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2.
Br J Radiol ; 93(1106): 20190017, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31899661

RESUMO

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


Assuntos
Aorta Abdominal/lesões , Aorta Torácica/lesões , Procedimentos Endovasculares , Ferimentos não Penetrantes/cirurgia , Ferimentos Perfurantes/cirurgia , Acidentes de Trânsito , Adolescente , Aorta Abdominal/cirurgia , Aorta Torácica/cirurgia , Criança , Pré-Escolar , Angiografia por Tomografia Computadorizada , Estudos de Viabilidade , Humanos , Angiografia por Ressonância Magnética , Masculino , Ferimentos não Penetrantes/diagnóstico , Ferimentos Perfurantes/diagnóstico
3.
J Surg Res ; 246: 153-159, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31586889

RESUMO

BACKGROUND: Injured children who arrive by self-transport to the emergency department (ED) may receive delayed or inadequate care. We studied differences in demographics, clinical characteristics, and trauma activation status for admitted pediatric trauma patients based on arrival by self-transport or Emergency Medical Services (EMS). MATERIALS AND METHODS: We performed a retrospective cohort study at two level I pediatric trauma centers. INCLUSION CRITERIA: <15 y old with blunt or penetrating injury. We used univariate and multivariate logistic regression analyses to determine associations between trauma activation, ED length of stay (LOS), and hospital LOS with demographic and clinical characteristics. RESULTS: We identified 1161 patients: 40.1% arrived by self-transport and 59.9% by EMS. Self-transport patients were less likely to have an abnormal Glasgow Coma Scale score < 15 (2.1% versus 22.0%, P < 0.001) and Injury Severity Score > 15 (2.4% versus 11.7%, P < 0.001). Trauma activation was initiated in 52.5% of patients, occurring less often in self-transport than EMS patients (2.4% versus 86.2%, P < 0.001). Trauma activation rate was negatively associated with arrival by self-transport (odds ratio [OR] 0.001, 95% CI 0.00-0.003), positively associated with Glasgow Coma Scale <15 (OR 25.9, 95% CI 6.6-101.2) and site (OR 15.4, 95% CI 6.3-37.5) but not with Injury Severity Score >15 (OR 2.8, 95% CI 0.8-9.2). Self-transport arrival was associated with longer ED LOS (estimated regression slope 0.47, 95% CI 0.13-0.82). CONCLUSIONS: Almost half of admitted pediatric trauma patients arrived by self-transport; however, trauma team activation rarely occurs for these patients. Trauma team activation may be underutilized in self-transport patients with injuries resulting in hospital admission.


Assuntos
Transporte de Pacientes/estatística & dados numéricos , Centros de Traumatologia/organização & administração , Triagem/organização & administração , Ferimentos não Penetrantes/diagnóstico , Ferimentos Penetrantes/diagnóstico , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços/organização & administração , Utilização de Instalações e Serviços/normas , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Masculino , Admissão do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Centros de Traumatologia/normas , Centros de Traumatologia/estatística & dados numéricos , Triagem/normas , Triagem/estatística & dados numéricos , Estados Unidos , Ferimentos não Penetrantes/terapia , Ferimentos Penetrantes/terapia
4.
J Surg Res ; 246: 182-189, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31593862

RESUMO

BACKGROUND: Trauma patients with pelvic fractures have a high rate of venous thromboembolism (VTEs). The reason for this high rate is unknown. We hypothesize that fibrinolysis shutdown (SD) predicts VTE in patients with severe pelvic fracture. METHODS: Retrospective chart review of trauma patients who presented with pelvic fracture from 2007 to 2017 was performed. Inclusion criteria were injury severity score > 15, abdomen/pelvis abbreviated injury scale >/= 3, blunt mechanism, admission citrated rapid thrombelastography (TEG). Fibrinolytic phenotypes were defined by fibrinolysis on citrated rapid TEG as hyperfibrinolysis, physiologic lysis, and SD. Univariate analysis of TEG measurements and clinical outcomes, followed by multivariable logistic regression (MV) with stepwise selection, was performed. RESULTS: Overall, 210 patients were included. Most patients (59%) presented in fibrinolytic shutdown. VTE incidence was 11%. There were no significant differences in fibrinolytic phenotypes or other TEG measurements between those who developed VTE and those who did not. There was a higher rate of VTE in patients who underwent pelvic external fixation or resuscitative thoracotomy. On MV, pelvic fixation and resuscitative thoracotomy were independent predictors of VTE. CONCLUSIONS: In severely injured patients with pelvic fractures, there was a high rate of VTE and the majority presented in SD. However, we were unable to correlate initial SD with VTE. Ultimately, the high rate of VTE in this patient population supports the concept of implementing VTE chemoprophylaxis measures as soon as hemostasis is achieved.


Assuntos
Fibrinólise/fisiologia , Fraturas Ósseas/complicações , Ossos Pélvicos/lesões , Tromboembolia Venosa/epidemiologia , Ferimentos não Penetrantes/complicações , Escala Resumida de Ferimentos , Adulto , Feminino , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/fisiopatologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tromboelastografia , Centros de Traumatologia/estatística & dados numéricos , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/fisiopatologia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/fisiopatologia
5.
J Surg Res ; 245: 593-599, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31499365

RESUMO

BACKGROUND: After traumatic arrest, resuscitative thoracotomy is lifesaving in appropriately selected patients, yet data are limited regarding hospital course after intensive care unit (ICU) admission. The objective of this study was to describe the natural history of resuscitative thoracotomy survivors admitted to the ICU. MATERIALS AND METHODS: We conducted a retrospective review (January 1, 2012-June 30, 2017) of all adult trauma patients who underwent resuscitative thoracotomy after traumatic arrest at two adult level 1 trauma centers. Data evaluated include demographics, injury characteristics, hospital course, and outcome. RESULTS: Over 66 mo, there were 52,624 trauma activations. Two hundred ninety-eight patients underwent resuscitative thoracotomy and 96 (32%) survived to ICU admission. At ICU admission, mean age was 35.8 ± 14.5 y, 79 (82%) were male, 36 (38%) sustained blunt trauma, and the mean injury severity score was 32.3 ± 13.7. Eight blunt and 20 penetrating patients (22% and 34% of ICU admissions, respectively) survived to discharge. 67% of deaths in the ICU occurred within the first 24 h, whereas 90% of those alive at day 21 survived to discharge. For the 28 survivors, mean ICU length of stay was 24.1 ± 17.9 d and mean hospital length of stay was 43.9 ± 32.1 d. Survivors averaged 1.9 ± 1.5 complications. Twenty-four patients (86% of hospital survivors) went home or to a rehabilitation center. CONCLUSIONS: After resuscitative thoracotomy and subsequent ICU admission, 29% of patients survived to hospital discharge. Complications and a long hospital stay should be expected, but the functional outcome for survivors is not as bleak as previously reported.


Assuntos
Parada Cardíaca/cirurgia , Complicações Pós-Operatórias/epidemiologia , Ressuscitação/efeitos adversos , Toracotomia/efeitos adversos , Ferimentos não Penetrantes/complicações , Ferimentos Penetrantes/complicações , Adulto , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Centros de Reabilitação/estatística & dados numéricos , Ressuscitação/métodos , Estudos Retrospectivos , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/cirurgia , Adulto Jovem
6.
Ann Vasc Surg ; 62: 106-113, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31394233

RESUMO

BACKGROUND: Current algorithms for the management of blunt lower extremity trauma recommend additional imaging in patients presenting with soft signs of vascular injury and an ankle-brachial index (ABI) less than 0.9. The aim of this study is to analyze lower extremity computed tomography angiographies (CTAs) to determine the incidence and characteristics of patients sustaining vascular injury from blunt lower extremity trauma. We hypothesized that a lower ABI threshold can avoid unnecessary imaging without missing clinically significant vascular injury. METHODS: A single-center, retrospective review of all consecutive patients who presented to a level 1 trauma center with blunt lower extremity trauma and underwent a CTA from January 2015 to December 2017 was conducted. Baseline demographics, clinical features, and outcomes were recorded. Patients without documented ABIs were excluded. A receiver operating characteristic curve was used to define the ABI threshold. RESULTS: One hundred twenty-five patients (133 injured limbs) met inclusion criteria. The mean age was 44 years (range 9-96), and 74% of the patients were male. A vascular abnormality was identified on CTA in 65 limbs (48.9%), of which only 8 (12%) required intervention. The ABIs in these 8 injured limbs were between 0 and 0.6. An ABI threshold of 0.6 maximized the balance between sensitivity (100%) and specificity (87%) and missed no injuries requiring revascularization. CONCLUSIONS: The ABI remains useful in evaluating blunt lower extremity trauma. A lower ABI threshold in patients presenting with soft signs of vascular injury after blunt trauma may avoid unnecessary imaging without missing vascular injuries requiring intervention. Further prospective studies are needed to validate the safety and effectiveness of a lower ABI threshold.


Assuntos
Índice Tornozelo-Braço , Artérias/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Extremidade Inferior/irrigação sanguínea , Procedimentos Desnecessários , Lesões do Sistema Vascular/diagnóstico , Ferimentos não Penetrantes/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artérias/fisiopatologia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/fisiopatologia , Lesões do Sistema Vascular/terapia , Washington , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/fisiopatologia , Ferimentos não Penetrantes/terapia , Adulto Jovem
7.
J Surg Res ; 245: 81-88, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31404894

RESUMO

BACKGROUND: Delayed emergency department (ED) LOS has been associated with increased mortality and increased hospital length of stay (LOS) for various patient populations. Trauma patients often require significant effort in evaluation, workup, and disposition; however, patient and hospital characteristics associated with increased LOS in the ED for trauma patients remain unclear. METHODS: The Trauma Quality Improvement Project database (2014-2016) was queried for all adult blunt trauma patients. Patients discharged from the ED to the operating room were excluded. Univariate and multivariable linear regression analysis was conducted to identify independent predictors of ED LOS, controlling for patient characteristics (age, gender, race, insurance status), hospital characteristics (teaching status, ACS trauma verification level, geographic region), abbreviated injury scale and comorbid status. RESULTS: 412,000 patients met inclusion criteria for analysis. When controlling for covariates, an increase in age by 1 y resulted in 0.63 increased minutes in the ED (P < 0.001). In multivariable linear regression controlling for injury severity and comorbid conditions, non-white race groups, university status, and northeast region were associated with increased ED LOS. Black and Hispanic patients spent on average 41 and 42 more minutes, respectively, in the ED room when compared with white patients (P < 0.001). Patients seen at University hospitals spent 52 more minutes in the ED when compared with community hospitals, whereas patients at nonteaching hospitals spent 31 fewer minutes (P < 0.001). Patients seen in the Midwest spent the least amount of time in the ED, with patients in the South, West, and Northeast spending 45, 36, and 89 more minutes, respectively (P < 0.001). Non-Medicaid patients at level 1 trauma centers and those requiring intensive care admission had significantly decreased ED LOS. Medicaid patients took the longest to move through the ED with Medicare, BlueCross, and Private insurance outpacing them by 17, 23, and 23 min, respectively (P < 0.001). ACS level 1 trauma centers moved patients through the ED fastest, whereas ACS level II trauma centers and level III trauma centers moved patients through 50 and 130 min slower when compared with ACS level 1 trauma centers (P < 0.001). CONCLUSIONS: ED LOS varied significantly by patient and hospital characteristics. Medicaid patients and those patients at university hospitals were associated with significantly higher ED LOS, whereas ACS trauma verification level status had strong correlation with ED LOS. These results may allow targeted quality improvement programs to enhance ED LOS.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Ferimentos não Penetrantes/terapia , Escala Resumida de Ferimentos , Adolescente , Adulto , Idoso , Feminino , Hospitais Comunitários/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Medição de Risco/métodos , Análise de Sobrevida , Estados Unidos , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/mortalidade , Adulto Jovem
8.
BMC Ophthalmol ; 19(1): 209, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640617

RESUMO

BACKGROUND: Crouzon syndrome (CS), which results from fibroblast growth factor receptor 2 mutations, is associated with craniosynostosis, exophthalmos, and other symptoms. Herein, we report the genetic abnormalities detected in a Chinese family with autosomal dominant CS, combined with luxation of the eyeball. This luxation was a consequence of the trauma to the shallow orbits. CASE PRESENTATION: The proband was a 4-year-old boy. He accidentally fell, following which luxation of the bulbus oculi occurred immediately. Computed tomography and magnetic resonance imaging clearly revealed ocular proptosis. Upon physical examination, the proband, his father, and grandfather had ocular proptosis, shallow orbits, and mid-face hypoplasia. However, their hands and feet were clinically normal. Genomic DNA was extracted from the peripheral blood through a polymerase chain reaction performed for the target sequence. Genetic assessments revealed a heterozygous missense mutation (c.1012G > C, p.G338R) in exon 10 of the human FGFR2, cosegregated with the disease phenotype in this family. These findings confirmed the diagnosis of CS. DISCUSSION: CS is usually caused by FGFR2 mutations. While there are a few reports of luxation of the bulbus oculi in Chinese families with CS, the ocular proptosis, shallow orbits, combined with luxation of eyeball after trauma observed in this patient were particularly interesting. Our findings enhance the current knowledge of traumatic luxation concomitant with CS.


Assuntos
Disostose Craniofacial/genética , DNA/genética , Traumatismos Oculares/complicações , Mutação de Sentido Incorreto , Órbita/lesões , Receptor Tipo 2 de Fator de Crescimento de Fibroblastos/genética , Ferimentos não Penetrantes/complicações , Pré-Escolar , China , Disostose Craniofacial/complicações , Disostose Craniofacial/metabolismo , Análise Mutacional de DNA , Traumatismos Oculares/diagnóstico , Humanos , Imagem por Ressonância Magnética , Masculino , Órbita/diagnóstico por imagem , Linhagem , Fenótipo , Receptor Tipo 2 de Fator de Crescimento de Fibroblastos/metabolismo , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnóstico
9.
Vet Ital ; 55(3): 275-278, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31599553

RESUMO

An adult male Eurasian otter, found dead on the roadside, was submitted for post-mortem examination in April 2014 at the Veterinary Pathology Unit of the Faculty of Veterinary Medicine of Teramo, as part of the RECAL [RECovery and post mortem Analysis of Eurasian otters (Lutra lutra) in the National Park of Cilento, Vallo di Diano and Alburni (Salerno, Italy), and surrounding areas] project. Necropsy revealed an abundant hemothorax associated with multifocal, bilateral pulmonary contusions and lacerations, and a severe hemopericardium characterised by the presence of a wide blood clot in the intact pericardial sac. Two small laceration wounds of the left auricle were found at the base, along the atrioventricular groove, and on the outer free wall. Since myocardial and endocardial tissues showed no other gross and histopathological abnormalities, a left atrial appendage rupture resulting from a blunt chest trauma was diagnosed. Blunt traumatic cardiac rupture is a rarely reported, life-threatening condition in humans. To the best of our knowledge, this is the first report on a left atrial appendage rupture due to blunt chest trauma in veterinary literature. The possible occurrence of a cardiac rupture following a blunt thoracic injury should be taken into consideration in veterinary emergency care.


Assuntos
Apêndice Atrial/patologia , Traumatismos Cardíacos/veterinária , Lontras , Traumatismos Torácicos/veterinária , Ferimentos não Penetrantes/veterinária , Animais , Evolução Fatal , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/patologia , Itália , Masculino , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/patologia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/patologia
11.
Ulus Travma Acil Cerrahi Derg ; 25(4): 369-377, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31297785

RESUMO

BACKGROUND: In cases of blunt abdominal trauma, the abdomen is the third most affected region. Computerized tomography (CT) is the gold standard for the evaluation of these patients. However, considering its damaging effects and high cost, it may not be proper to refer every patient applying to the emergency unit for a CT examination. In this study, our objective was to compare the accuracy of ultrasonography (US) and physical examination in blunt abdominal trauma patients to the gold standard CT in order to prevent unnecessary CT examinations. METHODS: In this retrospective study, the files and images of 2248 patients, who applied to the emergency department of our hospital were screened. A total of 535 adult patients who underwent CT scanning after the ultrasonographic and physical examinations were included in the study. The findings of the US and physical examinations, the intraabdominal free fluid, and organ lacerations were compared to the results of CT. The compatibility, sensitivity, specificity, positive estimated value, and the negative estimated value of the obtained data were analyzed with statistical methods. RESULTS: The sensitivity of US in the demonstration of the intraabdominal free fluid was comparable with the sensitivity of CT in the patients with blunt abdominal trauma (p=0.302). The sensitivity and specificity of US was 49.6% and 99.3% respectively in the determination of the intraabdominal organ injuries. The sensitivity and specificity of the physical examination was 59% and 87% respectively in the determination of the free fluid and organ injury as compared to CT. Although the sensitivity and specificity of the physical examination were high separately in the organ injuries according to the statistical calculations, they seemed not to have had a statistically significant predictive value (p<0.001). CONCLUSION: Even though US is a reliable method for the determination of the intraabdominal fluid, US and physical examination are not reliable in the determination of the organ injuries as compared to CT.


Assuntos
Traumatismos Abdominais/diagnóstico , Exame Físico , Ferimentos não Penetrantes/diagnóstico , Cavidade Abdominal , Traumatismos Abdominais/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Humanos , Rim/diagnóstico por imagem , Rim/lesões , Lacerações , Fígado/diagnóstico por imagem , Fígado/lesões , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Estudos Retrospectivos , Sensibilidade e Especificidade , Baço/diagnóstico por imagem , Baço/lesões , Tomografia Computadorizada por Raios X , Ultrassonografia , Ferimentos não Penetrantes/diagnóstico por imagem , Adulto Jovem
13.
Int Heart J ; 60(4): 998-1002, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31257334

RESUMO

Ventricular pseudoaneurysm (PSA) is a rare, yet life-threatening complication of myocardial infarction, cardiac surgery, and transcatheter valve replacement. Although conventional surgery is the preferred treatment strategy, transcatheter closure has emerged as an effective alternative in selected candidates. In this report, we describe successful transcatheter closure of two unique cases of ventricular pseudoaneurysm (PSA): first, a complex post-myocardial infarction left ventricular PSA (LVPSA) with multi-communications, and second, a case of post-traumatic right ventricular PSA (RVPSA) following blunt chest injury caused by domestic violence.


Assuntos
Falso Aneurisma/cirurgia , Cateterismo Cardíaco/métodos , Aneurisma Cardíaco/cirurgia , Ventrículos do Coração , Infarto do Miocárdio/complicações , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Idoso , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Violência Doméstica , Ecocardiografia , Feminino , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/etiologia , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Traumatismos Torácicos/diagnóstico , Ferimentos não Penetrantes/diagnóstico
14.
Torture ; 29(1): 47-55, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264815

RESUMO

INTRODUCTION: Changing patterns of migration has required states and governments to respond to the specific medical and legal needs of asylum seekers. Based on medical assessments undertaken at the University Institute of Legal Medicine, the present study aims to describe the cases of asylum applicants who have suffered from physical violence, including torture, and the variables involved. METHODS: Over a 10-year period, 225 survivors were examined by clinical forensic professionals from the University Institute of Legal Medicine. RESULTS: 85% of asylum applicants came from Africa, 87% were male, and the most common age group was 26-40 years old. 46% of applicants fled their country for political reasons. Blunt force injuries were reported in 45% of cases, the trunk was the most affected area of the body (40%), and applicants presented with an average of two different mechanisms of lesions and an average of four lesions each. DISCUSSION/CONCLUSION: Assessment of physical violence on asylum seekers requires the cooperation of professionals with different skillsets and training.


Assuntos
Medicina Legal , Refugiados , Tortura , Adolescente , Adulto , África/etnologia , Ásia/etnologia , Queimaduras/diagnóstico , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Violência , Ferimentos não Penetrantes/diagnóstico , Ferimentos Penetrantes/diagnóstico , Adulto Jovem
15.
Scand J Trauma Resusc Emerg Med ; 27(1): 70, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331379

RESUMO

BACKGROUND: Spinal immobilisation of blunt trauma victims with potential spinal cord injury is considered standard of care. The traditional management has, however, been increasingly questioned and concerns about harm have been raised. Few studies have described the perspective of the trauma patient regarding the spinal immobilisation. The objective of this study was therefore to evaluate the patient experience of immobilisation after trauma. METHODS: We prospectively screened adult trauma patients admitted to a level 1 trauma centre for eligibility. We included adult trauma patients who had been, and remembered being, immobilised for spinal protection with a cervical collar and a spine board prehospitally or upon arrival at the trauma centre. A semi-structured interview was conducted 2 to 72 h after admission either in person or by telephone. RESULTS: One hundred and fourteen patients were eligible for inclusion based on the patient charts. Out of 98 patients assessed for participation, 48 (49%) had no memory of being immobilised. We thus included 50 patients with a median age of 37 years (IQR: 26-60) of whom 38 (76%) were men. The median injury severity score was 9 (IQR: 3-15) and the median time with a cervical collar from initial application to in-hospital removal or until the interview was given was 91 min (IQR: 72-136). Nineteen patients (38%) reported discomfort and 12 patients (24%) experienced pain related to the immobilisation. Forty patients (80%) reported a sense of protection related to the immobilisation. CONCLUSION: Discomfort related to spinal immobilisation was reported in 38% of trauma patients. However, a sense of protection was a recurring theme in 80% of the trauma patients, who recalled being immobilised. Nearly half of the awake trauma patients had no memory of being immobilised.


Assuntos
Vértebras Cervicais/lesões , Imobilização/métodos , Traumatismos da Medula Espinal/terapia , Ferimentos não Penetrantes/terapia , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/diagnóstico , Centros de Traumatologia/estatística & dados numéricos , Ferimentos não Penetrantes/diagnóstico
16.
J Surg Res ; 244: 23-33, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31279260

RESUMO

BACKGROUND: Soluble suppression of tumorigenicity 2 (sST2), a decoy receptor for interleukin (IL)-33, has emerged as a novel biomarker in various disease processes. Recent studies have elucidated the role of the sST2/IL-33 complex in modulating the balance of Th1/Th2 immune responses after tissue stress. However, the role of sST2 as a biomarker after traumatic injury remains unclear. To address this, we evaluated serum sST2 correlations with mortality and in-hospital adverse outcomes as endpoints in blunt trauma patients. METHODS: We retrospectively analyzed clinical and biobank data of 493 blunt trauma victims 472 survivors (mean age: 48.4 ± 0.87; injury severity score [ISS]: 19.6 ± 0.48) and 19 nonsurvivors (mean age: 58.8 ± 4.5; ISS: 23.3 ± 2.1) admitted to the intensive care unit. Given the confounding impact of age on the inflammatory response, we derived a propensity-matched survivor subgroup (n = 19; mean age: 59 ± 3; ISS: 23.4 ± 2) using an IBM SPSS case-control matching algorithm. Serial blood samples were obtained from all patients (3 samples within the first 24 h and then once daily from day [D] 1 to D5 after injury). sST2 and twenty-nine inflammatory biomarkers were assayed using enzyme-linked immunosorbent assay and Luminex, respectively. Two-way analysis of variance on ranks was used to compare groups (P < 0.05). Spearman rank correlation was performed to determine the association of circulating sST2 levels with biomarker levels and in-hospital clinical outcomes. RESULTS: Circulating sST2 levels of the nonsurvivor cohort were statistically significantly elevated at 12 h after injury and remained elevated up to D5 when compared either to the overall 472 survivor cohort or a matched 19 survivor subcohort. Admission sST2 levels obtained from the first blood draw after injury in the survivor cohort correlated positively with admission base deficit (correlation coefficient [CC] = 0.1; P = 0.02), international normalized ratio (CC = 0.1, P = 0.03), ISS (CC = 0.1, P = 0.008), and the average Marshall multiple organ dysfunction score between D2 and D5 (CC = 0.1, P = 0.04). Correlations with ISS revealed a positive correlation of ISS with plasma sST2 levels across the mild ISS (CC = 0.47, P < 0.001), moderate ISS (CC = 0.58, P < 0.001), and severe ISS groups (CC = 0.63, P < 0.001). Analysis of biomarker correlations in the matched survivor group over the initial 24 h after injury showed that sST2 correlates strongly and positively with IL-4 (CC = 0.65, P = 0.002), IL-5 (CC = 0.57, P = 0.01), IL-21 (CC = 0.52, P = 0.02), IL-2 (CC = 0.51, P = 0.02), soluble IL-2 receptor-α (CC = 0.5, P = 0.02), IL-13 (CC = 0.49, P = 0.02), and IL-17A (CC = 0.48, P = 0.03). This was not seen in the matched nonsurvivor group. sST2/IL-33 ratios were significantly elevated in nonsurvivors and patients with severe injury based on ISS ≥ 25. CONCLUSIONS: Elevations in serum sST2 levels are associated with poor clinical trajectories and mortality after blunt trauma. High sST2 coupled with low IL-33 associates with severe injury, mortality, and worse clinical outcomes. These findings suggest that sST2 could serve as an early prognostic biomarker in trauma patients and that sustained elevations of sST2 could contribute to a detrimental suppression of IL-33 bioavailability in patients with high injury severity.


Assuntos
Proteína 1 Semelhante a Receptor de Interleucina-1/sangue , Ferimentos não Penetrantes/mortalidade , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/estatística & dados numéricos , Interleucina-33/sangue , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Prognóstico , Estudos Retrospectivos , Ferimentos não Penetrantes/sangue , Ferimentos não Penetrantes/diagnóstico
17.
J Trauma Acute Care Surg ; 87(2): 315-321, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348401

RESUMO

BACKGROUND: Helicopter emergency medical services improve survival in some injured patients but current utilization leads to significant overtriage with considerable numbers of transported patients discharged home from the emergency department or found to have non-time-sensitive injuries. Current triage models for utilization are complex and untested. METHODS: Data from a state trauma registry were reviewed from 1987 to 1993 and from 2013 to 2015 and compared. Data from 2013 to 2015 were analyzed for field information found to influence mortality and a model for low mortality-risk patients designed. RESULTS: Indexed to population, a major increase in numbers of injured patients transported directly to designated trauma centers (39.849-167.626/100,000/year) occurred with an increased portion transported by helicopter emergency medical services from 7.28% to 9.26%. A simple triage tool to predict low mortality rates was designed utilizing results from logistic regression. Nongeriatric adult patients (age, 16.0-69.9 years) with a blunt injury mechanism, normal Glasgow Coma Scale motor score, pulse rate of 60 bpm to 120 bpm and respiratory rate of 10 breaths per minute to 29 breaths per minute are at low risk for mortality. Cost for helicopter transportation was substantially higher than ground transportation based on available data. Cost differentials in transport mode increased patient financial risk when helicopter transportation was utilized. CONCLUSION: Implementing a simple decision tool designating nongeriatric adult patients with a blunt injury mechanism, normal Glasgow Coma Scale motor score, systolic blood pressure greater than 90 mm Hg, pulse rate of 60 bpm to 120 bpm, and respiratory rate of 10 breaths per minute to 29 breaths per minute to ground transportation would result in substantial savings without an increase in mortality and reduce risk of patient financial harm. LEVEL OF EVIDENCE: Prognostic/Epidemiological study, level IV. Economic and value based evaluation, level IV.


Assuntos
Resgate Aéreo/estatística & dados numéricos , Triagem/métodos , Ferimentos e Lesões/terapia , Adulto , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina , Sistema de Registros , Medição de Risco , Centros de Traumatologia , Sinais Vitais , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/mortalidade , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/terapia
19.
Br J Hosp Med (Lond) ; 80(6): 317-319, 2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31180783

RESUMO

Potential injury to the cervical spine should be considered in all patients who have suffered blunt trauma. Early spinal immobilization is required to minimize the risk of secondary spinal cord injury. However, prolonged immobilization is associated with its own morbidity. Clinical evaluation of the cervical spine in confused or unconscious adult trauma patients is challenging, and imaging is required to safely 'clear' the cervical spine. Despite the existence of national guidelines, significant variations in practice exist. This article summarizes the evidence for the initial stabilization of the cervical spine in adult trauma patients. It reviews the imaging modalities available and the criteria for discontinuation of cervical spine immobilization.


Assuntos
Vértebras Cervicais/lesões , Imobilização/métodos , Traumatismos da Medula Espinal/diagnóstico , Inconsciência , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/terapia , Vértebras Cervicais/diagnóstico por imagem , Protocolos Clínicos , Humanos , Imobilização/efeitos adversos , Imagem por Ressonância Magnética , Guias de Prática Clínica como Assunto , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/terapia , Tomografia Computadorizada por Raios X , Centros de Traumatologia , Ferimentos não Penetrantes/diagnóstico por imagem
20.
Sud Med Ekspert ; 62(3): 21-27, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31198200

RESUMO

The aim of this study was to compare the morphoscopic and morphometric features of local and remote liver ruptures under various external influences. It was found that the local main ruptures were formed in the case of impact trauma more often in the right side of the liver on its diaphragmatic surface, in the anterior third of the organ. They were linear and located in the longitudinal direction. The size of the ruptures increased as the impact force increased. Local additional ruptures were associated with impact and compression trauma and were located only on the diaphragmatic surface of the liver, more often in the right half, in the middle third of the organ. These ruptures were linear, co-directional and small in size under various external influences. Central ruptures were formed by impact and compression trauma, were located more often in the middle third of the right side of the liver and were slit-shaped with a longitudinal direction. The size of central ruptures was associated with falls on the stomach and compression trauma. Peripheral ruptures were formed in the case of impact and compression trauma, were located more often in the right half of the liver on its diaphragmatic surface, mainly in the middle third of the organ and were linear with a slanting direction. The relative constancy of the average sizes of peripheral ruptures was noted. Anti-shock ruptures were observed resulting from shock trauma and were located more often in the right side of the liver, on its visceral surface, in the rear third of the organ. They were linear and curvilinear, and longitudinally and obliquely oriented. Ruptures were relatively constant in size with different types of impact.


Assuntos
Traumatismos Abdominais/diagnóstico , Fígado/lesões , Ruptura/diagnóstico , Ferimentos não Penetrantes/diagnóstico , Acidentes por Quedas , Patologia Legal , Humanos
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