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1.
Vishwaratn Asthana Miel Sundararajan Ruth Linda Ackah Vivek Karun Arunima Misra Allison Pritchett Pallavi Bugga Angela Siler-Fisher William Frank Peacock 《The American journal of emergency medicine》2018,36(12):2166-2171
Background
Heart failure (HF) readmissions are a longstanding national healthcare issue for both hospitals and patients. Our purpose was to evaluate the efficacy of a structured, educational intervention targeted towards un- and under-insured emergency department (ED) HF patients.Methods
HF patients presenting to the ED for care were enrolled between July and December 2015 as part of an open label, interventional study, using a parallel observational control group. Eligible patients provided informed consent, had an established HF diagnosis, and were hemodynamically stable. Intervention patients received a standardized educational intervention in the ED waiting room before seeing the emergency physician, and a 30-day telephone follow-up. Primary and secondary endpoints were 30- and 90-day ED and hospital readmission rates, as well as days alive and out of hospital (DAOH) respectively.Results
Of the 94 patients enrolled, median age was 58.4?years; 40.4% were female, and 54.3% were African American. Intervention patients (n?=?45) experienced a 47.8% and 45.3% decrease in ED revisits (P?=?0.02 & P?<?0.001), and 60.0% and 47.4% decrease in hospital readmissions (P?=?0.049 & P?=?0.007) in the 30 and 90?days pre- versus post-intervention respectively. Control patients (n?=?49) had no change in hospital readmissions or 30-day ED revisits, but experienced a 36.6% increase in 90-day ED revisits (P?=?0.03). Intervention patients also saw a 59.2% improvement in DAOH versus control patients (P?=?0.03).Conclusion
An ED educational intervention markedly decreases ED and hospital readmissions in un- and under-insured HF patients. 相似文献2.
Ozgur Karcioglu Hakan Topacoglu Ozlem Dikme Ozgur Dikme 《The American journal of emergency medicine》2018,36(10):1886-1894
Objective
To carry out a systematic review to estimate the rate and magnitude of adverse effects following therapeutic hypothermia (TH) procedure in patients resuscitated from out-of-hospital cardiac arrest (OHCA) and highlight the specific complications seen after the procedure.Methods
A systematic review of currently published studies was performed following standard guidelines. Online database searches were performed for controlled trials for the last twenty years. Papers were examined for methodological soundness before being included. Data were independently extracted by two blinded reviewers. Studies were also assessed for bias using the Cochrane criteria. The adverse effects attributed to TH in the literature were appraised critically.Results
The initial data search yielded 78 potentially relevant studies; of these, 59 were excluded for some reason. The main reason for exclusion (n?=?43, 55.8%) was that irrelevance to adverse effects of TH. Finally, 19 underwent full-text review. Studies were of high-to-moderate (n?=?12, 63%) to low-to-very low (n?=?7, 37%) quality. Five studies (27.7%) were found to have high risk of bias, while 8 (42.1%) had low risk of bias.Interpretation
Although adverse effects related to the practice of TH have been studied extensively, there is substantial heterogeneity between study populations and methodologies. There is a considerable incidence of side effects attributed to the procedure, e.g., from life-threatening ventricular arrhythmias to self-limited consequences. Most studies analyzed in this systematic review indicated that the procedure of TH has not caused severe adverse effects leading to significant alterations in the outcomes following resuscitation from OHCA.PROSPERO, registration number is: CRD42018075026. 相似文献3.
4.
Hyeonseok Lee Seung Baik Han Ji Hye Kim Soo Kang Areum Durey 《The American journal of emergency medicine》2018,36(9):1608-1612
Objectives
The incidence of urinary tract infection (UTI) due to extended-spectrum β-lactamase (ESBL)-producing Escherichia coli has increased over recent years. Initial empirical therapy is often ineffective for these resistant isolates resulting in prolonged hospitalization and increased mortality. This study was conducted to determine the risk factors of UTI caused by ESBL E. coli in the emergency department (ED).Methods
This is a retrospective case-control study at a university hospital in Korea with UTI patients who visited ED between June 2015 and December 2016. We compared case patients with ESBL E. coli UTI (n?=?50) to control patients with non-ESBL-producing E. coli UTI (n?=?100), which were matched for age and sex. Multivariate logistic regression analysis was used to explore risk factors.Results
Our study showed that hospital-acquired infection (OR?=?3.86; 95% CI?=?1.26–11.8; p?=?.017), prior UTI within 1?year (OR?=?3.26; 95% CI?=?1.32–8.05; p?=?.010), and underlying cerebrovascular disease (OR?=?3.24; 95% CI?=?1.45–7.25; p?=?.004) were independent risk factors for acquisition of ESBL-producing E. coli. Notably, 35 (70%) out of 50 case patients had community-acquired infection, and 68% and 54% of ESBL E. coli were resistance to ciprofloxacin and trimethoprim-sulfamethoxazole, respectively. On the contrary, 98% of ESBL E. coli was susceptible to amikacin.Conclusion
The main risk factors identified in our study should be considered when treating UTI patients in ED. Amikacin may improve the outcome of empirical treatment without increasing carbapenem utilization. 相似文献5.
Brian J. Yun Pierre Borczuk Kori S. Zachrison Joshua N. Goldstein Yosef Berlyand Ali S. Raja 《The American journal of emergency medicine》2018,36(8):1463-1466
Introduction
Studies have shown increasing utilization of head computed tomography (CT) imaging of emergency department (ED) patients presenting with an injury-related visit. Multiple initiatives, including the Choosing Wisely? campaign and evidence-based clinical decision support based on validated decision rules, have targeted head CT use in patients with injuries. Therefore, we investigated national trends in the use of head CT during injury-related ED visits from 2012 to 2015.Methods
This was a secondary analysis of data from the annual United States (U.S.) National Hospital Ambulatory Medical Care Survey from 2012 to 2015. The study population was defined as injury-related ED visits, and we sought to determine the percentage in which a head CT was ordered and, secondarily, to determine both the diagnostic yield of clinically significant intracranial findings and hospital characteristics associated with increased head CT utilization.Results
Between 2012 and 2015, 12.25% (95% confidence interval [CI] 11.48–13.02%) of injury-related visits received at least one head CT. Overall head CT utilization showed an increased trend during the study period (2012: 11.7%, 2015: 13.23%, p?=?0.09), but the results were not statistically significant. The diagnostic yield of head CT for a significant intracranial injury over the period of four years was 7.4% (9.68% in 2012 vs. 7.67% in 2015, p?=?0.23).Conclusions
Head CT use along with diagnostic yield has remained stable from 2012 to 2015 among patients presenting to the ED for an injury-related visit. 相似文献6.
Joseph S. Colla Pavitra Kotini-Shah Savannah Soppet Yi-Fan Chen Robert Molokie Puja Prajapati Heather M. Prendergast 《The American journal of emergency medicine》2018,36(10):1855-1861
Background
Acute chest syndrome (ACS) is the leading cause of death for patients with sickle cell disease (SCD). Early recognition of ACS improves prognosis.Objective
Investigate the use of bedside lung ultrasound (BLU) in identification of early pulmonary findings associated with ACS in SCD patients.Methods
Prospective, observational study of a convenience sample of SCD patients presenting to the Emergency Department (ED) for a pain crisis. BLU interpretations were made by an emergency physician blinded to the diagnosis of ACS, and were validated by a second reviewer. The electronic medical record was reviewed at discharge and at 30?days.Results
Twenty SCD patients were enrolled. Median age was 31?years, median hemoglobin was 7.7?g/dL. Six patients developed ACS. Five patients in the ACS group had lung consolidations on BLU (83%) compared to 3 patients in the non-ACS group (21%), p?=?0.0181, (OR?=?12.05, 95% CI 1.24 to 116.73). The ACS group was also more likely to have a pleural effusion and B-lines on BLU than the non-ACS group, p?=?0.0175; 0.1657, respectively. In the ACS group, peripheral and frank consolidations on BLU was 83% and 50% sensitive, 79% and 100% specific for ACS, respectively; whereas an infiltrate on initial chest X-ray (CXR) was only 17% sensitive. BLU identified lung abnormalities sooner than CXR (median 3.6 vs. 31.8?h).Conclusions
Pulmonary abnormalities on BLU of an adult SCD patient presenting to the ED for a painful crisis appear before CXR, and highly suggest ACS. BLU is a promising predictive tool for ACS. 相似文献7.
Ettore Beghi Elisa Gervasoni Elisabetta Pupillo Elisa Bianchi Angelo Montesano Irene Aprile Michela Agostini Marco Rovaris Davide Cattaneo 《Archives of physical medicine and rehabilitation》2018,99(4):641-651
Objective
To compare the risk of falls and fall predictors in patients with Parkinson disease (PD), multiple sclerosis (MS), and stroke using the same study design.Design
Multicenter prospective cohort study.Setting
Institutions for physical therapy and rehabilitation.Participants
Patients (N=299) with PD (n=94), MS (n=111), and stroke (n=94) seen for rehabilitation.Interventions
Not applicable.Main Outcome Measures
Functional scales were applied to investigate balance, disability, daily performance, self-confidence with balance, and social integration. Patients were followed for 6 months. Telephone interviews were organized at 2, 4, and 6 months to record falls and fall-related injuries. Incidence ratios, Kaplan-Meier survival curves, and Cox proportional hazards models were used.Results
Of the 299 patients enrolled, 259 had complete follow-up. One hundred and twenty-two patients (47.1%) fell at least once; 82 (31.7%) were recurrent fallers and 44 (17.0%) suffered injuries; and 16%, 32%, and 40% fell at 2, 4, and 6 months. Risk of falls was associated with disease type (PD, MS, and stroke in decreasing order) and confidence with balance (Activities-specific Balance Confidence [ABC] scale). Recurrent fallers were 7%, 15%, and 24% at 2, 4, and 6 months. The risk of recurrent falls was associated with disease type, high educational level, and ABC score. Injured fallers were 3%, 8%, and 12% at 2, 4, and 6 months. The only predictor of falls with injuries was disease type (PD).Conclusions
PD, MS, and stroke carry a high risk of falls. Other predictors include perceived balance confidence and high educational level. 相似文献8.
Matthew E. Rossheim Caroline J. Stephenson 《The American journal of emergency medicine》2017,35(10):1503-1505
Background
Few studies have examined injuries resulting from practicing parkour. The current study provides details on more parkour-related emergency department visits than existed in the combined research literature.Methods
Cross-sectional data from the U.S. Consumer Product Safety Commission‘s National Electronic Injury Surveillance System were used to examine parkour-related injuries presenting to U.S. emergency departments over a seven year period.Results
Most parkour injuries were reportedly caused by landing or from striking objects. Common diagnoses included fractures, sprains/strains, abrasions/contusions, and lacerations. More than half of reported injuries (57.7%) affected the patients' extremities. In this data, there appears to be a trend of increasing parkour injuries over time. Patients as young as 8 years old have presented to emergency departments with parkour-related injuries in recent years.Conclusions
Given the relatively severe injuries obtained by youth participants, more research is needed to guide injury prevention efforts. Understanding the nature of parkour-related injuries may help inform prevention efforts. However, more systematic monitoring of participation in parkour and related injuries is needed. 相似文献9.
Allison Tadros Melinda Sharon Nicholas Chill Shane Dragan Jeremy Rowell Shelley Hoffman 《The American journal of emergency medicine》2018,36(8):1455-1458
Background
Work-related injuries are commonly seen in the emergency department (ED). This study sought to analyze characteristics of ED patient visits that were billed under workers' compensation.Methods
This was a retrospective chart review of visits during 2015 that were billed under workers' compensation at an academic ED. The following variables were collected: age, gender, mechanism of injury/exposure, diagnoses, imaging performed, specialty consultation, operative requirement, follow-up specialty, and ED disposition.Results
In 2015, 377 patients presented to the ED for work-related injuries. The most common mechanism of injury was fall. Frequent diagnoses included lower extremity injuries and hand/finger injuries. The most common consulting service was orthopedics. Only five patients were referred to occupational medicine for follow up.Conclusion
Knowledge of the types of occupational injuries and subsequent care required may help guide both workers and employers how to best triage patients within the healthcare system. Alternative settings such as occupational medicine or primary care services may be appropriate for some patients. 相似文献10.
Yuan Zhang Kai Sun Yuling Wang Yafei Qin Hui Li 《The American journal of emergency medicine》2018,36(8):1410-1417
Background
Patients suffered from craniocerebral trauma with extermities fracture is one of the most common multiple injuries.Actually there is no comparative study demonstrating advantages of early or delayed treatment of skeletal injuries.Purposes
To conduct a meta-analysis with studies published in full text to demonstrate database to show the associations of perioperative, postoperative outcomes of early fracture fixation(EFF) and late fracture fixation(LFF) for patients with severe head and orthopedic injuries to provide the predictive diagnosis for clinic.Patients and methods
Literature search was performed in PubMed, Embase, Web of Science and Cochrane Library for information from the earliest date of data collection to October 2017. Studies comparing the perioperative, postoperative outcomes of EFF with those of LFF patients with severe head and orthopedic injuries were included. Statistical heterogeneity was quantitatively evaluated by ×2 test with the significance set P < 0.10 or I2 > 50%.Results
Thirteen papers consisting of 2941 patients were included (1224EFF patients; 1717 LFF patients). The results showed that EFF was related to a greater increase in blood loss, intraoperative blood infusion, crystalloid, hypotension, hypoxia, length of surgery, non-neurologic complications and mortality(P < 0.1). No differences in ICU days, hospital days, neurologic complications and GCS on discharge scores (P > 0.1).Conclusions
Compared with LFF patients, EFF patients demonstrated an increased risk of perioperative and postoperative complications and clear difference about complications between EFF and LFF about patients with severe head and orthopedic injuries.Level of evidence
Level IV, therapeutic study. 相似文献11.
Kevin Yeboah Aakash Bodhit Ali Al Balushi Erik Krause Abhay Kumar 《The American journal of emergency medicine》2019,37(2):308-311
Introduction
Diagnosis of acute ischemic stroke is critical for acute intervention. Its diagnosis may be obscured in trauma patients due to confounding injuries. We report its incidence in trauma patients following their presentation at our institution.Methods
Electronic charts of all acute trauma patients presenting to a designated level 1 trauma center emergency department between September 2012–November 2015 were screened and included in the study if they had a discharge diagnosis of acute ischemic stroke. Patient data were reviewed to identify the presence of neurologic deficit on initial triage, imaging type obtained (intracranial or extracranial) and time to diagnosis of stroke.Results
Of 192 trauma patients screened, 11 were found to have acute ischemic stroke (5.7%). Patients were generally young (median age, 49?years) and predominantly males (n?=?8). Presentation after vehicular crash was most frequent (n?=?8 or 73%). Patients had predominantly skeletal injuries (n?=?8 or 73%). Initial workup involved vascular imaging below the neck (n?=?9), while only one had intracranial vascular imaging. When patients underwent cervicocranial vascular imaging, 64% (n?=?7) had findings explaining the etiology of their stroke. None of the patients was diagnosed with acute ischemic stroke on admission. Its diagnosis was delayed by an average 1.8?days following presentation.Conclusions
Acute ischemic stroke in trauma patients was a frequent diagnosis albeit with delay. Routine craniocervical vascular imaging at the time of presentation could potentially facilitate early diagnosis. A prospective study with routine craniocervical vascular imaging in trauma patients will be needed to further explore this hypothesis. 相似文献12.
Leigh White Thomas Melhuish Rhys Holyoak Thomas Ryan Hannah Kempton Ruan Vlok 《The American journal of emergency medicine》2018,36(12):2298-2306
Objectives
To assess the difference in survival and neurological outcomes between endotracheal tube (ETT) intubation and supraglottic airway (SGA) devices used during out-of-hospital cardiac arrest (OHCA).Methods
A systematic search of five databases was performed by two independent reviewers until September 2018. Included studies reported on (1) OHCA or cardiopulmonary resuscitation, and (2) endotracheal intubation versus supraglottic airway device intubation. Exclusion criteria (1) stimulation studies, (2) selectively included/excluded patients, (3) in-hospital cardiac arrest. Odds Ratios (OR) with random effect modelling was used. Primary outcomes: (1) return of spontaneous circulation (ROSC), (2) survival to hospital admission, (3) survival to hospital discharge, (4) discharge with a neurologically intact state.Results
Twenty-nine studies (n?=?539,146) showed that overall, ETT use resulted in a heterogeneous, but significant increase in ROSC (OR?=?1.44; 95%CI?=?1.27 to 1.63; I2?=?91%; p?<?0.00001) and survival to admission (OR?=?1.36; 95%CI?=?1.12 to 1.66; I2?=?91%; p?=?0.002). There was no significant difference in survival to discharge or neurological outcome (p?>?0.0125). On sensitivity analysis of RCTs, there was no significant difference in ROSC, survival to admission, survival to discharge or neurological outcome (p?>?0.0125). On analysis of automated chest compression, without heterogeneity, ETT provided a significant increase in ROSC (OR?=?1.55; 95%CI?=?1.20 to 2.00; I2?=?0%; p?=?0.0009) and survival to admission (OR?=?2.16; 95%CI?=?1.54 to 3.02; I2?=?0%; p?<?0.00001).Conclusions
The overall heterogeneous benefit in survival with ETT was not replicated in the low risk RCTs, with no significant difference in survival or neurological outcome. In the presence of automated chest compressions, ETT intubation may result in survival benefits. 相似文献13.
Shinsuke Tanizaki Shigenobu Maeda Hiroshi Ishida Toru Yamamoto Jun Yoshikawa 《The American journal of emergency medicine》2017,35(11):1636-1638
Introduction
The clinical characteristics of an injury of external iliac artery branches in blunt pelvic trauma have not yet been sufficiently studied. We evaluated the relationship between injury characteristics and the presence of an injury to external iliac artery branches in blunt pelvic trauma.Materials and methods
A retrospective review of patients admitted with blunt pelvic trauma was conducted over an 11-year period. Charts were reviewed for age, gender, injury characteristics, injury severity score, length of stay in the intensive care unit, transfusion requirements, and fracture pattern.Results
Of 286 blunt pelvic trauma patients, 90 patients (31%) underwent pelvic angiography. Of those patients, 10 (11%) had the injuries of the branches of external iliac artery and 88 (97%) had the injuries of the branches of internal iliac artery. Those patients with external iliac artery branch injuries were significantly associated with hemodynamic instability, when compared to those without external iliac artery branch injuries. There were no significant differences between the patients with and without external iliac artery branch injury with regard to the anatomical characteristics of pelvic trauma.Conclusion
Blunt pelvic trauma with hemodynamic instability may be associated with concomitant external iliac artery branch injury. 相似文献14.
Lucas Oliveira J. e Silva M. Fernanda Bellolio Elisa M. Smith David J. Daniels Christine M. Lohse Ronna L. Campbell 《The American journal of emergency medicine》2017,35(10):1485-1489
Background
Motor vehicle–related injuries (including off-road) are the leading cause of traumatic brain injury (TBI) and acute traumatic spinal cord injury in the United States.Objectives
To describe motocross-related head and spine injuries of adult patients presenting to an academic emergency department (ED).Methods
We performed an observational cohort study of adult ED patients evaluated for motocross-related injuries from 2010 through 2015. Electronic health records were reviewed and data extracted using a standardized review process.Results
A total of 145 motocross-related ED visits (143 unique patients) were included. Overall, 95.2% of patients were men with a median age of 25 years. Sixty-seven visits (46.2%) were associated with head or spine injuries. Forty-three visits (29.7%) were associated with head injuries, and 46 (31.7%) were associated with spine injuries. Among the 43 head injuries, 36 (83.7%) were concussions. Seven visits (16.3%) were associated with at least 1 head abnormality identified by computed tomography, including skull fracture (n = 2), subdural hematoma (n = 1), subarachnoid hemorrhage (n = 4), intraparenchymal hemorrhage (n = 3), and diffuse axonal injury (n = 3). Among the 46 spine injuries, 32 (69.6%) were acute spinal fractures. Seven patients (4.9%) had clinically significant and persistent neurologic injuries. One patient (0.7%) died, and 3 patients had severe TBIs.Conclusion
Adult patients evaluated in the ED after motocross trauma had high rates of head and spine injuries with considerable morbidity and mortality. Almost half had head or spine injuries (or both), with permanent impairment for nearly 5% and death for 0.7%. 相似文献15.
Corrie E. Chumpitazi Elizabeth A. Camp Divya R. Bhamidipati Almea M. Montillo A. Chantal Caviness Lesby Mayorquin Faria A. Pereira 《The American journal of emergency medicine》2018,36(9):1577-1580
Background
There is no evidence of an association between fasting time and the incidence of adverse events during procedural sedation and analgesia. Pediatric and adult emergency medicine guidelines support avoiding delaying procedures based on fasting time. General pediatric guidelines outside emergent care settings continue to be vague and do not support a set fasting period for urgent and emergent procedures.Objective
To describe shortened preprocedural fasting and vomiting event rates during the implementation of a shortened fasting protocol.Methods
This was a prospective study of patients undergoing procedural sedation and analgesia (PSA) in an urban, tertiary care children's hospital emergency center from March 2010–February 2012. All consecutive patients had documentation of preprocedural fasting time and adverse events recorded on a standardized data collection form.Results
PSA occurred in 2426 patients with fasting data available for 2188 (90.2%); 1472 were fasted ≥6?h for solids and 716 patients were in the shortened fasting group (<6?h). There is no evidence of an association between emesis at any time and shortened fasting time unadjusted (OR?=?1.18 (95% CI 0.75–1.84) or adjusted for known risk factors including age >12?years, initial ketamine dose >2.5?mg/kg or total dose >5.0?mg/kg (OR?=?1.14 (95% CI 0.74–1.75).Conclusion
Analysis of a large prospective cohort study failed to find evidence of an association between emesis and shortened fasting time upon implementation of a shortened fasting protocol for procedural sedation and analgesia. 相似文献16.
Uzma Rahim Khan Butool Hisam Nukhba Zia Muhammad Umer Mir Olakunle Alonge Seemin Jamali Adnan A Hyder Junaid Abdul Razzak 《BMC emergency medicine》2015,15(Z2):S6
Introduction
In low- and middle-income countries, injuries are a leading cause of mortality in children. Much work has been done in the context of unintentional injuries but there is limited knowledge about intentional injuries among children. The objective of this paper was to understand the characteristics of children with intentional injuries presenting to emergency departments in Pakistan.Methods
The data was from the Pakistan National Emergency Departments Surveillance (Pak-NEDS), conducted from November 2010 to March 2011 in seven major emergency departments of Pakistan. Data on 30,937 children under 18 years of age was collected. This paper reports frequency of intentional injuries and compares patient demographics, nature of injury, and discharge outcome for two categories of intentional injuries: assault and self-inflicted injuries.Results
Intentional injuries presenting to the emergency departments (EDs) accounted for 8.2% (2551/30,937) amongst all other causes for under 18 years. The boy to girl ratio was 1:0.35. Intentional injuries included assault (n = 1679, 65.8%) and self-inflicted injuries (n = 872, 34.2%). Soft tissue injuries were most commonly seen in assault injuries in boys and girls but fractures were more common in self-inflicted injuries in both genders.Conclusion
Intentional injury is one of the reasons for seeking emergency treatment amongst children and a contributor to morbidity in EDs of Pakistan. Moreover, such injuries may be underestimated due to lack of reporting and investigative resources. Early identification may be the first step leading to prevention.17.
Christopher Harris Jonathan Madonick Thomas Ryan Hartka 《The American journal of emergency medicine》2018,36(9):1565-1569
Objective
The objective of this study was to describe recent trends in the epidemiology of lawn mower injuries presenting to the Emergency Department in the United States using nationally representative data for all ages.Methods
Data for this retrospective analysis were obtained from the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS), for the years 2005–2015. We queried the system using all product codes under “lawn mowers” in the NEISS Coding Manual. We examined body part injured, types of injuries, gender and age distribution, and disposition.Results
There were an estimated 934,394 lawn mower injuries treated in U.S. ED's from 2005 to 2015, with an average of 84,944 injuries annually. The most commonly injured body parts were the hand/finger (22.3%), followed by the lower extremity (16.2%). The most common type of injury was laceration (23.1%), followed by sprain/strain (18.8%). The mean age of individuals injured was 46.5?years, and men were more than three times as likely to be injured as women. Patients presenting to the ED were far more likely to be discharged home after treatment (90.5%) than to be admitted (8.5%).Conclusion
Lawn mowers continue to account for a large number of injuries every year in the United States. The incidence of lawn mower injuries showed no decrease during the period of 2005–2015. Preventative measures should take into account the epidemiology of these injuries. 相似文献18.
Brinkley K. Sandvall Lauren Jacobson Erin A. Miller Ryan E. Dodge D. Alex Quistberg Ali Rowhani-Rahbar Monica S. Vavilala Jeffrey B. Friedrich Kari A. Keys 《The American journal of emergency medicine》2017,35(10):1469-1473
Background
There is a paucity of clinical data on severe fireworks-related injuries, and the relationship between firework types, injury patterns, and magnitude of impairment is not well understood. Our objective was to describe the relationship between fireworks type, injury patterns, and impairment.Methods
Retrospective case series (2005–2015) of patients who sustained consumer fireworks-related injuries requiring hospital admission and/or an operation at a Level 1 Trauma/Burn Center. Fireworks types, injury patterns (body region, injury type), operation, and permanent impairment were examined.Results
Data from 294 patients 1 to 61 years of age (mean 24 years) were examined. The majority (90%) were male. 119 (40%) patients were admitted who did not undergo surgery, 163 (55%) patients required both admission and surgery, and 12 (5%) patients underwent outpatient surgery. The greatest proportion of injuries was related to shells/mortars (39%). There were proportionally more rocket injuries in children (44%), more homemade firework injuries in teens (34%), and more shell/mortar injuries in adults (86%). Brain, face, and hand injuries were disproportionately represented in the shells/mortars group. Seventy percent of globe-injured patients experienced partial or complete permanent vision loss. Thirty-seven percent of hand-injured patients required at least one partial or whole finger/hand amputation. The greatest proportion of eye and hand injuries resulting in permanent impairment was in the shells/mortars group, followed by homemade fireworks. Two patients died.Conclusions
Severe fireworks-related injuries from homemade fireworks and shells/mortars have specific injury patterns. Shells/mortars disproportionately cause permanent impairment from eye and hand injury. 相似文献19.
20.
Robyn McDannold Bentley J. Bobrow Vatsal Chikani Annemarie Silver Daniel W. Spaite Tyler Vadeboncoeur 《The American journal of emergency medicine》2018,36(9):1640-1644