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2012| October-December | Volume 5 | Issue 4
Online since
October 15, 2012
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REVIEW ARTICLE
Hemorrhagic shock: The "physiology approach"
Fabrizio Giuseppe Bonanno
October-December 2012, 5(4):285-295
DOI
:10.4103/0974-2700.102357
PMID
:23248495
A shift of approach from 'clinics trying to fit physiology' to the one of 'physiology to clinics', with interpretation of the clinical phenomena from their physiological bases to the tip of the clinical iceberg, and a management exclusively based on modulation of physiology, is finally surging as the safest and most efficacious philosophy in hemorrhagic shock. ATLS
®
classification and recommendations on hemorrhagic shock are not helpful because antiphysiological and potentially misleading. Hemorrhagic shock needs to be reclassified in the direction of usefulness and timing of intervention: in particular its assessment and management need to be tailored to physiology.
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3
CASE REPORTS
Primary hepatic pregnancy
Reena Yadav, Chitra Raghunandan, Swati Agarwal, Shilpa Dhingra, Sarita Chowdhary
October-December 2012, 5(4):367-369
DOI
:10.4103/0974-2700.102417
PMID
:23248513
A 25-year-old G2P1L1 woman with 18-week pregnancy presented with right hypochondriac pain and vomiting for the past 1 week. She had borderline vitals and a diffusely tender abdomen. Ultrasound revealed a live 18-week fetus attached to the undersurface of the liver with moderate ascites. Laparotomy was carried out which revealed 500 cc of hemoperitoneum with a primary hepatic pregnancy of the right lobe of liver and bleeding from the placental site. After extracting the fetus, the placenta was left inn situ and the abdomen was packed to control the bleeding as other hemostatic measures failed. Hepatic artery embolization was done after surgery followed by relaparotomy but the abdomen had to be repacked again as the patient was unstable with uncontrollable bleeding. The patient succumbed to DIC despite adequate replacement. In retrospect, the authors conclude that embolization could have been done before surgery and partial hepatic resection attempted in the first instance.
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1
ORIGINAL ARTICLES
Presentation and outcome of traumatic spinal fractures
Ahmed El-Faramawy, Ayman El-Menyar, Ahmad Zarour, Kimball Maull, Jane Riebe, Krishna Kumar, John Mathew, Ashok Parchani, Hassan Al-Thani, Rifat Latifi
October-December 2012, 5(4):316-320
DOI
:10.4103/0974-2700.102381
PMID
:23248500
Background:
Motor vehicle crashes and falls account for most of the spine fractures with subsequent serious disability.
Aim:
To define the incidence, causes, and outcome of spinal fractures.
Materials and Methods:
Data were collected retrospectively from trauma registry database of all traumatic spinal injuries admitted to the section of trauma surgery in Qatar from November 2007 to December 2009.
Results:
Among 3712 patients who were admitted to the section of trauma surgery, 442 (12%) injured patients had spinal fractures with a mean age of 33.2 ± 12 years. The male to female ratio was 11.6:1. Motor vehicle crashes (36.5%) and falls from height (19.3%) were the leading causes of cervical injury (P = 0.001). The injury severity score ranged between 4 and 75. Nineteen percent of cases with cervical injury had thoracic injury as well (P = 0.04). Lumber injury was associated with thoracic injury in 27% of cases (P < 0.001). Combined thoracic and lumber injuries were associated with cervical injury in 33% of cases (P < 0.001). The total percent of injuries associated with neurological deficit was 5.4%. Fifty-three cases were managed surgically for spine fractures; 14 of them had associated neurological deficits. Overall mortalityrate was 5%.
Conclusions:
Spine fractures are not uncommon in Qatar. Cervical and thoracic spine injuries carry the highest incidence of associated neurological deficit and injuries at other spinal levels. Young males are the most exposed population that deserves more emphasis on injury prevention programs in the working sites and in enforcement of traffic laws.
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2
POINT OF VIEW
Issues of critical airway management (Which anesthesia; which surgical airway?)
Fabrizio Giuseppe Bonanno
October-December 2012, 5(4):279-284
DOI
:10.4103/0974-2700.102353
PMID
:23248494
Which anesthesia for patients with critical airway? Safe and effective analgesia and anesthesia in critical airway is a skilled task especially after severe maxillofacial injury combined with head injury and hemorrhagic shock. If on one side sedation is wanted, on the other hand it may worsen the airway and hemodynamic situation to a point where hypoventilation and decrease of blood pressure, common side-effect of many opioids, may prejudice the patient's level of consciousness and hemodynamic compensation, compounding an already critical situation. What to do when endotracheal intubation fails and blood is trickling down the airways in an unconscious patient or when a conscious patient has to sit up to breathe? Which surgical airway in critical airway? Comparative studies among the various methods of emergency surgical airway would be unethical; furthermore, operator's training and experience is relevant for indications and performance.
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2
CASE REPORTS
Hanging-induced burst suppression pattern in EEG
Nilgun Cinar, Sevki Sahin, Meral Bozdemir, Selçuk Simsek, Sibel Karsidag
October-December 2012, 5(4):347-349
DOI
:10.4103/0974-2700.102408
PMID
:23248507
Lethal suspension (hanging) is one of the most common methods of attempting suicide. Spinal fractures, cognitive and motor deficits as well as epileptic seizures can be detected after unsuccessful hanging attempts. Introduced here is the case of a 25-year-old man exemplifying the clinical observations stated hereafter, who was conveyed to our emergency room after having survived attempted suicide by hanging, with his post-anoxic burst-suppression electroencephalography (BS-EEG) pattern and clinical diagnoses in the post-comatose stage. The patient's state of consciousness was gradually improved over a period of time. His neuropsychiatric assessment proved that memory deficit, a slight lack of attention and minor executive dysfunction was observed a month after the patient was discharged. Although the BS-EEG pattern indicates severe brain dysfunction, it is a poor prognostic factor; rarely, patients survive with minor cognitive deficits and can perform their normal daily activities.
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ORIGINAL ARTICLES
Effects of volume and composition of the resuscitative fluids in the treatment of hemorrhagic shock
Pushpa Sharma, Brandi Benford, John E Karaian, Ryan Keneally
October-December 2012, 5(4):309-315
DOI
:10.4103/0974-2700.102372
PMID
:23248499
Objectives:
To evaluate the effectiveness of normal saline, hypertonic saline, and Ringer's lactate solution followed by blood infusion in ameliorating the physiological, biochemical, and organ functions following hemorrhagic shock (HS) in rats.
Materials and Methods:
Anesthetized, male Sprague-Dawley rats underwent computer-controlled HS, and were randomly divided into five groups consisting of (1) sham, (2) HS without resuscitation, (3) resuscitation with normal saline, (4) resuscitation with hypertonic saline, and (5) resuscitation with Ringer's lactate solution. All resuscitated animals were infused with subsequent infusion of shed blood. Animals were continuously monitored for physiological, hemodynamic, biochemical parameters, and organ dysfunctions.
Results:
Non-resuscitated animals were unable to survive due to hypotension, poor oxygen metabolism, and lactic acidosis. Although these HS related parameters were corrected by all the fluids used in this study, additional blood infusion was more effective than fluid resuscitation alone. Also, hypertonic saline was more effective than Ringer's lactate solution, and normal saline was the least effective in preserving the liver and kidney functions and muscle damage.
Conclusions:
All crystalloid fluids were significantly more effective in reversing the HS outcome when used with blood infusion, but hypertonic salinewith blood was more effective in preventing the organ damage than Lactated Ringers solutions or normal saline in the treatment of HS.
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CASE REPORTS
Incarcerated recurrent Amyand's hernia
Benjamin Quartey, Obinna Ugochukwu, Reed Kuehn, Karen Ospina
October-December 2012, 5(4):344-346
DOI
:10.4103/0974-2700.102407
PMID
:23248506
Amyand's hernia is a rarity and a recurrent case is extremely rare. A 71-year-old male with a previous history of right inguinal hernia repair presented to the emergency department with a 1-day history of pain in the right groin. A physical examination revealed a nonreducible right inguinal hernia. A computed tomography scan showed a 1.3-cm appendix with surrounding inflammation within a right inguinal hernia. An emergent right groin exploration revealed an incarcerated and injected non-perforated appendix and an indirect hernia. Appendectomy was performed through the groin incision, and the indirect hernia defect was repaired with a biological mesh (Flex-HD). We hereby present this unique case - the first reported case of recurrent Amyand's hernia and a literature review of this anatomical curiosity.
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1
Squash(ed): Craniofacial and vertebral injury from collision on squash court
Alp Atik, Matthew Krilis, Geoffrey Parker
October-December 2012, 5(4):360-362
DOI
:10.4103/0974-2700.102415
PMID
:23248511
Squash is a popular racquet sport not usually associated with severe head or spinal injury. The incidence of squash-related injury ranges from 35.5 to 80.9 per 100,000 players, with the most common sites being the lower-limbs and eyes. We present a case of extensive traumatic craniomaxillofacial and vertebral injury resulting from collision on a squash court, without use of protective gear. The patient sustained fractures of the frontal bone, orbits, maxillae, zygomas, the first and second cervical vertebrae and the spinous process of the seventh cervical vertrebra. This is the first case of squash-related injury with such extensive craniofacial and vertebral involvement. This unique case required multiple surgical procedures as well as an extensive admission to the intensive care unit and highlights the risk of significant craniomaxillofacial trauma in sports not usually associated with such injuries.
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ORIGINAL ARTICLES
Maximum surgical blood ordering schedule in a tertiary trauma center in northern India: A proposal
Arulselvi Subramanian, Sushma Sagar, Subodh Kumar, Deepak Agrawal, Venencia Albert, Mahesh Chandra Misra
October-December 2012, 5(4):321-327
DOI
:10.4103/0974-2700.102391
PMID
:23248501
Context:
Over ordering of blood is a common practice in elective surgical practice. Considerable time and effort is spent on cross-matching for each patient undergoing a surgical procedure.
Aims:
The aim of this study was to compile and review the blood utilization for two key departments (Neurosurgery and Surgery) in a level 1 trauma center. A secondary objective was to formulate a rational blood ordering practice for elective procedures for these departments.
Materials and Methods:
Analysis of prospectively compiled blood bank records of the patients undergoing elective surgical, neurosurgical procedures was carried out between April 2007 and March 2009. Indices such as the cross-matched/transfused ratio (C/T ratio), transfusion index and transfusion probability were calculated. The number of red cell units required for each procedure was calculated using the equation proposed by Nuttall
et al
, using preoperative hemoglobin and postoperative hemoglobin for each elective surgical procedure.
Results:
There were 252 surgery patients (age range: 2-80 years) in the study. One thousand and eighty-eight units of blood were cross-matched, 432 were transfused (CT ratio 2.5). 44.0% patients did not require transfusion during entire hospital stay. Three (50%) elective procedures had CT ratio >2.5and 4 (66.6%) elective procedures had TI <0.5. There were 200 neurosurgery patients (age range: 2-62 years) in the study. Total 717 units of blood were cross-matched and 161 transfused (CT ratio 4.5). Nine elective procedures had CT ratio >2.5, with five of them exceeding 4. In procedures like spinal instrumentation the CT ratio was <2.5 and 10 (90.9%) of elective procedures had TI <0.5.
Conclusions:
In this study 40% and 22% of cross-matched blood was being utilized for elective general surgery and neurosurgical procedures, respectively. The calculated required blood units for all elective Trauma surgery procedures were more than 2 units. The calculated required blood units were less than 0.5 units in four of the 11 neurosurgical procedures, and hence only one unit should be arranged for them. It is crucial for every institutional blood bank to formulate a blood ordering schedule. Regular auditing and periodic feedbacks are also vital to improve the blood utilization practices.
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CASE REPORTS
Rare combination of bilateral putaminal necrosis, optic neuritis, and polyneuropathy in a case of acute methanol intoxication among patients met with hooch tragedy in Gujarat, India
Bhavesh S Jarwani, Puja Motiani, Ruchir Divetia, Gurudutta Thakkar
October-December 2012, 5(4):356-359
DOI
:10.4103/0974-2700.102413
PMID
:23248510
Methanol poisoning is a rare but extremely hazardous form of intoxication, generally occurring after suicidal or accidental events. Methanol is a cheap and potent adulterant of illicit liquors. In India, we have witnessed number of mass emergencies due to adulterated alcohol consumption. Although Gujarat State had banned alcohol consumption since 1961, worse hooch tragedies have often taken place. The most severe consequences of methanol intoxication are blindness, a profound metabolic acidosis and various forms of neurological impairment; which occur characteristically after a latent period of several hours or days after ingestion. We present a unique case of acute methanol intoxication presented with, apart from metabolic acidosis and optic neuritis, involvement of central nervous system and peripheral nervous system. He had bilateral optic neuritis, delayed onset polyneuropathy with axonopathy, and radiculopathy. Magnetic resonance imaging findings were consistent with bilateral putaminal necrosis.
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ORIGINAL ARTICLES
Explosive attack: Lessons learned in Seyed Al Shohada mosque attack, April 2008, Shiraz, Iran
Shahram Paydar, Maryam Sharifian, Shahram Boland Parvaz, Hamid Reza Abbasi, Mohamad javad Moradian, Jamshid Roozbeh, Saman Nikghbalian, Mohammad Mahdi Sagheb, Fariborz Ghaffarpasand, Oveis Salehi, Javad Dehghani
October-December 2012, 5(4):296-298
DOI
:10.4103/0974-2700.102363
PMID
:23248496
Introduction:
The threat of explosive attacks has become a worldwide problem. Bombing is the preferred method of attacks. These attacks result in specific physical and psychiatric trauma. In this paper, we present an epidemiologic description of the physical injuries of patients who survived the explosive attack in Seyed Al Shohada mosque April 2008 Shiraz, Iran.
Materials and Methods:
All medical records of the patients admitted at Shiraz Hospitals on April 2008 due to Seyed Al Shohada mosque bombing attacks, Shiraz, Iran, were reviewed.
Results:
A total of 202 patients were referred to the hospitals over 24 h following the terrorist attack. One hundred sixty-four patients were admitted for short periods of observation (<24 h). Thirty-eight patients needed more than 1 day of hospitalization. The mean age of the patients was 26.2 (range 2 to 51) years. One hundred thirty-five (66.8%) patients were males. Twenty-six (12.8%) were children. Burn was the most prevalent cause of admission. Five (13.5%) patients needed chest tube insertion and eight (21%) needed skin grafts due to burn. Overall, 12 patients expired (5%). Three (25%) of them were children (2 and 6, and 11 years old). Mortality rate was significantly higher among the children than adults (P value <0.05). The most important cause of death was head trauma which was seen in five (41.6%) of the expired patients followed by burn (including air way burn) in four (33%), and internal bleeding in three (25%). Patients with head trauma had significantly a higher rate of mortality than other patients (P value <0.05).
Discussion:
Following a bombing attack, numerous victims were brought to the emergency unit suffering from a combination of multi-organ injuries caused by the blast, penetrating injuries caused by shrapnel and other debris, and burns. It is important for a physician to be familiar with the clinical features and treatments of explosive attacks victims. Early management of patients at the scene and hospital may save their life.
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Therapeutic hypothermia for out-of-hospital cardiac arrest: An analysis comparing cooled and not cooled groups at a Canadian center
D Alex MacLean, Robert S Stevenson, Iqbal Bata, Robert S Green
October-December 2012, 5(4):328-332
DOI
:10.4103/0974-2700.102403
PMID
:23248502
Background:
Out of hospital cardiac arrest is a devastating event and is associated with poor outcomes; however, therapeutic hypothermia (TH) is a novel treatment which may improve neurological outcome and decrease mortality. Despite this, TH is not uniformly implemented across Coronary Care and Intensive Care Units in Canada.
Objective:
The purpose of this study was to compare cerebral recovery and mortality rates between patients in our Coronary Care Unit who received TH with a historical control group.
Materials and Methods:
A retrospective chart review was performed of patients admitted to a tertiary care center with out-of-hospital cardiac arrest. Twenty patients who were admitted and cooled after December 2006 were compared with 29 noncooled patients admitted in the 5 years prior as a historical control group. The primary outcomes of interest were in-hospital mortality and neurological outcome.
Results:
Eleven of 20 (11/20, 55%) patients who were cooled as per protocol survived to hospital discharge, all having a good neurological outcome. Eleven of 29 (11/29, 38%) noncooled patients survived to hospital discharge (Odds Ratio: 0.50, 95% CI: 0.16- 1.60,
P
=0.26). Eleven of 20 patients who were cooled had a good neurological outcome (CPS I-II, 11/20, 55%), versus 7 of 29 (7/29, 24%) of noncooled patients (Odds ratio: 3.84, 95% CI: 1.13- 13.1,
P
=0.03). One hundred percent (11/11) of survivors in the cooled group had a good neurological outcome.
Conclusion:
In our center, the use of TH in out-of-hospital cardiac arrest survivors was associated with improved neurological outcome.
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A retrospective clinical audit of 696 central venous catheterizations at a tertiary care teaching hospital in India
Sanjay Agrawal, Yashwant S Payal, Jagdish P Sharma
October-December 2012, 5(4):304-308
DOI
:10.4103/0974-2700.102369
PMID
:23248498
Background:
Malpositions after central venous cannulation are frequently encountered and may need a change in catheter. The incidence of malpositions are varied according to various studies and depend on the experience of the operator performing the cannulation.
Aim:
To access the incidence of malpositions and related complications associated with landmark-guided central venous cannulation in a 15-bedded medical surgical ICU over a period of three years.
Settings and Design:
Retrospective analysis of records of all the central venous cannulation done in a 15- bedded medical- surgical ICU over the period of three years (April 2008 to June 2011) were evaluated for the site and side of insertion, number of attempts of puncture, arterial puncture as well as the malpositions on post procedural chest X-ray. The records were also evaluated for the experience of the operator performing cannulation and relationship between experience of operator to malpositions of catheter.
Statistical Analysis:
Analysis was done using SPSS v 17.0 for Windows. Chi-square test was applied to evaluate the statistical significance. P > 0.05 was significant.
Results:
Records of 696 cannulations were evaluated. Malpositions occurred in 40 patients. Subclavian vein cannulation resulted in increased malpositions in relation to internal jugular vein cannulation. More common with left sided cannulation. Experience of operator had positive correlation with malpositions and arterial puncture. Arterial puncture was common in 6%, while more than one attempt for cannulation was taken in 100 patients.
Conclusion:
Incidence of malpositions was low. We conclude that experience of operator improves successful catheterization with lesser number of complications.
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CASE REPORTS
Scapulothoracic dissociation: An emerging high-energy trauma in medical literature
Andrew McCague, Adam Schulte, Joseph Vivian Davis
October-December 2012, 5(4):363-366
DOI
:10.4103/0974-2700.102416
PMID
:23248512
Scapulothoracic dissociation (STD) is a devastating consequence of high-energy trauma sustained by the shoulder girdle that can easily result in rapid mortality. Since described by Oreck et al. in 1984, STD has been reported in a handful of journals and individual case series, though is still considered a rare occurrence in the context of shoulder injuries. In this report, we examine the case of a 25-year-old female involved in a high-speed rollover auto accident. Unique to this case was the discovery of a completely transected axillary artery and vein with intracorporeal bleeding and complete avulsion of the ipsilateral brachial plexus requiring immediate ligation of the vessels followed by interval above-elbow-amputation and later glenohumeral disarticulation.
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CLINICAL INVESTIGATIONS
Significance of the carboxyhemoglobin level for out-of-hospital cardiopulmonary arrest
Youichi Yanagawa
October-December 2012, 5(4):338-341
DOI
:10.4103/0974-2700.102405
PMID
:23248504
Background:
At low concentrations, carbon monoxide (CO) can confer cyto and tissue-protective effects, such as endogenous Heme oxygenase 1 expression, which has antioxidative, anti-inflammatory, antiproliferative, and antiapoptotic effects. The level of carboxyhemoglobin in the blood is an indicator of the endogenous production of CO and inhaled CO.
Aim of study:
To investigate the significance of the value of carboxyhemoglobin for out-of-hospital (OH) cardiopulmonary arrest (CPA).
Materials and Methods:
This study involved a medical chart review of cases treated from January to December 2005. The inclusion criteria included a patient who was transported to this department due to an OH CPA. The exclusion criteria included a patient who did not undergo blood gas analysis on arrival and who experienced CPA due to acute carbon monoxide intoxication. The subjects were divided into two groups based on their final outcome of either survival or non-survival.
Results:
There was no significant difference associated with the sex, age, frequency of witness collapse, bystander cardiopulmonary arrest, electrocardiogram at scene, cause of CPA, value of PCO
2
, HCO3
-
, and methemoglobin. The frequency of OH return of spontaneous circulation and the value of pH, PO
2
, base excess, and carboxyhemoglobin in the survival group were greater than those values in the non-survival group. There were no subjects whose carboxyhemoglobin level was 0% on arrival in the survival groups.
Conclusion:
There appeared to be an association between higher carboxyhemoglobin levels and survival in comparison with non-survival patients.
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CASE REPORTS
A large ventricular septal defect complicating resuscitation after blunt trauma
Henry D I De'Ath, Paul E D Vulliamy, Ceri Davies, Rakesh Uppal
October-December 2012, 5(4):350-352
DOI
:10.4103/0974-2700.102409
PMID
:23248508
A young adult pedestrian was admitted to hospital after being hit by a car. On arrival to the Accident and Emergency Department, the patient was tachycardic, hypotensive, hypoxic, and acidotic with a
Glasgow Coma Scale
of 3. Despite initial interventions, the patient remained persistently hypotensive. An echocardiogram demonstrated a traumatic ventricular septal defect (VSD) with right ventricular strain and increased pulmonary artery pressure. Following a period of stabilization, open cardiothoracic surgery was performed and revealed an aneurysmal septum with a single large defect. This was repaired with a bovine patch, resulting in normalization of right ventricular function. This case provides a vivid depiction of a large VSD in a patient following blunt chest trauma with hemodynamic compromise. In all thoracic trauma patients, and particularly those poorly responsive to resuscitation, VSDs should be considered. Relevant investigations and management strategies are discussed.
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2
LETTERS TO EDITOR
Birdshots in brain
Ali Ertug Arslankoylu, Anil Ozgur, Mustafa Komur
October-December 2012, 5(4):370-371
DOI
:10.4103/0974-2700.102420
PMID
:23248515
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2,497
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Brain death: Diagnostic clues on imaging
Aruna R Patil, Atin Kumar, Shivanand Gamanagati, Jeyaseelan
October-December 2012, 5(4):372-373
DOI
:10.4103/0974-2700.102422
PMID
:23248517
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2,465
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GUEST EDITORIAL
What's new in emergencies trauma and shock? Studying outcome in traumatic spinal fractures
Christian Zeckey, Philipp Mommsen, Christian Krettek, Frank Hildebrand
October-December 2012, 5(4):277-278
DOI
:10.4103/0974-2700.102352
PMID
:23248493
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2,319
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ORIGINAL ARTICLES
Comparing regression-adjusted mortality to standardized mortality ratios for trauma center profiling
Lynne Moore, James A Hanley, Alexis F Turgeon, André Lavoie
October-December 2012, 5(4):333-337
DOI
:10.4103/0974-2700.102404
PMID
:23248503
Background:
Trauma center profiling is commonly performed with Standardized Mortality Ratios (SMRs). However, comparison of SMRs across trauma centers with different case mix can induce confounding leading to biased trauma center ranks. We hypothesized that Regression-Adjusted Mortality (RAM) estimates would provide a more valid measure of trauma center performance than SMRs.
Objective:
Compare trauma center ranks generated by RAM estimates to those generated by SMRs.
Materials and Methods:
The study was based on data from a provincial Trauma Registry (1999-2006;
n
= 88,235). SMRs were derived as the ratio of observed to expected deaths using: (1) the study population as an internal standard, (2) the US National Trauma Data Bank as an external standard. The expected death count was calculated as the sum of mortality probabilities for all patients treated in a hospital conditional on the injury severity score, the revised trauma score, and age. RAM estimates were obtained directly from a hierarchical logistic regression model.
Results:
Crude mortality was 5.4% and varied between 1.3% and 13.5% across the 59 trauma centers. When trauma center ranks from internal SMRs and RAM were compared, 49 out of 59 centers changed rank and six centers changed by more than five ranks. When trauma center ranks from external SMRs and RAM were compared, 55 centers changed rank and 17 changed by more than five ranks.
Conclusions:
The results of this study suggest that the use of SMRs to rank trauma centers in terms of mortality may be misleading. RAM estimates represent a potentially more valid method of trauma center profiling.
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1
CASE REPORTS
Emergency abdominal surgery and colchicine overdose
Andrzej L Komorowski, JR Martin-Hidalgo Rodil
October-December 2012, 5(4):342-343
DOI
:10.4103/0974-2700.102406
PMID
:23248505
We report a case of a patient with an unrecognized colchicine overdose presenting to the emergency department with acute abdominal symptoms rapidly progressing to multiorgan failure. The patient died 16 h after a negative explorative laparotomy despite intensive supportive care. The problem of colchicine overdose is briefly discussed. We suggest that surgeons should be aware of the clinical presentation of colchicine overdose as it can mimic acute abdominal diseases.
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LETTERS TO EDITOR
Traumatic Brown-Séquard syndrome
Samuele Ceruti, Marco Previsdomini
October-December 2012, 5(4):371-372
DOI
:10.4103/0974-2700.102421
PMID
:23248516
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2,291
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CASE REPORTS
Selective non-operative management of a left ventricular pseudoaneurysm after penetrating cardiac wound
Peep Talving, Bernardino C Branco, David Plurad, Kenji Inaba, Jabi E Shriki, Nhien Nguyen, Thomas Lustenberger, Demetrios Demetriades
October-December 2012, 5(4):353-355
DOI
:10.4103/0974-2700.102411
PMID
:23248509
Post-traumatic cardiac pseudoaneurysm (PSA) is a rare, potentially life-threatening complication after penetrating cardiac injury. Early surgical intervention has been the treatment of choice for this sequela due to the risk of rupture. Nevertheless, selective non-operative management (SNOM) has been practiced in patients with postinfarct PSA that are small and stable. We report a case of a post-traumatic cardiac PSA subjected to SNOM.
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ORIGINAL ARTICLES
Predictors of assault among urban female trauma patients
Usha Periyanayagam, Aisha Waris Shaheen, Marie Crandall
October-December 2012, 5(4):299-303
DOI
:10.4103/0974-2700.102365
PMID
:23248497
Background:
Assault is a common mechanism of injury among female trauma victims. This paper identifies risk factors for assault in female victims and explores the interplay between identified predictors of assault and their combined contribution to female violent victimization.
Materials and Methods:
A retrospective analysis of all female trauma patients was performed using the Illinois Department of Public Health Trauma Registry from 1999-2003. Patients with assault listed as their mechanism of injury were compared to patients with other mechanisms of injury. Bivariate and multivariate analyses were performed using STATA statistical software to identify independent risk factors for assault. Finally, interaction affects were studied among these identified risk factors.
Results:
Female victims of assault were more likely to be African American (OR 1.32, P < 0.001), lack insurance (OR 1.79, P < 0.001), and to have tested positive for drugs (OR 1.32, P < 0.001) than women with other mechanisms of injury. In addition to the independent effects of these variables, patient drug use and lack of insurance demonstrated interaction effects (OR 1.67, P = 0.02).
Conclusion:
In this study, women of color, the uninsured, and those using drugs were disproportionately represented among assault victims, highlighting further evidence of trauma disparities. Most significantly, this study demonstrates that predictors of assault in women frequently coexist and both independently and in combination may increase the risk for female violent victimization.
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LETTERS TO EDITOR
An unusual cause of intestinal obstruction in pregnancy
Ananya Banerjee, Shashi Prateek, Sunita Malik, Deepali Dhingra
October-December 2012, 5(4):370-370
DOI
:10.4103/0974-2700.102418
PMID
:23248514
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© 2008 Journal of Emergencies, Trauma, and Shock | Published by Wolters Kluwer -
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Online since 15
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April, 2008