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1.
Kyu-Sun Choi Youngsuk Cho Bo-Hyoung Jang Wonhee Kim Chiwon Ahn Tae Ho Lim Hyoung-Joong Yi 《The American journal of emergency medicine》2017,35(10):1444-1450
Purpose
Copeptin, the C-terminal portion of provasopressin, has emerged as a novel prognostic marker in neurocritical care, such as in traumatic brain injury (TBI). The aim of this study was to quantitatively assess the prognostic significance of initial plasma copeptin levels in the neurological outcome and mortality after traumatic brain injury.Materials and methods
Six relevant studies with data from 552 patients were included in this meta-analysis.Results
The plasma copeptin levels were found to be significantly higher in patients who died than in the survivors (standardized mean difference [SMD], 1.80). In the four studies reporting Glasgow outcome scale (GOS) data, patients with unfavorable outcomes had significantly higher copeptin levels than those with favorable outcomes (SMD, 1.62). The plasma copeptin level predicted mortality and unfavorable outcomes (AUC, 0.873; AUC, 0.876).Conclusions
The present meta-analysis suggests that early measurement of plasma copeptin levels can provide better prognostic information about the functional outcome and mortality in patients with TBI. 相似文献2.
The intracranial number of foreign bodies as a predictor of mortality after penetrating brain injury
Introduction
Penetrating brain injury (PBI) is the most lethal form of traumatic brain injury, which is a leading cause of mortality. PBI has a mortality rate of 23%–93% and 87%–100% with poor neurological status. Despite the use of various prognostic factors there is still a need for a specific prognostic factor for early prediction of mortality in PBI to reduce mortality and provide good outcomes with cost-effective surgical treatments. The aim of this study was to investigate the predictive value of the number of intracranial foreign bodies (FBs) on mortality in PBI in the Emergency Department.Methods
The study included 95 patients admitted with PBI caused by barrel bomb explosion. The intracranial number of FB was examined by brain computed tomography. Logistic regression was used to assess the association of the intracranial number of FB on mortality. Correlation analyses were performed to investigate the association of Glasgow Coma Scale (GCS) with intracranial number of FB.Results
The optimal cut-off value of the intracranial number of FB calculated for mortality was 2, which was effective for predicting mortality (p?<?.001). In patients with >2 intracranial FB, the mortality rate was statistically significantly 51-fold higher than those with ≤2 (p?<?.001). A statistically significant negative correlation was determined between GCS and number FB (r?=??0.697; p?<?.001).Conclusion
When the intracranial number of FB was >2, mortality significantly increased in patients with PBI. The intracranial number of FBs may be considered as a novel prognostic factor for the prediction of mortality in PBI. 相似文献3.
Background
Acute kidney injury (AKI) is a common complication in septic patients, imposing a heavy burden of illness in terms of morbidity and mortality. Serum lactate is a widely used marker predicting the severity of sepsis. A paucity of research has investigated septic AKI in emergency departments (EDs) and its correlation with initial serum lactate level. This study aimed at identifying risk factors for septic AKI and clarifying the link between initial serum lactate level and septic AKI in ED patients.Methods
A retrospective cohort study was conducted at a single tertiary referral medical center. The medical records of all adult ED patients with measurement of serum lactate and creatinine between January 2012 and December 2016 were reviewed. A total of 696 septic patients were stratified into AKI and non-AKI groups according to Acute Kidney Injury Network (AKIN) criteria for further statistical analysis.Results
Ninety-nine septic patients (14.2%) had AKI, with AKIN-I, AKIN-II, and AKIN-III in 71.7%, 11.1%, and 17.2% of patients, respectively. Compared with the non-AKI group, the AKI group had a significantly higher mortality rate (71.7% vs. 21.3%, p?<?0.001). Independent risk factors for septic AKI included liver disease (adjusted odds ratio [AOR]?=?2.02, 95% confidence interval [CI]?=?1.16–3.52), diabetes mellitus (AOR?=?1.73, 95% CI?=?1.11–2.69), chronic kidney disease (AOR?=?1.68, 95% CI?=?1.06–2.66), and initial serum lactate (AOR?=?1.08, 95% CI?=?1.02–1.14).Conclusions
Patients with septic AKI had an overwhelmingly higher mortality rate. The comorbidities of liver disease, diabetes mellitus, and chronic kidney disease were correlated with septic AKI and in combination with an elevated initial serum lactate level had predictive regarding AKI and further mortality in ED septic patients. 相似文献4.
Tessa Hart John Whyte Monica Vaccaro Amanda R. Rabinowitz 《Archives of physical medicine and rehabilitation》2019,100(5):987-989
Objective
Determine agreement between self-reported dose and dose reflected in administrative records of outpatient physical, occupational, and speech therapies at 6 and 12 months after severe traumatic brain injury (TBI), for the purpose of examining accuracy and predictors of accuracy of self-reported health care utilization in this population.Design
Secondary analysis of survey used in a larger study; participants were queried about therapy doses using a structured interview, either alone or assisted by relatives if they so chose, with responses compared to administrative records.Setting
Rehabilitation center providing outpatient TBI therapies.Participants
Sixty-five people with severe TBI living in the community provided 6-month data (N=65); 54 provided 12-month data.Interventions
Not applicable.Main Outcome Measures
Degree of agreement with administrative records of scheduled and billed therapy appointments, measured using intraclass correlation coefficients (ICCs), with linear regression used to predict accuracy from demographic variables and cognitive status.Results
ICCs were in the moderate range at 6 months, but were more variable, with some in the poor range, at 12 months. Agreement was higher for scheduled than for billed (attended) appointments. Assisted and unassisted patients provided comparable agreement with records. No demographic factors were associated with accuracy, but lower cognitive FIM scores, as hypothesized, tended to predict lower agreement at 6 months.Conclusions
People with severe TBI can provide reasonable estimates of commonly prescribed outpatient therapy doses at 6 months postinjury. Accuracy may be improved by inviting patients to request assistance from relatives and by asking them to consider attended (vs scheduled) sessions. 相似文献5.
Lindley E. Folkerson Duncan Sloan Elizabeth Davis Ryan S. Kitagawa Bryan A. Cotton John B. Holcomb Jeffrey S. Tomasek Charles E. Wade 《The American journal of emergency medicine》2018,36(1):38-42
Study hypothesis
Traumatic brain injury (TBI) is a leading cause of mortality with penetrating TBI (p-TBI) patients having worse outcomes. These patients are more likely to be coagulopathic than blunt TBI (b-TBI) patients, thus we hypothesize that coagulopathy would be an early predictor of mortality.Methods
We identified highest-level trauma activation patients who underwent an admission head CT and had ICU admission orders from August 2009–May 2013, excluding those with polytrauma and anticoagulant use. Rapid thrombelastography (rTEG) was obtained after emergency department (ED) arrival and coagulopathy was defined as follows: ACT ≥ 128 s, KT ≥ 2.5 s, angle ≤ 56°, MA ≤ 55 mm, LY-30 ≥ 3.0% or platelet count ≤ 150,000/μL. Regression modeling was used to assess the association of coagulopathy on mortality.Results
1086 patients with head CT scans performed and ICU admission orders were reviewed. After exclusion criteria were met, 347 patients with isolated TBI were analyzed-99 (29%) with p-TBI and 248 (71%) with b-TBI. Patients with p-TBI had a higher mortality (41% vs. 10%, p < 0.0001) and a greater incidence of coagulopathy (64% vs. 51%, p < 0.003). After dichotomizing p-TBI patients by mortality, patients who died were younger and were more coagulopathic. When adjusting for factors available on ED arrival, coagulopathy was found to be an early predictor of mortality (OR 3.99, 95% CI 1.37, 11.72, p-value = 0.012).Conclusions
This study demonstrates that p-TBI patients with significant coagulopathy have a poor prognosis. Coagulopathy, in conjunction with other factors, can be used to earlier identify p-TBI patients with worse outcomes and represents a possible area for intervention. 相似文献6.
Jack Manquen Tyler Combs Anya Mazur-Mosiewicz Donald Sanders Michael Schiesel Joshua Gordon Michelle Farabough Matt Vassar 《The American journal of emergency medicine》2019,37(1):73-79
Background
The objective of this study was to evaluate the temporal relationship between clinical practice guideline development and subsequent research performed, with the goal of providing more data on areas of sparse evidence that serve to underlie guideline recommendations. We aimed to assess the quality of current research efforts to address the American College of Emergency Physicians guideline and to provide suggestions for future research of mild traumatic brain injury.Methods
We identified clinical practice guideline recommendations with low levels of underlying evidence and searched ClinicalTrials.gov and the World Health Organization's International Clinical Trial Registry Portal to determine whether subsequent research has reflected an effort to address guideline recommendations.Results
Few currently registered clinical trials attempt to focus on clinical practice guideline recommendations where the basis of evidence is weak, and even fewer might benefit future iterations of the guideline due to multiple problems in study design and reporting.Conclusions
The amount of research dedicated to investigation of mild traumatic brain injury continues to be sparse and of poor quality. Study results should always be posted, even if the null hypothesis is confirmed. Efforts to improve the evidence base of a guideline should be realized by designing studies that directly assess and speak to the questions posed by guideline authors. 相似文献7.
Samantha Backhaus Dawn Neumann Devan Parrott Flora M. Hammond Claire Brownson James Malec 《Archives of physical medicine and rehabilitation》2019,100(2):195-204.e1
Objectives
This study aimed to (1) examine the efficacy of a treatment to enhance a couple’s relationship after brain injury particularly in relationship satisfaction and communication; and (2) determine couples’ satisfaction with this type of intervention.Design
Randomized waitlist-controlled trial.Setting
Midwestern outpatient brain injury rehabilitation center.Participants
Participants (N=44; 22 persons with brain injury and their intimate partners) were randomized by couples to the intervention or waitlist-controlled group, with 11 couples in each group.Interventions
The Couples Caring and Relating with Empathy intervention is a 16-week, 2-hour, manualized small group treatment utilizing psychoeducation, affect recognition, empathy training, cognitive-behavioral and dialectical-behavioral strategies, communication skills training, and Gottman’s theoretical framework for couples adjusted for individuals with brain injury.Main Outcome Measures
The Dyadic Adjustment Scale, Quality of Marriage Index (QMI), and the Four Horsemen of the Apocalypse communication questionnaire were implemented. Measures were completed by the person with brain injury and that person’s partner at 3 time points: baseline, immediate postintervention, 3-month follow-up.Results
The experimental group showed significant improvement at posttest and follow-up on the Dyadic Adjustment Scale and the Horsemen questionnaire compared to baseline and to the waitlist-controlled group which showed no significant changes on these measures. No significant effects were observed on the QMI for either group. Satisfaction scores were largely favorable.Conclusions
Results suggest this intervention can improve couples’ dyadic adjustment and communication after brain injury. High satisfaction ratings suggest this small group intervention is feasible with couples following brain injury. Future directions for this intervention are discussed. 相似文献8.
V. Wang E. Fort M. Beaudoin-Gobert A. Ndiaye C. Fischer A. Bergeret B. Charbotel J. Luauté 《Annals of physical and rehabilitation medicine》2019,62(1):28-34
Background
Return to work (RTW) is a major objective in the rehabilitation of individuals with severe traumatic brain injury (TBI). Implications for long-term occupational integration (beyond 5 years) have rarely been studied.Objective
The objective was to assess long-term RTW and the associated factors after severe TBI.Material and methods
Retrospective analysis of a cohort of individuals 16 to 60 years old admitted to hospital after severe TBI from 2005 to 2009 and followed prospectively. Medical and occupational data were collected from medical files and by systematic telephone interview to assess outcome at a minimum of 6 years post-trauma. Factors associated with RTW were investigated by multivariable regression analysis, estimating prevalence ratios (PRs) and 95% confidence intervals (CIs). A proportional hazards model was used to study RTW delay, estimating hazard ratios (HRs).Results
Among the 91 individuals included (mean [SD] age 28.5 [11.3] years; 79% male), 63.7% returned to work after a mean of about 20 months, and 57.1% were still working at the time of the survey. Factors significantly associated with RTW on multivariable analysis were higher educational level (adjusted PR, 1.53; 95% CI, 1.15 to 2.03), absence of motor disability (adjusted PR, 1.82; 1.12 to 2.95) and behavioural disorder (adjusted PR, 1.26; 1.01 to 1.60), as well as disabled worker status (adjusted PR, 1.26; 1.01 to 1.60) (likelihood of the multivariate analysis model 53.1). Delayed RTW was associated with health insurance payments (adjusted HR, 0.40; 95% CI, 0.22 to 0.71), motor disability (adjusted HR, 0.34; 0.15 to 0.76), low educational level (adjusted HR, 2.20; 1.06 to 4.56) and moderate disability on the Extended Glasgow Outcome Scale (adjusted HR, 0.49; 0.27 to 0.91) (likelihood of the multivariate analysis model 335.5).Conclusion
Individuals with the most severe TBI are able to RTW and remain in work. This study highlights the multiple determinants involved in RTW and the role of socioenvironmental factors. 相似文献9.
Lenore A. Hawley Jessica M. Ketchum Clare Morey Kathleen Collins Susan Charlifue 《Archives of physical medicine and rehabilitation》2018,99(8):1584-1590
Objectives
To describe the prevalence of cannabis use in an adult sample with spinal cord injury (SCI) or traumatic brain injury (TBI) in Colorado, and to describe the self-reported reasons and side effects of cannabis use in this sample.Design
Mixed-methods observational study, using focus group data and telephone survey.Setting
Community.Participants
Colorado adults who sustained SCI or moderate to severe TBI and received services through Craig Hospital.Interventions
None.Main Outcome Measures
Survey.Results
Focus group participants identified issues that were then included in the survey development. Seventy percent of the 116 participants surveyed reported cannabis use before their injury (67% SCI, 74% TBI) and 48% reported use after their injury (53% SCI, 45% TBI). Overall, the most common reason for use was recreational (67%), followed by reducing stress/anxiety (62.5%) and improving sleep (59%). Among the respondents with SCI, the most common reasons for use were to reduce spasticity (70%), recreation (63%), and to improve sleep (63%). Among those with TBI, reasons endorsed were recreational (72%), reducing stress/anxiety (62%), and improving sleep (55%). Smoking was the most common method of use.Conclusions
A majority of this sample reported using cannabis before injury, and approximately half reported using cannabis after injury. Both groups reported recreational use, whereas the group with SCI also highly endorsed using cannabis to address chronic medical conditions. Clinicians should be aware of the high prevalence of cannabis use in these populations and the impact such use may have on the individual’s medical management. Further research in this area is needed. 相似文献10.
Deployment-Related Traumatic Brain Injury and Risk of New Episodes of Care for Back Pain in Veterans
Traumatic brain injury (TBI) may be a predisposing factor to pain syndromes other than headache. We conducted a longitudinal cohort study among veterans evaluated for TBI in the US Department of Veterans Affairs (VA). Among 36,880 veterans at baseline, 55% reported back pain. TBI history was classified by trained clinicians according to VA-US Department of Defense criteria. 14,223 Veterans without back pain were followed for up to 6 years for new (incident) episodes of VA care for back pain. We estimated adjusted odds ratios (aORs), adjusted hazard ratios (aHRs), and 95% confidence intervals (CI), accounting for covariates. Deployment-related mild TBI was significantly associated with self-reported back pain in cross-sectional analyses (aOR?=?1.27, 95% CI?=?1.21–1.35), but not with incident episodes of VA care for back pain in longitudinal analysis (aHR?=?1.07, 95% CI?=?0.99–1.17). Deployment-related moderate to severe TBI was significantly associated with self-reported back pain in cross-sectional (aOR?=?1.74, 95% CI?=?1.58–1.91), and longitudinal analyses (aHR?=?1.20, 95% CI?=?1.05–1.38; P?=?.01). These findings indicate that deployment-related moderate to severe TBI confers increased back pain risk, but do not support a causal effect of deployment-related mild TBI on back pain.
Perspective
Findings from this longitudinal study of veterans indicate that deployment-related moderate to severe TBI confers increased back pain risk, but do not support a causal effect of deployment-related mild TBI on back pain. 相似文献11.
Shinya Iwase Taka-aki Nakada Noriyuki Hattori Waka Takahashi Nozomi Takahashi Tuerxun Aizimu Masahiro Yoshida Toshio Morizane Shigeto Oda 《The American journal of emergency medicine》2019,37(2):260-265
Background
The ability of blood levels of interleukin (IL)-6 to differentiate between infection and non-infection in critically ill patients with suspected infection is unclear. We assessed the diagnostic accuracy of serum IL-6 levels for the diagnosis of infection in critically ill patients.Methods
We systematically searched the PubMed, MEDLINE, Cochrane Resister of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, and Igaku Chuo Zasshi databases for studies published from 1986 to August 2016 that evaluated the accuracy of IL-6 levels for the diagnosis of infection. We constructed 2?×?2 tables and calculated summary estimates of sensitivity and specificity using a bivariate random-effects model.Results
The literature search identified 775 articles, six of which with a total of 527 patients were included according to the predefined criteria. The pooled sensitivity, specificity, and diagnostic odds ratio were 0.73 (95% confidence interval [CI], 0.61–0.82), 0.76 (95% CI, 0.61–0.87), and 2.31 (95% CI, 1.20–3.48), respectively. The area under the curve (AUC) of the summary receiver operator characteristic (SROC) curve was 0.81 (95% CI, 0.78–0.85). In the secondary analysis of two studies with a total of 263 adult critically ill patients with organ dysfunction, the pooled sensitivity, specificity, and diagnostic odds ratio were 0.81 (95% CI, 0.75–0.86), 0.77 (95% CI, 0.67–0.84), and 2.87 (95% CI 2.15–3.60), respectively.Conclusions
Blood levels of IL-6 have a moderate diagnostic value and a potential clinical utility to differentiate infection in critically ill patients with suspected infection. 相似文献12.
Tara Rhine Shari L. Wade Nanhua Zhang Huaiyu Zang Stephanie Kennebeck Lynn Babcock 《The American journal of emergency medicine》2018,36(6):1027-1031
Objectives
Care decisions for young children presenting to the emergency department (ED) with head injury are often challenging (e.g. whether to obtain neuroimaging). We sought to identify factors associated with acute management of children at-risk for clinically important traumatic brain injury (ciTBI) and describe symptom management.Methods
Observational evaluation of children, ages 0–4 years, presenting to a pediatric ED following minor head injury. Children with ≥1 risk element per the Pediatric Emergency Care Academic Research Network's decision rule were deemed “at-risk” for ciTBI. Clinician surveys regarding their initial clinical management were used to identify three care groups. Nonparametric tests analyzed group differences and logistic regression investigated associations of putative high-risk factors with neuroimaging.Results
Of 104 children enrolled: (i) 30 underwent neuroimaging, (ii) 59 were observed, and (iii) 15 were discharged following the clinician's initial patient exam. Children with a non-frontal scalp hematoma were more likely to receive immediate neuroimaging and children not acting like themselves per caregiver report were more likely to be initially observed, relative to the other care groups (p ≤ 0.01). Among high-risk factors, altered mental status (OR 5.12, 95% CI 1.8–21.1), presence of ≥3 risk elements of the decision rule (OR 3.5, 95% CI 1.2–10.6), unclear skull fracture on exam (OR 31.3, 95% CI 5.4–593.8), and age < 3 months (OR 5.3, 95% CI 1.5–21.9) were associated with neuroimaging. No child had ciTBI. TBI symptoms (e.g. vomiting) were infrequently treated.Conclusions
ED management varied for young children with similar risk stratification. Investigation of how age in concert with specific risk factors influences medical decision making would advance evidenced-based care. 相似文献13.
Jennifer H. Marwitz Adam P. Sima Jeffrey S. Kreutzer Laura E. Dreer Thomas F. Bergquist Ross Zafonte Douglas Johnson-Greene Elizabeth R. Felix 《Archives of physical medicine and rehabilitation》2018,99(2):264-271
Objectives
To evaluate (1) the trajectory of resilience during the first year after a moderate-severe traumatic brain injury (TBI); (2) factors associated with resilience at 3, 6, and 12 months postinjury; and (3) changing relationships over time between resilience and other factors.Design
Longitudinal analysis of an observational cohort.Setting
Five inpatient rehabilitation centers.Participants
Patients with TBI (N=195) enrolled in the resilience module of the TBI Model Systems study with data collected at 3-, 6-, and 12-month follow-up.Interventions
Not applicable.Main Outcome Measure
Connor-Davidson Resilience Scale.Results
Initially, resilience levels appeared to be stable during the first year postinjury. Individual growth curve models were used to examine resilience over time in relation to demographic, psychosocial, and injury characteristics. After adjusting for these characteristics, resilience actually declined over time. Higher levels of resilience were related to nonminority status, absence of preinjury substance abuse, lower anxiety and disability level, and greater life satisfaction.Conclusions
Resilience is a construct that is relevant to understanding brain injury outcomes and has potential value in planning clinical interventions. 相似文献14.
Shuzhen Wei Ting Wu Ying Wu Ding Ming Xiaoli Zhu 《Diagnostic microbiology and infectious disease》2019,93(4):339-345
Background
Candida albicans germ tube antibody (CAGTA) may be helpful as a marker for the diagnosis of invasive candidiasis (IC). However, the performance has been variable. We conducted a meta-analysis to assess the diagnostic accuracy of this assay for diagnosing IC.Method
We searched MEDLINE, EMBASE, Cochrane Collaboration databases, reference lists of retrieved studies, and review articles. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and a summary receiver-operating characteristic curve of CAGTA for diagnosing IC were pooled using meta-analysis.Results
A total of 976 patients (262 with proven or probable IC), included in 7 studies, were analyzed. The pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratios and area under the curve were 66% (95% confidence interval [95% CI], 59% to 73%), 76% (95% CI, 58% to 88%), 2.8 (95% CI, 1.5 to 5.8), 0.44 (95% CI, 0.34 to 0.57), 6 (95% CI, 3 to 5), and 0.68 (95% CI, 0.64 to 0.72), respectively. Heterogeneity of specificity was significant.Conclusion
The diagnostic accuracy of the CAGTA assay is moderate for IC. Since the CAGTA assay is not absolutely sensitive and specific for IC, the CAGTA results should be interpreted in parallel with other biomarkers and clinical findings. 相似文献15.
Robert J. McLoughlin Jonathan Green Pradeep P. Nazarey Michael P. Hirsh Muriel Cleary Jeremy T. Aidlen 《The American journal of emergency medicine》2019,37(3):439-443
Purpose
In 2015, approximately 13,436 snowboarding or skiing injuries occurred in children younger than 15. We describe injury patterns of pediatric snow sport participants based on age, activity at the time of injury, and use of protective equipment.Methods
A retrospective analysis was performed of 10–17?year old patients with snow-sport related injuries at a Level-1 trauma center from 2005 to 2015. Participants were divided into groups, 10–13 (middle-school, MS) and 14–17?years (high-school, HS) and compared using chi-square, Student's t-tests, and multivariable logistic regression.Results
We identified 235 patients. The HS group had a higher proportion of females than MS (17.5% vs. 7.4%, p?=?0.03) but groups were otherwise similar. Helmet use was significantly lower in the HS group (51.6% vs. 76.5%, p?<?0.01). MS students were more likely to suffer any head injury (aOR 4.66, 95% CI: 1.70–12.8), closed head injury (aOR 3.69 95% CI: 1.37–9.99), or loss of consciousness (aOR 5.56 95% CI 1.76–17.6) after 4?pm. HS students engaging in jumps or tricks had 2.79 times the risk of any head injury (aOR 2.79 95% CI: 1.18–6.57) compared to peers that did not. HS students had increased risk of solid organ injury when helmeted (aOR 4.86 95% CI: 1.30–18.2).Conclusions
Injured high-school snow sports participants were less likely to wear helmets and more likely to have solid organ injuries when helmeted than middle-schoolers. Additionally, high-schoolers with head injuries were more like to sustain these injures while engaging in jumps or tricks. Injury prevention in this vulnerable population deserves further study.Level of evidence
Level III (Retrospective Comparative Study). 相似文献16.
Namkyung Jeong Kyung Su Kim Yoon Sun Jung Taegyun Kim So Mi Shin 《The American journal of emergency medicine》2019,37(2):277-280
Objectives
To determine the association between delayed (>24?h) endoscopy and hospital mortality in patients with upper gastrointestinal hemorrhage (UGIH).Methods
We retrospectively analyzed all adult patients with UGIH who underwent endoscopy in a single emergency room for 2?years. The primary exposure was defined as >24?h from the ED visit to the first endoscopy. The primary outcome was defined as all cause hospital mortality. Secondary outcomes were intensive care unit admission rate, ED length of stay, and hospital length of stay.Results
Among 1101 patients enrolled, 898 received endoscopy within 24?h (early group) and 203 received endoscopy after 24?h (delayed group). The hospital mortality of early and delayed group was 2.8% and 6.4%, respectively (unadjusted relative risk [RR] 2.30: 95% CI, 1.20–4.42, p?=?0.012). This was significant after adjusting covariates including AIMS65 and Glasgow-Blatchford score (adjusted RR 2.23: 95% CI, 1.18–4.20, p?=?0.013). Intensive care unit admission rate was not different between two groups. ED and hospital length of stay were significantly longer in delayed group.Conclusions
Endoscopy performed after 24?h was associated with increased hospital mortality in UGIH. Patients in the delayed group stayed longer in the ED and in the hospital. 相似文献17.
Sarah L. Martindale Erica L. Epstein Katherine H. Taber 《Archives of physical medicine and rehabilitation》2018,99(12):2485-2495
Objective
To characterize behavioral and health outcomes in veterans with traumatic brain injury (TBI) acquired in nondeployment and deployment settings.Design
Cross-sectional assessment evaluating TBI acquired during and outside of deployment, mental and behavioral health symptoms, and diagnoses.Setting
Veterans Affairs Medical Centers.Participants
Iraq and Afghanistan veterans who were deployed to a warzone (N=1399).Interventions
Not applicable.Main Outcome Measures
Comprehensive lifetime TBI interview, Structured Clinical Interview for DSM-IV Disorders, Combat Exposure Scale, and behavioral and health measures.Results
There was a main effect of deployment TBI on depressive symptoms, posttraumatic stress symptoms, poor sleep quality, substance use, and pain. Veterans with deployment TBI were also more likely to have a diagnosis of bipolar, major depressive, alcohol use, and posttraumatic stress disorders than those who did not have a deployment TBI.Conclusions
TBIs acquired during deployment are associated with different behavioral and health outcomes than TBI acquired in nondeployment environments. The presence of TBI during deployment is associated with poorer behavioral outcomes, as well as a greater lifetime prevalence of behavioral and health problems in contrast to veterans without deployment TBI. These results indicate that problems may persist chronically after a deployment TBI and should be considered when providing care for veterans. Veterans with deployment TBI may require treatment alterations to improve engagement and outcomes. 相似文献18.
Josh Greenstein Devjani Das Josie Acuna Monica Kapoor Cara Brown Abbas Husain Brendan Lally Barry Hahn 《The American journal of emergency medicine》2019,37(2):313-316
Background
In the emergency department, rib fractures are a common finding in patients who sustain chest trauma. Rib fractures may be a sign of significant, underlying pathology, especially in the elderly patients where rib fractures are associated with significant morbidity and mortality. To date, no studies have evaluated the ability of ultrasound to detect rib fractures using cadaver models and subsequently use this model as a teaching tool.Objectives
The purpose of this study was to determine if it is possible to generate rib fractures on cadaver models which could be accurately identified using ultrasound.Methods
This was a cross-sectional study performed during one session at a cadaver lab. A single hemithorax from four adult cadavers were used as models. Single rib fractures on each of rib five through eight were created. Four subjects, blinded to the normal versus fractured ribs, were asked to identify the presence of a fracture on each rib.Results
A total of 8 of 16 potential ribs had fractured induced by study staff. Mean accuracy was 55% for all subjects. The overall sensitivity and specificity for detecting rib fractures was 50% (CI: 31.89–68.11) and 59.38% (CI: 35.69–73.55) respectively. The overall PPV and NPV was 55.17% and 54.29% respectively.Conclusions
In this pilot study, subjects were not able to detect induced rib fractures using ultrasound on cadaver models. The use of this model as a teaching tool in the detection of rib fractures requires further investigation. 相似文献19.
Reza Zonozi Aozhou Wu Jung-Im Shin Alex Secora Josef Coresh Lesley A. Inker Alex R. Chang Morgan E. Grams 《Mayo Clinic proceedings. Mayo Clinic》2019,94(1):17-26
Objective
To investigate the frequency of, risk factors for, and outcomes after elevated levels of vancomycin.Patients and Methods
We identified hospitalizations among 21,285 individuals in which intravenous vancomycin was given between August 29, 2007, and October 10, 2014. We investigated frequency and risk factors for elevated vancomycin levels (trough levels >30 mg/L) as well as associations with subsequent acute kidney injury (AKI), length of stay, and in-hospital mortality.Results
Among the 21,285 patients, the mean age was 62.9 years, and 10,478 (49.2%) were female. Trough levels of vancomycin were checked in 7422 patients, and 755 elevated levels were detected. Compared with patients with trough levels checked but no elevated levels found, those with elevated levels had longer duration of vancomycin therapy (median, 6.0 days vs 3.4 days; P<.001) and slightly higher doses (mean, 1.72 g vs 1.58 g; P<.001). Patients with higher body mass index or lower estimated glomerular filtration rate had more elevated levels. In propensity-matched analyses, patients had higher risk of incident AKI after elevated levels compared with patients without elevated levels (hazard ratio, 1.55; 95% CI, 1.09-2.20; P=.02), as well as longer subsequent length of stay (relative risk, 1.14; 95% CI, 1.02-1.28; P=.03) but similar in-hospital mortality.Conclusion
In this study, elevated vancomycin levels were common, particularly in patients with higher body mass index and lower estimated glomerular filtration rate, and were associated with greater subsequent AKI and length of stay. 相似文献20.
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