1
|
Whitesell RT, Nordman CR, Johnston SK, Sheafor DH. Clinical management of active bleeding: what the emergency radiologist needs to know. Emerg Radiol 2024:10.1007/s10140-024-02289-z. [PMID: 39400642 DOI: 10.1007/s10140-024-02289-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 10/04/2024] [Indexed: 10/15/2024]
Abstract
Active bleeding is a clinical emergency that often requires swift action driven by efficient communication. Extravasation of intravenous (IV) contrast on computed tomography (CT) is a hallmark of active hemorrhage. This can be seen on exams performed for a variety of indications and can occur anywhere in the body. As both traumatic and non-traumatic etiologies of significant blood loss are clinical emergencies, exams demonstrating active bleeding are often performed in emergency departments and read by emergency radiologists. Prompt communication of these findings to the appropriate emergency medicine and surgical providers is crucial. Although many types of active hemorrhage can be managed by interventional radiology techniques, endoscopic and surgical management or clinical observation may be appropriate in certain cases. To facilitate optimal care, it is important for emergency radiologists to understand the scope of indications for embolization of bleeding by interventional radiologists (IR) and when an IR consultation is warranted. Similarly, timely comprehensive diagnostic radiology reporting including pertinent positive and negative findings tailored for IR colleagues can expedite the appropriate intervention.
Collapse
Affiliation(s)
- Ryan T Whitesell
- Division of Emergency Radiology, Midwest Radiology, 2355 Highway 36 West, Roseville, MN, USA.
| | - Cory R Nordman
- Division of Interventional Radiology, Midwest Radiology, 2355 Highway 36 West, Roseville, MN, USA.
| | - Sean K Johnston
- Division of Emergency Radiology, Midwest Radiology, 2355 Highway 36 West, Roseville, MN, USA.
| | - Douglas H Sheafor
- Division of Emergency Radiology, Midwest Radiology, 2355 Highway 36 West, Roseville, MN, USA.
| |
Collapse
|
2
|
Yoon JH, Kim J, Lagattuta T, Pinsky MR, Hravnak M, Clermont G. Early Physiologic Numerical and Waveform Characteristics of Simulated Hemorrhagic Events With Healthy Volunteers Donating Blood. Crit Care Explor 2024; 6:e1073. [PMID: 38545607 PMCID: PMC10969514 DOI: 10.1097/cce.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVES Early signs of bleeding are often masked by the physiologic compensatory responses delaying its identification. We sought to describe early physiologic signatures of bleeding during the blood donation process. SETTING Waveform-level vital sign data including electrocardiography, photoplethysmography (PPG), continuous noninvasive arterial pressure, and respiratory waveforms were collected before, during, and after bleeding. SUBJECTS Fifty-five healthy volunteers visited blood donation center to donate whole blood. INTERVENTION After obtaining the informed consent, 3 minutes of resting time was given to each subject. Then 3 minutes of orthostasis was done, followed by another 3 minutes of resting before the blood donation. After the completion of donating blood, another 3 minutes of postbleeding resting time, followed by 3 minutes of orthostasis period again. MEASUREMENTS AND MAIN RESULTS From 55 subjects, waveform signals as well as numerical vital signs (heart rate [HR], respiratory rate, blood pressure) and clinical characteristics were collected, and data from 51 subjects were analyzable. Any adverse events (AEs; dizziness, lightheadedness, nausea) were documented. Statistical and physiologic features including HR variability (HRV) metrics and other waveform morphologic parameters were modeled. Feature trends for all participants across the study protocol were analyzed. No significant changes in HR, blood pressure, or estimated cardiac output were seen during bleeding. Both orthostatic challenges and bleeding significantly decreased time domain and high-frequency domain HRV, and PPG amplitude, whereas increasing PPG amplitude variation. During bleeding, time-domain HRV feature trends were most sensitive to the first 100 mL of blood loss, and incremental changes of different HRV parameters (from 300 mL of blood loss), as well as a PPG morphologic feature (from 400 mL of blood loss), were shown with statistical significance. The AE group (n = 6) showed decreased sample entropy compared with the non-AE group during postbleed orthostatic challenge (p = 0.003). No significant other trend differences were observed during bleeding between AE and non-AE groups. CONCLUSIONS Various HRV-related features were changed during rapid bleeding seen within the first minute. Subjects with AE during postbleeding orthostasis showed decreased sample entropy. These findings could be leveraged toward earlier identification of donors at risk for AE, and more broadly building a data-driven hemorrhage model for the early treatment of critical bleeding.
Collapse
Affiliation(s)
- Joo Heung Yoon
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Jueun Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Theodore Lagattuta
- Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Michael R Pinsky
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Marilyn Hravnak
- Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Gilles Clermont
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
3
|
Mabry CD, Davis B, Sutherland M, Robertson R, Carger J, Wyrick D, Collins T, Porter A, Kalkwarf K. Progressive Reduction in Preventable Mortality in a State Trauma System Using Continuous Preventable Mortality Review to Drive Provider Education: Results of Analyzing 1,979 Trauma Deaths from 2015 to 2022. J Am Coll Surg 2024; 238:426-434. [PMID: 38149781 DOI: 10.1097/xcs.0000000000000935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
BACKGROUND The state legislature codified and funded the Arkansas Trauma System (ATS) in 2009. Quarterly preventable mortality reviews (PMRs) by the ATS began in 2015 and were used to guide state-wide targeted education to reduce preventable or potentially preventable (P/PP) deaths. We present the results of this PMR-education initiative from 2015 to 2022. STUDY DESIGN The ATS uses a statistical sampling model of the Arkansas Trauma Registry to select ~40% of the deaths for quarterly review, reflecting the overall the Arkansas Trauma Registry mortality population. A multispecialty PMR committee reviews the medical records from prehospital care to death, and hospital and regional advisory council reviews for each death. The PMR committee assigns opportunities for improvement (OFIs), cause(s) of death, and the likelihood of preventability for each case. Education to improve trauma care includes annual state-wide trauma meetings, novel classes targeted at level III/IV trauma center hospital providers, trauma evidence-based guidelines, and PMR "pearls." RESULTS We reviewed 1,979 deaths with 211 (10.6%) deaths judged to be P/PP deaths. There was a progressive decrease in P/PP deaths and OFIs for P/PP deaths. Five OFI types targeted by education accounted for 72% of the 24 possible OFI types in the P/PP cases, and 94% of the "contributory OFIs." Reductions in "delay in treatment" resulted in the most rapid decrease in P/PP deaths. CONCLUSIONS Using ongoing PMR studies to target provider education led to a reduction in P/PP deaths and OFIs for P/PP deaths. Focusing on education designed to improve preventable mortality can result in a substantial decrease in P/PP deaths by 43% (14% to 8%) for trauma systems.
Collapse
Affiliation(s)
- Charles D Mabry
- From the Department of Surgery, College of Medicine (Mabry, Davis, Robertson, Wyrick, Collins, Kalkwarf) University of Arkansas for Medical Sciences, Little Rock, AR
| | - Benjamin Davis
- From the Department of Surgery, College of Medicine (Mabry, Davis, Robertson, Wyrick, Collins, Kalkwarf) University of Arkansas for Medical Sciences, Little Rock, AR
| | - Michael Sutherland
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL (Sutherland)
| | - Ronald Robertson
- From the Department of Surgery, College of Medicine (Mabry, Davis, Robertson, Wyrick, Collins, Kalkwarf) University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Deidre Wyrick
- From the Department of Surgery, College of Medicine (Mabry, Davis, Robertson, Wyrick, Collins, Kalkwarf) University of Arkansas for Medical Sciences, Little Rock, AR
- Division of Pediatric Surgery and Section of Pediatric Critical Care Medicine, Department of Surgery, University of Arkansas College of Medicine and Arkansas Children's Hospital, Little Rock, AR (Wyrick)
| | - Terry Collins
- From the Department of Surgery, College of Medicine (Mabry, Davis, Robertson, Wyrick, Collins, Kalkwarf) University of Arkansas for Medical Sciences, Little Rock, AR
| | - Austin Porter
- Department of Health Policy and Management, Fay W Boozman College of Public Health, University of Arkansas for Medical Sciences and Arkansas Department of Health, Little Rock, AR (Porter)
| | - Kyle Kalkwarf
- From the Department of Surgery, College of Medicine (Mabry, Davis, Robertson, Wyrick, Collins, Kalkwarf) University of Arkansas for Medical Sciences, Little Rock, AR
| |
Collapse
|
4
|
Zhang LY, Zhang HY. Torso hemorrhage: noncompressible? never say never. Eur J Med Res 2024; 29:153. [PMID: 38448977 PMCID: PMC10919054 DOI: 10.1186/s40001-024-01760-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024] Open
Abstract
Since limb bleeding has been well managed by extremity tourniquets, the management of exsanguinating torso hemorrhage (TH) has become a hot issue both in military and civilian medicine. Conventional hemostatic techniques are ineffective for managing traumatic bleeding of organs and vessels within the torso due to the anatomical features. The designation of noncompressible torso hemorrhage (NCTH) marks a significant step in investigating the injury mechanisms and developing effective methods for bleeding control. Special tourniquets such as abdominal aortic and junctional tourniquet and SAM junctional tourniquet designed for NCTH have been approved by FDA for clinical use. Combat ready clamp and junctional emergency treatment tool also exhibit potential for external NCTH control. In addition, resuscitative endovascular balloon occlusion of the aorta (REBOA) further provides an endovascular solution to alleviate the challenges of NCTH treatment. Notably, NCTH cognitive surveys have revealed that medical staff have deficiencies in understanding relevant concepts and treatment abilities. The stereotypical interpretation of NCTH naming, particularly the term noncompressible, is the root cause of this issue. This review discusses the dynamic relationship between TH and NCTH by tracing the development of external NCTH control techniques. The authors propose to further subdivide the existing NCTH into compressible torso hemorrhage and NCTH' (noncompressible but REBOA controllable) based on whether hemostasis is available via external compression. Finally, due to the irreplaceability of special tourniquets during the prehospital stage, the authors emphasize the importance of a package program to improve the efficacy and safety of external NCTH control. This program includes the promotion of tourniquet redesign and hemostatic strategies, personnel reeducation, and complications prevention.
Collapse
Affiliation(s)
- Lian-Yang Zhang
- Department of Trauma Surgery, War Trauma Medical Center, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Hua-Yu Zhang
- Department of Trauma Surgery, War Trauma Medical Center, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, China.
| |
Collapse
|
5
|
Wooldridge AR, Carayon P, Hoonakker P, Hose BZ, Shaffer DW, Brazelton T, Eithun B, Rusy D, Ross J, Kohler J, Kelly MM, Springman S, Gurses AP. Team Cognition in Handoffs: Relating System Factors, Team Cognition Functions and Outcomes in Two Handoff Processes. HUMAN FACTORS 2024; 66:271-293. [PMID: 35658721 PMCID: PMC11022309 DOI: 10.1177/00187208221086342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study investigates how team cognition occurs in care transitions from operating room (OR) to intensive care unit (ICU). We then seek to understand how the sociotechnical system and team cognition are related. BACKGROUND Effective handoffs are critical to ensuring patient safety and have been the subject of many improvement efforts. However, the types of team-level cognitive processing during handoffs have not been explored, nor is it clear how the sociotechnical system shapes team cognition. METHOD We conducted this study in an academic, Level 1 trauma center in the Midwestern United States. Twenty-eight physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) participated in semi-structured interviews. We performed qualitative content analysis and epistemic network analysis to understand the relationships between system factors, team cognition in handoffs and outcomes. RESULTS Participants described three team cognition functions in handoffs-(1) information exchange, (2) assessment, and (3) planning and decision making; information exchange was mentioned most. Work system factors influenced team cognition. Inter-professional handoffs facilitated information exchange but included large teams with diverse backgrounds communicating, which can be inefficient. Intra-professional handoffs decreased team size and role diversity, which may simplify communication but increase information loss. Participants in inter-professional handoffs reflected on outcomes significantly more in relation to system factors and team cognition (p < 0.001), while participants in intra-professional handoffs discussed handoffs as a task. CONCLUSION Handoffs include team cognition, which was influenced by work system design. Opportunities for handoff improvement include a flexibly standardized process and supportive tools/technologies. We recommend incorporating perspectives of the patient and family in future work.
Collapse
Affiliation(s)
- Abigail R. Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign
| | - Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin–Madison
- Department of Industrial and Systems Engineering, University of Wisconsin – Madison
| | - Peter Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin–Madison
| | - Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania
| | | | - Tom Brazelton
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ben Eithun
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Deborah Rusy
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Joshua Ross
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Michelle M. Kelly
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Scott Springman
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ayse P. Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Schools of Medicine, Bloomberg School of Public Health and Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
6
|
Cui D, Li M, Zhang P, Rao F, Huang W, Wang C, Guo W, Wang T. Polydopamine-Coated Polycaprolactone Electrospun Nanofiber Membrane Loaded with Thrombin for Wound Hemostasis. Polymers (Basel) 2023; 15:3122. [PMID: 37514511 PMCID: PMC10385294 DOI: 10.3390/polym15143122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Hemorrhagic shock is the primary cause of death in patients with severe trauma, and the development of rapid and efficient hemostatic methods is of great significance in saving the lives of trauma patients. In this study, a polycaprolactone (PCL) nanofiber membrane was prepared by electrospinning. A PCL-PDA loading system was developed by modifying the surface of polydopamine (PDA), using inspiration from mussel adhesion protein, and the efficient and stable loading of thrombin (TB) was realized to ensure the bioactivity of TB. The new thrombin loading system overcomes the disadvantages of harsh storage conditions, poor strength, and ease of falling off, and it can use thrombin to start a rapid coagulation cascade reaction, which has the characteristics of fast hemostasis, good biocompatibility, high safety, and a wide range of hemostasis. The physicochemical properties and biocompatibility of the PCL-PDA-TB membrane were verified by scanning electron microscopy, the cell proliferation test, the cell adhesion test, and the extract cytotoxicity test. Red blood cell adhesion, platelet adhesion, dynamic coagulation time, and animal models all verified the coagulation effect of the PCL-PDA-TB membrane. Therefore, the PCL-PDA-TB membrane has great potential in wound hemostasis applications, and should be widely used in various traumatic hemostatic scenarios.
Collapse
Affiliation(s)
- Dapeng Cui
- Hepatobiliary Surgery Department, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China
| | - Ming Li
- Trauma Medicine Center, Peking University People's Hospital, Beijing 100044, China
- Key Laboratory of Trauma and Neural Regeneration, Ministry of Education, Peking University, Beijing 100044, China
- National Center for Trauma Medicine, Beijing 100044, China
| | - Peng Zhang
- Trauma Medicine Center, Peking University People's Hospital, Beijing 100044, China
- Key Laboratory of Trauma and Neural Regeneration, Ministry of Education, Peking University, Beijing 100044, China
- National Center for Trauma Medicine, Beijing 100044, China
| | - Feng Rao
- Trauma Medicine Center, Peking University People's Hospital, Beijing 100044, China
- Key Laboratory of Trauma and Neural Regeneration, Ministry of Education, Peking University, Beijing 100044, China
- National Center for Trauma Medicine, Beijing 100044, China
| | - Wei Huang
- Trauma Medicine Center, Peking University People's Hospital, Beijing 100044, China
- Key Laboratory of Trauma and Neural Regeneration, Ministry of Education, Peking University, Beijing 100044, China
- National Center for Trauma Medicine, Beijing 100044, China
| | - Chuanlin Wang
- Trauma Medicine Center, Peking University People's Hospital, Beijing 100044, China
- Key Laboratory of Trauma and Neural Regeneration, Ministry of Education, Peking University, Beijing 100044, China
- National Center for Trauma Medicine, Beijing 100044, China
| | - Wei Guo
- Trauma Medicine Center, Peking University People's Hospital, Beijing 100044, China
- Key Laboratory of Trauma and Neural Regeneration, Ministry of Education, Peking University, Beijing 100044, China
- National Center for Trauma Medicine, Beijing 100044, China
| | - Tianbing Wang
- Trauma Medicine Center, Peking University People's Hospital, Beijing 100044, China
- Key Laboratory of Trauma and Neural Regeneration, Ministry of Education, Peking University, Beijing 100044, China
- National Center for Trauma Medicine, Beijing 100044, China
| |
Collapse
|
7
|
Latif RK, Clifford SP, Baker JA, Lenhardt R, Haq MZ, Huang J, Farah I, Businger JR. Traumatic hemorrhage and chain of survival. Scand J Trauma Resusc Emerg Med 2023; 31:25. [PMID: 37226264 DOI: 10.1186/s13049-023-01088-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/05/2023] [Indexed: 05/26/2023] Open
Abstract
Trauma is the number one cause of death among Americans between the ages of 1 and 46 years, costing more than $670 billion a year. Following death related to central nervous system injury, hemorrhage accounts for the majority of remaining traumatic fatalities. Among those with severe trauma that reach the hospital alive, many may survive if the hemorrhage and traumatic injuries are diagnosed and adequately treated in a timely fashion. This article aims to review the recent advances in pathophysiology management following a traumatic hemorrhage as well as the role of diagnostic imaging in identifying the source of hemorrhage. The principles of damage control resuscitation and damage control surgery are also discussed. The chain of survival for severe hemorrhage begins with primary prevention; however, once trauma has occurred, prehospital interventions and hospital care with early injury recognition, resuscitation, definitive hemostasis, and achieving endpoints of resuscitation become paramount. An algorithm is proposed for achieving these goals in a timely fashion as the median time from onset of hemorrhagic shock and death is 2 h.
Collapse
Affiliation(s)
- Rana K Latif
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, University of Louisville Hospital, 530 S. Jackson St., Louisville, KY, 40202, USA.
- Paris Simulation Center, Office of Medical Education, University of Louisville School of Medicine, Louisville, KY, USA.
- Outcomes Research Consortium, Cleveland, OH, USA.
| | - Sean P Clifford
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, University of Louisville Hospital, 530 S. Jackson St., Louisville, KY, 40202, USA
| | - Jeffery A Baker
- Department of Emergency Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Rainer Lenhardt
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, University of Louisville Hospital, 530 S. Jackson St., Louisville, KY, 40202, USA
| | - Mohammad Z Haq
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, University of Louisville Hospital, 530 S. Jackson St., Louisville, KY, 40202, USA
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, University of Louisville Hospital, 530 S. Jackson St., Louisville, KY, 40202, USA
- Department of Cardiovascular & Thoracic Surgery, Cardiovascular Innovation Institute, University of Louisville, Louisville, KY, USA
- The Center for Integrative Environmental Health Sciences, University of Louisville, Louisville, KY, USA
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, USA
- Division of Infectious Diseases, Department of Medicine, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY, USA
| | - Ian Farah
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, University of Louisville Hospital, 530 S. Jackson St., Louisville, KY, 40202, USA
| | - Jerrad R Businger
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, University of Louisville Hospital, 530 S. Jackson St., Louisville, KY, 40202, USA
| |
Collapse
|
8
|
Biazar E, Heidari Keshel S, Niazi V, Vazifeh Shiran N, Saljooghi R, Jarrahi M, Mehdipour Arbastan A. Morphological, cytotoxicity, and coagulation assessments of perlite as a new hemostatic biomaterial. RSC Adv 2023; 13:6171-6180. [PMID: 36825295 PMCID: PMC9941756 DOI: 10.1039/d2ra07795g] [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: 12/07/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
Hemorrhage control is vital for clinical outcomes after surgical treatment and pre-hospital trauma injuries. Numerous biomaterials have been investigated to control surgical and traumatic bleeding. In this study, for the first time, perlite was introduced as an aluminosilicate biomaterial and compared with other ceramics such as kaolin and bentonite in terms of morphology, cytotoxicity, mutagenicity, and hemostatic evaluations. Cellular studies showed that perlite has excellent viability, good cell adhesion, and high anti-mutagenicity. Coagulation results demonstrated that the shortest clotting time (140 seconds with a concentration of 50 mg mL-1) was obtained for perlite samples compared to other samples. Therefore, perlite seems most efficient as a biocompatible ceramic for hemorrhage control and other biomaterial designs.
Collapse
Affiliation(s)
- Esmaeil Biazar
- Biomaterials and Tissue Engineering Group, Department of Biomedical Engineering, Islamic Azad University Tonekabon Branch Tonekabon Iran +981154271105 +981154271105
| | - Saeid Heidari Keshel
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences Tehran Iran +989125870517 +989125870517.,Medical Nanotechnology and Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Vahid Niazi
- Stem Cell Research Center, Golestan University of Medical ScienceGorganIran,Department of Molecular Medicine, Faculty of Advanced Medical Technologies, Golestan University of Medical ScienceGorganIran
| | - Nader Vazifeh Shiran
- Department of Hematology and Blood Banking, Faculty of Medical Sciences, Tarbiat Modares UniversityTehranIran
| | - Roxana Saljooghi
- Biomaterials and Tissue Engineering Group, Department of Biomedical Engineering, Islamic Azad University Tonekabon Branch Tonekabon Iran +981154271105 +981154271105
| | - Mina Jarrahi
- Biomaterials and Tissue Engineering Group, Department of Biomedical Engineering, Islamic Azad University Tonekabon Branch Tonekabon Iran +981154271105 +981154271105
| | - Ahmad Mehdipour Arbastan
- School of Medicine, Faculty of Medical Sciences, Islamic Azad UniversityTonekabon BranchTonekabonIran
| |
Collapse
|
9
|
Ferrada P, Cannon JW, Kozar RA, Bulger EM, Sugrue M, Napolitano LM, Tisherman SA, Coopersmith CM, Efron PA, Dries DJ, Dunn TB, Kaplan LJ. Surgical Science and the Evolution of Critical Care Medicine. Crit Care Med 2023; 51:182-211. [PMID: 36661448 DOI: 10.1097/ccm.0000000000005708] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Surgical science has driven innovation and inquiry across adult and pediatric disciplines that provide critical care regardless of location. Surgically originated but broadly applicable knowledge has been globally shared within the pages Critical Care Medicine over the last 50 years.
Collapse
Affiliation(s)
- Paula Ferrada
- Division of Trauma and Acute Care Surgery, Department of Surgery, Inova Fairfax Hospital, Falls Church, VA
| | - Jeremy W Cannon
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rosemary A Kozar
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Eileen M Bulger
- Division of Trauma, Burn and Critical Care Surgery, Department of Surgery, University of Washington at Seattle, Harborview, Seattle, WA
| | - Michael Sugrue
- Department of Surgery, Letterkenny University Hospital, County of Donegal, Ireland
| | - Lena M Napolitano
- Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Samuel A Tisherman
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Craig M Coopersmith
- Division of General Surgery, Department of Surgery, Emory University, Emory Critical Care Center, Atlanta, GA
| | - Phil A Efron
- Department of Surgery, Division of Critical Care, University of Florida, Gainesville, FL
| | - David J Dries
- Department of Surgery, University of Minnesota, Regions Healthcare, St. Paul, MN
| | - Ty B Dunn
- Division of Transplant Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Section of Surgical Critical Care, Surgical Services, Philadelphia, PA
| |
Collapse
|
10
|
Noshadi N, Heidari M, Naemi Kermanshahi M, Zarezadeh M, Sanaie S, Ebrahimi-Mameghani M. Effects of Probiotics Supplementation on CRP, IL-6, and Length of ICU Stay in Traumatic Brain Injuries and Multiple Trauma Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:4674000. [PMID: 36518854 PMCID: PMC9744609 DOI: 10.1155/2022/4674000] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/05/2022] [Accepted: 11/12/2022] [Indexed: 12/01/2023]
Abstract
METHOD This meta-analysis aims to evaluate the effectiveness of probiotics in reducing inflammatory biomarkers and the length of intensive care unit (ICU) stays. PubMed-Medline, SCOPUS, Embase, and Google Scholar databases up to July 2021 were searched. The meta-analysis was carried out using random-effect analysis. To determine the sources of heterogeneity, subgroup analyses were performed. In case of the presence of publication bias, trim and fill analysis was carried out. The Cochrane Collaboration tool was used for checking the quality assessment. We hypothesized that probiotics would improve inflammatory markers (CRP and IL-6) and the length of ICU stay in traumatic brain injury and multiple trauma patients. RESULTS The present meta-analysis, which includes a total of seven studies, showed that there were no significant effects of probiotics supplementation on interleukin (IL)-6 (Hedges's g = -2.46 pg/ml; 95% CI: -12.16, 7.25; P=0.39), C-reactive protein (CRP) (Hedges's g = -1.10 mg/L; 95% CI: -2.27, 0.06; P=0.06), and the length of staying in ICU. The overall number of RCTs included in the analysis and the total sample size were insufficient to make firm conclusions. CONCLUSION As a result, more carefully designed RCTs are needed to investigate the effect of probiotics on inflammatory biomarkers and the length of ICU stay in traumatic brain injuries and multiple trauma patients in greater detail.
Collapse
Affiliation(s)
- Nooshin Noshadi
- Department of Clinical Nutrition, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Marzieh Heidari
- Department of Clinical Nutrition, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Mohammad Naemi Kermanshahi
- Department of Clinical Nutrition, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Meysam Zarezadeh
- Department of Clinical Nutrition, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Sarvin Sanaie
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehrangiz Ebrahimi-Mameghani
- Nutrition Research Center, Department of Biochemistry and Diet Therapy, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Science, Tabriz, Iran
| |
Collapse
|
11
|
Developing a National Trauma Research Action Plan: Results from the postadmission critical care research gap Delphi survey. J Trauma Acute Care Surg 2022; 93:846-853. [PMID: 35916626 DOI: 10.1097/ta.0000000000003754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The 2016 National Academies of Science, Engineering and Medicine report included a proposal to establish a National Trauma Research Action Plan. In response, the Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma and burn care from prehospital care to rehabilitation as part of an overall strategy to achieve zero preventable deaths and disability after injury. The Postadmission Critical Care Research panel was 1 of 11 panels constituted to develop this research agenda. METHODS We recruited interdisciplinary experts in surgical critical care and recruited them to identify current gaps in clinical critical care research, generate research questions, and establish the priority of these questions using a consensus-driven Delphi survey approach. The first of four survey rounds asked participants to generate key research questions. On subsequent rounds, we asked survey participants to rank the priority of each research question on a 9-point Likert scale, categorized to represent low-, medium-, and high-priority items. Consensus was defined as ≥60% of panelists agreeing on the priority category. RESULTS Twenty-five subject matter experts generated 595 questions. By Round 3, 249 questions reached ≥60% consensus. Of these, 22 questions were high, 185 were medium, and 42 were low priority. The clinical states of hypovolemic shock and delirium were most represented in the high-priority questions. Traumatic brain injury was the only specific injury pattern with a high-priority question. CONCLUSION The National Trauma Research Action Plan critical care research panel identified 22 high-priority research questions, which, if answered, would reduce preventable death and disability after injury. LEVEL OF EVIDENCE Diagnostic Tests or Criteria; Level IV.
Collapse
|
12
|
Gonçalves AC, Parreira JG, Gianvecchio VAP, Lucarelli-Antunes PDES, Pivetta LGA, Perlingeiro JAG, Assef JC. The role of autopsy on the diagnosis of missed injuries and on the trauma quality program goal definitions: study of 192 cases. Rev Col Bras Cir 2022; 49:e20223319. [PMID: 36449941 PMCID: PMC10578793 DOI: 10.1590/0100-6991e-20223319_en] [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: 03/06/2022] [Accepted: 07/08/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE to assess the role of autopsy in the diagnosis of missed injuries (MI) and definition of trauma quality program goals. METHOD Retrospective analysis of autopsy reports and patient's charts. Injuries present in the autopsy, but not in the chart, were defined as "missed". MI were characterized using Goldman's criteria: Class I, if the diagnosis would have modified the management and outcome; Class II, if it would have modified the management, but not the outcome; Class III, if it would not have modified neither the management nor the outcome. We used Mann-Whitney's U and Pearson's chi square for statistical analysis, considering p<0.05 as significant. RESULTS We included 192 patients, with mean age of 56.8 years. Blunt trauma accounted for 181 cases, and 28.6% were due to falls from the same level. MI were diagnosed in 39 patients (20.3%). Using Goldman's criteria, MI were categorized as Class I in 3 (1.6%) and Class II in 11 (5.6%). MI were more often diagnosed in the thoracic segment (25 patients, 64.1% of the MI). The variables significantly associated (p<0.05) to MI were: time of hospitalization < 48 h, severe trauma mechanism, and not undergoing surgery or computed tomography. At autopsy, the values of ISS and NISS were higher in patients with MI. CONCLUSION the review of the autopsy report allowed diagnosis of MIs, which did not influence outcome in their majority. Many opportunities of improvement in quality of care were identified.
Collapse
Affiliation(s)
- Augusto Canton Gonçalves
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia - São Paulo - SP - Brasil
| | - José Gustavo Parreira
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia - São Paulo - SP - Brasil
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
| | | | | | | | - Jacqueline Arantes Gianninni Perlingeiro
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia - São Paulo - SP - Brasil
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
| | - Jose Cesar Assef
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia - São Paulo - SP - Brasil
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Serviço de Emergência - São Paulo - SP - Brasil
| |
Collapse
|
13
|
Wu CY, Chou CC, Hsu HC, Ma MHM, Ho YC, Lin CC, Chen YJ, Chiang WC. The preventability of trauma-related death: A two-year cohort study in a trauma center in middle Taiwan. Injury 2022; 53:3039-3046. [PMID: 35817606 DOI: 10.1016/j.injury.2022.06.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/14/2022] [Accepted: 06/26/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The preventable death rate (PDR) is an important parameter in the quality assurance of traumatic care. Medical errors or untimely management may occur during stressful trauma care, resulting in preventable deaths. We aimed to develop an applicable PDR model in a trauma center in middle Taiwan. MATERIALS AND METHODS We identified adult trauma-related deaths which occurred from January 1, 2018 to December 31, 2019 at our hospital. Patients with a trauma and injury severity score (TRISS) <75% or ≥75% but with a chance of preventability, as determined by a trauma surgeon, were discussed by a panel comprising an emergency physician and surgeons specializing in different fields of medicine. Deaths were subsequently classified as definitely preventable (DP), potentially preventable (PP), or non-preventable (NP). Causes of DP or PP deaths were categorized as delayed diagnosis, delayed treatment, technical error, or inadequate infection prevention/control. The relationship between the time and cause of preventable deaths was also analyzed. RESULTS This study included 127 trauma-related deaths, of which 39 were discussed by the panel. Eight patients (6.3%) were categorized as DP, eight (6.3%) as PP, and 111 (87.4%) as NP. Among patients with preventable deaths, inadequate infection prevention/control, delayed treatment, delayed diagnosis, and technical error were identified in six (37.5%), five (31.2%), three (18.8%), and two (12.5%) patients, respectively. Four patients in the inadequate infection prevention/control group (4/6, 66.7%) died of aspiration pneumonia during the recovery phase. CONCLUSION A PDR evaluation model was developed and revealed that postoperative care is as important as a timely diagnosis and treatment to avoid preventable deaths following trauma.
Collapse
Affiliation(s)
- Chao-Ying Wu
- Department of Surgery, National Taiwan University Hospital, Yunlin Branch, No. 579, Yunlin Road, Douliu City, 640 Yunlin, Taiwan (R.O.C.)
| | - Chun-Chih Chou
- Department of Surgery, National Taiwan University Hospital, Yunlin Branch, No. 579, Yunlin Road, Douliu City, 640 Yunlin, Taiwan (R.O.C.)
| | - Hao-Chun Hsu
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan (R.O.C.)
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan (R.O.C.); Department of Emergency Medicine, National Taiwan University Hospital
| | - Yi-Ching Ho
- Department of Surgery, National Taiwan University Hospital, Yunlin Branch, No. 579, Yunlin Road, Douliu City, 640 Yunlin, Taiwan (R.O.C.)
| | - Chen-Chiang Lin
- Department of Orthopedic Surgery, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan (R.O.C.)
| | - Yi-Jung Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan (R.O.C.)
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan (R.O.C.); Department of Emergency Medicine, National Taiwan University Hospital.
| |
Collapse
|
14
|
Factors Associated with Traumatic Diaphragmatic Rupture among Patients with Chest or Abdominal Injury: A Nationwide Study from Japan. J Clin Med 2022; 11:jcm11154462. [PMID: 35956077 PMCID: PMC9369230 DOI: 10.3390/jcm11154462] [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: 07/02/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Blunt traumatic diaphragmatic rupture (TDR) is a rare condition that is seen in patients with blunt thoracoabdominal trauma. However, factors that are associated with blunt TDR have not been fully revealed. The purpose of this study was to evaluate the factors that are associated with blunt TDR in trauma patients with a chest or abdominal injury using nationwide trauma registry data in Japan. Method: This study was a retrospective observational study with a 15-year study period from 2004 to 2018. We included trauma patients with a chest or abdominal Abbreviated Injury Score of two or more. We evaluated the relationship between confounding factors such as mechanism of injury and blunt TDR with multivariable logistic regression analysis. Results: This study included 65,110 patients, of whom 496 patients (0.8%) suffered blunt TDR. Factors that were associated with blunt TDR were disturbance of consciousness (adjusted OR [AOR]: 1.639, 95% CI: 1.326–2.026), FAST positive (AOR: 2.120, 95% CI: 1.751–2.567), front seat passenger (AOR: 1.748, 95% CI: 1.129–2.706), and compression injury by heavy object (AOR: 1.677, 95% CI: 1.017–2.765). Conclusion: This study revealed several factors that are associated with blunt TDR. The results of this study may be useful for clinicians when estimating blunt TDR.
Collapse
|
15
|
Dorken Gallastegi A, Naar L, Gaitanidis A, Gebran A, Nederpelt CJ, Parks JJ, Hwabejire JO, Fawley J, Mendoza AE, Saillant NN, Fagenholz PJ, Velmahos GC, Kaafarani HMA. Do not forget the platelets: The independent impact of red blood cell to platelet ratio on mortality in massively transfused trauma patients. J Trauma Acute Care Surg 2022; 93:21-29. [PMID: 35313325 DOI: 10.1097/ta.0000000000003598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Balanced blood component administration during massive transfusion is standard of care. Most literature focuses on the impact of red blood cell (RBC)/fresh frozen plasma (FFP) ratio, while the value of balanced RBC:platelet (PLT) administration is less established. The aim of this study was to evaluate and quantify the independent impact of RBC:PLT on 24-hour mortality in trauma patients receiving massive transfusion. METHODS Using the 2013 to 2018 American College of Surgeons Trauma Quality Improvement Program database, adult patients who received massive transfusion (≥10 U of RBC/24 hours) and ≥1 U of RBC, FFP, and PLT within 4 hours of arrival were retrospectively included. To mitigate survival bias, only patients with consistent RBC:PLT and RBC:FFP ratios between 4 and 24 hours were analyzed. Balanced FFP or PLT transfusions were defined as having RBC:PLT and RBC:FFP of ≤2, respectively. Multivariable logistic regression was used to compare the independent relationship between RBC:FFP, RBC:PLT, balanced transfusion, and 24-hour mortality. RESULTS A total of 9,215 massive transfusion patients were included. The number of patients who received transfusion with RBC:PLT >2 (1,942 [21.1%]) was significantly higher than those with RBC:FFP >2 (1,160 [12.6%]) (p < 0.001). Compared with an RBC:PLT ratio of 1:1, a gradual and consistent risk increase was observed for 24-hour mortality as the RBC:PLT ratio increased (p < 0.001). Patients with both FFP and PLT balanced transfusion had the lowest adjusted risk for 24-hour mortality. Mortality increased as resuscitation became more unbalanced, with higher odds of death for unbalanced PLT (odds ratio, 2.48 [2.18-2.83]) than unbalanced FFP (odds ratio, 1.66 [1.37-1.98]), while patients who received both FFP and PLT unbalanced transfusion had the highest risk of 24-hour mortality (odds ratio, 3.41 [2.74-4.24]). CONCLUSION Trauma patients receiving massive transfusion significantly more often have unbalanced PLT rather than unbalanced FFP transfusion. The impact of unbalanced PLT transfusion on 24-hour mortality is independent and potentially more pronounced than unbalanced FFP transfusion, warranting serious system-level efforts for improvement. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
Collapse
Affiliation(s)
- Ander Dorken Gallastegi
- From the Division of Trauma, Emergency Surgery, and Surgical Critical Care (A.D.G., L.N., A. Gaitanidis, A. Gebran, J.J.P., J.O.H., J.F., A.E.M., N.N.S., P.J.F., G.C.V., H.M.A.K.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and Leiden University Medical Center, Leiden, Netherlands (C.J.N.)
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Higgins MC, Shi J, Bader M, Kohanteb PA, Brahmbhatt TS. Role of Interventional Radiology in the Management of Non-aortic Thoracic Trauma. Semin Intervent Radiol 2022; 39:312-328. [PMID: 36062226 PMCID: PMC9433159 DOI: 10.1055/s-0042-1753482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Trauma remains a leading cause of death for all age groups, and nearly two-thirds of these individuals suffer thoracic trauma. Due to the various types of injuries, including vascular and nonvascular, interventional radiology plays a major role in the acute and chronic management of the thoracic trauma patient. Interventional radiologists are critical members in the multidisciplinary team focusing on treatment of the patient with thoracic injury. Through case presentations, this article will review the role of interventional radiology in the management of trauma patients suffering thoracic injuries.
Collapse
Affiliation(s)
- Mikhail C.S.S. Higgins
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Jessica Shi
- Boston University School of Medicine, Boston, Massachusetts
| | - Mohammad Bader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Paul A. Kohanteb
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Tejal S. Brahmbhatt
- Boston University School of Medicine, Boston, Massachusetts
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care; Boston Medical Center, Boston, Massachusetts
| |
Collapse
|
17
|
GONÇALVES AUGUSTOCANTON, PARREIRA JOSÉGUSTAVO, GIANVECCHIO VICTORALEXANDREPERCINIO, LUCARELLI-ANTUNES PEDRODESOUZA, PIVETTA LUCAGIOVANNIANTONIO, PERLINGEIRO JACQUELINEARANTESGIANNINNI, ASSEF JOSECESAR. Valor da autópsia no diagnóstico de lesões despercebidas e na definição de metas para programa de qualidade em trauma: estudo de 192 casos. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RESUMO Objetivo: Avaliar a utilidade da autópsia no diagnóstico de lesões despercebidas (LD) e no estabelecimento de metas para programa de qualidade em trauma. Método: análise retrospectiva dos laudos de autópsia por trauma entre outubro/2017 e março/2019 provenientes do mesmo hospital. Lesões descritas na autópsia, mas não no prontuário médico, foram consideradas como despercebidas (LD) e classificadas pelos critérios de Goldman: Classe I: mudariam a conduta e alterariam o desfecho; Classe II: mudariam a conduta, mas não o desfecho; Classe III: não mudariam nem a conduta nem o desfecho. As variáveis coletadas foram comparadas entre o grupo com LD e os demais, através de método estatístico orientado por profissional na área. Consideramos p<0,05 como significativo. Resultados: analisamos 192 casos, com média etária de 56,8 anos. O trauma fechado foi o mecanismo em 181 casos, sendo 28,6% por quedas da própria altura. LD foram observadas em 39 casos (20,3%), sendo 3 (1,6%) classe I e 11 (5,6%) classe II. O tórax foi o segmento com maior número de LD (25 casos - 64,1% das LD). Foram associados à presença de LD (p<0,05): tempo de internação menor que 48 horas, mecanismo de trauma grave e a não realização de procedimento cirúrgico ou tomografia. Nos óbitos até 48h, valores de ISS e NISS nas autópsias foram maiores que os da internação. Conclusão: a revisão das autópsias permitiu identificação de LD, na sua maioria sem influência sobre conduta e prognóstico. Mesmo assim, várias oportunidades foram criadas para o programa de qualidade.
Collapse
Affiliation(s)
| | - JOSÉ GUSTAVO PARREIRA
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil; Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil
| | | | | | | | | | - JOSE CESAR ASSEF
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil; Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil
| |
Collapse
|
18
|
Wooldridge AR, Carayon P, Hoonakker P, Hose BZ, Schroeer K, Brazelton T, Eithun B, Rusy D, Ross J, Kohler J, Kelly MM, Dean S, Springman S, Rahal R, Gurses AP. Care transition of trauma patients: Processes with articulation work before and after handoff. APPLIED ERGONOMICS 2022; 98:103606. [PMID: 34638036 PMCID: PMC10373374 DOI: 10.1016/j.apergo.2021.103606] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/23/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
While care transitions influence quality of care, less work studies transitions between hospital units. We studied care transitions from the operating room (OR) to pediatric and adult intensive critical care units (ICU) using Systems Engineering Initiative for Patient Safety (SEIPS)-based process modeling. We interviewed twenty-nine physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU) and administered the AHRQ Hospital Survey on Patient Safety Culture items about handoffs, care transitions and teamwork. Care transitions are complex, spatio-temporal processes and involve work during the transition (i.e., handoff and transport) and preparation and follow up activities (i.e., articulation work). Physicians defined the transition as starting earlier and ending later than nurses. Clinicians in the OR to adult ICU transition without a team handoff reported significantly less information loss and better cooperation, despite positive interview data. A team handoff and supporting articulation work should increase awareness, improving quality and safety of care transitions.
Collapse
Affiliation(s)
- Abigail R Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Pascale Carayon
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin, Madison, USA; Department of Industrial and Systems Engineering, University of Wisconsin, Madison, USA
| | - Peter Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin, Madison, USA
| | - Bat-Zion Hose
- Department of Anesthesiology and Critical Care at the Perelman School of Medicine, University of Pennsylvania, USA
| | - Katherine Schroeer
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin, Madison, USA; Department of Industrial and Systems Engineering, University of Wisconsin, Madison, USA
| | - Tom Brazelton
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ben Eithun
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Deborah Rusy
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Joshua Ross
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Michelle M Kelly
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Shannon Dean
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Scott Springman
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rima Rahal
- Vituity, Mercy General Hospital and Sutter Medical Center, Sacramento, CA, USA
| | - Ayse P Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Schools of Medicine, Bloomberg School of Public Health and Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
19
|
Hosomi S, Kitamura T, Sobue T, Ogura H, Shimazu T. Sex and age differences in isolated traumatic brain injury: a retrospective observational study. BMC Neurol 2021; 21:261. [PMID: 34225691 PMCID: PMC8256599 DOI: 10.1186/s12883-021-02305-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/22/2021] [Indexed: 11/12/2022] Open
Abstract
Background Among the many factors that may influence traumatic brain injury (TBI) progression, sex is one of the most controversial. The objective of this study was to investigate sex differences in TBI-associated morbidity and mortality using data from the largest trauma registry in Japan. Methods This retrospective, population-based observational study included patients with isolated TBI, who were registered in a nationwide database between 2004 and 2018. We excluded patients with extracranial injury (Abbreviated Injury Scale score ≥ 3) and removed potential confounding factors, such as non-neurological causes of mortality. Patients were stratified by age and mortality and post-injury complications were compared between males and females. Results A total of 51,726 patients with isolated TBI were included (16,901 females and 34,825 males). Mortality across all ages was documented in 12.01% (2030/16901) and 12.76% (4445/34825) of males and females, respectively. The adjusted odds ratio (OR) of TBI mortality for males compared to females was 1.32 (95% confidence interval [CI], 1.22–1.42]. Males aged 10–19 years and ≥ 60 years had a significantly higher mortality than females in the same age groups (10–19 years: adjusted OR, 1.97 [95% CI, 1.08–3.61]; 60–69 years: adjusted OR, 1.24 [95% CI, 1.02–1.50]; 70–79 years: adjusted OR, 1.20 [95% CI, 1.03–1.40]; 80–89 years: adjusted OR, 1.50 [95% CI, 1.31–1.73], and 90–99 years: adjusted OR, 1.72 [95% CI, 1.28–2.32]). In terms of the incidence of post-TBI neurologic and non-neurologic complications, the crude ORs were 1.29 (95% CI, 1.19–1.39) and 1.14 (95% CI, 1.07–1.22), respectively, for males versus females. This difference was especially evident among elderly patients (neurologic complications: OR, 1.27 [95% CI, 1.14–1.41]; non-neurologic complications: OR, 1.29 [95% CI, 1.19–1.39]). Conclusions In a nationwide sample of patients with TBI in Japan, males had a higher mortality than females. This disparity was particularly evident among younger and older generations. Furthermore, elderly males experienced more TBI complications than females of the same age. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02305-6.
Collapse
Affiliation(s)
- Sanae Hosomi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 215, Yamada-oka, Suita, Japan. .,Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 215, Yamada-oka, Suita, Japan.
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 215, Yamada-oka, Suita, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 215, Yamada-oka, Suita, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 215, Yamada-oka, Suita, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 215, Yamada-oka, Suita, Japan
| |
Collapse
|
20
|
The Flatness Index of Inferior Vena Cava can be an Accurate Predictor for Hypovolemia in Multi-Trauma Patients. Prehosp Disaster Med 2021; 36:414-420. [PMID: 33952376 DOI: 10.1017/s1049023x21000418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Shock is the leading cause of death in multi-trauma patients and must be detected at an early stage to improve prognosis. Many parameters are used to predict clinical condition and outcome in trauma. Computed tomography (CT) signs of hypovolemic shock in trauma patients are not clear yet, requiring further research. The flatness index of inferior vena cava (IVC) is a helpful method for this purpose. METHODS This is a prospective, cross-sectional study which included adult multi-trauma patients (>18 years) who were admitted to the emergency department (ED) and underwent a thoraco-abdominal CT from 2017 through 2018. The main objective of this study was to investigate whether the flatness index of IVC can be used to determine the hypovolemic shock at an early stage in multi-trauma patients, and to establish its relations with shock parameters. The patients' demographic features, trauma mechanisms, vitals, laboratory values, shock parameters, and clinical outcome within 24 hours of admission were recorded. RESULTS Total of 327 (229 males with an average age of 40.9 [SD = 7.93]) patients were included in the study. There was no significant difference in the flatness index of IVC within genders (P = .134) and trauma mechanisms (P = .701); however, the flatness index of IVC was significantly higher in hypotensive (systolic blood pressure [SBP] ≤90 mmHg and/or diastolic blood pressure [DBP] ≤60 mmHg; P = .015 and P = .019), tachycardic (P = .049), and hypoxic (SpO2 ≤%94; P <.001) patients. The flatness index of IVC was also higher in patients with lactate ≥ 2mmol/l (P = .043) and patients with Class III hemorrhage (P = .003). A positive correlation was determined between lactate level and the flatness index of IVC; a negative correlation was found between Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS) with the flatness index of IVC (for each of them, P <.05). CONCLUSION The flatness index of IVC may be a useful method to determine the hypovolemic shock at an early stage in multi-trauma patients.
Collapse
|
21
|
Dubé M, Laberge J, Sigalet E, Shultz J, Vis C, Ball CG, Kirkpatrick A, Biesbroek S. Evaluations for New Healthcare Environment Commissioning and Operational Decision Making Using Simulation and Human Factors: A Case Study of an Interventional Trauma Operating Room. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:442-456. [PMID: 33706559 DOI: 10.1177/1937586721999668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of this article is to provide a case study example of the preopening phase of an interventional trauma operating room (ITOR) using systems-focused simulation and human factor evaluations for healthcare environment commissioning. BACKGROUND Systems-focused simulation, underpinned by human factors science, is increasingly being used as a quality improvement tool to test and evaluate healthcare spaces with the stakeholders that use them. Purposeful real-to-life simulated events are rehearsed to allow healthcare teams opportunity to identify what is working well and what needs improvement within the work system such as tasks, environments, and processes that support the delivery of healthcare services. This project highlights salient evaluation objectives and methods used within the clinical commissioning phase of one of the first ITORs in Canada. METHODS A multistaged evaluation project to support clinical commissioning was facilitated engaging 24 stakeholder groups. Key evaluation objectives highlighted include the evaluation of two transport routes, switching of operating room (OR) tabletops, the use of the C-arm, and timely access to lead in the OR. Multiple evaluation methods were used including observation, debriefing, time-based metrics, distance wheel metrics, equipment adjustment counts, and other transport route considerations. RESULTS The evaluation resulted in several types of data that allowed for informed decision making for the most effective, efficient, and safest transport route for an exsanguinating trauma patient and healthcare team; improved efficiencies in use of the C-arm, significantly reduced the time to access lead; and uncovered a new process for switching OR tabletop due to safety threats identified.
Collapse
Affiliation(s)
- Mirette Dubé
- Alberta Health Services, Calgary, Alberta, Canada.,University of Calgary, Alberta, Canada.,Foothills Medical Centre, Calgary, Alberta, Canada
| | | | | | - Jonas Shultz
- Health Quality Council of Alberta, Calgary, Alberta, Canada.,Department of Anesthesia, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Christine Vis
- Alberta Health Services, Calgary, Alberta, Canada.,Foothills Medical Centre, Calgary, Alberta, Canada
| | - Chad G Ball
- University of Calgary, Alberta, Canada.,Foothills Medical Centre, Calgary, Alberta, Canada
| | - Andrew Kirkpatrick
- University of Calgary, Alberta, Canada.,Foothills Medical Centre, Calgary, Alberta, Canada
| | | |
Collapse
|
22
|
Use of fibrinogen concentrate for trauma-related bleeding: A systematic-review and meta-analysis. J Trauma Acute Care Surg 2021; 89:1212-1224. [PMID: 32890340 DOI: 10.1097/ta.0000000000002920] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Trauma-induced coagulopathy contributes to significant morbidity and mortality in patients who experience trauma-related bleeding. This study aimed to synthesize the evidence supporting the efficacy and safety of preemptive and goal-directed fibrinogen concentrate (FC) in the management of trauma-related hemorrhage. METHODS PubMed, Medline, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform were systematically searched. All trial designs, except individual case reports, which evaluated the preemptive or goal-directed use of FC for trauma-related bleeding/coagulopathy, in patients older than 16 years, were included in the systematic review. For the included randomized controlled trials comparing FC with control, meta-analysis was performed and a risk-of bias-assessment was completed using the Cochrane Methodology and Preferred Reporting Items Systematic Reviews and Meta-analysis guidelines. RESULTS A total of 2,743 studies were identified; 26 were included in the systematic review, and 5 randomized controlled trials (n = 238) were included in the meta-analysis. For the primary outcome of mortality, there was no statistically significant difference between the groups, with 22% and 23.4% in the FC and comparator arms, respectively (risk ratio, 1.00 [95% confidence interval, 0.39 to 2.56]; p = 0.99). In addition, there was no statistical difference between FC and control in packed red blood cell, fresh frozen plasma, or platelet transfusion requirements, and thromboembolic events. Overall, the quality of evidence was graded as low to moderate because of concerns with risk of bias, imprecision, and inconsistency. CONCLUSION Further high-quality, adequately powered studies are needed to assess the impact of FC in trauma, with a focus on administration as early as possible from the point of entry into the trauma system of care. LEVEL OF EVIDENCE Systematic review and Meta-analysis, level II.
Collapse
|
23
|
Bleeding to death in a big city: An analysis of all trauma deaths from hemorrhage in a metropolitan area during 1 year. J Trauma Acute Care Surg 2020; 89:716-722. [PMID: 32590562 DOI: 10.1097/ta.0000000000002833] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hemorrhage is the most common cause of potentially preventable trauma deaths, but no studies have focused on all civilian traumatic deaths from hemorrhage, so we describe a year of these deaths from a large county to identify opportunities for preventing hemorrhagic deaths. METHODS All trauma-related deaths in Harris County, Texas, in 2014 underwent examination by the medical examiner; patients were excluded if hemorrhage was not their primary reason for death. Deaths were then categorized as preventable/potentially preventable hemorrhage (PPH) or nonpreventable hemorrhage. These categories were compared across mechanism of injury, death location, and anatomic locations of hemorrhage to determine significant differences. RESULTS A total of 1,848 deaths were reviewed, and 305 were from uncontrolled hemorrhage. One hundred thirty-seven (44.9%) of these deaths were PPH. Of these PPH, 49 (35.8%) occurred prehospital and an additional 28 (20.4%) died within 1 hour of arriving at an acute care setting. Of the 83 PPH who arrived at a hospital, 21 (25.3%) died at a center not designated as level 1. Isolated truncal bleeding was the source of hemorrhage in 102 (74.5%) of the PPH. Of those who died with truncal PPH, the distribution was 22 chest (21.6%), 39 chest and abdomen (38.2%), 16 abdomen (15.7%), and 25 all other combinations (24.5%). When patients who died within 1 hour of arrival to a hospital were combined with the 168 deaths that occurred prehospital, 223 (74.3%) of 300 deaths occurred before spending 1 hour in a hospital and 77 (34.5%) of 223 of these deaths were PPH. CONCLUSION In a well-developed, urban trauma system, 34.5% of patients died from PPH in the prehospital setting or within an hour of hospitalization. Earlier, more effective prehospital resuscitation and truncal hemorrhage control strategies are needed to decrease deaths from PPH. LEVEL OF EVIDENCE Therapeutic/Care management, level IV.
Collapse
|
24
|
Hamsen U, Drotleff N, Lefering R, Gerstmeyer J, Schildhauer TA, Waydhas C. Mortality in severely injured patients: nearly one of five non-survivors have been already discharged alive from ICU. BMC Anesthesiol 2020; 20:243. [PMID: 32967620 PMCID: PMC7513498 DOI: 10.1186/s12871-020-01159-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 09/15/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Most trauma patients admitted to the hospital alive and die later on, decease during the initial care in the emergency department or the intensive care unit (ICU). However, a number of patients pass away after having been discharged from the ICU during the initial hospital stay. On first sight these cases could be seen as "failure to rescue" of potentially salvageable patients. A low rate of such patients might be a potential indicator of quality for trauma care on ICUs and surgical wards. METHODS Retrospective analysis of the TraumaRegister DGU® with data from 2015 to 2017. Patients that died during the initial ICU stay were compared to those who were discharged from the initial ICU stay for at least 24 h but died later on. RESULTS A total of 82,313 trauma patients were included in the TraumaRegister DGU®. In total, 6576 patients (8.0%) died during their hospital stay. Out of those, 5481 were admitted to the ICU alive and 972 patients (17.7%) were discharged from ICU and died later on. Those were older (mean age: 77 vs. 68 years), less severely injured (mean ISS: 23.1 vs. 30.0 points) and had a longer mean ICU length of stay (10 vs. 6 days). A limitation of life-sustaining therapy due to a documented living will was present in 46.1% of all patients who died during their initial ICU stay and in 59.9% of patients who died after discharge from their initial ICU stay. CONCLUSIONS 17.7% of all non-surviving severely injured trauma patients died within the hospital after discharge from their initial ICU treatment. Their death can partially be explained by a limitation of therapy due to a living will. In conclusion, the rate of such late deaths may partially represent patients that died of potentially avoidable or treatable complications.
Collapse
Affiliation(s)
- Uwe Hamsen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Buerkle de la Camp Platz 1, 44789, Bochum, Germany.
| | - Niklas Drotleff
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Buerkle de la Camp Platz 1, 44789, Bochum, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten-Herdecke, Ostheimer Str. 200, 51109, Cologne, Germany
| | - Julius Gerstmeyer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Buerkle de la Camp Platz 1, 44789, Bochum, Germany
| | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Buerkle de la Camp Platz 1, 44789, Bochum, Germany
| | - Christian Waydhas
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Buerkle de la Camp Platz 1, 44789, Bochum, Germany.,Medical Faculty University Duisburg-Essen, Essen, Germany
| | | |
Collapse
|
25
|
Severe traumatic brain injury is associated with a unique coagulopathy phenotype. J Trauma Acute Care Surg 2020; 86:686-693. [PMID: 30601456 DOI: 10.1097/ta.0000000000002173] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) patients present on a spectrum from hypocoagulability to hypercoagulability, depending on the injury complexity, severity, and time since injury. Prior studies have found a unique coagulopathy associated with TBI using conventional coagulation assays such as INR; however, few studies have assessed the association of TBI and coagulopathy using viscoelastic assays that comprehensively evaluate the coagulation in whole blood. This study aims to reevaluate the TBI-specific trauma-induced coagulopathy using arrival thrombelastography. Because brain tissue is high in key procoagulant molecules, we hypothesize that isolated TBI is associated with procoagulant and hypofibrinolytic profiles compared with injuries of the torso, extremities, and polytrauma, including TBI. METHODS Data are from the prospective Trauma Activation Protocol study. Activated clotting time (ACT), angle, maximum amplitude (MA), 30-minute percent lysis after MA (LY30), and functional fibrinogen levels (FFLEV) were recorded. Patients were categorized into isolated severe TBI (I-TBI), severe TBI with torso and extremity injuries (TBI + TORSO/EXTREMITIES), and isolated torso and extremity injuries (I-TORSO/EXTREMITIES). Poisson regression was used to adjust for multiple confounders. RESULTS Overall, 572 patients (48 I-TBI, 45 TBI + TORSO/EXTREMITIES, 479 I-TORSO/EXTREMITIES) were included in this analysis. The groups differed in INR, ACT, angle, MA, and FFLEV but not in 30-minute percent lysis. When compared with I-Torso/Extremities, after adjustment for confounders, severe I-TBI was independently associated with ACT less than 128 seconds (relative risk [RR], 1.5; 95% confidence interval [CI], 1.1-2.2), angle less than 65 degrees (RR, 2.2; 95% CI, 1.4-3.6), FFLEV less than 356 (RR, 1.7; 95% CI, 1.2-2.4) but not MA less than 55 mm, hyperfibrinolysis, fibrinolysis shutdown, or partial thromboplastin time (PTT) greater than 30. CONCLUSION Severe I-TBI was independently associated with a distinct coagulopathy with delayed clot formation but did not appear to be associated with fibrinolysis abnormalities. Low fibrinogen and longer ACT values associated with I-TBI suggest that early coagulation factor replacement may be indicated in I-TBI patients over empiric antifibrinolytic therapy. Mechanisms triggering coagulopathy in TBI are unique and warrant further investigation. LEVEL OF EVIDENCE Retrospective cohort study, prognostic, level III.
Collapse
|
26
|
Kamine TH, Rembisz A, Barron RJ, Baldwin C, Kromer M. Decrease in Trauma Admissions with COVID-19 Pandemic. West J Emerg Med 2020; 21:819-822. [PMID: 32726250 PMCID: PMC7390569 DOI: 10.5811/westjem.2020.5.47780] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 05/14/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has led to social distancing and decreased travel in the United States. The impact of these interventions on trauma and emergency general surgery patient volume has not yet been described. METHODS We compared trauma admissions and emergency general surgery (EGS) cases between February 1-April 14 from 2017-2020 in five two-week time periods. Data were compared across time periods with Poisson regression analysis. RESULTS There were significant decreases in overall trauma admissions (57.4% decrease, p<0.001); motor vehicle collisions (MVC) (80.5% decrease, p<0.001); and non-MVCs (45.1% decrease, p<0.001) from February-April 2020. We found no significant change in EGS cases (p = 0.70). Nor was there was a significant change in trauma cases in any other year 2017-2019. CONCLUSION The COVID-19 pandemic's burden of disease correlated with a significant decrease in trauma admissions, with MVCs experiencing a larger decrease than non-MVCs.
Collapse
Affiliation(s)
- Tovy H Kamine
- Portsmouth Regional Hospital, Department of Acute Care Surgery, Trauma, and Surgical Critical Care, Portsmouth, New Hampshire
| | - Adam Rembisz
- Portsmouth Regional Hospital, Department of Acute Care Surgery, Trauma, and Surgical Critical Care, Portsmouth, New Hampshire
| | - Rebecca J Barron
- Portsmouth Regional Hospital, Department of Emergency Medicine, Portsmouth, New Hamsphire
| | - Carey Baldwin
- University of Massachusetts, Isenberg Shool of Management, Amherst, Massachusetts
| | - Mark Kromer
- Portsmouth Regional Hospital, Department of Acute Care Surgery, Trauma, and Surgical Critical Care, Portsmouth, New Hampshire
| |
Collapse
|
27
|
Wooldridge AR, Carayon P, Hoonakker P, Hose BZ, Eithun B, Brazelton T, Ross J, Kohler JE, Kelly MM, Dean SM, Rusy D, Gurses AP. Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients. APPLIED ERGONOMICS 2020; 85:103059. [PMID: 32174347 PMCID: PMC7309517 DOI: 10.1016/j.apergo.2020.103059] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 11/13/2019] [Accepted: 01/13/2020] [Indexed: 06/02/2023]
Abstract
Hospital-based care of pediatric trauma patients includes transitions between units that are critical for quality of care and patient safety. Using a macroergonomics approach, we identify work system barriers and facilitators in care transitions. We interviewed eighteen healthcare professionals involved in transitions from emergency department (ED) to operating room (OR), OR to pediatric intensive care unit (PICU) and ED to PICU. We applied the Systems Engineering Initiative for Patient Safety (SEIPS) process modeling method and identified nine dimensions of barriers and facilitators - anticipation, ED decision making, interacting with family, physical environment, role ambiguity, staffing/resources, team cognition, technology and characteristic of trauma care. For example, handoffs involving all healthcare professionals in the OR to PICU transition created a shared understanding of the patient, but sometimes included distractions. Understanding barriers and facilitators can guide future improvements, e.g., designing a team display to support team cognition of healthcare professionals in the care transitions.
Collapse
Affiliation(s)
- Abigail R Wooldridge
- Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Peter Hoonakker
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Bat-Zion Hose
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Benjamin Eithun
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Thomas Brazelton
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Joshua Ross
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jonathan E Kohler
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michelle M Kelly
- Wisconsin Institute for Healthcare Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Shannon M Dean
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Deborah Rusy
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ayse P Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD, USA; Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Bloomberg School of Public Health and Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
28
|
Bakshi PS, Selvakumar D, Kadirvelu K, Kumar N. Chitosan as an environment friendly biomaterial – a review on recent modifications and applications. Int J Biol Macromol 2020; 150:1072-1083. [DOI: 10.1016/j.ijbiomac.2019.10.113] [Citation(s) in RCA: 316] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/12/2022]
|
29
|
|
30
|
Kim Y, Goodman MD, Jung AD, Abplanalp WA, Schuster RM, Caldwell CC, Lentsch AB, Pritts TA. Microparticles from aged packed red blood cell units stimulate pulmonary microthrombus formation via P-selectin. Thromb Res 2019; 185:160-166. [PMID: 31821908 DOI: 10.1016/j.thromres.2019.11.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/31/2019] [Accepted: 11/24/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION During storage, packed red blood cells undergo a series of physical, metabolic, and chemical changes collectively known as the red blood cell storage lesion. One key component of the red blood cell storage lesion is the accumulation of microparticles, which are submicron vesicles shed from erythrocytes as part of the aging process. Previous studies from our laboratory indicate that transfusion of these microparticles leads to lung injury, but the mechanism underlying this process is unknown. In the present study, we hypothesized that microparticles from aged packed red blood cell units induce pulmonary thrombosis. MATERIALS AND METHODS Leukoreduced, platelet-depleted, murine packed red blood cells (pRBCS) were prepared then stored for up to 14 days. Microparticles were isolated from stored units via high-speed centrifugation. Mice were transfused with microparticles. The presence of pulmonary microthrombi was determined with light microscopy, Martius Scarlet Blue, and thrombocyte stains. In additional studies microparticles were labelled with CFSE prior to injection. Murine lung endothelial cells were cultured and P-selectin concentrations determined by ELISA. In subsequent studies, P-selectin was inhibited by PSI-697 injection prior to transfusion. RESULTS We observed an increase in microthrombi formation in lung vasculature in mice receiving microparticles from stored packed red blood cell units as compared with controls. These microthrombi contained platelets, fibrin, and microparticles. Treatment of cultured lung endothelial cells with microparticles led to increased P-selectin in the media. Treatment of mice with a P-selectin inhibitor prior to microparticle infusion decreased microthrombi formation. CONCLUSIONS These data suggest that microparticles isolated from aged packed red blood cell units promote the development of pulmonary microthrombi in a murine model of transfusion. This pro-thrombotic event appears to be mediated by P-selectin.
Collapse
Affiliation(s)
- Young Kim
- Section of General Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael D Goodman
- Section of General Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew D Jung
- Section of General Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - William A Abplanalp
- Section of General Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rebecca M Schuster
- Section of General Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Charles C Caldwell
- Section of General Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alex B Lentsch
- Section of General Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Timothy A Pritts
- Section of General Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| |
Collapse
|
31
|
Wooldridge A, Carayon P, Hoonakker P, Hose BZ, Ross J, Kohler JE, Brazelton T, Eithun B, Kelly MM, Dean SM, Rusy D, Durojaiye A, Gurses AP. Complexity of the pediatric trauma care process: Implications for multi-level awareness. COGNITION, TECHNOLOGY & WORK (ONLINE) 2019; 21:397-416. [PMID: 31485191 PMCID: PMC6724740 DOI: 10.1007/s10111-018-0520-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/23/2018] [Indexed: 06/02/2023]
Abstract
Trauma is the leading cause of disability and death in children and young adults in the US. While much is known about the medical aspects of inpatient pediatric trauma care, not much is known about the processes and roles involved in in-hospital care. Using human factors engineering (HFE) methods, we combine interview, archival document and trauma registry data to describe how intra-hospital care transitions affect process and team complexity. Specifically, we identify the 53 roles directly involved in patient care in each hospital unit and describe the 3324 total transitions between hospital units and the 69 unique pathways, from arrival to discharge, experienced by pediatric trauma patients. We continue the argument to shift from eliminating complexity to coping with it and propose supporting three levels of awareness to enhance the resilience and adaptation necessary for patient safety in health care, i.e. safety in complex systems. We discuss three levels of awareness (individual, team and organizational) and describe challenges and potential sociotechnical solutions for each. For example, one challenge to individual awareness is high time pressure. A potential solution is clinical decision support of information perception, integration and decision making. A challenge to team awareness is inadequate "non-technical" skills, e.g., leadership, communication, role clarity; simulation or another form of training could improve these. The complex, distributed nature of this process is a challenge to organizational awareness; a potential solution is to develop awareness of the process and the roles and interdependencies within it, by using process modeling or simulation.
Collapse
Affiliation(s)
- Abigail Wooldridge
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, 3270 Mechanical Engineering Building, Madison WI 53706, USA
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, 3270 Mechanical Engineering Building, Madison WI 53706, USA
| | - Peter Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, 3135 Engineering Centers Building, Madison WI 53706, USA
| | - Bat-Zion Hose
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, 3270 Mechanical Engineering Building, Madison WI 53706, USA
| | - Joshua Ross
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 310, MC 9123, Madison WI 53705, USA
| | - Jonathan E Kohler
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Department of Surgery Administration MC: 7375, Madison WI 53792, USA
| | - Thomas Brazelton
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, 600 Highland Avenue, Madison WI 53793, USA
| | - Benjamin Eithun
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, 1675 Highland Avenue, Madison WI 53792, USA
| | - Michelle M Kelly
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, 3135 Engineering Centers Building, Madison WI 53706, USA
| | - Shannon M Dean
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, 600 Highland Avenue, Madison WI 53793, USA
| | - Deborah Rusy
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ashimiyu Durojaiye
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, 750 East Pratt Street, 15 Floor, Baltimore MD 21202, USA, Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, 2024 East Monument Street, S1-200, Baltimore MD 21205, USA
| | - Ayse P Gurses
- Center for Health Care Human Factors, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, 750 East Pratt Street, 15 Floor, Baltimore MD 21202, USA, Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, 2024 East Monument Street, S1-200, Baltimore MD 21205, USA
| |
Collapse
|
32
|
Carrying the torch: The life, work, and values of Basil A. Pruitt, Jr., MD, FACS, COL (ret), MC, USA. J Trauma Acute Care Surg 2019; 87:S3-S9. [PMID: 31033895 DOI: 10.1097/ta.0000000000002324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
33
|
Eastridge BJ, Holcomb JB, Shackelford S. Outcomes of traumatic hemorrhagic shock and the epidemiology of preventable death from injury. Transfusion 2019; 59:1423-1428. [DOI: 10.1111/trf.15161] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 12/26/2022]
Affiliation(s)
| | | | - Stacy Shackelford
- Joint Trauma SystemU.S. Army Institute of Surgical Research Fort Sam Houston Texas
| |
Collapse
|
34
|
Moon DH, Kang DY, Haam SJ, Yumoto T, Tsukahara K, Yamada T, Nakao A, Lee S. Hydrogen gas inhalation ameliorates lung injury after hemorrhagic shock and resuscitation. J Thorac Dis 2019; 11:1519-1527. [PMID: 31179095 DOI: 10.21037/jtd.2019.03.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Hemorrhagic shock and resuscitation (HSR) is known to cause inflammatory reactions in the lung parenchyma and acute lung injury, increasing the risk of complications that can lead to death. Hydrogen gas has shown to inhibit the formation and eliminate reactive oxygen species (ROS), which are known to cause reperfusion injury. Hence, the purpose of this study was to investigate the protective effect of 2% inhaled hydrogen gas on post-HSR lung injury. Methods Rats weighing 300-500 g were divided into three groups: sham, HSR, and hydrogen (H2)/HSR groups. In the latter two groups, HSR was induced via femoral vein cannulation. Gas containing 2% hydrogen gas was inhaled only by those in the H2/HSR group. Lung tissue and abdominal aorta blood were obtained for histologic examination and arterial blood gas analyses, respectively. Neutrophil infiltration and proinflammatory mediators were also measured. Results PO2 was lower in the HSR and H2/HSR groups than in the sham group. Blood lactate level was not significantly different between the sham and H2/HSR groups, but it was significantly higher in the HSR group. Infiltration of inflammatory cells into the lung tissues was more frequent in the HSR group. Myeloperoxidase (MPO) activity was significantly different among the three groups (highest in the HSR group). All proinflammatory mediators, except IL-6, showed a significant difference among the three groups (highest in the HSR group). Conclusions Inhalation of 2% hydrogen gas after HSR minimized the extent of lung injury by decreasing MPO activity and reducing infiltration of inflammatory cells into lung tissue.
Collapse
Affiliation(s)
- Duk Hwan Moon
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Du-Young Kang
- Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seok Jin Haam
- Department of thoracic and cardiovascular surgery, Ajou university hospital, Suwon, Republic of Korea
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kohei Tsukahara
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Taihei Yamada
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
35
|
Rauf R, von Matthey F, Croenlein M, Zyskowski M, van Griensven M, Biberthaler P, Lefering R, Huber-Wagner S. Changes in the temporal distribution of in-hospital mortality in severely injured patients-An analysis of the TraumaRegister DGU. PLoS One 2019; 14:e0212095. [PMID: 30794579 PMCID: PMC6386341 DOI: 10.1371/journal.pone.0212095] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/28/2019] [Indexed: 01/31/2023] Open
Abstract
Background The temporal distribution of trauma mortality has been classically described as a trimodal pattern with an immediate, early and late peak. In modern health care systems this time distribution has changed. Methods Data from the TraumaRegister DGU was analysed retrospectively. Between 2002 and 2015, all registered in-hospital deaths with an Injury Severity Score (ISS) ≥ 16 were evaluated considering time of death, trauma mechanism, injured body area, age distribution, rates of sepsis and multiple organ failure. Pre-hospital and post-discharge trauma deaths were not considered. Results 78 310 severely injured patients were registered, non-survivors constituted 14 816, representing an in-hospital mortality rate of 18.9%. Mean ISS of non-survivors was 36.0±16.0, 66.7% were male, mean age was 59.5±23.5. Within the first hour after admission to hospital, 10.8% of deaths occurred, after 6 hours the percentage increased to 25.5%, after 12 hours 40.0%, after 24 hours 53.2% and within the first 48 hours 61.9%. Mortality showed a constant temporal decrease. Severe head injury (defined by Abbreviated Injury Scale, AIS-Head≥3) was found in 76.4% of non-survivors. Patients with an isolated head injury showed a more distinct decrease in survival rate, which was accentuated in the first days after admission. The correlation of age and time of death showed a proportional increase with age (55-74a). The rate of sepsis and multiple organ failure among non-survivors was 11.5% and 70.1%, respectively. Conclusion In a modern trauma care system, the mortality distribution of severely injured patients has changed its pattern, where especially the third peak is no longer detectable.
Collapse
Affiliation(s)
- Rauend Rauf
- Department of Trauma Surgery, Technical University Munich, Hospital Rechts der Isar, Munich, Germany
- * E-mail:
| | - Francesca von Matthey
- Department of Trauma Surgery, Technical University Munich, Hospital Rechts der Isar, Munich, Germany
| | - Moritz Croenlein
- Department of Trauma Surgery, Technical University Munich, Hospital Rechts der Isar, Munich, Germany
| | - Michael Zyskowski
- Department of Trauma Surgery, Technical University Munich, Hospital Rechts der Isar, Munich, Germany
| | - Martijn van Griensven
- Department of Trauma Surgery, Technical University Munich, Hospital Rechts der Isar, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Technical University Munich, Hospital Rechts der Isar, Munich, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
| | - Stefan Huber-Wagner
- Department of Trauma Surgery, Technical University Munich, Hospital Rechts der Isar, Munich, Germany
| | | |
Collapse
|
36
|
Dargère M, Langlais ML, Gangloff C, Léostic C, Le Niger C, Ozier Y. Implementation and evaluation of a major haemorrhage protocol in the Emergency Department Resuscitation Area in the University-affiliated Hospital of Brest (France). Transfus Clin Biol 2018; 26:309-315. [PMID: 30262152 DOI: 10.1016/j.tracli.2018.08.160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/13/2018] [Indexed: 11/16/2022]
Abstract
Haemorrhagic shock is a rare occurrence in emergency medicine but it can be associated with significant mortality. The purpose of this study was to evaluate the impact of a major haemorrhage protocol on patient management in Emergency Department Resuscitation Area. METHODS A single-centre study was conducted to compare two periods, before and after institution of a massive haemorrhage protocol including the use of massive transfusion orders and the availability of packed red blood cell concentrates prior to patient's admission. Two groups of patients (in both trauma and non-trauma settings) were defined: "before protocol" and "after protocol". The primary outcome was the median transfusion time for a unit of red blood cell concentrate. RESULTS Forty patients were included: 22 for the "pre-protocol" group and 18 for the "post-protocol" group. The two groups were balanced with baseline characteristics. This study showed a significantly reduced median transfusion time for a unit of red blood cell concentrate from 20min pre-protocol to 9min post-protocol. The time between patient's admission and transfusion of the first red blood cell concentrate was reduced but non-significantly from 71min to 36min. CONCLUSION The major haemorrhage protocol optimised patient management by reducing the median transfusion time for red blood cell concentrates.
Collapse
Affiliation(s)
- M Dargère
- Emergency department, centre hospitalier regional universitaire de Brest, 29200 Brest, France
| | - M-L Langlais
- Emergency department, centre hospitalier regional universitaire de Brest, 29200 Brest, France
| | - C Gangloff
- Urgent Medical Aid Service (SAMU), centre hospitalier regional universitaire de Brest, 29200 Brest, France
| | - C Léostic
- French National Blood Service (EFS), centre hospitalier regional universitaire de Brest, 29200 Brest, France
| | - C Le Niger
- Centre hospitalier regional universitaire de Brest, 29200 Brest, France.
| | - Y Ozier
- Department of anaesthesiology and intensive care medicine, centre hospitalier regional universitaire de Brest, 29200 Brest, France
| |
Collapse
|
37
|
Abstract
To evaluate the potential risk factors which increase the incidence of post-trauma complications and mortality in pediatric population.A retrospective cohort study was conducted on patients below 18 years of age with a fatal outcome who were admitted to an Indian level-1 trauma center between January 2013 and December 2015. This cohort was analyzed to determine the demographics, injury mechanism, injury severity, microbiological profile, and cause of death.In total, 320 pediatric patients with a fatal outcome were studied which showed male preponderance (71.56%). The median age of the patients was 11 years (range, 0.14-18 years). Median duration of stay was 1 day (range, 0-183 days). Fall and road traffic accidents were the common mechanisms of trauma while the main injury was head injury. In total, 857 clinical samples were received from 56 patients. The clinical samples from 35 (10.94%) patients were culture positive. Culture-proven infections were significantly correlated with the length of hospital stay (P = .001). In total, 212 organisms were isolated from 193 positive samples of which gram-negative bacteria were predominant (89.15%). The most common gram-positive bacterial isolate was Staphylococcus aureus (12, 52.17%), while Acinetobacter baumannii (66, 34.92%) was the most prevalent gram-negative bacterial isolate followed by Pseudomonas spp. (36, 19.05%), Klebsiella pneumoniae (35, 18.52%), and Escherichia coli (16, 8.47%). Up to 100% multidrug resistance was seen in both gram-positive and gram-negative bacterial isolates. The first 24 hours after trauma were the deadliest for our patients. Head/central nervous system injury was the primary cause of disabilities and early death whereas infection attributed to prolonged hospital stay.From these observations we concluded that management of pediatric trauma requires expert, multidisciplinary, and timely interventions. Moreover, nosocomial infections with multidrug resistant gram-negative bacteria challenges the accepted tenets of trauma care affecting the outcome of the pediatric population. Early identification of such high-risk patients' infection may facilitate early intervention. Thus, many deaths in pediatric group are preventable.
Collapse
Affiliation(s)
| | - Fahmi Hasan
- Department of Lab Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Surbhi Khurana
- Department of Lab Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Purva Mathur
- Department of Lab Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
38
|
Surfactant Proteins-A and -D Attenuate LPS-Induced Apoptosis in Primary Intestinal Epithelial Cells (IECs). Shock 2018; 49:90-98. [PMID: 28591009 DOI: 10.1097/shk.0000000000000919] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION SP-A/D KO mice with sepsis demonstrate more severe lung, kidney, and gut injury/apoptosis than WT controls. We hypothesize SP-A and SP-D directly regulate lipopolysaccharide (LPS)-induced P38 mitogen-activated protein kinase (MAPK) activation and gut apoptosis during sepsis. METHODS Primary IECs were established from SP-A/D KO or C57BL/6 WT mice, stimulated with LPS and harvested at 24 h. IECs from WT mice were treated with SP-A, SP-D, or vehicle for 20 h, then LPS for 24 h. Apoptosis, cleaved caspase-3 levels and the ratio of BAX/Bcl-2 were assayed. The role of P38 MAPK was examined using the P38 MAPK-agonist U46619 and inhibitor SB203580 in LPS-treated cells. p-P38 MAPK/t-P38 MAPK, TLR4, and CD14 were measured by Western Blot. RESULTS LPS-induced apoptosis, caspase-3 levels, BAX/Bcl-2, and p-P38/t-P38 MAPK were increased in SP-A/D KO IECs. SP-A and SP-D attenuate LPS-induced increase in apoptosis, cleaved caspase-3, BAX/Bcl-2, and p-P38/t-P38 MAPK in WT IECs. U46619 increased apoptosis, caspase-3, and BAX/Bcl-2 in IECs which was attenuated by SP-A/D. SB203580 attenuates the LPS-induced increase in apoptosis, caspase-3, and BAX/Bcl-2 in WT IECs. Addition of SP-A or SP-D to SB203580 completely ameliorates LPS-induced apoptosis. The LPS-induced increase in TLR4 and CD14 expression is greater in IECs from SP-A/D KO mice and treatment of WT IECs with SP-A or SP-D prevents the LPS-induced increase in TLR4 and CD14. CONCLUSIONS SP-A and SP-D attenuate LPS-induced increases in apoptosis, caspase-3, and BAX/Bcl-2 in IECs. Attenuation of LPS-induced activation of TLR4 and P38 MAPK signaling pathways represents potential mechanisms for the protective effects of SP-A/D on apoptosis.
Collapse
|
39
|
Carrara M, Babini G, Baselli G, Ristagno G, Pastorelli R, Brunelli L, Ferrario M. Blood pressure variability, heart functionality, and left ventricular tissue alterations in a protocol of severe hemorrhagic shock and resuscitation. J Appl Physiol (1985) 2018; 125:1011-1020. [PMID: 30001154 PMCID: PMC6230573 DOI: 10.1152/japplphysiol.00348.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Autonomic control of blood pressure (BP) and heart rate (HR) is crucial during bleeding and hemorrhagic shock (HS) to compensate for hypotension and hypoxia. Previous works have observed that at the point of hemodynamic decompensation a marked suppression of BP and HR variability occurs, leading to irreversible shock. We hypothesized that recovery of the autonomic control may be decisive for effective resuscitation, along with restoration of mean BP. We computed cardiovascular indexes of baroreflex sensitivity and BP and HR variability by analyzing hemodynamic recordings collected from five pigs during a protocol of severe hemorrhage and resuscitation; three pigs were sham-treated controls. Moreover, we assessed the effects of severe hemorrhage on heart functionality by integrating the hemodynamic findings with measures of plasma high-sensitivity cardiac troponin T and metabolite concentrations in left ventricular (LV) tissue. Resuscitation was performed with fluids and norepinephrine and then by reinfusion of shed blood. After first resuscitation, mean BP reached the target value, but cardiovascular indexes were not fully restored, hinting at a partial recovery of the autonomic mechanisms. Moreover, cardiac troponins were still elevated, suggesting a persistent myocardial sufferance. After blood reinfusion all the indexes returned to baseline. In the harvested heart, LV metabolic profile confirmed the acute stress condition sensed by the cardiomyocytes. Variability indexes and baroreflex trends can be valuable tools to evaluate the severity of HS, and they may represent a more useful end point for resuscitation in combination with standard measures such as mean values and biological measures. NEW & NOTEWORTHY Autonomic control of blood pressure was highly impaired during hemorrhagic shock, and it was not completely recovered after resuscitation despite global restoration of mean pressures. Moreover, a persistent myocardial sufferance emerged from measured cardiac troponin T and metabolite concentrations of left ventricular tissue. We highlight the importance of combining global mean values and biological markers with measures of variability and autonomic control for a better characterization of the effectiveness of the resuscitation strategy.
Collapse
Affiliation(s)
- Marta Carrara
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan , Italy
| | - Giovanni Babini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan , Milan , Italy
| | - Giuseppe Baselli
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan , Italy
| | | | | | - Laura Brunelli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Manuela Ferrario
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan , Italy
| |
Collapse
|
40
|
|
41
|
Fernández Mondéjar E, Guerrero López F, Cordovilla Guardia S. Paciente traumatizado recuperado: buena suerte y… ¡hasta la próxima! Med Intensiva 2018; 42:205-206. [DOI: 10.1016/j.medin.2017.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/09/2017] [Accepted: 09/13/2017] [Indexed: 11/29/2022]
|
42
|
Sakran JV, Jehan F, Joseph B. Trauma Systems: Standardization and Regionalization of Care Improve Quality of Care. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0113-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
43
|
Geospatial mapping can be used to identify geographic areas and social factors associated with intentional injury as targets for prevention efforts distinct to a given community. J Trauma Acute Care Surg 2018; 84:70-74. [PMID: 29040200 DOI: 10.1097/ta.0000000000001720] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Geographic information systems (GIS) have proven effective in studying intentional injury in various communities; however, GIS is not implemented widely for use by Level I trauma centers in understanding patient populations. Our study of intentional injury combines the capabilities of GIS with a Level I trauma center registry to determine the spatial distribution of victims and correlated socioeconomic factors. METHODS One thousand ninety-nine of 3,109 total incidents of intentional trauma in the trauma registry from 2005 to 2015 had sufficient street address information to be mapped in GIS. Comparison of these data, coupled with demographic data at the block group level, determined if any clustering or spatial patterns existed. Geographic information systems delivered these comparisons using several spatial statistics including kernel density, ordinary least squares test, and Moran's index. RESULTS Kernel density analysis identified four major areas with significant clustering of incidents. The Moran's I value was 0.0318. Clustering exhibited a positive z-score and significant p value (p < 0.01). Examination of socioeconomic factors by spatial correlation with the distribution of intentional injury incidents identified three significant factors: unemployment, single-parent households, and lack of a high school degree. Tested factors did not exhibit substantial redundancy (variance inflation factor < 7.5). Nonsignificant tested factors included race, proximity to liquor stores and bars, median household income, per capita income, rate with public assistance, and population density. CONCLUSION Spatial representation of trauma registry data using GIS effectively identifies high-risk areas for intentional injury. Analysis of local socioeconomic data identifies factors unique to those high-risk areas in the observed community. Implications of this study may include the routine use of GIS by Level I trauma centers in assessing intentional injury in a given community, the use of that data to guide the development of trauma prevention, and the assessment of other mechanisms of trauma using GIS. LEVEL OF EVIDENCE Epidemiological, level IV.
Collapse
|
44
|
Microparticles from stored red blood cells promote a hypercoagulable state in a murine model of transfusion. Surgery 2017; 163:423-429. [PMID: 29198748 DOI: 10.1016/j.surg.2017.09.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 08/19/2017] [Accepted: 09/16/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Red blood cell-derived microparticles are biologically active, submicron vesicles shed by erythrocytes during storage. Recent clinical studies have linked the duration of red blood cell storage with thromboembolic events in critically ill transfusion recipients. In the present study, we hypothesized that microparticles from aged packed red blood cell units promote a hypercoagulable state in a murine model of transfusion. METHODS Microparticles were isolated from aged, murine packed red blood cell units via serial centrifugation. Healthy male C57BL/6 mice were transfused with microparticles or an equivalent volume of vehicle, and whole blood was harvested for analysis via rotational thromboelastometry. Serum was harvested from a separate set of mice after microparticles or saline injection, and analyzed for fibrinogen levels. Red blood cell-derived microparticles were analyzed for their ability to convert prothrombin to thrombin. Finally, mice were transfused with either red blood cell microparticles or saline vehicle, and a tail bleeding time assay was performed after an equilibration period of 2, 6, 12, or 24 hours. RESULTS Mice injected with red blood cell-derived microparticles demonstrated an accelerated clot formation time (109.3 ± 26.9 vs 141.6 ± 28.2 sec) and increased α angle (68.8 ± 5.0 degrees vs 62.8 ± 4.7 degrees) compared with control (each P < .05). Clotting time and maximum clot firmness were not significantly different between the 2 groups. Red blood cell-derived microparticles exhibited a hundredfold greater conversion of prothrombin substrate to its active thrombin form (66.60 ± 0.03 vs 0.70 ± 0.01 peak OD; P<.0001). Additionally, serum fibrinogen levels were lower in microparticles-injected mice compared with saline vehicle, suggesting thrombin-mediated conversion to insoluble fibrin (14.0 vs 16.5 µg/mL, P<.05). In the tail bleeding time model, there was a more rapid cessation of bleeding at 2 hours posttransfusion (90.6 vs 123.7 sec) and 6 hours posttransfusion (87.1 vs 141.4 sec) in microparticles-injected mice as compared with saline vehicle (each P<.05). There was no difference in tail bleeding time at 12 or 24 hours. CONCLUSION Red blood cell-derived microparticles induce a transient hypercoagulable state through accelerated activation of clotting factors.
Collapse
|
45
|
Rehn M, Weaver AE, Eshelby S, Røislien J, Lockey DJ. Pre-hospital transfusion of red blood cells in civilian trauma patients. Transfus Med 2017; 28:277-283. [PMID: 29067785 DOI: 10.1111/tme.12483] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The current management of severely injured patients includes damage control resuscitation strategies that minimise the use of crystalloids and emphasise earlier transfusion of red blood cells (RBC) to prevent coagulopathy. In 2012, London's air ambulance (LAA) became the first UK civilian pre-hospital service to routinely carry RBC to the trauma scene. OBJECTIVE To investigate the effect of pre-hospital RBC transfusion (phRTx) on overall blood product consumption. METHODS A retrospective trauma database study compares before implementation with after implementation of phRTx in exsanguinating trauma patients transported directly to one major trauma centre. Pre-hospital deaths were excluded. Univariate and multivariate Poisson regression analyses on data subject to multiple imputation were conducted. RESULTS We included 137 and 128 patients in the before and after the implementation of phRTx groups, respectively. LAA transfused 304 RBC units (median 2, inter quartile range 1-3). We found a significant reduction in total RBC usage and reduced early use of platelets and fresh-frozen plasma (FFP) after the implementation of phRTx in both univariate (P < 0·001) and multivariate analyses (P < 0·001). No immediate adverse transfusion reactions were identified. CONCLUSION Pre-hospital trauma transfusion practice is feasible and associated with overall reduced RBC, platelets and FFP consumption.
Collapse
Affiliation(s)
- M Rehn
- London's Air Ambulance, Royal London Hospital, London, UK.,The Norwegian Air Ambulance Foundation, Drøbak, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - A E Weaver
- London's Air Ambulance, Royal London Hospital, London, UK
| | - S Eshelby
- Croydon University Hospital, Croydon Healthcare Trust, London, UK
| | - J Røislien
- The Norwegian Air Ambulance Foundation, Drøbak, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - D J Lockey
- London's Air Ambulance, Royal London Hospital, London, UK.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| |
Collapse
|
46
|
Analysis of Injury and Mortality Patterns in Deceased Patients with Road Traffic Injuries: An Autopsy Study. World J Surg 2017; 41:3111-3119. [DOI: 10.1007/s00268-017-4122-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
47
|
Beck B, Smith K, Mercier E, Cameron P. Clinical review of prehospital trauma deaths-The missing piece of the puzzle. Injury 2017; 48:971-972. [PMID: 28268002 DOI: 10.1016/j.injury.2017.02.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 02/22/2017] [Indexed: 02/02/2023]
Affiliation(s)
- Ben Beck
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
| | - Karen Smith
- Department of Research and Evaluation, Ambulance Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia
| | - Eric Mercier
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Department of Family and Emergency Medicine, Laval University, Quebec City, Quebec, Canada; Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
| |
Collapse
|
48
|
Roy N, Kizhakke Veetil D, Khajanchi MU, Kumar V, Solomon H, Kamble J, Basak D, Tomson G, von Schreeb J. Learning from 2523 trauma deaths in India- opportunities to prevent in-hospital deaths. BMC Health Serv Res 2017; 17:142. [PMID: 28209192 PMCID: PMC5314603 DOI: 10.1186/s12913-017-2085-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 02/09/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND A systematic analysis of trauma deaths is a step towards trauma quality improvement in Indian hospitals. This study estimates the magnitude of preventable trauma deaths in five Indian hospitals, and uses a peer-review process to identify opportunities for improvement (OFI) in trauma care delivery. METHODS All trauma deaths that occurred within 30 days of hospitalization in five urban university hospitals in India were retrospectively abstracted for demography, mechanism of injury, transfer status, injury description by clinical, investigation and operative findings. Using mixed methods, they were quantitatively stratified by the standardized Injury Severity Score (ISS) into mild (1-8), moderate (9-15), severe (16-25), profound (26-75) ISS categories, and by time to death within 24 h, 7, or 30 days. Using peer-review and Delphi methods, we defined optimal trauma care within the Indian context and evaluated each death for preventability, using the following categories: Preventable (P), Potentially preventable (PP), Non-preventable (NP) and Non-preventable but care could have been improved (NPI). RESULTS During the 18 month study period, there were 11,671 trauma admissions and 2523 deaths within 30 days (21.6%). The overall proportion of preventable deaths was 58%, among 2057 eligible deaths. In patients with a mild ISS score, 71% of deaths were preventable. In the moderate category, 56% were preventable, and 60% in the severe group and 44% in the profound group were preventable. Traumatic brain injury and burns accounted for the majority of non-preventable deaths. The important areas for improvement in the preventable deaths subset, inadequacies in airway management (14.3%) and resuscitation with hemorrhage control (16.3%). System-related issues included lack of protocols, lack of adherence to protocols, pre-hospital delays and delays in imaging. CONCLUSION Fifty-eight percent of all trauma deaths were classified as preventable. Two-thirds of the deaths with injury severity scores of less than 16 were preventable. This large subgroup of Indian urban trauma patients could possibly be saved by urgent attention and corrective action. Low-cost interventions such as airway management, fluid resuscitation, hemorrhage control and surgical decision-making protocols, were identified as OFI. Establishment of clinical protocols and timely processes of trauma care delivery are the next steps towards improving care.
Collapse
Affiliation(s)
- Nobhojit Roy
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Bhabha Atomic Research Centre Hospital, Mumbai, India
- School of Habitat, Tata Institute of Social Sciences, Mumbai, India
| | | | | | - Vineet Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Harris Solomon
- Department of Cultural Anthropology and Global Health, Global Health Institute, Duke University, 205 Friedl Building, Box 90091, Durham, 27708 NC USA
| | - Jyoti Kamble
- School of Habitat, Tata Institute of Social Sciences, Mumbai, India
| | - Debojit Basak
- School of Habitat, Tata Institute of Social Sciences, Mumbai, India
| | - Göran Tomson
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics (LIME) and Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Johan von Schreeb
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
49
|
Liu J, Lan G, Lu B, He L, Yu K, Chen J, Wang T, Dai F, Wu D. Properties of a new hemostatic gauze prepared with
in situ
thrombin induction. Biomed Phys Eng Express 2017. [DOI: 10.1088/2057-1976/aa519b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
50
|
Mahamid A, Peleg K, Givon A, Alfici R, Olsha O, Ashkenazi I. Blunt traumatic diaphragmatic injury: A diagnostic enigma with potential surgical pitfalls. Am J Emerg Med 2016; 35:214-217. [PMID: 27802875 DOI: 10.1016/j.ajem.2016.10.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 10/08/2016] [Accepted: 10/20/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Blunt traumatic diaphragmatic injury (BTDI) is an uncommon injury and one which is difficult to diagnose. The objective of this study was to identify features associated with this injury. METHODS This was a retrospective study based on records of 354307 blunt trauma victims treated between 1998 and 2013 collected by the Israeli National Trauma Registry. RESULTS BTDI was reported in 231 (0.065%) patients. Motor vehicle accidents were responsible for 84.4% of the injuries: 97 (42.0%) were reported as drivers; 54 (23.4%) were passengers; 34 (14.7%) were pedestrians hit by cars; and 10 (4.3%) were on motorcycles. There were more males than females (2.5:1) compared with blunt trauma patients without BTDI (p<.001). Patients with BTDI were significantly younger than blunt trauma patients without BTDI (p<.001). ISS was 9-14 in 5.2%, 16-24 in 16.9%, 25-75 in 77.9%. Urgent surgery was performed in 62% of the patients and 79.7% had surgery within 24h of admission. Mortality was 26.8%. Over 40% of patients with BTDI had associated rib, pelvic and/or extremity injuries. Over 30% had associated spleen, liver and/or lung injuries. Nevertheless, less than 1% of patients with skeletal injuries and less than 2.5% with solid organ injuries overall had associated BTDI. Despite hollow viscus injury being less prevalent, up to 6% of patients with this injury had associated BTDI. CONCLUSIONS BTDI is infrequent following blunt trauma. Hollow viscus injuries were more predictive of BTDI than skeletal or solid organ injuries.
Collapse
Affiliation(s)
- Ahmad Mahamid
- Division of General Surgery, Hillel Yaffe Medical Center, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Kobi Peleg
- National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel; Disaster Medicine Department, Faculty of Medicine, Tel-Aviv University, Israel.
| | - Adi Givon
- National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.
| | - Ricardo Alfici
- Division of General Surgery, Hillel Yaffe Medical Center, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Oded Olsha
- Surgery Department, Shaare Zedek Medical Center, Jerusalem, Israel.
| | | | - Itamar Ashkenazi
- Division of General Surgery, Hillel Yaffe Medical Center, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| |
Collapse
|