Emergency Management of Blunt Splenic Injury in Hypotensive Patients

2020 ◽  
Vol 86 (6) ◽  
pp. 690-694
Author(s):  
Robyn Guinto ◽  
Patricia Greenberg ◽  
Nasim Ahmed
Keyword(s):  
Injury Severity ◽  
Splenic Injury ◽  
Data Bank ◽  
The United States ◽  
Multivariate Logistic Regression Model ◽  
Number Of Patients ◽  
Increased Risk ◽  
Group 2 ◽  
Total Splenectomy ◽  
Procedure Type

Objectives The purpose of this study is to examine the outcomes of splenic angioembolization (SAE) as the first modality for nonoperative management (NOM) in hypotensive patients with high-grade splenic injuries. Methods Data were collected from the 2007-2010 National Trauma Data Bank data sets of the United States. The data included patients with massive blunt splenic injuries with an Abbreviated Injury Scale (AIS) of 4 or 5, initial systolic blood pressure ≤90, and who underwent either a total splenectomy or SAE (Group 1 and Group 2, respectively) within 4 hours of hospital arrival. The outcomes of interest are in-hospital mortality and complications. Results Of the 1052 patients analyzed, 996 (94.7%) underwent total splenectomy while 56 (5.3%) underwent SAE. There were significant differences regarding injury mechanism ( P = .01) and the proportion of patients with an AIS of 5 (57.6% vs 39.3% respectively, P = .01). A significantly higher number of patients, however, developed organ space infections (3.9% vs 11.6%, P = .02) in Group 2. The multivariate logistic regression model for mortality, which accounted for demography, Glasgow Coma Scale Motor (GCSM) score, Injury Severity Score (ISS), AIS, time to procedure, and procedure type showed the procedure type was not a contributing factor to patient mortality, but higher age, ISS, and lower GCSM score were strong predictors of mortality. Conclusion The treatment of approximately 95% of hypotensive patients with massive splenic injury was total splenectomy. However, if the interventional radiology resources are immediately available, SAE can be used as a first intervention without an increased risk of mortality.

scholarly journals The impact of postoperative percent change of parathormone level from baseline value on the rate of hypocalcemia after total thyroidectomy

2017 ◽  
Author(s):  
Ismail Cem Sormaz ◽  
Ahmet Yalin Iscan ◽  
Ilker Ozgur ◽  
Seyma Karakus ◽  
Fatih Tunca ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Albumin Concentration ◽  
Postoperative Hypocalcemia ◽  
Percent Change ◽  
Number Of Patients ◽  
Increased Risk ◽  
Symptomatic Hypocalcemia ◽  
Postoperative Serum ◽  
Group 2 ◽  
The Impact

Background: To investigate the impact of the percent change of postoperative parathormone (PoPTH) level from baseline value (∆PTH) on the rate of hypocalcemia after total thyroidectomy. Methods: Assays of serum PTH and calcium (Ca) were performed preoperatively and at 24 hours postoperatively in 222 consecutive patients who underwent total thyroidectomy. Postoperative hypocalcemia was defined as serum calcium level corrected for albumin concentration (cCa) <8.5mg/dl. Patients with postoperative hypocalcemia were classified as group1 (n=100) and those with normal Ca levels as group 2 (n=122). The PoPTH levels and ∆PTH were compared between the two groups. ROC analysis was performed to determine the cut off values for PoPTH and ∆PTH. Results: The mean PoPTH level was significantly lower in group 1 compared to group 2 (18.6±15.3 pg/ml vs 32.3±15.6 pg/ml, respectively; P<0.0001). PoPTH values were within normal range in 54% of the patients with hypocalcemia and 35% of those with symptomatic hypocalcemia. PoPTH <28pg/ml or ∆PTH >45 were significantly associated with increased risk of post-thyroidectomy hypocalcemia (P=0.0001). A ∆PTH >70% ,PoPTH ≤ 15.5pg/ml and postoperative serum cCa concentrations<8.0mg/dl significantly predicted symptomatic hypocalcemia(P=0.009;P=0.006;andP=0.0001;respevtively).The sensitivities of ∆PTH,PoPTH level and postoperative serum cCa concentration to predict symptomatic hypocalcemia were 67%,64% and100, respectively. Conclusion: Although, PTH decline significantly correlate with symptomatic hypocalcemia, a considerable number of patients may experience hypocalcemic symptoms in spite of normal PoPTH levels. Analysis of serum Ca concentrations at 24 hours postoperatively help to achieve a more precise prediction of patients who bear a high risk for developing hypocalcemic symptoms.

Helicopter Transport Use for Trauma Patients Is Decreasing Significantly Nationwide but Remains Overutilized

2018 ◽  
Vol 84 (10) ◽  
pp. 1630-1634 ◽  
Author(s):  
Navpreet K. Dhillon ◽  
Nikhil T. Linaval ◽  
Kavita A. Patel ◽  
Christos Colovos ◽  
Ara Ko ◽  
...  
Keyword(s):  
Injury Severity ◽  
Data Bank ◽  
The United States ◽  
Trauma Patients ◽  
Effective Utilization ◽  
National Trauma ◽  
National Trauma Data Bank ◽  
Minor Injuries ◽  
Helicopter Transportation ◽  
Rapid Transfer

Rapid transfer of trauma patients to a trauma center for definitive management is essential to increase survival. The utilization of helicopter transportation for this purpose remains heavily debated. The purpose of this study was to characterize the trends in helicopter transportations of trauma patients in the United States over the last decade. Subjects with a primary mode of either ground or helicopter transportation were selected from the National Trauma Data Bank datasets 2007 to 2015. Over this period, the proportion of patients transported by a helicopter decreased significantly in a linear fashion from 17 per cent in 2007 to 10.2 per cent in 2015 ( P < 0.001). The overall mortality of this population was 7.6 per cent and remained unchanged over the study period ( P = 0.545). Almost 3 of 10 subjects (29.4%) transported by a helicopter had an Injury Severity Score <9. The proportion of elderly (>65 years) patients requiring helicopter transportation increased by 69.1 per cent, whereas their associated mortality decreased by 21.5 per cent. The use of a helicopter for the transportation of trauma patients has significantly decreased over the last decade without any significant change in mortality, possibly indicating more effective utilization of available resources. Overtriage of patients with minor injuries remained relatively unchanged.

Failure of Nonoperative Management of Splenic Injuries in Trauma Patients on Anticoagulation

2019 ◽  
Vol 85 (8) ◽  
pp. 848-850 ◽  
Author(s):  
Kristen Dougherty ◽  
Jay Collins ◽  
Jessica Burgess ◽  
Michael Martyak
Keyword(s):  
Primary Outcome ◽  
Injury Severity ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Traumatic Injury ◽  
Significant Risk ◽  
Splenic Tissue ◽  
Trauma Patients ◽  
Average Systolic Blood Pressure ◽  
Increased Risk

Although nonoperative management or embolization with preservation of splenic tissue is preferable, there is a significant risk of continued bleeding ultimately requiring splenectomy. It has been established that elderly patients on anticoagulation (AC) have an increased risk of splenic injury, but there are little data to show whether AC plays a role in outcomes of splenic injury in the setting of trauma. This is a retrospective cohort study, including 168 adults aged 50 to 79 years who presented as a trauma patient to Sentara Norfolk General Hospital from January 1, 2010, to March 31, 2018. The primary outcome is the management of the splenic injury. Of the 168 patients, 30 were presently taking AC at the time of their injury, and 138 were not taking any AC. These groups were similar in average Injury Severity Score, average grade of splenic injury, and average systolic blood pressure on arrival. However, the groups differed significantly in age and hemoglobin on arrival. We found that patients taking AC at the time of injury underwent splenectomy 23.3 per cent of the time, whereas patients not taking AC underwent splenectomy 11.6 per cent of the time ( P = 0.045). Patients taking AC failed nonoperative management 20 per cent of the time, whereas patients not taking AC failed 0.7 per cent of the time ( P < 0.05). We found that patients taking AC at the time of their traumatic injury were more likely to undergo splenectomy than patients not taking AC. We also found that patients taking AC were more likely to fail nonoperative management.

All-Terrain Vehicle Trauma in the Elderly: An Analysis of a National Database

2008 ◽  
Vol 74 (8) ◽  
pp. 767-769 ◽  
Author(s):  
Adeline M. Deladisma ◽  
William Parker ◽  
Regina Medeiros ◽  
Michael L. Hawkins
Keyword(s):  
Independent Predictor ◽  
Data Bank ◽  
The Elderly ◽  
The United States ◽  
National Database ◽  
National Trauma ◽  
Increased Risk ◽  
National Trauma Data Bank ◽  
Study Population ◽  
Safety Features

The elderly are a growing proportion of all-terrain (ATV) drivers. The purpose of this study was to determine if the outcomes of geriatric ATV trauma victims are different from those of their younger counterparts and if age is an independent predictor of mortality. ATV trauma cases in the United States reported to the National Trauma Data Bank between 1989 and 2003 comprised the study population. A logistic regression model was constructed with mortality as the outcome and age as the primary covariate of interest. A total of 6308 ATV-related traumas were reported to the National Trauma Data Bank during the study period. Geriatric victims presented with significantly higher systolic blood pressure (138.6 ± 34.4 vs 131.4 ± 24.8, P < 0.001) and had a significantly longer length of stay (8.3 ± 11.4 vs 4.8 ± 8.8, P < 0.001) and greater number of intensive care unit days (3.1 ± 7.1 vs 1.3 ± 4.0, P < 0.001). In a multivariate model, age older than 60 years was associated with increased risk of mortality (OR, 6.96; 95% CI, 3.75–12.92). Age older than 60 years is an independent predictor of mortality among ATV trauma cases. Improved training on the use of ATVs in this population and better safety features are warranted.

scholarly journals Exploratory Study on Trauma Scoring Systems for SAVE Triage

2020 ◽  
Vol 34 (5) ◽  
pp. 98-103
Author(s):  
Tai-Hwan Uhm ◽  
Jee Hee Kim ◽  
Sang-Kyu Park ◽  
Eun-Jwoo Kwag ◽  
Mi-Sook Kim ◽  
...  
Keyword(s):  
Injury Severity ◽  
Medical Center ◽  
Scoring Systems ◽  
Data Bank ◽  
The United States ◽  
International Classification Of Disease ◽  
Severity Classification ◽  
Trauma Scoring ◽  
Survival Risk

This study examined several trauma scoring systems that serve as the basis for applying the Secondary Assessment of Victim Endpoint (SAVE) severity classification to propose a method that can be applied during triage. By using an exploratory method, data collected from different trauma scoring systems was qualitatively evaluated. First, it was confirmed that the survival risk ratio (SRR) of the International Classification of Disease-based Injury Severity Score (ICISS) can be used for SAVE severity classification. Second, the Korean Trauma Data Bank (KTDB) of the Central Emergency Medical Center does not indicate the SRR of each injury according to the Korean standard classification of disease and cause of death (KCD). Third, the SRR of injuries, from data acquired from the United States can be used for classification of SAVE severity classification. Fourth, the addition of SRR from the KCD to the KTDB can be used for SAVE severity classification.

scholarly journals Pediatric Thoracic Trauma Mortality in Iraq and Afghanistan Compared to the United States National Trauma Data Bank

2021 ◽  
Author(s):  
Ryan J Keneally ◽  
Brittney A Meyers ◽  
Cynthia H Shields ◽  
Robert Ricca ◽  
Kevin M Creamer
Keyword(s):  
Thoracic Trauma ◽  
Injury Severity ◽  
Medical Training ◽  
Head Injuries ◽  
Data Bank ◽  
The United States ◽  
Mortality Rates ◽  
Trauma Patients ◽  
National Trauma ◽  
National Trauma Data Bank

ABSTRACT Introduction The authors compared pediatric thoracic patients in the Joint Theatre Trauma Registry (JTTR) to those in the National Trauma Data Bank (NTDB) to assess differences in patient mortality rates and mortality risk accounting for age, injury patterns, and injury severity. Materials and Methods Patients less than 19 years of age with thoracic trauma were identified in both the JTTR and NTDB. Multiple logistic regression, χ2, Student’s t-test, or Mann-Whitney U test were used as indicated to compare the two groups. Results Pediatric thoracic trauma patients seen in Iraq and Afghanistan (n = 955) had a significantly higher mortality rate (15.1 vs. 6.0%, P &lt;.01) than those in the NTDB (n = 9085). After controlling for covariates between the JTTR and the NTDB, there was no difference in mortality (odds ratio for mortality for U.S. patients was 0.74, 95% CI 0.52-1.06, P = .10). The patients seen in Iraq or Afghanistan were significantly younger (8 years old, interquartile ratio (IQR) 2-13 vs. 15, IQR 10-17, P &lt;.01) had greater severity of injuries (injury severity score 17, IQR 12-26 vs. 12, IQR 8-22, P &lt;.01), had significantly more head injuries (29 vs. 14%, P &lt;.01), and over half were exposed to a blast. Discussion Pediatric patients with thoracic trauma in Iraq and Afghanistan in the JTTR had similar mortality rates compared to the civilian population in the NTDB after accounting for confounding covariates. These findings indicate that deployed military medical professionals are providing comparable quality of care in extremely challenging circumstances. This information has important implications for military preparedness, medical training, and casualty care.

scholarly journals The study of cardiotoxicity of hydroxychloroquine and azithromycine combination in hospitalized patients with COVID-19

2020 ◽  
Vol 11 (2) ◽  
pp. 29-39
Author(s):  
Yu. N. Belenkov ◽  
I. V. Menshikova ◽  
I. S. Ilgisonis ◽  
Yu. I. Naimann ◽  
Yu. V. Pak ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Qt Interval ◽  
Ministry Of Health ◽  
Cardiovascular Comorbidity ◽  
Corrected Qt Interval ◽  
Number Of Patients ◽  
Increased Risk ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Hydroxychloroquine (HCH) is included in guidelines for treatment of novel coronavirus infection (COVID-19). Data on increased risk of cardiovascular complications when using it have been published. Aim. To evaluate the safety and tolerability of HCH and azithromycine (AZM) combination for the treatment of the patients with COVID-19 in recommended by Russian Ministry of Health doses in real practice.Methods. 132 patients (62 men and 70 women of average age 59.2 ± 9.3 years), 59% of whom had cardiovascular comorbidities, were included in prospective сohort study. 112 patients took HCH + AZM (group 1) and 20 patients took other medications without potential cardiotoxicity (group 2). At the admission to the hospital and after 5–7 days of the treatment corrected QT interval was calculated, new rhythm and conduction disorders, other side effects and hospital mortality have been registering. Relative risk (RR) and 95% confidence interval (CI) were calculated. Results. Elongation of corrected QT-interval within the normal range was registered in 22.3% of patients in group 1 and in 15% — in group 2. An increase in the QT length to the upper limit of the norm (480 msec) was observed in 1.8% of patients in group 1. There were no statistically significant differences between the groups in the number of patients with prolonged QT interval (RR = 1.488, 95% CI: 0.496–4.466, р = 0.478). The occurrence of new arrhythmias, conduction disturbances and allergic reactions was not recorded. Tolerability of combination HCH + AZM was satisfactory in the majority of patients. The hospital mortality in group 1 was 1.8%, in group 2 — 5% without statistically significant difference (p = 0.374). Conclusion. A combination of HCL + AZM according to the scheme recommended by the Ministry of Health of the Russian Federation for the treatment of the patients with COVID-19 and cardiovascular comorbidity in inpatient conditions is safe.

Geriatric Trauma Mortality: Does Trauma Center Level Matter?

2020 ◽  
pp. 000313482098319
Author(s):  
Frederick B. Rogers ◽  
Madison E. Morgan ◽  
Catherine Ting Brown ◽  
Tawnya M. Vernon ◽  
Kellie E. Bresz ◽  
...  
Keyword(s):  
Geriatric Patients ◽  
Injury Severity ◽  
Data Bank ◽  
Absolute Number ◽  
Geriatric Trauma ◽  
Multivariate Logistic Regression Model ◽  
Trauma Patients ◽  
Adjusted Analysis ◽  
Level Ii ◽  
Level I

Background Given their mostly rural/suburban locations, level II trauma centers (TCs) may offer greater exposure to and experience in managing geriatric trauma patients. We hypothesized that geriatric patients would have improved outcomes at level II TCs compared to level I TCs. Methods The Pennsylvania Trauma Outcome Study (PTOS) database was retrospectively queried from 2003 to 2017 for geriatric (age ≥65 years) trauma patients admitted to level I and II TCs in Pennsylvania. Patient demographics, injury severity, and clinical outcomes were compared to assess differences in care between level I and II TCs. A multivariate logistic regression model assessed the adjusted impact of care at level I vs II TCs on mortality, complications, and functional status at discharge (FSD). The National Trauma Data Bank (NTDB) was retrospectively queried for geriatric (age ≥65 years) trauma admissions to state-accredited level I or level II TCs in 2013. Results 112 648 patients met inclusion criteria. The proportion of geriatric trauma patients across level I and level II TCs were determined to be 29.1% and 36.2% ( P <.001), respectively. In adjusted analysis, there was no difference in mortality (adjusted odds ratio [AOR]: 1.13; P = .375), complications (AOR: 1.25; P = .080) or FSD (AOR: 1.09; P = .493) when comparing level I to level II TCs. Adjusted analysis from the NTDB (n = 144 622) also found that mortality was not associated with TC level (AOR: 1.04; P = .182). Discussion Level I and level II TCs had similar rates of mortality, complications, and functional outcomes despite a higher proportion (but lower absolute number) of geriatric patients being admitted to level II TCs. Future consideration for location of centers of excellence in geriatric trauma should include both level I and II TCs.

scholarly journals The impact of COVID-19 on primary retinopexy in preventing retinal detachment in a tertiary eye hospital emergency department

2021 ◽  
pp. 112067212199472
Author(s):  
George Moussa ◽  
Emma Samia-Aly ◽  
Walter Andreatta ◽  
Kim Son Lett ◽  
Arijit Mitra ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Case Series ◽  
Significant Shift ◽  
Number Of Patients ◽  
Increased Risk ◽  
Significant Difference ◽  
Male Patients ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Purpose: To review the effect of COVID-19 on rhegmatogenous retinal detachment (RRD) rate following primary retinopexy. Methods: Retrospective consecutive case series of 183 patients attending Birmingham and Midlands Eye Centre undergoing primary retinopexy (cryotherapy and laser) between March 23rd to June 30th in 2019 (Group 1) and 2020 (Group 2). Results: In total we reviewed 183 retinopexies, 122 in Group 1 and 61 in Group 2, a reduction of 50%. In Group 2 compared to Group 1, we showed a significant difference in characteristics of patients having primary retinopexy with an increase in proportion of male patients from 50 (41.0%) to 39 (63.9%) ( p = 0.005), increase in high myopes from 1 (0.8%) to 4 (6.6%) ( p = 0.043), more slit lamp laser retinopexy from 83 (68.0%) to 52 (85.2%) ( p = 0.013) and less cryopexy from 21 (17.2%) to 2 (3.3%) ( p = 0.008). In Group 2, primary retinopexy resulted in significantly more 3-month RRD rate 1 (0.8%) to 5 (8.2%) ( p = 0.016). There were no changes in number of patients requiring further retinopexy ( p = 1.000) Conclusion: This study demonstrates a reduction of primary retinopexy, an increased risk for RRD following primary retinopexy and a significant shift in type of primary retinopexy performed, demographics, operator and change in characteristics of type of retinal break observed during this pandemic. This study contributes to the growing literature of the secondary effects of the COVID-19 pandemic on other aspects of healthcare that is not just limited to the virus itself.

Shark-Related Injuries in the United States: A National Trauma Data Bank Analysis

2021 ◽  
pp. 000313482110241
Author(s):  
William Ganske ◽  
Rohit Sharma ◽  
Stephen Kaminski ◽  
Arianne Johnson
Keyword(s):  
Injury Severity ◽  
Nerve Repair ◽  
Skin Grafting ◽  
Soft Tissue Injuries ◽  
Data Bank ◽  
The United States ◽  
Lower Extremity Injuries ◽  
National Trauma ◽  
National Trauma Data Bank ◽  
Extremity Injuries

Background Shark-related injuries (SRIs) are a dreaded, but rare, source of injury that have not been well described. The present study aims to examine the incidence, injuries, and outcomes of SRIs presenting to US trauma centers. Study Design The National Trauma Data Bank was queried from 2015 to 2018 to identify SRIs using ICD-10 e-codes W56.41XA, W56.42XA, and W56.49XA. Descriptive analyses were conducted on patient demographics, injuries, hospital course, procedures, and outcomes. Results Fifty-three patients were identified with a mechanism of injury that was shark-related. The median age was 29 years (range: 3-67) and median injury severity score was 5 (IQR: 3-10). The majority of patients (96%) were admitted to the hospital (median length of stay (LOS): 4.0 days, IQR: 3.0-8.0), 55% went directly to the operating room, and 53% required intensive care unit (ICU) admission (median ICU LOS: 4.5 days, IQR: 1.3-7.0). Extremity injuries were common: 47% suffered lower extremity injuries, 40% had upper extremity injuries, and 13% had both. The majority of patients underwent surgical procedures: 83% had soft tissue injuries requiring debridement, flap coverage, or skin grafting; 28% suffered neurovascular injuries (17% requiring nerve repair and 2% requiring arterial bypass); and 59% required orthopedic intervention. Six patients (11%) required amputation(s). All patients survived to discharge. Conclusion Although an exceedingly rare source of trauma, SRIs are frequently associated with devastating injuries. Given the severity of injuries and associated procedures required, these patients warrant referral to a trauma center capable of providing comprehensive care.

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