Is post-traumatic stress disorder related to the severity of physical trauma?

SUMMARY OBJECTIVE: Trauma can cause physical morbidity and even result in death. Besides, it can lead to serious mental problems as well. The most well-known mental health problem is post-traumatic stress disorder. Through this study, it was primarily aimed to find out whether the severity of physical trauma is effective on post-traumatic stress disorder and other risk factors if any. METHODS: The reports of the patients who were transferred to the Turkish Council of Forensic Medicine Third Speciality Board between January 01, 2019, and December 31, 2020, for post-traumatic invalidity or disability evaluation and whose psychiatric examinations were performed were retrospectively analyzed in the electronic environment. RESULTS: It was found that 34 (26.4%) of the patients had a diagnosis of post-traumatic stress disorder (under treatment for at least 6 months), while 76 (58.9%) of them did not have a psychiatric disease and 19 (14.7%) of them had mental disorders not associated with trauma (i.e., affective disorder, anxiety disorder, etc.). No significant correlation was found between trauma scores and post-traumatic stress disorder (p>0.05). CONCLUSION: Based on the results of our study, post-traumatic stress disorder and the severity of physical trauma are not significantly correlated. Being of female gender, sustaining a non-accidental injury, and witnessing a fatal event stand out as significant risk factors.

Characteristics of injuries resulting from falls from height in the construction industry

INTRODUCTION@#Falls from heights contribute to 34% of fatal accidents in Singapore. Of these, 51% of the accidents occur in the construction industry. This retrospective review, of all persons falling from heights in the construction industry from 2006 to 2012 and attending a major hospital, analysed injury patterns and related them to mechanisms and contributory factors.@*METHODS@#Information collected included injury and casualty characteristics, safety measures, pre-existing medical conditions and clinical outcomes.@*RESULTS@#Of 1,085 patients, 951 were male with a mean age of 39.8 years, mean height of 165.9 cm and mean weight of 69.7 kg. Most of the casualties fell between 0800 and 2000 hours. Among the severely injured patients, 2.4% had head injuries, 54.9% had chest injuries and 39.2% had abdominal and pelvic injuries. For these casualties, the mortality rate was 60.8%. For patients with less than major trauma, the commonest injuries were in the lower limbs (41.8%), upper limbs (40.8%) and spine (22.2%). All the casualties survived. Falls from scaffolding, formwork and platforms were the most common causes of severe injuries (41.1%). Safety helmets and harnesses were reported to be used in 1.8% and 4.1% of instances of falls, respectively.@*CONCLUSION@#Studying the patterns of injuries following falls at construction sites has the potential for injury prevention through safe practices, use of safety equipment and targeted training.

Analysis of Related Factors Affecting the Risk Assessment of Death during Hospitalization of Extremely Low Birth Weight Infants / 中山大学学报(医学科学版)

ObjectiveTo explore the influencing factors of different scores on predicting death risk of extremely low birth weight infants （ELBWI）. MethodsA total of 186 cases of ELBWI admitted by the Children's Hospital affiliated to Nanjing Medical University and the Lishui Branch of the Affiliated Zhongda Hospital of Southeast University were admitted from January 1， 2019 to January 1， 2021， and 125 ELBWIs were finally included after screening by inclusion and exclusion criteria. There were 47 cases in the death group and 78 cases in the survival group. General data and the items of score for neonatal acute physiology version Ⅱ （SNAP-Ⅱ）， simplified version of the score for neonatal acute physiology perinatal extension （SNAPPE-Ⅱ）， clinical risk index for babies （CRIB）， clinical risk index for babies Ⅱ （CRIB-Ⅱ） and the national critical illness score （NCIS） were collected. Univariate and multivariate analysis was performed and nomogram was evaluated using receiver operating characteristic curve （ROC）. ResultsIt was found that systolic blood pressure， maximum inhaled oxygen concentration， BE value and birth weight were important factors in ELBWI mortality risk assessment ［systolic blood pressure OR： 0.968， 95%CI： 0.938-0.999， P=0.043； maximum inhaled oxygen concentration OR： 1.020， 95%CI： 1.006-1.034， P=0.006； BE OR： 0.868， 95%CI： 0.786-0.959， P=0.005； birth weight OR： 0.994， 95%CI： 0.991-0.997， P=0.000］. ROC showed that the area under the curve of the above four variables is 0.71， and the 95% confidence interval is 0.610-0.799， which is better than CRIB score. ConclusionLower systolic blood pressure， higher inhaled oxygen concentration， higher BE and lower birthweight are important influencing factors to predict the death risk of ELBWI. The above four items should be included in the newly developed score assessment to obtain a more effective ELBWI prediction system.

Chinese expert consensus on emergency surgery for severe trauma and infection prevention during corona virus disease 2019 epidemic (version 2023) / 中华创伤杂志

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Analysis of sex differences in severe traumatic death patients of different ages / 中国基层医药

Objective:To investigate the sex differences in severe traumatic death patients of different ages.Methods:A total of 408 patients with severe trauma who received treatment in The Second Affiliated Hospital of Zhejiang University School of Medicine and Taizhou First People's Hospital from June 2017 to June 2022 were retrospectively analyzed. These patients were divided into the children group (≤ 14 years old, n = 47), the adult group (14-50 years old, n = 171), and the older adult group (> 50 years old, n = 90). Multivariate logistic regression was used to evaluate the difference in sex-based mortality among the groups. Nonlinear regression was used to evaluate the mutual interaction of increasing age and sex on the predicted survival rate. Results:Traffic accidents were the most common cause of death among men in the adult group (58.93%, χ2 = 7.95, P = 0.027). Falls were the most common cause of death among men in the older adult group (57.36%, χ2 = 8.63, P = 0.001). The Injury Severity Score of women in the adult and older adult groups was significantly higher in women than that of men in the same group [adult group: men: (24.39 ± 4.17) points, women: (26.32 ± 4.31) points, t = 2.84, P = 0.005). The incidence of post-traumatic complications in the older adult group was very higher in men than in women (respiratory failure: 28.68% in men, 14.75% in women, χ2 = 4.37, P = 0.036; circulatory failure: men: 27.13%, women: 13.11%, χ2 = 4.64, P=0.031; neuropsychiatric disorders: men: 20.93%, women: 8.20%, χ2 = 4.79, P = 0.029; respiratory infection: men: 31.78%, women: 18.03%, χ2 = 5.55, P = 0.047; other infectious diseases: men: 28.68%, women: 13.11%, χ2 = 0.69, P = 0.018). After adjusting for covariates, the mortality rate of men in the older adult group was significantly higher than that of women in the same group ( OR: 1.261, 95% CI: 1.185-1.343, P < 0.001). With the increase of age, the predicted survival rate after the trauma in patients of different sexes also decreased, in particular in men aged > 50 years (interaction P = 0.051). Among patients with blunt and severe head trauma, age-related mortality decline in patients aged > 50 years had a strong interaction with sex (interaction P = 0.002). In patients with penetrating trauma, there was a weak interaction between the predicted survival rate of different sexes (interaction P = 0.192). Conclusion:There is no significant difference in age-related change in post-traumatic mortality between different sexes. In the population aged > 50 years, men have a relatively higher risk of death than women.

Predictive values of the Status Epilepticus in Pediatric Patients Severity Score and END-IT score for short-term prognosis of children with status epilepticus / 中华实用儿科临床杂志

Objective:To evaluate the predictive values of the Status Epilepticus in Pediatric Patients Severity Score (STEPSS) and END-IT score in the short-term prognosis of children with status epilepticus (SE).Methods:It was a retrospective study involving 103 children with SE who were admitted to the Qingdao Women and Children′s Hospital Affiliated to Qingdao University from January 1, 2012 to January 1, 2022.Glasgow Outcome Scale was used to evaluate the prognosis at discharge, and the children were divided into good prognosis group ( n=78) and poor prognosis group ( n=25). Risk factors for poor prognosis of SE in children were analyzed by Logistic regression.Receiver operating characteristic (ROC) curve was used to evaluate the prognostic values of STEPSS and END-IT score in children with SE. Results:Compared with those of the good prognosis group, significantly younger age [16 (9, 58) months vs.56 (21, 84) months, Z=-3.068, P=0.002], higher blood lactic acid levels [3.16 (2.43, 4.01) mmol/L vs.1.67 (1.32, 2.10) mmol/L, Z=-6.085, P<0.001], STEPSS scores [3.0(3.0, 4.0) points vs.1.0(1.0, 2.0) points, Z=-6.956, P<0.001], END-IT scores [3.0(1.5, 4.0) points vs.1.0(0, 1.0) points, Z=-5.502, P<0.001], proportion of developmental delay ( χ2=16.756, P<0.001), abnormal brain magnetic resonance imagine examination ( χ2=5.860, P=0.015), use of ventilator and multiple drugs (all P<0.001), and longer duration of anti-SE therapy time( Z=1.488, P=0.024) were detected in the poor prognosis group. Logistic regression analysis indicated that increased blood lactic acid ( OR=7.975, 95% CI: 2.705-23.518), increased drug types ( OR=14.562, 95% CI: 2.035-104.173), STEPSS scores( OR=8.914, 95% CI: 2.824-28.140) and END-IT scores ( OR=2.209, 95% CI: 1.046-4.667) were risk factors for the poor prognosis of SE in children.The area under the curve (AUC) of STEPSS in predicting the poor prognosis of SE in children was 0.939, with the cut-off value, sensitivity, specificity and Youden index of 2.5 points, 96.0%, 85.9% and 0.82, respectively.AUC of END-IT scores in predicting the poor prognosis of SE in children was 0.853, with the cut-off value, sensitivity, specificity and Youden index of 1.5 points, 76.0%, 75.6% and 0.52, respectively.AUC of STEPSS in predicting the poor prognosis of SE in children was significantly higher than that of END-IT scores ( U=36.91, P<0.05). The predictive value of STEPSS combined with END-IT was higher, and the sensitivity and negative predictive value of parallel test were 100.0%, while the specificity and positive predictive value of series test were 94.9% and 81.8%, respectively. Conclusions:STEPSS and END-IT scores may be used as predictors for the poor prognosis of SE in children.Their combination provides a better prediction.

De un centro de trauma a un sistema de trauma en el suroccidente colombiano / From a Trauma Center to a Trauma System in Southwest Colombia

Introducción. El objetivo de este estudio fue evaluar el impacto sobre la mortalidad según el perfil de ingreso a un centro de trauma del suroccidente colombiano, como método para entender las dinámicas de atención del paciente con trauma. Métodos. Se realizó un subanálisis del registro de la Sociedad Panamericana de Trauma asociado a un centro de trauma en el suroccidente colombiano. Se analizaron los pacientes atendidos entre los años 2012 y 2021. Se compararon los pacientes con condición de ingreso directo y aquellos que ingresaron remitidos. Se hicieron análisis de poblaciones de interés como pacientes con trauma severo (ISS > 15) y pacientes con/sin trauma craneoencefálico. Se evaluó el impacto de los pacientes remitidos y su condición al ingreso sobre la mortalidad. Resultados. Se incluyeron 10.814 pacientes. La proporción de pacientes remitidos fue del 54,7 %. Los pacientes que ingresaron remitidos presentaron diferencias respecto a la severidad del trauma y compromiso fisiológico al ingreso comparado con los pacientes con ingreso directo. Los pacientes remitidos tienen mayor riesgo de mortalidad (RR: 2,81; IC95% 2,44-3,22); sin embargo, es el estado fisiológico al ingreso lo que impacta en la mortalidad. Conclusión. Los pacientes remitidos de otras instituciones tienen un mayor riesgo de mortalidad, siendo una inequidad en salud que invita a la articulación de actores institucionales en la atención de trauma. Un centro de trauma debe relacionarse con las instituciones asociadas para crear un sistema de trauma que optimice la atención de los pacientes y la oportunidad

Introduction. This study aims to evaluate the impact on mortality by admission profile to a trauma center in Southwest Colombia between direct and referred patients, as a method to understand the dynamics of trauma care.Methods. A sub-analysis of the Panamerican Trauma Society registry associated with a trauma center in Southwest Colombia was performed. Patients attended between 2012-2021 were analyzed. Patients with direct admission and referred condition were compared. Analyses of populations of interest such as patients with severe trauma (ISS > 15) and patients with/without brain trauma were made. The impact of referred patients and their admission status on mortality was evaluated. Results. A total of 10,814 patients were included. The proportion of referred patients was 54.7%. Patients admitted referred vs. with direct admission have differences regarding trauma severity and physiological compromise on admission. The referred patient has a higher risk of mortality (RR: 2.81; 95% CI 2.44-3.22). There is a high proportion of penetrating trauma by gunshot wounds. However, it is the physiological state at admission that impacts mortality. Conclusion. Patients referred from other institutions have a higher mortality risk, being a health inequity that invites the articulation of institutional actors in trauma care. A trauma center should relate to partner institutions to create a trauma system that optimizes care and timeliness

Prospective study of acute intestinal obstruction in adults based on etiology and severity indicators

Background: Intestinal obstruction is a common clinical entity in surgeons practice. In a large number of patient, therapeutic options are surgery versus conservative treatment; the choice of the treatment, that is, surgical versus conservative depends mainly on the surgeon’s assessment and therefore, is a clinical challenge to decide. Aims and Objectives: The purpose of our study is early detection of strangulated bowel obstruction based on a clinical, laboratory, and radiological parameters, a severity indicator score developed by combining these parameters. Materials and Methods: It was a hospital-based prospective observational study of 100 patients between April 2019 and October 2020 who presented with intestinal obstruction. Clinical, laboratory, and radiological parameters were noted and scoring was done as per severity scores. Results: Common cause of obstruction in this study was adhesions 41%, tuberculosis 13%, malignance 8%, and mesenteric ischemia 6% followed by intussusception and volvulus. Patients who had score <3 were managed conservatively, while 90.9% of patients having a score of three or more where operated on, which was statistically significant. Conclusion: Evaluation of the patient is not only to confirm the diagnosis but also timely management of strangulation and prevention of ischemia of gut to improve morbidity and mortality. This study used a severity scoring system of clinical parameters, laboratory and radiological investigation to help in the decision-making of treatment in a case of intestinal obstruction.

Correlation between D-dimer and HRCT in Covid-19

Background: To retrospectively determine the correlation between CTseverity score & D-dimer. Methodology: This is retrospective original research of 227 patients (IPD & OPD) during April 1 to May 31, 2021 for Covid-19. Patients CTseverity scores, HRCTThorax findings, D-dimer, Platelet count and Demographic variables were recorded. The correlation between CTseverity score & D-dimer were determined. Results:Between the mentioned dates, 227 patients are taken into study which includes 146 Males & 81 Females. Mean of CTseverity score was 6.7, D-dimer was 0.46mg/l. Higher CTscore is seen in males (mean -7.1) as compare to females (mean -6.12). D-dimer are seen higher in males (mean =0.52mg/l) as compare to females (median=0.37mg/l). The study of 227 patients has shown positive correlation between CTscore & D-dimer (r=0.38, p<0.05). Males showed relatively stronger positive correlation (r=0.4, p<0 .05) than females (r=0.3, p<0.05). Patients with age less than equal to 45 has shown relatively stronger positive correlation between CTscore & D-dimer (r=0.4, p<0.05) than patients with age more than 45 (r=0.35, p<0.05). Conclusion:Pulmonary lesion induced by SARS-CoV-2 infection was associated with raised inflammatory response, impairment in exchange of gases, and end organ damage. In study, we can conclude that lung lesion may exert important role in COVID-19 pathogenesis & clinical presentation

Predictive ability of severity scores and outcomes for mortality in kidney transplant recipients with coronavirus disease 2019 admitted to the intensive care unit: results from a Brazilian single-center cohort study / Capacidade preditiva de escores de gravidade e desfechos para mortalidade em receptores de transplante renal com COVID-2019 admitidos em unidade de terapia intensiva: resultados de um estudo de coorte brasileiro de um único centro

Abstract Background: the predictive ability of severity scores for mortality in patients admitted to intensive care units is not well-known among kidney transplanted (KT) patients, especially those diagnosed with coronavirus disease 2019 (COVID-19). The purpose of the present study was to evaluate the predictive ability of severity scores for mortality in KT recipients. Methods: 51 KT recipients with COVID-19 diagnosis were enrolled. The performance of the SOFA, SAPS 3, and APACHE IV tools in predicting mortality after COVID-19 was compared by the area under the ROC curve (AUC-ROC) and univariate Cox regression analysis was performed. Results: The 90-day cumulative incidence of death was 63.4%. Only APACHE IV score differed between survivors and nonsurvivors: 91.2±18.3 vs. 106.5±26.3, P = 0.03. The AUC- ROC of APACHE IV for predicting death was 0.706 (P = 0.04) and 0.656 (P = 0.06) at 7 and 90 days, respectively. Receiving a kidney from a deceased donor (HR = 3.16; P = 0.03), troponin levels at admission (HR for each ng/mL = 1.001; P = 0.03), APACHE IV score (HR for each 1 point = 1.02; P = 0.01), mechanical ventilation (MV) requirement (HR = 3.04; P = 0.002) and vasopressor use on the first day after ICU admission (HR = 3.85; P < 0.001) were associated with the 90-day mortality in the univariate analysis. Conclusion: KT recipients had high mortality, which was associated with type of donor, troponin levels, early use of vasopressors, and MV requirement. The other traditional severity scores investigated could not predict mortality.

RESUMO Introdução: a capacidade preditiva dos escores de gravidade para mortalidade em pacientes admitidos em unidades de terapia intensiva não é bem conhecida entre pacientes transplantados renais (TR), especialmente aqueles diagnosticados com doença coronavírus 2019 (COVID-19). Este estudo avaliou a capacidade preditiva dos escores de gravidade para mortalidade em receptores de TR. Métodos: Foram inscritos 51 receptores de TR diagnosticados com COVID-19. O desempenho das ferramentas SOFA, SAPS 3, APACHE IV em predizer mortalidade após COVID-19 foi comparado pela área sob a curva ROC (AUC-ROC) e realizou-se análise de regressão univariada de Cox. Resultados: A incidência cumulativa de óbito em 90 dias foi 63,4%. Somente APACHE IV diferiu entre sobreviventes e não-sobreviventes: 91,2±18,3 vs. 106,5±26,3; P = 0,03. A AUC-ROC do APACHE IV para predizer óbito foi 0,706 (P = 0,04) e 0,656 (P = 0,06) aos 7 e 90 dias, respectivamente. Receber rim de doador falecido (HR = 3,16; P = 0,03), níveis de troponina na admissão (HR para cada ng/mL = 1,001; P = 0,03), escore APACHE IV (HR para cada 1 ponto = 1,02; P = 0,01), necessidade de ventilação mecânica (VM) (HR = 3,04; P = 0,002), uso de vasopressor no primeiro dia após admissão na UTI (HR = 3,85; P < 0,001) foram associados à mortalidade em 90 dias na análise univariada. Conclusão: Receptores de TR apresentaram alta mortalidade, associada ao tipo de doador, níveis de troponina, uso precoce de vasopressores e necessidade de VM. Os outros escores tradicionais de gravidade investigados não puderam predizer mortalidade.

ASSOCIATION BETWEEN CRP, D–DIMER, SERUM FERRITIN, INITIAL CT–CHEST SEVERITY SCORE AND THE OUTCOME OF COVID–19 IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Introduction: The surge of Covid -19 pandemic and the earlier depletion of resources have led to the need of allocation of patients based on levels of risk. The COVID 19 related mortality has been on increase in people with old age, male gender, infiammatory markers elevation and in people with history of co morbidities. With this background, thus study aimed to observe association between CRP, D-Dimer, Serum Ferritin, The Initial CT Chest Severity Score and the outcome of Covid 19 in patients with Type 2 Diabetes mellitus. A hospital based retrospective study was done among COVID 19 patie Materials and methods: nts from the period of September to December 2020. Patients with Type 2 diabetes mellitus admitted with RT-PCR positive (or) CT Thorax – CORADS 4 and above with age more than 18 years and having CRP, D-Dimer, Serum Ferritin results within 24 hours after admission were included in the study. The data was collected using a semi structured questionnaire. A total of 531 individuals were participa Results: ted in the study. The mean respiratory rate and oxygen saturation between the survived and deceased groups was statistically significant (p value 0.024 and 0.044 respectively). All the patients had normal blood urea and serum creatinine values. The mean CORADS score of the participants is 4.78 ± 0.60. There is statistically Conclusion: significant difference in the mean respiratory rate and mean SPO2 between deceased and recovered patients. With advancements in medical sciences, it may not be a rigid process to predict severity with laboratory investigations

To Study the Clinical Efficacy and Safety of Remdesivir in Hospitalized Adult Patients with Moderate-to-Severe COVID-19 Disease in ICU of a Tertiary Center in Bihar

Background: Coronavirus disease 2019 (COVID-19) pandemic has adversely affected the human health and wealth across the globe and is still posing a serious challenge to us. In the armamentarium of various drugs approved for COVID-19, remdesivir proved to be a major breakthrough in the treatment of moderate-to-severe cases. Our study is regarding its clinical efficacy and safety in hospitalized reverse transcription polymerase chain reaction (RT-PCR) confirmed adult patients with moderate-to-severe COVID-19 disease. Material and methods: A total of 100 patients with moderate-to-severe COVID-19 (RT-PCR positive) admitted in the intensive care unit (ICU) of Sri Krishna Medical College and Hospital (SKMCH), Muzaffarpur, Bihar, were enrolled in the study from 12th August to 11th November, 2020. All patients were given injection remdesivir as 200 mg IV loading dose on Day 1, followed by 100 mg IV daily for next 4 days along with other standard treatment. Results: Out of total 100 patients, 88 patients recovered and were discharged, while 12 patients died. Mean age of patients was 54 ± 16 years with male preponderance (4:1). Mean duration of hospital stay was 10.6 ± 5.4 days. C-reactive protein, D-dimer, ferritin and interleukin-6 decreased significantly after treatment with remdesivir, with p value <0.01, as compared to values at the time of admission, without any significant side effects. Conclusion: Early administration of remdesivir helps contribute to better clinical outcome in moderate-to-severe COVID-19 disease, without any significant side effects.

Umbral del ciclo de amplificación del gen de la toxina B de Clostridioides difficile como predictor de gravedad / Clostridioides difficile toxin B gen amplification cycle threshold as a predictor of severity

INTRODUCCIÓN: La infección por Clostridioides dfficile (ICD) es la principal causa de diarrea nosocomial, generalmente asociada al consumo de antimicrobianos. Esta infección puede causar desde diarrea no complicada hasta colitis pseudomembranosa o megacolon tóxico. Estudios recientes han intentado relacionar el valor el ciclo umbral (Ct) de la RT-PCR con la mortalidad, como un método rápido, sencillo, objetivo y eficaz. OBJETIVO: Evaluar el Ct como predictor de mala evolución en pacientes con y sin criterio clínico de dicha gravedad. PACIENTES Y MÉTODOS: Realizamos un estudio retrospectivo entre enero 2015 y diciembre 2018, incluyendo todos los pacientes del área de referencia del Hospital Universitario de Canarias en Tenerife (396.483 habitantes) en pacientes con criterios clínicos de gravedad (de acuerdo a la Guía para la Práctica Clínica de la enfermedad por C. dfficile de la Sociedad de Epidemiología del Cuidado de la Salud de América (SHEA) y la Sociedad de Enfermedades Infecciosas de Norteamérica (IDSA) y pacientes sin criterios clínicos de gravedad evaluando el Ct como predictor de mala evolución. RESULTADOS: Se diagnosticó un total de 202 episodios de ICD. El 77,7% (n = 157) presentó criterios clínicos de gravedad. La presencia de colitis ulcerosa (p < 0,001), fiebre (p < 0,001), leucocitosis (p < 0,001), neutrofilia (p < 0,001), creatininemia (p = 0,005) se presentaron como factores de riesgo para el desarrollo de ICD grave. El sexo femenino, la institucionalización, el ingreso previo y el exitus se describieron con mayor frecuencia en el grupo con ICD-G, no encontrando diferencias significativas. No encontramos diferencias respecto a los días de estancia previa, o de estancia post-ICD, aunque en este último, la media fue mayor en el caso de los pacientes con ICD-G. No se encontraron diferencias significativas en cuanto al Ct en ambos grupos; siendo sólo un punto menor en pacientes con criterio de gravedad (Ct = 26,1) que sin criterios de gravedad (Ct = 27,4) (p = 0,326).

BACKGROUND: Clostridioides dfficile infection (CDI) is the main cause of nosocomial diarrhea, generally associated with the use of antibiotics. This infection can cause uncomplicated diarrhea to pseudomembranous colitis or toxic megacolon. Recent studies have attempted to relate the threshold cycle (Ct) value of RT-PCR with mortality, as a fast, simple, objective and efficient method. AIM: To evaluate Ct as a predictor of poor outcome in patients with C. dfficile disease with/without clinical signs of severity. METHODS: We carried out a retrospective study between January 2015 and December 2018, including all patients in the reference area of the Hospital Universitario de Canarias in Tenerife (396,483 inhabitants) in patients with clinical criteria of severity and patients without clinical severity criteria (according to the guide for the clinical practice of CDI of the Society of Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of North America (IDSA). RESULTS: A total of 202 CDI episodes were diagnosed. 77.7% (n = 157) presented clinical severity criteria. The presence of ulcerative colitis (p < 0.001), fever (p < 0.001), leukocytosis (p < 0.001), neutrophilia (p < 0.001), creatininemia (p = 0.005) were presented as risk factors for the development of severe CDI (S-CDI). Female sex, institutionalization, previous admission and death were described more frequently in the group with S-CDI, not finding significant differences. We found no differences with respect to the days of previous stay, or of post-CDI stay, although in the latter, the mean was higher in the case of S-CDI patients. No significant differences were found in terms of Ct in both groups; being only one point lower in patients with severity criteria (Ct = 26.1) than without severity criteria (Ct = 27.4) (p = 0.326). CONCLUSION: Based on the results of our study, it has not been possible to systematically implement the Ct value as a predictor of severity to the clinical report, and it is not possible to extrapolate this predictive variable from S-CDI and standardize the Ct value as a predictor of severity. Conclusion: Basándonos en los resultados de nuestro estudio, no ha sido posible la implementación sistemática del valor Ct como predictor de gravedad al informe clínico, no siendo posible extrapolar esta variable predictora de enfermedad por C difficile-G y estandarizar el valor Ct como factor predictor de gravedad.

Correlation between D-dimer and computed tomographyseverity score in middle aged young adults with COVID-19 pneumonia: a retrospective study

Background:An unknown pneumonia broke out in Wuhan City in December 2019 and it was confirmed as an acute respiratory infectious disease caused by Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2, formerly known as 2019-nCoV). Consumption coagulopathy, which should be obviated in order to decrease mortality, arises in disseminated intravascular coagulation with a decrease in fibrinogen and an increase in D-dimer levels. However, studies on the predictive and prognostic values of coagulation parameters in the setting of patients with COVID-19 are still limited. The objectiveof this retrospective study was to investigate the correlation of D-dimer and computed tomography severity score in patients with COVID-19 pneumonia.Methods:The present retrospective study was conducted among 108 subjects reported COVID RT-PCR positive admitted during the study period i.e.;January-August 2021 in the department of medicine of Rural Medical College, Loni. Pneumonia was confirmed by Computed tomography (CT) examination and coagulation test completed within 12 hr after admission were enrolled. Coagulation tests, which Fibrinogen (Fib) and D-dimer were performed. CTscore was categorized into mild (0-7), moderate (8-16) and advanced grade (17-25 points).Results:The mean age of male and female was 38.52�34 and 35.67�22 years respectively, with an overall age of 37.79�58 years. Mean D-dimer level was 0.54�09, 0.91�22 and 1.96�47 mcg/ml among subjects having mild, moderate and severe CT score respectively. According to multivariate analysis, higher D-dimer (OR:3.61, p<0.01) was significantly associated with CTseverity score.Conclusions:Study concluded that the D-dimer level's time point was matched to the time of CTscan, we have reasons to correlate that the D-dimer level may predict the severity of inflammation prior to coagulopathy/thrombosis

Evolution of and controversy on definition of multiple trauma / 中华创伤杂志

Multiple trauma is complex and difficult to treat. The trauma at each site may obscure or delay the manifestation of each other. The severity of injury also exceeds the simple superposition of each injured site. There are numerous definitions of multiple trauma worldwide, with most regarding multiple trauma as major trauma. The definition of multiple trauma in China has evolved several times; however, it is currently still controversial, especially on whether the definition should be based on the nine body regions of the Abbreviated Injury Scale (AIS) or the six body regions of the Injury Severity Score (ISS). The absence of uniform anatomic region criteria in the definition of multiple trauma can lead to discrepancies in multiple trauma patients, causing the clinical application of the definition to be problematic. In this study, the authors elaborate the development and application status of the defination of multiple trauma at home and abroad, discuss the existed problems or controversies and put forward feasible suggestions on the definition of multiple trauma to further normalize the diagnosis and treatment of multiple trauma.

Discussion on key points in the diagnosis and treatment of infant traumatic brain injury / 中华创伤杂志

The diagnosis and treatment of infant traumatic brain injury (TBI) are different from adults due to their particular physiological structure and neurological function as well as disability to cooperate in physical examination. However, the relevant clinical guidelines in the dignosis and treatment of TBI in infant patients were rare in our nation because of the low incidence and lack of relative researches. Most of the infant patients tend to be treated as adults, which may not only lead to false or missed diagnoses, but also bring about unnecessary examination or treatment risks. As a result, the therapeutic efficiency may be affected. In this paper, the author explores the characteristics in the diagnosis and treatment of infant TBI and the therapeutic principles in order to improve the therapeutic efficiency of infant TBI.

Establishment and verification of LIPS score combined with APACHE Ⅱ score and oxygenation index to predict the occurrence model of ARDS / 中华危重病急救医学

Objective:To construct and verify the occurrence model of acute respiratory distress syndrome (ARDS) using lung injury prediction score (LIPS) combined with acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and oxygenation index (PaO 2/FiO 2). Methods:Using a prospective cohort study method, 244 patients with complete medical records who were admitted to the intensive care unit (ICU) of Peking University Third Hospital from December 2020 to July 2022 were selected as research objects according to the inclusion and exclusion criteria. They were divided into training set (173 cases) and validation set (71 cases). Patients' gender, age, body mass index (BMI), various causes (shock, sepsis, craniocerebral injury, pulmonary contusion, multiple trauma, aspiration, pneumonia, acute abdomen, hypoproteinemia, acidosis, major surgery, etc.), underlying diseases (diabetes, malignant tumor, cerebrovascular disease, liver disease, kidney disease) and laboratory test indicators were collected. According to the above data, the LIPS score, APACHE Ⅱ score, sequential organ failure assessment (SOFA) and PaO 2/FiO 2, etc within 24 hours after admission to the ICU were calculated. Univariate analysis was used to screen the influencing factors for the occurrence of ARDS, and the factors with P < 0.2 were included in the multivariate Logistic regression analysis to screen out the independent predictive factors for the occurrence of ARDS. According to the results of multivariate Logistic regression analysis, the risk score of patients with ARDS was obtained to construct the risk prediction model of ARDS, the receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) was calculated. The established ARDS prediction model was externally validated, and ROC curves were drawn to evaluate the predictive accuracy of the prediction model for the occurrence of ARDS in critically ill patients, and the AUC of the validation set was calculated to analyze the predictive performance of each risk factor on the occurrence of ARDS. Results:A total of 173 patients were enrolled in the training set, including 121 patients without ARDS and 52 patients with ARDS; 77 cases of acute abdomen, 64 cases of sepsis, 60 cases of shock, 51 cases of acidosis, 40 cases of hypoproteinemia, 37 cases of diabetes, 34 cases of craniocerebral injury, 34 cases of abnormal liver function, 28 cases of multiple trauma, 23 cases of malignant tumor, 23 cases of spinal orthopedic surgery, 17 cases of obesity, 12 cases of pneumonia, 11 cases of pulmonary contusion, and 7 cases of chronic kidney disease, chemotherapy in 6 cases, and aspiration in 2 cases. The rates of shock, sepsis, acute abdomen, acidosis, abnormal liver function, lung contusion, pneumonia and aspiration, gender, age, LIPS score, APACHE Ⅱ score, and SOFA score in the ARDS group were significantly higher than those in the non-ARDS group (all P < 0.05), moreover, PaO 2/FiO 2 ratio was significantly lower than that of non-ARDS group ( P < 0.01). Multivariate Logistic regression analysis showed that LIPS score, APACHE Ⅱ score, and PaO 2/FiO 2 ratio were independent risk factors for ARDS in ICU patients with high risk factors for ARDS, and the odds ratio ( OR) was 1.768 [95% confidence interval (95% CI) was 1.380-2.266], 1.242 (95% CI was 1.089-1.417), 0.985 (95% CI was 0.978-0.991), all P < 0.05. ROC curve analysis showed that the AUC of the ARDS prediction model training set was 0.920, the sensitivity was 86.5%, and the specificity was 86.8%; the AUC of the verification set was 0.896, the sensitivity was 96.8%, and the specificity was 76.6%. Conclusion:LIPS score, APACHE Ⅱ score and PaO 2/FiO 2 are independent risk factors for the occurrence of ARDS in ICU patients with high risk factors for ARDS. The ARDS risk prediction model established based on these three indicators has a good predictive ability for the occurrence of ARDS in critically ill patients, wihich needs to be verified by multicenter cohort studies.

Predictive value of six critical illness scores for 28-day death risk in comprehensive and specialized intensive care unit patients based on MIMIC-Ⅳ database / 中华危重病急救医学

Objective:To explore the basic characteristics of various types of intensive care unit (ICU) patients and the predictive value of six common disease severity scores in critically ill patients on the first day on the 28-day death risk.Methods:The general information, disease severity scores [acute physiology score Ⅲ (APSⅢ), Oxford acute disease severity (OASIS) score, Logistic organ dysfunction score (LODS), simplified acute physiology score Ⅱ (SAPSⅡ), systemic inflammatory response syndrome (SIRS) score and sequential organ failure assessment (SOFA) score], prognosis and other indicators of critically ill patients admitted from 2008 to 2019 were extracted from Medical Information Mart for Intensive Care-Ⅳ 2.0 (MIMIC-Ⅳ 2.0). The receiver operator characteristic curve (ROC curve) of six critical illness scores for 28-day death risk of patients in various ICU, and the area under the ROC curve (AUC) was calculated, the optimal Youden index was used to determine the cut-off value, and the AUC of various ICU was verified by Delong method.Results:A total of 53 150 critically ill patients were enrolled, with medical ICU (MICU) accounted for the most (19.25%, n = 10 233), followed by cardiac vascular ICU (CVICU) with 17.78% ( n = 9 450), and neurological ICU (NICU) accounted for the least (6.25%, n = 3 320). The patients in coronary care unit (CCU) were the oldest [years old: 71.79 (60.27, 82.33)]. The length of ICU stay in NICU was the longest [days: 2.84 (1.51, 5.49)] and accounted for the highest proportion of total length of hospital stay [63.51% (34.61%, 97.07%)]. The patients in comprehensive ICU had the shortest length of ICU stay [days: 1.75 (0.99, 3.05)]. The patients in CVICU had the lowest proportion of length of ICU stay to total length of hospital stay [27.69% (18.68%, 45.18%)]. The six scores within the first day of ICU admission in NICU patients were lower than those in the other ICU, while APSⅢ, LODS, OASIS, and SOFA scores in MICU patients were higher than those in the other ICU. SAPⅡ and SIRS scores were both the highest in CVICU, respectively. In terms of prognosis, MICU patients had the highest 28-day mortality (14.14%, 1 447/10 233), while CVICU patients had the lowest (2.88%, 272/9 450). ROC curve analysis of the predictive value of each score on the 28-day death risk of various ICU patients showed that, the predictive value of APSⅢ, LODS, and SAPSⅡ in comprehensive ICU were higher [AUC and 95% confidence interval (95% CI) were 0.84 (0.83-0.85), 0.82 (0.81-0.84), and 0.83 (0.82-0.84), respectively]. The predictive value of OASIS, LODS, and SAPSⅡ in surgical ICU (SICU) were higher [AUC and 95% CI were 0.80 (0.79-0.82), 0.79 (0.78-0.81), and 0.79 (0.77-0.80), respectively]. The predictive value of APSⅢ and SAPSⅡ in MICU were higher [AUC and 95% CI were 0.84 (0.82-0.85) and 0.82 (0.81-0.83), respectively]. The predictive value of APSⅢ and SAPSⅡ in CCU were higher [AUC and 95% CI were 0.86 (0.85-0.88) and 0.85 (0.83-0.86), respectively]. The predictive value of LODS and SAPSⅡ in trauma ICU (TICU) were higher [AUC and 95% CI were 0.83 (0.82-0.83) and 0.83 (0.82-0.84), respectively]. The predictive value of OASIS and SAPSⅡ in NICU were higher [AUC and 95% CI were 0.83 (0.80-0.85) and 0.81 (0.78-0.83), respectively]. The predictive value of APSⅢ, LODS, and SAPSⅡ in CVICU were higher [AUC and 95% CI were 0.84 (0.83-0.85), 0.81 (0.80-0.82), and 0.78 (0.77-0.78), respectively]. Conclusions:For the patients in comprehensive ICU, MICU, CCU, and CVICU, APSⅢ or SAPSⅡ can be applied for predicting 28-day death risk. For the patients in SICU and NICU, OASIS or SAPSⅡ can be applied to predict 28-day death risk. For the patients in TICU, SAPSⅡ or LODS can be applied for predicting 28-day death risk. For CVICU patients, APSⅢ or LODS can be applied to predict 28-day death risk.

Comparison of different neonatal illness severity scores in predicting mortality risk of extremely low birth weight infants / 浙江大学学报·医学版

To compare different illness severity scores in predicting mortality risk of extremely low birth weight infants (ELBWI). From January 1st, 2019 to January 1st, 2020, all ELBWI admitted in the Children's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital and the First Affiliated Hospital of Nanjing Medical University were included in the study. ELBWI with admission age ≥1 h, gestational age ≥37 weeks and incomplete data required for scoring were excluded. The clinical data were collected, neonatal critical illness score (NCIS), score for neonatal acute physiology version Ⅱ (SNAP-Ⅱ), simplified version of the score for neonatal acute physiology perinatal extension (SNAPPE-Ⅱ), clinical risk index for babies (CRIB) and CRIB-Ⅱ were calculated. The scores of the fatal group and the survival group were compared, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the above illness severity scores for the mortality risk of ELBWI. Pearson correlation analysis was used to analyze the correlation between illness scores and birth weight, illness scores and gestational age. A total of 192 ELBWI were finally included, of whom 114 cases survived (survival group) and 78 cases died (fatal group). There were significant differences in birth weight, gestational age and Apgar scores between fatal group and survival group (all <0.01). There were significant differences in NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ between fatal group and survival group (all <0.01). The CRIB had a relatively higher predictive value for the mortality risk. Its area under the ROC curve (AUC) was 0.787, the sensitivity was 0.678, the specificity was 0.804, and the Youden index was 0.482. The scores of NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ were significantly correlated with birth weight and gestational age (all <0.05). The correlation coefficients of CRIB-Ⅱ and CRIB with birth weight and gestational age were relatively large, and the correlations coefficients of NCIS with birth weight and gestational age were the smallest (0.191 and 0.244, respectively). Among these five illness severity scores, CRIB has better predictive value for the mortality risk in ELBWI. NCIS, which is widely used in China, has relatively lower sensitivity and specificity, and needs to be further revised.

Research progress in chest trauma scoring systems / 中华创伤杂志

Chest trauma accounts for 10%-15% of total trauma and is responsible for approximately 25% of trauma-related deaths. Standard and accurate assessment of trauma severity is the basis for effective treatment. The application of chest trauma scoring systems to evaluate the severity of trauma is of great significance to prediction of complication and prognosis, clinical decision making and treatment optimization. The chest trauma scoring systems are varied with different functions and characteristics. When performing injury evaluation, an appropriate chest trauma scoring system should be selected according to the injury mechanism, injury site and needs of diagnosis and treatment. The authors review the application scope, scoring methods and research status of different chest trauma scoring systems, in order to provide references for more rational use of trauma scoring systems in clinical evaluation and treatment of chest trauma.