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Fischer P, Abendschein R, Berberich M, Grundgeiger T, Meybohm P, Smul T, Happel O. Improved recall of handover information in a simulated emergency - A randomised controlled trial. Resusc Plus 2024; 18:100612. [PMID: 38590446 PMCID: PMC11000158 DOI: 10.1016/j.resplu.2024.100612] [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: 01/27/2024] [Revised: 02/25/2024] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
Background Handovers during medical emergencies are challenging due to time-critical, dynamic and oftentimes unorderly and distracting situations. We evaluated the effect of distraction-reduced clinical surroundings during handover on (1) the recall of handover information, (2) the recall of information from the surroundings and (3) self-reported workload in a simulated in-hospital cardiac arrest scenario. Methods In a parallel group design, emergency team leaders were randomly assigned to receive a structured handover of a cardio-pulmonary resuscitation (CPR) either inside the room ("inside group") right next to the ongoing CPR or in front of the room ("outside group") with no audio-visual distractions from the ongoing CPR. Based on the concept of situation awareness, the primary outcome was a handover score for the content of the handover (0-19 points) derived from the pieces of information given during handover. Furthermore, we assessed team leaders' perception of their surroundings during the scenario (0-5 points) and they rated their subjective workload using the NASA Task Load Index. Results The outside group (n = 30) showed significant better recall of handover information than the inside group (n = 30; mean difference = 1.86, 95% CI = 0.67 to 3.06, p = 0.003). The perception of the surroundings (n = 60; mean difference = -0.27, 95% CI = -0.85 to 0.32, p = 0.365) and the NASA Task Load Index (n = 58; mean difference = 1.1; p = 0.112) did not differ between the groups. Conclusions Concerning in-hospital emergencies, a structured handover in a distraction reduced environment can improve information uptake of the team leader.
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Affiliation(s)
- Paul Fischer
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Robin Abendschein
- Julius-Maximilians-Universität Würzburg, Institute Human-Computer-Media, Oswald-Külpe-Weg 82, 97074 Würzburg, Germany
| | - Monika Berberich
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Tobias Grundgeiger
- Julius-Maximilians-Universität Würzburg, Institute Human-Computer-Media, Oswald-Külpe-Weg 82, 97074 Würzburg, Germany
| | - Patrick Meybohm
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Thorsten Smul
- Department of Anaesthesiology and Critical Care, Hospital of Passau, Innstraße 76 94032 Passau, Germany
| | - Oliver Happel
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
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Tan JYH, Tan JH, Tan SHS, Shen L, Loo LMA, Iau P, Murphy DP, O’Neill GK. Epidemiology and estimated economic impact of musculoskeletal injuries in polytrauma patients in a level one trauma centre in Singapore. Singapore Med J 2023; 64:732-738. [PMID: 35739075 PMCID: PMC10775301 DOI: 10.11622/smedj.2022081] [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: 07/26/2018] [Accepted: 06/21/2020] [Indexed: 11/18/2022]
Abstract
Introduction Musculoskeletal injuries are the most common reason for surgical intervention in polytrauma patients. Methods This is a retrospective cohort study of 560 polytrauma patients (injury severity score [ISS] >17) who suffered musculoskeletal injuries (ISS >2) from 2011 to 2015 in National University Hospital, Singapore. Results 560 patients (444 [79.3%] male and 116 [20.7%] female) were identified. The mean age was 44 (range 3-90) years, with 45.4% aged 21-40 years. 39.3% of the patients were foreign migrant workers. Motorcyclists were involved in 63% of road traffic accidents. The mean length of hospital stay was 18.8 (range 0-273) days and the mean duration of intensive care unit (ICU) stay was 5.7 (range 0-253) days. Patient mortality rate was 19.8%. A Glasgow Coma Scale (GCS) score <12 and need for blood transfusion were predictive of patient mortality (p < 0.05); lower limb injuries, road traffic accidents, GCS score <8 and need for transfusion were predictive of extended hospital stay (p < 0.05); and reduced GCS score, need for blood transfusion and upper limb musculoskeletal injuries were predictive of extended ICU stay. Inpatient costs were significantly higher for foreign workers and greatly exceeded the minimum insurance coverage currently required. Conclusion Musculoskeletal injuries in polytrauma remain a significant cause of morbidity and mortality, and occur predominantly in economically productive male patients injured in road traffic accidents and falls from height. Increasing insurance coverage for foreign workers in high-risk jobs should be evaluated.
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Affiliation(s)
- Joel Yong Hao Tan
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Jiong Hao Tan
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Si Heng Sharon Tan
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lynette Mee-Ann Loo
- University Surgical Cluster, Division of General Surgery, National University Health System, Singapore
| | - Philip Iau
- University Surgical Cluster, Division of General Surgery, National University Health System, Singapore
| | - Diarmuid Paul Murphy
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Gavin Kane O’Neill
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
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Gyedu A, Stewart BT, Nakua E, Donkor P. Standardized trauma intake form with clinical decision support prompts improves care and reduces mortality for seriously injured patients in non-tertiary hospitals in Ghana: stepped-wedge cluster randomized trial. Br J Surg 2023; 110:1473-1481. [PMID: 37612450 PMCID: PMC10564400 DOI: 10.1093/bjs/znad253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/22/2023] [Accepted: 07/23/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND The WHO Trauma Care Checklist improved key performance indicators (KPIs) of trauma care at tertiary hospitals. A standardized trauma intake form (TIF) with real-time clinical decision support prompts was developed by adapting the WHO Trauma Care Checklist for use in smaller low- and middle-income country hospitals, where care is delivered by non-specialized providers and without trauma teams. This study aimed to determine the effectiveness of the TIF for improving KPIs in initial trauma care and reducing mortality at non-tertiary hospitals in Ghana. METHODS A stepped-wedge cluster randomized trial was conducted by stationing research assistants at emergency units of eight non-tertiary hospitals for 17.5 months to observe management of injured patients before and after introduction of the TIF. Differences in performance of KPIs in trauma care (primary outcomes) and mortality (secondary outcome) were estimated using generalized linear mixed regression models. RESULTS Management of 4077 injured patients was observed (2067 before TIF introduction, 2010 after). There was improvement in 14 of 16 primary survey and initial care KPIs after TIF introduction. Airway assessment increased from 72.9 to 98.4 per cent (adjusted OR 25.27, 95 per cent c.i. 2.47 to 258.94; P = 0.006) and breathing assessment from 62.1 to 96.8 per cent (adjusted OR 38.38, 4.84 to 304.69; P = 0.001). Documentation of important clinical data improved from 52.4 to 76.7 per cent (adjusted OR 2.14, 1.17 to 3.89; P = 0.013). The mortality rate decreased from 17.7 to 12.1 per cent among 302 patients (186 before, 116 after) with impaired physiology on arrival (hypotension or decreased level of consciousness) (adjusted OR 0.10, 0.02 to 0.56; P = 0.009). CONCLUSION The TIF improved overall initial trauma care and reduced mortality for more seriously injured patients. REGISTRATION NUMBER NCT04547192 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Surgery Unit, University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Emmanuel Nakua
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Peter Donkor
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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O'Neill K, Powell M, Lovell T, Brown D, Walsham J, Calleja P, Nielsen S, Mitchell M. Improving the handover of complex trauma patients by implementing a standardised process. Aust Crit Care 2023; 36:799-805. [PMID: 36621344 DOI: 10.1016/j.aucc.2022.10.020] [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: 08/01/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Patient handover continues to be an international health priority in the prevention of patient harm. Transitioning patients from the intensive care unit (ICU) to the ward is complex, particularly for trauma patients, due to the multifaceted aspects of their care requirements as a result of multiple injuries and different speciality teams. OBJECTIVES/AIM To design, implement, and evaluate the efficacy of a standardised handover process and tool for the transfer of ICU trauma patients. METHODS A multimethod before/after study design was used. This included observations before and after an implemented transfer process and semistructured interviews with ICU and ward nurses caring for trauma patients. Comparisons were made of data before and after the intervention. RESULTS Eleven patient handovers were observed, and 21 nurses (11 from the ICU and 10 from the ward) were interviewed. Patients and family members were included during the handover following the intervention (n = 0/10 [0%] vs n = 4/11 [36%]) and the ward nurses were asked if they had any concerns (n = 5/10 [50%] vs n = 10/11 [91%]). Improvements in patient observations handed over were reported following the intervention. However, omissions remained in some key areas including patient introduction, patient identity, fluid balance, and allergies/alerts. Thematic analysis of interviews revealed that the new handover process was perceived advantageous by both ICU and ward nurses because of its structured and comprehensive approach. Identified future improvements included the need for hospital service managers to ensure integration of ICU and ward electronic health record systems. CONCLUSION Precise, accurate, and complete handover remains a patient safety concern. Improvements were achieved using a standardised process and handover tool for the transfer of complex trauma patients. Further improvements are required to reduce the failure to hand over essential patient information.
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Affiliation(s)
- Kylie O'Neill
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia.
| | - Madeleine Powell
- School of Population Health, University of New South Wales, Sydney, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Tania Lovell
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia
| | - Duncan Brown
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia
| | - James Walsham
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Pauline Calleja
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Queensland, Australia; School of Nursing & Midwifery, Griffith University, Queensland, Australia
| | - Sue Nielsen
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia
| | - Marion Mitchell
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Hospital Health Service, Queensland, Australia; School of Nursing & Midwifery, Griffith University, Queensland, Australia; Patient Centred Health Services, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Rama EI, Adeosun JF, Thahir A, Krkovic M. Perioperative Management of Incidental Pulmonary Embolisms on Trauma CT Scans: A Narrative Review. Cureus 2023; 15:e34469. [PMID: 36874718 PMCID: PMC9981238 DOI: 10.7759/cureus.34469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Unsuspected pulmonary embolism (PE) may be identified on an initial trauma computed tomography (CT) scan. The clinical importance of these incidental PEs remains to be elucidated. In patients who require surgery, careful management is needed. We sought to investigate the optimal perioperative management of such patients, including the use of pharmacological and mechanical thromboprophylaxis, possible thrombolytic therapy, and inferior vena cava (IVC) filters. A literature search was conducted, and all relevant articles were identified, investigated, and included. Medical guidelines were also consulted where appropriate. Pharmacological thromboprophylaxis is the mainstay of preoperative treatment, and low-molecular-weight heparins, fondaparinux, and unfractionated heparin may all be used. It has been suggested that prophylaxis should be administered as soon as possible after trauma. Such agents may be contraindicated in patients with significant bleeding, and mechanical prophylaxis and inferior vena cava filters may be favoured in these patients. Therapeutic anticoagulation and thrombolytic therapies may be considered but are associated with an increased risk of haemorrhage. Delaying surgery might help to minimise the risk of recurrent venous thromboembolism, and any interruption of prophylaxis must be strategically planned. Recommendations for postoperative care include a continuation of prophylaxis and therapeutic anticoagulation, with follow-up clinical evaluation within six months. Incidental PE is a common finding on trauma CT scans. Although the clinical significance is unknown, careful management of the balance between anticoagulation and bleeding is needed, especially in trauma patients and even more so in trauma patients requiring surgery.
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Affiliation(s)
- Essam I Rama
- School of Clinical Medicine, University of Cambridge, Cambridge, GBR
| | - James F Adeosun
- School of Clinical Medicine, University of Cambridge, Cambridge, GBR
| | - Azeem Thahir
- Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
| | - Matija Krkovic
- Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
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Du Z, Wang Z, Guo F, Wang T. Dynamic structures and emerging trends in the management of major trauma: A bibliometric analysis of publications between 2012 and 2021. Front Public Health 2022; 10:1017817. [PMID: 36388390 PMCID: PMC9663840 DOI: 10.3389/fpubh.2022.1017817] [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: 08/12/2022] [Accepted: 10/17/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Major trauma is currently a global public health issue with a massive impact on health at both the individual and population levels. However, there are limited bibliometric analyses on the management of major trauma. Thus, in this study we aimed to identify global research trends, dynamic structures, and scientific frontiers in the management of major trauma between 2012 and 2021. Methods We searched the Web of Science Core Collection to access articles and reviews concerning the management of major traumas and conducted a bibliometric analysis using CiteSpace. Results Overall, 2,585 studies were screened and published by 403 institutions from 110 countries/regions. The most productive country and institution in this field of research were the USA and Monash University, respectively. Rolf Lefering was the most prolific researcher and Holcomb JB had the most co-citations. Injury published the highest number of articles, and the Journal of Trauma was the most co-cited journal. A dual-map overlay of the literature showed that the articles of most publications were confined to the areas of medicine/medical/clinical and neurology/sports/ophthalmology. Document clustering indicated severe traumatic brain injury, traumatic coagulopathy, and resuscitative endovascular balloon occlusion as the recent hot topics. The most recent burst keywords were "trauma management," "neurocritical care," "injury severity," and "emergency medical services." Conclusion The dynamic structures and emerging trends in the management of major trauma were extensively analyzed using CiteSpace, a visualization software. Based on the analysis, the following research hotspots emerged: management of severe traumatic brain injury and massive hemorrhage, neurocritical care, injury severity, and emergency medical service. Our findings provide pertinent information for future research and contribute toward policy making in this field.
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Juárez-Vela R, García-Erce JA, Gea-Caballero V, Ruiz de Viñaspre-Hernandez R, Santos-Sánchez JÁ, Sánchez-González JL, Andrés-Esteban EM, Czapla M, Tejada CI, Nanwani-Nanwani KL, Serrano-Lázaro A, Quintana-Díaz M. A Cohort Study in Intensive Care Units: Health Decisions Related to Blood Transfusion during the COVID-19 Pandemic. J Clin Med 2022; 11:jcm11154396. [PMID: 35956012 PMCID: PMC9368991 DOI: 10.3390/jcm11154396] [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: 06/09/2022] [Revised: 07/05/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Critically ill polytrauma patients with hemorrhage require a rapid assessment to initiate hemostatic resuscitation in the shortest possible time with the activation of a massive transfusion or a critical hemorrhage management protocol. The hospital reality experienced during the COVID-19 pandemic in all countries was critical, as it was in Spain; according to the data published daily by the Ministry of Health on its website, during the period of this study, the occupancy rate of intensive care units (ICUs) by patients diagnosed with the novel coronavirus disease (COVID-19) rose to 23.09% in Spain, even reaching 45.23% at the end of January 2021. We aimed to analyze the changes observed during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic period regarding the effectiveness of Spanish ICUs in terms of mortality reduction. We present a cross-sectional study that compares two cohorts of patients admitted to ICUs across all autonomous communities of Spain with a diagnosis of polytrauma. Results: Only age was slightly higher at admission during the first wave of the pandemic (47.74 ± 18.65 vs. 41.42 ± 18.82 years, p = 0.014). The transfusion rate during the pandemic increased by 10.4% compared to the previous stage (p = 0.058). Regarding hemostatic components, the use of tranexamic acid increased from 1.8% to 10.7% and fibrinogen concentrates from 0.9% to 1.9%. In the case of prothrombin complex concentrates, although there was a slight increase in their use, there were no significant differences during the pandemic compared to the previous period. Conclusion: Mortality showed no difference before and during the pandemic, despite the observed change in the transfusion policy. In summary, the immediate and global implementation of patient blood management (PBM) based on clinical transfusion algorithms should be mandatory in all hospitals in our country.
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Affiliation(s)
- Raúl Juárez-Vela
- Doctoral Program in Medicine and Surgery, Faculty of Medicine, Autonomous University of Madrid, 28049 Madrid, Spain; (R.J.-V.); (M.Q.-D.)
- Research Group in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, C/Duquesa Victoria 88, 26006 Logrono, Spain; (R.R.d.V.-H.); (M.C.); (C.I.T.)
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
| | - José Antonio García-Erce
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- Bank of Blood and Tissue of Navarra, Government of Navarra, 31008 Pamplona, Spain
- Correspondence:
| | - Vicente Gea-Caballero
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- Faculty of Health Sciences, Valencian International University, 46002 Valencia, Spain
| | - Regina Ruiz de Viñaspre-Hernandez
- Research Group in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, C/Duquesa Victoria 88, 26006 Logrono, Spain; (R.R.d.V.-H.); (M.C.); (C.I.T.)
| | - José Ángel Santos-Sánchez
- Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain;
- Salamanca Hospital Complex, 37008 Salamanca, Spain
| | | | - Eva María Andrés-Esteban
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- Department of Business Economics and Applied Economy, Faculty of Legal and Economic Sciences, University Rey Juan Carlos, 28032 Madrid, Spain
| | - Michał Czapla
- Research Group in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, C/Duquesa Victoria 88, 26006 Logrono, Spain; (R.R.d.V.-H.); (M.C.); (C.I.T.)
- Department of Emergency Medical Service, Wroclaw Medical University, 51-616 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
| | - Clara Isabel Tejada
- Research Group in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, C/Duquesa Victoria 88, 26006 Logrono, Spain; (R.R.d.V.-H.); (M.C.); (C.I.T.)
| | - Kapil Laxman Nanwani-Nanwani
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- La Paz Hospital Intensive Care Unit, 28046 Madrid, Spain
| | - Ainhoa Serrano-Lázaro
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- Intensive Care Unit, Hospital Clinico de Valencia, 46010 Valencia, Spain
| | - Manuel Quintana-Díaz
- Doctoral Program in Medicine and Surgery, Faculty of Medicine, Autonomous University of Madrid, 28049 Madrid, Spain; (R.J.-V.); (M.Q.-D.)
- Blood Management Patient Group, Research Institute Idi-Paz, 28046 Madrid, Spain; (V.G.-C.); (E.M.A.-E.); (K.L.N.-N.); (A.S.-L.)
- La Paz Hospital Intensive Care Unit, 28046 Madrid, Spain
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Chowdhury S, Almarhabi M, Varghese B, Leenen L. Trauma Resuscitation Training: An Evaluation of Nurses' Knowledge. J Trauma Nurs 2022; 29:192-200. [PMID: 35802054 DOI: 10.1097/jtn.0000000000000661] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Trauma resuscitation in the emergency department involves coordinated, well-equipped, and trained health care providers to make essential, prudent, and expedient management decisions. During resuscitation, health care providers' knowledge and skills are critical in minimizing the potential risks of mortality and morbidity. OBJECTIVE This study aimed to evaluate the impact of training on nurses' knowledge and confidence regarding trauma resuscitation and whether there was any difference between participants with and without previous trauma training. METHODS This study used a pre- and posttraining test study design to evaluate the effects of an intensive 8-hr trauma resuscitation training program on nurses' knowledge from January 2018 to August 2021. The training program consisted of lectures and patient scenarios covering initial assessment, resuscitation, and management priorities for trauma patients in life-threatening situations, stressing the principles of the trauma team approach. RESULTS A total of 128 nurses participated in 16 courses conducted during the study period. This study found significant improvement in nurses' knowledge after the training (pre- and posttraining median [interquartile range, IQR] test scores 5 [4-6] vs. 9 [8-9], p < .001). There was no significant difference in pretraining test scores between the participants with previous trauma training and those without training (median [IQR] test scores 5 [4-6] vs. 4 [4-5], p = .751). CONCLUSIONS Trauma resuscitation training affects nurses' knowledge improvement, emphasizing the need for training trauma care professionals to provide adequate care.
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Affiliation(s)
- Sharfuddin Chowdhury
- Trauma Center, King Saud Medical City, Riyadh, Saudi Arabia (Dr Chowdhury and Ms Varghese); Emergency and Critical Care Nursing, Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia (Ms Almarhabi); and Department of Trauma, University Medical Center Utrecht, Utrecht, the Netherlands (Dr Leenen)
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Gyedu A, Quainoo E, Nakua E, Donkor P, Mock C. Achievement of Key Performance Indicators in Initial Assessment and Care of Injured Patients in Ghanaian Non-tertiary Hospitals: An Observational Study. World J Surg 2022; 46:1288-1299. [PMID: 35286419 PMCID: PMC9058212 DOI: 10.1007/s00268-022-06507-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION We aimed to determine the level of achievement of key performance indicators (KPIs) during initial assessment and management of injured persons, as assessed by independent observers, at district and regional hospitals in Ghana. METHODS Trained observers were stationed at emergency units of six district (first level) and two regional (referral) hospitals, from October 2020 to February 2021, to observe management of injured patients by health service providers. Achievement of KPIs was assessed for all injured patients and for seriously injured patients (admitted for ≥ 24 h, referred, or died). RESULTS Management of 1006 injured patients was observed. Road traffic crash was the most common mechanism (63%). Completion of initial triage ranged from 65% for oxygen saturation to 92% for mobility assessment. For primary survey, airway was assessed in 77% of patients, chest examination performed in 66%, and internal abdominal bleeding assessed in 43%. Reassessment rates were low, ranging from 16% for respiratory rate to 23% for level of consciousness. Thirty-one percent of patients were seriously injured. Completion of KPIs was higher for these patients, but reassessment remained low, ranging from 25% for respiratory rate to 33% for level of consciousness. CONCLUSION KPIs were performed at a high level, but several specific elements should be performed more frequently, such as oxygen saturation and assessment for internal abdominal bleeding. Reassessment needs to be performed more frequently, especially for seriously injured patients. Overall, care for the injured at non-tertiary hospitals in Ghana could be improved with a more systematic approach.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, KNUST, Private Mail Bag, University Post Office, Kumasi, Ghana.
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Emmanuel Quainoo
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Nakua
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah, Kumasi, Ghana
| | - Peter Donkor
- Department of Surgery, School of Medicine and Dentistry, KNUST, Private Mail Bag, University Post Office, Kumasi, Ghana
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle, WA, USA
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Ghafil C, Matsushima K, Chiba H, Wu R, Shin H, Menchine M, Inaba K. Trauma Computed Tomography in the Modern Era: Not Always Quick and Safe. Am Surg 2021; 87:1690-1695. [PMID: 34780304 DOI: 10.1177/00031348211061330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Computed tomography (CT) has emerged as the diagnostic modality of choice in trauma patients. Recent studies suggest its use in hemodynamically unstable patients is safe and potentially lifesaving; however, the incidence of adverse events (AE) during the trauma CT scanning process remains unknown. STUDY DESIGN Over a 6-month period at a Level 1 trauma center, data on patients undergoing trauma CT (whole-body CT (WBCT) +/- additional CT studies) were prospectively collected. All patients requiring a trauma team activation (TTA) were included. Adverse events and specific time intervals were recorded from the time of TTA notification to the time of return to the resuscitation bay from the CT suite. RESULTS Of the 94 consecutive patients included in the study, 47.9% experienced 1 or more AE. Median duration away from the resuscitation bay for all patients was 24 minutes. Patients with AE spent a significantly longer time away from the resuscitation bay and had longer scan times. Vasopressor support and ongoing transfusion requirement at the time of CT scanning were associated with AE. CONCLUSION Adverse events of varying clinical significance occur frequently in patients undergoing emergent trauma CT. A standard trauma CT protocol could improve the efficiency and safety of the scanning process.
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Affiliation(s)
- Cameron Ghafil
- Division of Acute Care Surgery, 23336LAC+USC Medical Center, Los Angeles, CA, USA
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, 23336LAC+USC Medical Center, Los Angeles, CA, USA
| | - Hiroto Chiba
- Division of Acute Care Surgery, 23336LAC+USC Medical Center, Los Angeles, CA, USA
| | - Renqing Wu
- Division of Acute Care Surgery, 23336LAC+USC Medical Center, Los Angeles, CA, USA
| | - Heeseop Shin
- Department of Radiology, 23336LAC+USC Medical Center, Los Angeles, CA, USA
| | - Michael Menchine
- Department of Emergency Medicine, 23336LAC+USC Medical Center, Los Angeles, CA, USA
| | - Kenji Inaba
- Division of Acute Care Surgery, 23336LAC+USC Medical Center, Los Angeles, CA, USA
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Viola L, Lagazzi E, Ballardini G, Drogo A, Bonetti M, Marrone E, Chirico M, Ricci S. Design of a system to detect the force applied by tourniquets in a manikin's limb. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:5019-5022. [PMID: 34892334 DOI: 10.1109/embc46164.2021.9631020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Massive hemorrhage remains the number one cause of preventable death in trauma worldwide. However, immediate intervention by a bystander can significantly improve the survival of the injured person. In this context, the tourniquets represent the most quick and effective devices for stopping arterial and venous blood flow. The aim of this study was to implement a system to detect the force applied by a tourniquet on a simulated limb, without blood flow. The system we designed is characterized by four low-cost force sensing resistors placed on each lower limb of a manikin, below the groin. Tests on 21 tourniquets, revealed that our system is able to detect the force applied for 60 minutes, also discriminating between turns. Hence, this system can be used to compare the performance of different types of devices, but also to assess proper tourniquet placement in trainees and trauma care providers, thus making it a versatile low-cost device.
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12
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Chance TC, Wu X, Keesee JD, Garcia-Marcano J, Salgado CL, Liu B, Moseley JJ, Peck KA, R-Borlado L, Atai NA, Gould SJ, Marban LS, Cap AP, Rathbone CR, Bynum JA. Extracellular vesicles derived from cardiosphere-derived cells as a potential antishock therapeutic. J Trauma Acute Care Surg 2021; 91:S81-S88. [PMID: 34108422 DOI: 10.1097/ta.0000000000003218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Extracellular vesicles (EVs) isolated from cardiosphere-derived cells (CDC-EVs) are coming to light as a unique cell-free therapeutic. Because of their novelty, however, there still exist prominent gaps in knowledge regarding their therapeutic potential. Herein the therapeutic potential of CDC-EVs in a rat model of acute traumatic coagulopathy induced by multiple injuries and hemorrhagic shock is outlined. METHODS Extracellular vesicle surface expression of procoagulant molecules (tissue factor and phosphatidylserine) was evaluated by flow cytometry. Extracellular vesicle thrombogenicity was tested using calibrated thrombogram, and clotting parameters were assessed using a flow-based adhesion model simulating blood flow over a collagen-expressing surface. The therapeutic efficacy of EVs was then determined in a rat model of acute traumatic coagulopathy induced by multiple injuries and hemorrhagic shock. RESULTS Extracellular vesicles isolated from cardiosphere-derived cells are not functionally procoagulant and do not interfere with platelet function. In a rat model of multiple injuries and hemorrhagic shock, early administration of EVs significantly reduced the elevation of lactate and creatinine and did not significantly enhance coagulopathy in rats with acute traumatic coagulopathy. CONCLUSION The results of this study are of great relevance to the development of EV products for use in combat casualty care, as our studies show that CDC-EVs have the potential to be an antishock therapeutic if administered early. These results demonstrate that research using CDC-EVs in trauma care needs to be considered and expanded beyond their reported cardioprotective benefits.
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Affiliation(s)
- Tiffani C Chance
- From the Coagulation and Blood Research (Blood) (T.C.C., X.W., J.D.K., J.G.-M., C.L.S., B.L., A.P.C., J.A.B.), United States Army Institute of Surgical Research, San Antonio, Texas; Capricor Therapeutics Institute (J.J.M., K.A.P., L.R.-B., N.A.A., L.S.M.), Beverly Hills, California; Department of Biological Chemistry (S.J.G.), Johns Hopkins, Baltimore, Maryland; and Department of Biomedical Engineering (C.R.R.), The University of Texas at San Antonio, San Antonio, Texas
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Way TL, Tarrant SM, Balogh ZJ. Social restrictions during
COVID
‐19 and major trauma volume at a level 1 trauma centre. Med J Aust 2021; 214:38-39. [DOI: 10.5694/mja2.50843] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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14
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Almarhabi M, Cornish J, Lee G. The effectiveness of educational interventions on trauma intensive care unit nurses' competence: A systematic review and meta-analysis. Intensive Crit Care Nurs 2020; 64:102931. [PMID: 32950377 DOI: 10.1016/j.iccn.2020.102931] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/02/2020] [Accepted: 08/11/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To examine the current evidence on the effect of education on intensive care unit nurses' knowledge and skills competence in caring for adult major trauma patients. METHODOLOGY A systematic review and meta-analysis was conducted to identify relevant studies through a comprehensive search, following strict eligibility criteria. Five databases were searched: MEDLINE, PubMed, CINAHL, Cochrane and Web of Science. A subsequent hand search was performed. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tool was used to assess methodological quality. RESULTS Five eligible quantitative studies were identified and appraised. The overall results demonstrated that educational interventions have positive effects in improving intensive care nurses' knowledge and practice in managing major trauma patients. Meta-analysis was applied to three homogenous studies relating to knowledge outcome. Results demonstrated significant improvements immediately post-intervention and at one-to three-month follow-up [MD (mean difference) = 29.12, 95%CI (confidence interval) 10.29-47.95; P < 0.00001], and [MD = 23.70, 95%CI 8.84-38.56; P < 0.00001], respectively. A slight decrease in the knowledge and practice scores was noted from one- to three-month follow-up. CONCLUSION This review demonstrated the significant effects of trauma education on improving intensive care nurses' knowledge and practices. Further research should develop valid competencies and policies to drive nurses' practice and potentially improve the safety and quality of care.
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Affiliation(s)
- Maha Almarhabi
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK; Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Jocelyn Cornish
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
| | - Geraldine Lee
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
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Alharbi RJ, Lewis V, Mosley I, Miller C. Current trauma care system in Saudi Arabia: A scoping literature review. ACCIDENT; ANALYSIS AND PREVENTION 2020; 144:105653. [PMID: 32629227 DOI: 10.1016/j.aap.2020.105653] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 05/04/2020] [Accepted: 06/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Trauma is one of the leading causes of death worldwide with millions of people dying each year, particularly in low or middle-income countries. This paper describes and evaluates the current trauma system (TS) in Saudi Arabia (SA). METHODS A scoping literature review was performed, incorporating an extensive search of Medline and Embase databases for refereed literature, as well as a search of grey literature to locate unpublished articles or reports in English or Arabic. All publications were assessed against the World Health Organization (WHO) Trauma System Maturity Index (TSMI) and American College of Surgeon's (ACS) criteria. RESULTS Despite local injury prevention efforts, Motor Vehicle Crashes (MVC) remain the primary cause of injuries in SA. Prehospital trauma care in SA aligns with level III care as described in the WHO TSMI classification system, based on the presence of formal emergency medical services and universal access to care. With respect to the ACS classification, no clear written guidelines, either for field triage or trauma destination protocols such as trauma bypass, were identified in prehospital trauma care. The role of secondary and tertiary facilities in treating trauma patients is unclear, with no clear referral linkages, suggesting a level I to III grading of SA's trauma care facilities. Currently, there is no national or regional electronic trauma registry, no quality assurance program, and active involvement in research projects related to injuries is limited. CONCLUSION The current SA TS has strengths but there are key features missing in comparison to other systems globally. As MVCs remain a leading cause of death/ disability, efforts to reduce the prevalence and impact of MVC burden in SA through development of a stronger national TS are warranted.
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Affiliation(s)
- Rayan Jafnan Alharbi
- Alfred Health Clinical School, La Trobe University, Prahran, Victoria, Australia; Department of Emergency Medical Service, Jazan University, Jazan, Saudi Arabia.
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, School of Nursing & Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Ian Mosley
- School of Nursing & Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Charne Miller
- Alfred Health Clinical School, La Trobe University, Prahran, Victoria, Australia
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Kippnich M, Schorscher N, Kredel M, Markus C, Eden L, Gassenmaier T, Lock J, Wurmb T. Dual-room twin-CT scanner in multiple trauma care: first results after implementation in a level one trauma centre. Eur J Trauma Emerg Surg 2020; 47:1847-1852. [PMID: 32335685 PMCID: PMC7223892 DOI: 10.1007/s00068-020-01374-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/10/2020] [Indexed: 11/24/2022]
Abstract
Purpose The trauma centre of the Wuerzburg University Hospital has integrated a pioneering dual-room twin-CT scanner in a multiple trauma pathway. For concurrent treatment of two trauma patients, two carbon CT examination and intervention tables are positioned head to head with one sliding CT-Gantry in the middle. The focus of this study is the process of trauma care with the time to CT (tCT) and the time to operation (tOR) as quality indicator. Methods All patients with suspected multiple trauma, who required emergency surgery and who were initially diagnosed by the CT trauma protocol between 05/2018 and 12/2018 were included. Data relating to time spans (tCT and tOR), severity of injury and outcome was obtained. Results 110 of the 589 screened trauma patients had surgery immediately after finishing primary assessment in the ER. The ISS was 17 (9–34) (median and interquartile range, IQR). tCT was 15 (11–19) minutes (median and IQR) and tOR was 96.5 (75–119) minutes (median and IQR). In the first 30 days, seven patients died (6.4%) including two within the first 24 h (2%). There were two ICU days (1–6) (median and IQR) and one (0–1) (median and IQR) ventilator day. Conclusion The twin-CT technology is a fascinating tool to organize high-quality trauma care for two multiple trauma patients simultaneously.
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Affiliation(s)
- Maximilian Kippnich
- Department of Anesthesia and Critical Care, Subsection Emergency- and Disaster Relief Medicine, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Würzburg, Germany.
| | - Nora Schorscher
- Department of Anesthesia and Critical Care, Subsection Emergency- and Disaster Relief Medicine, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Würzburg, Germany
| | - Markus Kredel
- Department of Anesthesia and Critical Care, University Hospital of Wuerzburg, Würzburg, Germany
| | - Christian Markus
- Department of Anesthesia and Critical Care, University Hospital of Wuerzburg, Würzburg, Germany
| | - Lars Eden
- Department of Trauma Surgery, University Hospital of Wuerzburg, Würzburg, Germany
| | - Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany
| | - Johann Lock
- Department of General and Visceral Surgery, University Hospital of Wuerzburg, Würzburg, Germany
| | - Thomas Wurmb
- Department of Anesthesia and Critical Care, Subsection Emergency- and Disaster Relief Medicine, University Hospital of Wuerzburg, Oberduerrbacherstrasse 6, 97080, Würzburg, Germany
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Rollo G, Falzarano G, Ronga M, Bisaccia M, Grubor P, Erasmo R, Rocca G, Tomé-Bermejo F, Gómez-Garrido D, Pichierri P, Rinonapoli G, Meccariello L. Challenges in the management of floating knee injuries: Results of treatment and outcomes of 224 consecutive cases in 10 years. Injury 2019; 50 Suppl 4:S30-S38. [PMID: 30910244 DOI: 10.1016/j.injury.2019.03.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 12/01/2018] [Accepted: 12/04/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Floating knee is a flail knee joint resulting from fractures of the shafts or adjacent metaphyses of the femur and the ipsilateral tibia. It is usually associated with several complications and mortality. This study was designed to present our experience with the treatment of this injury. MATERIAL AND METHOD This study was performed between January 2004 and December 2014. 224 cases of floating knee injuries gathered from the 34,480 lower extremities trauma files were studied, and the target information recorded. The injuries most frequently occurred in subjects between 16 and 35 years of age (60.71%), and in male subjects (85.71%). The most frequent mechanism of injury was traffic accident (92.85%). External fixation was the common type of treatment (82.14%) in emergency or as a definitive treatment. The treatment was performed within 24 h of the trauma. We performed a 36-month follow up with clinical examination, radiographs, assessing the complications, and using the Modified Cincinnati Rating System Questionnaire (MCRSQ) and the Karlström/Olerud Score (KOS) to evaluate the progression of the outcomes. RESULTS Early complications included 8 cases of compartment syndrome, 60 open fractures and 24 partially amputated limbs. A total amputation was performed in 3 patients. The most common late complication was heterotopic calcifications of the knee (n = 68, 30.6%). Good scores for MCRSQ and KOS were obtained only after patients were sent to a reference center for knee surgery. CONCLUSIONS Our experience revealed that the complication rate associated with floatingknee injuries remains high, regardless of the performed treatment. Surgeons should focus on reducing complications while treating these severe injuries.
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Affiliation(s)
- Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Gabriele Falzarano
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Gaetano Rummo", Benevento, Italy
| | - Mario Ronga
- Department of Medicine and Health Sciences 'Vincenzo Tiberio' University of Molise, Campobasso, Italy
| | - Michele Bisaccia
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Santa Maria della Misericordia", Perugia, Italy
| | - Predrag Grubor
- Clinic of Traumatology, University Hospital Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Rocco Erasmo
- Department of Orthopedics and Traumatology, Santo Spirito Hospital, Pescara, Italy
| | - Guido Rocca
- Department of Orthopedics and Traumatology, Trauma Center "Pietro Cosma", Camposampiero, PD, Italy
| | - Felix Tomé-Bermejo
- Orthopaedic and Traumatology Unit, Hospital General de Villalba, Madrid, Spain
| | - David Gómez-Garrido
- Orthopaedic and Traumatology Unit, Hospital General de Villalba, Madrid, Spain
| | - Paolo Pichierri
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Giuseppe Rinonapoli
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Santa Maria della Misericordia", Perugia, Italy
| | - Luigi Meccariello
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
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Kosola J, Brinck T, Leppäniemi A, Handolin L. Blunt Abdominal Trauma in a European Trauma Setting: Need for Complex or Non-Complex Skills in Emergency Laparotomy. Scand J Surg 2019; 109:89-95. [PMID: 30782110 DOI: 10.1177/1457496919828244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Blunt abdominal trauma can lead to substantial organ injury and hemorrhage necessitating open abdominal surgery. Currently, the trend in surgeon training is shifting away from general surgery and the surgical treatment of blunt abdominal trauma patients is often done by sub-specialized surgeons. The aim of this study was to identify what emergency procedures are needed after blunt abdominal trauma and whether they can be performed with the skill set of a general surgeon. MATERIALS AND METHODS The records of blunt abdominal trauma patients requiring emergency laparotomy (n = 100) over the period 2006-2016 (Helsinki University Hospital Trauma Registry) were reviewed. The organ injuries and the complexity of the procedures were evaluated. RESULTS A total of 89 patients (no need for complex skills, NCS) were treated with the skill set of general surgeons while 11 patients required complex skills. Complex skills patients were more severely injured (New Injury Severity Score 56.4 vs 35.9, p < 0.001) and had a lower systolic blood pressure (mean: 89 vs 112, p = 0.044) and higher mean shock index (heart rate/systolic blood pressure: 1.43 vs 0.95, p = 0.012) on admission compared with NCS patients. The top three NCS procedures were splenectomy (n = 33), bowel repair (n = 31), and urinary bladder repair (n = 16). In patients requiring a complex procedure (CS), the bleeding site was the liver (n = 7) or a major blood vessel (n = 4). CONCLUSION The majority of patients requiring emergency laparotomy can be managed with the skills of a general surgeon. Non-responder blunt abdominal trauma patients with positive ultrasound are highly likely to require complex skills. The future training of surgeons should concentrate on NCS procedures while at the same time recognizing those injuries requiring complex skills.
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Affiliation(s)
- J Kosola
- Department of Orthopedics and Traumatology, Trauma Unit, Töölö Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - T Brinck
- Department of Orthopedics and Traumatology, Trauma Unit, Töölö Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A Leppäniemi
- Department of Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - L Handolin
- Department of Orthopedics and Traumatology, Trauma Unit, Töölö Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Rollo G, Falzarano G, Ronga M, Bisaccia M, Grubor P, Erasmo R, Rocca G, Tomé-Bermejo F, Gómez-Garrido D, Pichierri P, Rinonapoli G, Meccariello L. WITHDRAWN: Challenges in the management of floating knee injuries: Results of treatment and outcomes of 224 consecutive cases in 10 years. Injury 2019; 50:453-461. [PMID: 30563714 DOI: 10.1016/j.injury.2018.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 12/01/2018] [Accepted: 12/04/2018] [Indexed: 02/02/2023]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published in Injury, 50(2) (2019) 453–461, https://doi.org/https://doi.org/10.1016/j.injury.2018.12.009. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Gabriele Falzarano
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Gaetano Rummo", Benevento, Italy
| | - Mario Ronga
- Department of Medicine and Health Sciences 'Vincenzo Tiberio' University of Molise, Campobasso, Italy
| | - Michele Bisaccia
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Santa Maria della Misericordia", Perugia, Italy
| | - Predrag Grubor
- Clinic of Traumatology, University Hospital Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Rocco Erasmo
- Department of Orthopedics and Traumatology, Santo Spirito Hospital, Pescara, Italy
| | - Guido Rocca
- Department of Orthopedics and Traumatology, Trauma Center "Pietro Cosma", Camposampiero, PD, Italy
| | - Felix Tomé-Bermejo
- Orthopaedic and Traumatology Unit, Hospital General de Villalba, Madrid, Spain
| | - David Gómez-Garrido
- Orthopaedic and Traumatology Unit, Hospital General de Villalba, Madrid, Spain
| | - Paolo Pichierri
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Giuseppe Rinonapoli
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Santa Maria della Misericordia", Perugia, Italy
| | - Luigi Meccariello
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
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Struck MF, Fakler JKM, Bernhard M, Busch T, Stumpp P, Hempel G, Beilicke A, Stehr SN, Josten C, Wrigge H. Mechanical complications and outcomes following invasive emergency procedures in severely injured trauma patients. Sci Rep 2018; 8:3976. [PMID: 29507415 PMCID: PMC5838247 DOI: 10.1038/s41598-018-22457-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/23/2018] [Indexed: 11/16/2022] Open
Abstract
This study aimes to determine the complication rates, possible risk factors and outcomes of emergency procedures performed during resuscitation of severely injured patients. The medical records of patients with an injury severity score (ISS) >15 admitted to the University Hospital Leipzig from 2010 to 2015 were reviewed. Within the first 24 hours of treatment, 526 patients had an overall mechanical complication rate of 26.2%. Multivariate analysis revealed out-of-hospital airway management (OR 3.140; 95% CI 1.963–5.023; p < 0.001) and ISS (per ISS point: OR 1.024; 95% CI 1.003–1.045; p = 0.027) as independent predictors of any mechanical complications. Airway management complications (13.2%) and central venous catheter complications (11.4%) were associated with ISS >32.5 (p < 0.001) and ISS >33.5 (p = 0.005), respectively. Chest tube complications (15.8%) were associated with out-of-hospital insertion (p = 0.002) and out-of-hospital tracheal intubation (p = 0.033). Arterial line complications (9.4%) were associated with admission serum lactate >4.95 mmol/L (p = 0.001) and base excess <−4.05 mmol/L (p = 0.008). In multivariate analysis, complications were associated with an increased length of stay in the intensive care unit (p = 0.019) but not with 24 hour mortality (p = 0.930). Increasing injury severity may contribute to higher complexity of the individual emergency treatment and is thus associated with higher mechanical complication rates providing potential for further harm.
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Affiliation(s)
- Manuel F Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
| | - Johannes K M Fakler
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Michael Bernhard
- Emergency Department, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Thilo Busch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Patrick Stumpp
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Gunther Hempel
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - André Beilicke
- Emergency Department, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Sebastian N Stehr
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Christoph Josten
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Hermann Wrigge
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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Affiliation(s)
| | - S. W. Choi
- Department of Anaesthesiology; Queen Mary Hospital; Hong Kong HKSAR
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Abstract
UNLABELLED To evaluate the evidence for the resuscitation of patients with hip fracture in the preoperative or perioperative phase of their treatment and its impact on mortality. DESIGN We searched MEDLINE, EMBASE, CENTRAL and PROSPERO databases using a systematic search strategy for randomised trials and observational studies investigating the fluid resuscitation of any patient with hip fracture. No language limits were applied to the search, which was complemented by manually screening the reference lists of appropriate studies. OUTCOME MEASURES Mortality at 1 week, 30 days and 1 year following surgery. RESULTS Two hundred and ninety-eight citations were identified, and 12 full manuscripts were reviewed; no studies satisfied the inclusion criteria. The background literature showed that the mortality for these patients at 30 days is approximately 8.5% and that bone cement implantation syndrome is insufficient to explain this. The literature was explored to define the need for an interventional investigation into the preoperative resuscitation of patients with hip fracture. CONCLUSIONS Patients with hip fracture show similar physiological disturbance to major trauma patients. Nineteen per cent of patients presenting with hip fracture are hypoperfused and 50% show preoperative anaemia suggesting that under resuscitation is a common problem that has not been investigated. A properly conducted interventional trial could improve the outcome of these vulnerable patients.
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Affiliation(s)
- Brett Rocos
- Trauma and Orthopaedics, North Bristol NHS Trust, Bristol, UK
| | | | - Michael B Kelly
- Trauma and Orthopaedics, North Bristol NHS Trust, Bristol, UK
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Jennings FL, Mitchell M. Intensive care nurses' perceptions of Inter Specialty Trauma Nursing Rounds to improve trauma patient care-A quality improvement project. Intensive Crit Care Nurs 2017; 40:35-43. [PMID: 28259523 DOI: 10.1016/j.iccn.2017.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 12/01/2016] [Accepted: 01/01/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Trauma patient management is complex and challenging for nurses in the Intensive Care Unit. One strategy to promote quality and evidence based care may be through utilising specialty nursing experts both internal and external to the Intensive Care Unit in the form of a nursing round. Inter Specialty Trauma Nursing Rounds have the potential to improve patient care, collaboration and nurses' knowledge. OBJECTIVES The purpose of this quality improvement project was to improve trauma patient care and evaluate the nurses perception of improvement. METHODS The project included structured, weekly rounds that were conducted at the bedside. Nursing experts and others collaborated to assess and make changes to trauma patients' care. The rounds were evaluated to assess the nurse's perception of improvement. RESULTS There were 132 trauma patients assessed. A total of 452 changes to patient care occurred. On average, three changes per patient resulted. Changes included nursing management, medical management and wound care. Nursing staff reported an overall improvement of trauma patient care, trauma knowledge, and collaboration with colleagues. CONCLUSIONS Inter Specialty Trauma Nursing Rounds utilizes expert nursing knowledge. They are suggested as an innovative way to address the clinical challenges of caring for trauma patients and are perceived to enhance patient care and nursing knowledge.
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Affiliation(s)
- Fiona L Jennings
- Princess Alexandra Hospital, Intensive Care Unit, Ipswich Road, QLD 4102, Australia.
| | - Marion Mitchell
- Princess Alexandra Hospital, Intensive Care Unit, Ipswich Road, QLD 4102, Australia; Centre of Health Practice Innovation, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, 170 Kessels Road Nathan, QLD 4111, Australia
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[Anaesthesia procedures and invasive vascular access in severely injured patients at trauma room admission in Germany : An online survey]. Anaesthesist 2017; 66:100-108. [PMID: 28078374 DOI: 10.1007/s00101-016-0258-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/12/2016] [Accepted: 10/18/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND The continuous monitoring of vital parameters and subsequent therapy belong to the core duties of anaesthetists during acute trauma resuscitation in the trauma room. Important procedures may include placement of arterial lines and central venous catheters (CVCs). Knowledge of indication, performance and localization of invasive catheterisation of trauma care in Germany is scarce. METHODS After approval of the German Society of Anaesthesiology and Intensive Care Medicine we conducted an online survey about arterial and central venous catheterisation of severely injured patients with consideration of common practice used by anaesthetists in German trauma rooms. Data are presented in a descriptive manner. RESULTS Of 843 hospitals invited for the survey, 72 (8.5%) had complete and valid data and were thus included in the analysis. Of these, 47% were supra-regional (level 1) trauma centres, 38% regional trauma centres and 15% local trauma centres. The annual mean injury severity score (ISS) of admitted patients to these hospitals was 21 ± 10. In the trauma room, the responding hospitals place CVCs (49%) and arterial lines (59%) only in haemodynamically unstable patients, whereas 24% (CVC) and 39% (arterial line) do when pathological laboratory tests were confirmed. Standard operating procedures (SOPs) merely exist for placement of either arterial lines (25%) or CVCs (22%) in multiple trauma resuscitation. The decision to perform CVC or arterial line placement is usually (79%) at the discretion of the attending anaesthetist. The preferred anatomical access site for CVCs is the right internal jugular vein (46%) and for arterial lines the radial artery (without side preference) (57%), respectively. Of the responding hospitals, 49% prefer landmark-guided CVC-puncture (91% of arterial lines) instead of 43% using sonographic guidance (9% of arterial lines). Intravascular electrocardiography monitoring for CVC tip detection is used by 36%. CONCLUSION In Germany, medical indication and schedule of invasive vascular catheterisation of severely injured patients in the trauma room is rarely regulated by SOPs and often performed at the discretion of the attending trauma team. Sonographic assistance during vascular puncture and electrocardiography for CVC tip detection is not as common as in non-emergency anaesthesia. Further studies are required to explore the real necessity and safety of invasive vascular catheterisation in multiple trauma patients in order to improve trauma care.
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Lapierre A, Gauvin-Lepage J, Lefebvre H. La collaboration interprofessionnelle lors de la prise en charge d’un polytraumatisé aux urgences : une revue de la littérature. Rech Soins Infirm 2017:73-88. [DOI: 10.3917/rsi.129.0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Computed tomography in hemodynamically unstable severely injured blunt and penetrating trauma patients. J Trauma Acute Care Surg 2016; 80:597-602; discussion 602-3. [PMID: 26808032 DOI: 10.1097/ta.0000000000000975] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Dynamic and efficient resuscitation strategies are now being implemented in severely injured hemodynamically unstable (HU) patients as blood products become readily and more immediately available in the trauma room. Our ability to maintain aggressive resuscitation schemes in HU patients allows us to complete diagnostic imaging studies before rushing patients to the operating room (OR). As the criteria for performing computed tomography (CT) scans in HU patients continue to evolve, we decided to compare the outcomes of immediate CT versus direct admission to the OR and/or angio suite in a retrospective study at a government-designated regional Level I trauma center in Cali, Colombia. METHODS During a 2-year period (2012-2013), blunt and penetrating trauma patients (≥ 15 years) with an Injury Severity Score (ISS) greater than 15 who met criteria of hemodynamic instability (systolic blood pressure [SBP] <100 mm Hg and/or heart rate >100 beats/min and/or ≥ 4 U of packed red blood cells transfused in the trauma bay) were included. Isolated head trauma and patients who experienced a prehospital cardiac arrest were excluded. The main study outcome was mortality. RESULTS We reviewed 171 patients. CT scans were performed in 80 HU patients (47%) immediately upon arrival (CT group); the remaining 91 patients (53%) went directly to the OR (63 laparotomies, 20 thoracotomies) and/or 8 (9%) to the angio suite (OA group). Of the CT group, 43 (54%) were managed nonoperatively, 37 (46%) underwent surgery (15 laparotomies, 3 thoracotomies), and 2 (5%) underwent angiography (CT OA subgroup). None of the mortalities in the CT group occurred in the CT suite or during their intrahospital transfers. CONCLUSION There was no difference in mortality between the CT and OA groups in HU patients. CT scan was attainable in 47% of HU patients and avoided surgery in 54% of the cases. Furthermore, CT scan was helpful in deciding definitive/specific surgical management in 46% scanned HU patients who necessitated surgery after CT. LEVEL OF EVIDENCE Therapy/care management study, level IV.
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Affiliation(s)
- M. D. Wiles
- Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield UK
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Alted López E. Are the paradigms in trauma disease changing? Med Intensiva 2015; 39:382-9. [PMID: 26068224 DOI: 10.1016/j.medin.2015.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/23/2015] [Accepted: 03/29/2015] [Indexed: 11/26/2022]
Abstract
Despite an annual trauma mortality of 5 million people worldwide, resulting in countless physical disabilities and enormous expenses, there are no standardized guidelines on trauma organization and management. Over the last few decades there have been very notorious improvements in severe trauma care, though organizational and economical aspects such as research funding still need to be better engineered. Indeed, trauma lags behind other serious diseases in terms of research and organization. The rapid developments in trauma care have produced original models available for research projects, initial resuscitation protocols and radiological procedures such as CT for the initial management of trauma patients, among other advances. This progress underscores the need for a multidisciplinary approach to the initial management and follow-up of this complicated patient population, where intensivists play a major role in both the patient admission and subsequent care at the trauma unit.
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Affiliation(s)
- E Alted López
- Unidad de Cuidados Intensivos de Trauma, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
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