Current Issue : October - December Volume : 2017 Issue Number : 4 Articles : 6 Articles
Background: Hypothermia is common in trauma victims and is associated with increased mortality, however its\ncauses are little known. The objective of this study was to identify the risk factors associated with hypothermia in\nprehospital management of trauma victims.\nMethods: This was an ancillary analysis of data recorded in the HypoTraum study, a prospective multicenter study\nconducted by the emergency medical services (EMS) of 8 hospitals in France. Inclusion criteria were: trauma victim,\nage over 18 years, and victim receiving prehospital care from an EMS team and transported to hospital by the EMS\nteam in a medically equipped mobile intensive care unit. The following data were recorded: victim demographics,\ncircumstances of the trauma, environmental factors, patient presentation, clinical data and time from accident to\nEMS arrival. Independent risk factors for hypothermia were analyzed in a multivariate logistic regression model.\nResults: A total of 461 trauma patients were included in the study. Road traffic accidents (N = 261; 57%) and falls\n(N = 65; 14%) were the main causes of trauma. Hypothermia (<35 �°C) was present in 136/461 cases (29%). Independent\nfactors significantly associated with the presence of hypothermia were: a low GCS (Odds Ratio (OR) = 0,87 ([0,81-0,92];\np < 0.0001), a low air temperature (OR = 0,93 [0,91-0,96]; p < 0.0001) and a wet patient (OR = 2,08 [1,08-4,00]; p = 0.03).\nConclusion: The incidence of hypothermia was high on EMS arrival at the scene. Body temperature measurement and\nimmediate thermal protection should be routine, and special attention should be given to patients who are wet.\nLevel of evidence: Prospective, multicenter, open, observational study; Level IV....
Background: Traumatic, non-iatrogenic esophageal injuries, despite their rarity, are associated with significant\nmorbidity and mortality. The optimal management of these esophageal perforations remains largely debated.\nTo date, only a few small case series are available with contrasting results. The purpose of this study was to examine a\nlarge contemporary experience with traumatic esophageal injury management and to analyze risk factors associated\nwith mortality.\nMethods: This National Trauma Data Bank (NTDB) database study included patients with non-iatrogenic esophageal\ninjuries. Variables abstracted were demographics, comorbidities, mechanism of injury, Abbreviated Injury Scale (AIS),\nesophageal Organ Injury Scale (OIS), Injury Severity Score (ISS), level of injury, vital signs, and treatment. Multivariate\nanalysis was used to identify independent predictors for mortality and overall complications.\nResults: A total of 944 patients with non-iatrogenic esophageal injury were included in the final analysis. The cervical\nsegment of the esophagus was injured in 331 (35%) patients. The unadjusted 24-h mortality (8.2 vs. 14%, p = 0.\n008), 30-day mortality (4.2 vs. 9.3%, p = 0.005), and overall mortality (7.9 vs. 13.5%, p = 0.009) were significantly\nlower in the group of patients with a cervical injury. The overall complication rate was also lower in the cervical\ngroup (19.8 vs. 27.1%, p = 0.024). Multilogistic regression analysis identified age >50, thoracic injury, high-grade\nesophageal injury (OIS IVââ?¬â??V), hypotension on admission, and GCS <9 as independent risk factors associated with increased\nmortality. Treatment within the first 24 h was found to be protective (OR 0.284; 95% CI, 0.148ââ?¬â??0.546; p < 0.001). Injury to the\nthoracic esophagus was also an independent risk factor for overall complications (OR 1.637; 95% CI, 1.06ââ?¬â??2.53; p = 0.026).\nConclusions: Despite improvements in surgical technique and critical care support, the overall mortality for traumatic\nesophageal injury remains high. The presence of a thoracic esophageal injury and extensive esophageal damage are the\nmajor independent risk factors for mortality. Early surgical treatment, within the first 24 h of admission, is associated with\nimproved survival...
Background: Although open-chest cardiopulmonary resuscitation (OCCPR) is often considered as the last salvage\nmaneuver in critically injured patients, evidence on the effectiveness of OCCPR has been based only on the\ndescriptive studies of limited numbers of cases or expert opinions. This study aimed to compare the effectiveness\nof OCCPR with that of closed-chest cardiopulmonary resuscitation (CCCPR) in an emergency department (ED).\nMethods: A nationwide registry-based, retrospective cohort study was conducted. Patients with blunt trauma,\nundergoing cardiopulmonary resuscitation (CPR) in an ED between 2004 and 2015 were identified and divided\ninto OCCPR and CCCPR groups. Their outcomes (survival to hospital discharge and survival over 24 hours\nfollowing ED arrival) were compared with propensity score matching analysis and instrumental variable analysis.\nResults: A total of 6510 patients (OCCPR, 2192; CCCPR, 4318) were analyzed. The in-hospital and 24-hour survival\nrates in OCCPR patients were 1.8% (40/2192) and 5.6% (123/2192), and those in CCCPR patients were 3.6% (156/4318) and\n9.6% (416/4318), respectively. In the propensity score-matched subjects, OCCPR patients (n = 1804) had significantly lower\nodds of survival to hospital discharge (odds ratio (95% CI)) = 0.41 (0.25ââ?¬â??0.68)) and of survival over 24 hours following ED\narrival (OR (95% CI) = 0.59 (0.45ââ?¬â??0.79)) than CCCPR patients (n = 1804). Subgroup analysis revealed that OCCPR was\nassociated with a poorer outcome compared to CCCPR in patients with severe pelvis and lower extremity injury.\nConclusions: In this large cohort, OCCPR was associated with reduced in-hospital and 24-hour survival rates in patients\nwith blunt trauma. Further comparisons between OCCPR and CCCPR using additional information, such as time\ncourse details in pre-hospital and ED settings, anatomical details regarding region of injury, and neurological\noutcomes, are necessary....
Post-traumatic meningioma is a matter of controversy with many reported\ncases of cranial post-traumatic meningioma and rare cases for such pathology\nin human spine. The author reports a 61-year-old woman who had post-traumatic\nspinal meningioma at the site of old traumatic fracture for 26 year after\nher initial trauma. The patient treated successfully with microsurgical resection\nand posterior fusion with improvement of here recent weakness. The author\nreviews the literatures for similar cases as well as reviews the controversies\nregarding the development of post-traumatic meningiomas....
Background. Prolonged storage of packed red blood cells (PRBCs) may increase morbidity and mortality, and patients having\nmassive transfusion might be especially susceptible.We therefore tested the hypothesis that prolonged storage increasesmortality in\npatients receiving massive transfusion after trauma or nontrauma surgery. Secondarily, we considered the extent to which storage\neffects differ for trauma and nontrauma surgery. Methods. We considered surgical patients given more than 10 units of PRBC\nwithin 24 hours and evaluated the relationship between mean PRBC storage duration and in-hospital mortality usingmultivariable\nlogistic regression. Potential nonlinearities in the relationship were assessed via restricted cubic splines. The secondary hypothesis\nwas evaluated by considering whether there was an interaction between the type of surgery (trauma versus nontrauma) and the\neffect of storage duration on outcomes. Results. 305 patients were given a total of 8,046 units of PRBCs, with duration ranging from\n8 to 36 days (mean �± SD: 22 �± 6 days). The odds ratio [95% confidence interval (CI)] for in-hospital mortality corresponding to a\none-day in mean PRBC storage duration was 0.99 (0.95, 1.03, ...
Background: Treatment-limiting decisions (TLD) for severe traumatic brain injury (sTBI) have been sparsely studied.\nThis study determine prevalence, main reason for, categories and timing of TLDs in a Norwegian regional trauma\nsetting.\nMethods: A retrospective study of a 2-year cohort of 579 sTBI patients admitted to Oslo University Hospital (OUH).\nProspectively collected data in the OUH Trauma Registry were combined with retrospective data from a chart\nreview regarding TLDs.\nResults: TLDs were documented for 101/579 sTBI patients (17%). The situation was evaluated as futile in 59\ncases and as potentially inappropriate in 42 cases. The three most frequent types of TLDs were withholding\nof neurosurgery, do not resuscitate orders and withdrawing of organ support. In 70% of cases, the first TLD\nwas made within 2 days after injury, while in 14%, the first TLD was made later than day 7. Twenty percent\n(20/101) of the first TLDs were later adjusted, revoked in 4 patients and broadening of TLDs in 16 patients.\nThe median time from the decision to death was 2 days (range 1ââ?¬â??652). TLDs were documented in 93% of\nin-hospital death cases (n = 79). In-hospital deaths occurred in 73% of TLD group cases and 1% of non-TLD\ngroup cases. Family interaction and multi-team discussions were documented in >88% of cases, but no\nadvanced directives were found, and notifications of patientsââ?¬â?¢ preferences were found in only 7% of cases.\nDiscussion: Clinicians should consider limiting treatment if continued treatment is not in the patients best\ninterest. A range of different types of TLDs were applied for patients after sTBI in the trauma hospital setting.\nConclusion: TLDs were found in 17% of sTBI patients. Value considerations behind TLDs in this care context\nneed to be further explored....
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