90 research outputs found
Prognostic factors for important clinical outcomes in patients with a severe infection
Patients who are admitted with a suspicion of a severe infection usually enter the hospital through the emergency department (ED). The recognition of prognostic factors in an early stage affects further treatment and might improve clinical outcomes. WE EXAMINED POSSIBLE PROGNOSTIC FACTORS FOR FOUR IMPORTANT OUTCOMES: intensive care unit (ICU) admission, positive blood cultures, mortality and re-admission. All adult patients arriving at the ED with a suspected infection for whom admittance and intravenous (iv) antibiotics were indicated were included between March and December 2006. Possible prognostic variables were obtained from medical history, physical examination and laboratory results during the ED presentation. Data were analysed using logistic regression analysis. A total of 295 ED patients were evaluated, of whom 27 were referred to the ICU, 62 had a positive blood culture, 16 died and 48 were re-admitted. In multivariate analysis, patients with a respiration rate of >25/min were at higher risk for ICU admission. Patients with a positive blood culture had a higher heart rate and a higher percentage of segmented neutrophils. Patients who died during admission were more likely to be older, confused and had lower blood pressure. Patients who were re-admitted within 30 days were more likely to be male, younger and less likely to have a positive blood culture. Routine clinical and biochemical information can be used to predict ICU admission, the presence of bacteraemia, mortality and re-admission (within 30 days) and should be taken into consideration for treatment decision
Refining the criteria for immediate total-body CT after severe trauma
Objectives Initial trauma care could potentially be improved when conventional imaging and selective CT scanning is omitted and replaced by immediate total-body CT (iTBCT) scanning. Because of the potentially increased radiation exposure by this diagnostic approach, proper selection of the severely injured patients is mandatory. Methods In the REACT-2 trial, severe trauma patients were randomized to iTBCT or conventional imaging and selective CT based on predefined criteria regarding compromised vital parameters, clinical suspicion of severe injuries, or high-risk trauma mechanisms in five trauma centers. By logistic regression analysis with backward selection on the 15 study inclusion criteria, a revised set of criteria was derived and subsequently tested for prediction of severe injury and shifts in radiation exposure. Results In total, 1083 patients were enrolled with median ISS of 20 (IQR 9-29) and median GCS of 13 (IQR 3-15). Backward logistic regression resulted in a revised set consisting of nine original and one adjusted criteria. Positive predictive value improved from 76% (95% CI 74-79%) to 82% (95% CI 80-85%). Sensitivity decreased by 9% (95% CI 7-11%). The area under the receiver operating characteristics curve remained equal and was 0.80 (95% CI 0.77-0.83), original set 0.80 (95% CI 0.77-0.83). The revised set retains 8.78 mSv (95% CI 6.01-11.56) for 36% of the non-severely injured patients. Conclusions Selection criteria for iTBCT can be reduced from 15 to 10 clinically criteria. This improves the positive predictive value for severe injury and reduces radiation exposure for less severely injured patients
Internet-based early intervention to prevent poststraumatic stress disorder in injury patients: Randomized controlled trial.
Background: Posttraumatic stress disorder (PTSD) develops in 10-20% of injury patients. We developed a novel, self-guided Internet-based intervention (called Trauma TIPS) based on techniques from cognitive behavioral therapy (CBT) to prevent the onset of PTSD symptoms. Objective: To determine whether Trauma TIPS is effective in preventing the onset of PTSD symptoms in injury patients. Methods: Adult, level 1 trauma center patients were randomly assigned to receive the fully automated Trauma TIPS Internet intervention (n=151) or to receive no early intervention (n=149). Trauma TIPS consisted of psychoeducation, in vivo exposure, and stress management techniques. Both groups were free to use care as usual (nonprotocolized talks with hospital staff). PTSD symptom severity was assessed at 1, 3, 6, and 12 months post injury with a clinical interview (Clinician-Administered PTSD Scale) by blinded trained interviewers and self-report instrument (Impact of Event Scale-Revised). Secondary outcomes were acute anxiety and arousal (assessed online), self-reported depressive and anxiety symptoms (Hospital Anxiety and Depression Scale), and mental health care utilization. Intervention usage was documented. Results: The mean number of intervention logins was 1.7, SD 2.5, median 1, interquartile range (IQR) 1-2. Thirty-four patients in the intervention group did not log in (22.5%), 63 (41.7%) logged in once, and 54 (35.8%) logged in multiple times (mean 3.6, SD 3.5, median 3, IQR 2-4). On clinician-assessed and self-reported PTSD symptoms, both the intervention and control group showed a significant decrease over time (P<.001) without significant differences in trend. PTSD at 12 months was diagnosed in 4.7% of controls and 4.4% of intervention group patients. There were no group differences on anxiety or depressive symptoms over time. Post hoc analyses using latent growth mixture modeling showed a significant decrease in PTSD symptoms in a subgroup of patients with severe initial symptoms (n=20) (P<.001). Conclusions: Our results do not support the efficacy of the Trauma TIPS Internet-based early intervention in the prevention of PTSD symptoms for an unselected population of injury patients. Moreover, uptake was relatively low since one-fifth of individuals did not log in to the intervention. Future research should therefore focus on innovative strategies to increase intervention usage, for example, adding gameplay, embedding it in a blended care context, and targeting high-risk individuals who are more likely to benefit from the intervention
A multicenter, randomized controlled trial of immediate total-body CT scanning in trauma patients (REACT-2)
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110874.pdf (publisher's version ) (Open Access)BACKGROUND: Computed tomography (CT) scanning has become essential in the early diagnostic phase of trauma care because of its high diagnostic accuracy. The introduction of multi-slice CT scanners and infrastructural improvements made total-body CT scanning technically feasible and its usage is currently becoming common practice in several trauma centers. However, literature provides limited evidence whether immediate total-body CT leads to better clinical outcome then conventional radiographic imaging supplemented with selective CT scanning in trauma patients. The aim of the REACT-2 trial is to determine the value of immediate total-body CT scanning in trauma patients. METHODS/DESIGN: The REACT-2 trial is an international, multicenter randomized clinical trial. All participating trauma centers have a multi-slice CT scanner located in the trauma room or at the Emergency Department (ED). All adult, non-pregnant, severely injured trauma patients according to predefined criteria will be included. Patients in whom direct scanning will hamper necessary cardiopulmonary resuscitation or who require an immediate operation because of imminent death (both as judged by the trauma team leader) are excluded. Randomization will be computer assisted. The intervention group will receive a contrast-enhanced total-body CT scan (head to pelvis) during the primary survey. The control group will be evaluated according to local conventional trauma imaging protocols (based on ATLS guidelines) supplemented with selective CT scanning. Primary outcome will be in-hospital mortality. Secondary outcomes are differences in mortality and morbidity during the first year post trauma, several trauma work-up time intervals, radiation exposure, general health and quality of life at 6 and 12 months post trauma and cost-effectiveness. DISCUSSION: The REACT-2 trial is a multicenter randomized clinical trial that will provide evidence on the value of immediate total-body CT scanning during the primary survey of severely injured trauma patients. If immediate total-body CT scanning is found to be the best imaging strategy in severely injured trauma patients it could replace conventional imaging supplemented with CT in this specific group. TRIAL REGISTRATION: ClinicalTrials.gov: (NCT01523626)
Predicting posttraumatic stress disorder in children and parents following accidental child injury: evaluation of the Screening Tool for Early Predictors of Posttraumatic Stress Disorder (STEPP)
ΠΠ΅ΡΠΎΠ΄ΠΎΠ»ΠΎΠ³ΠΈΡ ΡΠΈΠ½ΡΠ΅Π·Π° Π°ΡΡ ΠΈΡΠ΅ΠΊΡΡΡΡ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠ½ΠΎ-ΡΠ΅Ρ Π½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ° Π°Π²ΡΠΎΠΌΠ°ΡΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΡΠΈΡΡΠ΅ΠΌΡ ΠΌΠΎΠ½ΠΈΡΠΎΡΠΈΠ½Π³Π° ΠΎΠ±ΡΡΠ°Π½ΠΎΠ²ΠΊΠΈ
ΠΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ ΠΊ ΠΏΡΠΎΠ΅ΠΊΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ Π°ΡΡ
ΠΈΡΠ΅ΠΊΡΡΡΡ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠ½ΠΎ-ΡΠ΅Ρ
Π½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ° Π°Π²ΡΠΎΠΌΠ°ΡΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΡΠΈΡΡΠ΅ΠΌΡ ΠΌΠΎΠ½ΠΈΡΠΎΡΠΈΠ½Π³Π° ΠΎΠ±ΡΡΠ°Π½ΠΎΠ²ΠΊΠΈ Π² ΡΠ΅Π°Π»ΡΠ½ΠΎΠΌ Π²ΡΠ΅ΠΌΠ΅Π½ΠΈ, ΠΎΡΠ½ΠΎΠ²Π°Π½Π½ΡΠΉ Π½Π° ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ ΡΠ΅ΡΠ°Π΅ΠΌΡΡ
ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΡ
Π·Π°Π΄Π°Ρ Π½Π° ΠΎΡΠ½ΠΎΠ²Π΅ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² ΠΊΠ»Π°ΡΡΠ΅ΡΠ½ΠΎΠ³ΠΎ Π°Π½Π°Π»ΠΈΠ·Π° ΠΈ Π²ΡΠ±ΡΠ°Π½Π½ΠΎΠ³ΠΎ ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²Π° ΠΏΡΠΈΠ·Π½Π°ΠΊΠΎΠ² ΠΏΠΎΠ΄ΠΎΠ±ΠΈΡ. Π Π°Π·ΡΠ°Π±ΠΎΡΠ°Π½Π½ΡΠΉ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΠΈΠ· ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²Π° ΡΡΠ½ΠΊΡΠΈΠΉ ΡΠΈΡΡΠ΅ΠΌΡ Π²ΡΠ΄Π΅Π»ΠΈΡΡ ΠΏΠΎΠ΄ΠΎΠ±Π½ΡΠ΅ (ΠΏΠΎ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½Π½ΡΠΌ ΠΏΡΠΈΠ·Π½Π°ΠΊΠ°ΠΌ) ΠΈ ΠΎΠ±ΡΠ΅Π΄ΠΈΠ½ΠΈΡΡ ΠΈΡ
Π² Π°ΡΡ
ΠΈΡΠ΅ΠΊΡΡΡΠ½ΡΠ΅ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΡ (ΡΠ½ΠΈΡΠΈΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠ΅ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠ΅ ΠΌΠΎΠ΄ΡΠ»ΠΈ).ΠΠ°ΠΏΡΠΎΠΏΠΎΠ½ΠΎΠ²Π°Π½ΠΎ ΠΏΡΠ΄Ρ
ΡΠ΄ Π΄ΠΎ ΠΏΡΠΎΠ΅ΠΊΡΡΠ²Π°Π½Π½Ρ Π°ΡΡ
ΡΡΠ΅ΠΊΡΡΡΠΈ ΡΠ΅Π½ΡΡΡ ΠΎΠ±ΡΠΎΠ±ΠΊΠΈ ΡΠ½ΡΠΎΡΠΌΠ°ΡΡΡ Π°Π²ΡΠΎΠΌΠ°ΡΠΈΠ·ΠΎΠ²Π°Π½ΠΎΡ ΡΠΈΡΡΠ΅ΠΌΠΈ ΠΌΠΎΠ½ΡΡΠΎΡΠΈΠ½Π³Ρ ΡΠ΅ΡΠ΅Π΄ΠΎΠ²ΠΈΡΠ° Π² ΡΠ΅Π°Π»ΡΠ½ΠΎΠΌΡ ΡΠ°ΡΡ, ΡΠΎ Π·Π°ΡΠ½ΠΎΠ²Π°Π½ΠΈΠΉ Π½Π° ΠΊΠ»Π°ΡΠΈΡΡΠΊΠ°ΡΡΡ ΡΡΠ½ΠΊΡΡΠΎΠ½Π°Π»ΡΠ½ΠΈΡ
Π·Π°Π΄Π°Ρ Π½Π° ΠΏΡΠ΄ΡΡΠ°Π²Ρ ΠΌΠ΅ΡΠΎΠ΄ΡΠ² ΠΊΠ»Π°ΡΡΠ΅ΡΠ½ΠΎΠ³ΠΎ Π°Π½Π°Π»ΡΠ·Ρ Ρ ΠΎΠ±ΡΠ°Π½ΠΎΡ ΠΌΠ½ΠΎΠΆΠΈΠ½ΠΈ ΠΎΠ·Π½Π°ΠΊ ΡΡ
ΠΎΠΆΠΎΡΡΡ. Π ΠΎΠ·ΡΠΎΠ±Π»Π΅Π½ΠΈΠΉ ΠΏΡΠ΄Ρ
ΡΠ΄ Π΄ΠΎΠ·Π²ΠΎΠ»ΡΡ Π²ΠΈΠ±ΡΠ°ΡΠΈ ΡΠ· ΠΌΠ½ΠΎΠΆΠΈΠ½ΠΈ ΡΡΠ½ΠΊΡΡΠΉ ΡΠΈΡΡΠ΅ΠΌΠΈ ΡΡ
ΠΎΠΆΡ (Π·Π° ΠΏΠ΅Π²Π½ΠΈΠΌΠΈ ΠΎΠ·Π½Π°ΠΊΠ°ΠΌΠΈ) Ρ ΠΏΠΎΡΠ΄Π½Π°ΡΠΈ ΡΡ
Π² Π°ΡΡ
ΡΡΠ΅ΠΊΡΡΡΠ½Ρ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠΈ (ΡΠ½ΡΡΡΠΊΠΎΠ²Π°Π½Ρ ΡΡΠ½ΠΊΡΡΠΎΠ½Π°Π»ΡΠ½Ρ ΠΌΠΎΠ΄ΡΠ»Ρ).The approach to designing architecture of the information processing complex of the automated real time conditions monitoring system based on classification of functional tasks on the basis of methods of cluster analysis and the chosen set of similarity attributes is offered. The developed approach allows to allocate from a set of functions the systems similar (on certain attributes) and to unite them in architectural components (unified functional modules)
Determinants of leptomeningeal collateral flow in stroke patients with a middle cerebral artery occlusion
Internal fracture fixation using the Stoppa approach in pelvic ring and acetabular fractures: technical aspects and operative results
BACKGROUND: The ilioinguinal approach is well established for the treatment of pelvic fractures. As an alternative, the modified Stoppa approach can be used to expose pelvic and acetabular fractures. We describe our experience with this approach in patients with pelvic and acetabular fractures with respect to fracture reduction, technical aspects, and the incidence of intra- and postoperative complications. METHODS: This retrospective study describes a series of 25 consecutive patients where a modified Stoppa approach was used for pelvic or acetabular fracture fixation. RESULTS: Fifteen patients with acetabular fractures, six patients with a pelvic ring injury not involving the acetabular joint and four patients with a combined fracture were operated through a Stoppa approach. Nine patients had a total of 13 complications, none of which required reoperation. Anatomic or satisfactory reduction was achieved in 95% of the acetabular fractures. Pelvic ring fractures had an anatomic (displacement <1 cm) postoperative result in all 10 cases. CONCLUSION: The modified Stoppa approach allows an adequate exposure and good postoperative results for treatment of pelvic ring fractures and acetabular fractures that are eligible for an anterior approac
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