464 Clinical characteristics of adrenal injury in trauma patients

2013 ◽  
Vol 12 (1) ◽  
pp. e464
Author(s):  
K.J. Oh ◽  
W.S. Jang ◽  
I. Hwang ◽  
E.C. Hwang ◽  
H.S. Yu ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Trauma Patients ◽  
Adrenal Injury

scholarly journals Effects of Not Intubating Non-Trauma Patients With Low Glasgow Coma Scale Scores: a Retrospective Study

2022 ◽  
Vol 2 (1) ◽  
pp. 83-90
Author(s):  
Loui K Alsulimani ◽  
Ohoud Baajlan ◽  
Khalid Alghamdi ◽  
Raghad Alahmadi ◽  
Abdullah Bakhsh ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Clinical Characteristics ◽  
Tertiary Care ◽  
Altered Mental Status ◽  
Trauma Patients ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Coma Scale ◽  
Scale Scores ◽  
Gcs Score

Background: Endotracheal intubation (EI) is a critical life-saving procedure commonly performed on emergency department (ED) patients who present with altered mental status (AMS).  Aims: We aimed to investigate the safety of observing, without EI, patients who present to the ED with decreased levels of consciousness (LOC).  Methods: We reviewed the data of all adult ED patients with a Glasgow Coma Scale (GCS) score ≤ 8, during the period between 2012 and 2018, in an academic tertiary care centre. Trauma patients were excluded. The patients were divided into two groups for comparison: those who were intubated and those who were not. Data on mortality, morbidity, and baseline clinical characteristics were collected and analysed.  Results: After screening 6334 electronic medical records of patients presenting to the ED with decreased LOC, only 257 patients met the inclusion criteria. 173 (67.3%) patients were intubated, while 84 (32.7%) were not. Among the intubated patients, 165 (95.4%) were intubated early (within two hours of presentation). Mortality, morbidity and length of stay for the intubated group were higher, although the baseline clinical characteristics were the same.  Conclusion: It might be safe to observe non-trauma emergency patients with a GCS score ≤ 8 without intubation. However, such decision should be taken carefully, as delayed intubation can be associated with higher mortality and morbidity

scholarly journals Characteristics, injuries, and clinical outcomes of geriatric trauma patients in Japan: an analysis of the nationwide trauma registry database

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yukari Miyoshi ◽  
Yutaka Kondo ◽  
Yohei Hirano ◽  
Tadashi Ishihara ◽  
Koichiro Sueyoshi ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Clinical Characteristics ◽  
Japanese Society ◽  
Trauma Registry ◽  
Economic Problem ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Age Group ◽  
Epidemiological Characteristics ◽  
Registry Database

Abstract Geriatric trauma is a major socio-economic problem, especially among the aging Japanese society. Geriatric people are more vulnerable to trauma than younger people; thus, their outcomes are often severe. This study evaluates the characteristics of geriatric trauma divided by age in the Japanese population. We evaluated trauma characteristics in patients (n = 131,088) aged ≥ 65 years by segregating them into 2 age-based cohorts: age 65–79 years (65–79 age group; n = 70,707) and age ≥ 80 years (≥ 80 age group; n = 60,381). Clinical characteristics such as patient background, injury mechanism, injury site and severity, treatment, and outcome were examined. Injuries among men were more frequent in the 65–79 age group (58.6%) than in the ≥ 80 age group (36.3%). Falls were the leading cause of trauma among the 65–79 age group (56.7%) and the ≥ 80 age group (78.9%). In-hospital mortality was 7.7% in the 65–79 age group and 6.6% in the ≥ 80 age group. High fall in the ≥ 80 age group showed 30.5% mortality. The overall in-hospital mortality was 11.8% (the 65–79 age group, 12.3%; the ≥ 80 age group, 11.2%). Most hospitalized patients were transferred to another hospital (the 65–79 age group, 52.5%; the ≥ 80 age group, 66.2%). We demonstrated the epidemiological characteristics of Japanese geriatric trauma patients. The overall in-hospital mortality was 11.8%, and fall injury in the ≥ 80 age group required caution of trauma care.

Calcaneal gait. Etiology and clinical presentation

1999 ◽  
Vol 89 (1) ◽  
pp. 39-49 ◽  
Author(s):  
E Sobel ◽  
A Glockenberg
Keyword(s):  
Clinical Characteristics ◽  
Clinical Presentation ◽  
Gait Pattern ◽  
Gait Disorders ◽  
Trauma Patients ◽  
The Past

Equinus deformities are common in neuromuscular and trauma patients. In contrast, calcaneal gait disorders tend to be overlooked, and few reports characterize and review calcaneal gait problems and disabilities. In the past 3 years, the authors treated 17 patients with calcaneal gait. Six of these cases are reviewed; in addition, the general clinical characteristics of the patient with calcaneal gait pattern are described.

scholarly journals Life-threatening Hypotension in a Multi-trauma-brain Injured Patient With Unilateral Adrenal Gland Damage; a Single Hydrocortisone Dose Unraveled Relative Corticosteroid Insufficiency.

2021 ◽  
Author(s):  
GEORGE E ZAKYNTHINOS ◽  
PARIS ZYGOULIS ◽  
ALEXANDRA TSIKRIKA ◽  
VASILIKI TSOLAKI
Keyword(s):  
Adrenal Gland ◽  
Ct Scan ◽  
Adrenal Insufficiency ◽  
Injured Patient ◽  
Trauma Patients ◽  
Brain Injured Patient ◽  
Brain Injured ◽  
Cortisol Levels ◽  
Corticosteroid Insufficiency ◽  
Adrenal Injury

Abstract BackgroundThe incidence of adrenal injury after trauma is very rare. Bilateral adrenal injury, which may lead to acute adrenal insufficiency and death, whereas unilateral adrenal trauma is often asymptomatic and masked by injuries to other organs. However, when unilateral adrenal trauma is associated with multiple injuries including brain trauma, critical illness‑related corticosteroid insufficiency (CIRCI) may be present; despite the importance, criteria for the diagnosis are not well established.Case presentationWe report a 16-year-old multi-trauma, brain-injured patient with unilateral adrenal gland injury. An intraparenchymal catheter for intracranial pressure (ICP) monitoring was inserted and craniectomy was performed. Postoperatively, the patient was admitted in the Intensive Care Unit (ICU) under sedation. He presented severe circulatory shock (noradrenaline dose of 1.86 μg/kg/min). which was not reversed despite red blood cell transfusions (noradrenaline increased to 2 μg/kg/min, lactate 1.8-2.1 mmol/L, although Hct was stabilized to 34 g/dl). Empiric hydrocortisone (150 mg intravenously) was administered for suspected adrenal insufficiency, after a blood sample for cortisol levels was drawn. An abrupt improvement in hemodynamics was noted [noradrenaline dose was reduced by half (1 μg/ kg/min) in less than 1 hour, and almost became insignificant during the next 8 hours, while lactate normalized (0.9 mmol/L)]. Hydrocortizone administration was continued for nine days. Fluid balance was restored after the first day. Baseline cortisol levels were 11.45 μg/dl. ICP was steadily less than 20 mmHg. Adrenal hematoma dimensions had increased (4 x 2.7 cm), as seen in the abdominal CT scan performed 9 hours after admission. Twenty days later, a follow up CT scan revealed regression of the hematoma. His remaining ICU course was complicated by fever and sepsis and remained in the ICU for 41 days.ConclusionAlthough, data do not support the use of empiric steroids in trauma patients (with or without brain injury), this case demonstrates that adrenal insufficiency must be considered in the differential diagnosis when shock exists; adrenal gland injury, even unilateral, may play an additional factor. An urgent decision is needed, that can influence outcome.

scholarly journals A Nomogram Based on Clinical Characteristics for Predicting Multiple Organ Dysfunction Syndrome(MODS) Following Multiple Trauma Patients

2020 ◽  
Author(s):  
ZhenJun Miao ◽  
Faxing Wei ◽  
Feng Zhou
Keyword(s):  
Logistic Regression ◽  
Multiple Trauma ◽  
Clinical Characteristics ◽  
Area Under The Curve ◽  
Trauma Patients ◽  
Multivariate Logistic Regression ◽  
Training Set ◽  
Lemeshow Test ◽  
Validation Set ◽  
Multiple Trauma Patients

Abstract BackgroundMultiple organ dysfunction syndrome (MODS) is the one of common complications,and the leading cause of late mortality in multiple trauma patients.The present study aims to develop and validate a nomogram based on clinical characteristics in order to identify the patients with multiple trauma who were at risk of developing MODS.MethodsAn retrospective cohort study was performed with data from January 2011 to December 2019,totally 770 patients with multiple trauma were enrolled in our study.They were randomly categorized into training set (n=514) and validation set (n=256).The univariate and multivariate logistic regression analyses were used to screen the predictors for multiple trauma patients who were at risk of developing MODS from training set data.Then we established a nomogram based on these above predictors.The discriminative capacity was assessed by receiver operating characteristic (ROC) curve area under the curve (AUC), and the predictive precision was depicted by calibration plot.The Hosmer-Lemeshow test was used to evaluate the the model’s goodness of fit.ResultsOur study showed that age,ISS,hemorrhagic shock,heart rate,blood glucose,D-dimer and APTT were independent risk factors for MODS in patients with multiple trauma by multivariate logistic regression analysis.A nomogram was established on basis of these above risk factors.The area under the curve (AUC) was 0.868 (95% confidence interval [CI]:0.829-0.908) in the training set and 0.884 (95% confidence interval [CI]:0.833-0.935) in the validation set.The Hosmer-Lemeshow test has a p value of 0.227 in training set and 0.554 in validation set respectively,which confirm the model’s goodness of fit.Calibration plot showed that the predicted and actual incidence of MODS probability were fitted well on both internal and external validations.ConclusionsThe present nomogram had a well predictive precision and discrimination capacity,which can facilitate improved screening and early identification of multiple trauma patients who were at high risk of developing MODS.

scholarly journals Epidemiological and clinical characteristics of road traffic crashes related thoracic traumas: analysis of 5095 hospitalized chest injury patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Shengcao Zhang ◽  
Xiangzhi Xiao ◽  
Jian Wang ◽  
Chengkai Hu ◽  
Qiancheng Du ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Injury Severity ◽  
Road Traffic ◽  
Rib Fractures ◽  
Motor Vehicles ◽  
Trauma Patients ◽  
Thoracic Injuries ◽  
Traffic Crashes ◽  
Road Traffic Crashes ◽  
Chest Injuries

Abstract Background Road traffic crashes related (RTCR) chest traumas remain important global public health challenge. The impact of boosting market of automobile vehicles in China during last decade on thoracic injury needs to be defined. This study aimed to review and analyze the demographic and clinical characteristics of RTCR thoracic injuries in China. Methods Clinical records of patients with thoracic trauma admitted to thoracic surgery department between January 2003 and June 2020 were retrospectively retrieved and reviewed. Patients’ profiles and clinical characteristics were comparatively analyzed between road traffic crashes caused injury and other injury mechanisms, and in RTCR chest trauma patients before January 2011 (2003 group), and after January 2011 (2011 group), when is considered as the beginning year of Chinese household vehicle era. Results The study included 5095 thoracic trauma patients with mean age of 50.2 years, of whom 79.4% were male. Most of the patients (70.3%, n = 3583) had rib fractures. Associated injuries were present in 52.0% of the patients, of them 78.5% (n = 2080) were extremity fractures. Road traffic crashes accounted for 41.4% (n = 2108) of the injuries, most of them (98.0%) were related to motor vehicles. In comparison with other chest trauma mechanisms, RTCR chest injuries affected females and older males more frequently, with a higher incidence of rib fractures and sternum fractures, and higher injury severity scores (ISS) (all p < 0.05). Surgeries were required in 1495 (70.9%) patients of the RRTCR chest traumas, while the majority of non-RTCR thoracic injuries were managed conservatively or with tube thoracostomy (30.2%, n = 901). RTCR chest traumas caused longer hospital stay (13.0 ± 9.6 days vs. 11.8 ± 7.4 days, p = 0.001), higher ICU usage (30.7% vs. 19.6%, p = 0.001), higher rate of ventilator support (12.9% vs. 7.5%, p = 0.001), and higher mortalities (3.8% vs. 1.6%, p = 0.005) than that of non-RTRA chest injuries. For RTCR patients, when compared with 2003 group, 2011 group had similar patterns in terms of accident category, associated injury and treatment. However, 2011 group had more females (38.5% vs. 18.0%, p = 0.001) and older males (50.6 ± 9.7 vs. 47.9 ± 17.2, p = 0.001), with a higher ISS (18.3 ± 10.2 vs. 17.1 ± 8.9, p = 0.004), and fewer were managed with chest tubes (25.0% vs. 29.2%, p = 0.031). Clinical outcomes were not significantly different between the groups in terms of hospital length of stay, intensive care unit (ICU) usage, ICU length of stay, duration of ventilator hours and mortality. However, the 2011 group had more patients requiring ventilator support (14.4% vs. 10.6%, p = 0.011). Conclusions Road traffic crashes remain to be the major etiology of thoracic injuries in China, which usually affects middle-aged males, causing rib fractures with concomitant injuries frequently occurring to other organ systems. Treatments mainly include tube thoracotomy and surgical procedures. Although the clinical characteristics and outcomes of traffic accident related chest traumas are largely unchanged in spite of the rapid increasing numbers of motor vehicles, variations in the pattern of injuries by gender, age, injury severity and ventilator usage may still provide important information for targeted management.

scholarly journals Effect of the COVID-19 pandemic on health insurance coverage among trauma patients: a study of six level I trauma centers

2021 ◽  
Vol 6 (1) ◽  
pp. e000640
Author(s):  
Erica Sercy ◽  
Therese M Duane ◽  
Mark Lieser ◽  
Robert M Madayag ◽  
Gina Berg ◽  
...  
Keyword(s):  
Health Insurance ◽  
Clinical Characteristics ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Insurance Type ◽  
Period 2 ◽  
Insured Patients ◽  
Privately Insured

BackgroundIncreased unemployment during the COVID-19 pandemic has likely led to widespread loss of employer-provided health insurance. This study examined trends in health insurance coverage among trauma patients during the COVID-19 pandemic, including differences in demographics and clinical characteristics by insurance type.MethodsThis was a retrospective study on adult patients admitted to six level 1 trauma centers between January 1, 2018 and June 30, 2020. The primary exposure was hospital admission date: January 1, 2018 to December 31, 2018 (Period 1), January 1, 2019 to March 15, 2020 (Period 2), and March 16, 2020 to June 30, 2020 (Period 3). Covariates included demographic and clinical variables. χ² tests examined whether the rates of patients covered by each insurance type differed between the pandemic and earlier periods. Mann-Whiney U and χ² tests investigated whether patient demographics or clinical characteristics differed within each insurance type across the study periods.ResultsA total of 31 225 trauma patients admitted between January 1, 2018 and June 30, 2019 were included. Forty-one per cent (n=12 651) were admitted in Period 1, 49% (n=15 258) were from Period 2, and 11% (n=3288) were from Period 3. Percentages of uninsured patients increased significantly across the three periods (Periods 1 to 3: 15%, 16%, 21%) (ptrend=0.02); however, there was no accompanying decrease in the percentages of commercial/privately insured patients (Periods 1 to 3: 40%, 39%, 39%) (ptrend=0.27). There was a significant decrease in the percentage of patients on Medicare during the pandemic period (Periods 1 to 3: 39%, 39%, 34%) (p<0.01).DiscussionThis study found that job loss during the COVID-19 pandemic resulted in increases of uninsured trauma patients. However, there was not a corresponding decrease in commercial/privately insured patients, as may have been expected; rather, a decrease in Medicare patients was observed. These findings may be attributable to a growing workforce during the study period, in combination with a younger overall patient population during the pandemic.Level of evidenceRetrospective, level III study.

scholarly journals Pediatric ocular trauma with pars plana vitrectomy in Southwest of China: clinical characteristics and outcomes

2021 ◽  
Vol 14 (9) ◽  
pp. 1321-1326
Author(s):  
Zuo-Xin Qin ◽  
◽  
Yu-Fei Xu ◽  
Tao Yu ◽  
Yong Liu ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Retinal Detachment ◽  
Odds Ratio ◽  
Clinical Characteristics ◽  
Ocular Trauma ◽  
Univariate Analysis ◽  
Trauma Patients ◽  
Female Ratio ◽  
Open Globe ◽  
Pediatric Ocular Trauma

AIM: To investigate the clinical characteristics and predictive factors of pediatric ocular trauma patients with vitrectomy. METHODS: Pediatric ocular trauma patients (aged 14y or younger) who received vitrectomy in Southwest Hospital between January 2007 and December 2017 were reviewed retrospectively. Age, gender, mechanism of injury, final visual acuity (VA), and prognostic factors were analyzed. RESULTS: A total of 139 eyes in 139 pediatric patients were included in the study. The mean age was 7.4±3.7 years old and the male-to-female ratio was 5:1. There were 104 (74.8%) open globe injuries and 35 (25.2%) closed globe injuries. The top one traumatic eye injuries were penetrating injuries occur through sharp metal objects (43.9%). After vitrectomy, 116 patients had favorable anatomic outcome at the last follow-up, and 30 eyes (21.6%) achieved VA of 20/200 or better. Following univariate analysis, we found zone III injuries (P=0.021), poor initial VA (P=0.005), endophthalmitis (P=0.024), and recurrent retinal detachment (P<0.001) were poor prognostic factors for pediatric ocular trauma. After Logistic regression analysis, the poor initial VA (odds ratio: 8.276, 95%CI: 1.597-42.897, P=0.012) and recurrent retinal detachment (odds ratio: 6.455, 95%CI: 2.372-17.562, P<0.001) were significantly correlated with unfavorable vision outcome in pediatric ocular trauma. CONCLUSION: The treatment of vitrectomy for severe ocular trauma results in favorable anatomic outcomes, but VA improvement is not as good as anatomic outcomes. Initial VA and recurrent retinal detachment are the independent prognostic indicators for unfavorable visual outcome of severe pediatric ocular trauma.

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