Severity Score Research Articles

Eosinophils and chronic obstructive pulmonary diseases (COPD) in hospitalized COVID-19 patients

BackgroundThe emergence of coronavirus disease 2019 (COVID-19) as a global health emergency necessitates continued investigation of the disease progression. This study investigated the relationship between eosinophilia and the severity of COVID-19 in chronic obstructive pulmonary disease (COPD) patients.MethodsThis cross-sectional study was conducted on 73 COPD patients infected by COVID-19 in Afzalipour Hospital, Iran. Peripheral blood samples were collected for hematological parameter testing, including eosinophil percentage, using Giemsa staining. Eosinophilia was defined as≥ 2% and non-eosinophilia as< 2%. The severity of pulmonary involvement was determined based on chest CT severity score (CT-SS) (based on the degree of involvement of the lung lobes, 0%: 0 points, 1–25%: 1 point, 26–50%: 2 points, 51–75%: 3 points, and 76–100%: 4 points). The CT-SS was the sum of the scores of the five lobes (range 0–20).ResultsThe average age of patients was 67.90±13.71 years, and most were male (54.8%). Non-eosinophilic COPD patients were associated with more severe COVID-19 (P= 0.01) and lower oxygen saturation (P= 0.001). In addition, the study revealed a significant difference in the chest CT severity score (CT-SS) between non-eosinophilic (9.76±0.7) and eosinophilic COPD patients (6.26±0.63) (P< 0.001). Although non-eosinophilic COPD patients had a higher mortality rate, this difference was not statistically significant (P= 0.16).ConclusionsOur study demonstrated that reduced peripheral blood eosinophil levels in COPD patients with COVID-19 correlate with unfavorable outcomes. Understanding this association can help us identify high-risk COPD patients and take appropriate management strategies to improve their prognosis.

Validation of Methotrexate Intolerance Severity Score (MISS) questionnaire to measure methotrexate intolerance among rheumatoid arthritis Egyptian patients

BackgroundRheumatoid arthritis (RA) is a systemic autoimmune chronic inflammatory disease, causing progressive disability. Methotrexate (MTX) is the gold standard drug treatment for RA. Long-term use of MTX is associated with intolerance including gastrointestinal effects. In addition, anticipatory, associative, and behavioral symptoms such as anxiety and irritability are also observed which are often inadequately managed, leading to discontinuation of treatment. Methotrexate Intolerance Severity Score (MISS) questionnaire designed to measure MTX intolerance. The work aims to validate the MISS questionnaire Arabic version for the detection of MTX intolerance among Egyptian RA patients to halt the progression of the disease.ResultsA total of 80 patients were involved in this study. Of those, 67 (83.8%) were females with a mean disease duration of 6.9 ± 6.1 years. Forty-eight patients (60%) were intolerant to MTX and 32 patients (40%) were tolerant. Comparison between the tolerant group (n = 32) to MTX and the intolerant group (n = 48) revealed a statistically significant difference between them regarding the DAS28 score and HAQ score. Behavioral intolerance is the predominant factor that directs MTX intolerance.ConclusionThe MISS questionnaire has a good predictive ability to detect MTX intolerance among Egyptian RA patients. Due to its good reliability, serves as an invaluable tool as it detects anticipatory and associative symptoms.

AnGong NiuHuang (AGNH) pill attenuated traumatic brain injury through regulating NF-κB/Nlrp3 axis and glycerophospholipid metabolism

BackgroundTraumatic brain injury (TBI), especially neuroinflammation after TBI persists for a long time and causes significant neurodegenerative pathologies and neuropsychiatric problems. PurposeIn this study, the neuroprotective effect of AnGong NiuHuang (AGNH) on TBI was investigated and the mechanism was revealed by integrating multiple omics. MethodsThe rats with TBI were administrated with AGNH for 5 consecutive days and the effect was evaluated by using modified neurologic severity score (mNSS), brain edema, H&E staining, Nissl staining and TUNEL staining. The mechanism was revealed by using RNA sequencing (RNA-seq) and metabolomic analysis. The inflammatory factors, apoptosis-related proteins and identified vital targets were validated by enzyme-linked immunosorbent assay, western blotting and immunofluorescence staining. ResultsAdministration of AGNH decreased mNSS, brain edema, brain structure damage, but increased Nissl body density in the rats with TBI. Additionally, AGNH reduced IL-1β, IL-17A, TNF-α, MMP9, MCP-1, IL-6, Bax and TUNEL staining,but elevated Bcl2 level. Integrating transcriptomic analysis and metabolomic analysis identified vital targets and critical metabolic pathways. Importantly, AGNH treatment reduced the expression of TLR4, MYD88, NLRP3, BTK, IL-18 and Caspase 1 as well as glycerophospholipid metabolism-related protein AGPAT2 and PLA2G2D, and decreased the nuclear translocation of NF-κB p65 in the brain of TBI rats. Additionally, AGNH increased phosphatidylcholine (PC), phosphatidylglycerol (PG), phosphatidylserine (PS), phosphatidylethanolamine (PE), but decreased 1-acyl-sn-glycero-3-phosphocholine (LysoPC) in the metabolic pathway of glycerophospholipid metabolism. ConclusionTaken together, AGNH inhibited NF-κB/NLRP3 axis to suppress neuroinflammation, cell apoptosis and pyroptosis, and improved metabolic pathways of glycerophospholipid metabolism after TBI.

Associations of the Serum KL-6 with Severity and Prognosis in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

As a biomarker of alveolar-capillary basement membrane injury, Krebs von den Lungen-6 (KL-6) is involved in the occurrence and development of pulmonary diseases. However, the role of the KL-6 in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has yet to be elucidated. This prospective study was designed to clarify the associations of the serum KL-6 with the severity and prognosis in patients with AECOPD. This study enrolled 199 eligible AECOPD patients. Demographic data and clinical characteristics were recorded. Follow-up was tracked to evaluate acute exacerbation and death. The serum KL-6 concentration was measured via an enzyme-linked immunosorbent assay. Serum KL-6 level at admission was higher in AECOPD patients than in control subjects. The serum KL-6 concentration gradually elevated with increasing severity of AECOPD. Pearson and Spearman analyses revealed that the serum KL-6 concentration was positively correlated with the severity score, monocyte count and concentrations of C-reactive protein, interleukin-6, uric acid, and lactate dehydrogenase in AECOPD patients during hospitalization. A statistical analysis of long-term follow-up data showed that elevated KL-6 level at admission was associated with longer hospital stays, an increased risk of future frequent acute exacerbations, and increased severity of exacerbation in COPD patients. Serum KL-6 level at admission is positively correlated with increased disease severity, prolonged hospital stay and increased risk of future acute exacerbations in COPD patients. There are positive dose-response associations of elevated serum KL-6 with severity and poor prognosis in COPD patients. The serum KL-6 concentration could be a novel diagnostic and prognostic biomarker in AECOPD patients.

Impaired social reward processing in individuals with Internet gaming disorder and its relationship with early face perception

Previous research has found that individuals with Internet gaming disorder (IGD) show different patterns of social function impairments in game-related and real-life social contexts. Impaired social reward processing may be the underlying mechanism according to the Social Motivation Theory. Thus, in this study, event-related potentials were recorded from 24 individuals with IGD and 24 healthy gamers during a social judgement task. We focused on reward positivity (RewP) elicited by game-related and real-life social rewards, and N170 elicited by game avatar faces and real faces. These indicators were used to explore the neurocognitive mechanism of impaired social reward processing in individuals with IGD and its relationship with early face perception. Results showed that (1) the RewP elicited by real-life social reward was considerably reduced in individuals with IGD relative to healthy gamers. (2) The N170 elicited by game avatar faces in individuals with IGD was larger than that elicited by real faces. However, the N170 was not associated with RewP in either group. (3) The score for IGD severity was correlated with the RewP elicited by real-life social reward and the N170 elicited by game avatar face. In conclusion, the present study suggests that the impaired social reward processing in individuals with IGD is mainly manifested in a decreased neural sensitivity to real-life social reward. Meanwhile, the reduced RewP elicited by real-life social reward and the enhanced N170 elicited by game avatar face might serve as potential biomarkers for IGD.

Feasibility and utilization of electronic patient-reported outcome measures for lung cancer in routine clinical care.

11107 Background: Prior studies have shown the value of Patient-Reported Outcomes (PRO) in cost burden, quality of life (QoL), and survival in cancer care. To facilitate focus on patient-centricity and value-based care, the International Consortium for Health Outcomes Measurements (ICHOM) and European Health Outcomes Observatory (H2O) developed a Core Outcomes Set (COS) in lung cancer. We explored the feasibility of deploying standardized PRO measures among patients with lung cancer in US clinical practice. Methods: A retrospective database study was conducted, with IRB waiver, using Carevive PROmPT, an electronic PRO (ePRO) remote symptom monitoring platform with weekly surveys comparable in scope to ICHOM/H2O COS, of symptomatic adverse events (PRO-CTCAE), physical function (PROMIS 4A Physical Function), and QoL items (EORTC QLQ-C30 items #29,30). Severe PRO-CTCAE symptom scores triggered care team alerts. From 9/2020 to 5/2023, 207 patients enrolled across 9 US cancer centers. Patients were ≥18 years, with lung cancer, and in current treatment. Patient engagement was measured by survey compliance, follow-up time, and completeness; clinician engagement was measured by platform utilization time, time to alert response, and clinical action taken. Results: Participants were 50% female, 86% White, 12% African American, median age 68, 81% NSCLC, and 26% with metastatic disease. Median survey persistence: 8 weeks, with 85% compliance over that time. Of domains assessed, 37 (58%) from Carevive data overlapped with ICHOM/H2O COS, with 19 measured over time. Overlapping domains included 15 clinical outcomes with 60% median completion rate and 22 PRO domains with 98% median completion. Of 19 domains assessed longitudinally, median compliance was 76%. Of patients triggering ≥1 ePRO symptom alert, 87% were within 4 weeks, with 46% requesting call-backs. Median clinician follow-up to alerts was 20 hours, with 69.3% addressed within 48 hours. Clinicians accessed the platform 2-3 times weekly, for median 2 minutes (range: 1-14 minutes) per login for nurses and Advanced Practitioners (AP). 89% of alerts were addressed by nurses and AP. Of alert responses, 66% indicated continuation of treatment, 12% were escalated to the clinical team, and 1% were escalated to hospitalization or ER visit. Conclusions: Results support the feasibility of integrating a standard set of multi-domain ePRO measures, comparable to the ICHOM/H2O COS, into routine cancer care, across multiple sites, with consistent patient engagement and provider utilization. One limitation is that clinical and financial impact were not directly assessed. Future research should explore direct clinician feedback, systematic implementation of PRO measures, and impacts on patient outcomes, resource utilization, and health systems.

Engaging student volunteers in non-clinical navigation: ACS community access to resources, education, and support (ACS CARES).

e13577 Background: Despite known benefits of oncology patient navigation in improving patient outcomes, implementation is variable and many programs are understaffed. The American Cancer Society (ACS) developed the ACS CARES (Community Access to Resources, Education, and Support) program to expand navigation capacity through the standardized training of students from local universities as volunteers providing non-clinical navigation support. Methods: This pragmatic, real-world hybrid type 2 study utilizes the Consolidated Framework for Implementation Research (CFIR) to evaluate the implementation of student volunteer navigation for patients receiving cancer care at 3 pilot sites. Volunteers meet with patients in clinic, administer a modified NCCN distress thermometer health-related social needs (HRSNs) screen, and administer non-clinical navigation support. Initial process measures from the first 3 months of the pilot data include number and demographics of patients served, distress scores and HRSNs, and time spent by volunteers. Results: Pilot sites spanned diverse geographic regions (rural mid-West, rural-suburban Southeast, urban West) and included clinics with multiple cancer types. From 10/23/23-12/23/23, 22 volunteers navigated 73 patients who were 53% female, 22% Black, and an average age of 57. Of all patients, 46% had a moderate (score 3-6) and 37% had a severe (score 7-10) distress score. ACS CARES volunteers identified 116 HRSNs (56% practical, 18% physical, 17% emotional, 7% social, 2% spiritual). The most common practical HRSNs were finances and transportation. Volunteers spent an average of 78.6 min per patient per in-person meeting, 14 min per patient per follow-up call, 25 min per patient coordinating care and sending encrypted messages, and 90 min per patient identifying and providing resources to address barriers to care. Total time providing non-clinical navigation was over 250 hours. Conclusions: Student volunteers embedded in oncology clinics provided non-clinical navigation support to 73 patients in the first 3 months of the ACS CARES program, further extending the reach and depth of support provided by pilot site care teams. Future analyses will include survey and EMR data to examine program impact on clinical and patient reported outcomes and healthcare utilization. Clinical trial information: 2013209-1.

Acupuncture for cancer symptoms: Clinical application and longitudinal impact.

e23191 Background: Evidence for acupuncture (ACUP) in cancer care is inconsistent. ACUP is variously used for multiple symptoms, e.g. anxiety, chemotherapy-related peripheral neuropathy, dyspnea, hot flashes, insomnia, and pain. Approximately 500 unique patients are treated for ACUP annually in our Section of Integrative Oncology. Our objective was to evaluate ACUP’s clinical application and longitudinal impact on symptoms severity. Methods: This was a retrospective analysis of those treated in a group ACUP session. Symptoms were rated before each session on a severity numeric rating scale (0-10). Clinical improvement was defined as a 2-point decrease from baseline (T1). We report symptoms from baseline to the fourth sessions (T1-T4). Counts are presented as percentages and numbers summarized by mean (standard deviation; SD) or median (interquartile range; IQR). Groups were compared statistically as appropriate. Results: 2239 consecutive patients were treated between 2015-2022. Mean (SD) age was 57 (±12); 83% were female; 57% breast primary site, 9% hematologic, 9% gastrointestinal, 8% gynecologic, 4% lung, 3% prostate, and 9% other malignancies. Symptoms treated were pain (61%), insomnia (48%), fatigue (44%), neuropathy (41%), anxiety (37%), hot flashes (37%), and other symptoms (17%). 68% presented with multiple symptoms. They received a median (IQR) of 4 (2-6) sessions and 7 (7-14) days apart. At T1 symptom severity scores, median (IQR), were anxiety 5(2-7), fatigue 5(3-7), hot flashes 6(4-8), insomnia 6(4-8), neuropathy 5(3-8), and pain 5(3-7); Table1. By T2, improvement was observed in patients, N (%), with hot flashes 476 (66%), anxiety 434 (62%), fatigue 464 (56%), insomnia 407 (55%), neuropathy 441 (55%), and pain 563 (50%). Symptom severity improvement was statistically significant by T2 and by T3 clinically relevant; Table 1. By T4, about 60% were still on ACUP treatment. Multiple ACUP sessions ( &gt; 1) were associated with older age and higher symptom burden, and fewer sessions with more severe T1 anxiety and fatigue. Fewer males were treated, yet symptoms improved like in females. Conclusions: Symptoms were of moderate severity at referral. In this large consecutive sample (N = 2239) of mostly younger breast cancer women, group ACUP was associated with broad based symptom benefit. Repeated ACUP treatments were important for clinical improvement. Males and females benefited equally however fewer males were referred. Several confounders need to be considered interpreting these results. [Table: see text]

Influence of aging, comorbidities, and chemotherapy on dementia in patients with metastatic cancer.

e23097 Background: Studies highlight cognitive decline in cancer survivors, exploring treatment-linked neurodegeneration risks. Yet, the effects of aging (age), comorbidities, and chemotherapy on dementia in metastatic patients are unclear. Methods: US Trauma Quality Program (2017-2019) for 17,940 metastatic cancer patients was analyzed. Our outcome was dementia diagnosis in metastatic cancer patients (no/yes). Independent variables were patient’s age (younger adults aged 18-55 years and seniors ≥56 years), any comorbid condition (yes/no), and received chemotherapy (yes/no). Covariates included sex, payment type, verification level, injury intent, mechanism, injury place, and Injury Severity Score. We used Stata.v18 for descriptive statistics, chi-square, and logistic regression with statistical significance at p≤0.05. Results: Of the 17,940 patients, 7.9% had dementia. Seniors had higher dementia rate than younger adults (98.9% vs. 1.1%; p &lt; 0.001). Most dementia patients had comorbidities (89.4%, p &lt; 0.001). Chemotherapy recipients had a lower dementia rate than those untreated (8.9% vs. 91.1%; p &lt; 0.001). In the adjusted analyses, seniors than younger adults (OR: 4.51, 95% CI: 2.38 - 8.56) and any comorbidities (OR: 1.33 ,95% CI: 1.07 - 1.65) exhibited higher odds of dementia. Notably, chemotherapy recipients had decreased odds of dementia than those untreated (OR: 0.42, 95% CI: 0.34 - 0.53). Conclusions: Metastatic cancer patients of older age and comorbidities had increased risk of dementia. Chemotherapy remarkably lowered this risk. This should guide clinicians in managing dementia risk. [Table: see text]

Disease Progression and Multiparametric Imaging Characteristics of Spinocerebellar Ataxia Type 3 With Spastic Paraplegia.

Spinocerebellar ataxia type 3 (SCA3) is a hereditary ataxia that occurs worldwide. Clinical patterns were observed, including the one characterized by marked spastic paraplegia. This study investigated the clinical features, disease progression, and multiparametric imaging aspects of patients with SCA3. We retrospectively analyzed 249 patients with SCA3 recruited from the Organization for Southeast China for cerebellar ataxia research between October 2014 and December 2020. Of the 249 patients, 145 were selected and assigned to 2 groups based on neurologic examination: SCA3 patients with spastic paraplegia (SCA3-SP) and SCA3 patients with nonspastic paraplegia (SCA3-NSP). Participants underwent 3.0-T brain MRI examinations, and voxel-wise and volume-of-interest-based approaches were used for the resulting images. A tract-based spatial statistical approach was used to investigate the white matter (WM) alterations using diffusion tensor imaging, neurite orientation dispersion, and density imaging metrics. Multiple linear regression analyses were performed to compare the clinical and imaging parameters between the 2 groups. The longitudinal data were evaluated using a linear mixed-effects model. Forty-three patients with SCA3-SP (mean age, 37.58years ± 11.72 [SD]; 18 women) and 102 patients with SCA3-NSP (mean age, 47.42years ± 12.50 [SD]; 39 women) were analyzed. Patients with SCA3-SP were younger and had a lower onset age but a larger cytosine-adenine-guanine repeat number, as well as higher clinical severity scores (all corrected p < 0.05). The estimated progression rates of the Scale for the Assessment and Rating of Ataxia (SARA) and International Cooperative Ataxia Rating Scale scores were higher in the SCA3-SP subgroup than in the SCA3-NSP subgroup (SARA, 2.136 vs 1.218 points; ICARS, 5.576 vs 3.480 points; both p < 0.001). In addition, patients with SCA3-SP showed gray matter volume loss in the precentral gyrus with a decreased neurite density index in the WM of the corticospinal tract and cerebellar peduncles compared with patients with SCA3-NSP. SCA3-SP differs from SCA3-NSP in clinical features, multiparametric brain imaging findings, and longitudinal follow-up progression.

Mental health prevalence in Brazil: Understanding anxiety and depression in southern Capixaba region.

e23295 Background: The rising significance of mental health issues and psychological distress among cancer patients has prompted an in-depth investigation. In the brazilian context, this crucial aspect remains largely unexplored, with limited available data and insufficient investment in understanding the psychosocial dimensions of cancer care. This study aims to generate brazilian-specific data to facilitate the development and implementation of targeted psychosocial interventions within cancer care. Methods: From August 1, 2023, to December 31, 2023, a random selection of 263 patients at a brazilian cancer center underwent assessment for signs and symptoms of anxiety and depression using the Anxiety and Depression Assessment Scale – HAD. This validated screening scale, comprising 14 Likert-type questions, features two subscales with seven items each to track anxiety and depression symptoms. Severity scores for each subscale range from zero to 21, with higher scores indicating increased anxiety and depression levels. In this study, interviewers assessed the severity of symptoms, employing scales ranging from 0 to 21. Three score levels were identified: mild (0-7), moderate (8-11), and high (12-21). Inclusion criteria encompassed age over 18, residency in the southern region of the State of Espírito Santo, a cancer diagnosis, and active treatment. Exclusion criteria included non-residency in th southern region of th state, lack of cancer diagnosis, and oncohematological treatments. Of the 263 eligible participants, 21 were excluded for not meeting inclusion criteria, and 16 declined to participate, resulting in a final sample of 226 patients. Results: The sample comprised 160 women, with 64.90% diagnosed with breast cancer and 35.10% with other neoplasms. Among the 66 men, 41% had prostate cancer and 59% had other neoplasms. Anxiety levels in women were mild (28%), moderate (24%), and high (48%), while in men, levels were mild (39%), moderate (21%), and high (53%). Depression levels in women were mild (42%), moderate (19%), and high (39%). Notably, six suicide attempts occurred among women before cancer diagnosis, and one occurred after diagnosis. Among men, depression levels were mild (47%), moderate (22%), and high (31%). With no history of attempts of suicide in the men population. Conclusions: The study's robust dataset provides compelling and valid information, unveiling a substantial prevalence of mental disorders within the analyzed populations. It emphatically underscores the critical need for tailored supportive care in addressing the unique psychosocial challenges faced by this demographic. Furthermore, the findings advocate for the urgent implementation of targeted psychosocial support interventions to enhance the overall well-being of individuals navigating the complex terrain of cancer and its associated mental health implications.

Hemoglobin and Its Relationship with Fatigue in Long-COVID Patients Three to Six Months after SARS-CoV-2 Infection.

Background: While some long-term effects of COVID-19 are respiratory in nature, a non-respiratory effect gaining attention has been a decline in hemoglobin, potentially mediated by inflammatory processes. In this study, we examined the correlations between hemoglobin levels and inflammatory biomarkers and evaluated the association between hemoglobin and fatigue in a cohort of Long-COVID patients. Methods: This prospective cohort study in the Netherlands evaluated 95 (mostly hospitalized) patients, aged 40-65 years, 3-6 months post SARS-CoV-2 infection, examining their venous hemoglobin concentration, anemia (hemoglobin < 7.5 mmol/L in women and <8.5 mmol/L in men), inflammatory blood biomarkers, average FSS (Fatigue Severity Score), demographics, and clinical features. Follow-up hemoglobin was compared against hemoglobin during acute infection. Spearman correlation was used for assessing the relationship between hemoglobin concentrations and inflammatory biomarkers, and the association between hemoglobin and fatigue was examined using logistic regression. Results: In total, 11 (16.4%) participants were suffering from anemia 3-6 months after SARS-CoV-2 infection. The mean hemoglobin value increased by 0.3 mmol/L 3-6 months after infection compared to the hemoglobin during the acute phase (p-value = 0.003). Whilst logistic regression showed that a 1 mmol/L greater increase in hemoglobin is related to a decrease in experiencing fatigue in Long-COVID patients (adjusted OR 0.38 [95%CI 0.13-1.09]), we observed no correlations between hemoglobin and any of the inflammatory biomarkers examined. Conclusion: Our results indicate that hemoglobin impairment might play a role in developing Long-COVID fatigue. Further investigation is necessary to identify the precise mechanism causing hemoglobin alteration in these patients.

Examining the role of social vulnerability, neighborhood characteristics, and geospatial patterns of firearm-related injuries and clinical outcomes in Milwaukee county

BackgroundPrevious work has shown socioenvironmental factors can influence firearm injury. Milwaukee County, Wisconsin is a diverse midwestern county with historic disinvestment in marginalized communities yielding stark segregation along racial and ethnic lines. It is also one of the many U.S. counties burdened by surging firearm injuries. The differences among communities within Milwaukee County provides a unique opportunity to explore the intersection of socioenvironmental factors that may affect clinical outcomes and geospatial patterns of firearm injury. MethodsThe trauma registry from the regional adult level 1 trauma center was queried for patients who sustained a firearm-related injury from 2015 to 2022 (N = 2402). The Social Vulnerability Index (SVI) ranking was derived using patient residence addresses to evaluate its association with traumatic injury clinical outcomes (i.e., in-hospital mortality, length of hospital stay, ICU or ventilator treatment, or injury severity score) and risk screening results for alcohol use disorder (AUD), posttraumatic stress disorder (PTSD), and depression. We evaluated hotspots of firearm injury density over time for patient residences and injury locations and distances between locations. A spatially lagged regression model tested the association between firearm injury density and SVI domains, alcohol outlet types, and park coverage. ResultsMost firearm injury patients were younger, male, racial or ethnic minorities from disadvantaged neighborhoods (SVI total; M = 0.86, SD = 0.15). SVI was not associated with any clinical outcomes. Of those screened, 12.9% screened positive for AUD and 44.5% screened at risk for PTSD, depression, or both. Hotspot analysis indicated consistent concentrations of firearm injury density. There were no differences in clinical outcomes between those injured inside or outside the home. Census tracts with lower socioeconomic status, greater off-premises and lower on-premises alcohol outlet density were associated with greater firearm injury density. ConclusionsIn Milwaukee County, firearm injury patients are injured in and often return to the same disadvantaged neighborhoods that may hamper recovery. Results replicate and expand previous work and implicate specific socioenvironmental factors for intervention and prevention of firearm injury.

Venous thromboembolism testing practices after orthopaedic trauma: prophylaxis regimen does not influence testing patterns.

To determine venous thromboembolism (VTE) testing patterns in an orthopaedic trauma population and to evaluate for differences in VTE surveillance by prophylaxis regimen through a secondary analysis of the ADAPT trial. Prospective randomized trial. Level I trauma center. Three hundred twenty-nine adult (18 years and older) trauma patients presenting with an operative extremity fracture proximal to the metatarsals/carpals or any pelvic or acetabular fracture requiring VTE prophylaxis. VTE imaging studies recorded within 90 days post injury. Percentage of patients tested for VTE were compared between treatment groups using Fisher's exact test. Subsequently, multivariable regression was used to determine patient factors significantly associated with risk of receiving a VTE imaging study. Sixty-seven patients (20.4%) had VTE tests ordered during the study period. Twenty (29.9%) of these 67 patients with ordered VTE imaging tests had a positive finding. No difference in proportion of patients tested for VTE by prophylaxis regimen (18.8% on aspirin vs. 22.0% on LMWH, P = 0.50) was observed. Factors associated with increased likelihood of VTE testing included White race (adjusted odds ratio [aOR]: 2.61, 95% CI: 1.26-5.42), increased Injury Severity Score (aOR for every 1-point increase: 1.10, 95% CI: 1.05-1.15), and lower socioeconomic status based on the Area Deprivation Index (aOR for every 10-point increase: 1.14, 95% CI: 1.00-1.30). VTE surveillance did not significantly differ by prophylaxis regimen. Patient demographic factors including race, injury severity, and socioeconomic status were associated with differences in VTE surveillance. Level I, Therapeutic.

Isolated injury, Charlson Comorbidity Index, and transfer from another facility are associated with delay in antibiotic administration: a retrospective study of 963 patients with open fractures.

To identify factors associated with delays in administration and pharmacy and nursing preparation of antibiotics for patients with open fractures. Retrospective review. Level I trauma center. Nine hundred sixty-three adults with open fractures administered antibiotics. Delay in antibiotic administration greater than 66 minutes from arrival and significant pharmacy-related and nursing-related delay. Isolated injury, Charlson Comorbidity Index, and transfer from another facility were associated with delay in antibiotic administration greater than 66 minutes. Injury Severity Score, transfer, and trauma team activation were associated with pharmacy-related or nursing-related delay. Interventions to reduce antibiotic administration time for open fractures should focus on early identification of open fractures and standardization of antibiotic protocols to ensure timely administration even in complex or resource-scarce care situations. Prognostic level III.

Surgical Outcomes of Epidural Hematoma in Trauma Patients with Absent Pupillary Reactions: A National Trauma Data Analysis.

Absent pupillary reaction occasionally heralds a poor prognosis following severe head injury. The purpose of the study was to evaluate the outcome of all patients who underwent acute evacuation of epidural hematoma (EDH) despite absent bilateral pupillary reaction. The Trauma Quality Improvement Program (TQIP) database for the calendar years 2017 and 2018 was accessed for the study. Adult patients ≥18 years of age who sustained severe traumatic brain injury (TBI) with the diagnosis of EDH and underwent evacuation of the hematoma were included in the study. The patients' characteristics, injury severity score (ISS), Glasgow Coma Scale (GCS) score, midline shift, and comorbidities were compared between patients who had absence of both pupillary reaction (ABPR) and those who presented with presence of both pupillary reaction (PBPR). The primary outcome of the study was in-hospital mortality. Propensity score matching analyses were performed for the study. No significant differences were found between the ABPR and PBPR groups regarding the median age (37 years [interquartile range (IQR): 26-53] vs. 40 years [IQR: 28-55]), gender (males; 81.9 vs. 79.5%), median ISS (29 [25.5-34] vs. 27 [25-33]), GCS score (3 [3-4] vs. 3 [3-3], presence of significant midline shift (75.9 vs. 79.5%), and comorbidities. The patients who presented with ABPR had a significantly higher mortality (34.9 vs. 10.8%; p = 0.002). A higher number of patients were discharged to skilled nursing and rehabilitation facilities (16.7 vs. 10.8% and 46.3 vs. 41.9%, respectively; p = 0.045). Approximately 65% of severe TBI patients survived after the evacuation of the EDH despite the absence of pupillary reaction.

Prognostic Value of Acute Gastrointestinal Injury Combined with Disease Severity Scores in Critically Ill Patients

Prognostic Value of Acute Gastrointestinal Injury Combined with Disease Severity Scores in Critically Ill Patients

Synergizing Survival: Uniting Acute Gastrointestinal Injury Grade and Disease Severity Scores in Critical Care Prognostication

Synergizing Survival: Uniting Acute Gastrointestinal Injury Grade and Disease Severity Scores in Critical Care Prognostication

Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for trauma and its performance in Japan over the past 18 years: a nationwide descriptive study

BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) has been used to control massive hemorrhages. Although there is no consensus on the efficacy of REBOA, it remains an option as a bridging therapy in non-trauma centers where trauma surgeons are not available. To better understand the current landscape of REBOA application, we examined changes in its usage, target population, and treatment outcomes in Japan, where immediate hemostasis procedures sometimes cannot be performed.MethodsThis retrospective observational study used the Japan Trauma Data Bank data. All cases in which REBOA was performed between January 2004 and December 2021 were included. The primary outcome was the in-hospital mortality rate. We analyzed mortality trends over time according to the number of cases, number of centers, severity of injury, and overall and subgroup mortality associated with REBOA usage. We performed a logistic analysis of mortality trends over time, adjusting for probability of survival based on the trauma and injury severity score.ResultsOverall, 2557 patients were treated with REBOA and were deemed eligible for inclusion. The median age of the participants was 55 years, and male patients constituted 65.3% of the study population. Blunt trauma accounted for approximately 93.0% of the cases. The number of cases and facilities that used REBOA increased until 2019. While the injury severity score and revised trauma score did not change throughout the observation period, the hospital mortality rate decreased from 91.3 to 50.9%. The REBOA group without severe head or spine injuries showed greater improvement in mortality than the all-patient group using REBOA and all-trauma patient group. The greatest improvement in mortality was observed in patients with systolic blood pressure ≥ 80 mmHg. The adjusted odds ratios for hospital mortality steadily declined, even after adjusting for the probability of survival.ConclusionsWhile there was no significant change in patient severity, mortality of patients treated with REBOA decreased over time. Further research is required to determine the reasons for these improvements in trauma care.

Ventilatory efficiency in long-term dyspnoeic patients following COVID-19 pneumonia

BackgroundLong COVID is defined as persistency of symptoms, such as exertional dyspnea, twelve weeks after recovery from SARS-CoV-2 infection. ObjectivesTo investigate ventilatory efficiency by the use of cardiopulmonary exercise testing (CPET) in patients with exertional dyspnea despite normal basal spirometry after 18 (T18) and 36 months (T36) from COVID-19 pneumonia. MethodsOne hundred patients with moderate-critical COVID-19 were prospectively enrolled in our Long COVID program. Medical history, physical examination and lung high-resolution computed tomography (HRCT) were obtained at hospitalization (T0), 3 (T3) and 15 months (T15). All HRCTs were revised using a semi-quantitative CT severity score (CSS). Pulmonary function tests were obtained at T3 and T15. CPET was performed in a subset of patients with residual dyspnea (mMRC ≥ 1), at T18 and at T36. ResultsRemarkably, at CPET, ventilatory efficiency was reduced both at T18 (V’E/V’CO2 slope = 31.4±3.9 SD) and T36 (V’E/V’CO2 slope = 31.28±3.70 SD). Furthermore, we identified positive correlations between V’E/V’CO2 slope at T18 and T36 and both percentage of involvement and CSS at HRCT at T0, T3 and T15. Also, negative linear correlations were found between V’E/V’CO2 slope at T18 and T36 and DLCO at T3 and T15. ConclusionsAt eighteen months from COVID-19 pneumonia, 20 % of subjects still complains of exertional dyspnea. At CPET this may be explained by persistently reduced ventilatory efficiency, possibly related to the degree of lung parenchymal involvement in the acute phase of infection, likely reflecting a damage in the pulmonary circulation.