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Noshadi N, Heidari M, Naemi Kermanshahi M, Zarezadeh M, Sanaie S, Ebrahimi-Mameghani M. Effects of Probiotics Supplementation on CRP, IL-6, and Length of ICU Stay in Traumatic Brain Injuries and Multiple Trauma Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:4674000. [PMID: 36518854 PMCID: PMC9744609 DOI: 10.1155/2022/4674000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/05/2022] [Accepted: 11/12/2022] [Indexed: 12/01/2023]
Abstract
METHOD This meta-analysis aims to evaluate the effectiveness of probiotics in reducing inflammatory biomarkers and the length of intensive care unit (ICU) stays. PubMed-Medline, SCOPUS, Embase, and Google Scholar databases up to July 2021 were searched. The meta-analysis was carried out using random-effect analysis. To determine the sources of heterogeneity, subgroup analyses were performed. In case of the presence of publication bias, trim and fill analysis was carried out. The Cochrane Collaboration tool was used for checking the quality assessment. We hypothesized that probiotics would improve inflammatory markers (CRP and IL-6) and the length of ICU stay in traumatic brain injury and multiple trauma patients. RESULTS The present meta-analysis, which includes a total of seven studies, showed that there were no significant effects of probiotics supplementation on interleukin (IL)-6 (Hedges's g = -2.46 pg/ml; 95% CI: -12.16, 7.25; P=0.39), C-reactive protein (CRP) (Hedges's g = -1.10 mg/L; 95% CI: -2.27, 0.06; P=0.06), and the length of staying in ICU. The overall number of RCTs included in the analysis and the total sample size were insufficient to make firm conclusions. CONCLUSION As a result, more carefully designed RCTs are needed to investigate the effect of probiotics on inflammatory biomarkers and the length of ICU stay in traumatic brain injuries and multiple trauma patients in greater detail.
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Affiliation(s)
- Nooshin Noshadi
- Department of Clinical Nutrition, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Marzieh Heidari
- Department of Clinical Nutrition, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Mohammad Naemi Kermanshahi
- Department of Clinical Nutrition, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Meysam Zarezadeh
- Department of Clinical Nutrition, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Sarvin Sanaie
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehrangiz Ebrahimi-Mameghani
- Nutrition Research Center, Department of Biochemistry and Diet Therapy, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Science, Tabriz, Iran
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Diagnostic accuracy of eFAST in the trauma patient: a systematic review and meta-analysis. CAN J EMERG MED 2019; 21:727-738. [DOI: 10.1017/cem.2019.381] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTObjectivesPerforming an extended Focused Assessment with Sonography in Trauma (eFAST) exam is common practice in the initial assessment of trauma patients. The objective of this study was to systematically review the published literature on diagnostic accuracy of all components of the eFAST exam.MethodsWe searched Medline and Embase from inception through October 2018, for diagnostic studies examining the sensitivity and specificity of the eFAST exam. After removal of duplicates, 767 records remained for screening, of which 119 underwent full text review. Meta-DiSc™ software was used to create pooled sensitivities and specificities for included studies. Study quality was assessed using the Quality in Prognostic Studies (QUADAS-2) tool.ResultsSeventy-five studies representing 24,350 patients satisfied our selection criteria. Studies were published between 1989 and 2017. Pooled sensitivities and specificities were calculated for the detection of pneumothorax (69% and 99% respectively), pericardial effusion (91% and 94% respectively), and intra-abdominal free fluid (74% and 98% respectively). Sub-group analysis was completed for detection of intra-abdominal free fluid in hypotensive (sensitivity 74% and specificity 95%), adult normotensive (sensitivity 76% and specificity 98%) and pediatric patients (sensitivity 71% and specificity 95%).ConclusionsOur systematic review and meta-analysis suggests that e-FAST is a useful bedside tool for ruling in pneumothorax, pericardial effusion, and intra-abdominal free fluid in the trauma setting. Its usefulness as a rule-out tool is not supported by these results.
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Fleet R, Dupuis G, Fortin JP, Gravel J, Ouimet M, Poitras J, Légaré F. Rural emergency care 360°: mobilising healthcare professionals, decision-makers, patients and citizens to improve rural emergency care in the province of Quebec, Canada: a qualitative study protocol. BMJ Open 2017; 7:e016039. [PMID: 28819068 PMCID: PMC5629661 DOI: 10.1136/bmjopen-2017-016039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Emergency departments (EDs) are an important safety net for rural populations. Results of our earlier studies suggest that rural Canadian hospitals have limited access to advanced imaging services and intensive care units and that patients are transferred over large distances. They also revealed significant geographical variations in rural services. In the absence of national standards, our studies raise questions about inequities in rural access to emergency services and the risks for citizens. Our goal is to build recommendations for improving services by mobilising stakeholders interested in rural emergency care. With help and full engagement of stakeholders, we will (1) identify solutions for improving quality and performance in rural EDs; (2) formulate and prioritise recommendations; (3) transfer knowledge of the recommendations to rural EDs and support operationalisation and (4) assess knowledge transfer and explore further impacts of this participatory action research project. METHODOLOGY We will use a participatory action research approach. We will plan for a governance structure that includes all stakeholders’ representatives, so throughout this project, stakeholders are fully engaged at every step. Our sample will be 26 EDs in rural Quebec. We will conduct semistructured individual and focus group interviews with relevant and representative participants, including patients and citizens (estimated n=200). Interviews will be thematically analysed to extract potential solutions and other qualitative information.An expert panel (±15) will use an analysis grid to develop consensus recommendations from solutions suggested and will evaluate feasibility, impacts, costs, conditions for implementation and establish monitoring indicators. Recommendations will be transferred to stakeholders using tailored knowledge translation strategies (web platform, meetings and so on). DISCUSSION AND EXPECTED RESULTS This study will result in a comprehensive consensus list of feasible and high-priority recommendations enabling decision-makers in emergency care to implement improvements in rural emergency care in Quebec. ETHICS AND DISSEMINATION This protocol has been approved by the CSSS Alphonse-Desjardins research ethics committee (Project number: MP 2017-009). The qualitative material will be kept confidential and the data will be presented in a way that respects confidentiality. The dissemination plan for the study includes publications in scientific and professional journals. We will also use social media to disseminate our findings and activities such as communications in public conferences.
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Affiliation(s)
- Richard Fleet
- Department of Family and Emergency Medicine, Université Laval, Quebec City, Québec, Canada
- Research Chair in Emergency Medicine, CHAU-Hôtel-Dieu de Lévis (Université Laval), Lévis, Québec, Canada
- Institut universitaire de première ligne en santé et services sociaux -Université Laval, Québec city, Québec, Canada
| | - Gilles Dupuis
- Department of Psychology, Université du Québec à Montréal, Montreal, Québec, Canada
| | - Jean-Paul Fortin
- Institut universitaire de première ligne en santé et services sociaux -Université Laval, Québec city, Québec, Canada
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | - Jocelyn Gravel
- CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Mathieu Ouimet
- Department of Political Science, Université Laval, Quebec City, Québec, Canada
| | - Julien Poitras
- Department of Family and Emergency Medicine, Université Laval, Quebec City, Québec, Canada
- Research Chair in Emergency Medicine, CHAU-Hôtel-Dieu de Lévis (Université Laval), Lévis, Québec, Canada
| | - France Légaré
- Institut universitaire de première ligne en santé et services sociaux -Université Laval, Québec city, Québec, Canada
- Department of Family Medicine and Emergency Medicine, Knowledge Transfer and Health Technology Assessment Group of the CHU de Québec Research Centre, Unité de Recherche Évaluative, Université Laval, Quebec City, Québec, Canada
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Fleet R, Tounkara FK, Ouimet M, Dupuis G, Poitras J, Tanguay A, Fortin JP, Trottier JG, Ouellet J, Lortie G, Plant J, Morris J, Chauny JM, Lauzier F, Légaré F. Portrait of trauma care in Quebec's rural emergency departments and identification of priority intervention needs to improve the quality of care: a study protocol. BMJ Open 2016; 6:e010900. [PMID: 27098826 PMCID: PMC4838705 DOI: 10.1136/bmjopen-2015-010900] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Trauma remains the primary cause of death in individuals under 40 years of age in Canada. In Quebec, the Trauma Care Continuum (TCC) has been demonstrated to be effective in decreasing the mortality rate among trauma victims. Although rural citizens are at greater risk for trauma and trauma death, no empirical data concerning the effectiveness of the TCC for the rural population in Quebec are available. The emergency departments (EDs) are important safety nets for rural citizens. However, our data indicate that access to diagnostic support services, such as intensive care units and CT is limited in rural areas. The objectives are to (1) draw a portrait of trauma services in rural EDs; (2) explore geographical variations in trauma care in Quebec; (3) identify adaptable factors that could reduce variation; and (4) establish consensus solutions for improving the quality of care. METHODS AND ANALYSIS The study will take place from November 2015 to November 2018. A mixed methodology (qualitative and quantitative) will be used. We will include data (2009-2013) from all trauma victims treated in the 26 rural EDs and tertiary/secondary care centres in Quebec. To meet objectives 1 and 2, data will be gathered from the Ministry's Database of the Quebec Trauma Registry Information System. For objectives 3 and 4, the project will use the Delphi method to develop consensus solutions for improving the quality of trauma care in rural areas. Data will be analysed using a Poisson regression to compare mortality rate during hospital stay or death on ED arrival (objectives 1 and 2). Average scores and 95% CI will be calculated for the Delphi questionnaire (objectives 3 and 4). ETHICS AND DISSEMINATION This protocol has been approved by CSSS Alphonse-Desjardins research ethics committee (Project MP-HDL-2016-003). The results will be published in peer-reviewed journals.
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Affiliation(s)
- Richard Fleet
- Department of Family and Emergency Medicine, Université Laval, Québec, Quebec, Canada
- Research Chair in Emergency Medicine, Univerité Laval - CHAU Hôtel-Dieu de Lévis, Lévis, Quebec, Canada
| | - Fatoumata Korika Tounkara
- Research Chair in Emergency Medicine, Univerité Laval - CHAU Hôtel-Dieu de Lévis, Lévis, Quebec, Canada
| | - Mathieu Ouimet
- Department of Political Science, Université Laval, Québec, Quebec, Canada
| | - Gilles Dupuis
- Département de Psychologie, Université du Québec à Montréal, Montréal, Quebec, Canada
| | - Julien Poitras
- Department of Family and Emergency Medicine, Université Laval, Québec, Quebec, Canada
| | - Alain Tanguay
- Research Chair in Emergency Medicine, Univerité Laval - CHAU Hôtel-Dieu de Lévis, Lévis, Quebec, Canada
| | - Jean Paul Fortin
- Département de Médecine Sociale et Préventive, Université Laval, Québec, Quebec, Canada
| | - Jean-Guy Trottier
- Centre de Santé et de Services Sociaux de l'Hématite, Fermont, Quebec, Canada
| | - Jean Ouellet
- Department of Family and Emergency Medicine, Université Laval, Québec, Quebec, Canada
| | - Gilles Lortie
- Department of Family and Emergency Medicine, Université Laval, Québec, Quebec, Canada
| | - Jeff Plant
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Judy Morris
- Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Jean Marc Chauny
- Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - François Lauzier
- CHU de Québec and Université Laval, Research center, Quebec, Quebec, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Knowledge Transfer and Health Technology Assessment of the CHUQ Research Centre (CRCHUQ), Unité de Recherche Évaluative, Université Laval, Québec, Quebec, Canada
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Ross AGP. Prudent care of head trauma in the elderly: a case report. J Med Case Rep 2014; 8:448. [PMID: 25526744 PMCID: PMC4307970 DOI: 10.1186/1752-1947-8-448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/11/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Severe traumatic brain injury is a major public health problem that accounts for one-third of all deaths due to trauma in the United States. This case report illustrates some of the challenges faced by the elderly in accessing essential emergency services for traumatic brain injury. CASE PRESENTATION A 74-year-old Caucasian man presented with head trauma at his local acute care hospital (level III/IV) in Canada at 2:30 PM. He was triaged at 4:00 PM and was seen by the emergency room physician at 4:50 PM. His vital signs were normal, and his Glasgow Coma Scale score was 15/15 upon admission. A computed tomography-based diagnosis of acute subdural hematoma was subsequently made by a radiologist at 5:00 PM. A neurosurgical transfer was requested to the nearby tertiary trauma center (level I/II), but was initially refused by the neurosurgical resident on call. The patient's condition slowly deteriorated until he became unconscious at 7:45 PM. The patient was intubated and transferred to the neurosurgical unit at 8:34 PM. He was seen by a consultant neurosurgeon at 9:30 PM, but surgery (craniotomy) was deemed not viable, given the patient's age and the fact that his pupils were now fixed and dilated (Glasgow Coma Scale score 3/15). The patient was taken off life support at 1:00 AM the following morning and died shortly thereafter. The patient's family made a formal complaint, but the decision by an independent medical review panel was that "the patient's care was prudent, timely and professional." CONCLUSIONS Geriatric patients with severe head injury are less likely than their younger counterparts to be transferred to neurosurgical trauma centers. Protocol-driven care of the elderly can reduce mortality due to head trauma through the application of the Brain Trauma Foundation guidelines.
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Affiliation(s)
- Allen G P Ross
- Griffith Health Institute, Griffith University, Gold Coast Campus, Gold Coast, Australia.
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Kirkpatrick AW, Vis C, Dubé M, Biesbroek S, Ball CG, Laberge J, Shultz J, Rea K, Sadler D, Holcomb JB, Kortbeek J. The evolution of a purpose designed hybrid trauma operating room from the trauma service perspective: the RAPTOR (Resuscitation with Angiography Percutaneous Treatments and Operative Resuscitations). Injury 2014; 45:1413-21. [PMID: 24560091 DOI: 10.1016/j.injury.2014.01.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/25/2013] [Accepted: 01/18/2014] [Indexed: 02/02/2023]
Abstract
Traumatic injury is the leading cause of potentially preventable lost years of life in the Western world and exsanguination is the most potentially preventable cause of post-traumatic death. With mature trauma systems and experienced trauma centres, extra-abdominal sites, such as the pelvis, constitute the most frequent anatomic site of exsanguination. Haemorrhage control for such bleeding often requires surgical adjuncts most notably interventional radiology (IR). With the usual paradigm of surgery conducted within an operating room and IR procedures within distant angiography suites, responsible clinicians are faced with making difficult decisions regarding where to transport the most physiologically unstable patients for haemorrhage control. If such a critical patient is transported to the wrong suite, they may die unnecessarily despite having potentially salvageable injuries. Thus, it seems only logical that the resuscitative operating room of the future would have IR capabilities making it the obvious geographic destination for critically unstable patients, especially those who are exsanguinating. Our trauma programme recently had the opportunity to conceive, design, build, and operationalise a purpose-designed hybrid trauma operating room, designated as the resuscitation with angiographic percutaneous techniques and operative resuscitation (RAPTOR) suite, which we believe to be the first such resource designed primarily to serve the exsanguinating trauma patient. The project was initiated after consultations between the trauma programme and private philanthropists regarding the greatest potential impacts on regional trauma care. The initial capital construction costs were thus privately generated but coincided with a new hospital wing construction allowing the RAPTOR to be purpose-designed for the exsanguinating patient. Many trauma programmes around the world are now starting to navigate the complex process of building new facilities, or else retrofitting existing ones, to address the need for single-site flexible haemorrhage control. This manuscript therefore describes the many considerations in the design and refinement of the physical build, equipment selection, human factors evaluation of new combined treatment paradigms, and the final introduction of a RAPTOR protocol in order that others may learn from our initial efforts.
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Affiliation(s)
- Andrew W Kirkpatrick
- Department of Surgery, Calgary, Alberta, Canada; Department of Regional Trauma Services, Calgary, Alberta, Canada; Department of Foothills Medical Centre and the University of Calgary Calgary, Alberta, Canada; Alberta Health Services, Alberta, Canada.
| | | | | | | | - Chad G Ball
- Department of Surgery, Calgary, Alberta, Canada; Department of Regional Trauma Services, Calgary, Alberta, Canada; Department of Foothills Medical Centre and the University of Calgary Calgary, Alberta, Canada
| | | | | | - Ken Rea
- Dialog Corporation, Calgary, Alberta, Canada
| | - David Sadler
- Department of Radiology, Calgary, Alberta, Canada; Alberta Health Services, Alberta, Canada
| | - John B Holcomb
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - John Kortbeek
- Department of Surgery, Calgary, Alberta, Canada; Department of Critical Care Medicine, Calgary, Alberta, Canada; Department of Regional Trauma Services, Calgary, Alberta, Canada; Department of Foothills Medical Centre and the University of Calgary Calgary, Alberta, Canada; Alberta Health Services, Alberta, Canada
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