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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

Background: Trauma has been a major cause of morbidity and mortality all across the globe. For the improvement of delivery of efficient care to these victims, various trauma severity indices have been devised which make it possible to plan emergency care and assess need for hospitalization and optimize hospital resources. This study was carried out to compare and evaluate Injury Severity Score (ISS) and New Injury Severity Score (NISS) as criteria for admission of trauma patients. Materials and Methods: It was a prospective observational study. The available data were analyzed to determine and compare ISS and NISS as the criteria for admission. The statistical software SPSS (version 20) was used for data analysis. Results: A total of 102 patients were studied at trauma center of our hospital. Out of the total patients, 59.8% of patients had their NISS scores greater than ISS, which showed that NISS is more sensitive and accurate than ISS. It was observed that NISS was not better in predicting hospital stay as compared to ISS. The relationship between NISS and number of hospitalization days was not statistically significant (P = 0.112) whereas ISS was a better predictor of hospital stay (P = 0.042). Conclusion: In this study, it was observed that majority of parameters have favored NISS whereas parameters like hospital stay have favored ISS. Hence, we concluded that NISS is a better score than ISS in many aspects and it can be preferred over ISS as one of the criteria for Hospital admission of trauma patients.

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

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.

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.

Identificar a influencia da gravidade do trauma e do atendimento intra-hospitalar no obito, em vitimas de acidentes motociclisticos. Estudo transversal, quantitativo com 31 vitimas encaminhadas para o Hospital no norte do Parana, entre dezembro de 2016 e marco de 2017. 80,6% das vitimas eram homens, 48,4% das ocorrencias aconteceram durante o dia. As escalas de trauma, Injury Severity Score (TRISS), Revised Trauma Score (RTS) e Injury Severity Score (ISS) evidenciaram escores leves com baixo risco de morte. Houve associacao entre gravidade do trauma e obito, chegaram ao hospital com imobilizacoes corporais 61,3%; o protocolo de atendimento ao trauma foi utilizado em 45,2% dos casos; a cirurgia ortopedica compreendeu 43,4%; houve associacao das cirurgias com o desfecho obito; 90,3% das vitimas nao tiveram infeccao. A gravidade do trauma e cirurgias tiveram associacao com o desfecho obito, todas as vitimas de trauma devem ser atendidas conforme protocolo. Descritores: Servico Hospitalar de Admissao de Paciente, Acidentes de Trânsito, Indices de Gravidade do Trauma, Motocicletas. Influence of accidents and in-hospital procedures on death Abstract : Identification of the influence of trauma severity and the in-hospital care at death, in victims of motorcycle accidents. Cross-sectional, quantitative study, considering 31 victims referred to the Hospital in northern Parana, between December 2016 and March 2017. 80.6% of the victims were men and 48.4% of the occurrences took place during the daytime. The trauma scales, Injury Severity Score (TRISS), Revised Trauma Score (RTS) and Injury Severity Score (ISS) presented soft scores of low risks of death. There was evidence of association between trauma severity and death, 61.3% of the patients arrived at the hospital with bodily immobilizations; the trauma care protocol was used in 45.2% of cases; surgery comprised 43.4% of cases; there was an association of surgeries with the outcome of death and 90.3% of the victims had no infection. The severity of trauma and surgeries were associated with the outcome of death; all trauma victims should be treated according to the protocol. Descriptors: Hospital Service for patient Admission, Traffic-Accidents, Trauma Severity Indices, Motorcycles. Influencia de los accidentes y procedimientos intrahospitales en la muerte Resumen : Identificar la influencia de la gravedad del trauma y del atendimiento intrahospitalario en la muerte, en victimas de accidentes motociclisticos. Estudio transversal, cuantitativo con 31 victimas encaminadas para el Hospital en el Norte del Parana, entre diciembre de 2016 y marzo de 2017. El 80.6% de las victimas eran hombres, un 48.4% de los casos ocurrieron durante el dia. La puntuacion de los traumas, Injury Severity Score (TRISS), RevisedTrauma Score (RTS) y Injury Severity Score (ISS) evidenciaron scores leves con bajo riesgo de muerte. Hubo asociacion entre la gravedad del trauma y la muerte, llegaron al hospital con inmovilizaciones corporales el 61.3%; el protocolo de atendimiento al trauma fue utilizado el 45.2% de los casos; la cirugia ortopedica comprendio 43.4%; hubo asociacion de las cirugias con la muerte; el 90.3% de las victimas no tuvieron infeccion. La gravedad del trauma y cirugias tuvieron asociacion con la muerte, todas las victimas de trauma deben ser atendidas segun el protocolo. Descriptores: Servicio Hospitalar de Admision de Paciente, Accidentes de Transito, Indices de Gravedad del Trauma, Motocicletas.

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

Resumen Objetivos Describir las características, índices de gravedad de traumatismo (IGT), morbilidad, mortalidad y factores asociados a mortalidad en pacientes hospitalizados por traumatismo torácico por arma blanca (TTAB). Materiales y Método Estudio analítico transversal. Período enero de 1981 a diciembre de 2017. Revisión base de datos prospectiva, protocolos quirúrgicos, fichas clínicas. Se describe y compara las características de los TTAB. Se calculó IGT: Injury Severity Score (ISS), Revised Trauma Score ( RTS-T) y Trauma Injury Severity Score (TRISS). Resultados Total 4.163 pacientes hospitalizados por TT, 2.286 hospitalizados por TTAB. Hombres: 2.131 (93,2%), edad promedio 27,8 ± 10,7 años, TTAB aislado 2.035 (89,0%), asociado a lesiones extratorácicas 251 (11,0%) y de éstos 124 (5,5%) se consideraron politraumatismos. Mecanismos principales del traumatismo: agresión 2.246 (98,3%) y autoagresión 22 (1,0%). Lesiones y hallazgos torácicos más frecuentes: neumotórax 1.473 (64,4%), hemotórax 1.408 (61,6%), enfisema subcutáneo 485 (21,2%). Tratamiento definitivo: pleurotomía 1.378 (60,3%), cirugía torácica 537 (23,5%) y tratamiento médico 370 (16,2%). Hospitalización promedio 6,2 ± 6,5 días, IGT: ISS promedio 10,9 ± 7,2, RTS-T promedio 11,6 ± 1,4 y TRISS promedio 3,6. Morbilidad: 318 (13,9%). Mortalidad: 32 (1,4%). Conclusión Los TTAB ocurren frecuentemente en hombres jóvenes por agresión. La mayoría se puede tratar con pleurotomía exclusiva. Aim Our objectives are to describe and correlate the clinical characteristics, trauma severity indexes (TSI) and morbidity and mortality in patients hospitalized for thoracic trauma by a bladed weapon (TTBW). Materials and Method Transversal analytic study. Period January-1981 to December-2017. Prospective database review, surgical protocols, clinical files. The characteristics of the TTBW are described and compared. Injury Severity Score (ISS), Revised Trauma Score (RTS-T) and Trauma Injury Severity Score (TRISS) were calculated. Results Total of 4,163 patients hospitalized for TT, 2,286 hospitalized for TTBW. Men: 2,131 (93.2%), average age 27.8 ± 10.7 years, isolated TTBW 2,035 (89.0%), associated with extra thoracic injuries 251 (11.0%) and of these 124 (5.5%) were considered polytrauma. Main mechanisms of trauma: Aggression 2,246 (98.3%) and self-aggression 22 (1.0%). Most frequent injuries and thoracic findings: pneumothorax 1,473 (64.4%), hemothorax 1,408 (61.6%), subcutaneous emphysema 485 (21.2%). Definitive treatment: Pleurotomy 1,378 (60.3%), thoracic surgery 537 (23.5%) and medical treatment 370 (16.2%). Average hospital stay: 6.2 ± 6.5 days. ISS average 10.9 ± 7.2, RTS-T average 11.6 ± 1.4 and TRISS average 3.6. Morbidity: 318 (13.9%). Mortality: 32 (1.4%). Discussion TTBW are frequent in our environment, unlike on an international level. Conclusions TTBW frequently occur in young male patients due to aggression. The majority can be treated with exclusive pleurotomy.

RESUMO: Objetivo: Estudar fatores associados à perda de produtividade em pessoas envolvidas em acidentes de trânsito (AT). Métodos: Realizou-se uma coorte prospectiva de base comunitária no município de Jequié, Bahia, Brasil, entre 2013 e 2015. Foi aplicado instrumento de coleta em forma de formulário em participantes que se envolviam em AT, seguido de entrevistas a cada quatro meses. Investigou-se, por meio da análise bivariada e multivariável, a associação entre perda de produtividade e variáveis sociodemográficas e ocupacionais, condições de saúde e gravidade das lesões. Resultados: Observaram-se incidência cumulativa de perda de produtividade de 61,1% e densidade de incidência geral de 7,45 casos/100 pessoas/mês. A análise multivariável demonstrou associação com perda de produtividade para quem utilizava o veículo como instrumento de trabalho (razão de densidade de incidência - RDI = 4,23; intervalo de confiança de 95% (IC95%) = 2,90 - 6,17) e aqueles que apresentaram lesão corporal (RDI = 2,80; IC95% = 1,62 - 4,85). Conclusão: São necessárias políticas públicas que assegurem a segurança no trânsito a fim de minimizar os efeitos dos AT sobre a produtividade, além da realização de novos estudos na área para ampliar o conhecimento sobre o tema. ABSTRACT: Objective: To study associated factors with loss productivity in people involved road traffic accidents (RTA). Methods: The population based cohort study was conducted in Jequié, Brazil between 2013 to 2015. The instrument for interview was used in people involved in RTA and interview in four months. Individuals, occupational, health conditions, injury and support variables were used for bivariate and multivariate analysis. Results: The cumulative incidence was loss productivity was 61.1% and density incidence of 7.45 cases/100 person-month. Multivariate analysis showed association for injury (IDR = 4.23; 95%CI = 2.90 - 6.17) and vehicle used with work instrument (IDR = 2.80; 95%CI = 1.62 - 4.85). Conclusion: Public policies are needed to ensure traffic safety in order to minimize the effects of RTA about productivity and to carry news studies to expand knowledge about loss productivity.

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.

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.

Purpose Patient-reported outcome measures (PROMs) have become a cornerstone for the evaluation of the effectiveness of treatment. The Achilles tendon Total Rupture Score (ATRS) is a PROM for outcome and assessment of an Achilles tendon rupture. The aim of this study was to translate the ATRS to Dutch and evaluate its reliability and validity in the Dutch population. Methods A forward–backward translation procedure was performed according to the guidelines of cross-cultural adaptation process. The Dutch ATRS was evaluated for reliability and validity in patients treated for a total Achilles tendon rupture from 1 January 2012 to 31 December 2014 in one teaching hospital and one academic hospital. Reliability was assessed by the intraclass correlation coefficients (ICC), Cronbach’s alpha and minimal detectable change (MDC). We assessed construct validity by calculation of Spearman’s rho correlation coefficient with domains of the Foot and Ankle Outcome Score (FAOS), Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A) and Numeric Rating Scale (NRS) for pain in rest and during running. Results The Dutch ATRS had a good test–retest reliability (ICC = 0.852) and a high internal consistency (Cronbach’s alpha = 0.96). MDC was 30.2 at individual level and 3.5 at group level. Construct validity was supported by 75 % of the hypothesized correlations. The Dutch ATRS had a strong correlation with NRS for pain during running (r = −0.746) and all the five subscales of the Dutch FAOS (r = 0.724–0.867). There was a moderate correlation with the VISA-A-NL (r = 0.691) and NRS for pain in rest (r = −0.580). Conclusion The Dutch ATRS shows an adequate reliability and validity and can be used in the Dutch population for measuring the outcome of treatment of a total Achilles tendon rupture and for research purposes. Level of evidence Diagnostic study, Level I. Electronic supplementary material The online version of this article (doi:10.1007/s00167-016-4242-7) contains supplementary material, which is available to authorized users.

Aim of the study: In Poland, approximately several hundred of individuals die due to falls from a height annually; in some cases, it is difficult to determine explicitly whether the fall was caused by an accident or suicidal attempt. The aim of the study was to verify the usefulness of the 14-point Berghaus scale for differentiation of fatal falls from a height resulting from accidents or suicides. Material and methods: The study material included the results of post-mortem examinations of 41 fatalities of falls from a height performed in the Department of Forensic Medicine in Lublin, which were confronted with the data from the records of prosecutor's proceedings. Conclusions: The analysis of materials confirmed high usefulness of the Berghaus score criteria to conclude whether the fall was accidental or resulted from suicide.bCel pracy/b: Rocznie w Polsce kilkaset osób ginie w wyniku upadków z wysokości i niekiedy trudno jest jednoznacznie rozstrzygnąć, czy w danym przypadku doszło do upadku na skutek nieszczęśliwego zdarzenia czy też targnięcia się na własne życie. Celem pracy była weryfikacja przydatności 14-punktowej skali Berghausa do różnicowania śmiertelnych upadków z wysokości będących następstwem zamachu samobójczego lub nieszczęśliwego wypadku.bMateriał i metody:/bMateriał do badań stanowiły wyniki przeprowadzonych w lubelskim Zakładzie Medycyny Sądowej, poszerzonych badań pośmiertnych 41 ofiar upadku z wysokości, które skonfrontowano z informacjami zawartymi w aktach prowadzonych postępowań prokuratorskich.bWnioski:/bNa podstawie przeprowadzonych analiz potwierdzono, że na podstawie kryteriów skali Berghausa można z dużym prawdopodobieństwem wnioskować, czy do upadku doszło w wyniku nieszczęśliwego zdarzenia czy też targnięcia się na własne życie.

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.

RESUMO: Objetivo: Analisar o efeito do uso de capacete na gravidade de lesões em condutores e passageiros de motocicletas envolvidos em acidentes de trânsito. Métodos: Estudo de corte seccional sobre vítimas de acidentes de transporte terrestre envolvendo motociclistas, atendidos nos serviços de urgência e emergência e participantes do Inquérito de Vigilância de Violências e Acidentes (Viva Inquérito) 2017. Resultados: Verificou-se predomínio de indivíduos na faixa de 18 a 29 anos (46,6%), negros (75,2%) e com ensino médio (50,6%). Em 14,1% dos acidentes houve relato de uso de álcool. O uso do capacete reduziu em 76% a ocorrência de trauma cranioencefálico e em 28% a ocorrência de encaminhamento para outro hospital, internação ou óbito. Conclusão: Motociclistas jovens, negros, de baixa escolaridade e do sexo masculino apresentaram-se mais vulneráveis aos acidentes. O uso do capacete mostrou-se protetor para lesões graves. ABSTRACT: Objective: To analyze the effect of helmet use on injury severity among motorcyclists and passengers involved in traffic accidents. Methods: Cross-sectional study of traffic accidents involving motorcyclists attended at the emergency healthcare units participating in the Violence and Accidents Survey Conducted in Sentinel Emergency Departments (Viva Survey) 2017. Results: There was a predominance of individuals aged 18 to 29 years old (46.6%), black (75.2%), with high school education (50.6%). Alcohol use was observed in 14.1% of cases. Helmet use was associated with a 76% reduction in the occurrence of head trauma and a 28% reduction in the referral, hospitalization or death. Conclusion: Young, male, black individuals and those with low education were the most frequent victims of accidents. Helmet use was protective for severe injuries.

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.

Author(s): Benipal, Simranjeet; Santamarina, John-Lloyd; Vo, Linda; Nishijima, Daniel K. | Abstract: Introduction: The CRASH-2 trial demonstrated that tranexamic acid (TXA) reduced mortality with no increase in adverse events in severely injured adults. TXA has since been widely used in injured adults worldwide. Our objective was to estimate mortality and adverse events in adults with trauma receiving TXA in studies published after the CRASH-2 trial.Methods: We systematically searched PubMed, Embase, MicroMedex, and ClinicalTrials.gov for studies that included injured adults who received TXA and reported mortality and/or adverse events. Two reviewers independently assessed study eligibility, abstracted data, and assessed the risk of bias. We conducted meta-analyses using random effects models to estimate the incidence of mortality at 28 or 30 days and in-hospital thrombotic events.Results: We included 19 studies and 13 studies in the systematic review and meta-analyses, respectively. The pooled incidence of mortality at 28 or 30 days (five studies, 1538 patients) was 10.1% (95% confidence interval [CI], 7.8-12.4%) (vs 14.5% [95% CI, 13.9-15.2%] in the CRASH-2 trial), and the pooled incidence of in-hospital thrombotic events (nine studies, 1656 patients) was 5.9% (95% CI, 3.3-8.5%) (vs 2.0% [95% CI, 1.8-2.3%] in the CRASH-2 trial).Conclusion: Compared to the CRASH-2 trial, adult trauma patients receiving TXA identified in our systematic review had a lower incidence of mortality at 28 or 30 days, but a higher incidence of in-hospital thrombotic events. Our findings neither support nor refute the findings of the CRASH-2 trial but suggest that incidence rates in adults with trauma in settings outside of the CRASH-2 trial may be different than those observed in the CRASH-2 trial.

Resumo Em países desenvolvidos, a violência é a principal causa de lesões bucomaxilofaciais (LBMF). No Brasil, há poucas evidências sobre tais lesões. Objetivou-se caracterizar as LBMF resultantes de agressão física em uma capital do nordeste brasileiro e analisar diferenças entre gêneros. Foram investigados 15.847 laudos do Instituto Médico Legal de São Luís/MA, ocorridos em 2012. Coletaram-se dados socioeconômicos, demográficos e características das LBMF. Utilizaram-se os testes Qui-quadrado e Exato de Fisher para avaliar diferenças entre gêneros. Dos casos periciados, 1977 eram LBMF. Vítimas do sexo feminino, com 20-59 anos de idade, cor parda, sem companheiro e empregadas foram mais afetadas. Lesões do tipo equimose, nas regiões bucinadora e labial, decorrentes do uso de instrumentos contundentes, ocasionando debilidade funcional permanente foram mais incidentes em mulheres (P < 0,05), ao passo que fratura dental, ferida contusa e perfurocontusa, decorrentes de instrumentos cortantes e perfurocontundentes, ocasionando deformidade permanente, incapacidade ocupacional e perigo de vida, em homens (P < 0,05). Conclui-se que a incidência de LBMF decorrente de agressão física é alta em São Luís, MA, e, embora as mulheres sejam mais acometidas, as LBMF em homens são mais severas. Abstract In developed countries, violence is the main cause of oral maxillofacial (OMF) injuries. In Brazil, there are scant records of such lesions. The scope of this study was to detail the OMF injuries resulting from physical aggression in a capital of the Brazilian northeast and analyze gender differences. The Forensic Medicine Institute of São Luís, state of Maranhão, featured 15,847 reports, which occurred in 2012, and they were investigated. Socioeconomic, demographic data and OMF characteristics were analyzed. The Chi-square and Fisher’s Exact tests were applied to assess gender differences. Of the cases examined, 1977 were OMF. Female victims, aged 20-59, dark-skinned, without a partner and maids were the most affected. Ecchymosis-type lesions, in the mouth and lip regions arising from the use of blunt instruments, causing permanent functional impairment, were the most prevalent in women (P < 0.05), whereas dental fracture and contusion arising from sharp instruments causing permanent deformity, occupational disability, and threat to life were detected in men (P < 0.05). The conclusion drawn is that the incidence of OMF due to physical aggression is high in São Luís, state of Maranhão, and although women are the most affected, the OMF in men are more severe.

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: To examine national ladder‐related fall injury patterns and trends, and compare the changes over time in occupational and non‐occupational falls across age groups. Methods: Analysis of national hospital morbidity data to examine trends over time and differences between groups. Results: There were 41,092 hospitalised falls from ladders in Australia over the ten year period from July 2002 to June 2012, rising from 3,374 hospitalisations in 2002/03 to 4,945 hospitalisations in 2011/12. The age standardised rate of ladder‐related fall hospitalisations rose significantly for males, and a higher increase was evident in people aged over 60 years. Occupational falls accounted for 20% of hospitalisations, and the hospitalisation rate for both occupational and non‐occupational falls increased significantly over the ten year period. Conclusions: With almost 5,000 hospital admissions per year in recent years and a significant rise in the rate of hospitalisations over the past decade, this paper highlights the importance of focusing injury prevention efforts to reduce the growing number of ladder‐related falls. Implications: This study demonstrates the significant burden that ladder‐related falls are continuing to have on the community, both in the occupational and domestic setting.

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.

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

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RESUMO Objetivo caracterizar e comparar os aspectos funcionais da deglutição e indicadores clínicos na população com traumatismo cranioencefálico (TCE) em unidade de terapia intensiva. Método Participaram do estudo 113 adultos com diagnóstico de TCE. As etapas de coleta de dados envolveram: a avaliação fonoaudiológica clínica do risco de broncoaspiração, determinação do nível funcional da deglutição (American Speech-Language-Hearing Association National Outcome Measurement System – ASHA NOMS), determinação da gravidade clínica do indivíduo de acordo com a Sequential Organ Failure Assessment (SOFA). Resultados Após a aplicação dos critérios de inclusão, os pacientes selecionados foram agrupados de acordo com os níveis funcionais de deglutição: níveis 1 e 2 – ASHA1 (n=25); níveis 3, 4 e 5 – ASHA2 (n=37); níveis 6 e 7 – ASHA3 (n=51). As análises estatísticas indicaram os seguintes resultados significantes: o grupo ASHA3 apresentou menor gravidade do TCE no momento da avaliação fonoaudiológica, menor tempo de intubação orotraqueal (um terço a menos que o grupo mais grave), ficou menos tempo hospitalizado e necessitou de menos sessões de atendimento fonoaudiológico para o retorno seguro para via oral de alimentação. Os sinais clínicos preditores de broncoaspiração que mais diferenciaram os grupos foi a presença de ausculta cervical alterada e presença de tosse após a deglutição, sendo que o grupo ASHA3 apresentou esses sinais com menor frequência. Conclusão O escore SOFA e o tempo de intubação orotraqueal foram indicadores do prognóstico da funcionalidade da deglutição. A presença ausculta cervical alterada e tosse foram preditores clínicos de disfagia. ABSTRACT Purpose To characterize and compare the functional aspects of swallowing and clinical markers in intensive care patients with traumatic brain injury (TBI) in Intensive Care Unit (ICU). Methods Participants of this study were 113 adults diagnosed with TBI. Data collection stage involved: clinical assessment of the risk for bronchoaspiration performed by a speech-language therapist; assessment of the functional level of swallowing (American Speech-Language-Hearing Association National Outcome Measurement System – ASHA NOMS ); assessment of the patient’ health status (Sequential Organ Failure Assessment - SOFA). Results After the inclusion criteria were applied, patients were grouped according to their swallowing functional level: levels 1 and 2 – ASHA1 (n=25); levels 3, 4 and 5 – ASHA2 (n=37); levels 6 and 7 – ASHA3 (n=51). The statistical analyses indicated the following significant results: the ASHA3 group presented lower severity levels of TBI at the clinical assessment of bronchoaspiration, remained less time intubated (approximately um third less than the more severe group), remained fewer days in hospital and needed less therapy sessions to return to safe oral feeding. The clinical predictor signs for bronchoaspiration that best characterized the groups were the presence of altered auscultation and the presence of coughing after swallowing. Patients in the ASHA3 group presented these signs less frequently. Conclusion The score obtained on the SOFA and the time of orotracheal intubation were identified as the prognostic indicators of functional swallowing. The presence of altered cervical auscultation and coughing were clinical predictors of dysphagia.

Resumo: O objetivo deste estudo foi analisar a tendência do número de mortos, feridos graves e feridos leves por acidentes de trânsito nas rodovias federais brasileiras, segundo macrorregião, antes e depois do início da Década de Ação pela Segurança no Trânsito (DAST). Trata-se de estudo de séries temporais interrompidas com dados sobre acidentes com vítimas, fatais ou feridas, disponibilizados pela Polícia Rodoviária Federal para o período de 2007 a 2017. Utilizou-se o método de Prais-Winsten para o cálculo da variação percentual mensal (VPM) do número de mortos, feridos graves e feridos leves. Antes da DAST, havia uma tendência de aumento mensal do número de mortos nesses acidentes no país (VPM de 0,71%) e em todas as regiões, com destaque para o Sul (VPM de 1,01%) e Centro-oeste (VPM de 0,84%). Verificou-se tendência inversa após o início da DAST, com diminuição significante no Brasil (VPM de -1,24%) e macrorregiões. Para cada pessoa que morre em um acidente em rodovia federal, há, pelo menos, 12 outras, em média, que sofrem lesões não fatais. Houve tendência de aumento do número de vítimas com ferimentos graves (VPM de 0,53%) e leves (VPM de 0,8%) no Brasil e nas macrorregiões no período que antecedeu a DAST. Após a introdução da DAST, houve uma tendência de diminuição nas frequências absolutas significantes desses desfechos nos níveis nacional e regional. Conclui-se que, antes da DAST, houve tendência de aumento mensal do número de vítimas fatais e feridas por acidentes de trânsito nas rodovias federais. Após o início da DAST, em 2011, observou-se tendência inversa, ou seja, de declínio desses desfechos nos locais estudados. Resumen: El objetivo de este estudio fue analizar la tendencia del número de muertos, heridos graves y heridos leves por accidentes de tráfico en las carreteras federales brasileñas, según macrorregión, antes y después del inicio de la Década de Acción por la Seguridad en el Tráfico (DAST). Se trata de un estudio de series temporales interrumpidas con datos sobre accidentes con víctimas, fatales o heridas, reveladas al público por la Policía de Carreteras Federal para el período de 2007 a 2017. Se utilizó el método de Prais-Winsten para el cálculo de la variación de porcentaje mensual (VPM) del número de muertos, heridos graves y heridos leves. Antes de la DAST, había una tendencia de aumento mensual del número de muertos en esos accidentes en el país (VPM de 0,71%) y en todas las regiones, resaltando la Sur (VPM de 1,01%) y Centro-oeste (VPM de 0,84%). Se verificó una tendencia inversa tras el comienzo de la DAST, con una disminución significativa en Brasil (VPM de -1,24%) y en sus macrorregiones. Por cada persona que muere en un accidente en una carretera federal, hay por lo menos otras 12, de media, que sufren lesiones no fatales. Hubo tendencia de aumento en el número de víctimas con heridas graves (VPM de 0,53%) y leves (VPM de 0,8%) en Brasil y en las macrorregiones durante el período que precedió la DAST. Tras la introducción de la DAST, hubo una tendencia de disminución en las frecuencias absolutas significativas de esos desenlaces en los niveles nacional y regional. Se concluye que antes de la DAST hubo una tendencia de aumento mensual en el número de víctimas fatales y heridas por accidentes de tráfico en las carreteras federales. Tras el inicio de la DAST, en 2011, se observó una tendencia inversa, o sea, de declive de esos desenlaces en los lugares estudiados. Abstract: This study aimed to analyze the trend in the number of fatalities, severe injuries, and minor injuries from traffic accidents on Brazil’s federal highways according to the country’s major geographic regions before and after the start of the Decade of Action for Road Safety (DARS). This was an interrupted time series study of data on accidents with fatal or injured victims provided by the Brazilian Federal Highway Police from 2007 to 2017. The Prais-Winsten method was used to calculate the monthly percentage change (MPC) in the number of fatalities, severe injuries, and minor injuries. Before the DARS, there was an upward monthly trend in the number of fatalities in these accidents in the country as a whole (MPC 0.71%) and in all five regions, especially in the South (MPC 1.01%) and Central-West (MPC 0.84%). There was an inverse trend after the start of the DARS, with a significant decrease in Brazil as a whole (MPC -1.24%) and in the major geographic regions. For each person that dies in an accident on a federal highway, at least 12 others suffer non-fatal injuries. There was an upward trend in the number of victims with severe injuries (MPC 0.53%) and minor injuries (MPC 0.8%) in Brazil and in the major geographic regions in the period prior to the DARS. After the start of the DARS, there was a significant downward trend in the absolute frequencies of these outcomes at the national and regional levels. In conclusion, before the DARS, there was an upward monthly trend in the number of fatal and injured victims of traffic accidents on Brazil’s federal highways. After the start of the DARS, in 2011, there was an inverse trend, namely a decline in these outcomes in the country.

Objectives: The causal role of the prototype alarmin high mobility group box 1 protein in systemic inflammation and remote organ injury after trauma and shock is established in animal models but not in humans. Our aim was therefore to determine high mobility group box 1 protein concentration kinetics with high time resolution during the first hours after trauma in individual patients and investigate the association with outcome. Design: Prospective single-center observational study. Setting: University hospital Level I trauma center. Patients: Convenience recruitment of 136 trauma patients. Interventions: None. Measurements and Main Results: Total plasma high mobility group box 1 protein levels were analyzed with enzyme-linked immunosorbent assay in repeated samples. Relationships between predefined predictor variables and outcome were examined in multivariable linear regression models. Ventilator-free days was used as primary outcome measure. Two distinct high mobility group box 1 protein release phases were identified. An initial exponential decay phase with half-life 26 minutes was not correlated with outcome. In contrast, a second high mobility group box 1 protein wave peaking 3–6 hours after trauma in the most severely injured and physiologically deranged patients was consistently the most important predictor of outcome in our multivariable models, rendering all other predictor variables insignificant except for smaller contributions from age and sex, and of admission base excess for maximal creatinine concentration. Conclusions: High mobility group box 1 protein was released in two consecutive phases. Only the second high mobility group box 1 protein wave was a significant predictor of outcome. Patients with a high high mobility group box 1 protein concentration between 3 and 6 hours after trauma might hypothetically benefit from high mobility group box 1 protein-specific antagonist therapy.

RESUMO Objetivo: avaliar a influência do local de ocorrência do trauma nos escores de trauma de pacientes submetidos à laparotomia de emergência. Métodos: estudo retrospectivo observacional analítico. Foram incluídos 212 pacientes submetidos à laparotomias exploratórias no período de janeiro de 2015 e dezembro de 2017. Informações sobre o local do acidente e dados vitais dos pacientes foram obtidas com base na coleta de dados por meio de prontuários eletrônicos e físicos. Foram analisados os índices de trauma de pacientes provenientes de Curitiba e Região Metropolitana e o local em que o paciente foi socorrido (estabelecimento físico ou via pública). Resultados: entre os 212 pacientes estudados, 184 (86,7%) foram trazidos pelo Serviço de Atendimento Pré-Hospitalar provenientes da cidade Curitiba e 28 (13,3%) provenientes de Região Metropolitana de Curitiba. Foram socorridos em estabelecimentos físicos 25 pacientes (17,6%), enquanto 117 (82,4%) foram socorridos em via pública. Observou-se maiores valores de ISS (Injurity Severity Score) dos pacientes procedentes da Região Metropolitana em relação aos procedentes de Curitiba (29,78 vs 22,46, P=0,009), enquanto valores maiores do TRISS (Trauma Trauma and Injury Severity Score) foram observados em pacientes procedentes de Curitiba em relação aos da Região Metropolitana (90,62 vs 81,30; P=0,015). Pacientes socorridos em via pública apresentaram menor valor de RTS (Revised Trauma Score) (6,96 vs 7,65; P=0,024) e TRISS (86,42 vs 97,21; P=0,012). Conclusão: pacientes vítimas de trauma procedentes de locais mais distantes do atendimento no centro de referência apresentaram pior prognóstico à admissão e foi observado pior prognóstico em pacientes socorridos em via pública.

This article presents the recommendations on the pharmacological treatment employed in traumatic brain injury (TBI) at the outpatient clinic of the Cognitive Rehabilitation after TBI Service of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. A systematic assessment of the consensus reached in other countries, and of articles on TBI available in the PUBMED and LILACS medical databases, was carried out. We offer recommendations of pharmacological treatments in patients after TBI with different symptoms. RESUMO Este artigo apresenta as recomendações sobre o tratamento farmacológico empregado para o traumatismo cranioencefálico (TCE) em pacientes ambulatoriais de Reabilitação Cognitiva pós-TCEno Serviço do HCFMUSP Foi realizada uma avaliação sistemática dos consensos publicados em outros países e dos artigos sobre TCE disponíveis nas bases de periódicos médicos como PUBMED e LILACS. Recomendamos tratamentos farmacológicos em pacientes pós-TCE com diferentes sintomas.

Background: Trauma is the leading cause of death in young patients and thoracic trauma (TT) is responsible for 25-35% of trauma deaths. Aim: To describe and compare features, trauma severity indexes and morbidity of patients admitted for TT in the past three decades. Material and Methods: Review of a TT database, operative notes and medical records of patients. These were separated by decade of admission (1981-1990, 1991-2000, 2001-2010). TT characteristics were compared. Injury Severity Score (ISS), Revised Trauma Score (RTS-T) and Trauma Injury Severity Score (TRISS) were calculated. Results: A total of 3,068 TT were reviewed. In the 1981-1990 period, 604 cases of TT were registered (19.7%), in the 1991-2000 period, 1,070 cases (34.9%) and in the 2001-2010 period, 1,394 cases (45.4%) (p < 0.05). The ages of patients in each of these periods were 34.9 ± 15.5, 33.9 ± 16.2 and 35.7 ± 18.2 years respectively (p < 0.05). The proportion of patients aged 65 years or more were 6.6, 7.7 and 10.1% respectively, the proportion of females was 6.1, 9.4 and 12.0%, respectively. The causing agents per decade were knife wounds in 51.5, 61.1 and 60.0% of cases respectively, firearms in 2.5, 3.3 and 5.0% of cases respectively, multiple trauma in 13.9, 14.5 and 9.0% respectively and morbidity in 18.7, 19.7 and 11.7%, respectively. The ISS per decade was 11.9 ± 6.5, 12.9 ± 6.9 and 10.4 ± 6.8 respectively. No significant difference were found in mortality (1.5, 3.0, 2.0% respectively) or TRISS score (2.7, 3.2 and 3.8% respectively). Conclusions: An increase in the number of hospital admission for TT has occurred in the last three decades, with an increase in the proportion of admissions of subjects aged 65 years or more, females and with firearm injuries.

Aim of the study: One of the basic issues discussed in forensic literature regarding falls from a height is determination of fall heights and differentiation between suicidal and accidental falls. The aim of the study was to verify the usefulness of the available methods for the purposes of forensic expertises. Material and methods: The study encompassed fatalities of falls from a height whose autopsies were performed in the Department of Forensic Medicine in Lublin. Results: Similarly to other authors, the severity of injuries was assessed using theiAbbreviated Injury Scale/i(AIS) and injury severity score (ISS). The study findings demonstrated a statistically significant correlation between the fall height and the severity of injuries according to ISS and a statistically significant difference in fall heights between the groups of accidents and suicides.bCel pracy/b: Jednymi z podstawowych problemów poruszanych w piśmiennictwie dotyczącym upadków z wysokości są kwestie ustalania wysokości, z jakiej spadła ofiara, oraz różnicowania między upadkiem samobójczym a upadkiem będącym skutkiem nieszczęśliwego wypadku. Celem niniejszej pracy było zweryfikowanie opracowanych dotąd metod służących ocenie wspomnianych okoliczności zdarzenia na potrzeby opiniowania sądowo-lekarskiego.bMateriał i metody/b: Przedmiotem badań objęto śmiertelne ofiary upadków z wysokości, których sekcje zwłok zostały przeprowadzone w Zakładzie Medycyny Sądowej w Lublinie. Podobnie jak autorzy poprzednich prac, przy ocenie ciężkości obrażeń posłużono się skaląiAbbreviated Injury Scale/i(AIS) oraz indeksemiInjury Severity Score/i(ISS).bWyniki/b: Na podstawie przeprowadzonych badań wykazano m.in. istotną statystycznie korelację między wysokością upadku a stopniem ciężkości urazu wyrażonej przez ISS, a także istotną statystycznie różnicę wysokości upadków pomiędzy ocenianymi grupami nieszczęśliwych wypadków i samobójstw.

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In the 20th century, the complications of head injuries were controlled but not eliminated. The wars of the 21st century turned attention to blast, the instant of impact and the primary injury of concussion. Computer calculations have established that in the first 5 milliseconds after the impact, four independent injuries on the brain are inflicted: 1) impact and its shockwave, 2) deceleration, 3) rotation and 4) skull deformity with vibration (or resonance). The recovery, pathology and symptoms after acute brain trauma have always been something of a puzzle. The variability of these four modes of injury, along with a variable reserve of neurones, explains some of this problem.

The authors suggested the advanced method of vessel separation and hemostasis, which was applied in 13 patients. This method was compared with the traditional method used for 8 patients. Proposed approach allowed separation of vascular fascicle twice faster than in usual way. There were noted a less decrease of hemoglobin level and shortening of hospital stay. The results of treatment were improved due to the application of the method of vessel mobilization and temporal hemostasis in surgery of stab-cut wound of the neck.

Hintergrund In samtlichen Ausbildungsprogrammen zur Traumabehandlung und auch in der S3-Leitlinie „Polytrauma/Schwerverletztenbehandlung“ wird eine Intubation bei einem Glasgow-Coma-Scale(GCS)-Wert von kleiner als 9 empfohlen. Die vorhandene Evidenz fur diese Aussage ist jedoch eher gering. Diese Studie analysiert den Effekt der praklinischen Intubation auf die Mortalitat bei schwerstverletzten Patienten mit einem GCS < 9.