Chinese Journal of Traumatology最新文献

Purpose: Quality improvement in trauma care often focuses on clinical protocols and systems, with limited emphasis on trauma-specific infrastructure. This study evaluated the impact of trauma-specific infrastructural improvements on patient outcomes in a newly established quaternary care trauma center.

Methods: Data from a prospectively maintained trauma registry were retrospectively analyzed. Patients treated over 8 months at the old center (OC) were compared to those treated during an equivalent period at the new center (NC), which included trauma-specific infrastructure such as a dedicated trauma bay, CT scanner, operating rooms, intensive care unit, and ward. Outcome indicators included time to CT, emergency department (ED) disposition time, hospital stay, 24-h survival, and overall mortality. Regression analyses adjusted for clinical confounders were performed.

Results: A total of 3542 patients (OC: 1627, NC: 1915) were analyzed. The median time to CT (incident rate ratios (IRR): 0.615, 95% confidence intervals (CI): 0.494-0.767) and ED disposition time (IRR: 0.766, 95% CI: 0.641-0.914) were significantly shorter in NC, particularly for priority 1 patients. However, hospital stay was longer in the new center (IRR 1.395, 95% CI: 1.224-1.590). There was no significant difference in 24-h survival (odds ratio: 0.330, 95% CI: 0.092-1.180) or overall mortality (odds ratio: 0.328, 95% CI: 0.084-1.275.

Conclusion: Trauma-specific infrastructure improves key operational metrics like time to CT and ED disposition without significant survival benefits. These findings suggest that infrastructure, while beneficial, should complement robust clinical systems and protocols for improved trauma care quality.

Purpose: Penetrating neck trauma can frequently be life-threatening, including those that appear minor. Consequently, thorough examination and quick operative treatment have been the standard measure. In addition, modern precision medicine has shifted the procedure towards more selective non-operative management, whereas advanced imaging like computed tomography angiography plays a key role. The diagnostic and therapeutic protocol remains to be adapted and optimized. The purpose of this study was to present our experience, outcomes, and management strategy, and contribute to establishing an evidence-based algorithm for stab wounds to the neck area.

Methods: This was a retrospective, observational cohort study conducted at 3 hospitals involving 5 patients with stab wounds to the neck. Preoperative interventions included airway and circulation restoration. Ancillary investigations, including imaging and electronic laryngoscopy, were used to assess potential vascular, nerve, and cervical vertebra injury. Surgeries included exploration, debridement, and closure under general anesthesia, with blood transfusion when necessary. Patients were followed up for recovery status and provided postoperative management.

Results: Among the 5 patients aged 21-64 years, 4 were males and 1 was female. All wounds were located on the lateral aspect of the neck. Four patients had pharyngocutaneous fistulas with hematemesis/hemoptysis, and 3 of them experienced hemorrhagic shock. One patient had nerve damage, and 1 patient had an airway compressed. All patients received surgeries that were successful. Patients were followed up for more than 6 months, and examinations revealed good wound healing, partial recovery of facial nerve function, and no other residual functional impairments in any of the 5 patients.

Conclusion: Adequate preoperative preparation and assessment, timely and effective exploratory surgery, efficient multidisciplinary cooperation, and comprehensive postoperative management can maximize the chances of life-saving and functional recovery for penetrating stab wounds in the neck area.

Purpose: Cough ability is crucial for extubation in mechanically ventilated acute brain injury (ABI) patients. Cough peak flow (CPF) assesses coughing ability. This study investigates its relationship with extubation outcomes.

Methods: A retrospective cohort study from April 2020 to April 2023 in an intensive care unit ward included mechanically ventilated adult ABI patients on ventilation for at least 24 h. ABI patients were divided by CPF (<60 L/min and ≥60 L/min). Outcomes included extubation success, ventilation days, pneumonia rate, tracheostomy rate, intensive care unit mortality, and length of stay. Multivariable logistic regression analyzed CPF-association with extubation, and receiver operating characteristic curve determined the optimal cutoff.

Results: There were 240 ABI patients included. In the CPF <60L/min group (29 patients), extubation failure after spontaneous breathing trial was 44.8%, median mechanical ventilation time was 3 days, tracheostomy rate was 10.3%, and ventilator-associated pneumonia rate was 20.7%. In the CPF≥60L/min group (211 patients), these were 8.5%, 1 day, 1.4%, and 3.3%, respectively. CPF was significantly associated with extubation failure (adjusted odds ratio: 0.94; 95% confidence intervals (CI): 0.92-0.96; p<0.001). The risk of extubation failure in the group with CPF<60 L/min was 5 times higher than that in the group with CPF≥60 L/min (adjusted odds ratio: 5.0; 95% CI: 2.32-11.11; p<0.001). Receiver operating characteristic analysis identified an optimal cutoff of 68.5 L/min (area under curve=0.829, 95% CI: 0.742-0.916).

Conclusions: CPF is significantly associated with extubation outcome in ABI patients with a successful spontaneous breathing trial.