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1.
J Surg Res ; 257: 69-78, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32818786

RESUMO

BACKGROUND: Despite improvements in operative techniques, major abdominal complications (MACs) continue to occur after penetrating abdominal trauma (PAT). This study aimed to evaluate the burden of MAC after PAT. METHODS: The (2012-2015) National Readmission Database was queried for all adult (age ≥18 y) trauma patients with penetrating injuries who underwent exploratory laparotomy and were readmitted within 6 mo of index hospitalization discharge. Patients were stratified by firearm injuries (FIs) and stab injuries (SIs). Primary outcomes were rates of MAC: intra-abdominal abscesses (IAAs), superficial surgical site infection (SSI), and fascial dehiscence within 6 mo after discharge. Secondary outcomes were both nonabdominal complications and mortality, postdischarge, and 6-mo readmission. Regression analysis was performed. RESULTS: A total of 4473 patients (FI, 2326; SI, 2147) were included in the study; the mean age was 32 ± 14 y, the Injury Severity Score was 19 (15-25), and 23% underwent damage control laparotomy (DCL). The rate of MAC within 6 mo was 22% (IAA 19%, SSI 7%, and fascial dehiscence 4%). Patients with FIs had a higher rate of IAA (27% versus 10%; P < 0.01), SSI (11% versus 3%; P < 0.01), fascial dehiscence (5% versus 3%; P = 0.03), nonabdominal complications (54% versus 24%; P < 0.01), and postdischarge mortality (8% versus 6%; P < 0.01) compared with patients with SIs . On regression analysis, DCL (P < 0.01), large bowel perforation (P < 0.01), biliary-pancreatic injury (P < 0.01), hepatic injury (P < 0.01), and blood transfusion (P = 0.02) were predictors of MAC. CONCLUSIONS: MAC developed in one in five patients after PAT. FIs have a higher potential for hollow viscus injury and peritoneal contamination, and are more predictive of MAC and nonabdominal complications, especially after DCL. LEVEL OF EVIDENCE: Level III Prognostic.


Assuntos
Abdome/cirurgia , Traumatismos Abdominais/cirurgia , Laparotomia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Ferimentos Penetrantes/cirurgia , Abscesso Abdominal/epidemiologia , Traumatismos Abdominais/complicações , Traumatismos Abdominais/mortalidade , Adolescente , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Laparotomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Deiscência da Ferida Operatória/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/cirurgia , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/mortalidade , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/cirurgia , Adulto Jovem
3.
J Card Surg ; 35(7): 1597-1599, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32485004

RESUMO

BACKGROUND AND AIM OF THE STUDY: Cardiac wounds have been described for centuries and still remain to be fatal. For a long period of time, the suturing of a myocardial laceration was thought to be absolutely impossible if not sacrilege. METHODS: It is only at the end of the 19th century that pioneers decided to defy such a dogma in desperate cases. RESULTS: Nowadays, it seems obvious that a cardiac stab wound requires emergent surgery whenever possible. CONCLUSIONS: The story of cardiac wounds highlights nicely the change of mind that is required to accept progress and new procedures in medicine.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/tendências , Traumatismos Cardíacos/cirurgia , Técnicas de Sutura , Ferimentos Perfurantes/cirurgia , Humanos , Lacerações/cirurgia , Técnicas de Sutura/tendências
5.
Rev. cir. (Impr.) ; 72(2): 137-143, abr. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1092905

RESUMO

Resumen Objetivos Describir las características, índices de gravedad de traumatismo (IGT), morbilidad, mortalidad y factores asociados a mortalidad en pacientes hospitalizados por traumatismo torácico por arma blanca (TTAB). Materiales y Método Estudio analítico transversal. Período enero de 1981 a diciembre de 2017. Revisión base de datos prospectiva, protocolos quirúrgicos, fichas clínicas. Se describe y compara las características de los TTAB. Se calculó IGT: Injury Severity Score (ISS), Revised Trauma Score ( RTS-T) y Trauma Injury Severity Score (TRISS). Resultados Total 4.163 pacientes hospitalizados por TT, 2.286 hospitalizados por TTAB. Hombres: 2.131 (93,2%), edad promedio 27,8 ± 10,7 años, TTAB aislado 2.035 (89,0%), asociado a lesiones extratorácicas 251 (11,0%) y de éstos 124 (5,5%) se consideraron politraumatismos. Mecanismos principales del traumatismo: agresión 2.246 (98,3%) y autoagresión 22 (1,0%). Lesiones y hallazgos torácicos más frecuentes: neumotórax 1.473 (64,4%), hemotórax 1.408 (61,6%), enfisema subcutáneo 485 (21,2%). Tratamiento definitivo: pleurotomía 1.378 (60,3%), cirugía torácica 537 (23,5%) y tratamiento médico 370 (16,2%). Hospitalización promedio 6,2 ± 6,5 días, IGT: ISS promedio 10,9 ± 7,2, RTS-T promedio 11,6 ± 1,4 y TRISS promedio 3,6. Morbilidad: 318 (13,9%). Mortalidad: 32 (1,4%). Conclusión Los TTAB ocurren frecuentemente en hombres jóvenes por agresión. La mayoría se puede tratar con pleurotomía exclusiva.


Aim Our objectives are to describe and correlate the clinical characteristics, trauma severity indexes (TSI) and morbidity and mortality in patients hospitalized for thoracic trauma by a bladed weapon (TTBW). Materials and Method Transversal analytic study. Period January-1981 to December-2017. Prospective database review, surgical protocols, clinical files. The characteristics of the TTBW are described and compared. Injury Severity Score (ISS), Revised Trauma Score (RTS-T) and Trauma Injury Severity Score (TRISS) were calculated. Results Total of 4,163 patients hospitalized for TT, 2,286 hospitalized for TTBW. Men: 2,131 (93.2%), average age 27.8 ± 10.7 years, isolated TTBW 2,035 (89.0%), associated with extra thoracic injuries 251 (11.0%) and of these 124 (5.5%) were considered polytrauma. Main mechanisms of trauma: Aggression 2,246 (98.3%) and self-aggression 22 (1.0%). Most frequent injuries and thoracic findings: pneumothorax 1,473 (64.4%), hemothorax 1,408 (61.6%), subcutaneous emphysema 485 (21.2%). Definitive treatment: Pleurotomy 1,378 (60.3%), thoracic surgery 537 (23.5%) and medical treatment 370 (16.2%). Average hospital stay: 6.2 ± 6.5 days. ISS average 10.9 ± 7.2, RTS-T average 11.6 ± 1.4 and TRISS average 3.6. Morbidity: 318 (13.9%). Mortality: 32 (1.4%). Discussion TTBW are frequent in our environment, unlike on an international level. Conclusions TTBW frequently occur in young male patients due to aggression. The majority can be treated with exclusive pleurotomy.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Traumatismos Torácicos/mortalidade , Traumatismos Torácicos/epidemiologia , Ferimentos Perfurantes/mortalidade , Ferimentos Perfurantes/epidemiologia , Traumatismos Torácicos/cirurgia , Traumatismos Torácicos/complicações , Ferimentos Perfurantes/cirurgia , Ferimentos Perfurantes/etiologia , Chile/epidemiologia , Estudos Retrospectivos
6.
World Neurosurg ; 138: e551-e556, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32156595

RESUMO

BACKGROUND: Gunshot wound (GSW) injuries are among the leading causes of penetrating spinal column injury (pSI). Patients with pSI often have concurrent polytrauma that complicates management. METHODS: We retrospectively reviewed charts between January 2012 to June 2018 at an urban Level 1 trauma center and analyzed bracing and surgical indications, antibiotic and magnetic resonance imaging (MRI) use, and patient outcomes. RESULTS: We identified 100 patients with pSI with an average age of 27.2 (range, 15-58) years. Five patients had knife injuries and 95 suffered GSW. Polytrauma occurred in 90% of patients with an average of 3.39 bullets per patient (range, 1-23). Fourteen patients underwent either decompressive surgery (n = 8) or decompression and fusion (n = 6). Thirty-five patients were externally braced. A total of 43% of patients presented as American Spinal Injury Association-A compared with 26% who were intact. Although 14 patients received prophylactic antibiotics for retained bullets or durotomies, only 2 patients had postoperative wound infections and 4 had extraspinal infections from retained bullets. All inpatient mortalities (n = 5) were patients with cervical pSI. Thirteen patients with GSW obtained MRI scans without complications. Among our cohort, only 65 patients had follow-up with a median follow-up period of 1.25 (range, 1-60) months. CONCLUSIONS: Management of pSI in urban trauma centers is complex, as these victims routinely have polytrauma that takes precedence. Indications for surgical intervention are narrow and secondary to surgery for polytrauma. External bracing may be overutilized. The efficacy of prophylactic antibiotics remains unclear. MRI can contribute valuable information but is limited by uncertainty regarding bullet compatibility. Lack of follow-up limits the study of this population.


Assuntos
Procedimentos Ortopédicos/métodos , Traumatismos da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Ferimentos Perfurantes/cirurgia , Adolescente , Adulto , Descompressão Cirúrgica , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Centros de Traumatologia , Resultado do Tratamento , Ferimentos por Arma de Fogo/diagnóstico por imagem , Ferimentos Perfurantes/diagnóstico por imagem , Adulto Jovem
8.
Rev. cir. (Impr.) ; 72(1): 43-47, feb. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1092889

RESUMO

Resumen Introducción Por su ubicación retroperitoneal, las lesiones de vena cava (LVC) son infrecuentes, presentándose en el contexto de un paciente con múltiples lesiones intraabdominales y en estado crítico. Objetivo Describir la experiencia de pacientes politraumatizados con LVC sometidos a resolución quirúrgica en Hospital Dr. Sotero del Río. Materiales y Método Análisis retrospectivo de 36 pacientes politraumatizados que dentro de la intervención quirúrgica se evidenció LVC en un período comprendido entre el 2010 y 2017. Resultados La serie estuvo compuesta por 36 pacientes, con LVC. El 88,8% son hombres, en el 97,2% el mecanismo de trauma es penetrante. Dentro de los niveles anatómicos vasculares más frecuentemente lesionados está la cava infrarrenal (41,6%), suprarrenal (25%), yuxtarrenal (22,2%) y la retrohepática e intratorácica (5,5% cada una). Las estructuras lesionadas asociadas más frecuentes fueron intestino delgado (38,8%), otros vasos de gran calibre (36,1%) y riñón (30,5%). Dentro del tipo de resolución quirúrgica, al 15,6% se realizó ligadura de vena cava y al 83,3% rafia simple. En 33,3% fue necesaria una toracotomía para el control vascular, siendo 2 de estas toracotomías resucitadoras. La media de hospitalización fue de 19,8 días. La mortalidad fue de 33,3%. Conclusiones De acuerdo a lo presentado, la alta mortalidad de LVC se encontró en el grupo de pacientes con inestabilidad hemodinámica y número de lesiones asociadas, en especial si involucran otros grandes vasos. Los esfuerzos para optimizar la supervivencia se deberían dirigir al traslado rápido prehospitalario y al entrenamiento de los cirujanos que enfrentan este tipo de lesiones.


Introduction For its retroperitoneal location, vena cava injuries are infrequent, however, occurring to a patient with multiple intra-abdominal injuries and in critical condition. Aim To describe the experience of polytraumatized patients with VCI who underwent surgical resolution in the Dr. Sotero del Rio hospital. Materials and Method Retrospective analysis of 36 polytraumatized patients that showed VCI during the surgical intervention within 2010 and 2017. Results The series was composed of 36 VCI patients. 88.8% are men, in 97.2% the mechanism of trauma is penetrating. Within the vascular anatomical levels, the most frequently injured are the infra-renal cava (41.6%) suprarenal (25%), yuxta-renal (22.2%) retro-hepatic and intrathoracic (5.5% each). The most frequent associated injured structures were the small intestine (38.8%) other vessels of large caliber (36.1%) and kidney (30.5%). In relation to the type of surgical resolution, 15.6% had a vena cava ligature and 83.3% simple raffia. In 33.3%, a thoracotomy was required for vascular control, two of them were resuscitative procedures. The average of hospitalization was 19.8 days. The mortality was 33.3%. Conclusions According to what presented, the high mortality of VCI was found in the group of patients with hemodynamic instability and the number of associated injuries; specially if other large vessels are involved. To optimize the survival, the efforts should be focused on a fast prehospital transfer and the training for surgeons who face this type of injury.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Veia Cava Inferior/cirurgia , Veia Cava Inferior/lesões , Traumatismos Abdominais/complicações , Fatores de Tempo , Ferimentos por Arma de Fogo/cirurgia , Ferimentos Penetrantes/cirurgia , Ferimentos Perfurantes/cirurgia , Chile , Resultado do Tratamento , Traumatismos Abdominais/cirurgia , Traumatismos Abdominais/mortalidade
9.
Br J Radiol ; 93(1106): 20190017, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31899661

RESUMO

Paediatric aortic trauma is a rare injury which can be fatal if not identified and managed appropriately. Surgical repair remains the gold-standard in moderate to severe aortic injuries. In the last decade however, endovascular treatment has gained popularity in children who have suitable vascular anatomy for intervention and are either not fit for surgery or in whom, endovascular intervention is the only alternative that will make a difference in the clinical outcome. Children pose a unique set of challenges to endovascular therapy. In this article, we aim to illustrate the different endovascular options that are available for the treatment of acute traumatic aortic injury and visceral thromboembolisation through pictorial representation. We will also demonstrate the feasibility and the limitation of this technique.


Assuntos
Aorta Abdominal/lesões , Aorta Torácica/lesões , Procedimentos Endovasculares , Ferimentos não Penetrantes/cirurgia , Ferimentos Perfurantes/cirurgia , Acidentes de Trânsito , Adolescente , Aorta Abdominal/cirurgia , Aorta Torácica/cirurgia , Criança , Pré-Escolar , Angiografia por Tomografia Computadorizada , Estudos de Viabilidade , Humanos , Angiografia por Ressonância Magnética , Masculino , Ferimentos não Penetrantes/diagnóstico , Ferimentos Perfurantes/diagnóstico
12.
Surg Endosc ; 34(1): 261-267, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30963262

RESUMO

BACKGROUND: Management of patients with thoracoabdominal penetrating injuries is challenging. Thoracoabdominal penetrating trauma may harbor hollow viscus injuries in both thoracic and abdominal cavities and occult diaphragmatic lesions. While radiological tests show poor diagnostic performance in these situations, evaluation by laparoscopy is highly sensitive and specific. Furthermore, minimally invasive surgery may avoid unnecessary laparotomies, despite concerns regarding complication and missed injury rates. The objective of the present study is to evaluate the diagnostic and therapeutic performance of laparoscopy in stable patients with thoracoabdominal penetrating injuries. METHODS: Retrospective analysis of hemodynamically stable patients with thoracoabdominal penetrating wounds was managed by laparoscopy. We collected data regarding the profile of the patients, the presence of diaphragmatic injury, perioperative complications, and the conversion rate. Preoperative imaging tests were compared to laparoscopy in terms of diagnostic accuracy. RESULTS: Thirty-one patients were included, and 26 (84%) were victims of a stab wound. Mean age was 32 years. Ninety-three percent were male. Diaphragmatic lesions were present in 18 patients (58%), and 13 (42%) had associated injuries. There were no missed injuries and no conversions. Radiography and computerized tomography yielded an accuracy of 52% and 75%, respectively. CONCLUSION: Laparoscopy is a safe diagnostic and therapeutic procedure in stable patients with thoracoabdominal penetrating wound, with low complication rate, and may avoid unnecessary laparotomies. The poor diagnostic performance of preoperative imaging exams supports routine laparoscopic evaluation of the diaphragm to exclude injuries in these patients.


Assuntos
Diafragma , Laparoscopia , Laparotomia , Sobremedicalização/prevenção & controle , Complicações Pós-Operatórias , Traumatismos Torácicos , Tomografia Computadorizada por Raios X/métodos , Ferimentos Perfurantes , Traumatismos Abdominais/cirurgia , Adulto , Brasil , Conversão para Cirurgia Aberta/estatística & dados numéricos , Diafragma/diagnóstico por imagem , Diafragma/lesões , Feminino , Hemodinâmica , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparotomia/efeitos adversos , Laparotomia/métodos , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Traumatismos Torácicos/etiologia , Traumatismos Torácicos/fisiopatologia , Traumatismos Torácicos/cirurgia , Procedimentos Desnecessários , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/cirurgia , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/diagnóstico , Ferimentos Perfurantes/cirurgia
14.
Ann Dermatol Venereol ; 147(2): 123-126, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-31813594

RESUMO

INTRODUCTION: Stingray injuries occur when people inadvertently step on these fish. Penetration of the barb results in puncture and/or laceration wounds and lesions related to the venom. PATIENTS AND METHODS: We report the case of a 76-year-old woman in French Polynesia who was stung on her right ankle by a stingray. She initially had a hypertensive episode with encephalopathy and a haemorrhagic wound due to an indwelling fragment of the barb. Necrosis due to the poison required medical-surgical management with debridement, which yielded a favourable outcome. DISCUSSION: Stingray injuries are rare and not well-known by doctors. They can be serious due to injury by the barb and to venom poisoning, leading to enzymatic tissue destruction, ischaemia and intense pain. The initial treatment consists in immersion in hot water, as the venom is thermolabile; antibiotics and surgery may be necessary, depending on the condition of the wound.


Assuntos
Traumatismos do Tornozelo/etiologia , Mordeduras e Picadas/complicações , Rajidae , Ferimentos Perfurantes/etiologia , Idoso , Animais , Traumatismos do Tornozelo/patologia , Traumatismos do Tornozelo/cirurgia , Encefalopatias/etiologia , Desbridamento , Feminino , Hemorragia/etiologia , Humanos , Hipertensão/etiologia , Necrose/cirurgia , Polinésia , Ferimentos Perfurantes/cirurgia
15.
Prensa méd. argent ; 105(11): 783-785, dic2019. fig
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1049774

RESUMO

Background: It is widely established that the extraction of impaled objects should be carried out under direct vision. In the case of stable patients, endoscopic vision can be used as an alternative. Clinical Case: A 70-year-old male is admitted for a 5-hour impaled precordial stab wound. Evolution valued according to ATLS standards. Clinically and hemodynamically compensated patient. On physical examination: left pulmonary hypoventilation, subcutaneous emphysema, no jugular engorgement. Control of vital signs: TA: 110 / 70mmHg, FC: 70min, FR: 20min, Sat02: 97%. Complementary studies: ECO FAST: no pericardial fluid. Rx thorax: mild left pneumothorax heme. Chest CT: Puncture object of 18 cm in the left lung of AP and medial to the lateral path, hematoma of the angle, and hemopneumothorax grade I. Surgery: Patient in dorsal recumbency, under ARM with selective intubation. An incision in 5th left intercostal space, middle axillary line. 10mm trocar placement, 30 ° optics introduction. After discarding the commitment of the pericardium, active bleeding, and observing that the end of the weapon was going through the end of the angle, the weapon is removed under endoscopic vision. Clot washing/aspiration. Verification of hemostasis, absence of air leakage and pulmonary expansion. Drainage with 28 French tubes. Evolution: Derived from UTI extubated. CT scan thorax 72 h post: small intraparenchymal hematoma left, expanded lung. Minimum serohematic debit. Pleural tube and definitive discharge are removed on the 4th post-surgical day. Discussion: The literature suggests in the urgency, the removal of impaled objects under direct vision of the compromised structures. However, in stable patients, the previous study with CT should be unavoidable. Video-thoracoscopy in these wounded can avoid open surgery, but the procedure must be performed in trauma reference centers, with the appropriate means and by a trained surgical team willing to perform an emergency thoracotomy


Assuntos
Masculino , Idoso , Ferimentos Perfurantes/cirurgia , Dor no Peito/cirurgia , Toracotomia , Laparoscopia , Cirurgia Torácica Vídeoassistida , Sinais Vitais
17.
Ghana Med J ; 53(2): 181-183, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31481815

RESUMO

The inferior vena cava is the most commonly injured abdominal vessel and accounts for about 25% of abdominal vascular injuries. Despite improved preoperative care and operative techniques, the mortality rates for the inferior vena cava injuries are still high due to delayed presentation, inadequate or delayed fluid resuscitation, difficulty of diagnosis and technical problems in repair. A case of the inferior vena cava injury encountered after abdominal stab injury with about 4cm vertical tear of infrarenal vena cava, survived due to immediate transportation, appropriate and successful perioperative fluid and blood resuscitation, prompt surgical management with a team approach and critical post-operative surgical management.


Assuntos
Hematoma/cirurgia , Lacerações/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Veia Cava Inferior/lesões , Ferimentos Perfurantes/cirurgia , Duodeno/lesões , Humanos , Perfuração Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal , Técnicas de Sutura , Ultrassonografia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
19.
World Neurosurg ; 131: 213-216, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31295608

RESUMO

BACKGROUND: A foreign object penetrating the brain via orbit is a rare occurrence. Accurate diagnosis and immediate intervention is essential to prevent ophthalmic or neurological deficits and to reduce chances of infection or hemorrhage. CASE DESCRIPTION: We report 2 cases of transorbital orbitocranial penetrating injury of metal objects in children. Computed tomography scan was obtained to assess the extent of the injury and to locate the objects. According to the trajectory, the best craniotomy approach was performed, and the objects were safely removed without any complication. Our cases are unique because of the absence of any neurological deficit on admission, before and after the removal. CONCLUSIONS: The importance of transorbital orbitocranial penetrating injury cannot be neglected because of possible orbital and intracranial damage. Therefore, in this report we aim to heighten awareness of the complexity and severity of transorbital penetrating brain injury.


Assuntos
Traumatismos Cranianos Penetrantes/cirurgia , Órbita/lesões , Ferimentos Perfurantes/cirurgia , Pré-Escolar , Corpo Caloso/diagnóstico por imagem , Corpo Caloso/lesões , Craniotomia/métodos , Ferimentos Oculares Penetrantes/cirurgia , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/lesões , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Humanos , Masculino , Base do Crânio/lesões , Tomografia Computadorizada por Raios X , Ferimentos Perfurantes/diagnóstico por imagem
20.
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
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