scholarly journals Epidemiological analysis of demographic characteristics and type of injuries in patients with multiple trauma with respect to conclusive treatment outcome

2008 ◽  
Vol 136 (3-4) ◽  
pp. 136-140 ◽  
Author(s):  
Slavisa Zagorac ◽  
Marko Bumbasirevic ◽  
Aleksandar Lesic ◽  
Ivan Milosevic
Keyword(s):  
Treatment Outcome ◽  
Multiple Trauma ◽  
Traffic Accidents ◽  
Injury Severity ◽  
Injury Mechanism ◽  
Organic System ◽  
Mortality And Morbidity ◽  
Number Of Patients ◽  
Significant Difference ◽  
Presentation Methods

Introduction Multiple trauma is one of the leading causes of mortality and morbidity in the population of people under 45 years of age. The consequences of multiple trauma have huge epidemiological, social and economic significance. Objective The aim of the paper was to analyze the conclusive treatment outcome of multiply traumatized patients with respect to their sex, age, injury mechanism and type. METHOD This retrospective study included 100 patients with multiple injuries (ISS>16) treated in the Emergency Room of the Clinical Centre of Serbia in the course of 2004. Clinical, X-ray, laboratory and numerical presentation methods - scores (ISS and GCS) were used to show the injury severity. Results Most of the injured were males (80%), and the average age was 40?20 (5-83). Out of the total number of patients who died, 23 (82%) were males, and 5 (18%) were females. The average age of the patients with fatal outcomes was 48?21 (8-86). Traffic accidents were the leading cause of injury (59%). The median GCS was 10?3 (3-15). The average ISS was 30 (20-66) in the surviving patients, and 53 (27-77) in those who died. Conclusion With respect to sex, in most cases multiple trauma affects males (p<0.01), with the average age of about 40. With respect to injury mechanism, the main cause of the occurrence of multiple trauma is traffic accidents (p<0.01). There is a statistically significant difference in the values of GCS and ISS relative to the definitive outcome (p<0.01). Statistical data processing indicated that there was a statistically significant correlation between mortality and type of injury in a given organic system (p<0.01), but that there was no statistically significant correlation between mortality and age. .

Cervical Spinal Cord Injury Shows Markedly Lower than Predicted Mortality (>72 Hours After Multiple Trauma) From Sepsis and Multiple Organ Failure

2018 ◽  
Vol 35 (4) ◽  
pp. 378-382
Author(s):  
Oliver Kamp ◽  
Oliver Jansen ◽  
Rolf Lefering ◽  
Renate Meindl ◽  
Christian Waydhas ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Multiple Organ Failure ◽  
Organ Failure ◽  
Multiple Trauma ◽  
Injury Severity ◽  
Multiple Organ ◽  
Injury Pattern ◽  
Significant Difference ◽  
Cord Injury

Background: Sepsis and multiple organ failure (MOF) remain one of the main causes of death after multiple trauma. Trauma- and infection-associated immune reactions play an important role in the pathomechanism of MOF, but the exact pathways remain unknown. Spinal cord injury (SCI) may lead to an altered immune response, and some studies suggest a prognostic advantage for such patients having sepsis or multiple trauma. Yet these findings need to be evaluated in larger cohorts of trauma patients. Methods: Retrospective, multicenter study, using the data of the TraumaRegister DGU. Patients with and without SCI surviving the initial first 72 hours after trauma were matched according to injury pattern and age. Comparative analysis considered morbidity (sepsis, MOF) and hospital mortality. Results: The study population included 800 matched pairs. As intended by the matching process, patients with cervical SCI had an otherwise comparable injury pattern but a higher severity of trauma (mean Injury Severity Score: 36 vs 29, mean number of diagnosis: 5.6 vs 4.4). They had a higher rate of sepsis (15.9% vs 10.9%, P = .005) and MOF (35.9% vs 24.1%, P < .001) while mortality revealed no significant difference (9.5% vs 9.9%, P = .866). Conclusions: Cervical SCI leads to an increased rate of sepsis and MOF but appears to be favorable with respect to outcome of sepsis and MOF following multiple trauma. Further research should focus on the pathomechanisms and the possible arising therapeutic options.

scholarly journals High Mortality from Major Vascular Trauma in Traffic Accidents: A Population-Based Study

2019 ◽  
Vol 109 (4) ◽  
pp. 328-335
Author(s):  
B. K. Johannesdottir ◽  
U. Johannesdottir ◽  
T. Jonsson ◽  
S. H. Lund ◽  
B. Mogensen ◽  
...  
Keyword(s):  
Traffic Accidents ◽  
Injury Severity ◽  
Road Traffic ◽  
Population Based ◽  
Vascular Trauma ◽  
Term Survival ◽  
Mortality And Morbidity ◽  
New Injury Severity Score ◽  
Discharged Patients ◽  
Discharge From Hospital

Background and Aims: Injuries involving major arteries are an important cause of mortality and morbidity, most often from road traffic accidents. Our aim was to study the outcome of major vascular trauma from traffic accidents in an entire population, including patients who die at the scene and those who reach hospital alive. Materials and Methods: This was a retrospective analysis of all patients who sustained major vascular trauma in traffic accidents in Iceland from 2000 to 2011. Patient demographics, mechanism, and location of vascular injury and treatment were registered. Injury scores were calculated and overall survival estimated. Results: There were 62 individuals (mean age 44 years, 79% males) with 95 major vascular traumas, giving an incidence of 1.69/100,000 inhabitants (95% confidence interval: 1.27–2.21). A total of 33 died at the scene and 8 during transportation to hospital but 21 (34%) reached hospital alive. Most patients who succumbed had thoracic major vascular traumas (76%) or abdominal major vascular traumas (23%). Mean new injury severity score for the 21 admitted patients was 44. A total of 18 were operated with vascular repair, 3 with endovascular stent graft insertion. The mean hospital stay for discharged patients was 34 days. Altogether, 15 of the 62 patients (24%) survived to discharge from hospital, with a 5-year survival of 86% for discharged patients. Conclusion: Every other patient with major vascular trauma following traffic accidents died at the scene and a further 13% died during transportation to hospital, most of whom sustained major vascular trauma to the thoracic aorta. However, one-third of the patients reached hospital alive and 71% of them survived to discharge, with excellent long-term survival.

Correlation between expression of MCM6, a new proliferative marker, and treatment outcome in patients with Hodgkin's disease

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19547-e19547
Author(s):  
K. Khodadad ◽  
S. Karimi ◽  
Z. Esfahani Monfared
Keyword(s):  
Treatment Outcome ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Univariate Analysis ◽  
Response To Treatment ◽  
G1 Arrest ◽  
Number Of Patients ◽  
Significant Difference ◽  
Proliferative Marker

e19547 Background: MCM6 is a proliferative marker, which in contrary to Ki67, is involved in all cell cycle phases, including early G1. We evaluated MCM6 expression in Hodgkin's disease (HD) patients in order to find any correlation between MCM6 expression and treatment outcome. Methods: Formalin-fixed paraffin-embedded lymph node specimens of 55 patients with HD treated with ABVD regimen (± radiotherapy) were assessed for MCM6 expression by IHC. The percentage of nuclear positivity in RS and mononuclear Hodgkin cells was evaluated in each case. Clinical data, response to treatment and relapse rates were obtained from patients’ medical records. These data were analyzed by SPSS software. Results: Mean MCM6 expression was 80.7% (ranging 35%-99%) with no significant difference between histology subtypes. In univariate analysis, MCM6 expression was not statistically significant for B-symptoms (P=0.27), sex (P=0.91), stage (P=0.18) and response to treatment (P=0.53), but was significant for age (P=0.008) (≤23 vs >23 yrs old). The MCM6 mean expression between relapsed and non-relapsed groups was marginally significant (21% vs 29.4%, P=0.057). In multivariate analysis, we evaluated MCM6 expression, B-symptoms, stage, response rate and age for relapse. None of risk factors were statistically significant predictor for relapse, including MCM6 expression (P=0.238), however, were significant regarding to response (P<0.001) and stage (P=0.048). We divided patients in 4 quartiles based on their MCM6 expression (Q1<74.25%, N=13, Q2=74.26–85.5%, N=14, Q3=85.6–91.75%, N=13, Q4>91.75%, N=12). Relapse and PFS were not significantly different between these quartiles (P=0.27 and P=0.83, respectively). Conclusions: Our study on a limited number of patients revealed MCM6 is not a strong predictor for treatment outcome in patients with HD. Our findings can be possibly explained by early G1 arrest of tumor cells and the role of cytokine production in pathogenesis of HD. We believe determining the accurate predictive role of proliferative markers needs to be focused on the markers which are exclusively involved in S phase. No significant financial relationships to disclose.

scholarly journals Methylprednisolone pulse therapy for patients with moderately severe Graves' orbitopathy: a prospective, randomized, placebo-controlled study

2008 ◽  
Vol 158 (2) ◽  
pp. 229-237 ◽  
Author(s):  
Rob J van Geest ◽  
Inna V Sasim ◽  
Hans P F Koppeschaar ◽  
Rachel Kalmann ◽  
Simone N Stravers ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Severe Disease ◽  
Clinical Signs ◽  
Pulse Therapy ◽  
Controlled Study ◽  
Clinical Activity ◽  
Number Of Patients ◽  
Significant Difference ◽  
Graves Orbitopathy ◽  
Minor Criteria

ObjectiveTo assess whether methylprednisolone (MP) pulse therapy is efficacious in the treatment of moderately severe Graves' orbitopathy (GO).DesignProspective, placebo (PL)-controlled, double-blind, randomized study.MethodsFifteen previously untreated patients with active, moderately severe GO participated in the study; 6 patients received MP and 9 patients a PL. Moderately severe disease was defined using the NOSPECS classification of clinical signs of GO . Activity was measured with the clinical activity score (CAS). A dose of 500 mg MP or only solvent was administered intravenously, over three consecutive days, in four cycles at 4 weekly intervals (6 g of MP in total). Qualitatively, a successful treatment outcome was defined as an improvement in one major and/or two minor criteria in the worst eye at week 48. The major criteria were: improvement in diplopia grade; improvement in eye movement; a decrease in CAS of three points. The minor criteria were: decrease of eyelid retraction; decrease of proptosis; improvement in grade of soft tissue swelling; a decrease in CAS of two points.ResultsThe qualitative treatment outcome was successful at the end of the trial in five out of six (83%) patients receiving MP and in one out of nine (11%) patients given the PL (relative risk=7.5; (95% confidence interval 1.1–49.3), P=0.005). The treatment was well tolerated.ConclusionsIn spite of the small number of patients, a significant difference in outcome was observed between MP- and PL-treated patients. We conclude that MP pulse therapy appears to be an effective treatment for active, moderately severe GO.

EVALUATION THE PROGNOSIS OF POLYTRAUMATIC PATIENTS WITH INJURY SEVERITY SCORE (ISS)

2017 ◽  
pp. 16-19
Author(s):  
Dzuy Vu ◽  
Viet Trung Lam
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Traffic Accidents ◽  
Injury Severity ◽  
Point Group ◽  
Traumatic Shock ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Polytrauma Patients ◽  
Total Point

Objectives:Surveying the relationship between Injury Severity Score features polytrauma patients.Survey correlation between Injury Severity Scorewith mortality in polytrauma patients. Subjects of study:75 patients aged 16 years, was diagnosed multiple injuries worse prognosis in the Emergency Department, Cho Ray Hospital from January 2015 to September 2015. Method: Cross-sectional descriptive. Results: Percentage of patients with polytrauma patients total points ISS > 40 points was 38.4%. Traffic accidents, patients with total points ISS > 40 points was 36.2%, labor accidents, the number of patients with total points ISS > 40 points was 54.5%. The difference was not statistically significant with p> 0.05. The percentage of patients with total points ISS > 40 points in the group with traumatic shock 48.2%, higher than the group without shock trauma. The differences are statistically significant at p <0.05. Patients with clotting disorders, who have a total point group ISS > 40 points accounted for 50%, higher than the group without coagulopathy. The differences are statistically significant at p <0.05. Patients with a total score ISS > 40 points, mortality or severe to very high, accounting for 53.6%, the differences are statistically significant with p <0.001. Key words: Polytrauma, ISS scale, Cho Ray Hospital

Metastases resection after FOLFIRI-aflibercept (FA) in oxaliplatin-refractory colorectal cancer patients (ORF-CRC).

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 862-862 ◽  
Author(s):  
Andres J. Muñoz Martín ◽  
Silvia Garcia Adrian ◽  
Carles Pericay ◽  
Ana Ruíz ◽  
Patricia Ibeas ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Real Life ◽  
Colorectal Metastases ◽  
Second Line ◽  
Surgical Mortality ◽  
Wild Type ◽  
Mortality And Morbidity ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

862 Background: Recent data suggest resection of colorectal metastases after second-line chemotherapy offers similar overall survival (OS) benefit compared to what described in first-line. The improvement in response rate with FA in second-line may increase the number of patients eventually undergo metastases resection. Methods: We performed a retrospective analysis of 32 patients from 26 Spanish hospitals who underwent surgical resection after FA in ORF-CRC in real-life setting. Our aim was to analyze the impact of metastases resection in different organs (liver, lung, etc.) in terms of OS and progression-free survival (PFS) and post-surgical mortality and morbidity. Results: Clinical characteristics: Median age: 65 years (43-83). Sex: 78.1% male, 21.9% female. ECOG 0/1 53.1/46.9%. Ras: wild-type/mutated 25/75%. Type of tumor: colon 75.0%, rectal 25.0%. Location: right 28.1%, transverse 9.4%, and left-side 62.5%. Previous treatment: oxaliplatin combinations (100%), bevacizumab 37.5%, cetuximab 21.97%. Ras wild-type patients received previous anti-EGFR therapy. FA in second-line 93.7% and beyond second-line 6.3%. Median FA cycles before surgery: 6.5 (range 3-44). Type of surgery: liver metastases 46.9%, lung metastases 25.0%, cytoreductive surgery for peritoneal carcinomatosis 15.6%, supraadrenalectomy 3.1%, simultaneous liver and peritoneal carcinomatosis 9.4%. Better tumor response with FA (RECIST1.1): partial response 56.3%, complete response 3.1%, stable disease 40.6%. Median follow-up: 20.9 months [m] (range 3.8-57.3 m). Median PFS from surgery: 8.0 m (confidence interval [CI] 95% 2.5-13.5 m). Median OS from surgery: 37.3 m (CI 95% 23.3-51.4 m). No significant difference between right and left-side tumors in OS or PFS were observed. 90-day postoperative mortality/morbidity: 18.8/0% Reoperation rate: 9.4%. Resection rates: R0 75.0%, R1 15.6%, R2 9.4%. Aflibercept after surgery: 22% patients. Conclusions: Metastases resection following FA in ORF-CRC offers encouraging OS with favorable surgical mortality and morbidity. Salvage surgery should be considered in highly selected patients in second-line setting with oligometastatic disease.

Outcomes in Traumatic Brain Injury for Patients Presenting on Antiplatelet Therapy

2015 ◽  
Vol 81 (2) ◽  
pp. 128-132 ◽  
Author(s):  
John David Cull ◽  
Lauren M. Sakai ◽  
Imran Sabir ◽  
Brent Johnson ◽  
Andrew Tully ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Antiplatelet Therapy ◽  
Injury Severity ◽  
Head Injuries ◽  
Hospital Length Of Stay ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Number Of Patients ◽  
Blunt Head Trauma ◽  
Significant Difference

An increasing number of patients are presenting to trauma units with head injuries on antiplatelet therapy (APT). The influence of APTon these patients is poorly defined. This study examines the outcomes of patients on APT presenting to the hospital with blunt head trauma (BHT). Registries of two Level I trauma centers were reviewed for patients older than 40 years of age from January 2008 to December 2011 with BHT. Patients on APT were compared with control subjects. Primary outcome measures were in-hospital mortality, intracranial hemorrhage (ICH), and need for neurosurgical intervention (NI). Hospital length of stay (LOS) was a secondary outcome measure. Multivariate analysis was used and adjusted models included antiplatelet status, age, Injury Severity Score (ISS), and Glasgow coma scale (GCS). Patients meeting inclusion criteria and having complete data (n = 1547) were included in the analysis; 422 (27%) patients were taking APT. Rates of ICH, NI, and in-hospital mortality of patients with BHT in our study were 45.4, 3.1, and 5.8 per cent, respectively. Controlling for age, ISS, and GCS, there was no significant difference in ICH (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.61 to 1.16), NI (OR, 1.26; 95% CI, 0.60 to 2.67), or mortality (OR, 1.79; 95% CI, 0.89 to 3.59) associated with APT. Subgroup analysis revealed that patients with ISS 20 or greater on APT had increased in-hospital mortality (OR, 2.34; 95% CI, 1.03 to 5.31). LOS greater than 14 days was more likely in the APT group than those in the non-APT group (OR, 1.85; 95% CI, 1.09 to 3.12). The effects of antiplatelet therapy in patients with BHT aged 40 years and older showed no difference in ICH, NI, and in-hospital mortality.

scholarly journals Trans-bronchial lung cryobiopsy in patients at high-risk of complications

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Benjamin Bondue ◽  
Pascal Schlossmacher ◽  
Nathalie Allou ◽  
Virgile Gazaille ◽  
Olivier Taton ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Lung Biopsy ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Systolic Pulmonary Artery Pressure ◽  
Mortality And Morbidity ◽  
Number Of Patients ◽  
Significant Difference

Abstract Background The surgical lung biopsy (SLB) is the recommended sampling technique when the pathological analysis of the lung is required in the work-up of an interstitial lung disease (ILD) but trans-bronchial lung cryobiopsy (TBLC) is increasingly recognized as an alternative approach. As TBLCs have lower mortality and morbidity risks than SLB, this study aimed to investigate the safety of TBLCs in patients at higher risk of complications and for whom SLB was not considered as an alternative. Method This prospective study was conducted in two hospitals in which TBLCs were performed in patients with body mass index (BMI) > 35, and/or older than 75 years, and/or with severely impaired lung function (FVC < 50% or DLCO < 30%), and/or systolic pulmonary artery pressure > 45 mmHg, and/or a clinically significant cardiac disease. Patients with any of these risk factors constituted the high-risk group. Clinical outcomes were compared with those obtained in patients without these risk factors (low-risk group). Results Ninety-six patients were included between April 2015 and April 2020, respectively 38 and 58 in the high-risk or the low-risk group. No statistically significant difference was observed between both groups in terms of severity and rate of bleeding, pneumothorax, or duration of hospital stay (p value ranging from 0.419 to 0.914). Conclusion This preliminary study on a limited number of patients suggests that TBLC appears safe in those in whom lung biopsy is at high-risk of complications according to their age, BMI, lung impairment, and cardiac comorbidities.

scholarly journals Epidemiology of trauma admissions in a level 1 trauma center in Northern Italy: a nine-year study

2021 ◽  
Author(s):  
Margherita Difino ◽  
Roberto Bini ◽  
Elisa Reitano ◽  
Roberto Faccincani ◽  
Fabrizio Sammartano ◽  
...  
Keyword(s):  
Trauma Center ◽  
Traffic Accidents ◽  
Injury Severity ◽  
Road Traffic ◽  
Age Distribution ◽  
Northern Italy ◽  
Number Of Patients ◽  
Level 1 ◽  
And Gender ◽  
Patterns Of Injury

AbstractThe aim of this study was to analyze the results of 9 years of trauma care and data collection in a level 1 urban trauma center in Northern Italy. Overall, 6065 patients have been included in the study; the number of patients managed yearly has doubled between 2011 and 2019. This rise mostly involved patients with injury severity score (ISS) < 16. Most injuries (94%) were blunt. Road traffic accidents, especially involving motorcycles, were the most common cause of injury. Self-inflicted injuries were responsible for less than 5% of trauma but they were severe in 56% of cases. The median age was 38 and it remained constant over the years; 43% of patients had 14–39 years of age. Different characteristics and patterns of injury were observed for each age group and gender. Males were more likely to be injured in the central years of life while females presented a trimodal pattern in the age distribution. Young adults (14–39 years old) were overall at higher risk of self-harm. Overall mortality was equal to 5.2%. Most deceased were male and ≥ 65 years of age.

scholarly journals Assessment and Clinical Outcomes of Fall Related Injuries at Emergency

2021 ◽  
Vol 4 (1) ◽  
pp. 50-59
Author(s):  
Shawbo Osman ◽  
◽  
Vian Naqshbandi ◽  
Keyword(s):  
Injury Severity ◽  
Emergency Services ◽  
Significant Degree ◽  
Cost Of Care ◽  
P Value ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Common Location ◽  
Significant Difference ◽  
Fall Height

Background and objectives: Falls are significant cause of mortality and morbidity with a considerable burden on societies, families and victims. The study aims to determine the interventions and outcomes of fall-related injuries, and the association between injury se-verity and fall height. Methods: A descriptive cross-sectional study was conducted among 322 fall-related in-jured persons in West and East emergency hospitals in Erbil City from September 2020 to February 2021. Study sample demography, location of injury, place of affected body re-gions, outcome, and hospital stay were analyzed. Results: Of the 322 patients studied, 68.9% were males, and 31.1% were female. Less than half of the samples (48.8%) were between the ages 18 to 36 years old. The most common location for fall-related injuries was residential facilities (44.1%) followed by the place of work (35.1%). According to the type of fall, fall from ground was 38.4%, and fall from a fall height of 1-3 meters was 48.8%. Finally, according to the injury classification, more than half (56.5%) of the study sample had a significant degree of severity. The discharged status of disposition at the emergency room had the highest percentage (64.9%) of the study sample. There was a significant difference between the scores of the items of fall conse-quences and outcomes regarding to type of ground (soft or hard). There was a significant relationship between injury severity and fall height (p-value = 0.00). Conclusion: Fall-related injuries are the most common cases at emergency departments in Erbil city. Among ages 18 to 36, men are more frequently exposed to falls than women. The highest risk of fall is occupation with construction laborers at the greatest risk. Fall-related injury is a burden on the health care system, particularly on emergency services in developing countries like Iraq in relations cost of care and resources.

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