scholarly journals Analysis of Casualties That Underwent Airway Management Before Reaching Role 2 Facilities in the Afghanistan Conflict 2008–2014

2020 ◽  
Vol 185 (Supplement_1) ◽  
pp. 10-18
Author(s):  
Ian L Hudson ◽  
Megan B Blackburn ◽  
Amanda M Staudt ◽  
Kathy L Ryan ◽  
Elizabeth A Mann-Salinas
Keyword(s):  
Demographic Data ◽  
Trauma Patients ◽  
Significant Other ◽  
Statistical Association ◽  
Multivariable Logistic Regression Model ◽  
Airway Intervention ◽  
Mortality Index ◽  
Military Patients ◽  
To Receive ◽  
Future Management

Abstract Introduction Airway compromise is the second leading cause of potentially survivable death on the battlefield. The purpose of this study was to better understand wartime prehospital airway patients. Materials and Methods The Role 2 Database (R2D) was retrospectively reviewed for adult patients injured in Afghanistan between February 2008 and September 2014. Of primary interest were prehospital airway interventions and mortality. Prehospital combat mortality index (CMI-PH), hemodynamic interventions, injury mechanism, and demographic data were also included in various statistical analyses. Results A total of 12,780 trauma patients were recorded in the R2D of whom 890 (7.0%) received prehospital airway intervention. Airway intervention was more common in patients who ultimately died (25.3% vs. 5.6%); however, no statistical association was found in a multivariable logistic regression model (OR 1.28, 95% CI 0.98–1.68). Compared with U.S. military personnel, other military patients were more likely to receive airway intervention after adjusting for CMI-PH (OR 1.33, 95% CI 1.07–1.64). Conclusions In the R2D, airway intervention was associated with increased odds of mortality, although this was not statistically significant. Other patients had higher odds of undergoing an airway intervention than U.S. military. Awareness of these findings will facilitate training and equipment for future management of prehospital/prolonged field care airway interventions.

scholarly journals Independent Predictors of Mortality in Torso Trauma Injuries

2020 ◽  
Vol 9 (10) ◽  
pp. 3202
Author(s):  
Roberto Bini ◽  
Caterina Accardo ◽  
Stefano Granieri ◽  
Fabrizio Sammartano ◽  
Stefania Cimbanassi ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Demographic Data ◽  
Trauma Patients ◽  
Related Condition ◽  
Predictors Of Mortality ◽  
Risk Of Death ◽  
Therapeutic Procedures ◽  
Torso Trauma ◽  
Enhanced Computed Tomography

Noncompressible torso injuries (NCTIs) represent a trauma-related condition with high lethality. This study’s aim was to identify potential prediction factors of mortality in this group of trauma patients at a Level 1 trauma center in Italy. Materials and Methods: A total of 777 patients who had sustained a noncompressible torso injury (NCTI) and were admitted to the Niguarda Trauma Center in Milan from 2010 to 2019 were included. Of these, 166 patients with a systolic blood pressure (SBP) <90 mmHg were considered to have a noncompressible torso hemorrhage (NCTH). Demographic data, mechanism of trauma, pre-hospital and in-hospital clinical conditions, diagnostic/therapeutic procedures, and survival outcome were retrospectively recorded. Results: Among the 777 patients, 69% were male and 90.2% sustained a blunt trauma with a median age of 43 years. The comparison between survivors and non-survivors pointed out a significantly lower pre-hospital Glasgow coma scale (GCS) and SBP (p < 0.001) in the latter group. The multivariate backward regression model identified age, pre-hospital GCS and injury severity score (ISS) (p < 0.001), pre-hospital SBP (p = 0.03), emergency department SBP (p = 0.039), performance of torso contrast enhanced computed tomography (CeCT) (p = 0.029), and base excess (BE) (p = 0.008) as independent predictors of mortality. Conclusions: Torso trauma patients who were hemodynamically unstable in both pre- and in-hospital phases with impaired GCS and BE had a greater risk of death. The detection of independent predictors of mortality allows for the timely identification of a subgroup of patients whose chances of survival are reduced.

scholarly journals Investigating the Level of Access to Hospital Medical Facilities Using the Geographical Information System (GIS) in Yazd, Iran, in 2019

2020 ◽  
Author(s):  
Roohollah Askari ◽  
Milad Shafiee ◽  
Zabihollah Charrahi ◽  
Seyed Ali Almodarresi ◽  
Seyed Mohammad Afrazandeh
Keyword(s):  
Information System ◽  
Geographical Information System ◽  
Emergency Services ◽  
Demographic Data ◽  
Geographical Information ◽  
Hospital Medical ◽  
Geographical Access ◽  
Medical Facilities ◽  
Yazd City ◽  
To Receive

Introduction: proper geographical access to hospital medical facilities will increase people’s visits to receive non-emergency services and no delay in providing emergency services. This research aimed to determine the level of access to hospital medical facilities with Geographical Information System in Yazd in 2019. Methods: This research is descriptive and applied. The required data for analyzing access included the information related to all existing hospitals, demographic data, and the layer of Yazd’s population blocks. Data analysis was carried out with GIS10.3 software. Results: Yazd city has 11 hospitals and 1915 active beds. The number of hospitals was proportional to the total population, but there was a shortage of 147 active beds. The per capita hospital space was 0.40 square meters, which is more than the standard (0.37 m2). The distribution of hospitals and beds in different regions of Yazd was inequitable. The population with high or desirable access (the population within a 1500-meter radius of the hospitals) to the hospitals with emergency, internal and surgery, pediatric, and gynecology units made up 54.12, 41.92, 44.44, and 48.34 percent of the Yazd’s population, respectively. Also, the population with limited access (the population out of a 3000-meter radius of hospitals) to the hospitals with emergency, internal and surgery, pediatric, and gynecology units made up 15.40, 31.72, 21.78, and 18.89 percent of the Yazd’s population, respectively. Conclusion: Regarding the obtained results, it is concluded that there is no shortage of hospitals and hospital space in Yazd, and the number of beds is not way below the international standard. However, locating the hospitals is not so that a large proportion of the population is placed within the radius of high or desirable access to hospitals.

Introduction

2018 ◽  
pp. 1-10
Author(s):  
Christopher A. Kearney ◽  
Anne Marie Albano
Keyword(s):  
Physical Symptoms ◽  
School Refusal ◽  
Significant Other ◽  
School Refusal Behavior ◽  
General Distress ◽  
Tangible Rewards ◽  
To Receive

Chapter 1 serves as an introduction to this parent workbook on treating school refusal behavior. School refusal behavior includes children aged 5 to 17 years who refuse to attend school and/or have trouble remaining in classes for an entire day. This is a common, difficult, and widespread problem, and can develop into a more serious one if left untreated. This introductory chapter covers the frequency and major features of school refusal behavior. Four reasons are outlined for school refusal behavior: (1) to stay away from objects or situations at school that make the child feel unpleasant physical symptoms or general distress; (2) to stay away from social or evaluative situations at school that are anxious for the child; (3) to receive attention from a parent or a significant other; and (4) to obtain tangible rewards outside of school that make skipping school more fun than staying in school.

Analysis of factors related to the development of ventilator-associated pneumonia: use of existing databases

2000 ◽  
Vol 9 (5) ◽  
pp. 344-349 ◽  
Author(s):  
JF Byers ◽  
ML Sole
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Odds Ratio ◽  
Demographic Data ◽  
Tube Feeding ◽  
Causative Organism ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Receptor Antagonists ◽  
Level I

OBJECTIVE: To investigate factors related to ventilator-associated pneumonia to assist in the development and implementation of prevention strategies. METHODS: A retrospective, descriptive design was used. Power analysis determined sample size. A consecutive sample of 120 patients admitted to the critical care units of a level I trauma center who were receiving mechanical ventilation was used. Data were obtained from clinical and financial databases. Variables included demographic data, causative organism of the pneumonia, medications, comorbid conditions, complications, duration of therapies, length of stay, and cost per case. RESULTS: The average patient was a 49-year-old man. The sample was 54.9% trauma patients, and the prevalence of ventilator-associated pneumonia was 16.7%. Significant factors included duration of intubation (r = 0.28, P = .005), mechanical ventilation (r = 0.26, P = .005), and tube feeding (r = 0.30, P = .001); trauma (phi = 0.24, P = .009); and use of histamine2 receptor antagonists (phi = -0.25, P = .006). The only variable that significantly increased the odds ratio for ventilator-associated pneumonia was trauma. The only variable that significantly decreased the odds ratio was use of histamine2 receptor antagonists. Patients in whom ventilator-associated pneumonia developed had a 16-day increase in length of stay (t = -2.68, P = .008), and a $29,369 increase in cost per case (t = -3.649, P = .000). CONCLUSIONS: These findings provide a baseline for discussions about potential changes in practice to help prevent ventilator-associated pneumonia.

scholarly journals P142: The anticoagulated trauma patient: a Canadian experience in the era of direct oral anticoagulants

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S125-S125 ◽  
Author(s):  
B. Wood ◽  
A. Ackery ◽  
S. Rizoli ◽  
B. Nascimento ◽  
M. Sholzberg ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Injury Severity ◽  
Hematological Parameters ◽  
Oral Anticoagulants ◽  
Demographic Data ◽  
Direct Oral Anticoagulants ◽  
Significant Proportion ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Trauma Population

Introduction: The anticoagulated trauma patient is a particularly vulnerable population. Our current practice is guided by experience with patients taking vitamin K dependent antagonists (VKA, like warfarin). It is currently unknown how the increasing use of direct oral anticoagulants (DOACs) will change our trauma population. We collected data about this new subset of patients to compare their clinical characteristics to patients on pre-injury VKA therapy. Methods: Retrospective review of anticoagulated trauma patients presenting to Toronto’s two adult trauma centres, Saint Michael’s Hospital and Sunnybrook Health Sciences Centre, from June 2014-June 2015 was undertaken. Patients were recruited through the institutions’ trauma registries and were eligible if they suffered a traumatic injury and taking an oral anticoagulant pre-injury. Clinical and demographic data were extracted by a trained reviewer and analysed with descriptive statistics. Results: Our study recruited 85 patients, 33% were taking DOACs and 67% VKAs. Trauma patients on DOACs & VKAs respectively had similar baseline characteristics such as age (75.9 vs 77.4), initial injury severity score (ISS (16.9 vs 20.6)) and concomitant antiplatelet use (7.1% vs 5.4%). Both groups’ most common mechanism for injury was falls and the most common indication for anticoagulation was atrial fibrillation. Patients on DOACs tended to have lower average INR (1.25 vs 2.3) and serum creatinine (94.9 vs 127.4). Conclusion: Patients on DOACs pre-injury now account for a significant proportion of orally anticoagulated trauma patients. Patients on DOACs tended to have less derangement of basic hematological parameters complicating diagnosis and management of coagulopathy.

Narcotrend Monitoring Allows Faster Emergence and a Reduction of Drug Consumption in Propofol–Remifentanil Anesthesia

2003 ◽  
Vol 99 (1) ◽  
pp. 34-41 ◽  
Author(s):  
Sascha Kreuer ◽  
Andreas Biedler ◽  
Reinhard Larsen ◽  
Simone Altmann ◽  
Wolfram Wilhelm
Keyword(s):  
Demographic Data ◽  
Clinical Parameters ◽  
Standard Practice ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Target Values ◽  
Recovery Times ◽  
The Impact ◽  
To Receive ◽  
Written Informed Consent

Background The Narcotrend is a new electroencephalographic monitor designed to measure depth of anesthesia, based on a six-letter classification from A (awake) to F (increasing burst suppression) including 14 substages. This study was designed to investigate the impact of Narcotrend monitoring on recovery times and propofol consumption in comparison to Bispectral Index (BIS) monitoring or standard anesthetic practice. Methods With institutional review board approval and written informed consent, 120 adult patients scheduled to undergo minor orthopedic surgery were randomized to receive a propofol-remifentanil anesthetic controlled by Narcotrend, by BIS(R), or solely by clinical parameters. Anesthesia was induced with 0.4 micro x kg-1 x min-1 remifentanil and a propofol target-controlled infusion at 3.5 microg/ml. After intubation, remifentanil was reduced to 0.2 micro x kg-1 x min-1, whereas the propofol infusion was adjusted according to clinical parameters or to the following target values: during maintenance to D(0) (Narcotrend) or 50 (BIS); 15 min before the end of surgery to C(1) (Narcotrend) or 60 (BIS). Recovery times were recorded by a blinded investigator, and average normalized propofol consumption was calculated from induction and maintenance doses. Results The groups were comparable for demographic data, duration of anesthesia, and mean remifentanil dosages. Compared with standard practice, patients with Narcotrend or BIS monitoring needed significantly less propofol (standard practice, 6.8 +/- 1.2 mg x kg-1 x h-1 vs. Narcotrend, 4.5 +/- 1.1 mg x kg-1 x h-1 or BIS(R), 4.8 +/- 1.0 mg x kg-1 x h-1; P &lt; 0.001), opened their eyes earlier (9.3 +/- 5.2 vs. 3.4 +/- 2.2 or 3.5 +/- 2.9 min), and were extubated sooner (9.7 +/- 5.3 vs. 3.7 +/- 2.2 or 4.1 +/- 2.9 min). Conclusions The results indicate that Narcotrend and BIS monitoring are equally effective to facilitate a significant reduction of recovery times and propofol consumption when used for guidance of propofol titration during a propofol-remifentanil anesthetic.

Compliance with Closest Hospital Transport Protocol

1992 ◽  
Vol 7 (3) ◽  
pp. 243-249 ◽  
Author(s):  
Robert L. Norton ◽  
Edward A. Bartkus ◽  
Keith W. Neely ◽  
John A. Schriver ◽  
Jerris R. Hedges
Keyword(s):  
Trauma System ◽  
Trauma Patients ◽  
Patient Transport ◽  
Multnomah County ◽  
Ground Ambulance ◽  
Hospital Transport ◽  
Trauma Score ◽  
Injured Patients ◽  
To Receive ◽  
Multiple Patients

AbstractHypothesis:Paramedics accurately estimate the closest trauma hospital for ground transport.Population:Ground ambulance scene transports of trauma system patients to six participating trauma hospitals in Multnomah County, Oregon from 1 January 1986 to 1 January 1987 were studied. Transports involving multiple patients or pediatric patients were excluded.Methods:A retrospective analysis was performed on consecutive patient transports to be taken to the closest trauma hospital as required by protocol. The availability of each hospital to receive trauma patients was monitored continuously by a central communications facility. Paramedics were provided hospital availability data at the time of patient system entry. When several hospitals were available, the paramedics were required by protocol to select the “closest” hospital. Subsequently, the vector distance from the trauma site to each of the available hospitals was measured using a grid map. This method was validated by odometer measurement (r2 = 0.924). Chisquare analysis was used to analyze hospital bypasses to specific hospitals.Results:Of the 1193 eligible patients entered into the trauma system, 160 (13%; 95% CI = 11–15%) transports bypassed the closest available hospital for a receiving hospital ≥1 mile more distant. There were 11 (1%; 0–2%) patients transported to a hospital more than five miles more distant. Of the 132 patients with a trauma score (TS) <12, 15 (11%; 6–18%) were taken to a hospital one mile or further beyond the closest hospital. None (0%; 0–2%) were transported more than five miles past the closest hospital. Of the six hospitals, three were bypassed more than one mile significantly more often then they received bypass patients. One hospital received such patients four times more than it was bypassed (p <.001).Conclusion:While paramedics generally can identify the closest hospital for trauma patient transport, some systematic hospital bypass errors occur. If a community wants assurance of an equitable patient distribution among participating trauma hospitals and assignment of the closest geographic hospital for injured patients, then map vector distance determination to identify the closest available hospital should supplement paramedic dispatching.

scholarly journals Improving postoperative radiographs for the parameter measurement of hexapod external fixator using an additional foot ring

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yanshi Liu ◽  
Kai Liu ◽  
Feiyu Cai ◽  
Tao Zhang ◽  
Aihemaitijiang Yusufu
Keyword(s):  
External Fixation ◽  
Clinical Outcomes ◽  
External Fixator ◽  
Demographic Data ◽  
Deformity Correction ◽  
Parameter Measurement ◽  
Fixation Time ◽  
Trauma Patients ◽  
Group I ◽  
Outcomes Evaluation

Abstract Background It is challenging to determine the orthogonality of radiographs in daily clinical practice. The purpose of this study was to show the usefulness of an additional foot ring which might determine the orthogonality of postoperative radiographs for the parameter measurement of hexapod external fixator. Methods We retrospectively analyzed 81 consecutive trauma patients with tibial shaft fractures treated by the hexapod external fixator at our institution from September 2014 to July 2019. Starting in March 2016, the postoperative radiographs for parameter measurement were obtained under the control of an additional foot ring. The final data consisted of 47 patients in traditional radiographs (Group I) and 34 patients under the control of foot ring during the radiographic process (Group II). The demographic data, original postoperative deformities, residual deformities after final correction, number of repeated radiographs after the first postoperative radiographs, time to the satisfactory reduction achieved, and external fixation time in all patients were documented and analyzed. The Johner–Wruhs criteria were used for the final clinical outcomes evaluation at the last clinical visit. Results Satisfactory reduction and bone union were achieved in all patients. There were no statistical significances between the two groups in the demographic data, original postoperative deformities, residual deformities after final correction, external fixation time, and the final clinical outcomes (P > 0.05). The mean number of repeated radiographs after the first radiographs (1.4 times) and mean time to the satisfactory reduction achieved (3.3 days) in patients with an additional foot ring used were all less than those without foot ring (2.4 times, 5.3 days) (P < 0.05). Conclusions The additional foot ring is a practical device to ensure the orthogonality of postoperative radiographs for the hexapod external fixator parameter measurement. Radiation exposure, duration of deformity correction, and cost for patients might be reduced due to the less repeated radiographs with the wrong position.

scholarly journals Impact of the COVID-19 outbreak on severe trauma trends and healthcare system reassessment in Lombardia, Italy: an analysis from the regional trauma registry

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Riccardo Giudici ◽  
Armando Lancioni ◽  
Hedwige Gay ◽  
Gabriele Bassi ◽  
Osvaldo Chiara ◽  
...  
Keyword(s):  
Injury Severity ◽  
Life Support ◽  
Trauma Registry ◽  
Demographic Data ◽  
Advanced Life Support ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Icu Admission ◽  
Patient Admissions ◽  
High Level

Abstract Backgrounds The COVID-19 pandemic drastically strained the health systems worldwide, obligating the reassessment of how healthcare is delivered. In Lombardia, Italy, a Regional Emergency Committee (REC) was established and the regional health system reorganized, with only three hospitals designated as hubs for trauma care. The aim of this study was to evaluate the effects of this reorganization of regional care, comparing the distribution of patients before and during the COVID-19 outbreak and to describe changes in the epidemiology of severe trauma among the two periods. Methods A cohort study was conducted using retrospectively collected data from the Regional Trauma Registry of Lombardia (LTR). We compared the data of trauma patients admitted to three hub hospitals before the COVID-19 outbreak (September 1 to November 19, 2019) with those recorded during the pandemic (February 21 to May 10, 2020) in the same hospitals. Demographic data, level of pre-hospital care (Advanced Life Support-ALS, Basic Life Support-BLS), type of transportation, mechanism of injury (MOI), abbreviated injury score (AIS, 1998 version), injury severity score (ISS), revised trauma score (RTS), and ICU admission and survival outcome of all the patients admitted to the three trauma centers designed as hubs, were reviewed. Screening for COVID-19 was performed with nasopharyngeal swabs, chest ultrasound, and/or computed tomography. Results During the COVID-19 pandemic, trauma patients admitted to the hubs increased (46.4% vs 28.3%, p < 0.001) with an increase in pre-hospital time (71.8 vs 61.3 min, p < 0.01), while observed in hospital mortality was unaffected. TRISS, ISS, AIS, and ICU admission were similar in both periods. During the COVID-19 outbreak, we observed substantial changes in MOI of severe trauma patients admitted to three hubs, with increases of unintentional (31.9% vs 18.5%, p < 0.05) and intentional falls (8.4% vs 1.2%, p < 0.05), whereas the pandemic restrictions reduced road- related injuries (35.6% vs 60%, p < 0.05). Deaths on scene were significantly increased (17.7% vs 6.8%, p < 0.001). Conclusions The COVID-19 outbreak affected the epidemiology of severe trauma patients. An increase in trauma patient admissions to a few designated facilities with high level of care obtained satisfactory results, while COVID-19 patients overwhelmed resources of most other hospitals.

scholarly journals Baseline patterns of infection in regions of Benin, Malawi and India seeking to interrupt transmission of soil transmitted helminths (STH) in the DeWorm3 trial

2020 ◽  
Vol 14 (11) ◽  
pp. e0008771
Author(s):  
Keyword(s):  
Demographic Data ◽  
Age Distribution ◽  
Age Groups ◽  
Risk Groups ◽  
Individual Characteristics ◽  
Force Of Infection ◽  
Transmission Interruption ◽  
To Receive ◽  
Weighted Prevalence ◽  
Epidemiological Parameters

Global efforts to control morbidity associated with soil-transmitted helminth infections (STH) have focused largely on the targeted treatment of high-risk groups, including children and pregnant women. However, it is not clear when such programs can be discontinued and there are concerns about the sustainability of current STH control programs. The DeWorm3 project is a large multi-country community cluster randomized trial in Benin, India and Malawi designed to determine the feasibility of interrupting the transmission of STH using community-wide delivery of mass drug administration (MDA) with anthelmintics over multiple rounds. Here, we present baseline data and estimate key epidemiological parameters important in determining the likelihood of transmission interruption in the DeWorm3 trial. A baseline census was conducted in October-December 2017 in India, November-December 2017 in Malawi and in January-February 2018 in Benin. The baseline census enumerated all members of each household and collected demographic data and information on occupation, assets, and access to water, sanitation and hygiene (WASH). Each study site was divided into 40 clusters of at least 1,650 individuals per cluster. Clusters were randomized to receive twice yearly community-wide MDA with albendazole (GSK) targeting eligible individuals of all ages (20 clusters), or to receive the standard-of-care deworming program targeting children provided in each country. In each site, a randomly selected group of 150 individuals per cluster (6,000 total per site) was selected from the baseline census using stratified random sampling, and each individual provided a single stool sample for analysis of STH infection using the Kato-Katz technique. Study site, household and individual characteristics were summarized as appropriate. We estimated key epidemiological parameters including the force of infection and the degree of parasite aggregation within the population. The DeWorm3 sites range in population from 94,969 to 140,932. The population age distribution varied significantly by site, with the highest proportion of infants and young children in Malawi and the highest proportion of adults in India. The baseline age- and cluster-weighted prevalence, as measured by Kato-Katz, varied across sites and by species, Baseline hookworm prevalence in India was 21.4% (95% CI: 20.4–22.4%), while prevalence of Ascaris and Trichuris by Kato-Katz was low (0.1% and 0.3% overall). In Malawi, the overall age- and cluster-weighted STH prevalence was 7.7% (95% CI: 7.1–8.4%) predominantly driven by hookworm infections (7.4%) while Ascaris (0.1%) and Trichuris (0.3%) infections were rare. In Benin, the overall age- and cluster-weighted prevalence was significantly lower (5.6%, 95% CI: 5.1–6.2%) and Ascaris (2.0%, 95% CI: 1.6–2.3%) was more common than in other sites. Ascaris infections were more likely to be moderate- or heavy-intensity (43.7%, unweighted) compared to hookworm (5.0%). The force of infection for hookworm was highest in adults in India and Malawi but appeared relatively stable across age groups in Benin. These data demonstrate the significant variability between the sites in terms of demography, socio-economic status and environmental characteristics. In addition, the baseline prevalence and intensity data from DeWorm3 suggest that each site has unique epidemiologic characteristics that will be critical in determining correlates of achieving STH transmission interruption in the DeWorm3 trial. Trial registration: The trial was registered at ClinicalTrials.gov (NCT03014167).

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