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Battle C.,NISCHR Haemostasis Biomedical Research Unit | Hutchings H.,University of Swansea | Bouamra O.,University of Manchester | Evans P.A.,NISCHR Haemostasis Biomedical Research Unit
Journal of the Intensive Care Society | Year: 2015

Introduction: The relationship between socioeconomic status and various components of health is well established. Research has also highlighted that social deprivation can affect patterns of injury and outcome after trauma. The interaction between outcomes following blunt chest trauma and socioeconomic status has received limited attention in trauma research. The aim of this study was to investigate the relationship between socioeconomic factors, mechanisms of injury and outcomes following blunt chest trauma using deprivation measures calculated on the basis of domicile postcodes. Methods: A retrospective study design was used in order to examine the medical notes of all blunt chest wall trauma patients who presented to the ED of a large regional trauma centre in South West Wales in 2012 and 2013. Baseline characteristics were presented as median and interquartile range or numbers and percentages. Differences between the baseline characteristics were analysed using Mann–Whitney U test and Fisher’s exact test. Odds ratios and 95% confidence intervals were presented from the univariable analysis. Multivariable logistic regression analysis was used to identify significant predictors for the development of complications. Results: Patients in the ‘more deprived’ group were more likely to be the victims of assault (p<0.001) and were more likely to have an unplanned re-attendance at the Emergency Department than the patients in the ‘less deprived’ group (p<0.001). On multivariable analysis, social deprivation was not a risk factor for the development of complications, but it was a significant risk factor for prolonged length of stay (p<0.05). Conclusions: This is the first study in which social deprivation has been investigated as a risk factor for complications following isolated blunt chest wall trauma. Residing in a ‘more deprived’ area in SouthWestWales is not associated with the development of complications following isolated blunt chest wall trauma. © The Intensive Care Society 2015. Source


Battle C.,NISCHR Haemostasis Biomedical Research Unit | Hutchings H.,University of Swansea | Bouamra O.,University of Manchester | Evans P.A.,NISCHR Haemostasis Biomedical Research Unit
PLoS ONE | Year: 2014

Introduction: The difficulties in the management of the blunt chest wall trauma patient in the Emergency Department due to the development of late complications are well recognised in the literature. Pre-injury anti-platelet therapy has been previously investigated as a risk factor for poor outcomes following traumatic head injury, but not in the blunt chest wall trauma patient cohort. The aim of this study was to investigate pre-injury anti-platelet therapy as a risk factor for the development of complications in the recovery phase following blunt chest wall trauma. Methods: A retrospective study was completed in which the medical notes were analysed of all blunt chest wall trauma patients presenting to a large trauma centre in Wales in 2012 and 2013. Using univariate and multivariable logistic regression analysis, pre-injury platelet therapy was investigated as a risk factor for the development of complications following blunt chest wall trauma. Previously identified risk factors were included in the analysis to address the influence of confounding. Results: A total of 1303 isolated blunt chest wall trauma patients presented to the ED in Morriston Hospital in 2012 and 2013 with complications recorded in 144 patients (11%). On multi-variable analysis, pre-injury anti-platelet therapy was found to be a significant risk factor for the development of complications following isolated blunt chest wall trauma (odds ratio: 16.9; 95% confidence intervals: 8.2-35.2). As in previous studies patient age, number of rib fractures, chronic lung disease and pre-injury anti-coagulant use were also found to be significant risk factors. Conclusions: Pre-injury anti-platelet therapy is being increasingly used as a first line treatment for a number of conditions and there is a concurrent increase in trauma in the elderly population. Pre-injury anti-platelet therapy should be considered as a risk factor for the development of complications by clinicians managing blunt chest wall trauma. © 2014 Battle et al. Source


Stanford S.N.,University of Swansea | Sabra A.,University of Swansea | D'Silva L.,University of Swansea | Lawrence M.,University of Swansea | And 10 more authors.
BMC Neurology | Year: 2015

Background: Stroke is the second largest cause of death worldwide. Hypercoagulability is a key feature in ischaemic stroke due to the development of an abnormally dense clot structure but techniques assessing the mechanics and quality of clot microstructure have limited clinical use. We have previously validated a new haemorheological technique using three parameters to reflect clot microstructure (Fractal Dimension (d f )) ex-vivo, real-time clot formation time (T GP ) and blood clot strength (elasticity at the gel point (G'GP)). We aimed to evaluate these novel clotting biomarkers in ischaemic stroke and changes of clot structure following therapeutic intervention. Methods: In a prospective cohort study clot microstructure was compared in ischaemic stroke patients and a control group of healthy volunteers. Further assessment took place at 2-4 hours and at 24 hours after therapeutic intervention in the stroke group to assess the effects of thrombolysis and anti-platelet therapy. Results: 75 patients (mean age 72.8 years [SD 13.1]; 47 male, 28 female) with ischaemic stroke were recruited. Of the 75 patients, 32 were thrombolysed with t-PA and 43 were loaded with 300 mg aspirin. The following parameters were significantly different between patients with stroke and the 74 healthy subjects: d f (1.760 ± .053 versus 1.735 ± 0.048, p = 0.003), TGP (208 ± 67 versus 231 ± 75, p = 0.05), G'GP (0.056 ± 0.017 versus 0.045 ± 0.014, p < 0.0001) and fibrinogen (3.7 ± 0.8 versus 3.2 ± 0.5, p < 0.00001). There was a significant decrease in d f (p = 0.02), G'GP (p = 0.01) and fibrinogen (p = 0.01) following the administration of aspirin and for d f (p = 0.003) and fibrinogen (p < 0.001) following thrombolysis as compared to baseline values. Conclusion: Patients with ischaemic stroke have denser and stronger clot structure as detected by d f and G'GP. The effect of thrombolysis on clot microstructure (d f ) was more prominent than antiplatelet therapy. Further work is needed to assess the clinical and therapeutic implications of these novel biomarkers. © 2015 Stanford et al.; licensee BioMed Central. Source


Lecky F.E.,University of Manchester | Omar M.,NISCHR Haemostasis Biomedical Research Unit | Bouamra O.,University of Manchester | Jenks T.,University of Manchester | And 3 more authors.
Emergency Medicine Journal | Year: 2015

Objective: To define the relationship between preinjury warfarin use and mortality in a large European sample of trauma patients. Methods: A multicentred study was conducted using data collated from European ( predominately English and Welsh) trauma receiving hospitals. Patient data from the Trauma Audit and Research Network database from 2009 to 2013 were analysed. Univariate and multivariate logistic regression was used to estimate OR for mortality associated with preinjury warfarin use in the whole adult trauma cohort and a matched sample of patients comparable in terms of age, gender, GCS, preexisting medical conditions and injury severity. Results: A total of 136 617 adult trauma patients (2009-2013) were included, with 499 patients reported to be using warfarin therapy at the time of trauma. Preinjury warfarin use was associated with a significantly higher mortality rate at 30 days postinjury compared with the non-users. Following adjustment of age, injury severity and GCS, preinjury warfarin use was associated with increased mortality in trauma patients (adjusted OR 2.14; 95% CI 1.66 to 2.76; p<0.001). In the matched subset, 22% of warfarinised trauma patients died compared with 16.3% of non-warfarinised trauma patients with comparable age, injury severity and GCS (adjusted OR 1.94; 95% CI 1.25 to 3.01; p=0.003). Conclusions: Preinjury warfarin use has been demonstrated to be an independent predictor of mortality in trauma patients. Clinicians managing major trauma patients on warfarin need to be aware of the vulnerability of this group. Source


Battle C.E.,NISCHR Haemostasis Biomedical Research Unit | Evans P.A.,NISCHR Haemostasis Biomedical Research Unit
Emergency Medicine Journal | Year: 2015

Objective: To summarise the risk factors for mortality in patients with flail chest based on available evidence in the literature. Methods: A systematic review was completed using articles from PubMed, EMBASE, the Centre for Review and Dissemination database and the Cochrane Library. Additional studies were identified by hand-searching bibliographies, and grey literature was sought by searching abstracts from all relevant Emergency Medicine Conferences. All published and unpublished observational studies were included if they investigated estimates of association between a risk factor and mortality for patients with flail chest. Results: This review found seven studies that matched the inclusion criteria, with a total of 944 patients. Patient age of ≥65 years was reported as a predictor of mortality when controlling for injury severity score (ISS) (p<0.02, OR 2.1, 95% CI 1.0 to 4.6). An ISS of ≥31 was reported to be a predictor of mortality in two studies; however, neither controlled for patient age. Pulmonary contusion, bilateral flail chest and hospital length of stay were not consistently found to be associated with mortality. Conclusions: The main independent predictors of mortality in patients with flail chest were reported to be increased age and ISS. More data are needed regarding the association of hospital length of stay, presence of pulmonary contusion and bilateral flail chest. Source

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