Group Of Trauma Research Articles

Implementation of a Multimodal Knowledge-Exchange Platform to Provide Trauma Critical Care Education During the Ongoing Conflict in Ukraine

The conflict in Ukraine has forced civilian hospitals with limited trauma and battlefield medicine experience to care for casualties of war, placing significant strain on the health care system. Using the Checklist for Early Recognition and Treatment of Acute Illness and Injury (CERTAIN) program, a multimodal trauma critical care knowledge-exchange platform was created for clinicians practicing in these institutions. To describe the development and implementation of the CERTAIN for Ukraine program and to evaluate the reach of this intervention, together with participant engagement and satisfaction. This quality improvement study included clinicians caring for critically ill patients during the ongoing Ukrainian conflict who were part of a community developed using a messaging app. The program was implemented by a group of international trauma and critical care experts in collaboration with critical care leaders from the Shupyk National Healthcare University in Kyiv, Ukraine. This study evaluates data collected from the CERTAIN for Ukraine program from its launch on April 9, 2022, to August 31, 2022. The initiative comprised a longitudinal series of interactive tele-education sessions, a webpage containing the CERTAIN approach and current trauma critical care guidelines translated into Ukrainian and Russian, and a private messaging chat for asynchronous discussion. Participant engagement and satisfaction were tracked using multimedia analytics and a post-session survey. Since program launch, 838 participants have joined the messaging group, and 6 tele-education sessions have been delivered, with 1835 total views. The CERTAIN website has had 3527 visits, mainly from Ukraine (1378 [39%]) and the United States (1060 [30%]). Of the 74 completed postsession surveys, 65 respondents (88%) rated the course content excellent or very good, and 73 (99%) recommended it to others. The findings of this quality improvement study indicate that, using widely available and low-cost platforms, knowledge was shared rapidly and efficiently to a large community of clinicians practicing in a wartime environment with broad-based engagement and a high level of learner satisfaction.

Analysis of the Validity of Perioperative Antibiotic Prophylaxis in Maxillofacial Surgery.

Perioperative antibiotic prophylaxis is the standard in surgical departments. The type of operation, the duration of the procedure, the degree of microbiological purity of the operating field and the current clinical condition of the patient determine its administration. The aim of this study was to validate the antibiotic prophylaxis used in a Maxillofacial Surgery Department for a group of trauma and non-trauma patients. To that end, an observational prospective cohort study was carried out. The study was conducted on a group of 83 patients of the Department of Cranio-Maxillo-Facial Surgery who were divided into a group of trauma patients (n = 43) and one of non-trauma patients (n = 40). In both groups, the classic microbiological tests were carried out, and the results were analyzed in relation to: the study group, age, sex, duration of surgery, type of surgical access. Most bacterial strains were isolated at the initial stage of the operation. Gram (+) cocci were isolated more often in the trauma group and Gram (−) rods in the non-trauma group. Significantly more often, strains of fungi were noted in the initial stage of the procedure in the trauma group. We conclude that the use of perioperative antibiotic prophylaxis in the Maxillofacial Surgery Departments is justified.

Evaluation of the Interobserver Agreement of the Fraser and Blake & McBryde Classifications for Floating Knee.

Objective To evaluate the interobserver agreement of two classifications for floating knee: Fraser and Blake & McBryde. Method Thirty-two observers, subdivided according to the degree of titration (26 resident physicians and 6 orthopedic physicians specialized in orthopedic trauma), classified 15 fractures of the ipsilateral femur and tibia. Interobserver agreement was evaluated by using the Kappa coefficient . Result When evaluating the agreement between the 9 R1, a Kappa index of 0.58 was obtained for the Fraser classification and of 0.46 for the Blake & McBryde classification. Among the 7 R2, a rate of 0.59 was obtained for the Fraser rating and 0.51 for the Blake & McBryde rating. Among the 10 R3, the agreement index was higher for both classifications: 0.72 for the Fraser and 0.71 for the Blake & McBryde classification. Considering the 3 groups (R1, R2, R3) as one large group, the general Kappa index was calculated, which resulted in 0.63 for the Fraser classification and 0.56 for the Blake & McBryde classification. In the group of trauma and orthopedic knee specialists, in turn, an agreement of 0.597 was obtained for the Blake and McBryde classification and of 0.843 for the Fraser classification. Conclusion Comparatively, the two classifications presented a weak to moderate degree of agreement. Fraser classification had better agreement in both groups. The agreement was higher when evaluating orthopedic trauma physicians.

Survey of senior frontline clinicians regarding the quality of information technology across the UK

Background/Aims The quality of information technology (IT) services is key to effective healthcare delivery. However, the high aspirations of health ministers for IT services in hospitals may not be aligned with clinicians' perceptions. This study aimed to assess frontline clinicians' perceptions of the quality of IT services in their institutions. Methods The British Orthopaedics Directors Society online forum was used to invite a group of trauma and orthopaedic clinical leads from a range of hospitals to complete a short questionnaire regarding their perceptions of IT service quality in their practice. Results Negative perceptions of IT service quality were found to be common, with 45% of respondents rating their trusts' overall IT quality as poor or very poor. Of these, 13% deemed their trust's IT service quality to be so poor as to put patients at increased risk. Wide disparities were also reported between respondents' ratings of IT infrastructure quality and institutional responsiveness to concerns. Conclusions This small initial evaluation highlights concerning variations in clinicians' perceptions of IT service quality across different trusts. It also suggests the need for further, more detailed assessment and monitoring of IT quality improvement, for which the same questionnaire method may be useful.

Description and Reliability of the AOSpine Sacral Classification System.

Background:Several classification systems exist for sacral fractures; however, these systems are primarily descriptive, are not uniformly used, have not been validated, and have not been associated with a treatment algorithm or prognosis. The goal of the present study was to demonstrate the reliability of the AOSpine Sacral Classification System among a group of international spine and trauma surgeons.Methods:A total of 38 sacral fractures were reviewed independently by 18 surgeons selected from an expert panel of AOSpine and AOTrauma members. Each case was graded by each surgeon on 2 separate occasions, 4 weeks apart. Intrarater reproducibility and interrater agreement were analyzed with use of the kappa statistic (κ) for fracture severity (i.e., A, B, and C) and fracture subtype (e.g., A1, A2, and A3).Results:Seventeen reviewers were included in the final analysis, and a total of 1,292 assessments were performed (646 assessments performed twice). Overall intrarater reproducibility was excellent (κ = 0.83) for fracture severity and substantial (κ = 0.71) for all fracture subtypes. When comparing fracture severity, overall interrater agreement was substantial (κ = 0.75), with the highest agreement for type-A fractures (κ = 0.95) and the lowest for type-C fractures (κ = 0.70). Overall interrater agreement was moderate (κ = 0.58) when comparing fracture subtype, with the highest agreement seen for A2 subtypes (κ = 0.81) and the lowest for A1 subtypes (κ = 0.20).Conclusions:To our knowledge, the present study is the first to describe the reliability of the AOSpine Sacral Classification System among a worldwide group of expert spine and trauma surgeons, with substantial to excellent intrarater reproducibility and moderate to substantial interrater agreement for the majority of fracture subtypes. These results suggest that this classification system can be reliably applied to sacral injuries, providing an important step toward standardization of treatment.

Identification of biopSychoSocial factors predictive of post-traUmatic stress disorder in patients admitted to the Emergency department after a trauma (ISSUE): protocol for a multicenter prospective study

BackgroundTraumatic exposure is a frequent issue in patients visiting emergency departments (EDs). Some patients will subsequently develop post-traumatic stress disorder (PTSD) while other will not. The problem is under-diagnosed in EDs and no standardized management is provided to prevent PTSD. Most studies focused on a particular group of trauma whereas we need a global approach to further develop interventions for detecting and treating patients at high risk. We aim to assess the prevalence of traumatic exposure and situation at high risk of further PTSD and identify pre and peri-traumatic biopsychosocial factors predisposing individuals to PTSD in the general context of EDs.MethodsThis comprehensive multicenter study will have two steps. The first step will be a cross-sectional study on moderate and high risk of PTSD prevalence among EDs visitors with a recent history of trauma. All patients aged 18–70 years, presenting with a recent history of trauma (< 1 month) in one of the six EDs in the Auvergne-Rhône-Alpes region (≈1/10° of the French population) will be included over a 1-month period and approximately 1500 subjects are expected in this cross-sectional step. The risk of PTSD will be assessed using the Impact of Event Scale Revised (IES-R). Self-administered questionnaires will be used to measure acute stress (IES–R), and a number of potential bio-psycho-social risk factors. Demographic and physical health-related data will be collected from medical file. Second step will be a prospective cohort study within a sub-sample of 400 patients enrolled in step 1, randomly selected with stratification on sex, age, ED, and IES–R score. At 3 months, PTSD will be defined by a ≥ 33 score at PTSD Check List for DSM–5 (PCL–5) through a telephone interview. We will evaluate definite PTSD biopsychosocial predictive factors using a multivariate logistic regression model and describe evolution of PTSD at 3 months.DiscussionThis is the first study to assess PTSD predictors prospectively with a biopsychosocial approach within a cohort representative of EDs visitors. The results will inform the development of dedicated interventions to decrease the risk of subsequent PTSD.Trial registrationClinicalTrials.gov: NCT03615014; ISSUE protocol 2nd version was approved on 07/08/2018.

Effectiveness of Surgical Management of Ankle Fractures in Attaining the Stability of Ankle

Introduction: Ankle injuries comprise a major group of lower limb trauma. Many of these injuries can be treated by manipulative reduction and conservative treatment and some of these yield satisfactory results, so present study was undertaken to know the effectiveness of surgical management of ankle fractures. Method: 42 surgically treated displaced fractures are included and studied in detail of age, sex, occupation, type of fracture, mode of injury, type of treatment, Clinical evidence of fracture union, Radiological evidence of fracture union, Relation of talus in the ankle mortise, Range of mobility of the ankle, Residual disability and pain, Ability to walk and time of return to duty and complications were noted. Result: 42 cases were surgically treated, most of the patients were operated on an emergency basis within 24 hours of injury. Based on the mechanism of injury Pronation- External Rotation (30.9%) and Based on Ao Classification Type B - B2 (53.3%) were the major type of fractures. In the majority of cases, Malleolar screws type of implants used. In overall the final status of patients is good (ability to walk). Conclusion: Displaced ankle fractures need accurate open reduction and internal fixation and postoperative immobilization for 6 weeks. This will suffice to get good results. Post-operative rigid immobilization and protected weight bearing for 12 weeks is minimal to achieve good union followed by physiotherapy to restore the maximum range of movements&#x0D; Keywords: Ankle Fractures; Surgical management, Stability; Effectiveness.

Clinical comparison of ocular and systemic findings in diagnosed cases of abusive and non-abusive head trauma

PurposeChild abuse is a leading cause of death in infants, which is often associated with abusive head trauma (AHT). The purpose of this retrospective analysis was to identify ocular and systemic findings in confirmed cases of AHT and compare them to a group of non-abusive head trauma (NAHT) patients.Patients and methodsA retrospective chart review of 165 patients with accidental and non-accidental trauma admitted between 2013 and 2015 to Children’s Hospital and Medical Center in Omaha, NE, USA, was performed. Diagnosis of AHT was made after the analysis of ocular and systemic findings by various subspecialists. The NAHT group consisted of accidental trauma, abusive trauma without significant apparent head involvement on initial evaluation and unconfirmed AHT cases.ResultsOf the 165 presenting cases, 30 patients were diagnosed with AHT and 127 were diagnosed with NAHT. Ocular findings in AHT patients were significant for retinal hemorrhages (63%) and vitreous hemorrhages (37%), while NAHT patients had no ocular findings (p<0.001). Neuroimaging revealed subdural hemorrhages (SDHs) in 29 out of 30 AHT patients (97%) and in 27 out of 127 NAHT patients (21%). Seizures were present in 43% of AHT patients (n=13) and only in 8% of NAHT patients (n=10).ConclusionAHT has statistically significant findings of retinal and vitreous hemorrhages. The absence of diffuse retinal hemorrhages, however, does not preclude the AHT diagnosis as more than one-third of AHT patients lacked retinal hemorrhages. SDHs, loss of consciousness and history of seizures also have high correlation with a diagnosis of AHT.

Gehört die Hand alleine in die Hand des Handchirurgen?

Background In Germany, Hand Surgery is an additional qualification that can only be obtained by a three-year training after a completed residency in General Surgery, Plastic Surgery or Trauma and Orthopaedic Surgery. Nevertheless, injuries and diseases of the hand are also treated by physicians without this particular qualification. It is questionable whether these treatments more often lead to medical malpractice. Material and Methods 376 charges of medical malpractice in surgical treatments of the hand and forearm that were closed in 2014 and 2015 were collected by the Arbitration Board for Medical Liability Issues of the Medical Association of North Germany.Cases with proven medical malpractice were classified by the qualification of the physician in charge and analysed. A statistical analysis was performed with the use of the program SPSS (IBM). Results Medical malpractice was proven in 42 of 113 cases with an attending physician who held the additional qualification for Hand Surgery (37.2 %). For physicians without this qualification, the figures were 79 out of 155 (51.0 %) in the group of trauma and orthopaedic surgeons and 54 out of 108 (50.0 %) in the group of general surgeons. The differences between the hand surgeons and the trauma and orthopaedic surgeons (p = 0.017) and between hand surgeons and general surgeons were significant (p = 0.037). Conclusions It was shown that physicians with an additional qualification in hand surgery had signifcantly fewer proven medical malpratice cases than physicians without this qualification. The following trends were observed in the cases of the physicians without the additional qualification in hand surgery: underestimation of the severity of trauma to soft tissues and infections of the hand, errors in the surgical examination of the hand, including functional tests of tendons and nerves, as well as in diagnostic findings after X-ray studies of the hand.

Epidemiology of orthopaedic trauma in Istanbul level 3 private hospital

Background: The distribution of patients who were admitted to the hospital for trauma depends on the location of hospital and the distribution of the population where the hospital is located. The aim was to answer the question regarding the distribution of orthopaedic traumas which were admitted to the emergency service of level 3 a private hospital and to be able to shed light on necessary training and equipment for the aforementioned emergency departments.Methods: The distribution of the patients who were admitted to level 3 private hospital for a year was analyzed retrospectively. The patients who admitted between January 2014 and January 2015 were divided into subgroups as upper extremity, lower extremity, vertebral disk pathology, vertebral trauma, infection and soft tissue trauma, accompanying thoracic trauma and then they were taken into consideration.Results: A total of 1538 patients admitted during a 12-month period. The number of the patients with upper extremity trauma was 539 while that of lower extremity was 423. There were 365 patients with vertebral trauma which was followed by 94 patients with pelvic trauma. The remaining patient group had thoracic trauma.Conclusions: The patients aged between 30-39 years constituted the majority of the cases in present study. The upper extremity injuries were predominant. Also, the number of male patients was higher in every month. The center where the hospital is located plays an important role in determining the age group and type of trauma.

Incidence and risk factors for delirium development in ICU patients - a prospective observational study.

Delirium is an acute brain dysfunction and a frequent complication in critically ill patients. When present it significantly worsens the prognosis of patients. The aim of this study was to evaluate the incidence of delirium and risk factors for delirium in a mixed group of trauma, medical and surgical ICU patients. A prospective observational study was conducted in one of the six-bed Intensive Care Units of the University Hospital Ostrava in the Czech Republic during a 12-month period. We evaluated the incidence of delirium and its predisposing and precipitating risk factors. All patients were assessed daily using the Confusion Assessment Method for the ICU (CAM-ICU). Of the total of 332 patients with a median APACHE II (the Acute Physiology and Chronic Health Evaluation) score of 12, who were evaluated for delirium, 48 could not be assessed using CAM-ICU (47 due to prolonged coma, 1 due to language barriers). The incidence of delirium was 26.1%, with trauma and medical patients being more likely to develop delirium than surgical patients. Risk of delirium was significantly associated with age ≥ 65 years, and alcohol abuse in their anamnesis, with APACHE II score on admission, and with the use of sedatives and/or vasopressors. Delirious patients who remained in the ICU for a prolonged period showed a greater need for ventilator support and had a greater ICU-mortality.

Patterns of Ocular Trauma among the Elderly in a South-American Urban Area and the Association between Eye Traumas with Sleep Disorders.

Aims:Eye trauma in the older population can lead to blindness. Sleep deterioration is associated with increased risk of occupational injuries. The purpose of the study was to assess the epidemiology of ocular trauma in the elderly population and to evaluate the relationship between eye trauma and sleep quality.Settings and Design:This was a cross-sectional, observational hospital based study done in a Sao Paulo, Brazil.Subjects and Methods:Patients with ocular trauma aged 60 years who attended the Eye Trauma Service of the Santa Casa de Sao Paulo Central Hospital were included. All subjects underwent a complete eye examination and answered to the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The results were compared with an age and gender matched control group.Results:Eighty-nine patients with ocular trauma were included in the epidemiological study, 71 (80%) were male and 18 (20%) were female. The patients’ ages ranged from 60 to 90 years (65.7 ± 7.1 years). Most accidents occurred at home and were of mild severity. The control group had a global PSQI score of 1.21 ± 1.37, whereas in the ocular trauma group the score was 3.11 ± 3.63 (P < 0.038). A post hoc analysis including only patients with severe trauma, the PSQI score was 8.80 ± 2.44 (P < 0.000).Conclusion:The elderly population represents an important group of ocular trauma in their own peculiar characteristics. Elderly victims of ocular trauma, particularly serious eye injury, have worse sleep quality than subjects of the same age.

The prevalent age group, cause and site of pediatric facial bone trauma at two tertiary units in Pakistan

Background: The pediatric oro-facial trauma is observed in Indian Subcontinent as well as in developing countries. The school group and teenage group children are frequently involved. Dento-alveolar fractures are common comparative to mandibular fractures whereas middle third of the face is exceedingly rare. The mandible is fractured at variety of sites in pediatric facial trauma. The condylar cartilage, developing permanent teeth and advancing growth, all result in injury at different sites of the mandible and hence the various treatment modalities are required to manage these fractures. In majority, the causes of fractures are accidental falls and road traffic accident (RTA). Method: 141 patients presented at Oral and Maxillofacial Surgery Department of Punjab Dental and Children Complex Hospitals, Lahore from September 2003 to December 2005. The age of the patients ranged from infancy to early teenage (&gt;0 years to 15 years) with facial bone injuries. The children were divided into four groups; Group "A " (Infants), Group "B" (Pre-school), Group "C" (School) and Group "D" (Teenage). After initial examination, different radiographs (orthopantomograph, posterioanterior mandible and occipitomentalis views) were utilized to confirm the site and diagnosis. Different treatment modalities depending upon the site, bone involved and age group of the patients were used to manage the fractures. Few patients were managed conservatively. Results: The dento-alveolar trauma was noticed frequently in group "C" and "D" and it is 50.35% of the total facial bone trauma. The cause of the trauma in majority of the patients was by accidental falls. 40 patients were of maxillary dento-alveolar trauma and nine were of mandible. Twenty-two children had bi-maxillary dento-alveolar trauma. It was observed that the maxillary trauma was common in skeletal /dental class II div I cases. The next common bony trauma was of the mandible (45.39%). 50% of total mandibular fractures were from group "C". The site of the fracture in these patien ts was the body of the mandible and frequently associated with mandibular condyles (29%) whereas 9.37% of them had unilateral condylar fractures. This group had the highest frequency of mandibular fractures among facial bone fractures. Group `D` (20.31%) of total mandibular fractures had high male prevalence (80%). Maxillary fractures were 2.83% of the total facial bone trauma. The patients had Le Fort I or high Le Fort I fractures while one patient (presented 15 days after trauma) had Le Fort III fracture. The Le Fort III patient had fall from double story building and had head injury too. Two patients had trauma due to automobile RTA. All patients of maxillary fracture were from early age group "C" and there was no associated mandibular fracture in these patients. Zygomatic fractures were 1.41% of the total facial bone trauma. One patient had fracture from fall (stairs) and other had RTA. Conclusion: The patterns and sites of pediatric facial bone fracture vary within age groups. Majority of facial bone tr auma results in school going and early teenage groups with definite male predominance. Dento-alveolar and mandibular fractures are frequent with negligible mid face fractures. The pediatric facial bone fractures should be managed at their earliest to avoid complications.

循证护理在重型颅脑外伤气管切开护理中的应用

Objective: This paper will give a clinical study on patients with severe craniocerebral injury, so as to explore the clinical effect of evidence-based nursing in the trachea incision in patients with severe craniocerebral trauma, in order to improve the effect of nursing patients with severe craniocerebral injury, and provide a reliable basis and ultimately improve the quality of life and life safety. Methods: The study group of severe craniocerebral injury patients with tracheotomy to evidence-based nursing measures; control group of severe craniocerebral injury patients with tracheotomy to routine clinical nursing measures. Observe and record the time of hospitalization, mortality and respiratory tract infection occurred in two patients, give statistical analysis, draw the conclusion. Results: The study group of severe craniocerebral trauma by clinical nursing of trachea evidence-based nursing measures for patients after incision, the incidence rate was 43.75%, the mortality rate was 12.50%, the average hospitalization time was 23.44± 7.83 days the respiratory tract infection, the incidence rate was 81.25%, the mortality rate was 37.50%, the average hospitalization time was 31.50± 9.25 days, and the P <0.05 patients with respiratory tract infection severe craniocerebral injury of trachea was significantly better than the control group only received routine nursing care measures for incision, the results of between two groups have statistical significance. Conclusion: Severe brain trauma after tracheotomy patient to prevent gas of evidence-based nursing, avoid infection of incision of evidence-based nursing, ensure unimpeded respiratory tract of evidence-based nursing, airway humidification of evidence-based nursing care, environment and equipment of evidence-based nursing in clinical nursing measures and subcutaneous bleeding, can effectively improve the clinical nursing effect, reduce the occurrence of rate and mortality in patients with respiratory tract infection, shorten hospitalized time, improve patient safety and quality of life, worthy of clinical application.

Posttraumatic Symptoms in Elementary and Junior High School Children after the 2011 Japan Earthquake and Tsunami: Symptom Severity and Recovery Vary by Age and Sex

To measure psychiatric symptoms exhibited by children in Ishinomaki City, Japan, an area severely damaged by the 2011 earthquake and tsunami, at 8 and 20 months post-tsunami to investigate differences in symptom severity and recovery rate by age, sex, and degree of trauma experienced. Prospective data were collected from children in elementary school (5th and 6th grades) and junior high school (8th and 9th grades). Students completed the Post-Traumatic Stress Symptoms for Children-15 (PTSSC-15) survey. Trauma severity was scored according to experiences of bereavement, home damage, and evacuation. In total, 3795 PTSSC-15 surveys were analyzed, yielding total scores, post-traumatic stress disorder (PTSD) factor subscores, and depression factor subscores, which were analyzed according to grade group, sex, and degree of trauma (trauma dose). In the elementary school children, mean total PTSSC-15 score, PTSD factor score, and depression factor score were significantly improved at 20 months post-tsunami compared with 8 months (P < .0001 for all), whereas there were no significant improvements in the junior high school children. In females of the older group, the depression factor score at 20 months post-tsunami was significantly higher than at 8 months (P < .01). Elementary school and junior high school children living near the epicenter of the 2011 Japan earthquake and tsunami exhibited marked differences in PTSD and depressive symptoms. The mental health status of elementary school children improved, whereas that of junior high school children did not.

A qualitative analysis of acute care surgery in the United States: It's more than just “a competent surgeon with a sharp knife and a willing attitude”

Since acute care surgery (ACS) was conceptualized a decade ago, the specialty has been adopted widely; however, little is known about the structure and function of ACS teams. We conducted 18 open-ended interviews with ACS leaders (representing geographic [New England, Northeast, Mid-Atlantic, South, West, Midwest] and practice [Public/Charity, Community, University] diversity). Two independent reviewers analyzed transcribed interviews using an inductive approach (NVivo qualitative analysis software). All respondents described ACS as a specialty treating "time-sensitive surgical disease" including trauma, emergency general surgery (EGS), and surgical critical care (SCC); 11 of 18 combined trauma and EGS into a single clinical team; 9 of 18 included elective general surgery. Emergency orthopedics, emergency neurosurgery, and surgical subspecialty triage were rare (1/18 each). Eight of 18 ACS teams had scheduled EGS operating room time. All had a core group of trauma and SCC surgeons; 13 of 18 shared EGS due to volume, human resources, or competition for revenue. Only 12 of 18 had formal signout rounds; only 2 of 18 had prospective EGS data registries. Streamlined access to EGS, evidence-based protocols, and improved education were considered strengths of ACS. ACS was described as the "last great surgical service" reinvigorated to provide "timely," cost-effective EGS by experts in "resuscitation and critical care" and to attract "young, talented, eager surgeons" to trauma/SCC; however, there was concern that ACS might become the "wastebasket for everything that happens at inconvenient times." Despite rapid adoption of ACS, its implementation varies widely. Standardization of scope of practice, continuity of care, and registry development may improve EGS outcomes and allow the specialty to thrive.

Abusive head trauma: Differentiation between impact and non-impact cases based on neuroimaging findings and skeletal surveys

ObjectivesTo determine whether imaging findings can be used to differentiate between impact and non-impact head trauma in a group of fatal and non-fatal abusive head trauma (AHT) victims. MethodsWe included all AHT cases in the Netherlands in the period 2005–2012 for which a forensic report was written for a court of law, and for which imaging was available for reassessment. Neuroradiological and musculoskeletal findings were scored by an experienced paediatric radiologist. ResultsWe identified 124 AHT cases; data for 104 cases (84%) were available for radiological reassessment. The AHT victims with a skull fracture had fewer hypoxic ischaemic injuries than AHT victims without a skull fracture (p=0.03), but the relative difference was small (33% vs. 57%). There were no significant differences in neuroradiological and musculoskeletal findings between impact and non-impact head trauma cases if the distinction between impact and non-impact head trauma was based on visible head injuries, as determined by clinical examination, as well as on the presence of skull fractures. ConclusionsNeuroradiological and skeletal findings cannot discriminate between impact and non-impact head trauma in abusive head trauma victims.

Effects of Human Immunodeficiency Virus Status on Trauma Outcomes: A Review of the National Trauma Database

The prevalence of human immunodeficiency virus (HIV) is disproportionately elevated in trauma patients. Although HIV traditionally has been associated with poorer outcomes among the critically ill, recent evidence suggests that the outcomes of surgical patients have improved with the greater use of antiretroviral regimens. The purpose of this study was to utilize the National Trauma Data Bank (NTDB) to examine the impact of HIV on surgical outcomes in a large group of trauma patients. We identified all patients for whom HIV status at time of admission was recorded. Results were stratified by age and Injury Severity Score. Our primary outcome was death. Secondary outcomes were length of hospital stay (LOS), length of intensive care unit (ICU) stay, duration of mechanical ventilation, and complications. Data were analyzed using Student t-tests or chi-square analysis, as appropriate. The overall mortality rates were not significantly different in the HIV-positive and HIV-negative groups. Mortality rates remained similar in the two groups even when stratifying by ISS and age, with the exception of those patients who were 65 years or older. The HIV-positive patients had significantly longer LOS (7.6 vs. 5.6 days), shorter duration of mechanical ventilation (6.3 vs. 8.3 days), and no difference in length of ICU stay. The HIV-positive patients were significantly more likely to develop pneumonia, bacteremia, or wound infection. These findings are consistent with those of recent smaller studies that demonstrated no significant difference in the mortality rate for patients with HIV. Although mortality rates are similar, HIV-positive patients are more likely to develop certain infectious complications and to require a longer LOS. Infection with HIV remains a major public health issue in the U.S. and internationally, and further research is necessary to explore the relation between HIV status and trauma outcomes, particularly with regard to the possible effects of antiretroviral treatment and individual immune status.

Experimentation and investigation of the effects of TNF and the acceptor expression in renal early trauma with extraneous adrenomedullin

To investigate the effects of TNF-alpha, TNF-beta and the acceptor expression about mechanical renal trauma with extraneous ADM. There were 104 healthy adult plain grade Wistar rat, randomly divided into four groups:8 in the group of control, 32 in the group of trauma, 32 in the group injected ADM before trauma, 32 in the group injected ADM post trauma. The experimental model of rat kidney with mechanical trauma was prepared by striking the area of rat skin reflecting by kidney with free dropping ferrous hammer in the last three groups. ADM (0.1 nmol/kg) administrated by intraperitoneal injection at 10 minutes before trauma or post trauma respectively in injected groups. All rats were executed by drawing-out all the blood in their hearts. Renal tissue was investigated to study positive expression of TNF-alpha, TNF-beta, TNFR after SABC stained. TNF-alpha expression:the TNF-alpha expression of trauma group was more positive than it of control group in the wound early time. The expression of group injected post trauma was less than it of trauma group at 1 h (P < 0.01). The expression of group injected before trauma was less than it of trauma group at 6 h (P < 0.05) TNF-beta expression: the TNF-beta expression of trauma group was less than it of control group at 1 h and 6 h (P < 0.05). The TNF-beta expression of group injected post trauma was more positive than it of trauma group at the same time of 1 h and 6 h (P < 0.01). TNFR expression: the TNFR expression of trauma group was less than it of control group at 6 h (P < 0.01). The TNFR expression of group injected before trauma was more positive than it of trauma group in the at the same time of 1 h and 6 h (P < 0.01). The TNFR can regulate the TNF-alpha and the TNF-beta in dynamic balancing. The regulation of TNFR is main to TNF-alpha. What the TNF-beta participated in renal trauma mainly is the anti-damage process. ADM can reduce the expression of TNF-alpha. ADM increases the expression of TNF-beta and TNFR.

Diagnosing bipolar disorder in trauma exposed primary care patients.

Bipolar disorder (BD) is often under-recognized in non-psychiatric settings, especially in African Americans. The Mood Disorder Questionnaire (MDQ) is a screening instrument proposed to show adequate sensitivity and specificity for bipolar spectrum disorders. The current study is an examination of the usefulness of this instrument in a trauma exposed subgroup of mainly African American patients attending primary care clinics. The sample is a part of a larger study exploring traumatic stress exposure and psychopathology. Consenting patients in 3 academically affiliated primary care clinics were asked to complete the MDQ. Ninety percent of the participants were African American. Diagnostic performance was determined in a trauma exposed subgroup by employing the Structured Clinical Interview for DSM-IV (SCID) as a gold standard. Of the total group of 579 participants, 178 (30.7%) screened positive for BD along with 77 (33.7%) of the 228 trauma exposed subjects who were SCID interviewed. Only 13 (27%) of the MDQ positives met SCID criteria for BD and were true positives. The sensitivity was 61.9% and the specificity was 69%, with a positive predictive value of 16.8% and a negative predictive value of 94.7%. The MDQ was found to have low specificity in a predominately African American group of trauma exposed patients attending primary care.