scholarly journals Both Autopsy and Computed Tomography Are Necessary for Accurately Detecting Rib Fractures Due to Cardiopulmonary Resuscitation

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 697
Author(s):  
Kunio Hamanaka ◽  
Kei Nishiyama ◽  
Mami Nakamura ◽  
Marin Takaso ◽  
Masahito Hitosugi
Keyword(s):  
Computed Tomography ◽  
Logistic Regression ◽  
Cardiopulmonary Resuscitation ◽  
Observational Study ◽  
Logistic Regression Model ◽  
Kappa Coefficient ◽  
Rib Fractures ◽  
Post Mortem ◽  
Single Centre ◽  
Cpr Quality

Few studies have compared the sensitivities of autopsy and post mortem computed tomography (PMCT) in detecting rib fractures caused by cardiopulmonary resuscitation (CPR). We aimed to compare the characteristics between both modalities for accurately detecting CPR-related rib fractures. This single-centre observational study included adult patients with autopsy records and PMCT scans at our institution from January 2013 to March 2019. CPR-related rib fractures were evaluated using autopsy and PMCT findings. In 62 patients enrolled, 339 rib fractures were detected on autopsy and/or PMCT (222 fractures on both PMCT and autopsy, 69 on PMCT alone, and 50 on autopsy alone). The agreement of detection for both modalities was substantial (kappa coefficient, 0.78). In the logistic regression model, incomplete fractures detected by PMCT and age <75 years were significantly associated with findings that were negative on autopsy but positive on PMCT, while rib number (ribs 1–3 and 7–12) and fracture location (posterolateral and paravertebral) were significantly associated with negative PMCT findings but positive autopsy findings. Autopsy and PMCT showed complementary roles, and are thus necessary in accurately detecting CPR-related rib fractures. Combining both modalities may contribute to improved CPR quality and better understanding of discrepancy in characteristics between the two modalities.

scholarly journals Helmet use among motorcyclists: observational study in the city of Mar del Plata, Argentina

2008 ◽  
Vol 42 (1) ◽  
pp. 143-145 ◽  
Author(s):  
Rubén Daniel Ledesma ◽  
Raquel Inés Peltzer
Keyword(s):  
Logistic Regression ◽  
Law Enforcement ◽  
Observational Study ◽  
Logistic Regression Model ◽  
Weather Conditions ◽  
Multiple Logistic Regression ◽  
Helmet Use ◽  
The City ◽  
Unfavorable Weather ◽  
Gender Type

The objective of the study was to assess the use of helmets in a community where helmet use is mandatory but low as there is no police enforcement. A sample comprising 451 motorcyclists in the city of Mar del Plata, Argentina, was studied in 2006. The following variables were studied: gender, type of motorcycle, weather conditions, time of the day, city area and type of road where motorcyclists traveled. Data were analyzed through a multiple logistic regression model. An overall 40% prevalence (95% CI: 35.5;44.5) of helmet use was found. Higher rates of helmet use were seen among women, and under unfavorable weather conditions, lower rates were found in the city outskirts, and variable use was seen according to the type of motorcycle. There is a need to improve law enforcement and to promote education of motorcyclists.

scholarly journals Could post-mortem computed tomography angiography inform cardiopulmonary resuscitation research?

Resuscitation ◽  
2017 ◽  
Vol 121 ◽  
pp. 34-40 ◽  
Author(s):  
Guy N. Rutty ◽  
Claire Robinson ◽  
Jasmin Amoroso ◽  
Tim Coats ◽  
Bruno Morgan
Keyword(s):  
Computed Tomography ◽  
Cardiopulmonary Resuscitation ◽  
Computed Tomography Angiography ◽  
Post Mortem

scholarly journals Association of Multiple Rib Fractures With Pneumonia After Successful Cardiopulmonary Resuscitation: A Retrospective Cohort Study Using Propensity Score Matching

2020 ◽  
Author(s):  
Yasuyuki Kawai ◽  
Keisuke Takano ◽  
Keita Miyazaki ◽  
Koji Yamamoto ◽  
Yusuke Tada ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Propensity Score ◽  
Cardiopulmonary Resuscitation ◽  
Propensity Score Matching ◽  
Retrospective Cohort ◽  
Rib Fractures ◽  
Confounding Factors ◽  
Fracture Group ◽  
Multiple Rib Fractures ◽  
Hospital Cardiac Arrest

Abstract Background: Few studies have examined the impact of chest wall injury on respiratory complications after cardiopulmonary resuscitation. This is due to many confounding factors for the development of complications after cardiopulmonary resuscitation. Accordingly, we investigated the association between multiple rib fractures and the incidence of pneumonia during the post-resuscitation period after adjusting for confounding factors using a propensity score.Methods: This single-centre, retrospective cohort study enrolled adult, non-traumatic, out-of-hospital, cardiac arrest patients who maintained circulation for >48 h between June 2015 and May 2019. Rib fractures were evaluated by computed tomography on the day of hospital admission, and the association with newly developed pneumonia within 7 days of hospitalisation was analysed using propensity score matching with adjustment for variables previously reported to be risk factors for the development of pneumonia.Results: Of the 683 out-of-hospital cardiac arrest patients treated during the study period, 87 eligible cases were enrolled for analysis. Thirty-two patients had multiple rib fractures identified by computed tomography and 35 patients developed pneumonia. The presence of multiple rib fractures was significantly associated with a higher incidence of pneumonia (propensity score-adjusted hazard ratio: 3.51; 95% confidence interval: 1.59–7.72; p=0.002). Consistently, after propensity score matching, the multiple rib fracture group showed significantly shorter pneumonia-free survival than the non-multiple rib fracture group (p<0.01).Conclusion: Multiple rib fractures are independently associated with the development of pneumonia after successful resuscitation.

scholarly journals Association of Multiple Rib Fractures With Pneumonia After Successful Cardiopulmonary Resuscitation: A Retrospective Cohort Study Using Propensity Score Matching

2020 ◽  
Author(s):  
Yasuyuki Kawai ◽  
Keisuke Takano ◽  
Keita Miyazaki ◽  
Koji Yamamoto ◽  
Yusuke Tada ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Propensity Score ◽  
Cardiopulmonary Resuscitation ◽  
Propensity Score Matching ◽  
Retrospective Cohort ◽  
Rib Fractures ◽  
Confounding Factors ◽  
Fracture Group ◽  
Multiple Rib Fractures ◽  
Hospital Cardiac Arrest

Abstract Background: Few studies have examined the impact of chest wall injury on respiratory complications after cardiopulmonary resuscitation. This is due to many confounding factors for the development of complications after cardiopulmonary resuscitation. Accordingly, we investigated the association between multiple rib fractures and the incidence of pneumonia during the post-resuscitation period after adjusting for confounding factors using a propensity score.Methods: This single-centre, retrospective cohort study enrolled adult, non-traumatic, out-of-hospital, cardiac arrest patients who maintained circulation for >48 h between June 2015 and May 2019. Rib fractures were evaluated by computed tomography on the day of hospital admission, and the association with newly developed pneumonia within 7 days of hospitalisation was analysed using propensity score matching with adjustment for variables previously reported to be risk factors for the development of pneumonia.Results: Of the 683 out-of-hospital cardiac arrest patients treated during the study period, 87 eligible cases were enrolled for analysis. Thirty-two patients had multiple rib fractures identified by computed tomography and 35 patients developed pneumonia. The presence of multiple rib fractures was significantly associated with a higher incidence of pneumonia (propensity score-adjusted hazard ratio: 3.51; 95% confidence interval: 1.59–7.72; p=0.002). Consistently, after propensity score matching, the multiple rib fracture group showed significantly shorter pneumonia-free survival than the non-multiple rib fracture group (p<0.01).Conclusion: Multiple rib fractures are independently associated with the development of pneumonia after successful resuscitation.

scholarly journals The Association between Cardiopulmonary Resuscitation in Out-of-Hospital Settings and Chest Injuries: A Retrospective Observational Study

2018 ◽  
Vol 33 (2) ◽  
pp. 171-175 ◽  
Author(s):  
Wataru Takayama ◽  
Hazuki Koguchi ◽  
Akira Endo ◽  
Yasuhiro Otomo
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Risk Factor ◽  
Cardiopulmonary Resuscitation ◽  
Observational Study ◽  
Independent Risk Factor ◽  
Retrospective Observational Study ◽  
Multivariate Logistic Regression ◽  
Chest Injuries ◽  
Independent Risk Factors

AbstractObjectivesThe aim of this study was to assess the risk of cardiopulmonary resuscitation (CPR) performed in out-of-hospital settings for chest injuries in patients with out-of-hospital cardiac arrest (OHCA).MethodsThis retrospective, observational study was conducted in an emergency critical care medical center in Japan. Non-traumatic OHCA patients transferred to the hospital from April 2013 through August 2016 were analyzed. The outcome was defined by chest injuries related to CPR, which is composite of rib fractures, sternal fractures, and pneumothoraces. A multivariate logistic regression analysis was performed to assess the independent risk factors for chest injuries related to CPR. The threshold of out-of-hospital CPR duration that increased risk of chest injuries was also assessed.ResultsA total of 472 patients were identified, of whom 233 patients sustained chest injuries. The multivariate logistic regression model showed that the independent risk factors for chest injuries were age and out-of-hospital CPR duration (age: AOR=1.06 [95% CI, 1.04 to 1.07]; out-of-hospital CPR duration: AOR=1.03 [95% CI, 1.01 to 1.05]). In-hospital CPR duration was not an independent risk factor for chest injuries. When the duration of out-of-hospital CPR extended over 15 minutes, the likelihood of chest injuries increased; however, this association was not statistically significant.ConclusionsLong duration of out-of-hospital CPR was an independent risk factor for chest injuries, possibly due to the difficulty of maintaining adequate quality of CPR. Further investigations to assess the efficacy of alternative CPR devices are expected in cases requiring long transportation times.TakayamaW, KoguchiH, EndoA, OtomoY. The association between cardiopulmonary resuscitation in out-of-hospital settings and chest injuries: a retrospective observational study. Prehosp Disaster Med. 2018;33(2):171–175.

scholarly journals Clinical Relevance of Unexpected Findings of Post-Mortem Computed Tomography in Hospitalized Patients: An Observational Study

2020 ◽  
Vol 17 (20) ◽  
pp. 7572
Author(s):  
Max G. Mentink ◽  
Bartholomeus G. H. Latten ◽  
Frans C. H. Bakers ◽  
Casper Mihl ◽  
Roger J. M. W. Rennenberg ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Observational Study ◽  
Cause Of Death ◽  
Clinical Relevance ◽  
Clinical Care ◽  
Hospitalized Patients ◽  
Post Mortem ◽  
Next Of Kin ◽  
Conventional Autopsy ◽  
Unexpected Findings

Background and objective: The current literature describing the use of minimally invasive autopsy in clinical care is mainly focused on the cause of death. However, the identification of unexpected findings is equally important for the evaluation and improvement of daily clinical care. The purpose of this study was to analyze unexpected post-mortem computed tomography (PMCT) findings of hospitalized patients and assess their clinical relevance. Materials and methods: This observational study included patients admitted to the internal medicine ward. Consent for PMCT and autopsy was requested from the next of kin. Decedents were included when consent for at least PMCT was obtained. Consent for autopsy was not obtained for all decedents. All findings reported by PMCT were coded with an International Classification of Diseases (ICD) code. Unexpected findings were identified and subsequently categorized for their clinical relevance by the Goldman classification. Goldman class I and III were considered clinically relevant. Additionally, correlation with autopsy results and ante-mortem imaging was performed. Results: In total, 120 decedents were included and evaluated for unexpected findings on PMCT. Of them, 57 decedents also underwent an autopsy. A total of 1020 findings were identified; 111 correlated with the cause of death (10.9%), 508 were previously reported (49.8%), 99 were interpreted as post-mortem changes (9.7%), and 302 were classified as unexpected findings (29.6%). After correlation with autopsy (in 57 decedents), 24 clinically relevant unexpected findings remained. These findings were reported in 18 of 57 decedents (32%). Interestingly, 25% of all unexpected findings were not reported by autopsy. Conclusion: Many unexpected findings are reported by PMCT in hospitalized patients, a substantial portion of which is clinically relevant. Additionally, PMCT is able to identify pathology and injuries not reported by conventional autopsy. A combination of PMCT and autopsy can thus be considered a more comprehensive and complete post-mortem examination.

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