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Onderková A, Quinn J, Meoli M, Taylor D, Nesterenko S, Schramm JM, Gimpelson AJ, O'Kelly A, Parks S, Rizek J, Davis T, Surkov D, Cherniawski B, Fernando R. Enhancing Prehospital Care During the Conflict in Ukraine: NATO's Role in Global Health Engagement. Mil Med 2024:usae380. [PMID: 39163204 DOI: 10.1093/milmed/usae380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/28/2024] [Accepted: 07/22/2024] [Indexed: 08/22/2024] Open
Abstract
INTRODUCTION The conflict in Ukraine, ongoing since 2014 and escalating with the Russian invasion in 2022, has unveiled profound challenges in prehospital care essential for the survival and recovery of warfighters and civilians alike, necessitating a detailed examination of the current medical response mechanisms and their effectiveness. MATERIALS AND METHODS This study provides an overview of these challenges and examines how these critical vulnerabilities have impacted the delivery of medical care in war-torn regions. It also explores the role of NATO and its member states in addressing these challenges, focusing on the efforts to standardize prehospital care, enhance training, and foster interoperability among medical services. Furthermore, it explores the role of global heath engagement through NGOs in addressing these prehospital care gaps within the Ukrainian conflict zone, drawing from direct observations, expert testimonials, and secondary data. RESULTS Findings reveal significant enhancements in prehospital care through improved training, interoperability, and logistics management, despite ongoing challenges in medical infrastructure and extended evacuation times, which continue to impact the quality of care. CONCLUSIONS The study underscores the critical role of international collaboration and standardized protocols in bolstering prehospital medical responses in conflict settings, highlighting the need for continuous adaptation and support to mitigate the complexities of modern warfare. The insights gained from the Ukraine conflict offer valuable lessons for future military and humanitarian medical responses in similar conflict settings.
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Affiliation(s)
- Anna Onderková
- Otorhinolaryngology, Imperial College London Healthcare Trust, London, W6 8RF, UK
| | - John Quinn
- Emergency Department, East Surrey Hospital, Redhill, RH1 5RH, UK
- Center for Global Health, Charles University, Prague, 121 08, Czech Republic
| | | | | | | | - Jessica M Schramm
- Neurocritical Care, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - A J Gimpelson
- Global Flight and Tactical Medical, Manchester, NH, USA
| | - Aebhric O'Kelly
- College of Remote and Offshore Medicine Foundation, 55543, Germany
| | - Steven Parks
- Hungarian Army Medical Center, NATO Liaison, Budapest 1143, Hungary
| | - Jamla Rizek
- Beth Israel Deaconess Medical Center, Boston, MA 20850, USA
| | - Terri Davis
- Florida State University, Tallahassee, FL 32306, USA
- Tallahassee Memorial Hospital, US Army National Guard, Tallahassee, FL 32308, USA
| | - Denys Surkov
- National Association of Emergency Medical Technicians, St Nicholas Children's Hospital, Lviv 79059, Ukraine
| | | | - Rajeev Fernando
- Heal-Corp, Society of Disaster Medicine and Public Health, Jersey City, NJ 07307, USA
- Special Interest Group, Infectious Diseases, World Association of Disaster Emergency Medicine (WADEM), Madison, WI 53705, USA
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Frelich M, Pavlicek J, Bursa F, Vodicka V, Salounova D, Sklienka P. Urinary tract trauma as a predictor of acute kidney injury in severely injured patients: A retrospective analysis of observational studies. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024. [PMID: 39171720 DOI: 10.5507/bp.2024.026] [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: 08/23/2024] Open
Abstract
AIM The main objective of this study was to determine whether urinary trauma increases the risk of acute kidney injury (AKI) in patients with severe trauma. As a secondary objective, we assessed the reliability of neutrophil gelatinase-associated lipocalin (NGAL) in the early prediction of AKI in this patient population. METHODS Retrospective analysis of two prospective observational studies involving 179 adult patients with severe trauma (Injury Severity Score >16). NGAL levels were measured by taking a blood sample 24 h after admission. AKI was diagnosed according to the Kidney Disease Improving Global Outcomes (KDIGO) classification. RESULTS The overall incidence of AKI was 29%. Kidney or vascular injury was an independent risk factor for AKI (risk ratio [RR] = 3.1, 95% confidence interval [CI] 1.93-4.90). Trauma to urinary passages was also associated with an increased risk of AKI (RR = 4.2, 95% CI 2.70-6.46). Among patients without urinary tract injury, serum NGAL levels were significantly higher in trauma patients who developed AKI during the first 5 days in the intensive care unit (ICU) compared to patients without this organ dysfunction (214.6 µg/L [IQR 167.3] vs. 90.6 µg/L [IQR 58.4]; P<0.001). In patients with urinary tract trauma, there was no difference in the NGAL levels between the two groups (184.6 µg/L [IQR 139.9] vs. 118.3 µg/L [IQR 118.1]; P=0.216). NGAL was not a reliable predictor of AKI in patients with urinary trauma (AUC 0.660). CONCLUSION Urinary tract injury is associated with a significant increase in AKI in patients with severe trauma during the first 5 days of hospitalization in the intensive care unit. In these patients, NGAL is not a reliable predictor of the development of AKI.
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Affiliation(s)
- Michal Frelich
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Jan Pavlicek
- Department of Pediatrics, University Hospital Ostrava and Faculty of Medicine, Ostrava University, Ostrava, Czech Republic
| | - Filip Bursa
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Vojtech Vodicka
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Dana Salounova
- Department of Science and Research, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Peter Sklienka
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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Bacik A, Lopreiato JO, Burke HB. Survey of Current Simulation Based Training in the US Military Health System. Mil Med 2024; 189:423-430. [PMID: 39160867 DOI: 10.1093/milmed/usae147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/23/2024] [Accepted: 03/19/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Simulation-based medical training has been shown to be effective and is widely used in civilian hospitals; however, it is unclear how widely and how effectively simulation is utilized in the U.S. Military Health System (MHS). The current operational state of medical simulation in the MHS is unknown, and there remains a need for a system-wide assessment of whether and how the advances in simulation-based medical training are employed to meet the evolving needs of the present-day warfighter. Understanding the types of skills and methods used within simulation programs across the enterprise is important data for leaders as they plan for the future in terms of curriculum development and the investment of resources. The aim of the present study is to survey MHS simulation programs in order to determine the prevalence of skills taught, the types of learners served, and the most common methodologies employed in this worldwide health care system. MATERIALS AND METHODS A cross-sectional survey of simulation activities was distributed to the medical directors of all 93 simulation programs in the MHS. The survey was developed by the authors based on lists of critical wartime skills published by the medical departments of the US Army, Navy, and Air Force. Respondents were asked to indicate the types of learners trained at their program, which of the 82 unique skills included in the survey are trained at their site, and for each skill the modalities of simulation used, i.e., mannequin, standardized patients, part task trainers, augmented/virtual reality tools, or cadaver/live tissue. RESULTS Complete survey responses were obtained from 75 of the 93 (80%) MHS medical simulation training programs. Across all skills included in the survey, those most commonly taught belonged predominantly to the categories of medic skills and nursing skills. Across all sites, the most common category of learner was the medic/corpsman (95% of sites), followed by nurses (87%), physicians (83%), non-medical combat lifesavers (59%), and others (28%) that included on-base first responders, law enforcement, fire fighters, and civilians. The skills training offered by programs included most commonly the tasks associated with medics/corpsmen (97%) followed by nursing (81%), advanced provider (77%), and General Medical Officer (GMO) skills (47%). CONCLUSION The survey demonstrated that the most common skills taught were all related to point of injury combat casualty care and addressed the most common causes of death on the battlefield. The availability of training in medic skills, nursing skills, and advanced provider skills were similar in small, medium, and large programs. However, medium and small programs were less likely to deliver training for advanced providers and GMOs compared to larger programs. Overall, this study found that simulation-based medical training in the MHS is focused on medic and nursing skills, and that large programs are more likely to offer training for advanced providers and GMOs. Potential gaps in the availability of existing training are identified as over 50% of skills included in the nursing, advanced provider, and GMO skill categories are not covered by at least 80% of sites serving those learners.
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Affiliation(s)
- Adam Bacik
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Silver Spring, MD 20910, USA
| | - Joseph O Lopreiato
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Harry B Burke
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Kaylor R, Edwards J, Yue I, Zarow GJ, Crane A, Boswell G, Auten J. Sternal Morphologic Characteristics of U.S. Military Males by Computed Tomography: Implications for Intraosseous Access. Mil Med 2024; 189:636-643. [PMID: 39160892 DOI: 10.1093/milmed/usae207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/28/2024] [Accepted: 04/09/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Sternal intraosseous (IO) access has advantages over humeral and tibial access for fluid resuscitation in military medical settings due to superior flow rates and pharmacokinetics. However, the morphology of the young adult manubrial cortical and medullary bone as it relates to IO catheter tips of currently available FDA-approved IO access devices is unclear. MATERIALS AND METHODS Computed tomography manubrium images of active duty service members (N = 93) aged 18 to 30 were assessed by radiologists, including manubrial height, width, and cortical thickness, as well as total thickness and medullary thickness at the thickest (superior) and thinnest (inferior) parts of the manubrium. Inference regarding medullary or cortical IO catheter tip placement rates were made for FAST1 (5.5 mm catheter depth) and TALON (4.5 mm catheter depth) sternal IO devices. Data were analyzed using ANOVA, non-parametric, and correlational statistics at P < 0.05. RESULTS As inferred from case-specific CT-derived manubrium dimensions and maximal catheter tip penetration depths, both FAST1 and TALON would be placed in the target medullary space on 100% of opportunities if properly applied in the superior manubrium and on 99% of opportunities if properly applied in the inferior manubrium. Age was not significantly related to IO-relevant manubrial dimensions. CONCLUSIONS Present findings suggest that both FAST1 and TALON sternal IO catheter tips can be successfully placed into the target medullary bone with high accuracy in male military members aged 18 to 30 who require rapid resuscitation.
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Affiliation(s)
- Ryan Kaylor
- Combat Trauma Research Group-West, Naval Medical Center San Diego, San Diego, CA 92134, USA
- Emergency Medicine Department, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Jared Edwards
- Combat Trauma Research Group-West, Naval Medical Center San Diego, San Diego, CA 92134, USA
- Radiology Department, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Ivan Yue
- Combat Trauma Research Group-West, Naval Medical Center San Diego, San Diego, CA 92134, USA
- Emergency Medicine Department, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Gregory J Zarow
- Combat Trauma Research Group-West, Naval Medical Center San Diego, San Diego, CA 92134, USA
- Emergency Medicine Department, Naval Medical Center San Diego, San Diego, CA 92134, USA
- The Emergency Statistician, Idyllwild, CA 92549, USA
| | - Anise Crane
- Combat Trauma Research Group-West, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Gilbert Boswell
- Combat Trauma Research Group-West, Naval Medical Center San Diego, San Diego, CA 92134, USA
- Radiology Department, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Jonathan Auten
- Combat Trauma Research Group-West, Naval Medical Center San Diego, San Diego, CA 92134, USA
- Emergency Medicine Department, Naval Medical Center San Diego, San Diego, CA 92134, USA
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Yoon YC, Song HK, Ham SH, Cho WT. Comparison of clinical and radiographic outcomes of bilateral versus unilateral ramus fixation in straddle fractures with posterior pelvic ring injury. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05463-7. [PMID: 39105833 DOI: 10.1007/s00402-024-05463-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/11/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION Superior and inferior ramus fractures, termed straddle fractures, are high-energy fractures often accompanied by unstable pelvic ring injuries. However, consensus is lacking regarding indications for surgical treatment or fixation methods. We aimed to compare clinical and radiological outcomes of unilateral ramus fixation (URF) and bilateral ramus fixation (BRF) for straddle fractures with unilateral posterior pelvic ring injuries. MATERIALS AND METHODS We enrolled 118 patients (73 males, 45 females; mean age, 47 years) diagnosed with straddle fractures between March 2015 and December 2021 with > 1 year of follow-up. Patients were divided into URF (n = 60) and BRF (n = 58) groups based on the anterior pelvic ring fixation method. Preoperative factors including body mass index, diabetes, smoking, injury mechanism, injury severity score, American Society of Anesthesiologists classification system, Tile classification, and Young and Burgess classification were compared. Intraoperative blood loss, operation time, postoperative bone union rate, complications, and the need for additional surgeries were analyzed. RESULTS There were no statistically significant preoperative differences between the two groups. However, the URF group showed a significantly lower mean operative time and blood transfusion requirement (63 min and 2 units, respectively) than the BRF group (104 min and 3 units, respectively) (both p < 0.001). Postoperatively, bone union was achieved in 57 (95.0%) and 56 (96.6%) patients in the URF and BRF groups, respectively. Complications occurred in 17 (28.3%) and 14 (24.1%) patients in the URF and BRF groups, respectively, with additional surgeries needed in 3 (5.0%) patients in the URF group and 2 (3.4%) patients in the BRF group. CONCLUSIONS Unilateral anterior fixation can provide sufficient stability and clinical effectiveness in the surgical treatment of straddle fractures in areas with posterior pelvic ring injuries. Compared with bilateral anterior fixation, unilateral fixation significantly reduces operation time and blood loss, making it a viable fixation method for straddle fractures.
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Affiliation(s)
- Yong-Cheol Yoon
- Orthopedic Trauma Division, Trauma Center, Gachon University College of Medicine, 21 Namdong-daero, 774 Beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Hyung Keun Song
- Department of Orthopaedic Surgery, Ajou University School of Medicine, 164, World Cupro, Yeongtong-gu, Suwon-si, 16499, Gyeonggi-do, Republic of Korea.
| | - Seong Hyup Ham
- Department of Orthopaedic Surgery, Gachon University College of Medicine, 21 Namdong-daero, 774 Beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Won-Tae Cho
- Department of Orthopaedic Surgery, Ajou University School of Medicine, 164, World Cupro, Yeongtong-gu, Suwon-si, 16499, Gyeonggi-do, Republic of Korea
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Aarhus M, Mirzamohammadi J, Rønning PA, Strøm M, Glott T, Rizvi SAM, Biernat D, Ølstørn H, Rydning PNF, Stenset VTV, Næss PA, Gaarder C, Brommeland T, Linnerud H, Helseth E. Time from injury to acute surgery for patients with traumatic cervical spinal cord injury in South-East Norway. Front Neurol 2024; 15:1420530. [PMID: 38978812 PMCID: PMC11228170 DOI: 10.3389/fneur.2024.1420530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 06/14/2024] [Indexed: 07/10/2024] Open
Abstract
Background The recommended treatment for cervical spinal cord injury (cSCI) is surgical decompression and stabilization within 24 h after injury. The aims of the study were to estimate our institutional compliance with this recommendation and identify potential factors associated with surgical delay. Methods Population-based retrospective database study of patients operated for cSCI in 2015-2022 within the South-East Norway Health Region (3.1 million inhabitants). Data extracted were demographics, injury description, management timeline, place of primary triage [local hospital (LH) or neurotrauma center (NTC)]. Main outcome variables were: (1) time from injury to surgery at NTC, (2) time from injury to admission NTC, and (3) time from admission NTC to surgery. Results We found 243 cSCI patients having acute neck surgery. Their median age was 63 years (IQR 47-74 years), 77% were male, 48% were ≥65 years old. Primary triage at an LH occurred in 150/243 (62%). The median time from injury to acute surgery was 27.8 h (IQR 15.4-61.9 h), and 47% had surgery within 24 h. The median time from injury to NTC admission was 5.6 h (IQR 1.9-19.4 h), and 67% of the patients were admitted to the NTC within 12 h. Significant factors associated with increased time from injury to NTC admission were transfer via LH, severe preinjury comorbidities, less severe cSCI, time of injury other than night, absence of multiple injuries. The median time from NTC admission to surgery was 16.7 h (IQR 9.5-31.0 h), and 70% had surgery within 24 h. Significant factors associated with increased time from NTC admission to surgery were increasing age and non-translational injury morphology. Conclusion Less than half of the patients with cSCI were operated on within the recommended 24 h time frame after injury. To increase the fraction of early surgery, we suggest the following: (1) patients with clinical suspicion of cSCI should be transported directly to the NTC from the scene of the accident, (2) MRI should be performed only at the NTC, (3) at the NTC, surgery should commence on the same calendar day as arrival or as the first operation the following day.
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Affiliation(s)
- Mads Aarhus
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | - Mona Strøm
- Spinal Unit, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Thomas Glott
- Spinal Unit, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | | | - Donata Biernat
- Department of Neuroradiology, Oslo University Hospital, Oslo, Norway
| | - Håvard Ølstørn
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | | | | | - Pål Aksel Næss
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Traumatology, Oslo University Hospital, Oslo, Norway
| | - Christine Gaarder
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Traumatology, Oslo University Hospital, Oslo, Norway
| | - Tor Brommeland
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Hege Linnerud
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Eirik Helseth
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Beck EM, Wolthers SA, Blomberg SN, Breindahl N, Eskesen V, Lippert F, Christensen HC. Head injuries related to bicycle collisions and helmet use - an observational study. TRAFFIC INJURY PREVENTION 2024:1-8. [PMID: 38905159 DOI: 10.1080/15389588.2024.2363476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 05/29/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVES In Denmark, the use of bicycles is widespread, and head injuries are often seen in cyclists involved in collisions. Despite the well-known effects of using a helmet to reduce head injuries, using helmets is not mandatory in Denmark. The primary objective of this study was to provide data regarding injury outcomes and helmet usage. METHODS Participants were bicyclists who sustained head injuries in bicycle collisions and were assessed by the Copenhagen Emergency Medical Services between 1 January 2016; and 15 June 2019. Patients with suspected head injury were identified in an electronic prehospital patient record. Data were linked to the Danish National Patient Registry to retrieve the diagnosis and were categorized into head injury or no head injury based on the diagnosis. Adjusted logistic regression analyses were reported with odds ratios and corresponding confidence intervals to assess the risk of head injury while adjusting for risk factors like age, sex, alcohol consumption, occurrence during weekends and traumatic brain injury. RESULTS A total of 407 patients were included in this study. Within this entity, 247 (61%) had sustained a head injury. The use of a helmet was reported in one-third of the included patients. Among the head-injured patients, 13% sustained moderate to severe head injuries. Patients with suspected alcohol involvement were significantly less likely to report the use of a helmet. Helmet use reduced the risk of head injury with an odds ratio of 0.52, (95% CI 0.31 - 0.86). In high-energy trauma, the use of a helmet showed a significant reduction in the risk of sustaining a head injury with an odds ratio of 0.28, (95% CI 0.12 - 0.80). CONCLUSIONS In this study, using a helmet was associated with a significantly decreased risk of head injury; this association was even more significant in high-energy trauma.
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Affiliation(s)
- Erik Malling Beck
- Copenhagen Emergency Medical Services, Ballerup, Denmark
- Prehospital Center, Region Zealand, Næstved, Denmark
| | - Signe Amalie Wolthers
- Prehospital Center, Region Zealand, Næstved, Denmark
- Faculty of Clinical Medicine, Copenhagen University Hospital Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
| | - Stig Nikolaj Blomberg
- Copenhagen Emergency Medical Services, Ballerup, Denmark
- Prehospital Center, Region Zealand, Næstved, Denmark
| | - Niklas Breindahl
- Prehospital Center, Region Zealand, Næstved, Denmark
- Faculty of Clinical Medicine, Copenhagen University Hospital Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
- Department of Neonatal and Paediatric Intensive Care, Copenhagen University Hospital, Denmark Rigshospitalet, Copenhagen, Denmark
- Neurosurgical Department, Copenhagen University Hospital, Denmark Rigshospitalet, København Ø, Denmark
| | - Vagn Eskesen
- National Clinical Registries, RKKP, København Ø, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Ballerup, Denmark
| | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, Ballerup, Denmark
- Prehospital Center, Region Zealand, Næstved, Denmark
- Faculty of Clinical Medicine, Copenhagen University Hospital Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
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Kaaber IA, Lesbo M, Wichmann TO, Olsen DA, Rasmussen MM, Brink O, Borris LC, Hviid CVB. Admission levels of serum biomarkers have additive and cumulative prognostic value in traumatic brain injury. Sci Rep 2024; 14:14139. [PMID: 38898030 PMCID: PMC11187066 DOI: 10.1038/s41598-024-64125-1] [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: 12/21/2023] [Accepted: 06/05/2024] [Indexed: 06/21/2024] Open
Abstract
Elevated levels of CNS-derived serum proteins are associated with poor outcome in traumatic brain injury (TBI), but the value of adding acute serum biomarker levels to common clinical outcome predictors lacks evaluation. We analyzed admission serum samples for Total-Tau (T-Tau), Neurofilament light chain (Nfl), Glial fibrillary acidic protein (GFAP), and Ubiquitin C-terminal hydrolase L1 (UCHL1) in a cohort of 396 trauma patients including 240 patients with TBI. We assessed the independent association of biomarkers with 1-year mortality and 6-12 months Glasgow Outcome Scale Extended (GOSE) score, as well as the additive and cumulative value of biomarkers on Glasgow Coma Scale (GCS) and Marshall Score for outcome prediction. Nfl and T-Tau levels were independently associated with outcome (OR: Nfl = 1.65, p = 0.01; T-Tau = 1.99, p < 0.01). Nfl or T-Tau improved outcome prediction by GCS (Wald Chi, Nfl = 6.8-8.8, p < 0.01; T-Tau 7.2-11.3, p < 0.01) and the Marshall score (Wald Chi, Nfl = 16.2-17.5, p < 0.01; T-Tau 8.7-12.4, p < 0.01). Adding T-Tau atop Nfl further improved outcome prediction in majority of tested models (Wald Chi range 3.8-9.4, p ≤ 0.05). Our data suggest that acute levels of serum biomarkers are independently associated with outcome after TBI and add outcome predictive value to commonly used clinical scores.
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Affiliation(s)
- Ida A Kaaber
- Department of Clinical Biochemistry, Aarhus University Hospital, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maj Lesbo
- Department of Ortopedic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Thea O Wichmann
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Dorte Aa Olsen
- Department of Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Mikkel M Rasmussen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Brink
- Department of Ortopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Lars C Borris
- Department of Ortopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Claus V B Hviid
- Department of Clinical Biochemistry, Aarhus University Hospital, 8200, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.
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Rahimpour A, Baxter J, Giangrosso G, Murphy A, Bown P, Denning DA, Ray P, Rahman B. Age-Related Patterns of Traumatic Facial Fractures in the Appalachian Tri-state Area: A Five-Year Retrospective Study. Cureus 2024; 16:e62090. [PMID: 38989341 PMCID: PMC11236472 DOI: 10.7759/cureus.62090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction Traumatic facial injuries, leading to facial fractures represent a significant subset of traumatic events, with age emerging as a crucial determinant influencing both their etiology and outcomes. Understanding the age-related patterns of traumatic facial fractures is essential for developing targeted prevention and management strategies. In this context, the Appalachian tri-state area stands as an underexplored region concerning this issue, necessitating comprehensive research to elucidate the nuances of age-related traumatic facial fractures within this geographic context. Methods This retrospective study delves into the age-related patterns of traumatic facial fractures within the Appalachian tri-state area, drawing upon patient records from Cabell Huntington Hospital and Saint Mary's Medical Center spanning a five-year period. The study cohort encompasses 623 patients categorized into three age groups: individuals aged <22 years, those aged 22-65 years, and individuals over 65 years. Data analysis involves meticulous examination of mechanisms of injury, injury severity scores (ISSs), hospital length of stay, and the prevalence of surgical interventions across different age cohorts. Results Out of 623 patients, 104 (16.7%) were under 22 years old, 367 (58.9%) were between 22 and 65 years old, and 152 (24.4%) were over 65 years old. The majority were male (70%). Falls were the most common cause of facial fractures in patients over 65 (78%), while assaults were predominant in the 22-65 age group (24%), and motor vehicle collisions (MCVs) in those under 22 (34%). The median ISS and hospital stay durations were similar across age groups. 28% of patients underwent surgery, with significant variation among age groups (p<0.001): 38% for <22 years, 33% for 22-65 years, and 11% for >65 years. Mandibular fractures were more prevalent in younger patients, with rates of 12% for <22 years compared to 5.3% for >65 years. Logistic regression analysis revealed that patients aged 22-65 had 4.10 times higher odds (95% CI=2.38, 7.45, p<0.001) of undergoing surgery, while those under 22 had 5.14 times higher odds (95% CI=2.73, 10.0, p<0.001) compared to those over 65. Significant associations were found for mandibular and bilateral mandibular outcomes in patients aged 22-65 years. Discussion These findings underscore the imperative for tailored prevention strategies and age-specific treatment protocols to optimize patient outcomes. Fall prevention initiatives for the elderly and interventions addressing sports-related injuries for younger individuals are paramount. Moreover, the study highlights the necessity of specialized care protocols for elderly patients to minimize hospital stay durations and manage age-related comorbidities effectively. Moving forward, further research should address limitations, validate findings, and explore the efficacy of specific interventions, thereby paving the way for enhanced preventive measures and management strategies tailored to the diverse age cohorts affected by traumatic facial fractures in the Appalachian region.
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Affiliation(s)
- Armein Rahimpour
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Jacy Baxter
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Gerard Giangrosso
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Abigail Murphy
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Paul Bown
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - David A Denning
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Peter Ray
- Plastic and Reconstructive Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Barry Rahman
- Plastic and Reconstructive Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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10
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Kaurani P, Moreira de Marchi Apolaro AV, Kunchala K, Maini S, Rges HAF, Isaac A, Lakkimsetti M, Raake M, Nazir Z. Advances in Neurorehabilitation: Strategies and Outcomes for Traumatic Brain Injury Recovery. Cureus 2024; 16:e62242. [PMID: 39006616 PMCID: PMC11244718 DOI: 10.7759/cureus.62242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
Traumatic brain injury (TBI) consists of an external physical force that causes brain function impairment or pathology and globally affects 50 million people each year, with a cost of 400 billion US dollars. Clinical presentation of TBI can occur in many forms, and patients usually require prolonged hospital care and lifelong rehabilitation, which leads to an impact on the quality of life. For this narrative review, no particular method was used to extract data. With the aid of health descriptors and Medical Subject Heading (MeSH) terms, a search was thoroughly conducted in databases such as PubMed and Google Scholar. After the application of exclusion and inclusion criteria, a total of 146 articles were effectively used for this review. Results indicate that rehabilitation after TBI happens through neuroplasticity, which combines neural regeneration and functional reorganization. The role of technology, including artificial intelligence, virtual reality, robotics, computer interface, and neuromodulation, is to impact rehabilitation and life quality improvement significantly. Pharmacological intervention, however, did not result in any benefit when compared to standard care and still needs further research. It is possible to conclude that, given the high and diverse degree of disability associated with TBI, rehabilitation interventions should be precocious and tailored according to the individual's needs in order to achieve the best possible results. An interdisciplinary patient-centered care health team and well-oriented family members should be involved in every stage. Lastly, strategies must be adequate, well-planned, and communicated to patients and caregivers to attain higher functional outcomes.
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Affiliation(s)
- Purvi Kaurani
- Neurology, DY Patil University School of Medicine, Navi Mumbai , IND
| | | | - Keerthi Kunchala
- Internal Medicine, Sri Venkateswara Medical College, Tirupati, IND
| | - Shriya Maini
- Medicine and Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Huda A F Rges
- Mental Health, National Authority for Mental Health and Psychosocial Support, Benghazi, LBY
| | - Ashley Isaac
- General Medicine, Isra University Hospital, Hyderabad, PAK
| | | | | | - Zahra Nazir
- Internal Medicine, Combined Military Hospital, Quetta, PAK
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11
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Berk T, Neuhaus V, Nierlich C, Balogh ZJ, Klingebiel FKL, Kalbas Y, Pape HC, Halvachizadeh S. Clinical validation of the "Straight-Leg-Evaluation-Trauma-Test" (SILENT) as a rapid assessment tool for injuries of the lower extremity in trauma bay patients. Eur J Trauma Emerg Surg 2024; 50:1119-1125. [PMID: 38261076 PMCID: PMC11249611 DOI: 10.1007/s00068-023-02437-z] [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: 10/14/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE Clinical assessment of the major trauma patient follows international validated guidelines without standardized trauma-specific assessment of the lower extremities for injuries. This study aimed to validate a novel clinical test for lower extremity evaluation during trauma resuscitation phase. METHODS This diagnostic, prognostic observational cohort study was performed on trauma patient treated at one level I trauma center between Mar 2022 and Mar 2023. The Straight-Leg-Evaluation-Trauma (SILENT) test follows three steps during the primary survey: inspection for obvious fractures (e.g., open fracture), active elevation of the leg, and cautious elevation of the lower extremity from the heel. SILENT was considered positive when obvious fracture was present and painful or pathological mobility was observed. The SILENT test was compared with standardized radiographs (CT scan or X-ray) as the reference test for fractures. Statistical analysis included sensitivity, specificity, and receiver operating characteristic testing. RESULTS 403 trauma bay patients were included, mean age 51.6 (SD 21.2) years with 83 fractures of the lower extremity and 27 pelvic/acetabular fractures. Overall sensitivity was 75% (95%CI 64 to 84%), and overall specificity was 99% (95%CI 97 to 100%). Highest sensitivity was for detection of tibia fractures (93%, 95%CI 77 to 99%). Sensitivity of SILENT was higher in the unconscious patient (96%, 95%CI 78 to 100%) with a near 100% specificity. AUC was highest for tibia fractures (0.96, 95%CI 0.92 to 1.0) followed by femur fractures (0.92, 95%CI 0.84 to 0.99). CONCLUSION The SILENT test is a clinical applicable and feasible rule-out test for relevant injuries of the lower extremity. A negative SILENT test of the femur or the tibia might reduce the requirement of additional radiological imaging. Further large-scale prospective studies might be required to corroborate the beneficial effects of the SILENT test.
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Affiliation(s)
- Till Berk
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Faculty of Medicine, University of Zurich, Raemistrasse 71, 8006, Zurich, Switzerland.
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland.
| | - Valentin Neuhaus
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Raemistrasse 71, 8006, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - Catalina Nierlich
- Faculty of Medicine, University of Zurich, Raemistrasse 71, 8006, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Felix Karl-Ludwig Klingebiel
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Raemistrasse 71, 8006, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - Yannik Kalbas
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Raemistrasse 71, 8006, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Raemistrasse 71, 8006, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
| | - Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Raemistrasse 71, 8006, Zurich, Switzerland
- Harald-Tscherne Laboratory for Orthopedic and Trauma Research, University of Zurich, Sternwartstrasse 14, 8091, Zurich, Switzerland
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12
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Lule H, Mugerwa M, Ssebuufu R, Kyamanywa P, Bärnighausen T, Posti JP, Wilson ML. Effect of Rural Trauma Team Development on the Outcomes of Motorcycle Accident-Related Injuries (Motor Registry Project): Protocol for a Multicenter Cluster Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e55297. [PMID: 38713507 PMCID: PMC11109866 DOI: 10.2196/55297] [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: 12/08/2023] [Accepted: 02/26/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Injury is a global health concern, and injury-related mortality disproportionately impacts low- and middle-income countries (LMICs). Compelling evidence from observational studies in high-income countries shows that trauma education programs, such as the Rural Trauma Team Development Course (RTTDC), increase clinician knowledge of injury care. There is a dearth of such evidence from controlled clinical trials to demonstrate the effect of the RTTDC on process and patient outcomes in LMICs. OBJECTIVE This multicenter cluster randomized controlled clinical trial aims to examine the impact of the RTTDC on process and patient outcomes associated with motorcycle accident-related injuries in an African low-resource setting. METHODS This is a 2-arm, parallel, multi-period, cluster randomized, controlled, clinical trial in Uganda, where rural trauma team development training is not routinely conducted. We will recruit regional referral hospitals and include patients with motorcycle accident-related injuries, interns, medical trainees, and road traffic law enforcement professionals. The intervention group (RTTDC) and control group (standard care) will include 3 hospitals each. The primary outcomes will be the interval from the accident to hospital admission and the interval from the referral decision to hospital discharge. The secondary outcomes will be all-cause mortality and morbidity associated with neurological and orthopedic injuries at 90 days after injury. All outcomes will be measured as final values. We will compare baseline characteristics and outcomes at both individual and cluster levels between the intervention and control groups. We will use mixed effects regression models to report any absolute or relative differences along with 95% CIs. We will perform subgroup analyses to evaluate and control confounding due to injury mechanisms and injury severity. We will establish a motorcycle trauma outcome (MOTOR) registry in consultation with community traffic police. RESULTS The trial was approved on August 27, 2019. The actual recruitment of the first patient participant began on September 01, 2019. The last follow-up was on August 27, 2023. Posttrial care, including linkage to clinical, social support, and referral services, is to be completed by November 27, 2023. Data analyses will be performed in Spring 2024, and the results are expected to be published in Autumn 2024. CONCLUSIONS This trial will unveil how a locally contextualized rural trauma team development program impacts organizational efficiency in a continent challenged with limited infrastructure and human resources. Moreover, this trial will uncover how rural trauma team coordination impacts clinical outcomes, such as mortality and morbidity associated with neurological and orthopedic injuries, which are the key targets for strengthening trauma systems in LMICs where prehospital care is in the early stage. Our results could inform the design, implementation, and scalability of future rural trauma teams and trauma education programs in LMICs. TRIAL REGISTRATION Pan African Clinical Trials Registry (PACTR202308851460352); https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25763. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55297.
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Affiliation(s)
- Herman Lule
- Injury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Micheal Mugerwa
- Injury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Patrick Kyamanywa
- Mother Kevin Postgraduate Medical School, Uganda Martyr's University, Nkozi, Uganda
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), University Hospital and University of Heidelberg, Heidelberg, Germany
| | - Jussi P Posti
- Neurocentre, Department of Neurosurgery and Turku Brain Injury Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Michael Lowery Wilson
- Heidelberg Institute of Global Health (HIGH), University Hospital and University of Heidelberg, Heidelberg, Germany
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13
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Steinheber J, Kanz KG, Biberthaler P, Flatz W, Bogner-Flatz V. [Head injuries and their wound treatment]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:391-402. [PMID: 38619616 DOI: 10.1007/s00113-024-01430-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/16/2024]
Abstract
Head injuries are frequent occurrences in emergency departments worldwide and are notable for the fact that attention must be paid to the sequelae of intracranial and extracranial trauma. It is crucial to assess potential intracranial injuries and to strive for both medically sound and esthetically pleasing extracranial outcomes. The aim of this continuing education article is to provide a refresher on knowledge of head injuries and the associated nuances for wound care.
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Affiliation(s)
- Jakob Steinheber
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungschirurgie, Sportmedizin, Kreisklinik Ebersberg, Ebersberg, Deutschland
| | - Karl-Georg Kanz
- Zentrale Notaufnahme, Klinikum rechts der Isar der Technischen Universität München und Ärztlicher Bezirksbeauftragter Rettungsdienst Oberbayern West, München, Deutschland
| | - Peter Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - Wilhelm Flatz
- Klinik und Poliklinik für Radiologie, Ludwig-Maximilians-Universität München, München, Deutschland
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14
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Kalbas Y, Heining SM, Kaiser A, Klingebiel FKL, Pfeifer R, Wanner GA, Pape HC. Fracture fixation in polytraumatized patients-From an interdisciplinary early total/appropriate care to the safe definitive surgery concept. Front Med (Lausanne) 2024; 11:1362986. [PMID: 38707191 PMCID: PMC11069308 DOI: 10.3389/fmed.2024.1362986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/18/2024] [Indexed: 05/07/2024] Open
Abstract
The strategies for the timing of fracture fixation in polytrauma patients have changed with improvements in resuscitation and patient assessment. Specifically, the criteria for damage control have been formulated, and more precise parameters have been found to determine those patients who can safely undergo primary definitive fixation of major fractures. Our current recommendations are supported by objective and data-based criteria and development groups. Those were validated and compared to existing scores. This review article introduces the concept of "safe definitive surgery" and provides an update on the parameters used to clear patients for timely fixation of major fractures.
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Affiliation(s)
- Yannik Kalbas
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sandro-Michael Heining
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anne Kaiser
- Department of Anesthesia, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Roman Pfeifer
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Guido A. Wanner
- Department of Spine and Trauma Surgery, Bethanien Hospital, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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15
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Qasim ZA, Joseph B. Intraosseous access in the resuscitation of patients with trauma: the good, the bad, the future. Trauma Surg Acute Care Open 2024; 9:e001369. [PMID: 38646033 PMCID: PMC11029384 DOI: 10.1136/tsaco-2024-001369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/09/2024] [Indexed: 04/23/2024] Open
Abstract
The timely restoration of lost blood in hemorrhaging patients with trauma, especially those who are hemodynamically unstable, is of utmost importance. While intravenous access has traditionally been considered the primary method for vascular access, intraosseous (IO) access is gaining popularity as an alternative for patients with unsuccessful attempts. Previous studies have highlighted the higher success rate and easier training process associated with IO access compared with peripheral intravenous (PIV) and central intravenous access. However, the effectiveness of IO access in the early aggressive resuscitation of patients remains unclear. This review article aims to comprehensively discuss various aspects of IO access, including its advantages and disadvantages, and explore the existing literature on the clinical outcomes of patients with trauma undergoing resuscitation with IO versus intravenous access.
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Affiliation(s)
- Zaffer A Qasim
- Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Bellal Joseph
- Department of Surgery, The University of Arizona College of Medicine Tucson, Tucson, Arizona, USA
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16
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Rajeh Saifan A, Al-Jaafreh A, Mosleh SM, Mohammad Alsaraireh M, Al-Yateem N, Refaat Ahmed F, Arsyad Subu M. The lived experiences of healthcare professionals working in pre-hospital emergency services in Jordan: A qualitative exploratory study. Int Emerg Nurs 2024; 73:101405. [PMID: 38266322 DOI: 10.1016/j.ienj.2023.101405] [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: 12/22/2022] [Revised: 12/12/2023] [Accepted: 12/29/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Globally, injuries account for 9% of all deaths, with road accidents contributing to approximately a quarter of these fatalities. A major concern is the inadequacy of pre-hospital care (emergency medical services provided before arrival at a hospital) and delays in transportation to medical facilities, identified as leading causes of preventable injury-related deaths. This study explores the experiences of emergency health professionals (EHPs) in peri-hospital services (emergency medical services provided immediately upon arrival and within the hospital setting). METHODS A qualitative exploratory design, underpinned by Van Manen's (1990) descriptive phenomenological principles, was used. Thirty EHPs from five central and southern Jordanian emergency departments were purposefully sampled, including physicians, nurses, and paramedics from both emergency departments and pre-hospital services. RESULTS Two primary themes emerged: (1) In Search of Clarity: The Unsettled Journey of Pre-hospital Emergency Care Providers; (2) Frustrations on the Frontline: Role Ambiguity and Emotional Exhaustion in Trauma Care, with EHPs reporting fluid and unclear roles, physical and verbal abuse, and limited authority in critical interventions. CONCLUSION The study highlights several service lapses in peri-hospital care that negatively impact healthcare professionals, posing risks to patient safety. These findings urge decision-makers to devise actionable strategies to rectify these deficiencies, enhancing care quality and thereby decreasing injury-induced mortality and morbidity.
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Affiliation(s)
- Ahmad Rajeh Saifan
- Associate Professor of Nursing, Nursing Department, Applied Science Private University, Amman, Jordan.
| | - Ali Al-Jaafreh
- Paramedics Trainer, Civil Defense College, Amman, Jordan
| | - Sultan M Mosleh
- Faculty of Health Sciences, Higher Colleges of Technology, Fujairah PO Box 1626, United Arab Emirates; Faculty of Nursing, Mutah University, Karak, Jordan.
| | - Mahmoud Mohammad Alsaraireh
- Princess Aisha Bint Al Hussein College for Nursing and Health Sciences, Al Hussaein Bin Talal University, Maan, Jordan.
| | - Nabeel Al-Yateem
- Department of Nursing, College of Health Sciences, University of Sharjah, United Arab Emirates; Adjunct Associate Professor, Charles Sturt University, Australia.
| | - Fatma Refaat Ahmed
- Department of Nursing, College of Health Sciences, University of Sharjah, United Arab Emirates; Criticl Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt.
| | - Muhammad Arsyad Subu
- Department of Nursing, College of Health Sciences, University of Sharjah, United Arab Emirates; Faculty of Nursing and Midwifery, Universitas Binawan, Jakarta, Indonesia.
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Magon F, Longhitano Y, Savioli G, Piccioni A, Tesauro M, Del Duca F, Napoletano G, Volonnino G, Maiese A, La Russa R, Di Paolo M, Zanza C. Point-of-Care Ultrasound (POCUS) in Adult Cardiac Arrest: Clinical Review. Diagnostics (Basel) 2024; 14:434. [PMID: 38396471 PMCID: PMC10887671 DOI: 10.3390/diagnostics14040434] [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: 12/30/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Point-of-Care Ultrasound (POCUS) is a rapid and valuable diagnostic tool available in emergency and intensive care units. In the context of cardiac arrest, POCUS application can help assess cardiac activity, identify causes of arrest that could be reversible (such as pericardial effusion or pneumothorax), guide interventions like central line placement or pericardiocentesis, and provide real-time feedback on the effectiveness of resuscitation efforts, among other critical applications. Its use, in addition to cardiovascular life support maneuvers, is advocated by all resuscitation guidelines. The purpose of this narrative review is to summarize the key applications of POCUS in cardiac arrest, highlighting, among others, its prognostic, diagnostic, and forensic potential. We conducted an extensive literature review utilizing PubMed by employing key search terms regarding ultrasound and its use in cardiac arrest. Apart from its numerous advantages, its limitations and challenges such as the potential for interruption of chest compressions during image acquisition and operator proficiency should be considered as well and are discussed herein.
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Affiliation(s)
- Federica Magon
- Department of Anesthesia and Critical Care, Bicocca University of Milano, 20126 Milano, Italy;
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Gabriele Savioli
- Departement of Emergency, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | - Andrea Piccioni
- Department of Emergency Medicine, Gemelli Hospital, Catholic University of Rome, 00168 Rome, Italy;
| | - Manfredi Tesauro
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
- Geriatric Medicine Residency Program, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Fabio Del Duca
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (G.N.); (G.V.)
| | - Gabriele Napoletano
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (G.N.); (G.V.)
| | - Gianpietro Volonnino
- Department of Anatomical, Histological, Forensic and Orthopedical Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (F.D.D.); (G.N.); (G.V.)
| | - Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Raffaele La Russa
- Department of Clinical Medicine, Public Health, Life Sciences, and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Marco Di Paolo
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Christian Zanza
- Geriatric Medicine Residency Program, University of Rome “Tor Vergata”, 00133 Rome, Italy;
- Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
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Kumabe Y, Kalbas Y, Halvachizadeh S, Teuben M, Cesarovic N, Weisskopf M, Hülsmeier A, Hornemann T, Cinelli P, Pape HC, Pfeifer R. Occult hypoperfusion and changes of systemic lipid levels after severe trauma: an analysis in a standardized porcine polytrauma model. Eur J Trauma Emerg Surg 2024; 50:107-114. [PMID: 35819473 PMCID: PMC10924008 DOI: 10.1007/s00068-022-02039-1] [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: 03/24/2022] [Accepted: 06/26/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Occult hypoperfusion describes the absence of sufficient microcirculation despite normal vital signs. It is known to be associated with prolonged elevation of serum lactate and later complications in severely injured patients. We hypothesized that changes in circulating lipids are related to responsiveness to resuscitation. The purpose of this study is investigating the relation between responsiveness to resuscitation and lipidomic course after poly trauma. METHODS Twenty-five male pigs were exposed a combined injury of blunt chest trauma, liver laceration, controlled haemorrhagic shock, and femoral shaft fracture. After 1 h, animals received resuscitation and fracture stabilization. Venous blood was taken regularly and 233 specific lipids were analysed. Animals were divided into two groups based on serum lactate level at the end point as an indicator of responsiveness to resuscitation (<2 mmol/L: responder group (R group), ≧2 mmol/L: occult hypoperfusion group (OH group)). RESULTS Eighteen animals met criteria for the R group, four animals for the OH group, and three animals died. Acylcarnitines showed a significant increase at 1 h compared to baseline in both groups. Six lipid subgroups showed a significant increase only in R group at 2 h. There was no significant change at other time points. CONCLUSIONS Six lipid groups increased significantly only in the R group at 2 h, which may support the idea that they could serve as potential biomarkers to help us to detect the presence of occult hypoperfusion and insufficient resuscitation. We feel that further study is required to confirm the role and mechanism of lipid changes after trauma.
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Affiliation(s)
- Yohei Kumabe
- Department of Trauma, Institute for Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Yannik Kalbas
- Department of Trauma, Institute for Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Sascha Halvachizadeh
- Department of Trauma, Institute for Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Michel Teuben
- Department of Trauma, Institute for Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Nikola Cesarovic
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Miriam Weisskopf
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Andreas Hülsmeier
- Department of Trauma, Institute for Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland
| | - Thorsten Hornemann
- Department of Trauma, Institute for Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland
| | - Paolo Cinelli
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, Institute for Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland
| | - Roman Pfeifer
- Department of Trauma, Institute for Clinical Chemistry, Zurich University Hospital, Zurich, Switzerland.
- Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland.
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19
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Quinn J, Panasenko SI, Leshchenko Y, Gumeniuk K, Onderková A, Stewart D, Gimpelson AJ, Buriachyk M, Martinez M, Parnell TA, Brain L, Sciulli L, Holcomb JB. Prehospital Lessons From the War in Ukraine: Damage Control Resuscitation and Surgery Experiences From Point of Injury to Role 2. Mil Med 2024; 189:17-29. [PMID: 37647607 DOI: 10.1093/milmed/usad253] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/26/2023] [Indexed: 09/01/2023] Open
Abstract
The ongoing war in Ukraine presents unique challenges to prehospital medical care for wounded combatants and civilians. The purpose of this article is to identify, describe, and address gaps in prehospital care, casualty evacuation, and medical evacuation throughout Ukraine to share lessons for other providers. Observations and experiences of medical personnel were collected and analyzed, focusing on pain management, antibiotic use, patient assessment, mass casualty triage, blood loss, hypothermia, transport immobilization, and clinical governance. Gaps identified include limited access to pain management, lack of antibiotic guidance, inadequate patient assessment and triage, access to damage control resuscitation and blood, challenged transport immobilization practices, and challenges with clinical governance for both local and foreign providers. Improved prehospital care and casualty and medical evacuation in Ukraine are required, through increased use of empiric pain management, focused antibiotic guidance, enhanced patient assessment and triage in the form of training, access to prehospital blood, and better transport immobilization practices. A robust and active lessons learned program, trauma data capture, and quality improvement process is needed to reduce preventable morbidity and mortality in the war zone. The recommendations presented in this article serve as a starting point for improvements in prehospital care in Ukraine with potential to change prehospital training for the NATO alliance and other organizations operating in similar areas of conflict. Graphical Abstract.
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Affiliation(s)
- John Quinn
- Prague Center for Global Health, Prague 120 00, Czech Republic
- East Surrey Emergency Department, Redhill RH1 5RH, UK
| | - Serhii I Panasenko
- Department of Surgery No 3, Poltava State Medical University, Poltava 36039, Ukraine
| | | | - Konstantyn Gumeniuk
- Ukrainian Armed Forces (UKR), Headquarters of Medical Forces of Military Forces, Kyiv 03168, Ukraine
| | - Anna Onderková
- Department of Oncology, Division of Surgery, University College London Hospital, London NW1 2BU, UK
| | - David Stewart
- Emergency & Deployed Medicine San Diego, California, USA
| | | | | | | | - Tracey A Parnell
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Leonid Brain
- NewYork-Presbyterian Brooklyn Methodist Hospital Emergency Department
| | - Luke Sciulli
- Auton Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - John B Holcomb
- Prague Center for Global Health, Prague 120 00, Czech Republic
- Emergency & Deployed Medicine San Diego, California, USA
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Alabama at Birmingham, Birmingham, AL
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20
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Howard A, Myatt A, Hodgson H, Naeem H, Pepple S, Perumal A, Panteli M, Kanakaris N, Giannoudis PV. Retrograde intramedullary nailing or locked plating for stabilisation of distal femoral fractures? A comparative study of 193 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:471-478. [PMID: 37612566 PMCID: PMC10771351 DOI: 10.1007/s00590-023-03650-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/15/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE The aim of this study was to evaluate the results of distal femoral fracture fixation of two different methods, lateral locking plate (LP) or an Intra-medullary nail (IMN), in patients managed in our institution. More specifically, to assess: (a) if there was a difference in functional outcomes between the LP and IMN groups; (b) whether the rate of complications was different between the two groups. METHODS Between January 2009 and December 2018 adult patients with distal femoral fractures managed in our unit with either LP or IMN for extra and intra-articular fractures were eligible to participate. Demographic details, fracture type, procedures performed, time to union, complications and functional scores (Oxford Knee Score) were recorded and analysed. The mean follow up was 4 years (12-120 months). RESULTS Out of 193 patients who met the inclusion criteria, 93 received an IMN whereas 100 patients were treated with LP. Mean age was 64.2 (18-99) and 70.1 (18-100) for the IMN and LP groups respectively. Overall, the two groups had similar demographics and there was no significant difference in the type of fractures sustained (p > 0.05). The Oxford Knee Score was highest for patients fixed with LP, mean 37.3 (6-48, SD 7.3) versus 28.4 (3-48, SD 14.4), (p = < 0.02) compared to the IMN group. In terms of complications, the rate of non-union was higher in the LP group 8.6% versus 4% in those patients treated with an IMN, p value < 0.01. CONCLUSION While the rate of non-union was higher in the LP group and the functional results were superior in the plating group.
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Affiliation(s)
- Anthony Howard
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
- Leeds General Infirmary University Hospital, Leeds, UK.
- NDORMS, Oxford University, Oxford, UK.
| | - A Myatt
- Leeds General Infirmary University Hospital, Leeds, UK
| | - H Hodgson
- Leeds General Infirmary University Hospital, Leeds, UK
| | - H Naeem
- Leeds General Infirmary University Hospital, Leeds, UK
| | - S Pepple
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - A Perumal
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - M Panteli
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds General Infirmary University Hospital, Leeds, UK
| | - N Kanakaris
- Leeds General Infirmary University Hospital, Leeds, UK
| | - P V Giannoudis
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds General Infirmary University Hospital, Leeds, UK
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21
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Hsieh TM, Chuang PC, Liu CT, Wu BY, Wu CH, Cheng FJ. Impact of Pelvic Fracture on Patients with Blunt Bowel Mesenteric Injury: Is Immediate Laparotomy Warranted? Life (Basel) 2023; 14:16. [PMID: 38276266 PMCID: PMC10821033 DOI: 10.3390/life14010016] [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: 11/11/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
The management of blunt abdominopelvic trauma with combined hemoperitoneum and pelvic fractures is challenging for trauma surgeons. Although angioembolization can achieve hemostasis in most visceral organ injuries and pelvic fractures after blunt abdominal trauma, it cannot effectively control hemorrhage in patients with blunt bowel mesenteric injury (BBMI). This study aimed to determine the risk factors associated with hemodynamically unstable patients with BBMI and to test the hypothesis that pelvic fracture is an independent risk factor for patients with unstable BBMI and concomitant pelvic fracture to guide the therapeutic sequence for difficult-to-manage patients. This retrospective study reviewed the data of hospitalized patients with trauma between 2009 and 2021 and included 158 adult patients with surgically proven BBMI. The patients were divided on the basis of the presence of a shock episode before emergency laparotomy. The shock group included 44.3% of all patients in the study (n = 70). Clinical injury severity and prognosis for patients in the shock group were poorer than those for patients in the non-shock group, and more invasive treatments and transfusions were performed for patients in the shock group than for those in the non-shock group. Pelvic fractures were more frequently associated with the shock group than with the non-shock group (21.4% vs. 5.7%; p = 0.003). In multivariate analysis, the presence of intracerebral hemorrhage (odds ratio [OR] = 10.87, 95% confidence intervals [CIs]: 1.70-69.75) and rib fracture (OR = 5.94, 95% CIs = 1.06-33.45) was identified as an independent predictor of shock, whereas the effect of pelvic fracture did not achieve statistical significance (OR = 2.94, 95% CIs = 0.66-13.13) after adjusting for confounding factors. For patients with BBMI, outcomes need to be improved during early diagnosis, and treatments should be expeditiously performed on the basis of the rapid identification of unstable hemodynamic status. Our results support the recommendation of emergency laparotomy in unstable patients with concomitant pelvic fractures, followed by damage control TAE if needed.
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Affiliation(s)
- Ting-Min Hsieh
- Division of Trauma, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan;
| | - Po-Chun Chuang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan;
| | - Chun-Ting Liu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (C.-T.L.); (B.-Y.W.)
| | - Bei-Yu Wu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (C.-T.L.); (B.-Y.W.)
| | - Chien-Hung Wu
- Department of Emergency Medicine, Yunlin Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Yunlin 638, Taiwan
| | - Fu-Jen Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan;
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22
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McArdle M. Trauma in the elderly: a bilateral rectus sheath haematoma. BMJ Case Rep 2023; 16:e256061. [PMID: 38061846 PMCID: PMC10711929 DOI: 10.1136/bcr-2023-256061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Life expectancy has more than doubled in the last century, and a new cohort of elderly and increasingly frail patients is presenting to emergency departments with new clinical challenges. When this patient cohort presents after injury, all aspects of clinical practice have to be recalibrated to provide safe and appropriate care. The prevalence of chronic disease, levels of organ failure, multiple comorbidities, greater use of anticoagulation and incidence of recurrent low- and high-impact trauma may delay and obscure diagnosis and, ultimately, increase mortality.Older age is a risk factor for rectus sheath haematoma (RSH), which is haemorrhage into the potential space surrounding the rectus abdominis muscle/s. It is a rare presentation following trauma but can provide diagnostic challenges and be fatal. Even more rare is bilateral RSH with only 12 reported in the literature since 1981.This case report describes bilateral RSH presenting in an elderly woman following a fall and the consequences of seemingly minor trauma in the elderly.
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Affiliation(s)
- Michael McArdle
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- South Warwickshire University NHS Foundation Trust, Warwick, UK
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23
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Calderon Martinez E, Diarte E, Othon Martinez D, Rodriguez Reyes L, Aguirre Cano DA, Cantu Navarro C, Ycaza Zurita MG, Arriaga Escamilla D, Choudhari J, Michel G. Point-of-Care Ultrasound for the Diagnosis of Frequent Cardiovascular Diseases: A Review. Cureus 2023; 15:e51032. [PMID: 38264374 PMCID: PMC10805123 DOI: 10.7759/cureus.51032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 01/25/2024] Open
Abstract
Point-of-care ultrasound (POCUS) has emerged as an indispensable diagnostic tool in cardiology, particularly within the emergency department. This narrative synthesis provides a comprehensive exploration of POCUS applications in cardiovascular diseases, elucidating its multifaceted roles and addressing challenges. The review delves into the technical attributes of POCUS, emphasizing its non-invasive nature, radiation-free qualities, and suitability for non-radiologists. It navigates through educational strategies, stressing the importance of structured programs for the seamless integration of POCUS into clinical practice. Highlighting its efficacy, the synthesis discusses POCUS applications in various scenarios such as dyspnea, chest pain, cardiac arrest, aortic dissection, pericardial effusion, and pulmonary embolism. Beyond acute care, the review explores the role of POCUS in outpatient and inpatient settings, focusing on chronic and acute heart failure, valvular heart diseases, and more. Acknowledging operator-dependent challenges and the need for continuous education, the review underscores the transformative potential of POCUS across diverse healthcare settings. This narrative synthesis accentuates POCUS as a valuable and versatile diagnostic tool in cardiology, offering efficiency, safety, and cost-effectiveness. Despite challenges, POCUS stands out as a transformative addition to clinical practices, poised to enhance patient outcomes and reshape the landscape of cardiovascular diagnostics.
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Affiliation(s)
| | - Edna Diarte
- Medicine, Universidad Autónoma de Sinaloa, Culiacán, MEX
| | | | | | | | | | | | | | - Jinal Choudhari
- Research & Academic Affairs, Larkin Community Hospital, South Miami, USA
| | - George Michel
- Internal Medicine, Larkin Community Hospital, South Miami, USA
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24
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Abraha D, Gebreyes E, Wolka E, Dender G, Sorsa A, Muhumuza J. Determinants of adverse management outcomes of blunt abdominal trauma patients operated at a referral hospital in southern Ethiopia: a retrospective record review. BMC Surg 2023; 23:357. [PMID: 37990208 PMCID: PMC10664474 DOI: 10.1186/s12893-023-02261-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Abdominal trauma is one of the common reasons for emergency visits yet there is paucity of data about the subject in the horn of Africa. This study was aimed at determining the determinants of adverse management outcomes of blunt abdominal trauma among operated patients at Wolaita Sodo University Teaching and Referral Hospital, Ethiopia. METHODS This was a three-year retrospective review conducted among 128 patient records selected using purposive sampling in which all records for the patients operated for a diagnosis of blunt abdominal trauma during the study period were included. A pretested checklist was used to extract the data relating to adverse outcomes and characteristics of the patients. A descriptive analysis followed by logistic regression was done. RESULTS Of the 128 patients, adverse management outcomes related to blunt abdominal trauma occurred in 52%. Patients residing in rural areas (adjusted odds ratio 3.23, 95% confidence interval: 1.13-9.24) and those with tachycardia, (adjusted odds ratio = 3.25, 95% confidence interval: 1.19-8.83) or tachypnea (adjusted odds ratio 3.25, 95% confidence interval: 1.19-8.83) were more likely to have adverse management outcomes. CONCLUSION Adverse management outcomes are relatively high and associated with rural residence and deranged vital signs (tachycardia and tachypnea). Close monitoring targeting patients from rural residence and those presenting with tachycardia and tachypnea is recommended.
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Affiliation(s)
- Demoz Abraha
- Department of Surgery, College of Heath Sciences and Medicine, Wolaita Sodo University Teaching and Referral Hospital, Wolaita Sodo, Ethiopia.
| | - Essay Gebreyes
- Department of Surgery, College of Heath Sciences and Medicine, Wolaita Sodo University Teaching and Referral Hospital, Wolaita Sodo, Ethiopia
| | - Eskinder Wolka
- Department of Surgery, College of Heath Sciences and Medicine, Wolaita Sodo University Teaching and Referral Hospital, Wolaita Sodo, Ethiopia
| | - Getahun Dender
- Department of Surgery, College of Heath Sciences and Medicine, Wolaita Sodo University Teaching and Referral Hospital, Wolaita Sodo, Ethiopia
| | - Abebe Sorsa
- Department of Surgery, College of Heath Sciences and Medicine, Wolaita Sodo University Teaching and Referral Hospital, Wolaita Sodo, Ethiopia
| | - Joshua Muhumuza
- Department of surgery, Faculty of clinical medicine and dentistry, Kampala international university- western campus, Ishaka-Bushenyi, Uganda.
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25
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Kani K, Yoshimura S, Ikeda N, Miyamae N, Sumida Y. Awake Fiberoptic Tracheal Intubation in a Patient With Traumatic Retropharyngeal Hematoma. Cureus 2023; 15:e48813. [PMID: 38106694 PMCID: PMC10721434 DOI: 10.7759/cureus.48813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Retropharyngeal hematoma is a rare disease triggered by neck trauma and can result in airway obstruction, requiring early recognition and consideration of tracheal intubation. We present a case of a 42-year-old woman brought to the emergency department with dyspnea after a traffic trauma, and a mild stridor was heard on cervical auscultation, indicating airway compromise. Contrast-enhanced computed tomography (CT) scan showed retropharyngeal hematoma. Considering her obesity and short neck, we performed awake fiberoptic intubation successfully without any complications. Awake fiberoptic intubation, directly confirming anatomic abnormalities, may increase the success rate of intubation and prevent complications, especially in patients at high risk for cannot intubate, cannot ventilate (CICV). Cervical auscultation may contribute to early diagnosis and treatment for airway obstruction in patients with cervical trauma. We report a case of awake fiberoptic tracheal intubation for a retropharyngeal hematoma in a patient at high risk for CICV and cervical auscultation in a primary survey.
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Affiliation(s)
- Keigo Kani
- Emergency Medicine, Rakuwakai Otowa Hospital, Kyoto, JPN
| | - Satoshi Yoshimura
- Preventive Services, Kyoto University, Kyoto, JPN
- Emergency Medicine, Rakuwakai Otowa Hospital, Kyoto, JPN
| | - Nobuhiro Ikeda
- Emergency Medicine, Rakuwakai Otowa Hospital, Kyoto, JPN
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26
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Leo MM, Potter IY, Zahiri M, Vaziri A, Jung CF, Feldman JA. Using Deep Learning to Detect the Presence and Location of Hemoperitoneum on the Focused Assessment with Sonography in Trauma (FAST) Examination in Adults. J Digit Imaging 2023; 36:2035-2050. [PMID: 37286904 PMCID: PMC10501965 DOI: 10.1007/s10278-023-00845-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/13/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
Abdominal ultrasonography has become an integral component of the evaluation of trauma patients. Internal hemorrhage can be rapidly diagnosed by finding free fluid with point-of-care ultrasound (POCUS) and expedite decisions to perform lifesaving interventions. However, the widespread clinical application of ultrasound is limited by the expertise required for image interpretation. This study aimed to develop a deep learning algorithm to identify the presence and location of hemoperitoneum on POCUS to assist novice clinicians in accurate interpretation of the Focused Assessment with Sonography in Trauma (FAST) exam. We analyzed right upper quadrant (RUQ) FAST exams obtained from 94 adult patients (44 confirmed hemoperitoneum) using the YoloV3 object detection algorithm. Exams were partitioned via fivefold stratified sampling for training, validation, and hold-out testing. We assessed each exam image-by-image using YoloV3 and determined hemoperitoneum presence for the exam using the detection with highest confidence score. We determined the detection threshold as the score that maximizes the geometric mean of sensitivity and specificity over the validation set. The algorithm had 95% sensitivity, 94% specificity, 95% accuracy, and 97% AUC over the test set, significantly outperforming three recent methods. The algorithm also exhibited strength in localization, while the detected box sizes varied with a 56% IOU averaged over positive cases. Image processing demonstrated only 57-ms latency, which is adequate for real-time use at the bedside. These results suggest that a deep learning algorithm can rapidly and accurately identify the presence and location of free fluid in the RUQ of the FAST exam in adult patients with hemoperitoneum.
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Affiliation(s)
- Megan M Leo
- Boston University School of Medicine, Boston, MA, USA.
- Department of Emergency Medicine, Boston Medical Center, BCD Building, 800 Harrison Ave1St Floor, Boston, MA, 02118, USA.
| | | | | | | | - Christine F Jung
- Division of Emergency Ultrasound, Department of Emergency Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
- Department of Emergency Medicine, Chicago Medical School of Rosalind, Franklin University of Medical Sciences, Chicago, IL, USA
- Department of Emergency Medicine, Rush Medical College, Chicago, IL, USA
| | - James A Feldman
- Boston University School of Medicine, Boston, MA, USA
- Department of Emergency Medicine, Boston Medical Center, BCD Building, 800 Harrison Ave1St Floor, Boston, MA, 02118, USA
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27
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Park J, Kim D, Park JH, Lee JY, Cho EJ. Cardiovascular Collapse after the Induction of Anesthesia Due to the MASS Effect of Unruptured Giant Bullae. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1689. [PMID: 37763808 PMCID: PMC10535054 DOI: 10.3390/medicina59091689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Giant bullae rupture easily and cause tension pneumothorax, which can cause problems during general anesthesia. However, the hemodynamic instability that can occur due to the mass effect of an unruptured giant bulla should not be overlooked. Case report: A 43-year-old male patient visited the emergency room with an abdominal wound. There was a giant emphysematous bulla in the left lung. Emergency surgery was decided upon because there was active bleeding according to abdominal CT. After tracheal intubation, the patient's blood pressure and pulse rate dramatically decreased. His blood pressure did not recover despite the use of vasopressors and discontinuation of positive pressure ventilation applied to the lungs. Thus, a bullectomy was immediately performed. The patient's blood pressure and pulse rate were normalized after the bullectomy. Conclusions: If emergency surgery under general anesthesia is required in a patient with a giant emphysematous bulla, it is safe to minimize positive pressure ventilation and remove the giant emphysematous bulla as soon as possible before proceeding with the remainder of the surgery. Tension pneumothorax due to the rupturing of a bulla should be considered first. However, hemodynamic changes might occur due to the mass effect caused by a giant bulla.
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Affiliation(s)
- Junghyun Park
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea; (J.P.); (D.K.); (J.-H.P.)
| | - Dulee Kim
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea; (J.P.); (D.K.); (J.-H.P.)
| | - Jae-Hoo Park
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea; (J.P.); (D.K.); (J.-H.P.)
| | - Ji-Yun Lee
- Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea;
| | - Eun-Jung Cho
- Department of Anesthesiology and Pain Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Republic of Korea; (J.P.); (D.K.); (J.-H.P.)
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Sa W, Shuihong C, Jingfen J, Mao Z, Zhiting G, Danping Y, Chang H, Yuwei W. The effect of trauma advanced practice nurse programme at a Level I regional trauma centre in mainland China. Nurs Open 2023; 10:6559-6565. [PMID: 37332249 PMCID: PMC10416056 DOI: 10.1002/nop2.1911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 05/25/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023] Open
Abstract
AIMS Trauma is the fifth-leading cause of death in China. Despite the establishment of the Chinese Regional Trauma Care System (CRTCS) in 2016, advanced trauma nurse practice has not been incorporated. This study aimed to identify the roles and responsibilities of trauma advanced practice nurse (APN), and to investigate the impact on patient outcomes in a Level I regional trauma centre in mainland China. DESIGN A single-centre pre- and post-control design was used. METHODS The trauma APN programme was established based on multidisciplinary experts' consultation. A retrospective study was conducted on all Level I trauma patients over a period of 5 years, spanning from January 2017 to December 2021, with a sample size of 2420. The data were divided into two comparison groups: a pre-APN programme (January 2017-December 2018; n = 1112) and post-APN programme (January 2020-December 2021; n = 1308). A comparison analysis was conducted to evaluate the effectiveness of trauma APN who were integrated into the trauma care team, with a focus on patient outcomes and time-efficiency indicators. RESULTS The certification of the regional Level I trauma centre resulted in a 17.63% increase in the number of trauma patients. The integration of advanced practice nurses (APN) into the trauma care system led to significant improvements in time-efficiency indicators, with the exception of advanced airway establishment time (p < 0.05). The average emergency department length of stay (LOS) decreased 21%, from 168 to 132 min (p < 0.001); additionally, the mean intensive care unit LOS decreased by nearly 1 day (p = 0.028). Trauma patients who were treated by trauma APN had a higher likelihood of survival, with an odds ratio of 1.816 (95%CI: 1.041, 3.167; p = 0.033), compared to patients who received care prior to the implementation of the trauma APN program. CONCLUSION A trauma APN programme has the potential to enhance the quality of trauma care in the CRTCS. IMPACT This study elucidates the roles and responsibilities of trauma advanced practice nurses (APN) in a Level I regional trauma centre in mainland China. Trauma care quality was significantly improved after the application of a trauma APN programme. In regions with inadequate medical resources, the utilization of advanced practice trauma nurses can enhance the quality of trauma care. In addition, trauma APN can provide a trauma nursing education programme within the regional centres as a strategy to augment the proficiency of regional trauma nursing. No patient or public contribution, the research data all from trauma data bank.
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Affiliation(s)
- Wang Sa
- Nursing DepartmentZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
- Emergency MedicineZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
| | - Chen Shuihong
- Quality Management DepartmentZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
| | - Jin Jingfen
- Nursing DepartmentZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang ProvinceHangzhouChina
| | - Zhang Mao
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang ProvinceHangzhouChina
- Emergency MedicineZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
| | - Guo Zhiting
- Nursing DepartmentZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
| | - Yan Danping
- Nursing DepartmentZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
- Emergency MedicineZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
| | - Huang Chang
- Nursing DepartmentZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
- Emergency MedicineZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
| | - Wang Yuwei
- Nursing DepartmentZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
- Emergency MedicineZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
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Zhang J, Zhang L, Li C, Chai W, Zhang L, Chen H, Zhang W, Hou Z, Chen B, Sun T, Tang P, Zhang Y. Clinical Guidelines for the Diagnosis and Treatment of Fragility Fractures of the Pelvis. Orthop Surg 2023; 15:2195-2212. [PMID: 37435891 PMCID: PMC10475682 DOI: 10.1111/os.13755] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Fragility fractures of the pelvis (FFPs) are osteoporotic pelvic fractures or insufficiency pelvic fractures caused by the low energy injury or stress fracture in daily livings in the elderly more than 60 years, which the incidence is increasing with the aging population in our country. FFPs result in considerable morbidity and mortality and as well as massive financial burden on the already strained health systems throughout the world. METHODS This clinical guideline was initiated by the Trauma Orthopedic Branch of Chinese Orthopedic Association; the External Fixation and Limb Reconstruction Branch of Chinese Orthopedic Association; the National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation; Senior Department of Orthopedics of Chinese PLA general hospital; the Third Hospital of Hebei Medical University. The grading of recommendations assessment, development and evaluation (GRADE) approach and the reporting items for practice guidelines in healthcare (RIGHT) checklist were adopted. RESULTS 22 evidence based recommendations were formulated based on 22 most concerned clinical problems among orthopedic surgeons in China. CONCLUSION Understanding these trends through this guideline will facilitate better clinical care of FFP patients by medical providers and better allocation of resources by policy makers.
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Affiliation(s)
- Jianzheng Zhang
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
- The National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
- The Trauma Orthopedic Branch of Chinese Orthopedic AssociationShijiazhuangChina
| | - Licheng Zhang
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
- The National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
- The Trauma Orthopedic Branch of Chinese Orthopedic AssociationShijiazhuangChina
| | - Chunbao Li
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
- The National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
| | - Wei Chai
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
- The National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
| | - Lihai Zhang
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
- The National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
- The Trauma Orthopedic Branch of Chinese Orthopedic AssociationShijiazhuangChina
| | - Hua Chen
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
- The National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
- The Trauma Orthopedic Branch of Chinese Orthopedic AssociationShijiazhuangChina
| | - Wei Zhang
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
- The National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
- The Trauma Orthopedic Branch of Chinese Orthopedic AssociationShijiazhuangChina
| | - Zhiyong Hou
- The Trauma Orthopedic Branch of Chinese Orthopedic AssociationShijiazhuangChina
- Group of Trauma Orthopaedics, Chinese Orthopaedic Association, Department of OrthopedicsThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Bin Chen
- Department of Orthopedics, Southern HospitalSouthern Medical UniversityGuangzhouChina
| | - Tiansheng Sun
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
- The National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
| | - Peifu Tang
- Senior Department of OrthopedicsThe Fourth Medical Center of PLA General HospitalBeijingChina
- The National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijingChina
- The Trauma Orthopedic Branch of Chinese Orthopedic AssociationShijiazhuangChina
| | - Yingze Zhang
- The Trauma Orthopedic Branch of Chinese Orthopedic AssociationShijiazhuangChina
- Group of Trauma Orthopaedics, Chinese Orthopaedic Association, Department of OrthopedicsThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
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Babi M, Tarter ZW, Shutt T, Cash E, Jorgensen J. A Throwing Knife Injury to the Neck: Management of a Unique Airway Situation. EAR, NOSE & THROAT JOURNAL 2023:1455613231186018. [PMID: 37491881 DOI: 10.1177/01455613231186018] [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: 07/27/2023] Open
Abstract
Penetrating neck injuries (PNIs) can present as a simple wound or can be complicated by a disruption of the airway or associated vasculature. As such, stabilization of the vasculature and the airway is paramount. Here we present a case in which a hemodynamically stable 28-year-old female presents with a PNI involving the oropharynx and laryngopharynx.
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Affiliation(s)
- Mohamad Babi
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, KY, USA
| | - Zachary W Tarter
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Travis Shutt
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, KY, USA
| | - Elizabeth Cash
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, KY, USA
- UofL Health - Brown Cancer Center, Louisville, KY, USA
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Murawski CD, Mittwede PN, Wawrose RA, Belayneh R, Tarkin IS. Management of High-Energy Tibial Pilon Fractures. J Bone Joint Surg Am 2023; 105:1123-1137. [PMID: 37235679 DOI: 10.2106/jbjs.21.01377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
➤ Pilon fractures in the younger patient population are frequently high-energy, intra-articular injuries and are associated with devastating, long-term impacts on patient-reported outcomes and health-related quality of life, as well as high rates of persistent disability.➤ Judicious management of associated soft-tissue injury, including open fractures, is essential to minimizing complications. Optimizing medical comorbidities and negative social behaviors (e.g., smoking) should be addressed perioperatively.➤ Delayed internal fixation with interval temporizing external fixation represents the preferred technique for managing most high-energy pilon fractures presenting with characteristically substantial soft-tissue trauma. In some cases, surgeons elect to utilize circular fixation for these scenarios.➤ Although there have been treatment advances, the results have been generally poor, with high rates of posttraumatic arthritis, despite expert care.➤ Primary arthrodesis may be indicated in cases with severe articular cartilage injury that, in the opinion of the treating surgeon, is likely unsalvageable at the time of the index management.➤ The addition of intrawound vancomycin powder at the time of definitive fixation represents a low-cost prophylactic measure that appears to be effective in reducing gram-positive deep surgical site infections.
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Affiliation(s)
- Christopher D Murawski
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Peiro A, Chegeni N, Danyaei A, Fatahiasl J, Tahmasbi M. Pelvic radiation dose measurement for trauma patients in multifield radiographic examinations: A phantom-based TLD dosimetry study. Health Sci Rep 2023; 6:e1424. [PMID: 37484057 PMCID: PMC10356977 DOI: 10.1002/hsr2.1424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 07/25/2023] Open
Abstract
Background and Aims Trauma patients often suffer from multiple injuries and require undergoing various radiography which is referred to as multifield radiographic examinations. Protective measures may be ignored for these examinations due to stressful emergency situations or patients' conditions. This study was conducted to evaluate the scattered doses received by the pelvis during different common multifield radiographic examinations with an emphasis on field size adjustment. Methods A whole-body phantom, PBU-50, resembling the body mass, was used to carry out the common examinations for trauma patients (extremities, skull, chest, abdomen, pelvis, femur, and lumbar radiography), using a Pars Pad X-ray machine. To measure the primary entrance skin doses, three calibrated GR 200 thermoluminescence dosimeter (TLD) chips were placed in the central X-ray beam of scanned organs. Three TLDs were also placed on the pelvis symphysis pubis to measure the scattered dose received by the pelvis due to each carried-out radiography for standard and clinically used field sizes. A Harshaw 3500 TLD Reader was used to read the chips. TLD readouts (nano-Coulomb) were converted to dose (milli Gray [mGy]) using the predefined calibration curve. Results The scattered doses to the pelvis due to scanning a single organ differed from 0.80 to 1.70, and 0.82 to 4.09 mGy for standard and clinically used field sizes, respectively. The scattered doses to the pelvis in multifield examinations varied from 0.80 to 8.43 and 0.82 to 13.6 mGy for standard and clinically used field sizes, respectively, depending on the number of scanned organs and their distances from the pelvis. Conclusions Multiple and repeated radiographs combined with insufficient protective measures can increase the patient's dose. The findings indicate that the scattered doses received by the pelvis can exceed the reference values in multifield radiography, especially if the radiation field is not restricted properly to the scanned organ.
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Affiliation(s)
- Ameneh Peiro
- Department of Medical Physics, School of MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Nahid Chegeni
- Department of Medical Physics, School of MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Amir Danyaei
- Department of Medical Physics, School of MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Jafar Fatahiasl
- Department of Radiologic Technology, School of Allied Medical SciencesAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Marziyeh Tahmasbi
- Department of Radiologic Technology, School of Allied Medical SciencesAhvaz Jundishapur University of Medical SciencesAhvazIran
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Mastrianni A, Sarcevic A, Hu A, Almengor L, Tempel P, Gao S, Burd RS. Transitioning Cognitive Aids into Decision Support Platforms: Requirements and Design Guidelines. ACM TRANSACTIONS ON COMPUTER-HUMAN INTERACTION : A PUBLICATION OF THE ASSOCIATION FOR COMPUTING MACHINERY 2023; 30:41. [PMID: 37694216 PMCID: PMC10489246 DOI: 10.1145/3582431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 12/16/2022] [Indexed: 09/12/2023]
Abstract
Digital cognitive aids have the potential to serve as clinical decision support platforms, triggering alerts about process delays and recommending interventions. In this mixed-methods study, we examined how a digital checklist for pediatric trauma resuscitation could trigger decision support alerts and recommendations. We identified two criteria that cognitive aids must satisfy to support these alerts: (1) context information must be entered in a timely, accurate, and standardized manner, and (2) task status must be accurately documented. Using co-design sessions and near-live simulations, we created two checklist features to satisfy these criteria: a form for entering the pre-hospital information and a progress slider for documenting the progression of a multi-step task. We evaluated these two features in the wild, contributing guidelines for designing these features on cognitive aids to support alerts and recommendations in time- and safety-critical scenarios.
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Affiliation(s)
- Angela Mastrianni
- College of Computing and Informatics, Drexel University, Philadelphia, USA
| | | | - Allison Hu
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, D.C., USA
| | - Lynn Almengor
- College of Computing and Informatics, Drexel University, Philadelphia, USA
| | - Peyton Tempel
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, D.C., USA
| | - Sarah Gao
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, D.C., USA
| | - Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Hospital, Washington, D.C., USA
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Ellington M, Walker I, Barnard E. Red cell haemolysis secondary to intraosseous (IO) blood transfusion in adult patients with major trauma: a systematic review. BMJ Mil Health 2023:military-2023-002378. [PMID: 37236652 DOI: 10.1136/military-2023-002378] [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: 02/15/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Intraosseous (IO) administration of medications and blood products is accepted practice in major trauma when intravenous access is not immediately available. However, there is a concern that the high infusion pressures required for IO transfusion may increase the risk of red cell haemolysis and its associated complications. The aim of this systematic review is to synthesise the existing evidence describing the risks of red cell haemolysis in IO blood transfusion. METHODS We undertook a systematic search of MEDLINE, CINAHL and EMBASE using the search terms: "intraosseous transfusion" and "haemolysis". Two authors independently screened abstracts, and reviewed full-text articles against the inclusion criteria. Reference lists of included studies were reviewed and a grey literature search undertaken. Studies were assessed for risk of bias. Inclusion criteria were: all human and animal study types that reported novel data on IO-associated red cell haemolysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was used. RESULTS Twenty-three abstracts were identified; n=9 full papers met the inclusion criteria. No further studies were identified from reference lists or grey literature. These papers included: seven large animal translational studies, a prospective and a retrospective human study. The overall risk of bias was high. One animal study with good translatability to adult patients with trauma demonstrated haemolysis. Other animal studies had methodological constraints that limit their human applicability. No haemolysis was observed in low-density flat bones (sternum), whereas haemolysis was reported in long bones (humerus, tibia). IO infusion using a three-way tap was associated with haemolysis. Conversely, pressure bag transfusion was not associated with haemolysis, but this method may result in insufficient flow rates for effective resuscitation. CONCLUSIONS There is a paucity of high-quality evidence surrounding the risks of red cell haemolysis in IO blood transfusion. However, evidence from one study suggests that the likelihood is increased by use of a three-way tap to administer blood transfusion to young adult male patients with trauma. Further research is needed to address this important clinical question. PROSPERO REGISTRATION NUMBER CRD42022318902.
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Affiliation(s)
- Matt Ellington
- Anaesthetic Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - I Walker
- Haematology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Haematology, University of Cambridge, Cambridge, UK
| | - E Barnard
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research and Clinical Innovation), Birmingham, UK
- Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Almutairi MK, Alqirnas MQ, Altwim AM, Alhamadh MS, Alkhashan M, Aljahdali N, Albdah B. Outcomes of Pediatric Traumatic Cardiac Arrest: A 15-year Retrospective Study in a Tertiary Center in Saudi Arabia. Cureus 2023; 15:e39598. [PMID: 37384094 PMCID: PMC10296779 DOI: 10.7759/cureus.39598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND/OBJECTIVE Traumatic cardiac arrest (TCA) is the cessation of cardiac pumping activity secondary to blunt or penetrating trauma. The aim of this study is to identify the outcomes of traumatic cardiac arrest in pediatric patients within the local community and report the causes and resuscitation management for the defined cases. METHODS This was a retrospectively conducted cohort study that took place in King Abdulaziz Medical City (KAMC) and King Abdullah Specialized Children Hospital (KASCH) from 2005 to 2021, Riyadh, Kingdom of Saudi Arabia. The study population involved pediatric patients aged 14 years or less who were admitted to our Emergency Department (ED) and had a traumatic cardiac arrest in the ED. RESULTS There were 26,510 trauma patients, and only 56 were eligible for inclusion. More than half (60.71%, n= 34) of the patients were males. Patients aged four years or less constituted 51.79% (n= 29) of the included cases. The majority of patients were Saudis (89.29%, n= 50). The majority of the patients had cardiac arrest prior to ED admission (78.57%, n= 44). The majority (89.29%, n= 50) had a GCS of 3 at ED arrival. The most frequently observed first cardiac arrest rhythm was asystole, followed by pulseless electrical activity and ventricular fibrillation, accounting for 74.55%, 23.64%, and 1.82%, respectively. CONCLUSION Pediatric TCA is high acuity. Children who experience TCA have dreadful outcomes, and survivors can suffer serious neurological impairments. We provided the experience of one of the largest trauma centers in Saudi Arabia to standardize the approach for managing TCA and, hopefully, improve its outcomes.
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Affiliation(s)
- Mohammed K Almutairi
- Department of Emergency Medicine, King Abdullah Specialized Children Hospital, Riyadh, SAU
| | - Muhannad Q Alqirnas
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | - Moustafa S Alhamadh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Munira Alkhashan
- Department of Emergency Medicine, King Abdulaziz Medical City Riyadh, Riyadh, SAU
| | - Nouf Aljahdali
- Department of Emergency Medicine, King Abdullah Specialized Children Hospital, Riyadh, SAU
| | - Bayan Albdah
- Section of Biostatistics, Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, SAU
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Herbosa CG, Leucht P, Egol KA, Tejwani NC. The 2-Window Posterolateral vs Single-Window Approach for Ankle Fracture Fixation. Foot Ankle Int 2023; 44:297-307. [PMID: 36946551 DOI: 10.1177/10711007231156163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND The posterolateral approach to the ankle allows for reduction and fixation of the posterior and lateral malleoli through the same surgical incision. This can be accomplished via 1 or 2 surgical "windows." The purpose of this study is to compare outcomes including wound complications following direct fixation of unstable rotational ankle fracture through the posterolateral approach using either 1 or 2 surgical windows. METHODS One hundred sixty-four patients with bi- or trimalleolar ankle fractures treated using the single-window posterolateral approach (between the peroneal tendons and the flexor hallucis longus [FHL]) or the 2-window technique (between the peroneal tendons and the FHL for posterior malleolus fixation; lateral to the peroneal tendons for fibula fixation) were reviewed for demographics, radiographic details, and clinical outcomes. We were able to review these 164 at the 3-month follow-up and a subset of 104 at a minimum of 12-month follow-up. RESULTS One hundred eight ankles had the single-window approach; 56 had the 2-window approach. These 2 cohorts did not differ in demographic or injury characteristics. Ankles in the 2-window group experienced a greater number of early (3 months postsurgery) wound complications (32% vs 12%, P < .01). Two-window patients had more wound complications among ankles treated later than 1 week after injury (44% vs 16%, P < .01). There was no difference in surgical site infection, with low rates in both cohorts. Single-window patients had greater plantarflexion (35 ± 10 vs 30 ± 11 degrees, P = .025) and dorsiflexion after 12 months (21 ± 10 vs 16 ± 11 degrees, P = .021). We did not find a significant difference in nerve complications for these 2 cohorts. CONCLUSION In our study, we found the single-window posterolateral approach to be associated with fewer wound complications and better postoperative range of ankle motion when compared to the 2-window approach. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Christopher G Herbosa
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Philipp Leucht
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Kenneth A Egol
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Nirmal C Tejwani
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
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Multidisciplinary Approach to Spinal Metastases and Metastatic Spinal Cord Compression—A New Integrative Flowchart for Patient Management. Cancers (Basel) 2023; 15:cancers15061796. [PMID: 36980681 PMCID: PMC10046378 DOI: 10.3390/cancers15061796] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/04/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Metastatic spine disease (MSD) and metastatic spinal cord compression (MSCC) are major causes of permanent neurological damage and long-term disability for cancer patients. The development of MSD is pathophysiologically framed by a cooperative interaction between general mechanisms of bone growth and specific mechanisms of spinal metastases (SM) expansion. SM most commonly affects the thoracic spine, even though multiple segments may be affected concomitantly. The great majority of SM are extradural, while intradural-extramedullary and intramedullary metastases are less frequently seen. The management of patients with SM is particularly complex and challenging, with multiple factors—such as the spinal stability status, primary tumor radio and chemosensitivity, cancer biological burden, patient performance status and comorbidities, and patient’s oncological prognosis—influencing the clinical decision-making process. Different frameworks were developed in order to systematize and support this process. A multidisciplinary, personalized approach, enriched by the expertise of each involved specialty, is crucial. We reviewed the most recent evidence and proposed an updated algorithmic approach to patients with MSD according to the clinical scenario of each patient. A flowchart-based approach offers an evidence-based management of MSD, providing a valuable clinical decision tool in a context of high uncertainty and quick-acting need.
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Smedley WA, Mabry CD, Collins T, Tabor J, Bowman S, Porter A, Young S, Klutts G, Deloach J, Bhavaraju A, Maxson T, Robertson RD, Holcomb JB, Kalkwarf KJ. Access to Immediately Available Balanced Blood Products in a Rural State's Trauma System. Am Surg 2023:31348231160836. [PMID: 36877979 DOI: 10.1177/00031348231160836] [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: 03/08/2023]
Abstract
INTRODUCTION The Arkansas Trauma System was established by law more than a dozen years ago, and all participating trauma centers are required to maintain red blood cells. Since then, there has been a paradigm shift in resuscitating exsanguinating trauma patients. Damage Control Resuscitation with balanced blood products (or whole blood) and minimal crystalloid is now the standard of care. This project aimed to determine access to balanced blood products in our state's Trauma System (TS). METHODS A survey of all trauma centers in the Arkansas TS was conducted, and geospatial analysis was performed. Immediately Available Balanced Blood (IABB) was defined as at least 2 units (U) of thawed plasma (TP) or never frozen plasma (NFP), 4 units of red blood cells (RBCs), 2 units of fresh frozen plasma (FFP), and 1 unit of platelets or 2 units of whole blood (WB). RESULTS All 64 trauma centers in the state TS completed the survey. All level I, II, and III Trauma Centers (TCs) maintain RBC, plasma, and platelets, but only half of the level II and 16% of the level III TCs have thawed or never frozen plasma. A third of level IV TCs maintain only RBCs, while only 1 had platelets, and none had thawed plasma. 85% of people in our state are within 30 min of RBCs, almost two-thirds are within 30 min of plasma (TP, NFP, or FFP) and platelets, while only a third are within 30 min of IABB. More than 90% are within an hour of plasma and platelets, while only 60% are within that time from an IABB. The median drive times for Arkansas from RBC, plasma (TP, NFP, or FFP), platelets, and an immediately available and balanced blood bank are 19, 21, 32, and 59 minutes, respectively. A lack of thawed or non-frozen plasma and platelets are the most common limitations of IABB. One level III TC in the state maintains WB, which would alleviate the limited access to IABB. CONCLUSION Only 16% of the trauma centers in Arkansas can provide IABB, and only 61% of the population can reach IABB within 60 minutes. Opportunities exist to reduce the time to balanced blood products by selectively distributing WB, TP, or NFP to hospitals in our state trauma system.
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Affiliation(s)
- W Andrew Smedley
- Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Terry Collins
- Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeff Tabor
- Arkansas Trauma Communications Center, Little Rock, AR, USA
| | - Stephen Bowman
- Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Austin Porter
- Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sean Young
- Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Garret Klutts
- Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Joseph Deloach
- Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Avi Bhavaraju
- Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Todd Maxson
- Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ronald D Robertson
- Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - John B Holcomb
- Center for Injury Sciences, Division of Acute Care Surgery, 9967University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kyle J Kalkwarf
- Department of Surgery, 12215University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Moroco AE, Patel VA, Saadi RA, Gniady JP, Lighthall JG. Systematic Review of Laryngeal Fractures and Trends in Operative Management. Craniomaxillofac Trauma Reconstr 2023; 16:62-69. [PMID: 36824183 PMCID: PMC9941301 DOI: 10.1177/19433875221074847] [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: 11/17/2022] Open
Abstract
Study Design Systematic review of the literature. Objective The goal of this study is to review the current literature on the trends in management of laryngeal fractures following trauma. Methods Independent searches of the PubMed and MEDLINE databases were performed. Articles from the period of 1963 to 2020 were collected. All studies which described laryngeal fractures using the Boolean method and relevant search term combinations, including "Laryngeal", "Fracture", "Operative", and "Management" were collected. Results A total of 588 relevant unique articles were identified for analysis. Of these, 24 articles were deemed appropriate for inclusion in the literature review. Due to variability in study design and outcome measures, formal synthesis of data in the form of a meta-analysis was not possible. Conclusions Laryngeal fractures are rare traumatic injuries that require early identification and evaluation with complex management options. This comprehensive review aims to highlight the breadth of the topic with regard to presentation and clinical management. Though there remains no clear best practice for laryngeal fracture management, we review trends in clinical practice throughout the literature.
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Affiliation(s)
- Annie E. Moroco
- Department of Otolaryngology – Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Vijay A. Patel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, UPMC Centers for Cranial Base Surgery & Sinonasal Disorders and Allergy, Pittsburgh, PA, USA
| | - Robert A. Saadi
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - John P. Gniady
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Jessyka G. Lighthall
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
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Makaram NS, Murray IR, Geeslin AG, Chahla J, Moatshe G, LaPrade RF. Diagnosis and treatment strategies of the multiligament injured knee: a scoping review. Br J Sports Med 2023; 57:543-550. [PMID: 36822842 DOI: 10.1136/bjsports-2022-106425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To map the current literature evaluating the diagnosis and treatment of multiligament knee injuries (MLKIs). DESIGN Scoping review. DATA SOURCES Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews and Arksey and O'Malley frameworks were followed. A three-step search strategy identified relevant published literature comprising studies reporting on at least one aspect in the diagnosis or treatment of MLKI in adults. Data were synthesised to form a descriptive analysis and thematic summary. RESULTS Overall, 417 studies were included. There was a substantial chronological increase in the number of studies published per year, with 70% published in the last 12 years. Of included studies, 128 (31%) were narrative reviews, editorials or technical notes with no original data. The majority of studies (n=239, 57%) originated from the USA; only 4 studies (1%) were of level I evidence. Consistent themes of contention included clinical assessment, imaging, operative strategy, timing of surgery and rehabilitation. There was a lack of gender and ethnic diversity reported within patient groups. CONCLUSIONS There remains insufficient high-level evidence to support definitive management strategies for MLKI. There is considerable heterogeneity in outcome reporting in current MLKI literature, precluding robust comparison, interpretation and pooling of data. Further research priorities include the development of expert consensus relating to the investigation, surgical management and rehabilitation of MLKI. There is a need for minimum reporting standards for clinical studies evaluating MLKI.
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Affiliation(s)
- Navnit S Makaram
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,The University of Edinburgh, Edinburgh, UK
| | - Iain R Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,The University of Edinburgh, Edinburgh, UK
| | | | - Jorge Chahla
- Rush University Medical Center, Chicago, Illinois, USA
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García-Pérez D, Panero I, Lagares A, Gómez PA, Alén JF, Paredes I. Atlanto-occipital dislocation with concomitant severe traumatic brain injury: A retrospective study at a level 1 trauma center. NEUROCIRUGIA (ENGLISH EDITION) 2023; 34:12-21. [PMID: 36623889 DOI: 10.1016/j.neucie.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 12/16/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Traumatic atlanto-occipital dislocation (AOD) is a life-threatening injury. Although traumatic brain injury (TBI) is associated with increased mortality in AOD patients, a detailed individual analysis of these patients is lacking in the literature. METHODS Patients ≥16 years old who were diagnosed of AOD with concomitant severe TBI from 2010 to 2020 were included in this retrospective study. We examined the epidemiology, injury mechanisms, associated injuries, and outcomes of these patients. RESULTS Eight patients were included. Six patients died before any intervention could be performed, and two patients underwent an occipito-cervical fixation, showing a notorious neurologic improvement on follow-up. Cardiorespiratory arrest (CRA) was a strong predictor of subsequent death. CT signs of diffuse axonal injury (DAI) were present in most patients and were confirmed by magnetic resonance imaging (MRI) in survivors. Although TBI was not the main cause of death, it was responsible for the delayed neurological improvement and deferred stabilization. The average sensitivity of the different used methodologies for AOD diagnosis ranged from 0.50 to 1.00, being the Basion Dens Interval (BDI) and the Condyle-C1 interval (CCI) sum the most reliable criteria. Non-survivors tended to show greater distraction measurements. The high incidence of condylar avulsion fractures suggests that their visualization on the initial CT study should heighten the suspicion for AOD. CONCLUSIONS Our data suggest that patients with AOD and concomitant severe TBI might be salvageable patients. In those who survive beyond the first hospital days and show neurological improvement, surgical treatment should be performed as they can achieve an important neurologic recovery.
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Affiliation(s)
- Daniel García-Pérez
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain.
| | - Irene Panero
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Pedro Antonio Gómez
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - José F Alén
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Igor Paredes
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
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REBOA: Expanding Applications From Traumatic Hemorrhage to Obstetrics and Cardiopulmonary Resuscitation, From the AJR Special Series on Emergency Radiology. AJR Am J Roentgenol 2023; 220:16-22. [PMID: 35920708 DOI: 10.2214/ajr.22.27932] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged over the past decade as a technique to control life-threatening hemorrhage and treat hemorrhagic shock, being increasingly used to treat noncompressible traumatic torso hemorrhage. Reports during this time also support the use of a REBOA device for an expanding range of indications including nontraumatic abdominal hemorrhage, postpartum hemorrhage, placenta accreta spectrum (PAS) disorder, and cardiopulmonary resuscitation (CPR). The strongest available evidence supports REBOA as a lifesaving adjunct to definitive surgical management in trauma and as a method to help avoid hysterectomy in select patients with postpartum hemorrhage or PAS disorder. In comparison with initial descriptions of complete REBOA inflation, techniques for partial REBOA inflation have been introduced to achieve hemodynamic stability while minimizing adverse events relating to reperfusion injuries. Fluoroscopy-free REBOA has been described in various settings, including trauma, obstetrics, and out-of-hospital cardiac arrest. As the use of REBOA expands outside the trauma setting and into nontraumatic abdominal hemorrhage, obstetrics, and CPR, it is imperative for radiologists to become familiar with this technology, its proper placement, and its potential adverse sequelae.
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Bonanno FG. Management of Hemorrhagic Shock: Physiology Approach, Timing and Strategies. J Clin Med 2022; 12:jcm12010260. [PMID: 36615060 PMCID: PMC9821021 DOI: 10.3390/jcm12010260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 12/30/2022] Open
Abstract
Hemorrhagic shock (HS) management is based on a timely, rapid, definitive source control of bleeding/s and on blood loss replacement. Stopping the hemorrhage from progressing from any named and visible vessel is the main stem fundamental praxis of efficacy and effectiveness and an essential, obligatory, life-saving step. Blood loss replacement serves the purpose of preventing ischemia/reperfusion toxemia and optimizing tissue oxygenation and microcirculation dynamics. The "physiological classification of HS" dictates the timely management and suits the 'titrated hypotensive resuscitation' tactics and the 'damage control surgery' strategy. In any hypotensive but not yet critical shock, the body's response to a fluid load test determines the cut-off point between compensation and progression between the time for adopting conservative treatment and preparing for surgery or rushing to the theater for rapid bleeding source control. Up to 20% of the total blood volume is given to refill the unstressed venous return volume. In any critical level of shock where, ab initio, the patient manifests signs indicating critical physiology and impending cardiac arrest or cardiovascular accident, the balance between the life-saving reflexes stretched to the maximum and the insufficient distal perfusion (blood, oxygen, and substrates) remains in a liable and delicate equilibrium, susceptible to any minimal change or interfering variable. In a cardiac arrest by exsanguination, the core of the physiological issue remains the rapid restoration of a sufficient venous return, allowing the heart to pump it back into systemic circulation either by open massage via sternotomy or anterolateral thoracotomy or spontaneously after aorta clamping in the chest or in the abdomen at the epigastrium under extracorporeal resuscitation and induced hypothermia. This is the only way to prevent ischemic damage to the brain and the heart. This is accomplishable rapidly and efficiently only by a direct approach, which is a crush laparotomy if the bleeding is coming from an abdominal +/- lower limb site or rapid sternotomy/anterolateral thoracotomy if the bleeding is coming from a chest +/- upper limbs site. Without first stopping the bleeding and refilling the heart, any further exercise is doomed to failure. Direct source control via laparotomy/thoracotomy, with the concomitant or soon following venous refilling, are the two essential, initial life-saving steps.
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Affiliation(s)
- Fabrizio G Bonanno
- Department of Surgery, Polokwane Provincial Hospital, Cnr Hospital & Dorp Street, Polokwane 0700, South Africa
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Johannesdottir BK, Geisner T, Gubberud ET, Gudbjartsson T. Civilian vascular trauma, treatment and outcome at a level 1-trauma centre. Scand J Trauma Resusc Emerg Med 2022; 30:74. [PMID: 36544205 PMCID: PMC9773450 DOI: 10.1186/s13049-022-01059-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Outcomes after vascular injuries in wartime are well documented, but studies on vascular injuries in a civilian European populations are scarce. METHODS A retrospective study on all adults admitted to a North-European level 1-trauma centre 2009-2018 with The Abbreviated Injury Scale-codes for non-iatrogenic vascular trauma (VT). Data were extracted from both national and regional trauma-registries, as well as patient charts. Patient demographics, mechanism, and location of vascular injury were registered as well as its treatment. Incidence and injury scores (ISS, NISS and TRISS) were calculated and overall survival (Kaplan-Meier) estimated. RESULTS Of 4042 trauma-patients, 68 (1.7%) (median age 44 years, 76% males) sustained 81 vascular injuries (69 arterial; 12 venous); 46 blunt and 22 (32%) penetrating injuries. The total incidence of vascular injuries was 1.45/100,000 inhabitants and did not change over the study-period (95% confidence interval 1.13-1.82). The injuries were located in thorax (n = 17), neck (n = 16) and abdominal region (n = 15); most of the blunt injuries followed traffic (n = 31) or falling accidents (n = 10), and with 17 of the 22 penetrating injuries due to stabbing. The median ISS and NISS-scores were 22 and 33, with 50 (74%) and 55 (81%) patients having scores > 15, respectively. Forty-three (63%) patients had open surgical repair and 8 (12%) received endovascular treatment. Twenty-one patients died within 30-days (31%), 33% and 27% after blunt and penetrating injuries, respectively. Half of the patients that died within 24 h sustained aortic injury. CONCLUSIONS Traumatic vascular injuries are rare in civilian settings and are less than 2% of major trauma admissions. These patients are often seriously injured and their treatment can be challenging with high 30-day mortality. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- B. K. Johannesdottir
- grid.412008.f0000 0000 9753 1393Department of Vascular Surgery, Haukeland University Hospital, Jonas Lies vei 65, P.O. Box 1400, 5021 Bergen, Norway ,grid.14013.370000 0004 0640 0021Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - T. Geisner
- grid.412008.f0000 0000 9753 1393Western Norway Trauma Centre, Haukeland University Hospital, Bergen, Norway
| | - E. T. Gubberud
- grid.412008.f0000 0000 9753 1393Department of Vascular Surgery, Haukeland University Hospital, Jonas Lies vei 65, P.O. Box 1400, 5021 Bergen, Norway
| | - T. Gudbjartsson
- grid.410540.40000 0000 9894 0842Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavík, Iceland ,grid.14013.370000 0004 0640 0021Faculty of Medicine, University of Iceland, Reykjavík, Iceland
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Analysis of mortality over 7 years in a mature trauma center: evolution of preventable mortality in severe trauma patients. Eur J Trauma Emerg Surg 2022; 49:1425-1431. [DOI: 10.1007/s00068-022-02194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
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Temporary or Permanent? A Clinical Challenge in the Evaluation of Traumatic Brain Injury Patients with Unconsciousness and Normal Initial Head CT. World J Surg 2022; 46:2882-2889. [PMID: 36131183 DOI: 10.1007/s00268-022-06747-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) patients with unconsciousness and normal initial head computed tomography (CT) present a clinical dilemma for physicians and neurosurgeons in the emergency department (ED). We recorded how long it took for patients to regain consciousness and evaluated the patients' characteristics. METHODS From 2018 to 2020, TBI patients with unconsciousness and normal initial head CT [Glasgow coma scale (GCS) score < 13, negative CT scan and normal laboratory test results] were evaluated. Patients who regained consciousness were analyzed. Multivariate logistic regression (MLR) analyses were used to evaluate independent factors for regaining consciousness. RESULTS A total of 77 patients were included in this study. Fifty-eight (75.3%) patients regained consciousness, most within one day (43.1%). Nineteen (24.7%) patients never regained consciousness. MLR analysis showed that initial GCS score (odds 1.85, p = 0.017), early airway protection in ED (odds 25.02, p = 0.018) and 72-h GCS score improvement by two points (odds 0.02, p = 0.001) were independent factors for regaining consciousness. Overall, 94.1% of patients who received early airway protection and improved 2 points in 72-h GCS score regained consciousness. The association between days to M5 status and days to M6 status (consciousness) was highly significant. Fewer days to M5 status were highly associated with needing fewer days to regain consciousness. CONCLUSIONS For TBI patients with unconsciousness and normal initial head CT, a higher probability of regaining consciousness was observed in those who underwent early airway protection and who improved 2 points in 72-h GCS score. Regaining consciousness within a short period could be expected in patients with M5 status.
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Hoepelman RJ, Beeres FJP, van Veelen N, Houwert RM, Babst R, Link BC, van de Wall BJM. Treatment and outcome in combined scapula and rib fractures: a retrospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03437-2. [PMID: 36401000 DOI: 10.1007/s00590-022-03437-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE The primary aim was to describe the population characteristics of patients with combined scapula and rib fractures and outcomes associated with different treatment strategies. METHODS All adult (≥ 18 years) patients with concurrent ipsilateral scapula and rib fractures admitted to the study hospital between 1st January 2010 and 31st June 2021 were retrospectively reviewed. RESULTS A total of 223 patients were admitted with concurrent ipsilateral rib and scapula fractures. A total of 160 patients (72%) were treated conservatively, 63 patients (28%) operatively. Among operatively treated patients, 32 (51%) underwent rib fixation (RF) only, 24 (38%) underwent scapula fixation (SF) only, and seven patients (11%) underwent combined fixation of scapula and ribs (SRF). In general, more severely injured patients were treated with more extensive surgery. RF patients had a median hospital length of stay of 16 days, the SF patients 11 days and SRF patients 18 days. There were no significant differences in complications (pneumonia, recurrent pneumothorax and revision surgery) between groups. CONCLUSION Injury severity resulted in different treatment modalities. As a result, different patient characteristics between treatment groups were observed, which makes direct comparison between treatment modalities impossible. All treatment modalities seem feasible; however, the additional value of both rib and scapula fixation has yet to be proven in large multicentre studies.
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Affiliation(s)
- Ruben Joost Hoepelman
- Department of Trauma Surgery, UMC Utrecht, Utrecht, the Netherlands
- Department of Orthopaedics and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Frank Joseph Paulus Beeres
- Department of Orthopaedics and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Spitalstrasse 16, 6000, Lucerne, Switzerland
| | - Nicole van Veelen
- Department of Orthopaedics and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Reto Babst
- Department of Orthopaedics and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Spitalstrasse 16, 6000, Lucerne, Switzerland
| | - Björn-Christian Link
- Department of Orthopaedics and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Bryan Joost Marinus van de Wall
- Department of Orthopaedics and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.
- Department of Health Sciences and Medicine, University of Lucerne, Spitalstrasse 16, 6000, Lucerne, Switzerland.
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Kunczik J, Hubbermann K, Mösch L, Follmann A, Czaplik M, Barbosa Pereira C. Breathing Pattern Monitoring by Using Remote Sensors. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22228854. [PMID: 36433452 PMCID: PMC9692983 DOI: 10.3390/s22228854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 06/12/2023]
Abstract
The ability to continuously and unobtrusively monitor and classify breathing patterns can be very valuable for automated health assessments because respiration is tightly coupled to many physiological processes. Pathophysiological changes in these processes often manifest in altered breathing patterns and can thus be immediately detected. In order to develop a breathing pattern monitoring system, a study was conducted in which volunteer subjects were asked to breathe according to a predefined breathing protocol containing multiple breathing patterns while being recorded with color and thermal cameras. The recordings were used to develop and compare several respiratory signal extraction algorithms. An algorithm for the robust extraction of multiple respiratory features was developed and evaluated, capable of differentiating a wide range of respiratory patterns. These features were used to train a one vs. one multiclass support vector machine, which can distinguish between breathing patterns with an accuracy of 95.79 %. The recorded dataset was published to enable further improvement of contactless breathing pattern classification, especially for complex breathing patterns.
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Tokuda R, Okada Y, Nagashima F, Kobayashi M, Ishii W, Iizuka R. Open pneumothorax with extensive thoracic defects sustained in a fall: a case report. Surg Case Rep 2022; 8:204. [PMID: 36303013 PMCID: PMC9613823 DOI: 10.1186/s40792-022-01555-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
Background Open pneumothorax with chest wall deficit is a rare chest trauma that is serious and can lead to severe respiratory failure; however, it is a potentially lifesaving injury if utilized appropriately. Case presentation Herein, we report a case of an open pneumothorax with extensive chest wall deficit due to falling from a height and highlight the importance of appropriate evaluation and intervention. The patient was a Japanese man in his 50 s who fell from the 6th floor to the 3rd floor while working at a height. The left chest wall was punctured due to injury, the thoracic cavity was open as if a left anterolateral thoracotomy had been performed, and the left lung had prolapsed from the thoracic cavity to the outside. In our emergency department, tracheal intubation with a double lumen tube for differential positive pressure ventilation and a right thoracic drain were inserted, and an emergency operation was started immediately. A pulmonary suture for lung injury and closure of the left thorax were performed during the surgery. The defect was closed with the remaining tissue, but the anterior thoracic skin with poor blood flow was necrotic, so debridement was undertaken. After his general condition was improved, pedicled latissimus dorsi myocutaneous flap was implanted. He was discharged home on the 63rd hospital day. Conclusions Although open pneumothorax is rare and sometimes presents lurid findings, we highlighted that it is important to quickly assess the life-threatening organ injury, perform positive pressure ventilation by tracheal intubation, thoracic drainage, and wound closure simultaneously respond calmly as a team. Supplementary Information The online version contains supplementary material available at 10.1186/s40792-022-01555-x.
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Affiliation(s)
- Rina Tokuda
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, 1094 Tobera, Toyooka, Hyogo 668-8501 Japan ,grid.415627.30000 0004 0595 5607Department of Emergency and Critical Care Medicine, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto, 602-8026 Japan
| | - Yohei Okada
- grid.415627.30000 0004 0595 5607Department of Emergency and Critical Care Medicine, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto, 602-8026 Japan ,grid.258799.80000 0004 0372 2033Department of Preventive Services, School of Public Health, Kyoto University, Yoshida-Konoe-Cho, Sakyo-ku, Kyoto, 606-8501 Japan ,grid.258799.80000 0004 0372 2033Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Yoshidahon-machi, Sakyo-ku, Kyoto City, Kyoto 606-8501 Japan
| | - Futoshi Nagashima
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, 1094 Tobera, Toyooka, Hyogo 668-8501 Japan
| | - Makoto Kobayashi
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, 1094 Tobera, Toyooka, Hyogo 668-8501 Japan
| | - Wataru Ishii
- grid.415627.30000 0004 0595 5607Department of Emergency and Critical Care Medicine, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto, 602-8026 Japan
| | - Ryoji Iizuka
- grid.415627.30000 0004 0595 5607Department of Emergency and Critical Care Medicine, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto, 602-8026 Japan
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Muchnok D, Vargo A, Deeb AP, Guyette FX, Brown JB. Association of Prehospital Needle Decompression With Mortality Among Injured Patients Requiring Emergency Chest Decompression. JAMA Surg 2022; 157:934-940. [PMID: 35976642 PMCID: PMC9386601 DOI: 10.1001/jamasurg.2022.3552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/30/2022] [Indexed: 11/14/2022]
Abstract
Importance Prehospital needle decompression (PHND) is a rare but potentially life-saving procedure. Prior studies on chest decompression in trauma patients have been small, limited to single institutions or emergency medical services (EMS) agencies, and lacked appropriate comparator groups, making the effectiveness of this intervention uncertain. Objective To determine the association of PHND with early mortality in patients requiring emergent chest decompression. Design, Setting, and Participants This was a retrospective cohort study conducted from January 1, 2000, to March 18, 2020, using the Pennsylvania Trauma Outcomes Study database. Patients older than 15 years who were transported from the scene of injury were included in the analysis. Data were analyzed between April 28, 2021, and September 18, 2021. Exposures Patients without PHND but undergoing tube thoracostomy within 15 minutes of arrival at the trauma center were the comparison group that may have benefited from PHND. Main Outcomes and Measures Mixed-effect logistic regression was used to determine the variability in PHND between patient and EMS agency factors, as well as the association between risk-adjusted 24-hour mortality and PHND, accounting for clustering by center and year. Propensity score matching, instrumental variable analysis using EMS agency-level PHND proportion, and several sensitivity analyses were performed to address potential bias. Results A total of 8469 patients were included in this study; 1337 patients (11%) had PHND (median [IQR] age, 37 [25-52] years; 1096 male patients [82.0%]), and 7132 patients (84.2%) had emergent tube thoracostomy (median [IQR] age, 32 [23-48] years; 6083 male patients [85.3%]). PHND rates were stable over the study period between 0.2% and 0.5%. Patient factors accounted for 43% of the variation in PHND rates, whereas EMS agency accounted for 57% of the variation. PHND was associated with a 25% decrease in odds of 24-hour mortality (odds ratio [OR], 0.75; 95% CI, 0.61-0.94; P = .01). Similar results were found in patients who survived their ED stay (OR, 0.68; 95% CI, 0.52-0.89; P < .01), excluding severe traumatic brain injury (OR, 0.65; 95% CI, 0.45-0.95; P = .03), and restricted to patients with severe chest injury (OR, 0.72; 95% CI, 0.55-0.93; P = .01). PHND was also associated with lower odds of 24-hour mortality after propensity matching (OR, 0.79; 95% CI, 0.62-0.98; P = .04) when restricting matches to the same EMS agency (OR, 0.74; 95% CI, 0.56-0.99; P = .04) and in instrumental variable probit regression (coefficient, -0.60; 95% CI, -1.04 to -0.16; P < .01). Conclusions and Relevance In this cohort study, PHND was associated with lower 24-hour mortality compared with emergent trauma center chest tube placement in trauma patients. Although performed rarely, PHND can be a life-saving intervention and should be reinforced in EMS education for appropriately selected trauma patients.
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Affiliation(s)
- Daniel Muchnok
- Division of General/Trauma Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Allison Vargo
- Division of General/Trauma Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew-Paul Deeb
- Division of General/Trauma Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Francis X. Guyette
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joshua B. Brown
- Division of General/Trauma Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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