Injury Pattern and Injury Severity of In-Hospital Deceased Road Traffic Accident Victims in The Netherlands: Dutch Road Traffic Accidents Fatalities

World Journal of Surgery - Further reduction in road traffic accident (RTA) fatalities is a key priority in the European Union. Since data on injury patterns related to mortality in RTAs are...     

Injury to the Thoracic Aorta Following Fatal Blunt Trauma: An Autopsy Study

Abstract Background:   Transection of the thoracic aorta (TTA) remains a leading cause of death after blunt trauma. In this autopsy study, the natural history of this injury is reviewed. Patients and Methods:   All blunt trauma deaths that occurred in the Milano urban area over a period of one year were collected. Autopsies were available in all cases. Incidence, mechanisms, anatomical locations of TTA, deaths due to TTA or coexisting injuries, and times of death were reviewed. Cause of death was established. Death was attributed to TTA if its abbreviated injury score was six (hemorrhage not confined to the mediastinum). Results:   199 cases of fatal blunt trauma were included, 72% of which were males; mean age 53 ± 21. A TTA was observed in 53 subjects (27%), with a significantly higher incidence between the ages of 45 and 64 years and after falls from height. The aorta was transected at the isthmus in 36% of cases. Victims with TTA had a higher pre-hospital mortality and more injuries to chest organs, the chest wall and pelvis. In victims with TTA, injury to the aorta was the cause of death in 58%. Only five patients with TTA survived more than 1 h, reaching the hospital alive; four of these died due to the rupture of a mediastinal hematoma during the first hours of in-hospital care. Conclusions:   This study demonstrates that TTA is a frequent cause of immediate deaths among blunt trauma victims. Patients with risk factors for TTA who reach the hospital alive need to be promptly investigated with a contrast CT scan. Evidence of mediastinal hematoma is suggestive for possible rapid evolution.     

Predictors and Time-Based Hospital Mortality in Patients with Isolated and Polytrauma Brain Injuries

Background

Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. We studied the predictors and time-based mortality in patients with isolated and polytrauma brain injuries in a rapidly developing country. We hypothesized that TBI-related 30-day mortality is decreasing over time.

Methods

A retrospective analysis was conducted for all patients with moderate-to-severe TBI who were admitted directly to a level 1 trauma center between 2010 and 2014. Patient’s data were analyzed and compared according to survival (survived vs. not survived), time (early death [2 days], intermediate [3–7 days] versus late [>7 days]) post-injury, and type (polytrauma vs. isolated TBI). Cox proportional hazards models were performed for the predictors of mortality.

Results

A total of 810 patients were admitted with moderate-to-severe TBI with a median age of 27 years. Traffic-related injury was the main mechanism of TBI (65%). Isolated TBIs represented 22.6% of cases and 56% had head AIS >3. The overall mortality rate was 27%, and most of deaths occurred in the intermediate (40%) and early period (38%). The incidence of TBI was greater in patients aged 21–30 years but the mortality was proportionately higher among elderly. The average annual incidence was 8.43 per 100,000 population with an overall mortality of 2.28 per 100,000 population. Kaplan–Meier curves showed that polytrauma had greater mortality than isolated TBI. However, Cox survival analysis showed that age [Hazard ratio (HR) 1.02], scene GCS (HR 0.86),subarachnoid hemorrhage (HR 1.7), and blood transfusion amount (HR 1.03) were the predictors of mortality regardless of being polytrauma or isolated TBI after controlling for 14 relevant covariates.

Conclusions

The 30-day survival in patients with TBI is improving over the years in Qatar; however, the mortality remains high in the elderly males. The majority of deaths occurred within a week after the injury. Further studies are needed to assess the long-term survival in patients with moderate-to-severe TBI.

     

The Financial Burden of Road Traffic Injuries in Mozambique: A Hospital-Related Cost-of-Illness Study of Maputo Central Hospital

Road traffic injuries (RTIs) are increasingly being recognized for their significant economic impact. Mozambique, like other low-income countries, suffers staggering rates of road traffic collisions. To our knowledge, this is the first study to estimate direct hospital costs of RTIs using a bottom-up, micro-costing approach in the Mozambican context. This study aims to calculate the direct, inpatient costs of RTIs in Mozambique and compare it to the financial capacity of the Mozambican public health care system. This was a retrospective, single-centre study. Charts of all patients with RTIs admitted to Maputo Central Hospital over a period of 2 months were reviewed. The costs were recorded and analysed based on direct costs, human resource costs, and overhead costs. Costs were calculated using a micro-costing approach. In total, 114 patients were admitted and treated for RTIs at Maputo Central Hospital during June–July 2015. On average, the hospital cost per patient was US$ 604.28 (IQR 1033.58). Of this, 44% was related to procedural costs, 23% to diagnostic imaging costs, 17% to length-of-stay costs, 9% to medication costs, and 7% to laboratory test costs. The average annual inpatient cost of RTIs in Mozambique was almost US$ 116 million (0.8% of GDP). The financial burden of RTIs in Mozambique represents approximately 40% of the annual public health care budget. These results help highlight the economic impact of trauma in Mozambique and the importance of an organized trauma system to reduce such costs.     

AIS评分法对540例车祸伤的评价

本文介绍采用“简明损伤定级标准”(AIS)对540例车祸伤的评价。伤员中行人占344例(63.7％),大型车辆致伤294例(55.4％),撞击伤有368例(68.3％),死亡74例。对812处损伤做了AIS等级评定,确定出ISS值及死亡病例ISS值的分布范围。AIS分析表明大型车辆对行人的致伤较严重,摩托车及自行车对驾驶员(车手)的致伤较严重。     

Analysis of 203 Patients with Penetrating Neck Injuries

Background  Selective nonoperative management (SNOM) of penetrating neck injuries (PNI) has steadily gained favor, but indications for surgery and adjunctive diagnostic studies remain debated. The purpose of the present study is to validate a protocol of SNOM of PNI based on physical examination, which further dictates complementary investigations and management. Patients and methods  A prospective observational study was conducted in a South African tertiary urban trauma center with a high prevalence of penetrating trauma. All consecutive patients admitted with penetrating neck injuries over a 13-month period were included. Results  A total of 203 patients were included in the study: 159 with stab wounds and 42 with gunshot wounds. A vascular injury was identified in 27 (13.3%) patients, pharyngoesophageal injury in 18 (8.9%) patients, and an upper airway injury in 8 (3.9%) patients. Only 25 (12.3%) patients required surgical intervention. A further 8 (3.9%) patients had therapeutic endovascular procedures. The remaining 158 (77.8%) patients, either asymptomatic or with negative work-up, were managed expectantly. There were no clinically relevant missed injuries. Conclusions  Selective nonoperative management of neck injuries based on clinical examination and selective use of adjunctive investigational studies is safe in a high-volume trauma center.     

Adrenalectomy in Older Americans has Increased Morbidity and Mortality: An Analysis of 6,416 Patients

Background  

The incidence of adrenal tumors increases with age. We examined the impact of older age (>60 years) on clinical and economic outcomes after adrenalectomy.     

Camel-Related Injuries: Prospective Study of 212 Patients

Background

Camel-related injuries have been less well studied than other animal-related injuries. We aimed to study prospectively the incidence, mechanism, distribution of injury, and outcome of patients admitted to hospital with camel-related injuries in Al-Ain, United Arab Emirates.

Methods

All patients who were admitted to Al-Ain Hospital with a camel-related injury were prospectively studied during the period of October 2001 to January 2010. Patient’s demography, time of injury, mechanism of injury, and distribution and severity of injury were studied.

Results

A total of 212 patients, all male, with a median age of 28?years (5–89?years) were studied. The estimated incidence of hospitalized camel-related injured patients in Al-Ain City was 6.88 per 100,000 population per year. Camel kicks were most common (36.8?%) followed by a fall from a camel (26.4?%) and camel bites (25.0?%). Camel kicks and falling from a camel were more common during the hot month of August, and camel bites were more common during the rutting season (November to February). Patients with a kick-related injury had a significantly higher rate of maxillofacial fractures compared with other mechanisms. Spinal injuries occurred significantly more often in vehicle occupants who collided with camels compared with other mechanisms (3/7 compared with 7/205, p?=?0.0022, Fisher’s exact test). Twelve patients (5.7?%) were admitted to the intensive care unit. The mean hospital stay was 8.6?days (1–103?days). Two patients died (overall mortality 1?%).

Conclusions

Understanding the biomechanisms and patterns of injury and correlating them with the behavior of the camel is important for identification and prevention of camel-related injuries.     

Effects of Seat Belt Usage on Injury Pattern and Outcome of Vehicle Occupants After Road Traffic Collisions: Prospective Study

Background  

Injury and death from road traffic collisions (RTCs) is a major health problem worldwide. The seat belt is the most important RTC safety innovation to reduce injury severity and death from RTCs. We aimed to study the effects of seat belt usage on injury patterns and outcomes of restrained vehicle occupants compared with unrestrained occupants after RTCs.     

Abdominal and Pelvic Injuries Caused by Road Traffic Accidents: Characteristics and Outcomes in a French Cohort of 2,009 Casualties

Background  

The frequency, characteristics, and effect on outcome of abdominal and pelvic injuries (API) caused by road traffic accidents are not well known. We studied them in a well-defined geographical area in France.     

Outcomes and Utilization of Kidneys from Deceased Donors with Acute Kidney Injury

Utilization and long-term outcomes of kidneys from donors with elevated terminal serum creatinine (sCr) levels have not been reported. Using data from the Scientific Registry of Transplant Recipients from 1995 to 2007, recipient outcomes of kidneys from adult donors were evaluated stratified by standard criteria (SCD; n = 82 262) and expanded criteria (ECD; n = 16 978) donor type and by sCr ≤1.5, 1.6–2.0 and >2.0 mg/dL. Discard rates for SCDs were ascertained. The relative risk of graft loss was similar for recipients of SCD kidneys with sCr of 1.6–2.0 and >2.0 mg/dL, compared to ≤1.5 mg/dL. For ECD recipients, the relative risk of graft failure significantly increased with increasing sCr. Of potential SCDs, the adjusted risk of discard was higher with sCr >2.0 mg/dL (adjusted odds ratio [AOR] 7.04, 95% confidence interval [CI] 6.5–7.6) and 1.6–2.0 mg/dL (AOR 2.7; CI 2.5–2.9) relative to sCr ≤1.5 mg/dL. Among potential SCDs, elevated terminal creatinine is a strong independent risk factor for kidney discard; yet, when kidney transplantation is performed elevated donor terminal creatinine is not a risk factor for graft loss. Further research is needed to identify safe practices for the optimal utilization of SCD kidneys from donors with acute kidney injury.     

Iatrogenic Radial Artery Injuries: Variable Injury Patterns, Treatment Times,and Outcomes

Background: The radial artery is commonly accessed for arterial blood sampling, invasive blood pressure monitoring, and vascular access for cardiac catheterization. Iatrogenic radial artery injury is a rare complication with potentially devastating outcomes. The purpose of our study was to identify the timing of these injuries and define a treatment algorithm. Methods: A retrospective chart review of all patients with iatrogenic radial artery injuries were identified between the years 2008 and 2018. Patient demographics, mechanism of injury, interventions, and outcomes were recorded. Results: A total of 18 patients were identified with iatrogenic radial artery injury over a 10-year period. Fifty percent of these resulted from arterial line cannulation, and 50% occurred after transradial cardiac catheterization. Thirty-three percent resulted in radial artery pseudoaneurysm (RAP), and 66% had acute radial artery thrombosis (RAT). Eleven of the 18 patients underwent operative intervention. Of the 12 patients with RAT, 4 were treated with systemic anticoagulation for 3 months. All patients with RAP who were surgically treated had resolution of symptoms on follow-up evaluation. Of the patients with RAT, 2 had persistent sensorimotor deficits after treatment, and 1 patient had multiple necrotic fingers requiring amputation. Conclusion: Radial artery injuries are an uncommon but potentially devastating complication of common invasive procedures resulting in thrombosis, pseudoaneurysm, or overt hand ischemia. The treatment options vary depending on presenting symptoms.     

Factors Predicting the Hospital Mortality of Patients with Corrosive Gastrointestinal Injuries Receiving Esophagogastrectomy in the Acute Stage

Objectives  

The aim of this study was to identify the preoperative factors that affect the survival of patients who undergo esophagogastrectomy after corrosive ingestion, using analysis of their physiological condition, associated diseases, physical examination, and laboratory data.     

消化系统手术围手术期死亡48例分析

本文分析了48例消化系统手术围手术期死亡病例的各项临床因素及其死亡原因,探讨消化系统手术围手术期的危险因素。高龄患者,合并有高血压、冠心病、糖尿病及肺部疾患的患者,急性化脓性胆管炎及恶性肿瘤中晚期患者,经受肝部分切除术、胰十二指肠切除术、开胸食道癌贲门癌根治术的患者等,围手术期有较高的死亡率。这些患者术前准备应力求完善,术中术后加强心电监护及营养支持,选择合理的手术时机及方式,对于降低围手术期死亡有重要意义。     

芦山地震所致胸部外伤17例临床分析

摘要目的总结“4·20”芦山地震胸部外伤的救治经验。方法回顾性分析华西医院胸外科2013年收治的芦山地震伤员17例的临床资料,其中男14例,女3例;年龄（57.3±16．1）岁。胸部外伤的诊断主要根据病史、体格检查、胸部x线片或胸部CT,分析其临床特点和治疗效果。结果重物砸伤12例（70．6％）,摔伤4例（23．5％）,车祸伤1例（5．9％）。胸部受伤情况包括皮肤软组织挫伤17例（100．0％）,肋骨骨折15例（88．2％）,1例伴有反常呼吸;肺挫伤15例（88．2％）,血气胸11例（64．7％）,胸骨骨折1例（5．9％）,双侧气胸伴广泛皮下气肿1例（5．9％）。13例（76．5％）分别合并颅脑、腹部、骨折及神经损伤。1例因左侧凝固性血胸,左下肺不张行左侧凝固性血胸清除,肋骨内固定术。17例均得到及时、有效治疗,无死亡病例。结论地震伤由于致伤机制多样,伤员往往为多发伤。胸部损伤以肋骨骨折及肺挫伤为主。胸腔闭式引流术是一种简单有效的治疗手段,良好的镇痛及积极的纤维支气管镜治疗可帮助伤员有效清理呼吸道,保持呼吸道通畅。     

Blunt Cerebrovascular Artery Injury and Stroke in Severely Injured Patients: An International Multicenter Analysis

Introduction

Blunt cerebrovascular injury (BCVI) is considered to be a rare entity in patients with high-energy trauma and is a potentially preventable cause of secondary brain damage. If it occurs, it may be fatal or associated with poor outcomes related to devastating complications. We hypothesized that analyses of epidemiology and concomitant injuries may predict the development of BCVI and associated complications.

Methods

The TraumaRegister DGU^® (TR-DGU), a prospectively maintained database, was used for retrospective data analysis (01/2009–12/2015). Inclusion criteria: adult trauma patients (≥16 years) with severe injuries (ISS ≥ 16 points) with and without BCVI. Subgroups: carotid artery injury (CAI) and vertebral artery injury (VAI). The degree of vascular injury was classified according to the Abbreviated Injury Scale values. Demographic, injury, therapy and outcome characteristic data (length of stay, stroke, multiple organ failure and mortality) were collected and analyzed for each patient with SPSS statistics (Version 23, IBM Inc., Armonk, NY).

Results

Out of 76,480 individuals, a total of 786 patients with BCVI (1%) were identified. The 435 CAI patients included 263 dissections, 78 pseudoaneurysms and 94 bilateral injuries. The 383 VAI patients presented with 198 dissections, 43 pseudoaneurysms, 122 thrombotic occlusions and 20 bilateral injuries. The risk for stroke was excessive in BCVI patients versus controls (11.5 vs. 1.1%, p < 0.001) and increased with vascular injury severity, up to 24.1% in CAI patients and 30.0% in VAI patients. We confirmed that cervical spine injuries were a major BCVI predictor (OR 6.46, p < 0.001, 95% CI 5.34–7.81); furthermore, high-energy mechanisms (OR 1.79), facial fractures (OR 1.56) and general injury severity (OR 1.05) were identified as independent predictors. Basilar skull fractures (BSF) were found with comparable frequency (p = 0.63) in both groups, and the predictive value was found to be insignificant (OR 1.1, p = 0.36, 95% CI 0.89–1.37). Age ≥ 60 years was associated with a decreased risk for BCVI (OR 0.54, p < 0.001, 95% CI 0.45–0.65); however, in BCVI patients over 60 years of age, mortality was excessive (OR 4.33, p < 0.001, 95% CI 2.40–7.80). Even after adjusting for head injuries, BCVI-associated stroke remained a significant risk factor for mortality (OR 2.52, p < 0.001, 95% CI 1.13–5.62).

Conclusion

Our data validated cervical spine injuries as a major predictor, but the predictive value of BSF must be scrutinized. Patient age appears to play a contradictory role in BCVI risk and BCVI-associated mortality. Predicting which patients will develop BCVI remains an ongoing challenge, especially since many patients do not present with concomitant injuries of the head or spine and therefore might not be captured by standard screening criteria.