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1.
Estima (Online) ; 19(1): e0421, jan.-dez. 2021.
Artigo em Português | BDENF - Enfermagem | ID: biblio-1178058

RESUMO

Objetivos:identificar na literatura científica o conhecimento produzido sobre lesões por fricção em idosos. Métodos: trata-se de uma revisão integrativa de literatura (2014-2019), realizada a partir de busca nas bases de dados/plataformas National Library of Medicine, Biomedical Answers e Biblioteca Virtual em Saúde, com descritores e os operadores booleanos "and" e "or". Resultados: a partir da busca bibliográfica, seleção e análise, oito artigos compuseram a amostra. Para lesão por fricção em idosos emergiram quatro pilares do cuidado: manutenção da homeostase orgânica e tissular com foco na nutrição e hidratação apropriada; evitar traumas na pele senil, proporcionando um ambiente seguro com dispositivos adequados; e a sistematização da assistência e educação em saúde do cuidado com a pele do idoso. Conclusão: como mecanismos de prevenção, encontram-se a realização da prevenção primária por meio de um plano de cuidados singular e as atividades de educação em saúde, focadas nos fatores de risco e nas vulnerabilidades, minimizando danos e complicações


Assuntos
Ferimentos e Lesões , Idoso , Fricção , Enfermagem Geriátrica
2.
Estima (Online) ; 19(1): e0921, jan.-dez. 2021.
Artigo em Português | BDENF - Enfermagem | ID: biblio-1280948

RESUMO

Objetivo:descrever o processo de implementação da Rede de Atenção à Saúde em Lesões Cutâneas no município de Divinópolis − MG. Método: trata-se de um relato de experiência sobre a implementação de uma Rede de Atenção à Saúde em Lesões Cutâneas a partir do Programa de Educação Pelo Trabalho para Saúde (PET-Saúde/GraduaSUS), no período de maio de 2016 a abril de 2018. Participaram das ações professores e alunos de uma universidade pública e profissionais enfermeiros vinculados à Secretaria Municipal de Saúde do município. Resultados: foi possível implementar a Rede de Atenção à Saúde para prevenção e tratamento de lesões cutâneas de maneira estruturada e sistematizada. Foi estabelecido um fluxo de atendimento, supervisão de casos e acompanhamento clínico por meio da construção de um protocolo assistencial. Conclusão: a habilidade prática e o conhecimento científico de alunos e profissionais de saúde para o tratamento e manejo de lesões cutâneas foram desenvolvidos fortalecendo, assim, a tríade ensino-serviço-comunidade.


Objective: describe the process of implementing the Rede de Atenção à Saúde em Lesões Cutâneas (Health Care Network for Skin Injuries) in the municipality of Divinópolis - MG. Method: it is an experience report on the implementation of a Health Care Network for Skin Injuries from the Programa de Educação Pelo Trabalho para Saúde (PET-Saúde/GraduaSUS) (Education Through Work for Health Program), from May 2016 to April 2018. Teachers and students from a public university and professional nurses linked to the Municipal Health Secretariat of the municipality participated in the actions. Results: it was possible to implement the Health Care Network for the prevention and treatment of skin lesions in a structured and systematic way. A flow of care, case supervision and clinical follow-up was established through the construction of an assistance protocol. Conclusion: the practical skill and scientific knowledge of students and health professionals for the treatment and management of skin lesions were developed, thus strengthening the teaching-service-community triad.


Assuntos
Ferimentos e Lesões , Relações Comunidade-Instituição , Atenção à Saúde , Acesso aos Serviços de Saúde
3.
Br J Community Nurs ; 26(Sup9): S6-S11, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34473537

RESUMO

Wound bed preparation is the management of a wound in order to optimise healing and/or facilitate other therapeutic measures. It is the most pivotal step in healing wounds. Early referral to a specialist wound clinic can markedly improve the wound healing process. This overview will discuss the techniques involved in the preparation of the wound bed that will effectively accelerate the healing process. The process begins with a correct diagnosis of the wound and optimising the patient's medical condition. The TIMERS framework is discussed. Wound dressings, including the use of negative-pressure wound therapy, are discussed, along with debridement techniques and agents. The timing of wound intervention and evaluating progress will also be discussed, and wound bed preparation strategies will be included. There has been an added challenge of wound care in the community as a result of the COVID-19 pandemic. The present article provides an overview of how to prepare a wound bed in the community.


Assuntos
Enfermagem em Saúde Comunitária , Ferimentos e Lesões , Bandagens , COVID-19 , Desbridamento/métodos , Desbridamento/enfermagem , Humanos , Ferimentos e Lesões/enfermagem
4.
J Spec Oper Med ; 21(3): 66-70, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34529808

RESUMO

BACKGROUND: United States Africa Command (US AFRICOM) is one of six US Defense Department's geographic combatant commands and is responsible to the Secretary of Defense for military relations with African nations, the African Union, and African regional security organizations. A full-spectrum combatant command, US AFRICOM is responsible for all US Department of Defense operations, exercises, and security cooperation on the African continent, its island nations, and surrounding waters. We seek to characterize blood product administration within AFRICOM using the in-transit visibility tracking tool known as TRAC2ES (TRANSCOM Regulating and Command & Control Evacuation System). METHODS: We performed a retrospective review of TRAC2ES medical evacuations from the AFRICOM theater of operations conducted between 1 January 2008 and 31 December 2018. RESULTS: During this time, there were 963 cases recorded in TRAC2ES originating within AFRICOM, of which 10 (1%) cases received blood products. All patients were males. One was a Department of State employee, one was a military working dog, and the remainder were military personnel. Of the ten humans, seven were the result of trauma, most by way of gunshot wound, and three were due to medical causes. Among human subjects receiving blood products for traumatic injuries, a total of 5 units of type O negative whole blood, 29 units of packed red blood cells (pRBCs), and 9 units of fresh frozen plasma (FFP) were transfused. No subjects underwent massive transfusion of blood products, and only one subject received pRBCs and FFP in 1:1 fashion. All subjects survived until evacuation. CONCLUSIONS: Within the TRAC2ES database, blood product administration within AFRICOM was infrequent, with some cases highlighting lack of access to adequate blood products. Furthermore, the limitations within this database highlight the need for systems designed to capture medical care performance improvement, as this database is not designed to support such analyses. A mandate for performance improvement within AFRICOM that is similar to that of the US Central Command would be beneficial if major improvements are to occur.


Assuntos
Militares , Ferimentos e Lesões , Ferimentos por Arma de Fogo , Animais , Transfusão de Sangue , Cães , Humanos , Masculino , Plasma , Estudos Retrospectivos , Estados Unidos , Ferimentos por Arma de Fogo/terapia
5.
Dan Med J ; 68(10)2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34498585

RESUMO

INTRODUCTION: The epidemiology of children admitted to Scandinavian trauma centres remains largely unknown. This study aimed to describe the characteristics of severe injuries in children admitted to a Danish university-level trauma centre. METHODS: A descriptive study of all severely injured (Injury Severity Score ≥ 16) children aged 0-15 years who were admitted to the university level trauma centre at Odense University Hospital, Denmark, in the 2002-2018 period. Data were extracted from the South Danish Register and from medical records. RESULTS: A total of 152 children were included. The median age was 11 (range: 0-15) years. Boys accounted for 57% of the cases. Accidents accounted for 99% of the cases. In the youngest age group (0-4 years), the majority of injuries occurred in domestic areas, in the daytime, in the summer and around the weekends. In the oldest age group (11-15 years), most injuries occurred in traffic areas, in the autumn, on weekdays and in the afternoon. In all age groups, the majority of lesions were sustained to the head/face/neck, limbs and thorax. The overall median number of days in hospital was six. Overall, 39 (26%) children died. Almost half of the injuries were traffic related and this proportion increased with increasing age group. One-third of the traffic injured children died. CONCLUSIONS: Based on a regional trauma register, we described the characteristics of severely injured children. The study included several aspects regarding injury pattern and severity, which may be useful for risk identification, prevention of accidents and for hospital resource planning. FUNDING: none TRIAL REGISTRATION: not relevant.


Assuntos
Centros de Traumatologia , Ferimentos e Lesões , Acidentes de Trânsito , Adolescente , Criança , Pré-Escolar , Dinamarca/epidemiologia , Hospitalização , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Masculino , Estudos Retrospectivos , Estações do Ano , Ferimentos e Lesões/epidemiologia
6.
N Z Med J ; 134(1540): 46-55, 2021 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-34482388

RESUMO

AIMS: To describe any change in the volume and mechanisms of injury of major trauma admissions during and after COVID-19 lockdown, and in doing so, to provide information for resource planning and identification of priority areas for injury prevention initiatives. METHODS: A retrospective, descriptive study conducted on Canterbury District Health Board trauma registry data. The study population consisted of all major trauma patients of all age groups admitted to Christchurch Hospital over three 33-day periods: before, during and after COVID-19 lockdown in New Zealand. Broadly speaking, major trauma is defined as having an injury severity score 13 or death following injury. RESULTS: There was a 42% reduction in the volume of major trauma admissions during lockdown. Falls were the most common injury during lockdown, and transport-related injuries after lockdown. Alcohol intoxication was associated with 19 to 33% of all injuries across the study periods. CONCLUSION: Major trauma inevitably occurred during lockdown, although at considerably lower volumes. After lockdown, once restrictions were eased, major trauma admissions reverted to pre-lockdown patterns. Injury prevention strategies can reduce avoidable pressures on hospitals at a time of pandemic. In New Zealand, focus should be placed on reducing alcohol- and transport-related injuries and increasing community awareness on falls prevention.


Assuntos
COVID-19/epidemiologia , Hospitalização/estatística & dados numéricos , Pandemias , Ferimentos e Lesões/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Idoso , Intoxicação Alcoólica/complicações , Intoxicação Alcoólica/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Distanciamento Físico , Estudos Retrospectivos , SARS-CoV-2 , Ferimentos e Lesões/etiologia
7.
Scand J Trauma Resusc Emerg Med ; 29(1): 133, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34507600

RESUMO

BACKGROUND: With an aging population, the number of elderly individuals exposed to traumatic injuries is increasing. The elderly age criterion for traumatic injuries has been inconsistent in the literature. This study aimed at specifying the elderly age criterion when the traumatic mortality rate increases. METHODS: This is a multicenter retrospective cohort study that was conducted utilizing the data from the Emergency Department-based Injury In-depth Surveillance Registry of the Korea Disease Control and Prevention Agency, collected between January 2014 and December 2018 from 23 emergency departments. The outcome variable was in-hospital mortality. Multivariable logistic regression analysis was used to calculate the adjusted mortality rate for each age group. By using the shape-restricted regression splines method, the relationship between age and adjusted traumatic mortality was plotted and the point where the gradient of the graph had the greatest variation was calculated. RESULTS: A total of 637,491 adult trauma patients were included. The number of in-hospital deaths was 6504 (1.0%). The age at which mortality increased the most was 65.06 years old. The adjusted odds ratio for the in-hospital mortality rate with age in the ≤ 64-year-old subgroup was 1.038 (95% confidence interval (CI) 1.032-1.044) and in the ≥ 65-year-old subgroup was 1.059 (95% CI 1.050-1.068). The adjusted odds ratio for in-hospital mortality in the ≥ 65-year-old compared to the ≤ 64-year-old subgroup was 4.585 (95% CI 4.158-5.055, p < 0.001). CONCLUSIONS: This study found that the in-hospital mortality rate rose with increasing age and that the increase was the most rapid from the age of 65 years. We propose to define the elderly age criterion for traumatic injuries as ≥ 65 years of age.


Assuntos
Serviço Hospitalar de Emergência , Ferimentos e Lesões , Adulto , Idoso , Mortalidade Hospitalar , Humanos , Pessoa de Meia-Idade , Razão de Chances , Sistema de Registros , Estudos Retrospectivos , Centros de Traumatologia
8.
Swiss Med Wkly ; 151(33-34)2021 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-34495600

RESUMO

INTRODUCTION: The COVID-19 pandemic and the associated restrictions may have modified the activities of the Swiss population and thus altered trauma patterns. MATERIALS AND PATIENTS: All adult patients with major trauma admitted to our institution in 2019 and 2020 were assessed using the Injury Severity Score (ISS), by body region involved, type of injury, age, admission to an intensive care unit and 30-day mortality. RESULTS: In 2020, 454 patients with major trauma were admitted to our institution, 17% fewer than in the previous year. The drop in the number of major trauma patients proceeded with and overlapped both the first and second peaks in incidence of the pandemic and the associated restrictions. The median ISS was higher in 2020 (25, interquartile range [IQR] 17-26.5) than in 2019 (22, IQR 16-26, p = 0.04). There were no significant differences in body region involved, type of injury or age (p >0.05). In 2020, a higher percentage of patients were admitted to an intensive care unit (86.5% vs 77.7%, p <0.001) and died within 30 days (8.8% vs 5.0%, p = 0.015). The 30-day mortality was higher in 2020 than in 2019, with an odds ratio of 1.80 (95% confidence interval 1.04-3.10, p= 0.036) after adjustment for the following potential confounders: ISS, age, gender and type of injury. CONCLUSION: In the first year of the COVID-19 pandemic, fewer patients with major trauma were admitted to our institution. However, the patients admitted were more severely injured and more often died within 30 days. Understanding the differences in injury patterns and admissions in major trauma patients under special conditions - such as a pandemic - could help to allocate rare resources adequately.


Assuntos
COVID-19 , Ferimentos e Lesões , Adulto , Estudos de Coortes , Humanos , Escala de Gravidade do Ferimento , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Suíça/epidemiologia , Centros de Traumatologia , Ferimentos e Lesões/epidemiologia
9.
BMC Pediatr ; 21(Suppl 1): 311, 2021 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-34496772

RESUMO

We looked at existing recommendations for preventing unintentional injuries in children under five years of age, and we attempted to identify the main sources used as evidence for formulating these recommendations.We conducted a literature search up to the 18th October 2019 by using key terms and manual search in selected sources. We summarized the recommendations and source of the evidence in tables for each of five areas of unintentional injuries: road traffic injuries, drowning, poisoning, thermal injuries, falls.In 2008, the World Health Organization (WHO) published a comprehensive report with strategies for child injury prevention for the European region. More recently, the WHO published several guidance documents focused on one area such as drowning, usually with a global focus. The PrevInfad workgroup (Spanish Association of Primary Care Pediatrics) updated their document on road safety in April 2019, providing recommendations and a summary of the existing evidence. Preventive strategies for injuries in childhood are mainly based on surveillance data and the identification of risk factors. The key strategies for preventing unintentional injuries are a combination of environmental and behaviour modification, that can be achieved through engineering, enforcement and education. Consequently, for this kind of strategies, it is important to evaluate the effectiveness of both the intervention itself, and the way the intervention is advised to parents and caretakers so that there is good compliance of the recommendation.


Assuntos
Lesões Acidentais , Queimaduras , Afogamento , Ferimentos e Lesões , Acidentes por Quedas , Acidentes de Trânsito , Criança , Pré-Escolar , Afogamento/epidemiologia , Afogamento/prevenção & controle , Humanos , Lactente , Fatores de Risco , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/prevenção & controle
10.
J Trauma Nurs ; 28(5): 316-322, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34491949

RESUMO

BACKGROUND: The Pediatric Trauma Society (PTS) is a multidisciplinary organization, with scientific presentations at its annual meeting addressing trauma care from prehospital through rehabilitation. OBJECTIVE: The purpose of this study was to identify and describe the scholarly areas of focus of presentations at the annual meeting over the society's first 5 years and evaluate research dissemination. METHODS: Data were collected on abstracts presented between 2014 and 2018, including titles, authors, and abstract classification. PubMed and Google Scholar searches identified abstracts that resulted in publications. Journal impact factors were identified. RESULTS: Over 5 years, 491 of 635 (77.3%) abstracts were accepted. The number of submitted and accepted abstracts increased, but the acceptance rate was stable (range = 72.1%-81.2%, p = NS [nonsignificant]). The most frequently accepted categories included "Epidemiology," "Abdominal or Thoracic Trauma," and "Neurosurgery or Traumatic Brain Injury (TBI)," whereas "Trauma Nursing" and "Quality Improvement" were less common. Among the 2014-2016 abstracts, 55.4% of podium and 24.3% of poster presentations were published. Abstracts categorized as "Epidemiology," "Education & Injury Prevention," and "Neurosurgery or TBI" were commonly presented but uncommonly published. The median journal impact factor of publications was 2.1 and 2.0 for podium and poster presentations, respectively (ranging from 0.11 to 10.25). CONCLUSION: Most of the scholarly effort presented at the PTS remains unpublished. Published work is mainly in low-impact factor journals. Mentorship in the publication process and encouragement of multidisciplinary collaboration within the society are needed to address limitations in the number and potential impact of the scientific content of the annual meeting. This type of analysis is relevant not only to the PTS but also to any professional society seeking to improve its impact.


Assuntos
Sociedades Médicas , Ferimentos e Lesões , Criança , Humanos , Pediatria
11.
J Trauma Nurs ; 28(5): 332-338, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34491952

RESUMO

OBJECTIVE: Early assessment of the clinical status of trauma patients is crucial for guiding the treatment strategy, and it requires a rapid and systematic approach. The aim of this report is to critically review the assessment parameters currently used in the prehospital setting to quantify blood loss in trauma. DATA SOURCES: Studies regarding hemorrhagic shock in trauma were pooled from PubMed, EMBASE, and Cochrane databases using key words such as "hemorrhagic shock," "vital signs evaluation," "trauma," "blood loss," and "emergency medical service," alone or combined. STUDY SELECTION: Articles published since 2009 in English and Italian were considered eligible if containing data on assessment parameters in blood loss in adults. DATA EXTRACTION: Sixteen articles matching the inclusion criteria were considered in our study. DATA SYNTHESIS: Current prehospital assessment measures lack precise correlation with blood loss. CONCLUSIONS: Traditional assessment parameters such as heart rate, systolic blood pressure, shock index, and Glasgow Coma Scale score often lag in providing accurate blood loss assessment. The current literature supports the need for a noninvasive, continuously monitored assessment parameter to identify early shock in the prehospital setting.


Assuntos
Serviços Médicos de Emergência , Choque Hemorrágico , Ferimentos e Lesões , Adulto , Escala de Coma de Glasgow , Hemorragia/diagnóstico , Hemorragia/terapia , Humanos , Monitorização Fisiológica , Choque Hemorrágico/diagnóstico , Choque Hemorrágico/terapia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia
12.
Traffic Inj Prev ; 22(7): 501-506, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34410833

RESUMO

OBJECTIVE: Little is known about the relationship between Stay-At-Home orders issued by state governments due to the COVID-19 pandemic and their impacts on motor vehicle-related injuries. The purpose of this study was to determine whether the presence of a Stay-At-Home order was associated with lower rates of motor vehicle-related injuries requiring emergency medical treatment among population sub-groups in West Virginia (i.e., males, females, 0-17, 18-25, 26-45, 46-65, ≥66 years old). METHODS: A Stay-At-Home order was in effect in West Virginia from March 23-May 4, 2020. Counts of individuals who incurred motor-vehicle-related injuries that required emergency medical treatment were obtained from the Centers for Disease Control and Prevention's National Syndromic Surveillance Program from January 1 thru September 6 of 2019 and 2020. Counts were obtained by week-year and by population sub-group in West Virginia. The presence of the Stay-At-Home order was binary coded by week. Negative binomial regression was used to assess the relationship between the presence of a Stay-At-Home and injury rates. 2019 population sub-group estimates were obtained from the United States Census Bureau and used as offsets in the models. Models were also adjusted for year and vehicle miles traveled by week-year. RESULTS: There were 23,418 motor-vehicle related injuries during the study period. The presence of the Stay-At-Home order was associated with 44% less injuries overall [Incident Rate Ratio (IRR)=0.56, 95% CI 0.48, 0.64]. Females experienced fewer injuries than males (IRR = 0.49 vs 0.63, respectively) and the number of injuries decreased with age (p-value 0.031) when comparing time periods when the Stay-At-Home was in effect compared to times when it was not. CONCLUSIONS: West Virginia's Stay-At-Home order was associated with lower motor-vehicle injury rates requiring medical treatment across all population sub-groups. Most population sub-groups likely altered their travel behaviors which resulted in lower motor-vehicle injury rates. These findings may inform future policies that impose emergency travel restrictions in populations.


Assuntos
Acidentes de Trânsito , COVID-19 , Pandemias , Saúde Pública , Ferimentos e Lesões , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Saúde Pública/legislação & jurisprudência , West Virginia/epidemiologia , Ferimentos e Lesões/epidemiologia , Adulto Jovem
13.
Nutrients ; 13(8)2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34444939

RESUMO

Globally, almost four and a half million people died from injury in 2019. Alcohol's contribution to injury-related premature loss of life, disability and ill-health is pervasive, touching individuals, families and societies throughout the world. We conducted a review of research evidence for alcohol's causal role in injury by focusing on previously published systematic reviews, meta-analyses and where indicated, key studies. The review summarises evidence for pharmacological and physiological effects that support postulated causal pathways, highlights findings and knowledge gaps relevant to specific forms of injury (i.e., violence, suicide and self-harm, road injury, falls, burns, workplace injuries) and lays out options for evidence-based prevention.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Etanol/efeitos adversos , Ferimentos e Lesões/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Queimaduras/epidemiologia , Feminino , Carga Global da Doença , Saúde Global , Política de Saúde , Humanos , Masculino , Traumatismos Ocupacionais/epidemiologia , Fatores de Risco , Comportamento Autodestrutivo/epidemiologia , Suicídio/estatística & dados numéricos , Violência/estatística & dados numéricos , Local de Trabalho , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/prevenção & controle
14.
Scand J Trauma Resusc Emerg Med ; 29(1): 127, 2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34461976

RESUMO

BACKGROUND: Pre-hospital identification of major trauma in elderly patients is key for delivery of optimal care, however triage of this group is challenging. Elderly-specific triage criteria may be valuable. This systematic review aimed to summarise the published pre-hospital elderly-specific trauma triage tools and evaluate their sensitivity and specificity and associated clinical outcomes. METHODS: MEDLINE and EMBASE databases were searched using predetermined criteria (PROSPERO: CRD42019140879). Two authors independently assessed search results, performed data extraction, risk of bias and quality assessments following the Grading of Recommendations, Assessment, Development and Evaluation system. RESULTS: 801 articles were screened and 11 studies met eligibility criteria, including 1,332,300 patients from exclusively USA populations. There were eight unique elderly-specific triage criteria reported. Most studies retrospectively applied criteria to trauma databases, with few reporting real-world application. The Ohio Geriatric Triage Criteria was reported in three studies. Age cut-off ranged from 55 to 70 years with ≥ 65 most frequently reported. All reported existing adult criteria with modified physiological parameters using higher thresholds for systolic blood pressure and Glasgow coma scale, although the values used varied. Three criteria added co-morbidity or anti-coagulant/anti-platelet use considerations. Modifications to anatomical or mechanism of injury factors were used by only one triage criteria. Criteria sensitivity ranged from 44 to 93%, with a median of 86.3%, whilst specificity was generally poor (median 54%). Scant real-world data showed an increase in patients meeting triage criteria, but minimal changes to patient transport destination and mortality. All studies were at risk of bias and assessed of "very low" or "low" quality. CONCLUSIONS: There are several published elderly-specific pre-hospital trauma triage tools in clinical practice, all developed and employed in the USA. Consensus exists for higher thresholds for physiological parameters, however there was variability in age-cut offs, triage criteria content, and tool sensitivity and specificity. Although sensitivity was improved over corresponding 'adult' criteria, specificity remained poor. There is a paucity of published real-world data examining the effect on patient care and clinical outcomes of elderly-specific triage criteria. There is uncertainty over the optimal elderly triage tool and further study is required to better inform practice and improve patient outcomes.


Assuntos
Triagem , Ferimentos e Lesões , Adulto , Idoso , Comorbidade , Escala de Coma de Glasgow , Hospitais , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia
15.
Artigo em Inglês | MEDLINE | ID: mdl-34444574

RESUMO

Unintentional injuries are major causes of mortality and morbidity. Although generally perceived as accidents, it is possible to identify those at higher risk and implement appropriate prevention measures. This study aims to investigate the common causes of unintentional injuries and their associated risk factors among a large representative sample. Data of 12,022 individuals who completed the Hong Kong Population Health Survey 2014/15 were extracted. The primary outcome was the prevalence of having unintentional injury(-ies) in the previous 12 months that was severe enough to limit daily activities. Multivariable logistic regression analyses were conducted to identify associations between injuries and sociodemographic, clinical and lifestyle factors. 14.5% of respondents reported episode(s) of unintentional injury in the past 12 months in the population level. The main causes of top three most severe unintentional injuries were sprains (24.0%), falls (19.9%) and being hit/struck (19.6%). 13.2% injury episodes were work-related among the most severe episode. Factors independently associated with significantly higher risks of injury included currently employed, homemaker or student, born in Hong Kong (as compared with immigrants), doctor-diagnosed chronic conditions, harmful alcohol consumption, insufficient sleep, and disturbed sleep. To summarize, unintentional injuries are highly prevalent and associated with harmful drinking, insufficient sleep, and disturbed sleep, which are potential modifiable risk factors for prevention.


Assuntos
Lesões Acidentais , Ferimentos e Lesões , Acidentes por Quedas , Hong Kong/epidemiologia , Humanos , Fatores de Risco , Estudantes , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia
16.
Rev Infirm ; 70(273): 16-18, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34446227

RESUMO

Coagulopathy, acidosis and hypothermia form the lethal triad in trauma patients with acute hemorrhage. The prevention of this chain reaction relies on an adapted management from the first care in pre-hospital situation: rapid arrest of bleeding, fight against hypothermia, limited vascular filling with an early recourse to vasoactive amines. Pre-hospital transfusion is still rare, whereas in the hospital, an adapted transfusion strategy can wait for or support a surgical or radiological hemostasis procedure.


Assuntos
Transtornos da Coagulação Sanguínea , Hipotermia , Ferimentos e Lesões , Transfusão de Sangue , Hemorragia/etiologia , Hemorragia/terapia , Hemostasia , Humanos
17.
Rev Infirm ; 70(273): 27-30, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34446231

RESUMO

Patients with tumor wounds have many symptoms that impair their quality of life and their general condition. Hemorrhaging is one of them. It can be a challenge for the caregivers and the medical team and will have an impact on the patient. There is no consensus on the management of this symptom, but the literature provides some food for thought. Simple measures can be easily implemented depending on the patient's risk factors, the wound and the oncological context.


Assuntos
Neoplasias , Ferimentos e Lesões , Cuidadores , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Neoplasias/complicações , Neoplasias/terapia , Qualidade de Vida , Fatores de Risco
19.
Hematology ; 26(1): 601-611, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34411495

RESUMO

There has been renewed interest in the use of low titer group O whole blood (LTOWB) for the resuscitation of civilian casualties. LTOWB offers several advantages over conventional components such as providing balanced resuscitation in one bag that contains less additive/preservative solution than an equivalent volume of conventional components, is easier and faster to transfuse than multiple components, avoids blood product ratio confusion, contains cold stored platelets, and reduces donor exposures. The resurgence in its use in the resuscitation of civilian trauma patients has led to the publication of an increasing number of studies on its use, primarily amongst adult recipients but also in pediatric patients. These studies have indicated that hemolysis does not occur amongst adult and pediatric non-group O recipients of a modest quantity of LTOWB. The published studies to date on mortality have shown conflicting results with some demonstrating a reduction following LTOWB transfusion while most others have not shown a reduction; there have not been any studies to date that have found significantly increased overall mortality amongst LTOWB recipients. Similarly, when other clinical outcomes, such as venous thromboembolism, sepsis, hospital or intensive care unit lengths of stay are evaluated, LTOWB recipients have not demonstrated worse outcomes compared to conventional component recipients. While definitive proof of the trends in these morbidity and mortality outcomes awaits confirmation in randomized controlled trials, the evidence to date indicates the safety of transfusing LTOWB to injured civilians.


Assuntos
Transfusão de Sangue/métodos , Ressuscitação/métodos , Ferimentos e Lesões/terapia , Sistema ABO de Grupos Sanguíneos/sangue , Doadores de Sangue , Preservação de Sangue , Humanos , Reação Transfusional , Resultado do Tratamento , Ferimentos e Lesões/sangue
20.
Pan Afr Med J ; 38: 414, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34381558

RESUMO

Introduction: trauma is the leading cause of mortality in individuals less than 45 years. The principles of Advanced Trauma Life Support (ATLS) which is used around the world in resuscitation of trauma patients have been considered to be safe. However, the outbreak of corona virus disease 2019 (COVID-19) has affected the processes and characteristics of acute trauma patients seen around the world. This study is intended to determine the impact of COVID-19 lockdown on the acute trauma patients seen in a Nigerian trauma centre. Methods: this is a cross-sectional observational study of trauma patients seen in the resuscitation room of the National Hospital trauma centre in Abuja, Nigeria, from 24th February,2020 to 3rd May, 2020. The participants were consecutive acute trauma patients who were grouped into two: five weeks preceding total lockdown and five weeks of total lockdown. Statistical analysis was done using the statistical package for social sciences (SPSS) version 24.0 while results were presented in tables and a figure. Results: a total of 229 patients were recruited into the study with age range 1 to 62 years, mean age of 28 ± 13 and male to female ratio of 3.87. The patient volume reduced by 41.31% during the lockdown. Though motor vehicular crash (MVC) was the predominant mechanism of injury in both groups making up 37.65% and 23.88% respectively, penetrating assault was more during the lockdown period (17.91% versus 6.17%). The lockdown was further associated with more delayed presentation (52.24% versus 48.15%), more referrals (53.73% versus 32.72%), less severe injury score (29.6% versus 56.7%) and no death in the resuscitation room (0% versus 1.85%). Conclusion: despite the reduction in the volume of trauma presentations by 41.31%, patients got the required care with less mortality. Efforts should be directed at sustaining access to acute trauma care in all circumstances to reduce preventable trauma deaths.


Assuntos
COVID-19 , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Tempo , Centros de Traumatologia , Índices de Gravidade do Trauma , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/terapia , Adulto Jovem
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