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Evaluation der Aufnahmekriterien von Patienten nach Verkehrsunfall in den Schockraum. Notf Rett Med 2021. [DOI: 10.1007/s10049-020-00695-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Zusammenfassung
Hintergrund
Die aktuelle S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung der Deutschen Gesellschaft für Unfallchirurgie (DGU) empfiehlt bei einem Pkw-Unfall mit einer Geschwindigkeitsveränderung von delta >30 km/h die Versorgung in einem Schockraum ohne Berücksichtigung der Verletzungen des Patienten. Ziel dieser Studie war es zu untersuchen, ob Patienten, die ausschließlich aufgrund dieses Kriteriums über einen Schockraum aufgenommen wurden, relevante Verletzungen aufwiesen, die intensivmedizinische Behandlungen oder (Not‑)Operationen benötigten.
Methode
Nach einem Pkw-Unfall wurden Patienten ohne spezifische Verletzung, bei denen ausschließlich eine Geschwindigkeitsveränderung von delta >30 km/h vorlag (Empfehlungsgrad B der S3-Leitlinie), der Studiengruppe, Patienten mit Verletzungen gem. Empfehlungsgrad A der Leitlinie der Vergleichsgruppe zugeordnet. Ein schockraumrelevantes Trauma wurde als Injury Severity Score (ISS) ≥16, operative Versorgung innerhalb 24 h, intensivmedizinische Überwachung >24 h, Versterben während des Krankenhausaufenthalts sowie DGU-Basiskollektiv (MAIS3+ oder MAIS2 mit Intensivverweildauer >24 h bzw. Versterben während des Krankenhausaufenthalts) definiert.
Ergebnisse
Der Vergleich zeigte einen hochsignifikanten Unterschied in Bezug auf den mittleren ISS (p ≤ 0,001), ein schockraumrelevantes Trauma (ISS ≥16; p ≤ 0,001), eine intensivmedizinische Versorgung >24 h (p ≤ 0,001), Operation innerhalb von 24 h nach Krankenhausaufnahme (p ≤ 0,001), Letalität (p ≤ 0,001) sowie DGU-Basiskollektiv (p ≤ 0,001). Anhand dieser Ergebnisse konnte gezeigt werden, dass innerhalb der Studiengruppe (Geschwindigkeitsveränderung von delta >30 km/h; Empfehlungsgrad B der S3-Leitlinie) lediglich ein Patient eine Traumafolge aufwies, die eine intensivmedizinische Behandlung >24 h oder eine Operation nötig machte. Studien- und Vergleichsgruppen waren in Bezug auf das mittlere Alter (p = 1,778), das männliche Geschlecht (p = 0,1728) sowie die durchschnittliche Unfallgeschwindigkeit (p = 0,4606) vergleichbar.
Diskussion
Ein alleiniges Vorliegen eines Pkw-Unfalls mit einer Geschwindigkeitsveränderung von delta >30 km/h kann nicht als adäquater Prädiktor für ein schockraumrelevantes Trauma gesehen werden. Weitere Studien könnten durch eine Leitlinienanpassung eine weiterhin sichere und hochwertige Patientenversorgung bei Reduktion von personellen und finanziellen Belastungen ermöglichen.
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Eaton J, Grudziak J, Hanif AB, Chisenga WC, Hadar E, Charles A. The effect of anatomic location of injury on mortality risk in a resource-poor setting. Injury 2017; 48:1432-1438. [PMID: 28551054 DOI: 10.1016/j.injury.2017.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/10/2017] [Accepted: 05/15/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Injury is a significant cause of death, with approximately 4.7 million people mortalities each year. By 2030, injury is predicted to be among the top 20 causes of death worldwide. We sought to characterize and compare the mortality probability in trauma patients in a resource-poor setting based on anatomic location of injury. METHODS We performed a retrospective analysis of prospectively collected data using the trauma database at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi. We included all adult trauma patients (≥16years) admitted between 2011 and 2015. We stratified patients according to anatomic location of injury, and used descriptive statistics to compare characteristics and management of each group. Bivariate analysis by mortality was done to determine covariates for our adjusted model. A Cox proportional hazard model was performed, using upper extremity injury as the baseline comparator. Descriptive statistics were used to describe the trend in incidence and mortality of head and spine injuries over five years. RESULTS Of the 76,984 trauma patients who presented to KCH from 2011 to 2015, 49,126 (63.8%) were adults, and 8569 (17.4%) were admitted. The most common injury was to the head or spine, seen in 3712 patients (43.6%). The highest unadjusted hazard ratio for mortality was in head and spine injury patients, at 3.685 (95% CI=2.50-5.44), which increased to 4.501 (95% CI=2.78-7.30) when adjusted for age, sex, injury severity, transfer status, injury mechanism, and surgical intervention. Abdominal trauma had the second highest adjusted hazard of mortality, at 3.62 (95% CI=1.92-6.84) followed by thoracic trauma (HR=1.3621, 95% CI=0.49-3.56). CONCLUSION In our setting, head or spine injury significantly increases the hazard of mortality significantly compared to all other anatomic injury locations. The prioritization of timely operative and non-operative head injury management is imperative. The development of head injury units may help attenuate trauma- related mortality in resource poor settings.
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Affiliation(s)
- Jessica Eaton
- UNC -Project Malawi, Lilongwe, Malawi; University of Louisville School of Medicine, Louisville, KY, United States
| | - Joanna Grudziak
- Department of Surgery, University of North Carolina, Chapel Hill, NC, United States
| | - Asma Bilal Hanif
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | | | - Eldad Hadar
- Department of Neurosurgery, University of North Carolina, Chapel Hill, NC, United States
| | - Anthony Charles
- UNC -Project Malawi, Lilongwe, Malawi; Department of Surgery, University of North Carolina, Chapel Hill, NC, United States; Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
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Improving the prognostic value of blunt abdominal trauma scoring systems in children. ANNALS OF PEDIATRIC SURGERY 2017. [DOI: 10.1097/01.xps.0000503402.52051.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sakellaris G, Blevrakis E, Petrakis I, Dimopoulou A, Dede O, Partalis N, Alegakis A, Seremeti C, Spanaki AM, Briassoulis G. Acute coagulopathy in children with multiple trauma: a retrospective study. J Emerg Med 2014; 47:539-45. [PMID: 25201343 DOI: 10.1016/j.jemermed.2014.06.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/21/2014] [Accepted: 06/30/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute coagulopathy associated with trauma has been recognized for decades and is a constituent of the "triad of death" together with hypothermia and acidosis. STUDY OBJECTIVE The aim of this study was to determine to what extent coagulopathy is already established upon emergency department (ED) admission and the association with the severity of injury, impaired outcome, and mortality. METHODS Ninety-one injured children were admitted to the ED in our hospital. Pediatric Trauma Score (PTS), Injury Severity Score (ISS), and Glasgow Coma Scale (GCS) score were used to estimate injury severity, and organ function was assessed by the Sequential Organ Failure Assessment (SOFA) score. RESULTS Coagulopathy upon pediatric intensive care unit admission was present in 33 children (39.3%): 21 males and 12 females. PTS ranged from 1 to 12 (mean 8.2) in 51 children without coagulopathy and from -1 to +11 (mean 6.8) in 33 children with coagulopathy (p = 0.087). ISS and GCS ranged from 4 to 57 (mean 28) and from 3 to 11 (mean 7.3), respectively, in the coagulopathy group, whereas in the group without coagulopathy, ISS score ranged from 4 to 41 (mean 20.5; p = 0.08) and GCS from 8 to 15 (mean 12.8; p = 0.01). SOFA ranged from 0 to 10 (mean 3.4) in children without coagulopathy and from 0 to 15 (mean 5.4) in the coagulopathy group (p = 0.002). Among 33 children with coagulopathy, 7 did not survive (21%), all with parenchymal brain damage, whereas all trauma patients without coagulopathy survived (p < 0.001). CONCLUSION Acute coagulopathy is present on admission to the ED and is associated with injury severity and significantly higher mortality.
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Affiliation(s)
- George Sakellaris
- Department of Pediatric Surgery, University Hospital of Heraklion, Greece
| | | | - Ioannis Petrakis
- Department of General Surgery, University Hospital of Heraklion, Greece
| | | | - Olga Dede
- Department of Pediatric Surgery, University Hospital of Heraklion, Greece
| | - Nikolaos Partalis
- Department of Pediatric Surgery, University Hospital of Heraklion, Greece
| | | | - Chrysa Seremeti
- Department of Pediatric Surgery, University Hospital of Heraklion, Greece
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Simon R, Gilyoma JM, Dass RM, Mchembe MD, Chalya PL. Paediatric injuries at Bugando Medical Centre in Northwestern Tanzania: a prospective review of 150 cases. J Trauma Manag Outcomes 2013; 7:10. [PMID: 24499558 PMCID: PMC3833645 DOI: 10.1186/1752-2897-7-10] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Accepted: 11/08/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Injuries continue to be the leading cause of death and disability for children. The is a paucity of published data on paediatric injuries in our local environment. This study describes the etiological spectrum, injury characteristics and treatment outcome of paediatric injuries in our local setting and provides baseline data for establishment of prevention strategies as well as treatment guidelines. METHODS This was a descriptive cross-sectional study involving paediatric injury patients admitted to Bugando Medical Centre from August 2011 to April 2012. Statistical data analysis was done using SPSS version 17.0 and STATA version 12.0. RESULTS A total of 150 patients were studied. The age of patients ranged from 1 month to 10 years with a median age of 5 years. The male to female ratio was 2.3:1. Road traffic accident was the most common cause of injury (39.3%) and motorcycle (71.2%) was responsible for the majority of road traffic accidents. Only 11 (7.3%) patients received pre-hospital care. The head /neck (32.7%) and musculoskeletal (28.0%) were the most frequent body region injured. Open wounds (51.4%), foreign bodies (31.3%) and fractures (17.3%) were the most common type of injuries sustained. The majority of patients 84 (56.0%) were treated surgically. Complication rate was 3.9%. The mean duration of hospitalization was 9.7 ± 13.1 days. Mortality rate was 12.7%. Age of the patient (< 5 years), late presentation and presence of complications were the main predictors of length of hospital stay (P < 0.001), whereas burn injuries, severe head injuries and severity of injury (Paediatric trauma score = 0-5) significantly predicted mortality (P < 0.0001). CONCLUSION Paediatric injuries resulting from road traffic accidents (RTAs) remain a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTAs is necessary to reduce the incidence of paediatric injuries in this region.
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Affiliation(s)
- Raymond Simon
- Department of Surgery, Catholic University of Health and Allied Sciences – Bugando, Mwanza, Tanzania
| | - Japhet M Gilyoma
- Department of Surgery, Catholic University of Health and Allied Sciences – Bugando, Mwanza, Tanzania
| | - Ramesh M Dass
- Department of Orthopaedic & Trauma, Catholic University of Health and Allied Sciences – Bugando, Mwanza, Tanzania
| | - Mabula D Mchembe
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Phillipo L Chalya
- Department of Surgery, Catholic University of Health and Allied Sciences – Bugando, Mwanza, Tanzania
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Norouzi V, Feizi I, Vatankhah S, Pourshaikhian M. Calculation of the probability of survival for trauma patients based on trauma score and the injury severity score model in fatemi hospital in ardabil. ARCHIVES OF TRAUMA RESEARCH 2013; 2:30-5. [PMID: 24396787 PMCID: PMC3876517 DOI: 10.5812/atr.9411] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 01/20/2013] [Accepted: 02/27/2013] [Indexed: 11/16/2022]
Abstract
Background Trauma, in addition to economic and social costs, is the fourth cause of death in the world and in the year 2000 alone, it led to the death of more than 6000000 people. In Iran, Trauma has the first burden of disease and also needs a long medical surveillance. Objectives The aim of this study was to evaluate the outcome of trauma cases using the trauma score and the injury severity score (TRISS) model and then comparing this with the results of a major trauma outcome study (MTOS) carried out in the US. Patients and Methods This study is a retrospective, descriptive and analytical study on 1000 patients aged 2 - 82 years old with closed or penetrating traumas staying at Ardebil Fatemi hospital. In this study, injury severity score (ISS), revised trauma score (RTS), and TRISS were calculated and patients' viability ratios were obtained. Results The results showed that 714 patients (71.4%) were male and 286 patients (28.6%) female with the mean age of 35.68 years. In this study 45 (4.5%) and 955 patients (95.5%) had penetrating and blunt traumas, respectively, whereby the head and neck were the most prevalent (74%) areas of injury. The most common reason for these traumas was, accident with vehicles with 670 cases (67%), which resulted in hospitalization. From this group, ninety-seven cases (9.7%) died in the hospital. From these results, calculations of ISS and RTS were 15.50 ± 11.31 and 7.49 ± 0.79, respectively. According to the calculation of the TRISS model, 91.5% of trauma victims should be survived, while only 90.3% survived practically. Conclusions We can conclude that the surveillance presented to our injured group probably had some defects that need to be revised in therapeutic services to enhance survival requirements.
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Affiliation(s)
- Vadood Norouzi
- Department of Anesthesia, Ardabil University of Medical Sciences, Ardabil, IR Iran
| | - Iraj Feizi
- Department of Surgery, Ardabil University of Medical Sciences, Ardabil, IR Iran
| | - Soodabe Vatankhah
- Department of Health Care Services Management, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Majid Pourshaikhian
- Department of Health Care Services Management, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Majid Pourshaikhian, Department of Health Care Services Management, Tehran University of Medical Sciences, Tehran, IR Iran. Tel.: +98-2188793805, Fax: +98-2188883334, E-mail:
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Şentürk GÖ, Ünlüer EE, Vandenberk N, Yavaşi Ö, Eroglu O, Sürüm N, Üstüner F, Kayayurt K. The prognostic value of cystatin C compared with trauma scores in multiple blunt trauma: a prospective cohort study. J Emerg Med 2013; 44:1070-6. [PMID: 23399394 DOI: 10.1016/j.jemermed.2012.11.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 03/12/2012] [Accepted: 11/05/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Many scoring systems have been developed to predict the prognosis of the traumatized patients in Emergency Departments, and the necessary calculations make complex scoring systems difficult to use as a part of the initial trauma patient assessment, and they also have limited accuracy. STUDY OBJECTIVE This study compares the accuracy of cystatin C with trauma scoring systems in predicting the mortality of trauma patients. METHODS Serum cystatin C levels were measured upon arrival in consecutive adult multiple blunt trauma patients during a 12-month period. Correlation analysis was used to assess the relationship between Injury Severity Score (ISS), Revised Trauma Score (RTS), Glasgow Coma Scale (GCS) Score, and cystatin C. Trauma scores and cystatin C were used in Cox regression models to predict trauma patients' risk of death. RESULTS During the study period, 153 patients were enrolled and 18 died. There were negative correlations between cystatin C levels and the GCS (r = -0.666, p < 0.001) as well as the RTS (r = -0.229, p = 0.004). A moderate correlation was found between the ISS and the cystatin C level (r = 0.492, p < 0.001). In Cox regression models, every increase in units of cystatin C levels and ISS (the cut-off levels were 0.93 mg/L and ≥ 16, respectively) results in a 4.22- and 1.068-fold increase in mortality, respectively. CONCLUSION Cystatin C may represent an important severity-of-illness indicator, easily available to clinicians during the initial assessment of trauma victims on admission.
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Affiliation(s)
- Güldehen Özmen Şentürk
- Department of Emergency Medicine, Izmir Ataturk Research and Training Hospital, Izmir, Turkey
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Ozturk H, Yagmur Y, Ozturk H. The prognostic importance of serum IL-1beta, IL-6, IL-8 and TNF-alpha levels compared to trauma scoring systems for early mortality in children with blunt trauma. Pediatr Surg Int 2008; 24:235-9. [PMID: 18060414 DOI: 10.1007/s00383-007-2083-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2007] [Indexed: 01/15/2023]
Abstract
The purpose of the present study was to determine whether a correlation exits between the main trauma scoring systems and the activation of inflammatory cells and mediators such as interleukin-(IL-) 1beta, IL-6, IL-8 and tumor necrosis factor alpha (TNF-alpha) after trauma, and moreover to assess if any of these can be used to predict the outcome in patients under care at a trauma center. Forty-seven children (37 boys, 10 girls) presenting with blunt trauma, were evaluated by an analysis of the relationship between overall mortality and potential risk factors. Admission data, including serum IL-1beta, IL-6, IL-8, TNF-alpha, pediatric trauma score (PTS), and injury severity score (ISS), were collected and analyzed. In descriptive statistics for independent variables, some prognostic factors such as IL-8 (P = 0.04), and ISS (P = 0.004) were significant in their relationship to mortality. In the univariate statistical analysis some other risk factors such as IL-8 (P = 0.004), >20 TNF-alpha (P = 0.04), and ISS (P = 0.007) were significant in their relationship to mortality. The relative risk of developing mortality was higher than two for each of the following risk factors: >10 ages, >25 IL-6, 10-20 TNF-alpha, >20 TNF-alpha, PTS <or= 8, and ISS > 15. There was a positive correlation between IL-8 (r = 0.31, P = 0.33), ISS (r = 0.31, P = 0.0001), and mortality. There was also a correlation with ISS and IL-8 (r = 0.32, P = 0.02). ISS, and the serum IL-8 level are the most important determinants of clinical outcome in critically injured patients. A correlation exits between IL-8 and mortality and between ISS and IL-8.
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Affiliation(s)
- Hayrettin Ozturk
- Department of Pediatric Surgery, Medical School, Abant Izzet Baysal University, 14280 Bolu, Turkey.
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Abstract
OBJECTIVES To examine the nature, severity and outcomes of injuries sustained from ladder falls. DESIGN Retrospective survey of medical records. PATIENTS AND SETTING Patients who presented after a fall from a ladder to the emergency department of a tertiary hospital in Melbourne, Victoria, between January 1994 and December 1997. MAIN OUTCOME MEASURES Demographic characteristics; height and mechanism of fall; injury site and Injury Severity Score (ISS); rate of hospital admissions. RESULTS 163 patients presented after ladder falls. They were aged 2.5 to 86 years (mean age, 48 years); 83% were male, and 78% were injured in non-occupational settings. Almost half the accidents (43%) were caused by ladder instability (ladder sliding from position or tilting sideways). Most patients had mild or moderate injuries (usually of the extremities), but 13% had an ISS > or = 16 (indicating severe trauma), usually with head, chest or spinal injuries; 42% were admitted to hospital. Multiple regression analyses showed that ISS increased signficantly with height of fall and age (P< 0.05 for both), although a substantial amount of variation was not attributable to these variables. Likelihood of hospital admission increased linearly with increasing ISS to an ISS of 8 and remained high thereafter. CONCLUSIONS Ladder falls resulted in significant morbidity, with men undertaking non-occupational activities comprising most of those injured. New strategies to encourage safe ladder use are needed.
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Affiliation(s)
- S Tsipouras
- Emergency Department, Austin and Repatriation Medical Centre, Melbourne, VIC
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