共查询到20条相似文献,搜索用时 0 毫秒
1.
OBJECTIVES: To determine the incidence, aetiology and contributing factors to injuries being missed during the primary and secondary surveys in patients with major trauma managed on a general Adult Intensive Care Unit (AICU). METHODS: The records for patients admitted to the AICU following severe injury (defined as injury severity score (ISS) >16) over a 1-year period were reviewed. Diagnostic imaging performed during the resuscitation was reviewed in cases where missed injuries were discovered. RESULTS: Forty-five patients with a median injury severity score of 26 were included in the study. Twelve missed injuries were discovered in 10 patients during the intensive care admission; three required an additional surgical procedure. There was no significant difference in Glasgow Coma Score, revised trauma score, ISS or admission systolic blood pressure between patients with missed injuries and those patients where all injures were found at resuscitation (P > 0.05). Three quarters of the undetected injuries were orthopaedic. CONCLUSIONS: Significant injuries can be missed during the primary and secondary surveys in severely injured patients. A tertiary survey should be completed in all trauma patients admitted to an intensive care unit. 相似文献
2.
创伤严重度改良评分法对2260例创伤患者的前瞻性研究 总被引:4,自引:0,他引:4
目的探讨创伤严重度改良评分法(RISS)的临床实用价值,根据RISS值界定损伤严重程度。方法运用RISS法对1997年1月~2002年12月收治的2260例创伤患者进行前瞻性评估分析。结果RISS值随损伤部位数量增加而增高,并与损伤程度、伤残及死亡率呈正相关(P〈0.01)。生存者RISS值平均为(12.82±8.51)分,死亡者RISS值平均为(34.47±14.88)分(P〈0.01)。单处伤RISS值最低[(11.12±8.20)分],多处伤次之[(13.81±4.67)分],多发伤RISS值最高[(18.23±11、75)分](P〈0.01)。结论RISS法能客观准确地反映各类损伤的创伤严重度,RISS〈9分为轻伤,RISS 9—15分为中度伤,RISS 16—25分为重伤,RISS 26~35分为严重伤,RISS〉35分为危重伤。 相似文献
3.
J. Tristan Cassidy Michael Phillips Daniel Fatovich Janine Duke Dale Edgar Fiona Wood 《Burns : journal of the International Society for Burn Injuries》2014
Background
There is limited research validating the injury severity score (ISS) in burns. We examined the concordance of ISS with burn mortality. We hypothesized that combining age and total body surface area (TBSA) burned to the ISS gives a more accurate mortality risk estimate.Methods
Data from the Royal Perth Hospital Trauma Registry and the Royal Perth Hospital Burns Minimum Data Set were linked. Area under the receiver operating characteristic curve (AUC) measured concordance of ISS with mortality. Using logistic regression models with death as the dependent variable we developed a burn-specific injury severity score (BISS).Results
There were 1344 burns with 24 (1.8%) deaths, median TBSA 5% (IQR 2–10), and median age 36 years (IQR 23–50). The results show ISS is a good predictor of death for burns when ISS ≤ 15 (OR 1.29, p = 0.02), but not for ISS > 15 (ISS 16–24: OR 1.09, p = 0.81; ISS 25–49: OR 0.81, p = 0.19). Comparing the AUCs adjusted for age, gender and cause, ISS of 84% (95% CI 82–85%) and BISS of 95% (95% CI 92–98%), demonstrated superior performance of BISS as a mortality predictor for burns.Conclusion
ISS is a poor predictor of death in severe burns. The BISS combines ISS with age and TBSA and performs significantly better than the ISS. 相似文献4.
Ikossi DG Knudson MM Morabito DJ Cohen MJ Wan JJ Khaw L Stewart CJ Hemphill C Manley GT 《The Journal of trauma》2006,61(4):780-8; discussion 788-90
BACKGROUND: Despite normalization of vital signs, critically injured patients may remain in a state of occult underresuscitation that sets the stage for sepsis, organ failure, and death. A continuous, sensitive, and accurate measure of resuscitation after injury remains elusive. METHODS: In this pilot study, we evaluated the ability of two continuous measures of peripheral tissue oxygenation in their ability to detect hypoperfusion: the Licox polarographic tissue oxygen monitor (PmO2) and the InSpectra near-infrared spectrometer (StO2). We hypothesized that deltoid muscle tissue oxygenation measurements could detect patients in "occult shock" who are at increased risk for post-injury complications. The study was designed to (1) define values for PmO2 and StO2 in patients who by all standard measures appeared to be clinically resuscitated; (2) evaluate the relationship between PmO2, StO2 and other physiologic variables including mean arterial pressure (MAP), lactate and base deficit (BD); and (3) examine the relationship between early low tissue oxygen values and the subsequent development of infections and organ dysfunction. Licox probes were inserted into the deltoid muscle of critically injured patients after initial surgical and radiologic interventions, and transcutaneous StO2 monitors were applied over the same muscle bed. PmO2, StO2, and standard physiologic data were collected continuously using a multimodal bioinformatics system. RESULTS: Twenty-eight critically injured patients were enrolled in this study at admission to the intensive care unit (ICU). For patients who appeared to be well resuscitated (defined as MAP > or = 70 mm Hg, heart rate [HR] < or = 110 bpm, BD > or = -2, and partial pressure of arterial oxygen (PaO2) = 80 and 150 mm Hg), the mean PmO2 was 34 +/- 11 mm Hg and StO2 was 63 +/- 27%. There was a strong relationship between PmO2 and BD (p < 0.001) but no significant relationship between StO2 and BD. The relationship between PmO2 and StO2 was weak but statistically significant. Early low values of both PmO2 and StO2 identified patients at risk for infectious complications or multiple organ failure (MOF). In patients who were well resuscitated by standard continuous parameters (HR and MAP), low PmO2 during the first 24 hours after admission (PmO2 < or = 25 for at least 2 hours) was strongly associated with the development of infectious complications (Odds Ratio = 16.5, 95% CI 1.49 to 183, p = 0.02). CONCLUSIONS: PmO2 is a responsive, reliable and continuous monitor of changes in base deficit. Initial low values for either PmO2 or StO2 were associated with post-injury complications. PmO2 monitoring may be useful in identifying patients in the state of occult underresuscitation who remain at risk for developing infection and MOF. 相似文献
5.
胸部闭合伤的损伤严重度评估及临床意义 总被引:1,自引:0,他引:1
目的:探讨胸部闭合伤的临床特点及其损伤严重度评估的临床意义。方法:分析456例胸部闭合伤的致伤因素和死亡率,并按有无合并伤(分为单纯胸伤组,合并伤组)和结局(分为生存组,死亡组)分组进行创伤评分,分别比较不同组间的损伤严重程度。结果:致伤原因为交通伤发生率最高(60.97%),其次为高处坠落伤(13.82%)。456例中288例合并其它部位损伤,占63.16%,死亡18例,死亡率3.95%,单纯胸伤组的格拉斯哥昏迷指(GCS),睡正创伤评分(RTS)和生存概率(Ps)较高,损伤严重评分(ISS)低于合并伤组,胸部简明损伤定级(AIS)评分两组间差别无显著性意义,死亡组和生存组比较,前者生理评分低,解剖评分高,生存概率亦低。结论:胸部闭合伤常合并全身多发伤,伤情判断困难,合理使用创伤评分有助于判断损伤严重度,指导临床救治。 相似文献
6.
V. Bogner C. Kirchhoff H. V. Baker J. C. Stegmaier L. L. Moldawer W. Mutschler P. Biberthaler 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2007,392(3):255-265
Background Posttraumatic immune system activation in major trauma patients is linked to systemic inflammatory response syndrome, multiple
organ failure (MOF), and mortality. Recent studies suggest that genome-wide expression is altered in response to distinct
clinical parameters; however, the functional allocation of theses genes remains unclear.
Patients and methods Thirteen patients after major trauma (Injury Severity Score < 16) were studied. Monocytes were obtained on admission (within
90 min) and at 6, 12, 24, 48, and 72 h after trauma. Complementary ribonucleic acid (RNA) targets were hybridized to Affymetrix
HG U 133A microarrays™. Searching for genes that are differentially expressed, the patients were dichotomously assigned depending
upon survival, injury severity, and MOF. The data were analyzed by supervised analysis, clustering, and comparative pathway
analysis.
Results Gene expression profiles of patients with adverse outcomes (763 probe sets) mainly consist of those involved in “immunological
activation” or “cellular movement,” whereas the gene set associated with MOF (660) is associated with “cancer” and “cell death.”
Injury severity (295) leads to an overexpression of genes involved in inflammatory disease.
Conclusion We demonstrate for the first time a serial, sequential screening analysis of monocyte messenger RNA expression patterns after
multiple injury indicating a strongly significant connection between the patients’ expression profile and different clinical
parameters. The latter provoke a characteristic overexpression of specific functional gene ontologies. Further studies to
clarify clinical consequence of this differential gene regulation are currently anticipated.
Best abstracts — Surgical Forum 2007 相似文献
7.
《American journal of surgery》2020,219(5):869-873
Injury severity scores (ISS) and shock index (SI) are popular trauma scoring systems. We assessed ISS and SI in combat trauma to determine the optimal cut-off values for mortality and trauma outcomes. Retrospective analysis of the Department of Defense Trauma Registry, 2008–2016, was performed. Areas under receiver operating characteristic curves (AUROCs) were calculated for ISS and SI on mortality, massive volume transfusion (MVT), and emergent surgical procedure (ESP). Optimal cut-off values were defined using the Youden index (YI). 22,218 patients (97.1% male), median ages 25–29 years, ISS 9.4 ± 0.07, with 58.1% penetrating injury were studied. Overall mortality was 3.4%. AUROCs for ISS on mortality, MVT, and ESP were 0.882, 0.898, and 0.846, while AUROCs for SI were 0.727, 0.864, and 0.711 respectively. The optimal cut-off values for ISS on mortality, MVT, and ESP were 12.5 (YI = 0.634), 12.5 (YI = 0.666), and 12.5 (YI = 0.819), with optimal values for SI being 0.94 (YI = 0.402), 0.88 (YI = 0.608), and 0.81 (YI = 0.345) respectively. Classic values for severe ISS underrepresent combat injury while the SI values defined in this study are consistent with civilian data. 相似文献
8.
Eileen Bernal Steven Wolf Michael Cripps 《Burns : journal of the International Society for Burn Injuries》2018,44(2):249-255
Tachyarrhythmias in critically ill surgical patients can have varying effects, from minimal consequence to lifetime sequelae. Atrial fibrillation can be common in the post-operative period, often a result of fluctuations in volume status and electrolyte derangements. While there is extensive literature regarding the critically ill medical or cardiac patient, there is less focusing on the critically ill surgical or trauma patient. More specifically, there is minimal regarding tachyarrhythmias in burn patients. The latter population tends to have frequent and wide variations in volume status given initial resuscitation and after major excisions, concomitant with acute blood loss anemia, which can contribute to cardiac disturbances. A literature review was conducted to investigate the incidence and consequences of tachyarrhythmias in critically ill surgical and trauma patients, with a focus on the burn population. While some similarities and conclusions can be drawn between these surgical populations, further inquiry into the unique burn patient is necessary. 相似文献
9.
Natalie A. Winings Brian J. Daley Reagan W. Bollig R. Frank Roberts Jennifer Radtke R. Eric Heidel Jessica E. Taylor James C. McMillen 《The surgeon》2021,19(3):129-134
Backgroundand Purpose: Currently, dexmedetomidine versus propofol has primarily been studied in medical and cardiac surgery patients with outcomes indicating safe and effective sedation. The purpose of this study was to assess the efficacy of dexmedetomidine versus propofol for prolonged sedation in trauma and surgical patients.MethodsThis was a single-center prospective study conducted in the Trauma/Surgical Intensive Care Unit (ICU) at a Level I academic trauma center. It included patients 18 years of age or older requiring mechanical ventilation who were randomly assigned based on unit bed location to receive either dexmedetomidine or propofol. The primary outcome was duration of mechanical ventilation. Secondary outcomes included mortality; proportion of time in target sedation; incidence of delirium, hypotension, and bradycardia; and ICU and hospital length of stay (LOS).ResultsA total of 57 patients were included. Baseline characteristics were similar between groups. There was no significant difference in duration of mechanical ventilation (median [IQR]) between the dexmedetomidine (78.5[125] hours) and propofol (105[130] hours; p = 0.15) groups. There was no difference between groups in ICU mortality, ICU and hospital LOS, or incidence of delirium. Safety outcomes were also similar. Patients in the dexmedetomidine group spent a significantly greater percentage of time in target sedation (98[8] %) compared to propofol group (92[10] %; p = 0.02).ConclusionsOur results suggest that, similar to medical and cardiac surgery patients, dexmedetomidine and propofol are safe and effective sedation agents in critically ill trauma and surgical patients; however, dexmedetomidine achieves target sedation better than propofol for this specific population. 相似文献
10.
Objective:To compare the characters and outcomes of patients injured from traffic accidents in different rank hospitals.Methods:From 8 hospitals of ranks I-Ⅲ,1915 cases were sampled and divided into 4 groups.Injuries of all patients were accessed by the method of RTS,AIS-ISS-AP and ASCOT.Results:(1)The higher rank of hospitals,the severer the patients‘ condition were.Mean ISSs in hospital ranks Ⅱ and Ⅲ were greater than 16,which were recommended as a standard of severe trauma.(2)Transportation of severe patients to high level hospitals prolonged the pre-hodpital duration by 5-9h.(3)Factors contributing to death were the trauma severity,complications,hospital ranks that reflect the quality of the medical care.Conclusions:(1)This sample of 1915 cases matches the condition of most Chinese hospitals in characteristics of traffic trauma patients.(2)Most Chinese hospitals can be divided into 3 degree of trauma center by a criteria of ISS and the unexpected death.(3) Incidence of multiple injuries shows no significant difference in each rank of hospitals.(4)The relationship between the hospital rank and the quality of trauma care is significant.We suggest that a RTS=11 or ISS=9 be triaged to trauma center,and a 10% Ps(survival probability) less than the average Ps of a hospital be triage to higher level hospitals. 相似文献
11.
Purpose
Injury is the leading cause of morbidity and mortality to children. The purpose of this study is to compare attention-deficit/hyperactivity disorder (ADHD) screening results in a select group of injured pediatric patients to noninjured patients.Methods
Parents of patients 6 to 12 years of age were enrolled in the study. Patients were either admitted for specific injury mechanisms (n = 133) or appendicitis (n = 157). Demographic and medical data were collected, and an ADHD screening tool was administered. Logistic regression models were used to compare screening results between groups.Results
The injured patient group was 3.25 times more likely to screen positive for ADHD (odds ratio, 3.25; 95% confidence interval, 1.57-6.72; P = .002) than the appendicitis group. Among the injured patients who screened positive for ADHD, only 34.0% reported currently receiving treatment.Conclusions
Our results suggest that pediatric patients with certain injury mechanisms may warrant screening and referral for ADHD. Appropriate identification and treatment of undiagnosed ADHD may reduce the burden of injury recidivism. Screening and referral for ADHD within a trauma service should be evaluated for effectiveness as an injury prevention initiative. 相似文献12.
《International Journal of Obstetric Anesthesia》2014,23(3):253-259
BackgroundIncreasing awareness of the risks of blood transfusion has prompted examination of red cell transfusion practice in obstetrics. A six-month prospective observational study was performed to examine blood transfusion practices in patients undergoing caesarean delivery at three hospitals in Pakistan.MethodsIn the three hospitals (two private, one public) 3438 caesarean deliveries were performed in the study period. Data were collected on patient demographics, indications for transfusion, ordering physicians, consent, associations with obstetric factors, estimated allowable blood loss, calculated blood loss, pre- and post-transfusion haemoglobin and discharge haemoglobin.ResultsA total number of 397 (11.5%) patients who underwent caesarean section received a blood transfusion. The highest transfusion rate of 16% was recorded in the public tertiary care hospital compared to 5% in the two private hospitals. Emergency caesarean delivery and multiparity were associated with blood transfusion (P < 0.05). More emergency caesarean sections were performed in the public compared to the private hospitals (85.4% vs. 41.6%). More multiparous patients underwent caesarean section in the public hospital (57.8% vs. 40.4%). Attending physicians took the decision for transfusion in 98% of cases. In 343 (86%) patients, blood transfusion was given even when the haemoglobin was >7 g/dL. The method for documenting the indication or consent for transfusion was not found in any of the three hospitals.ConclusionBlood transfusion was prescribed more readily in the public hospital. Identification of a transfusion trigger and the development of institutional guidelines to reduce unnecessary transfusion are required. 相似文献
13.
Thomas J. Schroeppel Timothy C. Fabian L. Paige Clement Peter E. Fischer Louis J. Magnotti John P. Sharpe Marilyn Lee Martin A. Croce 《Injury》2014
Propofol infusion syndrome (PIS) is defined by arrhythmia, rhabdomyolysis, lactic acidosis, and unrecognized leads to death. We sought to determine the incidence of PIS in trauma patients and evaluate the efficacy of a prospective screening protocol in this patient population. 相似文献
14.
Aspiration in severe trauma: a prospective study 总被引:7,自引:0,他引:7
The incidence and origin of contamination of the vocal cords in 53 trauma patients was studied when tracheal intubation was performed before hospital admission. Eighteen patients (34%) had gross contamination which was blood in 15 patients and gastric contents in three patients. This has implications for prehospital airway management and particularly for use of the laryngeal mask airway. 相似文献
15.
BACKGROUND: Trauma systems decrease morbidity and mortality of injured populations, and each component contributes to the final outcome. This study evaluated the association between a referring hospital's trauma designation and the survival and resource utilization of patients transferred to a level I trauma center. METHODS: Data from the Registry of the American College of Surgeons on patients transferred to a level I trauma center during a 7-year period were subdivided into 3 categories: group 1 = level III-designated trauma center; group 2 = potential level III trauma centers; and group 3 = other transferring hospitals. Trauma and Injury Severity Score methodology was used to provide a probability estimate of survival adjusted for the effect related to injury severity, physiologic host factors, and age. A W statistic was calculated for each type of referring hospital so that comparisons between observed survival and predicted survival could be measured. Differences in W, length of stay, intensive care unit days, and ventilator days were examined using general linear models. RESULTS: Patients transferred to a level I from a level III trauma center (group 1) were more seriously injured (P < .0001) and had improved survival (P < .0018) compared with those transferred from nondesignated hospitals (groups 2 and 3). Patients transferred from large nondesignated hospitals (group 2) had outcomes similar to patients transferred from all other hospitals (group 3). Level I hospital resource utilization did not show significant differences based on referring hospital type. COMMENTS: Outcomes of patients in a trauma system are associated with trauma-center designation of the referring hospitals. 相似文献
16.
Background
Recreational mountain biking continues to increase in popularity and is a significant source of traumatic injury, including injuries to the hand and wrist.Methods
A prospective survey of all hand and wrist injuries sustained while participating in recreational mountain biking presenting to the emergency department at the Municipality of Whistler and the District of Squamish was conducted over a 12-month consecutive period.Results
An analysis of 765 unique emergency department visits with 1,079 distinct injuries was performed. Of these injuries, 511 were sustained to the upper limb. Injury to the metacarpal and metacarpal phalangeal joints was the most common hand injury (52) followed by proximal phalanx and proximal interphalangeal joint (20).Conclusions
Mountain biking is a frequent source of a variety of upper limb trauma, and preventative efforts are necessary to minimize the burden of these injuries. 相似文献17.
《Injury》2017,48(9):1956-1963
BackgroundThere is a lack of information on the effect of age on perioperative care and outcomes after minor trauma in the elderly. We examined the association between perioperative hypotension and discharge outcome among non-critically injured adult patients.MethodsWe conducted a retrospective study of non-critically ill patients (ISS <9 or discharged within less than 24 h) who received anaesthesia care for surgery and Recovery Room care at a level-1 trauma centre between 5/1/2012 and 11/30/2013. Perioperative hypotension was defined as systolic blood pressure (SBP) <90 mmHg (traditional measure) for all patients, and SBP <110 mmHg (strict measure) for patients ≥65 years. Poor outcome was defined as death or discharge to skilled nursing facility/hospice.Results1744 patients with mean ISS 4.4 across age groups were included; 169 (10%) were ≥65 years. Among patients ≥ 65 years, intraoperative hypotension occurred in >75% (131/169, traditional measure) and in >95% (162/169, strict measure); recovery room hypotension occurred in 2% (4/169) and 29% (49/169), respectively. Mean age-adjusted anaesthetic agent concentration (MAC) was similar across age groups. Opioid use decreased from 9.3 (SD 5.7) mg/h morphine equivalents in patients <55 years to 6.2 (SD 4.0) mg/h in patients over 85 years. Adjusted for gender, ASA score, anaesthesia duration, morphine equivalent/hr, fluid balance, MAC and surgery type, and using traditional definition, older patients were more likely than patients <55 to experience perioperative hypotension: aRR 1.21, 95% CI 1.11–1.30 for 55–64 and aRR 1.19, 95% CI 1.07–1.32 for ages 65–74. Perioperative hypotension was associated with poor discharge outcome (aRR 1.55; 95% CI 1.04–2.31 and aRR 1.87; 95% CI 1.17–2.98, respectively).ConclusionDespite age related reduction in doses of volatile anaesthetic and opioids administered during anaesthesia care, and regardless of hypotension definition used, non-critically injured patients undergoing surgery experience a large perioperative hypotension burden. This burden is higher for patients 55–74 years and older and is a risk factor for poor discharge outcomes, independent of age and ASA status. 相似文献
18.
Venous access and fluid therapy should still be considered to be essential elements of pre-hospital advanced life support (ALS) in the critically injured patient. Initiation of fluid therapy should be based on a clinical assessment, most importantly the presence, or otherwise, of a radial pulse. The goal in penetrating injury is to avoid hypovolaemic cardiac arrest during transport, but at the same time not to delay transport, or increase systolic blood pressure. The goal in blunt injury is to secure safe perfusion of the injured brain through an adequate cerebral perfusion pressure, which generally requires a systolic blood pressure well above 100 mmHg. Patients without severe brain injury tolerate lower blood pressures (hypotensive resuscitation). Importantly, using systolic blood pressure targets to titrate therapy is not as easy as it seems. Automated (oscillometric) blood pressure measurement devices frequently give erroneously high values. The concept of hypotensive resuscitation has not been validated in the few studies done in humans. Hence, the suggested targeted systolic blood pressures should only provide a mental framework for the decision-making. The ideal pre-hospital fluid regimen may be a combination of an initial hypertonic solution given as a 10-20 minutes infusion, followed by crystalloids and, in some cases, artificial colloids. This review is intended to help the clinician to balance the pros and cons of fluid therapy in the individual patient. 相似文献
19.
BACKGROUND: Studies on stress hyperglycemia in trauma patients have largely ignored diabetes, a potential confounder. The purpose of this study was to assess the relationship between diabetes and outcome in trauma patients. METHODS: Data were obtained from the National Trauma Data Bank (version 4.0). The primary outcome measures were mortality and infections. Age, injury severity, and comorbidities were analyzed as independent variables using logistic regression. RESULTS: A total of 343,250 patients were analyzed, of whom 2.7% were diabetic. On multivariate analysis, insulin-dependent diabetes was an independent although weak predictor of infectious morbidity and intensive care unit length of stay. However, diabetes was not associated with mortality or hospital length of stay. Age and injury severity were the main predictors for all outcome measures. CONCLUSIONS: Diabetes was an independent, although weak, risk factor for infectious complications in trauma patients. Age and injury severity were the most important predictors of outcome. 相似文献
20.