Short- and long-term survival after cardiopulmonary resuscitation

BACKGROUND

The objective was to evaluate the effect of patient characteristics and other factors on cardiopulmonary resuscitation (CPR) survival, hospital discharge survival and function, and long-term survival.

METHODS

All patients 18 years and older experiencing in-hospital CPR from December 1983 through November 1991 at Marshfield Medical Center (Marshfield Clinic and adjoining St Joseph's Hospital), Marshfield, Wis, were selected. We performed a retrospective medical record review and augmented these data with updated vital status information.

MAIN OUTCOME MEASURES

Cardiopulmonary resuscitation survival, hospital discharge survival and function, and long-term survival.

RESULTS

Of 948 admissions during which CPR was performed, 61.2% of patients survived the arrest and 32.2% survived to hospital discharge. Mechanism of arrest was the most important variable associated with hospital discharge. Patients with pulseless electrical activity had the worst chance of hospital discharge, followed by those with asystole and bradycardia. Follow-up information was available for 298 patients who survived to discharge. One year after hospital discharge, 24.5% of patients, regardless of age, had died. Survival was 18.5% at 7 years in those 70 years or older, compared with 45.4% in those aged 18 to 69 years. Heart rhythm at the time of arrest strongly influenced long-term survival. Bradyarrhythmias produced a nearly 2-fold increased mortality risk compared with normal sinus rhythm.

CONCLUSIONS

Survival until hospital discharge after CPR at our institution during an 8-year period was higher than previously reported for other institutions. Long-term survival after discharge was equal to or higher than reported estimates from other institutions. Hospital admission practices and selection of patients receiving CPR may account for these findings.

Case-control study of agricultural injuries to women in central Wisconsin

A small number of women are the owner/operators of farms and women often participate in the work of production agriculture. Estimates of the percentage of females involved in agricultural injuries range from 11-45% and it is not clear if the risk factors associated with injuries to women are different from those for men. In a two year case-control study of injuries to farm residents, there were 40 injuries involving adult women. Multivariable analysis revealed that the two major risk factors for agricultural injury to females were number of hours worked and the presence of bulls on the farm. Most (55%) of the women were injured while in a barn. A cow was the primary agent of injury in 17 (42.5%) of the cases. Efforts to reduce the rate of injuries to women in agriculture should be targeted to the particular risks they experience.

A population based case-control study of agricultural injuries in children

OBJECTIVES

To identify preventable risk factors related to agricultural injuries occurring to children on family farms.

SETTING

A geographically defined central region of Wisconsin, USA with nearly 1800 family dairy farms.

METHODS

A two year, population based incidence study of occupational injuries among farm residents was conducted. For cases, trained staff abstracted information on the nature, severity, and treatment of the injury from the patient's medical record. Staff also administered a telephone questionnaire to cases and controls, usually answered by parents.

RESULTS

There were 60 cases of farm residents younger than 18 years who sought care for acute agriculture related injuries. Farms on which uninjured children lived served as controls (n = 102). Multivariate analyses of 16 different variables revealed three significantly related to injuries to children: hours worked per week (odds ratio (OR) = 1.05; 95% confidence interval (CI) = 1.01 to 1.08); presence of disabled safety device (OR = 2.64; 95% CI = 1.10 to 6.35); and feeding cows by grazing (OR = 0.22; 95% CI = 0.06 to 8.83).

CONCLUSIONS

Interventions designed to reduce the risk of agricultural injuries to farm children should acknowledge the participation of children as productive workers on the farm. Although education has been the standard method for encouraging safe practices in farm work, additional approaches, such as limiting the number of hours a child works, avoiding the disabling of safety devices, and using specific methods of managing cows, should also be adopted to minimize injury risks to farm children.

Representativeness of trauma center registries for farm injury surveillance

Trauma center registries are the foundation for many surveillance systems that attempt to define the frequency and spectrum of various types of injuries. To assess the representativeness of trauma center-based farm injury surveillance, we evaluated data for 1986-1991 from the Marshfield Clinic/St Joseph's Hospital, a major trauma center located in Central Wisconsin. We compared the pattern of farm injuries seen in residents of the Marshfield Epidemiologic Surveillance Area (MESA), a geographically defined, population-based surveillance area, with those from outside MESA, a nonpopulation-based mix of primary care and referral patients typical of most trauma registries. The population-based and nonpopulation-based surveillance data suggested similar patterns with respect to seasonality, circumstances of injury, and source of injury. There were significant differences with respect to the body part injured, severity of injury, and selected aspects of acute medical care. While useful for many purposes, trauma center-based injury surveillance data should be interpreted cautiously.

Evaluation of agricultural rescue course by providers

STUDY OBJECTIVE

To assess the characteristics of rural emergency medical services providers involved in the prehospital care of victims of agricultural injuries and determine which aspects of an agricultural rescue course were perceived as most useful.

DESIGN

A questionnaire was sent to participants of a course designed for agricultural prehospital providers who had attended a farm accident rescue course between 1986 and 1993.

SETTING

A rural referral center in central Wisconsin.

PARTICIPANTS

The questionnaire was sent to all persons who had participated in the course. Respondents to the questionnaire characterized their service experience and rated the topic areas in usefulness and whether the subject should be included in future courses.

RESULTS

A total of 459 surveys (44% of potential respondents) was returned. Of the respondents, 316 (74.4%) were men, and the mean age was 39.4 years. There were 247 (60.8%) who were volunteers, and an additional 126 (31%) were paid, on-call workers. There were 232 (56.4%) basic providers, and 365 (87.5%) were from a rural area. Many (n = 149; 36.9%) had not responded to farm accidents during the past year. Training course topics rated most useful were machinery extrication, tractor overturn, and enclosed-space rescue.

CONCLUSIONS

Respondents to an evaluation of an agricultural rescue course primarily were rural, basic providers. Future development of courses for emergency medical technicians involved in agriculture rescue must account for this level of training. Such courses should be short and modular with an emphasis on continuing education, practice, and focus on the identified needs of the participants.

Recreational injuries and deaths in northern Wisconsin: analysis of injuries and fatalities from snowmobiles over 3 years

Snowmobiles represent the second most common cause of trauma related to motorized vehicles in northern Wisconsin. The epidemiology of these injuries is evaluated. Specific comparisons between snowmobiles and other vehicles are made. We conclude that snowmobiles represent a controllable etiology for injuries and death. Our data suggest some interventions to prevent injuries and improve treatment.

Bilateral humeral fractures from electrically induced muscular spasm

Various injuries have been attributed to electrical injury. Low voltage current, especially alternating current, can lead to sustained muscular contraction and subsequent fracture of adjacent bones or dislocation of affected joints. We present the case of a 57-year-old male who suffered electrical injury from hand to hand. He did suffer bilateral humeral head fractures but did not suffer cardiac or long-term neurologic injury. Failure to recognize that sustained muscular contraction can lead to fracture or dislocation can result in delayed diagnosis and inappropriate therapy. However, with prompt diagnosis and appropriate therapy, morbidity can be minimized.

Hearing loss among high school farm students

To study the prevalence of hearing loss among teen-aged farm children in central Wisconsin, audiometric threshold testing of 872 vocational agriculture students was carried out over a three-year period. The results indicate an increased prevalence of hearing loss among students actively involved in farm work, as compared to their peers not involved in farm work. Findings also suggest that use of hearing protection may reduce the risk of hearing loss among students who work on the farm, although few students report the use of such devices. These data also suggest that the hearing loss often observed in adult farmers may begin in childhood.

Symptomatic benign lymphoid hyperplasia of the terminal ileum in an adult

An immunocompetent adult male was found to have obstructive lymphoid hyperplasia of the terminal ileum. The lesion persisted without malignant change for at least one year. Following surgical resection he had symptomatic relief.