scholarly journals Analysis of Scoring System to Identify High Risk Patients and their Outcome in Isolated Blunt Chest Trauma- A Prospective Observational Study

2021 ◽  
Author(s):  
Annrish Tan Baby ◽  
Anuraj Appukuttan ◽  
Harihara Jothi ◽  
Reema Sajan
Keyword(s):  
Observational Study ◽  
Scoring System ◽  
Blunt Chest Trauma ◽  
Prospective Observational Study ◽  
Chest Trauma ◽  
Tertiary Care ◽  
Treatment Protocol ◽  
Rib Fractures ◽  
Morbidity And Mortality ◽  
P Value

Introduction: Chest trauma is a major cause of mortality accounting for a substantial proportion of all trauma admissions and death. In India, the reported mortality range is between 4-60% and no current national guidelines exist to assist the management of this patient group unless patient has severe immediate life threatening injuries. A scoring system for identification of patients at higher risk for development of morbidity and mortality will allow early selection of vulnerable patients, choice of an appropriate treatment protocol and therapeutic interventions. Aim: This present study aims for the analysis of a scoring system to identify patients with isolated blunt chest trauma at higher risk for morbidity and mortality, in order to prioritise intervention and improve the outcome. Materials and Methods: This was a prospective observational study conducted at the departments of emergency medicine and general surgery of a tertiary care teaching hospital in South India over a period of 18 months. The study included 85 isolated blunt chest trauma patients. We utilised a Chest Trauma Score (CTS) composed of patient factors like age, smoking, lung disease and severity factors like rib fractures, parenchymal and pleural involvement, partial pressure of oxygen/ fraction of inspired oxygen (PaO2/FiO2) ratio. CTS were applied at the time of admission after detailed assessment of all injuries. Patient was followed-up at regular intervals upto 30 days. The CTS and outcome measurements were analysed using logistic regression analysis. Results: The area under Receiver Operating Characteristic curve (ROC) was found to be 0.979 (p-value <0.001). The CTS cut-off value was ≥11.5 with 89% sensitivity and 95% specificity. In patients with CTS ≥11.5, 98.3% had associated morbidity and complications whereas only 25.9% with CTS <11.5 had associated morbidity (p-value<0.001). Number of rib fractures, pulmonary contusion and PaO2/FiO2 ratio (odds ratio 10.632, 6.007, 12.859, respectively) were found to be significant independent predictors of morbidity and complications. Conclusion: In summary, CTS ≥11.5 has shown a significant association with poor outcome. Patients who sustained isolated blunt chest trauma and together with increasing scores, had increasing incidence of morbidity and complications. The scoring system used in this study proved that it makes a useful tool to predict the outcome in thoracic trauma.

scholarly journals Prospective observational study to evaluate the efficacy of labetalol versus nifedipine in the management of preeclampsia

2020 ◽  
Vol 9 (4) ◽  
pp. 1448
Author(s):  
Sarulatha D. ◽  
Menaga M.
Keyword(s):  
Blood Pressure ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Age Distribution ◽  
Unknown Etiology ◽  
P Value ◽  
Maternal Risk ◽  
Medical Disorders ◽  
Number Of Patients

Background: Hypertensive disorders of pregnancy are the common medical disorders in pregnancy. It has effects both on expectant mother and fetus. Pre-eclampsia is a pregnancy specific multisystem disorder of unknown etiology, and accounts for 12-18% of maternal mortality. There is general consensus that maternal risk is decreased by antihypertensive treatment that lowers very high blood pressure. Objective of this study was to study the efficacy of oral labetalol versus oral Nifedipine in the management of preeclampsia in the antepartum and intrapartum period.Methods: The present study was conducted in a tertiary care centre, Chennai from October 2013 to September 2014. It was a prospective observational study done in antenatal ward and labor ward. All antenatal women diagnosed to have pre-eclampsia, irrespective of gestation are included in this study.Results: Age distribution of PIH patients and the maximum number of patients were 20-25 years of age. maximum patients of severe preeclampsia were primigravida. Both systolic and diastolic BP in the two groups (oral labetalol and oral Nifedipine groups) were not statistically significant as the p value is >0.005.Conclusions: From this study, authors found that both oral labetalol and oral nifedipine are effective and well tolerated when used for rapid control of blood pressure in severe hypertension of pregnancy.

scholarly journals Rib fractures in blunt chest trauma-morbidity and mortality: self-experience study

2014 ◽  
Vol 12 (3) ◽  
pp. 272-276 ◽  
Author(s):  
Iv. Novakov ◽  
◽  
P. Timonov ◽  
Ch. Stefanov ◽  
G. Petkov ◽  
...  
Keyword(s):  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Rib Fractures ◽  
Morbidity And Mortality

Delayed Respiratory Failure After Blunt Chest Trauma

2020 ◽  
pp. 000313482096627
Author(s):  
Christina S. Martin ◽  
Ning Lu ◽  
David S. Inouye ◽  
Kazuma Nakagawa ◽  
Karen Ng ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Injury Severity ◽  
Rib Fractures ◽  
P Value ◽  
Clinical Predictors ◽  
Chi Square ◽  
Risk Patients ◽  
Student’S T

Background Patient factors associated with delayed respiratory failure (DRF) after blunt chest trauma are not well documented. Earlier identification and closer monitoring may improve outcomes for these patients. The purpose of this study was to identify the prevalence and clinical predictors of DRF in patients after blunt chest trauma. Materials and Methods A retrospective review of adult patients admitted to a Level 1 trauma center after blunt chest trauma between January 1, 2009 and December 31, 2013, was conducted. Patients with early respiratory failure were compared to patients with DRF using Fisher’s exact tests, chi square, and Student’s t-tests. A P-value of <.05 was considered significant. Results 1299 patients had blunt chest trauma and at least 1 rib fracture, of which 830 met inclusion criteria. 5.8% of patients progressed to respiratory failure. Respiratory failure was delayed in 25% of these patients. DRF patients had significantly lower ISS (16.5 vs. 22.7, P = .04), more bilateral rib fractures (66.7% vs. 28.7%, P = .02) and fewer pulmonary contusions (16.7% vs. 50.0%, P = .04). Discussion Injury patterns, including bilateral rib fractures without pulmonary contusions and low but severe Injury Severity Score burden, may help identify high-risk patients who may benefit from closer monitoring and more aggressive therapy.

scholarly journals Demographics in trauma: a prospective observational study in a tertiary care zonal hospital

2019 ◽  
Vol 7 (1) ◽  
pp. 98
Author(s):  
Shrikant Manwatkar ◽  
Aniket Sharma ◽  
Anurakshat Gupta ◽  
Amit Chhikara ◽  
Vikram Trehan ◽  
...  
Keyword(s):  
Observational Study ◽  
Traffic Accidents ◽  
Prospective Observational Study ◽  
Road Traffic ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Surgical Trauma ◽  
Trauma Registries ◽  
Socioeconomic Changes ◽  
Improved Outcomes

Background: Trauma represents a major challenge worldwide and is the leading cause of morbidity and mortality in young population. There is significant change in trauma related injuries due to urbanization, motorization, industrialization and the socioeconomic changes in India. Road traffic accidents (RTA) pose the largest threat to human lives and have become the number one public hazard all across the world causing morbidity and mortality. The aim of this study is to find out the demographics and to determine the injury pattern of surgical trauma cases presenting to this tertiary care zonal hospital.Methods: A prospective observational study was conducted in a tertiary care zonal hospital from June 2018 to December 2018. Data was collected for 105 patients presented with trauma in surgical emergency centre of this hospital were included in the study which excluded only orthopaedic trauma cases. The data collected was analysed.Results: Out of 105, 76 (72.38%) were male and 29 (27.61%) were female with 21 (20%) in the 31-40 age group. The average age of cases was 40.2 years.  RTA was the major cause of trauma i.e. (77.14%) followed by accidental fall and slips (18.09%) and assaults (4.76%). Contusion was the common injury sustained (45.71%) followed by laceration (38.09%), abrasion (35.23%) and fracture (17.14%).Conclusions: There is a need for trauma registries which can help to formulate strategies towards decreasing the burden of trauma and improved outcomes at hospital as well as in public health.

scholarly journals Microbiological study of cervical flora in preterm labour

2020 ◽  
Vol 9 (3) ◽  
pp. 945
Author(s):  
Meenakshi Ruhil ◽  
Priti A. Hatkar
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Preterm Labour ◽  
Tertiary Care ◽  
P Value ◽  
Tertiary Care Centre ◽  
Microbiological Study ◽  
Spontaneous Preterm Delivery ◽  
Causative Factors ◽  
Secondary Objective

Background: Preterm labour occurs due to various causative factors. Genital infections contribute significantly to the preterm labour. Ours is a prospective, observational study looking at the cervical microbiota involved in the preterm labour. The cervical flora contributing to the occurrence of preterm labour was studied. The results were analyzed based on the microbiological study of cervical swabs. The primary objectives of this study were to determine the association of cervical microbiota of pregnant women with spontaneous preterm delivery. To characterize the effect of cervical microbiota on birth gestation. The secondary objective of this study was to analyse the role of cervical microbiota and its relationship between social and behavioural factors.Methods: It is a prospective, observational study, which includes 193 patients, studied over a period of one and a half year. It was conducted at our tertiary care centre after the approval by ethics committee, and the results were analysed. As this is a purely observational study, management decisions of treating obstetrician were not interfered with. No additional cost, intervention or injury was caused to the study subject.Results: In our study, cervical swab culture shows growth in 2.07% which is statistically insignificant. Though, it was found that preterm labour is more common with leucocytosis, i.e. WBC > 11000 cmm, which is found to be statistically significant (p value = 0.023).Conclusions: In our study, we found that there was no significant association of cervical flora with preterm labour, though we found an association with leucocytosis.

scholarly journals Role of Comorbidity Polypharmacy Score in Prediction of PostOperative Outcome in Geriatric Patients - A Prospective Observational Study in a Tertiary Care Hospital in Mysore

2021 ◽  
Vol 8 (20) ◽  
pp. 1549-1553
Author(s):  
Adarsh Hegde ◽  
Nalini Kotekar
Keyword(s):  
Length Of Stay ◽  
Observational Study ◽  
Activities Of Daily Living ◽  
Correlation Coefficient ◽  
Barthel Index ◽  
Daily Living ◽  
Prospective Observational Study ◽  
Geriatric Patients ◽  
Tertiary Care ◽  
P Value

BACKGROUND Comorbidity in elderly has negative impact on physiological and cognitive functions, the prevalence of which is increasing. Management of multiple comorbidities has resulted in polypharmacy in elderly. Comorbidity Polypharmacy Score (CPS) is a clinical tool to quantify severity of comorbidities using polypharmacy as surrogate for intensity of treatment required to adequately manage comorbidities. We wanted to evaluate CPS as predictor of post-operative outcomes in geriatric patients undergoing elective surgeries. METHODS A prospective observational study was conducted in a tertiary care centre among elderly patients (more than 65 years) undergoing elective surgeries satisfying inclusion criteria. Calculated sample size was 250. CPS was calculated by assigning one point to each comorbidity and medication taken and sum calculated was categorised. Primary outcomes were defined by hospital length of stay and Barthel index at day 3 and day 5. RESULTS We found moderate positive correlation using Pearson Correlation with CPS and Barthel index at day 3 (p - value = 0.0024, correlation coefficient = - 0.191) and day 5 (p - value = 0.0013, correlation coefficient= -0.202). ANOVA test was applied to compare age with Barthel index at day 3 (p - value = 0.0005) and day 5 (p - value < 0.0001) which was statistically significant. Advanced age was not associated with longer Length of Stay (LOS) (p - value = 0.32). CPS was also not associated with longer LOS (p - value = 0.821). CONCLUSIONS CPS is an easy to measure tool for the evaluation of elderly surgical patients. CPS can be used to predict recovery in terms of activities of daily living (ADL) after surgery thereby preparing patient and family to cope up with stress of surgery and its financial and psychological outcomes. KEYWORDS Geriatric Anaesthesia, Comorbidity-Polypharmacy Score, Activities of Daily Living, Length of Stay, Barthel Index

scholarly journals A prospective observational study for the safety of Nd-YAG Laster posterior capsulotomy procedure in patients of Posterior Capsular Opacification (PCO) at the ophthalmology outpatient department of a tertiary care teaching hospital in western India

2021 ◽  
Vol 7 (3) ◽  
pp. 574-578
Author(s):  
Rajendra Choudhary ◽  
Nishant V Shah ◽  
Meet Mashru
Keyword(s):  
Observational Study ◽  
Teaching Hospital ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Posterior Capsular Opacification ◽  
P Value ◽  
Western India ◽  
Yag Laser ◽  
Tertiary Care Teaching Hospital ◽  
Care Teaching

: Nd YAG laser is preferred method to manage thickened posterior capsule because it is an easy, non-invasive and an OPD basis procedure considering the comfort of the patients.: The present study was carried out with objectives to evaluate the safety profile of Nd-YAG Laser Capsulotomy mainly in terms of rise in intraocular pressure (IOP) and other intra as well as post-operative complications.This prospective observational study was carried out with prior Institutional Ethics Committee (IEC) approval and written informed consent from the participants at Ophthalmology Outpatients Department (OPD) of a tertiary care teaching hospital of western India, for the duration of two years from Oct’2015 to Sept’2017. A detailed ocular, systemic, family history was taken of all the enrolled patients with pre- and post-procedure evaluation of IOP by Goldman’s Applanation Tonometry, Slit lamp examination and Fundus examination by direct and indirect ophthalmoscopy. Capsulotomy was done using VISULAS YAG III laser of Zeiss company.The data was entered and tabulated in Microsoft Excel 2007 and analyzed. Data was analyzed by frequency distribution. The ‘p’ value was determined to finally evaluate and P &#60;0.05 was considered as statistically significant.Acute transient rise of IOP up to 5mmHg or more (P value &#60;0.001) was found in Nine cases which is highly significant compared with pre-procedural stage. Intraocular lens pitting was observed in Four cases. Cystoid macular edema was found in one case. Two patients developed mild iritis. Nd-YAG laser capsulotomy is an easy, practical modality to treat posterior capsular opacities, but is not a completely innocuous procedure. Nd-YAG laser capsulotomy is an easy, practical modality to treat posterior capsular opacities, but is not a completely innocuous procedure. Due precautions should be taken in pre- and post-procedural stages including medications, thorough counselling, proper focusing and steady fixation of the patients to minimise the complication.

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