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1.
World J Surg ; 46(5): 1067-1075, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35211783

RESUMO

BACKGROUND: The foley catheter balloon tamponade (FCBT) has been widely employed in the management of trauma. This study reviews our cumulative experience with the use of FCBT in the management of patients presenting with a penetrating neck injury (PNI). METHODS: A retrospective study was conducted at a major trauma centre in South Africa over a 9-year period from January 2012 to December 2020. All patients who presented with a PNI who had FCBT were included. RESULTS: A total of 1581 patients with a PNI were managed by our trauma centre, and 44 (3%) patients had an FCBT. Of the 44 cases of FCBT, stab wounds accounted for 93% (41/44) and the remaining 7% were for gunshot wounds. Seventy-five per cent of all FCBT (33/44) were inserted at a rural hospital prior to transfer to our trauma centre; the remaining 25% (11/44) were inserted in our resuscitation room. The success rate of FCBT was 80% (35/44), allowing further CT with angiography (CTA) to be performed. CTA findings were: 10/35 (29%) positive, 18/35 (51%) negative, and 7/35 (20%) equivocal. Fifteen patients required additional intervention (open surgery or endovascular intervention). The overall morbidity was 14% (6/44). Eighteen per cent required intensive care unit admission. The median length of stay was 1 day. The overall mortality rate was 11% (5/44). CONCLUSION: FCBT is a simple and effective technique as an adjunct in the management of major haemorrhage from a PNI. In highly selective patients, it may also be used as definitive management.


Assuntos
Oclusão com Balão , Lesões do Pescoço , Ferimentos por Arma de Fogo , Ferimentos Penetrantes , Ferimentos Perfurantes , Cateteres , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Lesões do Pescoço/cirurgia , Lesões do Pescoço/terapia , Estudos Retrospectivos , Ferimentos por Arma de Fogo/cirurgia , Ferimentos Penetrantes/terapia , Ferimentos Perfurantes/cirurgia
2.
Ann R Coll Surg Engl ; 104(4): 308-313, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34931547

RESUMO

INTRODUCTION: This study reviews our experience with the management a retained knife in the setting of thoracic stab wounds. METHODS: A retrospective study was conducted at a major trauma in South Africa over a 15-year period from January 2004 to December 2018. RESULTS: There were 40 patients, of whom 37 were males (93%). Median age was 24 years; 78% of cases (31 of 40) were a retained knife and 23% (9 of 40) were a retained blade. The locations of the stab wounds were 19 (48%) anterior and 21 (53%) posterior. Plain x-ray was performed in 85% (34) of patients and computed tomography angiography was performed in 85% (34). Six patients had haemodynamic instability and were expedited to the operating room without further imaging. Three of these had cardiac tamponade and three a massive haemothorax. Simple extraction and wound exploration were performed in 58% (23 of 40) of cases and the remaining 43% (17 of 40) required operative exploration and extraction. The operative approach was anterolateral thoracotomy in nine cases, posterolateral thoracotomy in four and median sternotomy in three cases. One patient required extraction and concurrent vertebral laminectomy due to cord compression. Twelve patients (30%) experienced complications (nine wound sepsis and three hospital-acquired pneumonia). There was one mortality (3%). The median length of hospital stay was 6 days. CONCLUSION: Uncontrolled extraction of a retained thoracic knife outside the operating room must be avoided. An unstable patient should proceed directly for operative exploration. For stable patients, cross-sectional imaging will allow for planned extraction in operating room.


Assuntos
Ferimentos Penetrantes , Ferimentos Perfurantes , Adulto , Humanos , Masculino , Estudos Retrospectivos , África do Sul/epidemiologia , Centros de Traumatologia , Ferimentos Penetrantes/cirurgia , Ferimentos Perfurantes/epidemiologia , Ferimentos Perfurantes/cirurgia , Adulto Jovem
5.
J Trauma Nurs ; 29(3): 131-141, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35536341

RESUMO

BACKGROUND: Survivors of violent injuries are at risk for readmission, rehospitalization, and reinjury. In 2017, a novel home visiting nurse pilot program was implemented within a hospital-based violence intervention program (HVIP) to address disparities in care and combat the limited health care literacy and access, and the general mistrust of health care institutions among much of this population. OBJECTIVE: The purpose of this study was to review the design and implementation of the home visiting nurse component of the HVIP and to report the demographics, clinical characteristics, home care needs, and short-term health outcomes of the pilot sample. METHODS: This retrospective study was performed using a cohort of patients presenting to the emergency department at an urban, Level I trauma center for a violent penetrating injury between 2017 and 2018. The χ2 and Wilcoxon rank sum tests were used to compare patient demographics and injury characteristics. Cox proportional hazards regression models were used to estimate health outcomes. RESULTS: Of the 742 victims of violence included in this analysis, the 57 patients enrolled in the home visiting nurse pilot program were more likely to have severe gunshot wounds (68.4% vs. 40.3%, p < .001) requiring hospitalization (80.7% vs. 53.3%, p < .001), with 3.5% requiring rehospitalization within 90 days. The primary interventions provided by the home visiting nurse involved medical navigation and education, wound care, and consultation, underscoring the critical importance of health literacy and outreach for this vulnerable population. CONCLUSION: The nurse-advocate partnership provides the foundation for this novel program to aid a marginalized population in overcoming health inequities.


Assuntos
Enfermeiros de Saúde Comunitária , Ferimentos por Arma de Fogo , Ferimentos Penetrantes , Humanos , Projetos Piloto , Estudos Retrospectivos , Ferimentos por Arma de Fogo/epidemiologia
6.
Med J (Ft Sam Houst Tex) ; Per 22-04-05-06(Per 22-04-05-06): 62-72, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35373323

RESUMO

Prolonged Casualty Care (PCC) is a major US military research focus area. PCC is defined as the need to provide patient care for extended periods when evacuation or mission requirements surpass capabilities and/or capacity. US military experts have called for more data relevant to PCC. In response, we aimed to develop an innovative research model using a tiered system of trauma care in the Western Cape of South Africa as a framework for studying relevant US military trauma care and outcomes in a natural prolonged care environment. The objective of this report is to describe the research model and to illustrate how various components of the model may be helpful to provide data relevant to US military PCC. To develop the model, we used a combination of published data, open access reports, and expert opinion to identify, define, and compare relevant components of the Western Cape trauma system suitable for researching aspects of US military PCC. Several key features of the research model are as follows: In the Western Cape, patients are referred from primary and secondary to tertiary facilities (analogous to escalating capabilities by advancing roles of care in the US military). Western Cape civilian trauma providers' capabilities range from prehospital basic life support to definitive trauma surgical and critical care (comparable to US military Tactical Combat Casualty Care to advanced definitive surgical care). Patterns of injuries (e.g., high rates of penetrating trauma and hemorrhagic shock) and prolonged times from injury to definitive surgical care in the Western Cape system have relevance to the US military. This civilian research model for studying PCC is promising and can inform US military research. Importantly, this model also fills gaps in the South African civilian system and is useful for other prolonged trauma care communities worldwide.


Assuntos
Medicina Militar , Militares , Ferimentos Penetrantes , Cuidados Críticos , Humanos , África do Sul
7.
J Am Coll Surg ; 234(5): 872-880, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35426399

RESUMO

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) achieves temporary hemorrhage control via aortic occlusion. Existing REBOA literature focuses on blunt trauma without a clearly defined role in penetrating trauma. This study compared clinical/injury data and outcomes after REBOA in penetrating vs blunt trauma. STUDY DESIGN: All patients in the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) database, an observational American Association for the Surgery of Trauma dataset of trauma patients requiring aortic occlusion, who underwent REBOA were included (January 2014 through February 2021). Study groups were defined by mechanism: penetrating vs blunt. Subgroup analysis was performed of patients arriving with vital signs. Univariable/multivariable analyses compared injuries and outcomes. RESULTS: Seven hundred fifty-nine patients underwent REBOA: 152 (20%) penetrating and 607 (80%) blunt. Patients undergoing penetrating REBOA were less severely injured (injury severity score 25 vs 34; p < 0.001). The most common hemorrhage source was abdominal in penetrating REBOA (79%) and pelvic in blunt REBOA (31%; p = 0.002). Penetrating REBOA was more likely to occur in the operating room (36% vs 17%) and less likely in the emergency department (63% vs 81%; p < 0.001). Penetrating REBOA used more zone I balloon deployment (76% vs 64%) and less zone III (19% vs 34%; p = 0.001). Improved or stabilized hemodynamics were less frequent after penetrating REBOA (41% vs 62%, p < 0.001; 23% vs 41%, p < 0.001). On subgroup analysis of patients arriving alive, improvement or stabilization in hemodynamics was similar between groups (87% vs 86%, p = 0.388; 77% vs 72%, p = 0.273). Penetrating REBOA was not independently associated with mortality (odds ratio 1.253; p = 0.776). CONCLUSIONS: Despite lower injury severity, REBOA was significantly less likely to improve or stabilize hemodynamics after penetrating trauma. Among patients arriving alive, however, outcomes were comparable, suggesting that penetrating REBOA may be most beneficial among patients with vital signs. Because hemorrhage source, catheter insertion setting, and deployment zone varied significantly between groups, existing blunt REBOA data may not be appropriately extrapolated to penetrating trauma. Further study of REBOA as a means of aortic occlusion in penetrating trauma is needed.


Assuntos
Oclusão com Balão , Procedimentos Endovasculares , Choque Hemorrágico , Ferimentos não Penetrantes , Ferimentos Penetrantes , Aorta , Oclusão com Balão/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Escala de Gravidade do Ferimento , Ressuscitação/efeitos adversos , Estudos Retrospectivos , Choque Hemorrágico/etiologia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/cirurgia
8.
Ulus Travma Acil Cerrahi Derg ; 28(3): 328-335, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35485551

RESUMO

BACKGROUND: A total of 412 patients who applied to our clinic after a thoracic trauma between March 2010 and December 2019 were examined retrospectively In this study, late complications that developed as a result of blunt and penetrating thoracic traumas were evaluated and it was aimed to present a prediction for the management of these complications to physicians who are dealing with trauma. METHODS: Among the 412 thoracic trauma cases, 62 cases (15.04%) who developed late-term complications which constituted the main theme of this study were evaluated in terms of age, gender, the type of trauma, the cause of trauma, thorax, and concomitant organ pathologies that developed when the trauma first occurred, the late-term complications, and the treatment methods for them while considering mortality. RESULTS: Of 62 patients with late complications due to thoracic trauma, 47 (75.80%) were male, 15 (24.20%) were female, and the average age was 56.98±21.22. When the trauma type of the patients who developed posttraumatic late-term complications was evaluated, blunt traumas were seen in 90.33% (n=56) of the cases, whereas penetrating traumas were seen in 9.47% (n=6). Traffic accidents were the most common cause in blunt trauma cases (66.07%), whereas pointed and sharp-edged weapon injuries were the most common in penetrating traumas (83.33%). The most common thorax pathology is pulmonary contusion (75%) in blunt traumas and hemopneumothorax in penetrating traumas (66.66%). When the groups were analyzed separately, the most common late-term complication for penetrating traumas was retained hemothorax (66.66%), while pneumonia was the most common (41.07%) in blunt trauma cases. Video-assisted thoracoscopic surgery was performed in seventeen patients with retained post-traumatic hemothorax and thoracotomy was performed in eight cases. Seven patients with post-traumatic empyema underwent thoracoscopy, and four patients underwent decortication with thoracotomy. Six of the patients who developed late-term complications died. The mortality rate is 9.67%. Pneumonia was detected as a late complication type in 83.33% of cases with mortality. CONCLUSION: It will be appropriate for the physicians who are interested in trauma to determine the treatment modalities of the patients by considering many factors such as the age of the patient and the trauma type in terms of the late complications that they will not be able to detect at first glance.


Assuntos
Traumatismos Torácicos , Ferimentos não Penetrantes , Ferimentos Penetrantes , Adulto , Idoso , Feminino , Hemotórax/epidemiologia , Hemotórax/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Traumatismos Torácicos/cirurgia , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/cirurgia
9.
J Trauma Acute Care Surg ; 92(5): 821-830, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35468113

RESUMO

INTRODUCTION: Social determinants of health are known to impact patient-level outcomes, but they are often difficult to measure. The Social Vulnerability Index was created by the Centers for Disease Control to identify vulnerable communities using population-based measures. However, the relationship between SVI and trauma outcomes is poorly understood. METHODS: In this retrospective study, we merged SVI data with a statewide trauma registry and used three analytic models to evaluate the association between SVI quartile and inpatient trauma mortality: (1) an unadjusted model, (2) a claims-based model using only covariates available to claims datasets, and (3) a registry-based model incorporating robust clinical variables collected in accordance with the National Trauma Data Standard. RESULTS: We identified 83,607 adult trauma admissions from January 1, 2017, to September 30, 2020. Higher SVI was associated with worse mortality in the unadjusted model (odds ratio, 1.72 [95% confidence interval, 1.30-2.29] for highest vs. lowest SVI quintile). A weaker association between SVI and mortality was identified after adjusting for covariates common to claims data. Finally, there was no significant association between SVI and inpatient mortality after adjusting for covariates common to robust trauma registries (adjusted odds ratio, 1.10 [95% confidence interval, 0.80-1.53] for highest vs. lowest SVI quintile). Higher SVI was also associated with a higher likelihood of presenting with penetrating injuries, a shock index of >0.9, any Abbreviated Injury Scale score of >5, or in need of a blood transfusion (p < 0.05 for all). CONCLUSION: Patients living in communities with greater social vulnerability are more likely to die after trauma admission. However, after risk adjustment with robust clinical covariates, this association was no longer significant. Our findings suggest that the inequitable burden of trauma mortality is not driven by variation in quality of treatment, but rather in the lethality of injuries. As such, improving trauma survival among high-risk communities will require interventions and policies that target social and structural inequities upstream of trauma center admission. LEVEL OF EVIDENCE: Prognostic / Epidemiologic, Level IV.


Assuntos
Vulnerabilidade Social , Ferimentos Penetrantes , Escala Resumida de Ferimentos , Adulto , Humanos , Estudos Retrospectivos , Centros de Traumatologia
10.
S Afr J Surg ; 60(1): 59-61, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35451272

RESUMO

SUMMARY: Penetrating junctional torso trauma with multiple and complex injuries presents the clinician with many investigational and management decisions. This situation has been termed double jeopardy in the literature. The management of this multiple gunshot victim's injuries - massive haemothorax and severe liver and kidney injuries - describes how this pathway can be negotiated with a successful outcome.


Assuntos
Ferimentos por Arma de Fogo , Ferimentos Penetrantes , Humanos , Rim , Ferimentos por Arma de Fogo/terapia
12.
Emerg Radiol ; 29(3): 519-529, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35322323

RESUMO

PURPOSE: Selecting groups of low-risk penetrating trauma patients to forego laparotomy can be challenging. The presence of bowel injury may prevent non-operative management. Optimal CT technique to detect bowel injury related to penetrating injury is controversial. Our goal is to compare the diagnostic performance of triple-contrast (oral, rectal, and IV) against IV contrast-only CT, for the detection of bowel injury from penetrating abdominopelvic trauma, using surgical diagnosis as the reference standard. METHODS: Nine hundred ninety-seven patients who underwent CT for penetrating torso trauma at a single institution between 2009 and 2016 in our HIPPA-compliant and institutional review board-approved retrospective cohort study. A total of 143 patients, including 15 females and 123 males underwent a pre-operative CT, followed by exploratory laparotomy. Of these, 56 patients received triple-contrast CT. CT examinations were independently reviewed by two radiologists, blinded to surgical outcome and clinical presentation. Results were stratified by contrast type and injury mechanism and were compared based upon diagnostic performance indicators of sensitivity, specificity, negative predictive value, and positive predictive value. Area under the receiving operating characteristics curves were analyzed for determination of diagnostic accuracy. RESULTS: Bowel injury was present in 45 out of 143 patients (10 on triple-contrast group and 35 on IV contrast-only group). Specificity and accuracy were higher with triple-contrast CT (98% specific, 97-99% accurate) compared to IV contrast-only CT (66% specific, 78-79% accurate). Sensitivity was highest with IV contrast-only CT (91% sensitive) compared with triple-contrast CT (75% sensitive), although this difference was not statistically significant. Triple-contrast technique increased diagnostic accuracy for both radiologists regardless of mechanism of injury. CONCLUSION: In our retrospective single-institution cohort study, triple-contrast MDCT had greater accuracy, specificity, and positive predictive values when compared to IV contrast-only CT in evaluating for bowel injury from penetrating wounds.


Assuntos
Traumatismos Abdominais , Ferimentos Penetrantes , Traumatismos Abdominais/cirurgia , Estudos de Coortes , Feminino , Humanos , Masculino , Tomografia Computadorizada Multidetectores , Estudos Retrospectivos , Sensibilidade e Especificidade , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/cirurgia
14.
J Am Coll Surg ; 234(4): 444-449, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35290263

RESUMO

BACKGROUND: Traumatic subclavian artery injury (SAI) remains uncommon but can lead to significant morbidity and mortality. Although open and endovascular repair offer excellent limb salvage rates, their role in blunt and penetrating injuries is not well defined. The goal of this study was to examine the effect of mechanism of injury and type of repair on outcomes in patients with traumatic SAI. STUDY DESIGN: Patients undergoing procedures for traumatic SAI were identified from the Trauma Quality Improvement Program database between 2015 and 2018. Demographics, severity of injury and shock, type of subclavian repair (open vs endovascular), morbidity, and mortality were recorded. Patients with SAI were stratified by mechanism and type of repair and compared. Multivariable logistic regression (MLR) analysis was performed to determine independent predictors of mortality. RESULTS: Seven hundred thirty-seven patients undergoing procedures for SAI were identified. Of these, 39% were penetrating. The majority were male (80%) with a median age and Injury Severity Score (ISS) of 37 and 21, respectively. 58% of patients were managed endovascularly. For patients with blunt injury, the type of repair affected neither morbidity (25% vs 19%, p = 0.116) nor mortality (11% vs 10%, p = 0.70). For patients with penetrating injuries, endovascular repair had significantly lower morbidity (12% vs 22%, p = 0.028) and mortality (6% vs 21%, p = 0.001). MLR identified endovascular repair as the only modifiable risk factor associated with reduced mortality (odds ratio, 0.35; 95% confidence interval, 0.14 to 0.87, p = 0.02). CONCLUSIONS: SAI results in significant morbidity and mortality regardless of mechanism. Although the type of repair did not affect mortality in patients with blunt injury, endovascular repair was identified as the only modifiable predictor of reduced mortality in patients with penetrating injuries.


Assuntos
Procedimentos Endovasculares , Traumatismos Torácicos , Lesões do Sistema Vascular , Ferimentos não Penetrantes , Ferimentos Penetrantes , Procedimentos Endovasculares/métodos , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Estudos Retrospectivos , Fatores de Risco , Artéria Subclávia/lesões , Artéria Subclávia/cirurgia , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/cirurgia
15.
J Spec Oper Med ; 22(1): 76-80, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35278318

RESUMO

BACKGROUND: Open penetrating trauma wounds to the extremities remain the most common injuries encountered in combat and are frequently complicated by bacterial infections. These infections place a heavy burden on the Servicemember and the healthcare system as they often require multiple additional procedures and can frequently cause substantial debility. Previous studies have shown that vancomycin powder has demonstrated efficacy in decreasing infection risks in clean and contaminated orthopedic surgical wounds. METHODS: This review evaluates the most prevalent organisms cultured post-trauma, the current Tactical Combat Casualty Care (TCCC) guidelines for antibiotic prophylaxis, and relevant research of vancomycin's prophylactic use. RESULTS: Results from previous studies have shown a time-dependent reduction in bacterial load when vancomycin powder is introduced early post injury in traumatic orthopedic wounds. Furthermore, perioperative application affords a cost-effective method to prevent infection with minimal adverse effects. DISCUSSION: The current TCCC guidelines advocate for the use of antibiotics at the point of injury. When vancomycin powder is used in synergy with these guidelines, it can contribute a timely and powerful antibiotic to prevent infection. CONCLUSION: The prophylactic use of vancomycin powder is a promising adjunctive agent to current Clinical Practice Guidelines (CPG), but it cannot be conclusively determined to be effective without further research into its application in traumatic combat wounds.


Assuntos
Vancomicina , Ferimentos Penetrantes , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Humanos , Pós , Vancomicina/uso terapêutico
16.
Rev Col Bras Cir ; 49: e20223120, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35239854

RESUMO

OBJECTIVE: to describe, analyze, and trace the epidemiological profile for cardiac trauma victims on a referral trauma hospital of a major urban center. METHODS: a case series study to review, describe, compile and analyze medical records of all patients sustaining traumatic cardiac injuries, from January 2015 to January 2020 admitted to the referral trauma hospital of Curitiba, Brazil. Patients sustaining traumatic heart injuries were identified using the hospitals database. Patients who died prior to reaching hospital care were excluded. RESULTS: all 22 cases were urban victims, mostly penetrating injuries (12 stab wounds, 9 gunshot wounds); 82% were male; mean age, 37.1 years. 17 cases (77%) occurred during night hours, 15 between Friday and Sunday, and 15 were admitted hemodynamically stable. Only 27% were diagnosed with FAST, the remainder requiring other imaging exams. About incisions, 14 had thoracotomies, 6 median sternotomies and in 2 cases both. Of injuries, 8 affected the right ventricle, 3 right atrium, 9 left ventricle, 1 right coronary sulcus and 1 anterior wall. All had cardiorrhaphy repair. 3 patients died, 17 were discharged and 2 were transferred. 17 received postoperative echocardiograms, revealing ejection fractions ranging 55.1% to 75%. Patients spent a mean of 9.6 days on ICU and a mean of 15.2 days of total hospital stay. The mortality rate was 14%. CONCLUSIONS: cardiac traumas predominantly occurred in adult males, due to violent causes, during night hours on weekends. The overall mortality rate found (14%), as well as total hospital stay, accords with the literature.


Assuntos
Ferimentos por Arma de Fogo , Ferimentos Penetrantes , Ferimentos Perfurantes , Adulto , Feminino , Hospitais , Humanos , Masculino , Encaminhamento e Consulta , Estudos Retrospectivos , Centros de Traumatologia , Ferimentos Penetrantes/cirurgia
17.
JAMA Netw Open ; 5(2): e2145708, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-35133435

RESUMO

Importance: Public health measures instituted to reduce the spread of COVID-19 led to severe disruptions to the structure of daily life, and the resultant social and financial impact may have contributed to an increase in violence. Objective: To examine the trends in violent penetrating injuries during the first COVID-19 pandemic year compared with previous years. Design, Setting, and Participants: This retrospective cross-sectional study was performed to compare the prevalence of violent penetrating injuries during the first COVID-19 pandemic year, March 2020 to February 2021, with the previous 5 years, March 2015 to February 2020. This study was performed among all patients with a violent penetrating injury presenting at Boston Medical Center, an urban, level I trauma center that is the largest safety-net hospital and busiest trauma center in New England. Data were analyzed from January 4 to November 29, 2021. Main Outcomes and Measures: The primary outcomes were the incidence and timing of emergency department presentation for violent penetrating injuries during the first year of the COVID-19 pandemic compared with the previous 5 years. Patient demographics and injury characteristics were also assessed. Results: A total of 2383 patients (median [IQR] age, 29.5 [23.4-39.3] years; 2032 [85.4%] men and 351 [14.6%] women) presenting for a violent penetrating injury were evaluated, including 1567 Black patients (65.7%), 448 Hispanic patients (18.8%), and 210 White patients (8.8%). There was an increase in injuries during the first pandemic year compared with the previous 5 years, with an increase in shootings (mean [SD], 0.61 [0.89] injuries per day vs 0.46 [0.76] injuries per day; P = .002) but not stabbings (mean [SD], 0.60 [0.79] injuries per day vs 0.60 [0.82] injuries per day; P = .78). This surge in firearm violence began while Massachusetts was still under a stay-at-home advisory and before large-scale racial justice protests began. Patients presenting with violent penetrating injuries in the pandemic surge months (April-October 2020) compared with the same period in previous years were disproportionately male (153 patients [93.3%] vs 510 patients [87.6%]; P = .04), unemployed (70 patients [57.4%] vs 221 patients [46.6%]; P = .03), and Hispanic (40 patients [26.0%] vs 99 patients [17.9%]; P = .009), with a concurrent decrease in White patients (0 patients vs 26 patients [4.7%]), and were more likely to have no previous history of violent penetrating injury (146 patients [89.0%] vs 471 patients [80.9%]; P = .02). Conclusions and Relevance: These findings suggest that unprecedented measures implemented to mitigate the spread of COVID-19 were associated with an increase in gun violence. As the pandemic abates, efforts at community violence prevention and intervention must be redoubled to defend communities against the epidemic of violence.


Assuntos
COVID-19/epidemiologia , Pandemias , Violência/estatística & dados numéricos , Ferimentos Penetrantes/epidemiologia , Adulto , Boston/epidemiologia , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Incidência , Masculino , Quarentena , Estudos Retrospectivos , SARS-CoV-2 , Estados Unidos , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos Penetrantes/etnologia , Ferimentos Perfurantes/epidemiologia , Adulto Jovem
18.
JNMA J Nepal Med Assoc ; 60(245): 90-92, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-35199668

RESUMO

Penetrating neck injuries causing rupture of sternocleidomastoid muscle along with transection of major vessels of the neck have significant morbidity and mortality due to the risk of severe hemorrhage and cerebral infarction. However, there are no universal guidelines for the management of penetrating neck injuries. Here, we report a case of a 67-year-old female with a lacerated wound on the left side of the neck with a complete transection of the left sternocleidomastoid muscle along with transection of internal jugular vein and two superficial branches of internal carotid artery following penetrating injury to the neck by a bamboo stick. It was managed by emergency wound exploration with ligation of the injured vessels with repair of sternocleidomastoid muscle. Post-operatively the hemorrhage was controlled and the patient was discharged on the fourth postoperative day. Thus, in a case of penetrating injury to the neck, prompt surgical wound exploration is beneficial.


Assuntos
Lesões do Pescoço , Lesões do Sistema Vascular , Ferimentos Penetrantes , Idoso , Feminino , Humanos , Ligadura , Pescoço/cirurgia , Lesões do Pescoço/complicações , Lesões do Pescoço/diagnóstico , Lesões do Pescoço/cirurgia , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/cirurgia , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/cirurgia
19.
Cir Esp (Engl Ed) ; 100(2): 67-73, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35120850

RESUMO

INTRODUCTION: The relationship between the anatomical location of penetrating abdominal stab wounds (SW) and the rate of selective non-operative management (SNOM) based on that location is scarcely reflected in the specialized literature. Our main objective has been to assess this rate based on the anatomical location, and our results. METHODS: Retrospective review of a prospective registry of abdominal trauma from April 1993 to June 2020. The two study groups considered were the Operative Management (OM), and the SNOM, including in this one the use of diagnostic laparoscopy. Penetrating SWs in the abdomen were classified according to anatomical location. RESULTS: We identified 259 patients who fulfilled the inclusion criteria. SNOM was applied in 31% of the patients with a success rate of 96%, and it was more frequent in the lumbar, flank, and thoraco-abdominal regions; within the anterior abdomen it was more applicable in the RH, followed by the LH and epigastrium, respectively. An unnecessary laparotomy was done in 21% of patients, with the highest number in the epigastrium. Taking into account the unnecessary laparotomies and the rates of successful SNOM, 70.5% of lumbar, 66.5% of epigastric, 62% of flank, and 59% of RH penetrating SW could have been managed without a laparotomy. CONCLUSIONS: SNOM of penetrating SW in the abdomen has been safer and more applicable in those located in the lumbar, flank, epigastric, and RH regions.


Assuntos
Traumatismos Abdominais , Ferimentos Penetrantes , Ferimentos Perfurantes , Abdome/diagnóstico por imagem , Abdome/cirurgia , Traumatismos Abdominais/cirurgia , Humanos , Estudos Retrospectivos , Ferimentos Penetrantes/cirurgia , Ferimentos Perfurantes/cirurgia
20.
J Emerg Med ; 62(3): 356-358, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35109973

RESUMO

BACKGROUND: Fishhook injuries are an uncommon trauma, and removing a penetrating fishhook is a complicated maneuver, especially if the wound involves delicate anatomical structures like the ocular region. DISCUSSION: Several techniques that have been discussed in literature are reviewed and the authors present a novel approach that has been successfully performed on a patient with a fishhook penetrating his upper eyelid after a fishing accident. CONCLUSION: Emergency physicians should be aware of all the possible approaches to fishhook penetrating injuries. If the fishhook does not involve the globe and an ophthalmologist is not available, the injury may be managed in the emergency department.


Assuntos
Corpos Estranhos , Ferimentos Penetrantes , Serviço Hospitalar de Emergência , Pálpebras/lesões , Pálpebras/cirurgia , Corpos Estranhos/complicações , Corpos Estranhos/cirurgia , Humanos , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/cirurgia
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