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1.
Curr Sports Med Rep ; 19(1): 24-28, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31913920

RESUMO

Soft tissue injuries to the head and neck are a common occurrence in sports. These anatomical regions are somewhat predisposed because of the "athletic stance" that is utilized in many close-contact sports. Although appropriate use of protective equipment, including mouth guards, helmets, and face shields, has reduced the incidence and severity of these injuries, they still occur regularly. To provide appropriate medical care, one must possess adequate knowledge of the superficial and deep anatomical structures, fundamental knowledge and skill in regard to wound care, and awareness of potential poor outcomes related to lacerations of unique structures, such as the mouth, eye, or ear.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Faciais/diagnóstico , Lacerações/diagnóstico , Lesões do Pescoço/diagnóstico , Traumatismos em Atletas/terapia , Traumatismos Craniocerebrais/terapia , Traumatismos Faciais/terapia , Humanos , Lacerações/terapia , Lesões do Pescoço/terapia , Volta ao Esporte
3.
BMC Public Health ; 19(1): 1399, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660928

RESUMO

BACKGROUND: Head injuries account for 650,000 annual deaths worldwide. The cost for treating head injury was estimated at US $200 million annually. This contributes to economic impoverishment in low income countries like Ethiopia. Hence, this study was aimed to assess the cost of Traumatic Head Injury (THI) and associated factors in the University of Gondar Specialized Referral Hospital. METHOD: An institution-based cross-sectional study was conducted from March 01 to May 30, 2017. A total of 387 THI patients were included in the study. An interviewer-administered questionnaire was used for data collection. Direct costs and indirect costs were measured by using the bottom-up approach. Data were entered into Epi-Info version 7 and imported to SPSS version 20 for analysis. Simple and multiple linear regression analysis were done to identify factors associated with cost of THI. RESULTS: The mean cost of THI per patient was 4673.43 Ethiopian Birr (ETB), 95% CI (4523.6-4823.3), and length of hospital stay averaged 1.73, 95% CI (1.63-1.82). Direct non-medical cost, like transportation fee 1896.19 ETB (±762.56 SD) and medical costs 1101.66 ETB (±534.13 SD) were account for 40.57 and 23.58% of total costs respectively. The indirect cost, loss of income by patient and their attendant due to injury, was 1675.58 ETB (+ 459.26 SD). Patients with moderate and severe levels of injury have 635.167 ETB (Standardized coefficient = 0.173, p < 0.001) and 773.621 ETB (Standardized coefficient = 0. 132, p < 0.001) increased costs, respectively, compared to mild level THI patients. Costs for patients ages 31-45 years were 252.504 ETB (Standardized coefficient = - 0.066, p = 0.046) lower than costs for those 5-14 years old. The cost of THI patients increased by 1022.853 ETB for each additional day of hospital length of stay (Standardized coefficient = 0.648, p < 0.001). CONCLUSION: Most expenses of the THI were from direct non-medical cost. Prior health service use, length of stay, level of injury, and age were significant predictors of cost of THI.


Assuntos
Custos e Análise de Custo/estatística & dados numéricos , Traumatismos Craniocerebrais/economia , Hospitais Universitários/economia , Encaminhamento e Consulta/economia , Adolescente , Adulto , Criança , Pré-Escolar , Traumatismos Craniocerebrais/terapia , Estudos Transversais , Etiópia , Feminino , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
4.
S Afr J Surg ; 57(3): 54, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31392866

RESUMO

BACKGROUND: Humans come into contact and interact with an array of animals in a number of areas and environments. We set out to review our experience with animal-related injuries in Pietermaritzburg, KwaZulu-Natal, South Africa. METHOD: All patients who sustained an injury secondary to an interaction with an animal in the period December 2012-December 2017 were identified from the Hybrid Electronic Medical Registry (HEMR). RESULTS: There were 104 patients in the study sample. The mean age of patients in the study was 32.8 years, with a range from 1 to 76 years old. 75% (n = 78) were male and 25% (n = 26) female. Out of the 104 animal-related injuries, 67 were blunt trauma, 39 penetrating trauma and 3 a combination of blunt and penetrating trauma. The species causing trauma included dogs (53), horses (29), cows (18), buffalo (1), warthog (1), impala (1) and a single goat (1). The median time from injury to hospitalisation was 46.62 hours (range from 0 to 504 hours). Injuries occurred to the head (n = 32), face (n = 9), neck (n = 32), abdomen (n = 22), urogenital system (n = 6), upper limb (n = 39) and lower limb (n = 39). The Injury Severity Score (ISS) mean for the patients was 8.16, the range 1-4, the median 9 and the standard deviation 6.88. In 49 patients the treatment was non-operative. In the remaining 55 patients, a total of 68 operative procedures were required. Operations included wound debridement/surgical washout (n = 38), laparotomy (n = 9), arterial repair/ligation (n = 8), skin graft (n = 4), craniotomy (n = 5), fasciotomy (n = 2), amputation (n = 1), and placement of an ICP monitor (n = 1). 49 of these operations were for patients with dog bite injuries. The mean hospital stay was 0.13 days with a range of 0-4 days. Four patients were admitted to the Intensive Care Unit (ICU) and two patients died. CONCLUSION: Human interactions with animals may result in injuries which require surgical treatment. The most common animal injury is a dog bite but in the case of the larger domestic farm animals, blunt force type injuries and goring can result in significant injuries which require complex surgical interventions.


Assuntos
Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/cirurgia , Traumatismos Abdominais/epidemiologia , Adolescente , Adulto , Idoso , Animais , Bovinos , Criança , Pré-Escolar , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/terapia , Cães , Feminino , Cavalos , Humanos , Lactente , Escala de Gravidade do Ferimento , Tempo de Internação , Extremidade Inferior/lesões , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/epidemiologia , Lesões do Pescoço/terapia , Estudos Retrospectivos , África do Sul/epidemiologia , Tempo para o Tratamento , Centros de Traumatologia , Extremidade Superior/lesões , Sistema Urogenital/lesões , Ferimentos e Lesões/terapia , Adulto Jovem
5.
World Neurosurg ; 132: 390-396, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31394356

RESUMO

OBJECTIVE: Kitab al-Dhakhira fi 'Ilm al-Tibb is one of Thabit b. Qurra's most noteworthy books on medicine in Arabic in the ninth century. This study aims to present and discuss the section subtitled "wounds in the head" in the 24th chapter of Kitab al-Dhakhira considering the information in the literature. MATERIALS AND METHODS: This study is primarily based on a copy of Kitab al-Dhakhira edited by Dr. G. Sobhy and printed in al-Matba'at al-Amiriyya, Cairo in 1928. It is compared with the manuscript, which is in the Sehit Ali Pasa Collection, nr. 2028, in the Süleymaniye Manuscript Library in Istanbul, Turkey. The 24th chapter was first translated into English and then examined. The acquired knowledge from the chapter is discussed in this study by comparing it with that on this subject from the literature regarding the history of medicine. RESULTS: The 24th chapter, entitled "On Wounds and Wounds in the Head and Hemorrhage from Them and from Other Wounds and on Gently Drawing Arrowhead/Spearhead and Thorn," includes a section subtitled "wounds in the head." This section provides information regarding steps to be taken if the head is simply wounded or if there is an accompanying swelling, how to control hemorrhage, which medicines should be used for treatment, and how to bandage wounds in the head, but unfortunately, it specifies no details regarding surgical interventions for such wounds. CONCLUSIONS: Kitab al-Dhakhira presents interesting knowledge regarding wounds in the head, reflecting the medical paradigm of that era.


Assuntos
Traumatismos Craniocerebrais/terapia , Medicina Arábica/história , Neurocirurgia/história , Livros/história , História Medieval , Humanos , Hemorragias Intracranianas/terapia , Turquia
6.
Artigo em Russo | MEDLINE | ID: mdl-31251858

RESUMO

The craniocerebral injury is a global problem of health care and society. The fatal and incapacitating aftermaths developed because of this type of trauma result in significant social and economic losses. To develop effective measures of decreasing these losses epidemiological studies are needed to be implemented considering gender, age, regional and other characteristics. The purpose of study was to analyze regional and epidemiological characteristics of craniocerebral injury in children population of Russia. The study was based on data of state statistic reports in Russia and in its regions in 2003-2004. During analyzed period, dynamics of children morbidity of craniocerebral injury are characterized by its maximal level reached in 2010 (6.3 per 1,000 of children population) and by its decreasing to initial level (5.4% per 1,000 of children population) in 2014. The two-fold increase of percentage of children of the first year of life in mortality of craniocerebral injury was established against the background of stable decrease of craniocerebral injury mortality among children aged from 0 to 17 years. In 2014, every ninth child who died because of head trauma did not survived age of 1 year. In Russia, decreasing of level of hospitalization of children with craniocerebral injury was established. At that, indices of hospitalized morbidity of children of the first year of life increased up to 30%. The actual statistical reporting in Russian Federation provides no full measure evaluation of true levels of mortality, morbidity and hospitalized morbidity. this condition occurs due to limitations of including additional nosological forms in state statistic reporting and to specificity of main disease codification or leading causes of death. The study established significant regional specificity of craniocerebral injury in children that determines necessity of development effective measures considering established epidemiological characteristics.


Assuntos
Traumatismos Craniocerebrais , Adolescente , Criança , Pré-Escolar , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/terapia , Assistência à Saúde , Hospitalização , Humanos , Lactente , Recém-Nascido , Morbidade , Federação Russa/epidemiologia
7.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(5): 603-606, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31198148

RESUMO

OBJECTIVE: To investigate the dynamic changes in early gastric antrum contraction in patients with craniocerebral injury. METHODS: The patients with craniocerebral injury admitted to neurosurgery intensive care unit (ICU) of the First Affiliated Hospital of Sun Yat-sen University from July to November in 2018 were enrolled. The changes in antral contraction frequency (ACF), antral contraction amplitude (ACA) and antral motility index (MI) were dynamically observed at 1-6 days after injury by ultrasonography. According to Glasgow coma score (GCS), the patients were divided into moderate to severe craniocerebral (GCS ≤ 11) and mild craniocerebral injury groups (GCS > 11). The differences in ACF, ACA and MI between the two groups were compared to observe the effect of craniocerebral injury on gastric antral motility. The patients were divided into simple supratentorial and supratentorial combined infratentorial lesion groups according to the lesion location of craniocerebral injury. The differences in ACF, ACA and MI between the two groups were compared to analyze the influence of lesion location on gastric antrum activity. RESULTS: A total of 68 patients with craniocerebral injury were screened during the study period, 50 patients were in accorded with the admission criteria, 17 patients were withdrawn from the observation because they could not tolerate the ultrasonography of gastric antrum or discharged from ICU. Finally, 33 patients were enrolled in the analysis. (1) The ACF, ACA and MI at 1 day after injury were lower [ACF (times/min): 1.67 (0.00, 2.00), ACA: 42.06 (0.00, 44.45)%, MI: 0.70 (0.00, 0.87)], and then gradually increased, till 6 days after injury, ACF was 1.83 (1.25, 2.79) times/min, ACA was 56.80 (33.25, 60.77)%, and MI was 0.89 (0.50, 1.70), which showed no differences among all time points (all P > 0.05). (2) The contractile function of gastric antrum in two groups of patients with different degrees of craniocerebral injury was decreased, especially ACA in patients with moderate to severe craniocerebral injury (n = 22), which showed significant differences at 3 days and 5 days after injury as compared with mild craniocerebral injury [n = 11; 3 days: 35.05 (0.00, 53.69)% vs. 58.51 (49.90, 65.45)%, 5 days: 39.88 (0.00, 77.01)% vs. 56.94 (41.71, 66.66)%, both P < 0.05], indicating that the degree of craniocerebral injury affected the contractive function of gastric antrum. However, there was no significant difference in ACF or MI between the two groups at different time points after injury. (3) The contractile function of gastric antrum was decreased after craniocerebral injury in both groups of patients with different lesion locations of craniocerebral injury. The ACF, ACA, and MI at 3-4 days in patients with supratentorial combined infratentorial lesion (n = 12) were slightly lower than those in patients with simple supratentorial lesion [n = 21; 3 days: ACF (times/min) was 0.83 (0.00, 2.00) vs. 2.25 (0.00, 3.00), ACA was 35.05 (0.00, 53.60)% vs. 49.93 (0.00, 63.44)%, MI was 0.29 (0.00, 1.07) vs. 1.23 (0.00, 1.61); 4 days: ACF (times/min) was 1.42 (0.50, 2.63) vs. 2.00 (1.63, 2.63), ACA was 30.45 (21.69, 60.61)% vs. 43.29 (38.41, 53.35)%, MI was 0.50 (0.15, 1.45) vs. 0.97 (0.66, 1.28)] without statistical differences (all P > 0.05), indicating that the lesion location might not affect the contractive function of gastric antrum. CONCLUSIONS: In the early stage of craniocerebral injury, the contractile function of gastric antrum was decreased, and the more severe the craniocerebral injury, the worse contractive function of gastric antrum.


Assuntos
Traumatismos Craniocerebrais/fisiopatologia , Motilidade Gastrointestinal/fisiologia , Contração Muscular/fisiologia , Antro Pilórico/fisiologia , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/terapia , Hospitalização , Humanos , Unidades de Terapia Intensiva , Antro Pilórico/diagnóstico por imagem , Índices de Gravidade do Trauma , Ultrassonografia
8.
Medicine (Baltimore) ; 98(17): e15426, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027144

RESUMO

BACKGROUND: The role of early enteral nutrition (ENN) supplemented with probiotics (<48 hours) in improving clinical outcomes of patients with severe head injury (SHI) remains controversial. We performed this meta-analysis to investigate the efficacy of EEN supplemented with probiotics on clinical outcomes in these patients. METHODS: Systematic searches were performed in PubMed, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang database, and Chinese Biomedical Literature to identify potential studies. Two investigators checked citations, extracted data, appraised risk of bias, and then STATA 12.0 was used to perform statistical analysis. RESULTS: A total of 18 trials were eventually included in the present study. Meta-analysis indicated that EEN supplemented with probiotics was associated with decreased risk of infection (risk ratio [RR], 0.53; 95% confidence interval [CI], 0.44-0.65), decreased risk of mortality (RR, 0.56; 95% CI, 0.38-0.82), decreased risk of gastrointestinal complications (RR, 0.19; 95% CI, 0.13-0.25), and shortened stays in intensive care unit (ICU) (mean difference [MD], -4.55; 96% CI, -5.91 to -3.19). CONCLUSION: EEN supplemented with probiotics may be a promising alternative for patients with SHI because it effectively decreased the risk of infection, mortality, and gastrointestinal complications, as well as shortened the stays in ICU.


Assuntos
Traumatismos Craniocerebrais/terapia , Nutrição Enteral , Probióticos/uso terapêutico , Nutrição Enteral/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Medicine (Baltimore) ; 98(17): e15443, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027147

RESUMO

RATIONALE: Plasmacytoma as the 1st presentation of skull tumors is a rare disorder. When it is combined with brain trauma or dramatic changes in intracranial pressure, patients are more prone to misdiagnosis. PATIENT CONCERNS: A 67-year-old woman complaining of a headache presented with a history of head trauma for the past 1 hour. Emergency head computed tomography initially suggested an epidural hematoma. DIAGNOSIS: Emergency surgery was performed to remove the intracranial hematoma, but a tumor-like mass was found during surgery, and pathologic assessment confirmed plasmacytoma. Surgery was difficult because of bleeding. The tumor was radically removed. INTERVENTIONS AND OUTCOMES: The patient underwent whole-brain radiotherapy and chemotherapy. She died 40 months after the surgery. LESSONS: Epidural lesions found after a head injury may be assumed to be an epidural hematoma, leading to unnecessary surgery. Diseases such as hematomas, meningiomas, eosinophilic granulomas, bone metastases, and osteosarcomas must be considered.


Assuntos
Traumatismos Craniocerebrais/diagnóstico , Hematoma Epidural Craniano/diagnóstico , Plasmocitoma/diagnóstico , Neoplasias Cranianas/diagnóstico , Idoso , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/terapia , Diagnóstico Diferencial , Evolução Fatal , Feminino , Hematoma Epidural Craniano/cirurgia , Humanos , Plasmocitoma/patologia , Plasmocitoma/terapia , Neoplasias Cranianas/patologia , Neoplasias Cranianas/terapia
10.
Dtsch Arztebl Int ; 116(10): 167-173, 2019 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-30995953

RESUMO

BACKGROUND: The comprehensive expansion of the Trauma Register of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie; TR-DGU) now enables, for the first time, studies on traumatic brain injury (TBI) with special attention to care processes, clinical course, and outcomes of treatment on discharge or transfer from the acute-care hospital. METHODS: Retrospective analysis of patients documented in the TR-DGU in the period 2013-2017 who had moderate to severe head injury as defined by the Abbreviated Injury Scale (AIS). RESULTS: In the period 2013-2017, 41 101 patients with moderate to severe TBI were treated in TR-DGU-associated hospitals in Germany (n = 605 hospitals), corresponding to 8220 cases per year and thus to a population-wide incidence of 10.1 cases per 100 000 persons per year. TBI was present as an isolated injury in 39.1% of cases. The mean age of the patients was 60 years (median; range 0-104 years), and the male-to-female ratio was 2:1. 97.5% of the patients had blunt trauma. Falls from a low height were the most common cause of TBI (38.7%). 43.6% of the patients were intubated before arriving at the hospital, and more than 95% underwent cranial tomographic imaging within 22 minutes of arrival (standard deviation [SD] = 17 minutes). 18.4% underwent an emergency neurosurgical procedure. The in-hospital mortality was 23.5%, corresponding to a population-wide mortality from TBI of 2.4 per 100 000 persons per year. More than half of the patients recovered well or with only mild disability; 14.9% had persistent severe disability or remained in a vegetative state. CONCLUSION: Putting these figures in the appropriate international context requires the acquisition of comparable data in multiple countries and is the main task of international TBI consortia.


Assuntos
Traumatismos Craniocerebrais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/terapia , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Adulto Jovem
11.
World Neurosurg ; 128: e340-e346, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31029813

RESUMO

BACKGROUND: The telemedicine program in Albania includes a specialized teleneurotrauma program. There is only 1 national trauma center with neurosurgery capability in the capital city of Tirana. Patients with isolated head or spine injury who require consultation with neurosurgeons located at the National Trauma Center receive telemedicine consultation. The aim of this follow-up study was to evaluate the effectiveness of a nationwide teleneurotrauma network in preventing unnecessary transfers for neurotrauma. METHODS: Retrospective analysis was performed of prospectively collected data on all telemedicine consultations for isolated neurotrauma from March 2014 to February 2018. All teleconsultations were coded using the International Classification of Diseases, Tenth Revision coding system (codes S00, S01-S010). RESULTS: Of 590 teleconsultations for neurotrauma, most patients (76%) were male (median age 46.5 years; range, 1-93 years); 403 (68.31%; mean age 45.12 years) did not require a transfer to the tertiary center, and 187 (mean age 42.47 years) were transferred. An average 12.5 (monthly average range, 8.5-16) patients were seen monthly with a steady increase to a mature telemedicine program at the present time. Most teleconsultations (70.67%) occurred during business hours (8:00 am-4:30 pm); 173 (29.32%) occurred at night and on weekends. Analysis by diagnosis indicated that most cases of low severity were not transferred, whereas higher severity cases were twice as likely to be transferred (P < 0.05). CONCLUSIONS: Structured and coordinated telemedicine for neurotrauma increases access to care for neurosurgery patients in countries that do not have widespread neurosurgery services. Nearly 70% of patients may be treated locally by nonneurosurgeons.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Neurocirurgia , Transferência de Pacientes , Encaminhamento e Consulta , Traumatismos da Medula Espinal/terapia , Telemedicina/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Albânia , Criança , Pré-Escolar , Traumatismos Craniocerebrais/terapia , Gerenciamento Clínico , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
12.
Ulus Travma Acil Cerrahi Derg ; 25(2): 167-171, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30892669

RESUMO

BACKGROUND: Injuries caused by motorcycle accidents have been reported in several studies with an examination from a general trauma point of view. However, to our knowledge, there is no detailed study specific to central nervous system injuries. This research was focused on central nervous system injuries associated with motorcycle accidents. METHODS: The medical records of 540 patients who were admitted to the emergency department between 2008 and 2016 as the result of a motorcycle accident were retrospectively evaluated. Data were collected from electronic medical records, follow-up forms, and radiological images. Information on patient age, gender, type and site of injury, helmet use, alcohol level, Glasgow Coma Scale score on admission, length of stay in the intensive care unit and hospital, neurological status on discharge, and follow-up was collected and analyzed. RESULTS: A total of 486 of 540 patients (90%) were male, 54 (10%) were female, and the mean age was 31+-18 years (range: 2-85 years, median: 25 years). Cranial injuries were detected in 320 cases (59%). The distribution of cranial injuries was: epidural hemorrhage (12.6%), subdural hemorrhage (15.2%), depressed fracture (10.4%), linear fracture (23%), skull base fracture (5.5%), diffuse axonal injury (9.3%), subarachnoid hemorrhage (25.2%), intracerebral hemorrhage (13.5%), and contusion (26.3%). Spinal fractures were detected in 52 cases (9.6%). Twenty-two (4.07%) of the spinal fractures were observed in the cervical region, 10 (1.85%) in the thoracic region, and 20 (3.7%) in the lumbar region. The mean length of stay in the hospital was 8.2+-4 days and 7 days in the intensive care unit. Sixty-eight patients (12.6%) died. Traumatic cranial entities other than linear fracture were associated with an elevated level of mortality. A Glasgow Coma Scale score of 6 or less was associated with significant mortality (68%). CONCLUSION: A detailed report of motorcycle accident-associated central nervous system injuries is provided. The use of protective equipment, such as helmets, significantly reduced the rate of cerebral injury and death.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Traumatismos Craniocerebrais , Motocicletas , Traumatismos da Coluna Vertebral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/terapia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/cirurgia , Adulto Jovem
13.
Crit Care ; 23(1): 89, 2019 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-30871608

RESUMO

BACKGROUND: Anemia is frequent among patients with traumatic brain injury (TBI) and is associated with an increased risk of poor outcome. The optimal hemoglobin concentration to trigger red blood cell (RBC) transfusion in patients with TBI is not clearly defined. METHODS: All eligible consecutive adult patients admitted to the intensive care unit (ICU) with moderate or severe TBI were randomized to a "restrictive" (hemoglobin transfusion threshold of 7 g/dL), or a "liberal" (threshold 9 g/dL) transfusion strategy. The transfusion strategy was continued for up to 14 days or until ICU discharge. The primary outcome was the mean difference in hemoglobin between groups. Secondary outcomes included transfusion requirements, intracranial pressure management, cerebral hemodynamics, length of stay, mortality and 6-month neurological outcome. RESULTS: A total of 44 patients were randomized, 21 patients to the liberal group and 23 to the restrictive group. There were no baseline differences between the groups. The mean hemoglobin concentrations during the 14-day period were 8.4 ± 1.0 and 9.3 ± 1.3 (p < 0.01) in the restrictive and liberal groups, respectively. Fewer RBC units were administered in the restrictive than in the liberal group (35 vs. 66, p = 0.02). There was negative correlation (r = - 0.265, p < 0.01) between hemoglobin concentration and middle cerebral artery flow velocity as evaluated by transcranial Doppler ultrasound and the incidence of post-traumatic vasospasm was significantly lower in the liberal strategy group (4/21, 3% vs. 15/23, 65%; p < 0.01). Hospital mortality was higher in the restrictive than in the liberal group (7/23 vs. 1/21; p = 0.048) and the liberal group tended to have a better neurological status at 6 months (p = 0.06). CONCLUSIONS: The trial reached feasibility criteria. The restrictive group had lower hemoglobin concentrations and received fewer RBC transfusions. Hospital mortality was lower and neurological status at 6 months favored the liberal group. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02203292 . Registered on 29 July 2014.


Assuntos
Transfusão de Sangue/métodos , Traumatismos Craniocerebrais/terapia , Adulto , Anemia/complicações , Anemia/terapia , Transfusão de Sangue/normas , Brasil , Traumatismos Craniocerebrais/fisiopatologia , Estudos de Viabilidade , Feminino , Escala de Coma de Glasgow , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade
14.
World Neurosurg ; 127: e186-e192, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30878740

RESUMO

BACKGROUND: Consistent data on head injury is lacking especially in the low- and middle-income countries. Our study tries to characterize patients with head injury at the emergency department of one of the few tertiary public hospitals giving neurosurgical care in the country. METHODS: A retrospective cross-sectional study was performed from May 2015 to October 2015 in one of the neurosurgical teaching hospitals, Black Lion Specialized Hospital. All adult patients with head injury who visited the emergency department during the study period were included. Data on patients' sociodemographic, mechanism of trauma, clinical presentation, imaging findings, and presence of polytrauma were collected by a pretested questionnaire. The source of data was emergency department logbooks and patient charts. RESULTS: A total of 390 patients with head injury who visited the emergency department were included during the study period. There were 335 males (85.9%) and 55 females (14.1%) with the mean age (standard deviation) of 35.4 (15.6) years. Majority of patients came by taxi constituting 149 (38.2%) of all patients, whereas 147 patients (37.7%) used ambulance. Of 147 patients brought by ambulances, 133 (90.4%) were referred from other hospitals. The majority, 26 (45.6%), of patients who came directly to the emergency department used taxis. It is shown that the mode of arrival and origin of arrival are significantly related, P = 0.000. Mortality of severe head injury at the emergency department was 50.8%. CONCLUSIONS: Prehospital care coverage was low and ambulances were used mainly for interhospital transfers. Mortality of severe head injury at the emergency department is high and significantly associated with preventable causes like vital sign derangement.


Assuntos
Traumatismos Craniocerebrais/epidemiologia , Adolescente , Adulto , Criança , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/etiologia , Traumatismos Craniocerebrais/terapia , Estudos Transversais , Países em Desenvolvimento , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Etiópia/epidemiologia , Feminino , Mortalidade Hospitalar , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/epidemiologia , Transferência de Pacientes/estatística & dados numéricos , Estudos Retrospectivos , Fatores Socioeconômicos , Taxa de Sobrevida , Centros de Atenção Terciária/estatística & dados numéricos , Transporte de Pacientes/métodos , Transporte de Pacientes/estatística & dados numéricos , Adulto Jovem
15.
J Craniofac Surg ; 30(3): 630-635, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30817537

RESUMO

Autologous fat grafting is a technique with various applications in the craniofacial region ranging from the treatment of wounds, scars, keloids, and soft tissue deformities. In this review, alternative therapies to fat grafting are discussed. These are composed of established therapies like silicone gel or sheeting, corticosteroids, cryotherapy, and laser therapy. Novel applications of negative pressure wound therapy, botulinum toxin A injection, and biologic agents are also reviewed.


Assuntos
Traumatismos Craniocerebrais/terapia , Crioterapia , Traumatismos Faciais/terapia , Terapia a Laser , Tratamento de Ferimentos com Pressão Negativa , Tecido Adiposo/transplante , Autoenxertos , Toxinas Botulínicas Tipo A/uso terapêutico , Cicatriz/cirurgia , Humanos , Procedimentos Cirúrgicos Reconstrutivos , Géis de Silicone/uso terapêutico
17.
Eur J Pediatr ; 178(6): 837-850, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30900075

RESUMO

Situation awareness (SA) is an important human factor and necessary for effective teamwork and patient safety. Human patient simulation (HPS) with video feedback allows for a safe environment where health care professionals can develop both technical and teamwork skills. It is, however, very difficult to observe and measure SA directly. The Situation Global Assessment Technique (SAGAT) was developed by Endsley to measure SA during real-time simulation. Our objective was to measure SA among team members during simulation of acute pediatric care scenarios on the medical ward and its relationship with team effectiveness. Twenty-four pediatric teams, consisting of two nurses, one resident, and one consultant, participated in three acute care scenarios, using high-fidelity simulation. Individual SAGAT scores contained shared and complimentary knowledge questions on different levels of SA. Within each scenario, two "freezes" were incorporated to assess SA of each team members' clinical assessment and decision-making. SA overlap within the team (team SA) was computed and compared to indicators of team effectiveness (time to goal achievement, consensus on primary problem, diagnosis, task prioritization, leadership, and teamwork satisfaction). In 13 scenarios (18%), the team failed to reach the primary goals within the prescribed time of 1200 s. There was no significant difference in failure of goal completion between the scripted scenarios; however, there was a significant difference between scenario 3 and the other scenarios in time to goal completion. In all three scenarios, SA overlap level 2 (consensus on primary problem during the first freeze and consensus on diagnosis during the second freeze) leads to significantly faster achievement of the predefined goals. There was a strong relationship between team SA on the primary problem and diagnosis and team SA on task prioritization. Consensus on leadership within the team was low. Teamwork satisfaction was more influenced by knowledge about the importance of the assigned task than outcome of the scenario.Conclusion: The use of SAGAT enables us to measure SA of team members during real-time simulation of acute care scenarios. Although there is no direct connection between team SA and goal achievement, SAGAT provides insight in differences in SA among team members, and the process of shared mental model formation. By measuring SA, issues that may improve team effectiveness (prioritizing tasks, enhancing shared mental models, and providing leadership) can be trained and assessed during medical team simulation, enhancing teamwork in health care settings. What is known? • Teamwork skills such as communication, leadership, and situational awareness have become increasingly recognized as essential for good performance in pediatric resuscitation. However, the assessment of pediatric team performance in these clinical situations has been traditionally difficult. • The Situation Awareness Global Assessment Technique (SAGAT) is a method of objectively and directly measuring SA during a team simulation using "freezes" at predetermined points in time with participants reporting on "what is going on" from their perspective on the situation. What is new? • We assessed SA, and its relationship with team effectiveness, in multidisciplinary pediatric teams performing simulated critical events in critically ill children on the medical ward using the SAGAT model, outside the emergency room setting. • In all three scenarios, consensus on the primary problem (shared mental model) leads to faster achievement of predefined goals. Consensus on leadership was overall low, without a significant impact on goal achievement.


Assuntos
Conscientização , Competência Clínica , Tomada de Decisões , Equipe de Assistência ao Paciente/normas , Treinamento por Simulação/métodos , Suporte Vital Cardíaco Avançado/normas , Criança , Pré-Escolar , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/terapia , Cuidados Críticos/normas , Desidratação/diagnóstico , Desidratação/terapia , Feminino , Humanos , Masculino , Estudos Retrospectivos
18.
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
19.
Ital J Pediatr ; 45(1): 24, 2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30744682

RESUMO

BACKGROUND: Pediatric head trauma management varies between emergency departments globally. Here we aim to compare the pediatric minor head trauma management between a US and Italian hospital. METHODS: We conducted a retrospective chart review of children 0-18 years old presenting after minor head trauma (Glasgow Coma Scale 14-15) from two emergency departments, in Boston, Massachusetts, United States and Trieste, Italy, between January and December 2013. Frequencies of demographic, clinical, and management characteristic were calculated. We compared rate ratios for characteristics of patients receiving cranial computed tomography (CT) scans between the two populations. RESULTS: There were 1783 patients in Boston, Massachusetts and 183 patients in Trieste, Italy. Patients in Boston had more reported neurologic symptoms (61.2%) than in Trieste (6%) (p < 0.001). More CT scans were ordered on the patients in Boston (17.3% vs. 6.6%) (p < 0.001), while more children were hospitalized in Trieste (55.7% vs. 8.6%) (p < 0.001). Patients with neurological symptoms more commonly had a CT scan in Trieste (45.5%) than in Boston (23.5%) (RR 0.52, 95% CI 0.27, 1.00), while more patients without neurological symptoms had CTs in Boston (7.5%) than in Trieste (4.1%) (RR 1.85, 95% CI 0.86, 4.00). Assignment of triage levels and definitions of head injury severity varied considerably between the two hospitals, resulting in dissimilar populations presenting to the two hospitals, and thus, differences in the management of these children. CONCLUSION: The population of head trauma patients and the management of pediatric minor head trauma differs between Boston and Trieste, with a preference for CT scans in Boston and a preference for hospitalization in Trieste. Clinical guidelines used at each institution likely lead to this variation in care influenced by the different patient populations and institutional resources.


Assuntos
Traumatismos Craniocerebrais/terapia , Serviço Hospitalar de Emergência , Hospitais Pediátricos , Adolescente , Criança , Pré-Escolar , Protocolos Clínicos , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico por imagem , Feminino , Escala de Coma de Glasgow , Humanos , Lactente , Itália , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Estados Unidos
20.
Artigo em Russo | MEDLINE | ID: mdl-30790491

RESUMO

The analysis of the structure of treatment of patients with injuries in traumatological station of municipal clinical hospital established that the percentage of females was slightly higher than that one of males, 50.9% and 49.1% respectively. In all patients, 24.1% were of age group 30-39 years. This age group was also the largest one in males men and amounted up to 29.4%. In women, the largest age group was that one of 50-59 years (19.2%). In male patients 84.6% were in the age range of 18-60 years. Among female patients 60.0% were in the range of 18-55 years. Among males, the predominant localization of injury was wrist and hand (24.0%) and chest injuries (14.4%). Among females, the most frequently injured areas were ankle and foot, (26.8%) and knee and shin (17.4%). The duration of treatment of the patient and number of visits to traumatologist depends on localization and severity of the injury. The analysis demonstrated that the average duration of treatment of patient in the traumatological station made up to 4.2±0.13 days. The average duration of treatment of males was shorter (3.7±0.17 days) than that one of females (4.6±0,18 days). From those who applied to the traumatological station during the year, medical certificate was made out to 12.7% of patients. The average duration of medical certificate for all types of injuries made up to 28.9±1.2 days (28.1±1.1 days in males and 29.6±1.2 days in females) and ranged from 11.5±0.5 days in case of head injuries to 35.7±1.4 days in case of injuries of hip and thigh. In general, in case of single temporary disability, patient visited the traumatological station 3.7±0.2 times.


Assuntos
Traumatismos Craniocerebrais , Centros de Traumatologia , Adolescente , Adulto , Traumatismos Craniocerebrais/terapia , Feminino , Hospitais Municipais , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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