The electrophysiological effects of a brain injury on auditory memory functioning. The QEEG correlates of impaired memory.
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The effect of a brain injury on the quantitative EEG (QEEG) variables during an auditory memory activation condition was examined with 56 normal subjects and 85 mild traumatic brain-injured (MTBI) subjects. An analysis was conducted on the different response patterns of the two groups, the variables which were correlated with memory performance in the brain-injured group, and the variables which predicted the memory score for the combined two groups (normal and brain injured). The three conditions included the input task, the immediate recall, and the delayed recall task. The consistent effect of a brain injury was a lowering of the connectivity patterns in the beta1 and beta2 frequencies (phase and coherences) and increases predominantly in the relative power of beta1 (13-32Hz), which were correlated with the differences in recall. There is a subtle shift to right hemisphere/right temporal functioning and employment of the higher beta1 and beta2 frequencies (phase and coherence) in the response pattern of the MTBI subject. Memory functioning is predominantly positively correlated with connection activity (phase and coherence) and negatively correlated with beta activation at specific locations. (+info)
Validity of the Children's Category Test-Level 1 after pediatric traumatic brain injury.
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The performance of 38 5-8-year-old children with traumatic brain injury (TBI) on the Children's Category Test-Level 1 (CCT-1; ) was investigated in order to examine the criterion validity of the component subtests. Only subtests III and V varied in a consistent and meaningful manner with levels of injury severity and post-injury psychometric intelligence. In contrast, 21% of the sample performed at chance level on subtest IV, a task that did not demonstrate any criterion validity. It is concluded that when a substantial proportion of the total errors (e.g., >/=50%) on the CCT-1 pertain to items from subtest IV, interpretation of the composite summary T score may not be valid. (+info)
Cost factors in pediatric trauma.
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INTRODUCTION: There is a lack of information on the cost of treating trauma in children in developing countries. Therefore, in the pediatric emergency unit of a university hospital in Turkey, we prospectively investigated the cost factors of pediatric trauma and attempted to identify cost predictors. METHODS: We prepared questionnaires and charts for 91 children (50 boys, 41 girls) admitted with multiple trauma to obtain data on age, gender, date and mechanism of injury, site of injury, type of the treatment and length of hospital stay. We studied the physical findings, Pediatric Trauma Score (PTS), Revised Trauma Score (RETS) and pediatric Glasgow Coma Scale (GCS) score, and we totalled all hospital-based costs according to Ministry of Health guidelines. RESULTS: The mean (and standard deviation [SD]) age of the children was 79.4 (52.3) months. Motor vehicle crashes accounted for 45% of the injuries, followed by falls (41%) and bicycle accidents (14%). The mean (and SD) total cost of care was US dollar 376.60 (dollar 428.20) (range from dollar 20-dollar 1995). The cost associated with motor vehicle crashes was higher than that for the other injury types (p < 0.05). Seventeen patients required major and 27 patients required minor surgical treatment, whereas 44 patients were treated conservatively; 3 died. Forty-eight percent of patients were referred from another hospital, and the cost of care of referred patients was significantly higher than for those admitted directly (p < 0.001). The mean (and SD) duration of hospital stay was 98 (150) hours. Total cost correlated directly with the duration of hospital stay and distance of the referred hospital or accident scene from our hospital (p < 0.001, r = 0.827 and 0.374 respectively), but the cost correlated inversely with the PTS, the RETS and the pediatric GCS score (p < 0.001, r = -0.339, -0.301 and -0.453 respectively). CONCLUSION: Our findings indicate that the cost of pediatric trauma is high and may be predicted from admission data and trauma scores. (+info)
Alcohol related falls: an interesting pattern of injuries.
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OBJECTIVE: To discover if there is a significant difference in the pattern and severity of injury sustained during falls in patients who have consumed alcohol and those who have not. To determine how pattern and severity of injury correlates with blood alcohol concentration. METHOD: A prospective quasi-randomised controlled study between November 2001 and July 2002. All healthy adults between 16 and 60 years who had fallen from standing height were included. A systematic history and examination permitted calculation of injury severity scores as per abbreviated injury scale update 1998. Blood alcohol concentrations were obtained from intoxicated patients with consent. RESULTS: 351 healthy adult patients were included in the study, there were 238 in the no alcohol group, 113 had consumed alcohol and blood alcohol intake were obtained for 47. The alcohol group had a higher incidence of head injuries (46 (48%) versus 22 (9%)) with a lower incidence of limb injuries (39 (39%) versus 183 (76%)) than the no alcohol group. There was a significant difference in the pattern of injury between the alcohol and no alcohol groups (chi(2), p<0.001) and there was a significant difference in the injury severity scores (p<0.001, Z = -2.5). In the alcohol group severity and pattern correlated with alcohol concentration at the time of injury. Patients with an alcohol concentration<2 g/l had mostly soft tissue limb injuries (58%), 2-2.5 mostly significant limb fractures (55%), and >2.5 mostly significant head injuries (90%). CONCLUSIONS: Alcohol related falls are more often associated with severe craniofacial injury. The severity of both limb and head injury is greater and correlates directly with blood alcohol concentration. (+info)
Suicide bombing attacks: update and modifications to the protocol.
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OBJECTIVE: To review the experience of a large-volume trauma center in managing and treating casualties of suicide bombing attacks. SUMMARY BACKGROUND DATA: The threat of suicide bombing attacks has escalated worldwide. The ability of the suicide bomber to deliver a relatively large explosive load accompanied by heavy shrapnel to the proximity of his or her victims has caused devastating effects. METHODS: The authors reviewed and analyzed the experience obtained in treating victims of suicide bombings at the level I trauma center of the Hadassah University Hospital in Jerusalem, Israel from 2000 to 2003. RESULTS: Evacuation is usually rapid due to the urban setting of these attacks. Numerous casualties are brought into the emergency department over a short period. The setting in which the device is detonated has implications on the type of injuries sustained by survivors. The injuries sustained by victims of suicide bombing attacks in semi-confined spaces are characterized by the degree and extent of widespread tissue damage and include multiple penetrating wounds of varying severity and location, blast injury, and burns. CONCLUSIONS: The approach to victims of suicide bombings is based on the guidelines for trauma management. Attention is given to the moderately injured, as these patients may harbor immediate life-threatening injuries. The concept of damage control can be modified to include rapid packing of multiple soft-tissue entry sites. Optimal utilization of manpower and resources is achieved by recruiting all available personnel, adopting a predetermined plan, and a centrally coordinated approach. Suicide bombing attacks seriously challenge the most experienced medical facilities. (+info)
Evacuation priorities in mass casualty terror-related events: implications for contingency planning.
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OBJECTIVE: To assess evacuation priorities during terror-related mass casualty incidents (MCIs) and their implications for hospital organization/contingency planning. SUMMARY BACKGROUND DATA: Trauma guidelines recommend evacuation of critically injured patients to Level I trauma centers. The recent MCIs in Israel offered an opportunity to study the impositions placed on a prehospital emergency medical service (EMS) regarding evacuation priorities in these circumstances. METHODS: A retrospective analysis of medical evacuations from MCIs (29.9.2000-31.9.2002) performed by the Israeli National EMS rescue teams. RESULTS: Thirty-three MCIs yielded data on 1156 casualties. Only 57% (506) of the 1123 available and mobilized ambulances were needed to provide 612 evacuations. Rescue teams arrived on scene within <5 minutes and evacuated the last urgent casualty within 15-20 minutes. The majority of non-urgent and urgent patients were transported to medical centers close to the event. Less than half of the urgent casualties were evacuated to more distant trauma centers. Independent variables predicting evacuation to a trauma center were its being the hospital closest to the event (OR 249.2, P < 0.001), evacuation within <10 minutes of the event (OR 9.3, P = 0.003), and having an urgent patient on the ambulance (OR 5.6, P < 0.001). CONCLUSIONS: Hospitals nearby terror-induced MCIs play a major role in trauma patient care. Thus, all hospitals should be included in contingency plans for MCIs. Further research into the implications of evacuation of the most severely injured casualties to the nearest hospital while evacuating all other casualties to various hospitals in the area is needed. The challenges posed by terror-induced MCIs require consideration of a paradigm shift in trauma care. (+info)
Gunshot and explosion injuries: characteristics, outcomes, and implications for care of terror-related injuries in Israel.
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CONTEXT: An increase of terror-related activities may necessitate treatment of mass casualty incidents, requiring a broadening of existing skills and knowledge of various injury mechanisms. OBJECTIVE: To characterize and compare injuries from gunshot and explosion caused by terrorist acts. METHODS: A retrospective cohort study of patients recorded in the Israeli National Trauma Registry (ITR), all due to terror-related injuries, between October 1, 2000, to June 30, 2002. The ITR records all casualty admissions to hospitals, in-hospital deaths, and transfers at 9 of the 23 trauma centers in Israel. All 6 level I trauma centers and 3 of the largest regional trauma centers in the country are included. The registry includes the majority of severe terror-related injuries. Injury diagnoses, severity scores, hospital resource utilization parameters, length of stay (LOS), survival, and disposition. RESULTS: A total of 1155 terror-related injuries: 54% by explosion, 36% gunshot wounds (GSW), and 10% by other means. This paper focused on the 2 larger patient subsets: 1033 patients injured by terror-related explosion or GSW. Seventy-one percent of the patients were male, 84% in the GSW group and 63% in the explosion group. More than half (53%) of the patients were 15 to 29 years old, 59% in the GSW group and 48% in the explosion group. GSW patients suffered higher proportions of open wounds (63% versus 53%) and fractures (42% versus 31%). Multiple body-regions injured in a single patient occurred in 62% of explosion victims versus 47% in GSW patients. GSW patients had double the proportion of moderate injuries than explosion victims. Explosion victims have a larger proportion of minor injuries on one hand and critical to fatal injuries on the other. LOS was longer than 2 weeks for 20% (22% in explosion, 18% in GSW). Fifty-one percent of the patients underwent a surgical procedure, 58% in the GSW group and 46% in explosion group. Inpatient death rate was 6.3% (65 patients), 7.8% in the GSW group compared with 5.3% in the explosion group. A larger proportion of gunshot victims died during the first day (97% versus 58%). CONCLUSIONS: GSW and injuries from explosions differ in the body region of injury, distribution of severity, LOS, intensive care unit (ICU) stay, and time of inpatient death. These findings have implications for treatment and for preparedness of hospital resources to treat patients after a terrorist attack in any region of the world. Tailored protocol for patient evaluation and initial treatment should differ between GSW and explosion victims. Hospital organization toward treating and admitting these patients should take into account the different arrival and injury patterns. (+info)
Work-related injury sustained by foreign workers in Singapore.
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INTRODUCTION: Singapore has a resident population of 3.26 million and 0.53 million foreign workers. The objective of the study was to compare the injuries sustained by foreign and local workers presenting to an emergency department (ED). MATERIALS AND METHODS: Adult victims of work-related injury who presented to an urban public hospital ED from 1 December 1998 to 31 May 1999 were interviewed. Chart reviews were done for those hospitalised. Data collected were those of demographic, nature of injury, ambulance care, ED and hospital care, outcome and final diagnoses. RESULTS: There were 1244 local workers and 1936 foreign workers, giving a ratio of 1 local:1.6 foreign workers. The mean age of foreign workers was 29.6 years [standard deviation (SD) 6.2], which was younger (P < 0.0001) than the mean age 37.8 years (SD 14) of local workers. Fridays and Saturdays were the common days for injuries among foreign workers as opposed to Wednesdays and Mondays for local workers. Falls from height > or = 2m occurred among 9.1% of foreign workers, more (P < 0.0001) common than 4.3% of local workers, resulting in 2 out of 3 foreign workers death. Though the pattern of injuries was similar between foreign and local workers, foreign workers needed longer (P = 0.03) sick leave and more (P = 0.01) foreign workers were hospitalised, giving a ratio of 2 foreign workers for every 1 local worker hospitalised. CONCLUSION: Foreign workers had no difficulty accessing ED and hospital care for work-related injuries. The pattern and severity of injuries were similar between foreign and local workers but more foreign workers were hospitalised. (+info)