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Martin DA, Ashworth H, Nagdev A. Ultrasound-Guided Nerve Blocks. Emerg Med Clin North Am 2024; 42:905-926. [PMID: 39326994 DOI: 10.1016/j.emc.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
Ultrasound-guided nerve blocks serve as a valuable component of multimodal pain management for acutely injured patients in the emergency department and offer a potentially more efficient alternative to time-consuming procedural sedation.
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Affiliation(s)
- David A Martin
- Department of Emergency Medicine, Alameda Health System - Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Henry Ashworth
- Department of Emergency Medicine, Alameda Health System - Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA
| | - Arun Nagdev
- Department of Emergency Medicine, Alameda Health System - Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA
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Idrissi O, Rose J, Turner JP. Simulation tools in ultrasound-guided regional anesthesia: developing a simple, inexpensive erector spinae plane (ESP) block teaching model. CAN J EMERG MED 2024:10.1007/s43678-024-00762-9. [PMID: 39225970 DOI: 10.1007/s43678-024-00762-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 07/28/2024] [Indexed: 09/04/2024]
Abstract
The erector spinae plane (ESP) block is an increasingly utilized regional block in the emergency department, representing one effective alternative or adjunct to opioid analgesia in patients presenting with rib fractures. While there is growing interest, its widespread adoption faces hurdles, such as a lack of appropriate training resources. Gelatin-based phantoms to simulate human anatomy have been widely used to facilitate ultrasound-guided procedures, although no such model for the ESP block has yet been defined in the literature. To address this gap, we sought to design and assemble an inexpensive, simple to build, reusable phantom to simulate the sonographic anatomy of the posterior thoracic wall and serve as a task trainer for an ultrasound-guided ESP block. This novel phantom model reproduces an ultrasonographic fascial plane using a gelatin medium and 3D-printed thoracic spine with ribs allowing for needle guidance and hydrodissection.
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Affiliation(s)
- Omar Idrissi
- Faculty of Medicine, McGill University, Montreal, QC, Canada.
| | - Jake Rose
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Joel P Turner
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada
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Burton J, Chua C, Popovic G, Baitch L. Predictors of opioid use for rib fractures in a regional Australian hospital. Injury 2024; 55:111586. [PMID: 38677891 DOI: 10.1016/j.injury.2024.111586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/03/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Rib fractures (RFs) are the leading type of single serious injury in New South Wales trauma patients. Uncontrolled pain drives the sequelae of atelectasis, pneumonia, respiratory failure, and death in severe cases. Opioids are the mainstay of management; however, they carry numerous adverse effects. Understanding patient or injury factors which predict opioid requirement is important to tailor management. Existing evidence is limited to metropolitan trauma centres (MTCs). METHODS We conducted an observational, retrospective, single-centre cohort study of all admissions to Albury Wodonga Health diagnosed with one or more RFs and discharged between January 1st, 2017, and December 31st, 2022, inclusive. Data collected included demographics, injury characteristics, and management, including analgesia. LASSO regression was performed to determine predictors of average daily opioid use for the first five days of admission in oral morphine equivalents (mg). R2 and root mean square error (RMSE) were calculated to assess model performance. RESULTS We included 624 patients. LASSO selected number of RFs, fracture displacement score, pulmonary contusion, new injury severity score, age, chest tube use, chronic pain history, opioid history and upper or middle lateral RF location categories as predictors. Sex, middle anterior, middle posterior, and lower RF location categories were excluded by LASSO. The out of sample R2 was 28.6 %. On the scale of log OME, the RMSE was 1.08. CONCLUSION The model is effective at identifying predictors of opioid use in this regional centre, which are similar to those described in evidence from MTCs. However, the low R2 with wide prediction intervals limits its utility on an individual level.
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Affiliation(s)
- Joseph Burton
- Albury-Wodonga Rural Clinical School, UNSW Medicine, 559 East Street, Albury, NSW, 2640, Australia
| | | | - Gordana Popovic
- UNSW StatsCentral, UNSW Sydney, High Street, Kensington, NSW, 2052, Australia
| | - Luke Baitch
- Albury-Wodonga Rural Clinical School, UNSW Medicine, 559 East Street, Albury, NSW, 2640, Australia; Department of Anaesthesia, Albury Wodonga Health, PO Box 326, Albury, NSW, 2640, Australia.
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Lin YH, Hsu HS. Therapeutic efficacy of platelet-rich plasma in the management of rib fractures. J Chin Med Assoc 2024; 87:854-860. [PMID: 39017627 DOI: 10.1097/jcma.0000000000001136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND This study aimed to investigate the therapeutic efficacy of platelet-rich plasma (PRP) therapy in patients with rib fractures. METHODS This study retrospectively collected data from patients with acute rib fractures at Ming-Sheng General Hospital from 2020 to 2022 and excluded those who underwent surgical intervention or with severe extrathoracic injuries. PRP was extracted using the patient's blood and injected via ultrasound guidance near the fracture site. Patients self-assessed pain levels and medication usage at 0, 1, 2, 4, and 8 weeks. Pulmonary function tests were conducted at 4 weeks. RESULTS This study included 255 patients, with 160 and 95 patients in the conservative (only pain medications administered) and PRP groups (PRP and analgesics administered), respectively. The PRP group reported lower pain levels than the conservative group at 2 and 4 weeks. No substantial differences in medication usage were observed between the groups. The PRP group demonstrated lower pain levels and medication usage than the conservative group in severe rib fractures (≥3 ribs) and better lung function improvement at 4 weeks. After propensity score matching, the PRP group still had a better treatment outcome in pain control and lung function recovery. CONCLUSION PRP demonstrated considerable therapeutic efficacy in patients with severe rib fractures, resulting in reduced pain, decreased medication usage, and improved lung function but with no substantial benefits in patients with mild rib fractures.
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Affiliation(s)
- Yi-Han Lin
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Traumatology, Min-Sheng General Hospital, Taoyuan, Taiwan, ROC
| | - Han-Shui Hsu
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Villalta CI, Mian RK, Grossman Verner HM, Farsakh D, Browne TC, Goldstein ZS, McDaniel C. Bedside percutaneous cryoneurolysis technique for management of acute rib fracture pain in adult trauma patients. Trauma Surg Acute Care Open 2024; 9:e001521. [PMID: 39185271 PMCID: PMC11344524 DOI: 10.1136/tsaco-2024-001521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 07/28/2024] [Indexed: 08/27/2024] Open
Abstract
Background Acute pain due to rib fractures causes significant in-hospital morbidity and impacts patients' quality of life after discharge. Intraoperative transthoracic cryoneurolysis of the intercostal nerves can improve postoperative pain; however, non-surgical patients are provided limited analgesia options. Here, we describe our experience with a bedside cryoanalgesia technique for management of acute rib fracture pain. Methods Five patients at a single level I trauma center completed bedside intercostal nerve cryoneurolysis (INC) using a handheld cryotherapy device and ultrasound guidance. Relative pain ratings (scale 0-10/10) and maximal incentive spirometry (ISmax) volumes were taken prior to the procedure as a baseline. Patients were observed for 24 hours after procedure, with relative pain ratings and ISmax recorded at 1, 8, 16, and 24 hours after procedure. Results Our patients were 29-88 years old and had one to five single-sided rib fractures. At baseline, they had high pre-procedure pain ratings (7-10/10) and ISmax volumes of 800-2000 mL. Many had improvements in their pain rating but little change in their ISmax at 1 hour (1-5/10 and 1000-2000 mL, respectively) and 8 hours (1-5/10 and 1250-2400 mL, respectively). ISmax volumes improved by 16 hours (1500-2400 mL) with comparable pain ratings (0-5/10). At 24 hours, pain ratings and ISmax ranged from 0 to 8/10 and from 1500 mL to 2400 mL, respectively. Each patient had improved pain control and ISmax volumes compared with their pre-procedure values. All patients reported the procedure as an asset to their recovery at discharge. Conclusions Our study demonstrates patients with rib fractures may experience improved pain ratings and ISmax values after INC. Percutaneous INC appears to be a viable adjunct to multimodal pain control for patients with rib fractures and should be considered in patients with difficult pain control. Further studies are required to fully assess INC safety, efficacy, post-discharge outcomes, and utility in patients with altered mental status or on mechanical ventilation. Level of evidence Level V, case series.
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Affiliation(s)
- Cynthia I Villalta
- Clinical Research Institute, Methodist Health System, Dallas, Texas, USA
| | - Rabiya K Mian
- Clinical Research Institute, Methodist Health System, Dallas, Texas, USA
| | | | - Dana Farsakh
- Clinical Research Institute, Methodist Health System, Dallas, Texas, USA
| | - Timothy C Browne
- Department of Surgery, Methodist Dallas Medical Center, Dallas, Texas, USA
| | | | - Conner McDaniel
- Department of Surgery, Methodist Dallas Medical Center, Dallas, Texas, USA
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Lai J, Li X, Liu W, Liufu Q, Zhong C. Global burden of fracture of sternum and/or ribs: An analysis of 204 countries and territories between 1990 and 2019. Injury 2024; 55:111783. [PMID: 39146615 DOI: 10.1016/j.injury.2024.111783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 07/15/2024] [Accepted: 08/03/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Sternum and rib fractures represent a significant global health concern, contributing to morbidity and disability on a worldwide scale. However, there is a notable lack of recent epidemiological data detailing the global and regional burden of these fractures. METHODS We undertook a systematic analysis of the prevalence of sternum and rib fractures at the global, regional, and national levels in 2019, while also examining time trends spanning from 1990 to 2019. To achieve this, we extracted data from the Global Burden of Disease Study 2019, enabling us to determine incidence, prevalence, years lived with disability (YLDs), and their corresponding age-standardized rates. RESULTS In 2019, there were 4.1 million incident cases and 2 million prevalent cases of sternum and rib fractures worldwide. These figures represent increases of 43.7 % and 64.1 %, respectively, since 1990. YLDs also exhibited a notable increase, rising by 62.4 % to reach 190,834 cases. However, since 1990, their equivalent age-standardized rates, which ranged from 5.5 % to 7.1 %, have decreased. Notably, China had the greatest incidence (1.2 million cases), prevalence (573,000 cases), and number of YLDs (55,400 cases), all in 2019. The greatest age-standardized incidence rate (143/100,000) and age-standardized prevalence rate (65/100,000) were both recorded in Greenland in the same year. It's critical to emphasize that men experience these fractures at considerably higher rates than women. Around 70 % of incident instances included unintentional injuries worldwide and across all regions. High-socioeconomic regions had the highest rates of incidence, prevalence, and YLDs, albeit these rates have declined by 6.4 % to 7.1 % since 1990, whereas low-middle and low-income areas have had rises. CONCLUSIONS This study, which spans the years 1990 to 2019, provides a thorough and current assessment of the global burden attributed to sternum and rib fractures. In terms of nations, regions, sociodemographic index (SDI) levels, age groups, genders, and reasons, it reveals significant variances and trends. The knowledge obtained from this study can be extremely useful in formulating health policy, allocating resources, and developing methods to prevent these injuries.
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Affiliation(s)
- Jianqiang Lai
- Department of Orthopedic Surgery, Gaozhou People's Hospital, Gaozhou, PR China
| | - Xianmin Li
- Department of Orthopedic Surgery, Gaozhou People's Hospital, Gaozhou, PR China
| | - Wei Liu
- Department of Orthopedic Surgery, Gaozhou People's Hospital, Gaozhou, PR China
| | - Qian Liufu
- Department of Orthopedic Surgery, Gaozhou People's Hospital, Gaozhou, PR China
| | - Chengfan Zhong
- Department of Orthopedic Surgery, Gaozhou People's Hospital, Gaozhou, PR China.
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Kroeker J, Wess A, Yang Y, Al-Zeer B, Uppal H, Balmes P, Som R, Courval V, Lakha N, Brisson A, Sakai J, Garraway N, Tang R, Rose P, Joos E. Chest trauma clinical practice guideline protects against delirium in patients with rib fractures. Trauma Surg Acute Care Open 2024; 9:e001323. [PMID: 38860116 PMCID: PMC11163824 DOI: 10.1136/tsaco-2023-001323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 05/07/2024] [Indexed: 06/12/2024] Open
Abstract
Introduction Traumatic rib fractures present a considerable risk to patient well-being, contributing to morbidity and mortality in trauma patients. To address the risks associated with rib fractures, evidence-based interventions have been implemented, including effective pain management, pulmonary hygiene, and early walking. Vancouver General Hospital, a level 1 trauma center in British Columbia, Canada, developed a comprehensive multidisciplinary chest trauma clinical practice guideline (CTCPG) to optimize the management of patients with rib fractures. This prospective cohort study aimed to assess the impact of the CTCPG on pain management interventions and patient outcomes. Methods The study involved patients admitted between January 1, 2021 and December 31, 2021 (post-CTCPG cohort) and a historical control group admitted between November 1, 2018 and December 31, 2019 (pre-CTCPG cohort). Patient data were collected from patient charts and the British Columbia Trauma Registry, including demographics, injury characteristics, pain management interventions, and relevant outcomes. Results Implementation of the CTCPG resulted in an increased use of multimodal pain therapy (99.4% vs 96.1%; p=0.03) and a significant reduction in the incidence of delirium in the post-CTCPG cohort (OR 0.43, 95% CI 0.21 to 0.80, p=0.0099). There were no significant differences in hospital length of stay, ICU (intensive care unit) days, non-invasive positive pressure ventilation requirement, ventilator days, pneumonia incidence, or mortality between the two cohorts. Discussion Adoption of a CTCPG improved chest trauma management by enhancing pain management and reducing the incidence of delirium. Further research, including multicenter studies, is warranted to validate these findings and explore additional potential benefits of the CTCPG in the management of chest trauma patients. Level of evidence IIb.
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Affiliation(s)
- Jenna Kroeker
- Trauma and Acute Care Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Anas Wess
- Trauma and Acute Care Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Yuwei Yang
- Trauma and Acute Care Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Bader Al-Zeer
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Harjot Uppal
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Patricia Balmes
- Trauma and Acute Care Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Robin Som
- Trauma and Acute Care Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Valerie Courval
- Trauma and Acute Care Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Nasira Lakha
- Trauma and Acute Care Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Angie Brisson
- Trauma and Acute Care Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jennifer Sakai
- Perioperative Pain Service, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Naisan Garraway
- Trauma and Acute Care Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Surgery and Critical Care, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymond Tang
- Anesthesiology and Perioperative Care, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Rose
- Anesthesiology and Perioperative Care, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Emilie Joos
- Trauma and Acute Care Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
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Alhatemi AQM, Hashim HT, Hashim AT. Rib fracture secondary to cough-induced trauma. Clin Case Rep 2024; 12:e8823. [PMID: 38681031 PMCID: PMC11052678 DOI: 10.1002/ccr3.8823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/22/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024] Open
Abstract
Early identification of rib fractures, even in young patients without chronic diseases, is essential. Prompt diagnosis facilitates appropriate management, aiding in pain control and addressing underlying causes such as persistent coughing. Additionally, vigilance for complications such as pneumothorax and rib displacement is crucial for optimizing patient care.
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Ayyan SM, Ramesh S, Rath DP, Melepurakkal Sadanandan D. Response to "Assessing analgesic efficacy of single-injection erector spinae plane block for rib fractures in the emergency department". Acad Emerg Med 2024; 31:416-417. [PMID: 38130155 DOI: 10.1111/acem.14848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Affiliation(s)
- S Manu Ayyan
- Department of Emergency Medicine & Trauma, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Swetha Ramesh
- Department of Emergency Medicine & Trauma, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Durga Prasad Rath
- Department of Cardiovascular and Thoracic Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Deepthy Melepurakkal Sadanandan
- Women's & Children's Health Research Unit, Jawaharlal Nehru Medical College of KLE Academy of Higher Education and Research (KAHER), Belagavi, India
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Harford P, Tran L, Pollock D, Thiruvenkatarajan V, Munn Z. Effectiveness of erector spinae plane block for rib fracture analgesia: a systematic review protocol. JBI Evid Synth 2024; 22:706-712. [PMID: 37811918 DOI: 10.11124/jbies-23-00168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
OBJECTIVE This systematic review will investigate the effectiveness of the ultrasound-guided erector spinae plane block as an analgesic technique for patients with rib fractures compared with all other standard management techniques. Comparisons will be made with both nerve blocks (neuraxial techniques and peripheral nerve blocks) and systemic treatment (with patient-controlled analgesia and/or per required need analgesia for breakthrough pain). INTRODUCTION Erector spinae plane block is a well-established rescue analgesia option for patients with rib fractures. The use of ultrasound-guided erector spinae plane block in clinical practice has been largely based on observational data, with recent randomized controlled trials examining it against several other options for analgesic management. This review will compare the erector spinae against all other management techniques used in practice for rib fractures to determine whether this is the most effective analgesic technique. INCLUSION CRITERIA The review will include all randomized controlled and pseudo-randomized controlled trials examining ultrasound-guided erector spinae plane block for the analgesic management of traumatic rib fractures. All other study designs will be excluded. METHODS MEDLINE (PubMed), Embase (Ovid), CINAHL (EBSCOhost), the Cochrane Central Register of Controlled Trials, the Australian and New Zealand Clinical Trials Registry (ANZCTR), ClinicalTrials.gov, and the ISRCTN registry will be searched to identify all relevant ongoing clinical trials. Study selection, critical appraisal, and data extraction will be performed by 2 independent reviewers. Data will be extracted into software for statistical analysis (including meta-analysis where possible). REVIEW REGISTRATION PROSPERO CRD42023414849.
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Affiliation(s)
- Philip Harford
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Liem Tran
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Danielle Pollock
- Health Evidence Synthesis Recommendations and Impact (HESRI), School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Venkatesan Thiruvenkatarajan
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, SA, Australia
- Department of Anaesthesia, Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Zachary Munn
- Health Evidence Synthesis Recommendations and Impact (HESRI), School of Public Health, The University of Adelaide, Adelaide, SA, Australia
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Güleç Balbay E, Kayalar Ö, Balbay Ö, Dikensoy Ö, Arbak P, Bayram H. Impact of Earthquakes on Lung Health. THORACIC RESEARCH AND PRACTICE 2024; 25:89-98. [PMID: 38454205 PMCID: PMC11114252 DOI: 10.5152/thoracrespract.2024.23059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/10/2023] [Indexed: 03/09/2024]
Abstract
Earthquakes are catastrophic natural disasters that cause extensive damage to infrastructure and disrupt the lives of millions worldwide. Beyond the immediate physical and psychological damage caused by earthquakes, these events can significantly impact respiratory health. The inhalation of dust, smoke, particulates, toxic gases, and asbestos exposure can lead to various respiratory health pathologies. These include respiratory infections, exacerbations of pre-existing respiratory diseases, chest traumas, and pulmonary and venous thromboembolism. Longitudinal studies are necessary to assess the long-term respiratory health effects in affected populations. By addressing these knowledge gaps, future mitigation strategies and preparedness measures can be developed to minimize the respiratory health impacts of earthquakes and improve the well-being of affected communities. Robust building infrastructure and comprehensive earthquake preparedness are emerging as the most important determinants for not only mitigating building collapse but also significantly reducing the potential health impacts that follow. This comprehensive review aims to provide a systematic overview of the lung health impacts of earthquakes. It highlights the need for further research to identify specific pollutants, air contaminants, and environmental factors contributing to respiratory health issues following earthquakes.
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Affiliation(s)
- Ege Güleç Balbay
- Department of Pulmonary Medicine, Düzce University School of Medicine, Düzce, Turkey
| | - Özgecan Kayalar
- Koç University Research Center for Translational Medicine (KUTTAM), Koç University School of Medicine, İstanbul, Turkey
| | - Öner Balbay
- Department of Pulmonary Medicine, Düzce University School of Medicine, Düzce, Turkey
| | - Öner Dikensoy
- Department of Pulmonary Medicine, Koç University School of Medicine, İstanbul, Turkey
| | - Peri Arbak
- Department of Pulmonary Medicine, Düzce University School of Medicine, Düzce, Turkey
| | - Hasan Bayram
- Koç University Research Center for Translational Medicine (KUTTAM), Koç University School of Medicine, İstanbul, Turkey
- Department of Pulmonary Medicine, Koç University School of Medicine, İstanbul, Turkey
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Hammal F, Chiu C, Kung JY, Bradley N, Dillane D. Pain management for hospitalized patients with rib fractures: A systematic review of randomized clinical trials. J Clin Anesth 2024; 92:111276. [PMID: 37883901 DOI: 10.1016/j.jclinane.2023.111276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/24/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023]
Abstract
STUDY OBJECTIVE Rib fractures (RF) are common injuries. Multiple analgesia strategies are available for treatment of pain associated with RF. However, the optimal multimodal technique for pain management is not known. The primary aim of this review was to evaluate the status of evidence derived from randomized clinical trials (RCTs) on the effectiveness of pain management modalities for rib fracture pain. Other patient-centered outcomes were secondary objectives. METHODS Searches were conducted in MEDLINE, Embase, Scopus, and Cochrane Library. The screening process involved two phases, two researchers independently screened the title and abstract and subsequently screened full text. RCT data were extracted independently by two research team members. Consensus was achieved by comparison and discussion when needed. Risk of bias assessment was performed using the Cochrane Risk of Bias 2 tool. RESULTS A total of 1344 citations were identified. Title and abstract screening excluded 1128 citations, and full text review excluded 177 articles. A total of 32 RCTs were included in the full review. Multiple analgesia techniques and medications were identified and their effect on pain score and need for rescue opioid analgesia. None of the included studies were judged to have a high risk of bias, while only 10 studies were assessed as having a low risk of bias. CONCLUSIONS This systematic review found that studies are of low quality with diverse methodologies and outcomes. A reduction in pain scores was found for epidural analgesia when compared with other modalities. However, the low quality of the evidence necessitates cautious interpretation of this finding. PROSPERO registration: CRD42022376298 (Nov, 16, 2022).
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Affiliation(s)
- Fadi Hammal
- Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - Christine Chiu
- Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - Janice Y Kung
- John W. Scott Health Sciences Library, University of Alberta Hospital, Edmonton, AB, Canada
| | - Nori Bradley
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - Derek Dillane
- Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, AB, Canada.
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Ahn S, Lee S, Kim S, Moon S, Cho H, Shin HJ, Park JH. Risk factors for delayed hemothorax in patients with rib fracture in the emergency department. Am J Emerg Med 2024; 76:173-179. [PMID: 38086183 DOI: 10.1016/j.ajem.2023.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/01/2023] [Accepted: 11/25/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVES Although rib fractures are a risk factor, not all rib fracture patients will develop delayed hemothorax. This study aimed to evaluate risk factors which can identify rib fracture patients in the emergency department who may develop delayed hemothorax. METHODS Adult patients seen in the emergency room between January 2016 and February 2021 with rib fractures caused by blunt chest trauma were included in this retrospective observational study. Patients who underwent chest tube insertion within 2 days and those without follow-up chest radiographs within 2-30 days were excluded. We used a stepwise backward-elimination multivariable logistic regression model for analysis. RESULTS A total of 202 patients were included in this study. The number of total (P < 0.001), lateral (P = 0.019), and displaced (P < 0.001) rib fractures were significantly associated with delayed hemothorax. Lung contusions (P = 0.002), and initial minimal hemothorax (P < 0.001) and pneumothorax (P < 0.001) were more frequently associated with delayed hemothorax. Age (adjusted odds ratio (aOR) 1.03, 95% confidence interval (CI) 1.00-1.06, P = 0.022), mechanical ventilator use (aOR 9.67, 95% CI 1.01-92.75, P = 0.049), initial hemothorax (aOR 2.21, 95% CI 1.05-4.65, P = 0.037) and pneumothorax (aOR 2.99, 95% CI 1.36-6.54, P = 0.006), and displaced rib fractures (aOR 3.51, 95% CI 1.64-7.53, P = 0.001) were independently associated with delayed hemothorax. CONCLUSIONS Age, mechanical ventilation, initial hemo- or pneumothorax, and displaced rib fractures were risk factors for delayed hemothorax. Patients with these risk factors, and especially those with ≥2 displaced rib fractures, require close chest radiography follow-up of 2-30 days after the initial trauma.
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Affiliation(s)
- Sejoong Ahn
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Sukyo Lee
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Sungjin Kim
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Sungwoo Moon
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Hanjin Cho
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Hong Ju Shin
- Department of Thoracic and Cardiovascular Surgery, Myeongju Hospital, Yongin, Republic of Korea.
| | - Jong-Hak Park
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.
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Gupta A, Mohanty CR, Barik AK, Radhakrishnan RV, Prusty AV. Comment on "Beyond the short-term relief: outcomes of geriatric rib fracture patients receiving paravertebral nerve blocks and epidural analgesia". Injury 2024; 55:111270. [PMID: 38103532 DOI: 10.1016/j.injury.2023.111270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/03/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Anju Gupta
- Department of Anaesthesia, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
| | - Amiya Kumar Barik
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Aditya Vikram Prusty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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15
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Alizai Q, Arif MS, Colosimo C, Hosseinpour H, Spencer AL, Bhogadi SK, Nelson A, Anand T, Ditillo M, Joseph B. Beyond the short-term relief: Outcomes of geriatric rib fracture patients receiving paravertebral nerve blocks and epidural analgesia. Injury 2024; 55:111184. [PMID: 37989702 DOI: 10.1016/j.injury.2023.111184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 10/10/2023] [Accepted: 11/04/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Adequate pain control is a critical component of rib fracture management. Our study aimed to evaluate the in-hospital and post-discharge outcomes of geriatric rib fracture patients who received paravertebral nerve block (PVNB) versus epidural analgesia (EA) on a national level. METHODS We performed a 5-year (2011-15) retrospective analysis of the Nationwide Readmission database. We included all the geriatric (≥65 years) blunt trauma patients with rib fractures who received a paravertebral nerve block (PVNB) or Epidural analgesia (EA) for chest injuries. We excluded patients who were dead on arrival, those with head AIS≥3, spine AIS >0, and those with cognitive impairment. Patients were stratified into two groups (PVNB and EA). A propensity score matching (1:2) was performed, and the two groups were compared. Our outcomes included delirium, hospital length of stay (LOS), 90-day readmissions, 90-day mechanical ventilation, and initial and 90-day mortality. RESULTS A total of 2,855 geriatric rib fracture patients were identified, out of which 352 (12 %) received PVNB and 2,503 (87 %) received EA. The mean (SD) age was 78 (8) years and 53 % were female. A total of 1,041 patients were matched (PVNB=347, EA=694 patients). The median [IQR] Injury severity score was 9 [3-15], median chest AIS was 3 [2-4], and 70 % had ≥3 rib fractures. The total mortality during index admission was 6 %, 13 % experienced delirium, and the median hospital LOS was 6 [4-10] days. There was no difference in the primary outcomes of the two groups including rates of index admission mortality (PVNB: 5.2% vs. EA:6.3 %, p = 0.548) and delirium (PVNB: 12.4% vs. EA:12.9 %, p = 0.862). We also found no statistically significant difference between these groups in terms of 90-day respiratory complications (p = 1.000), 90-day readmission (p = 0.111), 90-day mortality (p = 0.718), and 90-day need for mechanical ventilation (p = 1.000). CONCLUSION The use of PVNB in geriatric trauma patients with multiple rib fractures is associated with comparable in-hospital and post-discharge outcomes relative to EA. PVNB is relatively easy to perform and has a better side effect profile. The use of PVNB as part of rib fracture management protocols warrants further consideration. LEVEL OF EVIDENCE III STUDY TYPE: Therapeutic/Care Management.
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Affiliation(s)
- Qaidar Alizai
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Muhammad Sohaib Arif
- Department of General Surgery, Prisma Health, University of South Carolina, School of Medicine, Columbia, SC, USA
| | - Christina Colosimo
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Hamidreza Hosseinpour
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Audrey L Spencer
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Sai Krishna Bhogadi
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Adam Nelson
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Tanya Anand
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Michael Ditillo
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
| | - Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
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Mohamed EH, Elmoheen A, Bashir K, Fayed M, Abdurabu M, Abdelrahim MG, Elkandow A, Basharat K, Lloyd S, Alwahsh G, Zaki HA. Comparative Analysis of Intravenous Opioids Versus Thoracic Epidural Anesthesia in Fractured Rib Pain Management: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e51740. [PMID: 38318591 PMCID: PMC10840374 DOI: 10.7759/cureus.51740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 02/07/2024] Open
Abstract
Rib fractures, common among trauma victims, lead to significant morbidity and mortality. Managing the associated pain is challenging, with IV opioids and thoracic epidural analgesia (TEA) being utilized. While epidural analgesia is often preferred for fractured rib pain, existing data encompasses both lumbar and thoracic approaches. This review aimed to compare TEA and IV opioids for persistent rib fracture pain. A comprehensive search across five databases yielded 987 articles, of which seven met the eligibility criteria. Outcomes were categorized into primary (pain reduction) and secondary (mortality, hospital/ICU stays, analgesia-related complications) endpoints. Analyzed with Review Manager (RevMan) Version 5.4.1 (2020; The Cochrane Collaboration, London, United Kingdom), the pooled data from two sources showed TEA significantly more effective in reducing pain than IV opioids (standardized mean difference (SMD): 2.23; 95%CI: 1.65-2.82; p < 0.00001). Similarly, TEA was associated with shorter ICU stays (SMD: 0.73; 95%CI: 0.33-1.13; p = 0.0004), while hospitalization duration showed no substantial difference (SMD: 0.82; 95%CI: -0.34-1.98). Mortality rates also did not significantly differ between TEA and IV opioids (risk ratio (RR): 1.20; 95%CI: 0.36-4.01; p = 0.77). Subgroup analysis revealed fewer pneumonia cases with TEA (RR: 2.06; 95%CI: 1.07-3.96; P = 0.03), with no notable disparities in other complications. While TEA's superiority in pain relief for rib fractures suggests it is the preferred analgesic, the recommendation's strength is tempered by the low methodological quality of supporting articles.
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Affiliation(s)
| | - Amr Elmoheen
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Khalid Bashir
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
- Emergency Medicine, Qatar University College of Medicine, Doha, QAT
| | - Mohamed Fayed
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | | | | | - Ali Elkandow
- Emergency Medicine, Hamad Medical Corporation, Al Khor, QAT
| | | | - Stuart Lloyd
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | | | - Hany A Zaki
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
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Gandhi RS, Bhoge SS, Fating T, Sawalkar RG. Positive Outcomes of Physiotherapy Intervention in a Wedge Compression Fracture of the L1 Vertebra: A Case Report. Cureus 2024; 16:e51774. [PMID: 38322069 PMCID: PMC10844797 DOI: 10.7759/cureus.51774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/06/2024] [Indexed: 02/08/2024] Open
Abstract
The thoracolumbar spine is prone to vertebral compression fractures (VCFs). An injury mechanism known as flexion compression is responsible for thoracolumbar spine compression fractures. Usually, this mechanism affects the longitudinal ligament at the front and the front part of the vertebral body as the first components. Pain is the first and foremost symptom; here we present a case report of a 34-year-old male, who came to the hospital with complaints of back pain, and difficulty in breathing followed by a road traffic accident (RTA). MRI and X-ray investigations were done. The patient was diagnosed with a fracture of the anterolateral aspect of the right fourth and fifth ribs and posterolateral aspect of the sixth rib, acute anterior wedge compression fracture of the L1 vertebra, and bilateral minimal pneumothorax and haemothorax. The patient was managed surgically with post-decompression and spinal fusion at the D12-L2 level. The outcomes used were the Oswestry Low-Back Disability Questionnaire, the numerical pain rating scale, and Manual Muscle Testing (MMT). This case report specifies the physiotherapeutic rehabilitation protocol, mainly focusing on techniques like breathing exercises, and upper limb and lower limb strengthening along with trunk and pelvic floor muscles strengthening.
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Affiliation(s)
- Richa S Gandhi
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shruti S Bhoge
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejaswini Fating
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rutuja G Sawalkar
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Lee NH, Kim SH, Kim JH, Kim HH, Lee SB, Park CI, Kim GH, Ryu DY, Kim SH. A decade of treating traumatic sternal fractures in a single-center experience in Korea: a retrospective cohort study. JOURNAL OF TRAUMA AND INJURY 2023; 36:362-368. [PMID: 39381582 PMCID: PMC11309256 DOI: 10.20408/jti.2023.0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2024] Open
Abstract
Purpose Clinical reports on treatment outcomes of sternal fractures are lacking. This study details the clinical features, treatment approaches, and outcomes related to traumatic sternal fractures over a 10-year period at a single institution. Methods A retrospective cohort study was conducted of patients admitted to a regional trauma center between January 2012 and December 2021. Among 7,918 patients with chest injuries, 266 were diagnosed with traumatic sternal fractures. Patient data were collected, including demographics, injury mechanisms, severity, associated injuries, sternal fracture characteristics, hospital stay duration, mortality, respiratory complications, and surgical details. Surgical indications encompassed emergency cases involving intrathoracic injuries, unstable fractures, severe dislocations, flail chest, malunion, and persistent high-grade pain. Results Of 266 patients with traumatic sternal fractures, 260 were included; 98 underwent surgical treatment for sternal fractures, while 162 were managed conservatively. Surgical indications ranged from intrathoracic organ or blood vessel injuries necessitating thoracotomy to unstable fractures with severe dislocations. Factors influencing surgical treatment included flail motion and rib fracture. The median length of intensive care unit stay was 5.4 days (interquartile range [IQR], 1.5-18.0 days) for the nonsurgery group and 8.6 days (IQR, 3.3-23.6 days) for the surgery group. The median length of hospital stay was 20.9 days (IQR, 9.3-48.3 days) for the nonsurgery group and 27.5 days (IQR, 17.0 to 58.0 days) for the surgery group. The between-group differences were not statistically significant. Surgical interventions were successful, with stable bone union and minimal complications. Flail motion in the presence of rib fracture was a crucial consideration for surgical intervention. Conclusions Surgical treatment recommendations for sternal fractures vary based on flail chest presence, displacement degree, and rib fracture. Surgery is recommended for patients with offset-type sternal fractures with rib and segmental sternal fractures. Surgical intervention led to stable bone union and minimal complications.
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Affiliation(s)
- Na Hyeon Lee
- Department of Trauma and Surgical Critical Care, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Seon Hee Kim
- Department of Trauma and Surgical Critical Care, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jae Hun Kim
- Department of Trauma and Surgical Critical Care, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Ho Hyun Kim
- Department of Trauma and Surgical Critical Care, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Sang Bong Lee
- Department of Trauma and Surgical Critical Care, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Chan Ik Park
- Department of Trauma and Surgical Critical Care, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Gil Hwan Kim
- Department of Trauma and Surgical Critical Care, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Dong Yeon Ryu
- Department of Trauma and Surgical Critical Care, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Sun Hyun Kim
- Department of Trauma and Surgical Critical Care, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Tokumaru T, Kurata H, Mitsui J, Tomioka J. Radical surgery for intractable thoracic empyema complicating traumatic pneumothorax and rib fractures. Surg Case Rep 2023; 9:185. [PMID: 37872459 PMCID: PMC10593627 DOI: 10.1186/s40792-023-01765-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Few cases of traumatic pneumothorax complicated by thoracic empyema have been reported. The indication of antibiotic prophylaxis administration for traumatic pneumothorax during tube thoracostomy remains controversial, and thoracic injury complicated by empyema can be life-threatening and intractable. CASE PRESENTATION A 42-year-old male patient was injured during a collision with a passenger car while driving a motorcycle. The patient (body mass index, 37 kg/m2) was diagnosed with right first-to-sixth-rib fractures without a flail segment, right clavicle fracture, and slight hemopneumothorax. Tube thoracostomy was performed for traumatic pneumothorax on day 3 without antibiotic prophylaxis. The patient demonstrated a progressive displaced rib fracture complicated by empyema on day 11. Radical surgery was performed for the empyema with rib fixation on day 15. The postoperative course was uneventful, and the patient was discharged from the hospital on day 31. CONCLUSIONS A traumatic pneumothorax can be complicated by empyema. Thoracic injuries complicated by empyema can be life-threatening and intractable. Antibiotic prophylaxis for traumatic pneumothorax with tube thoracotomy should therefore be considered in select cases. The strategy for thoracic injury requires the assumption of an occult thoracic infection and chest wall instability.
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Affiliation(s)
- Teppei Tokumaru
- Emergency and Critical Care Center, Yamaguchi Prefectural Grand Medical Center, Osaki, Hofu City, Yamaguchi, 10077747-8511, Japan.
- Department of Acute Medicine and Surgery, Yonemori Hospital, 1-7-1 Yojiro, Kagoshima City, Kagoshima, 890-0062, Japan.
| | - Hideaki Kurata
- Department of Acute Medicine and Surgery, Yonemori Hospital, 1-7-1 Yojiro, Kagoshima City, Kagoshima, 890-0062, Japan
| | - Jin Mitsui
- Department of Acute Medicine and Surgery, Yonemori Hospital, 1-7-1 Yojiro, Kagoshima City, Kagoshima, 890-0062, Japan
| | - Joji Tomioka
- Department of Acute Medicine and Surgery, Yonemori Hospital, 1-7-1 Yojiro, Kagoshima City, Kagoshima, 890-0062, Japan
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20
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Trabelsi B, Ghorbel S, Ben Rabeh R, Bouassida M, Ben Ali M. C-reactive protein in the early diagnosis of pneumonia complicating severe blunt chest trauma. LA TUNISIE MEDICALE 2023; 101:756-758. [PMID: 38465756 PMCID: PMC11261490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/17/2023] [Indexed: 03/12/2024]
Abstract
INTRODUCTION The early diagnosis of pneumonia following severe blunt chest trauma (SBCT) allows the early prescription of antibiotics and initiation of adequate supportive care. AIM To assess the usefulness of C-reactive protein (CRP) in the early diagnosis of pneumonia complicating SBCT. METHODS We conducted a prospective study of patients admitted to trauma intensive care unit for SBCT between January 2020 and February 2023. Patients were divided into two groups according to whether or not they developed pneumonia. The CRP levels were monitored daily. RESULTS One hundred sixty-seven patients were included. Pneumonia occurred in 40.1% of patients within a median of 5 days. We found statistically significant difference in mean CRP levels between groups from day 3 to day 9 following trauma. The increase in CRP level on the 4th day from a value greater than or equal to 192 mg/L was a marker of early diagnosis of pneumonia (sensitivity 80.6%; specificity 80.8%). CONCLUSION Daily CRP measurement from the 3rd day following SBCT may be useful for early diagnosis of pneumonia complicating SBCT.
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Affiliation(s)
- Becem Trabelsi
- Department of Anesthesiology and Intensive Care, Taher Maamouri Teaching Hospital of Nabeul, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Sahar Ghorbel
- Department of Anesthesiology and Intensive Care, Taher Maamouri Teaching Hospital of Nabeul, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Rania Ben Rabeh
- Pediatric Department C, Bechir Hamza Children's Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Mahdi Bouassida
- Department of Surgery, Taher Maamouri Teaching Hospital of Nabeul, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Mechaal Ben Ali
- Department of Anesthesiology and Intensive Care, Taher Maamouri Teaching Hospital of Nabeul, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
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Moka E, Allam AES, Rekatsina M, Abed L, Paladini A, AlKharabsheh A, Vadalouca A, Varrassi G. Current Approaches to Four Challenging Pain Syndromes. Cureus 2023; 15:e45573. [PMID: 37868397 PMCID: PMC10586888 DOI: 10.7759/cureus.45573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
During a conference of pain specialists, some of the experts addressed the potential management of four prevalent but difficult painful conditions, namely, chronic postsurgical pain (CPSP), knee osteoarthritis, chest trauma, and facet joint arthropathy. In all cases, the conditions posed challenges in accurate diagnoses as well as safe, effective treatments, especially using locoregional blocks. It is not clear why some surgical patients develop CPSP and others do not, although some risk factors have been identified. More importantly, the transitional phase of pain from acute to chronic deserves greater scrutiny. It appears as if more aggressive and more effective perioperative and postoperative analgesia could help mitigate or possibly prevent CPSP. Knee osteoarthritis is prevalent but is often managed pharmacologically and then with joint replacement; many patients simply live with the condition which can be viewed as a disease of the entire joint. New approaches with intra-articular injections of hyaluronic acid, platelet-rich plasma, and botulinum toxin may provide safe, effective, and durable pain control. Chest trauma can be extremely painful and a source of morbidity, but its management tends to rely on watchful waiting and drug therapy. New approaches to regional nerve blocks can be beneficial and may reduce troublesome symptoms such as the inability to cough or clear the lungs. Facet joint arthropathy is very prevalent among older people but is not completely clarified. It may be the source of intense pain with limited management strategies. The role of nerve blocks in facet joint arthropathy is an important new addition to the armamentarium of pain management, particularly for geriatric patients.
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Affiliation(s)
- Eleni Moka
- Department of Anesthesiology, Creta InterClinic Hospital, Herakleion, GRC
| | - Abdallah El-Sayed Allam
- Morphological Madrid Research Center (MoMaRC), UltraDissection Spain EchoTraining School, Madrid, ESP
- Physical Medicine, Rheumatology and Rehabilitation, Tanta University Hospitals & Faculty of Medicine, Tanta University, Tanta, EGY
| | | | - Lynda Abed
- Anesthesia and Intensive Care, Djilali Bounaama Douera Hospital University, Algiers, DZA
| | - Antonella Paladini
- Department of Life, Health and Environmental Sciences (MESVA, University of L'Aquila, L'Aquila, ITA
| | - Abdullah AlKharabsheh
- King Abdullah University Hospital, Jordan University of Science and Technology, Amman, JOR
| | - Athina Vadalouca
- Pain and Palliative Care Center, Athens Medical Hospital, Athens, GRC
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Singh S, Avinash R, Jaiswal S, Kumari A. Comparison of safety and efficacy of thoracic epidural block and erector spinae plane block for analgesia in patients with multiple rib fractures: A pilot single-blinded, randomised controlled trial. Indian J Anaesth 2023; 67:614-619. [PMID: 37601936 PMCID: PMC10436724 DOI: 10.4103/ija.ija_844_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 04/29/2023] [Accepted: 04/29/2023] [Indexed: 08/22/2023] Open
Abstract
Background and Aims Pain associated with rib fractures is challenging to manage. This pilot trial aimed to assess the efficacy of erector spinae plane block (ESPB) compared with thoracic epidural analgesia (TEA) for controlling pain associated with multiple rib fractures. Methods This randomised, single-blinded, controlled pilot study was conducted on trauma patients who had three or more rib fractures and had been admitted at a tertiary care centre. The study was conducted after receiving ethical approval and trial registration. Patients were randomised into two groups: TEA and ESPB, from February 2019 to February 2020. In the ESPB group, a unilateral or bilateral catheter was inserted in the erector spinae space, and an infusion of 0.125% bupivacaine was started. In the TEA group, the thoracic epidural catheter was inserted, and 0.125% bupivacaine infusion was started. Rescue analgesia using intravenous morphine (0.1 mg/kg) was administered if the Visual Analogue Scale (VAS) score was >3 for 48 hours postoperatively. The primary endpoint was total morphine consumption after administration of ESPB and TEA in patients with a rib fracture. Results Forty patients completed the study, with 20 in each group. Total morphine consumption by patients in the ESPB group was 5.38 ± 2.6 mg per 48 hours, and by those in the TEA group was 5.22 ± 2.11 mg per 48 hours (P = 0.883). Thirty minutes after starting the infusion, mean arterial pressure (MAP) was 64.8 ± 2.1 mmHg in the ESPB group and 57.2 ± 1.3 mmHg in the TEA group (P = 0.00001). Conclusion Total morphine consumption was not statistically different in this pilot trial among the two groups. ESP block may provide similar analgesia with better haemodynamic stability compared to TEA in patients with multiple traumatic rib fractures.
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Affiliation(s)
- Swati Singh
- Department of Anesthesia and Critical Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Raja Avinash
- Department of Anesthesia and Critical Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Shreyas Jaiswal
- Department of Anesthesia and Critical Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Anita Kumari
- Department of Anesthesia and Critical Care, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Shiroff AM, Wolf S, Wu A, Vanderkarr M, Anandan M, Ruppenkamp JW, Galvain T, Holy CE. Outcomes of surgical versus nonsurgical treatment for multiple rib fractures: A US hospital matched cohort database analysis. J Trauma Acute Care Surg 2023; 94:538-545. [PMID: 36730674 PMCID: PMC10045967 DOI: 10.1097/ta.0000000000003828] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/04/2022] [Accepted: 10/25/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Treatment for multiple rib fractures includes surgical stabilization of rib fractures (SSRF) or nonoperative management (NOM). Meta-analyses have demonstrated that SSRF results in faster recovery and lower long-term complication rates versus NOM. Our study evaluated postoperative outcomes for multiple rib fracture patients following SSRF versus NOM in a real-world, all-comer study design. METHODS Multiple rib fracture patients with inpatient admissions in the PREMIER hospital database from October 1, 2015, to September 30, 2020, were identified. Outcomes included discharge disposition, and 3- and 12-month lung-related readmissions. Demographics, comorbidities, concurrent injuries at index, Abbreviated Injury Scale and Injury Severity Scores, and provider characteristics were determined for all patients. Patients were excluded from the cohort if they had a thorax Abbreviated Injury Scale score of <2 (low severity patient) or a Glasgow Coma Scale score of ≤8 (extreme high severity patient). Stratum matching between SSRF and NOM patients was performed using fine stratification and weighting so that all patient data were kept in the final analysis. Outcomes were analyzed using generalized linear models with quasinormal distribution and logit links. RESULTS A total of 203,450 patients were included, of which 200,580 were treated with NOM and 2,870 with SSRF. Compared to NOM, patients with SSRF had higher rates of home discharge (62% SSRF vs. 58% NOM) and lower rates of lung-related readmissions (3 months, 3.1% SSRF vs. 4.0% NOM; 12 months, 6.2% SSRF vs. 7.6% NOM). The odds ratio (OR) for home or home health discharge in patients with SSRF versus NOM was 1.166 (95% confidence interval [CI], 1.073-1.266; p = 0.0002). Similarly, ORs for lung-related readmission at 3- and 12-month were statistically lower in the patients treated with SSRF versus NOM (OR [3 months], 0.764 [95% CI, 0.606-0.963]; p = 0.0227 and OR [12 months], 0.799 [95% CI, 0.657-0.971]; p = 0.0245). CONCLUSION Surgical stabilization of rib fractures results in greater odds of home discharge and lower rates of lung-related readmissions compared with NOM at 12 months of follow-up. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Vunvulea V, Melinte RM, Brinzaniuc K, Suciu BA, Ivănescu AD, Hălmaciu I, Incze-Bartha Z, Pastorello Y, Trâmbițaș C, Mărginean L, Kaller R, Kassas A, Hogea T. Blood Count-Derived Inflammatory Markers Correlate with Lengthier Hospital Stay and Are Predictors of Pneumothorax Risk in Thoracic Trauma Patients. Diagnostics (Basel) 2023; 13:diagnostics13050954. [PMID: 36900099 PMCID: PMC10000372 DOI: 10.3390/diagnostics13050954] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
(1) Background: Trauma is one of the leading causes of death worldwide, with the chest being the third most frequent body part injured after abdominal and head trauma. Identifying and predicting injuries related to the trauma mechanism is the initial step in managing significant thoracic trauma. The purpose of this study is to assess the predictive capabilities of blood count-derived inflammatory markers at admission. (2) Materials and Methods: The current study was designed as an observational, analytical, retrospective cohort study. It included all patients over the age of 18 diagnosed with thoracic trauma, confirmed with a CT scan, and admitted to the Clinical Emergency Hospital of Targu Mureş, Romania. (3) Results: The occurrence of posttraumatic pneumothorax is highly linked to age (p = 0.002), tobacco use (p = 0.01), and obesity (p = 0.01). Furthermore, high values of all hematological ratios, such as the NLR, MLR, PLR, SII, SIRI, and AISI, are directly associated with the occurrence of pneumothorax (p < 0.001). Furthermore, increased values of the NLR, SII, SIRI, and AISI at admission predict a lengthier hospitalization (p = 0.003). (4) Conclusions: Increased neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), aggregate inflammatory systemic index (AISI), and systemic inflammatory response index (SIRI) levels at admission highly predict the occurrence of pneumothorax, according to our data.
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Affiliation(s)
- Vlad Vunvulea
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Radiology, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | | | - Klara Brinzaniuc
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Bogdan Andrei Suciu
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Correspondence:
| | - Adrian Dumitru Ivănescu
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Ioana Hălmaciu
- Department of Radiology, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Zsuzsanna Incze-Bartha
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Ylenia Pastorello
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Cristian Trâmbițaș
- Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Lucian Mărginean
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Radiology, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Réka Kaller
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Ahmad Kassas
- Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Timur Hogea
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
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25
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Fitzpatrick ER. Evidence-Based Pearls. Crit Care Nurs Clin North Am 2023; 35:129-144. [PMID: 37127370 DOI: 10.1016/j.cnc.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
The challenge in caring for patients who sustain traumatic chest injuries centers on their complex needs from high acuity and the potential for multisystem effects and complications. Hemorrhage and respiratory compromise are common sequela of thoracic trauma. Patients must be resuscitated and their injuries managed with the primary goals of restoring cardiopulmonary structural integrity and preventing complications. There are evolving strategies for the management of the thoracic trauma victim including damage control resuscitation and surgery, endovascular repairs, and assessments implementing severity scores to aid in planning interventions.
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Lundin A, Akram SK, Berg L, Göransson KE, Enocson A. Thoracic injuries in trauma patients: epidemiology and its influence on mortality. Scand J Trauma Resusc Emerg Med 2022; 30:69. [PMID: 36503613 PMCID: PMC9743732 DOI: 10.1186/s13049-022-01058-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Thoracic injuries are common among trauma patients. Studies on trauma patients with thoracic injuries have reported considerable differences in morbidity and mortality, and there is limited research on comparison between trauma patients with and without thoracic injuries, particularly in the Scandinavian population. Thoracic injuries in trauma patients should be identified early and need special attention since the differences in injury patterns among patient population are important as they entail different treatment regimens and influence patient outcomes. The aim of the study was to describe the epidemiology of trauma patients with and without thoracic injuries and its influence on 30-day mortality. METHODS Patients were identified through the Karolinska Trauma Register. The Abbreviated Injury Scale (AIS) system was used to find patients with thoracic injuries. Logistic regression analysis was performed to evaluate factors [age, gender, ASA class, GCS (Glasgow Coma Scale), NISS (New Injury Severity Score) and thoracic injury] associated with 30-day mortality. RESULTS A total of 2397 patients were included. Of those, 768 patients (32%) had a thoracic injury. The mean (± SD, range) age of all patients (n = 2397) was 46 (20, 18-98) years, and the majority (n = 1709, 71%) of the patients were males. There was a greater proportion of patients with rib fractures among older (≥ 60 years) patients, whereas younger patients had a higher proportion of injuries to the internal thoracic organs. The 30-day mortality was 11% (n = 87) in patients with thoracic injury and 4.3% (n = 71) in patients without. After multivariable adjustment, a thoracic injury was found to be associated with an increased risk of 30-day mortality (OR 1.9, 95% CI 1.3-3.0); as was age ≥ 60 years (OR 3.7, 95% CI 2.3-6.0), ASA class 3-4 (OR 2.3, 95% CI 1.4-3.6), GCS 1-8 (OR 21, 95% CI 13-33) and NISS > 15 (OR 4.2, 2.4-7.3). CONCLUSION Thoracic injury was an independent predictor of 30-day mortality after adjustment for relevant key variables. We also found a difference in injury patterns with older patients having a higher proportion of rib fractures, whilst younger patients suffered more internal thoracic organ injuries.
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Affiliation(s)
- Andrea Lundin
- grid.24381.3c0000 0000 9241 5705Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, 171 64 Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Shahzad K. Akram
- grid.24381.3c0000 0000 9241 5705Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, 171 64 Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Lena Berg
- grid.4714.60000 0004 1937 0626Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden ,grid.411953.b0000 0001 0304 6002School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Katarina E. Göransson
- grid.4714.60000 0004 1937 0626Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden ,grid.411953.b0000 0001 0304 6002School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Anders Enocson
- grid.24381.3c0000 0000 9241 5705Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, 171 64 Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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27
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Mistry R, Moore J. Management of blunt thoracic trauma. BJA Educ 2022; 22:432-439. [PMID: 36304913 PMCID: PMC9596286 DOI: 10.1016/j.bjae.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 10/31/2022] Open
Affiliation(s)
- R.N. Mistry
- Gold Coast University Hospital, Southport, QLD, Australia
| | - J.E. Moore
- Wellington Regional Hospital, Wellington, New Zealand
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28
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Pathophysiology of respiratory disease and its significance to anaesthesia. ANAESTHESIA & INTENSIVE CARE MEDICINE 2022. [DOI: 10.1016/j.mpaic.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Beloy V, Dull M. Blunt chest wall trauma: Rib fractures and associated injuries. JAAPA 2022; 35:25-31. [PMID: 36219110 DOI: 10.1097/01.jaa.0000885136.91189.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
ABSTRACT Blunt injuries to the chest wall, specifically those related to rib fractures, need to be promptly identified and effectively managed to reduce patient morbidity and mortality. Furthermore, judicious use of multimodal pain management and early identification of patients who will benefit from the surgical stabilization of rib fractures are paramount to optimal outcomes.
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Affiliation(s)
- Victoria Beloy
- Victoria Beloy practices in general and trauma surgery at Intermountain Healthcare Good Samaritan Hospital in Lafayette, Colo. Matthew Dull is an acute care and trauma general surgeon at Spectrum Health Butterworth Hospital in Grand Rapids, Mich. The authors have disclosed no potential conflicts of interest, financial or otherwise
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30
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Malaka Munasinghe B, Pasindu M. Fernando U, M. Fernando UP. Comment on: Prompt Detection of Intravascular Migration of Cervical Epidural Catheter in Superior Vena Cava Avoids Impending Disaster! Turk J Anaesthesiol Reanim 2022; 50:394-395. [PMID: 36301291 PMCID: PMC9682940 DOI: 10.5152/tjar.2022.21327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- B. Malaka Munasinghe
- Department of Anaesthesiology and Intensive Care, District General Hospital, Mannar, Sri Lanka,Corresponding author: B. Malaka Munasinghe, e-mail: ;
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31
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Armin E, Movahedi M, Najafzadeh MJ, Honarmand A, Rukerd MRZ, Mirafzal A. COMPARISON OF ULTRASOUND-GUIDED ERECTOR SPINAE PLANE BLOCK WITH INTERCOSTAL NERVE BLOCK FOR TRAUMA-ASSOCIATED CHEST WALL PAIN. J Emerg Med 2022; 63:520-527. [DOI: 10.1016/j.jemermed.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/30/2022] [Accepted: 09/04/2022] [Indexed: 12/02/2022]
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32
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Development and assessment of deep learning system for the location and classification of rib fractures via computed tomography. Eur J Radiol 2022; 154:110434. [DOI: 10.1016/j.ejrad.2022.110434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 05/26/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022]
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33
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Jones EK, Hultman G, Schmoke K, Ninkovic I, Dodge S, Bahr M, Melton GB, Marquard J, Tignanelli CJ. Combined Expert and User-Driven Usability Assessment of Trauma Decision Support Systems Improves User-Centered Design. Surgery 2022; 172:1537-1548. [PMID: 36031451 DOI: 10.1016/j.surg.2022.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/11/2022] [Accepted: 05/30/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Trauma clinical decision support systems improve adherence with evidence-based practice but suffer from poor usability and the lack of a user-centered design. The objective of this study was to compare the effectiveness of user and expert-driven usability testing methods to detect usability issues in a rib fracture clinical decision support system and identify guiding principles for trauma clinical decision support systems. METHODS A user-driven and expert-driven usability investigation was conducted using a clinical decision support system developed for patients with rib fractures. The user-driven usability evaluation was as follows: 10 clinicians were selected for simulation-based usability testing using snowball sampling, and each clinician completed 3 simulations using a video-conferencing platform. End-users participated in a novel team-based approach that simulated realistic clinical workflows. The expert-driven heuristic evaluation was as follows: 2 usability experts conducted a heuristic evaluation of the clinical decision support system using 10 common usability heuristics. Usability issues were identified, cataloged, and ranked for severity using a 4-level ordinal scale. Thematic analysis was utilized to categorize the identified usability issues. RESULTS Seventy-nine usability issues were identified; 63% were identified by experts and 48% by end-users. Notably, 58% of severe usability issues were identified by experts alone. Only 11% of issues were identified by both methods. Five themes were identified that could guide the design of clinical decision support systems-transparency, functionality and integration into workflow, automated and noninterruptive, flexibility, and layout and appearance. Themes were preferentially identified by different methods. CONCLUSION We found that a dual-method usability evaluation involving usability experts and end-users drastically improved detection of usability issues over single-method alone. We identified 5 themes to guide trauma clinical decision support system design. Performing usability testing via a remote video-conferencing platform facilitated multi-site involvement despite a global pandemic.
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Affiliation(s)
- Emma K Jones
- Department of Surgery, University of Minnesota, Minneapolis, MN.
| | - Gretchen Hultman
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN
| | - Kristine Schmoke
- Veterans Health Administration, Department of Veterans Affairs, Washington, DC
| | | | - Sarah Dodge
- Fairview Health Services IT, Minneapolis, MN
| | - Matthew Bahr
- Trauma Services, Fairview Health Services, Minneapolis, MN
| | - Genevieve B Melton
- Department of Surgery, University of Minnesota, Minneapolis, MN; Institute for Health Informatics, University of Minnesota, Minneapolis, MN; Fairview Health Services IT, Minneapolis, MN; Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN
| | - Jenna Marquard
- School of Nursing, University of Minnesota, Minneapolis, MN
| | - Christopher J Tignanelli
- Department of Surgery, University of Minnesota, Minneapolis, MN; Institute for Health Informatics, University of Minnesota, Minneapolis, MN; Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN
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Weinberg BJ, Roos R, van Aswegen H. Effectiveness of nonpharmacological therapeutic interventions on pain and physical function in adults with rib fractures during acute care: A systematic review and meta-analysis. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2022; 78:1764. [PMID: 35814044 PMCID: PMC9257723 DOI: 10.4102/sajp.v78i1.1764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/04/2022] [Indexed: 11/01/2022] Open
Affiliation(s)
- Beverley J. Weinberg
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ronel Roos
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- The Wits – JBI Centre for Evidenced-Based Practice: A Joanna Briggs Institute Affiliated Group, Johannesburg, South Africa
| | - Heleen van Aswegen
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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35
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Liu CT, Hsieh TM, Wu BY, Huang YC, Shih CH, Hu WL, Tsai MY, Chen YH. Acupuncture Analgesia in Patients With Traumatic Rib Fractures: A Randomized-Controlled Trial. Front Med (Lausanne) 2022; 9:896692. [PMID: 35712110 PMCID: PMC9197317 DOI: 10.3389/fmed.2022.896692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/11/2022] [Indexed: 12/19/2022] Open
Abstract
Pain management for traumatic rib fracture is important to prevent complications and reduce associated comorbidities. This trial investigated the analgesic efficacy of acupuncture on traumatic rib fracture. Patients with traumatic rib fracture were randomly assigned to traditional acupuncture (TA), laser acupuncture (LA) or sham laser acupuncture (SLA) groups in a 1:1:1 ratio. The intervention was performed on days 1 to 3 after treatment allocation. The acupoints included bilateral LI4 (Hegu), SJ6 (Zhigou), ST36 (Zusanli) and GB34 (Yanglingquan). The primary outcome was Numeric Rating Scale (NRS) scores for pain after the intervention. Secondary outcomes included sustained maximal inspiration (SMI) lung volume, stress responses, the use of analgesics, and associated complications. Data were analyzed via one-way analysis of variance (ANOVA) with Scheffé's post hoc testing or chi-squared testing. Of the 120 study participants, 109 completed all interventions and measurements. The primary outcomes, which indicated average pain intensity levels and pain while deep breathing, were both significantly lower in the TA and LA groups than in the SLA group after 2 treatments. No between-group differences were observed in SMI lung volume, stress response, analgesics use or associated complications. These findings suggest that TA and LA are safe and effective analgesic modalities for pain management for traumatic rib fracture. Clinical Trial Registration [ClinicalTrials.gov], identifier [NCT03822273].
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Affiliation(s)
- Chun-Ting Liu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Integrated Medicine, School of Chinese Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan.,Department of Chinese Medicine, Dali Branch, Jen-Ai Hospital, Taichung, Taiwan
| | - Ting-Min Hsieh
- Division of Trauma, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Bei-Yu Wu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Integrated Medicine, School of Chinese Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan.,Fooyin University College of Nursing, Kaohsiung, Taiwan
| | - Yu-Chuen Huang
- Graduate Institute of Integrated Medicine, School of Chinese Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Han Shih
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Long Hu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Fooyin University College of Nursing, Kaohsiung, Taiwan
| | - Ming-Yen Tsai
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Integrated Medicine, School of Chinese Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, School of Chinese Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan.,Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
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36
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ICU Length of Stay and Factors Associated with Longer Stay of Major Trauma Patients with Multiple Rib Fractures: A Retrospective Observational Study. Crit Care Res Pract 2022; 2022:6547849. [PMID: 35273812 PMCID: PMC8904129 DOI: 10.1155/2022/6547849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/24/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Chest injury with multiple rib fractures is the most common injury among major trauma patients in New South Wales (23%) and is associated with a high rate of mortality and morbidity. The aim of this study was to determine the intensive care unit (ICU) length of stay (LOS) among major trauma patients with multiple rib fractures and to identify factors associated with a prolonged ICU LOS. Materials and Methods. Single-centre, retrospective observational cohort study of adult patients with 3 or more traumatic rib fractures, who were admitted to ICU between June 2014 and June 2019. A comparison was made between patients who stayed in ICU for less than 7 days and those that stay for 7 or more days. Results. Among 215 patients who were enrolled, 150 (69.7%) were male, the median Injury Severity Score (ISS) was 24 (interquartile range (IQR): 17–32). The median ICU LOS was 4 (IQR: 2–7) days and the average ICU LOS was 6.5 (SD 8.5; 95% CI 5.3–7.6) days. The median number of rib fractures was 6 (IQR: 5–9) and 76 (35.3%) patients had a flail chest. Patients who stayed longer than 7 days in ICU had higher ISS, higher APACHE-II score, greater number of rib fractures, higher rate of lung contusions, and required more respiratory support of any type. Conclusions. ISS, number of rib fractures, lung contusion, and flail chest were associated with prolonged ICU LOS in patients with traumatic multiple rib fractures.
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Soltys C, Landsbergen E, Chenger C. The Occasional ultrasound-guided serratus anterior plane blockade. CANADIAN JOURNAL OF RURAL MEDICINE 2022; 27:111-115. [DOI: 10.4103/cjrm.cjrm_46_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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38
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Curtis K, Kourouche S, Asha S, Considine J, Fry M, Middleton S, Mitchell R, Munroe B, Shaban RZ, D’Amato A, Skinner C, Wiseman G, Buckley T. Impact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation. PLoS One 2021; 16:e0256027. [PMID: 34618825 PMCID: PMC8496821 DOI: 10.1371/journal.pone.0256027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/28/2021] [Indexed: 12/03/2022] Open
Abstract
Background Blunt chest injury leads to significant morbidity and mortality. The aim of this study was to evaluate the effect of a multidisciplinary chest injury care bundle (ChIP) on patient and health service outcomes. ChIP provides guidance in three key pillars of care for blunt chest injury—respiratory support, analgesia and complication prevention. ChIP was implemented using a multi-faceted implementation plan developed using the Behaviour Change Wheel. Methods This controlled pre-and post-test study (two intervention and two non-intervention sites) was conducted from July 2015 to June 2019. The primary outcome measures were unplanned Intensive Care Unit (ICU) admissions, non-invasive ventilation use and mortality. Results There were 1790 patients included. The intervention sites had a 58% decrease in non-invasive ventilation use in the post- period compared to the pre-period (95% CI 0.18–0.96). ChIP was associated with 90% decreased odds of unplanned ICU admissions (95% CI 0.04–0.29) at the intervention sites compared to the control groups in the post- period. There was no significant change in mortality. There were higher odds of health service team reviews (surgical OR 6.6 (95% CI 4.61–9.45), physiotherapy OR 2.17 (95% CI 1.52–3.11), ICU doctor OR 6.13 (95% CI 3.94–9.55), ICU liaison OR 55.75 (95% CI 17.48–177.75), pain team OR 8.15 (95% CI 5.52 –-12.03), analgesia (e.g. patient controlled analgesia OR 2.6 (95% CI 1.64–3.94) and regional analgesia OR 8.8 (95% CI 3.39–22.79), incentive spirometry OR 8.3 (95% CI 4.49–15.37) and, high flow nasal oxygen OR 22.1 (95% CI 12.43–39.2) in the intervention group compared to the control group in the post- period. Conclusion The implementation of a chest injury care bundle using behaviour change theory was associated with a sustained improvement in evidence-based practice resulting in reduced unplanned ICU admissions and non-invasive ventilation requirement. Trial registration ANZCTR: ACTRN12618001548224, approved 17/09/2018
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
- * E-mail:
| | - Sarah Kourouche
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Stephen Asha
- Emergency Department, St George Hospital, Kogarah, NSW, Australia
- St George Clinical School, Faculty of Medicine, University of New South Wales, Kogarah, NSW, Australia
| | - Julie Considine
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Experience in the Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety Experience–Eastern Health Partnership, Box Hill, VIC, Australia
| | - Margaret Fry
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
- Northern Sydney Local Health District, Hornsby, NSW, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne, Fitzroy, Australia
- Australian Catholic University, Sydney, NSW, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Belinda Munroe
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, NSW, Australia
| | - Ramon Z. Shaban
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Camperdown, NSW, Australia
- Division of Infectious Diseases and Sexual Health, Department of Infection Prevention and Control, Westmead Hospital and Western Sydney Local Health District, Westmead, NSW, Australia
- New South Wales Biocontainment Centre, Western Sydney Local Health District and New South Wales Health, Warwick Farm, NSW, Australia
| | - Alfa D’Amato
- NSW Activity Based Funding Taskforce, NSW Ministry of Health, Sydney, Australia
| | - Clare Skinner
- Emergency Department, Hornsby Ku-ring-ai Hospital, Hornsby, NSW, Australia
| | - Glen Wiseman
- Emergency Services, Canterbury Hospital, Campsie, NSW, Australia
| | - Thomas Buckley
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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The Comparison of Analgesics and Kinesiological Taping in Rib Fractures. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02856-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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