Outcomes Of Injury Patients Research Articles

Predicting Thermal Injury Patient Outcomes in a Tertiary-Care Burn Center, Pakistan

IntroductionTo explore candidate parameters for their ability to predict survival and length of hospital stay (LOS) in thermal burns patients, to prepare multivariate predictive models for these two outcomes, and to compare performance of native models to other models. MethodsA retrospective cohort study was undertaken based on record review. Data was extracted from files of patients admitted to a tertiary-care burn center in Lahore, Pakistan from January 1, 2020 to October 31, 2020. After univariate preselection, we prepared multivariate logistic regression models for each outcome of interest (survival and LOS). Multivariate models were tested and compared to other models. ResultsIncreasing total body surface area (TBSA) of burn was associated with reduced survival and prolonged length of hospital stay. Advancing age and full-thickness burns independently predicted decreased survival. Burn etiology showed prognostic value: petrol-flame burns predicted decreased survival and prolonged LOS; scald was associated with improved survival-odds and shorter LOS. The Survival-model consisted of (1) Baux score, (2) TBSA>40% and (3) serum albumin <3.5 g/dL (AUC = 0.968, Nagelkerke R2 = 0.797). The LOS-model consisted of (1) TBSA2 and (2) serum albumin concentration (AUC = 0.832, Nagelkerke R2 = 0.408). In tests of discrimination and calibration, native models prepared for survival and LOS outperformed other models applicable to our dataset. ConclusionsData from a South Asian burn center has been used to explore factors influencing prognosis for their utility in predictive models for survival and the duration of hospital stay. The significant prognostic roles of TBSA, age, inhalational injury, burn-depth, etiology of burn, anatomic site of burn, hypoalbuminemia, and other biochemical parameters were observed. These tools hold significance in guiding healthcare policy and in communications with patients and their families.

Use of Thromboelastography in the Evaluation and Management of Patients With Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

MEDLINE, PubMed Central, Embase, and CENTRAL. Clinical studies of adult patients with traumatic brain injury (isolated or polytrauma) who were assessed by either standard thromboelastography or thromboelastography with platelet mapping plus either conventional coagulation assays or platelet function assays from January 1999 to June 2021. Demographics, injury mechanism and severity, diagnostic, laboratory data, therapies, and outcome data were extracted for analysis and comparison. Database search revealed 1,169 sources; eight additional articles were identified by the authors. After review, 31 publications were used for qualitative analysis, and of these, 16 were used for quantitative analysis. Qualitative and quantitative analysis found unique patterns of thromboelastography and thromboelastography with platelet mapping parameters in traumatic brain injury patients. Patterns were distinct compared with healthy controls, nontraumatic brain injury trauma patients, and traumatic brain injury subpopulations including those with severe traumatic brain injury or penetrating traumatic brain injury. Abnormal thromboelastography K-time and adenosine diphosphate % inhibition on thromboelastography with platelet mapping are associated with decreased survival after traumatic brain injury. Subgroup meta-analysis of severe traumatic brain injury patients from two randomized controlled trials demonstrated improved survival when using a viscoelastic hemostatic assay-guided resuscitation strategy (odds ratio, 0.39; 95% CI, 0.17-0.91; p = 0.030). Thromboelastography and thromboelastography with platelet mapping characterize coagulopathy patterns in traumatic brain injury patients. Abnormal thromboelastography profiles are associated with poor outcomes. Conversely, treatment protocols designed to normalize abnormal parameters may be associated with improved traumatic brain injury patient outcomes. Current quality of evidence in this population is low; so future efforts should evaluate viscoelastic hemostatic assay-guided hemostatic resuscitation in larger numbers of traumatic brain injury patients with specific focus on those with traumatic brain injury-associated coagulopathy.

Clinical Decision Support for Traumatic Brain Injury: Identifying a Framework for Practical Model-Based Intracranial Pressure Estimation at Multihour Timescales.

BackgroundThe clinical mitigation of intracranial hypertension due to traumatic brain injury requires timely knowledge of intracranial pressure to avoid secondary injury or death. Noninvasive intracranial pressure (nICP) estimation that operates sufficiently fast at multihour timescales and requires only common patient measurements is a desirable tool for clinical decision support and improving traumatic brain injury patient outcomes. However, existing model-based nICP estimation methods may be too slow or require data that are not easily obtained.ObjectiveThis work considers short- and real-time nICP estimation at multihour timescales based on arterial blood pressure (ABP) to better inform the ongoing development of practical models with commonly available data.MethodsWe assess and analyze the effects of two distinct pathways of model development, either by increasing physiological integration using a simple pressure estimation model, or by increasing physiological fidelity using a more complex model. Comparison of the model approaches is performed using a set of quantitative model validation criteria over hour-scale times applied to model nICP estimates in relation to observed ICP.ResultsThe simple fully coupled estimation scheme based on windowed regression outperforms a more complex nICP model with prescribed intracranial inflow when pulsatile ABP inflow conditions are provided. We also show that the simple estimation data requirements can be reduced to 1-minute averaged ABP summary data under generic waveform representation.ConclusionsStronger performance of the simple bidirectional model indicates that feedback between the systemic vascular network and nICP estimation scheme is crucial for modeling over long intervals. However, simple model reduction to ABP-only dependence limits its utility in cases involving other brain injuries such as ischemic stroke and subarachnoid hemorrhage. Additional methodologies and considerations needed to overcome these limitations are illustrated and discussed.

Utilizing heart rate variability to predict ICU patient outcome in traumatic brain injury

BackgroundPrediction of patient outcome in medical intensive care units (ICU) may help for development and investigation of early interventional strategies. Several ICU scoring systems have been developed and are used to predict clinical outcome of ICU patients. These scores are calculated from clinical physiological and biochemical characteristics of patients. Heart rate variability (HRV) is a correlate of cardiac autonomic regulation and has been evident as a marker of poor clinical prognosis. HRV can be measured from the electrocardiogram non-invasively and monitored in real time. HRV has been identified as a promising ‘electronic biomarker’ of disease severity. Traumatic brain injury (TBI) is a subset of critically ill patients admitted to ICU, with significant morbidity and mortality, and often difficult to predict outcomes. Changes of HRV for brain injured patients have been reported in several studies. This study aimed to utilize the continuous HRV collection from admission across the first 24 h in the ICU in severe TBI patients to develop a patient outcome prediction system.ResultsA feature extraction strategy was applied to measure the HRV fluctuation during time. A prediction model was developed based on HRV measures with a genetic algorithm for feature selection. The result (AUC: 0.77) was compared with earlier reported scoring systems (highest AUC: 0.76), encouraging further development and practical application.ConclusionsThe prediction models built with different feature sets indicated that HRV based parameters may help predict brain injury patient outcome better than the previously adopted illness severity scores.

The Military Orthopedics Tracking Injuries and Outcomes Network: A Solution for Improving Musculoskeletal Care in the Military Health System.

Musculoskeletal injuries are an endemic amongst U.S. Military Service Members and significantly strain the Department of Defense's Military Health System. The Military Health System aims to provide Service Members, military retirees, and their families the right care at the right time. The Military Orthopedics Tracking Injuries and Outcomes Network (MOTION) captures the data that can optimize musculoskeletal care within the Military Health System. This report provides MOTION structural framework and highlights how it can be used to optimize musculoskeletal care. MOTION established an internet-based data capture system, the MOTION Musculoskeletal Data Portal. All adult Military Health System patients who undergo orthopedic surgery are eligible for entry into the database. All data are collected as routine standard of care, with patients and orthopedic surgeons inputting validated global and condition-specific patient reported outcomes and operative case data, respectively. Patients have the option to consent to allow their standard of care data to be utilized within an institutional review board approved observational research study. MOTION data can be merged with other existing data systems (e.g., electronic medical record) to develop a comprehensive dataset of relevant information. In pursuit of enhancing musculoskeletal injury patient outcomes MOTION aims to: (1) identify factors which predict favorable outcomes; (2) develop models which inform the surgeon and military commanders if patients are behind, on, or ahead of schedule for their targeted return-to-duty/activity; and (3) develop predictive models to better inform patients and surgeons of the likelihood of a positive outcome for various treatment options to enhance patient counseling and expectation management. This is a protocol article describing the intent and methodology for MOTION; thus, to date, there are no results to report. MOTION was established to capture the data that are necessary to improve military medical readiness and optimize medical resource utilization through the systematic evaluation of short- and long-term musculoskeletal injury patient outcomes. The systematic enhancement of musculoskeletal injury care through data analyses aligns with the National Defense Authorization Act (2017) and Defense Health Agency's Quadruple Aim, which emphasizes optimizing healthcare delivery and Service Member medical readiness. This transformative approach to musculoskeletal care can be applied across disciplines within the Military Health System.

Korelasi Luaran dengan Ketebalan dan Lokasi Perdarahan Subaraknoid pada Pasien Cedera Kepala di RSUD Arifin Achmad

Subarachnoid hemorrhage (SAH)in head injury is a very common case. Research showed that 33% moderate andsevere head injury patients had SAH during initial CT scan. A prospective study was performed on 37 head injurypatients with SAH which had been treated in Arifin Achmad Hospital during January to June 2014 period. Bivariableanalysis that was used in this research was an unpaired categorical analytic statistical test, the chi square test. Meanwhile,multivariable analysis used was multiple logistic regression test. Significance was determined based on p value,which was d”0.05, and confidence interval (CI) of 95%. There were unfavourable outcome upon head injury patientswith SAH of &gt;5mm thickness (p=0,028) and located at cerebral hemisphere and basal cistern (p=0,001). Thicknessand SAH location was found to be associated with head injury patient outcome. SAH thickness of &gt; 5mm againstoutcome had a stronger association than location as a factor.

Association of Severe Traumatic Brain Injury Patient Outcomes With Duration of Cerebrovascular Autoregulation Impairment Events.

Cerebrovascular autoregulation (CA) is an important hemodynamic mechanism that protects the brain against inappropriate fluctuations in cerebral blood flow in the face of changing cerebral perfusion pressure. Temporal CA failure is associated with worse outcomes in various acute neurological diseases. An integrative approach is presently used according to the existing paradigm for the association of series of temporal CA impairments with the outcomes of patients with traumatic brain injury (TBI). To explore the influence of the duration of CA impairment events on severe TBI patient outcomes. Patient age was also included in the analysis of the prospectively collected clinical data. CA monitoring included 33 prospective severe TBI patients. The pressure reactivity index [PRx(t)] was continuously monitored to collect information on the dynamics of CA status and to analyze associations between the duration of the longest CA impairment event and patient outcomes. The Glasgow outcome scale and the duration of the longest CA impairment were negatively correlated. The duration of autoregulation impairment significantly correlated with worse outcomes. Multidimensional representation of Glasgow outcome scale plots showed that better outcomes were obtained for younger patients (age < 47 years) and those whose longest CA impairment event was shorter than 40 minutes if PRx(t) was above 0.7 in the CA impairment event. Unfavorable outcomes for TBI patients are more significantly associated with the duration of the single longest CA impairment episode at a high PRx(t) value, rather than with averaged PRx(t) values or the average time of all CA impairment episodes. ABP, arterial blood pressureABP(t), continuous reference arterial blood pressureCA, cerebrovascular autoregulationCBF, cerebral blood flowCPP, cerebral perfusion pressureGOS, Glasgow outcome scaleGOSHD, Glasgow outcome scale after hospital dischargeGOS6M, Glasgow outcome scale at 6 months after dischargeICP, intracranial pressureICP(t), continuously monitored intracranial pressureLCAI, longest CA impairmentoptCPP, optimal cerebral perfusion pressurePRx(t), pressure reactivity indexTBI, traumatic brain injury.

Characteristics and outcomes of injury patients in an Aboriginal and Torres Strait Islander population—Queensland Trauma Registry, Australia

Introduction There are few published data for the magnitude of injury-related health problems in indigenous people such as Aboriginal and Torres Strait Islanders. The objective of our study was to compare the characteristics and outcomes of injury in the indigenous population to the non-indigenous population, who are living in Queensland, Australia. Methods Participants were injured patients who presented to the emergency department for treatment and admitted to 15 public hospitals participating in the Queensland Trauma Registry (QTR) during 2003–2005. Results Amongst 38,036 injured patients, 1847 patients were identified as indigenous and 35,530 as non-indigenous. Compared to the non-indigenous group, the indigenous group was significantly younger with no difference by gender. The injury severity score (ISS) and percentage of major injury (ISS ≥ 16) were lower in the indigenous group. Indigenous patients had a significantly higher percentage of penetrating type injuries compared to non-indigenous (19.5% vs. 12.5%). The age- and injury severity-adjusted mortality rate was also significantly higher in indigenous. In age-stratified logistic regression analysis, the injury severity-adjusted odds for mortality was 3.0 times higher [95% confidence interval (95% CI): 1.6–5.5] in the indigenous, compared to the non-indigenous group, in 40–64-year olds, whilst increased odds in other age groups were not statistically significant. Conclusion Our results indicate that middle-aged indigenous patients are more likely to die due to injury compared to non-indigenous patients. This suggests that strategies are required to improve outcomes particularly in the most affected injury patient group.