The influence of age on quality of life after upper body burn.

BACKGROUND: In Spain, the number of aged persons is increasing. By the year 2066, it is expected that 34.6% of the Spanish population will be over 65 years of age. Elderly people present a higher burning risk owing in part to impaired balance and decreased physical strength, lower cognitive abilities, or socioeconomic context. OBJECTIVE: Burns to the upper body body are common and affect both emotional state and physical function, thus leading to reduced quality of life (QoL). Our objective was to determine the influence of age on the QoL of patients who experienced burns to the upper body, with burns with 2 years. METHODS: This is an observational study with a sample of 58 patients with burns only on the upper body. Patients were divided into two groups: 29 patients of age over 65 years and 29 patients under 65 years; all of them attended the Vall d'Hebron Burn Center, Barcelona, between 2011 and 2014. From the original sample, 45 patients had survived by the time the information was gathered. The QoL of these individuals was evaluated with the Spanish version of the Burn Specific Health Scale. Demographic data (sex, age, total burn surface area [TBSA], burn mechanism, pathological history, length of hospital stay, and rehabilitation duration) were collected. Statistical analysis included parametric and nonparametric tests as appropriate with R3.3.3. RESULTS: There were no differences between groups regarding the mechanism of burn, TBSA, length of hospital stay, and the domains of QoL test. High blood pressure, diabetes, and other comorbidities were significantly more common in the elderly group than in the younger group. Eleven patients died in the elderly group and two in the younger group (p=0.012). CONCLUSION: As opposed to what could be expected, in this study, there were no significant differences between surviving patients in both age groups in terms of perceived QoL. Nevertheless, mortality after a burn in the upper side of the body was significantly higher in elderly people than in younger people. The present study results do not support the use of different rehabilitation approaches in elderly patients.

Impact of rib fixation on quality of life after major trauma with multiple rib fractures.

INTRODUCTION: Multiple rib fractures have been shown to reduce quality of life both in the short and long term. Treatment of rib fractures with operative fixation reduces ventilator requirements, intensive care unit stay, and pulmonary complications in flail chest patients but has not been shown to improve quality of life in comparative studies to date. We therefore wanted to analyse a large cohort of multiple fractured rib trauma patients to see if rib fixation improved their quality of life. METHODS: Retrospective review (January 2012 - April 2015) of prospectively collected data on 1482 consecutive major trauma patients admitted to The Alfred Hospital with rib fractures. The main outcome measures were Quality of Life over 24 months post injury assessed using the Glasgow Outcome Scale Extended (GOSErate) and Short Form (SF12) health assessment forms and a pain questionnaire. RESULTS: 67 (4.5%) patients underwent rib fixation and were older, with a higher incidence of flail chest injury, and higher AIS and ISS scores than the remainder of the cohort. Rib fixation provided no benefit in pain, SF-12 or GOSErate scores over 24 months post injury. CONCLUSIONS: This study has not been able to demonstrate any quality of life benefit of rib fixation over 24 months post injury in patients with major trauma.

The long-term outcomes and health-related quality of life of patients following blunt thoracic injury: a narrative literature review.

BACKGROUND: Major Trauma remains a leading cause of mortality and morbidity worldwide. Blunt Thoracic Injury (BTI) accounts for > 15% of United Kingdom (UK) trauma admissions and is consistently associated with respiratory related complications that include pneumonia and respiratory failure. Despite this, it is unclear in current clinical practice how BTI impacts on the recovering trauma patients after discharge from hospital. This study aimed to investigate the state of knowledge on the impact of BTI on the long-term outcomes and health-related quality of life (HRQoL). METHODS: Data were sourced from Ovid MEDLINE, Ovid EMBASE, CINAHL and Science Direct using a pre-defined systematic search strategy. A subsequent hand search of key references was used to identify potentially missed studies. Abstracts were screened for eligibility and inclusion. Fifteen studies met the eligibility criteria and were critically appraised. Data were extracted, analysed and synthesised in categories and sub-categories following a narrative approach. RESULTS: Three major themes were identified from the 15 studies included in this review: (i) physical impact of BTI, (ii) psychological impact of BTI and (iii) socio-economic impact of BTI. The bulk of the available data focused on the physical impact where further sub-themes included: (i) physical functioning, (ii) ongoing unresolved pain, (iii) reduced respiratory function, (iv) thoracic structural integrity. Although there was a substantial difference in the length and method of follow up, there remains a general trend towards physical symptoms improving over time, particularly over the first six months after injury. Despite this, where sequelae continued at six months it remained likely that these would also be present at two years after injury. CONCLUSION: The literature review demonstrated that BTI is associated with substantial sequelae that impacts on all aspects of daily functioning. Despite this there remains a paucity of data relating to long term outcomes in the BTI population, especially relating to psychological and socio-economic impact. There is also little consensus on the measures, tools and time-frames used to measure outcomes and HRQoL in this population. The full impact of BTI on this population needs further exploration.

[Features of diagnostic and surgical tactics for suicidal and autoaggressive thoracic and abdominal lesions]. / Osobennosti diagnostiki i khirurgicheskoi taktiki pri povrezhdeniiakh grudi i zhivota vsledstvie suitsidal'nykh i autoagressivnykh deistvii.

AIM: To analyze diagnostic and surgical tactics for suicidal and autoaggressive thoracic and abdominal lesions. MATERIAL AND METHODS: We have analyzed the features of emergency surgical care depending on type of patients' behavior at admission. There were 516 patients with suicidal and autoaggressive thoracic and abdominal lesions. RESULTS AND DISCUSSION: Depressive (34%) and adequate (46%) patients were examined routinely. Inadequate (aggressive) behavior is inappropriate for instrumental examination while medical sedation may be followed by significant hemodynamic disorders in patients with severe lesions. It was noted that indications for explorative surgery should be expanded in these patients and administration of sedatives should be combined with induction of general anesthesia. CONCLUSION: Severity of trauma and type of surgery affect mental state dynamics while the kind of psychopathy influences postoperative period course.

Thoracic shock wave injury causes behavioral abnormalities in mice.

BACKGROUND: Mild traumatic brain injury (mTBI) is caused by complex mechanisms of systemic, local and cerebral responses to blast exposure. However, the molecular mechanisms of cognitive impairment after exposure to blast waves are not clearly known. We tested the hypothesis that thoracic injury induced functional and morphological impairment in the brain, leading to behavioral abnormalities. METHODS: Mice were exposed to laser-induced shock waves (LISWs) impacting the thorax and assessed for behavioral outcome at 7 and 28 days post injury. Hippocampus and lung were collected for histopathological analysis and gene expression profiling after injury. RESULTS: Thoracic injury transiently decreased the heart rate, blood pressure, peripheral oxyhemoglobin saturation and cerebral blood flow immediately after LISW exposure. Although LISWs exposure caused pulmonary contusions, hemorrhage was not apparent in the brain. At 7 and 28 days after, the injured mice exhibited impaired short-term memory and depression-like behavior compared with controls. Histological assessments showed an increase in neuronal cell death after shock wave exposure, especially in the CA3 region of the hippocampus. Moreover, shock wave exposure altered the expression of functionally relevant genes in the hippocampus at 1 h and 1 day post injury. CONCLUSIONS: Our findings indicate that the LISW-induced thoracic injury with no direct impact on the brain affected the hippocampal gene expression and led to morphological alterations, resulting in behavioral abnormalities. Therefore, body protection may be extremely important in the effective prevention against blast-induced alterations in brain function.

Quality of life after mild to moderate trauma.

INTRODUCTION: To evaluate potential reduction in health-related quality of life (HRQOL) after a mild to moderate trauma. MATERIALS AND METHODS: Follow-up study of a cohort of 153 trauma patients admitted to the High Dependency Unit of the Emergency Department of the University-Hospital of Florence from July 2008 to February 2012. After 6 months from the event, a telephone interview using the Physical (PCS) and Mental (MCS) Health Composite Score (SF12) was conducted. Patients reported their HRQOL both at present and before trauma. Scores ≥ 50 represent no disability; 40-49, mild disability; 30-39, moderate disability; and below 30, severe disability. RESULTS: Before the event 143 (93%) subjects reported a normal PCS and MCS. After the events, a significantly lower proportion of patients maintained a normal PCS and MCS values (52 and 68%, all p<0.01). One, two, three and four PCS items worsened in 14%, 15%, 18% and 38% of the study population, while one, two, three or four MCS dimensions worsened in 12%, 19%, 19% and 24%. We identified 109 subjects (N+), which showed normal PCS and MCS values before trauma, in the absence of any pre-existing medical condition. After the event, we observed a significant PCS (before: 54, standard deviation, SD 6; after 43, SD 11, p<0.0001) and MCS (before: 55, SD 7; after 47, SD 11, p<0.0001) worsening among N+ subjects. Distribution across the four disability categories was 52, 24, 17 and 6% for MCS score and 38, 25, 27 and 11% for PCS score: overall 8 (7%) patients reported a moderate disability and 5 (5%) reported a severe disability in both dimensions. Compared with subjects with preserved values, patients with an abnormal (<39) HRQOL were older, showed a higher prevalence of female gender and pre-existing medical conditions and a worst Sequential Organ Failure Assessment score. An advanced age (OR 1.033, 95% CI 1.010-1.057, p=0.005) and a higher SOFA T1 score (OR 1.500, 95% CI 1.027-2.190, p=0.036) were independently associated with a worsening PCS. CONCLUSIONS: After a mild trauma, we evidenced a relevant reduction in HRQOL; an advanced age and a higher degree of organ dysfunction were independently associated with HRQOL deterioration.

A prospective study on dinghy sailors' training habits and injury incidence with a comparison between elite sailor and club sailor during a 12-month period.

BACKGROUND: Sailing is an Olympic sport practiced by both men and women of all ages. Despite being a popular sport, we have found no prospective studies investigating the injury incidence and training quantity such as found for other sports. The purpose of this study was to do an inventory over dinghy sailors' training habits, injury incidence and type of injury. METHODS: In this prospective cohort study, 45 sailors (17 women and 28 men), age 17-31 years, were included. 24 sailors belonged to the SWE Sailing Team and 21 were club sailors. All the participants kept a training diary, and once a month for 12 months they reported their training and injuries through a web-based questionnaire. Each time a sailor reported an injury, they were contacted by the researchers and an injury form was completed. RESULTS: The SWE Sailing Team performed significantly (p=0.006) more physical training than the club sailor. There was no significant difference (p=0.7) in hours of sail training. A total of 144 injuries were reported. The most common injury location was the knee (19%), followed by the lower leg (13%) and shoulder (12%). 30% of the injuries occurred during physical training, 17% during sail training and 12% during sail racing. CONCLUSIONS: The most common injury location was the knee. The largest proportion of injuries occurred during physical training and unspecified activities. The least number of injuries occurred during sail racing. The injury location was different between the older more experienced sailor (more upper extremity injuries) compared with the younger sailors (more trunk injuries).

[Medical and social characteristics of patients with septic complications of the closed thoracic injury].

231 cases of septic complications after the closed thoracic injury were analyzed. All patients were divided into groups according to the injury mechanism and inhabitancy. Patients with medico-social deviations, as well as patients with hemocontact infections, mental insanity and social deviations were marked out. The leading mechanisms of the closed thoracic injury were: fall from a height (34.2%), assault and battery (24.7%) and automobile accident (16.4%). 51.1% of patients were reported to have any medico-social deviations. Among the patients with socially important infections, the distribution was as follows: persons with no fixed abode (50%), incomers from the near-abroad countries (36.4%), victims of assault (28.1%) and pedestrians (21.4%).

Suboptimal perception of illness due to self-realization constraints impairs psychological welfare in surgical patients.

OBJECTIVE: Recognizing patients' psychological problems and understanding their social needs constitute important tasks for medical personnel, because these issues substantially contribute to overall outcome of treatment. People afflicted with surgical diseases need to determine the sense of everyday pursuits and activities and balance it against the therapeutic process. The aim of the study was to assess the relationships between the perception of illness, satisfaction with life and meaning of life among surgical patients. METHODS: A total of 225 patients undergoing surgical treatment in the thoracic surgery department were enrolled in the questionnaire study using Multidimensional Essence of Disease and Illness Scale (MEDIS), Satisfaction With Life Scale (SWLS) and Life Meaningfulness Scale (LMS). Relationships between variables were assessed with Pearson's correlation. RESULTS: The analysis disclosed negative correlations between the perception of the disease in the light of self-realization constraints and the feeling of satisfaction with one's life (R = -0.25; P < 0.01), an affective component of the LMS (R = -0.29; P < 0.001) and the total result of the LMS (R = -0.21; P < 0.01). Similar relationships were observed between the MEDIS dimension describing a disease as a social withdrawal and the total result of the SWLS (R = -0.21; P < 0.05) and the affective component of the LMS (R = -0.23; P < 0.01). CONCLUSIONS: Suboptimal hospitalization-related perception of the disease due to self-realization constraints profoundly impairs psychological welfare of patients and may exert negative impact on the overall outcome of treatment. We believe that surgical patients require early psychological, social and spiritual support to prevent these harmful psycho-social consequences of illness and hospital stay. Preoperative clinical application of presented scales may be useful to select patients who require more psychological attention in providing information about planned surgical treatment and expected outcomes.

[Injuries of neck, thorax and abdomen due to suicide or aggressive actions].

288 patients were treated for suicide or auto-aggressive injuries of neck, thorax and abdomen, which amounted 12,8% of all patients with injuries of such localization. Able-bodied men with prolonged depressive disorders pre-dominated among them. Neck injuries were observed in 21,5%, thorax injuries - in 25,7%, abdominal injuries - in 33,7% of patients. Combined injuries of neck, thorax and abdomen were the most hard for surgical treatment (19,1%). Types of injuries and severity of clinical course in postoperative period depends on character and intensity of psychic disorders.

Dyspnea in the thoracic trauma patient: a human response to illness.

Dyspnea is one of the most common presenting symptoms in thoracic trauma patients; therefore, trauma nurses require extensive knowledge of this symptom. The Human Response to Illness model provides an organizing framework to establish a comprehensive understanding of the human response of dyspnea following thoracic trauma. The model is used to describe the physiological, pathophysiological, behavioral, and experiential perspectives of dyspnea in thoracic trauma, while considering personal and environmental factors. This comprehensive overview will provide the trauma nurse with appropriate evidence-based rationale for interventions in the management of acute dyspnea in the thoracic trauma population.

Long-term outcome in chest trauma.

BACKGROUND: Currently, there are limited data available describing the long-term outcomes of chest trauma survivors. Here, the authors sought to describe chest trauma survivor outcomes 6 months and 1 yr after discharge from the intensive care unit, paying special attention to pulmonary outcomes. METHODS: A cohort of 105 multiple trauma patients with blunt chest trauma admitted to the intensive care unit was longitudinally evaluated. After 6 months, a chest computed tomography scan, pulmonary function testing (PFT), and quality of life were collected in 55 of these patients. A subgroup of 38 patients was followed up for 1 yr. RESULTS: At least one abnormal PFT result was found in 39 patients (71%). Compared with normalized data of the age- and sex-matched population, physical function was decreased in 38 patients (70%). The 6-min walk distance was reduced for 29 patients (72%). Although pathologic images were observed on the chest computed tomography scan from 33 patients (60%), no relation was found between PFT and computed tomography. A ratio of arterial oxygen pressure to inspired oxygen fraction less than 200 at admission to the intensive care unit predicted an abnormal PFT result at 6 months. One year after discharge from the intensive care unit, paired comparisons showed a significant increase in forced vital capacity (P = 0.02) and Karnofsky Performance Status (P < 0.001). CONCLUSIONS: Survivors of multiple traumas including chest trauma demonstrate a persistent decrease in the 6-min walk distance, impairment on PFT, and reduced pulmonary-specific quality of life.

Patients with isolated musculoskeletal trauma have lower mental status scores.

UNLABELLED: The subjective concerns and needs of patients who have experienced trauma are important to recovery. However, the mental status of patients with isolated musculoskeletal trauma is not known. Is the mental status of such patients different and does the severity, site, and type of trauma affect this difference? We evaluated the mental status of 195 patients hospitalized for isolated musculoskeletal trauma and determined the characteristics of the factors that affect mental status; 197 patients hospitalized for elective surgery and not exposed to acute trauma constituted the control group. We administered the Mini-Mental State Examination to study and control groups within the first 24 hours of hospitalization. Age, gender, and educational status in the study and control groups were recorded. In addition, the severity, site, and type of trauma in the study group were recorded. Mini-Mental State Examination scores of the trauma group were lower than those of the control group. Mini-Mental State Examination scores decreased with increasing trauma severity. The mental status of the patients sustaining isolated musculoskeletal trauma was affected by the severity, site, and type of trauma. LEVEL OF EVIDENCE: Level I, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Face burns caused by flambé drinks.

This study was conducted to identify the epidemiology of face burns in Korean adults caused by flambé drinks in the hope of developing preventive programs. We reviewed the medical records of 25 patients with burns caused by flame drinks that were admitted to the Hallym Burn Centre, Hangang Sacred Heart Hospital, Seoul, Korea, during the 30-month period of July 2002 to December 2004. The injuries occurred while drinking and spilling the whisky on the flame (68%) during the hours of social gathering and festivity. There were more men than women (male:female ratio=21:4); the mean age was 27.5+/-5.7 years (mean 27, range 21-43 years). Alcohol flames inflicted superficial (56%) to mid-second-degree burns in a relatively small area of body (TBSA 3.2+/-3.0%). The head was most commonly involved, followed by the upper extremity and trunk. All patients except two were treated with observation and daily dressing changes only. The mean length of hospital stay was 12.1+/-6.5 (10, 5-25) days. Long-term cosmetic outcomes were excellent. Some victims suffered mild corneal (n=4) and ear (n=6) burns, without permanent sequelae. Post-traumatic stress disorder and depression also were reported. Burn injuries induced by flambé drinks may be prevented by increasing public awareness about its danger and the potential risk for corneal and facial burns and by implementing a safety policy. All the involved parties--public, distillers, and bar and restaurant management--need to coordinate their efforts achieve a reduction in injuries.

[Chest stab wound comparison in suicidal and homicidal cases]. / Porównanie ran klutych klatki piersiowej w samobójstwach i zabójstwach.

In view of the appearance of cases of homicides by stabbing in which the killer claims that the victim committed suicide cases of homicides and suicides of this type have been compared. Contrary to the opinions appearing in the medico-legal issues stating that the commonly described features of the suicidal wounds such as tentative wounds, stabbing in the intercostals space, "removal" of clothes do not appear in some of the suicides, a few of these features do appear in each of the examined cases. Having considered the horizontal wound arrangement in the skin, which is a newly described feature, the differentiation between homicides and suicides are more categorical. In addition to that, the low level of alcohol in the blood is an extremely characteristic feature of the suicide by chest stabbing. On the contrary, typical features of suicidal death don't appear in cases of "aggressive self-destruction", self inflicted fatal wounds inflicted by a person with mental disorders.

Long-term sequelae following blunt thoracic trauma.

People experiencing blunt thoracic trauma may sustain multiple rib fractures, flail chest, cardiac or pulmonary contusions, injury to the great vessels, sternal fractures, clavicular fractures, neck injuries, and lacerations of the liver and/or spleen. Long-term sequelae from blunt chest trauma include chest wall deformities, persistent dyspnea, and cardiac, neurologic, or esophageal complications. Chronic pain, depression, and loss of functional status are also frequent components of recovery from trauma.

Genital self-amputation and the Klingsor syndrome.

Two psychotic individuals, who performed acts of genital self-amputation, are presented. One of the patients had self-mutilated with the intention of suicide and had also in the past amputated his hand. Psychotic patients with delusions (often religious), sexual conflict associated with guilt, past suicide attempts or other self-destructive behaviour and depression, severe childhood deprivation, and major premorbid personality disorder, are the group at risk for genital self-amputation. It has been proposed that the eponym, the "Klingsor" syndrome, be applied only to acts of genital self-mutation, involving religious delusions. The author suggests that this syndrome should be expanded to include all cases of genital self-mutation resulting from a psychotic illness.