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Trauma Patients (trauma + patient)
Kinds of Trauma Patients Selected AbstractsREDUCING TIME TO URGENT SURGERY BY TRANSPORTING RESOURCES TO THE TRAUMA PATIENTANZ JOURNAL OF SURGERY, Issue 4 2007Morgan P. McMonagle Background: Time to definitive trauma care directly influences patient survival. Patient transport (retrieval) services are essential for the transportation of remotely located trauma patients to a major trauma centre. Trauma surgical expertise can potentially be combined with the usual retrieval response (surgically supported response) and delivered to the patient before patient transportation. We identified the frequency and circumstances of such surgically supported retrievals. Methods: Retrospective review of trauma patients transported by the NRMA CareFlight, New South Wales Medical Retrieval Service, Australia, from 1999 to 2003, identifying patients who had a surgically supported retrieval response and an urgent surgical procedure carried out before patient transportation to an major trauma centre. Results: Seven hundred and forty-nine trauma interhospital patient transfers were identified of which 511 (68%) were categorized as urgent and 64% of which were rural based. Three (0.4%) patients had a surgically supported retrieval response and had an urgent surgical procedure carried out before patient transportation. All patients benefited from that early surgical intervention. Conclusion: A surgically supported retrieval response allows for the more timely delivery of urgent surgical care. Patients can potentially benefit from such a response. There are, however, important operational considerations in providing a surgically supported retrieval response. [source] BLOOD TRANSFUSIONS IN ELDERLY TRAUMA PATIENTS: IS THERE A ROLE FOR RESTRICTIVE USE?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2008Kayla Keuter MPH, PA-C No abstract is available for this article. [source] Effect of Normal Saline Infusion on the Diagnostic Utility of Base Deficit in Identifying Major Injury in Trauma PatientsACADEMIC EMERGENCY MEDICINE, Issue 12 2006Richard Sinert DO Abstract Background Base deficit (BD) is a reliable marker of metabolic acidosis and is useful in gauging hemorrhage after trauma. Resuscitation with chloride-rich solutions such as normal saline (NS) can cause a dilutional acidosis, possibly confounding the interpretation of BD. Objectives To test the diagnostic utility of BD in distinguishing minor from major injury after administration of NS. Methods This was a prospective observational study at a Level 1 trauma center. The authors enrolled patients with significant mechanism of injury and measured BD at triage (BD-0) and at four hours after triage (BD-4). Major injury was defined by any of the following: injury severity score of ,15, drop in hematocrit of ,10 points, or the patient requiring a blood transfusion. Patients were divided into a low-volume (NS < 2L) and a high-volume (NS , 2L) group. Data were reported as mean (±SD). Student's t- and Wilcoxon tests were used to compare data. Receiver operating characteristic (ROC) curves tested the utility of BD-4 in differentiating minor from major injury in the study groups. Results Four hundred eighty-nine trauma patients (mean age, 36 [± 18] yr) were enrolled; 82% were male, and 34% had penetrating injury. Major-(20%) compared with minor-(80%) injury patients were significantly (p = 0.0001) more acidotic (BD-0 mean difference: ,3.3 mmol/L; 95% confidence interval [CI] =,2.5 to ,4.2). The high-volume group (n = 174) received 3,342 (±1,821) mL, and the low-volume group (n = 315) received 621 (±509) mL of NS. Areas under the ROC curves for the high-volume (0.63; 95% CI = 0.52 to 0.74) and low-volume (0.73; 95% CI = 0.60 to 0.86) groups were not significantly different from each other. Conclusions Base deficit was able to distinguish minor from major injury after four hours of resuscitation, irrespective of the volume of NS infused. [source] Pain Scores Improve Analgesic Administration Patterns for Trauma Patients in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 3 2004Paul A. Silka MD Abstract Objective: To determine the efficacy of pain scores in improving pain management practices for trauma patients in the emergency department (ED). Methods: A prospective, observational study of analgesic administration to trauma patients was conducted over a nine-week period following educational intervention and introduction of verbal pain scores (VPSs). All ED nursing and physician staff in an urban Level I trauma center were trained to use the 0,10 VPS. Patients younger than 12 years old, having a Glasgow Coma Scale score (GCS) <8, or requiring intubation were excluded from analysis. Demographics, mechanism of injury, vital signs, pain scores, and analgesic data were extracted from a computerized ED database and patients' records. The staff was blinded to the ongoing study. Results: There were 150 patients studied (183 consecutive trauma patients seen; 33 patients excluded per criteria). Pain scores were documented for 73% of the patients. Overall, 53% (95% confidence interval [CI] = 45% to 61%) of the patients received analgesics in the ED. Of the patients who had pain scores documented, 60% (95% CI = 51% to 69%) received analgesics, whereas 33% (95% CI = 18% to 47%) of the patients without pain scores received analgesics. No patient with a VPS < 4 received analgesics, whereas 72% of patients with a VPS > 4 and 82% with a VPS > 7 received analgesics. Mean time to analgesic administration was 68 minutes (95% CI = 49 to 87). Conclusions: Pain assessment using VPS increased the likelihood of analgesic administration to trauma patients with higher pain scores in the ED. [source] The Efficacy of Esmolol versus Lidocaine to Attenuate the Hemodynamic Response to Intubation in Isolated Head Trauma PatientsACADEMIC EMERGENCY MEDICINE, Issue 1 2001M. Andrew Levitt DO Abstract. Objective: To assess the effect of esmolol vs lidocaine to attenuate the detrimental rise in heart rate and blood pressure during intubation of patients with isolated head trauma. Methods: This was a prospective, double-blind, randomized study, performed at an urban, county teaching emergency department. Participants were 30 patients with isolated head trauma. Each underwent a standardized intubation protocol including esmolol or lidocaine, both at 2 mg/kg. Results: Esmolol was used in 16 patients and lidocaine in 14. Mechanisms of injury included 12 assaults, 6 motor vehicle collisions, 6 falls, 4 auto-vs-pedestrian crashes, and 2 bicycle incidents. Mean ethanol level was 0.116 ± 0.133 SD (range 0-0.482). Mean Glasgow Coma Scale (GCS) score was 7.9 ± 4.0 SD. Cranial computed tomography (CT) hemorrhagic findings included 9 subdural/epidural hematomas, 6 cortex hemorrhages, and 2 multi-hemorrhages. Eleven patients received surgical intervention: 9 patients received a craniotomy, and 2 a ventricular catheter. The 2-minute time interval around intubation was used to assess each drug's efficacy. The mean difference change between groups for heart rate was 4.0 beats/min (95% CI = -17.7 to 9.7 beats/min), for systolic blood pressure was 1.3 mm Hg (95% CI = -27.8 to 30.4 mm Hg), and for diastolic blood pressure was 2.6 mm Hg (95% CI = -27.1 to 21.9 mm Hg). The power of this study was 90% to detect a 20-beat/min difference in heart rate, a 35-mm Hg difference in systolic blood pressure, and a 20-mm Hg difference in diastolic blood pressure. Conclusions: Esmolol and lidocaine have similar efficacies to attenuate moderate hemodynamic response to intubation of patients with isolated head trauma. [source] Screening Trauma Patients With the Alcohol Use Disorders Identification Test and Biomarkers of Alcohol UseALCOHOLISM, Issue 6 2009Tim Neumann Background:, Alcohol screening and brief interventions have been shown to reduce alcohol-related morbidity in injured patients. Use of self-report questionnaires such as the Alcohol Use Disorder Identification Test (AUDIT) is recommended as the optimum screening method. We hypothesized that the accuracy of screening is enhanced by combined use of the AUDIT and biomarkers of alcohol use in injured patients. Methods:, The study was conducted in the emergency department of a large, urban, university hospital. Patients were evaluated with the AUDIT, and blood sampled to determine carbohydrate-deficient transferrin, gamma-glutamyl-transferase, and mean corpuscular volume. Alcohol problems were defined as presence of ICD-10 criteria for dependence or harmful use, or high-risk drinking according to World Health Organization criteria (weekly intake >420 g in males, >280 g in females). Screening accuracy was determined using Receiver Operating Characteristic curves. Results:, There were 787 males and 446 females in the study. Median age was 33 years. The accuracy of the AUDIT was good to excellent, whereas all biomarkers performed only fairly to poorly in males, and even worse in females. At a specificity >0.80, sensitivity for all biomarkers was <0.43, whereas sensitivity for the AUDIT was 0.76 for males and 0.81 for females. The addition of biomarkers added little additional discriminatory information compared to use of the AUDIT alone. Conclusions:, Screening properties of the AUDIT are superior to %CDT, MCV, and GGT for detection of alcohol problems in injured patients and are not clinically significantly enhanced by the use of biomarkers. [source] Utility of Base Deficit for Identifying Major Injury in Elder Trauma PatientsACADEMIC EMERGENCY MEDICINE, Issue 9 2007Shahriar Zehtabchi MD Background: Early identification of serious injuries is especially important in elders. Base deficit (BD) is an indicator of serious injury in trauma patients. There are limited data to support the utility of BD in elders who have sustained trauma. Objectives: To assess the diagnostic performance of BD in identifying major injury in elders. Methods: This was a prospective, observational, preliminary study. Elder (age 65 years and older) patients with significant injury mechanisms had BD analyzed during initial emergency department resuscitation. Major injury was defined by an Injury Severity Score ,15, a decrease in hematocrit of more than ten points, or blood transfusion. Patients were stratified into two groups of minor and major injuries. Data were reported as means (±SD). Receiver operating characteristic (ROC) curves tested the diagnostic ability of BD to identify major injury. Results: Seventy-four patients were enrolled; the mean (±SD) age was 75 (±7) years, and 57% were male. Twenty-four patients (32%) had major injury. The mean (±SD) for BD in the major injury group (,2.9 [±6] mmol/L) was significantly different from that in the minor injury group (0.8 [±3] mmol/L), with a mean difference of 3.7 (95% confidence interval = 1.4 to 5.9). ROC curves revealed that BD was able to identify major injury in elder patients (area under the ROC curve, 0.72; 95% confidence interval = 0.60 to 0.85; p = 0.0003). Conclusions: The preliminary data from this study indicate that in trauma patients aged 65 years and older, increased BD at emergency department arrival can predict life-threatening injury. [source] Risk factors for nosocomial intensive care infection: a long-term prospective analysisACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2001P. Appelgren Background: To identify risk factors for nosocomial infection in intensive care and to provide a basis for allocation of resources. Methods: Long-term prospective incidence study of risk factors for nosocomial infection in the surgical-medical intensive care unit of a university hospital. Results: A total of 2671 patients were admitted during four years, and 562 of 574 patients staying >48 h were observed during 4921 patient days (median length of stay 5 days, range 2,114). Of these, 196 (34%) patients had 364 nosocomial infections after median 8,10 days, an infection rate of 14/100 admissions. Infection prolonged length of stay 8,9 days and doubled the risk of death. The infections were 17% blood stream, 26% pneumonias, 34% wound, 10% urinary tract and 13% other infections. The incidence of bloodstream infection declined significantly during the study years, from 12% to 5%. In multiple regression analysis, the important variables for infection were central venous catheter, mechanical ventilation, pleural drainage and trauma with open fractures. High age, immunosuppression and infection on admission did not influence the risk of acquiring infection. Trauma patients constituted 24% of the study population. Trauma with open fractures increased the risk of infection more than twice (P=0.003), mainly due to wound infections. Conclusion: Trauma cases, with open fractures, were the patients most at risk of infection, despite low disease severity scores. Resources to prevent nosocomial infection should be allocated to these patients. [source] A comparison of severely injured trauma patients admitted to level 1 trauma centres in Queensland and GermanyANZ JOURNAL OF SURGERY, Issue 3 2010Johanna M. M. Nijboer Abstract Background:, The allocation of a trauma network in Queensland is still in the developmental phase. In a search for indicators to improve trauma care both locally as state-wide, a study was carried out comparing trauma patients in Queensland to trauma patients in Germany, a country with 82.4 million inhabitants and a well-established trauma system. Methods:, Trauma patients ,15 years of age, with an Injury Severity Score (ISS) , 16 admitted to the Princess Alexandra Hospital (PAH) and to the 59 German hospitals participating in the Trauma Registry of the German Society for Trauma Surgery (DGU-G) during the year 2005 were retrospectively identified and analysed. Results:, Both cohorts are comparable when it comes to demographics and injury mechanism, but differ significantly in other important aspects. Striking is the low number of primary admitted patients in the PAH cohort: 58% versus 83% in the DGU-G cohort. PAH patients were less physiologically deranged and less severely injured: ISS 25.2 ± 9.9 versus 29.9 ± 13.1 (P < 0.001). Subsequently, they less often needed surgery (61% versus 79%), ICU admission (49% versus 92%) and had a lower mortality: 9.8% versus 17.9% of the DGU-G cohort. Conclusions:, Relevant differences were the low number of primary admissions, the lesser severity of injuries, and the low mortality of the patients treated at the PAH. These differences are likely to be interrelated and Queensland's size and suboptimal organization of trauma care may have played an important role. [source] Use of exogenous erythropoietin in critically ill patientsJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 3 2004R. MacLaren PharmD Summary Objective:, Review the literature regarding the use of recombinant human erythropoietin (rHuEPO) to prevent red blood cell (RBC) transfusion in critically ill patients. Data sources:, A computerized search of MEDLINE and EMBASE from 1966 through June 2003 was conducted using the terms erythropoietin, anemia, hemoglobin, critical care, intensive care, surgery, trauma, burn, and transfusion. References of selected articles were reviewed. A manual search of critical care, surgery, trauma, burn, hematology, and pharmacy journals was conducted to identify relevant abstracts. Results:, Six randomized studies have evaluated exogenous administration of erythropoietin to prevent RBC transfusions in critically ill patients. Studies vary with respect to rHuEPO dosage regimens, dose of concurrently administered iron, patient characteristics, and transfusion thresholds. Administration of rHuEPO rapidly produces erythropoiesis to reduce the need for RBC transfusions. The largest study conducted to date used weekly rHuEPO administration and found a modest decrease in transfusion requirements although the time to first transfusion was delayed. Reduced intensive care unit (ICU) length of stay (LOS) was shown in only one study of surgical/trauma patients. Reduced LOS after ICU discharge was found in another study of severely ill patients (APACHE II score >22). Other clinical outcomes were not altered by rHuEPO use. No adverse events were associated with rHuEPO use although studies were not designed to evaluate safety. Conclusions:, rHuEPO reduces the need for transfusions. A cost-effectiveness analysis of rHuEPO for this indication is needed. Defining an optimal dosage regimen, identifying patients most likely to respond to rHuEPO, and determining risk factors for ICU associated anaemia would provide information for appropriate rHuEPO utilization. [source] Segmental osteotomy to reposition multiple osseointegrated dental implants in the anterior maxilla in a trauma patientDENTAL TRAUMATOLOGY, Issue 1 2007Shou-Yen Kao Abstract,,, A 16-year-old young man had severe loss of alveolar bone and lost four teeth in the anterior maxilla because of traumatic injury in a traffic accident. To overcome the surgically compromised condition for implant rehabilitation, the deficient ridge was augmented by autogenous bone graft from the mandibular symphysis. The augmented ridge had much improvement in width but less in vertical height. Four implants were placed to gain initial osseointegration. Segmental osteotomy was performed to occlusally reposition the implants and bone for 5-mm in the anterior maxilla. After 2 years of clinical follow-up, the rehabilitation outcome is satisfactory and stable. [source] The Prognostic Value of the Modified Glasgow Coma Scale in Head Trauma in DogsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 6 2001Simon R. Platt A clinical coma scale modified from the Glasgow Coma Scale used for humans has been suggested as a useful predictor of outcome in the head trauma patient. The objective of this study was to correlate the modified Glasgow Coma Scale (MGCS) score of dogs with head trauma with their probability of survival. Thirty-eight dogs with head trauma were selected and retrospectively evaluated. The information retrieved from the medical record of each dog included signalment, body weight, cause of head trauma, MGCS, presence of concurrent neck pain, and outcome (dead or alive) after 48 hours. Logistic regression was used to model survival in the 1st 48 hours as a function of MGCS, gender, weight, and calvarial fractures. The MGCS ranged from 5 to 18. Seven dogs died within 48 hours of the head trauma. The MGCS could predict the probability of survival in the 1st 48 hrs after head trauma with 50% probability in a patient with a score of 8. Gender, weight, and presence of skull fractures did not predict survival. In conclusion, the MGCS is a useful index for prediction of outcome in dogs with head trauma. [source] Use of rotation thromboelastometry (ROTEM®) to achieve successful treatment of polytrauma with fibrinogen concentrate and prothrombin complex concentrateANAESTHESIA, Issue 2 2010H. Schöchl Summary Goal-directed coagulation therapy is essential in the management of trauma patients with severe bleeding. Due to the complex nature of coagulation disorders in trauma, a quick and reliable diagnostic tool is essential. We report a severely injured multiple trauma patient who received haemostatic therapy with coagulation factor concentrates, guided by rotational thromboelastometry (ROTEM®). Initial therapy consisted of fibrinogen concentrate (Haemocomplettan® P), as maximum clot firmness in the ROTEM analyses was low, whereas clotting time was normal. Later on, prothrombin complex concentrate was given to optimise thrombin generation. This approach enabled extended emergency hemihepatectomy to be performed without using fresh frozen plasma. As the EXTEM maximum clot firmness showed good clot quality, no platelets were transfused despite low platelet counts. This case shows the potential success of treatment using both fibrinogen concentrate and prothrombin complex concentrate, not only in restoring haemostasis but also in minimising requirement for transfusion of allogeneic blood products. [source] Effect of Normal Saline Infusion on the Diagnostic Utility of Base Deficit in Identifying Major Injury in Trauma PatientsACADEMIC EMERGENCY MEDICINE, Issue 12 2006Richard Sinert DO Abstract Background Base deficit (BD) is a reliable marker of metabolic acidosis and is useful in gauging hemorrhage after trauma. Resuscitation with chloride-rich solutions such as normal saline (NS) can cause a dilutional acidosis, possibly confounding the interpretation of BD. Objectives To test the diagnostic utility of BD in distinguishing minor from major injury after administration of NS. Methods This was a prospective observational study at a Level 1 trauma center. The authors enrolled patients with significant mechanism of injury and measured BD at triage (BD-0) and at four hours after triage (BD-4). Major injury was defined by any of the following: injury severity score of ,15, drop in hematocrit of ,10 points, or the patient requiring a blood transfusion. Patients were divided into a low-volume (NS < 2L) and a high-volume (NS , 2L) group. Data were reported as mean (±SD). Student's t- and Wilcoxon tests were used to compare data. Receiver operating characteristic (ROC) curves tested the utility of BD-4 in differentiating minor from major injury in the study groups. Results Four hundred eighty-nine trauma patients (mean age, 36 [± 18] yr) were enrolled; 82% were male, and 34% had penetrating injury. Major-(20%) compared with minor-(80%) injury patients were significantly (p = 0.0001) more acidotic (BD-0 mean difference: ,3.3 mmol/L; 95% confidence interval [CI] =,2.5 to ,4.2). The high-volume group (n = 174) received 3,342 (±1,821) mL, and the low-volume group (n = 315) received 621 (±509) mL of NS. Areas under the ROC curves for the high-volume (0.63; 95% CI = 0.52 to 0.74) and low-volume (0.73; 95% CI = 0.60 to 0.86) groups were not significantly different from each other. Conclusions Base deficit was able to distinguish minor from major injury after four hours of resuscitation, irrespective of the volume of NS infused. [source] Ethnic differences in drinking outcomes following a brief alcohol intervention in the trauma care settingADDICTION, Issue 1 2010Craig A. Field ABSTRACT Background Evidence suggests that brief interventions in the trauma care setting reduce drinking, subsequent injury and driving under the influence (DUI) arrest. However, evidence on the effectiveness of these interventions in ethnic minority groups is lacking. The current study evaluates the efficacy of brief intervention among whites, blacks and Hispanics in the United States. Methods We conducted a two-group parallel randomized trial comparing brief motivational intervention (BMI) and treatment as usual with assessment (TAU+) to evaluate treatment differences in drinking patterns by ethnicity. Patients were recruited from a level 1 urban trauma center over a 2-year period. The study included 1493 trauma patients, including 668 whites, 288 blacks and 537 Hispanics. Hierarchical linear modeling was used to evaluate ethnic differences in drinking outcomes including volume per week, maximum amount consumed in 1 day, percentage days abstinent and percentage days heavy drinking at 6- and 12-month follow-up. Analyses controlled for age, gender, employment status, marital status, prior alcohol treatment, type of injury and injury severity. Special emphasis was given to potential ethnic differences by testing the interaction between ethnicity and BMI. Results At 6- and 12-month follow-up, BMI significantly reduced maximum amount consumed in 1 day (P < 0.001; P < 0.001, respectively) and percentage days heavy drinking (P < 0.05; P < 0.05, respectively) among Hispanics. Hispanics in the BMI group also reduced average volume per week at 12-month follow-up (,2 = 6.8, df = 1, P < 0.01). In addition, Hispanics in TAU+ reduced maximum amount consumed at 6- and 12-month follow-up (P < 0.001; P < 0.001) and volume per week at 12-month follow-up (P < 0.001). Whites and blacks in both BMI and TAU+ reduced volume per week and percentage days heavy drinking at 12-month follow-up (P < 0.001; P < 0.01, respectively) and decreased maximum amount at 6- (P < 0.001) and 12-month follow-up (P < 0.001). All three ethnic groups In both BMI and TAU+ reduced volume per week at 6-month follow-up (P < 0.001) and percentage days abstinent at 6- (P < 0.001) and 12-month follow-up (P < 0.001). Conclusions All three ethnic groups evidenced reductions in drinking at 6- and 12-month follow-up independent of treatment assignment. Among Hispanics, BMI reduced alcohol intake significantly as measured by average volume per week, percentage days heavy drinking and maximum amount consumed in 1 day. [source] Emergency Physician,Verified Out-of-hospital Intubation: Miss Rates by ParamedicsACADEMIC EMERGENCY MEDICINE, Issue 6 2004James H. Jones MD Abstract Objectives: To prospectively quantify the number of unrecognized missed out-of-hospital intubations by ground paramedics using emergency physician verification as the criterion standard for verification of endotracheal tube placement. Methods:The authors performed an observational, prospective study of consecutive intubated patients arriving by ground emergency medical services to two urban teaching hospitals. Endotracheal tube placement was verified by emergency physicians and evaluated by using a combination of direct visualization, esophageal detector device (EDD), colorimetric end-tidal carbon dioxide (ETCO2), and physical examination. Results: During the six-month study period, 208 out-of-hospital intubations by ground paramedics were enrolled, which included 160 (76.9%) medical patients and 48 (23.1%) trauma patients. A total of 12 (5.8%) endotracheal tubes were incorrectly placed outside the trachea. This comprised ten (6.3%) medical patients and two (4.2%) trauma patients. Of the 12 misplaced endotracheal tubes, a verification device (ETCO2 or EDD) was used in three cases (25%) and not used in nine cases (75%). Conclusions: The rate of unrecognized, misplaced out-of-hospital intubations in this urban, midwestern setting was 5.8%. This is more consistent with results of prior out-of-hospital studies that used field verification and is discordant with the only other study to exclusively use emergency physician verification performed on arrival to the emergency department. [source] Pain Scores Improve Analgesic Administration Patterns for Trauma Patients in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 3 2004Paul A. Silka MD Abstract Objective: To determine the efficacy of pain scores in improving pain management practices for trauma patients in the emergency department (ED). Methods: A prospective, observational study of analgesic administration to trauma patients was conducted over a nine-week period following educational intervention and introduction of verbal pain scores (VPSs). All ED nursing and physician staff in an urban Level I trauma center were trained to use the 0,10 VPS. Patients younger than 12 years old, having a Glasgow Coma Scale score (GCS) <8, or requiring intubation were excluded from analysis. Demographics, mechanism of injury, vital signs, pain scores, and analgesic data were extracted from a computerized ED database and patients' records. The staff was blinded to the ongoing study. Results: There were 150 patients studied (183 consecutive trauma patients seen; 33 patients excluded per criteria). Pain scores were documented for 73% of the patients. Overall, 53% (95% confidence interval [CI] = 45% to 61%) of the patients received analgesics in the ED. Of the patients who had pain scores documented, 60% (95% CI = 51% to 69%) received analgesics, whereas 33% (95% CI = 18% to 47%) of the patients without pain scores received analgesics. No patient with a VPS < 4 received analgesics, whereas 72% of patients with a VPS > 4 and 82% with a VPS > 7 received analgesics. Mean time to analgesic administration was 68 minutes (95% CI = 49 to 87). Conclusions: Pain assessment using VPS increased the likelihood of analgesic administration to trauma patients with higher pain scores in the ED. [source] Emergency room thoracotomy: Has availability triumphed over advisability in the care of trauma patients in Australasia?EMERGENCY MEDICINE AUSTRALASIA, Issue 4 2010Ian Civil No abstract is available for this article. [source] Investigating moderate to severe paediatric trauma in the Auckland regionEMERGENCY MEDICINE AUSTRALASIA, Issue 2 2010Louise Couch Abstract Objective: To investigate differences between paediatric patients with moderate to severe trauma admitted from two paediatric ED, with respect to: demographics, patterns of presentation, mechanism of injury, injury severity scores (ISS), interventions and outcome. Method: Retrospective cohort study. Moderate to severe trauma was defined as ISS >9. Paediatric patients admitted to hospital via Starship Children's Emergency or KidzFirst ED, with trauma from 1 May 2003 to 30 April 2004, with ISS >9 were identified using multiple databases. The charts were reviewed and data collected included: demographics, hospital of first presentation, diagnoses, ISS, Paediatric trauma score (PTS), Glasgow coma score (GCS), ventilator hours, length of admission, survival and discharge destination. Descriptive statistics with 95% confidence intervals, Mann,Whitney U -test, ,2 -test and Fisher's exact test were used as appropriate. Results: A total of 393 children with moderate to severe trauma were identified using initial search strategies. Of these, 82 children met the inclusion and exclusion criteria for the study; 42 children were admitted via KidzFirst ED and 40 via Starship Children's ED. There was no statistically significant difference in ISS (P= 0.86), PTS (P= 0.11), GCS (P= 0.62), hours on a ventilator (P= 0.28) and length of stay (P= 0.87) between children admitted from Starship or KidzFirst ED. Conclusion: This study suggests that there are no differences in the numbers or severity of paediatric trauma patients admitted from the Starship and KidzFirst ED. This indicates triage is to the closest ED despite having a tertiary referral centre for paediatric trauma available in Auckland City. [source] Review article: Indications for thoracolumbar imaging in blunt trauma patients: A review of current literatureEMERGENCY MEDICINE AUSTRALASIA, Issue 2 2009Enda O'Connor Abstract Thoracolumbar spine injury is a common complication of blunt multitrauma and up to one third of fractures are associated with spinal cord dysfunction. Delayed fracture diagnosis increases the risk of neurological complications. While validated screening guidelines exist for traumatic c-spine injury equivalent guidelines for thoracolumbar screening are lacking. We conducted a literature review evaluating studies of thoracolumbar injury in trauma patients to generate indications for thoracolumbar imaging. We performed MEDLINE and Pubmed searches using MeSH terms "Wounds, Nonpenetrating", "Spinal Fractures", "Spinal Injuries" and "Diagnostic Errors", MeSH/subheading terms "Thoracic Vertebrae/injuries" and "Lumbar Vertebrae/injuries" and keyword search terms "thoracolumbar fractures", "thoracolumbar injuries", "thoracolumbar trauma", "missed diagnoses" and "delayed diagnoses". Limits and inclusion criteria were defined prior to searching. We evaluated 16 articles; 5 prospective observational studies (1 cohort study) and 11 retrospective observational studies. Predictors of TL injury in prospective studies , high-risk injury mechanism, distracting injury, impaired cognition, symptoms/signs of vertebral fracture and known cervical fracture , were defined and used to construct a decision algorithm, which in a total of 14189 trauma patients from all eligible studies recommended TL screening in 856(99.1%) of 864 patients with TL fractures and would probably have directed TL imaging in the remaining 8 patients. There is limited low level evidence guiding surveillance TL imaging in adult blunt trauma patients. Despite this, we propose and evaluate an algorithm with a high negative predictive value for TL fractures. This should be incorporated into spinal injury assessment protocols. [source] A Comparison of Trauma Intubations Managed by Anesthesiologists and Emergency PhysiciansACADEMIC EMERGENCY MEDICINE, Issue 1 2004Joseph S. Bushra MD Although airway management by emergency physicians has become standard for general emergency department (ED) patients, many believe that anesthesiologists should manage the airways of trauma victims. Objectives: To compare the success and failure rates of trauma intubations performed under the supervision of anesthesiologists and emergency physicians. Methods: This was a prospective, observational study of consecutive endotracheal intubations (ETIs) of adult trauma patients in a single ED over a 46-month period. All ETIs before November 26, 2000, were supervised by anesthesiologists (34 months), and all ETIs from November 26, 2000, onward were supervised by emergency physicians (12 months). Data regarding clinical presentation, personnel involved, medications used, number of attempts required, and need for cricothyrotomy were collected. Study outcomes were: 1) successful intubation within two attempts, and 2) failure of intubation. Failure was defined as inability to intubate, resulting in successful intubation by another specialist, or cricothyrotomy. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were used to compare results between groups. Results: There were 673 intubations during the study period. Intubation within two attempts was accomplished in 442 of 467 patients (94.6%) managed by anesthesiologists, and in 196 of 206 of patients (95.2%) managed by emergency physicians (OR = 1.109, 95% CI = 0.498 to 2.522). Failure of intubation occurred in 16 of 467 (3.4%) patients managed by anesthesiologists, and in four of 206 (1.9%) patients managed by emergency physicians (OR = 0.558, 95% CI = 0.156 to 1.806). Conclusions: Emergency physicians can safely manage the airways of trauma patients. Success and failure rates are similar to those of anesthesiologists. [source] Heightened levels of circulating 20S proteasome in critically ill patientsEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 6 2005G. A. Roth Abstract Background, Recently, circulating proteasome core particles (20S proteasome) have been suggested as a marker of cell damage and immunological activity in autoimmune diseases. Aberrant leucocyte activation and increased lymphocyte apoptosis with consecutive T-cell unresponsiveness is deemed to play a pivotal role in the sepsis syndrome. Moreover sepsis-induced muscle proteolysis mainly reflects ubiqutin proteasome-dependent protein degradation. We therefore sought to investigate serum levels of 20S proteasome in critical ill patients. Material and methods, Case,control-study at a university hospital intensive care unit; 15 patients recruited within 24,48 h of diagnosis of sepsis, 13 trauma patients recruited within 24 h of admission to the ICU, a control group of 15 patients who underwent abdominal surgery, and 15 healthy volunteers. ELISA was used to measure the concentration of 20S proteasome in the sera of the patients and controls. Data are given as mean ± SEM. Mann,Whitney U -test was used to calculate significance and a P -value of 0·05 was considered to be statistically significant. Results, Marked increase of 20S proteasome was detected in the sera of septic patients (33 551 ± 10 034 ng mL,1) as well as in trauma patients (29 669 ± 5750 ng mL,1). In contrast, significantly lower concentrations were found in the abdominal surgery group (4661 ± 1767 ng mL,1) and in the healthy control population (2157 ± 273 ng mL,1). Conclusion, Detection of 20S proteasome may represent a novel marker of immunological activity and muscle degradation in sepsis and trauma patients, and may be useful in monitoring the clinical effect of proteasome-inhibitors. [source] MEGX disposition in critically-ill trauma patients: subsequent assessments during the first week following traumaFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 6 2002Federico Pea ABSTRACT The objective of this study was to evaluate MEGX disposition as a surrogate marker in assessing the influence that injury may exert on liver function during the first week after the traumatic event in young vs. elderly patients. The MEGX exposure over time was assessed at 0.25, 0.5, 1, 2, 4 and 6 h after the intravenous administration of a 1 mg/kg lidocaine test dose in 12 young and 7 elderly trauma patients on days1, 4 and 7 after a severe injury (Apache II score > 10). MEGX plasma concentration,time profiles were consistently different on day 1 in the elderly vs. young, consistent with a statistically significant lower rate of both lidocaine clearance and MEGX formation, and with a considerably longer MEGX elimination in the elderly than in the young. This suggests an impairment of liver blood flow as a result of splanchnic vasoconstriction occurring mainly in elderly trauma patients. A significant improvement in MEGX disposition occurred on days 4 and 7 vs. the day of trauma in most elderly, whereas minor changes were observed in the young. Multiple factors may account for these major changes in the elderly: the more severe status, the major sensitivity to the pathophysiologic changes induced by trauma, and also at least partially the ageing processes. Although referring to a limited number of observations, our findings on MEGX disposition suggest that liver function may be affected by the severity of injury, even if the influence of age should not be underestimated in these patients. [source] Radiation exposure and the justification of computed tomography scanning in an Australian hospital emergency departmentINTERNAL MEDICINE JOURNAL, Issue 11 2009M. Street Abstract In an emergency department (ED), computed tomography (CT) is particularly beneficial in the investigation of high-speed trauma patients. With the advent of multidetector CT (MDCT) scanners, it is becoming faster and easier to conduct scans. In recent years, this has become evident with an increasing number of CT requests. Patients who have multiple CT scans during their hospital stay can receive radiation doses that have an increased theoretical risk of induction of cancer. It is essential that the clinical justification for each CT scan be considered on an individual basis and that due consideration is given to the radiation risk and possible diagnostic benefit. The current lack of a central State or Commonwealth data repository for medical images is a contributing factor to excessive radiation dosage to the population. The principles of justification and radiation risks are discussed in this study. [source] Barriers to the implementation of evidence in osteoporosis treatment in hip fractureINTERNAL MEDICINE JOURNAL, Issue 3 2009M. R. Levinson Abstract An audit at a private tertiary hospital showed low rates of assessment and treatment of osteoporosis in minimal trauma patients of hip fracture. A survey sent to all doctors involved in hip fracture care to establish medical beliefs about effective management of osteoporosis in minimal trauma hip fracture patients showed a lack of ownership for investigation and beliefs influencing treatment choices. Understanding the barriers to the translation of evidence into practice is vital to improve patient care. [source] Early predictors of morbidity and mortality in trauma patients treated in the intensive care unitACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2010O. BRATTSTRÖM Background: We investigated the incidence and severity of post-injury morbidity and mortality in intensive care unit (ICU)-treated trauma patients. We also identified risk factors in the early phase after injury that predicted the later development of complications. Methods: A prospective observational cohort study design was used. One hundred and sixty-four adult patients admitted to the ICU for more than 24 h were included during a 21-month period. The incidence and severity of morbidity such as multiple organ failure (MOF), acute lung injury (ALI), severe sepsis and 30-day post-injury mortality were calculated and risk factors were analyzed with uni- and multivariable logistic regression analysis. Results: The median age was 40 years, the injury severity score was 24, the new injury severity score was 29, the acute physiology and chronic health evaluation II score was 15, sequential organ failure assessment maximum was 7 and ICU length of stay was 3.1 days. The incidences of post-injury MOF were 40.2%, ALI 25.6%, severe sepsis 31.1% and 30-day mortality 10.4%. The independent risk factors differed to some extent between the outcome parameters. Age, severity of injury, significant head injury and massive transfusion were independent risk factors for several outcome parameters. Positive blood alcohol was only a predictor of MOF, whereas prolonged rescue time only predicted death. Unexpectedly, injury severity was not an independent risk factor for mortality. Conclusions: Although the incidence of morbidity was considerable, mortality was relatively low. Early post-injury risk factors that predicted later development of complications differed between morbidity and mortality. [source] Acute kidney injury with renal replacement therapy in trauma patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2010S. BEITLAND Background: Acute kidney injury (AKI) with renal replacement therapy (RRT) is rare in trauma patients. The primary aim of the study was to assess incidence, mortality and chronic RRT dependency in this patient group. Methods: Adult trauma patients with AKI receiving RRT at a regional trauma referral center over a 12-year period were retrospectively reviewed. Results: Population-based incidence of post-traumatic AKI with RRT was 1.8 persons per million inhabitants per year (p.p.m./year) [95% confidence the interval (CI) 1.5,2.1 p.p.m./year]. In trauma patients admitted to hospital, incidence was 0.5, (95% CI 0.3,0.7,) of those treated in intensive care unit (ICU), it was 8.3% (95% CI 5.9,10.8%). The median age was 46 years. Odds ratio (OR) for post-traumatic AKI requiring RRT was higher in males than in females in general population (OR 5.6, 95% CI 2.2,14.0), and in trauma patients admitted to hospital (OR 4.4, 95% CI 1.9,10.3) and ICU (OR 4.5, 95% CI 1.9,10.7). The in-hospital mortality rate was 24% (95% CI 11,37%), 3-month mortality 36% (95% CI 21,51%) and 1-year mortality 40% (95% CI 25,55%). Age was a risk factor for death after 1 year, with 57% (95% CI 7,109%) increased risk for each 10 years added. None of the survivors was dialysis-dependent 3 months or 1 year after trauma. Conclusion: AKI in trauma patients requiring RRT was rare in this single-center study. More males than females were affected. Mortality was modest, and renal recovery was excellent as none of the survivors became dependent on chronic RRT. [source] Outcome of trauma patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2010D. Bäckström No abstract is available for this article. [source] Nursing and medical staff knowledge regarding the monitoring and management of accidental or exposure hypothermia in adult major trauma patientsINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 6 2006Sharyn Ireland RN Dip.HSc B.Nurs CritCareCert ACCN M.Ed Recording a patient's vital signs is a basic requirement that in part informs clinical decision-making. Practice suggests that recording a trauma patient's temperature is occasionally overlooked in the emergency department. A staff survey was undertaken to gain an appreciation of knowledge and understanding of the issues that surround accidental or exposure hypothermia in trauma patients. Results demonstrate that nurses and doctors are unsure of how to define hypothermia and are not conversant with simple ways to prevent heat loss or rewarm patients. Complications from hypothermia such as coagulopathy and metabolic acidosis were seldom identified. Issues that limit staff recording temperature include patient access and acuity, lack of knowledge and confidence and access to temperature-measuring devices. These results emphasize the need for regular education. Implications for clinical practice were considered; an algorithm to guide staff on ways to improve the monitoring and management of temperature in trauma patients was developed. Opportunities for ongoing and further research were identified. [source] Triage and mortality in 2875 consecutive trauma patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2010R. MEISLER Background: Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage. Methods: We prospectively registered all trauma patients in Eastern Denmark over 12 consecutive months. We analysed the flow of trauma patients through the system, the time spent at different locations, and we assessed the risk factors of mortality. Results: We included 2875 trauma patients, of whom 158 (5.5%) died before arrival at the hospital. Most patients (75.3%) were brought to local hospitals and patients primarily (n=82) or secondarily triaged (n=203) to the level I trauma centre were the most severely injured. Secondarily transferred patients spent a median of 150 min in the local hospital before transfer to the level I trauma centre and 48 min on transportation. Severe injury with an injury severity score >15 was seen in 345 patients, of whom 118 stayed at the local hospital. They had a significantly higher mortality than 116 of those secondarily transferred [45/118, 38.1% vs. 11/116, 9.7% (P<0.0001)]. Mortality within 30 days was 4.3% in admitted patients, and significant risk factors of death were violence [odds ratio (OR)=5.72], unconsciousness (OR=4.87), hypotension (OR=4.96), injury severity score >15 (OR=27.42), and age. Conclusions: Around 50% of all trauma deaths occurred at the scene. Increased survival of severely injured patients may be achieved by early transfer to highly specialised care. [source] | ||||||||||||||||||||||||||||||||||