1
|
Deodatus JA, Kratz MA, Steller M, Veeger N, Dercksen B, Lyon RM, Rehn M, Rognås L, Coniglio C, Sheridan B, Tschautscher C, Lockey DJ, Ter Avest E. Attributes of leadership skill development in high-performance pre-hospital medical teams: results of an international multi-service prospective study. Scand J Trauma Resusc Emerg Med 2024; 32:46. [PMID: 38773532 PMCID: PMC11107030 DOI: 10.1186/s13049-024-01221-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 05/15/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUNDS Team leadership skills of physicians working in high-performing medical teams are directly related to outcome. It is currently unclear how these skills can best be developed. Therefore, in this multi-national cross-sectional prospective study, we explored the development of these skills in relation to physician-, organization- and training characteristics of Helicopter Emergency Medicine Service (HEMS) physicians from services in Europe, the United States of America and Australia. METHODS Physicians were asked to complete a survey regarding their HEMS service, training, and background as well as a full Leader Behavior Description Questionnaire (LBDQ). Primary outcomes were the 12 leadership subdomain scores as described in the LBDQ. Secondary outcome measures were the association of LBDQ subdomain scores with specific physician-, organization- or training characteristics and self-reported ways to improve leadership skills in HEMS physicians. RESULTS In total, 120 HEMS physicians completed the questionnaire. Overall, leadership LBDQ subdomain scores were high (10 out of 12 subdomains exceeded 70% of the maximum score). Whereas physician characteristics such as experience or base-specialty were unrelated to leadership qualities, both organization- and training characteristics were important determinants of leadership skill development. Attention to leadership skills during service induction, ongoing leadership training, having standards in place to ensure (regular) scenario training and holding structured mission debriefs each correlated with multiple LBDQ subdomain scores. CONCLUSIONS Ongoing training of leadership skills should be stimulated and facilitated by organizations as it contributes to higher levels of proficiency, which may translate into a positive effect on patient outcomes. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- J A Deodatus
- Department of Acute Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M A Kratz
- Emergency Medical Services, Centre for Prehospital Emergency Care, Department of Emergency, Anaesthesia and Pain Medicine, FinnHEMS 30 & 40, Tampere University, Tampere, Finland
| | - M Steller
- Department of Acute Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - N Veeger
- Department of Epidemiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - B Dercksen
- Mobile Medical Team (MMT), Lifeliner 4, Eelde, the Netherlands
- Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R M Lyon
- Air Ambulance Kent Surrey Sussex & Department of Health Sciences, University of Surrey, Redhill, UK
| | - M Rehn
- Air Ambulance Department, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - L Rognås
- The Danish Air Ambulance, Brendstrupgårdsvej 7, 2. Th, 8200, Aarhus N, Denmark
| | - C Coniglio
- Department of Anesthesia, Intensive Care and Pre-Hospital Emergency Medical Services, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - B Sheridan
- Department of Anaesthesia and Hunter Retrieval Service, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW, 2305, Australia
| | - C Tschautscher
- Department of Emergency Medicine, School of Medicine and Public Health, UW Health Med Flight and Berbee Walsh University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA
| | - D J Lockey
- London's Air Ambulance and Bart's Health NHS Trust, Royal London Hospital, London, E1 1FR, UK
| | - E Ter Avest
- Department of Acute Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
- London's Air Ambulance and Bart's Health NHS Trust, Royal London Hospital, London, E1 1FR, UK.
| |
Collapse
|
2
|
Rose C, Ter Avest E, Lyon RM. Fatigue risk assessment of a Helicopter Emergency Medical Service crew working a 24/7 shift pattern: results of a prospective service evaluation. Scand J Trauma Resusc Emerg Med 2023; 31:72. [PMID: 37924156 PMCID: PMC10623805 DOI: 10.1186/s13049-023-01143-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND The work of Helicopter Emergency Medical Services (HEMS) teams crosses the boundaries of several high-risk occupations including medicine, aviation, and transport. Working conditions can be challenging and operational demands requires a 24-h rota, resulting in disruption of the normal circadian rhythm. HEMS crews are therefore prone to both mental and physical fatigue. As fatigue in medical providers is linked to poor cognitive performance, degradation of psychomotor skills and error, this study aimed to explore the existence of predictable patterns of crew-fatigue in a HEMS service. METHODS HEMS medical crew members working a 3-on 3-off forward rotating rota with a 5-week shift cycle were asked to do psychomotor vigilance tests (PVT) as an objective measure of fatigue. PVT testing was undertaken at the start, mid- and at the end of every shift during a full 5-week shift cycle. In addition, they were asked to score subjective tiredness with the Samn-Perelli Fatigue Scale (SPFS), and to keep a Transport Fatigue Assessment shift log, wherein they noted shift characteristics potentially related to fatigue. Primary outcome of interest was defined as the change in PVT and SPFS scores over time. RESULTS Mean baseline resting PVT in milliseconds at the start of the study period was 427 [390-464]. There was an overall trend towards higher PVT-scores with shift progression mean [95% CI] PVT at the start of shifts 447 [433-460]; halfway through the shift 452 [440-463]; end of the shift 459 [444-475], p = 0.10), whereas SPFS scores remained constant. Within a 5 week forward-rotating cycle, an overall trend towards a gradual increase in both average PVT (from 436 [238-454] to 460 [371-527, p = 0.68] ms;) and SPFS (from 2.9 [2.6-3.2] to 3.6 [3.1-4.0], p = 0.38) was observed, although significant interindividual variation was present. Reported SPFS scores ≥ 4 (moderate fatigue) were mainly related to workload (number of jobs) and transport mode (car-based shifts). CONCLUSION An overall trend towards a decline in psychomotor vigilance and an increase in self-reported tiredness was found for HEMS crew over a 5-week shift cycle. Using a bespoke predictive fatigue tool on a day-to-day basis could increase fatigue awareness and provide a framework to which relevant mitigating options can be applied.
Collapse
Affiliation(s)
- C Rose
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey, RH1 5YP, UK
| | - E Ter Avest
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey, RH1 5YP, UK.
- Department of Emergency Medicine, University Hospital Groningen, Groningen, The Netherlands.
| | - R M Lyon
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey, RH1 5YP, UK
- School of Health Sciences, University of Surrey, Guildford, UK
| |
Collapse
|
3
|
Barrett JW, Williams J, Skene SS, Griggs JE, Bootland D, Leung J, Da Costa A, Ballantyne K, Davies R, Lyon RM. Head injury in older adults presenting to the ambulance service: who do we convey to the emergency department, and what clinical variables are associated with an intracranial bleed? A retrospective case-control study. Scand J Trauma Resusc Emerg Med 2023; 31:65. [PMID: 37908011 PMCID: PMC10619243 DOI: 10.1186/s13049-023-01138-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/18/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE Most older adults with traumatic brain injuries (TBI) reach the emergency department via the ambulance service. Older adults, often with mild TBI symptoms, risk being under-triaged and facing poor outcomes. This study aimed to identify whether sufficient information is available on the scene to an ambulance clinician to identify an older adult at risk of an intracranial haemorrhage following a head injury. METHODS This was a retrospective case-control observational study involving one regional ambulance service in the UK and eight emergency departments. 3545 patients aged 60 years and over presented to one regional ambulance service with a head injury between the 1st of January 2020 and the 31st of December 2020. The primary outcome was an acute intracranial haemorrhage on head computed tomography (CT) scan in patients conveyed to the emergency department (ED). A secondary outcome was factors associated with conveyance to the ED by the ambulance clinician. RESULTS In 2020, 2111 patients were conveyed to the ED and 162 patients were found to have an intracranial haemorrhage on their head CT scan. Falls from more than 2 m (adjusted odds ratio (aOR) 3.45, 95% CI 1.78-6.40), chronic kidney disease (CKD) (aOR 2.80, 95% CI 1.25-5.75) and Clopidogrel (aOR 1.98, 95% CI 1.04-3.59) were associated with an intracranial haemorrhage. Conveyance to the ED was associated with patients taking anticoagulant and antiplatelet medication or a visible head injury or head injury symptoms. CONCLUSION This study highlights that while most older adults with a head injury are conveyed to the ED, only a minority will have an intracranial haemorrhage following their head injury. While mechanisms of injury such as falls from more than 2 m remain a predictor, this work highlights that Clopidogrel and CKD are also associated with an increased odds of tICH in older adults following a head injury. These findings may warrant a review of current ambulance head injury guidelines.
Collapse
Affiliation(s)
- J W Barrett
- South East Coast Ambulance Service NHS FT, Crawley, UK.
- University of Surrey, Guildford, UK.
| | - J Williams
- South East Coast Ambulance Service NHS FT, Crawley, UK
- Paramedic Clinical Research Unit, University of Hatfield, Hatfield, UK
| | | | - J E Griggs
- University of Surrey, Guildford, UK
- Air Ambulance Charity Kent, Surrey and Sussex, Redhill, UK
| | - D Bootland
- Air Ambulance Charity Kent, Surrey and Sussex, Redhill, UK
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - J Leung
- Air Ambulance Charity Kent, Surrey and Sussex, Redhill, UK
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - A Da Costa
- Medway Maritime Hospital NHS FT, Gillingham, UK
| | - K Ballantyne
- East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - R Davies
- South East Coast Ambulance Service NHS FT, Crawley, UK
| | - R M Lyon
- University of Surrey, Guildford, UK
- Air Ambulance Charity Kent, Surrey and Sussex, Redhill, UK
| |
Collapse
|
4
|
Heyworth BE, Ganley TJ, Liotta ES, Hergott KA, Miller PE, Wall EJ, Myer GD, Nissen CW, Edmonds EW, Lyon RM, Chambers HG, Milewski MD, Green DW, Weiss JM, Wright RW, Polousky JD, Nepple JJ, Carey JL, Kocher MS, Shea KG. Transarticular Versus Retroarticular Drilling of Stable Osteochondritis Dissecans of the Knee: A Prospective Multicenter Randomized Controlled Trial by the ROCK Group. Am J Sports Med 2023; 51:1392-1402. [PMID: 37039536 DOI: 10.1177/03635465231165290] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND When stable osteochondritis dissecans (OCD) lesions of the femoral condyle in a skeletally immature patient fail to heal with nonoperative methods, the standard of care treatment is condylar OCD drilling. Two primary OCD drilling techniques have been described, but no prospective studies have compared their relative effectiveness. PURPOSE/HYPOTHESIS The purpose of this study was to compare the healing and function after transarticular drilling (TAD) with that after retroarticular drilling (RAD). It was hypothesized that there would be no difference in rate or time to healing, rate or time to return to sports, patient-reported outcomes (PROs), or secondary OCD-related surgery. STUDY DESIGN Randomized controlled clinical trial; Level of evidence, 1. METHODS Skeletally immature patients with magnetic resonance imaging-confirmed stable OCD lesions of the medial femoral condyle who did not demonstrate substantial healing after a minimum of 3 months of nonoperative treatment were prospectively enrolled by 1 of 17 surgeon-investigators at 1 of 14 centers. Patients were randomized to the TAD or RAD group. Tourniquet time, fluoroscopy time, and complications were compared between the treatment groups. Postoperatively, serial radiographs were obtained every 6 weeks to assess healing, and PROs were obtained at 6 months, 12 months, and 24 months. RESULTS A total of 91 patients were included, consisting of 51 patients in the TAD and 40 patients in the RAD group, who were similar in age, sex distribution, and 2-year PRO response rate. Tourniquet time and fluoroscopy time were significantly shorter with TAD (mean, 38.1 minutes and 0.85 minutes, respectively) than RAD (mean, 48.2 minutes and 1.34 minutes respectively) (P = .02; P = .004). In the RAD group, chondral injury from K-wire passage into the intra-articular space was reported in 9 of 40 (22%) patients, but no associated postoperative clinical sequelae were identified in these patients. No significant differences between groups were detected in follow-up Pediatric-International Knee Documentation Committee, Lysholm, Marx Activity Scale, or Knee injury and Osteoarthritis Outcome Score Quality of Life scores. Healing parameters were superior at 6 months and 12 months in the TAD group, compared with the RAD group, and secondary OCD surgery occurred in 4% of patients who underwent TAD and 10% of patients who underwent RAD (P = .40). Patients in the TAD group returned to sports earlier than those in the RAD group (P = .049). CONCLUSION TAD showed shorter operative time and fluoroscopy time and superior healing parameters at 6 and 12 months, but no differences were seen in 24-month healing parameters or PROs at all follow-up time points, when compared with RAD. REGISTRATION NCT01754298 (ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
| | - Theodore J Ganley
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | - Roger M Lyon
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | | | | | - Rick W Wright
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Jeffrey J Nepple
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - James L Carey
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Kevin G Shea
- Stanford University Hospital, Palo Alto, California, USA
- Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Griggs JE, Lyon RM, Sherriff M, Barrett JW, Wareham G, Ter Avest E. Predictive clinical utility of pre-hospital point of care lactate for transfusion of blood product in patients with suspected traumatic haemorrhage: derivation of a decision-support tool. Scand J Trauma Resusc Emerg Med 2022; 30:72. [PMID: 36514084 DOI: 10.1186/s13049-022-01061-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Pre-hospital emergency medical teams can transfuse blood products to patients with suspected major traumatic haemorrhage. Common transfusion triggers based on physiological parameters have several disadvantages and are largely unvalidated in guiding pre-hospital transfusion. The addition of pre-hospital lactate (P-LACT) may overcome these challenges. To date, the clinical utility of P-LACT to guide pre-hospital blood transfusion is unclear. METHODS A retrospective analysis of patients with suspected major traumatic haemorrhage attended by Air Ambulance Charity Kent Surrey Sussex (KSS) between 8 July 2017 and 31 December 2019. The primary endpoint was the accuracy of P-LACT to predict the requirement for any in-hospital (continued) transfusion of blood product. RESULTS During the study period, 306 patients with suspected major traumatic haemorrhage were attended by KSS. P-LACT was obtained in 194 patients. In the cohort 103 (34%) patients were declared Code Red. A pre-hospital transfusion was commenced in 124 patients (41%) and in-hospital transfusion was continued in 100 (81%) of these patients, in 24 (19%) patients it was ceased. Predictive probabilities of various lactate cut-off points for requirement of in-hospital transfusion are documented. The highest overall proportion correctly classified patients were found for a P-LACT cut-point of 5.4 mmol/L (76.50% correctly classified). Based on the calculated predictive probabilities, optimal cut-off points were derived for both the exclusion- and inclusion of the need for in-hospital transfusion. A P-LACT < 2.5 mmol/L had a sensitivity of 80.28% and a negative likelihood ratio [LR-] of 0.37 for the prediction of in-hospital transfusion requirement, whereas a P-LACT of 6.0 mmol/L had a specificity of 99.22%, [LR-] = 0.78. CONCLUSION Pre-hospital lactate measurements can be used to predict the need for (continued) in-hospital blood products in addition to current physiological parameters. A simple decision support tool derived in this study can help the clinician interpret pre-hospital lactate results and guide pre-hospital interventions in the major trauma patient.
Collapse
Affiliation(s)
- J E Griggs
- Air Ambulance Charity Kent Surrey Sussex, Hanger 10 Redhill Aerodrome, Redhill, RH1 5YP, UK. .,University of Surrey, School of Health Sciences, Priestley Rd, Guildford, GU2 7YH, UK.
| | - R M Lyon
- Air Ambulance Charity Kent Surrey Sussex, Hanger 10 Redhill Aerodrome, Redhill, RH1 5YP, UK.,University of Surrey, School of Health Sciences, Priestley Rd, Guildford, GU2 7YH, UK
| | - M Sherriff
- University of Bristol, Child Dental Health, Bristol Dental School, Faculty of Health Sciences, Lower Maudlin Street, Bristol, BS1 2LY, UK
| | - J W Barrett
- University of Surrey, School of Health Sciences, Priestley Rd, Guildford, GU2 7YH, UK.,South East Coast Ambulance NHS Foundation Trust, Neptune House, Gatwick, Surrey, RH10 9BG, UK
| | - G Wareham
- Air Ambulance Charity Kent Surrey Sussex, Hanger 10 Redhill Aerodrome, Redhill, RH1 5YP, UK
| | - E Ter Avest
- Air Ambulance Charity Kent Surrey Sussex, Hanger 10 Redhill Aerodrome, Redhill, RH1 5YP, UK.,Department of Emergency Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | | |
Collapse
|
6
|
Jeyanathan J, Bootland D, Al-Rais A, Leung J, Wijesuriya J, Banks L, Breen T, DeCoverly R, Curtis L, McHenry A, Wright D, Griggs JE, Lyon RM. Lessons learned from the first 50 COVID-19 critical care transfer missions conducted by a civilian UK Helicopter Emergency Medical Service team. Scand J Trauma Resusc Emerg Med 2022; 30:6. [PMID: 35033171 PMCID: PMC8760584 DOI: 10.1186/s13049-022-00994-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/04/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has placed exceptional demand on Intensive Care Units, necessitating the critical care transfer of patients on a regional and national scale. Performing these transfers required specialist expertise and involved moving patients over significant distances. Air Ambulance Kent Surrey Sussex created a designated critical care transfer team and was one of the first civilian air ambulances in the United Kingdom to move ventilated COVID-19 patients by air. We describe the practical set up of such a service and the key lessons learned from the first 50 transfers. METHODS Retrospective review of air critical care transfer service set up and case review of first 50 transfers. RESULTS We describe key elements of the critical care transfer service, including coordination and activation; case interrogation; workforce; training; equipment; aircraft modifications; human factors and clinical governance. A total of 50 missions are described between 18 December 2020 and 1 February 2021. 94% of the transfer missions were conducted by road. The mean age of these patients was 58 years (29-83). 30 (60%) were male and 20 (40%) were female. The mean total mission cycle (time of referral until the time team declared free at receiving hospital) was 264 min (range 149-440 min). The mean time spent at the referring hospital prior to leaving for the receiving unit was 72 min (31-158). The mean transfer transit time between referring and receiving units was 72 min (9-182). CONCLUSION Critically ill COVID-19 patients have highly complex medical needs during transport. Critical care transfer of COVID-19-positive patients by civilian HEMS services, including air transfer, can be achieved safely with specific planning, protocols and precautions. Regional planning of COVID-19 critical care transfers is required to optimise the time available of critical care transfer teams.
Collapse
Affiliation(s)
- J Jeyanathan
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - D Bootland
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - A Al-Rais
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - J Leung
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - J Wijesuriya
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - L Banks
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - T Breen
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - R DeCoverly
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - L Curtis
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - A McHenry
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - D Wright
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - J E Griggs
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
- University of Surrey, Guildford, UK
| | - R M Lyon
- Air Ambulance Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK.
- University of Surrey, Guildford, UK.
| |
Collapse
|
7
|
Nissen CW, Albright JC, Anderson CN, Busch MT, Carlson C, Carsen S, Chambers HG, Edmonds EW, Ellermann JM, Ellis HB, Erickson JB, Fabricant PD, Ganley TJ, Green DW, Grimm NL, Heyworth BE, Po JHH, Kocher MS, Kostyun RO, Krych AJ, Latz KH, Loveland DM, Lyon RM, Mayer SW, Meenen NM, Milewski MD, Myer GD, Nelson BJ, Nepple JJ, Nguyen JC, Pace JL, Paterno MV, Pennock AT, Perkins CA, Polousky JD, Saluan P, Shea KG, Shearier E, Tompkins MA, Wall EJ, Weiss JM, Willimon SC, Wilson PL, Wright RW, Zbojniewicz AM, Carey JL. Descriptive Epidemiology From the Research in Osteochondritis Dissecans of the Knee (ROCK) Prospective Cohort. Am J Sports Med 2022; 50:118-127. [PMID: 34818065 DOI: 10.1177/03635465211057103] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteochondritis dissecans (OCD) occurs most commonly in the knees of young individuals. This condition is known to cause pain and discomfort in the knee and can lead to disability and early knee osteoarthritis. The cause is not well understood, and treatment plans are not well delineated. The Research in Osteochondritis Dissecans of the Knee (ROCK) group established a multicenter, prospective cohort to better understand this disease. PURPOSE To provide a baseline report of the ROCK multicenter prospective cohort and present a descriptive analysis of baseline data for patient characteristics, lesion characteristics, and clinical findings of the first 1000 cases enrolled into the prospective cohort. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Patients were recruited from centers throughout the United States. Baseline data were obtained for patient characteristics, sports participation, patient-reported measures of functional capabilities and limitations, physical examination, diagnostic imaging results, and initial treatment plan. Descriptive statistics were completed for all outcomes of interest. RESULTS As of November 2020, a total of 27 orthopaedic surgeons from 17 institutions had enrolled 1004 knees with OCD, representing 903 patients (68.9% males; median age, 13.1 years; range, 6.3-25.4 years), into the prospective cohort. Lesions were located on the medial femoral condyle (66.2%), lateral femoral condyle (18.1%), trochlea (9.5%), patella (6.0%), and tibial plateau (0.2%). Most cases involved multisport athletes (68.1%), with the most common primary sport being basketball for males (27.3% of cases) and soccer for females (27.6% of cases). The median Pediatric International Knee Documentation Committee (Pedi-IKCD) score was 59.9 (IQR, 45.6-73.9), and the median Pediatric Functional Activity Brief Scale (Pedi-FABS) score was 21.0 (IQR, 5.0-28.0). Initial treatments were surgical intervention (55.4%) and activity restriction (44.0%). When surgery was performed, surgeons deemed the lesion to be stable at intraoperative assessment in 48.1% of cases. CONCLUSION The multicenter ROCK group has been able to enroll the largest knee OCD cohort to date. This information is being used to further understand the pathology of OCD, including its cause, associated comorbidities, and initial presentation and symptoms. The cohort having been established is now being followed longitudinally to better define and elucidate the best treatment algorithms based on these presenting signs and symptoms.
Collapse
Affiliation(s)
- Carl W Nissen
- PRISM Sports Medicine, Hartford, Connecticut; Hartford Healthcare's Bone and Joint Institute, Hartford, Connecticut, USA
| | | | | | | | - Cathy Carlson
- College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
| | - Sasha Carsen
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Henry G Chambers
- Rady Children's Hospital and UC San Diego, San Diego, California, USA
| | - Eric W Edmonds
- Rady Children's Hospital and UC San Diego, San Diego, California, USA
| | | | - Henry B Ellis
- Scottish Rite for Children Sports Medicine, Frisco, Texas, USA
| | - John B Erickson
- Children's Hospital of Wisconsin, Greenfield, Wisconsin, USA
| | | | - Theodore J Ganley
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | - Regina O Kostyun
- Hartford Healthcare's Bone and Joint Institute, Hartford, Connecticut, USA
| | | | | | | | - Roger M Lyon
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Norbert M Meenen
- Asklepios Hospital St. George, Children's Sports Medicine, Hamburg, Germany
| | | | - Gregory D Myer
- Emory Sport Performance and Research Center, Flowery Branch, Georgia; Emory Sports Medicine Center, Atlanta, Georgia; Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Jeffrey J Nepple
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jie C Nguyen
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - J Lee Pace
- Andrew's Institute, Children's Health, Plano, Texas, USA
| | - Mark V Paterno
- Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew T Pennock
- Rady Children's Hospital and UC San Diego, San Diego, California, USA
| | | | - John D Polousky
- Akron Children's Hospital Department of Orthopedics, Akron, Ohio, USA
| | | | - Kevin G Shea
- Stanford Children's Hospital, Sunnyvale, California, USA
| | - Emily Shearier
- Hartford Healthcare's Bone and Joint Institute, Hartford, Connecticut, USA
| | - Marc A Tompkins
- Gillette Children's Specialty Healthcare; University of Minnesota; TRIA Orthopaedic Center, Minneapolis, Minnesota, USA
| | - Eric J Wall
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer M Weiss
- Southern California Permanente Medical Group, Los Angeles, California, USA
| | | | - Philip L Wilson
- Scottish Rite for Children Sports Medicine, Frisco, Texas, USA
| | - Rick W Wright
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew M Zbojniewicz
- Michigan State University; Advanced Radiology Services, Grand Rapids, Michigan, USA
| | - James L Carey
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | -
- Investigation performed at multiple sites
| |
Collapse
|
8
|
Leitch P, Hudson AL, Griggs JE, Stolmeijer R, Lyon RM, Ter Avest E. Incidence of hyperoxia in trauma patients receiving pre-hospital emergency anaesthesia: results of a 5-year retrospective analysis. Scand J Trauma Resusc Emerg Med 2021; 29:134. [PMID: 34507593 PMCID: PMC8434743 DOI: 10.1186/s13049-021-00951-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/03/2021] [Indexed: 12/17/2022] Open
Abstract
Background Previous studies have demonstrated an association between hyperoxia and increased mortality in various patient groups. Critically unwell and injured patients are routinely given high concentration oxygen in the pre-hospital phase of care. We aim to investigate the incidence of hyperoxia in major trauma patients receiving pre-hospital emergency anesthesia (PHEA) in the pre-hospital setting and determine factors that may help guide clinicians with pre-hospital oxygen administration in these patients. Methods A retrospective cohort study was performed of all patients who received PHEA by a single helicopter emergency medical service (HEMS) between 1 October 2014 and 1 May 2019 and who were subsequently transferred to one major trauma centre (MTC). Patient and treatment factors were collected from the electronic patient records of the HEMS service and the MTC. Hyperoxia was defined as a PaO2 > 16 kPA on the first arterial blood gas analysis upon arrival in the MTC. Results On arrival in the MTC, the majority of the patients (90/147, 61.2%) had severe hyperoxia, whereas 30 patients (20.4%) had mild hyperoxia and 26 patients (19.7%) had normoxia. Only 1 patient (0.7%) had hypoxia. The median PaO2 on the first arterial blood gas analysis (ABGA) after HEMS handover was 36.7 [IQR 18.5–52.2] kPa, with a range of 7.0–86.0 kPa. SpO2 pulse oximetry readings before handover were independently associated with the presence of hyperoxia. An SpO2 ≥ 97% was associated with a significantly increased odds of hyperoxia (OR 3.99 [1.58–10.08]), and had a sensitivity of 86.7% [79.1–92.4], a specificity of 37.9% [20.7–57.8], a positive predictive value of 84.5% [70.2–87.9] and a negative predictive value of 42.3% [27.4–58.7] for the presence of hyperoxemia. Conclusion Trauma patients who have undergone PHEA often have profound hyperoxemia upon arrival at hospital. In the pre-hospital setting, where arterial blood gas analysis is not readily available a titrated approach to oxygen therapy should be considered to reduce the incidence of potentially harmful tissue hyperoxia.
Collapse
Affiliation(s)
- P Leitch
- University of St Georges, Tooting, London, UK
| | - A L Hudson
- University of St Georges, Tooting, London, UK.,Air Ambulance Kent Surrey and Sussex, Hanger 10 Redhill Aerodrome, Redhill, RH1 5YP, UK
| | - J E Griggs
- Air Ambulance Kent Surrey and Sussex, Hanger 10 Redhill Aerodrome, Redhill, RH1 5YP, UK. .,University of Surrey, Guildford, UK.
| | - R Stolmeijer
- Department of Emergency Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - R M Lyon
- Air Ambulance Kent Surrey and Sussex, Hanger 10 Redhill Aerodrome, Redhill, RH1 5YP, UK.,University of Surrey, Guildford, UK
| | - E Ter Avest
- Air Ambulance Kent Surrey and Sussex, Hanger 10 Redhill Aerodrome, Redhill, RH1 5YP, UK.,Department of Emergency Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | | |
Collapse
|
9
|
Gavrilovski M, Griggs JE, Ter Avest E, Lyon RM. The contribution of helicopter emergency medical services in the pre-hospital care of penetrating torso injuries in a semi-rural setting. Scand J Trauma Resusc Emerg Med 2021; 29:112. [PMID: 34348780 PMCID: PMC8336281 DOI: 10.1186/s13049-021-00929-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the merit of pre-hospital critical care teams such as Helicopter Emergency Medical Services (HEMS) has been universally recognized for patients with penetrating torso injuries who present with unstable physiology, the potential merit in patients initially presenting with stable physiology is largely undetermined. The ability to predict the required pre-hospital interventions patients may have important implications for HEMS tasking, especially when transport times to definitive care are prolonged. METHODS We performed a retrospective cohort study of patients who sustained a penetrating torso injury and were attended by the Air Ambulance Kent Surrey Sussex (AAKSS) over a 6-year period. Primary outcome was defined as the percentage of patients with penetrating torso injuries requiring HEMS-specific interventions anytime between HEMS arrival and arrival at hospital. Secondary outcomes were the association of individual patient- and injury characteristics with the requirement for HEMS interventions. RESULTS During the study period 363 patients met inclusion criteria. 90% of patients were male with a median age of 30 years. 99% of penetrating trauma incident occurred more than 10-min drive from a Major Trauma Centre (MTC). Presenting GCS was > 13 in 83% of patients. Significant hemodynamic- or ventilatory compromise was present in more than 25% of the patients. Traumatic cardiac arrest was present in 34 patients (9.4%), profound hypotension with SBP < 80 mmHg in 30 (8.3%) and oxygen saturations < 92% in 30 (8.3%). A total of 121 HEMS-specific interventions were performed. Although HEMS-specific interventions were associated with presenting physiology (TCA OR 1.75 [1.41-2.16], SBP < 80 mmHg (OR 1.40 [1.18-1.67] and SpO2 < 92% (OR 1.39 [1.17-1.65], a minority of the patients presented initially with stable physiology but deteriorated on route to hospital and required HEMS interventions (n = 9, 3.3%). CONCLUSION HEMS teams provide potentially important contribution to the pre-hospital treatment of patients with penetrating torso injuries in rural and semi-rural areas, especially when they present with unstable physiology. A certain degree of over-triage is inevitable in these patients, as it is hard to predict which patients will deteriorate on route to hospital and will need HEMS interventions. The results of this study showing a potentially predictable geographical dispersion of penetrating trauma could inform multi-agency knife crime prevention strategy.
Collapse
Affiliation(s)
- M Gavrilovski
- Air Ambulance Kent Surrey Sussex Trust, Rochester City Airport, Maidstone Road, Kent, ME5 9SD, UK.
| | - J E Griggs
- Air Ambulance Kent Surrey Sussex Trust, Rochester City Airport, Maidstone Road, Kent, ME5 9SD, UK.,Department of Health Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - E Ter Avest
- Air Ambulance Kent Surrey Sussex Trust, Rochester City Airport, Maidstone Road, Kent, ME5 9SD, UK.,University Medical Center Groningen, Department of Emergency Medicine, University of Groningen, Groningen, The Netherlands
| | - R M Lyon
- Air Ambulance Kent Surrey Sussex Trust, Rochester City Airport, Maidstone Road, Kent, ME5 9SD, UK.,Department of Health Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | | |
Collapse
|
10
|
Griggs JE, Barrett JW, Ter Avest E, de Coverly R, Nelson M, Williams J, Lyon RM. Helicopter emergency medical service dispatch in older trauma: time to reconsider the trigger? Scand J Trauma Resusc Emerg Med 2021; 29:62. [PMID: 33962682 PMCID: PMC8103626 DOI: 10.1186/s13049-021-00877-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 04/21/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Helicopter Emergency Medical Services (HEMS) respond to serious trauma and medical emergencies. Geographical disparity and the regionalisation of trauma systems can complicate accurate HEMS dispatch. We sought to evaluate HEMS dispatch sensitivity in older trauma patients by analysing critical care interventions and conveyance in a well-established trauma system. METHODS All trauma patients aged ≥65 years that were attended by the Air Ambulance Kent Surrey Sussex over a 6-year period from 1 July 2013 to 30 June 2019 were included. Patient characteristics, critical care interventions and hospital disposition were stratified by dispatch type (immediate, interrogate and crew request). RESULTS 1321 trauma patients aged ≥65 were included. Median age was 75 years [IQR 69-89]. HEMS dispatch was by immediate (32.0%), interrogation (43.5%) and at the request of ambulance clinicians (24.5%). Older age was associated with a longer dispatch interval and was significantly longer in the crew request category (37 min [34-39]) compared to immediate dispatch (6 min [5-6] (p = .001). Dispatch by crew request was common in patients with falls < 2 m, whereas pedestrian road traffic collisions and falls > 2 m more often resulted in immediate dispatch (p = .001). Immediate dispatch to isolated head injured patients often resulted in pre-hospital emergency anaesthesia (PHEA) (39%). However, over a third of head injured patients attended after dispatch by crew request received PHEA (36%) and a large proportion were triaged to major trauma centres (69%). CONCLUSIONS Many patients who do not fulfil the criteria for immediate HEMS dispatch need advanced clinical interventions and subsequent tertiary level care at a major trauma centre. Further studies should evaluate if HEMS activation criteria, nuanced by age-dependant triggers for mechanism and physiological parameters, optimise dispatch sensitivity and HEMS utilisation.
Collapse
Affiliation(s)
- J E Griggs
- Air Ambulance Kent Surrey Sussex, Hanger 10 Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK. .,University of Surrey, Guilford, GU2 7XH, UK.
| | - J W Barrett
- University of Surrey, Guilford, GU2 7XH, UK.,South East Coast Ambulance Service NHS Foundation Trust, Nexus House, 4 Gatwick Road, Crawley, RH10 9BG, UK
| | - E Ter Avest
- Air Ambulance Kent Surrey Sussex, Hanger 10 Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK.,Department of Emergency Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - R de Coverly
- Air Ambulance Kent Surrey Sussex, Hanger 10 Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - M Nelson
- Air Ambulance Kent Surrey Sussex, Hanger 10 Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK.,South East Coast Ambulance Service NHS Foundation Trust, Nexus House, 4 Gatwick Road, Crawley, RH10 9BG, UK.,Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK
| | - J Williams
- South East Coast Ambulance Service NHS Foundation Trust, Nexus House, 4 Gatwick Road, Crawley, RH10 9BG, UK.,University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK
| | - R M Lyon
- Air Ambulance Kent Surrey Sussex, Hanger 10 Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK.,University of Surrey, Guilford, GU2 7XH, UK
| | | |
Collapse
|
11
|
Mohindru J, Griggs JE, de Coverly R, Lyon RM, Ter Avest E. Dispatch of a helicopter emergency medicine service to patients with a sudden, unexplained loss of consciousness of medical origin. BMC Emerg Med 2020; 20:92. [PMID: 33238877 PMCID: PMC7690130 DOI: 10.1186/s12873-020-00388-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background Sudden loss of consciousness (LOC) in the prehospital setting in the absence of cardiac arrest and seizure activity may be a challenge from a dispatcher’s perspective: The aetiology is varied, with many causes being transient and mostly self-limiting, whereas other causes are potentially life threatening. In this study we aim to evaluate the dispatch of HEMS to patients with LOC of medical origin, by exploring to which patients with a LOC HEMS is dispatched, which interventions HEMS teams perform in these patients, and whether HEMS interventions can be predicted by patient characteristics. Methods We performed retrospective cohort study of all patients with a reported unexplained LOC (e.g. not attributable to a circulatory arrest or seizures) attended by the Air Ambulance Kent, Surrey & Sussex (AAKSS), over a 4-year period (July 2013–December 2017). Primary outcome was defined as the number of HEMS-specific interventions performed in patients with unexplained LOC. Secondary outcome was the relation of clinical- and dispatch criteria with HEMS interventions being performed. Results During the study period, 127 patients with unexplained LOC were attended by HEMS. HEMS was dispatched directly to 25.2% of the patients, but mostly (74.8%) on request of the ground ambulance crews. HEMS interventions were performed in 65% of the patients (Prehospital Emergency Anaesthesia 56%, hyperosmolar therapy 21%, antibiotic/antiviral therapy 8%, vasopressor therapy 6%) and HEMS conveyed most patients (77%) to hospital. Acute neurological pathology was a prevalent underlying cause of unexplained LOC: 38% had gross pathology on their CT-scan upon arrival in hospital. Both GCS (r = − 0.60, p < .001) and SBP (r = 0.31, p < .001) were related to HEMS interventions being performed on scene. A GCS < 13 predicted the need for HEMS interventions in our population with a sensitivity of 94.9% and a specificity 75% (AUC 0.85). Conclusion HEMS dispatchers and ambulance personnel are able to identify a cohort of patients with unexplained LOC of medical origin who suffer from potentially life threatening (mainly neurological) pathology, in whom HEMS specific intervention are frequently required. Presenting GCS can be used to inform the triage process of patients with LOC at an early stage. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-020-00388-x.
Collapse
Affiliation(s)
- J Mohindru
- Air Ambulance Kent, Surrey and Sussex, Redhill Airfield Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - J E Griggs
- Air Ambulance Kent, Surrey and Sussex, Redhill Airfield Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - R de Coverly
- Air Ambulance Kent, Surrey and Sussex, Redhill Airfield Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - R M Lyon
- Air Ambulance Kent, Surrey and Sussex, Redhill Airfield Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK.,University of Surrey, Duke of Kent Building, Guildford, School of Health Sciences, Guildford, GU2 7XH, UK
| | - E Ter Avest
- Air Ambulance Kent, Surrey and Sussex, Redhill Airfield Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK. .,Department of Emergency Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | | |
Collapse
|
12
|
Fabricant PD, Milewski MD, Kostyun RO, Wall EJ, Zbojniewicz AM, Albright JC, Bauer KL, Carey JL, Chambers HG, Edmonds EW, Ellis HB, Ganley TJ, Green DW, Grimm NL, Heyworth BE, Kocher MS, Krych AJ, Lyon RM, Mayer SW, Nepple JJ, Nissen CW, Pennock AT, Polousky JD, Saluan P, Shea KG, Tompkins MA, Weiss J, Clifton Willimon S, Wilson PL, Wright RW, Myer GD. Osteochondritis Dissecans of the Knee: An Interrater Reliability Study of Magnetic Resonance Imaging Characteristics. Am J Sports Med 2020; 48:2221-2229. [PMID: 32584594 DOI: 10.1177/0363546520930427] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Imaging characteristics of osteochondritis dissecans (OCD) lesions quantified by magnetic resonance imaging (MRI) are often used to inform treatment and prognosis. However, the interrater reliability of clinician-driven MRI-based assessment of OCD lesions is not well documented. PURPOSE To determine the interrater reliability of several historical and novel MRI-derived characteristics of OCD of the knee in children. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS A total of 42 OCD lesions were evaluated by 10 fellowship-trained orthopaedic surgeons using 31 different MRI characteristics, characterizing lesion size and location, condylar size, cartilage status, the interface between parent and progeny bone, and features of both the parent and the progeny bone. Interrater reliability was determined via intraclass correlation coefficients (ICCs) with 2-way random modeling, Fleiss kappa, or Krippendorff alpha as appropriate for each variable. RESULTS Raters were reliable when the lesion was measured in the coronal plane (ICC, 0.77). Almost perfect agreement was achieved for condylar size (ICC, 0.93), substantial agreement for physeal patency (ICC, 0.79), and moderate agreement for joint effusion (ICC, 0.56) and cartilage status (ICC, 0.50). Overall, raters showed significant variability regarding interface characteristics (ICC, 0.25), progeny (ICC range, 0.03 to 0.62), and parent bone measurements and qualities (ICC range, -0.02 to 0.65), with reliability being moderate at best for these measurements. CONCLUSION This multicenter study determined the interrater reliability of MRI characteristics of OCD lesions in children. Although several measurements provided acceptable reliability, many MRI features of OCD that inform treatment decisions were unreliable. Further work will be needed to refine the unreliable characteristics and to assess the ability of those reliable characteristics to predict clinical lesion instability and prognosis.
Collapse
Affiliation(s)
- Peter D Fabricant
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Matthew D Milewski
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Regina O Kostyun
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Eric J Wall
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrew M Zbojniewicz
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | -
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jay C Albright
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kathryn L Bauer
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James L Carey
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Henry G Chambers
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Eric W Edmonds
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Henry B Ellis
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Theodore J Ganley
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Daniel W Green
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nathan L Grimm
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Benton E Heyworth
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Mininder S Kocher
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Aaron J Krych
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Roger M Lyon
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Stephanie W Mayer
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeffrey J Nepple
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Carl W Nissen
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrew T Pennock
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - John D Polousky
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paul Saluan
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kevin G Shea
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Marc A Tompkins
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer Weiss
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - S Clifton Willimon
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Philip L Wilson
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rick W Wright
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gregory D Myer
- Investigation performed at the Hospital for Special Surgery, New York, New York, USA, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| |
Collapse
|
13
|
Curtis L, Ter Avest E, Griggs J, Wiliams J, Lyon RM. The ticking clock: does actively making an enhanced care team aware of the passage of time improve pre-hospital scene time following traumatic incidents? Scand J Trauma Resusc Emerg Med 2020; 28:31. [PMID: 32349796 PMCID: PMC7189533 DOI: 10.1186/s13049-020-00726-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/15/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Pre-hospital enhanced care teams like Helicopter Emergency Medical Services (HEMS) are often dispatched to major trauma patients, including patients with traumatic brain injuries and those with major haemorrhage. For these patients, minimizing the time to definitive care is vital. The aim of this study was to determine whether increased awareness of elapsed on scene time produces a relevant time performance improvement for major trauma patients attended by HEMS, and weather introducing such a timer was feasible and acceptable to clinicians. Methods We performed a prospective cohort study of all single casualty traumatic incidents attended by Air Ambulance Kent Surrey Sussex (AAKSS) between 15 October 2016 and 23 May 2017 to test if introduction of a prompting scene timer within the service resulted in a reduction in pre-hospital scene times. Results The majority of the patients attended were male (74%) and sustained blunt trauma (92%). Overall, median scene time was 25.5 [IQR16.3] minutes before introduction of the scene timer and 23.0 [11.0] minutes after introduction, p = 0.13). Scene times for patients with a GCS < 8 and for patients requiring prehospital anaesthesia were significantly lower after introduction of the timer (28 [IQR 14] vs 25 [1], p = 0.017 and 34 [IQR 13] vs 28 [IQR11] minutes, p = 0.007 respectively). The majority of clinicians felt the timer made them more aware of passing time (91%) but that this had not made a difference to scene time (62%) or their practice (57%). Conclusion Audible scene timers may have the potential to reduce pre-hospital scene time for certain single casualty trauma patients treated by a HEMS team, particularly for those patients needing pre-hospital anaesthesia. Regular use of on-scene timers may improve outcomes by reducing time to definitive care for certain subgroups of trauma patients.
Collapse
Affiliation(s)
- L Curtis
- Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill Airfield, Redhill, Surrey, RH1 5YP, UK.
| | - E Ter Avest
- Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill Airfield, Redhill, Surrey, RH1 5YP, UK.,Department of Emergency Medicine, University Hospital Groningen, Groningen, the Netherlands
| | - J Griggs
- Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill Airfield, Redhill, Surrey, RH1 5YP, UK
| | - J Wiliams
- School of Health Sciences, University of Surrey, Guildford, UK.,South East Coast Ambulance Service NHS Foundation Trust, Crawley, UK
| | - R M Lyon
- Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill Airfield, Redhill, Surrey, RH1 5YP, UK.,School of Health Sciences, University of Surrey, Guildford, UK
| |
Collapse
|
14
|
Ter Avest E, Bateman D, Lyon RM. Comment on: "The effect of prehospital critical care on survival following out of hospital cardiac arrest: A prospective observational study". Resuscitation 2019; 145:204-205. [PMID: 31626867 DOI: 10.1016/j.resuscitation.2019.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 09/14/2019] [Indexed: 10/25/2022]
Affiliation(s)
- E Ter Avest
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey, UK; Department of Emergency Medicine, University Medical Center Groningen, The Netherlands.
| | - D Bateman
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey, UK; London Ambulance Service, London, UK
| | - R M Lyon
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey, UK; School of Health Sciences, University of Surrey, UK
| |
Collapse
|
15
|
Ter Avest E, Lambert E, de Coverly R, Tucker H, Griggs J, Wilson MH, Ghorbangholi A, Williams J, Lyon RM. Live video footage from scene to aid helicopter emergency medical service dispatch: a feasibility study. Scand J Trauma Resusc Emerg Med 2019; 27:55. [PMID: 31068199 PMCID: PMC6505217 DOI: 10.1186/s13049-019-0632-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/26/2019] [Indexed: 11/20/2022] Open
Abstract
Background Obtaining accurate information from a 112 caller is key to correct tasking of Helicopter Emergency Medical Services (HEMS). Being able to view the incident scene via video from a mobile phone may assist HEMS dispatch by providing more accurate information such as mechanism of injury and/or injuries sustained. The objective of this study is to describe the acceptability and feasibility of using live video footage from the mobile phone of a 112 caller as an HEMS dispatch aid. Methods Live footage is obtained via the 112 caller’s mobile phone camera through the secure GoodSAM app’s Instant-on-scene™ platform. Video footage is streamed directly to the dispatcher, and not stored. During the feasibility trial period, dispatchers noted the purpose for which they used the footage and rated ease of use and any technical- and operational issues they encountered. A subjective assessment of caller acceptance to use video was conducted. Results Video footage from scene was attempted for 21 emergency calls. The leading reasons listed by the dispatchers to use live footage were to directly assess the patient (18/21) and to obtain information about the mechanism of injury and the scene (11/21). HEMS dispatchers rated the ease of use with a 4.95 on a 5-point scale (range 4–5). All callers gave permission to stream from their telephone camera. Video footage from scene was successfully obtained in 19 calls, and was used by the dispatcher as an aid to send (5) or stand down (14) a Helicopter Emergency Medical Services team. Conclusion Live video footage from a 112 caller can be used to provide dispatchers with more information from the scene of an incident and the clinical condition of the patient(s). The use of mobile phone video was readily accepted by the 112 caller and the technology robust. Further research is warranted to assess the impact video from scene could have on HEMS dispatching.
Collapse
Affiliation(s)
- E Ter Avest
- Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK. .,Department of Emergency Medicine, University Hospital Groningen, Groningen, the Netherlands.
| | - E Lambert
- Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - R de Coverly
- Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - H Tucker
- Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - J Griggs
- Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - M H Wilson
- Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK.,Neurotrauma Centre, Imperial College, London, UK
| | | | - J Williams
- School of Health Sciences, University of Surrey, Guildford, UK.,South East Coast Ambulance Service NHS Foundation Trust, Crawley, UK
| | - R M Lyon
- Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK.,School of Health Sciences, University of Surrey, Guildford, UK
| |
Collapse
|
16
|
Ter Avest E, Griggs J, Prentice C, Jeyanathan J, Lyon RM. Out-of-hospital cardiac arrest following trauma: What does a helicopter emergency medical service offer? Resuscitation 2019; 135:73-79. [PMID: 30597132 DOI: 10.1016/j.resuscitation.2018.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/29/2018] [Accepted: 12/14/2018] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Helicopter emergency medical services (HEMS) are often dispatched to patients in traumatic cardiac arrest (TCA) as they can provide treatments and advanced interventions in the pre-hospital environment that have the potential to contribute to an increased survival. This study, aimed to investigate the added value of HEMS in the treatment of TCA. METHODS We performed a retrospective cohort study of all patients with a pre-hospital TCA who were attended by a non-urban HEMS (Kent, Surrey and Sussex Air Ambulance trust) between July 1st 2013 and May 1st 2018. We investigated how many patients got return of spontaneous circulation (ROSC) at scene, which HEMS specific advanced interventions were performed in these patients, and how these interventions were related to ROSC. RESULTS During the study period 263 patients with a TCA were attended by HEMS with an average response time of 30 min [range 13-109]. 51 patients (20%) regained ROSC at scene (28 before- and 23 after arrival of HEMS). The HEMS specific interventions of blood product administration (OR 8.54 [2.84-25.72]), and RSI (2.95 [1.32-6.58]) were positively associated with ROSC. Most patients who had a ROSC had one or more HEMS specific interventions being performed - RSI (n = 19, 37%), blood product administration (n = 32, 62%), thoracostomies (n = 36, 71%) and thoracotomy (n = 1, 2%). HEMS also delivered other important interventions to these patients as IV/IO access (n = 20, 39.2%) and endotracheal intubation without drugs (n = 9, 17.6%). CONCLUSION HEMS teams should be involved in the treatment of patients with a TCA, even in non-urban areas with prolonged response times, as they provide knowledge and skills that contribute to regaining and maintaining a sustained ROSC in this critically ill and injured cohort of patients.
Collapse
Affiliation(s)
- E Ter Avest
- Air Ambulance Trust Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, UK; Department of Emergency Medicine, Medical Centre Leeuwarden, the Netherlands.
| | - J Griggs
- Air Ambulance Trust Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, UK
| | - C Prentice
- Air Ambulance Trust Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, UK
| | - J Jeyanathan
- Air Ambulance Trust Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, UK; Academic Department of Military Anaesthesia and Critical Care, UK
| | - R M Lyon
- Air Ambulance Trust Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, UK; School of Health Sciences, University of Surrey, UK
| |
Collapse
|
17
|
Griggs JE, Lyon RM, Sherriff M, Leung J, Wareham G. PP27 Pre-hospital lactate monitoring: a worthy adjunct to systolic blood pressure and shock index in triggering blood product administration in patients with suspected traumatic haemorrhage? Arch Emerg Med 2019. [DOI: 10.1136/emermed-2019-999.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionPre-hospital identification of patients with suspected occult traumatic haemorrhage is problematic. Physiological parameters and clinical gestalt are inadequate surrogates for ongoing haemorrhage. Lactate monitoring may hold stronger predictive clinical utility to identify patients with suspected traumatic haemorrhage above other physiological parameters.MethodsA single centre, service evaluation of pre-hospital lactate monitoring. A point of care test was introduced into a Helicopter Emergency Medical Service in the United Kingdom. Clinicians adhered to strict education and governance, supported by standard operating procedure. Systolic blood pressure (SBP) and shock index (SI) was measured in patients that received pre-hospital transfusion therapy. A predetermined ‘cut off’ value of lactate >2.5 mmol was acknowledged. In-hospital follow up established further transfusion therapy.ResultsWilcoxon rank sum compared pre-lactate (n=22) and post-lactate (n=6) groups. Monte Carlo permutations were used to obtain exact probabilities. No statistically significant differences were found between groups for: SBP, p=0.955; and, SI, p=0.401. Univariate logistic regression identified the odds ratio (OR) and confidence interval (CI) for each continuous variable as: SBP, 0.97 (CI 0.94 to 1.01); SI, 26.91 (CI 1.11 to 652.48) and lactate >2.5 mmol, 2.33 (CI 0.23 to 23.91). Multivariate logistic regression identified OR as: SBP, 0.99 (CI 0.95 to 1.04); SI, 22.98 (CI 0.56 to 946.44); and lactate >2.5 mmol, 3.05 (CI 0.14 to 65.86).ConclusionLactate monitoring has been successfully introduced into an enhanced care service. The Results confirm SBP is not predictive of further transfusion. The OR for SI shows greater predictive power. Limited by a small dataset, the Results are hypothesis-generating only.
Collapse
|
18
|
Griggs JE, Jeyanathan J, Joy M, Russell MQ, Durge N, Bootland D, Dunn S, Sausmarez ED, Wareham G, Weaver A, Lyon RM. Mortality of civilian patients with suspected traumatic haemorrhage receiving pre-hospital transfusion of packed red blood cells compared to pre-hospital crystalloid. Scand J Trauma Resusc Emerg Med 2018; 26:100. [PMID: 30454067 PMCID: PMC6245557 DOI: 10.1186/s13049-018-0567-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/06/2018] [Indexed: 12/20/2022] Open
Abstract
Background Major haemorrhage is a leading cause of mortality following major trauma. Increasingly, Helicopter Emergency Medical Services (HEMS) in the United Kingdom provide pre-hospital transfusion with blood products, although the evidence to support this is equivocal. This study compares mortality for patients with suspected traumatic haemorrhage transfused with pre-hospital packed red blood cells (PRBC) compared to crystalloid. Methods A single centre retrospective observational cohort study between 1 January 2010 and 1 February 2015. Patients triggering a pre-hospital Code Red activation were eligible. The primary outcome measure was all-cause mortality at 6 hours (h) and 28 days (d), including a sub-analysis of patients receiving a major and massive transfusion. Multivariable regression models predicted mortality. Multiple Imputation was employed, and logistic regression models were constructed for all imputed datasets. Results The crystalloid (n = 103) and PRBC (n = 92) group were comparable for demographics, Injury Severity Score (p = 0.67) and mechanism of injury (p = 0.73). Observed 6 h mortality was smaller in the PRBC group (n = 10, 10%) compared to crystalloid group (n = 19, 18%). Adjusted OR was not statistically significant (OR 0.48, CI 0.19–1.19, p = 0.11). Observed mortality at 28 days was smaller in the PRBC group (n = 21, 26%) compared to crystalloid group (n = 31, 40%), p = 0.09. Adjusted OR was not statistically significant (OR 0.66, CI 0.32–1.35, p = 0.26). A statistically significant greater proportion of the crystalloid group required a major transfusion (n = 62, 60%) compared to the PRBC group (n = 41, 40%), p = 0.02. For patients requiring a massive transfusion observed mortality was smaller in the PRBC group at 28 days (p = 0.07). Conclusion In a single centre UK HEMS study, in patients with suspected traumatic haemorrhage who received a PRBC transfusion there was an observed, but non-significant, reduction in mortality at 6 h and 28 days, also reflected in a massive transfusion subgroup. Patients receiving pre-hospital PRBC were significantly less likely to require an in-hospital major transfusion. Further adequately powered multi-centre prospective research is required to establish the optimum strategy for pre-hospital volume replacement in patients with traumatic haemorrhage.
Collapse
Affiliation(s)
- J E Griggs
- Kent, Surrey & Sussex Air Ambulance Trust, Redhill Aerodrome, Redhill, RH1 5YP, UK.
| | - J Jeyanathan
- Kent, Surrey & Sussex Air Ambulance Trust, Redhill Aerodrome, Redhill, RH1 5YP, UK.,Academic Department of Military Anaesthesia and Critical Care, London, UK
| | - M Joy
- University of Surrey, Guildford, GU2 7XH, UK
| | - M Q Russell
- Kent, Surrey & Sussex Air Ambulance Trust, Redhill Aerodrome, Redhill, RH1 5YP, UK
| | - N Durge
- Kent, Surrey & Sussex Air Ambulance Trust, Redhill Aerodrome, Redhill, RH1 5YP, UK.,Royal London Hospital, Whitechapel Road, Whitechapel, London, E1 1BB, UK
| | - D Bootland
- Kent, Surrey & Sussex Air Ambulance Trust, Redhill Aerodrome, Redhill, RH1 5YP, UK.,Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK
| | - S Dunn
- Kent, Surrey & Sussex Air Ambulance Trust, Redhill Aerodrome, Redhill, RH1 5YP, UK
| | - E D Sausmarez
- Kent, Surrey & Sussex Air Ambulance Trust, Redhill Aerodrome, Redhill, RH1 5YP, UK
| | - G Wareham
- Kent, Surrey & Sussex Air Ambulance Trust, Redhill Aerodrome, Redhill, RH1 5YP, UK
| | - A Weaver
- Royal London Hospital, Whitechapel Road, Whitechapel, London, E1 1BB, UK
| | - R M Lyon
- Kent, Surrey & Sussex Air Ambulance Trust, Redhill Aerodrome, Redhill, RH1 5YP, UK.,University of Surrey, Guildford, GU2 7XH, UK
| | | |
Collapse
|
19
|
Gavrilovski M, El-Zanfaly M, Lyon RM. Isolated traumatic brain injury results in significant pre-hospital derangement of cardiovascular physiology. Injury 2018; 49:1675-1679. [PMID: 29706249 DOI: 10.1016/j.injury.2018.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/30/2018] [Accepted: 04/16/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Major trauma can result in both life-threatening haemorrhage and traumatic brain injury (TBI). The pre-hospital management of these conditions, particularly in relation to the cardiovascular system, is very different. TBI can result in cardiovascular instability but the exact incidence remains poorly described. This study explores the incidence of cardiovascular instability in patients undergoing pre-hospital anaesthesia for suspected TBI. METHODS Retrospective case series of all pre-hospital trauma patients attended by Kent, Surrey & Sussex Air Ambulance Trust (United Kingdom) trauma team during the period 1 January 2015-31 December 2016. Patients were included if they showed clinical signs of TBI, underwent pre-hospital anaesthesia and hospital computed tomography scanning subsequently confirmed an isolated TBI. RESULTS Out of 121 patients with confirmed isolated TBI, 68 were cardiovascularly stable throughout the pre-anaesthesia phase, whilst 53 (44%) showed signs of instability (HR > 100bpm and/or SBP < 100 mmHg pre-anaesthesia). Hypotension (SBP < 100) with or without tachycardia was present in 14 (12%) patients. 10 (8%) patients with isolated TBI received pre-hospital blood product transfusion. CONCLUSION Increased awareness that traumatic brain injury can cause significant derangement to heart rate and blood pressure, even in the absence of major haemorrhage, would allow the pre-hospital clinician to treat cardiovascular instability with the most appropriate means, such as crystalloid and vasopressors, to limit secondary brain injury.
Collapse
Affiliation(s)
- M Gavrilovski
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey RH1 5YP, United Kingdom
| | - M El-Zanfaly
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey RH1 5YP, United Kingdom
| | - R M Lyon
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey RH1 5YP, United Kingdom; University of Surrey, United Kingdom.
| |
Collapse
|
20
|
Wall EJ, Milewski MD, Carey JL, Shea KG, Ganley TJ, Polousky JD, Grimm NL, Eismann EA, Jacobs JC, Murnaghan L, Nissen CW, Myer GD, Weiss J, Edmonds EW, Anderson AF, Lyon RM, Heyworth BE, Fabricant PD, Zbojniewicz A. The Reliability of Assessing Radiographic Healing of Osteochondritis Dissecans of the Knee. Am J Sports Med 2017; 45:1370-1375. [PMID: 28398084 DOI: 10.1177/0363546517698933] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The reliability of assessing healing on plain radiographs has not been well-established for knee osteochondritis dissecans (OCD). PURPOSE To determine the inter- and intrarater reliability of specific radiographic criteria in judging healing of femoral condyle OCD. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 3. METHODS Ten orthopedic sports surgeons rated the radiographic healing of 30 knee OCD lesions at 2 time points, a minimum of 1 month apart. First, raters compared pretreatment and 2-year follow-up radiographs on "overall healing" and on 5 subfeatures of healing, including OCD boundary, sclerosis, size, shape, and ossification using a continuous slider scale. "Overall healing" was also rated using a 7-tier ordinal scale. Raters then compared the same 30 pretreatment knee radiographs in a stepwise progression to the 2-, 4-, 7-, 12-, and 24-month follow-up radiographs on "overall healing" using a continuous slider scale. Interrater and intrarater reliability were assessed using intraclass correlations (ICC) derived from a 2-way mixed effects analysis of variance for absolute agreement. RESULTS Overall healing of the OCD lesions from pretreatment to 2-year follow-up radiographs was rated with excellent interrater reliability (ICC = 0.94) and intrarater reliability (ICC = 0.84) when using a continuous scale. The reliability of the 5 subfeatures of healing was also excellent (interrater ICCs of 0.87-0.89; intrarater ICCs of 0.74-0.84). The 7-tier ordinal scale rating of overall healing had lower interrater (ICC = 0.61) and intrarater (ICC = 0.68) reliability. The overall healing of OCD lesions at the 5 time points up to 24 months had interrater ICCs of 0.81-0.88 and intrarater ICCs of 0.65-0.70. CONCLUSION Interrater reliability was excellent when judging the overall healing of OCD femoral condyle lesions on radiographs as well as on 5 specific features of healing on 2-year follow-up radiographs. Continuous scale rating of OCD radiographic healing yielded higher reliability than the ordinal scale rating. Raters showed substantial to excellent agreement of OCD overall radiographic healing measured on a continuous scale at 2, 4, 7, 12, and 24 months after starting treatment.
Collapse
Affiliation(s)
- Eric J Wall
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Matthew D Milewski
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James L Carey
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kevin G Shea
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Theodore J Ganley
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - John D Polousky
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nathan L Grimm
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Emily A Eismann
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jake C Jacobs
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lucas Murnaghan
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Carl W Nissen
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gregory D Myer
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | -
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer Weiss
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Eric W Edmonds
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Allen F Anderson
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Roger M Lyon
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Benton E Heyworth
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Peter D Fabricant
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andy Zbojniewicz
- Investigation performed at the Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| |
Collapse
|
21
|
Carey JL, Wall EJ, Grimm NL, Ganley TJ, Edmonds EW, Anderson AF, Polousky J, Murnaghan ML, Nissen CW, Weiss J, Lyon RM, Chambers HG. Novel Arthroscopic Classification of Osteochondritis Dissecans of the Knee: A Multicenter Reliability Study. Am J Sports Med 2016; 44:1694-8. [PMID: 27159302 DOI: 10.1177/0363546516637175] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several systems have been proposed for classifying osteochondritis dissecans (OCD) of the knee during surgical evaluation. No single classification includes mutually exclusive categories that capture all of the salient features of stability, chondral fissuring, and fragment detachment. Furthermore, no study has assessed the reliability of these classification systems. PURPOSE To determine the intra- and interobserver reliability of a novel, comprehensive arthroscopic classification system with mutually exclusive OCD lesion types. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS The Research in OsteoChondritis of the Knee (ROCK) study group developed a classification system for arthroscopic evaluation of OCD of the knee that includes 6 arthroscopic categories-3 immobile types and 3 mobile types. To optimize comprehensibility and applicability, each was developed with a memorable name, a brief description, a line diagram corresponding to the archetypal arthroscopic appearance, and an arthroscopic photograph depicting this archetype. Thirty representative arthroscopic videos were evaluated by 10 orthopaedic surgeon raters, who classified each lesion. After 4 weeks, the raters again classified the OCD lesions depicted in the 30 videos in a new, randomly selected order. Reliability was assessed via the intraclass correlation coefficient (ICC). RESULTS The interobserver reliability of this novel arthroscopy classification was estimated by an ICC of 0.94 (95% CI, 0.91-0.97) for the first round and 0.95 (95% CI, 0.93-0.98) for the second round. According to the standards for the magnitude of the reliability coefficient of Altman, these ICCs indicate that interobserver reliability was very good. The intraobserver reliability was estimated by an ICC of 0.96 (95% CI, 0.95-0.97), which indicates that the intraobserver reliability was similarly very good. CONCLUSION The ROCK OCD knee arthroscopy classification system demonstrated excellent intra- and interobserver reliability. In light of this reliability, this classification system may be used clinically and to facilitate future research, including multicenter studies for OCD.
Collapse
Affiliation(s)
- James L Carey
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eric J Wall
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Theodore J Ganley
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Eric W Edmonds
- Rady Children's Hospital-San Diego, San Diego, California, USA
| | | | - John Polousky
- Rocky Mountain Youth Sports Medicine Institute, Centennial, Colorado, USA
| | | | - Carl W Nissen
- Connecticut Children's Medical Center, Farmington, Connecticut, USA
| | - Jennifer Weiss
- Kaiser Permanente Southern California, Los Angeles, California, USA
| | - Roger M Lyon
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | |
Collapse
|
22
|
|
23
|
|
24
|
Liu XC, Tassone JC, Thometz JG, Paulsen LC, Lyon RM, Marquez-Barrientos C, Tarima S, Johnson PR. Development of a 3-Dimensional Back Contour Imaging System for Monitoring Scoliosis Progression in Children. Spine Deform 2013; 1:102-107. [PMID: 27927425 DOI: 10.1016/j.jspd.2012.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 09/19/2012] [Accepted: 10/28/2012] [Indexed: 10/27/2022]
Abstract
STUDY DESIGN Control study. OBJECTIVES To present a new surface topography system capable of taking 3-dimensional (3D) spine measurements, to establish baseline values for the measured parameters in a typically developing population, and to determine the intra-rater and inter-rater reproducibility of these parameters. SUMMARY OF BACKGROUND DATA Cumulative exposure to radiation from diagnostic radiographs increases patient risk for cancer development. There is a need for noninvasive and non-radiographic tools to accurately and reproducibly measure spine deformity and track scoliosis progression. METHODS We measured 10 typically developing subjects with the new Milwaukee Topography System, which is composed of 2 electromagnetic markers, an electronic processing unit, a handheld laser scanner, a software package, and a desktop computer. Two investigators separately scanned the same subjects multiple times, yielding a total of 4 scans per subject per investigator. We measured 17 3D back parameters in each scan. We performed a multivariate analysis of variances to test the hypothesis of no difference for all variables, measured intra-rater and inter-investigator reliability with intra-class correlation (ICC) coefficients, and calculated mean values. RESULTS There were highly reproducible ICC values between investigators for 6 parameters (ICC > 0.75), moderate ICC values for 8 parameters (0.75 > ICC > 0.4), and poor ICC values for 3 parameters (ICC < 0.4), all at p < .05. Intra-investigator ICCs were moderate to excellent for almost all parameters. CONCLUSIONS The Milwaukee Topography System can be used to monitor and measure 3D back contours in children. The 3D back parameters values measured in the typically developing population can be considered baseline values that can be compared with parameters measured in children with idiopathic scoliosis.
Collapse
Affiliation(s)
- Xue-Cheng Liu
- Department of Orthopaedic Surgery, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, PO Box 1997, Suite C360, Milwaukee, WI 53201, USA; Musculoskeletal Functional Assessment Center, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, PO Box 1997, Suite C360, Milwaukee, WI 53201, USA.
| | - J Channing Tassone
- Department of Orthopaedic Surgery, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, PO Box 1997, Suite C360, Milwaukee, WI 53201, USA
| | - John G Thometz
- Department of Orthopaedic Surgery, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, PO Box 1997, Suite C360, Milwaukee, WI 53201, USA
| | - Laura C Paulsen
- Musculoskeletal Functional Assessment Center, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, PO Box 1997, Suite C360, Milwaukee, WI 53201, USA
| | - Roger M Lyon
- Department of Orthopaedic Surgery, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, PO Box 1997, Suite C360, Milwaukee, WI 53201, USA
| | - Carlos Marquez-Barrientos
- Musculoskeletal Functional Assessment Center, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, PO Box 1997, Suite C360, Milwaukee, WI 53201, USA
| | - Sergey Tarima
- Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, USA
| | - Paul R Johnson
- Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, USA
| |
Collapse
|
25
|
Lyon RM, Clarke S, Milligan D, Clegg GR. Resuscitation feedback and targeted education improves quality of pre-hospital resuscitation in Scotland. Resuscitation 2011; 83:70-5. [PMID: 21787739 DOI: 10.1016/j.resuscitation.2011.07.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 07/10/2011] [Accepted: 07/14/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality and serious neurological morbidity in Europe. Recent studies have demonstrated the adverse physiological consequences of poor resuscitation technique and have shown that quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome from OHCA. Telemetry of the defibrillator transthoracic impedance (TTI) trace can objectively measure quality of pre-hospital resuscitation. This study aims to analyse the impact of targeted resuscitation feedback and training on quality of pre-hospital resuscitation. METHODS Prospective, single centre, cohort study over 13 months (1st December 2009-31st December 2010). Baseline pre-hospital resuscitation data was gathered over a 3-month period. Modems (n=40) were fitted to defibrillators on ambulance vehicles. Following a resuscitation attempt, the event was sent via telemetry and the TTI trace analysed. Outcome measures were time spent performing chest compressions, compression rate, the interval required to deliver a defibrillator shock and use of automatic or manual cardiac rhythm analysis. Targeted resuscitation classes were introduced and all ambulance crews received feedback following a resuscitation attempt. Pre-hospital resuscitation quality pre and post intervention were compared. RESULTS 111 resuscitation traces were analysed. Mean hands-on-chest time improved significantly following feedback and targeted resuscitation training (73.0% vs 79.3%, p=0.007). There was no significant change in compression rate during the study period. There was a significant reduction in median time-to-shock interval from 20.25s (IQR 15.50-25.50s) to 13.45 s (IQR 2.25-22.00 s) (p=0.006). Automatic rhythm recognition fell from 50% to 28.6% (p=0.03) following intervention. CONCLUSION Telemetry and analysis of the TTI trace following OHCA allows objective evaluation of the quality of pre-hospital resuscitation. Targeted resuscitation training and ambulance feedback improves the quality of pre-hospital resuscitation. Further studies are required to establish possible survival benefit from this technique.
Collapse
Affiliation(s)
- R M Lyon
- Emergency Department, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, Scotland, UK.
| | | | | | | |
Collapse
|
26
|
Lyon RM, Clegg GR. Pre-hospital cooling for out-of-hospital cardiac arrest--more research required. Resuscitation 2011; 82:1108-9. [PMID: 21636203 DOI: 10.1016/j.resuscitation.2011.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 05/09/2011] [Indexed: 11/19/2022]
|
27
|
|
28
|
|
29
|
Lyon RM, Wiggins CM. Expedition medicine--the risk of illness and injury. Wilderness Environ Med 2010; 21:318-24. [PMID: 21168784 DOI: 10.1016/j.wem.2010.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 09/02/2010] [Accepted: 09/02/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Expeditions organized by commercial companies are becoming increasingly popular. Charity expeditions take inexperienced participants on trips all over the world, with participants being sponsored to raise funds for charitable causes. The incidence of illness or injury while participating in charity expeditions is unknown. The objective of this study is to report the incidence and severity of illness and injuries occurring on worldwide charity expeditions. METHODS Retrospective, observational study reviewing expedition medical reports from 232 expeditions organized by a single commercial expedition company for a 5-year period (January 1, 2004 through December 31, 2008). RESULTS Complete expedition medical reports were available for 210 (91%) trips, involving 4077 participants over 1524 expedition days. Expeditions reported a total of 1564 incidents over 42482 participant-days in the field, including days spent traveling to the expedition site. In 1465 (94%) cases "minor" injury or illness was recorded, 79 (5%) "moderate," and 20 (1%) "major" in severity. No deaths were reported. Gastrointestinal upset was the commonest reported minor condition and severe acute mountain sickness the commonest major condition. Overall, the incidence per 1000 participant-days of minor illness or injury was 34.48, moderate illness or injury 1.86, and major illness or injury 0.47. CONCLUSION The risk of sustaining major injury or illness on an overseas charity expedition is low. The consequences of becoming injured or unwell in a remote environment can be serious, and appropriate medical care is required.
Collapse
Affiliation(s)
- R M Lyon
- Emergency Department, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
| | | |
Collapse
|
30
|
Lyon RM, Cowan GM, Janossy KM, Adams JR, Corfield AR, Hearns S. In-flight cooling after out-of-hospital cardiac arrest. Resuscitation 2010; 81:1041-2. [PMID: 20483523 DOI: 10.1016/j.resuscitation.2010.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 03/24/2010] [Accepted: 04/19/2010] [Indexed: 11/30/2022]
|
31
|
Rusy LM, Hainsworth KR, Nelson TJ, Czarnecki ML, Tassone JC, Thometz JG, Lyon RM, Berens RJ, Weisman SJ. Gabapentin Use in Pediatric Spinal Fusion Patients. Anesth Analg 2010; 110:1393-8. [DOI: 10.1213/ane.0b013e3181d41dc2] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
32
|
Lyon RM, Richardson SE, Hay AW, Andrews PJD, Robertson CE, Clegg GR. Esophageal temperature after out-of-hospital cardiac arrest: an observational study. Resuscitation 2010; 81:867-71. [PMID: 20413203 DOI: 10.1016/j.resuscitation.2010.03.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 03/17/2010] [Accepted: 03/20/2010] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Out-of-hospital cardiac arrest (OHCA) is a significant cause of death and severe neurological disability. The only post-return of spontaneous circulation (ROSC) therapy shown to increase survival is mild therapeutic hypothermia (MTH). The relationship between esophageal temperature post OHCA and outcome is still poorly defined. METHODS Prospective observational study of all OHCA patients admitted to a single centre for a 14-month period (1/08/2008 to 31/09/2009). Esophageal temperature was measured in the Emergency Department and Intensive Care Unit (ICU). Selected patients had pre-hospital temperature monitoring. Time taken to reach target temperature after ROSC was recorded, together with time to admission to the Emergency Department and ICU. RESULTS 164 OHCA patients were included in the study. 105 (64.0%) were pronounced dead in the Emergency Department. 59 (36.0%) were admitted to ICU for cooling; 40 (24.4%) died in ICU and 19 (11.6%) survived to hospital discharge. Patients who achieved ROSC and had esophageal temperature measured pre-hospital (n=29) had a mean pre-hospital temperature of 33.9 degrees C (95% CI 33.2-34.5). All patients arriving in the ED post OHCA had a relatively low esophageal temperature (34.3 degrees C, 95% CI 34.1-34.6). Patients surviving to hospital discharge were warmer on admission to ICU than patients who died in hospital (35.7 degrees C vs 34.3 degrees C, p<0.05). Patients surviving to hospital discharge also took longer to reach T(targ) than non-survivors (2h 48min vs 1h 32min, p<0.05). CONCLUSIONS Following OHCA all patients have esophageal temperatures below normal in the pre-hospital phase and on arrival in the Emergency Department. Patients who achieve ROSC following OHCA and survive to hospital discharge are warmer on arrival in ICU and take longer to reach target MTH temperatures compared to patients who die in hospital. The mechanisms of action underlying esophageal temperature and survival from OHCA remain unclear and further research is warranted to clarify this relationship.
Collapse
Affiliation(s)
- R M Lyon
- Emergency Medicine, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, United Kingdom.
| | | | | | | | | | | |
Collapse
|
33
|
Young D, Lyon RM, Ferris J, McKeown DW, Oglesby A. Prehospital intubation for out-of-hospital cardiac arrest. Crit Care 2009. [PMCID: PMC4083946 DOI: 10.1186/cc7224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
34
|
Abstract
STUDY DESIGN Patients with scoliosis from 1999 to 2001 were monitored using radiographs and the Quantec Spinal Imaging System (Quantec) to validate the Functional Classification System (FCS) developed at Children's Hospital of Wisconsin (CHW). OBJECTIVE To determine the accuracy of the FCS. SUMMARY OF BACKGROUND DATA The authors evaluated different noninvasive ways of evaluating the scoliotic spine. The FCS was developed as a means to predict the degree of scoliotic curve. METHODS Consecutive scoliosis visits (543) seen at CHW between 1999 and 2001 for initial or follow-up examination were investigated; of them, 157 had an radiograph within 6 months of Quantec. Subjects were placed into groups based on Cobb Angles. FCS classifications were compared to Cobb angle groupings and calculated sensitivity and specificity. Pearson's correlation coefficient was calculated for 39 subjects. RESULTS Sensitivity of the FCS for single curve groups ranged from 0.50 to 0.63 and specificity from 0.64 to 0.86. For double curve, both sensitivity and specificity ranged from 0.48 to 0.81. Pearson's correlation was statistically significant (r = 0.45, P < 0.05). CONCLUSIONS Sensitivity, specificity, and Pearson's correlation coefficient reflect the reliability of the Quantec method. Therefore, the FCS can be considered as a reliable tool for monitoring the progression of scoliosis with reduced need of radiographs.
Collapse
Affiliation(s)
- Stephen S Klos
- Musculoskeletal Functional Assessment Center, Children's Hospital of Wisconsin, Medical College of WI, Milwaukee, WI 53201, USA
| | | | | | | | | |
Collapse
|
35
|
Abstract
OBJECTIVE To find out if the response time, distance travelled to scene, and geographical location affect survival from out of hospital cardiac arrest (OHCA). METHODS Retrospective cohort study over 10 years, 1 December 1991 to 1 August 2001. Outcome and demographic data were obtained for 1956 OHCAs occurring at home, in the Lothians region, from the Heartstart Scotland database. Survival rates to hospital admission and discharge were examined by postcode district. RESULTS Certain postcode areas were served by quicker response times and shorter journeys. The survival to admission rate was greater in those areas where the median response time was <10 minutes (13.5% versus 8.1%, p<0.05). There was greater survival to discharge in these areas but not significantly so (4.1% versus 3.2%, p = 0.42). Survival to admission was more likely in areas where the median distance travelled was <four miles (13.3% versus 9.7%, p<0.05) but not survival to discharge (4.0% versus 3.7%, p = 0.72). A close correlation between distance travelled and response time was shown (Pearson = 0.93, p<0.01), likewise between distance travelled and survival to admission (Spearman = -0.87, p<0.01). Certain areas, particularly those at greater geographical distance from ambulance dispatch points, were found to be associated with significantly lower survival to admission rates. CONCLUSIONS Survival to admission from OHCA is strongly influenced by response time and distance travelled to the scene. The geographical location of an arrest can potentially influence survival to admission. Measures should be taken to strategically position ambulance dispatch points and to task the nearest geographically available vehicle to attend an OHCA.
Collapse
Affiliation(s)
- R M Lyon
- Department of Cardiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK.
| | | | | | | |
Collapse
|
36
|
Meyer NJ, Lyon RM. Lateral elbow ecchymosis as a clinical sign of lateral humeral condylar fractures. Am J Orthop (Belle Mead NJ) 2003; 32:260-1. [PMID: 12772878] [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] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Given the appropriate clinical history and mechanism of injury, the presence of localized lateral elbow ecchymosis in a young child is usually the sign of lateral condyle fracture of the humerus. Recognition of this clinical sign helps in directing the diagnostic studies and empiric treatment toward a lateral condyle fracture of the humerus not apparent on initial radiographs.
Collapse
Affiliation(s)
- Nicholas J Meyer
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | |
Collapse
|
37
|
Liu XC, Thometz JG, Lyon RM, McGrady L. Effects of trunk position on back surface-contour measured by raster stereophotography. Am J Orthop (Belle Mead NJ) 2002; 31:402-6. [PMID: 12180626] [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] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
A study of the contour of the surface of the back was conducted using the Quantec spinal image system (QSIS; raster stereophotography) and the Vicon 3-dimensional (3-D) motion analysis system with a plaster model of the scoliotic spine. With postural changes in 3 dimensions came alterations in the surface shape of the back. Most changes in QSIS parameters occurred in the coronal plane. The study showed that model 1, with 9 degrees of Q angle (similar to Cobb angle in the coronal plane) in right thoracolumbar scoliosis, altered 3-D metrics less than model 2 did, with 54 degrees of Q angle in scoliosis. The change in the position of the trunk in the transverse plane had a more significant impact on the QSIS parameters. Raster stereophotography has been used clinically to monitor curve progression. Changes in transverse rotation of the trunk correlate significantly with variations in Q angle and axial rotation. Clinicians using a raster stereophotograph system to assess scoliotic deformity need to control postural sway, as doing so results in more stable and reproducible measurements that can be used for clinical follow-up.
Collapse
Affiliation(s)
- Xue C Liu
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, USA
| | | | | | | |
Collapse
|
38
|
Liu XC, Thometz JG, Lyon RM, Klein J. Functional classification of patients with idiopathic scoliosis assessed by the Quantec system: a discriminant functional analysis to determine patient curve magnitude. Spine (Phila Pa 1976) 2001; 26:1274-8; discussion 1279. [PMID: 11389397 DOI: 10.1097/00007632-200106010-00020] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A stepwise discriminant analysis was used to define a spinal deformity score based on three-dimensional measurements by the Quantec spinal image system (raster stereophotograph). OBJECTIVE To provide functional classification of spinal deformity in patients with mild idiopathic scoliosis without using radiographs. SUMMARY OF BACKGROUND DATA Most studies classify the degree of spinal deformity in terms of coronal plane radiograph without analyzing transverse rotation. To the authors' knowledge, no studies investigating classification of spinal deformity in idiopathic scoliosis using Quantec system measurements have been documented. METHODS In this study, 129 patients with a single curve and 119 patients with a double curve were divided into three groups according to Cobb angle: Group 1 (less than 10 degrees ), Group 2 (10-20 degrees ), and Group 3 (greater than 20 degrees ). RESULTS The patients were assigned to the group with the highest scores after application of a stepwise discriminant analysis. The accuracy of the classification system by functional scores for the patients with a single curve was 85% for Group 1, 63.5% for Group 2, and 71.7% for Group 3. The accuracy of classification by functional scores for the patients with a double curve was 87.1% for Group 2 and 76.1% for Group 3. CONCLUSION The back surface image study is a method for providing a quantitative assessment of mild spinal deformity, allowing evaluation of patients by integrated three-dimensional parameters with no reference to radiographs.
Collapse
Affiliation(s)
- X C Liu
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, USA
| | | | | | | |
Collapse
|
39
|
Lyon RM, Evanich JD. Culture-negative septic arthritis in children. J Pediatr Orthop 1999; 19:655-9. [PMID: 10488870] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
To compare the incidence, characteristics, treatment course, and clinical outcome of children with culture-negative versus culture-positive septic arthritis, we reviewed all 105 children treated for septic arthritis at our institution from 1990 to 1997. Seventy-six children had a clinical presentation consistent with an isolated joint infection. All underwent a joint aspiration with fluid analysis including culture. All were followed up until resolution of their symptoms. Culture of the synovial aspirates identified an etiologic organism in only 30% of cases. No significant differences existed between the culture-positive and culture-negative groups in most clinical and laboratory criteria. No other diagnoses were demonstrated. All patients underwent joint drainage, received comparable antibiotic therapy, and had complete resolution of their infections. The current literature reports deceptively low rates of 18-48% for culture-negative septic arthritis. Seventy percent of children with clinical findings of septic arthritis had negative synovial fluid cultures. As the two culture groups were comparable and no other diagnoses were demonstrated, the culture-negative cases were likely infections. Thus we recommend the same aggressive treatment in those cases with and without identification of a causative organism.
Collapse
Affiliation(s)
- R M Lyon
- Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee 53226, USA
| | | |
Collapse
|
40
|
Abstract
When any athlete presents for evaluation of an injury, the history and physical examination is of paramount importance in establishing a differential diagnosis. A radiograph is often used to confirm a diagnosis or to reassess an injury following treatment failure. There are certain drawbacks involved with getting a radiograph including cost, inconvenience, radiation exposure, and misinterpretation. Therefore, the radiographic evaluation of the injured athlete should be used only as clinically necessary. The benefits of getting a radiograph, to allow assessment of the severity of the injury, and thereby allow a more appropriate and aggressive treatment and rehabilitation program. The skills of history taking and physical examination presented in this article should make it easier to decide when the child athlete needs a more comprehensive and aggressive evaluation including radiographic studies.
Collapse
Affiliation(s)
- R M Lyon
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, USA
| | | |
Collapse
|
41
|
Affiliation(s)
- D L Hamner
- Department of Orthopaedic Surgery, Children's Hospital, Boston, Massachusetts 02115, USA
| | | | | |
Collapse
|
42
|
Affiliation(s)
- L S Rusakow
- Department of Pediatric, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee 53226, USA
| | | | | | | |
Collapse
|
43
|
Woo SL, Newton PO, MacKenna DA, Lyon RM. A comparative evaluation of the mechanical properties of the rabbit medial collateral and anterior cruciate ligaments. J Biomech 1992; 25:377-86. [PMID: 1583017 DOI: 10.1016/0021-9290(92)90257-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The biomechanical properties of the medial collateral and anterior cruciate ligaments from 30 New Zealand White rabbits were measured. Because of its complex geometry, the ACL was divided into two portions (medial and lateral) to provide uniform loading. This allowed an examination of the intra-ligamentous properties. A laser micrometer system was used to measure the cross-sectional area for tensile stress and a video dimension analyzer was used to measure the strain. The mechanical properties (stress-strain curves) of the MCL and ACL were different, with the modulus (determined between 4 and 7% strain) in the MCL (1120 +/- 153 MPa) more than twice that of either portion of the ACL (516 +/- 64 and 516 +/- 69 MPa for the medial and lateral portions, respectively). This higher modulus correlated with the more uniform and dense appearance of the collagen fibrils examined with scanning electron microscopy (SEM).
Collapse
Affiliation(s)
- S L Woo
- Orthopaedic Bioengineering Laboratory, University of California, San Diego
| | | | | | | |
Collapse
|
44
|
Lyon RM, Akeson WH, Amiel D, Kitabayashi LR, Woo SL. Ultrastructural differences between the cells of the medical collateral and the anterior cruciate ligaments. Clin Orthop Relat Res 1991:279-86. [PMID: 1934745] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The anterior cruciate ligament (ACL) does not heal after an interstitial tear, in contrast to the medial collateral ligament (MCL), whose interstitial tears heal readily. The light microscopic and ultrastructural differences between the cells of the two ligaments were studied in rabbit knees to observe the healing characteristics of the two ligaments. A rabbit knee was chosen because the rabbit ACL, like that of humans, does not heal following interstitial injury. The cells populating the MCL have the characteristics of fibroblasts. The cells of the ACL resemble fibrocartilage cells. The phenotypic differences in the cells of the two ligaments may be important determinants of the differences in healing.
Collapse
Affiliation(s)
- R M Lyon
- Division of Orthopaedics and Rehabilitation, University of California, San Diego
| | | | | | | | | |
Collapse
|
45
|
Woo SL, Hollis JM, Adams DJ, Lyon RM, Takai S. Tensile properties of the human femur-anterior cruciate ligament-tibia complex. The effects of specimen age and orientation. Am J Sports Med 1991; 19:217-25. [PMID: 1867330 DOI: 10.1177/036354659101900303] [Citation(s) in RCA: 704] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The structural properties of 27 pairs of human cadaver knees were evaluated. Specimens were equally divided into three groups of nine pairs each based on age: younger (22 to 35 years), middle (40 to 50 years), and older (60 to 97 years). Anterior-posterior displacement tests with the intact knee at 30 degrees and 90 degrees of flexion revealed a significant effect of knee flexion angle, but not of specimen age. Tensile tests of the femur-ACL-tibia complex were performed at 30 degrees of knee flexion with the ACL aligned vertically along the direction of applied tensile load. One knee from each pair was oriented anatomically (anatomical orientation), and the contralateral knee was oriented with the tibia aligned vertically (tibial orientation). Structural properties of the femur-ACL-tibia complex, as represented by the linear stiffness, ultimate load, and energy absorbed, were found to decrease significantly with specimen age and were also found to have higher values in specimens tested in the anatomical orientation. In the younger specimens, linear stiffness (242 +/- 28 N/mm) and ultimate load (2160 +/- 157 N) values found when the femur-ACL-tibia complex was tested in the anatomical orientation were higher than those reported previously in the literature. These values provide new baseline data for the design and selection of grafts for ACL replacement in an attempt to reproduce normal knee kinematics.
Collapse
Affiliation(s)
- S L Woo
- Department of Orthopaedic Surgery, University of Pittsburgh, Pennsylvania 15261
| | | | | | | | | |
Collapse
|
46
|
Abstract
Anterior cruciate (ACL) and medial collateral (MCL) ligaments from control and immobilized rabbit knee joints were examined using transmission electron microscopy. The fibroblasts of these two tissues were distinct in control ligaments, but these differences in fibroblast morphology were less obvious after immobilization. The most drastic changes took place in the ACL; the ACL fibroblasts from control ligaments were ovoid-shaped, while after immobilization they were spindle-shaped with extensive cytoplasmic extensions. These cellular changes corroborate previously demonstrated changes in the mechanical properties of these ligaments seen following immobilization, and are consistent with biochemical studies.
Collapse
Affiliation(s)
- P O Newton
- Orthopaedic Bioengineering Laboratory University of California, San Diego
| | | | | | | | | | | |
Collapse
|
47
|
Ishizue KK, Lyon RM, Amiel D, Woo SL. Acute hemarthrosis: a histological, biochemical, and biomechanical correlation of early effects on the anterior cruciate ligament in a rabbit model. J Orthop Res 1990; 8:548-54. [PMID: 2162390 DOI: 10.1002/jor.1100080411] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The early histological, biochemical, and biomechanical characteristics of the anterior cruciate ligament (ACL) were determined in a rabbit model of acute hemarthrosis. The ACLs of 19 rabbits were given seven consecutive daily knee injections of 2 ml of fresh autologous blood, and then compared to contralateral ACLs from control knees injected with 2 ml of lactated Ringer's solution daily for 7 days. The rabbits were then sacrificed. Synovial proliferation with iron deposition within synoviocytes was observed; however, the architecture of the ACL was maintained. Additionally, the total collagen content, collagenase activity, and biomechanical properties of the ACL were unaltered.
Collapse
Affiliation(s)
- K K Ishizue
- Division of Orthopaedics and Rehabilitation, University of California, San Diego, La Jolla 92093
| | | | | | | |
Collapse
|
48
|
Lyon RM, Woo SL, Hollis JM, Marcin JP, Lee EB. A new device to measure the structural properties of the femur-anterior cruciate ligament-tibia complex. J Biomech Eng 1989; 111:350-4. [PMID: 2486375 PMCID: PMC9727839 DOI: 10.1115/1.3168390] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Previous studies of biomechanical properties of femur-anterior cruciate ligament-tibia complex (FATC) utilized a wide variety of testing methodologies, particularly with respect to ligament orientation relative to loading direction. A new device was designed and built to test the anterior-posterior displacement of the intact porcine knee at 30 and 90 deg of flexion, as well as the tensile properties of the FATC at any loading direction and flexion angle. Tensile tests were performed with the knees at 30 and 90 deg of flexion with the loading direction along either the axis of the tibia (tibial axis) or the axis of the anterior cruciate ligament (ligament axis). The results showed that the stiffness, ultimate load and energy absorbed were all significantly increased when the FATC was tested along the ligament axis. This study demonstrates the importance of alignment in the evaluation of the biomechanical characteristics of the femur-ACL-tibia complex.
Collapse
Affiliation(s)
- R M Lyon
- Orthopaedic Bioengineering Laboratory, University of California, San Diego
| | | | | | | | | |
Collapse
|
49
|
Ballock RT, Woo SL, Lyon RM, Hollis JM, Akeson WH. Use of patellar tendon autograft for anterior cruciate ligament reconstruction in the rabbit: a long-term histologic and biomechanical study. J Orthop Res 1989; 7:474-85. [PMID: 2738766 DOI: 10.1002/jor.1100070404] [Citation(s) in RCA: 177] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To assess the degree of success of anterior cruciate ligament (ACL) replacement using the patellar tendon (PT) autograft, 29 New Zealand white rabbits underwent ACL reconstruction using a medial one-third PT autograft. The femur-ligament-tibia complexes were evaluated at 0, 6, 30, and 52 weeks postoperatively for gross and histologic appearances and tensile load to failure properties. Grossly, the autografts did not resemble the control ACLs. Histologically, the autografts progressed from being hypercellular with a random collagen fiber bundle organization to having a near normal cellularity with a more parallel collagen fiber bundle pattern. Anteroposterior knee laxity was more than two times that of the control knees 52 weeks after reconstruction. Biomechanically, the PT autografts plateaued at 30 weeks postoperatively. The ultimate load and stiffness were 15 +/- 5% and 24 +/- 6% of the control ACLs, respectively. At 52 weeks, the appearance of the PT autograft had some general histologic similarities as compared with the native ACL. However, these similarities did not extend to the functional properties of the autograft.
Collapse
Affiliation(s)
- R T Ballock
- Orthopaedic Bioengineering Laboratory, University of California, San Diego, La Jolla 92093
| | | | | | | | | |
Collapse
|