Current Issue : January - March Volume : 2015 Issue Number : 1 Articles : 5 Articles
Objective: Severe burns are devastating injuries that result in considerable systemic inflammation and often require\nresuscitation with large volumes of fluid. The result of massive resuscitation is often raised intra-abdominal pressures\nleading to Intra-abdominal hypertension (IAH) and the secondary abdominal compartment syndrome. The objective\nof this study is to conduct (1) a 10 year retrospective study to investigate epidemiological factors contributing to\nburn injuries in Alberta, (2) to characterize fluid management and incidence of IAH and ACS and (3) to review fluid\nresuscitation with a goal to identify optimal strategies for fluid resuscitation.\nDesign: A comprehensive 10-year retrospective review of burn injuries from 1999.\nOutcome Measures: Age, sex, date, mechanism of injury, location of incident, on scene vitals and GCS, type of\ntransport to hospital and routing, ISS, presenting vitals and GCS, diagnoses, procedures, complications, hospital LOS,\nICU LOS, and events surrounding the injury.\nResults: One hundred and seventy five patients (79.4% M, 20.6% F) were identified as having traumatic burn\ninjuries with a mean ISS score of 21.8 (�±8.3). The mean age was 41.6 (�±17.5) (range 14-94) years. Nearly half (49.7%)\nof patients suffered their injuries at home, 17.7% were related to industrial incidents and 14.3% were MVC related.\nOne hundred and ten patients required ICU admission. ICU LOS 18.5 (�±8.8) days. Hospital LOS 38.0 (�±37.8) days. The\nmean extent of burn injury was 31.4 (�±20.9) % TBSA. Nearly half of the patients suffered inhalational injuries (mild\n12.5%, moderate 13.7%, severe 9.1%). Thirty-nine (22.2%) of patients died from their injuries. Routine IAP monitoring\nbegan in September, 2005 with 15 of 28 patients having at least two IAP measurements. The mean IAP was 16.5\n(�±5.7) cm H2O (range: 1-40) with an average of 58 (�±97) IAP measurements per patient. Those patients with IAP\nmonitoring had an average TBSA of 35.0 (�±16.0)%, ISS of 47.5 (�±7.5). The mean 48 hr fluid balance was 25.6 (�±11.1)L\nexceeding predicted Parkland formula estimates by 86 (�±32)%.\nConclusions: Further evaluation of IAP monitoring is needed to further characterize IAP and fluid resuscitation in\npatients with burn injuries....
Introduction: Damage control surgery and damage control resuscitation have reduced mortality in patients with\nsevere abdominal injuries. The shift towards non-operative management in haemodynamically stable patients\nsuffering blunt abdominal trauma has further contributed to the improved results. However, in many countries, low\nvolume of trauma cases and limited exposure to trauma laparotomies constitute a threat to trauma competence.\nThe aim of this study was to evaluate the institutional patient volume and performance for patients with abdominal\ninjuries over an eight-year period.\nMethods: Data from 955 consecutive trauma patients admitted in Oslo University Hospital Ulleval with abdominal\ninjuries during the eight-year period 2002-2009 were retrospectively explored. A separate analysis was performed\non all trauma patients undergoing laparotomy during the same period, whether abdominal injuries were identified\nor not. Variable life-adjusted display (VLAD) was used in order to describe risk-adjusted survival trends throughout\nthe period and the patients admitted before (Period 1) and after (Period 2) the institution of a formal Trauma\nService (2005) were compared.\nResults: There was a steady increase in admitted patients with abdominal injuries, while the number of patients\nundergoing laparotomy was constant exposing the surgical trauma team leaders to an average of 8 trauma\nlaparotomies per year. No increase in missed injuries or failures of non-operative management was detected.\nUnadjusted mortality rates decreased from period 1 to period 2 for all patients with abdominal injuries as well as\nfor the patients undergoing laparotomy. However, this apparent decrease was not confirmed as significant in\nTRISS-based analysis of risk-adjusted mortality. VLAD demonstrated a steady performance throughout the study\nperiod.\nConclusion: Even in a high volume trauma center the exposure to abdominal injuries and trauma laparotomies is\nlimited. Due to increasing NOM, an increasing number of patients with abdominal injuries was not accompanied by\nan increase in number of laparotomies. However, we have demonstrated a stable performance throughout the\nstudy period as visualized by VLAD without an increase in missed injuries or failures of NOM...
Background: Rib series (RS) are a special radiological technique to improve the visualization of the bony parts of\nthe chest.\nObjectives: The aim of this study was to evaluate the diagnostic accuracy of rib series in minor thorax trauma.\nMethods: Retrospective study of 56 patients who received RS, 39 patients where additionally evaluated by plain\nchest film (PCF). All patients underwent a computed tomography (CT) of the chest. RS and PCF were re-read\nindependently by three radiologists, the results were compared with the CT as goldstandard. Sensitivity, specificity,\nnegative and positive predictive value were calculated. Significance in the differences of findings was determined\nby McNemar test, interobserver variability by Cohens kappa test.\nResults: 56 patients were evaluated (34 men, 22 women, mean age =61 y.). In 22 patients one or more rib fracture\ncould be identified by CT. In 18 of these cases (82%) the correct diagnosis was made by RS, in 16 cases (73%) the\ncorrect number of involved ribs was detected. These differences were significant (p = 0.03). Specificity was 100%,\nnegative and positive predictive value were 85% and 100%. Kappa values for the interobserver agreement was\n0.92-0.96. Sensitivity of PCF was 46% and was significantly lower (p = 0.008) compared to CT.\nConclusions: Rib series does not seem to be an useful examination in evaluating minor thorax trauma. CT seems\nto be the method of choice to detect rib fractures, but the clinical value of the radiological proof has to be\ndiscussed and investigated in larger follow up studies....
Background: Equestrian sports are common outdoor activities that may carry a risk of liver injury. Due to the\nrelative infrequency of equestrian accidents the injury patterns and outcomes associated with liver trauma in these\npatients have not been well characterized.\nMethods: We examined our experience of the management of equestrian liver trauma in our regional\nhepatopancreaticobiliary unit at a tertiary referral center. The medical records of patients who sustained liver trauma\nsecondary to equestrian activities were analysed for parameters such as demographic data, liver function tests,\npatterns of injury, radiological findings, the need for intervention and outcomes.\nResults: 20 patients sustained liver trauma after falling from or being kicked by a horse. The majority of patients\nwere haemodynamically stable on admission. Alanine transaminase (ALT) levels were elevated in all patients and\nright-sided rib fractures were a frequently associated finding. CT demonstrated laceration of the liver in 12 patients,\ncontusion in 3 and subcapsular haematoma in 2. The right lobe of the liver was most commonly affected. Only two\npatients required laparotomy and liver resection; the remaining 18 were successfully managed conservatively.\nConclusions: The risk of liver injury following a horse kick or falling off a horse should not be overlooked. Early CT\nimaging is advised in these patients, particularly in the presence of high ALT levels and concomitant chest injuries\nsuch as rib fractures. Despite significant liver trauma, conservative management in the form of close observation,\nideally in a high-dependency setting, is often sufficient. Laparotomy is only rarely warranted and associated with a\nsignificantly higher risk of post-operative bile leaks....
Background: Trauma remains one of the leading causes of morbidity and mortality worldwide. Generally, the\nincidence of traumatic injuries is disproportionately high in males. However, trauma in females is underreported.\nAim: To study the epidemiology and outcome of different mechanisms and types of traumatic injuries in women.\nMethods: We conducted a traditional narrative review using PubMed, MEDLINE and EMBASE, searching for\nEnglish-language publications for gender-specific trauma between January 1993 and January 2013 using key words\nââ?¬Å?traumaââ?¬Â, ââ?¬Å?genderââ?¬Â, ââ?¬Å?femaleââ?¬Â and ââ?¬Å?womenââ?¬Â.\nResults: Among 1150 retrieved articles, 71 articles were relevant over 20 years. Although it is an important public\nhealth problem, traumatic injuries among females remain under-reported.\nConclusion: There is a need for further research and evaluation of the exact burden of traumatic injuries among\nfemales together with the implementation of effective community based preventive programs....
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