Whats new in emergencies, trauma and shock? Traumatic subarachnoid hemorrhages versus traumatic nonsubarachnoid intracranial hemorrhages Amit Agrawal Journal of Emergencies, Trauma, and Shock 2019 12(3):167-167 |
Obesity may not be protective in abdominal stab wounds Vivian Hsiao, Jacob Sim, Asha Zimmerman, Andrew Stephen Journal of Emergencies, Trauma, and Shock 2019 12(3):168-172 Context: Current protocols for the management of abdominal stab wounds were established based on retrospective data from prior decades. Few have investigated whether higher body mass index (BMI) affects outcomes after these injuries. Aim: The aim was to determine the effects of obesity on outcomes in abdominal stab wound patients. Setting and Design: This was a retrospective cohort study at a Level I university-associated trauma center in the United States. Materials and Methods: We reviewed medical records of 100 adult patients admitted to our trauma center with abdominal stab wounds. Demographics, types of internal organ injury, gastrointestinal (GI) resection and repair, mortality, length of hospital stay (LOS), units of blood transfused within 24 h of admission, need and indications for exploratory laparotomy, surgical site infections (SSI), and need for re-operation were compared between obese and nonobese patients. Statistical Analysis: Categorical and continuous outcome variables were compared between the two groups using Chi-squared and independent-samples t-tests, respectively. BMI was evaluated as a predictor of outcomes using univariate and multivariate logistic regression. Results: Records of 100 adult abdominal stab wound patients were reviewed. Twenty-five patients were obese. The obese group was older (38.76 vs. 31.23, P= 0.018). Rates of therapeutic laparotomy were similar between obese and nonobese patients (20 [80.00%] vs. 64 [85.33%]). Obesity was associated with longer LOS (9.6 vs. 6.5, P= 0.026). In the multivariate analysis, increasing BMI was an independent predictor of need for GI resection (odds ratio: 1.10 [1.02–1.18], P= 0.018). One patient from the obese group died. Conclusions: Obese patients with abdominal stab wounds have longer LOS than nonobese patients. Increasing BMI was an independent predictor of need for GI resection. |
Subarachnoid versus nonsubarachnoid traumatic brain injuries: The impact of decision-making on patient safety Brandon Diaz, Adel Elkbuli, Rachel Wobig, Kelly McKenney, Daniella Jaguan, Dessy Boneva, Shaikh Hai, Mark McKenney Journal of Emergencies, Trauma, and Shock 2019 12(3):173-175 Introduction: Traumatic intracranial hemorrhages (ICHs) are high priority injuries. Traumatic brain bleeds can be categorized as traumatic subarachnoid hemorrhage (SAH) versus non-SAH-ICH. Non-SAH-ICH includes subdural, epidural, and intraventricular hematomas and brain contusions. We hypothesize that awake patients with SAH will have lower mortality and needless interventions than awake patients with non-SAH-ICHs. Study Design and Methods: A review of data collected from our Level I trauma center was conducted. Awake was defined as an initial Glasgow coma score (GCS) 13–15. Patients were divided into two cohorts: awake SAH and awake non-SAH-ICH. Chi-square and t-test analyses were used with statistical significance defined as P < 0.05. Results: A total of 12,482 trauma patients were admitted during the study period, of which 225 had a SAH and GCS of 13–15 while 826 had a non-SAH-ICH with a GCS of 13–15. There was no significant difference in demographics between the two groups. Predicted survival between the two groups was similar (97.3 vs. 95.7%,P > 0.05). Mortality rates were, however, significantly lower in SAH patients compared to the non-SAH-ICH (4/225 [1.78%] vs. 22/826 [2.66%], P < 0.05). The need for neurosurgical intervention was significantly different comparing the SAH group versus non-SAH-ICH (2/225 [0.89%] vs. 100/826 [12.1%], P < 0.05). Conclusion: Despite similar predicted mortality rates, awake patients with a SAH are associated with a significantly lower risk of death and need for neurosurgical intervention when compared to other types of awake patients with a traumatic brain bleed. |
High-fidelity simulation versus case-based discussion for teaching bradyarrhythmia to emergency medical services students Shrimathy Vijayaraghavan, Parag Rishipathak, Anand Hinduja Journal of Emergencies, Trauma, and Shock 2019 12(3):176-178 Introduction: Bradyarrhythmias are a common clinical finding yet can be life-threatening in certain situations. Accordingly, diagnosis and prompt intervention remain the cornerstone of effective management of bradyarrhythmia. The study compares the two methods by assessing improvement in knowledge acquisition using pretest, posttest, and satisfaction survey with the teaching pedagogy. Materials and Methods: A randomized control trial of simulation-based teaching compared with case-based discussion was conducted among Postgraduate Diploma in Emergency Medical Services students. The students anonymously filled out pretest, posttest, and a satisfaction questionnaire composed of six statements in three domains (quality of instruction, debriefing, and overall satisfaction). The statements were rated using a 10-point scale. Test results were compared using t-test for equality of means of independent samples. Results and Discussion: All 40 students selected completed all the steps of the study. Knowledge improvement from pretest to posttest was observed in both teaching methods derived using paired sample t-test (P < 0.05). However, no significant difference was observed while comparing improvement scores of posttest versus pretest between both the groups. Mean satisfaction score of simulation group was significantly higher at 8.40 compared to case-based group which was at 7.87. Satisfaction survey showed marked significance (P = 0.03) for simulation-based teaching. Conclusion: As a single intervention, simulation-based teaching is superior to case-based discussion in terms of student satisfaction but remains similarly effective in terms of knowledge acquisition. |
Perception of workplace violence in the emergency department Seema Sachdeva, Nayer Jamshed, Praveen Aggarwal, Suman R Kashyap Journal of Emergencies, Trauma, and Shock 2019 12(3):179-184 Background: Workplace violence (WPV) is a serious issue worldwide. Violence against emergency department (ED) staffs causes significant physical and mental distress which affects work productivity and patient care. Objective: We seek amount and type of WPV perceived by the emergency physicians and nurses, their reporting agencies, and impact of violence on them. Methods: It was a cross-sectional study conducted at a tertiary health care center. Data were collected based on 24-item questionnaire between January and December 2017. Descriptive statistics was used to describe characteristics of participants and exposure to violence. Chi-square and Fisher's exact tests were used for bivariate analysis while logistic regression analysis was to analyze the impact of violence with participant characteristics. P < 0.05 was used to judge the clinical significance. Results: Two hundred and thirty-five participants (123 doctors and 112 nurses) completed the survey. About 67% of the participants (158/235) reported verbal abuse (VA), physical assault (PA) was reported by 17% (40/235), while confrontation was reported by 11% (27/235). Family members were the main perpetrator for VA (75%) and PA (35%). Regarding reporting, the violent incidences were mostly reported to ED security and ED faculty. Individuals with comparatively less age group, less experience, and male gender were more exposed to abuse both VA and PA at P < 0.05. Nurses and junior residents reported more abuse than senior residents (P < 0.05). Majority of the participants had reported lack of job satisfaction due to Verbal abuse (P = 0.01). Conclusion: WPV is common in ED of the current setting. It results in significant physiological and psychological effects on health-care providers. |
“That Can't Be!”: Perceptions of HIV and Hepatitis C screening during admission to an acute care surgery service Alicia R Privette, Pamela L Ferguson, Jama Olsen, Sarah Gay, Lauren E Richey Journal of Emergencies, Trauma, and Shock 2019 12(3):185-191 Background: A large number of patients live with undiagnosed HIV and/or hepatitis C despite broadened national screening guidelines. European studies, however, suggest many patients falsely believe they have been screened during a prior hospitalization. This study aims to define current perceptions among trauma and emergency general surgery (EGS) patients regarding HIV and hepatitis C screening practices. Methods: Prospective survey administered to adult (>18 years old) acute care surgery service (trauma and EGS) patients at a Level 1 academic trauma center. The survey consisted of 13 multiple choice questions: demographics, whether admission tests included HIV and hepatitis C at index and prior hospital visits and whether receiving no result indicated a negative result, prior primary care screening. Response percentages calculated in standard fashion. Results: One hundred and twenty-five patients were surveyed: 80 trauma and 45 EGS patients. Overall, 32% and 29.6% of patients believed they were screened for HIV and hepatitis C at admission. There was no significant difference in beliefs between trauma and EGS. Sixty-eight percent of patients had a hospital visit within 10 years of these, 49.3% and 44.1% believe they had been screened for HIV and hepatitis C. More EGS patients believed they had a prior screen for both conditions. Among patients who believed they had a prior screen and did not receive any results, 75.9% (HIV) and 80.8% (hepatitis C) believed a lack of results meant they were negative. Only 28.9% and 23.6% of patients had ever been offered outpatient HIV and hepatitis C screening. Conclusions: A large portion of patients believe they received admission or prior hospitalization HIV and/or hepatitis C screening and the majority interpreted a lack of results as a negative diagnosis. Due to these factors, routine screening of trauma/EGS patients should be considered to conform to patient expectations and national guidelines, increase diagnosis and referral for medical management, and decrease disease transmission. |
A novel risk score to predict post-trauma mortality in nonagenarians Anthony Kopatsis, Vishaka K Chetram, Katherine Kopatsis, Nicholas Morin, Christine Wagner Journal of Emergencies, Trauma, and Shock 2019 12(3):192-197 Background: Nonagenarians represent a rapidly growing age group who often have functional limitations and multiple comorbidities, predisposing them to trauma. Aims: The purpose of this study was to identify patient characteristics, hospital complications, and comorbidities that predict in-hospital mortality in the nonagenarian population following trauma. We also sought to create a scoring system using these variables. Settings and Design: This study was a retrospective chart review. Methods: We reviewed the medical records of 548 nonagenarian trauma patients admitted to two Level I trauma centers from 2006 to 2015. Statistical analysis was performed using logistic regression and a machine learning model, which calculated significant variables and computed a scoring system. Results: The in-hospital mortality rate was 7.1% (n = 39). Significant predictors of mortality were cardiac comorbidity, neuro-concussion, New Injury Severity Score (ISS) 16+, striking an object, ISS 25–75, and pulmonary and cardiac complications. Significant variables were assigned a numeric value. A score of 5+ carried a 41.1% mortality risk, 79% sensitivity, and 91% specificity. A score of 10+ had an associated 81.8% mortality risk with 31% specificity and 99% sensitivity. Conclusions: Our findings identified reliable predictors of mortality in nonagenarian population posttrauma. The scoring system performs with good specificity and sensitivity and incrementally correlates with mortality risk. |
Injury patterns and outcomes of trauma in the geriatric population presenting to the emergency department in a tertiary care hospital of South India Kundavaram Paul Prabhakar Abhilash, R Tephilah, Sharon Pradeeptha, Karthik Gunasekaran, Gina Maryann Chandy Journal of Emergencies, Trauma, and Shock 2019 12(3):198-202 Background: The geriatric population is more prone for injuries with complications due to their associated comorbidities. This study was done to understand the mode, severity, and outcome of injuries among geriatric patients presenting to the emergency department (ED). Materials and Methods: This retrospective study included all patients >60 years who presented with trauma between October 2014 and March 2015. Details of the incident, injuries, and hospital outcome were noted. Results: Among 8563 geriatric patients, who presented to the ED during the study, 427 (4.9%) patients were trauma related. The mean age was 69 (standard deviation: 6.76) years with 87.6% being young-old (60–79 years) and 12.4% being old-old (>80 years). Majority (63.2%) were Priority 2 patients. The median time between the incident and ED arrival among Priority 1 patients was 3 h (interquartile range: 2–5). Common modes of injuries were slip and fall (37.4%), two-wheeler accidents (25.8%), fall from height (9.1%), and pedestrian (8.9%). The ED team alone managed 25.8% of patients. Specialty departments referred to included orthopedics (48%), neurosurgery (18.3%), plastic surgery (4.2%), HLRS (4%), and others. Injuries due to slip and fall were significantly more among the old-old (P = 0.001), and two-wheeler accidents were more among the young-old (P = 0.001), respectively. Superficial head injuries (28.8%), extremity (24.8%), facial (18.7%), and traumatic brain injuries (17.8%) were common presentations. Thoracic injuries were significantly more among the old-old (P < 0.001). Half (46.3%) of the young-old were discharged stable (P = 0.017). In-hospital mortality rate was 0.7% (3/427), while 12.9% (55/427) left against medical advice due to poor prognosis. Conclusion: Our study demonstrates the pattern of injury seen in the elderly in an urban setting in India. From this, we perceive the need for a prospective study evaluating the causes for geriatric trauma, which would help work on ways to prevent and minimize injuries in the elderly. |
Predictive value of point-of-care lactate measurement in patients meeting Level II and III trauma team activation criteria that Present to the emergency department: A Prospective study Jessica Wentling, Scott P Krall, Afton McNierney, Kelly Dewey, Peter B Richman, Osbert Blow Journal of Emergencies, Trauma, and Shock 2019 12(3):203-208 Background: The aim of this study was to investigate the utility of early point-of-care (POC) lactate levels to help predict injury severity and ultimate emergency department (ED) disposition for trauma patients meeting Level II and III activation criteria. Methods: This was a blinded, prospective cohort study including a convenience sample of patients meeting our triage criteria for Level II or III team activation with stable vital signs. Bedside lactate samples were collected during the secondary survey. Clinical care/disposition was at the discretion of physicians who remained blinded to the bedside lactate result. An elevated lactate was defined as >2.0 mmol/L. Results: Ninety-six patients were in the study group; mean age was 41 ± 17 years, 26% were female, 57% were Hispanic, and 60% admitted. We found no difference in initial mean POC lactate levels (mmol/L) for admitted versus discharged groups and Injury Severity Score (ISS) ≥9 versus ISS <9 groups (3.71 [95% confidence interval (CI): 3.1–4.4] vs. 3.85 [95% CI: 2.8–4.9];P= 0.99 and 3.54 [95% CI: 2.7–4.4] vs. 3.89 [95% CI: 3.1–4.6];P= 0.60, respectively). Performance characteristics of early elevated lactate levels were poor both to predict need for hospital admission (sensitivity = 77% [65%–87%]; specificity = 26% [13%–43%]; negative predictive value [NPV] = 43% [27%–61%]; and positive predictive value [PPV] = 62% [56%–67%]) and to identify patients with ISS scores ≥9 (sensitivity = 76% [59%–89%]; specificity = 24% [14%–37%]; NPV = 65% [47%–80%]; and PPV = 36% [30%–41%]). Conclusions: For Level II/III, we found that early bedside lactate levels were not predictive of ISS ≥9 or the need for admission. Level of Evidence: III (diagnostic test). |
Evolution of the Qatar trauma system: The journey from inception to verification Hassan Al-Thani, Ayman El-Menyar, Mohammad Asim, Monira Mollazehi, Husham Abdelrahman, Ashok Parchani, Rafael Consunji, Nicholas Castle, Mohamed Ellabib, Ammar Al-Hassani, Ahmed El-Faramawy, Ruben Peralta Journal of Emergencies, Trauma, and Shock 2019 12(3):209-217 Traumatic injuries accounted for substantial burden of morbidity and mortality (M and M) worldwide. Despite better socioeconomic conditions and living standards, the incidence of trauma is rising in the Eastern Mediterranean Region (EMR). Road traffic injuries are the leading cause of the high fatality rate in young economically productive adults in our region. The provision of trauma care at high-volume, accredited trauma center by a team of dedicated full-time professional health-care providers has been shown to improve the quality of care and the outcomes for trauma victims. With persistent hard work and effective leadership, in Qatar, the Trauma Section has evolved into a well-reputed and internationally recognized Center of Excellence in Trauma Care, Hamad Level 1 Trauma Center. In 2014, Qatar Trauma System was accredited with Trauma Distinction Award by the Accreditation Canada International, for high-quality trauma care of severely injured patients; first in the Middle East. The Hamad Trauma Center is committed to the advancement of trauma care in different aspects right from the immediate prehospital care to the subsequent hospital-based care, involving diagnosis, treatment, support, rehabilitation, and community reintegration of the patients and injury prevention. Our trauma system has gradually embedded with a structured and matured research unit with dedicated clinicians and academic researchers. The trauma team embodies the 21st-century paradigm of translational research and injury prevention by going well beyond the bedside, out into the populations that need it most. The trauma system's future vision relies on the evidence-based health-care service and better outcomes; state-of-the-art infrastructure and multidimensional collaborations with health care and governmental services to minimize the burden of M and M caused by traumatic injury in the State of Qatar and to fulfill the population health enhancement strategy. |
ΩτοΡινοΛαρυγγολόγος Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,
Translate
Ετικέτες
Δευτέρα 26 Αυγούστου 2019
Αναρτήθηκε από
Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,
στις
11:01 μ.μ.
Ετικέτες
00302841026182,
00306932607174,
alsfakia@gmail.com,
Anapafseos 5 Agios Nikolaos 72100 Crete Greece,
Medicine by Alexandros G. Sfakianakis
Εγγραφή σε:
Σχόλια ανάρτησης (Atom)
Αρχειοθήκη ιστολογίου
-
►
2023
(278)
- ► Φεβρουαρίου (139)
- ► Ιανουαρίου (139)
-
►
2022
(1962)
- ► Δεκεμβρίου (107)
- ► Σεπτεμβρίου (158)
- ► Φεβρουαρίου (165)
- ► Ιανουαρίου (163)
-
►
2021
(3614)
- ► Δεκεμβρίου (152)
- ► Σεπτεμβρίου (271)
- ► Φεβρουαρίου (64)
- ► Ιανουαρίου (357)
-
►
2020
(3279)
- ► Δεκεμβρίου (396)
- ► Σεπτεμβρίου (157)
- ► Φεβρουαρίου (382)
- ► Ιανουαρίου (84)
-
▼
2019
(11718)
- ► Δεκεμβρίου (265)
- ► Σεπτεμβρίου (545)
-
▼
Αυγούστου
(750)
- Medicine by Alexandros G. Sfakianakis,Anapafseos 5...
- Inflammation
- Radiology
- Programmed chromosome fission and fusion enab...
- Distinct immunology of the placenta
- Topography of the central retinal artery rele...
- No ‘gay gene’: Massive study homes in on gen...
- American Journal of Primatology
- Dermatological and Epidemiological Profiles ...
- Reply to Dr. Suga and Dr. Takenoshita Abstr...
- Με αυτό τον τρόπο το παιδί δεν θα εκδηλώσει ...
- Legends of Allergy and Immunology: Donald Y....
- The use of aggregation-induced emission prob...
- Αυτό το παυσίπονο αυξάνει τον κίνδυνο υπογλυ...
- VASCULARITY TARGETED PERCUTANEOUS ETHANOL IN...
- Leucine depletion extends the lifespans of l...
- Trends in Mortality From Human Immunodeficien...
- Associations between cerebrovascular risk fa...
- Stem Cells in the Treatment of Disease New E...
- Head and Neck
- British Journal of Oral and Maxillofacial Sur...
- Cancer Science
- Clinical Anatomy
- Medicine by Alexandros G. Sfakianakis,Anapafseos 5...
- Nanomaterials, Vol. 9, Pages 1218: Fabrica...
- Medicina, Vol. 55, Pages 547: Total Serum ...
- International Journal of Environmental Resear...
- Arts, Vol. 8, Pages 111: The Persistence o...
- Arbuscular mycorrhiza and plant chromium toleran...
- Adenine decreases hypertrophic effects through i...
- Degradation of 17α-ethinylestradiol by Enterobac...
- Special issue on Intelligence Computation Evolut...
- A nonlinear state marginal price vector model fo...
- What's new in academic International medicine? T...
- Mādhyamikas Playing Bad Hands: The Case of Custo...
- Microporous scaffolds support assembly and diffe...
- The Gender Gap in Globalization and Well-Being A...
- Evaluation of a trap-and-transport program for a...
- Proceedings of the Royal Society B, Vol. 286, ...
- Nuclear Medicine and Molecular Imaging, FDG PET...
- Experimental DermatologyVolume 28, Issue 9Pages:...
- Understanding Connection Between Poverty, Child...
- Surveillance efficiency evaluation of air qualit...
- Opioid Prescribing Can Be Reduced in Oral and Ma...
- Exploring How Pediatric Residents Develop Adapti...
- Perceptions of Sexual Harassment in Oral and Max...
- Comparative Efficacy of 35% Glycolic Acid Peel A...
- The impact of a complex consulting process with ...
- Oropharyngeal recovery in a patient with the phar...
- Platelet-rich plasma protocols can potentiate vas...
- Relationship between Obesity and Balance in the ...
- Dabigatran for catastrophic antiphospholipid syn...
- Recovery of left ventricular twist and left vent...
- Don't Panic, Scientists Haven't Shown C-Section...
- USDA food safety leaders By Dan Flynn on Aug 29,...
- cGMP Signaling and Modulation in Heart FailureCy...
- SAGE Cardiology and Cardiovascular Medicine hu...
- A clinical comparative study of four interocclus...
- Global vascular guidelines on the management of ...
- Wound Repair and RegenerationEarly View Online...
- The ellipselet transformZahra Khodabandeh, Hosse...
- Public Health Law News Announcements...
- Determining the Association Between End-of-Life ...
- Incidence and risk factors of postoperative deli...
- Prognostic predictions based on pathological fin...
- Public Health Policies on E-Cigarettes Abstract ...
- Comparison of drug-eluting balloon with repeat d...
- What will surgical coronary revascularization lo...
- Anaesthetic considerations in nonagenarians and ...
- The statement of the Asia-Pacific Association fo...
- Duration of allergen immunotherapy for inhalant ...
- Transcranial Shear Wave Elastography of Neonatal...
- Effects of adjuvant mental practice using invers...
- Evidence-Based Use of Perioperative Antibiotic...
- Associations of awake and asleep blood pressure ...
- Diagnostic ‘nightmares’ in an HIV patient with a...
- Comparison of Commercial Enzyme-Linked Immunos...
- Archives of Disease in Childhood
- Segmental arterial mediolysis (SAM) is a nonathero...
- Cardiac MRI,
- Methods Used to Maximize Follow-up: Lessons Lear...
- Memories of Donald Dean Trunkey, Life-Saving Int...
- Building Blocks for Addressing Social Determin...
- Magnetic Resonance Imaging for the Follow-up of ...
- Pakistan Journal of Biological Sciences - Curre...
- Current Status and Future of Robotic Colorectal ...
- Daily Functioning in Schizophrenia: Is There Roo...
- Home-Based Cardiac Rehabilitation: A SCIENTIFIC...
- Obstructive Sleep Apnea and Primary Open-angle G...
- Correcting a Deficiency: Furthering Our Knowledg...
- Immunosuppression and Graft Rejection in Living-...
- American Journal of Orthodontics and Dentofacial O...
- The Pediatric Home Health Care Process: Perspe...
- ► Φεβρουαρίου (1143)
- ► Ιανουαρίου (744)
-
►
2017
(2)
- ► Φεβρουαρίου (1)
- ► Ιανουαρίου (1)
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου