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1.
Am Surg ; 85(10): 1150-1154, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657313

RESUMO

Bile duct injury represents a complication after laparoscopic cholecystectomy, impairing quality of life and resulting in subsequent litigations. A five-year experience of bile duct injury repairs in 52 patients at a community hospital was reviewed. Twenty-nine were female, and the median age was 51 years (range, 20-83 years). Strasberg classification identified injuries as Type A (23), B (1), C (1), D (5), E1 (5), E2 (6), E3 (4), E4 (6), and E5 (1). Resolution of the bile duct injury and clinical improvement represent main postoperative outcome measures in our study. The referral time for treatment was within 4 to 14 days of the injury. Type A injury was treated with endobiliary stent placement. The remaining patients required T-tube placement (5), hepaticojejunostomy (20), and primary anastomosis (4). Two patients experienced bile leak after hepaticojejunostomy and were treated and resolved with percutaneous transhepatic drainage. At a median follow-up of 36 months, two patients (Class E4) required percutaneous balloon dilation and endobiliary stent placement for anastomotic stricture. The success of biliary reconstruction after complicated laparoscopic cholecystectomy can be achieved by experienced biliary surgeons with a team approach in a community hospital setting.


Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/estatística & dados numéricos , Ductos Biliares/diagnóstico por imagem , Ductos Biliares Extra-Hepáticos/lesões , California , Colecistectomia Laparoscópica/estatística & dados numéricos , Feminino , Hospitais Comunitários , Humanos , Jejunostomia/métodos , Jejunostomia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Estudos Retrospectivos , Stents/estatística & dados numéricos , Fatores de Tempo , Tempo para o Tratamento , Ferimentos e Lesões/classificação , Adulto Jovem
2.
Am Surg ; 85(7): 772-777, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405427

RESUMO

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


Assuntos
Complicações na Gravidez/etiologia , Centros de Traumatologia/estatística & dados numéricos , Triagem/métodos , Ferimentos e Lesões , Adulto , Feminino , Idade Gestacional , Hospitalização/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Gravidez , Estudos Retrospectivos , Ferimentos e Lesões/classificação , Adulto Jovem
3.
Accid Anal Prev ; 131: 284-296, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31351231

RESUMO

There are more than 2000 pedestrians reported to be involved in traffic crashes with vehicles in North Carolina every year. 10%-20% of them are killed or severely injured. Research studies need to be conducted in order to identify the contributing factors and develop countermeasures to improve safety for pedestrians. However, due to the heterogeneity inherent in crash data, which arises from unobservable factors that are not reported by law enforcement agencies and/or cannot be collected from state crash records, it is not easy to identify and evaluate factors that affect the injury severity of pedestrians in such crashes. By taking advantage of the latent class clustering (LCC), this research firstly applies the LCC approach to identify the latent classes and classify the crashes with different distribution characteristics of contributing factors to the pedestrian-vehicle crashes. By considering the inherent ordered nature of the traffic crash severity data, a partial proportional odds (PPO) model is then developed and utilized to explore the major factors that significantly affect the pedestrian injury severities resulting from pedestrian-vehicle crashes for each latent class previously obtained in the LCC. This study uses police reported pedestrian crash data collected from 2007 to 2014 in North Carolina, containing a variety of features of motorist, pedestrian, environmental, roadway characteristics. Parameter estimates and associated marginal effects are mainly used to interpret the models and evaluate the significance of each independent variable. Lastly, policy recommendations are made and future research directions are also given.


Assuntos
Acidentes de Trânsito/mortalidade , Ambiente Construído/estatística & dados numéricos , Pedestres/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Acidentes de Trânsito/classificação , Adulto , Dirigir sob a Influência/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Ferimentos e Lesões/classificação , Adulto Jovem
4.
Am Surg ; 85(6): 611-619, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267902

RESUMO

The Medicare Severity Diagnosis Related Group (MS-DRG) weight, as derived from the MS-DRG assigned at discharge, is in part determined by the physician-documented diagnoses. However, the terminology associated with MS-DRG determination is often not aligned with typical physician language, leading to inaccurate coding and decreased hospital reimbursements. The goal of this study was to evaluate the impact of a diagnosis picklist within a paper-based history and physical examination (H&P) on the average MS-DRG weight and the Case-mix index (CMI). Our trauma center implemented a paper H&P form for trauma patients featuring picklist diagnoses aligned with the MS-DRG terminology and arranged by the physiologic system. To evaluate its impact, we conducted a cohort study using data from our trauma registry between July 2015 and November 2017. Our cohort included 442 (26.0%) paper and 1,261 (74.0%) dictated H&Ps. Average CMI (2.56 vs 2.15) and expected patients ($25,057 vs $19,825) were higher for the paper group (P < 0.001, P = 0.002). Adjusted regression models demonstrated paper coding to be associated with 0.265 CMI points, translating to an average increase in expected payment of 6.5 per cent per patient. Utilization of a standardized, paper-based H&P template with picklist diagnoses was associated with a higher trauma service CMI and higher expected payments. Preprinted diagnoses that align with the MS-DRG terminology lead to clinical documentation improvement.


Assuntos
Grupos Diagnósticos Relacionados/tendências , Documentação/tendências , Alta do Paciente/tendências , Melhoria de Qualidade , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/diagnóstico , Centros Médicos Acadêmicos/organização & administração , Arizona , Intervalos de Confiança , Bases de Dados Factuais , Grupos Diagnósticos Relacionados/normas , Documentação/métodos , Feminino , Humanos , Masculino , Medicare/economia , Admissão do Paciente/normas , Admissão do Paciente/tendências , Alta do Paciente/normas , Alta do Paciente/estatística & dados numéricos , Exame Físico/normas , Exame Físico/tendências , Sistema de Pagamento Prospectivo/normas , Sistema de Pagamento Prospectivo/tendências , Análise de Regressão , Estudos Retrospectivos , Estados Unidos , Ferimentos e Lesões/classificação
5.
J Trauma Acute Care Surg ; 87(3): 658-665, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31205214

RESUMO

BACKGROUND: Patients' trauma burdens are a combination of anatomic damage, physiologic derangement, and the resultant depletion of reserve. Typically, Injury Severity Score (ISS) >15 defines major anatomic injury and Revised Trauma Score (RTS) <7.84 defines major physiologic derangement, but there is no standard definition for reserve. The Need For Trauma Intervention (NFTI) identifies severely depleted reserves (NFTI+) with emergent interventions and/or early mortality. We hypothesized NFTI would have stronger associations with outcomes and better model fit than ISS and RTS. METHODS: Thirty-eight adult and pediatric U.S. trauma centers submitted data for 88,488 encounters. Mixed models tested ISS greater than 15, RTS less than 7.84, and NFTI's associations with complications, survivors' discharge to continuing care, and survivors' length of stay (LOS). RESULTS: The NFTI had stronger associations with complications and LOS than ISS and RTS (odds ratios [99.5% confidence interval]: NFTI = 9.44 [8.46-10.53]; ISS = 5.94 [5.36-6.60], RTS = 4.79 [4.29-5.34]; LOS incidence rate ratios (99.5% confidence interval): NFTI = 3.15 [3.08-3.22], ISS = 2.87 [2.80-2.94], RTS = 2.37 [2.30-2.45]). NFTI was more strongly associated with continuing care discharge but not significantly more than ISS (relative risk [99.5% confidence interval]: NFTI = 2.59 [2.52-2.66], ISS = 2.51 [2.44-2.59], RTS = 2.37 [2.28-2.46]). Cross-validation revealed that in all cases NFTI's model provided a much better fit than ISS greater than 15 or RTS less than 7.84. CONCLUSION: In this multicenter study, NFTI had better model fit and stronger associations with the outcomes than ISS and RTS. By determining depletion of reserve via resource consumption, NFTI+ may be a better definition of major trauma than the standard definitions of ISS greater than 15 and RTS less than 7.84. Using NFTI may improve retrospective triage monitoring and statistical risk adjustments. LEVEL OF EVIDENCE: Prognostic, level IV.


Assuntos
Escala de Gravidade do Ferimento , Índices de Gravidade do Trauma , Ferimentos e Lesões/classificação , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Centros de Traumatologia/estatística & dados numéricos , Estados Unidos , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/patologia , Ferimentos e Lesões/terapia , Adulto Jovem
6.
World J Emerg Surg ; 14: 30, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31236130

RESUMO

Background: The World Society of Emergency Surgery (WSES) spleen trauma classification meets the need of an evolution of the current anatomical spleen injury scale considering both the anatomical lesions and their physiologic effect. The aim of the present study is to evaluate the efficacy and trustfulness of the WSES classification as a tool in the decision-making process during spleen trauma management. Methods: Multicenter prospective observational study on adult patients with blunt splenic trauma managed between 2014 and 2016 in two Italian trauma centers (ASST Papa Giovanni XXIII in Bergamo and Sant'Anna University Hospital in Ferrara). Risk factors for operative management at the arrival of the patient and as a definitive treatment were analyzed. Moreover, the association between the different WSES grades of injury and the definitive management was analyzed. Results: One hundred twenty-four patients were included. At multivariate analysis, a WSES splenic injury grade IV is a risk factor for the operative management both at the arrival of the patients and as a definitive treatment. WSES splenic injury grade III is a risk factor for angioembolization. Conclusions: The WSES classification is a good and reliable tool in the decision-making process in splenic trauma management.


Assuntos
Baço/lesões , Ferimentos e Lesões/classificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Gerenciamento Clínico , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Baço/anormalidades , Baço/fisiopatologia , Esplenectomia/métodos , Cirurgiões/organização & administração , Cirurgiões/estatística & dados numéricos
8.
J Sci Med Sport ; 22(9): 997-1003, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31031085

RESUMO

OBJECTIVES: To describe the etiologic distribution of all injuries among U.S. Army Active Duty soldiers by causal energy categories. DESIGN: Retrospective cohort, descriptive analysis. METHODS: Injury was defined as the interruption of tissue function caused by an external energy transfer (mechanical, thermal, radiant, nuclear, chemical, or electrical energy). A comprehensive injury matrix standardized categories by causal energies, body locations, and injury types. Categories differentiated acute (ACT) from cumulative micro-traumatic (CMT) overuse injuries, and musculoskeletal injuries (MSKI) from those affecting other or multiple body systems (non-MSKI). International Classification of Diseases (ICD) diagnoses codes were organized into established categories. The matrix was applied to electronic health records for U.S. Army soldiers in 2017. RESULTS: Mechanical energy transfers caused most injuries (97%, n = 809,914): 76% were CMT overuse and the remaining were ACT (<21%). The majority (83%) were MSKI (71% CMT, 12% ACT). While almost one-half (47%) were to lower extremities (38% CMT, 9% ACT) the most frequently injured anatomical sites were the knee and lower back (16% each, primarily CMT). CONCLUSIONS: For the first time all soldiers' injuries have been presented in the same context for consistent comparisons. Findings confirm the vast majority of injuries in this physically-active population are MSKI, and most are CMT MSKI. A very small portion are non-MSKI or injuries caused by non-mechanical energy (e.g., heat- or cold-weather). Most Army injuries are to the lower extremities as a grouped body region, but additional matrix specificity indicates the most injured anatomical locations are the knee, lower back, and shoulder.


Assuntos
Transtornos Traumáticos Cumulativos/epidemiologia , Militares , Sistema Musculoesquelético/lesões , Ferimentos e Lesões/epidemiologia , Transtornos Traumáticos Cumulativos/classificação , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Estudos Retrospectivos , Estados Unidos , Ferimentos e Lesões/classificação
9.
Z Evid Fortbild Qual Gesundhwes ; 140: 22-34, 2019 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-30876780

RESUMO

OBJECTIVE: There are still few epidemiological data on patients with chronic wounds (leg ulcers, diabetic foot ulcers and pressure ulcers). Statutory health insurance (SHI) data is increasingly being used for questions relating to healthcare science. When using this data, which is primarily collected for billing purposes, the methodological procedure for defining cases must be presented transparently. Here, it must be checked whether the target group can be validly defined using the coded diagnoses and, if necessary, further information from routine data. Therefore, the aim of this contribution is, on the one hand, to develop criteria with the help of which patients with a florid (active) chronic wound can be identified safely or as doubtful cases in routine data and, on the other hand, to determine the corresponding frequency estimates. METHODS: Initially, a literature research was carried out to identify parameters relevant to care in patients with chronic wounds. In the next step, these were divided into specific, less specific and non-specific criteria (visual validity) in a multi-stage consensus procedure with regard to the specificity for wound care. On this basis, three different case definitions are used to identify florid chronic wounds. Based on an SHI sample of insured persons, frequency estimates were made for various case definitions (safe and questionable cases). RESULTS: Of the 21 parameters identified in the literature, eight were classified as specific, six as less specific and eight as non-specific criteria for the identification of patients with chronic florid wounds. Using diagnostic coding alone for the target diseases, an administrative prevalence of chronic wounds of 1.13% was observed for the year 2010. If a case is defined using the less specific and/or the specific criteria, prevalence drops to 0.79%; if only the specific criteria are used, prevalence drops only marginally to 0.78%. These changes were observed in patients with leg ulcers and diabetic foot ulcers, but not in patients with pressure ulcers. Here, the lowest administrative prevalence (0.18%) can be seen when only looking at the diagnoses, but this increases slightly when taking wound-relevant treatments into account (specific and less specific criteria: 0.25%). CONCLUSION: It is possible to define patients with a chronic florid wound on the basis of wound-relevant treatments using SHI data and to make estimates of administrative prevalence. Depending on the question, the criteria for defining cases can be narrowed down or broadened. The comparison provides information on the internal validity of diagnostic coding. However, further studies are needed to verify external validity.


Assuntos
Pé Diabético , Programas Nacionais de Saúde/estatística & dados numéricos , Lesão por Pressão , Ferimentos e Lesões/diagnóstico , Doença Crônica , Pé Diabético/diagnóstico , Alemanha , Humanos , Seguro Saúde , Úlcera da Perna/diagnóstico , Lesão por Pressão/diagnóstico , Prevalência , Ferimentos e Lesões/classificação
10.
Accid Anal Prev ; 127: 35-41, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30826695

RESUMO

OBJECTIVE: There is a lack of knowledge regarding sickness absence (SA) and disability pension (DP) as consequences of road traffic injuries, and on the association between DP and permanent medical impairment (PMI). Therefore, the aim of this study was to investigate SA, DP, and PMI among injured passenger car occupants two years after a crash, and how they are associated, accounting for sociodemographics, crash-related factors, and previous SA/DP. METHODS: This prospective cohort study included 64 007 injured car occupants aged 17-62 years at the time of a crash occurring in 2001-2013, involving a car insured at Folksam Insurance Group in Sweden. Information on sociodemographics, crash-related factors, SA (in SA spells >14 days) and DP status at inclusion and at two-year follow-up, and PMI assessed by the insurance company was used. PMI grades were categorized as 1-4, 5-9, 10-19, or >19%. Logistic regression was performed to calculate odds ratios (OR) with 95% confidence intervals (CI) for DP at follow-up and for PMI, respectively. RESULTS: At the time of the crash 13% were already on SA or DP. At follow-up two years after the crash, 6% among those not already on SA/DP at the time of the crash were on SA and 2% on DP. Furthermore, 8% of the total cohort had a determined PMI. Among those not already on DP at the crash, 3% with no PMI had DP at follow-up. This proportion was higher the higher PMI grade. Among individuals without already ongoing DP at the crash date, 10% of those with a PMI 1-4 ha d DP, compared to 76% among PMI ≥ 20. Already ongoing SA at the time of the crash (OR = 39.16, 95% CI 34.89-43.95) and PMI grade (PMI ≥ 5 OR = 27.44, 95% CI 23.88-31.52, reference group PMI 0) were found to be associated with DP at two years after crash. The factor most strongly associated with PMI was the model year of the car. The older the car, the higher the risk of PMI (Model year ≤ 1990 OR = 3.36, 95% CI 2.67-4.23, reference group model year 2006-2010). An association with the same direction was also found between the model year of the car and DP at follow-up. CONCLUSIONS: The association between PMI grade and DP status at follow-up among occupants not on DP at the crash date indicates that both could be used to measure long-term consequences of road traffic injury. In this cohort, already ongoing SA at the crash date was associated with DP at the two-year follow-up, emphasizing the importance of accounting for this factor in future research.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Adolescente , Adulto , Automóveis/classificação , Avaliação da Deficiência , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Suécia , Ferimentos e Lesões/classificação , Adulto Jovem
13.
Injury ; 50(2): 244-250, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30660332

RESUMO

BACKGROUND: Currently, two models of artificial neural network (ANN) and logistic regression (LR) are known as models that extensively used in medical sciences. The aim of this study was to compare the ANN and LR models in prediction of Health-related outcomes in traumatic patients using a systematic review. METHODS: The study was planned and conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. A literature search of published studies was conducted using PubMed, Embase, Web of knowledge, Scopus, and Google Scholar in May 2018. Joanna Briggs Institute (JBI) checklists was used for assessing the quality of the included articles. RESULTS: The literature searches yielded 326 potentially relevant studies from the primary searches. Overall, the review included 10 unique studies. The results of this study showed that the area under curve (AUC) for the ANN was 0.91, (95% CI 0.89-0.83) and 0.89, (95% CI 0.87-90) for the LR in random effect model. The accuracy rate for ANN and LR in random effect models were 90.5, (95% CI, 87.6-94.2) and 83.2, (95% CI 75.1-91.2), respectively. CONCLUSION: The results of our study showed that ANN has better performance than LR in predicting the terminal outcomes of traumatic patients in both the AUC and accuracy rate. Using an ANN to predict the final implications of trauma patients can provide more accurate clinical decisions.


Assuntos
Modelos Logísticos , Ferimentos e Lesões/mortalidade , Área Sob a Curva , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Valor Preditivo dos Testes , Análise de Sobrevida , Ferimentos e Lesões/classificação
14.
J Formos Med Assoc ; 118(1 Pt 2): 311-323, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29857951

RESUMO

BACKGROUND/PURPOSE: To explore the association of patient injury patterns and entrapped locations inside damaged buildings in the 2016 Taiwan earthquake. METHODS: A retrospective analysis was conducted using the Tainan incident registry system. Residents inside nine conjunctive, 16-story (49.3 m in height) reinforced concrete buildings were categorized as non-injured, injured, and dead. Residents were classified into different groups according to their entrapped locations in height and the severity of building damage. The field triage acuity and trauma severity among groups were compared. Statistical significance was set at the level of 0.05. RESULTS: There were 309 enrollees with 76 (24.6%) non-injured, 118 (38.2%) injured, and 115 (37.2%) dead. Residents either in the high floors (odds ratio [OR] = 2.9, 95% CI: 1.5-5.8, p = 0.003) or in the collapsed buildings (OR = 18.2, 95% CI: 7.6-43.6, p < 0.001) were more likely to be dead. Injured patients who were located in the high floors were more likely to have severe field triage acuities (adjusted OR = 14.7, 95% CI: 1.8-118.0, p = 0.012); intracranial hemorrhage (12.5%), intrathoracic injury (18.8%), or intra-abdominal damage (12.5%) (All p < 0.05); the need for emergency surgical intervention (31.3%, p = 0.035); and major trauma (18.8%, p = 0.001). Residents in the collapsed buildings were more likely to have a crush injury (80.0%, p < 0.001) or crush syndrome (80.0%, p < 0.001). CONCLUSION: People entrapped at different heights of floors or in differently damaged buildings could have a distinct pattern of injury. Our findings may facilitate strategic approaches of patients entrapped in damaged buildings and may contribute to future training for field searches and rescues after earthquakes.


Assuntos
Desastres , Terremotos , Ferimentos e Lesões/classificação , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Criança , Medicina de Desastres , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Taiwan/epidemiologia , Triagem/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Adulto Jovem
15.
Accid Anal Prev ; 122: 226-238, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30390518

RESUMO

Crash injury severity analysis is useful for traffic management agency to further understand severity of crashes. A two-layer Stacking framework is proposed in this study to predict the crash injury severity: The fist layer integrates advantages of three base classification methods: RF (Random Forests), AdaBoost (Adaptive Boosting), and GBDT (Gradient Boosting Decision Tree); the second layer completes classification of crash injury severity based on a Logistic Regression model. A total of 5538 crashes were recorded at 326 freeway diverge areas. In the model calibration, several parameters including the number of trees in three base classification methods, learning rate, and regularization coefficient are optimized via a systematic grid search approach. In the model validation, the performance of the Stacking model is compared with several traditional models including the Support Vector Machine (SVM), Multi-Layer Perceptron (MLP) and Random Forests (RF) in the multi classification experiments. The prediction results show that Stacking model achieves superior performance evaluated by two indicators: accuracy and recall. Furthermore, all the factors used in severity prediction are classified into different categories according to their influence on the results, and sensitivity analysis of several significant factors is finally implemented to explore the impact of their value variation on the prediction accuracy.


Assuntos
Acidentes de Trânsito/classificação , Ambiente Construído/estatística & dados numéricos , Escala de Gravidade do Ferimento , Ferimentos e Lesões/classificação , Acidentes de Trânsito/estatística & dados numéricos , Árvores de Decisões , Humanos , Modelos Logísticos , Máquina de Vetores de Suporte , Ferimentos e Lesões/epidemiologia
16.
Am J Emerg Med ; 37(3): 472-477, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30154024

RESUMO

INTRODUCTION: Hoverboards have become popular since they became available in 2015. We seek to provide an estimate of the number of injuries in the United States for 2015 and 2016, and to evaluate differences between adult and pediatric injury complexes. METHODS: We performed a retrospective analysis of the National Electronic Injury Surveillance System (NEISS) from January 1, 2015 to December 31, 2016. Using the weighted design of the NEISS, a nationally representative sample could be determined. RESULTS: During the 2 year period, there were 24,650 hoverboard related injuries (95% confidence interval [Cl], 17,635-31,664) in the US. The average age was 20.9 years old. There were 15,134 pediatric injuries (95%CI 9980-20,287) and 9515 adult injuries (95%CI 7185-11,845). Female patients compromised 51.2% of the sample. The upper extremity was the most common region injured [13,080 (95% CI 8848-17,311)] and fracture was the most common type of injury [10,074 (95% CI 6934-13,213)]. Hoverboard injuries increased from 2416 (95% CL 575-4245) in 2015 to 22,234 (95% CI 16,446-28,020) in 2016. Pediatric patients were more likely to be injured in the upper and lower extremity when compared to their adult cohort (p = 0.0031). Six percent of the cohort [1575 (95% CI 665-2485)] sustained critical injuries with pediatric patients being at 1.46 times higher risk for life threatening injuries. CONCLUSION: Emergency department (ED) visits for hoverboard related injuries appear to be increasing. Pediatric patients are more at risk for hoverboard related injuries than adults and almost 6% of ED visits involved critical injuries, highlighting that hoverboards may be more dangerous than previously recognized.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Patinação/lesões , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Modelos Logísticos , Masculino , Estudos Retrospectivos , Patinação/tendências , Estados Unidos/epidemiologia , Ferimentos e Lesões/classificação , Adulto Jovem
17.
Injury ; 50(1): 16-19, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30391069

RESUMO

INTRODUCTION: As the population ages, growing numbers of individuals are turning to assisted mobility devices (AMDs) to maintain independence. These devices often place users in a seated position. Like ambulatory pedestrians, pedestrians seated in an AMD are at risk for involvement in an automobile versus pedestrian crash. The purpose of this study is to compare the injury pattern and comorbidities of standing pedestrians struck by an automobile versus those of seated pedestrians. METHODS: The Arizona State Trauma Registry was queried for pedestrians struck by an automobile between 2010 and 2015. Using ICD 9 and 10 codes as well as other available documentation, seated pedestrians were identified and matched based on age and gender to standing pedestrians. Presence of co-morbidities, injury pattern, Injury Severity Score (ISS), hospital length of stay (LOS), and mortality were compared between the two groups. RESULTS: There were 70 seated pedestrians identified, matched to 140 standing pedestrians. Co-morbidities were present in 89% of seated pedestrians vs 66% of standing pedestrians (p = 0.002). Functional dependence was more prevalent in the seated pedestrians (21% vs 1%, p = 0.004). There were not significant differences in the proportion of AIS injuries by body region. However, within the thoracic region, seated pedestrians were more likely to suffer pulmonary contusions: 14% vs 4%, p = 0.05. CONCLUSIONS: The injury pattern for seated pedestrians differs slightly from that of standing pedestrians struck by an automobile. However, seated pedestrians are more likely to have co-morbid conditions that may complicate care. These findings are important when caring for the injured pedestrian and performing injury prevention outreach.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Pessoas com Deficiência/estatística & dados numéricos , Limitação da Mobilidade , Pedestres , Ferimentos e Lesões/classificação , Prevenção de Acidentes , Adulto , Arizona/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Postura Sentada , Posição Ortostática , Ferimentos e Lesões/epidemiologia
18.
Traffic Inj Prev ; 19(sup2): S109-S113, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30543458

RESUMO

OBJECTIVE: Although the Abbreviated Injury Scale (AIS) was initially developed in the mid-1960s for tracking injury in automotive and aircraft crashes, it has grown to become an internationally recognized scoring system for a variety of traumatic injuries. This shift in focus and advances in organized medical care, combined with feedback from field use and outcome analysis, have resulted in several AIS updates and revisions. This article demonstrates how AIS codes and severities have changed over the last 25 years and investigates the effects of those changes. METHODS: Data from each version and update of the AIS dictionary (AIS 1990, AIS 1998, AIS 2005, AIS 2008, and AIS 2015) were analyzed for changes and shifts in injury descriptions, severities, and code counts. RESULTS: The number of AIS codes has increased to improve coding specificity and reliability for a growing number of injury types. There has also been a shift in severities, mainly within the moderate (AIS 2) to severe (AIS 4) range. AIS 1990 was the first version to utilize the 6-digit predot identifier, to add modifiers for pediatric injury, and to substantially expand brain injury codes. AIS 1998 added coding rules and guidelines throughout the dictionary and integrated the Organ Injury Scale scores. The AIS 2005 dictionary added over 400 codes and made significant changes throughout. Fewer changes were made in the AIS 2008 update. AIS 2015 includes descriptions for tissue injuries with loss of soft tissue that do not qualify as amputations, a need identified in military injury analysis. CONCLUSIONS: Each updated version of AIS reflects improving medical care and new advances in understanding, measuring, and documenting injury. AIS changes over time reflect its international and cross-domain utilization for describing injury severity and set the standard for how the world now studies traumatic injury.


Assuntos
Escala Resumida de Ferimentos , Acidentes de Trânsito/classificação , Ferimentos e Lesões/história , História do Século XX , História do Século XXI , Humanos , Ferimentos e Lesões/classificação
19.
PLoS One ; 13(12): e0207766, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30507930

RESUMO

BACKGROUND: Increased knowledge of the temporal patterns in the distribution of trauma admissions could be beneficial to staffing and resource allocation efforts. However, little work has been done to understand how this distribution varies based on patient acuity, trauma mechanism or need for intervention. We hypothesize that temporal patterns exist in the distribution of trauma admissions, and that deep patterns exist when traumas are analyzed by their type and severity. STUDY DESIGN: We conducted a cross-sectional observational study of adult patient flow at a level one trauma center over three years, 7/1/2013-6/30/2016. Primary thermal injuries were excluded. Frequency analysis was performed for patients grouped by ED disposition and mechanism against timing of admission; in subgroup analysis additional exclusion criteria were imposed. RESULTS: 10,684 trauma contacts were analyzed. Trauma contacts were more frequent on Saturdays and Sundays than on weekdays (p<0.001). Peak arrival time was centered around evening shift change (6-7pm), but differed based on ED disposition: OR and ICU or Step-Down admissions (p = 0.0007), OR and floor admissions (p<0.0001), and ICU or Step-Down and floor admissions (p<0.0001). Step-Down and ICU arrival times (p = 0.42) were not different. Penetrating injuries peaked later than blunt (p<0.0001). Trauma varies throughout the year; we establish a high incidence trauma season (April to late October). Different mechanisms have varying dependence upon season; Motorcycle crashes (MCCs) have the greatest dependence. CONCLUSION: We identify new patterns in the temporal and seasonal variation of trauma and of specific mechanisms of injury, including the novel findings that 1) penetrating trauma tends to present at later times than blunt, and 2) critically ill patients requiring an OR tend to present later than those who are less acute and require an ICU or Step-Down unit. These patients present later than those who are admitted to the floor. Penetrating trauma patients arriving later than blunt may be the underlying reason why operative patients arrive later than other patients.


Assuntos
Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Sistema de Registros , Estações do Ano , Fatores de Tempo , Centros de Traumatologia , Estados Unidos/epidemiologia , Ferimentos e Lesões/classificação , Ferimentos não Penetrantes/epidemiologia , Ferimentos Penetrantes/epidemiologia , Adulto Jovem
20.
J Wound Care ; 27(11): 790-796, 2018 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-30398932

RESUMO

OBJECTIVE: Wound assessment is an essential part of wound management and has traditionally focused on the wound bed. The Triangle of Wound Assessment (Triangle) is a new assessment tool that includes a holistic evaluation of the patient with a wound. The aim of this pilot study was to describe the use of the Triangle in our clinical practice in Spain. METHODS: Prospective, consecutive patients, male and female, over 18 years old, with wounds of any aetiology and duration, who attended the centres involved in the study, were recruited between May and June 2017. The TWA was used during the first presentation, to assess the wound bed, edge and periwound skin. The study's expert panel met to discuss the results collected by the assessment, as well as the advantages and disadvantages of the system. RESULTS: We recruited 90 patients. Non-viable tissue (necrotic/sloughy) was recorded in 57.8% of the patients, elevated exudate (medium/high) in 52.2%. Approximately 25% of the patients had signs or symptoms of local infection. Maceration was the most prevalent issue recorded on the wound edge and periwound skin assessment, affecting 31.1% and 30.0% of the patients, respectively. The presence of hyperkeratosis was high for the study population as the main aeitologies of the wounds identified here were DFU. CONCLUSIONS: The implementation of Triangle Wound Assessment could help in the holistic approach to patient care by focusing on more than local wound care, identifying barriers to achieving wound healing and evaluating wound response and patient compliance.


Assuntos
Doença Crônica/classificação , Técnicas e Procedimentos Diagnósticos/normas , Guias de Prática Clínica como Assunto , Ferimentos e Lesões/classificação , Ferimentos e Lesões/diagnóstico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos
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