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1.
Medicine (Baltimore) ; 99(1): e18567, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895799

RESUMO

We investigated the epidemiological and clinical characteristics deaths from road traffic injury (RTI) in Beijing, and provided evidence useful for the prevention of fatal traffic trauma and for the treatment of traffic-related injuries.We retrospectively reviewed death cases provided by the Beijing Red Cross Emergency Center on road traffic injury deaths from 2008 to 2017. We analyzed population characteristics, time distribution, distribution of transportation modes, intervals to death, locations and injured body parts.From 2008 to 2017, there were 3327 deaths from RTI recorded by the Beijing Red Cross Emergency Center, with mainly males among these deaths. The average age at death was 46.19 ±â€Š17.43 years old (46.19, 0.43-100.24). In accidents with more detail recorded, pedestrians and people using nonmotorized transportation modes suffered the most fatalities (664/968, 68.60%). The most commonly injured body parts were the head (2569/3327, 77.22%), followed by the chest (180/3327, 5.41%), abdomen (130/3327, 3.91%), lower extremities (68/3327, 2.04%), pelvis (67/3327, 2.01%), spinal cord (31/3327, 0.93%), and upper extremities (26/3327, 0.78%). Burns accounted for 0.96% (32/3327), and unknown body parts were affected in 11.28% (365/3327). The average time interval from injury to death was 36.90 ±â€Š89.57 h (36.90, 0-720); 46.7% (1554/3327) died within 10 minutes after injury; 9.02% (300/3327) died between 10 min and 1 hour; 30.33% (1009/3327) died between 1 hour and 3 days; 13.95% (464/3327) died between 3 and 30 days.In Beijing, RTI is a significant cause of preventable death, particularly among pedestrians and users of non-motorized vehicles. Head trauma was the most lethal cause of RTI deaths. Our findings suggested that interventions to prevent collisions and reduce injuries, and improved trauma treatment process and trauma rescue system could address a certain proportion of avoidable RTI deaths.


Assuntos
Acidentes de Trânsito/mortalidade , Traumatismos Craniocerebrais/mortalidade , Pedestres/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Adulto , Idoso , Pequim/epidemiologia , Traumatismos Craniocerebrais/etiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/etiologia
3.
Int J Surg ; 66: 48-52, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31026517

RESUMO

BACKGROUND: This study aimed to identify the risk factors and complications associated with mortality in elderly patients with femoral fracture after a fall from the ground level. METHODS: This retrospective study reviewed data pertaining to elderly patients aged ≥65 years who were admitted into a Level I trauma center, between January 1, 2009 and December 31, 2017. Multivariate logistic regression analysis was performed to identify independent effects of univariate predictive variables on the occurrence of mortality. RESULTS: Of 2407 enrolled elderly patients, there were 42 mortal and 2365 survival patients. A greater percentage of fatal patients than survival patients had a head injury with abbreviated injury scale (AIS) score ≥ 2 in the head/neck region (4.8% vs. 0.7%, respectively; p = 0.042). Multivariate logistic regression analysis revealed that the age (odds ration [OR] 1.1, 95% confident interval [CI] 1.0-1.1, p < 0.001), pre-existence of end-stage renal disease (ESRD) (OR 3.2, 95% CI 1.2-8.7, p = 0.023), and subarachnoid hemorrhage (SAH) (OR 12.1, 95% CI 1.3-113.9, p = 0.029) were significant independent risk factors for mortality in elderly patients with a femoral fracture resulting from a ground level fall. The patients in mortality group had a significantly higher rates of pneumonia (OR 28.6, 95% CI 14.6-55.9, p < 0.001), respiratory failure (OR 68.7, 95% CI 32.2-146.4, p < 0.001), sepsis (OR 26.3, 95% CI 10.9-63.4, p < 0.001), and pulmonary embolism (OR 14.4, 95% CI 1.6-131.6, p = 0.002) than those in the survival groups. CONCLUSIONS: This study identified age, pre-existence of ESRD, and SAH as significant independent risk factors for mortality in elderly patients with femoral fracture in a fall. However, ESRD and SAH only contribute to the mortality in a small group of patients. In contrast, respiratory complications contributed greatly to mortality. Thus aggressive chest-protective measures are encouraged to decrease the respiratory complications associated with femoral fracture in elderly patients.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Fraturas do Fêmur/complicações , Idoso , Idoso de 80 Anos ou mais , Traumatismos Craniocerebrais/mortalidade , Estudos Transversais , Feminino , Fraturas do Fêmur/mortalidade , Hospitalização/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Falência Renal Crônica/complicações , Falência Renal Crônica/mortalidade , Masculino , Traumatismo Múltiplo/mortalidade , Pneumonia/complicações , Pneumonia/mortalidade , Embolia Pulmonar/complicações , Embolia Pulmonar/mortalidade , Sistema de Registros , Insuficiência Respiratória/complicações , Insuficiência Respiratória/mortalidade , Estudos Retrospectivos , Fatores de Risco , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/mortalidade , Taiwan/epidemiologia , Centros de Traumatologia
4.
Rev. medica electron ; 41(2): 368-381, mar.-abr. 2019. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1004274

RESUMO

RESUMEN Introducción: el traumatismo encefalocraneano es una causa frecuente de mortalidad y morbilidad. Según datos epidemiológicos aporta la mayor cantidad de fallecidos en menores de 45 años a nivel mundial. Objetivo: caracterizar el trauma craneoencefálico desde el punto de vista clínico-quirúrgico, neuroimagenológico y por neuromonitorización en los pacientes investigados. Materiales y métodos: estudio observacional, descriptivo, transversal, en el Servicio de Neurocirugía del Hospital Provincial Clínico Quirúrgico Docente José Ramón López Tabrane y Comandante Faustino Pérez Hernández, de Matanzas, durante el periodo comprendido entre enero del 2016 a enero del 2018. Resultados: predominó el sexo masculino con el 71,7% de los casos, la mayor prevalencia estuvo en edades inferiores a 48 años con el 80,1 %. La mayor cantidad presentaba un traumatismo encefalocraneano leve con el 56% de los casos seguido del traumatismo encefalocraneano moderado y severo con el 29% y 15% de los casos respectivamente. Predominaron las fracturas lineales (45,8%), seguido de las contusiones sin efecto de masa y los hematomas subdurales con el 24,2% y 23,3%. La mayoría de los pacientes presentó una escala de Marshall II con el 40,8%. Las cifras de presión intracraneal entre de 20-40 mmHg se presentó con mayor frecuencia (44,4 %). Conclusiones: la mitad de los pacientes neuromonitorizados presentaron una saturación del golfo de la vena yugular dentro de parámetros normales con el 50%. La operación más practicada fue la evacuación de hematomas subdurales con el 29,4%.


ABSTRACT Introduction: the encephalocranial trauma (ECT) is a frequent cause of mortality and morbidity. According to epidemiological data, it causes the highest number of deaths in people aged less than 45 years worldwide. Objective: to characterize the encephalocranial trauma from the clinical-surgical, neuroimaging and neuromonitoring point of view in the studied patients. Materials and methods: observational, descriptive, cross-sectional study carried out in the Neurosurgery Service of the Provincial Teaching Surgical Clinical Hospitals "Jose Ramon Lopez Tabrane" and "Comandante Faustino Perez Hernandez", of Matanzas, during the period from January 2016 to January 2018. Results: male sex predominated with 71.7% of the cases; the highest prevalence was in ages below 48 years with 80.1%. Most of them presented a mild encephalocranial trauma with 56% of the cases followed by moderate and severe encephalocranial trauma with 29% and 15% of the cases respectively. Linear fractures predominated (45.8%), followed by contusions without mass effect and subdural hematomas with 24.2% and 23.3%. Most of patients presented a Marshall II scale with 40.8%. The intracranial pressure between 20-40 mmHg occurred more frequently (44.4%). Conclusions: half of the neuromonitored patients presented jugular vein gulf saturation within normal parameters with 50%. The most practiced operation was the evacuation of subdural hematomas with 29.4%.


Assuntos
Humanos , Procedimentos Neurocirúrgicos , Tomografia Computadorizada Espiral , Traumatismos Craniocerebrais/cirurgia , Traumatismos Craniocerebrais/classificação , Traumatismos Craniocerebrais/mortalidade , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/diagnóstico por imagem , Epidemiologia Descritiva , Estudos Transversais , Estudo Observacional , Traumatismos Craniocerebrais/diagnóstico
5.
J Trauma Acute Care Surg ; 87(1): 125-129, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30908452

RESUMO

BACKGROUND: Tranexamic acid (TXA) has been shown to decrease mortality and blood product requirements in severely injured patients. Tranexamic acid has also been hypothesized to prevent secondary brain injury in patients with traumatic brain injury. While prior studies have demonstrated improved neurologic outcomes associated with TXA administration in severely injured pediatric patients, no such studies have been performed in adults. METHODS: A retrospective review of all adult trauma admissions to North Atlantic Treaty Organization hospitals in Iraq and Afghanistan between 2008 and 2015. Univariate and multivariate analysis was used to identify factors associated with TXA administration. Patients without a documented head Abbreviated Injury Scale (AIS) were excluded. Patients were propensity matched based on demographics, mechanism of injury, Injury Severity Score (AIS/ISS), presenting Glasgow Coma Scale (GCS) score, initial vitals/laboratory values, and initial transfusion requirement. Primary outcomes were in-hospital mortality and neurologic outcomes measured by discharge GCS scores. Secondary outcomes were respiratory failure and rates of thromboembolic events. RESULTS: Four thousand four hundred seventy-six injured patients 18 years or older were evaluated. Two hundred sixty-five (5.9%) of these patients required a massive transfusion in the first 24 hours, and 174 (3.9%) received TXA. The TXA patients had significantly higher ISS, more penetrating injuries, lower presenting GCS, higher incidence of severe head injury (AIS > 3), and higher transfusion requirements. Ninety-two patients were included in the propensity matched cohort. Of these, patients who received TXA had significantly lower mortality rate (0% vs. 10.1%, p = 0.02) and improvement of GCS score to 14 to 15, irrespective of admission GCS compared with patients who did not receive TXA (100% vs. 87%, p = 0.01). There were no significant differences in number of thromboembolic events recorded between the two groups. CONCLUSION: The TXA administration in adult combat trauma patients was independently associated with decreased mortality and improved neurologic outcomes, with no increase in thromboembolic events. Further study of the possible mechanisms and effect of TXA on brain injury and neurologic outcomes is warranted. LEVEL OF EVIDENCE: Therapeutic, level IV.


Assuntos
Antifibrinolíticos/uso terapêutico , Traumatismos Craniocerebrais/tratamento farmacológico , Ácido Tranexâmico/uso terapêutico , Escala Resumida de Ferimentos , Adulto , Campanha Afegã de 2001- , Transfusão de Sangue , Estudos de Casos e Controles , Traumatismos Craniocerebrais/mortalidade , Traumatismos Craniocerebrais/terapia , Feminino , Escala de Coma de Glasgow , Humanos , Guerra do Iraque 2003-2011 , Masculino , Medicina Militar/métodos , Medicina Militar/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos , Adulto Jovem
6.
Forensic Sci Med Pathol ; 15(2): 218-223, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30859375

RESUMO

Due to their anatomical location, occipital condylar fractures (OCFs) are usually not observed during traditional autopsies and are therefore considered a rare injury. The aim of this study was to determine the true frequency of OCFs using post-mortem computed tomography (PMCT) in traumatic casualties. We retrospectively analyzed 438 PMCT studies of victims of traffic accidents, falls from height, violence, and low-energy head injuries (324 males and 114 females). OCFs were present in 22.6% of cases (n = 99), mostly in victims of railway accidents (48.5%, n = 17), falls from height (26.6%, n = 29), cyclists (24%, n = 6), and pedestrians hit by cars (22.5%, n = 29). Isolated OCFs were found in 5.5% of cases (n = 24), most often in cyclists (12%, n = 3) and pedestrians (9.3%, n = 12) hit by cars. There were no OCFs in the cases of fatalities caused by violence or accidental low-energy head injury. PMCT scans revealed that OCFs are common in high-energy injury fatalities and can be useful for determining the mechanism of trauma more precisely.


Assuntos
Osso Occipital/diagnóstico por imagem , Osso Occipital/lesões , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Ciclismo/estatística & dados numéricos , Traumatismos Craniocerebrais/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pedestres/estatística & dados numéricos , Abuso Físico/estatística & dados numéricos , Polônia/epidemiologia , Estudos Retrospectivos , Distribuição por Sexo , Fraturas Cranianas/classificação , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
Rev. enferm. UFPE on line ; 13(1): 9-14, jan. 2019. ilus, tab
Artigo em Português | BDENF - Enfermagem | ID: biblio-1005918

RESUMO

Objetivo: identificar o perfil epidemiológico e os fatores relacionados ao óbito em pacientes críticos que sofreram traumatismo cranioencefálico. Método: trata-se de um estudo quantitativo, descritivo e transversal, com coleta de dados em prontuários. Realizaram-se estatísticas descritivas e o teste exato de Fisher adotando-se p-valor <0,05 como significativo. Apresentam-se os resultados em tabela. Resultados: revelam-se que, dos 61 pacientes, 80,3% eram do sexo masculino; 72,1% tinham <40 anos de idade; em 72,5% o traumatismo ocorreu por acidente motociclístico; 91,8% foram considerados graves; 65,5%, insuficiência circulatória; 48,1% apresentaram sequelas na alta por deficit neurológico e 32,7% por deficit motor e 16,4% foram a óbito. Acrescenta-se que o sexo masculino (p-valor = 0,02) e a insuficiência circulatória (p-valor = 0,05) apresentaram correlação com o óbito. Conclusão: identificou-se que a maioria dos pacientes era homens jovens, com trauma por motocicletas, apresentaram-se graves, com sequelas e o óbito relacionou-se com o sexo masculino e a insuficiência circulatória. Acredita-se que o percentual de óbitos não foi alto, porém, a morbidade foi elevada.(AU)


Assuntos
Humanos , Masculino , Feminino , Perfil de Saúde , Resultados de Cuidados Críticos , Traumatismos Craniocerebrais , Traumatismos Craniocerebrais/mortalidade , Unidades de Terapia Intensiva , Violência , Acidentes de Trânsito , Registros Médicos , Epidemiologia Descritiva , Estudos Transversais
9.
Eur J Trauma Emerg Surg ; 45(2): 245-253, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29234838

RESUMO

BACKGROUND: The aim of the present study is to analyze the clinical and epidemiological characteristics of Traumatic Brain Injury (TBI) following Road Traffic Accidents (RTAs). Moreover, we aim to evaluate the outcome of the TBI victims referred to our medico-surgical Intensive Care Unit (ICU), and to define predictive factors associated with poor prognosis. METHODS: A retrospective study over a 4-year period (2009 to 2012) of 694 patients with head injuries, incurred during road traffic accidents, admitted to the Intensive Care Unit (ICU) of a university hospital (Sfax-Tunisia). Basic demographic, clinical, biological, and radiological data were recorded on admission and during the ICU stay. RESULTS: There were 592 males (85.3%), and 102 female patients. The mean age was at 31.8 ± 17.8 years (range 1-91). The mechanism of the accident was detailed in 666 patients (96%). The majority of the victims were motorcycle riders and/or passengers (40.5%), followed by pedestrians (29.1%). Extra-cranial pathology was present in 452 patients (65%). A total of 677 patients (97.6%) required intubation, mechanical ventilation, and sedation. Mean ICU stay was 16 ± 17.4 days. A total of 187 patients (26.9%) died during their hospital stay. The GOS performed within a mean delay of 6 months after hospital discharge was as follows: 198 deaths (28.5%), 13 vegetative state (1.9%), and 349 (50.3%) good recovery and/or moderate disability. A multivariate analysis showed that the factors which correlated with a poor prognosis (mortality and severe disability) were: age > 38 years, Glasgow coma scale score < 8, subdural hematoma, and development of secondary systemic insults (respiratory, circulatory, and metabolic). CONCLUSION: In Tunisia, traumatic brain injury due to RTAs is a frequent cause of ICU admission, especially among young adults, and is associated with high mortality and morbidity rates. The majority of the victims were motorcycle riders and/or passengers and pedestrians. The factors associated with a poor outcome were: age > 38 years, Glasgow Coma Scale score < 8, subdural hematoma, and development of secondary systemic insults (respiratory, circulatory, and metabolic). As a consequence, prevention is highly warranted.


Assuntos
Acidentes de Trânsito , Lesões Encefálicas Traumáticas/fisiopatologia , Traumatismos Craniocerebrais/fisiopatologia , Unidades de Terapia Intensiva , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/mortalidade , Criança , Pré-Escolar , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/mortalidade , Feminino , Escala de Coma de Glasgow , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Tunísia/epidemiologia , Adulto Jovem
10.
J R Army Med Corps ; 165(1): 18-21, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29680818

RESUMO

INTRODUCTION: Death as a consequence of underbody blast (UBB) can most commonly be attributed to central nervous system injury. UBB may be considered a form of tertiary blast injury but is at a higher rate and somewhat more predictable than injury caused by more classical forms of tertiary injury. Recent studies have focused on the transmission of axial load through the cervical spine with clinically relevant injury caused by resultant compression and flexion. This paper seeks to clarify the pattern of head and neck injuries in fatal UBB incidents using a pragmatic anatomical classification. METHODS: This retrospective study investigated fatal UBB incidents in UK triservice members during recent operations in Afghanistan and Iraq. Head and neck injuries were classified by anatomical site into: skull vault fractures, parenchymal brain injuries, base of skull fractures, brain stem injuries and cervical spine fractures. Incidence of all injuries and of each injury type in isolation was compared. RESULTS: 129 fatalities as a consequence of UBB were identified of whom 94 sustained head or neck injuries. 87 casualties had injuries amenable to analysis. Parenchymal brain injuries (75%) occurred most commonly followed by skull vault (55%) and base of skull fractures (32%). Cervical spine fractures occurred in only 18% of casualties. 62% of casualties had multiple sites of injury with only one casualty sustaining an isolated cervical spine fracture. CONCLUSION: Improvement of UBB survivability requires the understanding of fatal injury mechanisms. Although previous biomechanical studies have concentrated on the effect of axial load transmission and resultant injury to the cervical spine, our work demonstrates that cervical spine injuries are of limited clinical relevance for UBB survivability and that research should focus on severe brain injury secondary to direct head impact.


Assuntos
Traumatismos por Explosões , Traumatismos Craniocerebrais , Militares , Lesões do Pescoço , Adulto , Campanha Afegã de 2001- , Afeganistão , Traumatismos por Explosões/epidemiologia , Traumatismos por Explosões/mortalidade , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/mortalidade , Feminino , Humanos , Iraque , Guerra do Iraque 2003-2011 , Masculino , Lesões do Pescoço/epidemiologia , Lesões do Pescoço/mortalidade , Estudos Retrospectivos , Reino Unido , Adulto Jovem
11.
Surg Today ; 49(3): 261-267, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30302552

RESUMO

The trauma team leader is a professional who receives and treats trauma patients. We aimed to evaluate whether or not the seniority of a qualified trauma team leader was a prognostic factor for multiple-trauma patients managed by a trauma team. This was a retrospective cohort study conducted at a Level I Trauma Center in North Taiwan. From January 2009 to December 2013, 284 patients were randomly assigned to one of two trauma team leaders (junior and senior leaders) on duty, irrespective of the seniority of the qualified trauma team leader. All parameters were collected and compared between these two groups. In the subgroup of multiple-trauma patients with Glasgow Coma Scale (GCS) ≤ 8, there were significant differences in the injury severity score, revised trauma score, and seniority of the leader between the alive and dead groups. A multivariate logistic regression analysis showed that the seniority of the trauma team leader was an important mortality risk factor [odds ratio (OR): 14.529, 95% confidence interval (CI) 1.683-125.429, p = 0.015] in patients with GCS ≤ 8. However, in patients with GCS > 8, age was the only independent risk factor [OR: 1.055, 95% CI 1.023-1.087, p = 0.001]. The seniority of the qualified trauma leader is important for teamwork, organization, and efficiency, all of which play an important role in improving the survival outcome of patients with GCS ≤ 8.


Assuntos
Traumatismos Craniocerebrais/mortalidade , Traumatismos Craniocerebrais/terapia , Liderança , Equipe de Assistência ao Paciente/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Análise Multivariada , Papel do Médico , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Taiwan/epidemiologia , Índices de Gravidade do Trauma
12.
Eur J Emerg Med ; 26(3): 158-162, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29112522

RESUMO

OBJECTIVES AND BACKGROUND: Head injury is a common paediatric emergency department presentation. The National Institute for Health and Clinical Excellence updated its guidance in January 2014 regarding imaging required for adults and children following a head injury (CG176). This study looked at the rates of computed tomography (CT) head scans performed and adherence rates to CG176. PATIENTS AND METHODS: A single-centre audit was carried out, examining imaging practice in children with head injuries. CG176 was implemented formally in August 2014 to the new trainee doctors. The primary outcome was adherence to CG176. As the data were binary, 95% confidence intervals were used for comparison. RESULTS: In all, 1797 patients were identified as having a head injury. Implementation at the Sheffield's Children NHS Foundation Trust resulted in a statistically significant increase in guideline adherence from 79.2% [95% confidence interval (CI): 76.4-81.9%] to 85.1% (95% CI: 82.9-87.4%). The greatest impact in adherence was found in CT head scans, from 95.8% (95% CI: 94.5-97.2%) to 97.7% (95% CI: 96.7-98.6%). CONCLUSION: The implementation at the Sheffield's Children NHS Foundation Trust was successful in satisfying the aim of CG176 by increasing adherence and decreasing CT head scans. This success could be explained by the formal implementation to the new cohort of doctors and better physician agreement with the guidelines. The increase in adherence is contrary to the previous studies.


Assuntos
Competência Clínica , Traumatismos Craniocerebrais/diagnóstico por imagem , Serviço Hospitalar de Emergência/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Tomografia Computadorizada por Raios X/normas , Adolescente , Criança , Pré-Escolar , Intervalos de Confiança , Traumatismos Craniocerebrais/mortalidade , Traumatismos Craniocerebrais/terapia , Inglaterra , Feminino , Escala de Coma de Glasgow , Mortalidade Hospitalar/tendências , Hospitais Pediátricos/normas , Humanos , Lactente , Masculino , Análise de Sobrevida , País de Gales
13.
Eur J Trauma Emerg Surg ; 45(1): 145-150, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28612168

RESUMO

INTRODUCTION: This study focuses on a specific and often dramatic injury, namely gunshot wounds (GSW) of the head in order to determine whether there is a discrepancy in outcome between patients who sustain their injury in a rural setting and those who sustain it in an urban setting. MATERIALS AND METHODS: This study involves a retrospective review of our prospectively maintained regional electronic trauma registry. All patients who sustained a cerebral GSW from January 2010 to December 2014 were reviewed. RESULTS: During the 5-year study period, a total of 102 patients sustained an isolated cerebral GSW. Ninety-two per cent (94/102) were male and the mean age was 29 years. Ninety-four per cent (94/102) of injuries were related to interpersonal violence. Of the 102 patients in the study, 54% (55/102) were urban and were transported directly to our trauma centre. The remaining 46% (47/102) were rural and were transported to a rural district hospital prior to being referred to our trauma centre. The time of injury was available in 60% (61/102) of patients. The mean time from injury to arrival for all patients was 11 h (SD 7). The mean time from injury to arrival was significantly shorter for urban versus rural, 6 h (SD 5) and 15 h (SD 5), respectively (p < 0.001). The median admission GCS score was significantly lower in rural compared to urban patients (p = 0.022). The need for neurosurgery, need for ICU admission or length of hospital stay was not significantly different between rural and urban patients. Rural patients have a fourfold higher mortality compared with urban patients (36 vs 9%, p = 0.001). Amongst survivors, there was no significant difference in median length of hospital stay or mean discharge GCS. CONCLUSIONS: Cerebral GSWs are highly lethal injuries associated with significant mortality. Rural patients have a significantly longer transfer time, lower GCS on arrival and higher mortality than urban patients. Efforts should be directed at improving the pre-hospital EMS system in order to reduce delay to definitive care so that patient outcome can be optimised.


Assuntos
Traumatismos Craniocerebrais/mortalidade , Ferimentos por Arma de Fogo/mortalidade , Adulto , Feminino , Humanos , Masculino , Sistema de Registros , Estudos Retrospectivos , População Rural , África do Sul/epidemiologia , Centros de Traumatologia , População Urbana
14.
Injury ; 50(1): 210-214, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30473371

RESUMO

INTRODUCTION: Large animal-related human injuries are associated with high morbidity and mortality. There are no studies on biomechanics of the camel-related head, face, and neck (HFN) injuries. We aimed to study the mechanism, anatomical distribution and severity of camel-related HFN injuries. METHODS: We analyzed our prospectively collected data of patients who were admitted to Al Ain Hospital with camel-related HFN injury during the period of October 2001 to January 2010. RESULTS: Seventy-three patients were studied; all were males having a median (range) age of 28 (5-89) years. Camel kick was the most common mechanism of injury (45%) followed by falling from a camel (22%). Facial fractures were significantly more common in patients who were kicked by a camel. Severe head injuries were significantly more in patients who fell from a camel or who had a car collision with a camel. Car collision with a camel was significantly associated with lower cervical spine fractures (p = 0.017) and severe cervical spine injuries (p = 0.004). Two patients died (overall mortality 3%) CONCLUSIONS: Our study provides an insight into the complex biomechanics and severity of camel-related HFN injuries. It is essential to adopt protective measures in our community so as to reduce camel-related HFN injuries.


Assuntos
Acidentes por Quedas , Mordeduras e Picadas , Camelus , Traumatismos Craniocerebrais/etiologia , Hospitalização/estatística & dados numéricos , Lesões do Pescoço/etiologia , Ferimentos não Penetrantes , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Traumatismos Craniocerebrais/mortalidade , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/mortalidade , Estudos Prospectivos , Índices de Gravidade do Trauma , Emirados Árabes Unidos/epidemiologia , Adulto Jovem
15.
Am J Emerg Med ; 37(8): 1455-1459, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30528051

RESUMO

BACKGROUND: Head injuries frequently occur in combat. Tactical Combat Casualty Care (TCCC) guidelines recommend pre-hospital use of ketamine for analgesia. Yet the use of this medication in patients with head injuries remains controversial, particularly among pediatric patients. We compare survival to hospital discharge rates among pediatric head injury subjects who received prehospital ketamine versus those who did not. METHODS: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric (<18 years of age) subjects from January 2007 to January 2016. We performed a sub-analysis of subjects with an abbreviated injury severity score for the head of 3 (serious) or higher and at least one documented Glasgow Coma Score (GCS) ≤13. RESULTS: Of the 3439 pediatric patients within our dataset, 555 subjects met inclusion criteria for head injury - 36 (6.5%) received prehospital ketamine versus 519 (93.5%) who did not. There was no significant difference noted between groups regarding median age (10 versus 8, p = 0.259), percent male gender (72.2% versus 76.3%, p = 0.579), mechanism of injury (p = 0.143), median composite injury scores (22 versus 20, p = 0.082), median ventilator-free days (28 versus 27, p = 0.068), median ICU-free days (27.5 versus 27, p = 0.767), median hospital days (3.5 versus 4, p = 0.876) or survival to discharge (66.7% versus 70.7%, p = 0.607). CONCLUSIONS: Within this data set, we were unable to detect any differences in mortality among pediatric head trauma subjects administered ketamine compared to subjects not receiving this medication in the prehospital setting.


Assuntos
Analgesia/estatística & dados numéricos , Traumatismos Craniocerebrais/tratamento farmacológico , Serviços Médicos de Emergência/estatística & dados numéricos , Ketamina/administração & dosagem , Dor/tratamento farmacológico , Lesões Relacionadas à Guerra/tratamento farmacológico , Adolescente , Analgesia/métodos , Criança , Pré-Escolar , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/mortalidade , Feminino , Escala de Coma de Glasgow , Humanos , Modelos Logísticos , Masculino , Manejo da Dor/métodos , Sistema de Registros , Estudos Retrospectivos , Estados Unidos , United States Department of Defense , Lesões Relacionadas à Guerra/complicações , Lesões Relacionadas à Guerra/mortalidade
16.
BMJ Open ; 8(12): e022279, 2018 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-30580260

RESUMO

OBJECTIVES: Head injury is a common reason for emergency department (ED) attendance. Around 1% of patients have life-threatening injuries, while 80% of patients are discharged. National guidelines (Scottish Intercollegiate Guidelines Network (SIGN)) were introduced in Scotland with the aim of achieving early identification of those with acute intracranial lesions yet safely reducing hospital admissions.This study aims to assess the impact of these guidelines and any effect the national 4-hour ED performance target had on hospital admissions for head injury. SETTING: All Scottish hospitals between April 1998 and March 2016. PARTICIPANTS: Patients admitted to hospital for head injury or traumatic brain injury (TBI) diagnosed by CT imaging identified using administrative Scottish Information Services Division data. There are 275 hospitals in Scotland. In 2015/2016, there were 571 221 emergency hospital admissions in Scotland. INTERVENTIONS: The SIGN head injury guidelines introduced in 2000 and 2009. The 4-hour ED target introduced in 2004. OUTCOMES: The monthly rate of hospital admissions for head injury and traumatic brain injury. STUDY DESIGN: An interrupted time series analysis. RESULTS: The first guideline was associated with a reduction in monthly admissions of 0.14 (95% CI 0.09 to 4.83) per 100 000 population. The 4-hour target was associated with a monthly increase in admissions of 0.13 (95% CI 0.06 to 0.20) per 100 000 population. The second guideline reduced monthly admissions by 0.09 (95% CI-0.13 to -0.05) per 100 000 population. These effects varied between age groups.The guidelines were associated with increased admissions for patients with injuries identified by CT imaging-guideline 1: 0.06 (95% CI 0.004 to 0.12); guideline 2: 0.05 (95% CI 0.04 to 0.06) per 100 000 population. CONCLUSION: Increased CT imaging of head injured patients recommended by SIGN guidelines reduced hospital admissions. The 4-hour ED target and the increased identification of TBI by CT imaging acted to undermine this effect.


Assuntos
Traumatismos Craniocerebrais/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Análise de Séries Temporais Interrompida/métodos , Admissão do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Tempo para o Tratamento , Adulto , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/terapia , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/mortalidade , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Escócia , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
18.
Adv Clin Exp Med ; 27(10): 1403-1409, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30058788

RESUMO

BACKGROUND: The growing popularity of cycling not only enhances self-efficacy, physical well-being and improves quality of life, but it also leads to the increasing number of bike-related injuries. OBJECTIVES: The aim of this study was to characterize the population of cyclists in Poland, assess the occurrence of safety behaviors among them and to precise the risk factors for bike accidents. Additionally, we analyzed bike-related injuries. MATERIAL AND METHODS: The survey was based on a 39-item questionnaire created for this study. We collected data concerning the demographical status of respondents, their cycling preferences, attitude toward safety behaviors during cycling, and the characteristics of bike-related injuries. Our research covered 729 people who declared themselves as cyclists (302 women - average age: 31.5 ±10.3 years; 427 men - average age: 32.6 ±10.7 years). RESULTS: In the study, 71.3% of the interviewees declared that they did not always wear helmets. Women more often than men claimed that they did not always use head protection (p < 0.001). Among 729 people, 277 suffered from bike-related injuries. In this group, we noted 870 accidents that resulted in 1,671 different injuries. In our study, wearing helmets did not influence the region of trauma nor its type (p < 0.05). We noted 811 injuries of the upper extremities and 541 of the lower extremities. CONCLUSIONS: Young men constitute the main group of cyclists in Poland. The risk factors for bike-related accidents in our study proved to be: educational level (secondary education and incomplete higher education), number of children (having at least 3 children), frequency of using a bike (the more often, the more injuries), type of bike used (mountain bikes and fold-up bikes), and frequency of using a helmet (using helmets was correlated with a higher rate of injuries). The upper and lower extremities were the most common location of injuries.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Ciclismo/lesões , Traumatismos Craniocerebrais/epidemiologia , Dispositivos de Proteção da Cabeça , Acidentes de Trânsito/prevenção & controle , Adulto , Ciclismo/estatística & dados numéricos , Causas de Morte , Traumatismos Craniocerebrais/mortalidade , Traumatismos Craniocerebrais/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polônia/epidemiologia , Qualidade de Vida , Fatores de Risco , Adulto Jovem
19.
Pediatr Radiol ; 48(8): 1048-1065, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29796797

RESUMO

Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term is AHT. There is no controversy concerning the medical validity of the existence of AHT, with multiple components including subdural hematoma, intracranial and spinal changes, complex retinal hemorrhages, and rib and other fractures that are inconsistent with the provided mechanism of trauma. The workup must exclude medical diseases that can mimic AHT. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. There is no reliable medical evidence that the following processes are causative in the constellation of injuries of AHT: cerebral sinovenous thrombosis, hypoxic-ischemic injury, lumbar puncture or dysphagic choking/vomiting. There is no substantiation, at a time remote from birth, that an asymptomatic birth-related subdural hemorrhage can result in rebleeding and sudden collapse. Further, a diagnosis of AHT is a medical conclusion, not a legal determination of the intent of the perpetrator or a diagnosis of murder. We hope that this consensus document reduces confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature.


Assuntos
Maus-Tratos Infantis/diagnóstico , Traumatismos Craniocerebrais/diagnóstico , Criança , Maus-Tratos Infantis/mortalidade , Pré-Escolar , Consenso , Traumatismos Craniocerebrais/mortalidade , Hematoma Subdural/diagnóstico , Humanos , Lactente , Recém-Nascido , Hemorragia Retiniana/diagnóstico , Fraturas das Costelas/diagnóstico , Sociedades Médicas , Traumatismos da Coluna Vertebral/diagnóstico
20.
Int J Inj Contr Saf Promot ; 25(4): 427-432, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29671372

RESUMO

This study describes injury patterns and outcomes related to the seating position of child passengers involved in motor vehicle crashes in Japan. Using data obtained from a national trauma registry database, we compared the occurrence of injuries by body parts, length of hospital stay and in-hospital deaths between front-seating and rear-seating among children. We analysed 166 children aged 0-5 years and 205 children aged 6-12 years. No significant differences were observed between front- and rear-seating for injured body parts, length of hospital stay or in-hospital deaths in the 0-5-year-old victims. Among those aged 6-12 years, rear-seating was associated with a higher incidence of head and chest injuries but the length of stay or in-hospital deaths did not differ. These findings contrast those of previous studies, which found that rear-seating reduces injury risk, possibly attributed to low age-appropriate restraint use among school-aged children in Japan.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Ferimentos e Lesões/etiologia , Acidentes de Trânsito/mortalidade , Automóveis , Criança , Pré-Escolar , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/etiologia , Traumatismos Craniocerebrais/mortalidade , Feminino , Humanos , Lactente , Recém-Nascido , Japão/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Sistema de Registros , Fatores de Risco , Traumatismos Torácicos/epidemiologia , Traumatismos Torácicos/etiologia , Traumatismos Torácicos/mortalidade , Ferimentos e Lesões/epidemiologia
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