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1.
J Forensic Leg Med ; 78: 102113, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33485089

RESUMO

Falls from height are the most common cause of blunt trauma after traffic accidents. The focus of this retrospective study was to analyze the relationship between injuries in fatal falls and fall height, body mass index (BMI), and sex in 206 autopsy reports. Age, sex, weight, height, place of the fall, fall height, period between the incidence and death, external examination findings in the autopsy, intracranial findings, fractures, internal organ injuries, and information about the causes of death were recorded. Accidents and men were the largest groups. Injuries to the upper and lower extremities were frequently detected in accidents. Lower extremity injuries were more common in women. The occurrence of head and neck injuries were rare in overweight individuals. When evaluated by manner of death, there were differences in extremities and posterior body injuries. There was no difference between sex in terms of autopsy findings. It was observed that the injuries increased as the height increased. There was a statistical difference between the BMI groups in terms of liver, rib and sternum injuries. The most common cause of death was head injuries. Many factors have been known to affect injury patterns in cases of falls from height. Fall height, BMI, and gender are just a few of these factors. This study will be beneficial to support the findings of this study with larger-scale studies and statistical modeling that consider more factors affecting injuries in cases of falls.


Assuntos
Acidentes por Quedas/mortalidade , Ferimentos e Lesões/mortalidade , Adulto , Autopsia , Índice de Massa Corporal , Osso e Ossos/lesões , Traumatismos Craniocerebrais/mortalidade , Feminino , Humanos , Extremidade Inferior/lesões , Masculino , Pelve/lesões , Estudos Retrospectivos , Fatores Sexuais , Turquia/epidemiologia , Extremidade Superior/lesões
2.
JAMA Netw Open ; 3(5): e204442, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32391891

RESUMO

Importance: Long-term adverse health outcomes, particularly those associated with repetitive head impacts, are of growing concern among US-style football players in the US and Canada. Objective: To assess whether exposure to repetitive head impacts during a professional football career is associated with an increase in the risk of all-cause mortality. Design, Setting, and Participants: This retrospective cohort study included 13 912 players in the 1969 to 2017 National Football League (NFL) seasons. All cause-mortality up until July 1, 2018, was included. Data collection was performed from July 13, 2017, to July 1, 2018, as reported in the Pro Football Reference. Exposures: The main exposure was a professional football cumulative head impact index (pfCHII). The pfCHII was measured by combining cumulative padded practice time and games played summed during seasons of play reported in the Pro Football Reference and a player position risk adjustment from helmet accelerometer studies. Main Outcomes and Measures: Demographic characteristics except for the pfCHII were calculated for 14 366 players with complete follow-up. The pfCHII was calculated for 13 912 players (eliminating the 454 specials teams players). Cox proportional hazards regression was used to compare hazard ratios (HRs) of death by repetitive head impacts. Analyses were unadjusted and adjusted for birth year, body mass index, and height. Results: Among 14 366 NFL players who had follow-up for analysis, the mean (SD) age was 47.3 (14.8) years, the mean (SD) body mass index was 29.6 (3.9), and 763 of 14 366 players (5.3%) had died. Among 13 912 players in the pfCHII analysis, the median pfCHII was 32.63 (interquartile range, 13.71-66.12). A 1-log increase in pfCHII was significantly associated with an increased hazard of death for the 1969 to 2017 seasons (HR, 2.02; 95% CI, 1.21-3.37; P = .01) after adjustment. The quadratic pfCHII was also statistically significant (HR, 0.91; 95% CI, 0.85-0.98; P = .01), indicating that the hazard of death increased at a decreasing rate, whereas the pfCHII increased. Conclusions and Relevance: The findings suggest that an increase in repetitive head impacts is associated with an increased hazard of death among NFL players. Reduction in repetitive head impacts from playing football or other activities through additional rule and equipment changes may be associated with reduced mortality.


Assuntos
Traumatismos em Atletas/epidemiologia , Traumatismos Craniocerebrais/epidemiologia , Futebol Americano/lesões , Traumatismos em Atletas/mortalidade , Estudos de Coortes , Traumatismos Craniocerebrais/mortalidade , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Estados Unidos
3.
World Neurosurg ; 139: e553-e571, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32339732

RESUMO

BACKGROUND: Whether early enteral nutrition with probiotics can reduce the mortality and infection rate of patients with severe craniocerebral injury (SCI), improve their gastrointestinal function, and shorten the length of stay in the intensive care unit (ICU) has not been determined. METHODS: PubMed, China National Knowledge Infrastructure, and Embase were electronically searched for the purpose of identifying randomized controlled trials investigated the potential of early enteral nutrition supplemented with probiotics on patients with SCI from the establishment of databases to August 26, 2019. STATA software version 12.0 was used to perform meta-analysis. RESULTS: A total of 39 trials enrolling 3387 patients were included. Early enteral nutrition supplemented with probiotics was associated with decreased risk of infection (pooled risk ratio [RR], 0.486; 95% confidence interval [CI], 0.394-0.599), decreased risk of 7-, 14-, and 28-day mortality (pooled RRs, 0.415, 0.497, and 0.385; 95% CIs, 0.196-0.878, 0.297-0.833, and 0.197-0.751, respectively), and decreased risk of gastrointestinal complications (pooled RR, 0.363; 95% CI, 0.274-0.481). It also shortened the time course recovery of enteral function and shortened the length of stay in hospital and length of ICU stay (standardized mean differences, -3.327 and -1.461; 95% CIs, -6.213 to -0.440 and -2.111 to -0.811, respectively). CONCLUSIONS: Enteral nutrition supplemented with probiotics effectively decreases the risk of mortality, gastrointestinal complications, and infection, and shortens the stays in ICU; therefore, it should be extensively adopted to manage these given patients.


Assuntos
Traumatismos Craniocerebrais/terapia , Nutrição Enteral/métodos , Probióticos/uso terapêutico , Traumatismos Craniocerebrais/mortalidade , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
J Clin Neurosci ; 75: 71-79, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32241644

RESUMO

Gunshot wounds (GSW) are one of the most lethal forms of head trauma. The lack of clear guidelines for civilian GSW complicates surgical management. We aimed to develop a decision-tree algorithm for mortality prediction and report long-term outcomes on survivors based on 15-year data from our level 1 trauma center. We retrospectively reviewed 96 consecutive patients who presented with cerebral GSWs between 2003 and 2018. Clinical information from our trauma database, EMR, and relevant imaging scans was reviewed. A decision-tree model was constructed based on variables showing significant differences between survivors and non-survivors. After excluding patients who died at arrival, 54 patients with radiologically confirmed intracranial injury were included. Compared to survivors (51.9%), non-survivors (48.1%) were significantly more likely to have perforating (entry and exit wound), as opposed to penetrating (entry wound only), injuries. Bi-hemispheric and posterior fossa involvement, cerebral herniation, and intraventricular hemorrhage were more commonly present in non-survivors. Based on the decision-tree, Glasgow Coma Scale (GCS) > 8 and penetrating, uni-hemispheric injury predicted survival. Among patients with GCS ≤ 8 and normal pupillary response, lack of 1) posterior fossa involvement, 2) cerebral herniation, 3) bi-hemispheric injury, and 4) intraventricular hemorrhage, were associated with survival. Favorable long-term outcomes (mean follow-up 34.4 months) were possible for survivors who required neurosurgery and stable patients who were conservatively managed. We applied clinical and radiological characteristics that predicted survival to construct a decision-tree to facilitate surgical decision-making for GSW. Further validation of the algorithm in a large patient setting is recommended.


Assuntos
Algoritmos , Regras de Decisão Clínica , Árvores de Decisões , Ferimentos por Arma de Fogo/mortalidade , Adulto , Lesões Encefálicas/etiologia , Lesões Encefálicas/mortalidade , Lesões Encefálicas/patologia , Traumatismos Craniocerebrais/etiologia , Traumatismos Craniocerebrais/mortalidade , Traumatismos Craniocerebrais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Traumatologia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/patologia
5.
Sci Rep ; 10(1): 2095, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-32034233

RESUMO

The reverse shock index (rSI), a ratio of systolic blood pressure (SBP) to heart rate (HR), is used to identify prognosis in trauma patients. Multiplying rSI by Glasgow Coma Scale (rSIG) can possibly predict better in-hospital mortality in patients with trauma. However, rSIG has never been used to evaluate the mortality risk in adult severe trauma patients (Injury Severity Score [ISS] ≥ 16) with head injury (head Abbreviated Injury Scale [AIS] ≥ 2) in the emergency department (ED). This retrospective case control study recruited adult severe trauma patients (ISS ≥ 16) with head injury (head AIS ≥ 2) who presented to the ED of two major trauma centers between January 01, 2014 and May 31, 2017. Demographic data, vital signs, ISS scores, injury mechanisms, laboratory data, managements, and outcomes were included for the analysis. Logistic regression and receiver operating characteristic analysis were used to evaluate the accuracy of rSIG score in predicting in-hospital mortality. In total, 438 patients (mean age: 56.48 years; 68.5% were males) were included in this study. In-hospital mortality occurred in 24.7% patients. The median (interquartile range) ISS score was 20 (17-26). Patients with rSIG ≤ 14 had seven-fold increased risks of mortality than those without rSIG ≤ 14 (odds ratio: 7.64; 95% confidence interval: 4.69-12.42). Hosmer-Lemeshow goodness-of-fit test and area under the curve values for rSIG score were 0.29 and 0.76, respectively. The sensitivity, specificity, positive predictive value, and negative predictive values of rSIG ≤ 14 were 0.71, 0.75, 0.49, and 0.89, respectively. The rSIG score is a prompt and simple tool to predict in-hospital mortality among adult severe trauma patients with head injury.


Assuntos
Traumatismos Craniocerebrais/mortalidade , Escala de Coma de Glasgow , Índice de Gravidade de Doença , Ferimentos e Lesões/mortalidade , Escala Resumida de Ferimentos , Pressão Sanguínea , Estudos de Casos e Controles , Traumatismos Craniocerebrais/diagnóstico , Feminino , Escala de Coma de Glasgow/estatística & dados numéricos , Frequência Cardíaca , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Choque/diagnóstico , Choque/patologia , Análise de Sobrevida , Ferimentos e Lesões/diagnóstico
6.
Public Health ; 181: 114-118, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32006854

RESUMO

OBJECTIVES: With the progress of aging, fall injuries have become a global public health issue. This research was conducted to describe in detail situations of injury occurrence among the elderly by distinguishing between falls from heights and ground-level falls. We assume that different fall mechanisms occur in different situations and result in a wide range of consequences. STUDY DESIGN: This is a registry-based descriptive study. METHODS: The analysis included 55,126 patients with fall injuries, aged 65 years and more, having an Injury Severity Score (ISS) ≧9, and registered in a trauma registry in Japan between 2004 and 2015. We described patients' distribution in terms of age, severity, outcome, season, time, and injured body parts by gender and fall mechanisms. RESULTS: Falls from heights (n = 15,748) were more common among men and those younger than 75 years. Ground-level falls (n = 39,378) were more common among women and those older than 75 years. The ISS was high in men and for those who fell from heights. Falls from heights were common in autumn, whereas ground-level falls were common in winter. Both mechanisms occurred frequently during the daytime. The head and lower extremities were the most commonly injured parts for those who fell from heights and ground-level falls, respectively. Injuries to the head, chest, spine, upper extremities, and pelvis were common among those who fell from heights. Injuries to the lower extremities were common in ground-level fallers. Among those who fell from heights, women had more frequent lower extremity injuries than did men. Among ground-level fallers, men had more frequent head injuries than did women. The highest case-fatality rate was recorded for abdominal injuries among those who fell from heights and head injuries among ground-level fallers. In both mechanisms of injury, the case-fatality rate of limbs was the lowest. CONCLUSIONS: Our study showed different patterns between falls from heights and ground-level falls, whereas previous studies rarely distinguished between these two fall mechanisms.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Envelhecimento , Sistema de Registros , Ferimentos e Lesões/mortalidade , Traumatismos Abdominais/etiologia , Traumatismos Abdominais/mortalidade , Acidentes por Quedas/mortalidade , Idoso , Idoso de 80 Anos ou mais , Traumatismos Craniocerebrais/mortalidade , Feminino , Fraturas Ósseas/etiologia , Fraturas Ósseas/mortalidade , Geriatria , Humanos , Escala de Gravidade do Ferimento , Japão/epidemiologia , Masculino , Estudos Retrospectivos , Estações do Ano , Ferimentos e Lesões/etiologia
7.
World Neurosurg ; 137: e159-e165, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32001409

RESUMO

OBJECTIVE: The aim of this retrospective study was to externally validate the CRASH (Corticosteroid Randomisation After Significant Head Injury) clinical calculator as a prognostic tool. Mortality at 14 days and an unfavorable outcome (i.e., Glasgow Outcome Scale score <4) after 6 months were the primary endpoints. METHODS: The study included adult patients admitted to the emergency department of Ghent University Hospital during 2010-2014 with traumatic brain injury. The CRASH score was calculated for every patient and compared with real-life outcome at 14 days and 6 months. Researchers were blinded for each other's results, and each observer either calculated the CRASH score or obtained clinical outcome. Receiver operating characteristic analysis was used to validate the CRASH calculator. The prognostic value of other variables was tested using logistic regression (P < 0.05 was significant). RESULTS: Of 417 included patients with traumatic brain injury, 94.7% were still alive at 14 days, and 65% had a Glasgow Outcome Scale score ≥4 at 6 months. Receiver operating characteristic analysis showed an area under the curve of 92.1% at 14 days and 90.7% at 6 months (P < 0.05). Calculated cutoff value for the CRASH score at 14 days was 31.50% (sensitivity 0.823, specificity 0.895). At 6 months, calculated cutoff value was 55.75% (sensitivity 0.793, specificity 0.830). CONCLUSIONS: The CRASH calculator is a good predictor of outcome in traumatic brain injury at 14 days and 6 months with high sensitivity and specificity. It does not replace clinical judgment of the physician treating the patient in the emergency department, but it constitutes a useful additional tool.


Assuntos
Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/cirurgia , Traumatismos Craniocerebrais/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/mortalidade , Feminino , Escala de Resultado de Glasgow , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Adulto Jovem
8.
Rev Paul Pediatr ; 38: e2019123, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31939519

RESUMO

OBJECTIVE: To determine the events associated with the occurrence of intracranial hypertension (ICH) in pediatric patients with severe cranioencephalic trauma. METHODS: This was a prospective cohort study of patients 18 years old and younger with cranioencephalic trauma, scores below nine on the Glasgow Coma Scale, and intracranial pressure monitoring. They were admitted between September, 2005 and March, 2014 into a Pediatric Intensive Care Unit. ICH was defined as an episode of intracranial pressure above 20 mmHg for more than five minutes that needed treatment. RESULTS: A total of 198 children and adolescents were included in the study, of which 70.2% were males and there was a median age of nine years old. ICH occurred in 135 (68.2%) patients and maximum intracranial pressure was 36.3 mmHg, with a median of 34 mmHg. A total of 133 (97.8%) patients with ICH received sedation and analgesia for treatment of the condition, 108 (79.4%) received neuromuscular blockers, 7 (5.2%) had cerebrospinal fluid drainage, 105 (77.2%) received mannitol, 96 (70.6%) received hyperventilation, 64 (47.1%) received 3% saline solution, 20 (14.7%) received barbiturates, and 43 (31.9%) underwent a decompressive craniectomy. The events associated with the occurrence of ICH were tomographic findings at the time of admission of diffuse or hemispheric swelling (edema plus engorgement). The odds ratio for ICH in patients with Marshall III (diffuse swelling) tomography was 14 (95%CI 2.8-113; p<0.003), and for those with Marshall IV (hemispherical swelling) was 24.9 (95%CI 2.4-676, p<0.018). Mortality was 22.2%. CONCLUSIONS: Pediatric patients with severe cranioencephalic trauma and tomographic alterations of Marshall III and IV presented a high chance of developing ICH.


Assuntos
Traumatismos Craniocerebrais/complicações , Hipertensão Intracraniana/epidemiologia , Hipertensão Intracraniana/terapia , Pressão Intracraniana/fisiologia , Adolescente , Vazamento de Líquido Cefalorraquidiano , Criança , Pré-Escolar , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/mortalidade , Craniectomia Descompressiva/métodos , Feminino , Escala de Coma de Glasgow , Humanos , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Hipertensão Intracraniana/diagnóstico por imagem , Masculino , Bloqueadores Neuromusculares/uso terapêutico , Prevalência , Estudos Prospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos
9.
PLoS One ; 15(1): e0227691, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929580

RESUMO

A helmet is critical for preventing head injuries during motorcycle accidents. However, South Korean motorcyclists have a lower prevalence of wearing a helmet, compared to developed countries. Therefore, we aimed to evaluate whether helmet wearing was associated with the clinical outcomes in Korean motorcycle accidents. Data were obtained from the Emergency Department-based Injury In-depth Surveillance database 2011-2015. We considered the patients had experienced a motorcycle accident and were only diagnosed with a craniocerebral trauma (CCT). The primary outcome was mortality and the secondary outcomes were the severity and hospitalization duration. The patients were separated whether they were wearing a helmet and the outcomes were compared using multivariate logistic regression after propensity score matching (PSM). Among 1,254,250 patients in the database, 2,549 patients were included. After PSM, 1,016 patients in each group were matched. The univariate analyses revealed that helmet wearing was associated with lesser severity (P < 0.001) and shorter hospitalization (P < 0.001). The regression analysis revealed that mortality was also lower in a helmet-wearing group (odds ratio: 0.34, 95% confidence interval: 0.21-0.56). In conclusion, wearing a helmet may reduce the mortality from a CCT after a motorcycle accident and associated with lesser severity and shorter hospitalization.


Assuntos
Acidentes de Trânsito/mortalidade , Traumatismos Craniocerebrais/mortalidade , Dispositivos de Proteção da Cabeça , Motocicletas , Adulto , Traumatismos Craniocerebrais/prevenção & controle , Traumatismos Craniocerebrais/terapia , Monitoramento Epidemiológico , Feminino , Humanos , Tempo de Internação , Masculino , Pontuação de Propensão , República da Coreia , Estudos Retrospectivos , Índices de Gravidade do Trauma
10.
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
11.
Am J Emerg Med ; 38(7): 1340-1345, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31836336

RESUMO

INTRODUCTION: As cities nation-wide combat gun violence, with less than 20% of shots fired reported to police, use of acoustic gunshot sensor (AGS) technology is increasingly common. However, there are no studies to date investigating whether these technologies affect outcomes for victims of gunshot wounds (GSW). We hypothesized that the AGS technology would be associated with decreased prehospital transport time. METHODS: All GSW patients from 2014 to 2016 were collected from our institutional registry and cross-referenced with local police department data regarding times and locations of AGS alerts. Each GSW incident was categorized as related or unrelated to an AGS alert. Admission data, trauma outcomes, and prehospital time were then compared. RESULTS: We analyzed 731 patients. Of these, 192 were AGS-related (26%) and 539 were not (74%). AGS-related patients were more likely to be female (p < 0.01), have a higher injury severity score (ISS) (p < 0.01), and require an operation (p = 0.03). Ventilator days (p < 0.05) and hospital length of stay (p < 0.01) was greater in the AGS cohort. Mortality, however, did not differ between groups (p = 0.5). On multivariable analysis, both total prehospital time and on-scene time were lower in the AGS group (p < 0.01). CONCLUSION: Our study suggests reduced transport times, decreased prehospital and emergency medical service on-scene times with AGS technology. Additionally, despite higher ISS and use of more hospital resources, mortality was similar to non-AGS counterparts. The potential of AGS technology to further decrease prehospital times in the urban setting may provide an opportunity to improve outcomes in trauma patients with penetrating injuries.


Assuntos
Traumatismos Abdominais/terapia , Serviços Médicos de Emergência , Armas de Fogo , Tempo de Internação/estatística & dados numéricos , Polícia , Som , Tempo para o Tratamento/estatística & dados numéricos , Ferimentos por Arma de Fogo/terapia , Traumatismos Abdominais/epidemiologia , Traumatismos Abdominais/mortalidade , Adulto , Automação , California/epidemiologia , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/mortalidade , Traumatismos Craniocerebrais/terapia , Bases de Dados Factuais , Extremidades/lesões , Traumatismos Faciais/epidemiologia , Traumatismos Faciais/mortalidade , Traumatismos Faciais/terapia , Feminino , Mapeamento Geográfico , Humanos , Escala de Gravidade do Ferimento , Masculino , Mortalidade , Sistema de Registros , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Distribuição por Sexo , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Traumatismos Torácicos/epidemiologia , Traumatismos Torácicos/mortalidade , Traumatismos Torácicos/terapia , Fatores de Tempo , Transporte de Pacientes/estatística & dados numéricos , Centros de Traumatologia , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/mortalidade
12.
Int J Legal Med ; 134(1): 295-307, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735980

RESUMO

Fatal head trauma (FHT) represents one of the most frequent causes of death diagnosed in forensic pathology. However, profound statistic autopsy data on FHT is still sparse. Therefore, the purpose of this study was to investigate the circumstances and injury patterns of FHT with particular focus on age and sex, and additionally, to describe a recent risk profile of FHT. To this end, the forensic autopsy records of each FHT case at a large German university hospital during a 10-year period (2006-2015) were analyzed retrospectively (n = 372). The male-female ratio was 2.6:1. Regarding median age, females were 12.5 years older than males. Traffic-associated FHT represents the major mechanism of death, followed by fall-associated FHT. While accident was the major manner of death and presented a similar distribution of age and sex, homicides were the only subgroup with a significantly lower ratio between males and females. Skull fractures occurred in 78.2% and intracranial hemorrhages in 80.6% of all cases. In summary and partly in contrast to clinical data on head trauma, FHT still occurs predominantly in male individuals under the age of 45 years, in the context of traffic accidents and affected by alcohol intake. Improvements in traffic security as well as continuing surveillance of the incidence of FHT by forensic autopsies are necessary to further reduce the incidence of FHT.


Assuntos
Distribuição por Idade , Causas de Morte , Traumatismos Craniocerebrais/classificação , Traumatismos Craniocerebrais/mortalidade , Distribuição por Sexo , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Autopsia , Criança , Pré-Escolar , Estudos de Coortes , Coleta de Dados , Feminino , Alemanha/epidemiologia , Homicídio/estatística & dados numéricos , Humanos , Hemorragia Intracraniana Traumática/mortalidade , Masculino , Registros Médicos , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco , Fraturas Cranianas/mortalidade , Suicídio/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade
13.
Neurosurg Rev ; 43(4): 1101-1107, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31197623

RESUMO

Clinical data following head or spine trauma in patients over 90 years is rare. The aim of this study was to analyze this patient cohort, assessing clinical characteristics, outcomes, and survival rates and to identify variables that may predict early mortality. A retrospective analysis of all patients over the age of 90 that were treated between January 2006 and December 2016 at our department was performed. Patient characteristics, type of injury, and comorbidities were analyzed with regard to the 30-day mortality rate as the primary outcome. One hundred seventy-nine patients were identified. Mean age was 93 (range 90-102); 105 (59%) patients were female. One hundred thirty-two (74%) and 34 (19%) of patients presented with head and spinal trauma, respectively. Fourteen patients (8%) had a combined head and spine injury. One hundred (56%) patients were treated operatively. Mean Charlson comorbidity index was 4.1 (range 0-18), mean diagnosis count was 6.2 (range 0-12), mean geriatric index of comorbidity (GIC) was 3.3 (range 1-4), and mean Barthel index was 28 (range 0-100). The 30-day mortality rate was 31%. Multivariate cox regression analysis showed that head trauma had a 1.66 hazard ratio (p = 0.036) of dying within 30 days of admission, whereas a higher Glasgow coma score and surgical treatment had a hazard ratio of 0.88 (p = 0.0001) and 0.72 (p = 0.05) to reach the primary outcome. None of the standard geriatric scores reached any significant correlation with the primary outcome. Standard geriatric prognostic scores seem less reliable to predict mortality for patients above the age of 90. Higher Glasgow coma score and surgical treatment were associated with a higher survival probability.


Assuntos
Idoso de 80 Anos ou mais , Vértebras Cervicais/lesões , Traumatismos Craniocerebrais/mortalidade , Traumatismos Craniocerebrais/cirurgia , Crânio/lesões , Traumatismos da Coluna Vertebral/mortalidade , Traumatismos da Coluna Vertebral/cirurgia , Estudos de Coortes , Comorbidade , Feminino , Avaliação Geriátrica , Escala de Coma de Glasgow , Humanos , Masculino , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
14.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 946-952, jan.-dez. 2020. tab, graf
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1117008

RESUMO

Objetivo: Identificar o perfil dos pacientes acometidos com traumatismo cranioencefálico atendidas em um hospital público de Teresina. Método: Estudo descritivo, exploratório, retrospectivo, documental de abordagem quantitativa realizado em um hospital público de Teresina-PI. Os dados foram coletados no período set/out/ de 2016 e janeiro de 2017 por meio de pesquisa nos prontuários através do formulário elaborado pelas pesquisadoras. Resultados: Registraram-se 1603 internações com o diagnóstico de traumatismo cranioencefálico destes, 5,67% tiveram traumatismo cranioencefálico leve, 92,67% moderado e 1,67% grave. Houve predomínio da faixa etária de 18 a 29 anos, sexo masculino, solteiro e o ensino fundamental. Nesta busca, 19,33% dos pacientes foram a óbito. Conclusão: Conclui-se que o perfil do paciente acometido por trauma cranioencefálico, no hospital estudado, é caracterizado por um predomínio do sexo masculino com uma faixa etária de 19 a 29 anos, solteiros e com escolaridade de até o ensino fundamental


Objective: This study meant to identifying the traumatic brain injury patients' profile in a public hospital of Teresina city, Piauí State, Brazil. Methods: It is a descriptive-exploratory, retrospective and documental study with a quantitative approach, which was performed in a public hospital from Teresina city. Data collection took place from September 2016 to January 2017 by researching medical records based on a developed form. Results: Considering the total number of traumatic brain injury hospitalizations, 5.67% were mild, 92.67% were moderate, and 1.67% were severe injuries. There was a predominance of single males within the age group from 19 to 29 years old, holding at most elementary school education. According to the study results, 19.33% of the patients died. Conclusion: It was concluded that the traumatic brain injury patients' profile is characterized by a predominance of single males within the age group from 19 to 29 years old, holding at most elementary school education


Objetivo: identificar el perfil de los pacientes acometidos con traumatismo craneoencefálico atendidos en un hospital público de Teresina. Método: Estudio descriptivo, exploratorio, retrospectivo, documental de abordaje cuantitativo realizado en un hospital público de Teresina-PI. Los datos fueron recolectados en el período set / out / de 2016 y enero de 2017 por medio de investigación en los prontuarios a través del formulario elaborado por las investigadoras. Resultados: Se registraron 1603 internaciones con el diagnóstico de traumatismo craneoencefálico de éstos, 5,67% tuvieron traumatismo craneoencefálico leve, 92,67% moderado y 1,67% grave. Se observó predominio del grupo de edad de 18 a 29 años, sexo masculino, soltero y la enseñanza fundamental. En esta búsqueda, el 19,33% de los pacientes fueron a muerte. Conclusión: Se concluye que el perfil del paciente acometido por trauma craneoencefálico, en el hospital estudiado, se caracteriza por un predominio del sexo masculino con una franja etaria de 19 a 29 años, solteros y con escolaridad de hasta la enseñanza fundamental


Assuntos
Humanos , Masculino , Adolescente , Adulto , Perfil de Saúde , Acidentes de Trânsito/prevenção & controle , Traumatismos Craniocerebrais/mortalidade
16.
Brain Inj ; 33(13-14): 1597-1601, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31514542

RESUMO

Background: It is essential to identify factors that predict helmet use, so as to mitigate the injury and mortality from bicycle accidents.Objective: To examine the relationship between helmet use and the bicycle-related trauma injury outcomes among bicyclists with head/neck injury in the US.Methods: Data from the 2002-2012 National Trauma Data Bank were used, including all trauma bicycle riders involved in bicycle-related accidents whose primary reason for the hospital or Intensive Care Unit stay was head or neck injury. Using multiple logistic regression, the association between helmet use, Injury severity score (ISS), length of stay in hospital (HLOS) and Intensive Care Unit (ICULOS), and mortality was examined.Results: Of the 76,032 bicyclists with head/neck injury, 22% worn helmets. The lowest was among Blacks, Hispanics, and <17 years old. Wearing a helmet significantly reduces injury severity, HLOS, ICULOS, and mortality (i.e total and in-hospital). Males had a severe injury, longer HLOS, ICULOS, and higher mortality than female. Blacks and Hispanics had longer HLOS and ICULOS and higher total mortality than Whites, but had a similar chance for in-hospital mortality.Conclusions: More effort is needed to enhance helmet use among at-risk bicycle riders, which may reduce injury severity, HLOS, ICULOS, and mortality.


Assuntos
Ciclismo/lesões , Traumatismos Craniocerebrais/prevenção & controle , Dispositivos de Proteção da Cabeça/tendências , Escala de Gravidade do Ferimento , Lesões do Pescoço/prevenção & controle , Adolescente , Adulto , Ciclismo/tendências , Traumatismos Craniocerebrais/etiologia , Traumatismos Craniocerebrais/mortalidade , Bases de Dados Factuais/tendências , Serviço Hospitalar de Emergência/tendências , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/etiologia , Lesões do Pescoço/mortalidade , Centros de Traumatologia/tendências , Adulto Jovem
17.
Epilepsy Behav ; 98(Pt A): 266-272, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31408827

RESUMO

INTRODUCTION: The objective of the study was to identify where epilepsy or seizures may be the underlying cause of death but not identified by the death certification process in the Australian coronial system and to better characterize such deaths. METHODS: Australian National Coronial Information System (NCIS) closed cases for the Australian Capital Territory (ACT) (population average 348,000) over 13 years were searched using cause of death, and a text search of police and autopsy reports, to identify all deaths where epilepsy or seizures were mentioned. Deaths where the underlying cause of death was not seizures or epilepsy were excluded (including suicide). The remaining cases (75) were categorized by the circumstances of death. Suspected sudden unexpected death in epilepsy (SUDEP) cases were further classified using the unified definition of SUDEP of Nashef and colleagues (2012). RESULTS: Of the final 75 cases, only 44 were found by the cause of death search. Key word document searches found another 31. Cases were classified as Definite SUDEP (37), Definite SUDEP Plus (10), Probable SUDEP (1), Possible SUDEP (3), Near SUDEP (4), Near SUDEP Plus (1), Asphyxia (3), Treatment-related (1), Head injury (2), Drowning (2), motor vehicle accident (MVA) (1), deaths related to a single convulsive seizure (6), and status epilepticus (SE) (4). Cases were 80% male. CONCLUSIONS: Epilepsy and seizure-related deaths are underreported in the Australian Coronial system. Enhanced documentation of the causal chain of events leading to deaths would increase recognition. Using the unified SUDEP definition would expand SUDEP identification.


Assuntos
Documentação/tendências , Epilepsia/diagnóstico , Epilepsia/mortalidade , Convulsões/diagnóstico , Convulsões/mortalidade , Morte Súbita Inesperada na Epilepsia/epidemiologia , Acidentes de Trânsito/mortalidade , Acidentes de Trânsito/tendências , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Criança , Pré-Escolar , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/mortalidade , Morte Súbita/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Nova Zelândia/epidemiologia , Estudos Retrospectivos , Suicídio/tendências , Adulto Jovem
18.
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
19.
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
20.
Sci Rep ; 9(1): 4914, 2019 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-30894655

RESUMO

In this study we aimed to produce the first detailed analysis of the epidemiology of the severe injury and mortality impacts of the 1931 Hawke's Bay earthquake in New Zealand (NZ). This involved the compilation and analysis of archival data (hospitalisations and deaths) including the examination of 324 death certificates. We found that there were 662 people for whom some hospitalisation data were available at four weeks post-earthquake: 54% were still in hospital, 4% were still classified as "serious", and 5% had died (n = 28). Our classification of death certificate data indicated 256 earthquake-attributable deaths and for another five deaths the earthquake was estimated to have played an indirect role. There were 15 buildings associated with three or more deaths each (accounting for 58% of deaths with a known location). Many of these buildings were multi-storey and involved unreinforced masonry - with some of this falling into the street and killing people there (19% of deaths). In contrast, deaths in homes, which were typically of wood construction and single stories, comprised only 3% of deaths. In conclusion, this earthquake had a relatively high injury impact that appears partly related to the lack of regulations for building construction that would mitigate earthquake-related risk. Such regulations continue to be of relevance for New Zealand and for other countries in earthquake zones.


Assuntos
Traumatismos Abdominais/epidemiologia , Traumatismos Craniocerebrais/epidemiologia , Lesões por Esmagamento/epidemiologia , Fraturas Ósseas/epidemiologia , Lacerações/epidemiologia , Traumatismos Abdominais/história , Traumatismos Abdominais/mortalidade , Adolescente , Adulto , Idoso , Baías , Códigos de Obras/história , Criança , Pré-Escolar , Indústria da Construção/história , Traumatismos Craniocerebrais/história , Traumatismos Craniocerebrais/mortalidade , Lesões por Esmagamento/história , Lesões por Esmagamento/mortalidade , Atestado de Óbito/história , Desastres , Terremotos , Feminino , Fraturas Ósseas/história , Fraturas Ósseas/mortalidade , História do Século XX , Hospitalização/estatística & dados numéricos , Humanos , Lacerações/história , Lacerações/mortalidade , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Fatores de Risco , Análise de Sobrevida
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