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Evaluation of differences in injury patterns according to seat position in trauma victims survived traffic accidents

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Chinese Journal of traumatology 2018年第5期21卷 273-276页

作者： Yaakov Daskal Ricardo Alfici Adi Givon Kobi Peleg Oded Olsha Boris Kessel israel trauma group Surgical.Division HiUel Yaffe Medical Center. Hadera Israel National Center for trauma and Emergency Medicine Research Gertner Institute for Epidemiology and Health Policy Research Tel Hashomer Israel Surgery Department Shaare Zedek Medical Center Jerusalem Israel trauma Unit Hillel Yaffe Medical Center Hadera Israel Disaster Medicine Department Faculty of Medicine Tel-Aviv University Israel

Purpose： Investigation of injury patterns epidemiology among car occupants may help to develop different therapeutic approach according to the seat position. The aim of the study was to evaluate and compare differences in the incidence of serious injuries, between occupants in different locations in private cars. Methods： A retrospective study including trauma patients who were involved in motor vehicle accidents and admitted alive to 20 hospitals （6 level I trauma centers and 14 level II trauma centers）. We examined the incidence of injures with abbreviated injury score 3 and more, and compared their occurrence be- tween seat locations. Results： The study included 28,653 trauma patients, drivers account for 60.8% （17,417）. Front passenger mortality was 0.47% higher than in drivers. Rear seat passengers were at greater risk （10.26%） for trau- matic brain injuries than front seat passengers （7.48%） and drivers （7.01%）. Drivers are less likely to suffer from serious abdominal injuries （3.84%） compared to the passengers （front passengers - 5.91%, rear passengers - 5.46%）. Conclusion： Out of victims who arrived alive to the hospital, highest mortality was found in front seat passengers. The rate of serious chest injuries was higher as well. Rear seat passengers are at greater risk for serious traumatic brain injuries. All passengers have a greater incidence of abdominal injuries. These findings need to be addressed in order to develop ＂customized＂ therapeutic policy in trauma victims.

关键词： Traffic accidents Injury pattern Seat position

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Is computed tomography cystography indicated in children with pelvic fractures?

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Chinese Journal of traumatology 2020年第3期23卷 181-184页

作者： Alexander Becker Ori Yaslowitz Joseph Dubose Kobi Peleg Yaakov Daskal Adi Givon israel trauma group Boris Kessel Department of Surgery Emek Medical Center.AfulaIsrael The Rappoport School of Medicine TechnionHaifaIsrael Department of Surgery A Meir Medical CenterKfar-SabaIsrael R Adams Cowley Shock trauma Center University of Maryland Medical SystemBaltimoreMDUSA National Center for trauma and Emergency Medicine Research Gertner Institute for Epidemiology and Health Policy ResearchTel HashomerIsrael Emergency and Disaster Management Department Faculty of Medicine.School of Public Health.Tel-Aviv UniversityIsrael trauma Unit Hillel Yaffe Medical CenterHaderaIsrael

Purpose: Pelvic fracture evaluation with abdominopelvic computed tomography (CT) and formal CT cystography for rule out of urine bladder injury have been commonly employed in pediatric trauma patients. The additional delayed imaging required to obtain optimal CT cystography is, however, associated with increased doses of ionizing radiation to pelvic organs and represent a significant risk in the pediatric population for future carcinogenic risk. We hypothesized that avoidance of routine CT cystography among pediatric pelvic fracture victims would not result in an appreciable rate of missed bladder injuries and would aid in mitigating the radiation exposure risk associated with these additional ***: A retrospective cohort study involving blunt trauma pelvic fractures among pediatric trauma patients (ageisraeli National trauma Registry. Statistical analysis was performed using SAS statistical software version 9.4 via the tests of Chisquare test and two-sided Fisher’s exact test. Ap value of less than 0.05 was considered statistically ***: A total of 1072 children were identified from the registry for inclusion. Mean age of patients was 7.7 years (range 0-14) and 713 (66.5%) were male. Overall mortality in this population was 4.1% (44/1072). Only 2.1% (23) of pediatric patients with pelvic fractures had bladder injury identified, with just 9 children having intraperitoneal bladder rupture (0.8% of all the patients).Conclusion: The vast majority of blunt pediatric trauma victims with pelvic fractures do not have urine bladder injuries. Based on our study results we do not recommend the routine utilization of CT cystography in this unique population.

关键词： Tomography,X-ray computed Cystography Bladder injury Child Pelvic fracture

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中国县域创伤救治体系建设标准专家共识(2024年版)

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中华骨科杂志 2024年第1期44卷 6-9页

作者：中国县域创伤救治体系建设标准专家共识专家组姜保国黄伟晋菲斐王艳华中国县域创伤救治体系建设标准专家共识专家组

创伤是导致我国45岁以下人群的第一死亡原因,是现阶段医疗体系面临的重大挑战,也是我国现存的重大公共卫生问题之一。在过去十余年中,国家创伤医学中心、中国创伤救治联盟在全国范围内不断推动区域性创伤体系建设及创伤中心建设,目前已... 详细信息

创伤是导致我国45岁以下人群的第一死亡原因,是现阶段医疗体系面临的重大挑战,也是我国现存的重大公共卫生问题之一。在过去十余年中,国家创伤医学中心、中国创伤救治联盟在全国范围内不断推动区域性创伤体系建设及创伤中心建设,目前已基本建立了适合我国国情的创伤救治体系,但统一的县域创伤救治体系建设标准仍未建立。由国家创伤医学中心发起并组织国内从事创伤领域的相关专家组成专家组,对县域创伤救治体系建设目的、建设要求和建设内容进行充分讨论,并形成本共识,以期为我国县域创伤救治体系的建设和评估提供参考。

关键词：创伤和损伤医院,县急救共识中国

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中国城市创伤救治体系建设标准专家共识(2024年版)

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中华骨科杂志 2024年第1期44卷 1-5页

作者：中国城市创伤救治体系建设标准专家共识专家组姜保国王艳华黄伟晋菲斐中国城市创伤救治体系建设标准专家共识专家组

随着我国经济快速增长,道路交通和建筑行业持续发展,创伤发病率不断升高。为此,国家创伤医学中心及中国创伤救治联盟的专家团队根据中国国情提出在综合医院建立创伤救治团队替代独立的创伤救治中心及建立以综合医院为核心的闭环式区域... 详细信息

随着我国经济快速增长,道路交通和建筑行业持续发展,创伤发病率不断升高。为此,国家创伤医学中心及中国创伤救治联盟的专家团队根据中国国情提出在综合医院建立创伤救治团队替代独立的创伤救治中心及建立以综合医院为核心的闭环式区域性创伤救治体系。过去几年中,在国家卫生健康委的推动下这一体系在全国得到广泛推广。尤其是在县域内,以县内最好的综合医院为救治主体,整合县域内的院前急救及周边救治点使其形成有效的创伤救治体系。而城市创伤体系建设更加复杂,因此目前尚未形成相对统一的建设标准。为规范城市创伤救治体系的建设,提高创伤尤其是严重创伤救治的成功率,国家创伤医学中心组织专家就如何优化大型城市城区内创伤救治中心布局、提升创伤救治能力进行研讨,制订了《中国城市创伤救治体系建设标准专家共识(2024版)》,以期为我国城市城区创伤救治布局提供参考。

关键词：创伤和损伤医院,市区急救共识中国

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中国儿童及青少年初次创伤性髌骨脱位诊疗指南(2024年版)

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中华骨科杂志 2024年第2期44卷 65-69页

作者：首都医科大学附属北京积水潭医院(国家骨科医学中心) 中华医学会小儿外科分会小儿骨科学组中华医学会骨科分会小儿创伤与矫形学组杨征冯超黄林中华医学会小儿外科分会小儿骨科学组中华医学会骨科分会小儿创伤与矫形学组

初次创伤性髌骨脱位(first-time traumatic patellar dislocation,FTPD)是一种常见的儿童及青少年运动损伤,近年来发病率有逐渐升高的趋势。国内骨科医生对儿童及青少年FTPD的诊疗水平也有了长足的进步,但尚未达成一致的共识。本指南由... 详细信息

初次创伤性髌骨脱位(first-time traumatic patellar dislocation,FTPD)是一种常见的儿童及青少年运动损伤,近年来发病率有逐渐升高的趋势。国内骨科医生对儿童及青少年FTPD的诊疗水平也有了长足的进步,但尚未达成一致的共识。本指南由首都医科大学附属北京积水潭医院(国家骨科医学中心)、中华医学会小儿外科分会小儿骨科学组及中华医学会骨科分会小儿创伤与矫形学组发起,采用推荐意见分级的评估、制订及评价分级体系和国际实践指南报告标准,基于文献证据评估形成8条推荐意见。推荐条目1~2为儿童及青少年FTPD发生的危险因素及病理解剖特点,条目3~8为FTPD手术治疗的原则。指南旨在提高儿童及青少年FTPD诊疗的科学性,最终提升以患者为中心的医疗服务质量。

关键词：髌骨脱位儿童青少年中国诊疗指南

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中国-中亚五国骨折相关感染诊断与治疗指南(2024)

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中华创伤骨科杂志 2024年第1期26卷 6-15页

作者：中华医学会骨科学分会创伤骨科学组中华医学会骨科学分会外固定与肢体重建学组中华医学会创伤学分会中国医师协会骨科医师分会外固定学组中国医师协会创伤外科医师分会创伤感染学组张英泽唐佩福曹力 Olzhas Bekarissov Murodjon Ergashevich Irismetov Qutbudin Sirojov Sabyrbek Dzhumabekov Allaberdiyev Akmuhammet 余斌姜楠不详河北医科大学第三医院创伤急救中心石家庄050051 解放军总医院骨科医学部北京100853 新疆医科大学第一附属医院骨科乌鲁木齐830054 哈萨克斯坦阿斯塔纳乌兹别克斯坦塔什干塔吉克斯坦杜尚别吉尔吉斯斯坦比什凯克土库曼斯坦阿什哈巴德南方医科大学南方医院骨科-创伤骨科广州510515

感染是骨折伤(术)后灾难性的并发症,不仅给患者带来巨大心理压力和经济负担,而且给临床诊疗带来巨大的风险与挑战。骨折相关感染主要包括开放性骨折伤(术)后感染及闭合性骨折内固定术后感染两种类型。近年来,随着以人工智能及增材制造... 详细信息

感染是骨折伤(术)后灾难性的并发症,不仅给患者带来巨大心理压力和经济负担,而且给临床诊疗带来巨大的风险与挑战。骨折相关感染主要包括开放性骨折伤(术)后感染及闭合性骨折内固定术后感染两种类型。近年来,随着以人工智能及增材制造等为代表的医学技术的快速发展,许多骨科疾病的疗效得到稳步提升。尽管如此,骨感染的临床诊疗仍面临诸多问题,疗效尚未达到预期。主要原因在于:①部分患者临床表现不典型或临床症状的隐匿性导致漏诊、误治;②虽然同为骨感染,不同分型、感染部位、致病菌等因素所致的临床治疗策略及预后有所区别,显著增加了疾病本身的异质性;③骨折相关感染不同于假体周围感染、化脓性关节炎及糖尿病足骨髓炎等感染,有其独特的临床特征与诊疗策略。目前,国内外仍缺乏高证据等级临床研究支持的相关诊疗指南。

关键词：开放性骨折闭合性骨折骨科疾病骨感染骨折伤化脓性关节炎诊疗策略增材制造

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Analysis of incidence of traumatic brain injury in blunt trauma patients with Glasgow Coma Scale of 12 or less

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Chinese Journal of traumatology 2018年第3期21卷 152-155页

作者： Alexander Becket Kobi Peleg Oded Olsha Adi Givon Boris Kessel israeli trauma group Department of Surgery A Emek Medical Center Afula Israel National Center for trauma and Emergency Medicine Research Germer Institute for Epidemiology and Health Policy Research Tel Hashomer Israel Surgery Department Shaare Zedek Medical Center Jerusalem Israel trauma Unit Hillel Yaffe Medical Center Hadera Israel Disaster Medicine Department School of Public Health Faculty of Medicine TelAviv University Israel Rappoport Medical School. Technion. Haifa Israel 不详

Purpose： Early diagnosis of traumatic brain injury （TBI） is important for improving survival and neurologic outcome in trauma victims. The purpose of this study was to assess whether Glasgow Coma Scale （GCS） of 12 or less can predict the presence of TBl and the severity of associated injuries in blunt trauma patients. Methods： A retrospective cohort study including 303,435 blunt trauma patients who were transferred from the scene to hospital from 1998 to 2013. The data was obtained from the records of the National trauma Registry maintained by israel＇s National Center for trauma and Emergency Medicine Research, in the Gertner Institute for Epidemiology and Health Policy Research. All blunt trauma patients with GCS 12 or less were included in this study. Data collected in the registry include age, gender, mechanism of injury, GCS, initial blood pressure, presence of TBI and incidence of associated injuries. Patients younger than 14 years old and trauma victims with GCS 13-15 were excluded from the study. Statistical analysis was performed by using Statistical Analysis Software Version 9.2. Statistical tests performed included Chi-square tests. A p-value less than 0.05 was considered statistically significant. Results： There were 303,435 blunt trauma patients, 8731 （2.9%） of them with GCS of 3-12 that including 6351 （72%） patients with GCS of 3-8 and 2380 （28%） patient with GCS of 9--12. In these 8731 patients with GCS of 3-12, 5372 （61.5%） patients had TBI. There were total 1404 unstable patients in all the blunt trauma patients with GCS of 3-12,1256 （89%） patients with GCS 3-8, 148 （11%） patients with GCS 9-12. In the 5095 stable blunt trauma patients with GCS 3-8, 32.4% of them had no TB1. The rate in the 2232 stable blunt trauma patients with GCS 9-12 was 50.1%. In the unstable patients with GCS 3-8, 60.5% of them had TBI, and in subgroup of patients with GCS 9-12, only 37.2% suffered from TBI. Conclusion： The utility of a GCS 12 and less is limited in prediction

关键词： Multiple trauma Transfer Glasgow Coma Scale

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Ⅱ度烧伤创面治疗专家共识(2024版)Ⅱ:手术治疗和感染防治

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中华烧伤与创面修复杂志 2024年第2期40卷 101-118页

作者：中华医学会烧伤外科学分会海峡两岸医药卫生交流协会暨烧创伤组织修复专委会夏照帆不详海军军医大学第一附属医院烧伤外科全军烧伤研究所中国医学科学院烧伤暨烧创复合伤救治关键技术创新单元上海200433

Ⅱ度烧伤是临床中最为常见但处理十分棘手的烧伤类型,其治疗不仅需要考虑换药或手术处置方式本身可能产生的不同影响,还需评估烧伤部位、患者年龄及烧伤面积等多方面的因素。目前对于Ⅱ度烧伤创面治疗的手术方式以及感染诊断、分级等尚... 详细信息

Ⅱ度烧伤是临床中最为常见但处理十分棘手的烧伤类型,其治疗不仅需要考虑换药或手术处置方式本身可能产生的不同影响,还需评估烧伤部位、患者年龄及烧伤面积等多方面的因素。目前对于Ⅱ度烧伤创面治疗的手术方式以及感染诊断、分级等尚未形成统一的标准和规范,严重影响临床治疗方案的制订。本共识编写组以循证医学证据为基础,结合专家意见,制订《Ⅱ度烧伤创面治疗专家共识(2024版)Ⅱ:手术治疗和感染防治》。本共识从Ⅱ度烧伤创面的手术治疗及感染防治2个方面提出29条具体推荐意见,旨在形成规范化的Ⅱ度烧伤临床治疗方案。

关键词：烧伤外科手术清创术感染

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Epidemiology and risk factors for mortality in critically ill patients with pancreatic infection

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Journal of Intensive Medicine 2024年第1期4卷 81-93页

作者： Marie Dejonckheere Massimo Antonelli Kostoula Arvaniti Koen Blot Ben CreaghBrown Dylan Wde Lange Jan De Waele Mieke Deschepper Yalim Dikmen George Dimopoulos Christian Eckmann Guy Francois Massimo Girardis Despoina Koulenti Sonia Labeau Jeffrey Lipman Fernando Lipovestky Emilio Maseda Philippe Montravers Adam Mikstacki JoseArtur Paiva Cecilia Pereyra Jordi Rello JeanFrancois Timsit Dirk Vogelaers Stijn Blot the Abdominal Sepsis Study(AbSeS)group on behalf of the Trials group of the European Society of Intensive Care Medicine Department of Internal Medicine and Pediatrics Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium Department of Anesthesiology Intensive Care and Emergency MedicineFondazione Policlinico Universitario A.Gemelli IRCCSRomeItaly UniversitàCattolica del Sacro Cuore RomeItaly Intensive Care Unit Papageorgiou University Affiliated HospitalThessaloníkiGreece Department of Epidemiology and Public Health SciensanoIxellesBelgium Surrey Perioperative Anaesthetic Critical Care Collaborative Research group(SPACeR) Royal Surrey County HospitalGuildfordUK Department of Clinical and Experimental Medicine University of SurreyGuildfordUK Department of Intensive Care Medicine University Medical Center UtrechtUniversity UtrechtUtrechtthe Netherlands Department of Intensive Care Medicine Ghent University HospitalGhentBelgium Data Science Institute Ghent University HospitalGhentBelgium Department of Anesthesiology and Reanimation Cerrahpasa School of MedicineIstanbul University-CerrahpasaIstanbulTurkey rd Department of Critical Care “EVGENIDIO”HospitalNational and Kapodistrian University of AthensAthensGreece Department of General Visceral and Thoracic SurgeryKlinikum Hannoversch-MuendenGoettingen UniversityGöttingenGermany Division of Scientific Affairs-Research European Society of Intensive Care MedicineBrusselsBelgium Anesthesia and Intensive Care Department University Hospital of ModenaModenaItaly UQ Centre for Clinical Research Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia nd Critical Care Department Attikon University HospitalAthensGreece Department of Nursing Faculty of EducationHealth and Social WorkUniversity College GhentGhentBelgium Jamieson trauma Institute The University of QueenslandBrisbaneQLDAustralia Nimes University Hospital University of MontpellierNimesFrance Critical Care Department Hospital of the Interamerican Open University(UAI)Buenos AiresArgentina Surgical Critical Care Department of AnesthesiaHospital Universitario

Background:The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the(1)setting of infection onset(community-acquired,early onset,or late-onset hospital-acquired),(2)presence or absence of either localized or diffuse peritonitis,and(3)severity of disease expression(infection,sepsis,or septic shock).This classification system demonstrated reliable risk stratification in intensive care unit(ICU)patients with intra-abdominal *** study aimed to describe the epidemiology of ICU patients with pancreatic infection and assess the relationship between the components of the AbSeS-classification and ***:This was a secondary analysis of an international observational study(“AbSeS”)investigating ICU patients with intra-abdominal *** patients with pancreatic infection were included in this analysis(n=165).Mortality was defined as ICU mortality within 28 days of observation for patients discharged earlier from the *** with mortality were assessed using logistic regression analysis and reported as odds ratio(OR)and 95%confidence interval(CI).Results:The overall mortality was 35.2%(n=58).The independent risk factors for mortality included older age(OR=1.03,95%CI:1.0 to 1.1 P=0.023),localized peritonitis(OR=4.4,95%CI:1.4 to 13.9 P=0.011),and persistent signs of inflammation at day 7(OR=9.5,95%CI:3.8 to 23.9,P<0.001)or after the implementation of additional source control interventions within the first week(OR=4.0,95%CI:1.3 to 12.2,P=0.013).Gramnegative bacteria were most frequently isolated(n=58,49.2%)without clinically relevant differences in microbial etiology between survivors and ***:In pancreatic infection,a challenging source/damage control and ongoing pancreatic inflammation appear to be the strongest contributors to an unfavorable short-term *** this limited series,essentials of the AbSeS-classification,such as the setting of infection onset,diffuse

关键词： Pancreatic infection Intensive care unit Mortality Intra-abdominal infection Sepsis

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Spinal cord injury in the setting of traumatic thoracolumbar fracture is not reliably associated with increased risk of associated intra-abdominal injury following blunt trauma:An analysis of a National trauma Registry database

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Chinese Journal of traumatology 2021年第3期24卷 132-135页

作者： Veacheslav Zilbermints Yehuda Hershkovitz Kobi Peleg Joseph J.Dubose Adi Givon David Aranovich Mickey Dudkiewicz israeli trauma group Boris Kessel Surgical Division Hillel Yaffe Medical Center Affiliated to Rappoport Medical SchoolTechnionHaderaIsrael Department of Surgery Shamir Medical Center Affiliated to Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael National Center for trauma and Emergency Medicine Research Gertner Institute for Epidemiology and Health Policy ResearchTel HashomerIsrael University of Maryland School of Medicine BaltimoreMDUSA Hospital Administration Hillel Yaffe Medical CenterHaderaIsrael

Purpose:There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries,specifically for intra-abdominal injury(IAI).The impact of concomitant spinal cord injury(SCI)with the risk of associated IAI has not been well *** aim of this study was to evaluate the incidence and severity of IAIs in patients suffering from spinal fractures with or without ***:A retrospective cohort study using the israeli National trauma Registry was *** with thoracic,lumbar and thoracolumbar fractures resulting from blunt mechanisms of injury from January 1,1997 to December 31,2018 were examined,comparing the incidence,severity and mortality of IAIs in patients with or without *** collected variables included age,gender,mechanism of injury,incidence and severity of the concomitant IAIs and pelvic fractures,abbreviated injury scale,injury severity score,and *** analysis was performed using GraphPad InStat?Version 3.10,with Chi-square test for independence and two sided Fisher’s exact probability ***:Review of the israeli National trauma Database revealed a total of 16,878 patients with spinal *** thoracic and lumbar fractures were observed in 1272 patients(7.5%),isolated thoracic fractures in 4967 patients(29.4%)and isolated lumbar fractures in 10,639 patients(63.0%).The incidence of concomitant SCI was found in 4.95%(63/1272),7.65%(380/4967)and 2.50%(266/10639)of these patients,*** overall mortality was 2.5%,proving higher among isolated thoracic fracture patient than among isolated lumbar fracture counterparts(11.3%vs.4.6%,p<0.001).Isolated thoracic fractures with SCI were significantly more likely to die than non-SCI counterparts(8.2%vs.3.1%,p<0.001).There were no differences in the incidence of IAIs between patients with or without SCI following thoracolumbar fractures overall or in isolated

关键词： Spinal fractures Blunt trauma Abdominal injuries Spinal cord injury

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