Current Issue : October - December Volume : 2012 Issue Number : 4 Articles : 5 Articles
Background: HIV infection in a patient with burn injuries complicates the care of both the patient and the\r\ntreating burn team. This study was conducted to establish the prevalence of HIV among burn patients in our\r\nsetting and to compare the outcome of these patients who are HIV positive with those who are HIV negative.\r\nMethods: This was a prospective cohort study involving burn injury patients admitted to Mulago Hospital\r\nbetween November 2005 and February 2006. Patients were stratified into HIV positive (exposed) group and HIVnegative\r\n(unexposed) group. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS\r\nstatistical computer software version 11.5.\r\nResults: Of the 130 patients included in the study, 17 (13.1%) patients tested HIV positive and this formed the study\r\n(exposed) group. The remaining 113 patients (86.9%) formed the control (unexposed) group. In the HIV positive group,\r\nfemales outnumbered males by a ratio of 1.4:1 and the mean age was 28.4 �± 21.5 years (range 3 months-34 years).\r\n64.7% of HIV positive patients reported to have risk factors for HIV infection. Of these, multiple sexual partners [Odds\r\nRatio 8.44, 95% C.I. (3.87-143.23), P = 0.011] and alcoholism [Odds Ratio 8.34, 95% C.I. (5.76-17.82), P = 0.002] were found\r\nto be independently and significantly associated with increased risk to HIV infection. The mean CD4 count for HIV\r\npositive and HIV negative patients were 394 �± 328 cells/�µL and 912 �± 234 cells/�µL respectively which is statistically\r\nsignificant (P = 0.001). There was no difference in the bacteria cultured from the wounds of HIV positive and negative\r\npatients (P = 0.322). Patients with clinical signs of sepsis had lower CD4 counts compared to patients without sepsis\r\n(P < 0.001). ). Skin grafting was carried out in 35.3% of HIV negative patients and 29.4% of HIV positive patients with no\r\nsignificant difference in skin graft take and the degree of healed burn on discharge was the same (P = 0.324). There was\r\nno significant difference in hospital stay between HIV positive and negative patients (P = 0.674). The overall mortality\r\nrate was 11.5%. Using multivariate logistic regression analysis, mortality rate was found to be independently and\r\nsignificantly related to the age of the patient, HIV positive with stigmata of AIDS, CD4 count, inhalation injury, %TBSA\r\nand severity of burn (p-value < 0.001).\r\nConclusion: HIV infection is prevalent among burn injury patients in our setting and thus presents an occupational\r\nhazard to health care workers who care for these patients. All burn health care workers in this region need to\r\npractice universal precautions in order to reduce the risk of exposure to HIV infection and post-exposure\r\nprophylaxis should be emphasized. The outcome of burn injury in HIV infected patients is dependent upon\r\nmultiple variables such as age of the patient, inhalation injury and %TBSA and not the HIV status alone....
Background: Injuries from skiing and snowboarding became a major challenge for emergency care providers in\r\nSwitzerland. In the alpine setting, early assessment of injury and health status is essential for the initiation of\r\nadequate means of care and transport. Nevertheless, validated standardized protocols for on-slope triage are\r\nmissing. This article can assist in understanding the characteristics of injured winter sportsmen and exigencies for\r\nfuture on-slope triage protocols.\r\nMethods: Six-year review of trauma cases in a tertiary trauma centre. Consecutive inclusion of all injured skiers and\r\nsnowboarders aged >15 (total sample) years with predefined, severe injury to the head, spine, chest, pelvis or\r\nabdomen (study sample) presenting at or being transferred to the study hospital. Descriptive analysis of age,\r\ngender and injury pattern.\r\nResults: Amongst 729 subjects (total sample) injured from skiing or snowboarding, 401 (55%, 54% of skiers and\r\n58% of snowboarders) suffered from isolated limb injury. Amongst the remaining 328 subjects (study sample), the\r\nmajority (78%) presented with monotrauma. In the study sample, injury to the head (52%) and spine (43%) was\r\nmore frequent than injury to the chest (21%), pelvis (8%), and abdomen (5%). The three most frequent injury\r\ncombinations were head/spine (10% of study sample), head/thorax (9%), and spine/thorax (6%). Fisher�s exact test\r\ndemonstrated an association for injury combinations of head/thorax (p < 0.001), head/abdomen (p = 0.019), and\r\nthorax/abdomen (p < 0.001).\r\nConclusion: The data presented and the findings from previous investigations indicate the need for development\r\nof dedicated on-slope triage protocols. Future research must address the validity and practicality of diagnostic onslope\r\ntests for rapid decision making by both professional and lay first responders. Thus, large-scale and detailed\r\ninjury surveillance is the future research priority....
Background: This case series report discusses patients presenting with hemorrhage and hemodymanic\r\ncompromise due to severe pelvic fractures and undergoing intraoperative angioembolization (IAE) with other\r\nresuscitative procedures.\r\nMethods: We used portable digital subtraction fluoroscopy units for IAE in patients with severe pelvic hemorrhage\r\nand hemodynamic instability (5/03-4/09). Data was collected on demographics, injury severity, resource utilization,\r\nand outcomes at our Level 1 trauma center.\r\nResults: There were 6,538 adult admissions with 912 having pelvic fractures and 65 of these undergoing pelvic\r\nangioembolization. Twelve hemodynamically compromised patients (10 males, 2 females) had intraoperative pelvic\r\nangiography (age: 22-79 years; mean 51.3 �± 17.4). Injury severity score (ISS) was 37.5 �± 8.4 (22-50). Mean\r\nemergency department (ED) length of stay (LOS) was 57.4 min �± 47.9 with 10 patients transported directly to the\r\nOR and 2 to the SICU prior to OR. Ten of 12 patients underwent exploratory laparotomy followed by\r\nangioembolization. Mortality was 50%. Among the 6 survivors (ISS 22 - 50), all had a pre-op CT scan, five had an\r\ninitial base deficit <13, and four were transfused = 6 units pre-incision/pre-procedure. Four of the 6 survivors had\r\nunilateral embolization. In contrast, all 6 non-survivors (ISS 29-41) required massive transfusion prior to OR (>6 units\r\nPRBCs) with 4 having a based deficit >13. Three of these patients bypassed CT and five underwent bilateral internal\r\niliac embolization (BIIE).\r\nConclusions: IAE for severe pelvic hemorrhage can be successfully performed concurrently with exploratory\r\nlaparotomy, pelvic packing or other resuscitative procedures. Patients most likely to benefit have a base deficit <13,\r\nand do not require massive transfusion prior to IAE or suffer from a vertically unstable pelvis fracture...
Background: In Switzerland there are about 150,000 equestrians. Horse related injuries, including head and spinal\r\ninjuries, are frequently treated at our level I trauma centre.\r\nObjectives: To analyse injury patterns, protective factors, and risk factors related to horse riding, and to define\r\ngroups of safer riders and those at greater risk\r\nMethods: We present a retrospective and a case-control survey at conducted a tertiary trauma centre in Bern,\r\nSwitzerland.\r\nInjured equestrians from July 2000 - June 2006 were retrospectively classified by injury pattern and neurological\r\nsymptoms. Injured equestrians from July-December 2008 were prospectively collected using a questionnaire with\r\n17 variables. The same questionnaire was applied in non-injured controls. Multiple logistic regression was\r\nperformed, and combined risk factors were calculated using inference trees.\r\nResults\r\nRetrospective survey: A total of 528 injuries occured in 365 patients. The injury pattern revealed as follows:\r\nextremities (32%: upper 17%, lower 15%), head (24%), spine (14%), thorax (9%), face (9%), pelvis (7%) and abdomen\r\n(2%). Two injuries were fatal. One case resulted in quadriplegia, one in paraplegia.\r\nCase-control survey: 61 patients and 102 controls (patients: 72% female, 28% male; controls: 63% female, 37% male)\r\nwere included. Falls were most frequent (65%), followed by horse kicks (19%) and horse bites (2%). Variables\r\nstatistically significant for the controls were: Older age (p = 0.015), male gender (p = 0.04) and holding a diploma\r\nin horse riding (p = 0.004). Inference trees revealed typical groups less and more likely to suffer injury.\r\nConclusions: Experience with riding and having passed a diploma in horse riding seem to be protective factors.\r\nEducational levels and injury risk should be graded within an educational level-injury risk index....
Background: Alcohol and drug use is known to be a major factor affecting the incidence of traumatic injury.\r\nHowever, the ways in which immediate pre-injury substance use affects patients� clinical care and outcomes\r\nremains unclear. The goal of the present study is to determine the associations between pre-injury use of alcohol\r\nor drugs and patient injury severity, hospital course, and clinical outcome.\r\nMaterials and methods: This study used more than 200,000 records from the National Trauma Data Bank (NTDB),\r\nwhich is the largest trauma registry in the United States. Incidents in the NTDB were placed into one of four\r\nclasses: alcohol related, drug related, alcohol-and-drug related, and substance negative. Logistic regression models\r\nwere used to determine comorbid conditions or treatment complications that were significantly associated with\r\npre-injury substance use. Hospital charges were associated with the presence or absence of drugs and alcohol, and\r\npatient outcomes were assessed using discharge disposition as delimited by the NTDB.\r\nResults: The rates of complications arising during treatment were 8.3, 10.9, 9.9 and 8.6 per one hundred incidents\r\nin the alcohol related, drug related, alcohol-and-drug related, and substance-negative classes, respectively.\r\nRegression models suggested that pre-injury alcohol use is associated with a 15% higher risk of infection, whereas\r\npre-injury drug use is associated with a 30% higher risk of infection. Pre-injury substance use did not appear to\r\nsignificantly impact clinical outcomes following treatment for traumatic injury, however.\r\nConclusion: This study suggests that pre-injury drug use is associated with a significantly higher complication rate.\r\nIn particular, infection during hospitalization is a significant risk for both alcohol and drug related trauma visits, and\r\ndrug-related trauma incidents are associated with increased risk for additional circulatory complications. Although\r\ndrug and alcohol related trauma incidents are not associated with appreciably worse clinical outcomes, patients\r\nexperiencing such complications are associated with significantly greater length of stay and higher hospitalization\r\ncosts. Therefore significant benefits to trauma patients could be gained with enhanced surveillance for pre-injury\r\nsubstance use upon admission to the ED, and closer monitoring for infection or circulatory complications during\r\ntheir period of hospitalization....
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