Non-fatal injuries sustained by seatbelt wearers: a comparative study.
The injuries sustained by 969 drivers and front-seat passengers in road-traffic accidents were studied. Altogether 196 (20-2%) of the drivers and passengers were wearing seat belts and 773 (79-8%) were not. The injuries among the two groups differed greatly in both severity and distribution. A total of 54 (27-6%) of the seatbelt wearers sustained one or more fractures compared with 300 (38-8%) of the non-wearers, and 18 (9-2%) of the seatbelt wearers were severely injured compared with 300 (38-8%) of the non-wearers. Soft-tissue injuries to the face were sustained by only 29 (14-8%) of the seatbelt wearers compared with 425 (55%) of the non-wearers. Since wearing seatbelts may become compulsory, the type and pattern of injuries to be expected in wearers should be appreciated. (+info)
HLA-DR expression and soluble HLA-DR levels in septic patients after trauma.
OBJECTIVE: To determine if cellular and soluble HLA-DR molecules may be relevant in severely injured patients for the development of gram-positive or gram-negative sepsis. SUMMARY BACKGROUND DATA: HLA-DR molecules play a central role in the specific immune response to infection. The reduced HLA-DR expression on monocytes is considered to correlate with infectious complications and the development of sepsis. Data on the role of HLA-DR expression on T cells and soluble HLA-DR molecules are rare. METHODS: HLA-DR expression on monocytes and T cells was measured by flow cytometry. Plasma levels of soluble HLA-DR were studied by enzyme-linked immunosorbent assay. RESULTS: HLA-DR expression on circulating T cells, calculated as mean fluorescence intensity in channels, was reduced at day 1 after admission in 20 patients with subsequent severe sepsis compared with 46 patients without sepsis. The septic patients immediately after trauma had significantly lower soluble HLA-DR plasma levels than the nonseptic patients. At day 2 after admission, HLA-DR expression on monocytes was significantly lower in the severe sepsis group than in the patients without sepsis, and lasted until day 14 after injury. CONCLUSIONS: In severely injured patients, decreased levels of cellular and soluble HLA-DR appear as early indicators of an immune deviation associated with the development of severe sepsis. Moreover, immune alterations of different cell types may promote distinct kinds of septicemia. (+info)
Bioelectrical impedance plethysmographic analysis of body composition in critically injured and healthy subjects.
BACKGROUND: Determination of body composition during critical illness is complex because of various patient-related and technical factors. Bioelectrical impedance is a promising technique for the analysis of body composition; however, its clinical utility in critically injured patients is unknown. OBJECTIVE: The purpose of this study was to compare bioelectrical impedance with metabolic activity in healthy and critically injured patients. If bioelectrical impedance accurately determines body composition during critical illness, the slope between body-composition variables and oxygen consumption would be the same in critically injured and healthy subjects. DESIGN: There is a strong linear relation between body composition and metabolic activity. In the present study, body composition (fat-free mass and body cell mass) was determined by using bioelectrical impedance and resting metabolic activity (metabolic rate and oxygen consumption) by using gas exchange analysis in a group of healthy and critically injured subjects. The relation between these variables was compared by using linear regression to a similar relation established by hydrostatic weighing in a large historical control group. RESULTS: The slope of the line relating fat-free mass to resting metabolic rate was the same in the healthy and critically ill groups (P = 0.62) and each was similar to the slope of the line for the control group. However, in 37% of the critically injured group, overhydration contributed to an increase in fat-free mass, disturbing the relation with resting metabolic rate. The slope of the line relating body cell mass to oxygen consumption in our healthy and critically ill groups was almost identical. CONCLUSION: These results support the use of bioelectrical impedance to determine body cell mass in healthy and critically ill subjects. (+info)
Ten-year trend in survival and resource utilization at a level I trauma center.
OBJECTIVE: To determine the impact of increasing trauma center experience over time on survival and resource utilization. METHODS: The authors studied a retrospective cohort at a single level I trauma center over a 10-year period, from 1986 to 1995. Patients included all hospital admissions and emergency department deaths. The main outcome measures were the case-fatality rate adjusted for injury severity, hospital length of stay, and costs. RESULTS: A total of 25,979 patients were admitted or died. The number of patients per year increased, from 2063 in 1986 to 3313 in 1995. The proportion of patients transferred from another institution increased from 16.2% to 34.4%. Although mean length of stay declined by 28.4%, from 9.5 to 6.8 days, costs increased by 16.7%, from $14,174 to $16,547. The use of specific radiologic investigations increased; the frequency of operative procedures either remained unchanged (craniotomy, fracture fixation) or decreased (celiotomy). After adjusting for injury severity and demographic factors, the mortality rate decreased over 10 years. The improvement in survival was confined to patients with an injury severity score > or =16. CONCLUSION: Over a 10-year period, the case-fatality rate declined in patients with severe injuries. Overall acute care costs increased, partially because of the increased use of radiologic investigations. Even in otherwise established trauma centers, increasing cumulative experience results in improved survival rates in the most severely injured patients. These data suggest that experience contributes to a decrease in mortality rate after severe trauma and that developing trauma systems should consider this factor and limit the number of designated centers to maximize cumulative experience at individual centers. (+info)
Dependence of explicit and implicit memory on hypnotic state in trauma patients.
BACKGROUND: It is still unclear whether memory of intraoperative events results entirely from moments of inadequate anesthesia. The current study was designed to determine whether the probability of memory declines with increasing depth of the hypnotic state. METHOD: A list of words was played via headphones during surgery to patients who had suffered acute trauma. Several commonly used indicators of anesthetic effect, including the bispectral index, were recorded during word presentation. First, these indicators served as predictors of the memory performance in a postoperative word stem completion test. Second, general memory performance observed in the first part was separated into explicit and implicit memory using the process dissociation procedure, and then two models of memory were compared: One model assumed that the probability of explicit and implicit memory decreases with increasing depth of hypnotic state (individual differences model), whereas the other assumed equal memory performance for all patients regardless of their level of hypnotic state. RESULTS: General memory performance declined with decreasing bispectral index values. None of the other indicators of hypnotic state were related to general memory performance. Memory was still significant at bispectral index levels between 60 and 40. A comparison of the two models of memory resulted in a better fit of the individual differences model, thus providing evidence of a dependence of explicit and implicit memory on the hypnotic state. Quantification of explicit and implicit memory revealed a significant implicit but no reliable explicit memory performance. CONCLUSIONS: This study clearly indicates that memory is related to the depth of hypnosis. The observed memory performance should be interpreted in terms of implicit memory. Auditory information processing occurred at bispectral index levels between 60 and 40. (+info)
Early growth response factor-1 induction by injury is triggered by release and paracrine activation by fibroblast growth factor-2.
Cell migration and proliferation that follows injury to the artery wall is preceded by signaling and transcriptional events that converge at the promoters of multiple genes whose products can influence formation of the neointima. Transcription factors, such as early growth response factor-1 (Egr-1), with nucleotide recognition elements in the promoters of many pathophysiologically relevant genes, are expressed at the endothelial wound edge within minutes of injury. The mechanisms underlying the inducible expression of Egr-1 in this setting are not clear. Understanding this process would provide important mechanistic insights into the earliest events in the response to injury. In this report, we demonstrate that fibroblast growth factor-2 (FGF-2) is released by injury and that antibodies to FGF-2 almost completely abrogate the activation and nuclear accumulation of Egr-1. FGF-2-inducible egr-1-promoter-dependent expression is blocked by PD98059, a specific inhibitor of mitogen-activated protein kinase/extracellular signal-regulated kinase (ERK)-1/2 (MEK-1/2), as well as by dominant negative mutants of ERK-1/2. Inducible ERK phosphorylation after injury is dependent on release and stimulation by endogenous FGF-2. Antisense oligonucleotides directed at egr-1 mRNA suggest that Egr-1 plays a necessary role in endothelial repair after denudation of the monolayer. These findings demonstrate that inducible Egr-1 expression after injury is contingent on the release and paracrine action of FGF-2. (+info)
Evaluation of the quality of an injury surveillance system.
The sensitivity, positive predictive value, and representativeness of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) were assessed. Sensitivity was estimated at four centers in June through August 1992, by matching independently identified injuries with those in the CHIRPP database. The positive predictive value was determined by reviewing all "injuries" in the database (at Montreal Children's Hospital) that could not be matched. Representativeness was assessed by comparing missed with captured injuries (at Montreal Children's Hospital) on demographic, social, and clinical factors. Sensitivity ranged from 30% to 91%, and the positive predictive value was 99.9% (i.e., the frequency of false-positive capture was negligible). The representativeness study compared 277 missed injuries with 2,746 captured injuries. The groups were similar on age, sex, socioeconomic status, delay before presentation, month, and day of presentation. Injuries resulting in admissions, poisonings, and those presenting overnight were, however, more likely to be missed. The adjusted odds ratio of being missed by CHIRPP for admitted injuries (compared with those treated and released) was 13.07 (95% confidence interval 7.82-21.82); for poisonings (compared with all other injuries), it was 9.91 (95% confidence interval 5.39-18.20); and for injuries presenting overnight (compared with those presenting during the day or evening), it was 4.11 (95% confidence interval 3.11-5.44). These injuries were probably missed because of inadequate education of participants in the system. The authors conclude that CHIRPP data are of relatively high quality and may be used, with caution, for research and public health policy. (+info)
Particle-mediated gene transfer of PDGF isoforms promotes wound repair.
Several techniques for cutaneous gene transfer have been investigated for either in vitro or in vivo applications. In the present study, we investigated whether the direct delivery of platelet-derived growth factor cDNA into skin results in improvement in tissue repair. Cutaneous transfections were carried out in rats using a particle-bombardment device (Accell). As revealed by reverse transcriptase-polymerase chain reaction, transgene expression in vivo was transient, with low level expression by day 5. When compared with wounds transfected with a control cytomegalovirus-luciferase plasmid, wounds transfected with platelet-derived growth factor A or B in the MFG vector showed a significant increase in wound tensile strength 7 and 14 d after transfection. At both time points platelet-derived growth factor A transfected wounds exhibited the highest increase in tensile strength over controls, resulting in a 3.5-fold increase at day 7 and a 1.5-fold increase at day 14. The degree of stimulation was not remarkably different between wounds transfected with platelet-derived growth factor B, which is predominantly cell associated, or a truncation mutant, platelet-derived growth factor B211, which is predominantly secreted. These findings demonstrate that in vivo gene transfer by particle bombardment can be used to improve the tissue repair response. This approach provides a robust tool to assess the biologic activity of various proteins and will aid in the development of therapeutic cutaneous gene delivery. (+info)