Journal articles on the topic 'Compensation, injury, trauma, outcome'
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Nguyen, Thi L., Katharine S. Baker, Liane Ioannou, Behrooz Hassani-Mahmooei, Stephen J. Gibson, Alex Collie, Jennie Ponsford, Peter A. Cameron, Belinda J. Gabbe, and Melita J. Giummarra. "Prognostic Role of Demographic, Injury and Claim Factors in Disabling Pain and Mental Health Conditions 12 Months after Compensable Injury." International Journal of Environmental Research and Public Health 17, no. 19 (October 7, 2020): 7320. http://dx.doi.org/10.3390/ijerph17197320.
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Identifying who might develop disabling pain or poor mental health after injury is a high priority so that healthcare providers can provide targeted preventive interventions. This retrospective cohort study aimed to identify predictors of disabling pain or probable mental health conditions at 12 months post-injury. Participants were recruited 12-months after admission to a major trauma service for a compensable transport or workplace injury (n = 157). Injury, compensation claim, health services and medication information were obtained from the Victorian Orthopaedic Trauma Outcome Registry, Victorian State Trauma Registry and Compensation Research Database. Participants completed questionnaires about pain, and mental health (anxiety, depression, posttraumatic stress disorder) at 12 months post-injury. One third had disabling pain, one third had at least one probable mental health condition and more than one in five had both disabling pain and a mental health condition at 12 months post-injury. Multivariable logistic regression found mental health treatment 3–6 months post-injury, persistent work disability and opioid use at 6–12 months predicted disabling pain at 12 months post-injury. The presence of opioid use at 3–6 months, work disability and psychotropic medications at 6–12 months predicted a mental health condition at 12 months post-injury. These factors could be used to identify at risk of developing disabling pain who could benefit from timely interventions to better manage both pain and mental health post-injury. Implications for healthcare and compensation system are discussed.
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Giummarra, Melita J., Katharine S. Baker, Liane Ioannou, Stella M. Gwini, Stephen J. Gibson, Carolyn A. Arnold, Jennie Ponsford, and Peter Cameron. "Associations between compensable injury, perceived fault and pain and disability 1 year after injury: a registry-based Australian cohort study." BMJ Open 7, no. 10 (October 2017): e017350. http://dx.doi.org/10.1136/bmjopen-2017-017350.
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ObjectivesCompensable injury increases the likelihood of having persistent pain after injury. Three-quarters of patients report chronic pain after traumatic injury, which is disabling for about one-third of patients. It is important to understand why these patients report disabling pain, in order to develop targeted preventative interventions. This study examined the experience of pain and disability, and investigated their sequential interrelationships with, catastrophising, kinesiophobia and self-efficacy 1 year after compensable and non-compensable injury.DesignObservational registry-based cohort study.SettingMetropolitan Trauma Service in Melbourne, Victoria, Australia.ParticipantsParticipants were recruited from the Victorian State Trauma Registry and Victorian Orthopaedic Trauma Outcomes Registry. 732 patients were referred to the study, 82 could not be contacted or were ineligible, 217 declined and 433 participated (66.6% response rate).Outcome measuresThe Brief Pain Inventory, Glasgow Outcome Scale, EuroQol Five Dimensions questionnaire, Pain Catastrophising Scale, Pain Self-Efficacy Questionnaire, Injustice Experience Questionnaire and the Tampa Scale of Kinesiophobia.MethodsDirect and indirect relationships (via psychological appraisals of pain/injury) between baseline characteristics (compensation, fault and injury characteristics) and pain severity, pain interference, health status and disability were examined with ordinal, linear and logistic regression, and mediation analyses.ResultsInjury severity, compensable injury and external fault attribution were consistently associated with moderate-to-severe pain, higher pain interference, poorer health status and moderate-to-severe disability. The association between compensable injury, or external fault attribution, and disability and health outcomes was mediated via pain self-efficacy and perceived injustice.ConclusionsGiven that the associations between compensable injury, pain and disability was attributable to lower self-efficacy and higher perceptions of injustice, interventions targeting the psychological impacts of pain and injury may be especially necessary to improve long-term injury outcomes.
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Giummarra, Melita J., Rongbin Xu, Yuming Guo, Joanna F. Dipnall, Jennie Ponsford, Peter A. Cameron, Shanthi Ameratunga, and Belinda J. Gabbe. "Driver, Collision and Meteorological Characteristics of Motor Vehicle Collisions among Road Trauma Survivors." International Journal of Environmental Research and Public Health 18, no. 21 (October 29, 2021): 11380. http://dx.doi.org/10.3390/ijerph182111380.
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Road trauma remains a significant public health problem. We aimed to identify sub-groups of motor vehicle collisions in Victoria, Australia, and the association between collision characteristics and outcomes up to 24 months post-injury. Data were extracted from the Victorian State Trauma Registry for injured drivers aged ≥16 years, from 2010 to 2016, with a compensation claim who survived ≥12 months post-injury. People with intentional or severe head injury were excluded, resulting in 2735 cases. Latent class analysis was used to identify collision classes for driver fault and blood alcohol concentration (BAC), day and time of collision, weather conditions, single vs. multi-vehicle and regional vs. metropolitan injury location. Five classes were identified: (1) daytime multi-vehicle collisions, no other at fault; (2) daytime single-vehicle predominantly weekday collisions; (3) evening single-vehicle collisions, no other at fault, 36% with BAC ≥ 0.05; (4) sunrise or sunset weekday collisions; and (5) dusk and evening multi-vehicle in metropolitan areas with BAC < 0.05. Mixed linear and logistic regression analyses examined associations between collision class and return to work, health (EQ-5D-3L summary score) and independent function Glasgow Outcome Scale - Extended at 6, 12 and 24 months. After adjusting for demographic, health and injury characteristics, collision class was not associated with outcomes. Rather, risk of poor outcomes was associated with age, sex and socioeconomic disadvantage, education, pre-injury health and injury severity. People at risk of poor recovery may be identified from factors available during the hospital admission and may benefit from clinical assessment and targeted referrals and treatments.
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Quested, Rachele, Scott Sommerville, and Michael Lutz. "Outcomes following non-life-threatening orthopaedic trauma: Why are they considered to be so poor?" Trauma 19, no. 2 (October 23, 2016): 133–38. http://dx.doi.org/10.1177/1460408616674233.
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The purpose of this review article is to assess the current literature on the outcomes of simple orthopaedic trauma. Simple trauma is defined as the fracture or injury of one limb due to an acute event. Fractures are the most common cause of hospitalized trauma in Australia and associated with multiple social, psychological and physical consequences for patients. The literature to date suggests that there are multiple factors leading to relatively poor outcomes following simple trauma, modifiable and non-modifiable. The most oft cited are older age, lower educational status, being injured at work, injury severity score, pre-existing disease, workers compensation, litigation and pain at initial assessment. Additional psychological risk factors quoted attribute to the injury to an external source and the use of passive coping strategies. This review aims to summarise the relevant literature relating to these risk factors and give direction to improving outcomes and future research into this important area.
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Rasool, Raffat, Erum Shahid, Roohi Ehsan, Hira Ahmed, Shazia Fehmi, and Arshad Sheikh. "Visual Outcome of Ocular Trauma and its Medicolegal Interpretation in a Tertiary Care Hospital, Karachi." ANNALS OF ABBASI SHAHEED HOSPITAL AND KARACHI MEDICAL & DENTAL COLLEGE 25, no. 3 (December 17, 2020): 124–29. http://dx.doi.org/10.58397/ashkmdc.v25i3.369.
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Objective: To evaluate the visual outcome of ocular trauma and its medicolegal interpretation in a tertiary care hospital, Karachi.Methods: This was a prospective, cross-sectional observational study conducted at Abbasi Shaheed Hospital, Karachi. Data was collected through nonprobability consecutive sampling technique. The study duration was 12 months, from 14 September 2014 to 15 September 2015. Inclusion criteria were patients of both genders aged between 18 - 60 years, presenting with ocular trauma in the outpatient department or admitted through an emergency in the department of Ophthalmology. The exclusion criterion was patients suffering from all extraocular injuries. Patients were followed up for a period of 6 months. Statistical analysis was done through SPSS version 20.0Results: There were 99 patients, with a mean age of 31.6 ± 18.5 SD years. Males were 74.7% and 82 (82.2 %) were unskilled. Closed globe injury was seen in 54 (54.5%) and the open globe in 45 (45.5%). Nine percent of the patients were assault cases and 90.9% cases were accidental. The corneal injury was seen in 43 (71.6%) and scleral injury in 5 (8.3%) of the patients. At the time of trauma 39.4% of patients presented with 6/60 visual acuity, in the early post-op period 50.5% were 6/6, whereas at six-month follow-up 90.9% patients were with 6/6 visual acuity. Wilcoxon Signed Ranks Test showed P-value less than 0.01.Conclusion: It was concluded that the major outcome of ocular trauma was impaired visual acuity, which improved significantly on regular follow-ups. Medicolegal interpretation of ocular trauma is imperative and should be accounted for properly. It should be exercised by the medicolegal officer, to not give the final report before at least 6 months of follow-up in case of poor visual outcome. Moreover, educate the person to demand compensation during this period.
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Collie, Alex, Pamela Simpson, Peter Cameron, Shanthi Ameratunga, Jennie Ponsford, Ronan Lyons, Sandra Braaf, Andrew Nunn, James Harrison, and Belinda Gabbe. "O4B.2 Patterns and predictors of return to work after major trauma: a prospective, population based registry study." Occupational and Environmental Medicine 76, Suppl 1 (April 2019): A34.2—A34. http://dx.doi.org/10.1136/oem-2019-epi.92.
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BackgroundEmployment is an important marker of functional recovery from injury. There are few population-based studies of long-term employment outcomes, and limited data on the patterns of return to work post injury.ObjectivesThis study sought to characterise patterns of engagement in work over the four-year period following major traumatic injury, and to identify factors associated with those patterns.MethodWe conducted a population-based, prospective cohort study using the Victorian State Trauma Registry. A total of 1086 working age individuals, in paid employment or full-time education before injury, were followed-up through telephone interview at 6, 12, 24, 36, and 48 months post-injury. Responses to return to work (RTW) questions were used to define four discrete patterns: early and sustained; delayed; failed; no RTW. Predictors of RTW patterns were assessed using multivariate multinomial logistic regression.ResultsSlightly more than half of respondents (51.6%) recorded early sustained RTW. A further 15.5% had delayed and 13.3% failed RTW. One in five (19.7%) did not RTW. Compared with early sustained RTW, predictors of delayed and no RTW included being in a manual occupation and injury in a motor vehicle accident. Older age and receiving compensation predicted both failed and no RTW patterns. Pre-injury disability was an additional predictor of failed RTW. Presence of co-morbidity was an additional predictor of no RTW.ConclusionsA range of personal, occupational, injury, health and compensation system factors influence RTW patterns after serious injury. Early identification of people at risk for delayed, failed or no RTW is needed so that targeted interventions can be delivered.
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Simske, Natasha M., Trenton Rivera, Bryan O. Ren, Alex Benedick, Megen Simpson, Sarah B. Hendrickson, and Heather A. Vallier. "Victims of Crime Recovery Program Decreases Risk for New Mental." Journal of Mental Health & Clinical Psychology 6, no. 1 (February 15, 2022): 3–10. http://dx.doi.org/10.29245/2578-2959/2022/1.1241.
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Mental illness is pervasive among trauma populations and is linked to worse outcomes and recidivism. The Victims of Crime Advocacy and Recovery Program (VOCARP) prospectively provides patient services such as educational materials, compensation, advocacy and mental health care to patients with physical injuries. The purpose was to assess for relationship between resource use and development of mental illness after injury. Two control groups: a random selection of patients who did not use VOCARP (n=212) and 201 patients with non-violent trauma were obtained. Over 22 months 1,019 patients utilized VOCARP. Of all 1,432 patients, 43% had preexisting mental illness, and 17% had a new or worsening mental illness after injury. Patients with VOCARP use had more preexisting mental illness (47% vs. 35%, p<0.01), particularly depression and stress disorders. Conversely, VOCARP use was associated with lower rates of mental illness post-injury (15% vs. 22%). Following injury, VOCARP users had more stress disorders (57% vs. 37%), but less depression (25% vs. 41%) and suicidal ideation (7% vs. 24%), all p<0.05. 113 patients (11% of 1,019) used mental health services, which was associated with lower recidivism for new violent injury (4.4% vs. 11.7%, p=0.016). On regression analysis, unemployment (OR: 0.61, p=0.012) and use of VOCARP services (OR: 0.54, p=0.008) were predictive of decreased risk for new mental illness. Mental illness is pervasive among patients with injuries resulting from violence. VOCARP programming appears beneficial for limiting risk of new mental illness after injury.
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Melhorn, J. Mark, LuAnn Haley, and Charles N. Brooks. "Compensability of Common Upper Extremity Conditions When Work Activities Are Repetitive." Guides Newsletter 21, no. 6 (November 1, 2016): 3–4. http://dx.doi.org/10.1001/amaguidesnewsletters.2016.novdec01.
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Abstract Repetitive illness sometimes is wrongly called repetitive injury or cumulative trauma, but the latter are misnomers because the employee cannot identify a specific injury as a cause of the symptoms. In workers’ compensation, such gradual illness claims may be compensable if the condition arises during the course of employment, which requires that it be caused by occupational duties, exposures, or equipment used on the employer's premises. Expert impairment evaluators face three requirements: they must know the best scientific evidence currently available regarding causation of the condition(s) in question, ie, generic causation; the facts of the individual case, ie, specific causation; and the legal threshold in the applicable jurisdiction for acceptance of a condition as work related. The AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition, is an excellent resource and provides the physician a blueprint for the assessment of causation in occupational injury and illness claims. The book adopts the methodology developed by the National Institute for Occupational Safety and Health and the American College of Occupational and Environmental Medicine. When asked to render opinions regarding causation, a physician is wise to consider this methodology in determining the work relatedness of the condition. Medical opinions based on an accepted methodology and the best scientific evidence will result in better patient outcomes.
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Akhadov, Tolibdzhon A., Ekaterina S. Zaytseva, Alisher D. Mamatkulov, Olga V. Bozhko, Ilya A. Melnikov, Nataliya A. Semenova, Svetlana A. Valiullina, et al. "Diagnostic capabilities of magnetic susceptibility-weighted images in traumatic brain injury in children." Russian Pediatric Journal 24, no. 5 (November 15, 2021): 311–16. http://dx.doi.org/10.46563/1560-9561-2021-24-5-311-316.
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Introduction. In MRI, the difference in sensitivity between tissues is used to obtain images weighted by the inhomogeneity of the magnetic field termed susceptibility-weighted imaging (SWI) and a high-resolution 3D radiofrequency gradient echo scan with full speed compensation is applied. The aim was to determine the features of lesions caused by traumatic brain injury in children using the SWI sequence. Materials and methods. 535 TBI children aged two months up to 18 years old (average age 9.58 ± 1.5) were studied. There were 325 boys (60.7%), 210 girls (39.3%). MRI was performed without and with intravenous contrast on a Phillips Achieva 3 T scanner with T1- and T2WI, 2D and 3D images, FLAIR, magnetic resonance angiography (TOF MRA), SWI, and DW/DTI, MRS and fMRI, SWI were used for visualization of DAI. Results. Patients included children with severe TBI - 178 (33.3%), moderate TBI - 172 (32.1%) and mild TBI - 185 (34.6%). Of the 535 injured children, 129 (24.1%) had MRI performed within the first 24 hours from the moment of injury, up to 48 hours - at 91 (17.0%), up to 72 hours - in 78 (14.6%) and up to 13 days - in 237 (44.3%). DAI foci at all degrees of TBI were detected in 422 (78.9%) children out of 535 children. Conclusion. SWI is a sensitive method for diagnosing brain lesions in TBI and significantly contributes to predicting outcomes in the early stages after trauma. The amount of brain lesions diagnosed by SWI correlates with the degree of injury according to the Glasgo Coma Scale. The study of the brain functional connections can inform about possible relationships between the localization of the SWI lesion and cognitive deficits, potentially providing an opportunity to use SWI in the hyperacute phase.
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Nguyen, Tu Q., Pamela M. Simpson, Sandra C. Braaf, Peter A. Cameron, Rodney Judson, and Belinda J. Gabbe. "Level of agreement between medical record and ICD-10-AM coding of mental health, alcohol and drug conditions in trauma patients." Health Information Management Journal 48, no. 3 (April 19, 2018): 127–34. http://dx.doi.org/10.1177/1833358318769482.
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Background: Despite the reliance on administrative data in epidemiological studies, there is little information on the completeness of co-morbidities in administrative data coded from medical records. Objective: The aim of this study was to quantify the agreement between the International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) administrative coding of mental health, drug and alcohol co-morbidities and medical records in a severely injured patient population. Method: A random sample of patients ( n = 500) captured by the Victorian State Trauma Registry and definitively managed at the state’s adult major trauma services was selected for the study. Retrospective medical record review was conducted to collect data about documented co-morbidities. The agreement between ICD-10-AM data generated from routine hospital coding and medical record–based co-morbidities was determined using Cohen’s κ and prevalence-adjusted bias-adjusted kappa (PABAK) statistics. Results: The percentage of agreement between the medical record and ICD-10-AM coding for mental health, drug and alcohol co-morbidities was 72.8%, and the PABAK showed moderate agreement (PABAK = 0.46; 95% confidence interval (CI): 0.37, 0.54). There was no difference in agreement between unintentional injury patients (PABAK = 0.52; 95% CI: 0.42, 0.62) compared with intentional injury patients (PABAK = 0.36, 95% CI: 0.23, 0.49), and no change in agreement for patients admitted before (PABAK = 0.40; 95% CI: 0.30, 0.50) and after the introduction of mandatory co-morbidity coding (PABAK = 0.46; 95% CI: 0.37, 0.54). Conclusion: Despite documentation in the medical record, a large proportion of mental health, drug and alcohol conditions were not coded in ICD-10-AM. Acknowledgement of these limitations is needed when using ICD-10-AM coded co-morbidities in research studies and health policy development. Implications: This work has implications for researchers of drug and alcohol abuse; mental health; accidents and injuries; workers' compensation; health workforce; health services; and policy decisions for healthcare, emergency services, insurance industry, national productivity and welfare costings reliant on those research outcomes.
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Convertino, Victor A., Steven G. Schauer, Erik K. Weitzel, Sylvain Cardin, Mark E. Stackle, Michael J. Talley, Michael N. Sawka, and Omer T. Inan. "Wearable Sensors Incorporating Compensatory Reserve Measurement for Advancing Physiological Monitoring in Critically Injured Trauma Patients." Sensors 20, no. 22 (November 10, 2020): 6413. http://dx.doi.org/10.3390/s20226413.
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Vital signs historically served as the primary method to triage patients and resources for trauma and emergency care, but have failed to provide clinically-meaningful predictive information about patient clinical status. In this review, a framework is presented that focuses on potential wearable sensor technologies that can harness necessary electronic physiological signal integration with a current state-of-the-art predictive machine-learning algorithm that provides early clinical assessment of hypovolemia status to impact patient outcome. The ability to study the physiology of hemorrhage using a human model of progressive central hypovolemia led to the development of a novel machine-learning algorithm known as the compensatory reserve measurement (CRM). Greater sensitivity, specificity, and diagnostic accuracy to detect hemorrhage and onset of decompensated shock has been demonstrated by the CRM when compared to all standard vital signs and hemodynamic variables. The development of CRM revealed that continuous measurements of changes in arterial waveform features represented the most integrated signal of physiological compensation for conditions of reduced systemic oxygen delivery. In this review, detailed analysis of sensor technologies that include photoplethysmography, tonometry, ultrasound-based blood pressure, and cardiogenic vibration are identified as potential candidates for harnessing arterial waveform analog features required for real-time calculation of CRM. The integration of wearable sensors with the CRM algorithm provides a potentially powerful medical monitoring advancement to save civilian and military lives in emergency medical settings.
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Ekegren, Christina, Elton Edwards, Richard de Steiger, and Belinda Gabbe. "Incidence, Costs and Predictors of Non-Union, Delayed Union and Mal-Union Following Long Bone Fracture." International Journal of Environmental Research and Public Health 15, no. 12 (December 13, 2018): 2845. http://dx.doi.org/10.3390/ijerph15122845.
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Fracture healing complications are common and result in significant healthcare burden. The aim of this study was to determine the rate, costs and predictors of two-year readmission for surgical management of healing complications (delayed, mal, non-union) following fracture of the humerus, tibia or femur. Humeral, tibial and femoral (excluding proximal) fractures registered by the Victorian Orthopaedic Trauma Outcomes Registry over five years (n = 3962) were linked with population-level hospital admissions data to identify two-year readmissions for delayed, mal or non-union. Study outcomes included hospital length-of-stay (LOS) and inpatient costs. Multivariable logistic regression was used to determine demographic and injury-related factors associated with admission for fracture healing complications. Of the 3886 patients linked, 8.1% were readmitted for healing complications within two years post-fracture, with non-union the most common complication and higher rates for femoral and tibial shaft fractures. Admissions for fracture healing complications incurred total costs of $4.9 million AUD, with a median LOS of two days. After adjusting for confounders, patients had higher odds of developing complications if they were older, receiving compensation or had tibial or femoral shaft fractures. Patients who are older, with tibial and femoral shaft fractures should be targeted for future research aimed at preventing complications.
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Falk, Alessandra L., Regina Hanstein, and Chaiyaporn Kulsakdinun. "Impact of Socioeconomic Status on Return to Work after Acute Ankle Fracture." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0020. http://dx.doi.org/10.1177/2473011420s00200.
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Category: Ankle; Trauma Introduction/Purpose: Socioeconomic status has been recognized throughout the medical literature, both within orthopedics and beyond, as a factor that influences outcomes after surgery, and can result in substandard care. Within the foot and ankle subspecialty, there is limited data regarding socioeconomic status and post-operative outcomes, with the current literature focusing on outcomes for diabetic feet. However, ankle fractures are among the most common fractures encountered by orthopedic surgeons. While a few studies have explored the impact of ankle fractures on employment and disability status, the effect of socioeconomic status on return to work post operatively has not yet been investigated. The purpose of this study was to determine the impact of low socioeconomic status on return to work. Methods: We retrospectively reviewed 592 medical charts of patients with CPT code 27766, 27792, 27814, 27822, 27823, 27827, 27829, 27826, 27828 from 2015-2018. Included were patients >18 yrs of age who sustained an acute ankle fracture, were employed prior to the injury, and with information on return to work after ankle surgery, zip code, race, ethnicity and insurance status. Excluded were patients who were not employed prior to their injury. Socioeconomic status was either defined by insurance status - Medicaid/Medicare, commercial, or workman’s compensation -, or by assessing socioeconomic status (SES) using medial household per capita income by zip code as generated and reported by the US National Census Bureau’s 2013-2017 American Community Survey 5-Year Estimates. The national dataset was divided into quartiles with the lowest quartile defined as low SES. Patients who had income that fell within this income category were classified as low SES. Results: 174 patients were included with an average follow-up of 10.2months. 22/174 (12.6%) patients didn’t return to work post-operatively. Univariate analysis identified non-sedentary work to decrease the likelihood of return to work (HR:0.637; p=0.03). Patients with a low SES were more prevalent in the no return group compared to the return to work group (86% vs 60%; p=0.028). 95% of patients with low SES were a minority compared to 56% with average/high SES (p<0.005). Patients with low SES had a higher BMI (p=0.026), a longer hospitalization (p=0.04) and more wound complications (p=0.032). Insurance type didn’t affect return to work (p=0.158). Patients with workman’s compensation had a longer follow-up time and a longer time to return to work compared to other insurances (p<0.005 for each comparison). Conclusion: Low socioeconomic status based on income, not insurance type, affected return to work after an ankle fracture ORIF. Patients with workman’s compensation took a longer time to return to work compared to other insurance types. These findings warrants the need to consider socioeconomic status when allocating resources to treat these patients.
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Cychosz, Chris, Phinit Phisitkul, Natalie Glass, Joseph A. Buckwalter, and John E. Femino. "Outcomes of Surgical Treatment for Symptomatic Superficial Peroneal Neuromas." Foot & Ankle Orthopaedics 7, no. 4 (October 2022): 2473011421S0064. http://dx.doi.org/10.1177/2473011421s00642.
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Category: Ankle; Midfoot/Forefoot; Trauma; Other Introduction/Purpose: Peripheral nerve injury or entrapment is a common complication following surgery in the foot and ankle region. The superficial peroneal nerve is particularly at risk following ankle arthroscopy and lateral approaches to the ankle or fibula. Symptoms can result in intense pain and significant disability for patients. The purpose of this study is to investigate the outcomes of superficial peroneal nerve neurolysis and neurectomy. Methods: All patients were identified who underwent operative treatment by two foot and ankle specialists for superficial peroneal nerve related pain. Exclusion criteria included patients under the age of 18, prisoners, those who underwent concomitant osseous procedures, and less than 6-week follow-up. Demographic data, baseline outcomes including FFI, SF-36, FAAM, and VAS were recorded. Final follow-up questionnaires using PROMIS measures and FAAM were administered using REDCap. Results: 55 patients were included in this study with a mean age of 43.0 years (IQR, 33.0-48.0). At a median follow-upof 6.8 months (IQR 1.2-20.2 months), VAS improved from a median of 9.0 (IQR 6.0-9.0) preoperatively to 2.0 (IQR 0.00-5.0) after surgery, p < 0.05. Patients reported a median VAS improvement of 4.0 (IQR 2.0-7.0). At final follow-up patients reported PROMIS lower extremity function score median of 58.6 (IQR 45.2-58.6), PROMIS neuropathic pain quality score of 42.9 (IQR 37.2-55.5), and PROMIS pain interference of 50.5 (IQR 41.1-57.0). Worker's compensation claims were independently associated with significantly poorer post-operative function measured using FAAM ADL (58.58 WC vs 74.86 non-WC, p<0.02) and higher post- operative VAS scores (4.46 WC vs 2.36 non-WC, p<0.01). ). Patients with current or recent tobacco use within 3 months leading up to surgery reported significantly higher post-operative VAS pain scores compared to nonsmokers (4.54 vs 2.47, p<0.02). Conclusion: Neurectomy or neurolysis has potential to significantly improve somatic pain for entrapment or neuroma formation of the superficial peroneal nerve. Tobacco use as well as worker's compensation claims were associated with significantly poorer outcomes. Further studies are needed to optimize perioperative management and surgical techniques for these patients.
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Ramkumar, Prem N., Sergio M. Navarro, Heather S. Haeberle, Rowland W. Pettit, Travis J. Miles, Salvatore J. Frangiamore, Michael A. Mont, Lutul D. Farrow, and Mark S. Schickendantz. "Short-Term Outcomes of Concussions in Major League Baseball: A Historical Cohort Study of Return to Play, Performance, Longevity, and Financial Impact." Orthopaedic Journal of Sports Medicine 6, no. 12 (December 1, 2018): 232596711881423. http://dx.doi.org/10.1177/2325967118814238.
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Background: The short-term outcomes of concussions within Major League Baseball (MLB) warrant further consideration beyond a medical standpoint given that performance, career, and financial data remain unknown. The perception of this injury directly affects decision making from the perspective of both player and franchise. Purpose: To evaluate the effect of concussion on MLB players by (1) establishing return-to-play (RTP) time after concussion; (2) comparing the career length and performance of players with concussion versus those who took nonmedical leave; and (3) analyzing player financial impact after concussion. Study Design: Cohort study; Level of evidence, 3. Methods: Contracts, transactions, injury reports, and performance statistics from 2005 to 2017 were analyzed by comparing matched players who sustained a concussion versus those who took nonmedical leave. Of the 4186 eligible MLB players, 145 sustained concussions resulting in the activation of concussion protocol and 538 took nonmedical leave. RTP time was recorded. Career length was analyzed in reference to an experience-based stratification of full seasons remaining after the concussion. Changes in player performance and salary before and after concussion were compared with the same parameters for players who took nonmedical leave. Results: The mean RTP time was 26 days (95% CI, 20-32 days) for athletes with concussion and 8 days (95% CI, 6-10 days) for those who took nonmedical leave. Athletes with concussion had a mean of 2.8 full seasons remaining, whereas athletes who took nonmedical leave had 3.1 seasons remaining ( P = .493). The probability of playing in the MLB after concussion compared with the nonmedical leave pool was not significantly lower ( P = .534, log-rank test; hazard ratio, 1.108). Postconcussion performance decreased significantly in position players, including a lower batting average and decreased on-base percentage in the players with concussion compared with those returning from nonmedical leave. Players who sustained a concussion lost a mean of US$654,990 annually compared with players who took nonmedical leave. Conclusion: This study of the short-term outcomes after concussion in limited-contact MLB athletes demonstrates that concussions may not decrease career spans but may result in decreased performance in addition to financial loss when compared with matched controls who took nonmedical leave. In sports such as baseball that are not subject to repetitive head trauma, career spans may not decrease after a single concussive event. However, sentinel concussions have deleterious short-term effects on performance and compensation among MLB players.
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Collie, A. "Impact of compensation systems on trauma outcome." Injury 41 (July 2010): S34—S35. http://dx.doi.org/10.1016/j.injury.2010.01.035.
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Howard, Alan, Vinaithan Krishnan, Gerard Lane, and John Caird. "Cranial burr holes in the emergency department: to drill or not to drill?" Emergency Medicine Journal 37, no. 3 (December 30, 2019): 151–53. http://dx.doi.org/10.1136/emermed-2019-208943.
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The practice of trepanning (referred to today as a craniotomy) dates back to the Neolithic period. Reasons for drilling a hole through the skull evolved from releasing evil spirits and curing insanity to practical management of head injuries in ancient Greece and Rome. Today, craniotomy or drilling a burr hole through the skull is very much the purview of the neurosurgeon. Yet one could argue that the procedure itself is more ‘bone surgery’ than ‘brain surgery’. Nevertheless, despite the fact that head injury is a common presentation at district general hospitals and traumatic extra-axial haemorrhages are encountered often, the straightforward skillset required to drill a burr hole as a pretransfer, temporising, life-saving measure is seldom taught and has never gained traction. What we advocate in this article is the adaptation and novel application of an old, tried and tested technique in new hands. The critical pathophysiological turning point of any expanding extra-axial haemorrhage is the inflection point on the volume/Intracranial pressure (ICP) curve beyond which compensation is impossible. The subsequent rising ICP initiates a predictable continuum of clinical signs signalling progressive herniation. There are few emergencies as time-critical as a patient with an isolated, expanding extradural haemorrhage embarking on a trajectory of rostrocaudal deterioration and inevitable death. In many cases, the tragedy is compounded by the knowledge that such a patient probably has a healthy underlying brain, often evidenced by a lucid period after trauma. Our emergency department is attached to a small 300-bed District General Hospital (DGH) on the rural North West coast of Ireland. We are 262 km distant by road from a national neurosciences department that can, at best, be reached in 2 hours and 30 min. Quality improvement review of years of dismal outcomes in patients such as those described earlier with potentially remediable pathology prompted research and development of the skillset we are now able to offer, an old technique in new hands.
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Wyatt, J. P., D. Beard, and A. Busuttil. "Quantifying injury and predicting outcome after trauma." Forensic Science International 95, no. 1 (July 1998): 57–66. http://dx.doi.org/10.1016/s0379-0738(98)00085-1.
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Curtis, Kate, Cara Dickson, Deborah Black, and Thomas Nau. "The cost and compensability of trauma patients." Australian Health Review 33, no. 1 (2009): 84. http://dx.doi.org/10.1071/ah090084.
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Injury in Australia was responsible for 400 000 hospitalisations in 2002. This study aimed to examine the direct costs of trauma patients in a Level 1 trauma centre and determine the compensability of those patients. Data on all admitted patients (206) filling trauma criteria were collected prospectively over a 3-month period (November 2006 to January 2007). A 10-question survey was completed on each patient to record mechanism of injury, third party private health insurance or workers compensation, and direct costs were also obtained. 30% of trauma admissions had an injury severity score (ISS)> 15 (n = 62; median ISS =9; range, 1?56). Median length of stay was 3 days (range, 1?126). Almost half (47%) of the patients were involved in road trauma, and 29% in falls. More than half (53.4%) were eligible for compensation (21.8% of patients had full hospital health insurance cover, 21.4% third party insurance and 9.2% workers compensation). The mechanism of injury with the highest median cost per patient was assault, followed by pedal cyclists, pedestrians then motor vehicle collisions.
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Oyekan, Anthony, Jonathan Dalton, Mitchell S. Fourman, Dominic Ridolfi, Landon Cluts, Brandon Couch, Jeremy D. Shaw, William Donaldson, and Joon Y. Lee. "Multilevel tandem spondylolisthesis associated with a reduced "safe zone" for a transpsoas lateral lumbar interbody fusion at L4–5." Neurosurgical Focus 54, no. 1 (January 2023): E5. http://dx.doi.org/10.3171/2022.10.focus22605.
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OBJECTIVE The aim of this study was to investigate the effect of degenerative spondylolisthesis (DS) on psoas anatomy and the L4–5 safe zone during lateral lumbar interbody fusion (LLIF). METHODS In this retrospective, single-institution analysis, patients managed for low-back pain between 2016 and 2021 were identified. Inclusion criteria were adequate lumbar MR images and radiographs. Exclusion criteria were spine trauma, infection, metastases, transitional anatomy, or prior surgery. There were three age and sex propensity-matched cohorts: 1) controls without DS; 2) patients with single-level DS (SLDS); and 3) patients with multilevel, tandem DS (TDS). Axial T2-weighted MRI was used to measure the apical (ventral) and central positions of the psoas relative to the posterior tangent line at the L4–5 disc. Lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and PI-LL mismatch were measured on lumbar radiographs. The primary outcomes were apical and central psoas positions at L4–5, which were calculated using stepwise multivariate linear regression including demographics, spinopelvic parameters, and degree of DS. Secondary outcomes were associations between single- and multilevel DS and spinopelvic parameters, which were calculated using one-way ANOVA with Bonferroni correction for between-group comparisons. RESULTS A total of 230 patients (92 without DS, 92 with SLDS, and 46 with TDS) were included. The mean age was 68.0 ± 8.9 years, and 185 patients (80.4%) were female. The mean BMI was 31.0 ± 7.1, and the mean age-adjusted Charlson Comorbidity Index (aCCI) was 4.2 ± 1.8. Age, BMI, sex, and aCCI were similar between the groups. Each increased grade of DS (no DS to SLDS to TDS) was associated with significantly increased PI (p < 0.05 for all relationships). PT, PI-LL mismatch, center psoas, and apical position were all significantly greater in the TDS group than in the no-DS and SLDS groups (p < 0.05). DS severity was independently associated with 2.4-mm (95% CI 1.1–3.8 mm) center and 2.6-mm (95% CI 1.2–3.9 mm) apical psoas anterior displacement per increased grade (increasing from no DS to SLDS to TDS). CONCLUSIONS TDS represents more severe sagittal malalignment (PI-LL mismatch), pelvic compensation (PT), and changes in the psoas major muscle compared with no DS, and SLDS and is a risk factor for lumbar plexus injury during L4–5 LLIF due to a smaller safe zone.
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Singh, Gurbax, Sumit Prinja, Suchina Parmar, Garima Bansal, and Simmi Jindal. "Laryngeal Trauma." Bengal Journal of Otolaryngology and Head Neck Surgery 29, no. 1 (June 3, 2021): 86–93. http://dx.doi.org/10.47210/bjohns.2021.v29i1.453.
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Introduction Laryngeal trauma can be an immediately life-threatening entity. Failure to recognize such injuries and delay in securing the airway may have fatal results. Early diagnosis and accurate evaluation with proper treatment is vital. Materials and Methods Fifteen patients with laryngotracheal injuries were analyzed prospectively. The outcome was assessed both in terms of voice and airway, on short term and long term basis. Result Commonest cause of injury was suicidal followed by road traffic accidents and strangulation. The main presenting symptoms and signs were stridor, hoarseness, haemoptysis and odynophagia. Five patients suffered penetrating trauma and ten patient sustained blunt trauma. Sites of laryngeal injury included; hyoid bone fracture, mixed soft tissue and cartilaginous injuries, thyrohyoid membrane and cricothyroid membrane injuries. Eleven patients presented within 24 hours of the injury. Outcome (airway and voice) was good in ten patients whereas it was poor in three patients. Poor results were seen in patients who had delayed surgical intervention. Conclusion Early surgical intervention is recommended for traumatic laryngeal injuries to ensure a good outcome; which further depends upon patient’s condition, injury and treatment-specific factors.
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Akmal, Mohammed, Rikin Trivedi, and John Sutcliffe. "Functional Outcome in Trauma Patients With Spinal Injury." Spine 28, no. 2 (January 2003): 180–85. http://dx.doi.org/10.1097/00007632-200301150-00016.
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Sabhesan, S., P. Ramasamy, and M. Natarajan. "Pre Trauma Psychobgical Disturbances and Head Injury Outcome." Indian Journal of Psychological Medicine 15, no. 1 (January 1992): 29–34. http://dx.doi.org/10.1177/0975156419920104.
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Rajkarnikar, Sagar, Ramesh Raj Bist, Anu Gurung, and Ram Shrestha. "Visual Outcome in Open Globe Injury." Medical Journal of Shree Birendra Hospital 11, no. 2 (April 6, 2013): 40–43. http://dx.doi.org/10.3126/mjsbh.v11i2.7909.
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Introduction: Ocular trauma is a major cause of monocular blindness and visual impairment throughout the world. It is estimated that more than 2 million people suffer from ocular trauma annually and 40,000 become visually handicapped permanently. The aim of this study was to evaluate the visual outcome in open globe injury patients. Methods: This study was conducted in Nepal Eye Hospital. All the cases of admitted open globe injuries were examined and managed in the hospital were included in this study. The detail history of trauma and visual acuity was recorded. Clinical diagnosis was made after detail examination of anterior and posterior segment. Patient was treated according to the type of injury. Visual recovery and the cause of poor vision at the time of discharge was also noted. Data was analyzed using the SPSS 11 program. Results: Out of the 100 cases enrolled in the study work related injury was the most frequent injury, metal was the most common causative agent. Males of 20-50 years of age are more vulnerable to open globe injury. Vision improved in 48%, same vision in 39% and deteriorated vision in 13% cases was recorded. Conclusions: Present study reveals that open globe injury can present in varying severity and though the overall prognosis is grave, prompt surgical intervention can result in better visual outcome. The visual outcome in mild to moderate ocular injury was satisfactory but poor in severe injuries.Medical Journal of Shree Birendra Hospital; July-December 2012/vol.11/Issue2/40-43 DOI: http://dx.doi.org/10.3126/mjsbh.v11i2.7909
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Vahdati, Samad Shams, Ozgur Tatli, Pouya Paknejad, Neda Parnianfard, and Ali Aygun. "Demographic study of patients with vertebral column trauma in North-West of Iran trauma center." Advances in Bioscience and Clinical Medicine 5, no. 1 (January 31, 2017): 25. http://dx.doi.org/10.7575/aiac.abcmed.17.05.01.04.
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Background: Spinal Traumatic injuries is the major damage which is associated with morbidity and mortality rates. In this study the epidemiological characteristics of trauma, spine and their relationship to outcome were investigated. Methods: In this cross sectional study, patients’ information such as age, sex, type of injury, severity of injury, site of injury trauma who admitted to Imam Reza hospital from 29 march 2012 to 20 march 2014 were included. We used Chi-square tests to compare the types of injuries associated with the injury and regression methods. Results: The spinal trauma was identified in 105 cases, of which 9/61% were male. 1.18% of patients with incomplete injury, 5/10% 4/71% damage and no injuries were full. 6/48% of vehicle accidents, 22 cases (21%) of motorcycle accidents, 14 cases 3/13% due to the fall, the equivalent of 10 5/9% of pedestrian accidents, the equivalent of 5 7/4% injury 3 people with a knife and the rest of 9/2% were due to other causes. 6 people, equivalent to 2/9% were experiencing mortality. Type of injury, site of injury and injury severity was significantly associated with outcome. Conclusion: accidents caused by motor vehicles (cars and motorcycles) are the most common cause of trauma in spines in our country. Three factors as well as stable or unstable trauma, the severity of the initial injury and the injury as factors influencing outcome were obtained. According to the achievement of the emergency department in the early diagnosis, appropriate management such as surgery in preventing complications and improving outcome becomes more clear.Key words: Trauma; Spine;
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Bernath, Megan M., Sunu Mathew, and Jerry Kovoor. "Craniofacial Trauma and Vascular Injury." Seminars in Interventional Radiology 38, no. 01 (March 2021): 045–52. http://dx.doi.org/10.1055/s-0041-1724012.
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AbstractCerebrovascular injury is a potentially devastating outcome following craniofacial trauma. Interventional radiologists play an important role in detecting, grading, and treating the different types of vascular injury. Computed tomography angiography plays a significant role in the detection of these injuries. Carotid-cavernous fistulas, extra-axial hematomas, pseudoaneurysms, and arterial lacerations are rare vessel injuries resulting from craniofacial trauma. If left untreated, these injuries can lead to vessel rupture and hemorrhage into surrounding areas. Acute management of these vessel injuries includes early identification with angiography and treatment with endovascular embolization. Endovascular therapy resolves vessel abnormalities and reduces the risk of vessel rupture and associated complications.
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Saravanan, S., K. Elancheralathan, C. Shanmugavelayutham, and Deepan Kumar. "BRACHIAL ARTERY REPAIR IN TRAUMA PATIENTS - OUTCOME ANALYSIS." International Journal of Advanced Research 9, no. 02 (February 28, 2021): 84–88. http://dx.doi.org/10.21474/ijar01/12421.
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Introduction: RTA occurs commonly in young adults,so polytrauma including vascular injury is commonly managed in our institution,and this study is to analyse the out comes brachial artery injury repair Methods: This is a prospective study from august 2015 to may 2018,. All patients admitted with upper limb vascular trauma with brachial artery injury (n=27) included in our study. Results: Though graft thrombosis or anastomotic thrombosis seen in two patients,on 3rd or 4th post operative day, the limb salvage rate is 100% in our study. Conclusion: Since brachial artery injury commonly occurs in young individuals timely intervention saves the upper limb in most cases so that they can do their works which is essential for their family because they are the breadwinners of the family.
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Aoki, Makoto, Toshikazu Abe, Shuichi Hagiwara, Daizoh Saitoh, and Kiyohiro Oshima. "Severe liver trauma among pediatric patients in the Japan Trauma Registry." World Journal of Pediatric Surgery 4, no. 2 (April 2021): e000270. http://dx.doi.org/10.1136/wjps-2021-000270.
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BackgroundLimited information exists regarding the clinical characteristics, management practices, and outcomes of pediatric patients with liver injury in Japan. The aim of this study is to evaluate the characteristics, management, and outcome of pediatric patients with liver injury in Japan.MethodsWe conducted a multicenter, retrospective cohort study using data from the Japan Trauma Data Bank between 2004 and 2018. Pediatric patients with liver injury were classified into the following management groups: nonoperative management (NOM); NOM with angioembolization (AE); operative management (OM). The primary outcome was in-hospital survival, and the secondary outcomes were dispositions, hospital length of stay (LOS), and rate of discharge to home.ResultsThere were 308 pediatric patients with severe liver injury (organ injury scale grades ≥Ⅲ) during the study period; 135 patients had isolated liver injury and 173 patients had non-isolated liver injury. The rates of NOM, NOM with AE, and OM among all patients were 65%, 23%, and 12%, respectively. AE was highly used both in patients with isolated liver injury (27%) and non-isolated liver injury (22%). In-hospital survival of patients with isolated liver injury and those with non-isolated liver injury were 99% and 88%, respectively. Regarding secondary outcomes among patients with isolated liver injury, 82% were admitted to the intensive care unit. LOS was 11 (8–14) days and 82% were discharged to home.ConclusionsOur retrospective observational study showed that management of pediatric patients with severe liver injury in Japan was characterized by high utilization of AE. The in-hospital survival rate in Japan was comparable with that of other developed countries.
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Paudel, Santosh, Siddhartha Dhungana, Nabin Pokhrel, and Gaurav Raj Dhakal. "Epidemiology of Trauma Patients Presented at Emergency Department of Trauma Center." Journal of Nepal Health Research Council 19, no. 1 (April 23, 2021): 158–61. http://dx.doi.org/10.33314/jnhrc.v19i1.3425.
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Background: Emergency Department of National Trauma Center Nepal Center is the only specialized trauma care hospital in Nepal, in operation since 2012. Traumatic injury is one of the major causes for mortality worldwide. This study aims to see the epidemiology, pattern of injuries and outcome of the patients presenting to the emergency room.Methods: After getting ethical approval, we included all patients presenting to the Emergency Department with at least one injury, between Jan 2018 to Dec 2020. Informations on age, gender, mechanism of injury and outcome was abstracted for all patients presenting to the emergency department. Data were extracted from hospital database with the permission of hospital authority.Results: Total of 49991 patients presented to emergency department with different types of injuries. Among them 7792 (14.0%) needed hospital admission. Fall and road crashes comprised almost 80% of admitted cases. Mortality was 2.1% of admitted patients, mostly with head injuries followed by multiple injuries. Conclusions: Among the patient visiting the trauma center during the study period most common mechanism of the injury were fall and road crash with head and neck injury. Majority of the patients were only managed in the ward without surgery.Keywords: Emergency care; triage; trauma care system; unintentional injury
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Seifert, Clinton, Mark Rogers, Stephen Helmer, Jeanette Ward, and James M. Haan. "Rodeo Trauma: Outcome Data from 10 Years of Injuries." Kansas Journal of Medicine 15, no. 2 (June 20, 2022): 208–11. http://dx.doi.org/10.17161/kjm.vol15.16389.
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Introduction. There is little data addressing rodeo injury outcomes, though injury incidence is well described. The purpose of this study was to describe rodeo-related injury patterns and outcomes. Methods. A 10-year retrospective case series was performed of patients injured in rodeo events and who were treated at an ACS-verified Level I trauma center. Data regarding demographics, injury characteristics and outcomes were summarized. Results. Seventy patients were identified. Half were injured by direct contact with rodeo stock, 34 by falls. Head injuries were most common, occurring in 38 (54.3%). Twenty injuries (28.6%) required surgery. Sixty-nine patients (98.6%) were discharged to home. There was 1 death. Conclusions. Head injuries were the most common injury among this cohort. With the exception of one fatality, immediate outcomes after injury were good, with 98.6% of patients dismissed home. Improved data collection at the time of admission may help to evaluate the success of current safety equipment use.
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Hadjizacharia, Pantelis, Donald J. Green, David Plurad, Linda S. Chan, Kenji Inaba, Ira Shulman, and Demetrios Demetriades. "Methamphetamines in Trauma: Effect on Injury Patterns and Outcome." Journal of Trauma: Injury, Infection, and Critical Care 66, no. 3 (March 2009): 895–98. http://dx.doi.org/10.1097/ta.0b013e318164d085.
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Matheson, Leonard N. "Commentary: Functional Outcome in Trauma Patients with Spinal Injury." Spine 28, no. 2 (January 2003): 105–6. http://dx.doi.org/10.1097/00007632-200301150-00002.
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Rutledge, Robert, Samir M. Fakhry, Christopher Baker, and Dale Oiler. "GRADING INJURY SEVERITY AND PREDICTING OUTCOME IN TRAUMA PATIENTS." Journal of Trauma: Injury, Infection, and Critical Care 33, no. 1 (July 1992): 161. http://dx.doi.org/10.1097/00005373-199207000-00081.
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Giannoudis, Peter V., Saurabh Sagar Mehta, and Eleftherios Tsiridis. "Incidence and Outcome of Whiplash Injury After Multiple Trauma." Spine 32, no. 7 (April 2007): 776–81. http://dx.doi.org/10.1097/01.brs.0000259223.77957.76.
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O’Reilly, DA, O. Bouamra, A. Kausar, EJ Dickson, and F. Lecky. "The Epidemiology of and Outcome from Pancreatoduodenal Trauma in the UK, 1989–2013." Annals of The Royal College of Surgeons of England 97, no. 2 (March 2015): 125–30. http://dx.doi.org/10.1308/003588414x14055925060712.
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IntroductionPancreatoduodenal (PD) injury is an uncommon but serious complication of blunt and penetrating trauma, associated with high mortality. The aim of this study was to assess the incidence, mechanisms of injury, initial operation rates and outcome of patients who sustained PD trauma in the UK from a large trauma registry, over the period 1989–2013.MethodsThe Trauma Audit and Research Network database was searched for details of any patient with blunt or penetrating trauma to the pancreas, duodenum or both.ResultsOf 356,534 trauma cases, 1,155 (0.32%) sustained PD trauma. The median patient age was 27 years for blunt trauma and 27.5 years for penetrating trauma. The male-to-female ratio was 2.5:1. Blunt trauma was the most common type of injury seen, with a ratio of blunt-to-penetrating PD injury ratio of 3.6:1. Road traffic collision was the most common mechanism of injury, accounting for 673 cases (58.3%). The median injury severity score (ISS) was 25 (IQR: 14–35) for blunt trauma and 14 (IQR: 9–18) for penetrating trauma. The mortality rate for blunt PD trauma was 17.6%; it was 12.2% for penetrating PD trauma. Variables predicting mortality after pancreatic trauma were increasing age, ISS, haemodynamic compromise and not having undergone an operation.ConclusionsIsolated pancreatic injuries are uncommon; most coexist with other injuries. In the UK, a high proportion of cases are due to blunt trauma, which differs from US and South African series. Mortality is high in the UK but comparison with other surgical series is difficult because of selection bias in their datasets.
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Chukwubuike, Kevin Emeka. "Pattern and Outcome of Splenic Injury in Children." Annals of African Surgery 18, no. 3 (July 20, 2021): 150–54. http://dx.doi.org/10.4314/aas.v18i3.5.
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Background: The spleen is the most frequently injured organ in abdominal trauma. The aim of this study was to evaluate the pattern and management outcome of splenic injury in children in a tertiary hospital.
Methods: This was a retrospective study of children treated for splenic trauma at the Pediatric Surgery Unit of Enugu State University Teaching Hospital (ESUTH) Enugu, Nigeria. The medical records of the patients over a 10-year period were evaluated.
Results: There were 61 cases of splenic trauma of which 72.1% were male. Their ages ranged from 4 to 14 years with a median of 10 years. Road traffic accident and fracture were the most common mechanism of injury and associated injury respectively. The majority had grade III splenic injury and nonoperative management was the predominant modality of treatment. Operative procedures included splenectomy and splenorrhaphy. Mortality occurred in two (3.3%) patients.
Conclusions: Splenic injury can be associated with significant morbidity and mortality. Road traffic accidents are a common cause of splenic injury and nonoperative management is an effective modality of treatment.
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Babar, Khan Muhammad, Humera Sadaf Bugti, Fida Ahmed Baloch, Shakeel Akbar, Abdullah Makki, and Bilal Elahi. "PATTERNS AND OUTCOME OF PENETRATING ABDOMINAL TRAUMA." Professional Medical Journal 26, no. 07 (July 10, 2019): 1067–73. http://dx.doi.org/10.29309/tpmj/2019.26.07.3768.
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Objectives: To determine the mode of penetrating injuries to abdomen and to determine the effect of these injuries on outcome and to formulate recommendations for management of patients sustaining penetrating abdominal trauma. Study Design: Descriptive, cross sectional. Setting: Surgical Department Sandeman Provincial hospital, Quetta. Period: 1 year 2012-2013. Methodology: 147 consecutive cases of abdominal trauma presenting to emergency were studied for pattern of injury and management outcome. Data was recorded and analyzed using SPSS v10. Frequency tables were generated for various variables. Results: The commonest mode of injury was stabbing occurring in 76 cases (51.7%) followed by gunshot injuries in 60 cases (40.8%), 11 patients (7.4%) sustained blast pellet injuries. Patients were either managed conservatively or underwent laparotomy depending on mechanism of injury and clinical presentation. Stab and blast pallet wounds which were superficial were managed by local wound exploration those with peritoneal breach, hemodynamic instability and visceral evisceration were managed by Laprotomy. All gunshot injuries underwent mandatory Laprotomy. Gut was most commonly injured viscus followed by liver and kidney. Types of procedure performed were primary repair, bowel resection, protective ileostomy, splenectomy, nephrectomy, 2 patients were managed by damage control i.e. liver packing. Overall mortality was 5%. Conclusion: Mandatory laprotomy for all gunshots, and stabs and pellets that penetrate the peritoneal cavity proves to be safe and a prudent policy.
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Joestl, Julian, Nikolaus W. Lang, Anne Kleiner, Patrick Platzer, and Silke Aldrian. "The Importance of Sex Differences on Outcome after Major Trauma: Clinical Outcome in Women Versus Men." Journal of Clinical Medicine 8, no. 8 (August 20, 2019): 1263. http://dx.doi.org/10.3390/jcm8081263.
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Purpose: The purpose of this study was to evaluate epidemiological and clinically relevant sex-related differences in polytraumatized patients at a Level 1 Trauma Center. Methods: 646 adult patients (210 females and 436 males) who were classified as polytraumatized (at the point of admission) and treated at our Level I Trauma Center were reviewed and included in this study. Demographic data as well as mechanism of injury, injury severity, injury pattern, frequency of preclinical intubation, hemodynamic variables on admission, time of mechanical ventilation and of intensive care unit (ICU) treatment, as well as the incidence of acute respiratory distress syndrome (ARDS), multi organ failure (MOF), and mortality were extracted and analyzed. Results: A total of 210 female and 436 male patients formed the basis of this report. Females showed a higher mean age (44.6 vs. 38.3 years; p < 0.0001) than their male counterparts. Women were more likely to be injured as passengers or by suicidal falls whereas men were more likely to suffer trauma as motorcyclists. Following ICU treatment, female patients resided significantly longer at the casualty ward than men (27.1 days vs. 20.4 days, p = 0.013) although there was no significant difference regarding injury severity, hemodynamic variables on admission, and incidence of MOF, ARDS, and mortality. Conclusion: The positive correlation of higher age and longer in-hospital stay in female trauma victims seems to show women at risk for a prolonged in-hospital rehabilitation time. A better understanding of the impact of major trauma in women (but also men) will be an important component of efforts to improve trauma care and long-term outcome.
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Mnguni, M. N., D. J. J. Muckart, and T. E. Madiba. "Abdominal Trauma in Durban, South Africa: Factors Influencing Outcome." International Surgery 97, no. 2 (October 1, 2012): 161–68. http://dx.doi.org/10.9738/cc84.1.
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Abstract Abdominal injury as a result of both blunt and penetrating trauma has an appreciable mortality rate from hemorrhage and sepsis. In this article, we present our experience with the management of abdominal trauma in Durban and investigate factors that influence outcome. We performed a prospective study of patients with abdominal trauma in one surgical ward at King Edward VIII Hospital in Durban over a period of 7 years, from 1998 through 2004. Demographic details, cause of injury, delay before surgery, clinical presentation, findings at surgery, management and outcome were documented. There were 488 patients with abdominal trauma with a mean age of 29.2 ± 10.7 years. There were 440 penetrating injuries (240 firearm wounds; 200 stab wounds) and 48 blunt injuries. The mean delay before surgery was 11.7 ± 16.4 hours, and 55 patients (11%) presented in shock. Four hundred and forty patients underwent laparotomy, and 48 were managed nonoperatively. The Injury Severity Score was 11.1 ± 6.7, and the New Injury Severity Score was 17.1 ± 11.1. One hundred and thirty-seven patients (28%) were admitted to the intensive care unit (ICU), with a mean ICU stay of 3.6 ± 5.5 days. One hundred and thirty-two patients developed complications (28%), and 52 (11%) died. Shock, acidosis, increased transfusion requirements, number of organs injured, and injury severity were all associated with higher mortality. Delay before surgery had no influence on outcome. Hospital stay was 9.2 ± 10.8 days. The majority of abdominal injuries in our environment are due to firearms. Physiological instability, mechanism of injury, severity of injury, and the number of organs injured influence outcome.
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Tremblay, Lorraine N., David V. Feliciano, and Grace S. Rozyckl. "Assessment of Initial Base Deficit as a Predictor of Outcome: Mechanism of Injury Does Make a Difference." American Surgeon 68, no. 8 (August 2002): 689–94. http://dx.doi.org/10.1177/000313480206800807.
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Initial base deficit in injured patients has been shown to predict the adequacy of resuscitation and outcome. The usefulness of base deficit as a predictor of outcome, however, may be dependent on the mechanism of injury. We conducted a retrospective review of the trauma registry, supplemented by chart review, of all trauma patients treated at a Level I trauma center from January 1995 through July 2001. Data collected included mechanism of injury, base deficit, Injury Severity Score, and outcome. From 1995 through 2001 a total of 3275 patients (23% of trauma admissions) at a mean age of 34 ± 15 years had a base deficit recorded at the time of admission. The patients were 78 per cent male, and the mechanism of injury was blunt trauma in 58.2 per cent. Mortality increased with successive increases in base deficit but was markedly lower for a given base deficit in those patients having sustained stab wounds and/or severe lacerations as compared with those with gunshot wounds or blunt trauma. The value of the base deficit as a predictor of outcome depends upon the mechanism of injury and appears most useful for patients sustaining gunshot wounds or blunt trauma. Future studies in patients with penetrating trauma using base deficit as a predictor of outcome should separate patients with gunshot wounds from those with stab wounds or lacerations.
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Abdo, AlaaG A., TamerF A. El-Aziz, AbdallahS El Din Abdallah, and MohammedA El-Hag-Aly. "Thorax trauma severity score and trauma injury severity score evaluation as outcome predictors in chest trauma." Research and Opinion in Anesthesia and Intensive Care 9, no. 2 (2022): 112. http://dx.doi.org/10.4103/roaic.roaic_6_21.
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Byers, JF, and MB Flynn. "Acute burn injury: a trauma case report." Critical Care Nurse 16, no. 4 (August 1, 1996): 55–66. http://dx.doi.org/10.4037/ccn1996.16.4.55.
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Acute major burn injury provides the critical care nurse with a dynamic and complex patient care challenge. Understanding the physiological processes associated with acute major burn injury allows for proactive assessment and interventions. A thorough knowledge base regarding acute burn injury facilitates optimal patient care and improves the probability of a quality patient outcome.
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Majeed, Sehrish, Zain Ul Abideen Ali, Tahir Hamid, Amir Usman, Javeria Usman, Fahad Abbas, and Mansab Ali. "Management and Outcome of Liver Trauma in Jinnah Hospital Lahore." Pakistan Journal of Medical and Health Sciences 16, no. 5 (May 30, 2022): 712–14. http://dx.doi.org/10.53350/pjmhs22165712.
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Background: Liver injury is the most commonly encountered trauma among all abdominal traumas. It is associated with high morbidity and mortality. The choice of treatment for such injury depends on the type as well as severity of injury. Objective: To determine the outcome in terms of (success and complications) of managing liver trauma either conservatively or with operative management. Methodology: 62 patients with liver trauma (blunt or penetrating) who presented in the surgical emergency department of Jinnah Hospital, Lahore were enrolled in the study. Detailed history, clinical examination and radiological examination of all patients were carried out using CT scan. Depending on the grade of injury and type of trauma patients were managed either conservatively or by operating them. Success of treatment and its outcomes were noted down. Results: The results revealed that the mean age of the patients was 40.1±11.74, mean diastolic blood pressure was 62.34±14.36, mean systolic blood pressure was 105.2±11.41, mean pulse rate was 92.37±19.06, mean respiratory rate was 19.8±5.353 and mean number of fresh frozen plasma (FFPs) infused were 2.8±0.81. Conservative management was carried out in 42 (67.7%) patients and operative management was carried out in 20 (32.3%). Out of these, conservative management was successful in 35 (56.5%) patients and operative management was successful in 18 (29%) patients. Common complications seen were intra-abdominal sepsis in 24.2%, bile leakage 14.5%, recurrent hemorrhage 6.5%, coagulopathy 3.2% and death 4.8%. Conclusion: Conservative management of liver trauma is highly successful and is associated with less complications and unless needed must be adapted and operative management should only be carried out in patients who have injury to liver of such an extent that cannot be managed conservatively. Keywords: Liver injury, Blunt trauma, Penetrating trauma, Conservative management, Outcome
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Салман оглу Микаилов, Ульфет, and Джавид Ширали оглу Ахадов. "Assessment of injury for prediction of in-hospital mortality and outcome of patient injury." SCIENTIFIC WORK 71, no. 10 (October 23, 2021): 80–84. http://dx.doi.org/10.36719/2663-4619/71/80-84.
Full textAbstract:
The present study is a retrospective, descriptive and analytical study that was conducted on 300 patients with multiple trauma, aged 5 to 75 years. Inclusion criteria included the presence of multiple injuries caused by road traffic accidents and other events. The exclusion criterion was injury to only one area of the body. The causes of injury were divided into four categories: 1) injuries from road traffic crashes, 2) injuries caused by falls from a height, 3) injuries caused by assault, and 4) injuries caused by road traffic accidents with pedestrians. The most common cause of hospitalization due to injury in men and women was road traffic injuries, and there was a significant correlation between injury types and gender (p = 0.001). The results showed that 28 injured people (9.3%) died in hospital, with the largest percentage of deaths occurring in the 21 to 33 age group. The results were based on the number of people who died: 7 (25.0%) of them had penetrating injuries, and 21 (75.0%) had blunt injuries. Data analysis showed a significant correlation between mortality and type of injury (p = 0.004). Key words: Key words: trauma, medical assessment, organ damage, patient, trauma outcome, in-hospital mortality
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Kinsella, Glynda J., John Olver, Ben Ong, Russell Gruen, and Eleanor Hammersley. "Mild Traumatic Brain Injury in Older Adults: Early Cognitive Outcome." Journal of the International Neuropsychological Society 20, no. 6 (May 16, 2014): 663–71. http://dx.doi.org/10.1017/s1355617714000447.
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AbstractSevere traumatic brain injury (TBI) in older age is associated with high rates of mortality. However, little is known about outcome following mild TBI (mTBI) in older age. We report on a prospective cohort study investigating 3 month outcome in older age patients admitted to hospital-based trauma services. First, 50 mTBI older age patients and 58 orthopedic controls were compared to 123 community control participants to evaluate predisposition and general trauma effects on cognition. Specific brain injury effects were subsequently evaluated by comparing the orthopedic control and mTBI groups. Both trauma groups had significantly lower performances than the community group on prospective memory (d=0.82 to 1.18), attention set-shifting (d=−0.61 to −0.69), and physical quality of life measures (d=0.67 to 0.84). However, there was only a small to moderate but non-significant difference in the orthopedic control and mTBI group performances on the most demanding task of prospective memory (d=0.37). These findings indicate that, at 3 months following mTBI, older adults are at risk of poor cognitive performance but this is substantially accounted for by predisposition to injury or general multi-system trauma. (JINS, 2014, 20, 1–9)
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Bhatoe, Harjinder S. "Trauma to the cranial nerves." Indian Journal of Neurotrauma 04, no. 02 (December 2007): 89–100. http://dx.doi.org/10.1016/s0973-0508(07)80022-0.
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AbstractCranial nerve injury is often an overlooked aspect of neurotrauma, which is diagnosed later in the course of recovery. Most of these injuries do not require active intervention in the acute stage. Cranial nerve injuries are important cause of morbidity, which requires long-term management, repeated surgical procedures or reconstructive measures. Management of optic nerve injury remains controversial, and injury to lower cranial nerves may influence the ultimate outcome due to paralysis of aerodigestive passage. Cranial nerve injury in the setting of head injury should be diagnosed early, so that appropriate treatment can be planned early.
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Miller, John Michael. "Compensation for Motor Vehicle Injuries in New Zealand." Régimes de no-fault 39, no. 2-3 (April 12, 2005): 371–94. http://dx.doi.org/10.7202/043497ar.
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Compensation for Motor Vehicle injuries in New Zealand is included as part of the overall no fault accident compensation scheme in the Accident Rehabilitation and Compensation Insurance Act 1992. This Act replaced the Accident Compensation Act 1982 and abolished lump sum compensation for injuries and excluded mental trauma injury claims which were available under the previous Act. This led to considerable public dissatisfaction with the 1992 Act and brought lawyers back into the compensation process with damages claims for mental trauma injuries. The renewed interest of lawyers in litigation also led to an increase in exemplary/punitive damages claims. Despite this return to litigation the motor vehicle part of the no fault scheme presents few problems. It is well funded and is well accepted apart from the recurrent question of compensating drunken drivers for their injuries.
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HORTON, T. C. "SOCIAL DEPRIVATION AND HAND INJURY." Journal of Hand Surgery (European Volume) 32, no. 3 (June 2007): 256–61. http://dx.doi.org/10.1016/j.jhsb.2006.10.005.
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This study investigated the relationship between socioeconomic deprivation and the incidence, patterns of injury, process of care and outcome of hand trauma using data collected prospectively on 1,234 injuries presented during six months. The Index of Multiple Deprivation 2004 was derived from census data and postcodes. Socioeconomic deprivation is significantly associated with hand trauma. The odds ratio for suffering hand injuries in the most deprived quintile is 1.6 (SE 0.09 95% CI 1.45, 1.83) compared to the least deprived quintile. This is most marked among older children and adults. Fractures, sprains and ligament injuries showed the strongest association with the degree of deprivation. Injuries related to sport were not associated with deprivation. Surgical time utilised is greater in more deprived patients and their self reported physical outcome is worse. Hand surgery units working in areas of high socioeconomic deprivation will have higher trauma workloads and unit costs. Social deprivation may also influence physical outcomes.
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Hui, Thomas, Itzhak Avital, Harmik Soukiasian, Daniel R. Margulies, and M. Michael Shabot. "Intensive Care Unit Outcome of Vehicle-Related Injury in Elderly Trauma Patients." American Surgeon 68, no. 12 (December 2002): 1111–14. http://dx.doi.org/10.1177/000313480206801218.
Full textAbstract:
Vehicle-related trauma is a common mechanism of injury in elderly (age ≥65 years) trauma patients. Several hospital-based studies have shown that patients with pedestrian injury have a higher mortality compared with those with motor vehicle collision (MVC) injury partially because of older patients found in the former group. In addition the injury patterns also differ significantly between these two mechanisms of vehicle-related trauma. The purpose of the present study is to compare the demographics, injury severity, injury patterns, and outcomes of elderly patients with pedestrian injury admitted to a surgical intensive care unit (SICU) of a Level I trauma center between January 1, 1994 and December 31, 2000 with those admitted with MVC injury. During the study period there were 187 elderly patients admitted to the surgical intensive care unit with vehicle-related injury. Fifty-one per cent of the patients had MVC injury. Patients were divided into two groups based on their mechanisms of injury (pedestrian vs MVC) for comparison. There was no difference in the mean age and gender between the two groups. Injury Severity Score, admission Simplified Acute Physiology Score, and mortality were significantly higher in the pedestrian group compared with the MVC group. Using logistic regression analysis three factors were found to be independently predictive of mortality: Simplified Acute Physiology Score, intracranial hemorrhage with mass effect on CT scan, and cardiac complications.
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Thompson, P. N., B. B. Chang, D. M. Shah, R. C. Darling, and R. P. Leather. "Outcome following Blunt Vascular Trauma of the Upper Extremity." Cardiovascular Surgery 1, no. 3 (June 1993): 248–50. http://dx.doi.org/10.1177/096721099300100310.
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Blunt trauma to the upper extremity may cause extensive vascular damage in addition to severe musculoskeletal injury. Over a 5.5-year period. 17 patients with a total of 23 arterial injuries were treated. Diagnosis was made in 16 patients before surgery by physical and Doppler ultrasonographic examination. Angiography performed in ten patients assessed the extent of injury. Associated orthopedic injuries were present in 11 patients and neurologic injury in 16. At surgery, 21 of 23 arterial repairs required autologous vein. The initial limb salvage rate was 76%. Pour patients underwent above-elbow amputation because of progressive sepsis and myonecrosis. A fifth underwent delayed amputation at 7 months due to loss of limb function. Neurologic impairment was the major long-term morbidity. The data show that outcome following blunt vascular trauma of the upper extremity is governed by the associated injuries.