摘要:

ObjectiveTo examine the psychosocial adjustment of survivors of massive pediatric burn injuries, the change in adjustment across time, and the impact on parents.BackgroundPatients/parents were assessed at regular intervals postburn using standardized tests of adjustment. Patients who could not be included in standardized longitudinal assessments were administered questionnaires by mail/telephone.MethodsThe Child Behavior Checklist, the Teacher Report Form, the Youth Self Report Form, and the Parenting Stress Index were utilized to assess adjustment.ResultsOn all objective measures, the group of survivors and their parents were within normal limits. Adjustment neither improved nor deteriorated over time.ConclusionChildren who survive massive burn injuries can achieve positive psychosocial adaptation.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo delineate which injury-related, demographic, and psychosocial variables were predictive of severe disability (limitations in the performance of socially defined roles and tasks) at 3 months after discharge from acute hospitalization for non-central nervous system traumatic injury.Patients and MethodsThe study design was prospective, longitudinal, and correlational. The sample consisted of 109 injured patients at three urban trauma centers. Data were obtained from patient interview using the Sickness Impact Profile, the Impact of Event Scale, and the Social Support Questionnaire; injury-related data were obtained from the medical record and computerized trauma registries.ResultsThe sample had a mean age of 37.4 +/- 16.8 years, a mean number of injuries per person of 4.4 +/- 2.8, and a mean Injury Severity Score of 15.5 +/- 9.9. Motor vehicle crashes (34.9%) and violent injuries (33%) were the predominant causes of injuries. Patients experienced severe levels of disability (Sickness Impact Profile, mean = 26.1) and moderate levels of psychological distress (Impact of Event Scale, mean = 30.6; intrusion mean = 14.6 and avoidance mean = 16.0). Three variables were predictive of severe disability at 3 months: high levels of intrusive thoughts (odds ratio, 2.9; 95% confidence interval, 1.1-7.7); injury with a maximal Abbreviated Injury Scale score in an extremity (odds ratio, 2.9; 95% confidence interval, 1.2-6.9); and having not graduated from high school (odds ratio, 3.4; 95% confidence interval, 1.2-10).ConclusionExtremity injuries, lack of high school graduation, and high level of posttraumatic psychological distress with intrusive thoughts are risk factors for severe disability at 3 months after discharge from the hospital.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundPsychological morbidity compromises return to work after trauma. We demonstrate this relationship and present methods to identify risks for significant psychological morbidity.MethodsThirty-five adults were evaluated prospectively for return to functional employment after injury using demographic data, validated psychological and health measures, and the Michigan Critical Events Perception Scale. Evaluation was conducted at admission and at 1 and 5 months after injury.ResultsPoor return to work at 5 months was attributable to physical disability (p < 0.05) and psychological disturbance (p < 0.05) in a regression model that controlled for preinjury employment and psychopathologic factors as well as injury severity. A high score on the Impact of Events Scale administered during acute admission predicted development of acute stress disorder at 1 month (p < 0.01, odds ratio (OR) = 9.4) and posttraumatic stress disorder at 5 months (p < 0.05, OR = 6.7). Peritraumatic dissociation on the Michigan Critical Events Perception Scale was predictive for development of acute stress disorder (p < 0.05, OR = 5.8) at 1 month and posttraumatic stress disorder (p < 0.05, OR = 7.5) at 5 months.ConclusionPsychological morbidity after injury compromises return to work independent of preinjury employment and psychopathologic condition, Injury Severity Score, or ambulation. A high Impact of Events Scale score or peritraumatic dissociation at admission predicts this morbidity.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo determine whether surgeons and residents with minimal training can evaluate accurately emergency ultrasound (US) examinations compared with radiologists for blunt abdominal trauma.MethodsOver 7 months, we conducted a prospective study comparing the evaluation of emergency US for blunt abdominal trauma by surgeons and attending radiologists. US readings from the surgical team and the radiologists were correlated with outcome.ResultsOne hundred-twelve patients were included in the study. Ninety-two patients had an US read as negative by the surgical and radiology services with no subsequent injuries identified. Eighteen patients had an US deemed positive by the surgical service and radiologists. Injuries were confirmed in this group by operation or computed tomography. One patient had an US deemed positive by the surgical team and subsequently negative by the radiologist. A diagnostic peritoneal lavage was performed which was negative. Another patient had an US interpreted as negative by the surgical evaluator and positive by the radiologist. Exploratory laparotomy was negative for intra-abdominal hemorrhage or organ injury. Overall results reveal an accuracy on US reading of 99% for the surgical team and 99% for the attending radiologists.ConclusionSurgeons and surgical residents at different levels of training can accurately interpret emergency ultrasound examinations for blunt trauma from the real-time images, at a level comparable to attending radiologists.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundTo demonstrate the injury patterns of Alpine skiing and snowboarding in a northeastern state and evaluate potential risk factors.MethodsThe medical records of a single pediatric and adult Level I trauma center were evaluated from January 1, 1990, through December 31, 1995. All admissions with injuries caused by Alpine skiing or snowboarding were reviewed. Those patients arriving from two local ski resorts, all of whose injuries are referred to the institution for care, were separated out for consideration. Age, sex, type of injury, date of injury, Injury Severity Score, operations performed, and outcome (including mortality) were evaluated. In addition, resort utilization for the study period was obtained from the two resorts included in the evaluation. Mortality data was obtained from the Vermont office of the Chief Medical Examiner for the same time period.ResultsFor the 6-year period of the study approximately 2,978,000 skier and snowboarder days were recorded at the study sites. Approximately 447,000 of those days were attributed to snowboarders (15%). In all, 279 patients were admitted for injuries (0.01%), 238 were related to Alpine skiing (incidence 0.01%) and 40 to snowboarding (incidence 0.01%). Snowboarders were statistically younger (20 years; range, 4-44 years) than skiers (29 years; range, 6-70 years) (p < 0.001) and had a significantly lower Injury Severity Score (15 in snowboarders vs. 27 in skiers, p < 0.03). Two female patients were injured snowboarding and 68 female patients were injured skiing. Eight percent of injured snowboarders and 16% of injured skiers sustained multiple injuries (p < 0.01). Injury patterns were significantly different. Upper extremity injuries were almost exclusively found in snowboarders (24% vs. 7%, p < 0.003), whereas cruciate ligament injuries occurred far more commonly in skiers (45% vs. 4%, p < 0.001 Lower extremity injuries in general were more common in skiers (78% vs. 38%, p < 0.001). Central nervous system injuries, including head and spine, were evenly distributed over the two groups, although the snowboarders with central nervous system injuries were younger. In addition, splenic injuries were more common in snowboarders (13% vs. 2%, p < 0.01). Snowboarding accidents were far more common in December, March, and April than other months. Fifty-one patients sustained abdominal or chest injuries and only two of these required operative intervention (two splenectomies). Other operative interventions were limited to extremity injuries, injuries of the spine, or placement of an intracranial pressure monitor. There were no fatalities recorded in this population, although over the 6.5 years, there were 25 deaths related to alpine skiing and one to snowboarding in the State (incidence 0.0000009 skier days). Victims tended to be male: 96% of the skiers and the one snowboarder. The predominant cause of death was blunt head trauma followed by blunt chest trauma. Helmets were not worn by those sustaining head injuries or fatalities. Spine injuries were recorded only in extremely young snowboarders and skiers out of control.ConclusionSnowboarders and Alpine skiers are equally prone to injury. Snowboarding accidents are typically less severe and show significantly different injury patterns than skiing accidents. Abdominal and chest injuries in this population are generally amenable to nonoperative management. Prevention programs are best targeted at safe skiing and snowboarding practices, not skiing or snowboarding in poor conditions, use of helmets for skiers, and restraint of snowboard use in very young children.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundRecent clinical reports suggest that early femoral intramedullary rod (IMR) fixation in patients with multiple injuries increases the risk of adult respiratory distress syndrome (ARDS). We have shown that lipid-mediated neutrophil (PMN) priming and elevated circulating levels of secretory phospholipase A2(sPLA2) within the first 24 hours after injury correlate with the development of ARDS. We thus hypothesized that circulating lipid products, generated by sPLA (2) cleavage of intravasated bone marrow, prime PMNs for enhanced superoxide anion (O2-) production.MethodsIsolated PMNs from healthy volunteers were incubated for 5 minutes with buffer or sPLA2-lysedbone marrow (100 U/mL) collected from trauma patients. After formyl-methionyleucylphenylalanine (fMLP) activation, O2-production was quantified by the superoxide dismutase-inhibitable reduction of cytochrome c. Blood samples were also drawn from five injured patients before and 24 hours after femoral IMR fixation. PMNs were isolated and assessed for in vivo priming.ResultsPMNs incubated with sPLA2-lysedbone marrow were primed for more than 3.5 times greater fMLP-induced O2-production. Furthermore, in patients with femoral fractures, PMN O2-release in response to fMLP after IMR fixation was more than 2.5 times higher than before fixation.ConclusionCollectively, the findings suggest that bone marrow released from acute fracture sites may become a lipid substrate for the elevated sPLA2levels found in injured patients. The resultant priming of PMNs may thus render the injured patient at risk for ARDS. Although clearly hypothetical at present, we submit that these observations warrant further investigation because of their clinical implications.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundHistorically, frontal sinus fractures and associated maxillofacial fractures were addressed at different times. We retrospectively reviewed our experience with a series of 79 consecutive patients with bitable frontal sinus fractures, most with associated facial fractures, who underwent early combined cranial and maxillofacial procedures.MethodsThe operations were performed emergently for patients with open or depressed skull fractures and hematomas with mass effect, and electively within 2 weeks for those with closed fractures. The cranial procedures were performed first. The nasofrontal ducts were packed with "cigars" of bacitracin powder wrapped in Surgicel. All patients received antibiotics for 2 weeks.ResultsPostoperatively, good subjective cosmetic results were obtained except in one patient. Eight patients with lumbar drains had expected temporary cerebrospinal fluid (CSF) leaks of less than 72 hours duration. Six postoperative intracranial infections (four cases of meningitis, one epidural empyema, and one intracerebral abscess) were detected; five of these occurred in patients with open depressed fractures. Patients with preoperative CSF leaks (p = 0.0039, Fisher's exact test) and open fractures (p = 0.065, Fisher's exact test) were more likely to develop intracranial infections.ConclusionThe combined neurosurgical and maxillofacial repairs achieved good cosmetic outcomes, with relatively low morbidity. By combining the two-stage procedure into one stage, standard surgical and anesthetic risks could potentially be reduced. Preoperative CSF leaks and open fractures were associated with a higher incidence of postoperative central nervous system infection. Early operations did not appear to be associated with a higher complication rate.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BackgroundTo show that magnetic resonance imaging (MRI) can be useful to diagnose radiographically invisible greater tuberosity fractures in patients with clinical presentations suspicious for rotator cuff injury.MethodsSix patients with subtle greater tuberosity fractures who were sent for MRI because of possible rotator cuff tear are reviewed (age range, 27-51 years; mean, 40.5 +/- 8.4 years). Five of the patients recount direct trauma to their shoulders, whereas one noticed shoulder pain after a fall in which she fractured her ankle.ResultsMRI showed an area of edema confined to the greater tuberosity with linear low signal extending through the tuberosity consistent with a fracture in all cases. Although five patients had a complete set of shoulder radiographs before MRI, these were interpreted as normal in all cases. Full-thickness rotator cuff tears were not present in any of the cases. All of the patients were treated conservatively with good results.ConclusionsMRI can prevent unnecessary arthroscopy in patients clinically suspected of rotator cuff damage by showing subtle fractures of the greater tuberosity not visible on radiographs.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We investigated the effect of intermittent hyperbaric oxygen (HBO) therapy on the bone healing of tibial lengthening in rabbits.Twelve male rabbits were divided into two groups of six animals each. The first group went through 2.5 atmospheres absolute of hyperbaric oxygenation for 2 hours daily, and the second group did not go through hyperbaric oxygenation. Each animal's right tibia was lengthened 5 mm using an uniplanar lengthening device. Bone mineral density (BMD) study was performed for all of the animals at 1 day before operation and at 3, 4, 5, and 6 weeks after operation. All of the animals were killed at 6 weeks postoperatively for biomechanical testing. Using the preoperative BMD as an internal control, we found that the BMD of the HBO group was increased significantly compared with the non HBO group. The mean %BMD at 3, 4, 5, and 6 weeks were 69.5%, 80.1%, 87.8%, and 96.9%, respectively, in HBO group, whereas the mean %BMD were 51.6%, 67.7%, 70.5%, and 79.2%, respectively, in non-HBO group (two tailed t test, p < 0.01, p < 0.01, p < 0.01, and p < 0.01 at 3, 4, 5, and 6 weeks, respectively). Using the contralateral nonoperated tibia as an internal control, we found that torsional strength of lengthened tibia of the HBO group was increased significantly compared with the non-HBO group. The mean percent of maximal torque was 88.6% in HBO group at 6 weeks, whereas the mean percent of maximal torque was 76.0% in non-HBO group (two-tailed t test, p < 0.01). The results of this study suggest that the bone healing of tibial lengthening is enhanced by intermittent hyperbaric oxygen therapy.

ISSN:0022-5282    

出版商:OVID    

年代:1998

数据来源: OVID