Risk factors analysis for acute lower deep venous thrombosis in multiple injury patients / 上海交通大学学报（医学版）

Objective • To explore the incidence and analyze the risk factors of acute lower deep venous thrombosis (ALDVT) in multiple injury patients. Methods • A total of 175 multiple injury patients in trauma emergency center of The Sixth People's Hospital, Shanghai Jiao Tong University, from Jan. to Jun. in 2017 were chosen, and their clinical data were collected. The ALDVT group and the non-ALDVT group were differentiated according to the results of ultrasound, and the incidence of ALDVT was calculated. Univariate analysis and multivariate Logistic regression analysis were used to investigate the correlations between the occurrance of ALDVT and the factors, including demographic characteristics, vital signs and hematological parameters. Results • Fifty-six patients (32%) developed ALDVT in 175 multiple injury patients. Univariate analysis showed that there were statistically significant differences in the numbers of multiple injury patients with upper limb fracture, lower limb fracture, spinal injury, pelvic fracture, chest and abdomen injury, higher injury severity score (ISS) (≥ 25 scores), or higher glucose (≥ 10 mmol/L) between two groups (all P<0.05). In the coagulation parameters, compared with the non-ALDVT group, the levels of D-dimer and fibrinogen degradation products in the ALDVT group were significantly elevated (both P=0.001). Multivariate Logistic regression analysis showed that the level of glucose (≥ 10 mmol/L) (P=0.009), ISS (≥ 25 scores) (P=0.024), multiple injury with spinal injury (P=0.048), and multiple injury with pelvic fracture (P=0.029) were the independent risk factors of the ALDVT patients. Conclusion • There is a high occurrence of ALDVT in multiple injury patients. The level of glucose, ISS, multiple injury with spinal injury, and multiple injury with pelvic fracture have important predictive significance for the diagnosis of ALDVT.

Diagnostic value of dynamic-extended focused assessment with sonography for trauma in patients with multiple trauma / 中华危重病急救医学

Objective To investigate the diagnostic value of dynamic-extended focused assessment with sonography for trauma (D-EFAST) in patients with multiple trauma in intensive care unit (ICU). Methods A prospective clinical study was conducted. Eighty patients with multiple trauma admitted to ICU of Anhui Provincial Hospital from September 1st, 2014 to December 31st, 2016 were enrolled. Extended focused assessment with sonography for trauma (E-FAST) check was conducted at first, for those who had positive findings diagnosis was confirmed by immediately CT examination or surgical exploration. If it was negative, the patients received E-FAST every morning for 7 days (defined as D-EFAST), for those with positive findings, immediately CT or surgery was performed to clarify the diagnosis. The final clinical diagnosis was used as the "gold standard" to calculate the diagnostic accordance rate of EFAST and D-EFAST examination technique for pneumothorax, pleural effusion, spleen injury, kidney damage, liver damage, gastrointestinal injury, pericardial effusion, bladder rupture, and pancreatic injury, as well as their sensitivity, specificity, positive predictive value, negative predictive value, accuracy rate, and missed diagnosis rate, and the difference between EFAST and D-EFAST was compared. Results There were 4 patients excluded because of death and abandoning treatment, and finally 76 patients were included in the study. The total sensitivity of E-FAST examination technique for pneumothorax, pleural effusion, spleen injury, liver damage, gastrointestinal injury, pericardial effusion, and bladder rupture was 75.9% (66/87), and the specificity was 98.3% (587/597), the positive predictive value was 86.8% (66/76), and the negative predictive value was 96.5% (587/608), the accuracy rate was 95.5% (653/684), and the rate of missed diagnosis was 24.1% (21/87). The most of the delayed injury in patients with multiple trauma occurred at 2-7 days after injury with incidence of 4.8% (33/684). The diagnostic sensitivity of D-EFAST for delayed injury was 98.3% (118/120), the specificity was 99.8% (563/564), the positive predictive value was 99.2% (118/119), the negative predictive value was 99.6% (563/565), the diagnostic accuracy rate was 99.6% (681/684), and rate of missed diagnosis was 1.7% (2/120). When the final clinical diagnosis was set as the "gold standard", D-EFAST technology for the detection rate was 98.3% (118/120) for patients with multiple trauma on organ injury while the detection rate of E-FAST was 75.9% (66/87), with statistical significant difference (P < 0.01), indicating that D-EFAST was better than E-FAST in check of multiple trauma patients with organ injury. Conclusion Although the E-FAST technology can quickly diagnose the multiple trauma patients and win the rescue time for critical patients, multiple trauma patients injured after 2-7 days prone to delayed damage and are difficult to detect, and D-EFAST can be used to find delayed damage earlier, and reduce the misdiagnosis rate of multiple trauma patients.

Application of rescue video logical slices and interactive analysis in the continuous improvement of nursing quality of multiple injury emergency / 中国实用护理杂志

Objective To explore the role of rescue video logical slice and interactive analysis in the continuous improvement of quality of emergency care of multiple injury. Methods To establish a management team for the rescue video interactive analysis. From May, 2015 to April, 2016, every Wednesday from 8:00-11:00 am, the data of multi-injury patients registered in our management software of critical emergency cases were selected. A typical case study of the rescue video logical slices were processed through sorting the video cases in the video surveillance system installed in the emergency room. According to the characteristics of diagnosis and treatment of multiple injury, the evaluation indexes of nursing quality in emergency treatment of multiple injury were formulated and video data was analyzed interactively by using the failure mode analysis and root cause analysis. Based on the above analyzed results, the quality of emergency care of Multiple Injury was controlled and improved. Before and after performing the rescue video logic slices and interactive analysis management, the examined results of multiple injury first-aid nursing quality index, as well as the rate of patients satisfaction and nursing defects were compared. Results Before the implementation of the above method, the time of emergency treatment for multiple injury, the rate of patients with successful rescue, the rate of patient transport defect and the rate of missing items in the rescue unit were respectively as follows:(87.1±7.4)min, 90.77%(59/65), 30.77%(20/65), 12.31%(8/65),whereas after the implementation, the relevant data were (57.5 ± 5.2) min, 100.00%(68/68), 10.29%(7/68), 2.94%(2/68). The comparative difference before and after the implementation was statistically significant (t=26.84, χ2=2.15, 2.72, 1.72, all P < 0.05). Besides, the satisfaction with the various evaluations of patients′ family members was increased and the differences were statistically significant (χ2=15.45-23.21, P<0.05). Conclusions The introduction of rescue video slices and interactive analysis can effectively reduce the patient′s rescue time, improve the success rate of patients rescues, decrease the rate of patient transport defect and missing items in the rescue unit, effectively control the quality of links, improve the management efficiency, and thus realize the standardized management under normal working condition.

Predictores de mortalidad tardía en niños politraumatizados / Predictors of late mortality in pediatric trauma patients

Introducción: El traumatismo constituye una de las principales causas de mortalidad y morbilidad en niños mayores de 2 años de edad. Métodos: Para identificar predictores de mortalidad tardía en niños politraumatizados entre 2 y 15 años de edad se realizó un estudio observacional, analítico y prospectivo, donde se incluyeron 82 pacientes politraumatizados, divididos según la sobrevivencia. Resultados: La mortalidad tardía fue del 20,7%. En el análisis univariable los factores asociados a mortalidad luego de 24 horas de admitido el paciente fueron: trauma craneoencefálico, lesión de víscera sólida abdominal, GCS (Glasgow Coma Score) < 9 puntos, PTS (Pediatric Trauma Score) < 4 puntos, PRISM (Pediatric Risk of Mortality score) > 20 puntos, coma prolongado, shock, coagulopatía y falla multiorgánica. Mediante regresión logística binaria se identificó como predictores independientes de mortalidad tardía en niños politraumatizados: trauma craneoencefálico (RO: 2,5; 95% IC 1,8 - 8,9, p = 0,039), lesión de víscera sólida abdominal (RO: 1,9; 95% IC 1,5 - 17,3, p = 0,047), PTS < 4 puntos (RO: 3.1; 95% IC 1,7 - 12,8, p = 0,012) y PRISM score > 20 puntos (RO: 3,3; 95% IC 2,2 - 9,2, p = 0,010). La curva ROC mostró un área bajo la curva de 0,803. Conclusión: El PTS y PRISM score son herramientas fiables para predecir mortalidad tardía en niños politraumatizados. El trauma craneoencefálico continúa siendo un predictor importante de mortalidad en el politraumatizado. Diagnosticar precozmente y optimizar el manejo de las lesiones de vísceras sólidas abdominales podría mejorar la sobrevida en este grupo de pacientes. El modelo final resulta útil para predecir desenlace fatal en niños politraumatizados.

Introduction: Trauma is the predominant cause of morbidity and mortality among children over 2 years of age. Methods: To identify predictors for late mortality in pediatric trauma patients between 2 and 15 years of age, an observational, analytical and prospective study was conducted with 82 polytrauma patients, divided according to survival. Results: Late mortality was 20.7%. In a univariate analysis, the factors associated with mortality 24 hours after admission were: traumatic brain injury, intra-abdominal solid organ injury, GCS (Glasgow Coma Score) < 9 points, PTS (Pediatric Trauma Score) < 4 points, PRISM (Pediatric Risk of Mortality score) > 20 points, prolonged coma, shock, coagulopathy and multiple organ failure. By means of binary logistic regression, traumatic brain injury (OR: 2.5; CI 95% 1.8 - 8.9, p = 0.039), intra-abdominal solid organ injury (OR: 1.9; CI 95% 1.5 - 17.3, p = 0.047), PTS < 4 points (OR: 3.1; CI 95% 1.7 - 12.8, p = 0.012) and PRISM score > 20 points (OR: 3.3; CI 95% 2.2 - 9.2, p = 0.010) were identified as predictors of late mortality in pediatric trauma patients. ROC curve showed an area under the curve of 0.803. Conclusion: PTS and PRISM score are reliable tools to predict late mortality in children with polytrauma. Traumatic brain injury remains a significant predictor of mortality in children with multiple traumas. Early diagnosis and optimizing management of intra-abdominal solid organ injury may improve survival in this group of patients. The final model is useful for predicting fatal outcome in pediatric trauma patients.

Epidemiología de la mortalidad por accidentes de tránsito en Granma (2005-2011) / Epidemiology of the traffic accident mortality in Granma (2005-2011)

Introducción: los accidentes de tránsito emergen como un factor de muerte que requiere ser reducido y evitado. Objetivo: describir la epidemiología de la mortalidad por accidentes de tránsito. Métodos: se realizó un estudio descriptivo y retrospectivo, de corte transversal, que incluyó a los pacientes fallecidos por accidentes de tránsito en la provincia Granma, en el período 2005-2011. Resultados: se observó una disminución progresiva de la mortalidad por esta causa, con una media anual de 59,8 defunciones. Predominaron los fallecidos del sexo masculino, con edades comprendidas entre 25 y 44 años, para una razón promedio hombre/mujer de 3,5. Como indicadores de mortalidad, las tasas brutas ajustadas a la población y de años de vida potencialmente perdidos descendieron con el paso de los años, pero permanecen altas. Conclusiones: las muertes por accidentes de tránsito en la citada provincia se produjeron predominantemente en hombres jóvenes, aún con altos indicadores de mortalidad.

Introduction: traffic accidents emerge as a death factor that requires to be reduced and prevented. Objective: to describe the epidemiology of traffic accident mortality. Methods: a descriptive, retrospective and cross-sectional study, which included patients dead by traffic accidents in Granma province in the period 2005 - 2011, was carried out. Results: there was a progressive decrease in mortality from this cause, with an annual average of 59.8 deaths. Dead males aged between 25 and 44 years predominated, for an average male/female ratio of 3.5. As indicators of mortality, the gross rates adjusted to the population and those of potentially lost years of life decreased over the years, but remain high. Conclusions: deaths from traffic accidents in that province occurred predominantly in young men, even with high mortality indicators.

The prognosis and relationship between soluble differentiation antigen of cluster designation 14 and the injury severity score of patients with multiple injuries / 中华急诊医学杂志

ObjectiveTo explore the prognosis and relationship between soluble differentiation antigen of cluster designation 14 (sCD14) and the injury severity score (ISS) of casualties with multiple injuries.Methods A total of 86 casualties with multiple injuries were enrolled from October 2009 to March 2010,and the severity of trauma of casualties were assessed in ISS score within the first 24 hours after accident,and the patients were divided into survival and non-survival groups as per the outcomes in 28 days after accident. Another 20 healthy subjects served as control group. In multiple injuries group,sCD14 concentrations were detected and APACHE Ⅱ scores were calculated on the 1st,3rd,5th and 7th days after accident.The related coefficient between sCD14 and ISS was calculated and then the values of sCD14 in predicting prognosis were analyzed by ROC curve. ResultsCompared with control group, sCD14 concentrations were obviously higher in casualties of multiple injuries group at all observation intervals ( P ＜0.01). Compared with survival group, casualties of non-survival group had more higher sCD14 concentrations and APACHE Ⅱ scores ( P ＜ 0.05 ).The sCD14 concentration was correlated with ISS and the related coefficient was 0.469 ( P ＜ 0.01 ). ROC curve analysis suggested sCD14 had values in predicting prognosis of casualties with multiple injuries and area under ROC curve was 0.820.Conclusions The concentration of sCD14 is correlated with ISS and can be used for predicting the prognosis of casualties with multiple injuries.

Variation of T regulatory cells and its relation with injury severity and sepsis in patients with se-vere multiple injury / 中华创伤杂志

Objective To observe change of T regulatory cells (Tregs) and its relation with in-jury severity and sepsis following severe muhiple injury. Methods A total of 60 patients were em-ployed in the study and divided into severe group (30 patients) and critical group (30 patients) based on ISS scores and into sepsis group (22 patients) and non-sepsis group (38 patients) based on complication of sepsis. The proportion of Tregs in peripheral blood in different groups was detected by flow cytometry at days 1,3,5 and 8 after injury. Results The proportion of Tregs was significantly increased at day 5 postinjury, with statistical difference compared with that at day 3 postinjury (P < 0.01). The proportion of Tregs remained increasing at day 8 pestinjury (P < 0.05). At day 8 postinjury, the proportion of Tregs in critical group was significantly higher than that in severe group (P < 0.01). At the same time, the proportion of Tregs in sepsis group was significantly higher than that in non-sepsis group (P < 0.05). Spearman correlation analysis showed a positive correlation of Tregs proportion with ISS score (rs =0.654, P < 0.01). Conclusions Tregs play an important role in suppression of T cell-mediated im-munity after severe injury. The variation of Tregs can help evaluate prognosis and predict the risk of com-plicating sepsis in patients with severe multiple injury.

Relationship of neutrophil apoptosis and caspase-3 activity with multiple organ dysfunction syn-drome after multiple injury / 中华创伤杂志

Objective To investigate apoptosis of polymorphonuclear neutrophil and activity of caspase-3 in the peripheral blood and discuss their correlation with development of multiple organ dysfunc- tion syndrome (MODS) after multiple injury. Methods A total of 55 patients with multiple injury were included in the prospective study, and divided into two groups, ie, MODS group (multiple injury patients who developed MODS,) and non-MODS group (multiple injury patients who were free from MODS). The activity of caspase-3 was detected by flow cytometry and the serum levels of IL-6 and IL-10 were detected by ELISA. Then, we evaluated whether the neutrophil apoptesis was correlated with the ser- um levels of IL-6 and IL-10 in patients with MODS. Results Compared with non-MODS group, neu- trophil apoptesis was significantly reduced and activated caspase-3 decreased significantly in MODS group (P <0.05). In MODS group, serum IL-6 was increased significantly while serum IL-10 was decreased significantly compared with non-MODS group. The apoptosis of neutrophil in multiple injury patients with MODS had a negative correlation with IL-6 levels but a positive correlation with IL-10 levels. Conclu- sions The delayed apoptosis of neutrophil due to decreased activated caspase-3 may play partial roles in the development of MODS after multiple injury. IL-6 and IL-10 may contribute to the apoptotic changes.

Effect of immune enteral nutrition support on the patients in early stage after severe multiple injury / 中华急诊医学杂志

Objective To explore the recuperative effect of immunological function and nutritional status on the patients treated by immune enteral nutrition in early stage after severe multiple injury (SMI). Method The patients with SMI,in department of Trauma Surgery,Tongji Hospital,Tongji Medical College, Huazhong University of Science and Technology,between January 2006 to May 2007 were randomly divided into 2 groups: immune enteral nutrition group (IEN group, 20 cases), enteral nutrition group (EN group, 20 cases). The health persons served as the control group(15 cases) .Since 1st postinjury day, all patients were treated with nutritional support. The T-cell subgroup in periphera blood were detected by FCM and the level of PA, RBP, IL-2 and IL-4 in blood serum were detected by ELASA on the 1st, 3rd,5th, 8th postinjury day. Results After the treatment of IEN and EN,the serum levels of PA, RBP and the proportion of T-cell subgroup were significantly increased on the 8th postinjury day compared with on 1st postinjury day (P ＜ 0.01), but there were no differences between IEN group and EN group. The level of IL-4 were significantly decreased and the level of IL-2 were significantly increased in each group on 8th postinjury day, at same time, the level of IL-2 were significantly increased in IEN group compared with EN group (P ＜ 0.05), and the level of IL-4 were significantly decreased in IEN group compared with EN group (P ＜ 0.05). The duration of SIRS was transient and the infected complication was low on the patients treatment by IEN than EN. Conclusions On the patients with severe multiple injury, IEN was most ascendant than EN to improve the immunosuppression and clinical prognosis.

Conservative Treatment of the Displaced Clavicular Shaft Fracture in Multiple Injury

PURPOSE: To analyse the comparative clinical results between adults with multiple injury including the clavicular shaft fracture and only clavicular shaft fracture who had supportive care through retrospective aspect. MATERIALS AND METHODS: We had 48 adult patients in this hospital with simple fracture and multiple injury including the clavicular shaft whom we were able to evaluate at least more than a year. 12 of 48 patients were with only clavicular shaft fracture and the rest of them were with multiple injury. We classified patients into two groups those who had fracture with displacement for group A (A1 for the cases with over 50% of fracture surface contact rate and A2 for less than 50% from the images of simple X-ray) and those who had comminuted fracture for B. We compared the time of bone union, nonunion rate of only clavicular fractures and multiple injury, clinical results for patients who had supportive care with retrospective aspect. RESULTS: A1 (7 cases), A2 (4 cases), B (1 case) were prevalent in the group of only clavicular shaft fracture and A1 (8 cases) and A2 (16 cases) and B (12 cases) were prevalent in the group of multiple injury. For the cases with supportive care, we could find 1 nonunion case (8%) and 11 union cases on average 2.91 months in the group of only clavicular shaft fracture and 7 nonunion cases (19%) and 29 union cases on average 3.58 months in the group of multiple injury. The best clinical results had occurred in 8 cases (67%) of only clavicular shaft fracture group and 19 cases (53%) of multiple injury group. We could find out the union from all 8 nonunion cases that took operation afterward. CONCLUSION: Although the choice of treatment of clavicular fracture is supportive care, but multiple injury including the clavicular fracture is a high-energy injury, so the possibility of comminuted and displacement is high, so that nonunion rate is high. The possibility of early surgery must be considered seriously.

Changes of plasma thrombomodulin levels in multiple-injury patients and their relation with disseminated intravascular coagulation / 第三军医大学学报

Objective To explore the relation between traumatic disseminated intravascular coagulation (DIC) and the level of plasma thrombomodulin (TM) in severe multiple-injury patients. Methods Sixty-six multiple-injury patients were divided into minor-injury group (ISS

Sedative effect of disoprofol used in cases of multiple injury / 重庆医科大学学报

Objective:To study the sedative effect of disoprofol used in cases of multiple injury.Methods:13 cases of multiple injury were analyzed retrospectively.All patients were induced sedative with disoprofol.The change in vital signs,blcod gas analysis,PaO_2/FiO_2,etc were observed.Results:In the initial stage,cases of multiple injury could develop fidgety,increase in breath and blood pressure.Disoprofol could ameliorate the heart rate,reath,blood pressure and PaO2/FiO2 quickly.Conclusion:Disoprofol have the quick and positive sedative effect in comprehens-ive therapy for multiple injury.

Renal Trauma, 80 cases / 대한비뇨기과학회지

Recently, renal traumas caused by traffic and industrial accidents have risen sharply due to rapid industrialization and an increase in automobiles. Renal traumas in such a modem industrialized era show different aspects compared with those in the past. We reviewed the charts and x-ray films of the 80 patients who had been hospitalized due to renal trauma during the period January 1988 to June 1993 to examine the causes and the extents of trauma, methods of imaging study, their treatments and results. According to the review, the ratio of men to woman was 66:14. with 46 cases in the active 21 to 50 age group. By cause, traffic accidents comprised 41 cases or 51.3%, falls marked 20 cases, followed by 16 cases of assault and 3 cases of stab injury. 5 patients died among the 28 cases suffering serious renal trauma associated with multiple injuries, for a high mortality rate of 19%. The reason for this high rate was that the degree of multiple injuries with renal trauma was most severe in traffic accidents and falls. We are of the opinion that close and prompt cooperation with other associated medical departments is mandatory in order to reduce morbidity and mortality caused by multiple injury.

Clinical Study of the Mlutiple Injuries in Children / 대한정형외과학회잡지

Accidents are the leading cause of childhood mortality and rank second only to acute infections as the cause of morbidity. The hospital morbidity and long term sequelae of injuries in children have greater medical and social significance than in adults. In order to determine what role the skeletal injuries play in morbidity and residual impairment in the severely injured children, We studied 75 consecutive surviving children who had multiple injuries, including a major fracture of at least one extremity or of the pelvic girdle. The severity of injuries was classified according to the Modified Injury Severity Scale (MISS) and compared severity of injuries with residual impariment. The results were obtained as follows. 1. Of 75 injured children, boys were 47 and 33 of the children were 6 to 10 years old. 2. Cause of injury of 66 children was motor-Vehicle related accident. 3. Most frequently combined injury with muosulosgkeletal injury was neural injury. 4. There were 133 fractures in 75 children and femoral fracture was most frequent. 5. The mean score on the MISS of 75 children was 21. Fifty-three ehildren had a score of 25 points or less. 6. Twenty-eight children had residual impairment, and their mean on the MISS was 25. 7. Most of the musculoskeletal impairment were attributable to the nature of initial injury.