Injury-International Journal of the Care of the Injured最新文献_第10页

Navigating the intersection of AI and orthopaedic trauma research: Promise, pitfalls, and the path forward 人工智能和骨科创伤研究的交叉导航：希望、陷阱和前进的道路。

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2025-01-01 DOI: 10.1016/j.injury.2024.112085

Christopher G. Hendrix , Sean Young , Stephen D. Forro , Brent L. Norris

引用次数: 0

Optimizing patient selection for ECMO after pediatric hypothermic cardiac arrest 优化小儿低体温心脏骤停后 ECMO 患者的选择。

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2025-01-01 DOI: 10.1016/j.injury.2024.111731

Jack H. Scaife , Hilary A. Hewes , Stephanie E. Iantorno , Christopher E. Clinker , Stephen J. Fenton , David E. Skarda , Zachary J. Kastenberg , Robert A. Swendiman , Katie W. Russell

Background

In 2004, our level 1 regional pediatric trauma center created a protocol to activate ECMO for children with suspected hypothermic cardiac arrest based on inclusion criteria: serum potassium ≤9, submersion <90 min, and core body temperature <30 °C. In 2017, Pasquier et al. developed a model to help predict the survival of adults after hypothermic cardiac arrest (HOPE score) that has not been validated in children. We sought to apply this score to our pediatric patient population to determine if it can optimize our patient selection.

Methods

This was a retrospective review of all patients cannulated onto VA ECMO for hypothermic cardiac arrest between 2004 and 2022. We used abstracted data points to calculate the HOPE score for our patient population, both with and without presumed asphyxia.

Results

Over 19 years, 18 patients were cannulated for suspected hypothermic arrest, with three survivors (17 %). The HOPE score survival prediction ranged from 1 to 86 % with presumed asphyxia and 6–98 % without presumed asphyxia. Survivor HOPE scores ranged from 9 to 86 % with presumed asphyxia and 42–98 % without presumed asphyxia. Non-survivors’ scores ranged 1–29 % with asphyxia and 6–57 % without asphyxia. A cutoff of >5 % predicted survival with asphyxia for ECMO could have decreased our cannulations by half without missing survivors.

Conclusion

ECMO can be a lifesaving measure for specific children after hypothermic arrest. However, identifying the patients that will benefit from this resource-intensive intervention remains difficult. HOPE score utilization may decrease the rate of futile cannulation in children, but multi-centered research is needed in the pediatric population.

背景：2004 年，我们地区一级儿科创伤中心制定了一项协议，根据纳入标准（血清钾≤9，浸没方法）为疑似低体温心脏骤停的儿童启动 ECMO：这是对 2004 年至 2022 年期间因体温过低心脏骤停而插管至 VA ECMO 的所有患者的回顾性研究。我们使用摘录的数据点来计算患者群体的 HOPE 评分，包括假定窒息和未假定窒息的患者：结果：19 年间，18 名患者因疑似低体温骤停而插管，其中 3 人存活（17%）。根据 HOPE 评分预测的存活率，推测窒息患者的存活率为 1% 至 86%，未推测窒息患者的存活率为 6% 至 98%。幸存者的 HOPE 分数在 9% 到 86% 之间，其中有假定窒息，42% 到 98% 没有假定窒息。非幸存者的得分范围为 1-29% 有窒息，6-57% 无窒息。如果 ECMO 的预测存活率大于 5%，我们的插管量就会减少一半，而不会漏掉存活者：结论：对于低体温骤停后的特定儿童来说，ECMO 是一项挽救生命的措施。结论：ECMO 可以挽救低体温骤停后特定儿童的生命。然而，确定哪些患者将从这种资源密集型干预中获益仍然很困难。使用 HOPE 评分可降低儿童的无用插管率，但需要在儿童群体中开展多中心研究。

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引用次数: 0

Lived experiences of working-age polytrauma patients in Germany - A qualitative Analysis 德国工作年龄段多发性创伤患者的生活经历--定性分析。

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2025-01-01 DOI: 10.1016/j.injury.2024.111938

Anne Neubert , Sebastian Hempe , Carina Jaekel , Catharina Gaeth , Christopher Spering , Katharina Fetz , Joachim Windolf , Erwin Kollig , Dan Bieler , LeAf-Trauma-Group

Background

Survivors of a major trauma experience a range of difficulties in relation to the reduction in physical, psychosocial, and cognitive functions, which can result in a reduced health-related quality of life. This study aims to explore lived experiences of major trauma survivors in the German healthcare system.

Methods

Semi-structured exploratory interviews were performed with nine major trauma survivors (18–55 years; Injury Severity Score ≥16). For exploratory analyses, an artificial intelligence-based coding software was used. Further, results were clustered by using the International Classification of Functioning, Disability and Health framework (ICF).

Results

Communication was one of the major topics concerning amongst others diverting opinions between different healthcare disciplines and a general lack of information. The participants showed a high demand for a contact person. Furthermore, social support was essential during recovery for those interviewed. Social network was not only important as emotional and physical support but also for overcoming of gaps in the healthcare system. The support by employers and colleagues seemed to be beneficial for our participants in relation to returning to work. Further, psychological consequences of trauma, and that mobility is a key factor for quality of life, self-efficacy and return to work were discussed.

Discussion

The qualitative analyses highlight several topics such as communication, burden of sickness, support systems that the participants mentioned as important along their journey through the German healthcare system during recovery. Through the ICF model the interplay of certain components that influenced the outcome of the major trauma survivors was visualized.

Implications

These results might offer a deepened understanding of modifiable components of a patient pathway in recovery process such as improvements of patient communication, provision of a contact person and others.

背景：重大创伤幸存者在身体、社会心理和认知功能下降方面会遇到一系列困难，从而导致与健康相关的生活质量下降。本研究旨在探讨德国医疗系统中重大创伤幸存者的生活经历：方法：对九名重大创伤幸存者（18-55 岁；受伤严重程度评分≥16 分）进行了半结构式探索性访谈。在探索性分析中，使用了基于人工智能的编码软件。此外，还使用国际功能、残疾和健康分类框架（ICF）对结果进行了分组：结果：交流是主要议题之一，涉及不同医疗学科之间的意见分歧和信息的普遍缺乏。参与者对联系人的需求很高。此外，社会支持对受访者的康复至关重要。社会网络不仅是情感和身体上的支持，而且对于克服医疗系统的不足也很重要。雇主和同事的支持似乎对受访者重返工作岗位很有帮助。此外，我们还讨论了创伤的心理后果，以及流动性是生活质量、自我效能感和重返工作岗位的关键因素：定性分析突出了几个主题，如沟通、疾病负担、支持系统，这些都是参与者在康复过程中通过德国医疗系统所提到的重要问题。通过 ICF 模型，可以直观地看出影响重大创伤幸存者康复结果的某些因素之间的相互作用：这些结果可能会加深人们对患者康复过程中可改变的因素的理解，如改善患者沟通、提供联系人等。

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引用次数: 0

Accuracy of the Norwegian trauma protocol. An observational population study from South-Western Norway 挪威创伤治疗方案的准确性。一项来自挪威西南部的观察性人口研究。

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2025-01-01 DOI: 10.1016/j.injury.2024.112063

Guro Bjørke , Ingvild Dalen , Kenneth Thorsen

Background

The Norwegian trauma plan was established in 2007 and renewed in 2017 defining national trauma team activation (TTA) criteria. Norwegian studies validating the performance of previous TTA protocols have found overtriage and undertriage to be out of line with the quality indicators set in the national trauma plan, but studies have not yet been published validating the new TTA protocol.

Material and method

This was a registry study of a prospectively maintained database in the period from 01/01/2018 to 12/31/2020. Data were collected from the Trauma Registry including prehospital documents. A total of 1519 patients were eligible, of which 95 were excluded, yielding a study population of 1424 patients. All patients were evaluated for a total of 29 criteria in four criteria groups: 1 Physiology, 2 Anatomical injury, 3 Mechanism of injury, and 4 Special considerations. Overtriage, undertriage, sensitivity and positive predictive value (PPV) were estimated for the current and alternative TTA protocols, criteria groups, and single criteria.

Results

The current Norwegian TTA protocol involving criteria groups 1–3 had a total sensitivity of 84.8 %, hence an undertriage of 15.2 % (95 % confidence interval, 11.1–20.3 %), and PPV of 19.2 % hence an overtriage of 80.8 % (78.3–83.1 %). Patients 60 years and older had an undertriage of 21.6 %, whilst patients under 60 years of age had an undertriage of 11.2 %. A TTA protocol including criteria group 4 as well yielded a lower undertriage (5.6 %) without significantly increasing overtriage (81.7 %), and a TTA protocol with criteria group 4 replacing group 3 yielded an undertriage of 7.4 % and an overtriage of 81.0 %. Criteria group 3 Mechanism of injury was the criteria group with the most overtriage, at 95 %. Patients that did not meet any criteria had a similar overtriage of 94 %.

Conclusion

Both overtriage and undertriage are out of line with the goals set in the Norwegian trauma plan. Undertriage is often caused by older patients that do not fulfill the trauma criteria in the current TTA protocol. Mechanism of injury increases overtriage but does not reduce undertriage. The TTA protocol could be improved by changing the composition of criteria groups, removal of single criteria with low PPV, and by better compliance to the existing criteria.

背景：挪威创伤计划于2007年建立，并于2017年更新，确定了国家创伤小组激活（TTA）标准。挪威的研究证实了以前的诊断辅助治疗方案的表现，发现过度分类和分类不足不符合国家创伤计划中设定的质量指标，但尚未发表的研究证实了新的诊断辅助治疗方案。材料和方法：本研究是对2018年1月1日至2020年12月31日期间前瞻性维护的数据库进行注册研究。数据收集自创伤登记处，包括院前文件。共有1519例患者符合条件，其中95例被排除，研究人群为1424例患者。所有患者分为4个标准组，共29项标准进行评估：1生理，2解剖损伤，3损伤机制，4特殊考虑。评估了当前和备选TTA方案、标准组和单一标准的过度分类、分类不足、敏感性和阳性预测值（PPV）。结果：目前挪威TTA方案涉及标准组1-3，总敏感性为84.8%，因此分类不足为15.2%(95%置信区间，11.1- 20.3%)，PPV为19.2%，因此分类过度为80.8%（78.3- 83.1%）。60岁及以上患者的分类不足率为21.6%，而60岁以下患者的分类不足率为11.2%。包括第4组标准的TTA方案也产生了较低的分类不足（5.6%），但没有显著增加过度分类（81.7%），而用第4组标准取代第3组的TTA方案产生了7.4%的分类不足和81.0%的过度分类。损伤机制是过度分类最多的标准组，占95%。不符合任何标准的患者有类似的94%的过度分类。结论：分诊过多和分诊不足均不符合挪威创伤计划的目标。分类不足通常是由于老年患者不符合当前TTA协议中的创伤标准。损伤机制增加了过度分类，但不减少分类不足。可以通过改变标准组的组成、删除PPV低的单一标准以及更好地遵守现有标准来改进TTA协议。

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引用次数: 0

Recent trends and risk factors for chemical and physical restraint use in the emergency department evaluation and treatment of trauma patients 急诊评估和治疗创伤患者使用化学和物理约束的最新趋势和危险因素。

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2025-01-01 DOI: 10.1016/j.injury.2024.112066

Jordan M Rook , Ami Hayashi , Daniela Salinas , Yasmine Abbey , Danielle Newton , Daniel Carrera , Jesus G. Ulloa , Rochelle A. Dicker , Vickie M. Mays , Catherine J. Juillard

Background

Despite research linking chemical and physical restraints to negative outcomes including unplanned intubations and psychological distress, there is little guidance for their use in the care of trauma patients. We used institutional data to describe recent trends in chemical and physical restraint in the emergency department evaluation and treatment of trauma patients and to identify characteristics associated with their use.

Methods

This study includes adult trauma activations at a United States urban level I trauma center from January 2016 to July 2022. Data were collected from the trauma registry and medical record. We assessed the use of chemical restraints and physical restraints during care provided in the trauma resuscitation bay and emergency department. We assessed trends over time graphically and with logistic regression. We used multivariable regression models to evaluate associations between restraint use and patient and clinical characteristics and the outcomes of ICU admission, hospitalization duration, and mortality.

Results

Of the 8,112 patients, most were male (74.8 %), White (55.8 %), and privately insured (35.2 %). Overall, 8.1 % were restrained with 7.1 % chemically restrained and 2.7 % physically restrained. Overall restraint use increased 254 % (p < 0.001) from 2016 to 2022 driven primarily by a 460 % (p < 0.001) increase in chemical restraint use including a 630 % increase in ketamine administrations (p < 0.001).

Use of restraints was associated with pre-existing psychotic disorders, intoxication, altered mental status, increasing injury severity, and Medicaid insurance (p < 0.001). Chemical restraint administration was associated with a 3.5 percentage point (95 %CI 1.1–5.9; p = 0.004) increase in the probability of ICU admission and a 1.0 day (95 %CI 0.6–1.4; p < 0.001) increase in hospitalization duration.

Conclusions

In this institutional study, nearly one-in-twelve trauma patients were restrained during emergency department evaluation and treatment. Restraint utilization increased during the study driven primarily by increases in ketamine and restraints utilized during trauma bay evaluation and resuscitation. Future research should assess the generalizability of these findings. It is important that rigorous guidelines are established to ensure the safe and effective use of restraints in trauma.

背景：尽管有研究将化学和物理约束与包括计划外插管和心理困扰在内的负面结果联系起来，但在创伤患者的护理中使用化学和物理约束的指导很少。我们使用机构数据来描述急诊科评估和治疗创伤患者时化学和物理约束的最新趋势，并确定其使用相关的特征。方法：本研究包括2016年1月至2022年7月在美国城市一级创伤中心进行的成人创伤激活。数据收集自创伤登记和医疗记录。我们评估了创伤复苏室和急诊科在护理过程中使用化学约束和物理约束的情况。我们用图形和逻辑回归评估了随时间变化的趋势。我们使用多变量回归模型来评估约束使用与患者和临床特征、ICU入院结局、住院时间和死亡率之间的关系。结果：8112例患者中，男性占74.8%，白人占55.8%，私人保险占35.2%。总的来说，8.1%的人受到了约束，其中7.1%受到了化学约束，2.7%受到了物理约束。从2016年到2022年，总体约束使用量增加了254% (p < 0.001)，主要原因是化学约束使用量增加了460% (p < 0.001)，其中氯胺酮使用量增加了630% （p < 0.001）。使用约束与先前存在的精神障碍、中毒、精神状态改变、伤害严重程度增加和医疗补助保险相关（p < 0.001）。化学约束管理与3.5个百分点相关(95% CI 1.1-5.9；p = 0.004)入院ICU的概率增加1天(95% CI 0.6-1.4；P < 0.001)住院时间增加。结论：在本机构研究中，近十二分之一的创伤患者在急诊评估和治疗期间受到约束。在研究期间，约束的使用增加主要是由于在创伤室评估和复苏期间氯胺酮和约束的使用增加。未来的研究应评估这些发现的普遍性。制定严格的指导方针以确保在创伤中安全有效地使用约束是很重要的。

{"title":"Recent trends and risk factors for chemical and physical restraint use in the emergency department evaluation and treatment of trauma patients","authors":"Jordan M Rook , Ami Hayashi , Daniela Salinas , Yasmine Abbey , Danielle Newton , Daniel Carrera , Jesus G. Ulloa , Rochelle A. Dicker , Vickie M. Mays , Catherine J. Juillard","doi":"10.1016/j.injury.2024.112066","DOIUrl":"10.1016/j.injury.2024.112066","url":null,"abstract":"<div><h3>Background</h3><div>Despite research linking chemical and physical restraints to negative outcomes including unplanned intubations and psychological distress, there is little guidance for their use in the care of trauma patients. We used institutional data to describe recent trends in chemical and physical restraint in the emergency department evaluation and treatment of trauma patients and to identify characteristics associated with their use.</div></div><div><h3>Methods</h3><div>This study includes adult trauma activations at a United States urban level I trauma center from January 2016 to July 2022. Data were collected from the trauma registry and medical record. We assessed the use of chemical restraints and physical restraints during care provided in the trauma resuscitation bay and emergency department. We assessed trends over time graphically and with logistic regression. We used multivariable regression models to evaluate associations between restraint use and patient and clinical characteristics and the outcomes of ICU admission, hospitalization duration, and mortality.</div></div><div><h3>Results</h3><div>Of the 8,112 patients, most were male (74.8 %), White (55.8 %), and privately insured (35.2 %). Overall, 8.1 % were restrained with 7.1 % chemically restrained and 2.7 % physically restrained. Overall restraint use increased 254 % (<em>p</em> < 0.001) from 2016 to 2022 driven primarily by a 460 % (<em>p</em> < 0.001) increase in chemical restraint use including a 630 % increase in ketamine administrations (<em>p</em> < 0.001).</div><div>Use of restraints was associated with pre-existing psychotic disorders, intoxication, altered mental status, increasing injury severity, and Medicaid insurance (<em>p</em> < 0.001). Chemical restraint administration was associated with a 3.5 percentage point (95 %CI 1.1–5.9; <em>p</em> = 0.004) increase in the probability of ICU admission and a 1.0 day (95 %CI 0.6–1.4; <em>p</em> < 0.001) increase in hospitalization duration.</div></div><div><h3>Conclusions</h3><div>In this institutional study, nearly one-in-twelve trauma patients were restrained during emergency department evaluation and treatment. Restraint utilization increased during the study driven primarily by increases in ketamine and restraints utilized during trauma bay evaluation and resuscitation. Future research should assess the generalizability of these findings. It is important that rigorous guidelines are established to ensure the safe and effective use of restraints in trauma.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 1","pages":"Article 112066"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Establishing thresholds for shock index in children to identify major trauma 确定儿童休克指数阈值，以识别重大创伤。

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2025-01-01 DOI: 10.1016/j.injury.2024.111840

Sriram Ramgopal , Jillian K. Gorski , Pradip P. Chaudhari , Ryan G. Spurrier , Christopher M. Horvat , Michelle L. Macy , Rebecca E. Cash , Anne M. Stey , Christian Martin-Gill

Background

An abnormal shock index (SI) is associated with greater injury severity among children with trauma. We sought to empirically-derive age-adjusted SI cutpoints associated with major trauma in children, and to compare the accuracy of these cutpoints to existing criteria for pediatric SI.

Methods

We performed a retrospective cohort study using the 2021 National Trauma Data Bank (NTDB) Participant Use File. We included injured children (<18 years), excluding patients with traumatic arrests, mechanical ventilation upon hospital presentation, and inter-facility transfers. Our outcome was major trauma defined by the standardized triage assessment tool (STAT) criteria. Our exposure of interest was the SI. We empirically-derived upper and lower cutpoints for the SI using age-adjusted Z-scores. We compared the performance of these to the SI, pediatric-adjusted (SIPA), and the Pediatric SI (PSI). We validated the performance of the cutpoints in the 2019 NTDB.

Results

We included 64,326 and 64,316 children in the derivation and validation samples, of whom 4.9 % (derivation) and 4.0 % (validation) experienced major trauma. The empirically-derived age-adjusted SI cutpoints had a sensitivity of 43.2 % and a specificity of 79.4 % for major trauma in the validation sample. The sensitivity of the PSI for major trauma was 33.9 %, with a specificity of 90.7 % among children 1–17 years of age. The sensitivity of the SIPA was 37.4 %, with a specificity of 87.8 % among children 4–16 years of age. Evaluated using logistic regression, patients with an elevated age-adjusted SI had 3.97 greater odds (95 % confidence interval [CI] 3.63–4.33) of major trauma compared to those with a normal age-adjusted SI. Patients with a depressed SI had 1.55 greater odds (95 % CI 1.36–1.78) of major trauma. The area under the receiver operator characteristic curve (AUROC) for the empirically-derived model (0.62, 95 % CI 0.61–0.63) was similar to the AUROC for PSI (0.62, 95 % CI 0.61–0.63); both of which were greater than the SIPA model (0.58, 95 % CI 0.57–0.59).

Conclusion

Age-adjusted SI cutpoints demonstrated a mild gain in sensitivity compared to existing measures. However, our findings suggest that the SI alone has a limited role in the identification of major trauma in children.

背景：休克指数（SI）异常与儿童外伤的严重程度有关。我们试图根据经验得出与儿童重大创伤相关的年龄调整后 SI 切点，并将这些切点的准确性与现有的儿科 SI 标准进行比较：我们使用 2021 年国家创伤数据库（NTDB）参与者使用文件进行了一项回顾性队列研究。我们纳入了受伤儿童（结果：64,326 名受伤儿童和 64 名受伤儿童）：我们在推导样本和验证样本中分别纳入了 64,326 名和 64,316 名儿童，其中 4.9%（推导样本）和 4.0%（验证样本）经历过重大创伤。在验证样本中，根据经验得出的年龄调整后 SI 切点对重大创伤的灵敏度为 43.2%，特异度为 79.4%。在 1-17 岁儿童中，PSI 对重大创伤的敏感性为 33.9%，特异性为 90.7%。在 4-16 岁儿童中，SIPA 的灵敏度为 37.4%，特异性为 87.8%。使用逻辑回归进行评估，与年龄调整后 SI 正常的患者相比，年龄调整后 SI 升高的患者发生重大创伤的几率要高出 3.97（95 % 置信区间 [CI] 3.63-4.33）。SI 低于正常值的患者发生重大创伤的几率为 1.55（95 % 置信区间为 1.36-1.78）。经验模型的接收者操作特征曲线下面积（0.62，95 % CI 0.61-0.63）与 PSI 的接收者操作特征曲线下面积（0.62，95 % CI 0.61-0.63）相似，均大于 SIPA 模型（0.58，95 % CI 0.57-0.59）：结论：与现有的测量方法相比，年龄调整后的 SI 切点显示出轻微的灵敏度增加。然而，我们的研究结果表明，仅用 SI 来识别儿童重大创伤的作用是有限的。

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引用次数: 0

Identifying opportunities for community EMS fall prevention 确定社区急救服务预防跌倒的机会。

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2025-01-01 DOI: 10.1016/j.injury.2024.111915

Tynan H. Friend , Alexander J. Ordoobadi , Zara Cooper , Ali Salim , Molly P. Jarman

Background

Falls are a leading cause of morbidity and mortality among older adults in the United States. Current fall prevention interventions rely on provider referral or enrollment during inpatient admissions and require engagement and independence of the patient. Community emergency medical services (CEMS) are a unique opportunity to rapidly identify older adults at risk for falls and provide proactive fall prevention interventions in the home. We describe the demographics and treatment characteristics of the older adult population most likely to benefit from these interventions.

Materials and methods

We linked 2019 Healthcare Cost and Utilization Project Massachusetts State Emergency Department (ED) and State Inpatient Databases with American Hospital Association survey data to query ED encounters and inpatient admissions for adults age ≥55 with ED encounters for fall-related injury between July 1, 2019 and December 31, 2019. Univariable descriptive statistics assessed participant characteristics and bivariable tests of significance compared diagnoses, disposition, and hospital characteristics between older adults with and without an EMS encounter in the six months prior to the presenting fall.

Results

Of 66,027 older adults who presented with a fall to a Massachusetts ED in July-December 2019, 7,942 (11%) had a prior encounter with EMS in the preceding six months, most of which included an injury diagnosis (99%). Compared to older adults without previous EMS encounters, those with previous EMS encounters were more often in poorer health (17% vs. 10% with multiple or complex comorbidities, p < 0.001) and of lower socioeconomic status (12% vs. 8% in lowest neighborhood income quartile, p < 0.001; 10% vs. 6% enrolled in Medicaid, p < 0.001) compared to those without a prior EMS encounter.

Conclusions

A significant proportion of older adults presenting to the ED with fall related injury have encounters with EMS in the preceding months. These participants are predisposed to poorer health and economic outcomes worsened by their fall and thus demonstrate a population that would benefit from CEMS fall prevention programs.

背景：跌倒是美国老年人发病和死亡的主要原因。目前的预防跌倒干预措施依赖于医疗服务提供者的转介或住院病人的登记，需要病人的参与和独立。社区紧急医疗服务（CEMS）提供了一个独特的机会，可以快速识别有跌倒风险的老年人，并在家中提供积极的跌倒预防干预措施。我们描述了最有可能从这些干预措施中受益的老年人群的人口统计学和治疗特征：我们将 2019 年医疗成本与利用项目马萨诸塞州急诊科（ED）和州住院病人数据库与美国医院协会调查数据相链接，以查询 2019 年 7 月 1 日至 2019 年 12 月 31 日期间因跌倒相关伤害而在急诊科就诊的年龄≥55 岁的成年人的急诊科就诊和住院情况。单变量描述性统计评估了参与者的特征，双变量显著性检验比较了在出现跌倒前六个月内遇到和未遇到急救服务的老年人之间的诊断、处置和医院特征：2019年7月至12月，在马萨诸塞州急诊室就诊的66027名跌倒老年人中，有7942人（11%）在之前的6个月中曾遇到过急救服务，其中大部分包括伤害诊断（99%）。与以前未遇到过急救服务的老年人相比，以前遇到过急救服务的老年人通常健康状况较差（17%与10%患有多种或复杂的并发症，p < 0.001），社会经济地位较低（12%与8%处于最低社区收入四分位数，p < 0.001；10%与6%加入了医疗补助计划，p < 0.001）：结论：在因跌倒受伤而到急诊室就诊的老年人中，有很大一部分在之前的几个月中曾遇到过急救服务。这些患者的健康状况和经济状况都会因跌倒而恶化，因此，他们是CEMS跌倒预防项目的受益人群。

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引用次数: 0

Challenges of a regional trauma center in treating combat and civilian casualties. The experience of Assuta Ashdod Hospital in the Iron Swords War 地区创伤中心在治疗战斗和平民伤员方面面临的挑战。阿苏塔-阿什杜德医院在铁剑战争中的经验。

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2025-01-01 DOI: 10.1016/j.injury.2024.111885

Itay Zoarets , Dalia Bider , Mohamad Molham , Hanoch Kashtan , Erez Barenboim

Introduction

Assuta Ashdod Hospital is a regional trauma center. The hospital received casualties on the first day of the civilian massacre of October 7th and thereafter. The Assuta Ashdod Hospital was designated as an emergency landing site only for unstable or deteriorating patients who would not survive longer flights to a central trauma center. The aim of this study is to share our experience and challenges as a new regional trauma center in a war zone.

Methods

A descriptive cohort study consisting of all trauma patients admitted in the Emergency Department, between October 7, 2023, and December of the same year. The data is part of the Israel National Trauma Registry.

Results

A total of 397 heavily wounded patients were admitted, of which 3 were declared dead on arrival, 95 were hospitalized and 299 were discharged from the emergency department after initial care. Of the 95 wounded patients hospitalized, 60 (63.1 %) had a single mechanism of injury, of which, 35.7 % were penetrating injuries. The most frequent injury was to the extremities (60 %) followed by chest and abdomen, 35.7 % and 14.7 % respectively. Multi-trauma injuries were present in 40 % of the wounded patients. The average ISS was 15 (median=9). Of all patients, 10.5 % of patients were considered to have severe and 23.1 % to have profound (very-severe) injuries by the ISS classification. Twelve patients received whole blood transfusions, fourteen received the Massive Transfusion Protocol. Sixty-one of the 95 (64 %) patients underwent surgery, with a total of 137 surgeries performed. Sixty-seven percent of surgical procedures were orthopedic and 16.7 % were of general surgery. The average length of stay was 6.5 days (median=6). We transferred 14 patients to central trauma centers, 3 of which did not survive.

Conclusion

The outcomes of patients admitted to the Assuta Ashdod Hospital were good in treating major trauma patients in a mass casualty event, reaffirming its capabilities as an excellent regional trauma center. Therefore, we suggest that the guidelines for evacuation of battle or major casualty events victims only to central trauma centers unless patients are unstable should be reconsidered, and regional trauma centers could effectively share the burden of the treatment of those patients.

简介阿什杜德 Assuta 医院是一家地区创伤中心。该医院在 10 月 7 日平民大屠杀的第一天及其后接收了伤员。阿苏塔-阿什杜德医院被指定为紧急着陆点，仅用于救治病情不稳定或恶化的病人，这些病人无法在前往中心创伤中心的长途飞行中存活下来。本研究旨在分享我们作为战区新成立的地区创伤中心的经验和挑战：描述性队列研究包括 2023 年 10 月 7 日至同年 12 月期间急诊科收治的所有外伤患者。这些数据是以色列国家创伤登记处的一部分：共有 397 名重伤患者入院，其中 3 人在抵达时被宣布死亡，95 人住院治疗，299 人在急诊科接受初步治疗后出院。在住院的 95 名伤员中，60 人（63.1%）的受伤机制单一，其中 35.7% 为穿透伤。最常见的受伤部位是四肢（60%），其次是胸部和腹部，分别占 35.7% 和 14.7%。40%的伤员有多处创伤。平均ISS值为15（中位数=9）。根据国际伤残标准分类，10.5%的患者伤势严重，23.1%的患者伤势极重。12 名患者接受了全血输注，14 名患者接受了大规模输血方案。95 名患者中有 61 名（64%）接受了手术，共进行了 137 次手术。67%的手术为骨科手术，16.7%为普外科手术。平均住院时间为 6.5 天（中位数=6）。我们将14名患者转至中心创伤中心，其中3人未能存活：阿苏塔-阿什杜德医院在治疗大规模伤亡事件中的重大创伤患者方面取得了良好的疗效，再次证明了该医院作为优秀的地区创伤中心的能力。因此，我们建议重新考虑关于除非患者病情不稳定，否则只能将战斗或重大伤亡事件受害者后送至中心创伤中心的指导方针，地区创伤中心可以有效分担这些患者的治疗负担。

{"title":"Challenges of a regional trauma center in treating combat and civilian casualties. The experience of Assuta Ashdod Hospital in the Iron Swords War","authors":"Itay Zoarets , Dalia Bider , Mohamad Molham , Hanoch Kashtan , Erez Barenboim","doi":"10.1016/j.injury.2024.111885","DOIUrl":"10.1016/j.injury.2024.111885","url":null,"abstract":"<div><h3>Introduction</h3><div>Assuta Ashdod Hospital is a regional trauma center. The hospital received casualties on the first day of the civilian massacre of October 7th and thereafter. The Assuta Ashdod Hospital was designated as an emergency landing site only for unstable or deteriorating patients who would not survive longer flights to a central trauma center. The aim of this study is to share our experience and challenges as a new regional trauma center in a war zone.</div></div><div><h3>Methods</h3><div>A descriptive cohort study consisting of all trauma patients admitted in the Emergency Department, between October 7, 2023, and December of the same year. The data is part of the Israel National Trauma Registry.</div></div><div><h3>Results</h3><div>A total of 397 heavily wounded patients were admitted, of which 3 were declared dead on arrival, 95 were hospitalized and 299 were discharged from the emergency department after initial care. Of the 95 wounded patients hospitalized, 60 (63.1 %) had a single mechanism of injury, of which, 35.7 % were penetrating injuries. The most frequent injury was to the extremities (60 %) followed by chest and abdomen, 35.7 % and 14.7 % respectively. Multi-trauma injuries were present in 40 % of the wounded patients. The average ISS was 15 (median=9). Of all patients, 10.5 % of patients were considered to have severe and 23.1 % to have profound (very-severe) injuries by the ISS classification. Twelve patients received whole blood transfusions, fourteen received the Massive Transfusion Protocol. Sixty-one of the 95 (64 %) patients underwent surgery, with a total of 137 surgeries performed. Sixty-seven percent of surgical procedures were orthopedic and 16.7 % were of general surgery. The average length of stay was 6.5 days (median=6). We transferred 14 patients to central trauma centers, 3 of which did not survive.</div></div><div><h3>Conclusion</h3><div>The outcomes of patients admitted to the Assuta Ashdod Hospital were good in treating major trauma patients in a mass casualty event, reaffirming its capabilities as an excellent regional trauma center. Therefore, we suggest that the guidelines for evacuation of battle or major casualty events victims only to central trauma centers unless patients are unstable should be reconsidered, and regional trauma centers could effectively share the burden of the treatment of those patients.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 1","pages":"Article 111885"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The global, regional, and national burden of burns: An analysis of injury by fire, heat, and hot substances in the global burden of disease study 2019 全球、地区和国家的烧伤负担：2019年全球疾病负担研究中对火灾、高温和热物质伤害的分析。

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2025-01-01 DOI: 10.1016/j.injury.2024.111955

Xi Yin , Shengyu Huang , Zhihao Zhu , Qimin Ma , Yusong Wang , Xiaobin Liu , Tuo Shen , Feng Zhu

Background

Burn caused by exposure to hot substances is a common occurrence but there is little data on prevalence trends and disease burden. This research report the burden of burn injuries globally, regionally, and nationally from 1990 to 2019, identify hotspots, and analyze factors affecting disease burden with data from Global Burden of Disease 2019 survey.

Methods

The Global Burden of Disease 2019 estimated the incidence, death rate, and disease-adjusted life years (DALY) for injuries due to exposure to fire, heat, and hot substances from 1990 to 2019. For comparison, all rates were age standardized. And the estimated annual percentage change (EAPC) was used to reflect the degree of change of the annual rate.

Results

Globally, there were an estimated 8,378,122 (95 % uncertainty interval [UI]: 6,531,887–10,363,109) burn injuries in 2019, with age-standardized incidence, death, and DALY rates of 118 (95 % UI: 89–147), 1.44 (95 % UI: 1.14–1.72), and 96.6 (95 % UI: 75.03–123.05) per 100,000 people, which were 22 %, 43 %, and 43 % lower than those in 1990, respectively. Regionally, age-standardized incidence rate showed a positive association with Socio-demographic Index (SDI) from 1990 to 2019, whereas age-standardized death and DALY rates were negatively associated with SDI. The variation in the age-standardized incidence rate was intrinsic, and the variation in the age-standardized death rate was related to the human development index in the country. The global burn incidence population was skewed, with peaks mainly in the 5 to 19 years age group, but age-specific death rates and disease burden were higher in the under-5 and older age groups.

Conclusions

The results of this study indicate the need to consider regional differences in burns when allocating health resources. Despite the reduced global burden of burns, incidence and deaths remain high. Moreover, there are significant differences between regions which are associated with the SDI and the human development index. Additionally, differences exist in the age and sex of the affected populations. Although the exact causes require further study, there is no doubt that the prevention of burns requires serious attention.

背景：接触高温物质导致的烧伤是一种常见病，但有关流行趋势和疾病负担的数据却很少。本研究报告了 1990 年至 2019 年全球、地区和国家的烧伤负担，确定了热点地区，并利用《2019 年全球疾病负担》调查数据分析了影响疾病负担的因素：2019 年全球疾病负担调查估计了 1990 年至 2019 年期间因暴露于火、热和高温物质而受伤的发病率、死亡率和疾病调整生命年（DALY）。为便于比较，所有发病率都进行了年龄标准化。并使用估计年度百分比变化（EAPC）来反映年度比率的变化程度：全球范围内，2019 年估计有 8,378,122 人（95 % 不确定区间 [UI]：6,531,887-10,363,109）烧伤，年龄标准化发病率、死亡率和残疾调整寿命年率分别为每 10 万人 118 例（95 % UI：89-147）、1.44 例（95 % UI：1.14-1.72）和 96.6 例（95 % UI：75.03-123.05），分别比 1990 年低 22%、43% 和 43%。从地区来看，1990 年至 2019 年，年龄标准化发病率与社会人口指数（SDI）呈正相关，而年龄标准化死亡率和残疾调整寿命年率与社会人口指数呈负相关。年龄标准化发病率的变化是内在的，而年龄标准化死亡率的变化与国家的人类发展指数有关。全球烧伤发病人群呈偏态分布，高峰主要出现在 5 至 19 岁年龄组，但 5 岁以下和更大年龄组的特定年龄死亡率和疾病负担更高：这项研究的结果表明，在分配卫生资源时需要考虑烧伤的地区差异。尽管全球烧伤负担有所减轻，但发病率和死亡率仍然居高不下。此外，各地区之间存在着明显的差异，这与 SDI 和人类发展指数有关。此外，受影响人群的年龄和性别也存在差异。虽然确切的原因还需要进一步研究，但毫无疑问，预防烧伤需要引起高度重视。

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引用次数: 0

Variables for reporting studies on extended - focused assessment with sonography for trauma (E-FAST): An international delphi consensus study 创伤超声聚焦评估（E-FAST）研究报告的变量：国际德尔菲共识研究。

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured

Pub Date : 2025-01-01 DOI: 10.1016/j.injury.2024.111931

Federico Moro , Valentina Chiarini , Tommaso Scquizzato , Etrusca Brogi , Marco Tartaglione

Background

The Extended Focused Assessment with Sonography for Trauma (E-FAST) is a diagnostic ultrasound technique used in hospital and pre-hospital settings for patients with torso trauma. While E-FAST is common in emergency departments, its pre-hospital use is less routine. This study aims to establish a set of variables for designing studies on pre-hospital E-FAST through a Delphi consensus process involving international experts.

Methods

A Delphi consensus process was utilized, involving four rounds of e-mail to the experts. The experts proposed variables for each category, assessed them using a 5-point Likert scale, and voted on whether they should be included in the final template.

Results

Out of 14 invited experts, 9 participated in the study. In total, the experts proposed 247 variables. After four rounds, a final list of 32 variables was approved by all experts. These variables related to the system, patient, process, training, imaging, outcome, and others.

Conclusions

This Delphi consensus study presents a list of 32 variables for future research studies concerning the use of E-FAST ultrasound in pre-hospital settings. The results of this study are significant as they provide a standardized set of variables that will facilitate the comparison of data obtained from various studies. This will ultimately contribute to the advancement of pre-hospital E-FAST research and practice.

背景：创伤超声聚焦评估（E-FAST）是一种超声诊断技术，用于医院和院前环境中的躯干创伤患者。虽然 E-FAST 在急诊科很常见，但院前使用却不太常规。本研究旨在通过有国际专家参与的德尔菲共识程序，为院前 E-FAST 的研究设计建立一套变量：方法：采用德尔菲共识程序，向专家发送四轮电子邮件。专家们为每个类别提出变量，使用 5 点李克特量表对其进行评估，并就是否将其纳入最终模板进行投票：在 14 位受邀专家中，有 9 位参与了研究。专家们总共提出了 247 个变量。经过四轮投票，最终 32 个变量获得了所有专家的认可。这些变量涉及系统、患者、流程、培训、成像、结果等：这项德尔菲共识研究提出了一份 32 个变量的清单，供未来有关在院前环境中使用 E-FAST 超声波的研究使用。这项研究的结果意义重大，因为它提供了一套标准化的变量，有助于比较从不同研究中获得的数据。这将最终促进院前 E-FAST 研究和实践的发展。

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引用次数: 0