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severe combined trauma

Lisette Dekker, Hansje M Heller, Jessica E van der Meij, Annelies E J Toor, Leo M G Geeraedts
BACKGROUND: A medical-psychiatric unit (MPU) is a special ward where staff is trained in caring for patients with psychiatric or behavioural problems that need hospitalisation for physical health problems. It is well known that these patients are at higher risk of complications and have a longer length of stay resulting in higher costs than patients without psychiatric comorbidity. The objective of this study was to analyse the trauma patient population of the first 10 years of existence of the MPU in a level I trauma center...
February 15, 2019: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Marlina E Lovett, Nicole F O'Brien, Jeffrey R Leonard
Severe traumatic brain injury is a leading cause of morbidity and mortality in children. In 2003 the Brain Trauma Foundation released guidelines that have since been updated (2010) and have helped standardize and improve care. One area of care that remains controversial is whether the placement of an intracranial pressure monitor is advantageous in the management of traumatic brain injury. Another aspect of care that is widely debated is whether management after traumatic brain injury should be based on intracranial pressure-directed therapy, cerebral perfusion pressure-directed therapy, or a combination of the two...
January 11, 2019: Pediatric Neurology
Eun Young Choi, Jae Yong Han, Hyukmin Lee, Sung Chul Lee, Hyoung Jun Koh, Sung Soo Kim, Min Kim
PURPOSE: Infectious endophthalmitis (IE) is a severe complication that can lead to blindness even with treatment. However, the impact of antibiotic resistance and early vitrectomy on its prognosis has scarcely been documented. This study investigated the impact of antibiotic resistance of pathogen and early vitrectomy on the prognosis of IE. METHODS: The medical records of 171 patients treated for IE at a tertiary referral center between 2007 and 2016 were retrospectively reviewed and analyzed for etiology, pathogen, drug resistance to vancomycin or third-generation cephalosporins, treatment types and timing, and visual outcomes...
February 13, 2019: Graefe's Archive for Clinical and Experimental Ophthalmology
Adel Elkbuli, Reed Yaras, Ahmad Elghoroury, Dessy Boneva, Shaikh Hai, Mark McKenney
The revised trauma score combined with the Injury Severity Score (ISS) remains the mostly commonly used system for predicting trauma mortality, but these scoring systems do not account for the patient's comorbidities. This study aims to evaluate the effect of comorbidities on ISS-related mortality and length of stay. A review of our trauma center's data registry from 2014 to 2016 was carried out. Patients were divided according to ISS into two groups: ISS ≤ 15 and ISS > 15. Each ISS group was then subdivided by number of comorbidities into two groups: 1 to 2 or ≥3 comorbidities...
January 1, 2019: American Surgeon
Shuang Long, Guojian Wang, Mingqiang Shen, Na Zhao, Huimin Wan, Yang Xu, Song Wang, Cheng Wang, Jining Gao, Yuhui Hao, Aiping Wang, Rong Li, Xinze Ran, Yongping Su, Junping Wang, Tao Wang
Exposure to ionizing radiation combined with traumatic tissue injury is an important life-threatening condition found in the civilian populations after nuclear and radiological events. The significance feature of radiation combined injury (RCI) is the severe combined effect, which makes the injury more complicated. At present, there are limited measures available to treat RCI. Here we show that a chimeric protein dTMP-GH, fusing human growth hormone (hGH) with a tandem dimer of thrombopoietin mimetic peptide (dTMP), could be an effective therapy agent for RCI in a mice model...
February 13, 2019: Radiation Research
Carol L Clark, Thomas A Gibson, Robert E Weiss, Annick N Yagapen, Susan E Malveau, David H Adler, Aveh Bastani, Christopher W Baugh, Jeffrey M Caterino, Deborah B Diercks, Judd E Hollander, Bret A Nicks, Daniel K Nishijima, Manish N Shah, Kirk A Stiffler, Alan B Storrow, Scott T Wilber, Benjamin C Sun
OBJECTIVE: An estimated 1.2 million annual emergency department (ED) visits for syncope/ near syncope occur in the United States. Cardiac biomarkers are frequently obtained during the ED evaluation, but the prognostic value of index high-sensitivity troponin (hscTnT) and Natriuretic Peptide (NT-proBNP) are unclear. The objective of this study was to determine if hscTnT and NT-proBNP drawn in the ED are independently associated with 30-day death/ serious cardiac outcomes in adult patients presenting with syncope...
February 5, 2019: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Oliver C Radke, Catherine Heim
Monitoring the quality of trauma care is important but particularly challenging. Preventable death assessment aims to identify those cases where the patient's death would have not occurred if the patient had been treated differently. Determination of preventable death in trauma care is often based on calculated probability of survival, commonly by using the Trauma and Injury Severity Score (TRISS). TRISS is not suited for identifying all cases with opportunities for improvement. Combined with other methods such as morbidity and mortality conferences, however, it might be a valid approach if a complete review of all trauma deaths is not feasible at an institution...
March 2019: Anesthesiology Clinics
F E Zhang, J Y Li, P Bo, J Q Zhang, T Ren, X R Cao
Objective: To investigate the indication and midterm outcomes of surgical treatment of traumatic tricuspid insufficiency. Methods: Totally 19 patients with traumatic tricuspid insufficiency who underwent surgical treatment at Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University from January 2002 to January 2018 were included in this retrospective study. There were 12 male and 7 female patients, aged (43.1±12.9) years (range: 17-68 years). The main causes of traumatic tricuspid insufficiency included blunt chest trauma following high-speed vehicle accidents (17 patients) and high-fall trauma (2 patients)...
February 1, 2019: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Rahul Vaidya, Kevin Blue, Bryant Oliphant, Fred Tonnos
OBJECTIVE: The purposes of this article were to (1) compare our combined pelvic ring and acetabular fracture patients' rate of mortality and Injury Severity Score (ISS) to those of patients with isolated injuries at our center and to those with combined injuries as reported in the literature, (2) describe our treatment algorithm using the INFIX for these combination injuries, and (3) report our patients' radiographic and functional outcomes. DESIGN: Retrospective IRB-approved case series and literature review...
February 2019: Journal of Orthopaedic Trauma
Ivo P Torres Filho, David Barraza, Charnae Williams, Kim Hildreth, Michael A Dubick
BACKGROUND: Many studies evaluating blood flow and oxygen partial pressure (PO2) do not directly measure both parameters, are confined to few locations/microvessels, and depend on investigator's selection of measuring sites. Moreover, clinically/physiologically-relevant systemic parameters are not simultaneously recorded. We implemented an automated system for prolonged blood flow/PO2 acquisition in large areas while collecting relevant systemic information. METHODS: In anesthetized animals, cardio-respiratory parameters were continuously recorded...
January 25, 2019: Journal of Trauma and Acute Care Surgery
Alasdair Bott, Adekoyejo Odutola, Ruth Halliday, Mehool R Acharya, Anthony Ward, Timothy J S Chesser
OBJECTIVES: To report the long-term functional outcome of a cohort of patients with operatively treated unstable pelvic fractures using validated patient-reported outcome measures. DESIGN: Long-term observational study using prospective and retrospective data. SETTING: Tertiary referral pelvic trauma center, Bristol, United Kingdom. PATIENTS: Seventy-four polytraumatized patients with operatively treated unstable pelvic ring injuries (50 OTA/AO type B and 24 OTA/AO type C, mean Injury Severity Score 17) treated between 1994 and 2005...
February 2019: Journal of Orthopaedic Trauma
Steven L Raymond, Russell B Hawkins, Zhongkai Wang, Juan C Mira, Julie A Stortz, Feifei Han, Jennifer D Lanz, Laura V Hennessy, Babette A Brumback, Henry V Baker, Philip A Efron, Scott C Brakenridge, Wenzhong Xiao, Ronald G Tompkins, Joseph Cuschieri, Frederick A Moore, Ronald V Maier, Lyle L Moldawer
MINI: Here, for the first time, we prospectively validate a previously discovered transcriptomic metric that predicts at 24 hours postsevere blunt trauma, long-term clinical outcomes. The metric also performed well (AUC 0.80-0.85) in a preexisting, independent published data set. This validated transcriptomic metric outperforms clinical markers, is based on an Food and Drug Administration-cleared analytical platform, and has a rapid 24-hour turnaround. OBJECTIVE: To prospectively validate a previously discovered transcriptomic biomarker consisting of 63 blood leukocyte gene expression (S63) values to discriminate between trauma patients who rapidly recover and those with prolonged hospital stays who would benefit from early biological interventions...
January 24, 2019: Annals of Surgery
Marissa A Ruehle, Mon-Tzu Alice Li, Albert Cheng, Laxminarayanan Krishnan, Nick J Willett, Robert E Guldberg
Traumatic musculoskeletal injuries that result in bone defects or fractures often affect both bone and the surrounding soft tissue. Clinically, these types of multi-tissue injuries have increased rates of complications and long-term disability. Vascular integrity is a key clinical indicator of injury severity, and revascularization of the injury site is a critical early step of the bone healing process. Our lab has previously established a pre-clinical model of composite bone-muscle injury that exhibits impaired bone healing; however, the vascularization response in this model had not yet been investigated...
January 25, 2019: Acta Biomaterialia
James Rainville, Moorice Caparó, Eric Laxer, Enrique Pena, David H Kim, R Alden Milam, Eric Carkner
BACKGROUND: Cervical radiculopathy (CR) is a clinical diagnosis defined as a combination of neck, shoulder and arm pain, often accompanied by sensory and motor symptoms. CR is often caused by degenerative spine pathology associated with impingement of a cervical nerve root, and this pathology can be visualized using MRI or CT scan. Factors that are associated with the onset of CR have not been explored. OBJECTIVE: To investigate the types and frequencies of patient-reported inciting events associated with CR in patients with imaged confirmed pathologies that correlate with symptoms...
January 25, 2019: PM & R: the Journal of Injury, Function, and Rehabilitation
Kate Curtis, Belinda Kennedy, Andrew J A Holland, Gary Tall, Holly Smith, Soundappan S V Soundappan, Brian Burns, Rebecca J Mitchell, Kellie Wilson, Allan Loudfoot, Michael Dinh, Timothy Lyons, Tona Gillen, Stuart Dickinson
BACKGROUND: There is known variability in the quality of care delivered to injured children. Identifying where care improvement can be made is critical. This study aimed to review paediatric trauma cases across the most populous Australian State to identify factors contributing to clinical incidents. METHODS: Medical records from three New South Wales Paediatric Trauma Centres were reviewed for children <16 years requiring intensive care; with an injury severity score of ≥9, or who died following injury between July 2015 and September 2016...
January 16, 2019: Injury
Marília Silva Paulo, Tom Loney, Luís Velez Lapão
BACKGROUND: The United Arab Emirates (UAE) is a rapidly developing high-income country that was formed from the union of seven emirates in 1971. The UAE has experienced unprecedented population growth coupled with increased rates of chronic diseases over the past few decades. Healthcare workers are the core foundation of the health system, especially for chronic care conditions, and the UAE health workforce needs to be fully prepared for the increased rates of chronic diseases in the adult population...
January 24, 2019: Human Resources for Health
Philipp Homan, Ifat Levy, Eric Feltham, Charles Gordon, Jingchu Hu, Jian Li, Robert H Pietrzak, Steven Southwick, John H Krystal, Ilan Harpaz-Rotem, Daniela Schiller
By combining computational, morphological, and functional analyses, this study relates latent markers of associative threat learning to overt post-traumatic stress disorder (PTSD) symptoms in combat veterans. Using reversal learning, we found that symptomatic veterans showed greater physiological adjustment to cues that did not predict what they had expected, indicating greater sensitivity to prediction errors for negative outcomes. This exaggerated weighting of prediction errors shapes the dynamic learning rate (associability) and value of threat predictive cues...
January 21, 2019: Nature Neuroscience
Johanna Klinger-König, Hans J Grabe
BACKGROUND: In traumatized parents with mental disorders, pregnancy and related medical examinations can lead to high emotional distress and flashbacks and increase the already tense emotional situation. Besides psychiatric burdens, parental insecurity concerning dealing with and reduced sensitivity for the child often exist. The children themselves have a higher risk of being neglected or abused and to also develop mental disorders. OBJECTIVE: How does interventional research take the special needs of traumatized parents with mental disorders into account? What kind of interventions predominate and what impact do they have on parents and children? MATERIAL AND METHODS: Publications on perinatal and postnatal interventions for traumatized and mentally disordered parents were included in the review if at least one intervention was explicitly described, a parental trauma was discussed and the impact of the intervention on the parents and children was analyzed...
January 14, 2019: Der Nervenarzt
Kristin Salottolo, Laura Peck, Matthew Carrick, Allen Tanner, Robert Madayag, Emmett McGuire, David Bar-Or
INTRODUCTION: Substance use and abuse may have the significant, but unanticipated, consequence of lessening the efficacy of opioid analgesics for acute pain management. We hypothesized that pre-injury substance use increases opioid analgesic consumption following traumatic injury. METHODS: This retrospective multi-institutional pilot study included admitted patients to four level 1 trauma centers with vehicular trauma over four months (n = 176). We examined the effect of positive urine drug screen (UDS; 7-drug panel, examined individually and combined, yes/no) and positive blood alcohol content (BAC, ≥80 mg/dL) on pain management with opioid analgesics over the hospital stay...
January 8, 2019: Injury
Richard Y Calvo, C Beth Sise, Michael J Sise, Vishal Bansal
INTRODUCTION: Pre-existing medical conditions (PEC) represent a unique domain of risk among older trauma patients. The study objective was to develop a metric to quantify PEC burden for trauma patients. METHODS: A cohort of 4526 non-severe blunt-injured trauma patients aged 55 years and older admitted to a Level I trauma center between January 2006 and December 2012 were divided into development (80%) and test (20%) sets. Cox regression was used to develop the model based on in-hospital and 90-day mortality...
December 27, 2018: American Journal of Emergency Medicine
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