scholarly journals Early Factors Associated with the Development of Chronic Pain in Trauma Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Raoul Daoust ◽  
Jean Paquet ◽  
Lynne Moore ◽  
Marcel Émond ◽  
Sophie Gosselin ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Motor Vehicle ◽  
Characteristic Curve ◽  
Pain Clinic ◽  
Trauma Patients ◽  
Vehicle Accidents ◽  
Pain Medications ◽  
Cord Injury ◽  
History Of ◽  
Observational Cohort

Objective. To identify factors, available at the time of trauma admission, associated with the development of chronic pain to allow testing of preventive approaches.Methods. In a retrospective observational cohort study, we included all patients ≥ 18 years old admitted for injury in 57 adult trauma centers in the province of Quebec (Canada) between 2004 and 2014. Chronic pain was defined as follows: treated in a chronic pain clinic, diagnosed with chronic pain, or received at least 2 prescriptions of chronic pain medications 3 to 12 months postinjury.Results. A total of 95,134 patients were retained for analysis. Mean age was 59.8 years (±21.7), and 52% were men. The causes of trauma were falls (63%) and motor vehicle accidents (22%). We identified 14,518 patients (15.3%; 95% CI: 15.1–15.5) who developed chronic pain. After controlling for confounding factors, the variables associated with chronic pain were spinal cord injury (OR = 3.9; 95% CI: 3.4–4.6), disc-vertebra trauma (OR = 1.6; 95% CI: 1.5–1.7), history of alcoholism (OR = 1.4; 95% CI: 1.2–1.7), history of anxiety (OR = 1.4; 95% CI: 1.2–1.5), history of depression (OR = 1.3; 95% CI: 1.1–1.4), and being female (OR = 1.3; 95% CI: 1.2–1.3). The area under the receiving operating characteristic curve derived from the model was 0.80.Conclusions. We identified risk factors present on hospital admission that can predict trauma patients who will develop chronic pain. These factors should be prospectively validated.

scholarly journals Renal trauma: the current best practice

2018 ◽  
Vol 10 (10) ◽  
pp. 295-303 ◽  
Author(s):  
Tomer Erlich ◽  
Noam D. Kitrey
Keyword(s):  
Renal Injury ◽  
Best Practice ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
High Energy ◽  
Renal Trauma ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Vehicle Accidents ◽  
Enhanced Computed Tomography

The kidneys are the most vulnerable genitourinary organ in trauma, as they are involved in up to 3.25% of trauma patients. The most common mechanism for renal injury is blunt trauma (predominantly by motor vehicle accidents and falls), while penetrating trauma (mainly caused by firearms and stab wound) comprise the rest. High-velocity weapons impose specifically problematic damage because of the high energy and collateral effect. The mainstay of renal trauma diagnosis is based on contrast-enhanced computed tomography (CT), which is indicated in all stable patients with gross hematuria and in patients presenting with microscopic hematuria and hypotension. Additionally, CT should be performed when the mechanism of injury or physical examination findings are suggestive of renal injury (e.g. rapid deceleration, rib fractures, flank ecchymosis, and every penetrating injury of the abdomen, flank or lower chest). Renal trauma management has evolved during the last decades, with a distinct evolution toward a nonoperative approach. The lion’s share of renal trauma patients are managed nonoperatively with careful monitoring, reimaging when there is any deterioration, and the use of minimally invasive procedures. These procedures include angioembolization in cases of active bleeding and endourological stenting in cases of urine extravasation.

Incidence and severity of acute complications after spinal cord injury

2012 ◽  
Vol 17 (Suppl1) ◽  
pp. 119-128 ◽  
Author(s):  
Robert G. Grossman ◽  
Ralph F. Frankowski ◽  
Keith D. Burau ◽  
Elizabeth G. Toups ◽  
John W. Crommett ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Trials ◽  
Motor Vehicle ◽  
Spinal Injury ◽  
Vehicle Accidents ◽  
The North ◽  
Treatment And Prevention ◽  
Cord Injury ◽  
Study Population

Object The aim of this multicenter, prospective study was to determine the spectrum, incidence, and severity of complications during the initial hospitalization of patients with spinal cord injury. Methods The study was conducted at 9 university-affiliated hospitals that comprise the clinical centers of the North American Clinical Trials Network (NACTN) for Treatment of Spinal Cord Injury. The study population comprised 315 patients admitted to NACTN clinical centers between June 25, 2005, and November 2, 2010, who had American Spinal Injury Association (ASIA) Impairment Scale grades of A–D and were 18 years of age or older. Patients were managed according to a standardized protocol. Results The study population was 79% male with a median age of 44 years. The leading causes of injury were falls (37%) and motor vehicle accidents (28%). The distribution of initial ASIA grades were A (40%), B (16%), C (15%), and D (29%). Fifty-eight percent of patients sustained 1 or more severe, moderate, or mild complications. Complications were associated with more severe ASIA grade: 84% of patients with Grade A and 25% of patients with Grade D had at least 1 complication. Seventy-eight percent of complications occurred within 14 days of injury. The most frequent types of severe and moderate complications were respiratory failure, pneumonia, pleural effusion, anemia, cardiac dysrhythmia, and severe bradycardia. The mortality rate was 3.5% and was associated with increased age and preexisting morbidity. Conclusions Knowledge of the type, frequency, time of occurrence, and severity of specific complications that occur after spinal cord injury can aid in their early detection, treatment, and prevention. The data are of importance in evaluating and selecting therapy for clinical trials.

scholarly journals Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding

2021 ◽  
Vol 18 (21) ◽  
pp. 11051
Author(s):  
Fang-Yu Hsu ◽  
Shih-Hsuan Mao ◽  
Andy Deng-Chi Chuang ◽  
Yon-Cheong Wong ◽  
Chih-Hao Chen
Keyword(s):  
Motor Vehicle ◽  
Early Recognition ◽  
Arterial Embolization ◽  
Maxillary Artery ◽  
Trauma Patients ◽  
Shock Index ◽  
Packed Red Blood Cells ◽  
Vehicle Accidents ◽  
Life Threatening ◽  
Craniofacial Trauma

The objective of this retrospective study was to identify predictors of angiographic hemostasis among patients with life-threatening traumatic oronasal bleeding (ONB) and determine the threshold for timely referral or intervention. The diagnosis of traumatic, life-threatening ONB was made if the patient suffered from craniofacial trauma presenting at triage with unstable hemodynamics or required a definitive airway due to ONB, without other major bleeding identified. There were 4404 craniofacial trauma patients between January 2015 and December 2019, of which 72 (1.6%) fulfilled the diagnosis of traumatic life-threatening ONB. Of these patients, 39 (54.2%) received trans-arterial embolization (TAE), 11 (15.3%) were treated with other methods, and 22 (30.5%) were excluded. Motor vehicle accidents were the most common cause of life-threatening ONB (52%), and the internal maxillary artery was the most commonly identified hemorrhaging artery requiring embolization (84%). Shock index (SI) was significantly higher in the angiographic hemostasis group (p < 0.001). The AUC-ROC was 0.87 (95% CI, 0.88–1.00) for SI to predict angiographic hemostasis. Early recognition and timely intervention are crucial in post-traumatic, life-threatening ONB management. Patients initially presenting with SI > 0.95 were more likely to receive TAE, with the TAE group having statistically higher SI than the non-TAE group whilst receiving significantly more packed red blood cells. Hence, for patients presenting with life-threatening traumatic ONB and a SI > 0.95, TAE should be considered if preliminary attempts at hemostasis have failed.

Subdural Hemorrhage in Utero

PEDIATRICS ◽  
1985 ◽  
Vol 76 (4) ◽  
pp. 605-610
Author(s):  
TANIA R. GUNN ◽  
PUI M. MOK ◽  
DAVID M. O. BECROFT
Keyword(s):  
Case Report ◽  
Head Circumference ◽  
Motor Vehicle ◽  
Motor Vehicle Accidents ◽  
Subdural Hemorrhage ◽  
Maternal Trauma ◽  
Vehicle Accidents ◽  
First Case ◽  
Subdural Hemorrhages ◽  
History Of

Acute subdural hemorrhage following the trauma of a difficult birth is a recognized cause of an increase in head circumference and anemia soon after birth.1 Although major subdural hemorrhages occurring in the fetus before the onset of labor are relatively rare, in most reported cases these also have been traumatic, the result of motor vehicle accidents or assaults.2-7 With few exceptions, there have been associated uteroplacental or other fetal injuries. In 1977, MacDonald et al8 believed they were making the first case report of an infant born with hydrocephalus and anemia due to bilateral subdural hematomas in which there was no history of maternal trauma.

Characteristics of patients with chronic pain accessing treatment with medical cannabis in Washington State

2018 ◽  
Vol 5 (5) ◽  
pp. 257 ◽  
Author(s):  
Sunil K. Aggarwal, PhD, MD Candidate ◽  
Gregory T. Carter, MD, MS ◽  
Mark D. Sullivan, MD, PhD ◽  
Craig ZumBrunnen, PhD ◽  
Richard Morrill, PhD ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Myofascial Pain ◽  
Visceral Pain ◽  
Pain Syndrome ◽  
Pain Clinic ◽  
Phantom Pain ◽  
Medical Cannabis ◽  
Treatment Access ◽  
Common Diagnosis ◽  
Cord Injury

Objectives: This study was conducted to better understand the characteristics of chronic pain patients seeking treatment with medicinal cannabis (MC).Design: Retrospective chart reviews of 139 patients (87 males, median age 47 years; 52 females, median age 48 years); all were legally qualified for MC use in Washington State.Setting: Regional pain clinic staffed by university faculty.Participants: Inclusion criteria: age 18 years and older; having legally accessed MC treatment, with valid documentation in their medical records. All data were de-identified.Main Outcome Measures: Records were scored for multiple indicators, including time since initial MC authorization, qualifying condition(s), McGill Pain score, functional status, use of other analgesic modalities, including opioids, and patterns of use over time.Results: Of 139 patients, 15 (11 percent) had prior authorizations for MC before seeking care in this clinic. The sample contained 236.4 patientyears of authorized MC use. Time of authorized use ranged from 11 days to 8.31 years (median of 1.12 years). Most patients were male (63 percent) yet female patients averaged 0.18 years longer authorized use. There were no other gender-specific trends or factors. Most patients (n = 123, 88 percent) had more than one pain syndrome present. Myofascial pain syndrome was the most common diagnosis (n = 114, 82 percent), followed by neuropathic pain (n = 89, 64 percent), discogenic back pain (n = 72, 51.7 percent), and osteoarthritis (n = 37, 26.6 percent). Other diagnoses included diabetic neuropathy, central pain syndrome, phantom pain, spinal cord injury, fibromyalgia, rheumatoid arthritis, HIV neuropathy, visceral pain, and malignant pain. In 51 (37 percent) patients, there were documented instances of major hurdles related to accessing MC, including prior physicians unwilling to authorize use, legal problems related to MC use, and difficulties in finding an affordable and consistent supply of MC.Conclusions: Data indicate that males and females access MC at approximately the same rate, with similar median authorization times. Although the majority of patient records documented significant symptom alleviation with MC, major treatment access and delivery barriers remain.

scholarly journals Analysis of patients with spinal cord trauma associated with traumatic brain injury

2014 ◽  
Vol 13 (4) ◽  
pp. 302-305 ◽  
Author(s):  
João Simão de Melo Neto ◽  
Waldir Antônio Tognola ◽  
Antonio Ronaldo Spotti ◽  
Dionei Freitas de Morais
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Spinal Cord ◽  
Brain Injury ◽  
Injury Risk ◽  
Motor Vehicle ◽  
Motor Vehicle Accidents ◽  
Vehicle Accidents ◽  
Risk Of Death ◽  
Cord Injury

Objective: Characterize victims of spinal cord injury (SCI) associated with traumatic brain injury (TBI) and risk factors. Methods: Study conducted with 52 victims of SCI associated with TBI. The variables studied were: sex; age; marital status; occupation; educational level; religion; etiology and the lesion area; neurological condition by the ASIA scale; associated injuries and potential risk factors. Results: The male (85%), aged between 21-30 years (25%), civil status stable union (56%), low level of education (69%) and the Roman Catholic religion (77%) presented the greater number of victims. Motor vehicle accidents (58%) were the main etiology. The cervical segment had higher injury risk (RR=3.48, p&lt;0.0001). The neurological status ASIA-E (52%), the syndromic neck pain (35%) and the rate of mild TBI (65%) were the most frequent. Complications occurred in 13 patients with increased frequency of pneumonia (62%). The length of hospital stay was significantly higher (20&#177;28 days) and 17% of patients died. Men (RR=2.14, p=0.028) and individuals exposed to motor vehicle accidents (RR=1.91, p=0.022) showed a higher risk of these lesions concurrently. Moreover, these patients had 2.48 (p&lt;0.01) higher risk of death than victims of SCI alone. Conclusion: The SCI associated with TBI was more frequent in men, young adults, and individuals exposed to motor vehicle accidents. The cervical spine is more likely to be affected. Furthermore, the length of hospitalization is significantly higher and the subjects analyzed have higher risk of death.

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