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1.
J Orthop Trauma ; 34(10): e377-e381, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32947588

RESUMO

BACKGROUND: Hospitals worldwide have postponed all nonessential surgery during the COVID-19 pandemic, but non-COVID-19 patients are still in urgent need of care. Uncertainty about a patient's COVID-19 status risks infecting health care workers and non-COVID-19 inpatients. We evaluated the use of quantitative reverse transcription polymerase chain reaction (RT-qPCR) screening for COVID-19 on admission for all patients with fractures. METHODS: We conducted a retrospective cohort study of patients older than 18 years admitted with low-energy fractures who were tested by RT-qPCR for SARS-CoV-2 at any time during hospitalization. Two periods based on the applied testing protocol were defined. During the first period, patients were only tested because of epidemiological criteria or clinical suspicion based on fever, respiratory symptoms, or radiological findings. In the second period, all patients admitted for fracture treatment were screened by RT-qPCR. RESULTS: We identified 15 patients in the first period and 42 in the second. In total, 9 (15.8%) patients without clinical or radiological findings tested positive at any moment. Five (33.3%) patients tested positive postoperatively in the first period and 3 (7.1%) in the second period (P = 0.02). For clinically unsuspected patients, postoperative positive detection went from 3 of 15 (20%) during the first period to 2 of 42 (4.8%) in the second (P = 0.11). Clinical symptoms demonstrated high specificity (92.1%) but poor sensitivity (52.6%) for infection detection. CONCLUSIONS: Symptom-based screening for COVID-19 has shown to be specific but not sensitive. Negative clinical symptoms do not rule out infection. Protocols and separated areas are necessary to treat infected patients. RT-qPCR testing on admission helps minimize the risk of nosocomial and occupational infection. LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , RNA Viral/análise , Triagem/métodos , Ferimentos e Lesões/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Espanha/epidemiologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/epidemiologia
2.
Am Surg ; 86(7): 773-781, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32730098

RESUMO

BACKGROUND: Increased prevalence of patients on anticoagulants and the advent of new therapies raise concern over how these patients fare if they sustain a traumatic injury. We investigated the role of prehospitalization anticoagulation therapy in trauma-related mortality and postacute disposition. METHODS: A retrospective analysis was performed on patients who sustained traumatic injury identified in the 2017 National Trauma Data Bank (NTDB). Patients with and without anticoagulation therapy were analyzed to identify differences in demographics, injury type, Injury Severity Score (ISS), and trauma outcomes including hospital length of stay, ER, final hospital disposition, and mortality. Logistic regression was used to correlate anticoagulation to mortality and facility discharge. RESULTS: Of the 1 000 596 patients included, 73 602 (7%) patients were on anticoagulants at the time of their trauma. Increased age was the strongest predictor for anticoagulation therapy (odds ratio 5.54, 95% CI 5.44-5.63), but being female and white were also independent predictors of anticoagulation (P < .001). Patients on anticoagulants had a significantly longer length of stay (5.11 days; 95% CI 5.06-5.15) than those who were not (4.37 days, 95% CI 4.36-4.39), were 2.20 times more likely to die (95% CI 2.12-2.28, P < .001), and were 2.77 times more likely to be discharged to a facility (95% CI 2.73-2.81, P < .001). Anticoagulation remained a significant predictor of worse trauma outcomes even when accounting for age and ISS in multivariate analysis. DISCUSSION: Anticoagulation preceding trauma-related admission is associated with higher mortality and an increased likelihood of the need for a posthospital care facility.


Assuntos
Anticoagulantes/uso terapêutico , Centros de Traumatologia , Ferimentos e Lesões/mortalidade , Adolescente , Adulto , Idoso , Bases de Dados Factuais , Feminino , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia , Adulto Jovem
3.
Nat Med ; 26(7): 1084-1088, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32632194

RESUMO

Annually, approximately 30 million patients are discharged from the emergency department (ED) after a traumatic event1. These patients are at substantial psychiatric risk, with approximately 10-20% developing one or more disorders, including anxiety, depression or post-traumatic stress disorder (PTSD)2-4. At present, no accurate method exists to predict the development of PTSD symptoms upon ED admission after trauma5. Accurate risk identification at the point of treatment by ED services is necessary to inform the targeted deployment of existing treatment6-9 to mitigate subsequent psychopathology in high-risk populations10,11. This work reports the development and validation of an algorithm for prediction of post-traumatic stress course over 12 months using two independently collected prospective cohorts of trauma survivors from two level 1 emergency trauma centers, which uses routinely collectible data from electronic medical records, along with brief clinical assessments of the patient's immediate stress reaction. Results demonstrate externally validated accuracy to discriminate PTSD risk with high precision. While the predictive algorithm yields useful reproducible results on two independent prospective cohorts of ED patients, future research should extend the generalizability to the broad, clinically heterogeneous ED population under conditions of routine medical care.


Assuntos
Medição de Risco , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Ferimentos e Lesões/diagnóstico , Adolescente , Adulto , Idoso , Algoritmos , Ansiedade , Serviço Hospitalar de Emergência/normas , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/patologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/fisiopatologia , Ferimentos e Lesões/psicologia , Adulto Jovem
4.
Am Surg ; 86(9): 1185-1193, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32723180

RESUMO

BACKGROUND: Venous thromboembolism (VTE) remains a serious complication for trauma patients. While early VTE prophylaxis has gained traction, the timing of prophylaxis remains uncertain. We hypothesized that VTE prophylaxis within 24 hours of admission would have lower VTE rates and similar rates of adverse events in seriously injured patients. METHODS: Trauma patients were included from 32 American College of Surgeons verified Level 1 and 2 trauma centers over a 10-year period. Patients with injury severity score (ISS) <15, death or discharge within 48 hours of arrival, or who received no prophylaxis were excluded. RESULTS: 14 096 patients received VTE prophylaxis with an ISS of ≥15. Patients given prophylaxis at <24 hours had fewer VTE events and trended toward fewer serious in-hospital complications. Mortality and return to the operating room were similar across groups. Hospital and intensive care unit length of stay in the <24 hours prophylaxis group was significantly shorter when VTE prophylaxis was initiated earlier. CONCLUSIONS: In severely injured trauma patients with ISS >15, early VTE prophylaxis within 24 hours significantly reduced the risk of VTE as compared with delayed prophylaxis. Early chemoprophylaxis was found to be efficacious in reducing the incidence of VTE; however, the safety of this practice should be evaluated by future prospective studies.


Assuntos
Anticoagulantes/uso terapêutico , Quimioprevenção/métodos , Unidades de Terapia Intensiva/estatística & dados numéricos , Medição de Risco/métodos , Centros de Traumatologia/estatística & dados numéricos , Tromboembolia Venosa/prevenção & controle , Ferimentos e Lesões/complicações , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia , Ferimentos e Lesões/diagnóstico
6.
J Trauma Acute Care Surg ; 89(4): 821-828, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32618967
7.
J Plast Reconstr Aesthet Surg ; 73(7): 1357-1404, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32475734

RESUMO

Charles Moore in The Telegraph recently described the NHS as 'lumbering'.1 Far from this description, it has been our experience that the NHS has rapidly transformed across specialties in order to respond to the unprecedented global crisis of COVID-19. We describe here the multiple ways in which the plastic surgery trauma service at Salisbury District Hospital swiftly adapted over a two-week period in March 2020. Our aim is to deliver a tailored trauma service whilst adhering to the same high standards of patient care established prior to the COVID-19 pandemic. It is our view that many of these changes will be positive enduring practices for the future.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Acesso aos Serviços de Saúde/organização & administração , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/cirurgia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Telemedicina/organização & administração , Centros de Traumatologia/estatística & dados numéricos , Reino Unido , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia
8.
Medicine (Baltimore) ; 99(25): e20741, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569217

RESUMO

Vital signs (VS) are dynamic parameters and understanding the significance of changes in VS in the acute setting may offer clinical meaning. We aimed to measure dynamic changes in vital signs (ΔVS) between site of trauma and presentation to hospital and investigate the association between ΔVS and in-hospital mortality among elderly with trauma.We conducted a retrospective cohort study between 2004 and 2015 using data from the nationwide trauma registry. Patients aged ≥75 years were included. Data were collected at scene of trauma and at arrival of emergency department (ED) in Japan with blunt or penetrating trauma. ΔVS scoring was defined based on clinical implications and previous reports. One point was given for each of the following criteria: systolic blood pressure reduction (-ΔSBP) of ≥30 mm Hg, heart rate increase (ΔHR) of ≥20/minute, and respiratory rate increase (ΔRR) of ≥10/minute between site of trauma and ED. The primary outcome was in-hospital mortality.Of 236,698 patients in the registry, data from 28,860 eligible patients (12.2%) were analyzed [mean age (SD), 83.2 (0.3); males, 57%]. Overall in-hospital mortality rate was 10.0%. In-hospital mortality increased from 9.0% to 16.5% for -ΔSBP; 9.2% to 22.2% for ΔHR; and 9.7% to 15.9% for ΔRR. ΔVS scores of 0, 1, 2, and 3 points were associated with in-hospital mortality of 8.2%, 14.9%, 30.1%, and 50.0%, respectively.A score based on the dynamic changes of VS, ΔVS score, may be helpful in predicting in-hospital mortality among elderly with trauma.


Assuntos
Mortalidade Hospitalar , Sinais Vitais , Ferimentos e Lesões/mortalidade , Idoso de 80 Anos ou mais , Feminino , Humanos , Japão/epidemiologia , Masculino , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Sensibilidade e Especificidade , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/fisiopatologia
9.
Ann Plast Surg ; 85(2S Suppl 2): S161-S165, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32501839

RESUMO

BACKGROUND: The COVID-19 crisis has brought many unique challenges to the health care system. Across the United States, social distancing measures have been put in place, including stay-at-home (SAH) orders, to combat the spread of this infection. This has impacted the type and volume of traumatic injuries sustained during this time. Meanwhile, steps have been taken in our health care system to assure that adequate resources are available to maintain a high standard of patient care while recognizing the importance of protecting health care providers. Using comparative data, we aim to describe the trends in traumatic injuries managed by our plastic surgery service and detail the changes in consultation policies made to minimize provider exposure. METHODS: A retrospective chart review was performed of all plastic surgery emergencies at our institution during the 3 weeks preceding the issuance of SAH orders in Chicago and the 3 weeks after. The electronic medical record was queried for patient age, type and mechanism of injury, location where injury was sustained, presence of domestic violence, length of inpatient hospital stays, and treatment rendered. The two 3-week periods were then comparatively analyzed to determine differences and trends in these variables and treatment rendered. The 2 periods were then comparatively analyzed to determine differences and trends in these variables. RESULTS: There was a significant decrease in trauma consults since the issuance of SAH (88 pre-SAH vs 62 post-SAH) with a marked decrease in trauma-related hand injuries. There was an increase in the percentage of assault-related injuries including those associated with domestic violence, whereas there was an overall decrease in motor vehicle collisions. There was no notable change in the location where injuries were sustained. Significantly fewer patients were seen by house staff in the emergency room, whereas those requiring surgical intervention were able to receive care without delay. CONCLUSIONS: Stay-at-home orders in Chicago have impacted traumatic injury patterns seen by the Section of Plastic and Reconstructive Surgery at a level I Trauma Center. Safe and timely care can continue to be provided with thorough communication, vigilance, and guidance from our colleagues.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Utilização de Instalações e Serviços/tendências , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/tendências , Centros de Traumatologia/tendências , Ferimentos e Lesões/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Chicago/epidemiologia , Criança , Pré-Escolar , Protocolos Clínicos , Emergências , Feminino , Política de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centro Cirúrgico Hospitalar , Estados Unidos , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Adulto Jovem
10.
PLoS One ; 15(6): e0235092, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574183

RESUMO

INTRODUCTION: Ladder-related falls are a common cause of patients presenting to emergency departments (ED) with serious injury. The impacts of ladder-related injuries were assessed at six-months post-injury using the quality of life, AQoL 4D Basic (AQoL) instrument. MATERIALS AND METHODS: This was a prospective observational study, conducted and reported according to the STROBE statement. All adult patients with ladder-related injuries who presented to two EDs in southeast Queensland, Australia between October 2015 and October 2016 were approached. Initial participant interviews took place at the time of ED presentation or shortly thereafter, with follow-up telephone interview at six-months. RESULTS: There were 177 enrolments, 43 (24%) were lost to follow up. There were statistically significant changes post-injury for three of the four AQoL dimensions: independence, social relationships and psychological wellbeing, as well as the global AQoL. Twenty-four (18%) participants reported a clinically significant deterioration in independence, 26 (20%) participants reported a clinically significant deterioration in their social relationships, and 34 participants (40%) reporting a clinically significant deterioration in their psychological wellbeing. Nine of the twelve individual items (in AQoL dimension) deteriorated after injury, there was no change in two items (vision and hearing) and an improvement reported in one (communication). The largest changes (> 25% of participants) were reported with sleeping, anxiety worry and depression, and pain. Across the global AQoL dimension, 65 (49%) participants reported a clinically significant deterioration. The severity of injury as measured by the ISS was an independent predictor of the change in AQoL scores (p<0.001). CONCLUSIONS: Injuries related to falls from ladders continue to have a profound impact on patients at six-months post-injury as measured using the AQoL instrument. This adds to previous research which has demonstrated considerable morbidity and mortality at the time of injury. PREVENTION: Older males using ladders at home are at high risk for serious long-term injury. Injury prevention strategies and the safety instructions packaged with the ladder need to be targeted to this at-risk community group. There may also be a role for regulatory bodies to mandate a stabilising device to be included with the ladder at the time of purchase.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Qualidade de Vida , Inquéritos e Questionários/estatística & dados numéricos , Ferimentos e Lesões/terapia , Acidentes por Quedas/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Queensland , Fatores de Risco , Índices de Gravidade do Trauma , Ferimentos e Lesões/classificação , Ferimentos e Lesões/diagnóstico , Adulto Jovem
11.
World J Emerg Surg ; 15(1): 33, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: covidwho-268764

RESUMO

BACKGROUND: A novel coronavirus pneumonia outbreak began in Wuhan, Hubei Province, in December 2019; the outbreak was caused by a novel coronavirus previously never observed in humans. China has imposed the strictest quarantine and closed management measures in history to control the spread of the disease. However, a high level of evidence to support the surgical management of potential trauma patients during the novel coronavirus outbreak is still lacking. To regulate the emergency treatment of trauma patients during the outbreak, we drafted this paper from a trauma surgeon perspective according to practical experience in Wuhan. MAIN BODY: The article illustrates the general principles for the triage and evaluation of trauma patients during the outbreak of COVID-19, indications for emergency surgery, and infection prevention and control for medical personnel, providing a practical algorithm for trauma care providers during the outbreak period. CONCLUSIONS: The measures of emergency trauma care that we have provided can protect the medical personnel involved in emergency care and ensure the timeliness of effective interventions during the outbreak of COVID-19.


Assuntos
Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Controle de Infecções/normas , Pandemias , Pneumonia Viral , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia , Algoritmos , Anestesia/normas , China , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Emergências , Unidades Hospitalares/normas , Humanos , Pandemias/prevenção & controle , Assistência Perioperatória/normas , Equipamento de Proteção Individual/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Procedimentos Cirúrgicos Operatórios/normas , Tomografia Computadorizada por Raios X/normas , Triagem/normas
12.
Scand J Trauma Resusc Emerg Med ; 28(1): 34, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375842

RESUMO

BACKGROUND: Early identification of life-threatening injuries is essential to reduce morbidity and mortality in trauma patients. Failure to detect severe injury may cause delayed diagnosis and therapeutic interventions and is associated with increased morbidity. A national trauma system will contribute to ensure the optimal care for seriously injured patients throughout the treatment chain by, among other things, defining a sensitive triage tool for identifying severe injury and contribute to correct treatment destination. In 2017, a National trauma plan was implemented in Norway and several quality indicators were recommended to ensure an evaluation of potential gaps between achieved and desired quality, and thereby highlighting areas with potential for quality improvement. With this commentary, we want to draw attention to, what we believe is, an ignoring of an important quality indicator: undertriage in trauma. MAIN BODY: Severely injured patients not met by a trauma team is commonly referred to as undertriage. An undertriage rate below 5 % is an internationally recognized quality indicator in trauma care and is emphasized in the Norwegian national trauma plan. However, whether hospitals measure and report data about undertriage, have received little attention. Therefore, a national survey was performed among Norwegian hospitals, where thirty-seven of forty trauma receiving hospitals contributed. The results of the survey showed that only half of Norwegian trauma hospitals were capable of providing these data. The results of this survey show that currently the national trauma system is not equipped to obtain important data on an important and specific quality indicator. An ongoing discussion at a national level is how to define severe injury, which may alter future definitions on undertriage. CONCLUSIONS: Knowledge of undertriage in trauma is important to enhance patient safety, increase the precision of the triage tool and provide valuable learning information to individual hospitals and prehospital services. Currently only half of Norwegian hospitals who receive trauma patients report undertriage rates and unfortunately, only few hospital administrators request these data.


Assuntos
Melhoria de Qualidade , Centros de Traumatologia/normas , Triagem/normas , Ferimentos e Lesões/diagnóstico , Feminino , Humanos , Masculino , Segurança do Paciente , Estudos Retrospectivos , Inquéritos e Questionários
13.
Scand J Trauma Resusc Emerg Med ; 28(1): 35, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32398058

RESUMO

BACKGROUND: Prompt prehospital triage and transportation are essential in an organised trauma system. The benefits of helicopter transportation on mortality in a physician-staffed pre-hospital trauma system remains unknown. The aim of the study was to assess the impact of helicopter transportation on mortality and prehospital triage. METHODS: Data collection was based on trauma registry for all consecutive major trauma patients transported by helicopter or ground ambulance in the Northern French Alps Trauma system between 2009 and 2017. The primary endpoint was in-hospital death. We performed multivariate logistic regression to compare death between helicopter and ground ambulance. RESULTS: Overall, 9458 major trauma patients were included. 37% (n = 3524) were transported by helicopter, and 56% (n = 5253) by ground ambulance. Prehospital time from the first call to the arrival at hospital was longer in the helicopter group compared to the ground ambulance group, respectively median time 95 [72-124] minutes and 85 [63-113] minutes (P < 0.001). Median transport time was similar between groups, 20 min [13-30] for helicopter and 21 min [14-32] for ground ambulance. Using multivariate logistic regression, helicopter was associated with reduced mortality compared to ground ambulance (adjusted OR 0.70; 95% CI, 0.53-0.92; P = 0.01) and with reduced undertriage (OR 0.69 95% CI, 0.60-0.80; P < 0.001). CONCLUSION: Helicopter was associated with reduced in-hospital death and undertriage by one third. It did not decrease prehospital and transport times in a system with the same crew using both helicopter or ground ambulance. The mortality and undertriage benefits observed suggest that the helicopter is the proper mode for long-distant transport to a regional trauma centre.


Assuntos
Resgate Aéreo/estatística & dados numéricos , Aeronaves/estatística & dados numéricos , Sistema de Registros , Centros de Traumatologia/estatística & dados numéricos , Triagem/métodos , Ferimentos e Lesões/diagnóstico , Adulto , Feminino , França/epidemiologia , Humanos , Masculino , Taxa de Sobrevida/tendências , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/terapia
15.
World J Emerg Surg ; 15(1): 33, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32414390

RESUMO

BACKGROUND: A novel coronavirus pneumonia outbreak began in Wuhan, Hubei Province, in December 2019; the outbreak was caused by a novel coronavirus previously never observed in humans. China has imposed the strictest quarantine and closed management measures in history to control the spread of the disease. However, a high level of evidence to support the surgical management of potential trauma patients during the novel coronavirus outbreak is still lacking. To regulate the emergency treatment of trauma patients during the outbreak, we drafted this paper from a trauma surgeon perspective according to practical experience in Wuhan. MAIN BODY: The article illustrates the general principles for the triage and evaluation of trauma patients during the outbreak of COVID-19, indications for emergency surgery, and infection prevention and control for medical personnel, providing a practical algorithm for trauma care providers during the outbreak period. CONCLUSIONS: The measures of emergency trauma care that we have provided can protect the medical personnel involved in emergency care and ensure the timeliness of effective interventions during the outbreak of COVID-19.


Assuntos
Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Controle de Infecções/normas , Pandemias , Pneumonia Viral , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia , Algoritmos , Anestesia/normas , China , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Emergências , Unidades Hospitalares/normas , Humanos , Pandemias/prevenção & controle , Assistência Perioperatória/normas , Equipamento de Proteção Individual/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Procedimentos Cirúrgicos Operatórios/normas , Tomografia Computadorizada por Raios X/normas , Triagem/normas
16.
Acta Chir Orthop Traumatol Cech ; 87(2): 120-126, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32396513

RESUMO

PURPOSE OF THE STUDY The purpose of the study is to verify the sensitivity of pre-hospital triage algorithm used in the Czech Republic, which decides on directing the patients at risk of a failure of vital functions into a trauma centre. Another aim is to find out whether the triage algorithm extension by items F4-persistent traumatic paralysis and M7-buried under heavy objects, implemented in 2015, resulted in an increased sensitivity of triage. MATERIAL AND METHODS It is a retrospective, observational, monocentric study. Included in the study were all the trauma patients with the National Advisory Committee on Aeronautics (NACA) score 3-6 treated in the given period, directed by the emergency medical service to the trauma centre. Two groups of patients were compared. In the first group, triage was performed in line with the Bulletin of the Ministry of Health of 2008, while in the second group it was performed in line with the updated version published in the Bulletin of the Ministry of Health in 2015. Both the groups were later compared with the Injury Severity Score (ISS) obtained after the diagnosis of injury in the Trauma Centre of the University Hospital Ostrava. In the second group, also certain selected parameters were assessed. Group A: Patients treated by the Emergency Medical Service of the Moravia-Silesia Region in the period from 1 January 2013 to 31 December 2014 who met the NACA 3-6 criterion and were identified by paramedics as triage positive in line with the pre-hospital triage 2008. Group B: Patients treated by the Emergency Medical Service of the Moravia-Silesia Region in the period from 1 January 2016 to 31 December 2017 who met the NACA 3-6 criterion and were identified by paramedics as triage positive in line with the pre-hospital triage 2015. In Group B, also monitored was the number of patients identified as triage positive only based on F4 and M7. RESULTS The first group included 3,475 patients, of whom 435 were triage positive. In the respective period, the Trauma Centre of the University Hospital Ostrava identified 262 patients with ISS greater than 15 points. The pre-hospital triage and ISS greater than 15 points corresponded in 210 patients. 19.9% were false negative (52/262). The mean ISS was 33.1±9.4, median 34, IQR 25.5--1. In Group A, the sensitivity of triage criteria reached 80.2% (95% IS: 74.7-84.7%), the specificity was 93.0% (95% IS: 92.0-93.8%). The second group included 3,816 patients, of whom 586 were triage positive. In the monitored period, the Trauma Centre of the University Hospital Ostrava identified 363 patients with ISS greater than 15 points. The pre-hospital triage and ISS greater than 15 points corresponded in 313 patients. 13.8% were false negative (50/363). The mean ISS was 43.7±12.0, median 42, IQR 33-54. In Group B, the sensitivity of triage criteria reached 86.2% (95% IS: 82.1-89.5%), the specificity was 98.5% (95% IS: 97.9-98.8%). In Group B, 11 patients were identified as triage positive based on F4 and M7 items. No statistically significant difference was found (chi-squared test, p = 0.257) after adding the F4 and M7 items to the algorithm. CONCLUSIONS The triage system for pre-hospital care in the Czech Republic in line with the applicable pre-hospital triage has high sensitivity as well as specificity and the results correspond to the latest triage algorithms used abroad. Increased sensitivity as a result of adding the new triage items was not confirmed. Key words: pre-hospital triage.


Assuntos
Serviços Médicos de Emergência/normas , Escala de Gravidade do Ferimento , Centros de Traumatologia/normas , Triagem/normas , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia , Algoritmos , República Tcheca , Serviços Médicos de Emergência/métodos , Humanos , Estudos Retrospectivos , Sensibilidade e Especificidade , Centros de Traumatologia/organização & administração , Triagem/métodos
19.
J Surg Res ; 252: 107-115, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32278964

RESUMO

BACKGROUND: The American College of Surgeons (ACS) publishes Resources for Optimal Care of the Injured Patient (Orange Book) to provide common requirements to verify trauma centers (TCs), throughout the United States. There are very few studies that assess the impact of geography on TC outcomes. Our study aimed to evaluate the differences in geographic regions in terms of injury-adjusted all-cause mortality at ACS Level 1, 2, and 3 TCs. METHODS: Review of the 2016 Research Data Set provided by the National Trauma Data Bank. TCs were categorized by the Research Data Set into geographic regions: Northeast, Midwest, South, and West. TCs were subcategorized into ACS Level 1, 2, or 3; all others were excluded. Injury-adjusted mortality was determined using observed/expected mortality (O/E) ratios, derived from TRISS methodology. Chi-squared and t-test analyses were used with significance defined as P-value<0.05. RESULTS: Among Level 1 TCs, the West (O/E = 0.62) and South (0.61) regions had significantly higher adjusted mortality rates than the Level 1s in the Midwest (0.52) and Northeast (0.52) (P < 0.05). Among Level 2s, the West (O/E = 0.61) and South (0.55) regions had significantly higher mortality than the Level 2s in the Midwest (0.40) and Northeast (0.35) (P < 0.05). Among Level 3 TCs, the South (O/E = 0.48) and the West (0.43) had significantly higher mortality than the Midwest (0.26) and Northeast (0.22) (P < 0.05). CONCLUSIONS: In the United States, injury-adjusted all-cause mortality rates are significantly higher in the South and West regions for ACS Level 1, 2, and 3 TCs compared with the Midwest and Northeast. This geographic disparity necessitates a deeper evaluation.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Mortalidade Hospitalar , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/terapia , Adulto , Bases de Dados Factuais/estatística & dados numéricos , Conjuntos de Dados como Assunto , Feminino , Geografia , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Masculino , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/mortalidade
20.
J Surg Res ; 252: 139-146, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32278968

RESUMO

BACKGROUND: Age and massive transfusion are predictors of mortality after trauma. We hypothesized that increasing age and high-volume transfusion would result in progressively elevated mortality rates and that a transfusion "ceiling" would define futility. METHODS: The Trauma Quality Improvement Program (TQIP) database was queried for 2013-2016 records and our level I trauma registry was reviewed from 2013 to 2018. Demographic, mortality, and blood transfusion data were collected. Patients were grouped by decade of life and by packed red blood cell (pRBC) transfusion requirement (zero units, 1-3 units, or ≥4 units) within 4 h of admission. RESULTS: TQIP analysis demonstrated an in-hospital mortality risk that increased linearly with age, to an odds ratio of 10.1 in ≥80 y old (P < 0.01). Mortality rates were significantly higher in older adults (P < 0.01) and those with more pRBCs transfused. In massively transfused patients, the transfusion "ceiling" was dependent on age. Owing to the lack granularity in the TQIP database, 230 patients from our institution who received ≥4 units of pRBCs within 4 h of admission were reviewed. On arrival, younger patients had significantly higher heart rates and more severe derangements in lactate levels, base deficits, and pH compared with older patients. There were no differences among age groups in injury severity score, systolic blood pressure, or mortality. CONCLUSIONS: In massively transfused patients, mortality increased with age. However, a significant proportion of older adults were successfully resuscitated. Therefore, age alone should not be considered a contraindication to high-volume transfusion. Traditional physiologic and laboratory criteria indicative of hemorrhagic shock may have reduced reliability with increasing age, and thus providers must have a heightened suspicion for hemorrhage in the elderly. Early transfusion requirements can be combined with age to establish prognosis to define futility to help counsel families regarding mortality after traumatic injury.


Assuntos
Transfusão de Eritrócitos/normas , Futilidade Médica , Ressuscitação/normas , Choque Hemorrágico/terapia , Ferimentos e Lesões/terapia , Adulto , Fatores Etários , Idoso , Tomada de Decisão Clínica/métodos , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Sistema de Registros/estatística & dados numéricos , Ressuscitação/métodos , Ressuscitação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Choque Hemorrágico/etiologia , Choque Hemorrágico/mortalidade , Centros de Traumatologia/normas , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento , Estados Unidos/epidemiologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/mortalidade
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