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Comorbidities in trauma patients

Eric J Charles, Nicholas J Napoli, Lily E Johnston, Carrie A Foster, Deirdre A Goode, Trevor B Parker, Eleanor A Sharp, Laura Barnes, Jeffrey S Young
The most common mechanism of traumatic injury is ground-level fall. The objective of this study was to understand how patients sustaining falls and their outcomes have evolved. An institutional trauma database was used to identify adult patients who suffered a fall and were admitted to a Level I trauma center during two distinct time periods: 1998 to 2003 (past) and 2008 to 2013 (current). Data on anticoagulant use and comorbidities was gathered by retrospective chart review of patients treated during 2003 and 2013...
March 1, 2018: American Surgeon
Chih-Yuan Wang, Yi-Chan Chen, Ti-Hsuan Chien, Hao-Yu Chang, Yu-Hsien Chen, Chih-Ying Chien, Ting-Shuo Huang
Here we conducted a retrospective analysis of hospital-based trauma registry database for evaluating the impacts of comorbidities on the prognosis for traumatized patients using Index of Coexistent Comorbidity Disease (ICED) scores. We analyzed the data of patients with blunt trauma who visited emergency department between January 1, 2011, and December 31, 2015 in Chang-Gung Memorial Hospital, Keelung branch, a single level I trauma center in the Northern Taiwan. All consecutive patients with blunt trauma who admitted to the intensive care unit or ordinary ward after initial managements in the emergency department were included...
2018: PloS One
M Gioffrè-Florio, L M Murabito, C Visalli, F P Pergolizzi, F Famà
AIM: Trauma, in geriatric patients, increases with age, and is a leading cause of disability and institutionalization, resulting in morbidity and mortality. The aim of our study was to analyse the prevalence of trauma, the related risk factors, mortality and sex differences in the prevalence in a geriatric population. PATIENTS AND METHOD: We observed 4,554 patients (≥65 years) with home injuries or car accidents. Patients were evaluated with ISS (Injury Severity Score) and major trauma with ATLS (Advanced Trauma Life Support)...
January 2018: Il Giornale di Chirurgia
Tiago Gai Aita, Cecília Luiz Pereira Stabile, Cássia Cilene Dezan Garbelini, Glaykon Alex Vitti Stabile
PURPOSE: We aimed to evaluate whether the Facial Injury Severity Scale (FISS), proposed by Bagheri et al in 2006, can predict intervention needs in the operating room (OR), length of hospital stay, and need for support by other specialties. PATIENTS AND METHODS: Data were collected from the medical records of trauma patients from a public tertiary hospital between January 2009 and December 2015, related to age, gender, comorbidities, habits, history of maxillofacial trauma, etiology, and presence and location of fractures and lacerations, in addition to type of treatment performed and period of hospitalization...
February 20, 2018: Journal of Oral and Maxillofacial Surgery
Matthew Hernandez, Joaquim Havens, Shahid Shafi, Marie Crandall
Patients with emergency general surgery (EGS) diseases display variable severity. The extent of disease can be amplified by comorbidity or dramatic changes in presenting physiology. Estimating the extent of disease severity in order to adequately provide prognosis, determine optimal operative or non-operative management, and plan for potential outcomes is difficult. A variety of risk factors have been studied for specific diseases but these criteria may not be universally applied. This limits the generalizability of prior work...
March 12, 2018: Journal of Trauma and Acute Care Surgery
Mark Gage, Frank Liporace, Kenneth Egol, Toni McLaurin
Treatment of traumatic bone defects is dictated by a multitude of clinical factors including the defect size, patient comorbidities, soft tissue condition, and the possibility of infection present in the defect. With a variety of treatment strategies described, it is critical to choose the approach that will maximize outcomes in addressing this difficult problem. When addressing small-scale defects, bone grafting is the primary treatment. For large-scale defects, there are two major options to consider: induced membrane technique and distraction osteogenesis...
March 2018: Bulletin of the Hospital for Joint Diseases
Raquel Bernardelli Iamaguchi, Renan Lyuji Takemura, Gustavo Bersani Silva, Jairo Andre de Oliveira Alves, Luciano Ruiz Torres, Alvaro Baik Cho, Teng Hsiang Wei, Marcelo Rosa de Rezende, Rames Mattar
INTRODUCTION: Indication of free tissue transfer for limb reconstruction continues to grow, and despite the good results with this treatment option, complications can impair the functional results and cause a raise in health costs, with prolonged hospitalization. Therefore, peri-operative surgical information and comorbidities were described and analyzed, for identification of independent risk factors for complications of free flaps results for traumatic wounds. For our knowledge, intraoperative ischemia time of free flap was not previously studied for post-traumatic limb reconstruction, which could influence results, in these traumatic cases, with the highest rates of complications among microsurgical flap reconstructions...
March 13, 2018: International Orthopaedics
Richa Aggarwal, Neha Rastogi, Purva Mathur, Kapil Dev Soni, Subodh Kumar, Amit Gupta, Sushma Sagar
Introduction: There have been isolated case reports and reports of outbreak of colistin-resistant Klebsiella from various parts of the world but only two from India and that too from oncology centers. We report cluster of colistin-resistant Klebsiella pneumonia bloodstream infection cases from our surgical trauma Intensive Care Unit. Methodology: The study was carried out in surgical ICU of Level-I trauma center. Retrospective analysis of all the five patients with CRK was done...
February 2018: Indian Journal of Critical Care Medicine
Karen J Riemenschneider
Prevention of hospital-acquired pressure injuries (HAPIs) remains a crucial clinical challenge especially for those patients undergoing surgery. The purpose of this project was to examine whether a 5-layer silicone foam dressing applied to the sacrum of patients undergoing vascular surgery decreased the occurrence of sacral pressure injuries and to explore participant characteristics associated with the development of operating room (OR)-related pressure injuries. A pre-/postintervention design, quality improvement project in a convenience sample of 81 patients undergoing vascular surgery, in a 700-bed level I trauma acute care setting, in the Northeastern United States...
March 2018: Journal of Wound, Ostomy, and Continence Nursing
Stephen C Gale, JoAnn Peters, Jason S Murry, Jessica S Crystal, Viktor Y Dombrovskiy
Background: Late middle age (LMA), is a watershed between youth and old age, with unique physical and social changes and declines in vitality, but a desire to remain active despite increasing comorbidity. While post-injury outcomes in the elderly are well studied, little is known regarding LMA patients. We analyzed the injured LMA population admitted to a rural, regional Level 1 Trauma Center relative to outcomes for both younger and older patients. Materials and methods: Our registry was queried retrospectively for patients admitted 7/2008- 12/2015; they were divided into three cohorts: 18-54, 55-65, and >65 years...
March 2018: Annals of Medicine and Surgery
Jennifer L Creamer, Matthew S Brock, Panagiotis Matsangas, Vida Motamedi, Vincent Mysliwiec
STUDY OBJECTIVES: Sleep disturbances are common in United States military personnel. Despite their exposure to combat and trauma, little is known about nightmares in this population. The purpose of this study was to describe the prevalence and associated clinical and polysomnographic characteristics of nightmares in United States military personnel with sleep disturbances. METHODS: Retrospective review of 500 active duty United States military personnel who underwent a sleep medicine evaluation and polysomnography at our sleep center...
February 27, 2018: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
Krista L Haines, Tiffany Zens, Megan Beems, Ryan Rauh, Hee Soo Jung, Suresh Agarwal
BACKGROUND: Health-care disparities based on socioeconomic status have been well documented in the trauma literature; however, there is a paucity of data on how these factors affect outcomes in patients experiencing severe thoracic trauma. This study aims to identify the effect of insurance status and race on patient mortality and disposition after thoracic trauma. METHODS: The National Trauma Data Bank was queried from 2007 to 2012 for patients with sternal fractures, rib fractures, and flailed chest...
April 2018: Journal of Surgical Research
Stefano Carbone, Riccardo Mezzoprete, Matteo Papalia, Valerio Arceri, Andrea Carbone, Stefano Gumina
OBJECTIVE: The objectives of the study were: a) to identify osteoporotic proximal humerus fractures in a large consecutive series of patients; b) to identify radiographic fracture patterns among osteoporotic and non-osteoporotic proximal humerus fractures; and c) to calculate intra- and inter-observer reliability of assessment of osteoporosis and of radiographic fracture patterns. METHODS: This was a prospective observational study of patients admitted to the emergency department affected by a proximal humerus fracture between June 2014 and June 2016...
March 2018: European Journal of Radiology
Stephanie A Mason, Avery B Nathens, James P Byrne, Christina Diong, Robert A Fowler, Paul J Karanicolas, Rahim Moineddin, Marc G Jeschke
OBJECTIVE: To estimate long-term mortality following major burn injury compared with matched controls. SUMMARY BACKGROUND DATA: The effect of sustaining a major burn injury on long-term life expectancy is poorly understood. METHODS: Using health administrative data, all adults who survived to discharge after major burn injury between 2003 and 2013 were matched to between 1 and 5 uninjured controls on age, sex, and the extent of both physical and psychological comorbidity...
February 27, 2018: Annals of Surgery
Roi Anteby, Aya Barzelay, Adiel Barak
Purpose: To evaluate visual and surgical outcomes in very elderly patients (above 85 years of age) undergoing pars plana vitrectomy (PPV). Patients and methods: A single-center, retrospective study was carried out on the medical records of 82 patients aged 85 years and older who had undergone PPV from 2006 to 2013. Patients ranged in age from 86 to 99 years, with a mean age of 88.9 years (±2.88). Visual results and intraoperative and postoperative complications were the main outcome measures...
2018: Clinical Interventions in Aging
Denis Ehrl, Paul I Heidekrueger, Milomir Ninkovic, P Niclas Broer
OBJECTIVE: Burns represent a special form of severe trauma. Due to long hospitalization, rehabilitation, and extensive scar treatment, severe burn injuries rank among the most expensive traumatic injuries regarding associated health care costs. The presented single-burn-center experiences evaluated the effects of primary versus secondary burn intensive care unit (BICU) admissions on outcomes in severely burned patients. METHODS: Within 30 months, 186 patients were admitted to the BICU...
February 17, 2018: Burns: Journal of the International Society for Burn Injuries
Melissa K James, R Jonathan Robitsek, Syed M Saghir, Patricia A Gentile, Marylin Ramos, Frances Perez
BACKGROUND: Falls can result in injuries that require rehabilitation and long-term care after hospital discharge. Identifying factors that contribute to prediction of discharge disposition is crucial for efficient resource utilization and reducing cost. Several factors may influence discharge location after hospitalization for a fall. The aim of this study was to examine clinical and non-clinical factors that may predict discharge disposition after a fall. We hypothesized that age, injury type, insurance type, and functional status would affect discharge location...
February 14, 2018: Injury
Debra M Glick, Joan M Cook, Jennifer Moye, Anica Pless Kaiser
Post traumatic stress disorder (PTSD) may first emerge, reemerge, or worsen as individuals approach end of life and may complicate the dying process. Unfortunately, lack of awareness of the occurrence and/or manifestation of PTSD at end of life can lead to PTSD going unaddressed. Even if PTSD is properly diagnosed, traditional evidence-based trauma-focused treatments may not be feasible or advisable with this group as many patients at end of life often lack the physical and mental stamina to participate in traditional psychotherapy...
January 1, 2018: American Journal of Hospice & Palliative Care
Philip Myers, Patrick Laboe, Kory J Johnson, Peter D Fredericks, Renn J Crichlow, Dean C Maar, Timothy G Weber
OBJECTIVES: To estimate 1-year mortality rates in elderly patients who undergo operative treatment for distal femur fractures and identify potential risk factors for mortality. DESIGN: Retrospective chart review. SETTING: Level 1 and Level 2 trauma centers. PATIENTS/PARTICIPANTS: Two hundred eighty-three elderly patients (average age 76.0 years ± 9.8) who sustained distal femur fractures between 2002 and 2012. INTERVENTION: Fracture fixation of the distal femur...
March 2018: Journal of Orthopaedic Trauma
Antonio D'Andrilli, Erino A Rendina
Main specific interventions for preoperative clinical optimisation of patients undergoing lung cancer surgery include assessment and treatment of comorbidities, minimizing preoperative hospitalization, minimizing preoperative fasting, and optimisation of antibiotic and thrombo-embolic prophylaxis. Preoperative patient optimisation is considered a crucial part of enhanced recovery after thoracic surgery pathways. Potentially, advantages of this fast-track management could be even higher when considering video-assisted thoracic surgery (VATS) major lung resection, because reduced trauma related to minimally invasive techniques is one of the main factors improving postoperative outcome...
2018: Journal of Visualized Surgery
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