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Affecting factors of severe multiple trauma patients in PICU

Affecting factors of severe multiple trauma patients in PICU

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第17届世界灾难及急救医学学术会议暨第14次全国急诊医学学术年会

作者： Chen hui Qian suyun Wang quan Li zhen Zeng jiansheng The capital university of medical sciences,Beijing children's hospital affiliated rescue center 100045

Background Our cases analysis was aimed to identify the potential risk factors that could affect mortality rate in severely injured multiple trauma children,especially those treated in PICU. Methods It is a follow-up study of multiple trauma children cases admitted to *** with severe multiple trauma were *** were examined and analysed by different risk factors that could affect the mortality. Results There were 32 severe multiple trauma children admitted to PICU during the study period. The risk factors that affected the mortality were Pediatric Critical Illness Score(PCIS ),duration of trauma,age,coma score,shock,acute lung injury(ALI),multiple organ failure(MOF).Specific risk factors also affected different subgroup children at different degrees of PCIS. Conclusions PCIS,duration of trauma,age,coma, shock,acute lung injury(ALI),multiple organ failure(MOF) could affect the mortality of pediatric severe multiple trauma patients.

关键词： Affecting factors of severe multiple trauma patients in PICU

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Diagnosis of Pneumothorax by Radiography and Ultrasonography-A Meta-analysis

Diagnosis of Pneumothorax by Radiography and Ultrasonography...

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第17届世界灾难及急救医学学术会议暨第14次全国急诊医学学术年会

作者： Wu Ding~1 Yuehong Shen~2 Jianxin Yang~1 Xiaojun He~1 Zhang mao~1 1.Department of Emergency Medicine,Second Affiliated Hospital,Zhejiang University,School of Medicine and Research Institute of Emergency Medicine 2.Department of Burns,Second Affiliated Hospital, Zhejiang University 310009

Objective To compare,by a meta-analysis, anterior-posterior chest radiography(CR) with transthoracic ultrasonography(US) for diagnosis of pneumothorax. Methods English language articles on the diagnostic performance of CR and/or US for diagnosis of a pneumothorax were *** eligible studies,data were recalculated and the forest plots and summary receiver operating characteristic(sROC) curves were analyzed with Meta-Disc software. Results Pooled sensitivity and specificity were 0.88 and 0.99,respectively,for US,and 0.52 and 1.00, respectively,for *** US performed by clinicians other than radiologists,pooled sensitivity and specificity were 0.89 and 0.99,respectively. The areas under the sROC curves were compared and no significant differences were found. Meta-regression analysis implied that the operator is strongly associated with accuracy(relative DOR = 0.21;95%CI:0.05-0.96;p = 0.0455) Conclusions The meta-analysis indicated thatbedside US performed by clinicians had higher sensitivity and similar specificity compared with CR in the diagnosis of *** the accuracy of US in diagnosis of pneumothorax depended on the skill of the operators

关键词： Diagnosis of Pneumothorax by Radiography and Ultrasonography-A Meta-analysis

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Revised trauma score has limited ability in predicting trauma outcomes other than mortality

Revised trauma score has limited ability in predicting traum...

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第17届世界灾难及急救医学学术会议暨第14次全国急诊医学学术年会

作者： Li hui~1 shen weifeng~1 chen weiqiang~3 he xiaojun~3 wu junsong~1 yijianhua~1 ma yuefeng~1 1.Zhejiang university second affiliated hospital emergency center 2.The emergency medical journal editorial staff 3.Hangzhou municipal bureau 310009

Objectives To study the predicting power of RTS-w for the outcomes of injured patients and compare with that of ISS including mortality, hospital length of stay,ICU length of stay and severe disability. Methods A total of 3323 adult trauma patients were enrolled in this *** data,variables related to the trauma scores and outcomes were *** have a measure of the performance of the two scores,receiver operating characteristics (ROC) curves were generated,and the area under the curve(AUC) with 95%confidence interval and p values was also calculated. Results RTS-w was significantly better than ISS in predicting mortality of trauma patients (AUC:0.934vs.0.880,p<0.000l).However,for the other four outcomes,including intensive care unit admission,hospital length of stay,intensive care unit length of stay and severe disability,the predictive abilities of RTS-w were limited. Conclusions The RTS-w was a good predictor of mortality but with limited power when predict other *** studies are needed to identify the predictive ability of RTS-w for the outcomes other than ***,updating the coefficients of the formula may make the RTS-w more accurate.

关键词： ISS Revised trauma score has limited ability in predicting trauma outcomes other than mortality

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The expression of transforming growth factor-βlin the pulmonary fibrosis induced by paraquat in mice

The expression of transforming growth factor-βlin the pulmo...

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第17届世界灾难及急救医学学术会议暨第14次全国急诊医学学术年会

作者： DONG Xuesong LIU Wei LIU Shuying LIU zhi Department of Emergency,the First Affiliated Hospital, China Medical University 110001

Objective The expression of transforming growth factor-β1(TGF-β1) in the pulmonary fibrosis induced by paraquatwas detected by immunohistochemical method. Methods C57BL/6J male mice(n=58 ) were divided randomly into the experimental group and the control *** fibrosis was induced by intraperitoneal injection of paraquat(10mg/kg) in the experimental group(n=48 ),while physiological saline was used in the control group (n=10 ) by the same *** mice weresacrificed on days 2,5,7 and 14in the experimental group and the ones on day 7 in the control *** wereisolated and histological changes in the lungs were evaluatedby haematoxylin-eosin stain and the location of TGF-piwas determined by immunohistochemical *** integrated Optical Density(iOD )value of TGF-β1was measured and *** comparisonbetween groups was estimated using ttest. Results The expression of TGF-β1 was markedly increased in macrophages during the process of pulmonary fibrosis induced by *** the progression in fibrosis,the positive stain of TGF-piwas mainly seen in macrophages' and neutrophils' *** day 14 after paraquat administration,TGF-β1-positive cells were also detected in the fibroblasts and myofibroblast in fibroblastic *** with the control group,the experimental group showed theincreased iOD value of TGF-β1(P<0.01) and its upgrade tendency during the fibrosis process. Conclusions The expression of TGF-β1 was significantly increased during the PQ-induced pulmonary fibrosis and played an important role in thedevelopment of the disease.

关键词： TGF The expression of transforming growth factor lin the pulmonary fibrosis induced by paraquat in mice

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Diagnosis and management of tooth aspiration in multiple trauma patients with mechanical ventilation

Diagnosis and management of tooth aspiration in multiple tra...

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第17届世界灾难及急救医学学术会议暨第14次全国急诊医学学术年会

作者： Mao Zhang,Guang-Ju Zhou,Song Zhao,Jian-Xin Yang, Xiao Lu,Jian-Xin Gan,Shao-Wen Xu Department of Emergency Medicine,Second Affiliated Hospital,School of Medicine & Institute of Emergency Medicine,Zhejiang University 310009

Introduction Tooth aspiration is a critical and rare complication in multiple trauma *** aspirated tooth can remain undetected and misdiagnosed particularly in patients with mechanical *** diagnosis of an aspirated tooth is essential,and delay in treatment may be dangerous even fatal. Method All adult multiple trauma patients admitted to a 16-bed emergency ICU in a university hospital from Jan 1,2007 to Dec 31,2010 were reviewed for foreign body(FB) in the trachea and *** diagnosis and management were retrospectively studied. Three cases with occult bronchial teeth aspiration were *** were all young men suffered from traffic accidents,with an average ISS of 48.3 and GCS of *** aspiration wasn't diagnosed for 1-3 days in the local hospitals,laterly confirmed by chest CT/radiography and flexible bronchoscopy in our *** the first case,the authors failed to remove it with neither flexible nor rigid bronchoscopy,and subsequent obstructive pneumonia *** the second case,the tooth was fortunately expectorated via the tracheotomy tube following a vigorous *** the third case,the tooth was successfully removed by flexible *** patients were discharged from our hospital in survival to the local hospitals and 2 cases died laterly. Conclusion Tooth aspiration should be suspected in multiple trauma patients with mechanical ventilation,and the medical history,clinical signs and radiological findings should be carefully *** bronchoscopy is a useful tool for early diagnosis and removal of aspirated tooth.

关键词： Diagnosis and management of tooth aspiration in multiple trauma patients with mechanical ventilation

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Risk factors predicting prolonged intensive care unit stay of trauma patients:a multihospital study

Risk factors predicting prolonged intensive care unit stay o...

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第17届世界灾难及急救医学学术会议暨第14次全国急诊医学学术年会

作者： MA yuefeng~1 LI hui~1 SHEN weifeng~1 SHAO jufang~2 HE xiaojun~3 WUjunsong~1 YI jianhua~1 CHEN weiqiang~3 1.Zhejiang university second affiliated hospital emergency center 2.The emergency medical journal editorial staff 3.Hangzhou municipal bureau 310009

Objective pre-hospital trauma service,hospital trauma service and critical care service,all the three components of trauma emergency service play a crucial role for the outcome of trauma patients,but whether they have an impact on the ICU length of stay remains ***,a study was performed to identify which factors of trauma emergency service are associated with the prolonged ICU length of stay. Methods All records of the trauma patients (n=1641) admitted to the ICU of five hospitals in 2009 were *** data,length of ICU stay and variables related to the trauma care were *** regression was performed to analyze the independent risk factors of prolonged ICU length of stay with significance p< 0.05. Results Overall,14.1%of the trauma patients had a prolonged ICU length of stay(>14days).Age, injury severity score(ISS),Glasgow coma scale (GCS),trauma mechanism,pre-hospital stabilization,emergency department length of stay, mechanical ventilation and central venous pressure monitoring were associated with prolonged ICU length of *** multivariate analysis showed that pre-hospital stabilization is a protective factor for the prolonged ICU length of *** ventilation,Emergency room length of stay>4hours, ISS>15 are independent risk factors for the prolonged ICU length of stay. Conclusion Each phase of trauma emergency service has an impact on the ICU length of stay. Strengthening the link and integrity of the three components of trauma emergency services may decrease the length of ICU stay and save health resources.

关键词： ICU ISS Risk factors predicting prolonged intensive care unit stay of trauma patients:a multihospital study service

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The new injury severity score was superior to injury severity score in predicting outcomes of trauma patients:data from China

The new injury severity score was superior to injury severit...

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第17届世界灾难及急救医学学术会议暨第14次全国急诊医学学术年会

作者： Li hui~1 shen weifeng~1 chen weiqiang~3 he xiaojun~3 wu jun~1 yi jianhua~1 ma yuefeng~1 1.Zhejiang university second affiliated hospital emergency center 2.The emergency medical journal editorial staff 3.Hangzhou municipal bureau 310009

Objective To compare the predicting ability of the new injury severity score(NISS) and injury severity score(ISS) for the outcomes of trauma patients, including mortality,intensive care unit(ICU) admission and intensive care unit length of stay. Methods This was a retrospective study and the population consisted of 1825 trauma patients from three hospitals in Zhejiang province,*** comparison of NISS and ISS in predicting mortality, ICU admission and ICU length of stay was performed by using Receiver Operator Characteristic(ROC) curves and Hosmer-Lemeshow statistics. Results A total of 1825 trauma patients were enrolled in our ***,1243patients admitted to the ICU and 215 patients died before *** ISS and NISS were equivalent in predicting mortality(AUC:0.886 vs.0.887, p=0.9113),but ISS showed improved calibration (H-L:19.22 vs.27.13).But for the patients with ISS≥25,NISS showed better performance in predicting mortality than ***,NISS was also a significantly better predictor than ISS for ICU admission and prolonged ICU length of stay. Conclusion NISS had an equivalent or better performance in predicting the outcomes for trauma patients than ISS,including mortality,ICU admission and ICU length of *** the ISS with NISS may improve the trauma scoring system and make the trauma evaluation more precisely.

关键词： ISS The new injury severity score was superior to injury severity score in predicting outcomes of trauma patients:data from China ICU

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Study on the composition and shunt of emergency critical illness in a major tertiary hospital

Study on the composition and shunt of emergency critical ill...

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第17届世界灾难及急救医学学术会议暨第14次全国急诊医学学术年会

作者： Zhang mao Li-Gang YE Guang-Ju Zhou Wei-Feng Shen Jian-Xin GAN Shao-Wen XU Department of Emergency Medicine,Second Affiliated Hospital,School of Medicine & Institute of Emergency Medicine,Zhejiang University 310009

Objective To survey the proportion,composition of departments,and shunt of emergency critical illness in a major tertiary hospital,then to promote the quality of hospital's emergency medical service. Methods Emergency critical illness who present to a major tertiary hospital in 2010 were retrospectively analyzed using an emergency triage *** number of emergency critical illness, emergency room(ER) lengh of stay,composition of departments,patients shunt and utilization rate of ER beds were studied. Results 1) 7966 critical illness were rescued in the emergency room in 2010,which accounts for 10.1%of all the emergency *** rate of ER beds was(90.1±9.1)%.Bed turnover was (1.2±0.1) times per *** of stay in ER was (18±44) hours.2) The top four departments in rescuing numbers were neurosurgery department, emergency internal medicine,neurology department and emergency department,accounting for 79.07%of all emergency critical illness.3) 4983(62.6%) patients were directly admitted, 1263(15.9%) cases admitted after emergency operation,545(6.8%) cases discharged due to recovery,1084(13.6%) cases discharged due to withdraw of family,and 91(1.1%) cases died. Shunts of emergency critical illness among these departments were statistically different. Conclusion This hospital had a high proportion of emergency critical illness and the emergency room was under a high load *** critical illnesses were mainly from four departments,and most of them needed *** administrators should optimize the medical resources to promote the quality of emergency medical service.

关键词： Study on the composition and shunt of emergency critical illness in a major tertiary hospital

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Significance of early detection of N-terminal pro-B-type Natriuretic Peptide in patients with major trauma

Significance of early detection of N-terminal pro-B-type Nat...

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第17届世界灾难及急救医学学术会议暨第14次全国急诊医学学术年会

作者： Zhang mao Anyu Qian Li Ba Jianxin Gan Shaowen Xu Department of Emergency Medicine,Second Affiliated Hospital,School of Medicine & Institute of Emergency Medicine,Zhejiang University 310009

Objective To detect the serum NT-proBNP level in major trauma patients 24 hours after injury,then to find the possible correlated factors and evaluate its clinical significance. Methods It was a prospective observational study conducted in a tertiary *** patients with major trauma admitted to the emergency ICU were *** NT-proBNP level was detected 24 hours after injury,then compared between survivors and *** efficacy of NT-proBNP for predicting outcome was analyzed by receiver operating characteristic(ROC) curve. The correlation between NT-proBNP level and ICU lenth of stay,mechanical ventilation time was determined in those *** and stepwise linear regression analysis were used to find the significantly correlated factors with *** factors included injury severity score(ISS),head abbreviated injury score(AIS), acute physiology and chronic health evaluationⅡ(APACHEⅡ),Glasgow coma score (GCS),creatine kinase-MB(CK-MB),cardiac troponin-Ⅰ(cTn-Ⅰ) and central venous pressure. Results The median NT-proBNP level were 762 pg/ml(IQR,400-1131pg/ml) in nonsurvivors versus 200 pg/ml(IQR,80-383pg/ml) in survivors (Z=-3.972,P<0.001).The area under ROC curve of NT-proBNP had no statistical difference with those of ISS and APACHEⅡ.The best threshold value of NT-proBN to predict the outcome was 384 pg/ml (sensitivity 0.846,specifity 0.766).A positive correlation was found between NT-proBNP and ICU LOS(r=0.32,P<0.05),mechanical ventilation time(r= 0.37,p<0.05) in *** linear regression analysis indicated APACHEⅡand CK-MB were the significantly correlated with NT-proBNP. Conclusion Serum NT-proBNP level 24 hours after inury is correlated with the severity and outcome of major trauma *** may be uesed as a complementary index for rapid assessment of trauma.

关键词： ISS Significance of early detection of N-terminal pro-B-type Natriuretic Peptide in patients with major trauma

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