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Carles Ferré Ferran Llopis Francisco Javier Martín-Sánchez Gonzalo Sempere Pere Llorens Carmen Navarro Mikel Martínez-Ortiz Antoni Juan 《The Journal of emergency medicine》2017,52(5):764-768
Background
Emergency Department (ED) overcrowding mainly due to the lack of access to inpatient beds negatively affects safety and quality of care. Implementation of ED short-stay units (EDSSUs) may help to mitigate this situation.Objectives
To describe the general characteristics and evaluate the activity of EDSSUs in Spanish hospitals.Methods
This is a cross-sectional study. A questionnaire was sent to coordinators responsible for the EDSSUs identified among Spanish hospitals appearing on the Ministry of Health Web page. Data regarding structure, caseloads, and clinical management practices were collected.Results
Among the 591 hospitals surveyed, 35 EDSSUs (5.9%) were identified and 23 participated in the study. Admissions to EDSSUs over different periods in 2011 were assessed: 12-month activity in 17 EDSSUs and between 5 and 10.5 months in six EDSSUs. A total of 25,568 patients with a mean age of 67.2 ± 9.8 years were admitted, representing between 6% and 16.3% of hospital admissions from the ED. The most frequent diagnoses were acute heart failure, chronic obstructive pulmonary disease exacerbation, and urinary and respiratory tract infections. The average length of stay (LOS) was 2.6 ± 1.1 days (range 1.2–5.3), in-hospital mortality 0.59% (range 0–2.68), and the 30-day readmission rate after discharge was 6.7% (range 0–14.6).Conclusions
To date, only a few Spanish hospitals have implemented EDSSUs. Prevalent infections and exacerbation of chronic conditions are the most frequent causes for admission. Considering LOS, 30-day readmission rate and mortality, EDSSUs appear to be safe and effective and might be considered a tool to alleviate ED overcrowding. 相似文献3.
Richard D. Shih Brian Walsh Barnet Eskin John Allegra Frederick W. Fiesseler Dave Salo Michael Silverman 《The Journal of emergency medicine》2017,52(1):23-27
Background
Vertigo is a debilitating disease that is commonly encountered in the emergency department (ED). Diazepam and meclizine are oral medications that are commonly used to alleviate symptoms.Objectives
We sought to determine whether meclizine or diazepam is superior in the treatment of patients with peripheral vertigo in the ED.Methods
We performed a double-blind clinical trial at a suburban, teaching ED. We randomized a convenience sample of adult patients with acute peripheral vertigo (APV) to diazepam 5 mg or meclizine 25 mg orally. Demographic and historical features were recorded on a standardized data form. Patients recorded their initial level (t0) of vertigo on a 100-mm visual analog scale (VAS) and after 30 min (t30) and 60 min (t60). The primary outcome parameter was the mean change in VAS score from t0 to t60. Differences between groups and 95% confidence intervals were calculated. Our a priori power calculation estimated that a sample size of 20 patients in each group was required to have an 80% power to detect a difference of 20 mm between treatment groups.Results
There were 20 patients in the diazepam group and 20 in the meclizine group. The two groups were similar with respect to patient demographics and presenting signs and symptoms. At t60, the mean improvements in the diazepam and meclizine groups were 36 and 40, respectively (difference ?4; 95% confidence interval ?20 to 12; p = 0.60).Conclusion
We found no difference between oral diazepam and oral meclizine for the treatment of ED patients with acute peripheral vertigo. 相似文献4.
Patrick Joseph Maher Alisha Emily Cutler Brown Medley O&#x;Keefe Gatewood 《The Journal of emergency medicine》2017,52(5):639-644
Background
Urinalysis testing is frequently ordered in the emergency department (ED), but contamination of urine specimens limits the interpretation of results. The mid-stream, clean-catch (MSCC) procedure for urine specimen collection is recommended to decrease contamination rates, but without instructions this procedure has poor compliance.Objective
To evaluate the effectiveness of written instructions alone, we analyzed the rate of specimen contamination, defined by presence of squamous epithelial cells (SECs) and culture results, in the ED after posting information on the MSCC procedure.Methods
Instructions in simple English for the MSCC procedure were posted in all patient-accessible restrooms in the ED. Frequency of contamination, defined microscopically as > 5 SECs per high-powered field or through growth of mixed or non-pathologic flora on urine culture, was determined over a 3-month period for comparison to historical controls from the previous year.Results
During the intervention period, 754 urinalyses were sent, with 392 contaminated specimens (51.98%), and 193 urine cultures were sent, with 77 contaminated results (39.8%). Historical controls from the previous year yielded 827 urinalyses sent, with 430 contaminated (51.99%), and 251 urine cultures, with 125 contaminated results (49.8%). The difference between groups was not significant for urinalysis (p = 0.99) or urine culture (p = 0.13).Conclusions
A poster-based educational intervention with instructions on MSCC procedure failed to decrease contamination rates in this ED-based study. Possible explanations include poor compliance with MSCC technique in the ED, or poor efficacy of this technique at decreasing contamination rates. These results may indicate that other efforts are necessary to improve urine collection methods. 相似文献5.
Background
Return visits to the emergency department (RTED) contribute to overcrowding and may be a quality of care indicator. Previous studies focused on factors predicting returns to and from the same center. Little is known about RTEDs across a range of community and specialty hospitals within a large geographic area.Objective
We sought to measure the frequency of pediatric RTEDs and describe their directional pattern across centers in a large catchment area.Methods
We conducted a multicenter, retrospective cross-sectional study of pediatric emergency visits in the Vancouver lower mainland within 1 year. Visits were linked across study sites, including one pediatric quaternary care referral center and 17 sites ranging from large regional centers to smaller community emergency departments (EDs). Returns were defined as subsequent visits to any site with a compatible diagnosis within 7 days of an index visit.Results
Among a total of 139,278 index ED visits by children, 12,133 (8.7% [95% confidence interval 8.6–8.9%]) were associated with 14,645 return visits to an ED. Three quarters of all index visits occurred at a general ED center, of which 8.9% had at least one RTED and 22% of these returns occurred at the pediatric ED (PED). Among PED index visits, 8.2% had at least one RTED and 13.6% of these returned to a general center. Overall, 38.9% of all RTEDs occurred at the PED. Multivariate regression did not identify any statistically significant association between ED crowding measures and likelihood of RTEDs.Conclusions
Compared to single-center studies, this study linking hospitals within a large geographic area identified a higher proportion of RTEDs with a disproportionate burden on the PED. 相似文献6.
Stephen J. Traub M&#x;Hamed Temkit Soroush Saghafian 《The Journal of emergency medicine》2017,52(6):885-893
Background
Holding orders help transition admitted emergency department (ED) patients to hospital beds.Objective
To describe the effect of ED holding orders.Methods
We conducted a single-site retrospective study of ward admissions from the ED to the hospital internal medicine (HIM) service over 2 years. Patients were classified based on whether the ED did (group 1) or did not (group 2) write holding orders; group 1 was subdivided into patients sent to the floor with only ED holding orders (group 1A) vs. with subsequent HIM admission orders (group 1B). Outcomes were ED length of stay (LOS), time from decision to admit to ED departure (D→D), transfer to a higher level of care within 6 h (potential undertriage), and discharge from admission ward within 12 h (potential overtriage).Results
There were 9501 admissions: 6642 in group 1 (2369 in group 1A and 4273 in group 1B) and 2859 in group 2. Reductions in mean LOS between groups (with 95% confidence intervals [CIs] of the differences) were as follows: group 1 vs. 2: 44 min (39–49 min); group 1A vs. 1B, 48 min (43–53 min); group 1B vs. 2: 27 min (22–32 min); group 1A vs. 2: 75 min (69–81 min). Mean D→D was shorter in group 1A than 1B by 43 min (40–45 min). Holding orders were not associated with increases in potential undertriage or overtriage.Conclusions
ED holding orders were associated with improved ED throughput, without evidence of undertriage or overtriage. This work supports the use of holding orders as a safe and effective means to improve ED patient flow. 相似文献7.
Michael D. April Jose Aguirre Lloyd I. Tannenbaum Tyler Moore Alexander Pingree Robert E. Thaxton Daniel J. Sessions James H. Lantry 《The Journal of emergency medicine》2017,52(5):622-631
Background
Quick Sequential Organ Failure Assessment (qSOFA) is a prognostic score for patients with sepsis.Objective
Our aim was to compare the area under the receiver operating curve (AUROC), sensitivity, specificity, and likelihood ratios of qSOFA vs. systemic inflammation response syndrome (SIRS) in predicting in-hospital mortality among emergency department (ED) patients with suspected infection admitted to intensive care units (ICUs).Methods
We conducted a retrospective cohort chart review study of ED patients admitted to an ICU with suspected infection from August 1, 2012 to February 28, 2015. We included all patients with body fluid cultures sampled either during their ED stay without antibiotic administration or within 24 h of antibiotics administered in the ED. Trained chart abstractors blinded to the study hypothesis double-entered data from each patient's electronic medical record including demographic characteristics, vital signs, laboratory study results, physical examination findings, and in-hospital mortality. We then calculated the AUROC, sensitivity, specificity, and likelihood ratios for qSOFA and SIRS for predicting in-hospital mortality.Results
Of 214 patients admitted to an ICU with presumed sepsis, 39 (18.2%) died during hospitalization. The AUROC value was 0.65 (95% confidence interval [CI] 0.56–0.74) for SIRS vs. 0.66 (95% CI 0.57–0.76) for qSOFA; 2+ qSOFA criteria predicted in-hospital mortality with 89.7% sensitivity, 27.4% specificity, 1.2 positive likelihood ratio, and 0.4 negative likelihood ratio.Conclusions
Among ED patients admitted to an ICU, the SIRS and qSOFA criteria had comparable prognostic value for predicting in-hospital mortality. These prognostic values are similar to those reported by the Sepsis-3 guidelines for ICU encounters. 相似文献8.
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Megan Sutter Laiene Olabarrieta Landa Amilkar Calderón Chagualá Helmer Chacón Peralta Gina Vergara Torres Paul B. Perrin Juan Carlos Arango-Lasprilla 《PM & R》2017,9(1):8-14
Background
Stroke is a primary cause of death and disability in upper-middle–income countries such as Colombia. Given the lack of comprehensive rehabilitation for stroke patients in Colombia, there is a need to assess longitudinal mental health problems poststroke in this region.Objective
To compare the course of mental health in stroke patients to healthy controls over the first year poststroke in Ibague, Colombia.Design
Cross-sectional study.Setting
The Psychological Attention Center of Antonio Nariño University in Ibague, Colombia.Participants
Stroke patients (n = 50) and age- and gender-matched healthy controls (n = 50).Methods
Patients and controls completed self-report Spanish versions of demographic information, injury-related characteristics, and mental health questionnairesMain Outcome Measurements
Outcomes assessed included mental health (depression, anxiety, and stress) at 3, 6, and 12 months poststroke.Results
Hierarchical linear models suggested that stroke patients had worse depression and anxiety over time than controls (P < .001). Among patients, depression and anxiety decreased over time (P < .001), whereas stress increased over time (P < .01). The findings suggest that although anxiety and depression improved over time in stroke patients, their mental health remained significantly lower than that of controls.Conclusions
This is the first study to examine the course of mental health over the first year poststroke in Latin America, specifically in Ibague, Colombia. Despite the improvements in anxiety and depression over the first year poststroke, patient anxiety and depression were still worse in comparison to those in healthy controls. The current findings indicate a need for rehabilitation services in Colombia, especially targeting mental health issues.Level of Evidence
I 相似文献10.
Amber Rice Jennifer Dudek Toni Gross Tomi St Mars Dale Woolridge 《The Journal of emergency medicine》2017,52(6):894-901
Background
The Emergency Medical Services for Children State Partnership Program, as well as the Institute of Medicine report on pediatric emergency care, encourages recognition of emergency departments (EDs) through categorization and verification systems. Although pediatric verification programs are associated with greater pediatric readiness, clinical outcome data have been lacking to track the effects and patient-centered outcomes by implementing such programs.Objective
To describe pediatric mortality rates prior to and after implementation of a pediatric emergency facility verification system in Arizona.Methods
This was a cross-sectional study conducted using data from ED visits between 2011 and 2014 recorded in the Arizona Hospital Discharge Database. The primary outcome measure was the mortality rate for ED visits by patients under 18 years old. Rates were compared prior to and after facility certification by the Arizona Pediatric Prepared Emergency Care program.Results
The total number of ED visits by children during the study period was 1,928,409. Of these, 1,127,294 were at facilities undergoing certification. For hospitals becoming certified, overall ED mortality rates were 35.2 deaths/100,000 ED visits (95% confidence interval [CI] 29.5–41.7) in the precertification analysis and 34.4 deaths/100,000 ED visits (95% CI 30.4–38.9) in the postcertification analysis. The injury-related ED visit mortality rate for certified hospitals showed a decrease from 40.0 injury-related deaths/100,000 ED visits (95% CI 28.6–54.4) in the precertification analysis to 25.8 injury-related deaths/100,000 ED visits (95% CI 18.7–34.8) in the postcertification analysis.Conclusion
The implementation of the Arizona pediatric ED verification system was associated with a trend toward lower mortality. These results offer a platform for further research on pediatric ED preparedness efforts and their effects on improved patient outcomes. 相似文献11.
Kerrin C. DePeter Stephen M. Blumberg Sarah Dienstag Becker James A. Meltzer 《The Journal of emergency medicine》2017,52(4):426-432
Background
Despite being an effective analgesic for children with fractures, some clinicians may avoid prescribing ibuprofen due to its potentially harmful effect on bone healing.Objective
To determine if exposure to ibuprofen is associated with an increased risk of bone healing complications in children with fractures.Methods
We performed a retrospective study of children aged 6 months to 17 years who presented to the pediatric emergency department (PED) with a fracture of the tibia, femur, humerus, scaphoid, or fifth metatarsus and who followed up with the orthopedic service. We chose these fractures due to their higher risk for complications. We classified patients as exposed if they received ibuprofen in the PED or during hospitalization or were prescribed ibuprofen at discharge. The main outcome was a bone healing complication as evidenced by nonunion, delayed union, or re-displacement on follow-up radiographs.Results
Of the 808 patients included in the final analysis, 338 (42%) were exposed to ibuprofen. Overall, 27 (3%) patients had a bone healing complication; 8 (1%) developed nonunion, 3 (0.4%) developed delayed union, and 16 (2%) developed re-displacement. Ten (3%) patients who were exposed to ibuprofen, and 17 (4%) who were not, developed a bone healing complication (odds ratio 0.8, 95% confidence interval 0.4–1.8; p = 0.61). There was no significant association between ibuprofen exposure and the development of a bone healing complication despite adjustment for potential confounders.Conclusion
Children with extremity fractures who are exposed to ibuprofen do not seem to be at increased risk for clinically important bone healing complications. 相似文献12.
Gardner Yost Laura Coyle Kristen Milkevitch Roy Adair Antone Tatooles Geetha Bhat 《PM & R》2017,9(1):40-45
Background
Left ventricular assist devices (LVADs) have become an increasingly popular and effective means for treating advanced heart failure. LVAD implantation requires extensive surgery and postoperative rehabilitation. The Functional Independence Measure (FIM) has been used to quantify functional gains in numerous patient populations, including those with stroke and spinal cord injury. This study investigated functional improvements in patients undergoing LVAD implantation using the FIM score.Objective
To assess functional improvements in patients with advanced heart failure who underwent LVAD implantation.Design
Retrospective.Setting
Inpatient rehabilitation unit.Subjects
Ninety consecutive patients who received acute inpatient rehabilitation after continuous flow LVAD implantation.Methods
Demographic, laboratory, and functional outcomes data including inpatient rehabilitation unit (IRU) length of stay (LOS), discharge disposition, and FIM score were collected for all patients. Paired t-tests were used to assess change in functional measures and laboratory data.Main Outcome Measures
Primary outcome measures included FIM gain, FIM efficiency, discharge disposition, rates of readmission after discharge from rehabilitation, and LOS in the rehabilitation unit.Results
The FIM gain was statistically significant at 28.4 ± 12.3 (P < .001) and compared favorably with benchmarks for mean FIM gains at our facility (26.4), regionally (21.5), and nationally (22.7) for patients admitted to IRUs with a cardiac diagnosis. FIM efficiency (FIM gain/IRU LOS) was 1.9 ± 1.0 compared with the mean FIM efficiency at our facility (2.2), regionally (2.1), and nationally (2.2). Seventy-four percent (n = 67) of patients were discharged directly home after inpatient rehabilitation, 17% (n = 16) were readmitted to the acute hospital service, and 8% (n = 7) required additional rehabilitation at a subacute rehabilitation facility. The IRU LOS was 16.2 ± 6.9 days.Conclusions
Our study indicates that most patients with an LVAD achieve clinically meaningful functional gains from acute inpatient rehabilitation, with the majority of patients being discharged home. Further studies need to be performed to analyze clinical outcomes after acute inpatient rehabilitation.Level of Evidence
IV 相似文献13.
Billy Sin Tamara Tatunchak Mohammad Paryavi Maria Olivo Usman Mian Josel Ruiz Bupendra Shah Sylvie de Souza 《The Journal of emergency medicine》2017,52(5):601-608
Background
Pain is one of the most common reasons for emergency department (ED) visits in the United States. Ketamine is a sedative with N-methyl-D-aspartate (NMDA) receptor antagonism. Recent literature has suggested that the use of subdissociative dose ketamine (SDDK) may be safe and effective for acute pain.Objective
The objective of our study was to evaluate ketamine in subdissociative doses as an adjunct for acute pain in the ED.Methods
This was a single-center, prospective, randomized, double-blind, placebo-controlled trial that evaluated the use of SDDK in adult patients who presented to the ED with acute pain. Patients received ketamine 0.3 mg/kg via intravenous piggyback over 15 min or placebo. Morphine 0.1 mg/kg intravenous push was administered with the study interventions. The primary outcome was the patient's pain score 15 min after initiation of the intervention. Secondary outcomes included adverse events, consumption of rescue analgesia, patient's length of stay, and patient satisfaction with treatment.Results
Thirty patients were enrolled in each group. Median pain scores in patients who received ketamine were lower than in controls at 15 min (3.5 [interquartile range {IQR} 1.0–7.3 vs. 6.0 [IQR 4.0–9.0], respectively; p = 0.018). No serious adverse events occurred. No difference was detected in the amount of rescue analgesia used or in length of stay. Patients who received ketamine reported a higher mean satisfaction score with their pain management (8.57 [standard deviation {SD} 2.1]) than patients who received placebo (6.05 [SD 2.6]; p = 0.01).Conclusion
When used as an adjunct, SDDK administered at 0.3 mg/kg over 15 min resulted in safe and effective analgesia for ≤30 min in patients who presented with acute pain in the ED. 相似文献14.
Kenneth W. Dodd Rebecca L. Kornas Matthew E. Prekker Lauren R. Klein Robert F. Reardon Brian E. Driver 《The Journal of emergency medicine》2017,52(4):403-408
Background
Removal of a functioning King laryngeal tube (LT) prior to establishing a definitive airway increases the risk of a “can't intubate, can't oxygenate” scenario. We previously described a technique utilizing video laryngoscopy (VL) and a bougie to intubate around a well-seated King LT with the balloons deflated; if necessary, the balloons can be rapidly re-inflated and ventilation resumed.Objective
Our objective is to provide preliminary validation of this technique.Methods
Emergency physicians performed all orotracheal intubations in this two-part study. Part 1 consisted of a historical analysis of VL recordings from emergency department (ED) patients intubated with the King LT in place over a two-year period at our institution. In Part 2, we analyzed VL recordings from paired attempts at intubating a cadaver, first with a King LT in place and then with the device removed, with each physician serving as his or her own control. The primary outcome for all analyses was first-pass success.Results
There were 11 VL recordings of ED patients intubated with the King LT in place (Part 1) and 11 pairs of cadaveric VL recordings (Part 2). The first-pass success rate was 100% in both parts. In Part 1, the median time to intubation was 43 s (interquartile range [IQR] 36–60 s). In Part 2, the median time to intubation was 23 s (IQR 18–35 s) with the King LT in place and 17 s (IQR 14–18 s) with the King LT removed.Conclusions
Emergency physicians successfully intubated on the first attempt with the King LT in situ. The technique described in this proof-of-concept study seems promising and merits further validation. 相似文献15.
Background
Ideally, high-stakes examinations assess 1 dimension of medical knowledge to produce precise estimates of a candidate’s performance. It has not been reported whether the American Board of Physical Medicine and Rehabilitation Part 1 Certification Examination (ABPMR-CE-1) is unidimensional or not.Objective
To examine the ABPMR-CE-1 to measure how many dimensions it assesses.Design
Retrospective observational study.Setting
We assessed examination results from the 2015 ABPMR-CE-1.Participants
A total of 489 deidentified candidates taking the 2015 ABPMR-CE-1.Methods
A 1-parameter Item Response Theory (IRT) measurement model was utilized. A Principal Components Analysis (PCA) of standardized residual correlations was used to detect multidimensionality.Main Outcome Measure
Number of primary dimensions reflected in the 325 test questions.Results
The results of the dimensionality analysis indicated that the ABPMR-CE-1 examination is highly unidimensional from a psychometric perspective. Expert content review of the substantive content of small contrasting clusters of questions provided additional assurance of the unidimensional nature of the examination.Conclusions
The ABPMR-CE-1 appears indeed to measure a single construct, which suggests a sound structure of the examination. It closely approximates the assumption of statistical unidimensionality.Level of Evidence
Not applicable. 相似文献16.
Allison D. Lane Matthew R. Berkman David Verbunker Taylor Shekell Michael Bouska Lauren Barnett Allie Keogh Tomas Nuno Uwe Stolz Anna L. Waterbrook 《The Journal of emergency medicine》2017,52(5):690-698
Background
Recognition and diagnosis of concussion is increasing, but current research shows these patients are discharged from the emergency department (ED) with a wide variability of recommendations and instructions.Objective
To assess the adequacy of documentation of discharge instructions given to patients discharged from the ED with concussions.Methods
This was a quality-improvement study conducted at a University-based Level I trauma center. A chart review was performed on all patients discharged with closed head injury or concussion over a 1-year period. Chi-squared measures of association and Fisher's exact test were used to compare the proportion of patients receiving discharge instructions (printed or documented in the chart as discussed by the physician). Multivariable logistic regression was used to assess the relationship between whether the concussion was sport-related in relation to our primary outcomes.Results
There were 1855 charts that met inclusion criteria. The physician documented discussion of concussion discharge instructions in 41% (95% confidence interval [CI] 39.2–43.7) and printed instructions were given in 71% (95% CI 69.1–73.2). Physicians documented discussion of instructions more often for sport-related vs. non-sport-related concussion (58% vs. 39%, p = 0.008) with an odds ratio (OR) of 2.1 (95% CI 1.6–2.8). Discharge instructions were given more often for sport-related injuries than those without sport-related injuries (85% vs. 69%, p = 0.047), with an OR of 2.2 (95% CI 1.6–3.1). Children were more likely to have had physician-documented discussion of instructions (56%, 95% CI 52.3–59.1 vs. 31%, 95% CI 28.0–33.6), printed discharge instructions (86%, 95% CI 83.2–88.1 vs. 61%, 95% CI 57.6–63.4), and return-to-play precautions given (11.2%, 95% CI 9.2–13.6 vs. 4.5%, 95% CI 3.4–5.9) compared with adults.Conclusions
Documentation of discharge instructions given to ED patients with concussions was inadequate, overall. 相似文献17.
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Alexander J. Bajorek Chloe Slocum Richard Goldstein Jacqueline Mix Paulette Niewczyk Colleen M. Ryan Carla Tierney Hendricks Ross Zafonte Jeffrey C. Schneider 《PM & R》2017,9(1):1-7
Background
A significant proportion of burn injury patients are admitted to inpatient rehabilitation facilities (IRFs). There is increasing interest in the use of functional variables, such as cognition, in predicting IRF outcomes. Cognitive impairment is an important cause of disability in the burn injury population, yet its relationship to IRF outcomes has not been studied.Objective
To assess how cognitive function affects rehabilitation outcomes in the burn injury population.Design
Retrospective study.Setting
Inpatient rehabilitation facilities in the United States.Participants
A total of 5347 adults admitted to an IRF with burn injury between 2002 and 2011.Methods or Interventions
Multivariable regression was used to model rehabilitation outcome measures, using the cognitive domain of the Functional Independence Measure (FIM) instrument as the independent variable and controlling for demographic, medical, and facility covariates.Main Outcome Measurements
FIM total gain, readmission to an acute care setting at any time during inpatient rehabilitation, readmission to an acute care setting in the first 3 days of IRF admission, rate of discharge to the community setting, and length of stay efficiency.Results
Cognitive FIM total at admission was a significant predictor of FIM total gain, length of stay efficiency, and acute readmission at 3 days (P < .05). Cognitive FIM total scores did not have an impact on acute care readmission rate or discharge to the community setting.Conclusions
Cognitive status may be an important predictor of rehabilitation outcomes in the burn injury population. Future work is needed to further examine the impact of specific cognitive interventions on rehabilitation outcomes in this population.Level of Evidence
II 相似文献19.
Eduard Alentorn-Geli Nathan R. Wanderman Andrew T. Assenmacher Bassem T. Elhassan Joaquín Sánchez-Sotelo Robert H. Cofield John W. Sperling 《PM & R》2017,9(10):1006-1012
Background
Theoretically, patients with only one functional arm secondary to contralateral amputation or paralysis will subject their only functional upper extremity to increased loads. This could become an issue after reverse shoulder arthroplasty (RSA). However, there are no reported data on the implant survival or function for patients with a nonfunctional contralateral upper extremity.Objective
To report the outcomes of RSA in patients with contralateral upper extremity amputation or paralysis.Design
Retrospective case series.Setting
Tertiary university hospital.Patients
All patients who underwent RSA between January 2004 and December 2013.Methods
Of 1335 RSA procedures performed, 5 patients had a minimum 2-year follow-up and nonfunctional contralateral upper extremity. There were 3 men and 2 women, with a mean (standard deviation) age and length of follow-up of 72.4 (7.5) years and 56.4 (24-132) months. Two of the patients had a contralateral upper extremity amputation, and the other 3 had contralateral upper extremity paralysis as a result of stroke, traumatic brain injury, and traumatic brachial plexus injury at birth.Main Outcomes
Pain, range of motion, functional scores (Simple Shoulder Test, American Shoulder and Elbow Society and Quick-Disability of the Arm, Shoulder and Hand), satisfaction, complications/reoperations, and radiographic loosening.Results
RSA resulted in substantial improvement in pain (P = .008), forward flexion (P = .02), and external range of motion (P = .01). The mean (standard deviation) Simple Shoulder Test, American Shoulder and Elbow Society, and Quick-Disability of the Arm, Shoulder, and Hand scores were 9.8 (1.3), 82 (13), and 17.8 (13.4), respectively. The results were excellent in 3, satisfactory in 1, and unsatisfactory in 1 patient (due only to external rotation limited to 10°). Subjectively, all 5 patients felt greatly improved and stated they would undergo RSA again. There were no complications or reoperations. There were no shoulders with component loosening.Conclusions
RSA seems to be a safe, effective, and successful surgical procedure for patients with a nonfunctional contralateral upper extremity. Studies with larger sample sizes and longer follow-up will hopefully validate the present findings.Level of Evidence
IV 相似文献20.
Sara J. Morgan Janna L. Friedly Dagmar Amtmann Rana Salem Brian J. Hafner 《Archives of physical medicine and rehabilitation》2017,98(1):105-113