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1.
Takayuki Otani Hirotaka Sawano Tomoaki Natsukawa Reiko Matsuoka Masaya Morita Yasuyuki Hayashi 《The American journal of emergency medicine》2017,35(5):685-691
Purpose
The aim of this study was to assess the usefulness of the Global Registry of Acute Coronary Events (GRACE) risk score in predicting in-hospital mortality and neurological outcome of patients resuscitated after out-of-hospital cardiac arrest (OHCA).Methods
We retrospectively analyzed the data of patients admitted to our hospital between October 2009 and October 2015 with OHCA and shockable initial cardiac rhythm who were resuscitated via conventional cardiopulmonary resuscitation. We calculated the GRACE risk score on admission and assessed its usefulness in predicting in-hospital mortality and neurological outcome.Results
Among 91 patients, 42 (46%) had acute myocardial infarction (AMI), 19 (21%) died in-hospital, and 52 (57%) had favorable neurological outcome. Among all the study patients, GRACE risk score was lower in survivors than in non-survivors (median 211 [interquartile range 176–240] vs. 266 [219–301], p < 0.001, respectively) and in favorable than in unfavorable neurological outcome group (202 [167–237] vs. 242 [219–275], p < 0.001, respectively). Multivariate analysis showed significant association between GRACE risk score and favorable neurological outcome (odds ratio, 0.975; 95% confidence interval, 0.961–0.990). Areas under receiver-operating characteristic curves, that describe the accuracy of GRACE risk score in predicting in-hospital mortality and favorable neurological outcome, were both 0.79.Conclusion
GRACE risk score may predict the in-hospital mortality and neurological outcome associated with resuscitated patients with OHCA and shockable initial cardiac rhythm, regardless of the cause of arrest. 相似文献2.
Nooraldeen Al-Dury Araz Rawshani Johan Israelsson Anneli Strömsöe Solveig Aune Jens Agerström Thomas Karlsson Annica Ravn-Fischer Johan Herlitz 《The American journal of emergency medicine》2017,35(12):1839-1844
Aim
To investigate characteristics and outcome among patients suffering in-hospital cardiac arrest (IHCA) with the emphasis on gender and age.Methods
Using the Swedish Register of Cardiopulmonary Resuscitation, we analyzed associations between gender, age and co-morbidities, etiology, management, 30-day survival and cerebral function among survivors in 14,933 cases of IHCA. Age was divided into three ordered categories: young (18–49 years), middle-aged (50–64 years) and older (65 years and above). Comparisons between men and women were age adjusted.Results
The mean age was 72.7 years and women were significantly older than men. Renal dysfunction was the most prevalent co-morbidity. Myocardial infarction/ischemia was the most common condition preceding IHCA, with men having 27% higher odds of having MI as the underlying etiology. A shockable rhythm was found in 31.8% of patients, with men having 52% higher odds of being found in VT/VF. After adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30 days. Older individuals were managed less aggressively than younger patients. Increasing age was associated with lower 30-day survival but not with poorer cerebral function among survivors.Conclusion
When adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30 days after in-hospital cardiac arrest. Older individuals were managed less aggressively than younger patients, despite a lower chance of survival. Higher age was, however, not associated with poorer cerebral function among survivors. 相似文献3.
Shuichi Hagiwara Kiyohiro Oshima Makoto Aoki Dai Miyazaki Atsushi Sakurai Yoshio Tahara Ken Nagao Naohiro Yonemoto Arino Yaguchi Naoto Morimura 《The American journal of emergency medicine》2017,35(3):391-396
Background
It is unclear whether the number of paramedics in an ambulance improves the outcome of patients with out-of-hospital cardiac arrest (OHCA) or not.Methods and Results
This study was a prospective, observational study conducted on patients with OHCA. Patients were divided into the One-paramedic group (Group O) and the Two-or-more-paramedic group (Group T) and we analyzed the differences. Patients who were treated with only basic life support during transportation, and whose cause of cardiac arrest were extrinsic cause such as trauma and poisoning were excluded. Good neurological outcome was defined as cerebral performance category (CPC) 1 or 2.In Group O, there were 1516 patients (male/female, 922/594). In Group T, there were 2932 patients (male/female, 1798/1134). Return of spontaneous circulation (ROSC) was obtained in 528 patients (34.8%) in Group O and 1058 patients (36.1%) in Group T (p = 0.589). 320 patients (21.1%) in Group O and 656 patients (22.4%) in Group T were admitted to hospital after ROSC (p = 0.461). At 90 days, there were 57 survivors (3.8%) in Group O and 114 survivors (3.9%) in Group T (p = 0.873). At 90 days, 14 patients (0.9%) in Group T had a CPC of 1 or 2, while 30 patients (1.0%) in Group T did so (p = 0.87). From the results of logistic regression analysis, age [odds ratio (OR): 0.983, 95% confidence interval (CI): 0.952–0.993], witnessed OHCA (OR: 4.583, 95% CI: 1.587–13.234), and shockable rhythm as first documented (OR: 19.67, 95% CI: 9.181–42.13) were associated with good outcome.Conclusion
The number of paramedics in an ambulance did not affect the outcome in OHCA patients. 相似文献4.
Saee Byel Kang Kyung Su Kim Gil Joon Suh Woon Yong Kwon Kyoung Min You Min Ji Park Jung-In Ko Taegyun Kim 《The American journal of emergency medicine》2017,35(10):1457-1461
Background
The aim of this study was to investigate whether the 1-year survival rate of out-of-hospital cardiac arrest (OHCA) patients with malignancy was different from that of those without malignancy.Methods
All adult OHCA patients were retrospectively analyzed in a single institution for 6 years. The primary outcome was 1-year survival, and secondary outcomes were sustained return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge and discharge with a good neurological outcome (CPC 1 or 2). Kaplan-Meier survival analysis and Cox proportional hazard regression analysis were performed to test the effect of malignancy.Results
Among 341 OHCA patients, 59 patients had malignancy (17.3%). Sustained ROSC, survival to admission, survival to discharge and discharge with a good CPC were not different between the two groups. The 1-year survival rate was lower in patients with malignancy (1.7% vs 11.4%; P = 0.026). Kaplan-Meier survival analysis revealed that patients with malignancy had a significantly lower 1-year survival rate when including all patients (n = 341; P = 0.028), patients with survival to admission (n = 172, P = 0.002), patients with discharge CPC 1 or 2 (n = 18, P = 0.010) and patients with discharge CPC 3 or 4 (n = 57, P = 0.008). Malignancy was an independent risk factor for 1-year mortality in the Cox proportional hazard regression analysis performed in patients with survival to admission and survival to discharge.Conclusions
Although survival to admission, survival to discharge and discharge with a good CPC rate were not different, the 1-year survival rate was significantly lower in OHCA patients with malignancy than in those without malignancy. 相似文献5.
Ki Hong Kim Sang Do Shin Kyoung Jun Song Young Sun Ro Yu Jin Kim Ki Jeong Hong Joo Jeong 《The American journal of emergency medicine》2017,35(11):1682-1690
Objectives
It is unclear whether scene time interval (STI) is associated with better neurological recovery in the emergency medical service (EMS) system with intermediate service level.Methods
Adult out-of-hospital cardiac arrest (OHCA) patients with presumed cardiac etiology (2012 to 2014) were analyzed, excluding patients not-resuscitated, occurred in ambulance/medical/nursing facility, unknown STI or extremely longer STI (> 60 min), and unknown outcomes. STI was classified into short (0.0–3.9 min), middle (4.0–7.9 min), long (8.0–11.9 min), and very-long (12.0–59.9 min), respectively. The end point was a good cerebral performance category (CPC) 1 or 2. Multivariable logistic regression by STI group (reference = short) was performed to calculate adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs) for outcomes with or without interaction term (STI 1 prehospital return of spontaneous circulation, (PROSC)).Results
Of 79,832 OHCA patients, 41,054 cases were analyzed; good CPC in the short (3.0%), middle (3.2%), long (3.0%), and very-long (2.9%) STI groups were similar, respectively (p = 0.55). The AORs (95% CI) for good CPC in the final model without interaction term were 0.74 (0.58–0.95) for the middle, 0.51 (0.39–0.67) for the long, and 0.45 (0.33–0.61) for the very-long STI group (reference = short STI). The AORs in PROSC group were 1.18 (0.97–1.44) for middle STI group, 0.72 (0.57–0.92) for long group, and 0.56 (0.42–0.77) for very-long group. The AORs in non-PROSC group were 1.22 (1.06–1.40) for middle STI group, 0.82 (0.70–0.96) for long group, and 0.70 (0.57–0.85) for very-long group.Conclusion
The middle STI (4–7 min) was associated with the highest odds of neurological recovery for patients who could not be restored in the field. The STI may be a clinically useful predictor of good neurology outcome in victims of cardiac arrest. 相似文献6.
Louise Martinell Johan Herlitz Thomas Karlsson Niklas Nielsen Christian Rylander 《The American journal of emergency medicine》2017,35(11):1595-1600
Background
Mild induced hypothermia (MIH) was introduced for post cardiac arrest care in Sweden in 2003, based on two clinical trials. This retrospective study evaluated its association with 30-day survival after out-of-hospital cardiac arrest (OHCA) in a Swedish community from 2003 to 2015.Methods
Out of 3680 patients with OHCA, 1100 were hospitalized after return of spontaneous circulation and 871 patients who remained unconscious were included in the analysis. Prehospital data were extracted from the Swedish Registry of Cardiopulmonary Resuscitation and in-hospital data were extracted from clinical records. Propensity score analysis on complete data sets and multivariable logistic regression with multiple imputations to compensate for missing data were performed.Results
Unadjusted 30-day survival was 23.5%; 37% in 386/871 (44%) MIH treated and 13% in 485/871 (56%) non-MIH treated patients. Unadjusted odds ratio (OR) for 30-day survival in patients treated with MIH compared to non-MIH treated patients was 3.79 (95% CI 2.71–5.29; p < 0.0001). Using stratified propensity score analysis and in addition adjusting for in-hospital factors, 30-day survival was not significantly different in patients treated with MIH compared to non-MIH treated patients; OR 1.33 (95% CI 0.83–2.15; p = 0.24). Using multiple imputations to handle missing data yielded a similar adjusted OR of 1.40 (95% CI 0.88–2.22; p = 0.15). Good neurologic outcome at hospital discharge was seen in 82% of patients discharged alive.Conclusion
Treatment with MIH was not significantly associated with increased 30-day survival in patients remaining unconscious after OHCA when adjusting for potential confounders. 相似文献7.
Qiang Zhang Bo Liu Lianxing Zhao Zhijiang Qi Huan Shao Le An Chunsheng Li 《The American journal of emergency medicine》2017,35(10):1555-1560
Objective
The aim of this study was to conduct a meta-analysis to evaluate the efficacy of vasopressin-epinephrine compared to epinephrine alone in patients who suffered out-of-hospital cardiac arrest (OHCA).Methods
Relevant studies up to February 2017 were identified by searching in PubMed, EMBASE, the Cochrane Library, Wanfang for randomized controlled trials(RCTs) assigning adults with cardiac arrest to treatment with vasopressin-epinephrine (VEgroup) vs adrenaline (epinephrine) alone (E group). The outcome point was return of spontaneous circulation (ROSC) for patients suffering from OHCA. Heterogeneity, subgroup analysis, sensitivity analysis and publication bias were explored.Results
Individual patient data were obtained from 5047 participants who experienced OHCA in nine studies. Odds ratios (ORs) were calculated using a random-effects model and results suggested that vasopressin-epinephrine was associated with higher rate of ROSC (OR = 1.67, 95% CI = 1.13–2.49, P < 0.00001, and total I2 = 83%). Subgroup showed that vasopressin-epinephrine has a significant association with improvements in ROSC for patients from Asia (OR = 3.30, 95% CI = 1.30–7.88); but for patients from other regions, there was no difference between vasopressin-epinephrine and epinephrine alone (OR = 1.07, 95% CI = 0.72–1.61).Conclusion
According to the pooled results of the subgroup, combination of vasopressin and adrenaline can improve ROSC of OHCA from Asia, but patients from other regions who suffered from OHCA cannot benefit from combination of vasopressin and epinephrine. 相似文献8.
Min Li Wei Song Yan-hong Ouyang Duo-hu Wu Jun Zhang Li-xiang Wang Jing Li 《The American journal of emergency medicine》2017,35(12):1892-1894
Background
Chest compression is a standard recommendation during cardiopulmonary resuscitation (CPR). However, chest compression cannot be effectively applied under certain situations, such as chest wall deformity, rib fracture, or hemopneumothorax. An alternative method, abdominal compression, was reported to achieve better resuscitation outcomes in these patients.Materials and methods
A prospective study was performed in adult patients with cardiac arrest and anticipated ineffective chest compression (thoracic trauma, chest deformity, rib fracture, and hemopneumothorax). Active abdominal lifting and compression cardiopulmonary resuscitation was used. Primary outcome was success rate of restoration of spontaneous circulation (ROSC). Secondary outcomes included heart rate (HR), mean arterial pressure (MAP), pulse oximetry saturation (SpO2), arterial blood pH value, arterial oxygen pressure (PaO2), and arterial carbon dioxide tension (PaCO2), which were measured during the periods of pre-CPR, CPR, and 30 min post-ROSC.Results
A total of 35 patients were enrolled into the study. Five of them had ROSC (14.3%), which was statistically significantly higher than that (0%) reported in the 2015 Advanced Cardiovascular Life Support manual. HR, MAP, and SpO2 during CPR were also statistically significantly higher during CPR when compared to the period of pre-CPR period (HR 58 versus 0 beats/min, P < 0.01; MAP 25 versus 0 mm Hg, P < 0.01; SpO2 0.68 versus 0.48%, P < 0.01). In post-ROSC period, HR was statistically significantly higher than that during pre-CPR period (121 versus 0 best/min, P < 0.01).Conclusions
Active abdominal lifting and compression cardiopulmonary resuscitation could reach better resuscitation outcomes in certain cardiac arrest patients. 相似文献9.
R. Sagisaka H. Tanaka H. Takyu H. Ueta S. Tanaka 《The American journal of emergency medicine》2017,35(10):1462-1468
Background
Repeated administration of epinephrine is associated with unfavorable cerebral outcome after out-of-hospital cardiac arrests (OHCA), but the timing of epinephrine administration has not been considered.Aim
The aim of the study was to analyze the effects of repeated epinephrine administration after OHCA on favorable cerebral function coded by cerebral performance categories (CPC 1–2).Methods
A nationwide, retrospective, population-based observational study was conducted by using Utstein-style data between 2010 and 2012 in Japan. The total of 11,876 cardiogenic and witnessed OHCA were stratified into 3 categories by the number of times epinephrine was administered (single, double, and three or more). In addition, the time elapsed between the emergency call and the initial epinephrine administration was divided into 3 time intervals (5 to 20 min for the early administration group [EAG], 21 to 26 min for the intermediate administration group [IAG], and 27 to 60 min for the late administration group [LAG]). The primary endpoint was CPC 1–2 at 1 month after cardiac arrest. A multivariable logistic regression was used for analysis.Results
Achievement of CPC 1–2 at 1 month was 4.8% for single, 2.4% for double, and 1.7% for three or more administered doses. For single and three or more administrationConclusion
Repeated epinephrine administration improved CPC 1–2 outcome when epinephrine was administrated within 20 min after an emergency call for witnessed cardiogenic OHCA. 相似文献10.
Background & objectives
A previous review of transfusion practices in our institution between 1998 and 2008 showed a trend of high ratios of red cells (RC) to plasma (FFP) and platelets to RC towards the later years of review period. The aim of the study was to further evaluate transfusion practices in the form of blood product usage and outcomes following massive transfusion (MT)Methods
All adult patients with critical bleeding who received a MT (defined as ≥10 units of RC in 24 h) in 2008 and between January 2010 and December 2014 were identified. Blood and blood products transfused, in-hospital mortality, 24 h and 90-day mortality were analysed for the period 2010–2014. Blood and blood product usage, massive transfusion protocol (MTP) activation and use of ROTEM between 2008 and 2014 were compared.Results
A total of 190 MT including surgical (52.1%), gastro-intestinal bleeding (25.3%), trauma (11.6%) and obstetric haemorrhage (5.8%) episodes were identified between 2010 and 2014. The overall in-hospital mortality was 26.7% with a significant difference in 24 h (p = 0.04) and 90-day mortality (p = 0.02) between diagnostic groups. Comparing 2008 (n = 33) and 2014 (n = 23), there was no significant difference in median RC, FFP and platelet units, cryoprecipitate doses and RC:FFP ratio; however there was an increase in number of patients who used cryoprecipitate (54.5% vs 87%, p = 0.01).Conclusion
Aligned with haemostatic resuscitation, the trend continues in the form of increased use of plasma and higher RC:FFP transfusion ratios including an increase in number of patients receiving cryoprecipitate. 相似文献11.
Şeref Kerem Çorbacıoğlu Emine Akıncı Yunsur Çevik Halit Aytar Mehmet Veysel Öncül Sedat Akkan Hüseyin Uzunosmanoğlu 《The American journal of emergency medicine》2017,35(11):1662-1665
Purpose
The study aimed to detect whether modified Valsalva maneuver (VM) is more effective than the standard VM in terminating paroxysmal supraventricular tachycardia (PSVT).Methodology
This randomized controlled trial was conducted in the emergency department of a training and research hospital between Dec. 1, 2015 and Dec. 31, 2016. Participants were divided into two groups, randomly assigned standard VM or modified VM, as the first treatment with two-dimensional permutation blocks; in the order of arrival of the patients. In both groups; the determined procedure for standard or modified VM was repeated up to three times in patients whose PSVT did not convert to sinus rhythm. In both groups; if the maneuver was unsuccessful after three attempts, anti-arrhythmic medication was administered. The primary outcome was defined to compare the success rate of achieving sinus rhythm after standard VM or modified VM.Results
Fifty-six patients were randomized to modified or standard VM with 28 patients in each treatment arm. Three of 28 patients (10.7%) in VM group and 12 of 28 patients (42.9%) in modified VM group were returned to sinus rhythm after intervention (p = 0.007). The number of patients who needed rescue treatment was lower in the modified VM group - 16 (57.1%) of 28 versus 25 (89.3%) of 28 in the standard VM group (p = 0.007).Conclusion
This study suggests that modified VM therapy was more effective than standard VM for terminating PSVT. The modified VM therapy also indirectly reduced the need for anti-arrhythmic medication and indirectly caused fewer side effects. 相似文献12.
Yen-Nien Lin Shih-Sheng Chang Lee-Min Wang Hwan-Ting Chi Kwo-Chang Ueng Chin-Feng Tsai Chee-Seong Phan Li-Hua Lu Choon-Hoon Hii Yu-Ting Chung Sumeet S. Chugh Ming-Fong Chen Tsu-Juey Wu Kuan-Cheng Chang 《Mayo Clinic proceedings. Mayo Clinic》2017,92(3):347-359
Objective
To identify the incidence and prehospital predictors of ventricular tachycardia/ventricular fibrillation (VT/VF) as the initial arrhythmia in patients with out-of-hospital cardiac arrest (OHCA) in central Taiwan.Patients and Methods
The Taichung Sudden Unexpected Death Registry program encompasses the Taichung metropolitan area in central Taiwan, with a population of 2.7 million and 17 destination hospitals for patients with OHCA. We performed a detailed analysis of demographic characteristics, circumstances of cardiac arrest, and emergency medical service records using the Utstein Style.Results
From May 1, 2013, through April 30, 2014, resuscitation was attempted in 2013 individuals with OHCA, of which 384 were excluded due to trauma and noncardiac etiologies. Of the 1629 patients with presumed cardiogenic OHCA, 7.9% (n=129) had initial shockable rhythm; this proportion increased to 18.8% (61 of 325) in the witnessed arrest subgroup. Male sex (odds ratio [OR], 2.45; 95% CI, 1.46-4.12; P<.001), age younger than 65 years (OR, 2.39, 95% CI, 1.58-3.62; P<.001), public location of arrest (OR, 4.61; 95% CI, 2.86-7.44; P<.001), and witnessed status (OR, 3.98; 95% CI, 2.62-6.05; P<.001) were independent predictors of VT/VF rhythm.Conclusion
The proportion of patients with OHCA presenting with VT/VF was generally low in this East Asian population. Of the prehospital factors associated with VT/VF, public location of OHCA was the strongest predictor of VT/VF in this population, which may affect planning and deployment of emergency medical services in central Taiwan. 相似文献13.
H. Ueta H. Tanaka S. Tanaka R. Sagisaka H. Takyu 《The American journal of emergency medicine》2017,35(5):676-680
Objective
This research is to study if quick administration of adrenaline on OHCA prior to hospitalization has an effect on improving CPC1-2 at one month.Methodology
A total 13,326 cases were extracted from 2011 to 2014 Utstein data for this retrospective cohort study, also, EMT reached the patients within 16 min after 119 called and adrenaline was then administered within 22 min of after contact.Patients divided into two groups
Patients were contacted within 8 min of the 119 call (n = 6956), and were contacted between 8 and 16 min after the call (n = 6370). Further divided into groups in which the adrenaline was administered within/without 10 min after contact. Primary outcome was the rate of a good prognosis for cerebral performance (CPC1-2) at 1 month and secondary outcome was the return of spontaneous circulation (ROSC) rate.Results
The odds ratio of the CPC1-2 at 1 month by the EMS reached within 8 min after 119 call and then adrenaline administered within 10 min was 2.12 (1.54–2.92).Those reached between 8 and 16 min was 2.66 (1.97–3.59). However, the ROSC rate was 2.00 (1.79–2.25) for those reached within 8 min and also 2.00 (1.79–2.25) for those reached between 8 min and 16 min.Considerations
In cases of OHCA, it appears that the CPC1-2 rate after 1 month can be improved even in cases where the victim is reached > 8 min after the 119 call, as long as the victim is reached within 16 min and emergency responders administer the adrenaline as quickly as possible. 相似文献14.
Lucas Oliveira J. e Silva M. Fernanda Bellolio Elisa M. Smith David J. Daniels Christine M. Lohse Ronna L. Campbell 《The American journal of emergency medicine》2017,35(10):1485-1489
Background
Motor vehicle–related injuries (including off-road) are the leading cause of traumatic brain injury (TBI) and acute traumatic spinal cord injury in the United States.Objectives
To describe motocross-related head and spine injuries of adult patients presenting to an academic emergency department (ED).Methods
We performed an observational cohort study of adult ED patients evaluated for motocross-related injuries from 2010 through 2015. Electronic health records were reviewed and data extracted using a standardized review process.Results
A total of 145 motocross-related ED visits (143 unique patients) were included. Overall, 95.2% of patients were men with a median age of 25 years. Sixty-seven visits (46.2%) were associated with head or spine injuries. Forty-three visits (29.7%) were associated with head injuries, and 46 (31.7%) were associated with spine injuries. Among the 43 head injuries, 36 (83.7%) were concussions. Seven visits (16.3%) were associated with at least 1 head abnormality identified by computed tomography, including skull fracture (n = 2), subdural hematoma (n = 1), subarachnoid hemorrhage (n = 4), intraparenchymal hemorrhage (n = 3), and diffuse axonal injury (n = 3). Among the 46 spine injuries, 32 (69.6%) were acute spinal fractures. Seven patients (4.9%) had clinically significant and persistent neurologic injuries. One patient (0.7%) died, and 3 patients had severe TBIs.Conclusion
Adult patients evaluated in the ED after motocross trauma had high rates of head and spine injuries with considerable morbidity and mortality. Almost half had head or spine injuries (or both), with permanent impairment for nearly 5% and death for 0.7%. 相似文献15.
C. Kajetanek R. Rousseau K. Makridis M. Sanchez C. Delin P. Djian 《Journal de Traumatologie du Sport》2017,34(1):37-43
Background
Anterior cruciate ligament (ACL) rupture is a common pathology. Risk factors include significant tibial slope. The purpose of this study was to determine whether this relationship is observed in recurrent rupture of the ACL. Our hypothesis was that significant tibial slope is a risk factor for rupture.Material and methods
We reviewed at two years follow-up 386 ligamentoplasties performed from 2000 to 2012. There were 20 recurrent ruptures in this series (5.2%). These patients, mean age 21 ± 6.3 years, underwent 3D EOS goniometry to measure the medial and lateral tibial slope (MTS and LTS, respectively). These same measures were made in a comparative group of controls that had ACL surgery without secondary rupture and seen at mean 33.4 (range 28–37) months follow-up.Results
Mean MTS was significantly lower in the recurrent rupture group (10.5 ± 3.3° vs. 12.8 ± 2.7°; P = 0.02). This led to asymmetrical tibial slope with a mean LTS in the recurrent rupture group greater than the mean MTS (delta = –0.52 vs. +0.83). The mean LTS was not significantly different between groups (11 ± 3.4° vs. 12 ± 3.4°; P = 0.30).Conclusion
This study demonstrated that asymmetrical tibial slope due to a MTS lower than the LTS can be a risk factor for recurrent rupture of the ACL.Case-control
Level III. 相似文献16.
Mauro Giordano Tiziana Ciarambino Emanuela Lo Priore Pietro Castellino Lorenzo Malatino Alessandro Cataliotti Giuseppe Paolisso Luigi Elio Adinolfi 《The American journal of emergency medicine》2017,35(11):1691-1694
Study objective
We investigated the serum sodium correction rate on length of hospitalization and survival rate, in severe chronic hyponatremic patients at the Emergency Department (ED).Design
An observational study using clinical chart review.Setting
The ED of the University Hospital of Marcianise, Caserta, Italy with approximately 30,000 patients visits a year.Type of participants
We reviewed sixty-seven patients with severe hyponatremia subdivided in 2 subgroups: group A consisting of 35 patients with serum sodium correction rate < 0.3 mmol/h and group B consisting of 32 patients with serum sodium correction rate between < 0.5 and ≥ 0.3 mmol/h.Intervention
Emergency patients were evaluated for serum sodium correction rate for hyponatremia by clinical chart review.Measurements and main results
Severe hyponatremia was defined as a serum sodium level < 120 mmol/l. Mean serum sodium correction rate of hyponatremia was of 0.17 ± 0.09% in group A and 0.41 ± 0.05% in group B (p < 0.001 vs group A). The length of hospital stay was 10.7 ± 3.7 days for group A, and it was significantly decreased to 3.8 ± 0.4 days for group B (p < 0.005 vs group A). In addition we observed that correction rate of hyponatremia in group A was associated with a significantly lower survival rate (25%) in comparison to group B (60%) (p < 0.001 vs group A).Conclusion: We observed that serum sodium correction rate ≥ 0.3 and < 0.5 mmol/h was associated with a shorter length of hospital stay and a major survival rate. 相似文献17.
Mauro Giordano Tiziana Ciarambino Pietro Castellino Lorenzo Malatino Alessandro Cataliotti Luca Rinaldi Giuseppe Paolisso Luigi Elio Adinolfi 《The American journal of emergency medicine》2017,35(5):749-752
Study objective
We investigated seasonal prevalence of hyponatremia in the emergency department (ED).Design
A cross-sectional study using clinical chart review.Setting
University Hospital ED, with approximately 28 000 patient visits a year.Type of participants
We reviewed 15 049 patients, subdivided in 2 groups: the adult group consisting of 9822 patients aged between 18 and 64 years old and the elderly group consisting of 5227 patients aged over 65 years presenting to the ED between January 1st, 2014 and December 31st, 2015.Intervention
Emergency patients were evaluated for the presence of hyponatremia by clinical chart review.Measurements and main results
Hyponatremia was defined as a serum sodium level < 135 mmol/l. Mean monthly prevalence of hyponatremia was of 3.74 ± 0.5% in the adult group and it was significantly increased to 10.3 ± 0.7% in the elderly group (p < 0.05 vs adults). During the summer, hyponatremia prevalence was of 4.14 ± 0.2% in adult and markedly increased to 12.52 ± 0.7% (zenith) in elderly patients (p < 0.01 vs adult group; p < 0.05 vs other seasons in elderly group). In the elderly group, we reported a significant correlation between weather temperature and hyponatremia prevalence (r: 0.491; p < 0.05).Conclusion
We observed a major influence of climate on the prevalence of hyponatremia in the elderly in the ED. Decline in renal function, salt loss, reduced salt intake and increased water ingestion could all contribute to developing hyponatremia in elderly patients during the summer. These data could be useful for emergency physicians to prevent hot weather-induced hyponatremia in the elderly. 相似文献18.
Matthew J. Binks Rhys S. Holyoak Thomas M. Melhuish Ruan Vlok Elyse Bond Leigh D. White 《The American journal of emergency medicine》2017,35(10):1542-1546
Background
Hypoxemia increases the risk of intubation markedly. Such concerns are multiplied in the emergency department (ED) and during retrieval where patients may be unstable, preparation or preoxygenation time limited and the environment uncontrolled. Apneic oxygenation is a promising means of preventing hypoxemia in this setting.Aim
To test the hypothesis that apnoeic oxygenation reduces the incidence of hypoxemia during endotracheal intubation in the ED and during retrieval.Methods
We undertook a systematic review of six databases for all relevant studies published up to November 2016. Included studies evaluated apneic oxygenation during intubation in the ED and during retrieval. There were no exemptions based on study design. All studies were assessed for level of evidence and risk of bias. The Review Manager 5.3 software was used to perform meta-analysis of the pooled data.Results
Six trials and a total 1822 cases were included for analysis. The study found a significant reduction in the incidence of desaturation (RR = 0.76, p = 0.002) and critical desaturation (RR = 0.51, p = 0.01) when apneic oxygenation was implemented. There was also a significant improvement in first pass intubation success rate (RR = 1.09, p = 0.004).Conclusion
Apneic oxygenation may reduce patient hypoxemia during intubation performed in the ED and during retrieval. It also improves intubation first-pass success rate in this setting. 相似文献19.
Yong Hun Jung Byung Kook Lee Dong Hun Lee Sung Min Lee Yong Soo Cho Kyung Woon Jeung 《The American journal of emergency medicine》2017,35(2):268-273
Purpose
Obesity is a well-known risk factor in various health conditions. We analyzed the association between obesity and clinical outcomes, and its effect on targeted temperature management (TTM) practice for cardiac arrest survivors by calculating and classifying their body mass indexes (BMIs).Methods
We conducted a retrospective data analysis of adult comatose cardiac arrest survivors treated with TTM from 2008 to 2015. BMI was calculated and the cohort was divided into four categories based on the cut-off values of 18.5, 23.0, and 27.5 kg m? 2. The primary outcome was six-month mortality and the secondary outcomes were neurologic outcome at hospital discharge, cooling rate, and rewarming rate.Results
The study included 468 patients. Poor neurologic outcome at discharge and six-month mortality were reported in 311 (66.5%) and 271 (57.9%) patients, respectively. A multivariate logistic analysis showed that an overweight compared to normal BMI was associated with lower probability of six-month mortality (odds ratio [OR], 0.481; 95% confidence interval [CI], 0.274–0.846; p = 0.011) and poor neurologic outcome at discharge (OR, 0.482; 95% CI, 0.258–0.903; p = 0.023). BMI correlated with cooling rate (B, ? 0.073; 95% CI, ? 0.108 to ? 0.039; p < 0.001), but had no association with rewarming rate (B, 0.003; 95% CI, ? 0.001–0.008; p = 0.058).Conclusion
Overweight BMI compared to normal BMI classification was found to be associated with lower six-month mortality and poor neurologic outcome at discharge in cardiac arrest survivors treated with TTM. Higher BMI correlated with a slower induction rate. 相似文献20.
Inanc Karakoyun Ayfer Colak Fatma Demet Arslan Aybike Gunaslan Hasturk Can Duman 《The American journal of emergency medicine》2017,35(11):1677-1681