Risk factors and outcomes of unrecognised endobronchial intubation in major trauma patients

BackgroundEmergency tracheal intubation during major trauma resuscitation may be associated with unrecognised endobronchial intubation. The risk factors and outcomes associated with this issue have not previously been fully defined.MethodsWe retrospectively analysed adult patients admitted directly from the scene to the ED of a single level 1 trauma centre, who received either prehospital or ED tracheal intubation prior to initial whole-body CT from January 2008 to December 2019. Our objectives were to describe tube-to-carina distances (TCDs) via CT and to assess the risk factors and outcomes (mortality, length of intensive care unit stay and mechanical ventilation) of patients with endobronchial intubation (TCD <0 cm) using a multivariable model.ResultsWe included 616 patients and discovered 26 (4.2%) cases of endobronchial intubation identified on CT. Factors associated with an increased risk of endobronchial intubations were short body height (OR per 1 cm increase 0.89; 95% CI 0.84 to 0.94; p≤0.001), a high body mass index (OR 1.14; 95% CI 1.04 to 1.25; p=0.005) and ED intubation (OR 3.62; 95% CI 1.39 to 8.90; p=0.006). Eight of 26 cases underwent tube thoracostomy, four of whom had no evidence of underlying chest injury on CT. There was no statistically significant difference in mortality or length of stay although the absolute number of endobronchial intubations was small.ConclusionsShort body height and high body mass index were associated with endobronchial intubation. Before considering tube thoracostomy in intubated major trauma patients suspected of pneumothorax, the possibility of unrecognised endobronchial intubation should be considered.

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Global Burden and Attributable Risk Factors of Acute Lymphoblastic Leukemia in 204 Countries and Territories from 1990-2019: Estimation Based on Global Burden of Disease Study 2019

10.21203/rs.3.rs-508326/v1 ◽

2021 ◽

Author(s):

Yuefen Hu ◽

Xiuping Zhang ◽

Aijun Zhang ◽

Yu Hou ◽

Yang Liu ◽

...

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Acute Lymphoblastic Leukemia ◽

Body Mass ◽

Burden Of Disease ◽

Lymphoblastic Leukemia ◽

High Body Mass Index ◽

Attributable Risk ◽

Global Burden ◽

Disease Study

Abstract Purpose: To provide a foundational guideline for policy-makers to efficiently allocate medical resources in the context of population aging and growth, a latest spatial distribution and temporal trend of acute lymphoblastic leukemia (ALL) along with attributable risk factors by sex and age were mapped.Methods: Based on the Global Burden of Disease Study 2019, we calculated the estimated annual percentage change (EAPC) values to quantify temporal trends in morbidity and mortality of ALL. We used applied Spearman rank correlation to estimate the relationship between the EAPC and potential influence factors. The population attributable fraction of potential risk factors for ALL-related disability-adjusted life years (DALYs) were estimated by the comparative risk assessment framework. Results: We found that new ALL cases increased significantly by 129% worldwide, and the age-standardized incidence rate (ASIR) increased by 1.61 percent per year. The proportion of elder patients sharply increased, especially within the higher socio-demographic index (SDI) region. Smoking and high body mass index remained the predominant risk factors for ALL-related mortality. Notably, the contribution of high body mass index presented an increasing trend. Conclusion: The global burden of ALL has steadily increased, especially in middle SDI region. Health measures should be taken into consideration to improve the treatment of elders with ALL due to a great proportion in the higher SDI region. Attention should be paid to the environmental problems caused by industrial development in low SDI areas.

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Estimated and projected burden of multiple sclerosis attributable to smoking and childhood and adolescent high body-mass index: a comparative risk assessment

International Journal of Epidemiology ◽

10.1093/ije/dyaa151 ◽

2020 ◽

Author(s):

Julia Pakpoor ◽

Klaus Schmierer ◽

Jack Cuzick ◽

Gavin Giovannoni ◽

Ruth Dobson

Keyword(s):

Risk Factors ◽

Multiple Sclerosis ◽

Body Mass Index ◽

Body Mass ◽

Early Life ◽

Time Lag ◽

Early Adulthood ◽

High Body Mass Index ◽

High Body ◽

High Bmi

Abstract Background Smoking and childhood and adolescent high body-mass index (BMI) are leading lifestyle-related risk factors of global premature morbidity and mortality, and have been associated with an increased risk of developing multiple sclerosis (MS). This study aims to estimate and project the proportion of MS incidence that could be prevented with elimination of these risk factors. Methods Prevalence estimates of high BMI during childhood/adolescence and smoking in early adulthood, and relative risks of MS, were obtained from published literature. A time-lag of 10 years was assumed between smoking in early adulthood and MS incidence, and a time-lag of 20 years was assumed between childhood/adolescent high BMI and MS incidence. The MS population attributable fractions (PAFs) of smoking and high BMI were estimated as individual and combined risk factors, by age, country and sex in 2015, 2025 and 2035 where feasible. Results The combined estimated PAFs for smoking and high BMI in 2015 were 14, 11, 12 and 12% for the UK, USA, Russia and Australia in a conservative estimate, and 21, 20, 19 and 16% in an independent estimate, respectively. Estimates for smoking are declining over time, whereas estimates for high early life BMI are rising. The PAF for high early life BMI is highest in the USA and is estimated to increase to 14% by 2035. Conclusions Assuming causality, there is the potential to substantially reduce MS incidence with the elimination of lifestyle-related modifiable risk factors, which are the target of global public health prevention strategies.

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Female Urinary Incontinence: Prevalence, Risk Factors and Impact on the Quality of Life of Gynecological Clinic Attendees in Lagos, Nigeria

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v15i1.29338 ◽

2020 ◽

Vol 15 (1) ◽

pp. 31-38

Author(s):

Fatimat Motunrayo Akinlusi ◽

Tawaqualit Abimbola Ottun ◽

Yusuf Abisowo Oshodi ◽

Bilkees Oluwatoyin Seriki ◽

Folasade D. Haleemah Olalere ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Body Mass Index ◽

Urinary Incontinence ◽

Body Mass ◽

Odds Ratio ◽

High Body Mass Index ◽

Female Urinary Incontinence ◽

Substantial Impact

Aims: To determine the prevalence of urinary incontinence, risk factors and impact on the quality of life in gynecological clinic attendees of a University Hospital. Methods: A cross sectional descriptive study was conducted amongst gynecological clinic attendees in a Teaching Hospital in Nigeria from 1st February to 31st July 2017. Structured questionnaires were used to ascertain the presence of urinary incontinence. Socio-demographic and medical factors; impact on daily activities and treatment history were assessed. Women with and without urinary incontinence were compared. Univariate, bivariate and multivariable analyses were performed. Results: There were 395 women of 25 - 67 years (mean age = 38.81±10.1). About 33% had experienced urinary incontinence in the previous 6 months with Urgency, Mixed and Stress urinary incontinence occurring in 18.0%, 7.6% and 7.3% respectively. Independent risk factors for urinary incontinence were age (odds ratio=0.49, 95% confidence interval [CI] =0.26 - 0.92, P =0.026), higher body mass index (odds ratio=1.92, 95% CI =1.53 - 3.00, P =0.004) and history of constipation (odds ratio=2.11, 95% CI =1.30 - 3.43, P =0.003). About 47% of those with urinary incontinence admitted to negative feelings like anxiety and depression; 45% had moderate to severe impact on their quality of life in all domains but only 27.7% sought help. Conclusions: Urinary incontinence is common and risk factors include older age, high body mass index and constipation. Despite its substantial impact on the quality of life, majority do not seek help. Addressing modifiable risks factors and improving treatment seeking behaviour will assist in reducing the prevalence of urinary incontinence. Keywords: female urinary incontinence; quality of life; risk factors; stress incontinence; urgency incontinence.

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Prevalence and outcome of contrast-induced nephropathy in major trauma patients

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01496-w ◽

2020 ◽

Author(s):

Julian Alexander Kelemen ◽

Alexander Kaserer ◽

Kai Oliver Jensen ◽

Philipp Stein ◽

Burkhardt Seifert ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Independent Risk Factor ◽

Major Trauma ◽

Whole Body ◽

Trauma Patients ◽

Contrast Induced Nephropathy ◽

Whole Body Ct ◽

Contrast Enhanced ◽

Body Ct

Abstract Background Contrast-induced nephropathy (CIN) has been well investigated in patients undergoing coronary angiography, but not in trauma patients. The main aim of this study was to determine the prevalence and to investigate independent risk factors for the development of CIN. Methods Between 2008 and 2014, all pre-hospital intubated major trauma patients with documented serum creatinine levels (SCr) undergoing a contrast-enhanced whole-body CT at admission were retrospectively analyzed. CIN was defined as a relative increase in SCr > 25% over the baseline value or an absolute SCr increase of > 44 µmol/l within 72 h. Univariate and multivariable regression analyses were performed to identify significant risk factors. A p value of < 0.01 was considered statistically significant and a p value of 0.01–0.049 suggested evidence. Results Of 284 analyzed patients, 41 (14%) met the criteria for CIN. There is suggestive evidence that age and lactate level influenced the development of CIN. Six patients (15%) had hemodialysis in the CIN-group and eight (3.3%) in the group without CIN. Complication and mortality rate was higher in patients with CIN (71% vs. 56% and 32% vs. 23%, respectively). CIN was not an independent risk factor for complications or mortality while controlling for age, gender, injury severity score, and lactate level. The length of stay was not affected by CIN. Conclusion CIN occurs frequently in trauma patients, but is not an independent risk factor for complications or mortality. Therefore, contrast enhanced whole-body CT can safely be performed in trauma patients.

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