Chinese Journal of Traumatology最新文献

{"title":"Management of multiple and displaced mandibular fractures in a pediatric patient sans mandibular immobilization, sans open reduction and internal fixation","authors":"","doi":"10.1016/j.cjtee.2024.03.005","DOIUrl":"10.1016/j.cjtee.2024.03.005","url":null,"abstract":"<div><p>Maxillofacial fractures in the pediatric population are generally managed by conservative approaches such as soft diet and medication or semi-invasive procedures namely inter-maxillary fixation or circum-mandibular wiring. These approaches are preferred over any invasive treatment to minimize injury to the growing skeleton and tooth germs. Displaced fractures that cause functional problems such as restricted mouth opening, malocclusion or impaired breathing, mandate open reduction and internal fixation. However, surgical management is associated with morbidity related to general anesthesia, risk of injury to vital structures, and potential, skeletal or dental growth disturbances. This case report describes a non-invasive method of managing displaced, multiple fractures of the mandible in a pediatric patient, with the use of low intensity pulsed ultrasound to achieve favorable clinical outcomes and nil complications. Neither immobilization of the mandible with inter-maxillary fixation nor open reduction and internal fixation was used. Low intensity pulsed ultrasound therapy is painless and patient-friendly.</p></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 5","pages":"Pages 284-287"},"PeriodicalIF":1.8,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1008127524000312/pdfft?md5=5a9e233f8f7c9f5534b29068803236e9&pid=1-s2.0-S1008127524000312-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140271911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics associated with pediatric traumatic intracranial hemorrhage","authors":"Pattama Tanaanantarak ,&nbsp;Soraya Suntornsawat ,&nbsp;Srila Samphao","doi":"10.1016/j.cjtee.2024.03.003","DOIUrl":"10.1016/j.cjtee.2024.03.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Traumatic brain injury (TBI) can cause significant morbidity and mortality in the pediatric population. Brain CT is the mainstay in the diagnosis of intracranial hemorrhage (ICH). The aim of this study was to explore the clinical characteristics that can predict ICH on brain CT in pediatric TBI patients, to assist physicians in deciding on the use of brain CT.</div></div><div><h3>Methods</h3><div>A total of 475 pediatric TBI patients who underwent brain CT within 24 h after injury from January 2012 to December 2021 in the level 1 trauma center in Thailand were included in this cross-sectional study. Clinical data and brain CT findings were collected. Logistic regression analysis was applied to evaluate clinical characteristics that could predict ICH on brain CT in pediatric TBI patients. A <em>p</em> value was less than 0.05 being indicated that the difference is statistically significant. R software version 3.6.1 was used to statistical analysis.</div></div><div><h3>Results</h3><div>The included cases have a median (Q₁, Q₃) age of 7.7 (3.5, 12.6) years. ICH was found in 98 (20.6%) pediatric patients based on brain CT findings. On multivariable analysis, high blunt energy injury (odds ratio (<em>OR</em>) = 2.79, 95% <em>CI</em> 1.27 – 6.11, <em>p</em> = 0.010), motor vehicle accidents (<em>OR</em> = 2.04, 95% <em>CI</em>: 1.14 – 3.67, <em>p</em> = 0.017), Glasgow coma scale score &lt;13 (<em>OR</em> = 4.28, 95% <em>CI</em>: 1.87 – 9.78, <em>p</em> &lt; 0.001), palpable skull fractures (<em>OR</em> = 7.30, 95% <em>CI</em>: 1.44 – 37.04, <em>p</em> = 0.016), signs of basilar skull fracture (<em>OR</em> = 6.10, 95% <em>CI</em>: 2.16 – 17.24, <em>p</em> &lt; 0.001), and vomiting ≥ 3 times (<em>OR</em> = 2.60, 95% <em>CI</em>: 1.17 – 5.77, <em>p</em> = 0.022) were statistically significant predictive factors for ICH in pediatric TBI patients.</div></div><div><h3>Conclusion</h3><div>These factors might aid clinicians in making an appropriate decision regarding the use of brain CT in pediatric TBI cases.</div></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 6","pages":"Pages 334-339"},"PeriodicalIF":1.8,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140137523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic analysis on global epidemiology and burden of foot fracture over three decades.","authors":"Cheng Chen, Jin-Rong Lin, Yi Zhang, Tian-Bao Ye, Yun-Feng Yang","doi":"10.1016/j.cjtee.2024.03.001","DOIUrl":"https://doi.org/10.1016/j.cjtee.2024.03.001","url":null,"abstract":"<p><strong>Purpose: </strong>To comprehensively analyze the geographic and temporal trends of foot fracture, understand its health burden by age, sex, and sociodemographic index (SDI), and explore its leading causes from 1990 to 2019.</p><p><strong>Methods: </strong>The datasets in the present study were generated from the Global Burden of Diseases Study 2019, which included foot fracture data from 1990 to 2019. We extracted estimates along with the 95% uncertainty interval (UI) for the incidence and years lived with disability (YLDs) of foot fracture by location, age, gender, and cause. The epidemiology and burden of foot fracture at the global, regional, and national level was exhibited. Next, we presented the age and sex patterns of foot fracture. The leading cause of foot fracture was another focus of this study from the viewpoint of age, sex, and location. Then, Pearson's correlations between age-standardized rate (ASR), SDI, and estimated annual percentage change were calculated.</p><p><strong>Results: </strong>The age-standardized incidence rate was 138.68 (95% UI: 104.88 - 182.53) per 100,000 persons for both sexes, 174.24 (95% UI: 134.35 - 222.49) per 100,000 persons for males, and 102.19 (95% UI: 73.28 - 138.00) per 100,000 persons for females in 2019. The age-standardized YLDs rate was 5.91 (95% UI: 3.58 - 9.25) per 100,000 persons for both genders, 7.35 (95% UI: 4.45 - 11.50) per 100,000 persons for males, and 4.51 (95% UI: 2.75 - 7.03) per 100,000 persons for females in 2019. The global incidence and YLDs of foot fracture increased in number and decreased in ASR from 1990 to 2019. The global geographical distribution of foot fracture is uneven. The incidence rate for males peaked at the age group of 20 - 24 years, while that for females increased with advancing age. The incidence rate of older people was rising, as younger age incidence rate declined from 1990 to 2019. Falls, exposure to mechanical forces, and road traffic injuries were the 3 leading causes of foot fracture. Correlations were observed between ASR, estimated annual percentage change, and SDI.</p><p><strong>Conclusions: </strong>The burden of foot fracture remains high globally, and it poses an enormous public health challenge, with population ageing. It is necessary to allocate more resources to the high-risk populations. Targeted realistic intervention policies and strategies are warranted.</p>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ipsilateral fractures of the acromion and coracoid processes of the scapula","authors":"Yusuf Omar Qalib ,&nbsp;Srinivasa Reddy Medagam ,&nbsp;Sunil Dachepalli","doi":"10.1016/j.cjtee.2023.04.003","DOIUrl":"10.1016/j.cjtee.2023.04.003","url":null,"abstract":"<div><p>A fracture of the acromion and coracoid processes of scapula is rarely seen in the outpatient clinic, due to the acromion's anatomical position and shape, as well as the strong ligaments and muscles that are attached to it. These fractures are caused by either direct or indirect high-energy trauma injuries to the shoulder joint, leading to severe pain and a grossly restricted range of motion. Several acromial classifications were reported, but this type of longitudinal plane fracture of the acromion process in our case is yet to be described in the current literature. We present a rare combination of the coracoid process and unstable acromion bony projection fractures that have not previously been noted for this type of fracture. The closest to this is Kuhn's type III classification. A 51-year-old male presented to our emergency department complaining of the right shoulder pain and difficulty raising his arm following a 2-wheeler accident. The patient was managed by open reduction and internal fixation with 3 cannulated cancellous screws fixation and progressed well with no postoperative complications. He was asymptomatic postoperatively and regained full range of motion after 4 months.</p></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 2","pages":"Pages 121-124"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1008127523000275/pdfft?md5=1e15aac75fc4d8ed21863720fcb2d26e&pid=1-s2.0-S1008127523000275-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9493448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FM1-Editorial board","authors":"","doi":"10.1016/S1008-1275(24)00018-X","DOIUrl":"https://doi.org/10.1016/S1008-1275(24)00018-X","url":null,"abstract":"","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 2","pages":"Page i"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S100812752400018X/pdfft?md5=850943e760bc4efa04dcee9870a65e24&pid=1-s2.0-S100812752400018X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140296148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of the INFECTIONS scoring system in identifying bacterial infections among patients presenting at the emergency department of a middle-income country: A pilot study","authors":"Dooshanveer C. Nuckchady","doi":"10.1016/j.cjtee.2023.09.001","DOIUrl":"10.1016/j.cjtee.2023.09.001","url":null,"abstract":"<div><h3>Purpose</h3><p>To investigate which scoring system is the most accurate tool in predicting mortality among the infected patients who present to the emergency department in a middle-income country, and to validate a new scoring system to predict bacterial infections.</p></div><div><h3>Methods</h3><p>This was a retrospective, single-center study among patients who were admitted via the emergency department of a public hospital. All patients who were started on antibiotics were included in the study, while patients aged &lt; 18 years were excluded. Data collected includeding patients' demographics, vital signs and basic laboratory parameters like white blood cell count and creatinine. The sensitivity and specificity of different scoring systems were calculated as well as their negative and positive predictive values. Logistic regression was used to derive a novel early warning system for bacterial infections. The area under the receiver operating characteristic (AUROC) was computed for each scoring model.</p></div><div><h3>Results</h3><p>In total, 109 patients were included in this study. The quick sequential organ failure assessment (qSOFA), search out severity and rapid acute physiology score had the highest AUROC (≥ 0.89) for predicting mortality, while qSOFA and universal vital assessment were the simplest scoring systems with an AUROC &gt; 0.85; however, these scoring systems failed to predict whether patients were truly infected. The INFECTIONS (short for impaired mental status, not conscious, fast heart rate, elevated creatinine, high temperature, on inotrope, low oxygen, high neutrophils and high sugar) model reached an AUROC of 0.88 to more accurately predict the infectious state of a patient.</p></div><div><h3>Conclusions</h3><p>Middle-income countries should use the qSOFA or universal vital assessment score to identify the sickest patients in emergency department. The INFECTIONS score may help recognize patients with bacterial infections, but it should be further validated in multiple countries prior to widely use.</p></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 2","pages":"Pages 77-82"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1008127523000895/pdfft?md5=ee4fcb6caac60d5a692fbedc91011bd2&pid=1-s2.0-S1008127523000895-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10204914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical practice of sepsis-induced immunosuppression: Current immunotherapy and future options","authors":"Fei Pei ,&nbsp;Bin Gu ,&nbsp;Shu-Min Miao ,&nbsp;Xiang-Dong Guan ,&nbsp;Jian-Feng Wu","doi":"10.1016/j.cjtee.2023.11.001","DOIUrl":"10.1016/j.cjtee.2023.11.001","url":null,"abstract":"<div><p>Sepsis is a potentially fatal condition characterized by the failure of one or more organs due to a disordered host response to infection. The development of sepsis is closely linked to immune dysfunction. As a result, immunotherapy has gained traction as a promising approach to sepsis treatment, as it holds the potential to reverse immunosuppression and restore immune balance, thereby improving the prognosis of septic patients. However, due to the highly heterogeneous nature of sepsis, it is crucial to carefully select the appropriate patient population for immunotherapy. This review summarizes the current and evolved treatments for sepsis-induced immunosuppression to enhance clinicians' understanding and practical application of immunotherapy in the management of sepsis.</p></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 2","pages":"Pages 63-70"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1008127523001141/pdfft?md5=3a061909b7d2f634fa50bf15bc0c6a73&pid=1-s2.0-S1008127523001141-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135515181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A newly proposed heatstroke-induced coagulopathy score in patients with heat illness: A multicenter retrospective study in China","authors":"Qing-Wei Lin ,&nbsp;Lin-Cui Zhong ,&nbsp;Long-Ping He ,&nbsp;Qing-Bo Zeng ,&nbsp;Wei Zhang ,&nbsp;Qing Song ,&nbsp;Jing-Chun Song","doi":"10.1016/j.cjtee.2023.08.001","DOIUrl":"10.1016/j.cjtee.2023.08.001","url":null,"abstract":"<div><h3>Purpose</h3><p>In patients with heatstroke, disseminated intravascular coagulation (DIC) is associated with greater risk of in-hospital mortality. However, time-consuming assays or a complex diagnostic system may delay immediate treatment. Therefore, the present study proposes a new heatstroke-induced coagulopathy (HIC) score in patients with heat illness as an early warning indicator for DIC.</p></div><div><h3>Methods</h3><p>This retrospective study enrolled patients with heat illness in 24 Chinese hospitals from March 2021 to May 2022. Patients under 18 years old, with a congenital clotting disorder or liver disease, or using anticoagulants were excluded. Data were collected on demographic characteristics, routine blood tests, conventional coagulation assays and biochemical indexes. The risk factors related to coagulation function in heatstroke were identified by regression analysis, and used to construct a scoring system for HIC. The data of patients who met the diagnostic criteria for HIC and International Society on Thrombosis and Haemostasis defined-DIC were analyzed. All statistical analyses were performed using SPSS 26.0.</p></div><div><h3>Results</h3><p>The final analysis included 302 patients with heat illness, of whom 131 (43.4%) suffered from heatstroke, including 7 death (5.3%). Core temperature (<em>OR</em> = 1.681, 95% <em>CI</em> 1.291 − 2.189, <em>p</em> &lt; 0.001), prothrombin time (<em>OR</em> = 1.427, 95% <em>CI</em> 1.175 − 1.733, <em>p</em> &lt; 0.001) and D-dimer (<em>OR</em> = 1.242, 95% <em>CI</em> 1.049 − 1.471, <em>p</em> = 0.012) were independent risk factors for heatstroke, and therefore used to construct an HIC scoring system because of their close relation with abnormal coagulation. A total score ≥ 3 indicated HIC, and HIC scores correlated with the score for International Society of Thrombosis and Hemostasis -DIC (<em>r</em> = 0.8848, <em>p</em> &lt; 0.001). The incidence of HIC (27.5%) was higher than that of DIC (11.2%) in all of 131 heatstroke patients. Meanwhile, the mortality rate of HIC (19.4%) was lower than that of DIC (46.7%). When HIC developed into DIC, parameters of coagulation dysfunction changed significantly: platelet count decreased, D-dimer level rose, and prothrombin time and activated partial thromboplastin time prolonged (<em>p</em> &lt; 0.05).</p></div><div><h3>Conclusions</h3><p>The newly proposed HIC score may provide a valuable tool for early detection of HIC and prompt initiation of treatment.</p></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 2","pages":"Pages 83-90"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1008127523000706/pdfft?md5=8ca3a2a44898cc513fa7a9b69b08673b&pid=1-s2.0-S1008127523000706-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10448760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does topical vancomycin prevent fracture-related infections in closed fractures undergoing open reduction and internal fixation? A randomised controlled trial","authors":"Mohit Gandhi ,&nbsp;Gopisankar Balaji ,&nbsp;Jagdish Menon ,&nbsp;Ruben Raj Thomas","doi":"10.1016/j.cjtee.2023.11.006","DOIUrl":"10.1016/j.cjtee.2023.11.006","url":null,"abstract":"<div><h3>Purpose</h3><p>The role of topical vancomycin in fracture-related infection (FRI) is debatable. Very few studies have reported their efficacy in open and high-risk extremity fractures. This study aimed to assess topical vancomycin's role in reducing FRI in closed fractures undergoing open surgical intervention with an implant.</p></div><div><h3>Methods</h3><p>This prospective randomized cohort study was carried out between February 2021 to January 2022. Patients with isolated closed fractures, who were planned for open reduction and internal fixation within 2 weeks from the time of injury were included for this study. The data collected included age, gender, socioeconomic status, mechanism of injury, diagnosis, Tscherne classification, and time interval to take up for surgery. Patients were randomized into the intervention and control groups using the block randomization technique. The control group received only systemic antibiotic prophylaxis, whereas the intervention group received topical application of vancomycin powder in the surgical wound alongside systemic antibiotic prophylaxis. The primary outcome measure was the incidence of FRI among these individuals. Clinical and radiological findings and culture reports (in cases with infection) were recorded during the post-operative period and at 6 weeks of follow-up. All relevant statistical calculations were done using STATA statistical/data analysis-parallel edition version 16.0 (StataCorp LLC). The quantitative variables like age and duration of the surgery were assessed for normalcy by Shapiro-Wilk W test. An independent samples <em>t</em>-test with equal variances was applied to the age data. Fisher's exact test was used for the analysis of the primary outcome measure (presence of FRI following surgery), and “Risk of FRI” and “Risk difference” between the 2 groups was calculated. The strength of the association between qualitative variables was assessed using the Fisher's exact and Chi-square tests, respectively.</p></div><div><h3>Results</h3><p>There were 88 patients included in this study. No statistical significance was found about FRI between both groups (<em>p</em> = 0.494). At 6 weeks following surgery, no incidence of infection was observed in the intervention group. Two infections (4.5%) were found in the control group, with positive cultures reported in one of them but none in the treatment group. Radiologically, 15.9% of patients in the control group showed lysis around the implant compared to 2.3% in the intervention group. Impaired fracture healing was observed in 22.7% of patients in the intervention group compared to 15.9% in the control group.</p></div><div><h3>Conclusion</h3><p>Applying topical vancomycin in closed fractures undergoing open reduction and internal fixation does not significantly reduce the incidence of FRI until the end of 6 weeks following surgery.</p></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 2","pages":"Pages 71-76"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1008127523001281/pdfft?md5=5c4d0fd5c2e191fe393ca625c3dd6e06&pid=1-s2.0-S1008127523001281-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138810391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for brain injury in patients with exertional heatstroke: A 5-year experience","authors":"Li Zhong ,&nbsp;Ming Wu ,&nbsp;Zhe-Ying Liu ,&nbsp;Yan Liu ,&nbsp;Zhi-Feng Liu","doi":"10.1016/j.cjtee.2023.10.003","DOIUrl":"10.1016/j.cjtee.2023.10.003","url":null,"abstract":"<div><h3>Purpose</h3><p>Minimal data exist on brain injury in patients with exertional heatstroke (EHS) in developing country. In this study, we explored the risk factors for brain injury induced by EHS 90-day after onset.</p></div><div><h3>Methods</h3><p>A retrospective cohort study of patients with EHS was conducted in the intensive care unit of the General Hospital of Southern Theater Command of PLA in China from April 2014 to June 2019. Patients were divided into non-brain injury (fully recovered) and brain injury groups (comprising deceased patients or those with neurological sequelae). The brain injury group was further subdivided into a death group and a sequela group for detailed analysis. General information, neurological performance and information on important organ injuries in the acute stage were recorded and analysed. Multivariable logistic regression was used to identify risk factors for brain injury after EHS and mortality risk factors for brain injury, and Kaplan-Meier survival curve was used to evaluate the effect of the neurological dysfunction on survival.</p></div><div><h3>Results</h3><p>Out of the 147 EHS patients, 117 were enrolled, of which 96 (82.1%) recovered, 13 (11.1%) died, and 8 (6.8%) experienced neurological sequelae. Statistically significant differences were found between non-brain injury and brain injury groups in age, hypotension, duration of consciousness disorders, time to drop core body temperature below 38.5°C, lymphocyte counts, platelet counts, procalcitonin, alanine aminotransferase, aspartate aminotransferase, creatinine, cystatin C, coagulation parameters, international normalized ratio, acute physiology and chronic health evaluation II scores, sequential organ failure assessment (SOFA) scores, and Glasgow coma scale scores (all <em>p</em> &lt; 0.05). Multivariate logistic regression showed that age (<em>OR</em> = 1.090, 95% <em>CI</em>: 1.02 − 1.17, <em>p</em> = 0.008), time to drop core temperature (<em>OR</em> = 8.223, 95% <em>CI</em>: 2.30 − 29.40, <em>p</em> = 0.001), and SOFA scores (<em>OR</em> = 1.676, 95% <em>CI</em>: 1.29 − 2.18, <em>p</em> &lt; 0.001) are independent risk factors for brain injury induced by EHS. The Kaplan-Meier curves suggest significantly prolonged survival (<em>p</em> &lt; 0.001) in patients with early Glasgow coma scale score &gt; 8 and duration of consciousness disorders ≤ 24 h.</p></div><div><h3>Conclusions</h3><p>Advanced age, delayed cooling, and higher SOFA scores significantly increase the risk of brain injury post-EHS. These findings underscore the importance of rapid cooling and early assessment of organ failure to improve outcomes in EHS patients.</p></div>","PeriodicalId":51555,"journal":{"name":"Chinese Journal of Traumatology","volume":"27 2","pages":"Pages 91-96"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1008127523001013/pdfft?md5=cd4fbcd96e1695609ce12fffe0c97c9b&pid=1-s2.0-S1008127523001013-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135410936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}