Management and outcome in patients following head injury admitted to an Irish Regional Hospital

Primary objective: Each year in Ireland, 11 000 patients are admitted to hospital with a traumatic brain injury (TBI) but there are no data on subsequent disability in such patients. The objective of this study was to assess the management and outcome in patients of working age admitted with TBI to the unit.

Methods: Two hundred and sixteen patients admitted with TBI aged 16-65 were identified. Self-reported incidence of disability and access to appropriate services was assessed using the Glasgow outcome scale and a problem-orientated questionnaire.

Results: Eighty-five per cent of patients eligible for review agreed to participate. The majority of injuries (86%) were mild. An intracranial injury was identified on 35% of CT brain scans performed. Patients with an abnormality on CT scanning were more likely to report difficulties with headache, concentration and memory at time of follow-up. When questioned, 34% of patients still perceived difficulties since their injury. Of this group, 60% didn't receive any input from rehabilitation services. One year post-injury, 11% of patients remained unfit for work.

Conclusion: A significant number of patients, even with mild TBI, continue to suffer sequelae from their injury augmented by difficulty in accessing appropriate rehabilitation services.     

Hospital resource use and costs among abdominal aortic aneurysm repair patients admitted to the intensive care unit

BackgroundAbdominal aortic aneurysm (AAA) repair is associated with significant morbidity and mortality. As a result, many of these patients are monitored postoperatively in the intensive care unit (ICU). However, little is known about resource utilization and costs associated with ICU admission in this population. We sought to evaluate predictors of total costs among patients admitted to the ICU after repair of nonruptured or ruptured AAA.MethodsWe retrospectively analyzed prospectively collected data (2011-2016) of ICU patients admitted after AAA repair. The primary outcome was total hospital costs. We used elastic net regression to identify pre-ICU admission predictors of hospitalization costs separately for nonruptured and ruptured AAA patients.ResultsWe included 552 patients in the analysis. Of these, 440 (79.7%) were admitted after repair of nonruptured AAA, and 112 (20.3%) were admitted after repair of ruptured AAA. The mean age of patients with nonruptured AAA was 74 (standard deviation, 9) years, and the mean age of patients with ruptured AAA was 70 (standard deviation, 8) years. Median total hospital cost (in Canadian dollars) was $21,555 (interquartile range, $17,798-$27,294) for patients with nonruptured AAA and $33,709 (interquartile range, $23,173-$53,913) for patients with ruptured AAA. Among both nonruptured and ruptured AAA patients, increasing age, illness severity, use of endovascular repair, history of chronic obstructive pulmonary disease, and excessive blood loss (≥4000 mL) were associated with increased costs, whereas having an anesthesiologist with vascular subspecialty training was associated with lower costs.ConclusionsPatient-, procedure-, and clinician-specific variables are associated with costs in patients admitted to the ICU after repair of AAA. These factors may be considered future targets in initiatives to improve cost-effectiveness in this population.     

上海市三级甲等医院ICU机械通气患者镇静护理实践的现状调查

目的 了解上海市三级甲等综合性医院ICU机械通气患者镇静护理实践的现状.方法 在14所上海市三级甲等综合性医院中抽取ICU护士133名,采用ICU机械通气患者镇静护理实践调查问卷进行调查.结果 19.55％的护士所在ICU常规开展机械通气患者镇静治疗;70.67％采用持续泵入镇静药物给药方式;52.63％有个体化镇静目标,并能动态调整;51.88％镇静评分者为医生,28.57％使用评分工具;19.55％护士所护理的患者处于不正确的镇静状态;50.37％给药速度调整者为医生;57.14％的护士没有接受过培训.结论 上海市ICU机械通气患者镇静实践现状与指南仍有差距,对护士进行规范化培训及探索建立操作性强的适合护士执行的镇静给药方案,将是镇静治疗护理领域今后的研究方向.     

Epidemiology and short-term mortality in traumatic patients admitted to Shariati Hospital in Iran between 2012 and 2013

Purpose: Trauma is an inevitable part of the health burden in every country. Both the preventive and rehabilitative aspects of traumatic injuries are expensive. Since most of the injuries happen in low- and middle-income developing countries, a judicious allocation of the limited resources to the most costefficient strategies is necessary. The present study was designed to report the causes of trauma, injured body regions, trauma severity scores and the one year survival rate of a randomly selected sample of trauma patients in a major referral hospital in Tehran, Iran. Methods: We chose and analyzed a random subgroup of traumatic patients admitted during the oneyear period of May 2012 to May 2013 to Shariati Hospital, a major University Teaching Hospital in Tehran, Iran. Patients who stayed at the hospital for less than 24 h were excluded. In total, 73 traumatic patients were registered. The mean age was (40.19 ± 20.34) years and 67.1% of them were male. Results: In general, the most common cause of injury was falls (47.9%), followed by road traffic crashes (RTCs, 40.8%). Assault and exposure to inanimate mechanical forces each were only associated with 5.6% of all injuries. The only cause of injury in ages of more than 65 years was fall. The most common cause of injury in ages between 15 and 45 years was RTCs. During the study, two deaths occurred: one was at ICU and the other was at home. The most commonly injured body region was the head (23.8%), followed by the elbow and forearm (19%), hip and thigh (15.9%), and multiple body regions (14.3%). The mean abbreviated injury score was 2.23±1.02; injury severity index was 7.26±7.06; and revised trauma score was 7.84, calculated for 38 patients. Conclusion: Prevention strategy of traumatic injury should focus on falls and RTCs, which are respectively the most common cause of trauma in older aged people and young males.     

Clinical statistics of the patients admitted to the Department of Urology, Kyoto City Hospital, July 1981 to December 1986

A statistic survey was made on the patients, diseases, and operations experienced at the urological ward of Kyoto City Hospital between July, 1981 and December, 1986.     

Clinical statistics of the patients admitted to the Department of Urology, Kobe General Hospital, 1982-1986

A statistic survey was made on the patients, diseases and operations experienced at the urological ward of Kobe General Hospital between 1982 and 1986.     

Current treatment practices of venous thromboembolism in children admitted to pediatric intensive care units

Objective: To describe current treatment practices of VTE in patients admitted to a pediatric intensive care unit (PICU) and compare these practices to published guidelines. Background: While the incidence of VTE is increasing, current treatment practices of VTE in patients admitted to PICUs are not known. Methods: This multicenter, prospective, observational study enrolled patients with confirmed VTE admitted to 11 PICUs over a rolling 6‐month study period. Treatment data were collected and analyzed. Results: Sixty‐six VTEs occurred in 6653 patients. Empiric treatment for VTE was initiated in 30% prior to VTE confirmation, and children with cyanotic heart disease were 15.7 times more like to receive empiric therapy. Overall, 78% received systemic anticoagulation, 8% treated with only catheter‐based interventions, and 13% of VTE were not treated. Seven patients (11%) underwent systemic fibrinolysis; more commonly in neonates (23%) vs children (5%). Surgical and interventional procedures were performed on 4 patients. The American College of Chest Physicians recommendations were incompletely followed. Only 28% of the 32 cases treated with low molecular weight heparin titrated dosing to a goal anti‐FXa level 0.5–1. Five of the 15 cases treated with unfractionated heparin titrated dosing to aPTT 60–90, and one case did not use goal‐directed therapy. Conclusions: Confirmed VTEs in patients admitted to PICUs are most frequently treated with systemic anticoagulation; however, more intensive treatments such as systemic thrombolysis and surgical or interventional procedures are not uncommon in this critically ill population. Current practices deviate from the published antithrombotic guidelines developed for the general pediatric population.     

Clinical statistics of the patients admitted to the Department of Urology, Kobe University Hospital, 1985-1987

Between 1985 and 1987, a total number of 791 inpatients were treated at our department and 683 operations were performed. Urogenital malignant tumors (42.0%) were most frequently treated. Male infertility (14.8%) and urolithiasis (8.5%) followed. Bladder tumor was the most frequent disease in our hospital and transurethral resection of bladder tumor was the most frequent operation. Clearly endourological procedures have replaced so-called open surgeries.     

急诊创伤患者低体温风险评分量表的研制

目的 研制急诊创伤患者低体温风险评分量袁,验证其临床预测效果.方法 选取489例急诊创伤患者作为建模组,根据是否出现低体温分为为低体温组和常温组,采用二元Logistic回归法分析影响创伤低体温的独立风险因素,构建创伤低体温风险评分量表,确定预测界值.再选取228例急诊创伤患者作为验证组,使用构建的量表预测评分,根据实际低体温的发生情况验证预测效果.结果 建模组构建的创伤低体温风险评分量表包括4个条目:受伤环境温度≤8℃(1分),修正创伤评分＜4分(2分),衣物潮湿(2分),入室时发生休克(2分).验证组中低体温组患者和体温正常组患者风险评分量袁评分差异具有统计学差异(P＜0.01).预测界值3分时,量表预测敏感度为0.709、特异度为0.920、阳性预测值为82.24％、阴性预测值为85.63％、总体正确率为86.08％,ROC曲线下面积为0.829[95％CI(0.769,0.888)].结论 构建的急诊创伤患者低体温风险评分量表具有良好的区分度和预测效果,可用于创伤患者低体温预测.     

Evaluating mechanism and severity of injuries among trauma patients admitted to Sina Hospital, the National Trauma Registry of Iran

Purpose: Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries. Methods: The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset. Results: The most common injury mechanism was road traffic injuries (49.0%), followed by falls (25.5%). The mean age of those who fell was significantly higher in comparison with other mechanisms (p < 0.001). Severe extremity injuries occurred more often in the fall group than in the vehicle collision group (69.0% vs. 43.5%, p < 0.001). Moreover, cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls (27.8% vs. 12.9%, p = 0.003). Conclusion: Comparing falls with motor vehicle collisions, patients who fell were older and sustained more extremity injuries. Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls. Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.     

Clinical statistics of the patients admitted to the Department of Urology Shizuoka Red Cross Hospital between 1981 and 1990]

A statistic survey was made on the patients, diseases and operations experienced at the Urological ward of Shizuoka Red Cross Hospital between 1981 and 1991. The total number of inpatients was 2,830 and the male to female ratio was 3.5 to 1. The most frequent diseases among the inpatients were obstructive uropathy (25.5%), malignant neoplasia (23.7%), non-specific infection (16.4%) urolithiasis (16.1%). The number of operations was 1922. Endoscopic surgery was the most frequent form of operation (55.2%).     

An investigation into puerperal psychoses in black women admitted to Baragwanath Hospital.

OBJECTIVES: Puerperal psychosis was studied in black African women at Baragwanath Hospital in Johannesburg. DESIGN: A retrospective study analysed the clinical notes of 314 cases of puerperal psychosis seen over previous years. A prospective study researched 67 cases of puerperal psychosis referred during a full calendar year. A control group of 98 patients was matched with the prospective study patients for age, marital status, parity and month of delivery. RESULTS: The incidence (2-3 cases per 1,000 births), onset and pattern of illness are all remarkably similar to that described in the international literature. Confirmed risk factors were a primiparous patient; a family history of psychiatric illness; and a personal psychiatric history, particularly a history of mania. Additional risk factors found in this study were substance dependence; a medical illness; the season of the year; a male child; and psychosocial stress including need for intensive medical care for the baby or death of the baby. CONCLUSION: The conclusion reached is that the puerperal psychoses are undifferentiated psychoses, usually mood disorders, showing some special symptomatology, and are precipitated in constitutionally predisposed patients by the physiological factors of the involutionary period.     

Evaluation of mortality of patients admitted to ICU for the last 12 years

We evaluated mortality of 2689 patients admitted to the Intensive Care Unit, Osaka University Hospital from January, 1987 to December, 1998. The patients were divided into 3 groups. Group A consisted of 1408 patients who underwent cardiovascular surgery, group B, 1082 patients who underwent other surgical procedures and group C, 199 patients who were transferred from the department of medicine. We studied mortality rate, causes of death, correlation between length of ICU stay and mortality rate, and mortality rate among age groups for 12 years. The main causes of death were cardiac failure and sepsis in group A, and respiratory failure and sepsis in group B and C. Mortality rate in each group showed no significant change for the last 12 years. Those who stayed more than 2 weeks in ICU showed a significantly higher mortality rate (p < 0.0001). Thus, length of ICU stay and mortality rate showed a positive correlation (p < 0.0001). The youngest group (age 0-1) showed a significantly higher mortality rate than other age groups (p < 0.0001). As sepsis was the most important cause of death in all the groups, the prevention and treatment of infection are the most important issue in our ICU to reduce mortality rate.     

预防手外科自杀入院患者再次自杀的措施探讨

目的防止手外科自杀入院患者在住院期间再次出现自杀行为,保障患者住院期间的生命安全。方法加强护理人员预防患者自杀以及患者自杀后应急预案培训,对手外科收治的30例自杀入院患者进行严格入院精神评估,对患者进行心理评估及干预,加强病房环境管理及巡视,严格交接班,加强服药监护。结果 30例患者住院期间均未出现再次自杀或自伤行为,出院时自杀意念及自杀倾向评分显著低于入院时(均P0.01)。结论预防手外科自杀入院患者再次自杀的强化措施有利于提高护理人员应急能力及风险意识,保障自杀患者安全。     

Clinical statistics of the Urological Clinic of Sapporo Sanjukai Hospital. Clinical statistics on patients admitted from 1985 to 1989]

A clinical statistic survey was carried out on the patient admitted, diseases and operations experienced at our urological clinic during 1985-1989. The total number of inpatients was 8,750 (The male to female ratio was 2.8:1). The major diseases of the inpatients were urolithiasis (4,134 cases, 47.2%) and benign prostatic hypertrophy (1,529 cases, 17.5%). Among the operations extracorporeal shock-wave lithotripsy 2,589 cases (44.6%) and transurethral resection of prostate 1,295 cases (22.3%) were predominant.     

Laparoscopy in patients admitted for acute abdominal pain

In 81 patients with acute abdominal pain, laparoscopy was performed because of diagnostic doubt. Diagnosis by clinical methods proved to be correct in 42 of the patients and laparoscopy gave correct diagnosis in 70. Appendectomy revealed acute appendicitis in 19 patients and normal appendix in five. Failure to establish a diagnosis by laparoscopy was due to incomplete visualization of appendix in nine patients, pelvic adhesions in one patient, and failure to enter the peritoneal cavity in another. A clinical diagnosis of acute appendicitis could be invalidated by laparoscopy in 17 of 40 patients. Negative laparotomy is potentially avoidable by use of laparoscopy when a diagnosis of appendicitis is questionable. Laparoscopy may therefore be warrantable in such cases.     

Head injury patients admitted to general hospitals in Merseyside

During 1975 and 1976, 11 837 patients with head injury were admitted to 16 general hospitals serving 2.1 million people. Eight hundred and seventy-five had fractures of the skull, 178 died and 103 were transferred to the regional department of neurosciences. A fall was the cause of injury in 49 per cent, a traffic accident in 24 per cent and assault in 17 per cent. Seventeen per cent of adult patients had taken alcohol and 16 per cent had major extracranial injuries (including fractures of the bones of the face). Sixty-seven per cent stayed in hospital for 0–48 hours and 8 per cent for 8 days or more. The mortality rate and the number of deaths associated with avoidable factors both increased with the patient's ages. After standardization for age and sex, neither of these measures of the effectiveness of the management of head injury in hospital was found to differ significantly amongst the sixteen hospitals; nor were they related to differences in the way in which head injury patients were managed (for example, duration of stay in hospital) or to admission policy, work load (number of patients admitted with head injury per year) or the distance by road to the regional neurosciences department.