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Article: Clinical outcomes of multiple rib fractures: does age matter?
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ABSTRACT: Purpose To evaluate the clinical outcomes of multiple rib fracture due to blunt trauma in young patients, a 3-year retrospective study was conducted. Patients with ≥3 rib fractures were divided into two groups (group I: <45 years old and group II: ≥45 years old). Mortality, hospital stay, ventilatory support, chest tubes insertion and associated injuries were studied. Results Of the 902 patients admitted with blunt chest trauma, 240 (27 %) met the inclusion criteria and 72.5 % patients were <45 years old. The most common causes of injury were motor vehicle crash (59 %) and fall (29 %). The Injury Severity Score (ISS) was higher in group I (16 ± 9 vs. 13 ± 6; p = 0.04). Hospital mortality was higher in group II (6 vs. 2 %; p = 0.18). Pneumothorax, haemothorax and ventilatory support were comparable. Patients in group II were more likely to undergo chest tubes insertion (26 vs. 14 %; p = 0.04), while group I had a significantly higher incidence of associated abdominal injuries (25 vs. 12 %; p = 0.03). Conclusion Old age presenting with rib fractures is associated with higher mortality in comparison to young age; however, this difference becomes statistically insignificant in the presence of multiple rib fracture.European Journal of Trauma and Emergency Surgery 04/2013; · 0.33 Impact Factor -
Article: Intra-abdominal hypertension in the current era of modern trauma resuscitation
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ABSTRACT: Background: This study aimed to determine the incidence and outcome of posttraumatic (PT) intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) after the advances in haemostatic resuscitation. Methods: This is a prospective cohort study from January 2009–December 2011 involving patients with PT haemorrhagic shock. Patients’ demographics, fluid resuscitation (<24 h) and damage control laparotomy (DCL), morbidity and mortality were assessed. Patients were divided into group 1 (no DCL) and group 2 (DCL needed). Further, group 1 was subdivided into three subgroups (IA pressure (IAP) <12, 12–20 and >20 mmHg). Results: One hundred seventeen patients enrolled in the study (102 in group 1 and 15 in group 2) with a mean age of 35 � 14, injury severity score (ISS) of 23 � 10, base deficit of -8.7 �2.7 mmol/L, serum lactate of 4.6 �2.5 mg/dL and haemoglobin level of 8.8 � 2. Patients received 7 � 5 red blood cell units, 6 � 4.7 fresh frozen plasma units and 8.3 � 3 L of crystalloid per 24 h. There were significant difference between the two groups regarding crystalloid volume, blood transfusion, base deficit and intensive care unit length of stay. However, mortality was higher in group 2 (20% versus 6%). IAP � 20 mmHg was reported in 16.7% patients, while 25.5% had IAP < 12 and 57.8% had IAP of 12–20 mmHg. Patients with IAP > 20 had worse metabolic acidosis and received more blood compared with other groups. One patient died because of ACS (0.9%). Overall multiorgan failure and mortality were 5 and 7.7%, respectively. Conclusion: With current practice of minimal fluid resuscitation and liberal use of damage control strategies among trauma patients, the IAH was common transient phenomena but the incidence of ACS is remarkably low.ANZ Journal of Surgery 04/2013; · 1.25 Impact Factor -
Article: Age and traumatic chest injury: a 3-year observational study
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ABSTRACT: Background A quarter of trauma-related deaths are attributable to traumatic chest injury (TCI). Objective To outline the pattern and outcome of TCI in a rapidly developing country among different age groups. Methods We conducted a retrospective observational study for patients who sustained TCI and admitted between January 2008 and December 2010 to the Level I trauma center at Hamad General Hospital in Qatar. Patients were classified and analyzed in four age groups (group 1 ≤18, group 2 between 19–44, group 3 45–59, and group 4 >60 years). Multivariate regression analysis was performed for predictors of mortality. Results Of 5,118 cases admitted to the Section of Trauma Surgery, 1,355 (26.5 %) had TCI (12, 67, 16, and 5 % in groups 1–4, respectively), which was due to blunt trauma in 96 % of cases. The overall mean age was 33 ± 15 years and males comprised 94 % of cases. Children (≤18 years of age) had more traffic-related injury, intubation, high Injury Severity Score (ISS) (19 ± 12), and associated head and liver injuries in comparison to the other groups. The overall mortality rate was 13 % (24, 11, 12, and 16 % in groups 1–4, respectively). The death rate was higher in pedestrians, followed by motor vehicle crashes (MVCs) and fall-related injuries (24 vs. 13 vs. 7 %, respectively, p = 0.001). The highest mortality occurred within the first day (n = 115, 65 %). In comparison to old age, children were more likely to die early (on the first day) and the adult group died mostly within the first week of hospitalization. Independent predictors for mortality included associated head injury [odds ratio (OR) 2.3, 95 % confidence interval (CI) 1.48–3.62), ISS (OR 1.11, 95 % CI 1.09–1.13), and age (OR 0.37, 95 % CI 0.22–0.62). Conclusion TCI is an alarming problem in Qatar, with a bimodal mortality curve. The highest mortality peak occurred in children, followed by old age. However, young males are the most exposed population. Regulatory efforts and strict enforcement of traffic laws would likely reduce morbidity and mortality.European Journal of Trauma and Emergency Surgery 04/2013; · 0.33 Impact Factor -
Article: Gastrointestinal tract access for enteral nutrition in critically ill and trauma patients: indications, techniques, and complications
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ABSTRACT: Background Enteral nutrition (EN) is a widely used, standard-of-care technique for nutrition support in critically ill and trauma patients. Objective To review the current techniques of gastrointestinal tract access for EN. Methods For this traditional narrative review, we accessed English-language articles and abstracts published from January 1988 through October 2012, using three research engines (MEDLINE, Scopus, and EMBASE) and the following key terms: “enteral nutrition,” “critically ill,” and “gut access.” We excluded outdated abstracts. Results For our nearly 25-year search period, 44 articles matched all three terms. The most common gut access techniques included nasoenteric tube placement (nasogastric, nasoduodenal, or nasojejunal), as well as a percutaneous endoscopic gastrostomy (PEG). Other open or laparoscopic techniques, such as a jejunostomy or a gastrojejunostomy, were also used. Early EN continues to be preferred whenever feasible. In addition, evidence is mounting that EN during the early phase of critical illness or trauma trophic feeding has an outcome comparable to that of full-strength formulas. Most patients tolerate EN through the stomach, so postpyloric tube feeding is not needed initially. Conclusion In critically ill and trauma patients, early EN through the stomach should be instituted whenever feasible. Other approaches can be used according to patient needs, available expertise, and institutional guidelines. More research is needed in order to ensure the safe use of surgical tubes in the open abdomen.European Journal of Trauma and Emergency Surgery 01/2013; · 0.33 Impact Factor -
Article: Concurrent Rib and Pelvic Fractures as an Indicator of Solid Abdominal Organ Injury.
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ABSTRACT: OBJECTIVES: To study the association of solid organ injuries (SOIs) in patients with concurrent rib and pelvic fractures. METHODS: Retrospective analysis of prospectively collected data from November 2007 to May 2010. Patients' demographics, mechanism of injury, Injury severity scoring, pelvic fracture, and SOIs were analyzed. Patients with SOIs were compared in rib fractures with and without pelvic fracture. RESULTS: The study included 829 patients (460 with rib fractures ± pelvic fracture and 369 with pelvic fracture alone) with mean age of 35±12.7 years. Motor vehicle crashes (45%) and falls from height (30%) were the most common mechanism of injury. The overall incidence of SOIs in this study was 22% (185/829). Further, 15% of patient with rib fractures had associated pelvic fracture. SOI was predominant in patients with concurrent rib fracture and pelvic fracture compared to ribs or pelvic fractures alone (42% vs. 26% vs. 15%, respectively, p=0.02). CONCLUSIONS: Concurrent multiple rib fractures and pelvic fracture increases the risk of SOI compared to either group alone. Lower RFs and pelvic fracture had higher association for SOI and could be used as an early indicator of the presence of SOIs.International journal of surgery (London, England) 04/2013;
