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International Journal of Dermatology Nov 2023
PubMed: 37377163
DOI: 10.1111/ijd.16778 -
The Journal of Trauma and Acute Care... Nov 2023The optimal time to initiate venous thromboembolism prophylaxis (VTEp) for patients with intracranial hemorrhage (ICH) is controversial and must balance the risks of VTE...
Early venous thromboembolism prophylaxis in patients with trauma intracranial hemorrhage: Analysis of the prospective multicenter Consortium of Leaders in Traumatic Thromboembolism study.
BACKGROUND
The optimal time to initiate venous thromboembolism prophylaxis (VTEp) for patients with intracranial hemorrhage (ICH) is controversial and must balance the risks of VTE with potential progression of ICH. We sought to evaluate the efficacy and safety of early VTEp initiation after traumatic ICH.
METHODS
This is a secondary analysis of the prospective multicenter Consortium of Leaders in the Study of Thromboembolism study. Patients with head Abbreviated Injury Scale score of > 2 and with immediate VTEp held because of ICH were included. Patients were divided into VTEp ≤ or >48 hours and compared. Outcome variables included overall VTE, deep vein thrombosis (DVT), pulmonary embolism, progression of intracranial hemorrhage (pICH), or other bleeding events. Univariate and multivariate logistic regressions were performed.
RESULTS
There were 881 patients in total; 378 (43%) started VTEp ≤48 hours (early). Patients starting VTEp >48 hours (late) had higher VTE (12.4% vs. 7.2%, p = 0.01) and DVT (11.0% vs. 6.1%, p = 0.01) rates than the early group. The incidence of pulmonary embolism (2.1% vs. 2.2%, p = 0.94), pICH (1.9% vs. 1.8%, p = 0.95), or any other bleeding event (1.9% vs. 3.0%, p = 0.28) was equivalent between early and late VTEp groups. On multivariate logistic regression analysis, VTEp >48 hours (odds ratio [OR], 1.86), ventilator days >3 (OR, 2.00), and risk assessment profile score of ≥5 (OR, 6.70) were independent risk factors for VTE (all p < 0.05), while VTEp with enoxaparin was associated with decreased VTE (OR, 0.54, p < 0.05). Importantly, VTEp ≤48 hours was not associated with pICH (OR, 0.75) or risk of other bleeding events (OR, 1.28) (both p = NS).
CONCLUSION
Early initiation of VTEp (≤48 hours) for patients with ICH was associated with decreased VTE/DVT rates without increased risk of pICH or other significant bleeding events. Enoxaparin is superior to unfractionated heparin as VTE prophylaxis in patients with severe TBI.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
Topics: Humans; Anticoagulants; Enoxaparin; Heparin; Intracranial Hemorrhage, Traumatic; Intracranial Hemorrhages; Prospective Studies; Pulmonary Embolism; Retrospective Studies; Venous Thromboembolism
PubMed: 37314427
DOI: 10.1097/TA.0000000000004007 -
International Journal of Gynaecology... Aug 2023
Topics: Pregnancy; Female; Humans; Cicatrix; Pregnancy, Ectopic; Hysteroscopy; Laparoscopy
PubMed: 37269103
DOI: 10.1002/ijgo.14900 -
Jornal de Pediatria 2023Determine the frequency of dermatological diagnoses in preterm newborns up to 28 days of life and associated perinatal factors.
OBJECTIVES
Determine the frequency of dermatological diagnoses in preterm newborns up to 28 days of life and associated perinatal factors.
METHOD
a cross-sectional analytical study with a convenience sample and prospective data collection, was conducted between November 2017 and August 2019. Overall, 341 preterm newborns who had been admitted to a University hospital - including those admitted to the Neonatal Intensive Care Unit - were evaluated.
RESULTS
61 (17.9%) had less than 32 weeks gestational age (GA), with a mean GA and birth weight of 33.9 ± 2.8 weeks and 2107.8 ± 679.8g (465 to 4230g), respectively. The median age at the time of evaluation was 2.9 days (4 h to 27 days). The frequency of dermatological diagnoses was 100% and 98.5% of the sample had two or more, with an average of 4.67+1.53 dermatoses for each newborn. The 10 most frequent diagnoses were lanugo (85.9%), salmon patch (72.4%), sebaceous hyperplasia (68.6%), physiological desquamation (54.8%), dermal melanocytosis (38.7%), Epstein pearls (37.2%), milia (32.2%), traumatic skin lesions (24%), toxic erythema (16.7%), and contact dermatitis (5%). Those with GA< 28 weeks showed more traumatic injuries and abrasions, whereas those with ≥ 28 weeks had physiological changes more frequently, and those with GA between 34-36 weeks, had transient changes.
CONCLUSION
Dermatological diagnoses were frequent in our sample and those with higher GA showed a higher frequency of physiological (lanugo and salmon patch) and transient changes (toxic erythema and miliaria). Traumatic lesions and contact dermatitis were among the 10 most frequent injuries, reinforcing the need to effectively implement neonatal skin care protocols, especially in preterm.
Topics: Pregnancy; Female; Humans; Infant, Newborn; Cross-Sectional Studies; Infant, Newborn, Diseases; Birth Weight; Erythema; Gestational Age; Dermatitis, Contact; Intensive Care Units, Neonatal
PubMed: 37172615
DOI: 10.1016/j.jped.2023.04.005 -
Prehospital Emergency Care 2024Early pelvic binder placement in the field stabilizes pelvic fractures and tamponades potential hemorrhage within the pelvis. Despite known risk factors for pelvic... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Early pelvic binder placement in the field stabilizes pelvic fractures and tamponades potential hemorrhage within the pelvis. Despite known risk factors for pelvic fracture, it remains challenging to quickly triage and correctly apply a pelvic binder. We aim to develop a prediction model that exclusively uses prehospital criteria to inform the decision to place a pelvic binder.
METHODS
The trauma registry was used to identify all trauma patients admitted to an urban Level I trauma center between January 2013 and December 2017. Variables collected included patient demographics, mechanism of injury, prehospital vital signs, and the presence of a pelvic fracture. Participants were randomly assigned to a training group (70%) or a validation group (30%). Univariate analyses were used to identify significant predictors for use in multivariate predictive models.
RESULTS
A total of 8,480 (65% male; median age 49; median ISS 9) and 3,676 (65% male; median age 48; median ISS 9) trauma patients were randomly assigned to the training and validation groups, respectively. Univariate analysis showed significant likelihood of pelvic fracture associated with female sex, hemodynamic instability (initial systolic blood pressure < 90 mmHg), blunt injury type, specific mechanisms of injury (motor vehicle collision, motorcycle collision, pedestrian struck by motor vehicle, crushing injury, and riding an animal), impact location, and position in vehicle. Multivariate models adjusting for blunt type injury, hemodynamic instability, impact location, and position in vehicle showed that presence of two or more of these risk factors is significantly associated with presence of pelvic fracture.
CONCLUSION
Establishing select prehospital criteria for the empiric application of pelvic binders for patients in the field with blunt injuries, hemodynamic instability, frontal or side motor vehicle collision impact, and non-front seat passenger may improve outcomes among patients with pelvic fractures.
Topics: Humans; Male; Female; Middle Aged; Emergency Medical Services; Retrospective Studies; Fractures, Bone; Pelvic Bones; Wounds, Nonpenetrating; Vascular Diseases; Injury Severity Score
PubMed: 37171847
DOI: 10.1080/10903127.2023.2213316 -
The American Surgeon Dec 2023Observative management of small traumatic pneumothoraces (PTX) has been shown to decrease chest tube utilization in non-mechanically ventilated patients without...
BACKGROUND
Observative management of small traumatic pneumothoraces (PTX) has been shown to decrease chest tube utilization in non-mechanically ventilated patients without compromising outcomes. This approach could be used in mechanically ventilated (MV) patients, though many feel these patients are at increased risk of observation failure.
METHODS
A single center retrospective study of all adults undergoing observation of a computed tomography (CT) diagnosed PTX from 2015-2019. Patients with chest tube placement within 4-hours of arrival, concurrent hemothorax, or death within 24-hours were excluded. Observation failure was defined as chest tube placement.
RESULTS
Of 340 patients, 64 were on MV. The groups were of similar age, BMI, underlying pulmonary comorbidities, and PTX size (10.1 mm vs 8.8 mm, = .20). The MV group was more severely injured (ISS [25+] [60.9% vs 11.2%, < .001]). There was no difference in observation failure rates by MV status overall (6.3% vs 5.1%, = .75) or by PTX size (<15 mm [5% vs 2.2%, P = .37], <20 mm [4.8% vs 3.1%, = .45], <25 mm [4.8% vs 4.1%, = .73], <30 mm [4.8% vs 4.1%, = .73], <35 mm [4.8% vs 4.7%, = 1.00]). MV was not an independent predictor of observation failure on multivariable analysis (OR .64, 95% CI .18-2.20), though PTX size was (OR 1.11, 95% CI 1.05-1.17). When comparing those who failed vs those who did not, the only difference was PTX size (9.34 mm vs 19.41 mm, < .001).
CONCLUSION
MV is not an independent predictor of PTX observation failure. While PTX size appears to play a role, further studies are needed to outline safe parameters for observation in those undergoing MV.
Topics: Adult; Humans; Pneumothorax; Respiration, Artificial; Retrospective Studies; Chest Tubes; Lung; Thoracic Injuries; Thoracostomy
PubMed: 36448872
DOI: 10.1177/00031348221142583