Gunshot injury to spine: An institutional experience of management and complications from a developing country / 中华创伤杂志(英文版)

PURPOSE@#Gunshot wounds are the second leading cause of spinal cord injuries. Surgical intervention for gunshot injury to the spine carries a high rate of complications. There is a scarcity of data on civilian gunshot injuries to the spine in Pakistan. Approximately 60 cases over the last 10 years have been recoded, with unusual presentation and neurological recovery. Thus it is imperative to fill this gap in data, by reviewing cases of civilian gunshot injuries to spine presenting at a tertiary care hospital (Aga Khan University Hospital, Karachi).@*METHODS@#This is a retrospective cohort study. Patients of all ages who presented to the emergency department of Aga Khan University Hospital, with gunshot injuries to spine between January 2005 and December 2016 were included in the study. Data were collected on neurological status (American Spinal Injury Association score was used for the initial and follow-up neurological assessment), extent of cord transection, motor and sensory deficits. The patients were further grouped into those with cord transection, and those with fractures of the bony spine but an intact spinal cord. These patients were then followed and the outcomes were recorded.@*RESULTS@#A total of 40 patients were identified. The mean ± SD of patients age was (30.9 ± 9.5) years. Of the 40 patients with gunshot wounds, 31 had the medical imaging performed at the facility, and hence they were included in this categorization. The remaining 9 patients were excluded from this additional grouping. Thirteen patients were managed surgically and 27 patients underwent the conservative management. The mean ± SD of follow-up was (8.7 ± 7.2) months. In our study, the thoracic spine was the most commonly injured region in gunshot injuries. Of the 31 patients with medical imaging performed at our institute, 17 (54.8%) had cord transection, of whom 8 (47%) ultimately developed paraplegia.@*CONCLUSION@#The prognosis of gunshot injuries to the spine can be varied depending on whether the spinal cord is intact or transected. This will help healthcare providers to plan the further management of the patient and counsel them accordingly.

Prognostic Predictors of Outcome in Patients with Snake Bite, Based on Initial Findings in the Emergency Department

PURPOSE: This study was conducted to identify predictors of serious poisoning in patients with snake bite based on initial findings. METHODS: We conducted a retrospective study of patients with snake bite who were treated at the emergency department between January 2010 and December 2016. The patients were divided into two groups according to the severity of symptoms based on the traditional snakebite severity grading scale. The mild poisoning group (MP) was classified as those who had a grade I snakebite severity during the hospital stay, and the severe poisoning group (SP) was classified as patients who had grade I at the time of admission, but progressed to grade II-IV during hospitalization. Initial clinical manifestations and laboratory findings of the two groups were compared. RESULTS: Bite to hospital time intervals of SP were longer than those of MP (p=0.034), and the local effect score (LES) was higher in SP (p<0.001). Laboratory analyses revealed that creatine phosphokinase (p=0.044), creatine phosphokinase MB isoenzyme (CK-MB, p=0.011) and serum amylase (p=0.008) were significantly higher in SP. LES, CK-MB and serum amylase were significant prognostic predictors as indicated by univariate logistic regression analysis. Multivariate analysis revealed the following two significant predictors: LES (odds ratio=3.983, p<0.001) and serum amylase (odds ratio=1.020, p=0.017). CONCLUSION: In managing cases of snake bites, clinical manifestations and laboratory findings must be carefully evaluated. LES and serum amylase are predictive factors for severe poisoning, which is especially important to rapid determination of the intensive care of the patient.

Identification of prognostic predictors in critically ill non-cancer patients without severe organ failure in a medical long-term care ward / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : The aim of this study was to identify prognostic predictors in critically ill non-cancer patients without severe organ failure in a medical long-term care ward.<br><b>Method</b> : We retrospectively studied 36 non-cancer patients who died in our ward between October 2011 and March 2014. All patients were bedridden with mild impairment of consciousness, were unable to consume food or water, but had no severe organ failure. We attempted to identify the factors that significantly affected their prognosis.<br><b>Result</b> : Mean age was 85 years and the male to female ratio was 19 : 17. Diagnoses were dementia (21cases), senility (8 cases), Parkinson's disease (4cases) and multiple cerebral infarctions (3 cases). Median survival time after subcutaneous drip infusion was 31days. No significant prognostic factors were identified by correlation and multivariate regression. Prognosis for patients who had serum albumin levels under 3mg/dl, however, was worse than in patients with levels above 3mg/dl (27 days vs 61 days , p=0.001).<br><b>Conclusion</b> : We were unable to identify clear prognostic predictors in this study. Serum albumin levels, however, may influence prognosis in critically ill non-cancer patients without severe organ failure.

Comparisons of the Prognostic Predictors of Traumatic Brain Injury According to Admission Glasgow Coma Scale Scores-Based on 1- and 6-month Assessments / 간호학회지

PURPOSE: The purpose of this study was to identify the clinical variables that predict functional and cognitive recovery at 1- and 6-month in both severe and moderate/mild traumatic brain injury patients. METHODS: The subjects of this study were 82 traumatically brain-injured patients who were admitted to a Neurological Intensive Care Unit at a university hospital. Potential prognostic factors included were age, motor and pupillary response, systolic blood pressure, heart rate, and the presence of intracranial hematoma at admission. RESULTS: The significant predictors of functional disability in severe traumatic brain injury subjects were, age, systolic blood pressure, the presence of intracranial hematoma, motor response, and heart rate at admission. In moderate/mild traumatic brain injury patients, motor response, abnormal pupil reflex, and heart rate at admission were identified as significant predictors of functional disability. On the other hand, the significant predictors of cognitive ability for severe traumatic brain injury patients were motor response and the presence of intracranial hematoma at admission, whereas those for moderate/mild patients were motor response, pupil reflex, systolic blood pressure at admission, and age. CONCLUSIONS: The results of the present study indicate that the significant predictors of TBI differ according to TBI severity on admission, outcome type, and outcome measurement time. This can be meaningful to critical care nurses for a better understanding on the prediction of brain injury patients. On the other hand, the model used in the present study appeared to produce relatively low explicabilities for functional and cognitive recovery although a direct comparison of our results with those of others is difficult due to differences in outcome definition and validation METHODS: This implies that other clinical variables should be added to the model used in the present study to increase its predicting power for determining functional and cognitive outcomes.