Journal of trauma management & outcomes最新文献

{"title":"Routine versus ad hoc screening for acute stress following injury: who would benefit and what are the opportunities for prevention.","authors":"Nathaniel Bell,&nbsp;Boris Sobolev,&nbsp;Stephen Anderson,&nbsp;Robert Hewko,&nbsp;Richard K Simons","doi":"10.1186/1752-2897-8-5","DOIUrl":"https://doi.org/10.1186/1752-2897-8-5","url":null,"abstract":"<p><strong>Background: </strong>Screening for acute stress is not part of routine trauma care owing in part to high variability of acute stress symptoms in identifying later onset of posttraumatic stress disorder (PTSD). The objective of this pilot study was to assess the sensitivity, specificity, and power to predict onset of PTSD symptoms at 1 and 4 months using a routine screening program in comparison to current ad hoc referral practice.</p><p><strong>Methods: </strong>Prospective cross-sectional observational study of a sample of hospitalized trauma patients over a four-month period from a level-I hospital in Canada. Baseline assessments of acute stress (ASD) and subsyndromal ASD (SASD) were measured using the Stanford Acute Stress Reaction Questionnaire (SASRQ). In-hospital psychiatric consultations were identified from patient discharge summaries. PTSD symptoms were measured using the PTSD Checklist-Specific (PCL-S). Post-discharge health status and health services utilization surveys were also collected.</p><p><strong>Results: </strong>Routine screening using the ASD (0.43) and SASD (0.64) diagnoses were more sensitive to PTSD symptoms at one month in comparison to ad hoc referral (0.14) and also at four months (0.17, 0.33 versus 0.17). Ad hoc referral had greater positive predictive power in identifying PTSD caseness at 1 month (0.50) in comparison to the ASD (0.46) and SASD (0.43) diagnoses and also at 4 months (0.67 versus 0.25 and 0.29).</p><p><strong>Conclusions: </strong>Ad hoc psychiatric referral process for acute stress is a more conservative approach than employing routine screening for identifying persons who are at risk of psychological morbidity following injury. Despite known limitations of available measures, routine patient screening would increase identification of trauma survivors at risk of mental health sequelae and better position trauma centers to respond to the circumstances that affect mental health during recovery.</p>","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"8 ","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2014-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1752-2897-8-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32352371","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":"Reviewer acknowledgement 2013","authors":"D. Stengel, Annette Luckmann","doi":"10.1186/1752-2897-8-1","DOIUrl":"https://doi.org/10.1186/1752-2897-8-1","url":null,"abstract":"","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"8 1","pages":"1 - 1"},"PeriodicalIF":0.0,"publicationDate":"2014-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1752-2897-8-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65728073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality after road traffic crashes in a system with limited trauma data capability.","authors":"Hassan Saidi,&nbsp;Ben Kasyoka Mutiso,&nbsp;Julius Ogengo","doi":"10.1186/1752-2897-8-4","DOIUrl":"https://doi.org/10.1186/1752-2897-8-4","url":null,"abstract":"<p><strong>Background: </strong>Africa has 4% of the global vehicles but accounts for about one tenth of global vehicular deaths. Major trauma in Kenya is associated with excess mortality in comparison with series from trauma centers. The determinants of this mortality have not been completely explored.</p><p><strong>Objectives: </strong>To determine the factors affecting mortality among road users in Nairobi, Kenya.</p><p><strong>Methods: </strong>Cross-sectional study of prospectively collected data of trauma admissions at the Kenyatta National Hospital over a calendar year (2009-2010). Information collected included age, gender, road user type, principal anatomical region of injury, admission status, admission blood pressure and GCS, disposition destination, Injury Severity Score (ISS), injuries sustained, treatment and mortality at two weeks. Major or severe injury was defined as injuries of ISS > 15. Groups based on in-hospital survival were compared using determinants of mortality using X2 or students t-test as appropriate. Logistic regression was used to assess the independence of predictive variables.</p><p><strong>Results: </strong>One thousand six hundred forty seven (1647) patients were admitted for trauma during the study period. Traffic admissions were 1013 (61.7%) and males predominated (79.8%). The average age of patients admitted was 31.7 years. Pedestrians, vehicle occupants and motorcyclists represented 43.3%, 27.2% and 15.2% of the road users injured. The proportion of patients with ISS > 15 was 10.9%.The overall mortality was 7.7%. Mortality for ISS > 15 was 27.6%. The following factors significantly predicted mortality on univariate analysis: head injury, abdominal injury, transfer in status, blood transfusion, ICU admission, age > 60 years, Glasgow coma scale (GCS) and injury severity. GCS (p = 0.001) and ISS > 15 (p < 0.05) remained significant predictors on regression analysis.</p><p><strong>Conclusion: </strong>Trauma mortality rates in this study exceed those from mature trauma systems. Head injury and injury severity based on the ISS are independent predictors of mortality after traffic trauma. Improvements in neurosurgical and critical care services ingrained within wider primary and secondary prevention initiatives are logical targets.</p>","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"8 1","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2014-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1752-2897-8-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32113504","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":"Propensity for performing interventions in pre-hospital trauma management - a comparison between physicians and non-physicians.","authors":"Mathias C Blom,&nbsp;Ludwig Aspelin,&nbsp;Kjell Ivarsson","doi":"10.1186/1752-2897-8-3","DOIUrl":"https://doi.org/10.1186/1752-2897-8-3","url":null,"abstract":"<p><strong>Background: </strong>In 2005, the Advanced Life Support (ALS) teams delivering pre-hospital care in RegionSkane in southern Sweden received additional support by physicians, who were part of \"Pre-hospital acute teams\" (PHAT). The study objective is to compare the incidence of pre-hospital medical interventions for trauma-patients cared for by conventional ALS teams and patients who received additional support by PHAT.</p><p><strong>Methods: </strong>Trauma patients with Injury Severity Score (ISS) >9 were identified retrospectively in the national quality registry KVITTRA at three hospitals in RegionSkane, for the time period October 2005 to December 2008. Interventions include e.g. tracheal intubation, administration of i.v. fluids, neck immobilization and spine board usage. Confounding effects from trauma severity, trauma mechanism, vital parameters, age and sex were addressed in multivariate models.</p><p><strong>Results: </strong>Data from 202 cases was included. 9 pre-hospital interventions were assessed. The incidence of endotracheal intubation and immobilisation of extremities was higher among patients in the PHAT-group compared to the ALS-only group (16.3% vs. 6.9%, p = 0.034) and (12.8% vs. 4.3%, p = 0.027) respectively. PHATs presence remained a significant predictor of these interventions also after taking confounding factors into account (OR 5.5, CL 1.5-19.7) and (OR 3.2 CI 1.0-9.8).PHAT was involved in a greater proportion of cases with <50.0% of survival (19.8% vs. 12.1%, p = 0.134). The average ISS was higher among cases receiving PHAT support in strata ISS 16-24 and ISS > 24 than cases in corresponding strata cared for by ALS teams alone (ISS 20.0 vs. 17.0, p = 0.048 and ISS 34.0 vs. 29.0, p = 0.019).</p><p><strong>Conclusions: </strong>The incidence of endotracheal intubation and immobilization of extremities was greater among patients supported by PHAT, compared to patients cared for by ALS teams alone. This finding has to be interpreted in the light of a selection-bias where PHAT support was directed to more severely injured patients.</p>","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"8 1","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2014-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1752-2897-8-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32096760","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 intra-abdominal hypertension and abdominal compartment syndrome: a review.","authors":"Leanne Hunt, Steve A Frost, Ken Hillman, Phillip J Newton, Patricia M Davidson","doi":"10.1186/1752-2897-8-2","DOIUrl":"10.1186/1752-2897-8-2","url":null,"abstract":"<p><strong>Unlabelled: </strong>Patients in the intensive care unit (ICU) are at risk of developing of intra abdominal hypertension (IAH) and abdominal compartment syndrome (ACS).</p><p><strong>Aim: </strong>This review seeks to define IAH and ACS, identify the aetiology and presentation of IAH and ACS, identify IAP measurement techniques, identify current management and discuss the implications of IAH and ACS for nursing practice. A search of the electronic databases was supervised by a health librarian. The electronic data bases Cumulative Index of Nursing and Allied Health Literature (CINAHL); Medline, EMBASE, and the World Wide Web was undertaken from 1996- January 2011 using MeSH and key words which included but not limited to: abdominal compartment syndrome, intra -abdominal hypertension, intra-abdominal pressure in adult populations met the search criteria and were reviewed by three authors using a critical appraisal tool. Data derived from the retrieved material are discussed under the following themes: (1) etiology of intra-abdominal hypertension; (2) strategies for measuring intra-abdominal pressure (3) the manifestation of abdominal compartment syndrome; and (4) the importance of nursing assessment, observation and interventions. Intra-abdominal pressure (IAP) and abdominal compartment syndrome (ACS) have the potential to alter organ perfusion and compromise organ function.</p>","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"8 1","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2014-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32092084","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":"The impact of shorter prehospital transport times on outcomes in patients with abdominal vascular injuries.","authors":"Chad G Ball,&nbsp;Brian H Williams,&nbsp;Clarisse Tallah,&nbsp;Jeffrey P Salomone,&nbsp;David V Feliciano","doi":"10.1186/1752-2897-7-11","DOIUrl":"https://doi.org/10.1186/1752-2897-7-11","url":null,"abstract":"<p><strong>Background: </strong>Most deaths in patients with abdominal vascular injuries (ABVI) are caused by exsanguination and irreversible shock. Therefore, time to definitive hemorrhage control is an important factor affecting survival. The study goals were: (1) document current outcomes in patients with ABVI, and (2) compare outcomes to those from the era preceding improvements in an urban prehospital system.</p><p><strong>Methods: </strong>A retrospective review of all patients with ABVI at an urban level 1 trauma center was completed. Patients injured prior to prehospital transport improvements (1991-1994) were compared to those following a reduction in transport times (1995-2004).</p><p><strong>Results: </strong>Of 388 patients, 70 (18%) arrived prior to prehospital improvements (1991-1994). Patient/injury demographics were similar in both groups (age, sex, penetrating mechanism; p > 0.05). The number of patients presenting with ABVI increased (23 vs. 35 per year; p < 0.05) concurrent to a reduction in transport times (27 vs. 20 minutes; p < 0.05). Patients were more frequently unstable (63% vs. 91%; p < 0.05). Regardless of the specific vessel, mortality increased (37% vs. 67%; p < 0.05) following prehospital improvements.</p><p><strong>Conclusions: </strong>A reduction in urban transport times resulted in an increase in (1) the number of patients arriving with abdominal vascular injuries, (2) the proportion presenting in physiologic extremis, and (3) overall mortality.</p>","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"7 1","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2013-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1752-2897-7-11","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31973279","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":"Paediatric injuries at Bugando Medical Centre in Northwestern Tanzania: a prospective review of 150 cases.","authors":"Raymond Simon, Japhet M Gilyoma, Ramesh M Dass, Mabula D Mchembe, Phillipo L Chalya","doi":"10.1186/1752-2897-7-10","DOIUrl":"10.1186/1752-2897-7-10","url":null,"abstract":"<p><strong>Background: </strong>Injuries continue to be the leading cause of death and disability for children. The is a paucity of published data on paediatric injuries in our local environment. This study describes the etiological spectrum, injury characteristics and treatment outcome of paediatric injuries in our local setting and provides baseline data for establishment of prevention strategies as well as treatment guidelines.</p><p><strong>Methods: </strong>This was a descriptive cross-sectional study involving paediatric injury patients admitted to Bugando Medical Centre from August 2011 to April 2012. Statistical data analysis was done using SPSS version 17.0 and STATA version 12.0.</p><p><strong>Results: </strong>A total of 150 patients were studied. The age of patients ranged from 1 month to 10 years with a median age of 5 years. The male to female ratio was 2.3:1. Road traffic accident was the most common cause of injury (39.3%) and motorcycle (71.2%) was responsible for the majority of road traffic accidents. Only 11 (7.3%) patients received pre-hospital care. The head /neck (32.7%) and musculoskeletal (28.0%) were the most frequent body region injured. Open wounds (51.4%), foreign bodies (31.3%) and fractures (17.3%) were the most common type of injuries sustained. The majority of patients 84 (56.0%) were treated surgically. Complication rate was 3.9%. The mean duration of hospitalization was 9.7 ± 13.1 days. Mortality rate was 12.7%. Age of the patient (< 5 years), late presentation and presence of complications were the main predictors of length of hospital stay (P < 0.001), whereas burn injuries, severe head injuries and severity of injury (Paediatric trauma score = 0-5) significantly predicted mortality (P < 0.0001).</p><p><strong>Conclusion: </strong>Paediatric injuries resulting from road traffic accidents (RTAs) remain a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTAs is necessary to reduce the incidence of paediatric injuries in this region.</p>","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"7 1","pages":"10"},"PeriodicalIF":0.0,"publicationDate":"2013-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32092133","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":"Citywide trauma experience in Mwanza, Tanzania: a need for urgent intervention.","authors":"Phillipo L Chalya, Ramesh M Dass, Mabula D Mchembe, Nkinda Mbelenge, Isdori H Ngayomela, Alphonce B Chandika, Japhet M Gilyoma, Joseph B Mabula","doi":"10.1186/1752-2897-7-9","DOIUrl":"10.1186/1752-2897-7-9","url":null,"abstract":"<p><strong>Background: </strong>Trauma remains a leading cause of morbidity and mortality in resource limited countries. There is paucity of published reports on trauma care in Tanzania, particularly the study area. This study was carried out to describe our experiences in trauma management outlining the etiological spectrum, injury characteristics and treatment outcome of trauma patients at our local setting and compare our results with those from other centers in the world.</p><p><strong>Methods: </strong>A descriptive prospective study of trauma patients was conducted at Bugando Medical Centre from April 2010 to March 2012. Statistical data analysis was done using SPSS software version 17.0.</p><p><strong>Results: </strong>A total of 5672 trauma patients were enrolled in the study. The male to female ratio was 2.3: 1. The majority of patients were in the 2nd decade of life. Road traffic accident was the most common cause of trauma accounting for 60.7% of cases. The majority of patients (76.6%) sustained blunt injuries. Musculoskeletal (68.5%) and head/neck (52.6%) were the most frequent body region injured. Soft tissue injuries (open wounds) and fractures were the most common injuries accounting for 82.8% and 76.8% respectively. Majority of patients (74.4%) were treated surgically with wound debridement (94.0%) being the most frequently performed procedure. Postoperative complications were recorded in 31.5% of cases.The overall median duration of hospitalization was 26 days (range 1 day to 144 days). Mortality rate was 16.7%. Patients who had polytrauma, burn injuries and those who had tetanus and long bone fractures stayed longer in the hospital and this was statistically significant (P < 0.001), whereas the age > 65 years, severe trauma, admission Systolic Blood Pressure < 90 mmHg, presence of tetanus, severe head injury, the duration of loss of consciousness, the need for intensive care unit admission and finding of space occupying lesion on CT scan of the brain significantly influenced mortality (P < 0.001).</p><p><strong>Conclusion: </strong>Trauma resulting from road traffic accidents remains a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of road traffic accidents is necessary to reduce the incidence of trauma in this region.</p>","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"7 1","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2013-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4028861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32092079","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":"Retraction Note: Decompressive craniectomy without durotomy for traumatic coma and uncontrollable intracranial hypertension","authors":"Daniel J. Miller, D. Lobel","doi":"10.1186/S13032-016-0032-Y","DOIUrl":"https://doi.org/10.1186/S13032-016-0032-Y","url":null,"abstract":"","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/S13032-016-0032-Y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65753793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RETRACTED ARTICLE: Decompressive craniectomy without durotomy for traumatic coma and uncontrollable intracranial hypertension","authors":"Daniel J. Miller, D. Lobel","doi":"10.1186/1752-2897-7-8","DOIUrl":"https://doi.org/10.1186/1752-2897-7-8","url":null,"abstract":"","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"7 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2013-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1752-2897-7-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65728060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}