and morbidity.


Assuntos
Escala de Gravidade do Ferimento , Ferimentos por Arma de Fogo , Pressão Sanguínea/fisiologia , Escala de Coma de Glasgow/estatística & dados numéricos , Humanos , Contagem de Leucócitos/estatística & dados numéricos , Taxa Respiratória/fisiologia , Estudos Retrospectivos , Ferimentos por Arma de Fogo/diagnóstico , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/fisiopatologia
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