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Bodas M, Givon A, Peleg K, Abbod N, Bahouth H, Bala M, Becker A, Ben Eli M, Braslavsky A, Grevtsev I, Jeroukhimov I, Karawani M, Kessel B, Klein Y, Lin G, Merin O, Mnouskin Y, Rivkind A, Shaked G, Soffer D, Stein M, Schwartz A, Weiss M. Are casualties from mass-casualty Motor Vehicle Crashes different from casualties of other Motor Vehicle Crashes? Journal of Transport & Health 2020; 19:100928. [DOI: 10.1016/j.jth.2020.100928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
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Ashkenazi I, Schecter WP, Peleg K, Givon A, Olsha O, Turegano-Fuentes F, Alfici R, Bahouth H, Becker A, Ben Ely M, Braslavsky A, Jeroukhimov I, Qarawany M, Kessel B, Klein Y, Lin G, Merin O, Bala M, Mnouskin Y, Rivkind AI, Shaked G, Soffer D, Stein M, Weiss M. Glasgow Coma Scale Score in Survivors of Explosion With Possible Traumatic Brain Injury in Need of Neurosurgical Intervention. JAMA Surg 2016; 151:954-958. [PMID: 27409973 DOI: 10.1001/jamasurg.2016.1742] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
IMPORTANCE Head injury following explosions is common. Rapid identification of patients with severe traumatic brain injury (TBI) in need of neurosurgical intervention is complicated in a situation where multiple casualties are admitted following an explosion. OBJECTIVE To evaluate whether Glasgow Coma Scale (GCS) score or the Simplified Motor Score at presentation would identify patients with severe TBI in need of neurosurgical intervention. DESIGN, SETTING, AND PARTICIPANTS Analysis of clinical data recorded in the Israel National Trauma Registry of 1081 patients treated following terrorist bombings in the civilian setting between 1998 and 2005. Primary analysis of the data was conducted in 2009, and analysis was completed in 2015. MAIN OUTCOMES AND MEASURES Proportion of patients with TBI in need of neurosurgical intervention per GCS score or Simplified Motor Score. RESULTS Of 1081 patients (median age, 29 years [range, 0-90 years]; 38.9% women), 198 (18.3%) were diagnosed as having TBI (48 mild and 150 severe). Severe TBI was diagnosed in 48 of 877 patients (5%) with a GCS score of 15 and in 99 of 171 patients (58%) with GCS scores of 3 to 14 (P < .001). In 65 patients with abnormal GCS (38%), no head injury was recorded. Nine of 877 patients (1%) with a GCS score of 15 were in need of a neurosurgical operation, and fewer than 51 of the 171 patients (30%) with GCS scores of 3 to 14 had a neurosurgical operation (P < .001). No difference was found between the proportion of patients in need of neurosurgery with GCS scores of 3 to 8 and those with GCS scores of 9 to 14 (30% vs 27%; P = .83). When the Simplified Motor Score and GCS were compared with respect to their ability to identify patients in need of neurosurgical interventions, no difference was found between the 2 scores. CONCLUSIONS AND RELEVANCE Following an explosion in the civilian setting, 65 patients (38%) with GCS scores of 3 to 14 did not experience severe TBI. The proportion of patients with severe TBI and severe TBI in need of a neurosurgical intervention were similar in patients presenting with GCS scores of 3 to 8 and GCS scores of 9 to 14. In this study, GCS and Simplified Motor Score did not help identify patients with severe TBI in need of a neurosurgical intervention.
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Affiliation(s)
- Itamar Ashkenazi
- Department of Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | | | - Kobi Peleg
- National Center for Trauma and Emergency Medicine Research, Gertner Institute, Tel Hashomer, Israel4Disaster Medicine Department, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Givon
- National Center for Trauma and Emergency Medicine Research, Gertner Institute, Tel Hashomer, Israel
| | - Oded Olsha
- Department of Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Ricardo Alfici
- Department of Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Hany Bahouth
- Trauma and Emergency Surgery Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Alexander Becker
- Department of Surgery, HaEmek Medical Center, Afula, Ruth and Bruce Rappaport Medical School, Technion, Haifa, Israel
| | | | | | - Igor Jeroukhimov
- Assaf Harofeh Medical Center, Tel Aviv University, Tel Aviv, Israel
| | | | - Boris Kessel
- Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel14Bruce Rappaport Medical School, Technion, Haifa, Israel
| | - Yoram Klein
- Divison of Acute Care Surgery and Trauma, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Guy Lin
- Kaplan Medical Center, Rehovot, Israel
| | - Ofer Merin
- Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Youri Mnouskin
- Surgery Department, Barzilai Medical Center, Ashkelon, Israel
| | | | - Gad Shaked
- Trauma Unit, Soroka Medical Center, Beer-Sheva, Israel
| | - Dror Soffer
- The Yitzhak Rabin Trauma Division, Division of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Michael Stein
- Trauma Unit, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
| | - Michael Weiss
- Trauma Unit, Galilee Medical Center, Nahariya, Israel
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Tverskoy M, Braslavsky A, Mazor A, Ferman R, Kissin I. The peripheral effect of fentanyl on postoperative pain. Anesth Analg 1998; 87:1121-4. [PMID: 9806693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
UNLABELLED The clinical value of the analgesic effect of opioids administered peripherally (except for intraarticular administration) has not been clearly demonstrated. The aim of this study was to test the hypothesis that fentanyl, added to a local anesthetic for wound infiltration, can enhance postoperative analgesia via a peripheral mechanism. Patients with inguinal herniorrhaphy performed under spinal anesthesia were randomly assigned to one of two groups (n = 10 each). At the end of surgery, the wound was infiltrated with 10 mL of lidocaine 0.5% and fentanyl 0.001% (10 microg) in one group; in the other group, the wound was infiltrated with 10 mL of lidocaine 0.5% alone (and fentanyl 10 microg IM contralaterally). The following variables were determined in a double-blind manner: the duration of anesthesia (response to a von Frey filament), the duration of analgesia (time to mild postoperative pain), postoperative meperidine consumption, intensity visual analog scale of spontaneous and movement-associated pain 24 h after surgery, and wound pain threshold 24 h after surgery (pressure algometry). The addition of fentanyl for wound infiltration enhanced the duration of anesthesia (130+/-37 vs 197+/-27 min; P < 0.001) and decreased the intensity of spontaneous (50+/-17 vs 19+/-18 mm; P < 0.002) and movement-associated (56+/-15 vs 26+/-21 mm; P < 0.002) pain 24 h postoperatively. Differences between groups for other variables were not statistically significant. Fentanyl added to a local anesthetic for wound infiltration after spinal anesthesia can enhance postoperative analgesia by a peripheral mechanism. IMPLICATIONS Fentanyl can enhance analgesia by a peripheral mechanism. Added to a local anesthetic for wound infiltration, it may be of benefit for the relief of postoperative pain.
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Affiliation(s)
- M Tverskoy
- Department of Anesthesia, Rebecca Sieff Government Hospital, Safed, Israel
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