Beta-blockade is not associated with improved outcomes in isolated severe extracranial injury: an observational cohort study.

BACKGROUND: There is evidence supporting the use of beta-blockade in patients with traumatic brain injury. The reduction in sympathetic drive is thought to underlie the relationship between beta-blockade and increased survival. There is little evidence for similar effects in extracranial injuries. This study aimed to assess the association between beta-blockade and survival in patients suffering isolated severe extracranial injuries. METHODS: Patients treated at an academic urban trauma centre during a 5-year period were retrospectively identified. Adults suffering isolated severe extracranial injury [Injury Severity Score (ISS) ≥ 16 with Abbreviated Injury Score of ≤ 2 for any intracranial injury] were included. Patient characteristics and outcomes were collected from the trauma registry and hospital medical records. Patients were subdivided into beta-blocker exposed and unexposed groups. Patients were matched using propensity score matching. Differences were assessed using McNemar's or paired Student's t test. The primary outcome of interest was 90-day mortality and secondary outcome was in-hospital complications. RESULTS: 698 patients were included of whom 10.5% were on a beta-blocker. Most patients suffered blunt force trauma (88.5%) with a mean [standard deviation] ISS of 24.6 [10.6]. Unadjusted mortality was higher in patients receiving beta-blockers (34.2% vs. 9.1%, p < 0.001) as were cardiac complications (8.2% vs. 1.4%, p = 0.002). Patients on beta-blockers were significantly older (69.5 [14.1] vs. 43.2 [18.0] years) and of higher comorbidity. After matching, no statistically significant differences were seen in 90-day mortality (34.2% vs. 30.1%, p = 0.690) or in-hospital complications. CONCLUSIONS: Beta-blocker therapy does not appear to be associated with improved survival in patients with isolated severe extracranial injuries.

Surgical Needs at the End of the Battle of Mosul: Results from Mosul General Hospital.

PURPOSE: The aim of the study was to analyze the surgical needs of patients seeking emergency care at the Mosul General Hospital in the final phase of the battle of Mosul in northern Iraq between an international military coalition and rebel forces. During the conflict, the International Red Committee of the Red Cross (ICRC) supported the hospital with staff and resources. Ceasefire in the conflict was declared at the end of July 2017. METHODS: Routinely collected hospital data from the ICRC-supported Mosul General Hospital from June 6, 2017, to October 1, 2017 were collected and analyzed retrospectively. All patients with weapon-related injuries as well as all patients with other types of injuries or acute surgical illness were included. RESULTS: Some 265 patients were admitted during the study period. Non-weapon-related conditions were more common than weapon-related (55.1%). The most common non-weapon-related condition was appendicitis followed by hernia and soft tissue wounds. Blast/fragment was the most frequent weapon-related injury mechanism followed by gunshot. The most commonly injured body regions were chest and abdomen. Children accounted for 35.3% of all weapon-related injuries. Patients presented at the hospital with weapon-related injuries more than 2 months after the official declaration of ceasefire. A majority of the non-weapon-related, as well as the weapon-related conditions, needed surgery (88.1% and 87.6%, respectively). Few postoperative complications were reported. CONCLUSIONS: The number of children affected by the fighting seems to be higher in this cohort compared to previous reports. Even several months after the fighting officially ceased, patients with weapon-related injuries were presenting. Everyday illnesses or non-weapon-related injuries dominated. This finding underlines the importance of providing victims of conflicts with surgery for life-threatening conditions, whether weapon related or not.

Short and long-term survival in type A aortic dissection justifies the operative risk and effort.

OBJECTIVES: To evaluate the survival rate and complications after operation for acute aortic dissection type A. DESIGN: Chart review of all consecutive patients with aortic dissection admitted during 1999-2008 (n = 99) to Oslo University Hospital Ullevål, Oslo. RESULTS. Thirty-day mortality was 14 patients and late mortality 21 patients. Twenty-nine patients had no postoperative complications. Cerebral affection was seen in 22 patients. Seventy-nine patients were operated on with deep hypothermic circulatory arrest. Mean circulatory arrest time was 23 minutes (range 12-47). Eighty-three of the patients were cannulated through the femoral artery, with a 30-day mortality rate of 17% (n = 14) versus 0% for other cannulations (n = 16); and a stroke rate of 24% (n = 20) versus 17% (n = 2) in patients cannulated in the subclavian or axillary artery (no statistically significant difference in either mortality or stroke). CONCLUSIONS: Our study confirms that overall mortality and neurological complications are acceptable and the long-term survival rate is good in patients operated on for acute aortic dissection. Circulatory arrest time seems not to affect neurological complications when being relatively short.