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[PMID]:29310322
[Au] Autor:Gordillo Martin R; Alcaráz PE; Rodriguez LJ; Fernandez-Pacheco AN; Marín-Cascales E; Freitas TT; Rios MP
[Ad] Endereço:Doctoral Program in Health Sciences and Professor of the Faculty of Nursing of the Catholic University of Murcia (UCAM) and Nurse in the Emergency Services 061 (112) of Murcia, Spain.
[Ti] Título:Effect of training in advanced trauma life support on the kinematics of the spine: A simulation study.
[So] Source:Medicine (Baltimore);96(48):e7587, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:More than 7.5 million people in the world are affected by spinal cord injury (SCI). In this study, we aimed to analyze the effect of training in advanced trauma life support (ATLS) on the kinematics of the spine when performing different mobilization and immobilization techniques on patients with suspected SCI. A quasi-experimental study, clinical simulation, was carried out to determine the effect of training in ATLS on 32 students enrolled in the Master's program of Emergency and Special Care Nursing. The evaluation was performed through 2 maneuvers: placing of the scoop stretcher (SS) and spinal board (SB), with an actor who simulated a clinical situation of suspected spinal injury. The misalignment of the spine was measured with the use of a Vicon 3D motion capture system, before (pre-test) and after (post-test) the training. In the overall misalignment of both maneuvers, statistically significant differences were found between the pre-test misalignment of 62.1°â€Š±â€Š25.9°, and the post-test misalignment of 32.3°â€Š±â€Š10.0°, with a difference between means of 29.7° [(95% confidence interval, 95% CI 22.8-36.6°), (P = .001)]. The results obtained for the placing of the SS showed that there was a pre-test misalignment of 65.1°â€Š±â€Š28.7°, and a post-test misalignment of 33.2°â€Š±â€Š10.1°, with a difference of means of 33.9° [(95% CI, 23.1-44.6°), (P = .001)]. During the placing of the SB, a pre-test misalignment of 59.0°â€Š±â€Š28.7° and a post-test misalignment of 33.4°â€Š±â€Š10.0° were obtained, as well as a difference of means of 25.6° [(95% CI 16.6-34.6°), (P = .001)]. The main conclusion of this study is that training in ATLS decreases the misalignment provoked during the utilization of the SS and SB, regardless of the device used.
[Mh] Termos MeSH primário: Cuidados de Suporte Avançado de Vida no Trauma/normas
Educação de Pós-Graduação em Enfermagem/métodos
Treinamento por Simulação/métodos
Traumatismos da Coluna Vertebral/enfermagem
Traumatismos da Coluna Vertebral/fisiopatologia
Traumatologia/educação
[Mh] Termos MeSH secundário: Adulto
Fenômenos Biomecânicos
Feminino
Seres Humanos
Imobilização
Masculino
Gravação em Vídeo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180115
[Lr] Data última revisão:
180115
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007587


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[PMID]:29180170
[Au] Autor:Carlin MN; Daneshpajouh A; Catino J; Bukur M
[Ad] Endereço:Department of Trauma & Critical Care, Delray Medical Center, Nova Southeastern University, Delray Beach, Florida; Department of General Surgery, Larkin Community Hospital, Nova Southeastern University, South Miami, Florida. Electronic address: margoca@pcom.edu.
[Ti] Título:Money well spent? A cost and utilization analysis of prophylactic inferior vena cava filter placement in high-risk trauma patients.
[So] Source:J Surg Res;220:105-111, 2017 Dec.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Inferior vena cava filters (IVCF) for venous thromboembolic prophylaxis in high-risk trauma patients is a controversial practice. Utilization of IVCF prophylaxis was evaluated at a level 1 trauma center. Daily cost of IVCF prophylaxis, time to IVCF, duration between IVCF and chemoprophylaxis, and number of patients needed to treat (NNT) to prevent pulmonary embolism (PE) was calculated. METHODS: A retrospective review of prophylactic IVCF over a 5-year period (2010-2014). Demographic, physiologic, injury, procedural, and outcome data were abstracted from the administrative trauma database. Medicare fees and days without chemoprophylaxis were used to determine daily IVCF cost. NNT was calculated using PE events in a cohort without IVCF. RESULTS: Over the 5-year period, 146 patients with mean age 56.3 y (SD ± 24.2), 67.8% male, underwent prophylactic IVCF. Predominant mechanisms of injuries were falls (45.9%) and motor vehicle accidents (20.5%) with median Injury Severity Score of 25 (intraquartile range [IQR] 16-29) and head Abbreviated Injury Score of 3 (IQR 3-5). Most common operative interventions required in 24.7% were orthopedic (25.3%) and neurosurgical (21.9%). Median time to IVCF was 78 h (IQR 48-144). Most common IVCF indications were closed head injury (48.6%) and spinal injuries (30.8%). Median time to administration of chemoprophylaxis was 96 h after IVCF (IQR 24-192) in 57.5%. Median IVCF cost was $759/d (IQR $361-$1897) compared with $4.32 for chemoprophylaxis. PE occurred in 0.26% without IVCF. PE did not occur with prophylactic IVCF. Estimated NNT was 379 (95% CI 265, 661). CONCLUSIONS: Prophylactic IVCF placement is a costly practice with relatively low benefit. Anticipated time without chemoprophylaxis and patient criteria should be considered before routine IVCF placement.
[Mh] Termos MeSH primário: Custos e Análise de Custo
Embolia Pulmonar/prevenção & controle
Filtros de Veia Cava/economia
Filtros de Veia Cava/utilização
Veia Cava Inferior/cirurgia
[Mh] Termos MeSH secundário: Acidentes por Quedas/economia
Acidentes de Trânsito/economia
Adulto
Idoso
Idoso de 80 Anos ou mais
Anticoagulantes/uso terapêutico
Feminino
Traumatismos Cranianos Fechados/cirurgia
Seres Humanos
Escala de Gravidade do Ferimento
Masculino
Medicare
Meia-Idade
Estudos Retrospectivos
Fatores de Risco
Traumatismos da Coluna Vertebral/cirurgia
Fatores de Tempo
Centros de Traumatologia/economia
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE


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[PMID]:28803621
[Au] Autor:Chilvers G; Janjua U; Choudhary S
[Ad] Endereço:Department of Imaging, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
[Ti] Título:Blunt cervical spine injury in adult polytrauma: incidence, injury patterns and predictors of significant ligament injury on CT.
[So] Source:Clin Radiol;72(11):907-914, 2017 Nov.
[Is] ISSN:1365-229X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: To describe the pattern of cervical spine fractures in adult major trauma and identify computed tomography (CT) parameters that can predict significant ligament injury when fractures are absent; to define the normal range for parameters used; and identify common variations due to position of cervical immobilisation in a trauma patient. MATERIALS AND METHODS: In this retrospective study all polytrauma patients imaged using multidetector CT over a period of 5 years were identified. Patients with cervical spine fracture and suspected ligament injury in the absence of fracture were collated based on the polytrauma CT report. Predictors of ligament injury were defined based on published historical data on plain radiographs and posterior paraspinal fat pad assessment at CT. These parameters were recorded for each study with comparison to subsequent magnetic resonance imaging (MRI) as the reference standard. RESULTS: Significant ligament injury on MRI was detected at the craniocervical junction, when CT showed a basion dens interval of >10 mm, widened incongruous C0/C1 facet joint space of >3 mm, and widened C1/2 facet joint space of >6 mm. In the subaxial cervical spine, facet subluxation >50% and obscured posterior paraspinal fat pad were the only reliable predictors of ligament injury, as confirmed on subsequent MRI. CONCLUSION: When fractures are absent, signs of significant ligament injury on CT at the craniocervical junction were increased basion dens interval and widened facet joints. In the subaxial cervical spine, >50% subluxation of a facet joint and obscured posterior paraspinal fat pad are indicators of significant ligament injury.
[Mh] Termos MeSH primário: Vértebras Cervicais/lesões
Ligamentos/lesões
Traumatismo Múltiplo/diagnóstico por imagem
Traumatismos da Coluna Vertebral/diagnóstico por imagem
Tomografia Computadorizada por Raios X/métodos
Ferimentos não Penetrantes/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Vértebras Cervicais/diagnóstico por imagem
Feminino
Seres Humanos
Incidência
Ligamentos/diagnóstico por imagem
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Estudos Retrospectivos
Fraturas da Coluna Vertebral/diagnóstico por imagem
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170815
[St] Status:MEDLINE


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[PMID]:28799857
[Au] Autor:Palmer V; Cohen RB; Braffman B; Brockmeyer DL; Spader HS
[Ad] Endereço:Keiser University Physician Assistant Program, Ft. Lauderdale, Florida.
[Ti] Título:Delayed osteomyelitis resulting from an extension injury of the cervical spine: case report.
[So] Source:J Neurosurg Pediatr;20(4):388-392, 2017 Oct.
[Is] ISSN:1933-0715
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Osteomyelitis of the cervical spine is an exceedingly rare lesion in pediatric practice and is caused by a variety of mechanisms. The authors present a case in which cervical osteomyelitis presented in a delayed manner after the patient experienced a stable cervical extension injury at the C4-5 level. On review of the original images, the authors noted a likely perforation in the retropharyngeal space. This case highlights the risk of retropharyngeal injury in cervical trauma, with the seldom-seen complication of osteomyelitis as a result.
[Mh] Termos MeSH primário: Vértebras Cervicais/lesões
Osteomielite/etiologia
Traumatismos da Coluna Vertebral/complicações
[Mh] Termos MeSH secundário: Adolescente
Vértebras Cervicais/diagnóstico por imagem
Seguimentos
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Osteomielite/diagnóstico por imagem
Osteomielite/cirurgia
Traumatismos da Coluna Vertebral/diagnóstico por imagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170812
[St] Status:MEDLINE
[do] DOI:10.3171/2017.5.PEDS1777


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[PMID]:28617741
[Au] Autor:Devulapalli C; Broyles JM; Bello R; Elgendy T; Yalanis G; Redett R; Rosson GD; Sacks JM
[Ad] Endereço:Baltimore, Md. From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital.
[Ti] Título:Soft-Tissue Reconstruction of Large Spinal Defects: A 12-Year Institutional Experience.
[So] Source:Plast Reconstr Surg;140(4):806-814, 2017 Oct.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Spinal resections can lead to defects requiring soft-tissue reconstruction. The purpose of this study was to review the authors' institutional experience with reconstruction of spinal defects and identify risk factors predictive of wound complications, focusing on timing of reconstruction with ablative surgery. METHODS: The authors retrospectively reviewed patients who underwent spinal resection and required soft-tissue reconstruction from 2002 to 2014. Logistic regression was performed to identify risk factors for complications. RESULTS: Of 289 reconstructions performed in 259 patients, 64 cases (22.1 percent) had major wound complications requiring reoperation. Lumbosacral defects were the most common location (43.6 percent) and paraspinous muscle flaps were the preferred reconstructive method used for all defect regions. A total of 224 reconstructions (77.5 percent) were performed immediately at the time of spinal surgery, and 65 (22.5 percent) were performed in delayed fashion as a result of wound complications from previous spinal surgery. Patients undergoing immediate reconstruction had significantly lower rates of instrumentation removal (0.9 percent versus 4.6 percent; p = 0.043), unplanned reoperations (0.5 versus 1.3; p < 0.001), and mortality (0.9 percent versus 9.2 percent; p < 0.001) compared with those undergoing delayed reconstruction. On logistic regression analysis, presence of instrumentation (OR, 3.2; p = 0.012), requirement for a free flap (OR, 9.0; p = 0.016), and spinal cord exposure (OR, 2.6; p = 0.036) were associated with increased odds of a major wound complication. CONCLUSION: Spinal resections carry significant surgical-site morbidity, and selection of high-risk patients for immediate reconstruction with locoregional muscle flaps may be beneficial for improving wound-related outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
[Mh] Termos MeSH primário: Previsões
Procedimentos Cirúrgicos Reconstrutivos/métodos
Lesões dos Tecidos Moles/cirurgia
Traumatismos da Coluna Vertebral/cirurgia
Retalhos Cirúrgicos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Criança
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Lesões dos Tecidos Moles/diagnóstico
Traumatismos da Coluna Vertebral/diagnóstico
Índices de Gravidade do Trauma
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170616
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003679


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[PMID]:28546119
[Au] Autor:Xu Y; Xiong W; Han SII; Fang Z; Li F
[Ad] Endereço:Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.
[Ti] Título:Posterior Bilateral Intermuscular Approach for Upper Cervical Spine Injuries.
[So] Source:World Neurosurg;104:869-875, 2017 Aug.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To investigate a novel intermuscular surgical approach for posterior upper cervical spine fixation. METHODS: Twenty-three healthy volunteers underwent magnetic resonance imaging. By using the magnetic resonance imaging scans in transverse view at the level of lower edge of atlas, the distances from the posterior midline to lateral margin of trapezius, to the medial margin of splenius capitis, and to middle line of semispinalis capitis were recorded. The angle between posterior middle line and the line crossing the lateral margin of trapezius and middle point of ipsilateral pedicles. From October 2009 to May 2013, 12 patients with upper cervical spine injuries were operated via the bilateral intermuscular approach. The time required for surgery, blood loss, and pre- and postoperative visual analogue scale scores were analyzed. RESULTS: The average distance of 0-T was 39.2 ± 7.5 mm, the angle between the approach and posterior middle line was 33.2 ± 8.4°. The surgical time was 78.3 ± 22.5 minutes (45-140 minutes), and the mean intraoperative blood loss was 87.5 ± 44.2 mL (30-200 mL). Preoperative and postoperative visual analogue scale scores were 6.4 ± 0.8 and 1.8 ± 0.7, respectively. The average follow-up time was 19.7 ± 11.5 months (9-48 months). CONCLUSIONS: The posterior bilateral intermuscular approach for upper cervical spine injuries is a valid alternative for Hangmans' fractures type I, type II, and type Ia according to Levine and Edwards classification as well as atlantoaxial subluxation caused by upper cervical spine trauma.
[Mh] Termos MeSH primário: Vértebras Cervicais/lesões
Vértebras Cervicais/cirurgia
Luxações Articulares/cirurgia
Músculos do Pescoço/cirurgia
Fraturas da Coluna Vertebral/cirurgia
Fusão Vertebral/métodos
Traumatismos da Coluna Vertebral/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Articulação Atlantoaxial/diagnóstico por imagem
Articulação Atlantoaxial/cirurgia
Perda Sanguínea Cirúrgica
Vértebras Cervicais/diagnóstico por imagem
Feminino
Seres Humanos
Luxações Articulares/diagnóstico por imagem
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Músculos do Pescoço/diagnóstico por imagem
Dor Pós-Operatória/etiologia
Fraturas da Coluna Vertebral/diagnóstico por imagem
Traumatismos da Coluna Vertebral/diagnóstico por imagem
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170527
[St] Status:MEDLINE


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[PMID]:28511807
[Au] Autor:Hyldmo PK; Horodyski M; Conrad BP; Aslaksen S; Røislien J; Prasarn M; Rechtine GR; Søreide E
[Ad] Endereço:Department of Research, Norwegian Air Ambulance Foundation, Drøbak, Norway; Trauma Unit, Sørlandet Hospital, Kristiansand, Norway. Electronic address: pkh@sshf.no.
[Ti] Título:Does the novel lateral trauma position cause more motion in an unstable cervical spine injury than the logroll maneuver?
[So] Source:Am J Emerg Med;35(11):1630-1635, 2017 Nov.
[Is] ISSN:1532-8171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Prehospital personnel who lack advanced airway management training must rely on basic techniques when transporting unconscious trauma patients. The supine position is associated with a loss of airway patency when compared to lateral recumbent positions. Thus, an inherent conflict exists between securing an open airway using the recovery position and maintaining spinal immobilization in the supine position. The lateral trauma position is a novel technique that aims to combine airway management with spinal precautions. The objective of this study was to compare the spinal motion allowed by the novel lateral trauma position and the well-established log-roll maneuver. METHODS: Using a full-body cadaver model with an induced globally unstable cervical spine (C5-C6) lesion, we investigated the mean range of motion (ROM) produced at the site of the injury in six dimensions by performing the two maneuvers using an electromagnetic tracking device. RESULTS: Compared to the log-roll maneuver, the lateral trauma position caused similar mean ROM in five of the six dimensions. Only medial/lateral linear motion was significantly greater in the lateral trauma position (1.4mm (95% confidence interval [CI] 0.4, 2.4mm)). CONCLUSIONS: In this cadaver study, the novel lateral trauma position and the well-established log-roll maneuver resulted in comparable amounts of motion in an unstable cervical spine injury model. We suggest that the lateral trauma position may be considered for unconscious non-intubated trauma patients.
[Mh] Termos MeSH primário: Vértebras Cervicais/lesões
Lesões do Pescoço/terapia
Posicionamento do Paciente/métodos
Amplitude de Movimento Articular
Traumatismos da Coluna Vertebral/terapia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Manuseio das Vias Aéreas/métodos
Fenômenos Biomecânicos
Cadáver
Estudos Cross-Over
Serviços Médicos de Emergência/métodos
Feminino
Seres Humanos
Disco Intervertebral/lesões
Ligamento Amarelo/lesões
Ligamentos Longitudinais/lesões
Masculino
Meia-Idade
Medula Espinal
Fraturas da Coluna Vertebral
Decúbito Dorsal
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171106
[Lr] Data última revisão:
171106
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170518
[St] Status:MEDLINE


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[PMID]:28501121
[Au] Autor:Tatum JM; Melo N; Ko A; Dhillon NK; Smith EJT; Yim DA; Barmparas G; Ley EJ
[Ad] Endereço:Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
[Ti] Título:Validation of a field spinal motion restriction protocol in a level I trauma center.
[So] Source:J Surg Res;211:223-227, 2017 May 01.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Spinal motion restriction (SMR) after traumatic injury has been a mainstay of prehospital trauma care for more than 3 decades. Recent guidelines recommend a selective approach with cervical spine clearance in the field when criteria are met. MATERIALS AND METHODS: In January 2014, the Department of Health Services of the City of Los Angeles, California, implemented revised guidelines for cervical SMR after blunt mechanism trauma. Adult patients (aged ≥18 y) with an initial Glasgow Coma Scale (GCS) score of ≥13 presented to a single level I trauma center after blunt mechanism trauma over the following 1-y period were retrospectively reviewed. Demographics, injury data, and prehospital data were collected. Cervical spine injury (CSI) was identified by International Classification of Disease, Ninth Revision, codes. RESULTS: Emergency medical services transported 1111 patients to the emergency department who sustained blunt trauma. Patients were excluded if they refused c-collar placement or if documentation was incomplete. A total of 997 patients were included in our analysis with 172 (17.2%) who were selective cleared of SMR per protocol. The rate of Spinal Cord Injury was 2.2% (22/997) overall and 1.2% (2/172) in patients without SMR. The sensitivity and specificity of the protocol are 90.9% (95% confidence interval: 69.4-98.4) and 17.4% (95% confidence interval: 15.1-20.0), respectively, for CSI. Patients with CSI who arrived without immobilization having met field clearance guidelines, were managed without intervention, and had no neurologic compromise. CONCLUSIONS: Guidelines for cervical SMR have high sensitivity and low specificity to identify CSI. When patients with injuries were not placed on motion restrictions, there were no negative clinical outcomes.
[Mh] Termos MeSH primário: Vértebras Cervicais/lesões
Serviços Médicos de Emergência/métodos
Restrição Física/métodos
Traumatismos da Medula Espinal/terapia
Traumatismos da Coluna Vertebral/terapia
Ferimentos não Penetrantes/terapia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Algoritmos
Protocolos Clínicos
Técnicas de Apoio para a Decisão
Serviços Médicos de Emergência/normas
Feminino
Seres Humanos
Los Angeles
Masculino
Meia-Idade
Restrição Física/normas
Estudos Retrospectivos
Centros de Traumatologia
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170515
[St] Status:MEDLINE


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[PMID]:28499787
[Au] Autor:Silva LOJE; Fernanda Bellolio M; Smith EM; Daniels DJ; Lohse CM; Campbell RL
[Ad] Endereço:Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States.
[Ti] Título:Motocross-associated head and spine injuries in adult patients evaluated in an emergency department.
[So] Source:Am J Emerg Med;35(10):1485-1489, 2017 Oct.
[Is] ISSN:1532-8171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Motor vehicle-related injuries (including off-road) are the leading cause of traumatic brain injury (TBI) and acute traumatic spinal cord injury in the United States. OBJECTIVES: To describe motocross-related head and spine injuries of adult patients presenting to an academic emergency department (ED). METHODS: We performed an observational cohort study of adult ED patients evaluated for motocross-related injuries from 2010 through 2015. Electronic health records were reviewed and data extracted using a standardized review process. RESULTS: A total of 145 motocross-related ED visits (143 unique patients) were included. Overall, 95.2% of patients were men with a median age of 25years. Sixty-seven visits (46.2%) were associated with head or spine injuries. Forty-three visits (29.7%) were associated with head injuries, and 46 (31.7%) were associated with spine injuries. Among the 43 head injuries, 36 (83.7%) were concussions. Seven visits (16.3%) were associated with at least 1 head abnormality identified by computed tomography, including skull fracture (n=2), subdural hematoma (n=1), subarachnoid hemorrhage (n=4), intraparenchymal hemorrhage (n=3), and diffuse axonal injury (n=3). Among the 46 spine injuries, 32 (69.6%) were acute spinal fractures. Seven patients (4.9%) had clinically significant and persistent neurologic injuries. One patient (0.7%) died, and 3 patients had severe TBIs. CONCLUSION: Adult patients evaluated in the ED after motocross trauma had high rates of head and spine injuries with considerable morbidity and mortality. Almost half had head or spine injuries (or both), with permanent impairment for nearly 5% and death for 0.7%.
[Mh] Termos MeSH primário: Traumatismos em Atletas/epidemiologia
Traumatismos Craniocerebrais/epidemiologia
Serviço Hospitalar de Emergência
Veículos Off-Road
Traumatismos da Coluna Vertebral/epidemiologia
[Mh] Termos MeSH secundário: Acidentes de Trânsito
Adulto
Traumatismos em Atletas/diagnóstico
Traumatismos em Atletas/terapia
Estudos de Coortes
Traumatismos Craniocerebrais/diagnóstico
Traumatismos Craniocerebrais/terapia
Feminino
Hospitalização
Seres Humanos
Masculino
Traumatismos da Coluna Vertebral/diagnóstico
Traumatismos da Coluna Vertebral/terapia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170514
[St] Status:MEDLINE


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[PMID]:28399555
[Au] Autor:Song R; Fan D; Wu H; Zhang Z; Zhao L; Liu Y; Liao W; Tan H; Wang L; Wang W
[Ad] Endereço:Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
[Ti] Título:Management of Unusual Atlantoaxial Dislocation.
[So] Source:Spine (Phila Pa 1976);42(8):573-577, 2017 Apr 15.
[Is] ISSN:1528-1159
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:STUDY DESIGN: A case report and review of the literature. OBJECTIVE: The aim of this study was to describe the successful treatment of one posterior atlantoaxial dislocation without fracture and to review the relevant literature. SUMMARY OF BACKGROUND DATA: Posterior atlantoaxial dislocation without fracture of the odontoid process is extremely rare. Management of these patients is still unknown. METHODS: A posterior atlantoaxial dislocation without fracture in a 58-year-old man with incomplete quadriplegia was treated surgically with posterior atlantoaxial pedicle screws internal fixation and fusion after closed reduction. The images, treatment, and related literature are reviewed. RESULTS: The patient had complete recovery of neurologic deficit and bony fusion of the atlantoaxial joint was identified on the follow-up computed tomography taken 3 months after posterior fixation. To our knowledge, no case of posterior atlantoaxial dislocation with neurologic deficit has been previously reported in English medical literature. CONCLUSION: We described a rare case of posterior atlantoaxial dislocation with neurologic deficit. Treatment procedure of posterior atlantoaxial dislocation was presented. LEVEL OF EVIDENCE: 5.
[Mh] Termos MeSH primário: Articulação Atlantoaxial/lesões
Luxações Articulares/cirurgia
Quadriplegia/cirurgia
Fusão Vertebral
Traumatismos da Coluna Vertebral/cirurgia
[Mh] Termos MeSH secundário: Articulação Atlantoaxial/cirurgia
Fixação Interna de Fraturas
Seres Humanos
Luxações Articulares/complicações
Masculino
Meia-Idade
Processo Odontoide
Parafusos Pediculares
Quadriplegia/etiologia
Recuperação de Função Fisiológica
Traumatismos da Coluna Vertebral/complicações
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171017
[Lr] Data última revisão:
171017
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170412
[St] Status:MEDLINE
[do] DOI:10.1097/BRS.0000000000001872



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