摘要:

BackgroundAlthough injury is the leading cause of cardiac arrests in children older than 1 year, few studies have examined the survival and functional outcome of cardiopulmonary resuscitation (CPR) in pediatric trauma patients.MethodsA historical cohort of 957 trauma patients younger than 15 years who received CPR at the scene of injury or at the admitting hospital was constructed on the basis of the National Pediatric Trauma Registry. The rate of survival to discharge and factors related to survival were examined. Functional impairments were documented for surviving patients.ResultsThe overall survival rate was 23.5%. With adjustment for the Injury Severity Score, the risk of fatality after CPR increased for children with systolic blood pressure below 60 mm Hg at admission (odds ratio [OR] 24.5, 95% confidence interval [CI] 8.6-69.3), for those who were comatose at admission (OR, 4.7; 95% CI, 1.9-11.6), for those with penetrating injury (OR, 4.4; 95% CI, 1.5-13.3), and for those with CPR initiated at the hospital (OR, 2.4; 95% CI, 1.5-3.9). Surviving patients stayed in hospitals for an average of 24.3 days; at discharge, 64% had at least one impairment in the functional activities of daily living.ConclusionsSurvival outcome of CPR in pediatric trauma patients appears to be comparable to that reported in adults of mixed arrest causes. Future research needs to identify factors underlying the excess mortality associated with penetrating trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundThe purpose of this study was to determine the statistical model that best predicted mortality from blunt trauma using a contemporary population-based database.Methods1994-1995 New York State Trauma Registry data for patients with blunt injuries were used to predict mortality using three statistical models: (1) the original Trauma and Injury Severity Score (TRISS) model based on Major Trauma Outcome Study data, (2) a new TRISS model whose coefficients were derived using New York data, and (3) the International Classification of Disease, Ninth Revision-based Injury Severity Score (ICISS) with predicted survival values obtained from the Agency for Health Care Policy and Research's Health Care Utilization Project. The models were compared with respect to discrimination (using the C statistic) and calibration (using the Hosmer-Lemeshow [H-L] statistic). In addition, the models were tested to see how well they predicted outcomes for each of the three mechanisms of blunt injury.ResultsThe ICISS model had a significantly higher C statistic (0.878) and a better H-L statistic (29.38) for predicting mortality for all adult patients with blunt injuries. The original TRISS model had very poor calibration (H-L = 687.38). None of the three models predicted mortality accurately for victims of motor vehicle crashes or victims of low falls. When separate models were developed for all motor vehicle crashes, low falls, and other blunt injuries, the ICISS and New York TRISS models both fit well, although the calibration was marginal in most cases. The ICISS model had a statistically significantly higher C statistic for other blunt injuries and for motor vehicle crashes. The New York TRISS model had better calibration for low falls.ConclusionsThe ICISS has promise as an alternative to TRISS, but many more comparative studies need to be undertaken using updated TRISS coefficients. Models should also be developed for mechanisms of injury, not just for blunt and penetrating injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundThe study of disabilities, use of health services, and absenteeism of parents among 0- to 17-year-old residents of Jerusalem (n = 432) hospitalized for unintentional injuries.MethodsTelephone interviews with parents, 6 months after hospitalization. Disabilities among 4 to 17 year olds were measured by a 25-item scale derived from the International Classification of Impairments, Disabilities, and Handicaps and by limitations of activities.ResultsSix months after the injury, limitations ranged from 8.3% (daily activities) to 19.4% (sport activities). About one in three presented at least one disability in the 25-item scale. All disabilities were present in higher proportions among adolescents. The more severe injuries whether to the head or other parts of the body presented higher percentages of disabilities. Burns and traffic crashes were associated with higher proportions of disabilities than other causes and with more frequent work absenteeism by their parents.ConclusionA relatively large proportion of children remain with long-term disabilities irrespective of cause and body part injured. Because the sequelae of injuries is multifaceted, rehabilitation should include coordination between health and other services.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo compare the effectiveness of calf-thigh sequential pneumatic compression devices with the effectiveness of plantar venous intermittent pneumatic compression devices in prevention of venous thrombosis after major trauma.Subjects and MethodsWe evaluated 181 consecutive patients after major trauma without lower extremity injuries that precluded the use of pneumatic compression devices. We randomly assigned 149 patients to either calf-thigh sequential pneumatic compression or plantar venous pneumatic compression. After blinding the observers to the method of prophylaxis against deep-vein thrombosis, we performed bilateral compression ultrasonography on or before day 8 after randomization.ResultsAmong 149 randomized patients, 62 who received calf-thigh sequential pneumatic compression and 62 who received plantar venous intermittent pneumatic compression devices completed the trial. Thirteen patients randomized to plantar venous intermittent pneumatic compression (21.0%) and 4 patients randomized to calf-thigh sequential pneumatic compression (6.5%) had deep-vein thrombosis (p = 0.009). Seven of 13 patients with deep-vein thrombosis after prophylaxis with plantar venous intermittent pneumatic compression had bilateral deep-vein thromboses, whereas all 4 patients with deep-vein thrombosis after prophylaxis with calf-thigh sequential pneumatic compression had unilateral deep-vein thrombosis.ConclusionCalf-thigh sequential pneumatic compression prevents deep-vein thrombosis more effectively than plantar venous intermittent pneumatic compression after major trauma without lower extremity injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundOutcome after severe head injury has been shown in some studies to be more favorable in children than in adults. Mortality rates reported range between 20% and 40% for children. Only contradicting data are available regarding the impact of trauma modalities on long-term outcome, or the relative influence of head fractures, intracranial hemorrhages, and brain edema on survival or neurologic sequelae in children.MethodsA retrospective study in a tertiary care facility of long-term outcome of children after severe head injury, and analysis of risk factors for poor outcome. All children up to 16 years of age with severe head injury (Glasgow Coma Scale [GCS] score <or=to 8), which have been treated in the pediatric intensive care unit from 1977 until 1994 in a single institution.ResultsA total of 150 children with severe head injury (GCS score <or=to 8) were treated, 92 of them (61.3%) had traffic-related injuries. The median age was 6.6 years (SD +/- 3.6). There were 96 boys (64%) and 54 girls (36%). Sixty-five children (43.3%) had skull fractures, 87 patients (58.0%) developed an intracranial hemorrhage, and 79 patients (52.7%) developed a diffuse brain swelling/edema visible in computed tomographic scans within 72 hours after trauma. Of 150 children treated, 33 died (22%). In most cases, death was related to the development of secondary brain edema. Fifty-nine children (39.3%) had severe neurologic impairments at the time of discharge. The most significant risk factors for adverse outcome, shown by multivariate analysis, were primary areflexia and secondary brain edema. The risk for development of brain edema and poor prognosis was well predicted by the GCS score.ConclusionThe overall death rate in this study of children with severe head injury was low (22%) compared with other studies. However, the incidence of severe neurologic impairment at discharge remained high. The major risks for death or neurologic impairment were primary areflexia and the development of secondary brain swelling/edema, indicated by a low GCS score.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundTo report the experience in the management of 489 consecutive patients with traumatic intracranial hematoma and determine the prognostic factors.MethodsAll patients were classified into three groups based on the number of operations for each case. A total of 538 operations were performed for evacuation of 720 intracranial hematomas.ResultsThe most common cause of injury was motor vehicular traffic crashes (68.7%) and most victims were motorcyclists (40.1%). The most common type of lesion was acute epidural hematoma (31.0%). The overall mortality rate was 9.6%, and the complication rate was 11.2%. Follow-up assessment of 480 patients revealed that 270 (56.2%) patients made a good recovery, 99 (20.6%) were moderately disabled, 32 (6.7%) were severely disabled, 21 (4.4%) were vegetative, and 58 (12.1%) had died.ConclusionThe surgical outcome was significantly correlated with the score of the Glasgow Coma Scale, pupillary reactivity, number of operations, and type of lesion.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundTo compare magnetic resonance imaging (MRI) and electrophysiologic investigation as prognostic methods in acute head injury.Methods8) or severe (Glasgow Coma Scale score < 8) head injury were included. Both groups were analyzed as a total and separately for outcome as assessed by Glasgow Outcome Score. Two outcome groups were separated (Glasgow Outcome Score 1-3: unfavorable vs. Glasgow Outcome Score 4-5: favorable). MRI scans (T1-, T2-, T2*-sequences; transverse, coronal, and sagittal slices) were obtained 1 to 39 days after trauma (mean, 14 days). Electrophysiologic investigations consisted of median nerve-evoked somatosensory responses to assess corticosubcortical function and brain stem auditory-evoked potentials and brain stem reflexes for brain stem function. Recordings were performed 24 to 72 hours after trauma and repeated every 3 to 5 days.ResultsEvaluation of all patients revealed a prognostic significance of MRI lesions within the corpus callosum, the basal ganglia, the hippocampus, the midbrain, and the pons. In the severe head injury subgroup, significance was limited to lesions within the corpus callosum, the basal ganglia, and the midbrain. Among the electrophysiologic findings, dysfunction of the corticosubcortical region as well as of the midbrain were linked to an unfavorable outcome. In severe head injury, prognostic significance was restricted to bilateral corticosubcortical dysfunction. A statistical test for diagnostic convergence of both methods indicated a distinct convergence only for lesions of the midbrain and the pons.ConclusionMRI scans performed early after head injury provide several indicators for unfavorable outcome. Electrophysiologic investigations add to this prognostic evidence. Both methods have comparably high specificity. However, because of the higher density of prognostic information obtained, MRI seems superior to electrophysiologic testing.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID