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A wide range of factors have traditionally led to early in-hospital death following severe injury. The primary goal of this commentary was to evaluate the causes of early posttraumatic inpatient deaths over an extended period. Although early posttraumatic in-hospital death remains multifactorial, severe traumatic brain injuries are the dominant cause and have increased in proportion over time. Other traditional causes of death have also decreased owing to improved clinical care., Awide range of factors have traditionally led to in-hospital death following severe injury. Although the most dramatic is ongoing hemorrhage and subsequent physiological exhaustion, other factors include severe neurological injuries, [...]

Background: Trauma centres continue to evolve with respect to clinical care and their impact on public health. Despite improvements in patient outcomes, operative volumes, and therefore maintenance of surgical skills, has become a challenging issue. We sought to determine whether injury demographics and treatments at a high-volume centre changed over time. Methods: We used the Alberta Trauma Registry to analyze all severely injured (injury severity score [ISS] ≥ 12) patient admissions over a 16-year period (1995-2011). Results: Of the 12 879 severely injured patients requiring admission, there was a 1.5-fold increase in the annual admission rate despite population normalization (p = 0.001). Over the 16-year interval, patients were older with a subsequent lower mortality (p = 0.001) and length of hospital stay (p = 0.007). In patients with the most severe ISS ([greater than or equal to] 48), there was no change in mortality (27%, p = 0.26). In 2011, falls were the most common mechanism compared with motor vehicle crashes (41% v. 23%; p < 0.001); this was a complete reversal compared with 1995 (25% v. 41%). Motorized recreational vehicle and motorcycle injuries also increased (p < 0.001). The mean number of operations performed by trauma surgeons decreased (laparotomies: 67 [17%] in 1995 v. 47 [5%] in 2011, p < 0.001). Thoracotomies and tracheostomies remained unchanged (p = 0.19). Conclusion: Clinical care has improved despite an increasing overall volume of severely injured patient admissions. The number of operative interventions performed by trauma surgeons continues to decrease concurrent to a change in injury mechanisms. Despite these improvements, maintenance of technical skills among trauma surgeons has become an important issue. Contexte : Les centres de traumatologie continuent d'evoluer au plan des soins cliniques et de leur impact sur la sante publique. Malgre certaines ameliorations, les resultats pour les patients, le volume operatoire et par consequent, le maintien des habiletes chirurgicales sont devenus un enjeu delicat. Nous avons voulu determiner si les caracteristiques demographiques et les traitements en traumatologie ont evolue avec le temps dans un centre qui traite un volume eleve de cas. Methodes : Nous avons eu recours au Registre albertain des traumatismes pour analyser toutes les admissions de grands blesses (indice de gravite des blessures [IGB] ≥ 12) au cours d'une periode de 16 ans (1995-2011). Resultats : Chez les 12 879 grands blesses ayant du etre hospitalises, nous avons note une augmentation selon un facteur de 1,5 du taux annuel d'admissions, malgre une normalisation de la population (p = 0,001). Au cours de cet intervalle de 16 ans, les patients ont graduellement ete plus ages, et la mortalite (p = 0,001) et la duree des sejours hospitaliers (p = 0,007) ont subsequemment diminue. Chez les patients presentant les IGB les plus eleves (≥ 48), on n'a note aucun changement de la mortalite (27%, p = 0,26). En 2011, les chutes ont ete la cause la plus frequente des traumatismes, par rapport aux accidents de la route (41% c. 23%,p < 0,001), ce qui s'est revele etre un renversement complet par rapport a 1995 (25% c. 41%). Le nombre de blessures subies avec des vehicules motorises recreatifs et des motocyclettes a aussi augmente (p < 0,001). Le nombre moyen d'interventions effectuees par les chirurgiens en traumatologie a diminue (laparotomies : 67 [17%] en 1995 c. 47 [5%] en 2011, p < 0,001). Le nombre de thoracotomies et de tracheotomies est reste inchange (p = 0,19). Conclusion : Les soins cliniques se sont ameliores malgre l'augmentation du volume global d'hospitalisations de patients grievement blesses. Le nombre d'interventions chirurgicales effectuees par les chirurgiens en traumatologie continue de diminuer parallelement a une evolution des causes de traumatismes. Malgre ces ameliorations, le maintien des habiletes techniques des chirurgiens en traumatologie est devenu un enjeu important., Over the past 16 years, important advances in the care of injured patients have occurred. These include, but are not limited to, the development of regionalized trauma referral centres, (1,2) [...]

Following the innovations and new discoveries of the last 10 years in the field of lung ultrasound (LUS), a multidisciplinary panel of international LUS experts from six countries and from different fields (clinical and technical) reviewed and updated the original international consensus for point‐of‐care LUS, dated 2012. As a result, a total of 20 statements have been produced. Each statement is complemented by guidelines and future developments proposals. The statements are furthermore classified based on their nature as technical (5), clinical (11), educational (3), and safety (1) statements. [ABSTRACT FROM AUTHOR]

Background: The 'weekend warrior' engages in demanding recreational sporting activities on weekends despite minimal physical activity during the week. We sought to identify the incidence and injury patterns of major trauma from recreational sporting activities on weekends versus weekdays. Methods: We performed a retrospective cohort study using the Alberta Trauma Registry comparing all adults who were severely injured (injury severity score [ISS] [greater than or equal to] 12) while engaging in physical activity on weekends versus weekdays between 1995 and 2009. Results: Among the 351 identified patients (median ISS 18; median hospital stay 6 d; mortality 6.6%), significantly more were injured on the weekend than during the week (54.8% v. 45.2%, p = 0.016). Common mechanisms were motocross (23.6%), hiking or mountain/rock climbing (15.4%), skateboarding or rollerblading (12.3%), hockey/ice-skating (10.3%) and aircraft- (9.9%) and water-related (7.7%) activities. This distribution was similar regardless of the day of the week. Most patients were injured as a result of a ground-level (21.9%) or higher fall while hiking, mountain climbing or rock climbing (25.9%); motocross-related incidents (24.2%); or collision with a tree, person, man-made object or moving vehicle (14.0%). Injury patterns were similar across both groups (allp > 0.05): head (55.8%), spine (35.1%), chest (35.0%), extremities (31.1%), face (17.4%), abdomen (13.1%). Surgical intervention was required in 41% of patients: 15.1% required open reduction and internal fixation, 8.3% spinal fixation, 7.4% craniotomy, 5.1% facial repair and 4.3% laparotomy. Conclusion: The weekend warrior concept may be a validated entity for major trauma. Contexte : Le <> s'adonne a des activites sportives recreatives la fin de semaine, malgre un degre minime d'activite physique durant la semaine. Nous avons voulu mesurer l'incidence des blessures et les types de traumatismes majeurs consecutifs a des activites sportives pratiquees la fin de semaine plutot que les jours de semaine. Methodes : Nous avons procede a une etude de cohorte retrospective a partir du registre de traumatologie de l'Alberta pour comparer tous les adultes victimes d'une blessure grave (score de gravite des traumatismes [greater than or equal to] 12) lors de la pratique d'activites physiques la fin de semaine plutot que les jours de semaine, entre 1995 et 2009. Resultats : Parmi les 351 patients recenses (score median 18, sejour hospitalier median 6 j, mortalite 6,6 %), un nombre significativement plus grand se sont blesses la fin de semaine plutot qu'un jour de semaine (54,8 % c. 45,2 %, p = 0,016). Les activites les plus souvent en cause etaient : motocross (23,6 %), randonnee/alpinisme/ escalade (15,4 %), planche a roulettes ou patins a roues alignees (12,3 %), hockey/ patin sur glace (10,3 %) et activites pratiques dans les airs (9,9 %) et sur l'eau (7,7 %). Cette distribution est demeuree similaire, independamment du jour de la semaine. La plupart des patients ont subi leurs blessures par suite d'une chute au niveau du sol (21,9 %) ou de plus haut lors de randonnees, d'alpinisme ou d'escalade (25,9 %), d'un accident de motocross (24,2 %) ou d'une collision avec un arbre, une personne, un obstacle artificiel ou un vehicule en mouvement (14,0 %). Les types de traumatismes etaient similaires dans tous les groupes (tous, p > 0,05) : tete (55,8 %), colonne vertebrale (35,1 %), thorax (35,0 %), membres (31,1 %), visage (17,4 %), abdomen (13,1 %). Chez 41 % des patients, il a fallu intervenir chirurgicalement : 15,1 % reduction ouverte avec fixation interne, 8,3 % fixation vertebrale, 7,4 % craniotomie, 5,1 % intervention au visage et 4,3 % laparotomie. Conclusion: Le concept de <> pourrait etre une entite valide associee a des traumatismes majeurs., Given that physical activity is associated with personal and public health benefits, both the Centers for Disease Control and Prevention (CDC) and the American Heart Association recommended in 1995 that [...]

Background: Delirium is associated with increased morbidity and mortality in injured patients. Wernicke encephalopathy (WE) is delirium linked to malnutrition and chronic alcoholism. It is prevented with administration of thiamine. Our primary goal was to evaluate current blood alcohol level (BAL) testing and thiamine prophylaxis in severely injured patients. Methods: We retrospectively reviewed the cases of 1000 consecutive severely injured patients admitted to hospital between Mar. 1, 2009, and Dec. 31, 2009. We used the patients' medical records and the Alberta Trauma Registry. Results: Among 1000 patients (mean age 48 yr, male sex 70%, mean injury severity score 23, mortality 10%), 627 underwent BAL testing at admission; 221 (35%) had a BAL greater than 0 mmol/L, and 189 (30%) had a BAL above the legal limit of 17.4 mmol/L. The mean positive BAL was 41.9 mmol/L. More than 4% had a known history of alcohol abuse. More patients were assaulted (20% v. 9%) or hit by motor vehicles (10% v. 6%) when intoxicated (both p < 0.05). Most injuries occurred after falls (37%) and motor vehicle collisions (33%). Overall, 17% of patients received thiamine prophylaxis. Of the 221 patients with elevated BAL, 44% received thiamine prophylaxis. Of those with a history of alcohol abuse, 77% received thiamine prophylaxis. Conclusion: Despite the strong link between alcohol abuse, trauma and WE, more than one-third of patients were not screened for alcohol use. Furthermore, a minority of intoxicated patients received adequate prophylaxis against WE. Given the low risk and cost of BAL testing and thiamine prophylaxis and the high cost of delirium, standard protocols for prophylaxis are essential. Contexte : Le delire est associe a une morbidite et une mortalite accrues chez les traumatises. L'encephalopathie de Wernicke (EW) est un delire associe a la malnutrition et a l'alcoolisme chronique que l'on peut prevenir en administrant de la thiamine. Notre objectif principal etait d'evaluer le recours actuel aux tests d'alcoolemie et au traitement prophylactique a la thiamine chez les grands traumatises. Methodes : Nous avons passe en revue de maniere retrospective 1000 cas consecutifs d'hospitalisation pour traumatismes graves entre le 1er mars 2009 et le 31 decembre 2009. Nous avons utilise les dossiers medicaux des patients et le Registre des traumatismes de l'Alberta. Resultats : Sur 1000 patients (age moyen 48 ans, sexe masculin 70%, indice moyen de gravite des traumatismes 23, mortalite 10%), 627 ont subi un test d'alcoolemie a leur admission; 221 (35%) presentaient un taux d'alcoolemie superieur a 0 mmol/L et 189 (30%) avaient un taux d'alcoolemie au-des sus de la limite permise de 17,4 mmol/L. Le taux moyen des tests d'alcoolemie positifs etait de 41,9 mmol/L. Plus de 4% de ces cas avaient des antecedents d'alcoolisme. Les patients qui etaient sous l'effet de l'alcool ont davantage ete victimes d'agressions (20% c. 9%) ou d'accidents impliquant un vehicule (10% c. 6%; tous deuxp < 0,05). La majorite des traumatismes ont ete causes par des chutes (37%) ou des accidents de la route (33%). Dans l'ensemble, 17% des patients ont recu un traitement prophylactique a la thiamine. Parmi les 221 patients qui presentaient un taux d'alcoolemie eleve, 44% ont recu de la thiamine en prophylaxie. Parmi ceux qui presentaient des antecedents d'abus d'alcool, 77% ont recu un traitement prophylactique a la thiamine. Conclusion : Malgre le lien etroit entre abus d'alcool, traumatismes et EW, plus du tiers des patients n'ont subi aucun test d'alcoolemie. En outre, seule une minorite de patients intoxiques ont recu une prophylaxie adequate contre l'EW. Compte tenu des risques faibles et des couts peu eleves du test d'alcoolemie et de la prophylaxie par thiamine et des couts eleves occasionnes par les episodes de delire, il est essentiel d'instaurer des protocoles standard de prophylaxie., Delirium is associated with increased morbidity and mortality and length of stay in hospital (LOS) for severely injured patients. (1) Many patient variables have been identified as risk factors for [...]

The field of human space travel is in the midst of a dramatic revolution. Upcoming missions are looking to push the boundaries of space travel, with plans to travel for longer distances and durations than ever before. Both the National Aeronautics and Space Administration (NASA) and several commercial space companies (e.g., Blue Origin, SpaceX, Virgin Galactic) have already started the process of preparing for long-distance, long-duration space exploration and currently plan to explore inner solar planets (e.g., Mars) by the 2030s. With the emergence of space tourism, space travel has materialized as a potential new, exciting frontier of business, hospitality, medicine, and technology in the coming years. However, current evidence regarding human health in space is very limited, particularly pertaining to short-term and long-term space travel. This review synthesizes developments across the continuum of space health including prior studies and unpublished data from NASA related to each individual organ system, and medical screening prior to space travel. We categorized the extraterrestrial environment into exogenous (e.g., space radiation and microgravity) and endogenous processes (e.g., alteration of humans' natural circadian rhythm and mental health due to confinement, isolation, immobilization, and lack of social interaction) and their various effects on human health. The aim of this review is to explore the potential health challenges associated with space travel and how they may be overcome in order to enable new paradigms for space health, as well as the use of emerging Artificial Intelligence based (AI) technology to propel future space health research. [ABSTRACT FROM AUTHOR]

Background: Modern trauma care relies heavily on nonoperative, emergent percutaneous procedures, particularly in patients with splenic, pelvic and hepatic injuries. Unfortunately specific quality measures (e.g., arrival to angiography times) have not been widely discussed. Our objective was to evaluate the time interval from arrival to initiation of emergent percutaneous procedures in severely injured patients. Methods: All severely injured trauma patients (injury severity score [ISS] > 12) presenting to a level 1 trauma centre (2007-2010) were analyzed with standard statistical methodology. Results: Among 60 severely injured patients (mean ISS 31, hypotension 18%, mortality 12%), the median time interval to the initiation of an angiographic procedure was 270 minutes. Of the procedures performed, 85% were therapeutic embolizations and 15% were diagnostic procedures. Splenic (median time 243 min, range 32-801 min) and pelvic (median time 278 min, range 153-466 min) embolizations accounted for 43% and 25% of procedures, respectively. The median embolization procedure duration for the spleen was 28 (range 15-153) minutes compared with 59 (range 34-171) minutes for the pelvis. Nearly 22% of patients required both an emergent percutaneous and subsequent operative procedure. Percutaneous therapy typically preceded open operative explorations. Conclusion: The time interval from arrival at the trauma centre to emergent percutaneous procedures varied widely. Improved processes emphasizing patient transition from the trauma bay to the angiography suite are essential. Discussion regarding the appropriate time to angiography is needed so this marker can be used as a quality outcome measure for all level 1 trauma centres. Contexte: De nos jours, en traumatologie, les soins reposent largement sur des interventions non chirurgicales percutanees d'extreme urgence, particulierement chez les patients blesses a la rate, au bassin et au foie. Malheureusement, les indices de qualite specifiques (p. ex., temps ecoule entre l'arrivee et l'angiographie) n'ont pas fait l'objet de discussions approfondies. Notre objectif etait de mesurer le temps ecoule entre l'arrivee et l'instauration des interventions percutanees d'extreme urgence chez les grands blesses. Methodes: Tous les grands polytraumatises (indice de gravite des blessures [IGB] > 12) amenes dans un centre de traumatologie de niveau 1 (2007-2010) ont fait l'objet d'une analyse au moyen d'une methodologie statistique standard. Resultats: Pour 60 patients gravement blesses (IGB moyen 31, hypotension 18 %, mortalite 12 %), le temps ecoule avant l'instauration d'une intervention angiographique a ete de 270 minutes. Parmi les interventions effectuees, 85 % ont ete des embolisations therapeutiques et 15 % des interventions diagnostiques. Les embolisations spleniques (temps ecoule median 243 minutes, intervalle 32-801 minutes) et pelviennes (temps ecoule median 278 minutes, intervalle 153-466 minutes) ont represente 43 % et 25 % des interventions, respectivement. La duree mediane de l'intervention d'embolisation dans le cas de la rate a ete de 28 (intervalle 15-153) minutes, contre 59 (intervalle 34-171) minutes pour les blessures touchant le bassin. Pres de 22 % des patients ont eu besoin d'une intervention percutanee d'extreme urgence et d'une intervention chirurgicale par la suite. Les explorations chirurgicales ouvertes ont generalement ete precedees d'un traitement percutane. Conclusion: Le temps ecoule entre l'arrivee au centre de traumatologie et les interventions percutanees d'extreme urgence varie beaucoup. Il faut, sans contredit, ameliorer les processus en soulignant l'importance du transfert des patients de la salle de traumatologie a la salle d'angiographie et poursuivre la discussion sur le temps ecoule avant l'angiographie pour que ce marqueur puisse servir comme parametre de mesure de la qualite dans tous les centres de traumatologie de niveau 1., Most preventable deaths from trauma are a consequence of untreated hemorrhage and subsequent early exsanguination. Treatment modalities range from minimally invasive percutaneous techniques to invasive open procedures. Angiography has emerged [...]