scholarly journals A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Alexander F. Bedard ◽  
Lina V. Mata ◽  
Chelsea Dymond ◽  
Fabio Moreira ◽  
Julia Dixon ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Organ Failure ◽  
Scoping Review ◽  
Case Reports ◽  
Prehospital Care ◽  
Morbidity And Mortality ◽  
Main Body ◽  
Trauma Outcomes ◽  
Trauma Registries ◽  
Prehospital Time

Abstract Background Annually, over 1 billion people sustain traumatic injuries, resulting in over 900,000 deaths in Africa and 6 million deaths globally. Timely response, intervention, and transportation in the prehospital setting reduce morbidity and mortality of trauma victims. Our objective was to describe the existing literature evaluating trauma morbidity and mortality outcomes as a function of prehospital care time to identify gaps in literature and inform future investigation. Main body We performed a scoping review of published literature in MEDLINE. Results were limited to English language publications from 2009 to 2020. Included articles reported trauma outcomes and prehospital time. We excluded case reports, reviews, systematic reviews, meta-analyses, comments, editorials, letters, and conference proceedings. In total, 808 articles were identified for title and abstract review. Of those, 96 articles met all inclusion criteria and were fully reviewed. Higher quality studies used data derived from trauma registries. There was a paucity of literature from studies in low- and middle-income countries (LMIC), with only 3 (3%) of articles explicitly including African populations. Mortality was an outcome measure in 93% of articles, predominantly defined as “in-hospital mortality” as opposed to mortality within a specified time frame. Prehospital time was most commonly assessed as crude time from EMS dispatch to arrival at a tertiary trauma center. Few studies evaluated physiologic morbidity outcomes such as multi-organ failure. Conclusion The existing literature disproportionately represents high-income settings and most commonly assessed in-hospital mortality as a function of crude prehospital time. Future studies should focus on how specific prehospital intervals impact morbidity outcomes (e.g., organ failure) and mortality at earlier time points (e.g., 3 or 7 days) to better reflect the effect of early prehospital resuscitation and transport. Trauma registries may be a tool to facilitate such research and may promote higher quality investigations in Africa and LMICs.

scholarly journals Guidelines and practice recommendations on Obstetric care of pregnant patients with Covid-19 infection: Scoping review.

2020 ◽  
Author(s):  
Wondimu Gudu Jeldu ◽  
Lemi Belay Tolu
Keyword(s):  
Pregnant Women ◽  
Organ Failure ◽  
Scoping Review ◽  
Case Reports ◽  
Obstetric Care ◽  
Professional Associations ◽  
Growth Monitoring ◽  
Practice Recommendations ◽  
Expert Opinions ◽  
Consensus Statements

Abstract Introduction: The Management of pregnant women with Covid-19 infection is usually based on limited evidence from care reports and expert opinions. The aim of this scoping review is to identify available guidelines and practice recommendations on obstetric care of pregnant women with COVID-19.Methods: We searched guideline databases and websites of professional associations and international organizations working on sexual and reproductive health. We looked for guidelines, protocols, consensus statements and practice recommendations on management of pregnant women with COVID-19. Additionally, we searched: MEDLINE, EMBASE and Google Scholar. Data extraction was done by two independent reviewers using a customized tool that was developed to record the key information of the source that’s relevant to the review question.Results: The antenatal care for covid-19 positive mothers should be delayed until they test negative twice. Anatomic scanning may be considered in women who had the infection in the first trimester. Growth monitoring is recommended every 2-4wks. Antenatal corticosteroids can be administered in those women with preterm pregnancy (<34 wks) and mild illness. Low dose Aspirin can be continued safely. Tocolytics, particularly NSAIDs should be used cautiously. Covid-19 infection is not an indication for delivery. Termination is recommended in those with organ failure and in pts with severe respiratory failure. A single, asymptomatic or screen negative birth partner be permitted to stay with the woman. Continuous electronic fetal monitoring in labor is recommended. Cesarean delivery only in those with severe respiratory distress on ventilators & organ failure. Shortening of the second stage is considered in Covid-19 parturients who are on face masks. There are no consistent recommendations on immediate cord clamping and options of breast feeding. Universal isolation of mother from the neonate is not a standard of practice. Postpartum care can be provided with telemedicine.Conclusions: Obstetric care provision for Covid-19 infected mothers is primarily based on limited experience from case reports and expert opinions. Updated guidance for clinical practice are imperative as new scientific evidence emerges.

scholarly journals Opioid-Induced Respiratory Depression in Pediatric Palliative Care Patients with Severe Neurological Impairment—A Scoping Literature Review and Case Reports

Children ◽  
2020 ◽  
Vol 7 (12) ◽  
pp. 312
Author(s):  
Maximilian David Mauritz ◽  
Carola Hasan ◽  
Larissa Alice Dreier ◽  
Pia Schmidt ◽  
Boris Zernikow
Keyword(s):  
Risk Factors ◽  
Palliative Care ◽  
Young Adults ◽  
Scoping Review ◽  
Pediatric Patients ◽  
Case Reports ◽  
Neurological Impairment ◽  
Opioid Therapy ◽  
Pediatric Palliative Care ◽  
Severe Neurological Impairment

Pediatric Palliative Care (PPC) addresses children, adolescents, and young adults with a broad spectrum of underlying diseases. A substantial proportion of these patients have irreversible conditions accompanied by Severe Neurological Impairment (SNI). For the treatment of pain and dyspnea, strong opioids are widely used in PPC. Nonetheless, there is considerable uncertainty regarding the opioid-related side effects in pediatric patients with SNI, particularly concerning Opioid-Induced Respiratory Depression (OIRD). Research on pain and OIRD in pediatric patients with SNI is limited. Using scoping review methodology, we performed a systematic literature search for OIRD in pediatric patients with SNI. Out of n = 521 identified articles, n = 6 studies were included in the review. Most studies examined the effects of short-term intravenous opioid therapy. The incidence of OIRD varied between 0.13% and 4.6%; besides SNI, comorbidities, and polypharmacy were the most relevant risk factors. Additionally, three clinical cases of OIRD in PPC patients receiving oral or transdermal opioids are presented and discussed. The case reports indicate that the risk factors identified in the scoping review also apply to adolescents and young adults with SNI receiving low-dose oral or transdermal opioid therapy. However, the risk of OIRD should never be a barrier to adequate symptom relief. We recommend careful consideration and systematic observation of opioid therapy in this population of patients.

scholarly journals Spatio-Temporal Distribution of Acinetobacter baumannii in Germany—A Comprehensive Systematic Review of Studies on Resistance Development in Humans (2000–2018)

2020 ◽  
Vol 8 (3) ◽  
pp. 375 ◽  
Author(s):  
Gamal Wareth ◽  
Christian Brandt ◽  
Lisa D. Sprague ◽  
Heinrich Neubauer ◽  
Mathias W. Pletz
Keyword(s):  
Case Reports ◽  
Temporal Distribution ◽  
Extensive Study ◽  
Multi Drug Resistance ◽  
Main Body ◽  
Resistance Development ◽  
Outbreak Investigations ◽  
Spatio Temporal ◽  
Specialized Institutions ◽  
Multiresistant Strains

Acinetobacter (A.) baumannii has gained global notoriety as a significant nosocomial pathogen because it is frequently associated with multi-drug resistance and hospital-based outbreaks. There is a substantial difference in the incidence of A. baumannii infections between different countries and within Germany. However, its continuous spread within Germany is a matter of concern. A systematic literature search and analysis of the literature published between 2000 and 2018 on A. baumannii in humans was performed. Forty-four studies out of 216 articles met the criteria for inclusion, and were selected and reviewed. The number of published articles is increasing over time gradually. Case reports and outbreak investigations are representing the main body of publications. North Rhine-Westphalia, Hesse and Baden-Wuerttemberg were states with frequent reports. Hospitals in Cologne and Frankfurt were often mentioned as specialized institutions. Multiresistant strains carrying diverse resistance genes were isolated in 13 of the 16 German states. The oxacillinase blaOXA-23-like, intrinsic blaOXA-51-like, blaOXA-58 variant, blaNDM-1, blaGES-11, blaCTX-M and blaTEM are the most predominant resistance traits found in German A. baumannii isolates. Five clonal lineages IC-2, IC-7, IC-1, IC-4 and IC-6 and six sequence types ST22, ST53, ST195, ST218, ST944/ST78 and ST348/ST2 have been reported. Due to multidrug resistance, colistin, tigecycline, aminoglycosides, fosfomycin, ceftazidime/avibactam and ceftolozan/tazobactam were often reported to be the only effective antibiotics left to treat quadruple multi-resistant Gram-negative (4MRGN) A. baumannii. Dissemination and infection rates of A. baumannii are on the rise nationwide. Hence, several aspects of resistance development and pathogenesis are not fully understood yet. Increased awareness, extensive study of mechanisms of resistance and development of alternative strategies for treatment are required. One-Health genomic surveillance is needed to understand the dynamics of spread, to identify the main reservoirs and routes of transmission and to develop targeted intervention strategies.

Abstract 15990: Incidence and Outcomes of Elevated Troponins in Patients With Rhabdomyolysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nitheesha Ganta ◽  
Hilda Gonzalez ◽  
Olubode Olufajo ◽  
Prafulla P Mehrotra
Keyword(s):  
Hospital Mortality ◽  
Hospital Cost ◽  
Myocardial Injury ◽  
Case Reports ◽  
Coronary Intervention ◽  
Troponin Elevation ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
The Relationship ◽  
Cost Differences

Introduction: The relationship between rhabdomyolysis and elevated troponins has not been clearly established. Literature has been limited to case reports and small single center studies. However, there are no studies that evaluated the incidence and outcomes of troponin elevation in patients with rhabdomyolysis. Methods: Patients of 18 years and older with rhabdomyolysis were selected from the Healthcare Cost and Utilization Project National Inpatient Sample, 2005 to 2014. Patients with elevated troponins were identified. Information on demographics, co-morbidities and interventions (percutaneous coronary intervention (PCI) vs. no PCI) were extracted. The two main outcomes were mortality and hospital cost. Differences in characteristics and outcomes of patients with elevated troponins and those without elevated troponins were evaluated using descriptive analyses and multivariate regression models. Results: A total of 404,369 rhabdomyolysis participants were identified with 24,986 (6.18%) having elevated troponins. Of these, only 133 (0.03%) patients underwent PCI. Compared to the patients without elevated troponins, patients with elevated troponins were older (69y vs. 61y; P <0.001), and the majority were white (73.9% vs. 66.0%; P <0.001). In-hospital mortality in patients with elevated troponins was 20.5% compared to 5.4% in patients without elevated troponins ( P <0.001) resulting in an adjusted odds ratio of 4.05 (95% CI: 3.90 - 4.20). Compared to the patients without elevated troponins, the median hospital cost in patients with elevated troponins was $17,308 vs. $8,434 ( P <0.001) resulting in an adjusted mean difference of $9,547 (95% CI: $9,189 - $9,904). Conclusions: Our analysis showed that 6.1% of rhabdomyolysis patients have elevated troponins. Of these, very few patients underwent PCI, suggesting myocardial injury in these patients. Patients with elevated troponins had higher in-hospital mortality and increased cost of hospitalization. Due to the bad prognosis associated with elevated troponins, there is need for further evaluation for underlying coronary artery disease in patients with myocardial injury.

scholarly journals Penetrating Atherosclerotic Ulcer of Aorta: A Giant Lurking in the Dark

2014 ◽  
Vol 10 (1) ◽  
pp. 57-60
Author(s):  
Rabindra B Timala ◽  
Jyotindra Sharma ◽  
Siddhartha Pradhan ◽  
Navin Chandra Gautam
Keyword(s):  
Case Reports ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Management Option ◽  
Penetrating Atherosclerotic Ulcer

Penetrating atherosclerotic ulcer is one of the acute aortic conditions, associated with high morbidity and mortality. Management option is often debated between conservative vs. surgical, with different data supporting each of the option. Here we present two case reports, managed conservatively. Nepalese Heart Journal | Volume 10 | No.1 | November 2013| Pages 57-60 DOI: http://dx.doi.org/10.3126/njh.v10i1.9748

scholarly journals Burden of arrhythmia in hospitalized patients with cannabis use related disorders: analysis of 2016-2018 national inpatient sample

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
H Thyagaturu ◽  
S Thangjui ◽  
B Shrestha ◽  
K Shah ◽  
R Naik ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Cardiac Arrhythmia ◽  
Case Reports ◽  
Cannabis Use ◽  
Categorical Variables ◽  
Cannabis Use Disorder ◽  
National Inpatient Sample ◽  
Income Status ◽  
Co Morbidity ◽  
Study Results

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cannabis is being more widely use as a recreational substance worldwide. There have been case reports and systematic review describing the association of cannabis use and cardiac arrhythmia (1). Purpose We sought out to measure the prevalence of different types of cardiac arrhythmia in hospitalizations associated with cannabis use disorder. Methods We queried January 2016 to December 2018 National Inpatient Sample (NIS) databases to identify adult (≥18 yrs) hospitalizations in the US with a diagnosis of cannabis use related disorders. Patients with an associated diagnosis of arrhythmias were also identified based on appropriate ICD-10 CM codes. We used the Chi-square test to evaluate the differences between binary or categorical variables, and Student’s t-test for continuous variables. Multivariate logistic regression was used in outcomes analysis to adjust for potential hospital and patient-level confounders (age, sex, race, diabetes, heart failure, chronic kidney disease, anemia, obesity, elixhauser co-morbidity index, hospital location, teaching status, bed size, income status and others). The discharge weights provided in the databases were used to calculate the national estimates. STATA 16.1 software was used to perform all statistical analysis. Results We identified 2,457,544 hospitalizations associated with cannabis use related disorders across three years. Of which, 187,825 (7.6%) were associated with any arrhythmia. We found that atrial fibrillation was the most associated arrhythmia. The complete list of types of arrhythmia and their prevalence are described in Figure-1. Patients with arrhythmia group were older (mean age 50.5 vs 38.3 yrs; P &lt; 0.01) and had higher co-morbidity (% of &gt;3 Elixhauser comorbidity score 94.1% vs 60.6%; P &lt; 0.01). After adjusting for patient and hospital-level confounders, we observed arrhythmia group was associated with higher odds of in-hospital mortality compared to the group without arrhythmia [Odds Ratio (OR): 4.5 (4.09 – 5.00); P &lt; 0.01]. We also observed statistically significant increase in hospitalization length of stay due to the status of any arrhythmia [5.7 vs 5.1 days; P &lt; 0.01]. Conclusion The prevalence of Afib is high in hospitalizations associated with cannabis use. Hospitalizations associated with cannabis use disorder and any arrhythmia are associated with higher in-hospital mortality and LOS. Therefore, all electrocardiograms should be scrutinized in hospitalized cannabis users. However, further prospective studies are necessary to endorse our study results. Abstract Figure.

scholarly journals The use of MELD scores in critically ill cirrhotic patients

2016 ◽  
Vol 4 (16) ◽  
pp. 45
Author(s):  
Supannee Rassameehiran ◽  
Tinsay Woreta
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Hospital Mortality ◽  
Organ Failure ◽  
Critically Ill ◽  
Meld Score ◽  
Chronic Liver Failure ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
End Stage

The Model for End-Stage Liver Disease (MELD) was originally created to predict survival following transjugular intrahepatic portosystemic shunt and was subsequently found to accurately predict mortality in patients with end-stage liver disease. It has been used in the United States for liver allocation since 2002, and implementation of the MELD score resulted in a reduction in total number of deaths on the waitlist and a reduction in waiting time. Critically ill cirrhotic patients have an in-hospital mortality greater than 50%. Although the MELD score was also found to be an accurate predictor of in-ICU mortality and in-hospital mortality after ICU admission in critically ill cirrhotic patients, the Sequential Organ Failure Assessment (SOFA) score appears to perform better in many studies. The Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure (CLIF-C ACLF) score was later developed by using specific cut-points for each organ failure score system in CLIF patients to predict mortality in patients with ACLF. Neither the MELD nor SOFA score independently predicts post-liver transplantation mortality in cirrhotic patients with extrahepatic organ failure and should not be use as a delisting criterion for these patients. More data are needed to determine the accuracy of the CLIF-C ACLF score in predicting post-liver transplantation outcomes. Prospective evaluation of critically ill cirrhotic patients is needed to optimize liver organ allocation.

scholarly journals Accuracy of the Sequential Organ Failure Assessment Score for In-Hospital Mortality by Race and Relevance to Crisis Standards of Care

2021 ◽  
Vol 4 (6) ◽  
pp. e2113891
Author(s):  
William Dwight Miller ◽  
Xuan Han ◽  
Monica E. Peek ◽  
Deepshikha Charan Ashana ◽  
William F. Parker
Keyword(s):  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Standards Of Care ◽  
Assessment Score ◽  
Failure Assessment
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