Clinical and Laboratory Prognosis of Patients at Risk for Traumatic ARDS

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Ahmed Mohamed Eshohady ◽  
Galal Adel El Kady ◽  
Milad Ragaey Zakry
Keyword(s):  
At Risk ◽  
Injury Severity ◽  
Data Extraction ◽  
Multiple Organ ◽  
Apache Ii Score ◽  
Trauma Patients ◽  
Eligibility Criteria ◽  
Laboratory Findings ◽  
Lung Protection ◽  
Modifiable Factors

Abstract Background Trauma victims who survive their initial injuries to hospitalization in the intensive care unit (ICU) face the possibility of life-threatening complications such as multiple organ failure (MOF), the leading cause of death in these patients. Acute respiratory distress syndrome (ARDS) is the most frequent manifestation of MOF after trauma. Objective Diagnosis of traumatic patients who are at risk of developing ARDS based on clinical and laboratory findings and their proper management. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2020. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion Identifying potentially causal and modifiable factors that could lead to the development and testing of preventative ARDS therapies has been slow in part because of an incomplete understanding of which patients are likely to develop ARDS after major trauma. There are several ARDS predictors including an injury severity score (ISS), Acute Physiology and Chronic Health Evaluation (APACHE) II Score and others which try to identify trauma patients at greatest risk for ARDS. However, despite the intense research, only few effective therapies for ARDS have been postulated, including the lung protection strategies.

scholarly journals Prognostic value of presepsin (soluble CD14-subtype) in diagnosis of ventilator-associated pneumonia and sepsis in trauma patients

2018 ◽  
Vol 75 (10) ◽  
pp. 968-977
Author(s):  
Bojan Jovanovic ◽  
Olivera Djuric ◽  
Ljiljana Markovic-Denic ◽  
Aleksandra Isakovic ◽  
Krstina Doklestic ◽  
...  
Keyword(s):  
Septic Shock ◽  
Injury Severity ◽  
Medical Condition ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Soluble Cd14 ◽  
Sepsis And Septic Shock ◽  
Injured Patients

Background/Aim. Presepsin (soluble CD14-subtype) is a fragment of CD14 produced in response to bacterial infections and a novel biomarker of pneumonia, sepsis and septic shock. The aim of this study was to compare sensitivity and specificity of persepsin, soluble CD14-subtype (sCD14-ST) with other biomarkers: procalcitonine (PCT), C-reactive protein (CRP) and leukocyte count (Le) in mechanically ventilated injured patients, as a marker of pneumonia, sepsis and septic shock. Methods. The prospective study was undertaken in trauma and surgery intensive care unit of the Emergency Center, the Clinical Center of Serbia from January to April 2013. The study included 39 trauma patients requiring mechanical ventilation, and who developed one of the following inclusion criteria: Systemic Inflammatory Response Syndrome (SIRS), ventilator associated pneumonia (VAP), sepsis and/or septic shock. On admission Acute Physiology and Chronic Health Evaluation II (APACHE II) Score and Injury Severity Score (ISS) were calculated. Seventy-two measurements of four biomarkers (presepsin, PCT, CRP and Le) were performed in 39 patients at the moments of diagnosis of SIRS, VAP, sepsis and/or septic shock (21 when SIRS diagnosis was established, 21 after the diagnosis of VAP, 18 at the moment of diagnosis of sepsis and the remaining 12 measurements were conducted while diagnosing the septic shock). The Sequential Organ Failure Assessment (SOFA) score was calculated at these points as well. Results. Patients were mainly severely injured (mean ISS = 24.2) and had moderately severe medical condition at admission (mean Apache II score, 14.5). Presepsin concentration significantly differed among all the four groups, except between sepsis and septic shock. The strongest positive correlation of presepsin evinced with PCT (r = 0.741, p < 0.001). The sCD14-ST indicated better performance in diagnosis of both VAP (AUC = 0.909) and sepsis (AUC = 0.899), compared to PCT (AUCs: 0.863, 0.885, respectively), CRP (AUCs: 0.703, 0.677, respectively) and Le (AUCs: 0.668, 0.700, respectively). Conclusion. This study revealed that sCD14-ST is a reliable biomarker for distinguishing sepsis severity. It also showed a good correlation with the infection development as well as worsening in injured patients.

scholarly journals Non-Modifiable Risk Factors for Stress Fractures in Military Personnel Undergoing Training: A Systematic Review

2021 ◽  
Vol 19 (1) ◽  
pp. 422
Author(s):  
Grace M. Lennox ◽  
Patrick M. Wood ◽  
Ben Schram ◽  
Elisa F. D. Canetti ◽  
Vini Simas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Military Personnel ◽  
Data Extraction ◽  
Stress Fractures ◽  
Modifiable Risk Factors ◽  
Eligibility Criteria ◽  
Menstrual Dysfunction ◽  
Increased Risk ◽  
Modifiable Factors ◽  
Repetitive Stress

A fracture, being an acquired rupture or break of the bone, is a significant and debilitating injury commonly seen among athletes and military personnel. Stress fractures, which have a repetitive stress aetiology, are highly prevalent among military populations, especially those undergoing training. The primary aim of this review is to identify non-modifiable risk factors for stress fractures in military personnel undergoing training. A systematic search was conducted of three major databases to identify studies that explored risk factors for stress fractures in military trainees. Critical appraisal, data extraction, and a narrative synthesis were conducted. Sixteen articles met the eligibility criteria for the study. Key non-modifiable risk factors identified were prior stress fracture and menstrual dysfunction, while advancing age and race other than black race may be a risk factor. To reduce the incidence of stress fractures in military trainees, mitigating modifiable risk factors among individuals with non-modifiable risk factors (e.g., optimising conditioning for older trainees) or better accommodating non-modifiable factors (for example, extending training periods and reducing intensity to facilitate recovery and adaptation) are suggested, with focus on groups at increased risk identified in this review.

The Effect of Older Blood on Mortality, Need for ICU Care, and the Length of ICU Stay after Major Trauma

2005 ◽  
Vol 71 (9) ◽  
pp. 781-785 ◽  
Author(s):  
Zuri Murrell ◽  
Jason S. Haukoos ◽  
Brant Putnam ◽  
Stanley R. Klein
Keyword(s):  
Risk Factor ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Independent Risk Factor ◽  
Injury Severity ◽  
Multiple Organ ◽  
Independent Effect ◽  
Trauma Patients ◽  
Packed Red Blood Cells ◽  
Icu Stay

The purpose of this study was to determine if the quantity and age of blood is an independent risk factor for in-hospital mortality, need for intensive care unit (ICU) care, and an increased length of stay in the ICU. This was a retrospective cohort study performed at a level I trauma center between 2001 and 2003. Consecutive trauma patients who received at least 1 unit of packed red blood cells (PRBCs) were included. The number of units of PRBCs transfused and the ages of each unit of PRBCs were recorded. Other variables including the patient's age, sex, Trauma-Related Injury Severity Score (TRISS), and whether the blood was leukopoor were collected. End points included in-hospital mortality, need for ICU care, and the length of stay in the ICU (in days). Multivariable logistic and Poisson regression analyses were performed to model the independent effect of the dose of aged blood (defined as the product of the average age of all units received and the total number of units received) with respect to each end point while controlling for age, TRISS, the total number of units administered, and the proportion of blood that was leukopoor. During the study period, 275 patients were studied. Patients who received older blood had a significantly longer ICU stay (RR 1.15, 95% CI: 1.11–1.20), possibly reflecting a higher level of organ dysfunction. Patients who received older blood, however, did not have a significantly higher in-hospital mortality rate (OR 1.21, 95% CI: 0.87–1.69) or a significantly higher need for ICU care (OR 1.20, 95% CI: 0.87–1.64). The quantity of aged blood is an independent risk factor for length of ICU care. This may be a proxy indicator for multiple organ failure. Further research is required to define which patients may benefit from newer blood.

scholarly journals Effect of Anti-Inflammatory and Antimicrobial Cosupplementations on Sepsis Prevention in Critically Ill Trauma Patients at High Risk for Sepsis

2021 ◽  
Vol 12 ◽  
Author(s):  
Noha A. Kamel ◽  
Moetaza M. Soliman ◽  
Maha A. Abo-Zeid ◽  
Mona I. Shaaban
Keyword(s):  
High Risk ◽  
Injury Severity ◽  
Vitamin B1 ◽  
Severe Trauma ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Trauma Patients ◽  
Monocyte Chemoattractant Protein 1 ◽  
Icu Discharge ◽  
Intravenous Vitamin

Background: Sepsis development in patients with trauma is associated with bad prognosis. This study investigated the effect of immunomodulatory interventions in major trauma patients at high risk for sepsis.Methods: In a randomized, double-blinded, controlled design, severe trauma patients were stratified by leukocyte anti-sedimentation rate (LAR) test into high risk (HR) and low risk (LR) for sepsis. The HR patients were randomly allocated into intravenous vitamin C plus vitamin B1 (HR-CB), intramuscular vitamin D plus oral Lactobacillus probiotics (HR-DP), or control (HR-C) groups. The clinical trial was registered at clinicaltrials.gov (https://clinicaltrials.gov/show/NCT04216459).Outcomes: The primary outcome was Acute Physiologic Assessment and Chronic Health Evaluation score II (APACHE II) score. Secondary outcomes included sepsis incidence, changes in Sequential Organ Failure Assessment (SOFA) score, and serum monocyte chemoattractant protein-1 (MCP-1) on day 6 from baseline, 28-day mortality, intensive care unit (ICU), and hospital discharge.Results: The HR-DP, HR-CB, and LR groups showed a significantly lower incidence of sepsis development (20%, 20%, and 16%, respectively, versus 60% in the HR-C group, p-value = 0.004). The three groups also showed a significant improvement in APACHE II and SOFA scores. Besides, MCP-1 levels were significantly decreased in HR-DP and HR-CB groups compared to the HR-C group (p-value ≤ 0.05). Significantly decreased mortality (10% and 16% versus 60% in the HR-C group) and increased ICU discharge (95% and 84% versus 45% in the HR-C group) were observed in HR-CB and LR groups (p-value = 0.001).Conclusion: Both combinations of interventions improved APACHE II scores and reduced sepsis incidence in trauma patients. The LAR combined with injury severity score were good sepsis predictors.

scholarly journals Impact of the Body Mass on Complications and Outcome in Multiple Trauma Patients: What Does the Weight Weigh?

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Hagen Andruszkow ◽  
Juliane Veh ◽  
Philipp Mommsen ◽  
Christian Zeckey ◽  
Frank Hildebrand ◽  
...  
Keyword(s):  
Risk Factor ◽  
Inflammatory Response ◽  
Multiple Trauma ◽  
Body Mass ◽  
Injury Severity ◽  
Multiple Organ ◽  
The Body ◽  
Apache Ii Score ◽  
Obese Patients ◽  
The Impact

Obesity is known as an independent risk factor for various morbidities. The influence of an increased body mass index (BMI) on morbidity and mortality in critically injured patients has been investigated with conflicting results. To verify the impact of weight disorders in multiple traumatized patients, 586 patients with an injury severity score >16 points treated at a level I trauma center between 2005 and 2011 were differentiated according to the BMI and analyzed regarding morbidity and outcome. Plasma levels of interleukin- (IL-) 6 and C-reactive protein (CRP) were measured during clinical course to evaluate the inflammatory response to the “double hit” of weight disorders and multiple trauma. In brief, obesity was the highest risk factor for development of a multiple organ dysfunction syndrome (MODS) (OR 4.209, 95%-CI 1.515–11.692) besides injury severity (OR 1.054, 95%-CI 1.020–1.089) and APACHE II score (OR 1.059, 95%-CI 1.001–1.121). In obese patients as compared to those with overweight, normal weight, and underweight, the highest levels of CRP were continuously present while increased systemic IL-6 levels were found until day 4. In conclusion, an altered posttraumatic inflammatory response in obese patients seems to determine the risk for multiple organ failure after severe trauma.

scholarly journals Assessment of patient-reported outcomes after polytrauma – instruments and methods: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e050168
Author(s):  
Michaela Ritschel ◽  
Silke Kuske ◽  
Irmela Gnass ◽  
Silke Andrich ◽  
Kai Moschinski ◽  
...  
Keyword(s):  
Systematic Review ◽  
Social Participation ◽  
Patient Reported Outcomes ◽  
Injury Severity ◽  
Short Form ◽  
Data Extraction ◽  
Grey Literature ◽  
Eligibility Criteria ◽  
Patient Reported

ObjectivesWe (1) collected instruments that assess health-related quality of life (HRQoL), activities of daily living (ADL) and social participation during follow-up after polytrauma, (2) described their use and (3) investigated other relevant patient-reported outcomes (PROs) assessed in the studies.DesignSystematic Review using the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline.Data sourcesMEDLINE, Embase, CINAHL, PsycINFO, CENTRAL, as well as the trials registers ClinicalTrials.gov and WHO ICTRP were searched from January 2005 to April 2018.Eligibility criteriaAll original empirical research published in English or German including PROs of patients aged 18–75 years with an Injury Severity Score≥16 and/or an Abbreviated Injury Scale≥3. Studies with defined injuries or diseases (e.g. low-energy injuries) and some text types (e.g. grey literature and books) were excluded. Systematic reviews and meta-analyses were excluded, but references screened for appropriate studies.Data extraction and synthesisData extraction, narrative content analysis and a critical appraisal (e.g. UK National Institute for Health and Care Excellence) were performed by two reviewers independently.ResultsThe search yielded 3496 hits; 54 publications were included. Predominantly, HRQoL was assessed, with Short Form-36 Health Survey applied most frequently. ADL and (social) participation were rarely assessed. The methods most used were postal surveys and single assessments of PROs, with a follow-up period of one to one and a half years. Other relevant PRO areas reported were function, mental disorders and pain.ConclusionsThere is a large variation in the assessment of PROs after polytrauma, impairing comparability of outcomes. First efforts to standardise the collection of PROs have been initiated, but require further harmonisation between central players. Additional knowledge on rarely reported PRO areas (e.g. (social) participation, social networks) may lead to their consideration in health services provision.PROSPERO registration numberCRD42017060825.

scholarly journals Developing trauma mortality prediction models to measure injury severity

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Angharad Walters ◽  
Alan Cook ◽  
Belinda Gabbe ◽  
Ronan Lyons
Keyword(s):  
Injury Severity ◽  
Prediction Models ◽  
Laboratory Data ◽  
Population Based ◽  
Multiple Organ ◽  
Mortality Prediction ◽  
Trauma Patients ◽  
Mortality Models ◽  
Mortality Prediction Models ◽  
Trauma Mortality

IntroductionInjury severity measurement is integral to meaningful benchmarking and injury prevention strategies. Numerous injury mortality prediction methods have been developed and advanced, however, no consensus on the best model has been reached. Objectives and ApproachThe International Collaborative Effort (ICE) on Injury Statistics propose to develop a set of trauma mortality models for use in diverse settings by deriving and validating models with data from member countries including Wales, Australia, New Zealand and USA. The ICE team will create a definitive list of injuries required to identify trauma patients using ICD-10 codes. Models will be developed using Welsh data then validated with data from other member nations. The outcomes of interest are in-hospital and 30-day mortality. Models will be used for country benchmarking by comparing the distribution of injury severity and outcomes between nations. ResultsInitial results from replicating the model published by Wada, et al., as closely as possible using 348,433 cases held in SAIL for the years 2000 to 2013 achieved an AUROC value of 0.908 (95% CI 0.905-0.911). This model included 38 injury indicator variables, age, sex and comorbidity score. From 2009 onwards, the estimated number of deaths exceeded the actual number of deaths indicating improving risk adjusted survival. We aim to further enhance these models with additional covariates by linking with critical care data to enable us to determine the level of support patients received during their hospital stay, linking with laboratory data to provide indications of multiple organ dysfunction, acute physiological response and infection, and with GP data to incorporate measures of frailty. Conclusion/ImplicationsUsing multi-sourced population based linked data allows us to develop a suite of enhanced mortality models for use in observational and interventional research. Applying these methods to data from different countries will allow comparisons to be made of trends in severity and outcomes and support collaborative research.

Pediatric Trauma Patients with Temporal Bone Fractures Are at Risk for Multiple Cranial CT Scans

2020 ◽  
Author(s):  
Joshua Ewy ◽  
Martin Piazza ◽  
Brian Thorp ◽  
Michael Phillips ◽  
Carolyn Quinsey
Keyword(s):  
At Risk ◽  
Temporal Bone ◽  
Bone Fractures ◽  
Pediatric Trauma ◽  
Ct Scans ◽  
Trauma Patients ◽  
Cranial Ct

scholarly journals Diversity in health professional education scholarship: a document analysis of international author representation in leading journals

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e043970
Author(s):  
Brittany Buffone ◽  
Ilena Djuana ◽  
Katherine Yang ◽  
Kyle J Wilby ◽  
Maguy S El Hajj ◽  
...  
Keyword(s):  
Health Professional ◽  
Professional Education ◽  
Teaching And Learning ◽  
Western Europe ◽  
English Language ◽  
Data Extraction ◽  
Document Analysis ◽  
Original Research ◽  
Health Professional Education ◽  
Eligibility Criteria

ObjectivesThe global distribution of health professionals and associated training programmes is wide but prior study has demonstrated reported scholarship of teaching and learning arises from predominantly Western perspectives.DesignWe conducted a document analysis to examine authorship of recent publications to explore current international representation.Data sourcesThe table of contents of seven high-impact English-language health professional education journals between 2008 and 2018 was extracted from Embase.Eligibility criteriaThe journals were selected according to highest aggregate ranking across specific scientific impact indices and stating health professional education in scope; only original research and review articles from these publications were included for analysis.Data extraction and synthesisThe table of contents was extracted and eligible publications screened by independent reviewers who further characterised the geographic affiliations of the publishing research teams and study settings (if applicable).ResultsA total 12 018 titles were screened and 7793 (64.8%) articles included. Most were collaborations (7048, 90.4%) conducted by authors from single geographic regions (5851, 86%). Single-region teams were most often formed from countries in North America (56%), Northern Europe (14%) or Western Europe (10%). Overall lead authorship from Asian, African or South American regions was less than 15%, 5% and 1%, respectively. Geographic representation varied somewhat by journal, but not across time.ConclusionsDiversity in health professional education scholarship, as marked by nation of authors’ professional affiliations, remains low. Under-representation of published research outside Global North regions limits dissemination of novel ideas resulting in unidirectional flow of experiences and a concentrated worldview of teaching and learning.

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