scholarly journals Physician-Led Thoracic Trauma Management in a Specialist Emergency Care Centre

2021 ◽  
Vol 10 (24) ◽  
pp. 5806
Author(s):  
Jonathan Bates-Powell ◽  
David Basterfield ◽  
Karl Jackson ◽  
Avinash Aujayeb
Keyword(s):  
Length Of Stay ◽  
Large Scale ◽  
Thoracic Trauma ◽  
Needle Aspiration ◽  
Rib Fractures ◽  
Erector Spinae ◽  
Thoracic Injury ◽  
Trauma Management ◽  
Support Unit ◽  
Co Morbidity

Introduction: Falls cause 75% of trauma in patients above 65 years of age, and thoracic trauma is the second commonest injury; rib fractures are the most common thoracic injury. These patients have up to 12% mortality, with 31% developing pneumonias. There is wide variation in care. Northumbria Healthcare has a team of respiratory consultants, physiotherapists, specialist nurses and anesthetists for thoracic-trauma management on a respiratory support unit. Methods: With Caldicott approval, basic demographics and clinical outcomes of patients admitted with thoracic trauma between 20 August 20–21 Aprilwere analyzed. A descriptive statistical methodology was applied. Results: A total of 119 patients were identified with a mean age of 71.1 years (range 23–97). Of the 119 patients, 53 were male, 66 females. The main mechanism of injury was falls from standing (65) and falls down stairs/bed or in the bath (18). Length of stay was 7.3 days (range 1–54). In total, 85 patients had more than one co-morbidity, 26 had a full trauma assessment and 75 had pan CTs. The mean number of rib fractures was 3.6 and 31 (26%) patients had a pneumothorax and/or haemothorax. A total of 18 chest drains were inserted (all small bore) and one needle aspiration was performed. No cardiothoracic input was required. Isolated chest trauma was present only in 45 patients. All patients had a pain team review, 22 erector spinae catheters were inserted with 2 paravertebral blocks. Overall, 82 patients did not require oxygen, 1 required CPAP and 1 HFNC. 7 needed intensive care transfer. Furthermore, 20 (17%) developed pneumonias and 16 (14%) deaths occurred within 30 days—all were in those with falls from standing. There was no correlation between number of fractured ribs, length of stay and mortality. Conclusions: High level care for thoracic trauma can be performed by a physician led team. Overall, 42% pneumothoraces/haemothoraces were observed. Further large scale randomised trials are warranted for definitive outcomes.

scholarly journals A Case Report of Delayed Hemothorax Complicated by Fibrothorax

2021 ◽  
Vol 4 (3) ◽  
pp. 184-190
Author(s):  
Tanvi Chokshi ◽  
Alexandra Theodosopoulos ◽  
Ethan Wilson ◽  
Michael Ysit ◽  
Sameir Alhadi ◽  
...  
Keyword(s):  
Thoracic Trauma ◽  
Tube Thoracostomy ◽  
Rib Fractures ◽  
Thoracic Injury ◽  
Open Thoracotomy ◽  
Older Patient ◽  
Ct Guided ◽  
Life Threatening ◽  
Retained Hemothorax ◽  
Life Threatening Complication

Delayed hemothorax is a potentially life-threatening complication of thoracic trauma that should be carefully considered in all patients presenting with thoracic injury. We report a case of delayed hemothorax in a 77-year-old male presenting eleven days’ status post multiple right mid- to high-rib fractures. His case was complicated by retained hemothorax after CT-guided chest-tube with subsequent video-assisted tube thoracostomy (VATS) revealing fibrothorax necessitating conversion to open thoracotomy. Known risk factors for development of delayed hemothorax include older patient age, three or more rib fractures, and presence of mid- to high-rib fractures, and should be used in risk stratification of thoracic trauma. Tube thoracostomy is often sufficient in management of delayed hemothorax. In rare cases, hemothoraces can be complicated by retained hemothorax or fibrothorax, which require more invasive therapy and carry greater morbidity and mortality.

scholarly journals Chest Trauma Score of Thoracic Trauma Patients in Dr. Mohammad Hoesin Palembang January-June 2020

2021 ◽  
Vol 4 (2) ◽  
pp. 316-331
Author(s):  
Satria Marrantiza ◽  
Ahmat Umar ◽  
Bermansyah ◽  
Gama Satria ◽  
Aswin Nugraha
Keyword(s):  
Length Of Stay ◽  
Prognostic Value ◽  
Thoracic Trauma ◽  
Chest Trauma ◽  
Mortality Rates ◽  
Rib Fractures ◽  
Trauma Patients ◽  
Length Of Treatment ◽  
Priority Needs ◽  
Trauma Score

Introduction: Thoracic trauma has mortality rates varying from 10% to 60%. Various scoring frameworks have been created for prognostic value in thoracic trauma patients, including the chest trauma score (CTS). This has not been studied in Indonesian patients. The authors decided to study the picture of CTS in thoracic trauma patients in the Indonesian subpopulation, especially in our hospital. Methods: This research is an analytical observational study at dr. Mohammad Hoesin (RSMH) Palembang in January-June 2020. Our research variables are age, lung contusions, number of rib fractures, bilateral rib fractures, and Chest Trauma Score (CTS). 37 cases could be analyzed with the length of stay, ICU care, mortality, and surgery option. Results: The most common thoracic trauma occurred at the age between less than 45 years, the highest degree of lung contusions was unilateral minor lung contusions. The most common rib fractures were <3 rib fractures. Chest Trauma Score in this study were less than 5. The CTS score had a significant relationship with length of stay and the need of ICU, but was not significantly associated with mortality and surgery option. Conclusion: Chest trauma score can be used to consider the length of treatment and priority needs of the ICU which will be prepared for the management of thoracic trauma patients, especially the young who are accompanied by lung contusions and rib fractures.

scholarly journals Predictive Factors of Ventilatory Support in Chest Trauma

Life ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1154
Author(s):  
Silvia Fattori ◽  
Elisa Reitano ◽  
Osvaldo Chiara ◽  
Stefania Cimbanassi
Keyword(s):  
Predictive Factors ◽  
Thoracic Trauma ◽  
Univariate Analysis ◽  
Ventilatory Support ◽  
Rib Fractures ◽  
Pulmonary Contusion ◽  
Thoracic Injury ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

This study aims to define possible predictors of the need of invasive and non-invasive ventilatory support, in addition to predictors of mortality in patients with severe thoracic trauma. Data from 832 patients admitted to our trauma center were collected from 2010 to 2017 and retrospectively analyzed. Demographic data, type of respiratory assistance, chest injuries, trauma scores and outcome were considered. Univariate analysis was performed, and binary logistic regression was applied to significant data. The injury severity score (ISS) and the revised trauma score (RTS) were both found to be predictive factors for invasive ventilation. Multivariate analysis of the anatomical injuries revealed that the association of high-severity thoracic injuries with trauma in other districts is an indicator of the need for orotracheal intubation. From the analysis of physiological parameters, values of systolic blood pressure, lactate, and Glasgow coma scale (GCS) score indicate the need for invasive ventilatory support. Predictive factors for non-invasive ventilation include: RTS, ISS, number of rib fractures and presence of hemothorax. Risk factors for death were: age over 65, the presence of bilateral rib fractures, pulmonary contusion, hemothorax and associated head trauma. In conclusion, the need for invasive ventilatory support in thoracic trauma is associated to the patient’s systemic severity. Non-invasive ventilation is a supportive treatment indicated in physiologically stable patients regardless of the severity of thoracic injury.

scholarly journals Preoperative Fluoroscopically Guided Regional Erector Spinae Plane Blocks Reduce Opioid Use, Increase Mobilization, and Reduce Length of Stay Following Lumbar Spine Fusion

2021 ◽  
pp. 219256822110107
Author(s):  
Robert J. Owen ◽  
Noah Quinlan ◽  
Addisyn Poduska ◽  
William Ryan Spiker ◽  
Nicholas T. Spina ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Length Of Stay ◽  
Lumbar Fusion ◽  
Spine Fusion ◽  
Erector Spinae ◽  
Control Group ◽  
Block Group ◽  
Opioid Use ◽  
Lumbar Spine Fusion ◽  
Delivery Technique

Study Design: Retrospective review. Objective: To determine the effectiveness of erector spinae plane (ESP) blocks at improving perioperative pain control and function following lumbar spine fusions. Methods: A retrospective analysis was performed on patients undergoing < 3 level posterolateral lumbar fusions. Data was stratified into a control group and a block group. We collected postop MED (morphine equivalent dosages), physical therapy ambulation, and length of stay. PROMIS pain interference (PI) and physical function (PF) scores, ODI, and VAS were collected preop and at the first postop visit. Chi-square and student’s t-test ( P = .05) were used for analysis. We also validated a novel fluoroscopic technique for ESP block delivery. Results: There were 37 in the block group and 39 in the control group. There was no difference in preoperative opioid use ( P = .22). On postop day 1, MED was reduced in the block group (32 vs 51, P < .05), and more patients in the block group did not utilize any opioids (22% vs 5%, P < .05). The block group ambulated further on postop day 1 (312 ft vs 204 ft, P < .05), and had reduced length of stay (2.4 vs 3.2 days, P < .05). The block group showed better PROMIS PI scores postoperatively (58 vs 63, P < .05). The novel delivery technique was validated and successful in targeting the correct level and plane. Conclusions: ESP blocks significantly reduced postop opioid use following lumbar fusion. Block patients ambulated further with PT, had reduced length of stay, and had improved PROMIS PI postoperatively. Validation of the block demonstrated the effectiveness of a novel fluoroscopic delivery technique. ESP blocks represent an underutilized method of reducing opioid consumption, improving postoperative mobilization and reducing length of stay following lumbar spine fusion.

Twelve-month prevalence and disability of DSM-IV bipolar disorder in an Australian general population survey

2004 ◽  
Vol 34 (5) ◽  
pp. 777-785 ◽  
Author(s):  
P. B. MITCHELL ◽  
T. SLADE ◽  
G. ANDREWS
Keyword(s):  
Bipolar Disorder ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
National Survey ◽  
Large Scale ◽  
Well Being ◽  
Major Depressive ◽  
Co Morbidity ◽  
Dsm Iv ◽  
Days Out Of Role

Background. There have been few large-scale epidemiological studies which have examined the prevalence of bipolar disorder. The authors report 12-month prevalence data for DSM-IV bipolar disorder from the Australian National Survey of Mental Health and Well-Being.Method. The broad methodology of the Australian National Survey has been described previously. Ten thousand, six hundred and forty-one people participated. The 12-month prevalence of euphoric bipolar disorder (I and II) – similar to the euphoric-grandiose syndrome of Kessler and co-workers – was determined. Those so identified were compared with subjects with major depressive disorder and the rest of the sample, on rates of co-morbidity with anxiety and substance use disorders as well as demographic features and measures of disability and service utilization. Polychotomous logistic regression was used to study the relationship between the three samples and these dependent variables.Results. There was a 12-month prevalence of 0·5% for bipolar disorder. Compared with subjects with major depressive disorder, those with bipolar disorder were distinguished by a more equal gender ratio; a greater likelihood of being widowed, separated or divorced; higher rates of drug abuse or dependence; greater disability as measured by days out of role; increased rates of treatment with medicines; and higher lifetime rates of suicide attempts.Conclusions. This large national survey highlights the marked functional impairment caused by bipolar disorder, even when compared with major depressive disorder.

45 Application of Machine Learning Models to Thermal Burn Patient Outcome Predictions in the Aftermath of a Nuclear Event

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S33-S34
Author(s):  
Morgan A Taylor ◽  
Randy D Kearns ◽  
Jeffrey E Carter ◽  
Mark H Ebell ◽  
Curt A Harris
Keyword(s):  
Machine Learning ◽  
Logistic Regression ◽  
Length Of Stay ◽  
Regression Models ◽  
Large Scale ◽  
Prediction Models ◽  
Burn Patients ◽  
Thermal Burn ◽  
Logistic Regression Models ◽  
Burn Patient

Abstract Introduction A nuclear disaster would generate an unprecedented volume of thermal burn patients from the explosion and subsequent mass fires (Figure 1). Prediction models characterizing outcomes for these patients may better equip healthcare providers and other responders to manage large scale nuclear events. Logistic regression models have traditionally been employed to develop prediction scores for mortality of all burn patients. However, other healthcare disciplines have increasingly transitioned to machine learning (ML) models, which are automatically generated and continually improved, potentially increasing predictive accuracy. Preliminary research suggests ML models can predict burn patient mortality more accurately than commonly used prediction scores. The purpose of this study is to examine the efficacy of various ML methods in assessing thermal burn patient mortality and length of stay in burn centers. Methods This retrospective study identified patients with fire/flame burn etiologies in the National Burn Repository between the years 2009 – 2018. Patients were randomly partitioned into a 67%/33% split for training and validation. A random forest model (RF) and an artificial neural network (ANN) were then constructed for each outcome, mortality and length of stay. These models were then compared to logistic regression models and previously developed prediction tools with similar outcomes using a combination of classification and regression metrics. Results During the study period, 82,404 burn patients with a thermal etiology were identified in the analysis. The ANN models will likely tend to overfit the data, which can be resolved by ending the model training early or adding additional regularization parameters. Further exploration of the advantages and limitations of these models is forthcoming as metric analyses become available. Conclusions In this proof-of-concept study, we anticipate that at least one ML model will predict the targeted outcomes of thermal burn patient mortality and length of stay as judged by the fidelity with which it matches the logistic regression analysis. These advancements can then help disaster preparedness programs consider resource limitations during catastrophic incidents resulting in burn injuries.

A High-Fidelity Model to Predict Length of Stay in the Neonatal Intensive Care Unit

2021 ◽  
Author(s):  
Kanix Wang ◽  
Walid Hussain ◽  
John R. Birge ◽  
Michael D. Schreiber ◽  
Daniel Adelman
Keyword(s):  
Length Of Stay ◽  
Clinical Data ◽  
Neonatal Intensive Care ◽  
Large Scale ◽  
Expert Knowledge ◽  
Clinical Analysis ◽  
Healthcare Operations ◽  
Lengths Of Stay ◽  
Health Trajectories ◽  
Widespread Implementation

Having an interpretable, dynamic length-of-stay model can help hospital administrators and clinicians make better decisions and improve the quality of care. The widespread implementation of electronic medical record (EMR) systems has enabled hospitals to collect massive amounts of health data. However, how to integrate this deluge of data into healthcare operations remains unclear. We propose a framework grounded in established clinical knowledge to model patients’ lengths of stay. In particular, we impose expert knowledge when grouping raw clinical data into medically meaningful variables that summarize patients’ health trajectories. We use dynamic, predictive models to output patients’ remaining lengths of stay, future discharges, and census probability distributions based on their health trajectories up to the current stay. Evaluated with large-scale EMR data, the dynamic model significantly improves predictive power over the performance of any model in previous literature and remains medically interpretable. Summary of Contribution: The widespread implementation of electronic health systems has created opportunities and challenges to best utilize mounting clinical data for healthcare operations. In this study, we propose a new approach that integrates clinical analysis in generating variables and implementations of computational methods. This approach allows our model to remain interpretable to the medical professionals while being accurate. We believe our study has broader relevance to researchers and practitioners of healthcare operations.

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

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