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1.
Rohit P. Shenoi Elizabeth A. Camp Daniel M. Rubalcava Andrea T. Cruz 《The American journal of emergency medicine》2017,35(12):1791-1797
Introduction
Blunt trauma is a leading cause of pediatric morbidity. We compared injuries, interventions and outcomes of acute pediatric blunt torso trauma based on intent.Methods
We analyzed de-identified data from a prospective, multi-center emergency department (ED)-based observational cohort of children under age eighteen. Injuries were classified based on intent (unintentional/inflicted). We compared demographic, physical and laboratory findings, ED disposition, hospitalization, need for surgery, 30-day mortality, and cause of death between groups using Chi-squared or Fisher's test for categorical variables, and Mann-Whitney test for non-normal continuous factors comparing median values and interquartile ranges (IQR).Results
There were 12,044 children who sustained blunt torso trauma: Inflicted = 720 (6%); Unintentional = 9563 (79.4%); Indeterminate = 148 (1.2%); Missing = 1613 (13.4%). Patients with unintentional torso injuries significantly differed from those with inflicted injuries in median age in years (IQR) [10 (5, 15) vs. 14 (8, 16); p-value < 0.001], race, presence of pelvic fractures, hospitalization and need for non-abdominal surgery. Mortality rates did not differ based on intent. Further adjustment using binary, logistic regression revealed that the risk of pelvic fractures in the inflicted group was 96% less than the unintentional group (OR: 0.04; 95%CI: 0.01–0.26; p-value = 0.001).Conclusions
Children who sustain acute blunt torso trauma due to unintentional causes have a significantly higher risk of pelvic fractures and are more likely to be hospitalized compared to those with inflicted injuries. 相似文献2.
Chun Tat Lui Oi Fung Wong Kwok Leung Tsui Chak Wah Kam Siu Man Li Mina Cheng Ka Kit Gilberto Leung 《The American journal of emergency medicine》2018,36(8):1444-1450
Background
Currently existing predictive models for massive blood transfusion in major trauma patients had limitations for sequential evaluation of patients and lack of dynamic parameters.Objective
To establish a predictive model for predicting the need of massive blood transfusion major trauma patients, integrating dynamic parameters.Design
Multi-center retrospective cohort study.Setting
Four designated trauma centers in Hong Kong.Methods
Trauma patients aged > 12 years were recruited from the trauma registries from 2005 to 2012. MBT was defined as delivery of ≥ 10 units of packed red cells within 24 h. Split sampling method was adopted for model building and validation. Multivariate logistic regression was adopted for model building, with weight assigned based on logarithmic of adjusted odds ratios. The performance of the dynamic MBT score (DMBT) was compared with the PWH score and the Trauma Associated Severe Hemorrhage (TASH) score in the validation data set.Results
4991 patients were included in the study. The DMBT was established with 8 parameters: systolic blood pressure, heart rate, hemoglobin, hemoglobin drop within the first 2 h, INR, base deficit, unstable pelvic fracture and hemoperitoneum in radiological imaging. At cut-off score of 6 the DMBT achieved sensitivity of 78.2% and specificity of 89.2%. In the validation set, the AUCs of the DMBT, PWH score, and TASH score were 0.907, 0.844, and 0.867 respectively.Conclusions
The DMBT score allows both snapshot and sequential activation along the trauma care pathway and has better performance than the PWH score and TASH score. 相似文献3.
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4.
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5.
Ahmad Mahamid Kobi Peleg Adi Givon Ricardo Alfici Oded Olsha Itamar Ashkenazi 《The American journal of emergency medicine》2017,35(2):214-217
Background
Blunt traumatic diaphragmatic injury (BTDI) is an uncommon injury and one which is difficult to diagnose. The objective of this study was to identify features associated with this injury.Methods
This was a retrospective study based on records of 354 307 blunt trauma victims treated between 1998 and 2013 collected by the Israeli National Trauma Registry.Results
BTDI was reported in 231 (0.065%) patients. Motor vehicle accidents were responsible for 84.4% of the injuries: 97 (42.0%) were reported as drivers; 54 (23.4%) were passengers; 34 (14.7%) were pedestrians hit by cars; and 10 (4.3%) were on motorcycles. There were more males than females (2.5:1) compared with blunt trauma patients without BTDI (p < .001). Patients with BTDI were significantly younger than blunt trauma patients without BTDI (p < .001). ISS was 9–14 in 5.2%, 16–24 in 16.9%, 25–75 in 77.9%. Urgent surgery was performed in 62% of the patients and 79.7% had surgery within 24 h of admission. Mortality was 26.8%. Over 40% of patients with BTDI had associated rib, pelvic and/or extremity injuries. Over 30% had associated spleen, liver and/or lung injuries. Nevertheless, less than 1% of patients with skeletal injuries and less than 2.5% with solid organ injuries overall had associated BTDI. Despite hollow viscus injury being less prevalent, up to 6% of patients with this injury had associated BTDI.Conclusions
BTDI is infrequent following blunt trauma. Hollow viscus injuries were more predictive of BTDI than skeletal or solid organ injuries. 相似文献6.
Joseph R. Starnes Purnima Unni Cherie A. Fathy Kelly A. Harms Shelby R. Payne Dai H. Chung 《The American journal of emergency medicine》2018,36(6):1049-1052
Background
Golf cart injuries represent an increasing source of morbidity and mortality in the United States. Characterization of the circumstances of these injuries can inform injury prevention efforts.Methods
This study retrospectively reviews a prospective trauma registry at a level-one pediatric trauma center for golf cart-related injuries in patients under 18 years of age admitted to the hospital between 2008 and 2016.Results
The 40 identified crashes were associated with 82 hospital days, 17 ICU days, and more than $1 million in hospital charges over the study period. The median hospital stay was 1.5 days, and the median hospital charge was $20,489. Severe injuries with an Injury Severity Score of >15 were identified in 25% of patients, and moderate injuries with scores between nine and 15 were identified in an additional 30%. The most common injures were head and neck (60%) and external injuries to the body surface (52.5%). Only a single child was wearing a seatbelt, and the vast majority was not using any safety equipment. Children as young as nine years old were driving golf carts, and child drivers were associated with the cart overturning (p = 0.007).Conclusions
Golf cart crashes were a source of substantial morbidity at a level-one trauma center. Increased safety measures, such as higher hip restraints, seatbelts, and front-wheel breaks could substantially increase the safety of golf carts. Increased regulation of driving age as well as driver education may also reduce these injuries. 相似文献7.
Matthew B. Doelp Jack A. Puleo Paul Cowan Michelle Arford-Granholm 《The American journal of emergency medicine》2018,36(8):1372-1379
Introduction
Beaches are a popular destination for recreation activities. Surf zone injuries (SZI) can occur resulting from a variety of in-water activities. Little is known regarding the sustained injury types, or demographics of injured persons and activities leading to injuries.Methods
This study examines the distribution of SZI types, activities and populations occurring on Delaware Beaches as recorded by a local level III trauma center (Department of Emergency Medicine at Beebe Healthcare in Lewes, Delaware).Results
There were 2021 injuries over the eight study years (2010–2017). The relative demographics of the injured population are similar despite fluctuating injury totals (mean [SD], 253.1 [104.4]). Non-locals (n = 1757) were 6.7 times more likely to be injured as their local (n = 264) counterparts (RR, 2.62; 95% CI, 2.08–3.31). Males (n = 1258) were 1.7 times more likely to be injured than their female (n = 763) counterparts (RR, 1.29; 95% CI, 1.21–1.37). Serious injuries, defined as patients requiring admission to a trauma service, represented 9.1% (n = 184) of injuries. Fatal SZI (n = 6) were categorized as serious injuries. Wading (50.1%) was found to be the dominant activity associated with injury followed by body surfing (18.4%), and body boarding (13.3%).Conclusion
To the authors' knowledge, this study is one of the first to investigate long-term trends in SZI data, injury activity, and demographics. Better understanding of the characteristics of injuries will allow for improved awareness techniques, targeted at populations with higher injury rates. 相似文献8.
Matthew C. Hernandez Johnathon M. Aho Martin D. Zielinski Scott P. Zietlow Brian D. Kim David S. Morris 《The American journal of emergency medicine》2018,36(1):114-119
Background
Prehospital airway management increasingly involves supraglottic airway insertion and a paucity of data evaluates outcomes in trauma populations. We aim to describe definitive airway management in traumatically injured patients who necessitated prehospital supraglottic airway insertion.Methods
We performed a single institution retrospective review of multisystem injured patients (≥ 15 years) that received prehospital supraglottic airway insertion during 2009 to 2016. Baseline demographics, number and type of: supraglottic airway insertion attempts, definitive airway and complications were recorded. Primary outcome was need for tracheostomy. Univariate and multivariable statistics were performed.Results
56 patients met inclusion criteria and were reviewed, 78% were male. Median age [IQR] was 36 [24–56] years. Injuries comprised blunt (94%), penetrating (4%) and burns (2%). Median ISS was 26 [22–41]. Median number of prehospital endotracheal intubation (PETI) attempts was 2 [1-3]. Definitive airway management included: (n = 20, 36%, tracheostomy), (n = 10, 18%, direct laryngoscopy), (n = 6, 11%, bougie), (n = 9, 15%, Glidescope), (n = 11, 20%, bronchoscopic assistance). 24-hour mortality was 41%. Increasing number of PETI was associated with increasing facial injury. On regression, increasing cervical and facial injury patterns as well as number of PETI were associated with definitive airway control via surgical tracheostomy.Conclusions
After supraglottic airway insertion, operative or non-operative approaches can be utilized to obtain a definitive airway. Patients with increased craniofacial injuries have an increased risk for airway complications and need for tracheostomy. We used these factors to generate an evidence based algorithm that requires prospective validation.Level of evidence
Level IV – Retrospective study.Study type
Retrospective single institution study. 相似文献9.
Somer Harvey A. Brad Hall Kayla Wilson 《The American journal of emergency medicine》2018,36(2):290-293
Background
Targeted antibiotic treatment reduces the infection risk of open fractures when soft tissue and bone are exposed to the environment. The risk of infection increases with higher degrees of injury. The Gustilo-Anderson system was developed to identify the degree of injury of open fractures and can be utilized to guide initial antibiotic therapy. Few studies have been published evaluating the potential impact of emergency medicine pharmacists in trauma, and currently no study has evaluated a pharmacist's influence on antibiotic selection and timing for open fractures.Objective
The objective of this study was to determine the impact of an emergency medicine pharmacist on initial antibiotic selection and timing in trauma patients with open fractures.Methods
This was a retrospective cohort study. Trauma alerts with open fractures from May 1, 2014 to June 30, 2016 were eligible for inclusion. The primary outcome was to determine if pharmacist participation during trauma resuscitation was associated with an increased proportion of initial antibiotic selection meeting guideline recommendations. The secondary outcome was the door-to-antibiotic administration time during resuscitation.Results
Initial prophylactic antibiotic recommendations were met in 81% of trauma resuscitations when a pharmacist was present versus 47% without a pharmacist present (p < 0.01). The median door-to-antibiotic time was 14 min in the PHARM group versus 20 min in the NO-PHARM group (p = 0.02).Conclusions
The participation of an EM pharmacist during initial trauma resuscitation resulted in improved initial antibiotic selection and faster door-to-antibiotic administration times in trauma patients with open fractures. 相似文献10.
Ehsan Akbari Saeed Safari Hamidreza Hatamabadi 《The American journal of emergency medicine》2018,36(11):1947-1950
Introduction
The debate on replacing coagulation factors and its effect on the final outcome of the patients with acute traumatic coagulopathy (ATC) in need of transfusion is still ongoing. Therefore, the present study is designed with the aim of comparing the outcome of patients with acute traumatic coagulopathies receiving fibrinogen and fresh frozen plasma (FFP).Methods
In this quasi-experimental randomized controlled study, patients with severe blunt trauma (ISS > 16) and in need of packed cells transfusion were divided into 3 groups of receiving fibrinogen, receiving FFP, and control, and their final outcome was compared.Results
90 patients with the mean age of 33.16 ± 16.32 years were randomly allocated to one of the 3 study groups (82.2% male). The 3 groups were similar regarding baseline characteristics. Patients receiving fibrinogen needed significantly less packed cells (p = 0.044) and intravenous fluid in the initial 24 h of hospitalization (p = 0.022). In addition, mortality rate (p = 0.029), need for admission to intensive care unit (p = 0.020) and duration of hospitalization (p = 0.045) were also lower in the group receiving fibrinogen. The number of sepsis cases in patients receiving fibrinogen and control group was lower than those who received FFP (p = 0.001). The number of multiple organ failure cases in patients receiving fibrinogen was about one fourth of the other 2 groups (p = 0.106), and a fewer number of them needed mechanical ventilation (p = 0.191). No case of venous thrombosis was detected in any of the 3 groups.Conclusion
Multiple trauma patients in need of transfusion who received fibrinogen along with packed cells had significantly better outcomes regarding mortality, sepsis, need for admission to the intensive care unit, need for receiving packed cells, need for receiving intravenous fluids in the initial 24 h, and duration of hospitalization. 相似文献11.
C. López-López A. Arranz-Esteban M.V. Martinez-Ureta M.C. Sánchez-Rascón C. Morales-Sánchez M. Chico-Fernández 《Enfermería intensiva / Sociedad Espa?ola de Enfermería Intensiva y Unidades Coronarias》2018,29(2):64-71
Objective
To analyse the influence of psychotropic substance use on the level of pain in patients with severe trauma.Design
Longitudinal analytical study.Scope
Intensive Care Unit (ICU) of Trauma and Emergencies.Patients
severe trauma, non-communicative and mechanical ventilation > 48 hours. Two groups of patients were created: users and non-users of psychotropic substances according to medical records.Interventions
Measurement of pain level at baseline and during mobilization, using the Pain Indicator Behaviour Scale.Variables
demographic characteristics, pain score, sedation level and type and dose of analgesia and sedation.Results
Sample of 84 patients, 42 in each group. The pain level in both groups, during mobilisation, showed significant differences p = 0.011, with a mean of 3.11 (2.40) for the user group and 1.83 (2.14) for the non-user group. A relative risk of 2.5 CI (1,014-6,163) was found to have moderate / severe pain in the user group compared to the non-user group. The mean dose of analgesia and continuous sedation was significantly higher in the user group: P=.032 and P=.004 respectively. There was no difference in bolus dose of analgesia and sedation with P=.624 and P=.690 respectively.Conclusions
Patients with a history of consumption of psychoactive substances show higher levels of pain and experience a higher risk of this being moderate/severe compared to non-users despite receiving higher doses of analgesia and sedation infusion. Key words: pain, multiple trauma, drug users. 相似文献12.
Mauro Giordano Tiziana Ciarambino Pietro Castellino Lorenzo Malatino Alessandro Cataliotti Luca Rinaldi Giuseppe Paolisso Luigi Elio Adinolfi 《The American journal of emergency medicine》2017,35(5):749-752
Study objective
We investigated seasonal prevalence of hyponatremia in the emergency department (ED).Design
A cross-sectional study using clinical chart review.Setting
University Hospital ED, with approximately 28 000 patient visits a year.Type of participants
We reviewed 15 049 patients, subdivided in 2 groups: the adult group consisting of 9822 patients aged between 18 and 64 years old and the elderly group consisting of 5227 patients aged over 65 years presenting to the ED between January 1st, 2014 and December 31st, 2015.Intervention
Emergency patients were evaluated for the presence of hyponatremia by clinical chart review.Measurements and main results
Hyponatremia was defined as a serum sodium level < 135 mmol/l. Mean monthly prevalence of hyponatremia was of 3.74 ± 0.5% in the adult group and it was significantly increased to 10.3 ± 0.7% in the elderly group (p < 0.05 vs adults). During the summer, hyponatremia prevalence was of 4.14 ± 0.2% in adult and markedly increased to 12.52 ± 0.7% (zenith) in elderly patients (p < 0.01 vs adult group; p < 0.05 vs other seasons in elderly group). In the elderly group, we reported a significant correlation between weather temperature and hyponatremia prevalence (r: 0.491; p < 0.05).Conclusion
We observed a major influence of climate on the prevalence of hyponatremia in the elderly in the ED. Decline in renal function, salt loss, reduced salt intake and increased water ingestion could all contribute to developing hyponatremia in elderly patients during the summer. These data could be useful for emergency physicians to prevent hot weather-induced hyponatremia in the elderly. 相似文献13.
Shinsuke Tanizaki Shigenobu Maeda Makoto Sera Hideya Nagai Taizo Nakanishi Minoru Hayashi Hiroyuki Azuma Ken-ichi Kano Hiroki Watanabe Hiroshi Ishida 《The American journal of emergency medicine》2018,36(12):2172-2176
Introduction
Massive hemorrhage is often associated with unstable pelvic fractures with posterior ring injury. Initial pelvic radiography alone may not detect these posterior lesions. We examined whether the presence of an anterior pelvic fracture on initial pelvic radiography alone may identify patients who are at a high risk of major hemorrhage.Materials and methods
A total of 288 patients with pelvic fractures were admitted to the Fukui Prefectural Hospital during an 11-year period. After excluding 33 patients who were in cardiopulmonary arrest on arrival and nine with concomitant abdominal organ injuries requiring emergency laparotomy, 246 eligible patients were retrospectively reviewed. Anterior pelvic fractures were defined as displacement of the obturator ring, obturator ring with laterality, or displacement of the pubic symphysis on pelvic radiography.Results
Massive hemorrhage was identified in 106 of 246 patients. Patients with massive hemorrhage had a higher frequency of anterior pelvic fractures on pelvic radiography and higher frequency of posterior pelvic fractures on computed tomography than those without massive hemorrhage. Logistic regression analysis identified displacement of the obturator ring by ≥5 mm, obturator ring with laterality of ≥5 mm, and displacement of the pubic symphysis by ≥4 mm on pelvic radiography as predictors of massive pelvic hemorrhage.Conclusion
The results of the present study suggested that the presence of displaced anterior lesions of the pelvic ring on pelvic radiography alone, without the use of computed tomography during the initial treatment stage, may promptly identify patients at high risk of massive pelvic hemorrhage who require intervention for hemorrhage control. 相似文献14.
Serhad Omercikoglu Erhan Altunbas Haldun Akoglu Ozge Onur Arzu Denizbasi 《The American journal of emergency medicine》2017,35(3):383-390
Introduction
Atlantodental interval (ADI), basion-dental interval (BDI) and the thickness of prevertebral soft tissue (TOPST) measured in lateral cervical radiographs were reported to be useful indicators and indirect signs of underlying cervical spine injuries. However, cervical computed tomography (MDCT) is the first method of imaging used in all trauma patients and upper normal limits (UNLs) of cervical distances according to age and sex are undetermined. Therefore, we aimed to calculate these metrics.Methods
500 adult trauma patients with cervical MDCT at the time of admission were retrospectively selected. ADI, BDI, and TOPSTs were measured by two blinded researchers.Results
488 cervical spine CT scans were reported to be normal and 12 has pathological findings. Mean ADI, BDI and TOPST of C1, C2, C6 and C7 were statistically significantly wider in males. In females, ADI and BDI were significantly narrower with the increase in age. In males, only ADI was significantly narrower, and TOPST of C6 and C7 vertebra were significantly wider with the increase in age. We found the optimal UNLs as follows: ADI 2.5 mm, BDI 8.5 mm, C1 6.5 mm, C2 5.7 mm, C3 6.3 mm (6 mm for C1–3 for practical purposes), C4 11.7 and C5–7 17 mm.Discussion
We believe that the increase in distances with age may be affected by the height losses of discs and vertebral bodies, formation of anterior osteophytes and regional kyphosis by age. Those results were compatible with the previous reports. 相似文献15.
Mehdi Torabi Fereshteh Mazidi Sharaf Abadi Mohammad Reza Baneshi 《The American journal of emergency medicine》2018,36(5):816-819
Objectives
Hyperglycemia with unknown mechanism plays a predictive role in determining the prognosis of multiple trauma patients. The exact time of blood sugar measurement and the role of blood sugar changes in the monitoring of these patients have not been well established.Methods
This follow-up study was done on multiple trauma patients (> 18 years) with an Injury Severity Scores (ISS) > 16. These patients didn?t have any history of diabetes, underlying disease, or drug or alcohol use. Data collection was done by the questionnaire (checklist), and the patients were followed by the medical records. Cox regression was used to measure the effect of independent variables on the patients' hospital mortality.Results
Of a total of 963 patients, 280 patients were enrolled. Of those, 202 were male (72.1%) and 78 were female (27.9%). Hospital mortality was 18 (6.4%). Cox regression analysis suggested that those who had high blood sugar 3 h after admission had higher hospital mortality (P = 0.04). Changes in blood sugar, ΔBS (BS 3 h after admission – BS on admission), in these patients was also significantly correlated with hospital mortality (P < 0.001). The multivariate model using the backward conditional method showed that ΔBS (P < 0.001), international normalized ration (INR) (P < 0.001), and heart rate (P = 0.036) were significantly correlated with hospital mortality.Conclusions
In multiple trauma patients, blood sugar changes in the early hours of admission to the emergency department may help predict hospital mortality, but further studies are needed. Blood sugar monitoring in these patients during this time frame may be helpful in predicting these patients' outcomes. In addition, coagulopathy and tachycardia were significantly associated with hospital mortality. 相似文献16.
Objective
We evaluated the effectiveness of point-of-care wrist ultrasonography compared with 3T-magnetic resonance imaging (MRI) for diagnosing triangular fibrocartilage complex (TFCC) injuries in trauma patients with ulnar-sided pain and instability. Moreover, we assessed the inter-observer variability between an emergency physician and a musculoskeletal radiology fellow.Material and methods
A prospective cross-sectional study was conducted in an emergency department; patients with ulnar-sided sprain and instability were recruited. An emergency physician and a musculoskeletal radiology fellow independently evaluated the TFC, meniscal homologue, volar and dorsal distal radioulnar ligaments, and extensor carpi ulnaris using point-of-care ultrasonography. Findings were classified as normal, partial rupture, or complete rupture. Wrist 3T-MRI was used as the reference standard. We compared the diagnostic values for point-of-care ultrasonography obtained by both reviewers using DeLong's test. Intra-class correlation coefficients (ICCs) were calculated for agreement between each reviewer and the reference standard, and directly between the two reviewers.Results
Sixty-five patients were enrolled. Point-of-care wrist ultrasonography showed acceptable sensitivity (97.2–99.1%), specificity (96.8–97.3%), and accuracy (96.9–97.9%); these diagnostic performance values did not differ significantly between reviewers (p = 0.58–0.98). Agreement between each reviewer and the reference standard was excellent (emergency physician, ICC = 0.964; musculoskeletal radiology fellow, ICC = 0.976), as was the inter-observer agreement (ICC = 0.968).Conclusion
Point-of-care wrist ultrasonography is as precise as MRI for detecting TFCC injuries, and can be used for immediate diagnosis and further preoperative imaging. Moreover, it may shorten the interval from emergency department admission to surgical intervention while reducing costs. 相似文献17.
Andrew Katirai Mark J. Landau Jack M. Berger 《The American journal of emergency medicine》2018,36(7):1253-1256
Background
Patients who experience trauma with severe hemorrhage requiring immediate surgery and massive blood transfusion often present with markedly abnormal laboratory values. These cases require valuable resources; however, little is known regarding prognostic factors that correlate with mortality. The purpose of this study was to determine whether abnormal initial arterial blood gas (ABG) pH, a marker for severe blood loss, could serve as a prognostic indicator for these patients.Methods
An IRB approved retrospective study was performed at LAC + USC Medical Center Level I Trauma Center. Data was collected from trauma patients with severe hemorrhage admitted between June 2015 and April 2016 who were immediately admitted to the OR following entry into the ER. Baseline variables of age, sex and mechanism of trauma were collected. The pH readings from the initial three ABG data were obtained, and mortality was determined for each patient.Results
We identified 247 patients, 84.2% of which were male. Ages ranged from 1 to 91 years (average = 38.4). Overall mortality was 13.8%. The average initial pH value for non-survivors (7.10 ± 0.13) was significantly lower than for survivors (7.34 ± 0.07) [p < 0.001]. Among patients whose initial three ABG pH values averaged ≤7.15, the survival rate was 8.7%. Ten patients had any single recorded pH value ≤ 6.91. The mortality rate among these patients was 90%.Conclusions
Consideration should be given to initial pH values when resuscitating “red blanket” patients. However, the pH values alone cannot reliably be used to determine clinical futility in individual patients in the early period after injury. 相似文献18.
Serkan Dogan Utku Murat Kalafat Bülent Yüksel Türker Karaboğa Mustafa Basturk Tarik Ocak 《The American journal of emergency medicine》2017,35(3):465-468
Purpose
To compare the diagnostic value of ultrasonography (USG), which is rapid, inexpensive, simple, and does not involve radiation, with that of direct radiography for identifying fractures in the nasal bones of pediatric patients presenting in the emergency department with nasal trauma.Equipment and methods
Patients under 18 years old presenting with nasal trauma at the emergency department included prospectively. The patients' age and sex distribution, trauma type, GCS, physical examination findings, direct radiography, and USG results were recorded. The physical examination made by the emergency medicine specialist on arrival was accepted as the gold standard for diagnosis.Findings
In total, 133 patients, 34.6% female and 65.4% male, were included in this study. The average patient age was 7.44 ± 5.05 years, with the greatest proportion (21.8%, n = 29) of patients in the age ranges of 0–2 and 6–8 years. The most frequently observed finding on physical examinations was swelling (51.1%, n = 68). In total, 50 (37.6%) patients had nasal fractures according to their first physical examination, which was performed by emergency medicine specialists. That is, fractures were detected by direct radiography in only 11 of the 34 cases who were diagnosed with fractures by USG.Conclusions
We consider that USG should be preferred over direct radiography for use at the bedside of pediatric patients who present at emergency department with nasal trauma, because of its superior diagnostic ability and the lack of a requirement for radiation. 相似文献19.
Danielle Herbert Blazewick Thitphalak Chounthirath Nichole L. Hodges Christy L. Collins Gary A. Smith 《The American journal of emergency medicine》2018,36(4):608-614
Objective
To investigate the characteristics of stair-related injuries among individuals of all ages and estimate national injury frequencies and rates using a representative sample of patients treated in United States emergency departments.Methods
Data from the National Electronic Injury Surveillance System were analyzed for patients treated for stair-related injuries in United States emergency departments from 1990 through 2012.Results
An estimated 24,760,843 patients were treated in emergency departments for a stair-related injury during the 23-year study period, averaging 1,076,558 patients annually, or 37.8 injuries per 10,000 United States residents. The annual rate of stair-related injuries decreased by 12.6% (p < 0.001) during 1990–1996, followed by an increase of 24.0% (p < 0.001) during 1996–2012. Although the highest injury rates occurred among younger children and older adults, the majority (67.2%) of emergency department visits for stair-related injuries was by individuals 11–60 years old. Most patients were female (62.4%), who also had a higher injury rate (46.5 vs. 29.1 per 10,000) than males. Sprains and strains (32.3%), soft tissue injuries (23.8%), and fractures (19.3%) were the most common types of injury. The body regions most frequently injured were the lower extremities (42.1%) and head/neck (21.6%). Patients ≤ 10 years old experienced more head/neck injuries. Older adult patients more frequently sustained fractures than younger age groups.Conclusions
Stairs are a common source of injury among individuals of all ages and the frequency and rate of stair-related injuries are increasing. This underscores the need for increased prevention efforts, particularly those related to stair design and construction. 相似文献20.
Brittany A. Walsh Thiphalak Chounthirath Laura Friedenberg Gary A. Smith 《The American journal of emergency medicine》2017,35(11):1666-1671