共查询到10条相似文献，搜索用时 140 毫秒
1.
Roshan Givergis Swapna Munnangi Katayoun Fayaz M Fomani Anthony Boutin Luis Carlos Zapat LD George Angus 《中华创伤杂志(英文版)》2018,21(5):261-266
Purpose
To evaluate massive transfusion protocol practices by trauma type at a level I trauma center.Methods
A retrospective analysis was performed on a sample of 76 trauma patients with MTP activation between March 2010 and January 2015 at a regional trauma center. Patient demographics, transfusion practices, and clinical outcomes were compared by type of trauma sustained.Results
Penetrating trauma patients who required MTP activation were significantly younger, had lower injury severity score (ISS), higher probability of survival (POS), decreased mortality, and higher Glasgow Coma scale (GCS) compared to blunt trauma patients. Overall, the mortality rate was 38.16%. The most common injury sustained among blunt trauma patients was head injury (36.21%), whereas the majority of the penetrating trauma patients sustained abdominal injuries (55.56%). Although the admission coagulation parameters and timing of coagulopathy were not significantly different between the two groups of patients, a significantly higher proportion of penetrating trauma patients received high plasma content therapy relative to blunt trauma patients (p < 0.01).Conclusion
Despite the use of the same MTP for all injured patients requiring massive transfusion, significant differences existed between blunt trauma patients and penetrating trauma patients. These differences in transfusion characteristics and outcomes following MTP activation underscore the complexity of implementing MTPs and warrant vigilant transfusion practices to improve outcomes in trauma patients. 相似文献2.
Introduction
Rib fractures after blunt trauma contribute substantially to morbidity and mortality in the elderly.Methods
Retrospective review of 255 patients ≥65 years old at a level 2 trauma center over 6 years, who sustained blunt trauma resulting in rib fractures. Outcomes measured include mortality, hospital length of stay(LOS), intensive care unit(ICU) admission, ICU LOS, need for MV, and MV days.Results
There were 24 deaths (9.4%), of which 7 were early (<24?h). 130 patients (51%) were admitted to ICU, and 49 (19.2%) required MV. Mean ICU and MV days were 5.9 and 6.3, respectively. ICU admission was predicted by a base deficit <-2.0, ISS>15, bilateral rib fractures, pneumothorax or hemothorax on chest x-ray (All p?<?0.001), as well as hypotension, GCS<15, and 1st rib fractures (All p?<?0.05). Mortality was predicted by a base deficit?<?-5.0, GCS score of 3(Both p?<?0.001), as well as hypotension, ISS≥25, RTS <7.0, bilateral pneumothoraces, 1st rib fractures, and >5 rib fractures (All p?<?0.05).Conclusion
Rib fractures in elderly blunt trauma patients are associated with significant mortality and morbidity, but outcomes can be predicted to improve care. 相似文献3.
Yaakov Daskal Ricardo Alfici Adi Givon Kobi Peleg Oded Olsh Boris Kessel 《中华创伤杂志(英文版)》2018,21(5):273-276
Purpose: Investigation of injury patterns epidemiology among car occupants may help to develop different therapeutic approach according to the seat position. The aim of the study was to evaluate and compare differences in the incidence of serious injuries, between occupants in different locations in private cars.
Methods: A retrospective study including trauma patients who were involved in motor vehicle accidents and admitted alive to 20 hospitals (6 level Ⅰ trauma centers and 14 level Ⅱ trauma centers). We examined the incidence of injures with abbreviated injury score 3 and more, and compared their occurrence between seat locations.
Results: The study included 28,653 trauma patients, drivers account for 60.8% (17,417). Front passenger mortality was 0.47% higher than in drivers. Rear seat passengers were at greater risk (10.26%) for traumatic brain injuries than front seat passengers (7.48%) and drivers (7.01%). Drivers are less likely to suffer from serious abdominal injuries (3.84%) compared to the passengers (front passengers - 5.91%, rear passengers - 5.46%).
Conclusion: Out of victims who arrived alive to the hospital, highest mortality was found in front seat passengers. The rate of serious chest injuries was higher as well. Rear seat passengers are at greater risk for serious traumatic brain injuries. All passengers have a greater incidence of abdominal injuries. These findings need to be addressed in order to develop “customized” therapeutic policy in trauma victims. 相似文献
4.
Adrian T. Billeter M.D. Ph.D. Frank B. Miller Brian G. Harbrecht Wanda BowenMatthew J. Stephens M.D. Gregory C. Postel Jason W. Smith Matthew Penta Royce Coleman Glen A. Franklin Donald D. Trunkey Hiram C. Polk Jr. 《American journal of surgery》2014
Background
Stops at nontrauma centers for severely injured patients are thought to increase deaths and costs, potentially because of unnecessary imaging and indecisive/delayed care of traumatic brain injuries (TBIs).Methods
We studied 754 consecutive blunt trauma patients with an Injury Severity Score greater than 20 with an emphasis on 212 patients who received care at other sites en route to our level 1 trauma center.Results
Referred patients were older, more often women, and had more severe TBI (all P < .05). After correction for age, sex, and injury pattern, there was no difference in the type of TBI, Glasgow Coma Scale (GCS) upon arrival at the trauma center, or overall mortality between referred and directly admitted patients. GCS at the outside institution did not influence promptness of transfer.Conclusions
Interhospital transfer does not affect the outcome of blunt trauma patients. However, the unnecessarily prolonged stay of low GCS patients in hospitals lacking neurosurgical care is inappropriate. 相似文献5.
A. Millet A. Cuisinier P. Bouzat C. Batandier B. Lemasson V. Stupar K. Pernet-Gallay T. Crespy E.L. Barbier J.F. Payen 《British journal of anaesthesia》2018,120(6):1295-1303
Background
The mechanisms by which hypertonic sodium lactate (HSL) solution act in injured brain are unclear. We investigated the effects of HSL on brain metabolism, oxygenation, and perfusion in a rodent model of diffuse traumatic brain injury (TBI).Methods
Thirty minutes after trauma, anaesthetised adult rats were randomly assigned to receive a 3 h infusion of either a saline solution (TBI–saline group) or HSL (TBI–HSL group). The sham–saline and sham–HSL groups received no insult. Three series of experiments were conducted up to 4 h after TBI (or equivalent) to investigate: 1) brain oedema using diffusion-weighted magnetic resonance imaging and brain metabolism using localized 1H-magnetic resonance spectroscopy (n = 10 rats per group). The respiratory control ratio was then determined using oxygraphic analysis of extracted mitochondria, 2) brain oxygenation and perfusion using quantitative blood-oxygenation-level-dependent magnetic resonance approach (n = 10 rats per group), and 3) mitochondrial ultrastructural changes (n = 1 rat per group).Results
Compared with the TBI–saline group, the TBI–HSL and the sham-operated groups had reduced brain oedema. Concomitantly, the TBI–HSL group had lower intracellular lactate/creatine ratio [0.049 (0.047–0.098) vs 0.097 (0.079–0.157); P < 0.05], higher mitochondrial respiratory control ratio, higher tissue oxygen saturation [77% (71–79) vs 66% (55–73); P < 0.05], and reduced mitochondrial cristae thickness in astrocytes [27.5 (22.5–38.4) nm vs 38.4 (31.0–47.5) nm; P < 0.01] compared with the TBI–saline group. Serum sodium and lactate concentrations and serum osmolality were higher in the TBI–HSL than in the TBI–saline group.Conclusions
These findings indicate that the hypertonic sodium lactate solution can reverse brain oxygenation and metabolism dysfunction after traumatic brain injury through vasodilatory, mitochondrial, and anti-oedema effects. 相似文献6.
Mario Schietroma Beatrice Pessia Sara Colozzi Francesco Carlei Gianfranco Amicucci 《The surgeon》2018,16(2):94-100
Background
Some studies suggested that after abdominal trauma, postoperative infections are associated with bacterial translocation, whereas others have not replicated these findings. We have assessed the bacterial translocation and postoperative infections in patients undergoing splenectomy after abdominal trauma, using a very homogeneous study population.Methods
We consecutively studied, in a prospective observational clinical study, 125 patients who required urgent surgical treatment (splenectomy) following blunt abdominal trauma. For bacterial translocation identification, tissue samples were taken from liver, spleen and mesenteric lymph nodes (MLNs). Postoperative infectious complications in these patients were registered, confirmed by a positive culture obtained from the septic focus. Associations between clinical variables, bacterial translocation presence, and postoperative infection development were established.Results
Bacterial translocation was detected in 47 (37.6%) patients. Postoperative infections were present in 29 (23.2%) patients. A significant statistical difference was found between postoperative infections in patients with bacterial translocation evidence (22 of 47 patients: 46.8%) in comparison with patients without bacterial translocation (7 of 78 patients: 8.9%) (P < 0.05). After multivariate adjustment analysis: a) the bleeding ≥ 1500 mL was significantly associated with the risk of bacterial translocation and, b) bacterial translocation was significantly associated with the risk of postoperative infections. Bacterial strains isolated from infection sites were the same as those cultured in MLNs in 48.3% of the cases (n = 14 of 29).Conclusions
There is higher risk of bacterial translocation in patients who required urgent surgical treatment (splenectomy) following blunt abdominal trauma and it is associated with a significant higher number of postoperative infections. 相似文献7.
Introduction
Cycling has seen a large increase in popularity worldwide over the last number of years. This has been linked to an increase in the number of road traffic accidents involving cyclists. Participation in cycling as part of competitive sport and endurance events has seen particular growth.Aim
To examine patients referred with spinal trauma related to cycling and to assess whether the growing popularity of cycling and particularly competitive cycling is linked to an increase in spinal trauma.Methods
A retrospective analysis was carried out of a prospectively maintained database of referrals to a national referral centre for spinal trauma over a 4-year period (2010–2013). Data were further analysed for years 2012–2013, as there were incomplete data for years 2010–2011.Results
Spinal injuries involving cyclists increased by 200% from 2010 to 2013. In comparison those involving cars only increased by 29% and motorcycles reduced by 68%. From 2012 to 2013 there were 24 cyclist trauma referrals. The most common level injured was cervical spine (71%). Five patients (20.8%) had neurological deficit with 12.5% complete paralysis ASIA A disability score. The spinal fixation rate was 29.1%, 16.6% were managed with a HALO device. In total, 25% of patients were injured whilst training on a racer style bicycle, including all of the patients with complete spinal cord injury.Conclusion
There has been a significant increase in spinal trauma due to cycling accidents over this four year period. Competitive cycling has been a factor in the most severely injured patients. Increased public awareness campaigns for those participating in cycling for sport may be warranted. 相似文献8.
Zhamak Khorgami William J. Fleischer Yuen-Jing A. Chen Nasir Mushtaq Michael S. Charles C. Anthony Howard 《American journal of surgery》2018,215(4):727-734
Background
The Oklahoma Trauma Registry (OTR) collects data from all state-licensed acute care hospitals. This study investigates trends and outcomes of trauma in Oklahoma using OTR.Methods
107,549 patients (2005–2014) with major severity and one of the following criteria were included: length of hospital stay ≥48?h, dead on arrival or death in the hospital, hospital transfer, ICU admission, or surgery on the head, chest, abdomen, or vascular system. Patient characteristics, mechanisms of injury, and outcomes of trauma were analyzed.Results
Hospital admissions due to falls increased with an annual percent change of 4.0% (95%CI: 3.1%–4.9%) while hospital admissions due to motor vehicle crashes decreased. The number of overall deaths per year remained stable except for the fall-related deaths, which increased proportionate to the increase in the incidence of fall. Fall-related mortality was 4.2% and intracranial bleeding was present in 60% in these patients.Conclusion
Falls are significantly increasing as a mechanism of trauma admissions and trauma-related deaths in Oklahoma. Analysis of state-based trauma registries can identify trends in etiologies of injuries and may indicate a reference point to prioritize preventive plans. 相似文献9.
Thomas W. Clements Michael Dunham Andrew Kirkpatrick Ruphus Rajakumar Carolyn Gratton Rohan Lall Paul McBeth Chad G. Ball 《American journal of surgery》2018,215(5):843-846
Background
Evidence for repeat computed tomography (CT) in minor traumatic brain injury (mTBI) patients with intracranial pathology is scarce. The aim of this study was to investigate the utility of clinical cognitive assessment (COG) in defining the need for repeat imaging.Methods
COG performance was compared with findings on subsequent CT, and need for neurosurgery in mTBI patients (GCS 13–15 and positive CT findings).Results
Of 152 patients, 65.8% received a COG (53.0% passed). Patients with passed COG underwent fewer repeat CT (43.4% vs. 78.7%; p?=?.001) and had shorter LOS (8.7 vs. 19.5; p?<?.05). Only 1 patient required neurosurgery after a passed COG. The negative predictive value of a normal COG was 90.6% (95%CI?=?81.8%–95.4%).Conclusion
mTBI patients with an abnormal index CT who pass COG are less likely to undergo repeat CT head, and rarely require neurosurgery. The COG warrants further investigation to determine its role in omitting repeat head CT. 相似文献10.
Purpose: “Polytrauma” patients are of a higher risk of complications and death than the summation of expected mortality and morbidity of their individual injuries. The ideal goal in trauma resuscitation care is to identify and treat all injuries. With clinical and technological advanced imaging available for diagnosis and treatment of traumatic patients, point of careerapid ultrasound in shock and hypotension (RUSH) significantly affects modern trauma services and patient outcomes. This study aims to evaluate the accuracy of RUSH and patient outcomes by early detection of the causes of unstable polytrauma.
Methods: This cross-sectional, prospective study included 100 unstable polytrauma patients admitted in Suez Canal University Hospital. Clinical exam, RUSH and pan-computed tomography (pan-CT) were conducted. The result of CT was taken as the standard. Patients were managed according to the advanced trauma life support (ATLS) guidelines and treated of life threatening conditions if present. Patients were followed up for 28 days for a short outcome.
Results: The most diagnostic causes of unstability in polytrauma patients by RUSH are hypovolemic shock (64%), followed by obstructive shock (14%), distributive shock (12%) and cardiogenic shock (10%) respectively. RUSH had 94.2% sensitivity in the diagnosis of unstable polytrauma patients; the accuracy of RUSH in shock patients was 95.2%.
Conclusion: RUSH is accurate in the diagnosis of unstable polytrauma patients; and 4% of patients were diagnosed during follow-up after admission by RUSH and pan-CT. 相似文献