scholarly journals Demographics of the injury pattern in severely injured patients with an associated clavicle fracture: a retrospective observational cohort study

2013 ◽  
Vol 8 (1) ◽  
Author(s):  
Jacqueline JEM van Laarhoven ◽  
Steven Ferree ◽  
R Marijn Houwert ◽  
Falco Hietbrink ◽  
Egbert Jan MM Verleisdonk ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clavicle Fracture ◽  
Observational Cohort Study ◽  
Injury Pattern ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Observational Cohort ◽  
Injured Patients ◽  
Retrospective Observational Cohort Study

scholarly journals Changing from a two-tiered to a one-tiered trauma team activation protocol: a before–after observational cohort study investigating the clinical impact of undertriage

2021 ◽  
Author(s):  
Kenneth Thorsen ◽  
Jon Kristian Narvestad ◽  
Kjell Egil Tjosevik ◽  
Johannes Wiik Larsen ◽  
Kjetil Søreide
Keyword(s):  
Cohort Study ◽  
Transition Period ◽  
Trauma System ◽  
Trauma Team ◽  
Observational Cohort Study ◽  
University Hospital ◽  
Severely Injured ◽  
Observational Cohort ◽  
The One ◽  
Injured Patients

Abstract Background The aim of this study was to compare the effect of the change in TTA protocol from a two-tier to one-tier, with focus on undertriage and mortality. Material and methods A before–after observational cohort study based on data extracted from the Stavanger University Hospital Trauma registry in the transition period from two-tier to a one-tier TTA protocol over two consecutive 1-year periods (2017–2018). Comparative analysis was done between the two time-periods for descriptive characteristics and outcomes. The main outcomes of interest were undertriage and mortality. Results During the study period 1234 patients were included in the registry, of which 721 (58%) were in the two-tier and 513 (42%) in the one-tier group. About one in five patients (224/1234) were severely injured (ISS > 15). Median age was 39 in the two-tier period and 43 years in the one-tier period (p = 0.229). Median ISS was 5 for the two-tier period vs 9, in the one-tier period (p = 0.001). The undertriage of severely injured patients in the two-tier period was 18/122 (15%), compared to 31/102 (30%) of patients in the one-tier period (OR = 2.5; 95% CI 1.8–4.52). Overall mortality increased significantly between the two TTA protocols, from 2.5 to 4.7% (p = 0.033), OR 0.51 (0.28–0.96) Conclusion A protocol change from two-tiered TTA to one-tiered TTA increased the undertriage in our trauma system. A two-tiered TTA may be beneficial for better patient care.

scholarly journals Disorders of placental villous maturation in fetal death

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Sunil Jaiman ◽  
Roberto Romero ◽  
Percy Pacora ◽  
Eunjung Jung ◽  
Gaurav Bhatti ◽  
...  
Keyword(s):  
Cohort Study ◽  
Fetal Death ◽  
Prevalence Ratio ◽  
Normal Pregnancy ◽  
Observational Cohort Study ◽  
Maturation Arrest ◽  
Inflammatory Lesions ◽  
Multiple Gestations ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

Abstract Objective The aims of this study were to ascertain the frequency of disorders of villous maturation in fetal death and to also delineate other placental histopathologic lesions in fetal death. Methods This was a retrospective observational cohort study of fetal deaths occurring among women between January 2004 and January 2016 at Hutzel Women’s Hospital, Detroit, MI, USA. Cases comprised fetuses with death beyond 20 weeks’ gestation. Fetal deaths with congenital anomalies and multiple gestations were excluded. Controls included pregnant women without medical/obstetrical complications and delivered singleton, term (37–42 weeks) neonate with 5-min Apgar score ≥7 and birthweight between the 10th and 90th percentiles. Results Ninety-two percent (132/143) of placentas with fetal death showed placental histologic lesions. Fetal deaths were associated with (1) higher frequency of disorders of villous maturation [44.0% (64/143) vs. 1.0% (4/405), P < 0.0001, prevalence ratio, 44.6; delayed villous maturation, 22% (31/143); accelerated villous maturation, 20% (28/143); and maturation arrest, 4% (5/143)]; (2) higher frequency of maternal vascular malperfusion lesions [75.5% (108/143) vs. 35.7% (337/944), P < 0.0001, prevalence ratio, 2.1] and fetal vascular malperfusion lesions [88.1% (126/143) vs. 19.7% (186/944), P < 0.0001, prevalence ratio, 4.5]; (3) higher frequency of placental histologic patterns suggestive of hypoxia [59.0% (85/143) vs. 9.3% (82/942), P < 0.0001, prevalence ratio, 6.8]; and (4) higher frequency of chronic inflammatory lesions [53.1% (76/143) vs. 29.9% (282/944), P < 0.001, prevalence ratio 1.8]. Conclusion This study demonstrates that placentas of womem with fetal death were 44 times more likely to present disorders of villous maturation compared to placentas of those with normal pregnancy. This suggests that the burden of placental disorders of villous maturation lesions is substantial.

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