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Beliaev A.M.,Auckland City Hospital | Barber P.A.,University of Auckland | Marshall R.J.,University of Auckland | Civil I.,Trauma Services
ANZ Journal of Surgery | Year: 2014

Background: Blunt cerebrovascular injury (BCVI) occurs in 0.2-2.7% of blunt trauma patients and has up to 30% mortality. Conventional screening does not recognize up to 20% of BCVI patients. To improve diagnosis of BCVI, both an expanded battery of screening criteria and a multi-detector computed tomography angiography (CTA) have been suggested. The aim of this study is to investigate whether the use of CTA restricted to the Denver protocol screen-positive patients would reduce the unnecessary use of CTA as a pre-emptive screening tool. Methods: This is a registry-based study of blunt trauma patients admitted to Auckland City Hospital from 1998 to 2012. The diagnosis of BCVI was confirmed or excluded with CTA, magnetic resonance angiography and, if these imaging were non-conclusive, four-vessel digital subtraction angiography. Results: Thirty (61%) BCVI and 19 (39%) non-BCVI patients met eligibility criteria. The Denver protocol applied to our cohort of patients had a sensitivity of 97% (95% confidence interval (CI): 83-100%) and a specificity of 42% (95% CI: 20-67%). With a prevalence of BCVI in blunt trauma patients of 0.2% and 2.7%, post-test odds of a screen-positive test were 0.03 (95% CI: 0.002-0.005) and 0.046 (95% CI: 0.314-0.068), respectively. Conclusions: Application of the CTA to the Denver protocol screen-positive trauma patients can decrease the use of CTA as a pre-emptive screening tool by 95-97% and reduces its hazards. © 2013 Royal Australasian College of Surgeons.

Ali S.,Trauma Services | Brown C.V.R.,University Medical Center Brackenridge
American Surgeon | Year: 2015

The objective of this study is to compare rates of venous thromboembolism (VTE) in patients who receive enoxaparin prophylaxis compared with no enoxaparin prophylaxis after craniotomy for traumatic brain injury (TBI). This retrospective cohort evaluated all trauma patients admitted to a Level I trauma center from January 2006 to December 2011 who received craniotomy after acute TBI. Patients were excluded if developed VTE before administration of enoxaparin or they died within the first 72 hours of hospital admission. A total of 271 patients were included (enoxaparin prophylaxis, n 5 45; no enoxaparin prophylaxis, n 5 225). The median time until enoxaparin initiation was 11 6 1 days. There was no significant difference in the proportion of patients who developed a VTE when using enoxaparin prophylaxis compared with no enoxaparin prophylaxis (2 vs 4%; P 5 0.65). Rates of deep vein thrombosis (2 vs 3%; P 5 0.87) and pulmonary embolism (0 vs 1%; P 5 0.99) were similar between treatment groups, respectively. Late enoxaparin prophylaxis did not demonstrate a protective effect for VTE. Given the overall low event rate, the administration of pharmacologic prophylaxis against VTE late in the treatment course may not be routinely warranted after craniotomy for acute TBI. Further investigation with early administration of enoxaparin is needed.

Cinnamon J.,Simon Fraser University | Schuurman N.,Simon Fraser University | Hameed S.M.,Trauma Services
PLoS ONE | Year: 2011

Background: Human behaviour is an obvious, yet under-studied factor in pedestrian injury. Behavioural interventions that address rule violations by pedestrians and motorists could potentially reduce the frequency of pedestrian injury. In this study, a method was developed to examine road-rule non-compliance by pedestrians and motorists. The purpose of the study was to examine the potential association between violations made by pedestrians and motorists at signalized intersections, and collisions between pedestrians and motor-vehicles. The underlying hypothesis is that high-incident pedestrian intersections are likely to vary with respect to their aetiology, and thus are likely to require individualized interventions - based on the type and rate of pedestrian and motorist violation. Methods: High-incident pedestrian injury intersections in Vancouver, Canada were identified using geographic information systems. Road-rule violations by pedestrians and motorists were documented at each incident hotspot by a team of observers at several different time periods during the day. Results: Approximately 9,000 pedestrians and 18,000 vehicles were observed in total. In total for all observed intersections, over 2000 (21%) pedestrians committed one of the observed pedestrian road-crossing violations, while approximately 1000 (5.9%) drivers committed one of the observed motorist violations. Great variability in road-rule violations was observed between intersections, and also within intersections at different observation periods. Conclusions: Both motorists and pedestrians were frequently observed committing road-rule violations at signalized intersections, suggesting a potential human behavioural contribution to pedestrian injury at the study sites. These results suggest that each intersection may have unique mechanisms that contribute to pedestrian injury, and may require targeted behavioural interventions. The method described in this study provides the basis for understanding the relationship between violations and pedestrian injury risk at urban intersections. Findings could be applied to targeted prevention campaigns designed to reduce the number of pedestrian injuries at signalized intersections. © 2011 Cinnamon et al.

BACKGROUND: We sought to characterize trends in neurosurgical practice patterns and outcomes for serious to critical traumatic brain injuries (TBI) from 2003-2013 in the mature trauma state of Pennsylvania. METHODS: All 2003-2013 admissions to Pennsylvania’s 30 accredited level I-II trauma centers with serious to critical TBIs (head Abbreviated Injury Score [AIS] ≥3, Glasgow Coma Score [GCS] <13) were extracted from the state registry. Adjusted temporal trend tests controlling for demographic and injury severity covariates assessed the impact of admission year on intervention rates (craniotomy, craniectomy, and intracranial pressure monitor/ventriculostomy [ICP]), and outcome measures for the total population as well as serious (head AIS≥3, GCS 9-12) and critical (head AIS≥3, GCS≤8) subgroups. RESULTS: A total of 22,229 patients met inclusion criteria. Admission year was significantly associated with an adjusted increase in craniectomy (AOR: 1.12 [1.09-1.14]; p<0.001) and ICP rates (AOR: 1.03 [1.02-1.04]; p<0.001) and a decrease in craniotomy rate (AOR: 0.96 [0.95-0.97]; p<0.001). No significant trends in adjusted mortality were found for the total study population (AOR: 1.01 [1.00-1.02]; p=0.150), however a significant reduction was found for the serious subgroup (AOR: 0.95 [0.92-0.98]; p=0.002) and a significant increase was found for the critical subgroup (AOR: 1.02 [1.01-1.03]; p=0.004). CONCLUSIONS: Total study population trends showed a reduction in rates of craniotomy and increase in craniectomy and ICP rates without any change in outcome. Despite significant adaptations in neurosurgical practice patterns from 2003-2013, only patients with serious head injuries are experiencing improved survival. LEVEL OF EVIDENCE: Level III Study © 2016 Lippincott Williams & Wilkins, Inc.

Maher A.,Trauma Services
Annals of Vascular Surgery | Year: 2010

Intralobular capillary hemangioma is an extremely a rare form of vascular tumor that has important clinical implications. We report a case of 41-year-old woman that presented to us as a primary neck mass in an outpatient setting. This case reinforces the need to consider vascular tumors in the evaluation of swellings in the root of the neck. It also demonstrates the importance of an ultrasound exam as a first-line diagnostic tool in such cases. We also present an up to date review of the literature on this subject. © Annals of Vascular Surgery Inc.

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