Current Issue : July - September Volume : 2014 Issue Number : 3 Articles : 5 Articles
Background: Securing high-quality mortality statistics requires systematic evaluation of all trauma deaths. We\nexamined the proportion of trauma patients dying within 30 days from causes not related to the injury and the\nimpact of exclusion of patients dead on arrival on 30-day trauma mortality. We also defined the demographics,\ninjury characteristics, cause of death and time to death in patients admitted to our trauma center who died within\n30 days, between 2007-2011.\nMethods: Demographics, injury characteristics, status alive/dead on arrival, cause of death and time to death of\nall patients were reviewed. Deaths were analyzed based on injury mechanism (penetrating, blunt trauma and\nlow energy blunt trauma) and cause of death (traumatic brain injury (TBI), hemorrhage, organ dysfunction and\nother/unknown).\nResults: Of the 7422 admissions, 343 deaths were identified of which 36 (10.5%) involved causes not related to\nthe injury. The overall age was 71 years, Injury Severity Score (ISS) 29 and time to death 24 hours (all medians).\nFifty-four patients (17.6%) were dead on arrival. Exclusion of patients dead on arrival reduced the overall mortality\nrate (P < 0.05) and median ISS (P < 0.05) and increased median age (P < 0.01) and time to death (P < 0.001). Injury\nmechanism was penetrating trauma in 7.5%, blunt trauma in 56.0%, and low energy blunt trauma in 36.5%. TBI\naccounted for 58.6%; hemorrhage 16.3%, organ dysfunction 15.0%, and other/unknown for 10.1% of the deaths.\nPatients who died after low energy blunt trauma were older, had lower ISS and longer time to death compared\nto those who died after penetrating and blunt trauma (all P < 0.01).\nConclusions: Clinical review of all trauma deaths was essential to interpret mortality. Thirty-day trauma mortality\nincluded 10.5% deaths not directly related to the injury and the exclusion of patients dead on arrival significantly\naffected the unadjusted mortality rate, ISS, median age and time to death....
Objective: Trauma is one of the most common causes of morbidity and mortality in modern society, and traumatic\nbrain injuries (TBI) are the single leading cause of mortality among young adults. Pre-hospital acute care management\nhas developed during recent years and guidelines have shown positive effects on the pre-hospital treatment and\noutcome for patients with severe traumatic brain injury. However, reports of impacts on improved nursing competence\nin the ambulance services are scarce. Therefore, the aim of this study was to investigate if increased nursing competence\nlevel has had an impact on pre-hospital assessment and interventions in severe traumatic brain-injured patients in the\nambulance services.\nMethod: A retrospective study was conducted. It included all severe TBI patients (>15 years of age) with a Glasgow\nComa Score (GCS) of less than eight measured on admission to a level one trauma centre hospital, and requiring\nintensive care (ICU) during the years 2000ââ?¬â??2009.\nResults: 651 patients were included, and between the years 2000ââ?¬â??2005, 395 (60.7%) severe TBI patients were injured,\nwhile during 2006ââ?¬â??2009, there were 256 (39.3%) patients. The performed assessment and interventions made at the\nscene of the injury and the mortality in hospital showed no significant difference between the two groups. However,\nthe assessment of saturation was measured more frequently and length of stay in the ICU was significantly less in the\ngroup of TBI patients treated between 2006ââ?¬â??2009.\nConclusion: Greater competence of the ambulance personnel may result in better assessment of patient needs, but\nshowed no impact on performed pre-hospital interventions or hospital mortality....
Patients in the intensive care unit (ICU) are at risk of developing of intra abdominal hypertension (IAH) and\nabdominal compartment syndrome (ACS).\nAim: This review seeks to define IAH and ACS, identify the aetiology and presentation of IAH and ACS, identify IAP\nmeasurement techniques, identify current management and discuss the implications of IAH and ACS for nursing\npractice. A search of the electronic databases was supervised by a health librarian. The electronic data bases\nCumulative Index of Nursing and Allied Health Literature (CINAHL); Medline, EMBASE, and the World Wide Web was\nundertaken from 1996- January 2011 using MeSH and key words which included but not limited to: abdominal\ncompartment syndrome, intra -abdominal hypertension, intra-abdominal pressure in adult populations met the\nsearch criteria and were reviewed by three authors using a critical appraisal tool. Data derived from the retrieved\nmaterial are discussed under the following themes: (1) etiology of intra-abdominal hypertension; (2) strategies for\nmeasuring intra-abdominal pressure (3) the manifestation of abdominal compartment syndrome; and (4) the\nimportance of nursing assessment, observation and interventions. Intra-abdominal pressure (IAP) and abdominal\ncompartment syndrome (ACS) have the potential to alter organ perfusion and compromise organ function...
Background: Africa has 4% of the global vehicles but accounts for about one tenth of global vehicular deaths.\nMajor trauma in Kenya is associated with excess mortality in comparison with series from trauma centers. The\ndeterminants of this mortality have not been completely explored.\nObjectives: To determine the factors affecting mortality among road users in Nairobi, Kenya.\nMethods: Cross-sectional study of prospectively collected data of trauma admissions at the Kenyatta National\nHospital over a calendar year (2009ââ?¬â??2010). Information collected included age, gender, road user type, principal\nanatomical region of injury, admission status, admission blood pressure and GCS, disposition destination, Injury\nSeverity Score (ISS), injuries sustained, treatment and mortality at two weeks. Major or severe injury was defined as\ninjuries of ISS > 15. Groups based on in-hospital survival were compared using determinants of mortality using X2\nor students t-test as appropriate. Logistic regression was used to assess the independence of predictive variables.\nResults: One thousand six hundred forty seven (1647) patients were admitted for trauma during the study period.\nTraffic admissions were 1013 (61.7%) and males predominated (79.8%). The average age of patients admitted was\n31.7 years. Pedestrians, vehicle occupants and motorcyclists represented 43.3%, 27.2% and 15.2% of the road users\ninjured. The proportion of patients with ISS > 15 was 10.9%.\nThe overall mortality was 7.7%. Mortality for ISS > 15 was 27.6%. The following factors significantly predicted\nmortality on univariate analysis: head injury, abdominal injury, transfer in status, blood transfusion, ICU admission,\nage > 60 years, Glasgow coma scale (GCS) and injury severity. GCS (p = 0.001) and ISS > 15 (p < 0.05) remained\nsignificant predictors on regression analysis.\nConclusion: Trauma mortality rates in this study exceed those from mature trauma systems. Head injury and\ninjury severity based on the ISS are independent predictors of mortality after traffic trauma. Improvements in\nneurosurgical and critical care services ingrained within wider primary and secondary prevention initiatives are\nlogical targets....
Background: In 2005, the Advanced Life Support (ALS) teams delivering pre-hospital care in RegionSkane in\nsouthern Sweden received additional support by physicians, who were part of ââ?¬Å?Pre-hospital acute teamsââ?¬Â (PHAT).\nThe study objective is to compare the incidence of pre-hospital medical interventions for trauma-patients cared for\nby conventional ALS teams and patients who received additional support by PHAT.\nMethods: Trauma patients with Injury Severity Score (ISS) >9 were identified retrospectively in the national quality\nregistry KVITTRA at three hospitals in RegionSkane, for the time period October 2005 to December 2008.\nInterventions include e.g. tracheal intubation, administration of i.v. fluids, neck immobilization and spine board\nusage. Confounding effects from trauma severity, trauma mechanism, vital parameters, age and sex were addressed\nin multivariate models.\nResults: Data from 202 cases was included. 9 pre-hospital interventions were assessed. The incidence of\nendotracheal intubation and immobilisation of extremities was higher among patients in the PHAT-group\ncompared to the ALS-only group (16.3% vs. 6.9%, p = 0.034) and (12.8% vs. 4.3%, p = 0.027) respectively. PHATs\npresence remained a significant predictor of these interventions also after taking confounding factors into account\n(OR 5.5, CL 1.5-19.7) and (OR 3.2 CI 1.0-9.8).\nPHAT was involved in a greater proportion of cases with <50.0% of survival (19.8% vs. 12.1%, p = 0.134). The average\nISS was higher among cases receiving PHAT support in strata ISS 16-24 and ISS > 24 than cases in corresponding\nstrata cared for by ALS teams alone (ISS 20.0 vs. 17.0, p = 0.048 and ISS 34.0 vs. 29.0, p = 0.019).\nConclusions: The incidence of endotracheal intubation and immobilization of extremities was greater among\npatients supported by PHAT, compared to patients cared for by ALS teams alone. This finding has to be interpreted\nin the light of a selection-bias where PHAT support was directed to more severely injured patients...
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