scholarly journals Emergency Room Thoracotomy (ERT): A retrospective audit of results.

2021 ◽  
Vol 5 (1) ◽  
pp. 745-749
Author(s):  
Barbaro I Monzon ◽  
Maria Del Carmen Ortega ◽  
Jacques Goosen ◽  
Dietrich Doll ◽  
Maeyane Stephen Moeng
Keyword(s):  
Emergency Room ◽  
Injury Severity ◽  
Metabolic Parameters ◽  
Thoracic Injury ◽  
Time Of Arrival ◽  
Mechanism Of Injury ◽  
Resource Constrained ◽  
Constrained System ◽  
Management Algorithm ◽  
Retrospective Audit

Background: An Emergency Room Thoracotomy (ERT) is a resource-intensive, high-risk procedure in which rapid decision-making is essential. In a resource-constrained system, identification of the group of patients that could achieve the best outcome will avoid futile use. Incorporating physiological and metabolic parameters at the time of arrival to the emergency department into the management algorithm may assist with better patient selection and could improve outcomes. Material and Methods: A retrospective review of the results of subjects who underwent Emergency Room Thoracotomy at a Level 1 Academic Trauma Center over a 13-year period (01 January 2005 to 31 December 2017) was conducted. Mechanism of injury, physiological and metabolic parameters, anatomical injuries, Injury Severity Score (ISS), calculated Revised Trauma score (cRTS), volume and type of fluids administered, and mortality were analyzed comparing survivors and non-survivors. Results: One hundred and ten (n=110) patients underwent ERT during the study period. Variables such as the mechanism of injury, physiological and metabolic parameters, type, and volume of fluids administered did not show any statistically significant influence in the final outcome. Penetrating cardiac and chest trauma had better survival (40.6 % and 20 % respectively) compared to those with thoraco-abdominal, abdominal, pelvic, and femoral vessel trauma. Overall survival was 21,8%. Conclusions: In a resource-constrained environment an Emergency Room Thoracotomy should be performed in patients with a thoracic injury, especially cardiac, to achieve the best possible outcome.

Injuries to the Chest Part 1

2019 ◽  
Author(s):  
Erika B. Call ◽  
Amy N. Hildreth ◽  
J. Jason Hoth
Keyword(s):  
Emergency Department ◽  
Injury Severity ◽  
Flail Chest ◽  
Rib Fractures ◽  
Pulmonary Contusion ◽  
Thoracic Injury ◽  
Resuscitative Thoracotomy ◽  
Pulmonary Laceration ◽  
Tracheobronchial Injury ◽  
Early Trauma

Thoracic injury is common and is associated with significant morbidity and mortality. Injuries to the chest are responsible for 25% of blunt trauma fatalities and contribute to an additional 50% of deaths in this population.1 Fortunately, the majority of thoracic injuries can be treated effectively, and often definitively, by relatively simple maneuvers that can be learned and performed by most physicians involved in early trauma care. Only 5 to 10% will require operative intervention.2 These extremes in injury severity are unique to the chest and require treatment by a surgeon with a correspondingly broad range of knowledge and skills.  This article will address the following procedures and injuries:  tube thoracostomy, thoracotomy, emergency department resuscitative thoracotomy, video-assisted thoracoscopy, chest wall injuries including rib fractures and flail chest, pneumothorax, hemothorax, empyema, pulmonary contusion and laceration, and tracheobronchial injury. This review 6 figures, 1 table, and 49 references. Keywords: Tube thoracoscopy, emergency department resuscitative thoracotomy (EDRT), rib fractures, flail chest, pneumothorax, hemothorax, empyema, pulmonary contusion, pulmonary laceration, tracheobronchial injury

Helicopter Transport of Trauma Patients Improves Survival Irrespective of Transport Time

2020 ◽  
pp. 000313482094356
Author(s):  
Andrew M. Schneider ◽  
Joseph A. Ewing ◽  
John D. Cull
Keyword(s):  
Injury Severity ◽  
Survival Rates ◽  
Trauma Patients ◽  
Mechanism Of Injury ◽  
Transport Time ◽  
Level 1 ◽  
Student’S T ◽  
Level 1 Trauma Center ◽  
Student’S T Test ◽  
Transportation Type

Objectives Helicopter transport of trauma patients remains controversial. We examined the survival rates of patients undergoing helicopter versus ground transport to a Level 1 trauma center. Methods Retrospective analysis was performed on trauma patients treated between 2014 and 2017. Student’s t-test was used to compare air versus ground transport times. A logistic regression was then used to examine the association of transportation type on survival controlling for demographics, mechanism of injury, transport time, field intubation, and injury severity. Results Of 3967 patients identified, 69.6% (2762) were male, and the average age was 40 years. Most patients suffered blunt injuries (86.8%, 3445), while the remaining had penetrating injuries (11.6%, 459) or burns (1.6%, 63). The majority of patients were transferred by ground (3449) with only 13% (518) transferred by air. Patients transported by air had increased Injury Severity Score (ISS) with a median of 17 (IQR 9-24) versus 9 (IQR 5-14), increased length of stay (LOS) at 6 days versus 3 ( P < .001), and increased mortality at 12.6% vs 6.5% ( P < .001). Patients transported by air arrived 16.6 ± 6.7 minutes faster compared with ground for the zip codes examined. When adjusting for the mechanism of injury, ISS, age, gender, intubation status, and transport time, air transport was associated with an increased likelihood of survival (odds ratio [OR] = 1.57, 95% CI = 1.06-2.40). Conclusion In our analysis of 3967 patients, those transported by air had a significant improvement in the likelihood of survival compared with those transported by ground even when adjusting for both ISS and time.

Nonoperative Management of the Damaged Spleen: A Community Surgeon Looks Back

2017 ◽  
Vol 83 (5) ◽  
pp. 502-506
Author(s):  
Mark L. Walker
Keyword(s):  
Injury Severity Score ◽  
Retrospective Analysis ◽  
Severity Score ◽  
Blood Cells ◽  
Injury Severity ◽  
Nonoperative Management ◽  
Packed Red Blood Cells ◽  
Management Algorithm ◽  
Splenic Salvage

Blunt spleen injury is usually managed nonoperatively. An 8-year retrospective analysis by one community surgeon was done to provide an overview of the role of CT, angiography, and transfusion in the management algorithm. A total of 2750 patients were screened and 125 patients were identified with spleen injury. Of these 125 patients, 72 were managed without surgery. These were young (mean age 32 ± 16 years) patients with mean Injury Severity Score of 16 ± 8. Angiography was used in 14 patients. These patients received more blood (5 ± 6 vs 2 ± units of packed red blood cells) than their nonangiogram counterparts. Overall failure of nonoperative care was 3 per cent. Community surgeons can provide safe nonoperative care and current adjuncts including angi-ography may enhance splenic salvage.

Operative Intervention for Complete Pancreatic Transection in Children Sustaining Blunt Abdominal Trauma: Revisiting an Organ Salvage Technique

2011 ◽  
Vol 77 (5) ◽  
pp. 612-620 ◽  
Author(s):  
Matthew J. Borkon ◽  
Stephen E. Morrow ◽  
Elizabeth A. Koehler ◽  
Yu Shyr ◽  
Melissa A. Hilmes ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Injury Severity ◽  
Demographic Data ◽  
Operative Management ◽  
Pancreatic Injury ◽  
Pancreatic Tissue ◽  
Management Algorithm ◽  
Lengths Of Stay ◽  
Pancreatic Transection

Complete pancreatic transection (CPT) in children is managed commonly with distal pancreatectomy (DP). Alternatively, Roux-en-Y distal pancreaticojejunostomy (RYPJ) may be performed to preserve pancreatic tissue. The purpose of this study was to review our experience using either procedure in the management of children sustaining CPT after blunt abdominal trauma. We retrospectively reviewed the records of all children admitted to our institution during the last 15 years who were confirmed at operation to have CPT after blunt mechanisms. Summary statistics of demographic data were performed to describe children receiving either RYPJ or DP. CPT occurred in 28 children: 15 had DP, 10 had RYPJ, and three had cystogastrostomy. RYPJ children, compared with DP, were younger (7.5 vs 12.3 years, P = 0.039) and sustained more grade IV pancreatic injuries (70% vs 14%, P = 0.01). DP patients were 5.63 times more likely to tolerate full enteral feeds ( P = 0.009). Nevertheless, when controlling for age, injury severity score, and pancreatic injury grade, procedure type did not statistically affect total and postoperative lengths of stay and postoperative complications. In the operative management algorithm of children sustaining CPT, DP may afford an earlier return to full enteral feeds. RYPJ seems otherwise equivalent to DP and preserves significant pancreatic glandular tissue and the spleen.

scholarly journals The significance of the levels of fibrin/fibrinogen degradation products for predicting trauma severity

2018 ◽  
Vol 26 (3) ◽  
pp. 143-150 ◽  
Author(s):  
Masato Murata ◽  
Shuichi Hagiwara ◽  
Makoto Aoki ◽  
Jun Nakajima ◽  
Kiyohiro Oshima
Keyword(s):  
Injury Severity Score ◽  
Emergency Room ◽  
Severity Score ◽  
Injury Severity ◽  
Degradation Products ◽  
Area Under The Curve ◽  
Trauma Patients ◽  
Fibrinogen Degradation Products ◽  
Trauma Severity ◽  
D Dimer

Background: On initial treatment in the emergency room, trauma patients should be assessed using simple clinical indicators that can be measured quickly. Objectives: The purpose of this study is to investigate the relationship between the injury severity score and blood test parameters measured on emergency room arrival in trauma patients. Methods: Trauma patients transferred to Gunma University Hospital between May 2013 and April 2014 were evaluated in this prospective, observational study. Blood samples were collected immediately on their arrival at our emergency room and their hematocrit, platelet, international normalized ratio of prothrombin time, activated partial thromboplastin time, fibrin/fibrinogen degradation products, and D-dimer were measured. We evaluated the correlations between the injury severity score and those biomarkers, and examined whether the correlation varied according to the injury severity score value. We also evaluated the correlations between the biomarkers and the abbreviated injury scale values of six regions. Results: We analyzed 371 patients. Fibrin/fibrinogen degradation products and D-dimer showed the greatest coefficients of correlation with injury severity score (0.556 and 0.543, respectively). The area under the curve of the receiver operating characteristic was larger in patients with injury severity score ⩾ 9 than in those with injury severity score ⩾ 4; however, patients with injury severity score ⩾ 9 or ⩾16 showed no significant differences. The area under the curve of fibrin/fibrinogen degradation products was larger than that of D-dimer at all injury severity score values. The chest abbreviated injury scale had the strongest relationship with fibrin/fibrinogen degradation products. Conclusion: Fibrin/fibrinogen degradation products and D-dimer were positively correlated with injury severity score, and the relationships varied according to trauma severity. Chest trauma contributed most strongly to fibrin/fibrinogen degradation product elevation.

scholarly journals Ensemble machine learning prediction of posttraumatic stress disorder screening status after emergency room hospitalization

2018 ◽  
Author(s):  
Santiago Papini ◽  
Derek Pisner ◽  
Jason Shumake ◽  
Mark B. Powers ◽  
Christopher G Beevers ◽  
...  
Keyword(s):  
Machine Learning ◽  
Posttraumatic Stress Disorder ◽  
Emergency Room ◽  
Posttraumatic Stress ◽  
Injury Severity ◽  
Census Data ◽  
Stress Disorder ◽  
Good Prediction ◽  
Population Total ◽  
Ensemble Machine Learning

Posttraumatic stress disorder (PTSD) develops in a substantial minority of emergency room admits. Inexpensive and accurate person-level assessment of PTSD risk after trauma exposure is a critical precursor to large-scale deployment of early interventions that may reduce individual suffering and societal costs. Toward this aim, we applied ensemble machine learning to predict PTSD status three months after severe injury using cost-effective and minimally invasive data. Participants (N = 271) were recruited at a Level 1 Trauma Center where they provided variables routinely collected at the hospital, including pulse, injury severity, and demographics, as well as psychological variables, including self-reported current depression, psychiatric history, and social support. Participant zip codes were used to extract contextual variables including population total and density, average annual income, and health insurance coverage rates from publicly available U.S. Census data. Machine learning yielded good prediction of PTSD status 3 months post-hospitalization, AUC = 0.85 95% CI [0.83, 0.86], and significantly outperformed all benchmark comparison models in a cross-validation procedure designed to yield an unbiased estimate of performance. These results demonstrate that good prediction can be attained from variables that individually have relatively weak predictive value, pointing to the promise of ensemble machine learning approaches that do not rely on strong isolated risk factors.

scholarly journals 1213 Cycling-related Trauma Admissions to the Major Trauma Centre in the Cycling Capital of the United Kingdom

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
Z Arshad ◽  
M majeed ◽  
A Thahir ◽  
F Anwar ◽  
J Rawal ◽  
...  
Keyword(s):  
United Kingdom ◽  
Major Trauma ◽  
Injury Severity ◽  
Trauma Centre ◽  
Vehicle Group ◽  
Mechanism Of Injury ◽  
Helmet Use ◽  
The United Kingdom ◽  
Body Regions ◽  
Major Trauma Centre

Abstract Aim The number of cyclists travelling on roads in the United Kingdom (UK) is increasing. The government has recently introduced initiatives to promote cycling uptake and so these numbers are likely to increase. This study aims to characterise cycling related injuries presenting to a major trauma centre located within a region with the highest rates of cycling in the UK. Method A retrospective review of cycling related trauma admissions occurring between January 2012 and June 2020 was performed. All patients were split into three groups based on the mechanism of injury. Our institution’s electronic patient record system was used to collect data including age, gender, mechanism of injury, Glasgow coma scale score on arrival, incident date and time, injured body regions, 30-day mortality, helmet use, and length of stay. Results A total of 606 cycling related trauma cases were identified, with 52 being excluded due to incomplete data. The ‘cyclist v vehicle’ group was associated with a significantly higher Injury Severity score (ISS), lower GCS and longer hospital stay than the other two groups. Helmet wearers were significantly older than non-wearers and helmet use was associated with a significantly reduced risk of head injury, lower ISS and higher GCS. Conclusions With a likely increase in future cycling uptake, it is crucial that effective interventions are put in place to improve the safety of cyclists. A multi-faceted strategy involving driver and cyclist education, road infrastructure changes and helmet promotion campaigns targeting the younger generation could be employed.

scholarly journals The Association of Early Electrocardiographic Abnormalities With Brain Injury Severity and Outcome in Severe Traumatic Brain Injury

2021 ◽  
Vol 11 ◽  
Author(s):  
Jelmer-Joost Lenstra ◽  
Lidija Kuznecova-Keppel Hesselink ◽  
Sacha la Bastide-van Gemert ◽  
Bram Jacobs ◽  
Maarten Willem Nicolaas Nijsten ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Cardiac Arrhythmias ◽  
Injury Severity ◽  
Thoracic Injury ◽  
Diffuse Brain Injury ◽  
Severe Tbi ◽  
Ecg Abnormalities ◽  
Diffuse Brain

The aim of this study was to evaluate the frequency of electrocardiographic (ECG) abnormalities in the acute phase of severe traumatic brain injury (TBI) and the association with brain injury severity and outcome. In contrast to neurovascular diseases, sparse information is available on this issue. Data of adult patients with severe TBI admitted to the Intensive Care Unit (ICU) for intracranial pressure monitoring of a level-1 trauma center from 2002 till 2018 were analyzed. Patients with a cardiac history were excluded. An ECG recording was obtained within 24 h after ICU admission. Admission brain computerized tomography (CT)-scans were categorized by Marshall-criteria (diffuse vs. mass lesions) and for location of traumatic lesions. CT-characteristics and maximum Therapy Intensity Level (TILmax) were used as indicators for brain injury severity. We analyzed data of 198 patients, mean (SD) age of 40 ± 19 years, median GCS score 3 [interquartile range (IQR) 3–6], and 105 patients (53%) had thoracic injury. In-hospital mortality was 30%, with sudden death by cardiac arrest in four patients. The incidence of ECG abnormalities was 88% comprising ventricular repolarization disorders (57%) mostly with ST-segment abnormalities, conduction disorders (45%) mostly with QTc-prolongation, and arrhythmias (38%) mostly of supraventricular origin. More cardiac arrhythmias were observed with increased grading of diffuse brain injury (p = 0.042) or in patients treated with hyperosmolar therapy (TILmax) (65%, p = 0.022). No association was found between ECG abnormalities and location of brain lesions nor with thoracic injury. Multivariate analysis with baseline outcome predictors showed that cardiac arrhythmias were not independently associated with in-hospital mortality (p = 0.097). Only hypotension (p = 0.029) and diffuse brain injury (p = 0.017) were associated with in-hospital mortality. In conclusion, a high incidence of ECG abnormalities was observed in patients with severe TBI in the acute phase after injury. No association between ECG abnormalities and location of brain lesions or presence of thoracic injury was present. Cardiac arrhythmias were indicative for brain injury severity but not independently associated with in-hospital mortality. Therefore, our findings likely suggest that ECG abnormalities should be considered as cardiac mimicry representing the secondary effect of traumatic brain injury allowing for a more rationale use of neuroprotective measures.

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