IED Injuries Even Worse Than Landmines

MedicalResearch.com Interview with:

Dr. Vivian Mcalister, M.B., CCFP(C), FRCSC, FRCS(I), FACS Professor - Department of Surgery London Health Sciences Centre University Hospital London, Ontario, Canada

Dr. McAlister

Dr. Vivian Mcalister, M.B., CCFP(C), FRCSC, FRCS(I), FACS
Professor – Department of Surgery
London Health Sciences Centre
University Hospital
London, Ontario, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study was performed by medical and nursing officers who were all deployed to the war zone. We were deeply concerned about the type of injuries we were seeing. They were more awful than any we had seen before. We were familiar with reviews of antipersonnel landmine injuries that were reported by Red Cross surgeons in the 1990s. The injuries that we were dealing with were from antipersonnel IEDs more than landmines. We decided to do a formal prospective study for two reasons: first was to carefully describe the pattern of injury so we could develop new medical strategies, if possible, to help victims. The second reason was to catalogue these injuries so we could impartially and scientifically report what we were witnessing.

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Blood Biomarkers Signal Multiple Organ Dysfunction Syndrome After Critical Injuries

MedicalResearch.com Interview with:

Dr. Joanna Shepherd Centre for Trauma Sciences Blizard Institute Queen Mary, University of London

Dr. Shepherd

Dr. Joanna Shepherd
Centre for Trauma Sciences
Blizard Institute
Queen Mary, University of London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Recent advances in resuscitation and treatment of life-threatening critical injuries means that patients with previously unsurvivable injuries are now surviving to reach hospital.  However, many of these patients develop Multiple Organ Dysfunction Syndrome (MODS), which is a failure of several organs including the lung, heart, kidney, and liver.

We studied immune cell genes in the blood of critically injured patients within the first few minutes to hours after injury, a period called the ‘hyperacute window’. We found a small and specific response to critical injury during this window that then evolved into a widespread immune reaction by 24 hours.  The development of MODS was linked to changes in the hyperacute window, with central roles for innate immune cells (including natural killer cells and neutrophils) and biological pathways associated with cell death and survival.  By 24 hours after injury, there was widespread immune activation present in all critically injured patients, but the MODS signal had either reversed or disappeared.

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Stop Using Cotton Tip Applicators in Kids’ Ears

MedicalResearch.com Interview with:

Kris Jatana, MD FAAP Pediatric Otolaryngologist Nationwide Children’s Hospital

Dr. Jatana

Kris Jatana, MD FAAP
Pediatric Otolaryngologist
Nationwide Children’s Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study looked at a 21-year period – 1990 through 2010 – and focused on children younger than 18 years of age treated in U.S. hospital emergency departments for cotton tip applicator-related ear injuries. About 263,000 children were injured during the study period, which comes out to approximately 1000 injuries seen in emergency departments every month or 34 per day.

The majority of injuries occurred when cotton tip applicators were used to clean a child’s ear canal (73%), and most of those injuries occurred when a child was using a cotton tip applicator on their own (77%), or their parent was using the device (16%) to clean the ear canal. About two out of every three patients were younger than 8 years of age, and patients aged 0-3 years accounted for 40% of all injuries.

Surprisingly, the highest rate of injury was in children 0-3 years old. The most common injuries were foreign body sensation (30%), perforated ear drum (25%) and soft tissue injury (23%).

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More Trauma Centers Can Reduce Quality By Decreasing Volume of Patients

MedicalResearch.com Interview with:

Joshua Brown, M.D., M.S., research fellow Division of Trauma and General Surgery University of Pittsburgh School of Medicine

Dr. Joshua Brown

Joshua Brown, M.D., M.S., research fellow
Division of Trauma and General Surgery
University of Pittsburgh School of Medicine

MedicalResearch.com: What is the background for this study?

Response: A trauma center is a hospital equipped to immediately provide specialized care to patients suffering from major traumatic injuries, such as falls, car crashes, burns or shootings. In the U.S., the American College of Surgeons sets criteria and conducts reviews for trauma center validation, and the individual states ultimately grant trauma center designation. In Pennsylvania, trauma centers are granted “Level” designations based on their capabilities, ranging from Level-I (highest) to Level-IV (lowest).

We examined records of nearly 840,000 seriously injured patients seen at 287 trauma centers between 2000 and 2012. The centers averaged 247 severely injured patients per year, and 90 percent of the cases involved blunt injury. We compared the expected death rate for each center if everything involving each trauma patient’s care had gone perfectly to the center’s actual death rate.

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Childhood Trauma Associated With Lifetime Drug Use in Teens

MedicalResearch.com Interview with:

Hannah Carliner, ScD MPH Post Doctoral Fellow in Substance Abuse Epidemiology Mailman School of Public Health Columbia University

Dr. Hannah Carliner

Hannah Carliner, ScD MPH
Post Doctoral Fellow in Substance Abuse Epidemiology
Mailman School of Public Health
Columbia University

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Carliner: We know from previous research that traumatic experiences in childhood can have far-reaching effects on the mental and physical health of adults, including increasing the risk for substance use disorders. There is a particularly strong body of evidence about this concerning exposure to child abuse and various other forms of family dysfunction and violence.

However, no previous studies have examined a wider range of traumatic childhood experiences and their link to experimentation with different kinds of drugs in adolescence. While some studies have interviewed adults about initiation of drug use at this age, those results are not as reliable as interviewing teens directly.

Using a nationally-representative sample of almost 10,000 non-institutionalized U.S. adolescents, we therefore determined that childhood trauma was associated with lifetime drug use in teens– not only with clinically-significant disordered drug use, but even with just trying drugs one time.

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Fewer Pediatric Abusive Head Trauma In States With Paid Family Leave

MedicalResearch.com Interview with:

Joanne Klevens, MD, PhD Division of Violence Prevention US Centers for Disease Control and Prevention Atlanta, Georgia

Dr. Joanne Klevens

Dr. Joanne Klevens, MD, PhD, MPH
Division of Violence Prevention
US Centers for Disease Control and Prevention
Atlanta, Georgia

Medical Research: What is the background for this study? What are the main findings?

Dr. Klevens: Pediatric abusive head trauma is a leading cause of fatal child maltreatment among young children and current prevention efforts have not been proven to be consistently effective. In this study, compared to seven states with no paid family leave policies, California’s policy showed significant decreases of hospital admissions for abusive head trauma in young children. This impact was observed despite low uptake of policy benefits by Californians, particularly among populations at highest risk of abusive head trauma.

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Mass Casualty Planning Needs To Go Beyond Level 1 Trauma Centers

Dr. Rachael Callcut M.D., M.S.P.H Assistant Professor of Surgery Division of General Surgery UCSF

Dr. Rachael Callcut

MedicalResearch.com Interview with:
Dr. Rachael Callcut M.D., M.S.P.H
Assistant Professor of Surgery
Division of General Surgery
UCSF

Medical Research: What is the background for this study? What are the main findings?

Dr. Callcut: San Francisco General Hospital (SFGH) responded on July 6, 2013 to one of the larger multiple casualty events in the history of our institution.  Asiana Airlines flight 214 crashed on approach to San Francisco International Airport with 307 people on board.  192 patients were injured and SFGH received the highest total of number of patients of area hospitals. The majority of data that is available on disaster response focuses on initial scene triage or initial hospital resources required to respond to these types of major events.  Our paper focuses on some additional considerations for optimizing disaster response not typically included in literature on these events including nursing resources, blood bank needs, and radiology studies. As an example, over 370 hours of nursing overtime were needed just in the first 18 hours following the disaster to care for patients.  This type of information in traditionally not been included in disaster planning, but clearly was a critical element of providing optimum care to our patients.

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Severely Injured Patients Do Better In High Level Trauma Centers

dr-Huiyun-XiangMedicalResearch.com Interview with:
Huiyun Xiang, M.D., M.P.H.
Center for Pediatric Trauma Research
The Research Institute at Nationwide Children’s Hospital
Columbus, OH

Medical Research: What is the background for this study? What are the main findings?

Response: In the United States trauma system, the most severe injuries ideally should receive definitive treatment at level I or level II trauma centers, while less severe injuries should receive treatment at level III or nontrauma centers. “Undertriage” occurs when a severe injury receives definitive treatment at a lower level trauma center instead of a level I or level II trauma center. But no study had used nationally representative data to evaluate mortality outcomes of undertriage at nontrauma centers.

Our study found detrimental consequences associated with undertriage at nontrauma centers. There was a significant reduction in the odds of emergency department (ED) death – by approximately half – in severely injured trauma patients who were properly triaged to a level I or level II trauma center versus those who were undertriaged to a nontrauma center. We also found that patients with moderate injuries may not have a reduction in the odds of ED death when triaged to a level I or level II trauma center instead of a nontrauma center. That suggests a possible threshold of injury severity when triaging trauma patients.

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Trauma Is Leading Cause of US Deaths in Age Group 47 and Younger

 

Peter M. Rhee, MD, MPH Chief, Division of Trauma, Critical Care, Burn and Emergency Surgery Professor of Surgery Medical Director, UMC Trauma Center Co-Medical Director, Pediatric ICU Program Director, Acute Care Surgery Fellowship Program Director, Critical Care Fellowship Vice Chair, Clinical Affairs Martin Gluck Endowed Chair in Trauma, Critical Care, Burn and Emergency SurgerMedicalResearch.com Interview with:
Peter M. Rhee, MD, MPH
Chief, Division of Trauma, Critical Care, Burn and Emergency Surgery
Professor of Surgery, Medical Director, UMC Trauma Center
Co-Medical Director, Pediatric ICU
Program Director, Acute Care Surgery Fellowship
University of Arizona

MedicalResearch.com: What are the main findings of the study?

Dr. Rhee: In just 10 years from 2000 to 2010, the death rate from cancer and cardiovascular disease in the United Sates has been falling according to the data from the Center for Disease Control (CDC). But during the same time period, the number of people that died from trauma increased by 23%.  As a result, Trauma is now the leading cause of death in the United States for those aged 47 and younger.  Just 10 years ago trauma used to be the leading cause of death for those aged 42 and younger.

It is also the leading cause of cumulative death for those younger than 59.  As our population ages and we live longer, trauma is no longer the disease of the young.  In 2000, those between the ages of 17-27 made up the largest group of trauma deaths.  In 2010, the group with the largest trauma deaths were 45-55. In fact the number of deaths in 54 year olds more than doubled as trauma deaths increased by 118% in just 10 years.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Rhee: The results were surprising in how quickly the changes are occurring and how much the trauma deaths are in the older population. It is suspected but not yet proven that as we as a population are getting healthier and more active, that we are more susceptible to trauma and its consequences more than ever.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Rhee: Trauma is not a disease only of the young and it effects everyone of every age. These changes are nationwide and the highest number of trauma deaths are in the baby boomer generation as well as the elderly. We should also be aware of the magnitude of trauma on our daily lives.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Rhee: With the maturation of the trauma system in this country which arguably is one of the best in the world, the mortality rate at these trauma centers has been decreasing.  The question is then with improvement in access and treatment of trauma patients, what is the real cause for these increasing trauma deaths. Future research is needed in the field of trauma more than ever. However, national funding for research allocated to trauma is only a 10th of what is currently allocated to cancer in 2012.  Trauma is the greatest increasing killer in our era. Trauma has been invisible to policy makers who allocate resources.
Citation:

Increasing Trauma Deaths in the United States

Ann Surg. 2014 Mar 19. [Epub ahead of print]

Rhee P1, Joseph B, Pandit V, Aziz H, Vercruysse G, Kulvatunyou N, Friese RS.