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C-reactive Protein/Albumin Ratio as a Prognostic Indicator in Posttraumatic Shock and Outcome of multiple trauma Patients

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Current Medical Science 2023年第2期43卷 360-366页

作者： Xin LU Wei-chen LIU Yan QIN Du CHEN Peng YANG Xiong-hui CHEN Si-rong WU Feng XU Emergency Department the First Affiliated Hospital of Soochow UniversitySuzhou215000China

Objective C-reactive protein(CRP)/albumin ratio(CAR)is a new inflammation-based index for predicting the prognosis of various diseases.The CAR determined on admission may help to predict the prognostic value of multiple trauma patients.Methods A total of 264 adult patients with severe multiple trauma were included for the present retrospective study,together with the collection of relevant clinical and laboratory data.CAR,CRP,albumin,shock index and ISS were incorporated into the prognostic model,and the receiver operating characteristic(ROC)curve was drawn.Then,the shock index for patients with different levels of CAR was analyzed.Finally,univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for the 28-day mortality of multiple trauma patients.Results A total of 36 patients had poor survival outcomes,and the mortality rate reached 13.6%.Furthermore,after analyzing the shock index for patients with different levels of CAR,it was revealed that the shock index was significantly higher when CAR was≥4,when compared to CARmultiple trauma patients.The multivariate logistic analysis helped to identify the independent association between the variables CAR(P=0.029)and shock index(P=0.019),and the 28-day mortality of multiple trauma patients.Conclusion CAR is higher in patients with severe multiple trauma.Furthermore,CAR serves as a risk factor for independently predicting the 28-day mortality of multiple trauma patients.The shock index was significantly higher when CAR was≥4 in multiple trauma patients.

关键词： C-reactive protein/albumin ratio multiple trauma C-reactive protein albumin prognosis

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Early changes in white blood cell,C-reactive protein and procalcitonin levels in children with severe multiple trauma

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World Journal of Emergency Medicine 2022年第6期13卷 448-452页

作者： Cai-fang Xu Ming-chao Huo Jin-hui Huang Chun-feng Liu Wei Xu The Pediatrics Department Shengjing Hospital of China Medical UniversityShenyang 110004China Department of Critical Care Medicine Shanghai Children’s HospitalShanghai Jiao Tong University School of MedicineShanghai 200062China

BACKGROUND:To analyze early changes in white blood cells(WBCs),C-reactive protein(CRP)and procalcitonin(PCT)in children with multiple trauma,before secondary inflammation develops.METHODS:This single-center retrospective study collected data from patients with blunt traumatic injury admitted to the pediatric intensive care unit(PICU).According to the prognostic outcome of 28 d after admission to the PICU,patients were divided into survival group(n=141)and non-survival group(n=36).Characteristics between the two groups were compared.Receiver operation characteristic(ROC)curve analysis was conducted to evaluate the capacity of different biomarkers as predictors of mortality.RESULTS:The percentages of children with elevated WBC,CRP,and PCT levels were 81.36%,31.07%,and 95.48%,respectively.Patients in the non-survival group presented a statistically significantly higher injury severity score(ISS)than those in the survival group:37.17±16.11 vs.22.23±11.24(t=6.47,Pmultiple trauma,PCT levels increased in more patients,even if their WBC and CRP levels remained unchanged.However,early rising WBC and ISS were superior to PCT at predicting the mortality of multiple trauma patients in the PICU.

关键词： Pediatric Procalcitonin Injury severity score multiple trauma

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Advantage of surgical intensive care unit(SICU)predominant by cardiothoracic surgeons in multiple trauma management in a primary hospital

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Chinese Journal of traumatology 2021年第1期24卷 45-47页

作者： Ya-Jun Chen Xin-Ling Mu Pan-Pan Xie Hong-Kai Lian Zhengzhou First People's Hospital Zhengzhou450004China Zhengzhou Central Hospital Central Hospital of Zhengzhou UniversityZhengzhou450007China

Purpose It is a challenge for the primary hospitals to manage multiple trauma patients.In this article,we explored the advantage of establishing a surgical intensive care unit(SICU)predominant by cardiothoracic surgeons in the early management of multiple trauma.Methods This was a retrospective study and patients with multiple trauma in our hospital were collected and divided into two groups,based on time period and treat modes:group A(retrospective observation group)where patients were treated with the traditional treatment mode from January 2017 to December 2017 and group B(study group)where patients were treated in the SICU predominant by cardiothoracic surgeons from January 2018 to December 2018.Clinical data including demographics,injury severity score(ISS),causes of injury,time intervals from reception to entering SICU or operating room and mortality three days after injuries were collected.Data were analyzed by SPSS 20.0 software.Categorical variables were presented as number and/or frequency and continuous variables as mean±SD.Results Altogether 406 patients were included in this study,including 217 patients in group A and 189 patients in group B.General data between the two groups revealed no significant difference:mean age(years)(35.51±12.97 vs.33.62±13.61,p=0.631),gender distribution(mean/female,130/87 vs.116/73,p=0.589)and ISS(15.92±7.95 vs.16.16±6.89,p=0.698).Fall from height were the dominant mechanism of injury,with 135 cases in group A(71.4%)and 121 cases in group B(55.8%),followed by traffic accidents.Injury mechanism showed no significant differences between two groups(p=1.256).Introduction of the SICU significantly improved the care of trauma patients,regarding speed and mortality.Time intervals between reception and entering SICU or operating room was(108.23±6.72)min and(45.67±7.96)min in group A and B,respectively(p=0.001).Mortality three days after injuries was 13.89%and 5.53%in group A and B,respectively(p=0.005).Conclusion Establishing a SICU predominant by cardiothoracic surgeons can redu

关键词： multiple trauma Cardiothoracic surgeon Surgical intensive care unit Limited fluid resuscitation Damage control theory Primary hospitals

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Application of revised trauma evaluation program in emergency treatment of multiple injuries

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Chinese Medical Journal 2006年第5期119卷 426-429页

作者： JIN Jing-fen SHAO Ju-fang HE Xiao-jun YAO Mei-qi Department of Emergency Medicine Second Affiliated Hospital Medical School of Zhejiang University Hangzhou 310009 China Editorial Board of Chinese Journal of Emergency Medicine Second Affiliated Hospital Medical School of Zhejiang UniversityHangzhou 310009 China

Recently, with the rapid development of highway ,and high-rise buildings, trauma shows a tendency to increase continuously. The proportion of trauma patients with multiple injuries has increased and trauma arising fro... 详细信息

关键词： Glasgow outcome scale injury severity score multiple trauma emergency treatment

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Epidemiology of pelvic and acetabular fractures across 12-mo at a level-1 trauma centre

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World Journal of Orthopedics 2022年第8期13卷 744-752页

作者： Rory Cuthbert Samuel Walters David Ferguson Edward Karam Jonathan Ward Homa Arshad Paul Culpan Peter Bates Department of trauma and Orthopaedic Surgery Royal London HospitalBarts HealthLondon E11BBUnited Kingdom

BACKGROUND Despite motor-vehicle safety advancements and increasingly rigorous workplace safety regulations,trauma/suicide remains the leading cause of death under the age of 45 in the United Kingdom.To promote centralisation of care and optimisation of major trauma outcomes,in 2012 the National Health Service introduced the trauma Network System.To our knowledge,this is the first study to analyse the epidemiology of pelvic and acetabular trauma over a one-year period at a level-1 trauma centre in the United Kingdom,since nationwide introduction of the trauma Network System.AIM To characterize the epidemiology of high-energy pelvic and acetabular fractures over a one-year period at a level-1 trauma centre,and explore both resources required to care for these patients and opportunities for future research and injury prevention initiatives.METHODS 227 consecutive patients at a level-1 trauma centre with pelvic and acetabular fractures were analysed between December 2017-December 2018.Paediatric patients(trauma was more commonly associated with abdominal injury(P=0.01)and spine fractures(P<0.001)than acetabular fractures.Vertical shear pelvic ring fractures were associated with falls(P=0.03)while lateral compression fractures were associated with road traffic accidents(P=0.01).CONCLUSION High energy pelvic and acetabular fractures are associated with concomitant orthopaedic fractures(most commonly spine and lower limb),intensive care admission and pro

关键词： Pelvis Acetabulum Orthopedics multiple trauma trauma centers

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Hypopituitary syndrome with pituitary crisis in a patient with traumatic shock:A case report

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World Journal of Clinical Cases 2022年第20期10卷 7029-7036页

作者： Xing-Cheng Zhang Yun Sun Department of Critical Care Medicine The Second Affiliated HospitalAnhui Medical UniversityHefei 230601Anhui ProvinceChina

BACKGROUND Shock is among the most common conditions that clinicians face in intensive care unit(ICU),of which hypovolemic shock is encountered most frequently;some patients instead suffer from neurogenic,cardiogenic,or infectious forms of shock.However,there are additional types of shock from unusual causes that are often undiagnosed.Here,we report the case of a patient who was initially misdiagnosed with hypovolemic shock,but exhibited persistent hypotension because of continuous fluid replacement and vasoactive drug administration,and was eventually diagnosed with hypopituitarism with crisis.CASE SUMMARY A 73-year-old Chinese man was admitted to the neurosurgery department following injury caused by a heavy object with symptoms of anemia and high fever.He was transferred to the ICU on the fourth day after hospitalization because of hypotension and unconsciousness.Blood analysis indicated that the patient was suffering from anemia and thrombocytopenia.Ultrasonography showed that there was no apparent abnormality in the cardiac structure but there was mild tricuspid regurgitation.Computed tomography revealed that there were signs of hemorrhage at the right basal ganglia;accordingly,hypovolemic shock,possibly septic shock,was initially considered.Even after routine treatment for shock,the hypotension remained severe.The patient was again thoroughly examined to investigate the underlying cause.The antishock therapy was supplemented with corticosteroids to counter potential hypopituitarism.The patient made a full recovery,and the blood pressure returned to normal.CONCLUSION A case of pituitary adenoma with multiple injuries was identified.Because of hypopituitarism,functionality of the corresponding endocrine system was restricted,with the most pronounced manifestation being unstable blood circulation requiring hormone replacement therapy.Such cases are relatively rare but may occur if multiple injuries are sustained.The present case represents a reference for the clinical treatment of patients with multiple injuri

关键词： multiple trauma Shock Hypopituitary syndrome Hormone replacement therapy Pituitary adenoma Case report

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Treatment strategy on traumatic mid-lumbar spondyloptosis with concomitant multiple injuries:A case report and literature review

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Chinese Journal of traumatology 2023年第1期26卷 33-40页

作者： Lin Cheng Cheng Qiu Xin-Yu Liu Xi-Guang Sang Department of Emergency Medicine Qilu Hospital of Shandong UniversityJinan250012China Department of Orthopaedic Surgery Qilu Hospital of Shandong UniversityJinan250012China Cheeloo College of Medicine Shandong UniversityJinan250012China

Spondyloptosis in the clinic is rarely reported.We herein present a 47-year-old female,who suffered from a crush injury directly by a heavy cylindrical object from the lateral side.She was diagnosed to have traumatic L3 spondyloptosis with multiple traumas.Staged surgical procedures were conducted and a three-year follow-up was obtained.Eventually,normal spinal alignment was restored,and neurological deficits were gradually improved.At three years follow-up,the motor strength scores and function of the sphincters were incompletely improved.Previously published reports on traumatic lumbar spondyloptosis were reviewed and several critical points for management of this severe type of spinal injury were proposed.First,thoracolumbar and lumbosacral junction were mostly predilection sites.Second,numerous patients involving traumatic lumbar spondyloptosis were achieved to American Spinal Injury Association grade A.Third,lumbar spondyloptosis was commonly coupling withcauda equina injury.Finally,the outcomes were still with poorly prognosis and recovery of patients was correlation to spondyloptosis severity.Based on this case report and literatures review,we highlighted that the spinal alignment restoration relying on staged operations and following rehabilitation hereof are both important once facing with multiple traumas.Furthermore,we suggested to perform routine CT angiography during lumbar spondyloptosis to justify whether there are large vessel compression or injury.

关键词： Spondyloptosis multiple trauma Fracture dislocation American Spinal Injury Association Lumbar spine

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Effects of enteral immunonutrition on immune function in patients with multiple trauma

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World Journal of Emergency Medicine 2011年第3期2卷 206-209页

作者： Sha-luo Li Yong-hua Xu Xi Wang Xuc-fcng Liu Liang Zhao Emergency Department Shanghai Jiading District Chinese Medicine Hospital Shanghai 201800 China Emergency Department Changzheng Hospital Affiliated to Second Military Medical University Shanghai 200003 China

BACKGROUND:Enteral immunonutrition (EIN) refers to addition of some specific nutrients in enteral nutrition (EN), which can help to increase the immune function, and reduce the inflammatory reaction and septic complications. This study aimed to determine whether EIN can improve the immune function in multiple trauma patients.;METHODS:Thirty-two patients with multiple trauma who had been admitted to the general ICU of Changzheng Hospital, Shanghai, from March 2007 to May 2008, were randomly divided into two groups: an enteral immunonutrition group (EIN group, n=16) and an enteral nutrition group (EN group, n=16). EIN suspension (RuiNeng produced by Sino-Swed Co., Ltd) and ordinary nutrition liquid (RuiSu produced by Sino-Swed Co., Ltd) were given to patients of the EIN group and EN group respectively for at least for 14 days. Peripheral blood lymphocyte count (TLC), immunoglobulin (IgG, IgM, IgA), and T-lymphocyte subsets (CD3, CD4, CD8, CD4 / CD8) were detected on the 1st day after grouping, and the 7th day and 14th day after nutritional support.;RESULTS:TLC, IgG, IgM, IgA, CD4 and CD4/CD8 ratio were significantly higher in the EIN group on the 7th and 14th day than that on the 1st day (Ptraumatic phase.

关键词： Enteral immune nutrition Immune function multiple trauma

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Tropical cyclone Fani-perspective from the trauma and emergency department of an affected tertiary hospital

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Chinese Journal of traumatology 2020年第4期23卷 243-248页

作者： Chitta Ranjan Mohanty Mantu Jain Rakesh Vadakkethil Radhakrishnan Prabeer Chandra Mohanty Ritesh panda Department of trauma and Emergency All India Institute of Medical SciencesBhubaneswarIndia Department of Orthopedics All India Institute of Medical SciencesBhubaneswarIndia College of Nursing All India Institute of Medical SciencesBhubaneswarIndia

Purpose:To explore the epidemiological and clinical profile of patients admitted to the trauma and emergency department(TED)of a tertiary care hospital due to tropical cyclone Fani and highlight the challenges faced by the hospital in this natural disaster.Methods:A retrospective study was conducted in the TED in the affected zone.Data of all victims affected by the cyclone Fani on May 3,2019 were obtained from disaster records and medical case sheets.All patients except death on admission were included.Clinical variables included anatomical sites and severity of injuries which was assessed by revised trauma score(RTS)and injury severity score(ISS).trauma injury severity score(TRISS)was also calculated.Results:Of 75 patients,74 were included and the other one was brought dead and thus excluded.The age,median±interquartile range(IQ),was 41.0(27.7-53.0)years.The male to female ratio was 2:1.Most of the wounded were transported by the police control room vans on day 1:first 10 h,50.0%;10-24 h,20.3%.The median±IQ range of RTS,ISS and TRISS were 20(14-28),7.84(7.841-7.841),and 97.4(91.6-98.9),respectively.Simple external injury was the dominant injury type.Polytrauma(ISS>15)was seen in 67%cases and spine injury in 14%cases(7%cervical and 7%thoracolumbar).Injury causes included sharp flying objects(broken pieces of glasses and asbestos)in 31%cases,followed by fall of trees in 20.3%.Twenty-four patients were discharged after primary treatment,30 admitted to the indoor-trauma ward or intensive care unit and 20 deferred or transferred to another center.There was no in-house mortality.Challenges were related to electricity failure,mobile network breakdown,infrastructure collapse,and delay in expertise repair from outside due to airport/railway closure.Conclusion:In cyclonic storm like Fani,sharp flying objects,fall of trees/poles and collapsing walls constitute the common mode of injuries causing harm to more than one body regions.Polytrauma was seen in the majority of patients though external injury was the commonest.The

关键词： Natural disasters Tropical cyclone multiple trauma Tertiary care

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Acute celiac artery occlusion secondary to blunt trauma:Two case reports

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World Journal of Clinical Cases 2020年第23期8卷 6164-6171页

作者： Hui Li Yu Zhao Yan-An Xu Tao Li Jun Yang Ping Hu Tao Ai Department of traumatology Chongqing University Central HospitalChongqing 400080China Department of Radiology Chongqing University Central HospitalChongqing 400080China

BACKGROUND Acute celiac artery(CA)injuries are extremely rare but potentially life-threatening and are more often caused by a penetrating injury rather than a blunt injury.The clinical manifestation of CA injuries is usually atypical,which easily causes missed diagnosis and misdiagnosis.Currently,there are only a few reports of acute traumatic occlusion of CA.The CA artery gives off branches to dominate the liver,stomach.and spleen;however,occluded CA did not cause significant organ ischemia,and the compensatory blood flow from the superior mesenteric artery(SMA)played a pivotal role.CASE SUMMARY Herein,we report two cases of acute CA occlusion secondary to severe blunt trauma.Case one was a 19-year-old male,suffered from a motorcycle crash.He complained of dyspnea,and the closed drainage was performed soon after the hemopneumothorax was confirmed by ultrasound.Computed tomography(CT)scan revealed hemopneumothorax,multiple rib fractures,right scapular fracture,and liver rupture.Reexamination with contrast-enhanced CT suggested perihepatic fluid was significantly increased,and CA was occluded.Because the hepatic hemorrhage is associated with hepatic artery injury,the CA was retrogradely opened through the SMA,and then,the right hepatic artery was embolized with coils successfully through the conventional pathway.Stent implantation was not performed,and the CA occlusion was managed by conservative treatment.A follow-up CT scan 3 mo after discharge showed the origin of CA remained occluded.Case two was a 37-year-old man,suffered injury from fall from height.He complained of lower back and bilateral heel pain.Contrast-enhanced CT examination revealed multiple rib fractures,bilateral pneumothorax,fourth lumbar(L4)vertebral burst fracture,and pelvic fractures.Furthermore,a small high-density mass in a lesser peritoneal sac and in front of the abdominal aorta was detected.The reexamination 14 h after admission showed the CA was occluded.The patient was conservatively treated.The symptoms of nausea after meals disappeare

关键词： Celiac artery Acute occlusion Superior mesenteric artery multiple trauma Liver injury Case report Collateral branches

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