Emergency medicine
Shiva Salmasi; Sadaf Dilmaqani; Hanieh Ebrahimi Bakhtavar; Alireza Ala; Farzad Rahmani
Articles in Press, Accepted Manuscript, Available Online from 13 April 2024
Abstract
Objective: This study aimed to evaluate the relationship between clavicular fracture and associated injuries in multi-traumatic patients.Methods: In this prospective cohort study, 185 multi-traumatic patients referred to the Emergency Department of Imam Reza (AS) Hospital of Tabriz University of Medical ...
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Objective: This study aimed to evaluate the relationship between clavicular fracture and associated injuries in multi-traumatic patients.Methods: In this prospective cohort study, 185 multi-traumatic patients referred to the Emergency Department of Imam Reza (AS) Hospital of Tabriz University of Medical Sciences were selected between August 2019 and September 2021. The census sampling method was used until the required sample size was achieved. The following patient information was recorded and studied: mechanism of trauma, age, gender, Glasgow Coma Scale (GCS) score, systolic blood pressure (SBP), the presence of clavicular fracture, concomitant injuries, hospital outcome, duration ofhospitalization, and severity of trauma. The participants were divided into two groups based on the presence of a clavicular fracture. Data were analyzed using SPSS software.Results: Of all 185 patients, 51 had clavicular fractures. The mean age of the patients was 34.72±12.99. Of all patients, 27.6% had clavicular fractures. There was no statistically significant difference in GCS scores between the two groups (P=0.927). The highest percentage of injuries associated with clavicular traumas was traumatic brain injuries, with rates of 22.4% and 19.6% in the study and control groups, respectively. There were statistically significant differences inconcomitant injuries between the two groups (P<0.001). There was no statistically significant relationship between clavicular fracture and the patient’s outcome (P=0.10), nor between clavicular fracture and GAP (GCS, age, SBP) (P=0.143) or New Trauma Score (NTS) (P=0.257).Conclusion: The results showed a difference in the associated injuries between the groups; however, there was no statistically significant difference in patient outcomes. Healthcare providers are suggested to consider concomitant injuries in patients with clavicular fractures.
Pediatrics
Sangeetha Shenoy; Shruti PATIL
Articles in Press, Accepted Manuscript, Available Online from 03 June 2024
Abstract
Objective: Organ dysfunction is an important factor determining the severity and outcome of critical illness in children. Organ dysfunction scores are based on the number of organs involved and the severity of dysfunction in each. This study aimed to evaluate organ dysfunction using PELOD-2 in critically ...
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Objective: Organ dysfunction is an important factor determining the severity and outcome of critical illness in children. Organ dysfunction scores are based on the number of organs involved and the severity of dysfunction in each. This study aimed to evaluate organ dysfunction using PELOD-2 in critically ill children.Methods: This prospective observational study included all consecutive critically ill children with organ dysfunction aged one month to 15 years admitted to pediatric intensive care unit of a Ramaiah Medical College Hospital, Bangalore between January 2018 and December 2020. The severity of organ dysfunction was scored using Pediatric logistic organ dysfunction-2 (PELOD-2) and evaluated based on the outcome using SPSS and PASW statistics for Windows version 18.0. The sample size required for the study with 95% confidence level and 10% relative precision was 149 critically ill children. The children were classified based on the presence of single and multiple organ dysfunction. Demographics and laboratory parameters were compared between the two groups using non parametric tests. The factors affecting mortality among children with multiple organ dysfunction were assessed using univariate and multivariate analysis.Results: Of the 550 children admitted with critical illness during the study period, organ dysfunction was present in 84% of the patients. Of these, 43% had multiple-organ dysfunction. The median (interquartile range) of the patients was 5.5 (1, 11) years with a male-to-female ratio of 1.7:1. The mortality rate was 14.4%. The PELOD-2 score and mortality steadily increased with the number of organs involved. The presence of more than two organ dysfunctions had an odd ratio (OR) of 45.7 for mortality (95% CI: 18.9–110.6, P value<0.001). The area under the receiver operating curve(ROC) for predicting mortality using the number of organs affected was 0.96 (95% CI: 0.94–0.97, P value<0.001). Dysfunction in more than two organs had a sensitivity of 92.5% and a specificity of 91% in predicting mortality. The presence of cardiovascular dysfunction and the need for ventilation were found to be independent predictors of mortality.Conclusion: The presence of more than two organ dysfunctions in PELOD-2 increased the risk of mortality; the need for ventilation and the presence of cardiovascular dysfunction were independent predictors of mortality.
Emergency medicine
Navid Kalani; Masoud Tavasolian; Khaterh Dehghani; Seyed Reza Mousavi; Erfan Ghanbarzadeh; Masihallah Shakeri; Elahe Rahmanian; Poorya Aryanpoor; Naser Hatami; Zhila Rahmanian; Samaneh Abiri
Volume 9, Issue 1 , January 2023, , Pages 19-24
Abstract
Objective: The goal of our study was to determine the prognostic value of CURB-65,Sequential Organ Failure Assessment (SOFA), pneumonia severity index (PSI), MuLBSTA,and Acute Physiology and Chronic Health Evaluation (APACHE) II upon admission inpatients with coronavirus disease 2019 (COVID-19, as well ...
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Objective: The goal of our study was to determine the prognostic value of CURB-65,Sequential Organ Failure Assessment (SOFA), pneumonia severity index (PSI), MuLBSTA,and Acute Physiology and Chronic Health Evaluation (APACHE) II upon admission inpatients with coronavirus disease 2019 (COVID-19, as well as the prediction cut-off valuefor death regarding these parameters.Methods: This observational retrospective study was performed in COVID-19 triagein Peymaniyeh hospital in Jahrom in 2021. In order to calculate SOFA, APACHE II, PSI,MuLBSTA, and CURB-65, data were collected from patients who were selected by availablesampling method from PCR-confirmed COVID-19 patients. Thirty-day mortality wasassessed as the primary outcome. ROC analysis was conducted using the STATA software toevaluate the prognostic value of the scoring systems. DeLong test was utilized to compareAUC of scores using a web based tool.Results:Ninety-two patients were included in this study with the mean age of 51.02±17.81years (male to female ratio was 1:1). SOFA had an AUC of 0.656 (P=0.130), but other indiceshad statistically significant values of AUC. Based on the comparison of the AUCs, SOFAwas the worst scoring system in COVID-19 as it had significantly lower AUC than PSI andAPACHE II (P<0.05); while its comparison with MULBSTA and CURB65 was not statisticallysignificant (P>0.05).Conclusion: It seems that APACHE II and PSI are the best prognostic factors in our studywith no statistical difference compared together (P>0.05). The sensitivity of APACHE II andPSI was 0.857 with the specificity of 0.927 and 0.976, respectively. The optimal cut-off pointwas 13 and 50 for APACHE II and PSI, respectively
Emergency medicine
Pegah Sepehri Majd; Amirhossein Alimohammadi Siyabani; Haniyeh Ebrahimi Bakhtavar; Farzad Rahmani
Volume 8, Issue 2 , July 2022, , Pages 128-133
Abstract
Objective: Awareness of the severity of trauma and the outcome of patients can help physicians decide how long to treat patients. The objective of this study is to design a new score (R-GAP: Revised-GCS, Age, Pressure) for multi-trauma patients and determine its predictive value concerning in-hospital ...
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Objective: Awareness of the severity of trauma and the outcome of patients can help physicians decide how long to treat patients. The objective of this study is to design a new score (R-GAP: Revised-GCS, Age, Pressure) for multi-trauma patients and determine its predictive value concerning in-hospital outcome of these patients.Methods: This cross-sectional study was performed in the emergency ward of Imam Reza (AS) and Shohada hospitals (referral centers for trauma patients) affiliated to Tabriz University of Medical Sciences from 2019 to 2020. The sample size of this study was estimated to be 2000 people. Required information was collected and the final diagnosis of the patients was recorded. The hospital outcome was recorded at the time of discharge. Patients’ outcome was also recorded using the Glasgow Outcome Scale (GOS) system. Based on the obtained data, GAP, R-GAP, new trauma score (NTS) scores were also collected and their results were compared with the designed model. Receiver operating characteristic (ROC) curve and logistic regression were used to analyze the predictive value of the scores.Results: The mean age of the subjects was 34.09 (± 15.23) years. The highest outcome of patients based on the GOS system was recovery, moderate disability, and severe disability with 1309 cases (54.9%), 743 cases (31.2%), and 212 cases (8.9%), respectively. The mean of GAP, R-GAP, and NTS scores were 21.83 (± 3.1), 21.47 (± 3.4), and 21.27 (± 3.3), respectively. The intensity of GAP, R-GAP, and NTS in most subjects was low with 2143 cases (89.9%), 1994 cases (83.6%), and 2138 cases (89.7%). Among the significant variables included in the regression model, O2sat, primary GCS, GAP, R-GAP, and NTS with modulation on other variables, significantly equalized the mortality chance by 0.416, 0.622, 0.595, 0.601, 0.637, respectively (P value < 0.001).Conclusion: According to the study results, it seems that GAP, R-GAP, and NTS respectively, have the highest strength of predictive value in the survival of patients with multiple traumas. It is suggested that a comprehensive study be conducted to better estimate this issue.
Emergency medicine
Payman Moharamzadeh; Kavous Shahsavari Nia; Mohammadhossein Somi; Mahboub Pouraghaei; Akbar Fadaeihaghi; Farzad Rahmani
Volume 4, Issue 1 , January 2018, , Pages 34-38
Abstract
Objective: In recent years, there has been a great attention concerning red blood cell distribution width (RDW) in clinical decisions as well as determining the severity of diseases. This study was conducted to evaluate the primary level of RDW to predict hospital mortality in pancreatitis.
Methods: ...
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Objective: In recent years, there has been a great attention concerning red blood cell distribution width (RDW) in clinical decisions as well as determining the severity of diseases. This study was conducted to evaluate the primary level of RDW to predict hospital mortality in pancreatitis.
Methods: This was a descriptive analytical study performed on 100 patients with acute pancreatitis in the emergency department of Imam Reza hospital of Tabriz University of Medical Sciences. In this study, the primary level of RDW in patients with acute pancreatitis presenting to the emergency ward was collected and after patients’ admission we followed them. Also, the admission outcome (mortality or discharge) of patients was registered, and finally we evaluated the predictive value of RDW in determining the patient’s outcome in hospital.
Results: In our study, 47 patients were male, and 53 patients were female. Mean RDW in patients was 13.82 ± 1.69. Five patients died during the study. Mean RDW in dead patients and other patients was 16.44 ± 4.22 and 13.68 ± 1.37, respectively (P < 0.001). The cut-off point of 14.55 for RDW with 80% sensitivity and 85% specificity was determined for predicting mortality in patients.
Conclusion: Based on our study results, the initial RDW level is an independent factor for predicting in-hospital mortality in pancreatitis but not for determining the need for surgery or admission to the intensive care unit (ICU).
Critical Care
Maryam Ziaee; Amirhossein Mirafzal
Volume 2, Issue 2 , July 2016, , Pages 50-54
Abstract
Objective: To evaluate the association of base deficit (BD) with mortality in traumatized children, and to assess this association in a subgroup of patients with traumatic brain injury (TBI). Methods: In this cross-sectional study performed prospectively on a convenience sample of patients ...
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Objective: To evaluate the association of base deficit (BD) with mortality in traumatized children, and to assess this association in a subgroup of patients with traumatic brain injury (TBI). Methods: In this cross-sectional study performed prospectively on a convenience sample of patients under 16 years of age with trauma presenting to an academic level ІІ trauma center, we obtained venous BD values initially and followed the patients for in-hospital mortality. Initial vital signs were measured and injury severity score (ISS), randomized trauma score (RTS), and pediatric trauma score (PTS) were calculated. Results: A total of 102 patients were included, with 48 patients diagnosed with TBI. Nine patients (8.8%) died during admission, of which 6 were diagnosed with TBI. Based on the univariate analysis, BD was associated with mortality in the whole group (P = 0.01), but not in the TBI subgroup (P = 0.08). In multivariable analysis, RTS was the only variable independently associated with mortality (P = 0.001, odds ratio [OR] = 0.197). Linear regression model showed that BD was predictive of ISS, RTS, and PTS. Receiver operating characteristics (ROC) curve showed a cutoff point of -7 mmol/L for BD, below which there is a 12 fold increased risk for mortality. Conclusion: BD is a useful parameter in mortality prediction in pediatric trauma like in adult age group, but this predictive role in TBI patients is not supported by our results.