Journal of Emergencies, Trauma, and Shock最新文献

{"title":"A Nomogram Prediction Model for Clinical Outcome of Trauma-induced Coagulopathy Patients with Severe Multiple Trauma.","authors":"Jun Shen, Feng Xu","doi":"10.4103/jets.jets_124_24","DOIUrl":"https://doi.org/10.4103/jets.jets_124_24","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study was to investigate the predictive value of thromboelastography (TEG) combined with conventional coagulation test parameters for the clinical outcome of patients with trauma-induced coagulopathy (TIC) and establish and evaluate a clinical nomogram for predicting the prognosis of TIC patients.</p><p><strong>Methods: </strong>Clinical data of severe multiple trauma patients who underwent emergency treatment in the hospital from November 2018 to August 2021 were enrolled retrospectively. The prognosis was evaluated according to the length of hospital stay and the 30-day survival rate. Multivariable logistic regression model was used to evaluate the correlation between TEG parameters and clinical outcomes. A nomogram model was constructed and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value.</p><p><strong>Results: </strong>Univariate analysis indicated that there were significant differences in age, hypertension, temperature fluctuation (>3°C), transfusion, kinetics time (K), angle (α) value, maximal amplitude (MA), and international normalized ratio between the good and poor outcome group (<i>P</i> < 0.05). Multivariate logistic regression analysis showed that age, Glasgow Coma Scale scores, temperature fluctuation (>3°C), and MA parameters were independent risk factors for poor outcome, and we established the nomogram prediction model. According to ROC curve analysis, the area under the curve for MA parameter was 0.689 (95% confidence interval [CI]: 0.610-0.760), and the corresponding sensitivity and specificity were 44.12% and 91.87%, respectively. The area under the curve for temperature fluctuation (>3°C) was 0.697 (95% CI: 0.618-0.768), and the corresponding sensitivity and specificity were 60.00% and 79.67%, respectively.</p><p><strong>Conclusion: </strong>TEG parameters combined with relevant clinical indicators can be used to evaluate the prognosis of TIC patients with severe multiple trauma. The establishment of correlation nomogram model was guiding significance for clinical evaluation of long-term prognosis of trauma patients.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"18 1","pages":"3-9"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Penile Strangulation by Multiple Metallic Rings: Innovation at a Time of Tribulation.","authors":"Sadiq Abu, Sharadchandra K Prasad, Fahmi Sabr Raza, Imoh Ibiok, Mohamed Hassan Ahmed, Robert McCormick","doi":"10.4103/jets.jets_114_24","DOIUrl":"https://doi.org/10.4103/jets.jets_114_24","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"18 1","pages":"44-45"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unusual Retrieval of Dislodged Introducer Needle from Right Jugular Vein Using a Magnet.","authors":"Biswajit Naskar, Manoj Kumar, Ravi Anand, Atul Aman","doi":"10.4103/jets.jets_3_25","DOIUrl":"https://doi.org/10.4103/jets.jets_3_25","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"18 1","pages":"48-49"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demographic Perspectives and De-escalation Challenges in Pediatric Emergency Care for Children with Special Health Care Needs.","authors":"Ninoshka Rivera-Koberstein, Amit Agrawal, Sagar Galwankar","doi":"10.4103/jets.jets_88_24","DOIUrl":"https://doi.org/10.4103/jets.jets_88_24","url":null,"abstract":"<p><strong>Introduction: </strong>Medical literature on emergency care for children with special healthcare needs (SHCNs) reports the inherent challenges in the managing of these children, like limited history, distress for patients and families, and unique management requirements for healthcare teams. This study analyzed the demographic data on children with SHCNs to explore de-escalation strategies, the effectiveness of chemical de-escalation, and clinical management strategies used and compared the length of stay in the emergency department (ED) between patients who received medications and those who did not.</p><p><strong>Methods: </strong>This was a retrospective and cross-sectional study. Data were collected from the last 150 patients diagnosed with SHCNs across three ED s within this hospital system since July 1, 2023. Children aged 18 years or younger diagnosed with SHCNs requiring special modifications. Chi-square test, Mann-Whitney <i>U</i>-test, and Kruskal-Wallis <i>H</i>-test.</p><p><strong>Results: </strong>The demographic analysis showed that 60% of children with SHCNs were female, with a mean age of 12.3 years. The most common presentation time was 6-8 pm. autism spectrum disorder (28%) and anxiety disorder (27%) were the most frequent diagnoses, with substance abuse present in 45% of patients. Medications helped reduce the ED stay, which was statistically significant, suggesting that medications may facilitate effective de-escalation; At the same time, in a few cases, verbal de-escalation also appeared helpful. There is a need for robust documentation on verbal de-escalation strategies, such as details on patients who did not receive medications and were successfully managed verbally or required repeated reassurance.</p><p><strong>Conclusions: </strong>This study provides insight into the diverse challenges of managing children with SHCNs in the emergency settings. The high prevalence of substance abuse, particularly in children with autism spectrum, increases the complexity of care. While medications may reduce ED stay, further research is needed to understand this patient population's complex needs better.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"18 1","pages":"26-31"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Repair and Management of an Orbital Floor Fracture in the Setting of Globe Entrapment within the Fracture.","authors":"Pelin Celiker, Lily Koo Lin","doi":"10.4103/jets.jets_18_24","DOIUrl":"https://doi.org/10.4103/jets.jets_18_24","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"18 1","pages":"41-42"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophageal Injury Following Blunt Trauma: A Diagnostic Dilemma.","authors":"Divij Agarwal, Shivanand Gamanagatti","doi":"10.4103/jets.jets_121_24","DOIUrl":"https://doi.org/10.4103/jets.jets_121_24","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"18 1","pages":"47-48"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's New in Emergencies, Trauma, and Shock: Nomograms in Emergency Medicine.","authors":"Siju V Abraham, Reuben W Holland","doi":"10.4103/jets.jets_30_25","DOIUrl":"10.4103/jets.jets_30_25","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"18 1","pages":"1-2"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral First Rib Fractures in Blunt Trauma Patients: A Retrospective Study.","authors":"Ashraf Fathi Hefny, Nirmin A Mansour, Mai A Fathi","doi":"10.4103/jets.jets_40_24","DOIUrl":"https://doi.org/10.4103/jets.jets_40_24","url":null,"abstract":"<p><strong>Introduction: </strong>Unilateral fracture of the first rib frequently led to severe complications such as brachial plexus or major vascular injury. Bilateral first rib fracture (BFRF) is very rare. We aimed to study the incidence, mechanism of injury, management, and outcome of BFRF in blunt trauma patients in a community-based hospital.</p><p><strong>Methods: </strong>Data of all blunt trauma patients who were admitted to our institution with (BFRF from December 2014 through January 2017) were retrospectively collected. Data included demography, mechanism of injury, severity of the injury, associated injuries, management, and outcome.</p><p><strong>Results: </strong>During the study period, 4779 patients with blunt trauma were included in the trauma registry and 12 (0.25%) patients had BFRF. The mean age of standard deviation (SD) was 29 (8.3) years. Seven (58.3%) patients were involved in road traffic collisions and 5 (41.7%) patients fell from more than 3 m height. The most commonly associated thoracic injury was lung contusions in 8 (66.7%) patients. The median (range) Glasgow Coma Score on admission was 15 (14-15) and Injury Severity Score (SD) was 19 (10.5). Length of hospital stay mean (SD) was 6.8 (6.4) days. No patients died in the study.</p><p><strong>Conclusions: </strong>BFRF is a rare entity in blunt trauma patients caused by high-energy trauma. Major vascular or brachial plexus injuries in patients with BFRF are much less than those reported in the medical literature on unilateral first rib fractures. Associated injuries are the main cause of trauma-related morbidity rather than the direct effect of BFRF.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"18 1","pages":"22-25"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Single-Center Review of Cases to Understand the Indian Polyvalent Antivenom Use in Hump-Nosed Pit Viper Bites in South India.","authors":"Siju V Abraham, Sarah Paul, Martin V Paul, Clint Davis, Aboobacker Mohamed Rafi, Appu Suseel, Deo Mathew, C K Kassyap, Rajeev Punchalil Chathappan","doi":"10.4103/jets.jets_74_24","DOIUrl":"https://doi.org/10.4103/jets.jets_74_24","url":null,"abstract":"<p><strong>Introduction: </strong>India, with nearly 60 venomous snake species, has just one commercially available antivenom, the Indian polyvalent antivenom (IPAV). The hump-nosed pit viper (<i>Hypnale hypnale</i>), an indigenous venomous snake, causes considerable morbidity and at time mortality for which we have no commercially available antivenom. However, most clinicians rely purely on the clinical syndromes and end up using the available IPAV for <i>H. hypnale</i> envenomation.</p><p><strong>Methods: </strong>Between April 2017 and December 2022, we reviewed 41 cases of <i>H. hypnale</i> envenomation, comparing clinical and laboratory profiles of patients who received IPAV with those who did not.</p><p><strong>Results: </strong>Local signs of envenomation were seen in 39 (95.12%) cases, with the most common being edema or swelling at the bite site. Eight (19.5%) patients developed coagulopathy, and two developed renal failure during their hospital stay. Among the 39 envenomated individuals, 13 received polyvalent snake antivenom. Over half of those receiving antivenom had hypersensitivity reactions. Patients who received antisnake venom (ASV) had increased intensive care unit stay, duration of hospitalization, and hospital expenses as compared to patients who did not. There was one death among the patients who received antivenom.</p><p><strong>Conclusion: </strong><i>H. hypnale</i> viper envenomation is associated with local and systemic signs of envenomation, with coagulopathy being a common complication. Administering the current polyvalent antivenom to victims of <i>H. hypnale</i> bites did not reduce the morbidities or prevent mortality; instead, it exposes them to additional risks associated with ASV administration.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"18 1","pages":"15-21"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation and Adaptation of Pathway of Resuscitative Endovascular Balloon Occlusion of the Aorta after Traumatic Injury.","authors":"Ammar Al-Hassani, Bianca M Wahlen, Ayman El-Menyar, Ibrahim Al-Hassani, Naushad A Khan, Sagar Galwankar, Sandro Rizoli, Hassan Al-Thani","doi":"10.4103/jets.jets_79_24","DOIUrl":"https://doi.org/10.4103/jets.jets_79_24","url":null,"abstract":"<p><p>Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an invented method to facilitate a minimally invasive occlusion of the aorta to stop a life-threatening hemorrhage. This review described an established pathway for noncompressible exsanguination (REBOA procedures) in trauma patients at a Level 1 trauma center. A detailed description starting from the structural changes of the hospital and facilities itself, the initial thoughts, implementation of the process, and continuous revision and improvement of guidelines were discussed. A multidisciplinary core team consisting of trauma surgeons, anesthesiologists, interventional radiologists, and operating room (OR) staff developed step-by-step clinical practice guidelines for using REBOA at our trauma center. A comprehensive training program for specialized procedural training was implemented to ensure the competency of all relevant medical personnel in managing trauma patients. The REBOA guidelines underwent plan-do-check-act quality cycle improvement until the latest guidelines were reached with each use of REBOA in a trauma patient, leading to further auditing of the guidelines to identify areas for improvement. The current review discusses the critical role of adopting innovative technologies and adapting protocols in trauma care, particularly for vulnerable patients with a high risk of morbidity and mortality. Continuous process improvement, procedural refinement, and evolving guidelines are essential prerequisites for optimizing patient outcomes. We described a valuable framework for other trauma programs to implement and adapt similar endovascular bleeding control approaches, thereby potentially enhancing patient care.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"18 1","pages":"32-40"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}