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Whether the depth and healing of scalds and contact burns are similar is controversial. Due to water's greater heat capacity, we hypothesized that when exposed to similar temperatures and durations of exposure, burns caused by hot water would be deeper than those caused by contact with hot metal. Forty standardized burns were created in two anesthetized female domestic pigs using a brass bar or circulating heated water. In one pig, the temperature was kept constant (95°C) while the duration of exposure varied (5, 10, 15 seconds) In the second pig, the exposure time was kept constant (10 seconds) while the temperature of exposure varied (70°C, 80°C, 98°C). Periodic punch biopsies were taken to determine burn depth immediately after injury, percentage burns reepithelialized within 21 days, and depth of scar at 28 days. The analysis was performed using analysis of variance. When the temperature was held constant, duration of exposure (5, 10, and 15 seconds) was associated with scar depth (2.1 vs 3.8 vs 5.0 mm, respectively, P = 0.001) but not with burn depth (2.0 vs 2.2 vs 2.3 mm, respectively, P = 0.10). When exposure duration was held constant, temperature (70°C, 80°C, 98°C) was associated with scar depth (0.6 vs 1.7 vs 3.6, P < 0.001) but not with burn depth (1.2 vs 1.5 vs 1.7 mm, respectively, P = 0.21). Burn depths were greater for scald than contact burns although not significantly greater. After controlling for temperature, the difference in scar depth between scalds and contact burns was statistically significant (marginal means 3.0 for contact burns, 4.3 for scalds, P = 0.008). We conclude that burns created in swine with circulating hot water result in deeper scars than those created by contact with a brass bar when controlling for temperature and duration of exposure.

Introducción: Los traumatismos son una de las diez principales causas de muerte a nivel mundial y la primera en personas jóvenes. El traumatismo torácico (TT) es la segunda causa de muerte luego del traumatismo encefalocraneano. Objetivos: Analizar las variables asociadas a mortalidad, las causas principales y la distribución temporal de la mortalidad en hospitalizados fallecidos con TT.Material y método: Estudio observacional de hospitalizados con TT, período enero-1981 a diciembre-2018. Revisión de protocolos prospectivos de TT y base de datos. Se consignaron las causas de muerte sindromaticas principales y se realizó una regresión logística para variables asociadas a mortalidad. Se utilizó SPSS25® con pruebas chi-cuadrado para comparar clasificación, tipo de TT y su distribución temporal, considerando significativo p

Patients with severe burn injuries pose significant challenges for the intensivist. Though average burn sizes have decreased over time, severe burn injuries involving greater than 20% of the total body surface area still occur. Verified burn centers are limited, making the management of severely burn injured patients at nonspecialized ICUs likely. Current practices in burn care have increased survivability even from massive burns. It is important for intensivists to be aware of the unique complications and therapeutic options in burn critical care management. This review critically discusses current practices and recently published data regarding the evaluation and management of severe burn injury.Burn patients have long, complex ICU stays with accompanying multiorgan dysfunction. Recent advances in burn intensive care have focused on acute respiratory distress syndrome from inhalation injury, acute kidney injury (AKI), and transfusion, resulting in new strategies for organ failure, including renal replacement therapy and extracorporeal life support.Initial evaluation and treatment of acute severe burn injury remains an ongoing area of study. This manuscript reviews current practices and considerations in the acute management of the severely burn injured patient.

Rib fractures are a common reason for hospital admission and are associated with significant morbidity and mortality. This article discusses the management of simple rib fractures and provides practical guidance for junior doctors involved in the care of these patients. Careful assessment to identify patients at high risk of complications is essential and calculation of a rib fracture score can aid management decisions. Pain from rib fractures can be severe and requires multimodal analgesia started promptly and proactively on hospital admission. This may include the use of regional anaesthetic techniques such as thoracic epidurals and erector spinae blocks for patients with significant chest trauma or those at high risk of pulmonary complications.

Purpose of review Hyperventilation is commonly used in neurological patients to decrease elevated intracranial pressure (ICP) or relax a tense brain. However, the potentially deleterious effects of hyperventilation may limit its clinical application. The aim of this review is to summarize the physiological and outcome evidence related to hyperventilation in neurological patients. Recent findings Physiologically, hyperventilation may adversely decrease cerebral blood flow (CBF) and the match between the cerebral metabolic rate and CBF. In patients with severe traumatic brain injury (TBI), prolonged prophylactic hyperventilation with arterial carbon dioxide tension (PaCO2) less than 25 mmHg or during the first 24 h after injury is not recommended. Most patients (>90%) with an aneurysmal subarachnoid hemorrhage undergo hyperventilation (PaCO2

This article gives a practical guide to the management of supracondylar fractures of the humerus in paediatric patients, from initial presentation to definitive treatment. It reviews the optimal management of this common and serious injury based on current evidence including the British Orthopaedic Association Standards for Trauma (BOAST) 11 standard.

We aimed to describe elderly engagement in recreational activities, their injury patterns, preinjury risks and outcomes.A 16-year retrospective trauma registry review. All trauma patients ≥65 years admitted after injury sustained during sport were evaluated, and compared to a non-sport cohort of elderly trauma patients.During the study period, 9697 admissions age ≥65 were identified. 526 (5%) were sport-related. Compared to the non-sport group, the sport cohort was younger, had fewer medical comorbidities, and was more severely injured. The common sport mechanisms were skiing, offroad vehicle use and bicycling, and common sport injuries involved lower extremity, chest, and head. Sport patients were more often discharged home than non-sport patients (73% vs 36%, p 0.001). There was no difference in ICU or hospital LOS between groups. The hospital mortality rate was 3% in sport and 5% in non-sport patients (p = 0.06).Over time, the number of elderly sport-related trauma patients increased. Our data suggest that being active may improve outcomes after trauma in older adults.

OBJECTIVES: Each year, pedestrian injuries constitute over 40% of all road casualty deaths and up to 60% of all urban road casualty deaths in Ghana. This is as a result of the overwhelming dependence on walking as a mode of transport in an environment where there is high vehicular speeds, and inadequate pedestrian facilities. The objectives of this research were to establish (1) the impact of traffic calming measures on vehicle speeds and (2) the association between traffic calming measures and pedestrians’ injury severity in built-up areas in Ghana. METHOD: Vehicle speeds were unobtrusively measured in 38 selected settlements comprising 19 “with” and 19 “without” traffic calming schemes. The study design used in this research was a matched case-control. A regression analysis compared case and control casualties using a conditional logistic regression. RESULTS: Generally, the mean vehicle speeds and the proportion of vehicles exceeding the 50 km/hour speed limit were significantly lower in settlements which have traffic calming measures compared with towns without any traffic calming measures. Additionally, the proportion of motorists who exceeded the speed limit was 30% or less in settlements which have traffic calming devices whilst the proportion who exceeded the speed limit was 60% or more in towns without any traffic calming measures. The odds of pedestrian fatality was significantly higher in settlements which have no traffic calming devices compared to those which have, OR=1.98; (95% CI=1.09 to 4.43). The protective effects of a traffic calming scheme which has a speed table was notably higher than where there were no speed tables. CONCLUSION: It was clearly evident that traffic calming devices reduce vehicular speeds and for that matter, the incidence and severity of pedestrian injuries in built-up areas in Ghana. However, the fact that they are deployed on arterial roads is increasingly becoming a road safety concern. Given the emerging safety challenges associated with speed calming measures, we recommend their use to be restricted to residential streets but not on arterial roads. Long term solutions for improving pedestrian safety proposed herein include by-passing settlements along the highways to reduce pedestrians’ exposure to traffic collisions, adopting a modern way of enforcement such as evidence-based laser monitoring in conjunction with a punishment regime which utilizes the demerit points system.

Initial Care of the Severely Injured Patient Trauma care has improved owing to interventions first used on the battlefield. Recent advances include the use of tourniquets, permissive hypotension, t...

RESUMO Objetivo: Identificar a capacidade preditiva de mortalidade dos índices Revised Trauma Score, Rapid Emergency Medicine Score, modified Rapid Emergency Medicine Score e Simplified Acute Physiology Score III em vítimas de trauma contuso internadas em unidade de terapia intensiva e comparar seu desempenho. Método: Coorte retrospectiva de pacientes com trauma contuso de uma unidade de terapia intensiva a partir do registro em prontuários. Receiver Operating Characteristic e intervalo de confiança de 95% da área sob a curva foram analisados para comparar os resultados. Resultados: Dos 165 pacientes analisados, 66,7% tiveram tratamento cirúrgico. A mortalidade na unidade de terapia intensiva e no hospital foi de 17,6% e 20,6%, respectivamente. Para mortalidade na terapia intensiva, houve variação das áreas sob a curva entre 0,672 e 0,738; porém, melhores resultados foram observados em pacientes cirúrgicos (0,747 a 0,811). Resultados similares foram observados para mortalidade hospitalar. Em todas as análises, as áreas sob a curva dos índices não diferiram significativamente. Conclusão: Houve acurácia moderada dos índices de gravidade, com melhora na performance quando aplicados em pacientes cirúrgicos. Os quatro índices apresentaram predição similar para os desfechos analisados.

Purpose: to analyze the relation between Trauma Quality Indicators (QI) and death, as well as clinical adverse events in severe trauma patients. Methods: analysis of data collected in the Trauma Register between 2014-2015, including patients with Injury Severity Score (ISS) > 16, reviewing the QI: (F1) Acute subdural hematoma drainage > 4 hours with Glasgow Coma Scale (GCS) 6 hours; (F10) Surgery > 24 hours. T the chi-squared and Fisher tests were used to calculate statistical relevance, considering p

In 1989, Moore et al. on behalf of the American Association for the Surgery of Trauma (AAST) published the Organ Injury Scale (OIS) for spleen, liver, and kidney.1 This was then updated for spleen and liver in 1994.2 These initial classification schemes were based on an anatomic description of the i

To describe the current state of the art regarding management of the critically ill trauma patient with an emphasis on initial management in the ICU.A PubMed literature review was performed for relevant articles in English related to the management of adult humans with severe trauma. Specific topics included airway management, hemorrhagic shock, resuscitation, and specific injuries to the chest, abdomen, brain, and spinal cord.The basic principles of initial management of the critically ill trauma patients include rapid identification and management of life-threatening injuries with the goal of restoring tissue oxygenation and controlling hemorrhage as rapidly as possible. The initial assessment of the patient is often truncated for procedures to manage life-threatening injuries. Major, open surgical procedures have often been replaced by nonoperative or less-invasive approaches, even for critically ill patients. Consequently, much of the early management has been shifted to the ICU, where the goal is to continue resuscitation to restore homeostasis while completing the initial assessment of the patient and watching closely for failure of nonoperative management, complications of procedures, and missed injuries.The initial management of critically ill trauma patients is complex. Multiple, sometimes competing, priorities need to be considered. Close collaboration between the intensivist and the surgical teams is critical for optimizing patient outcomes.

Fractures at the thoracolumbar region are commonly followed after major traumatic injuries, and up to 20% of these fractures are known to be burst fractures. Making surgical decisions for these patients are of great interest however there is no golden standard so far. Since the introduction of Thoracolumbar Injury Classification and Severity (TLICS) score in 2007, it has been widely used as a referential guideline for making surgical decisions in thoracolumbar fractures. However, there is still limitations in this system. In this clinical case report, we introduce a L1 burst fracture after motor vehicle injury, who was successfully treated conservatively even while she was graded as a TLICS 5 injury. A case report is presented as well as discussion on the limitations of this grading system.

Background Traumatic Brain Injury is a major cause of morbidity and mortality in the pediatric population affecting millions of people yearly. It is important that practitioners have the knowledge and skills to care for these complicated patients, as the initial care can significantly affect the course of the injury. We discuss the initial management of traumatic brain injury based on mild, moderate and severe presentations. Result and conclusion Management strategies to address Intracranial Pressure and Cerebral perfusion pressure, the use of oxygenation and ventilation strategies, temperature, correction of metabolic abnormalities and seizure care are discussed.

Ocular near point of convergence (NPC) has been shown to be sensitive to the effects of concussion and subconcussive impacts. To determine if NPC is also sensitive to a previous history of concussion, male contact-sport athletes either with (n=26) or without (n=16) a history of at least one previous concussion had their NPC assessed. The results showed that participants with a history of concussion displayed NPC values (9.4±1.6 cm) indistinguishable from those with no history of concussion (8.4±2.1 cm, t-test, p=0.09). This was the case regardless of whether 1, 2, or 3 or more concussions had occurred and despite the fact participants with concussion (mean time since last concussion: 1136 days) suffered from an increased number and severity of symptoms as assessed with the SCAT 3 (3.6±2.2 vs. 2.13±1.89 symptoms, 6.1±4.1 vs. 3.19±2.99 severity, t-test, p

This study evaluated the safety impacts of pedestrian countdown signals (PCSs) with and without pushbuttons based on pedestrian crashes and pedestrian injuries in Michigan.This study used 10 years of intersection data-5 years before PCSs were installed and 5 years after they were installed-along with a comparison group, to evaluate the crash impacts of PCSs; at 107 intersections the PCS had a pushbutton and at 96 it did not. At these intersections, and at their comparison sites (where no PCS was installed), crash data (from 2004 to 2016) were examined, along with traffic and geometric characteristics, population, education, and poverty level data.Intersections where PCSs with pushbuttons have been installed showed a 29% reduction in total pedestrian crashes and a 30% reduction in fatal/injury pedestrian crashes. Further, when considering only pedestrians age 65 and below, these respective reductions are 33 and 35%. Intersections with PCSs but without pushbuttons did not show any significant change in any type of pedestrian crash.Although the Manual on Uniform Traffic Control Devices (Federal Highway Administration [FHWA] 2009 ) requires the use of PCSs at new traffic signal installations, this study suggests a safety benefit of installing PCSs with pushbutton at signals where a PCS without a pushbutton is present.

Purpose: We examined radiographic predictors of intervention for blunt renal trauma independent of AAST-OIS (American Association for the Surgery of Trauma-Organ Injury Scale).Materials and Methods...

Angioembolization (AE) is widely used for hemorrhagic control in patients with pelvic fracture. The latest version of the Resources for Optimal Care of the Injured Patient issued by the American College of Surgeons Committee on Trauma requires interventional radiologists to be available within 30 minutes to perform an emergency AE. However, the impact of time-to-AE on patient outcomes remains unknown. We hypothesized that a longer time-to-AE would be significantly associated with increased mortality in patients with pelvic fracture.This is a 2-year retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database from January 2013 to December 2014. We included adult patients (age ≥ 18 years) with blunt pelvic fracture who underwent pelvic AE within 4 hours of hospital admission. Patients who required any hemorrhage control surgery for associated injuries within 4 hours were excluded. Hierarchical logistic regression was performed to evaluate the impact of time-to-AE on in-hospital and 24-hour mortality.A total of 181 patients were included for analysis. The median age was 54 years (interquartile range, 38-68) and 69.6% were male. The median injury severity score was 34 (interquartile range, 27-43). Overall in-hospital mortality rate was 21.0%. The median packed red blood cell transfusions within 4 and 24 hours after admission were 4 and 6 units, respectively. After adjusting for other covariates in a hierarchical logistic regression model, a longer time-to-pelvic AE was significantly associated with increased in-hospital mortality (odds ratio, 1.79 for each hour; 95% confidence interval, 1.11-2.91; p = 0.018).The current study showed an increased risk of in-hospital mortality related to a prolonged time-to-AE for hemorrhagic control following pelvic fractures. Our results suggest that all trauma centers should allocate resources to minimize delays in performing pelvic AE.Therapeutic/care management, level IV.

Background: Blunt pharyngoesophageal injuries pose a management challenge to the trauma surgeon. The purpose of this study was to explore whether these injuries can be managed expectantly without neck exploration. Methods: The National Trauma Databank datasets 2007–2011 were reviewed for blunt trauma patients who sustained a pharyngeal injury, including an injury to the cervical esophagus. Patients who survived over 24 h and were not transferred from other institutions were divided into two groups based on whether a neck exploration was performed. Outcomes included mortality and hospital stay. Results: A total of 545 (0.02%) patients were identified. The median age was 18 years and 69% were male. Facial fractures were found in 16%, while 13% had an associated traumatic brain injury. Of the 284 patients who survived over 24 h and were not transferred from another institution, 65 (23%) underwent a neck exploration. The injury burden was significantly higher in this group as indicated by the higher median Injury Severity Score (17 vs 10, p Conclusion: Pharyngoesophageal injuries are rare following blunt trauma. Only a quarter require a neck exploration and this decision appears to be dictated by the injury burden. Selective non-operative management based on clinical status seems to be feasible and is not associated with increased mortality.

The objective of this study was to investigate the injury incidence and patterns in elite youth football at a category 1 Premier League Academy before and after the introduction of a new development strategy, the Elite Player Performance Plan (EPPP). A prospective study was performed over six consecutive seasons encompassing three years before and after the introduction of the EPPP. The findings revealed a most likely moderate increase in total exposure per player per season when the post-EPPP football exposure (640.86 ± 83.25 hours per player per year) was compared with the pre-EPPP football exposure (539.08 ± 71.59). The total injury incidence pre-EPPP was 3.0/1000 hours compared to 2.1/1000 hours post-EPPP (rate ratio 1.43). 6% of all injuries were re-injuries (20.24 ± 33.43 days) but did not result in a substantially longer absence (16.56 ± 15.77 days). The injury burden decreased for the U12-U15 from pre- to post-EPPP, whereas the injury burden increased for the U16-U18 (respectively 125 and 47% higher). These findings suggest that following the introduction of the EPPP there has been a reduction in injuries in the younger age groups U12-U15 but in the older age groups U16-U18 there has been an increase in the severity of the injuries sustained at this club.

To characterize admission patterns, critical care resource utilization, and outcomes in moderate pediatric traumatic brain injury.Retrospective cohort study.National Trauma Data Bank.Children under 18 years old with a diagnosis of moderate traumatic brain injury (admission Glasgow Coma Scale score of 9-13) in the National Trauma Data Bank between 2007 and 2014.We examined clinical characteristics, critical care resource utilization, and discharge outcomes. Poor outcomes were defined as discharge to hospice, skilled nursing facility, long-term acute care, or death. We examined 20,010 patient records. Patients were 9 years old (interquartile range, 2-15 yr), male (64%) with isolated traumatic brain injury (81%), Glasgow Coma Scale score of 12, head Abbreviated Injury Scale score of 3, and Injury Severity Score of 10. Majority (34%) were admitted to nontrauma hospitals. Critical care utilization was 58.7% including 11.5% mechanical ventilation and 3.2% intracranial pressure monitoring. Compared to patients with Glasgow Coma Scale score of 13, admission Glasgow Coma Scale score of 9 was associated with greater critical care resource utilization, such as ICU admission (72% vs 50%), intracranial pressure monitoring (7% vs 1.8%), mechanical ventilation (21% vs 6%), and intracranial surgery (10% vs 5%). Most patients (70%) were discharged to home, but up to one third had poor outcomes. Older age group had a higher risk of poor outcomes (10-14 yr; adjusted relative risk, 1.32; 95% CI, 1.13-1.54; 15-17 yr; adjusted relative risk, 2.39; 95% CI, 2.12-2.70). Poor outcomes occurred with lower Glasgow Coma Scale (Glasgow Coma Scale score of 9 vs Glasgow Coma Scale score of 13: adjusted relative risk, 2.89; 95% CI, 2.47-3.38), higher Injury Severity Score (Injury Severity Score of ≥ 16 vs Injury Severity Score of9: adjusted relative risk, 8.10; 95% CI 6.27-10.45), and polytrauma (adjusted relative risk, 1.40; 95% CI, 1.22-1.61).Critical care resources are used in more than half of all moderate pediatric traumatic brain injury, and many receive care at nontrauma hospitals. Up to one third of moderate pediatric traumatic brain injury have poor outcomes, risk factors for which include age greater than 10 years, lower admission Glasgow Coma Scale, higher Injury Severity Score, and polytrauma. There is urgent need to optimize triage, care, and outcomes in this vulnerable population.

Compression of the spinal cord can result from trauma, cancer, epidural abscess, or epidural hematoma and can have a variety of clinical manifestations based on the anatomical level and completeness of the compression. Treatment approaches are outlined.

Background The Mangled Extremity Severity Score is a decision-making tool for limb amputation after trauma. The Disabilities of the Arm, Shoulder and Hand questionnaire was developed to quantify posttraumatic functional deficits of the upper extremity. This study aims to determine the correlation between these two assessments. Methods In this study, a retrospective review of all patients with upper extremity injuries who had been treated with vascular reconstruction at two centres between 2005 and 2014 was performed. The respective Mangled Extremity Severity Score was calculated for each participant. Patients were recalled for follow-up examination and assessment of the Disabilities of the Arm, Shoulder and Hand Score. Results In this study, 14 patients met the inclusion criteria. The mean total Mangled Extremity Severity Score was 5.9 and the mean total Disabilities of the Arm, Shoulder and Hand Score was 30 points. There was no statistically significant correlation between these assessments (Spearman's rank correlation coefficient: 0.49, p=0.075). Conclusion The Disabilities of the Arm, Shoulder and Hand Score did not correlate significantly with the Mangled Extremity Severity Score.

There are many clinical decision rules for adults with minor head injury, but it is unclear how they compare in terms of diagnostic accuracy. This study aimed to systematically identify clinical decision rules for adults with minor head injury and compare the estimated diagnostic accuracies for any intracranial injury and injury requiring neurosurgical intervention.Several electronic bibliographic databases covering biomedical, scientific, and gray literature were searched from inception to March 2010. At least two independent reviewers determined the eligibility of cohort studies that described a clinical decision rule to identify adults with minor head injury (Glasgow Coma Scale score, 13-15) at risk of intracranial injury or injury requiring neurosurgical intervention.Twenty-two relevant studies were identified. Differences existed in patient selection, outcome definition, and reference standards used. Nine rules stratified patients into high- and moderate-risk categories (to identify neurosurgical or nonsurgical intracranial lesions). The Canadian Computed Tomography Head Rule (CCHR) high-risk criteria have sensitivity of 99% to 100% with specificity of 48% to 77% for injury requiring neurosurgical intervention. Other rules such as New Orleans criteria, National Emergency X-Radiography Utilization Study II, Neurotraumatology Committee of the World Federation of Neurosurgical Societies, Scandinavian, and Scottish Intercollegiate Guidelines Network produce similar sensitivities for injury requiring neurosurgical intervention but with lower and more variable specificity values.The most widely researched decision rule is the CCHR, which has consistently shown high sensitivity for identifying injury requiring neurosurgical intervention with an acceptable specificity to allow considered use of cranial computed tomography. No other decision rule has been as widely validated or demonstrated as acceptable results, but its exclusion criteria make it difficult to apply universally.

Orbital compartment syndrome is a rare presentation of orbital trauma and is an ophthalmic emergency. Delay in clinical diagnosis and subsequent surgical intervention will lead to loss of vision in nick of time. We presented a case series of orbital compartment syndrome secondary to trauma who presented to the emergency department of Tribhuvan University Teaching Hospital during the devastating earthquake in April 2015. Clinical diagnosis of orbital compartment syndrome was made in the bedside and all the patients underwent emergency lateral canthotomy and inferior cantholysis. This case series was aimed to describe clinical features and management of orbital compartment syndrome.

This report discusses the potential ocular injuries associated with an air-powered salt gun, a new product that may appeal to children. The authors hope to inform both providers and patients of the potential risks and treatment considerations if an injury of this type is sustained. [ J Pediatr Ophthalmol Strabismus . 2019;56:e65–e67.]

Craniomaxillofacial injuries account for a large number of emergency attendances and a substantial proportion of the workload of acute clinicians. Although data exist on frequency of involvement of the craniofacial bones, assessments of severity are lacking, and scoring systems for fractures of individual bones and complex craniomaxillofacial trauma often fail to include the frontobasal unit. To rectify this, we have devised a validated scoring system to evaluate the severity of trauma to this region and have merged it with a pre-existing model to create a cohesive craniofacial disruption index. Published papers were reviewed and the frontobasal unit defined. Clinically important anatomical regions were assigned a graduated score that depended on the severity of disruption, and this was applied in the cases of 13 patients with known craniofacial fractures of varying severity. Correlation with existing models was calculated and used as a marker of validity. Our frontobasal system showed strong positive correlation with a consensus of OMFS clinicians (r=0.783, p0.01). When amalgamated with the pre-existing ZS score to create the Craniofacial Disruption Index, it correlated strongly with all previous scoring systems (r≥0.729, p0.001). The index is a user-friendly, validated model that enables comparison of the severity of complex craniofacial injuries. It has many potential uses because of its digital, automated method of calculation.

Nasal fractures are the most common facial bone fractures, and soft tissue injuries are frequently accompanied. This study intends to make a deep analysis on the relationship between the 2.Patients diagnosed with nasal fracture between 2015 and 2017 were included. Patients younger than 17 years and those with previous facial fractures or aesthetic surgeries were excluded. Nasal fractures were classified according to the Stranc-Robertson (S-R) classification, and the severity of soft tissue injury was evaluated by length and depth. The authors compared the frequency of soft tissue injury between frontal and lateral groups. Second, the authors investigated whether the incidence of soft tissue injuries increases as a function of the increase in the S-R classification both in frontal and lateral group (from plane I to III). The authors also analyzed the difference in severity of soft tissue injuries in each group. Pearson chi-square analysis, linear by linear and Jonckheere-Terpstra tests were used for statistical analysis.Of 621 patients, 296 were frontal plane and 325 were lateral plane. The frontal group had a higher incidence of soft tissue injury than the lateral group (P = 0.004). The incidence of soft tissue injury and severity by depth increased as a function of the increase in the S-R classification only in the frontal group (P = 0.046, 0.019).In nasal fractures, frontal impact is more associated with frequency and severity of soft tissue injury than lateral impact. This seems to be related to the anatomical characteristics of nasal area and mechanism of injuries in each group.

Introdução: O trauma abdominal tem uma alta morbidade e mortalidade, e é fundamental que o seu diagnóstico seja feito o mais rápido possível para minimizar as lesões. Com o objetivo de melhorar a qualidade dos protocolos de suporte à vítima traumatizada, são utilizados programas, usando os índices de gravidade. Objetivo: Avaliar o perfil das vítimas de trauma abdominal, com ou sem politrauma, utilizando os índices de gravidade TRISS e TRISS-like, atendidas no eixo crítico de um hospital referência em urgência e emergência do estado de Sergipe. Métodos: Estudo transversal, observacional do tipo prospectivo, com abordagem quantitativa das vítimas de trauma abdominal. Utilizou-se um instrumento de elaboração própria, tendo como base o instrumento de Domingues (2013), que possui questões objetivas com dados fisiológicos e sociodemográficos sobre a topografia e informações clínicas do estudo. Resultados: Da amostra de 42 pacientes, obteve-se uma média de idade de 33,1 anos, com 81% sendo do sexo masculino e 19% sendo do sexo feminino, em que 61,9% sofreu acidente de transporte com diferença entre mecanismo contuso 66,7% e mecanismo penetrante 33,3%. Todos os acidentes 100% tiveram atendimento pré-hospitalar, sendo que 28,6% foram a óbito e 50% precisaram de cuidados em UTI. O grupo TRISS-like teve menor probabilidade de sobrevida que o TRISS (7,1% vs 97,2%). Conclusão: A causa predominante de trauma abdominal foi acidente de transporte com o mecanismo contuso prevalecendo, maior parte homens, adultos, idade média de 33,1 anos. Todas as vítimas tiveram suporte pré-hospitalar e a taxa de óbito considerável.

Introduction In Taiwan, patients with major trauma are often sent to the closest non-trauma centre for initial resuscitation and transferred to distant trauma centres subsequently. This study aimed to evaluate the in-hospital mortality of severe trauma patients treated in a trauma centre versus in a non-trauma centre. Methods This prospective observational study reviewed 223 patients with major trauma (defined as Injury Severity Scale [ISS] score >15) who visited either a Level I trauma centre or a non-trauma centre from April 2013 to March 2014. Data of clinical status, trauma mechanisms, laboratory and radiology, interventions, and mortality/survival were evaluated. Logistic regression analysis was performed to assess effects of initial hospital treatment on mortality. Results A total of 158 major trauma patients were taken to the trauma centre hospital, and 65 patients were taken to the non-trauma centre. Age > 70 years (odds ratio [OR] 6.24, 95% confidence interval [CI] 1.01 to 38.62, compared to age ≤40 years), Glasgow Coma Scale [GCS] 3-8 (OR 19.00, 95% CI 2.30-157.01, compared to GCS 13-15), GCS 9-12 (OR 28.88, 95% CI 4.40-189.86, compared to GCS 13-15), ISS score >25 (OR 6.95, 95% CI 1.27-38.08) and taken to non-trauma centre initially (OR 30.90, 95% CI 5.00-191.27) were significantly associated with mortality. Conclusion Initial treatment of patients with major trauma in a non-trauma centre was associated with increased mortality compared to initial treatment in a trauma centre.

To characterise children presenting with hot beverage scalds versus scalds caused by starchy water.Retrospective survey of prospectively collected database of all children presenting over a two-year period.There were 138 starch scalds and 262 hot beverage injuries. Children with hot beverage injuries were significantly younger (18.2 months; IQR 14.1, 27.8) than those suffering starch scald injuries (51.4 months; 18.7, 102.3; p0.001). Perineal burns were more common in the starch group than the hot beverage scald group (10.9% vs. 2.4%, p0.001). Chest/breast and abdominal burns were more common in the hot beverage group than the starch group (60.7% vs. 36.9%, p0.001). Children under three years of age in both groups are significantly less likely to receive adequate first aid at the scene (p0.001). There are no differences in the need for skin grafting or scar management when comparing hot beverage scalds and scalds caused by starchy liquids.Scald injuries caused by starchy liquids do not appear to cause a more severe injury than hot beverage scalds. There is a different pattern of injury from starchy liquids in older children. Children under three years old are less likely to receive appropriate first aid at the scene.

Objective In Japan, stroke care is provided through medical cooperation and standardized treatment. However, various factors affect mortality in the hyperacute phase. The present study investigated factors associated with death within 24 h after admission for acute stroke. Methods Among 2335 patients admitted within 24 h after stroke onset from 1 January 2007 to 31 December 2012, a total of 139 deaths occurred. Forty-eight deaths occurred within 24 h after admission. We retrospectively examined the clinical features of these 48 patients. Results The overall mortality rate was 6.0%. When the initial 72-h period was divided into ≤24 h (Period I), >24 to 48 h (Period II), and >48 to 72 h (Period III), deaths were significantly more frequent in Period I than in the other two periods. The frequency of intracerebral haemorrhage (ICH) was also significantly higher in Period I than in the other two periods. Factors significantly associated with death from ICH were systolic blood pressure, hematoma volume, and surgery. Conclusion The mortality rate was low among patients with stroke transported to the authors’ medical center within 24 h of onset. Blood pressure management and the timing of determining indications for surgery are important factors in acute haemorrhagic stroke care.

Introduction Throughout the years, several methods have been developed to help determine injury severity and obtain accurate prognoses in trauma patients. Trauma scores that have been used for more than 40 years are extremely useful in clinical practice as well as in research. Objective To conduct a review of the most relevant literature on trauma and to make a description of each of the scoring tools, focusing on their limitations and their application in clinical trials. Materials and methods Narrative review conducted in different databases such as PubMed, ScienceDirect and OVID. A manual search was also conducted of articles on the subject in both English and Spanish. Results The review articles provided an adequate description of each of the scores, the way they are calculated, the main limitations in their application, and the most relevant findings in the literature. Conclusion There is a wide range of severity scores used in trauma patients for anticipating clinically significant outcomes with varying degrees of accuracy. Creating and validating a single, universally valid score is a huge challenge; consequently, the selection of the scoring tool is based, to a large extent, on experience, the context and the available evidence.

OBJECTIVE:To evaluate the association of a forceps simulation training curriculum for obstetrics residents on rates of severe perineal lacerations after forceps deliveries.METHODS:This was a retrospective cohort study. We created a novel simulation curriculum for forceps-assisted vaginal delivery ba

The authors described the variants of initial surgical d-bridement on the basis of experience of treatment of 183 patients of multistaged treatment program.