Articles: trauma.
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Post injury immune dysfunction can result in serious complications. Measurement of biomarkers may guide the optimal timing of surgery in clinically borderline patients and therefore prevent complications. ⋯ Neutrophil oxidative burst capacity response to orthopaedic trauma surgery is associated with the infective post injury complications. There was no correlation between magnitude of injury or operation and oxidative burst capacity. These results are promising for the development of tools for prediction of post-operative complications and guidance for optimal timing for surgical intervention.
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To date, no studies have attempted to utilize data from a combination of vital signs, heart rate variability and complexity (HRV, HRC), as well as machine learning (ML), for identifying the need for lifesaving interventions (LSIs) in trauma patients. The objectives of this study were to examine the utility of the above for identifying LSI needs and compare different LSI-associated models, with the hypothesis that an ML model would be superior in performance over multivariate logistic regression models. One hundred four patients transported from the injury scene via helicopter were selected for the study. ⋯ Likewise, ROC curves demonstrated better identification for LSIs using GCS and HRC (AUC of 0.94) than using GCS and HR (AUC of 0.92). Importantly, ROC curves demonstrated that an ML model using HR, GCS, and HRC (AUC of 0.99) had superior performance over multivariate logistic regression models for identifying the need for LSIs in trauma patients. Development of computer decision support systems should utilize vital signs, HRC, and ML in order to achieve more accurate diagnostic capabilities, such as identification of needs for LSIs in trauma patients.
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Journal of neurotrauma · Jul 2014
Cost-effectiveness analysis (CEA) of an early-initiated, continuous chain of rehabilitation after severe traumatic brain injury.
The aim of this study is to estimate the long-term cost-effectiveness of two different rehabilitation trajectories after severe traumatic brain injury (sTBI). A decision tree model compared hospitalization costs, health effects, and incremental cost-effectiveness ratios (ICER) of a continuous chain versus a broken chain of rehabilitation. The expected costs were estimated by the reimbursement system using diagnosis-related group and based on point estimates of the Disability Rating Scale (DRS); the health effects were measured by means of area under the curve (AUC). ⋯ By replacing the broken chain with the continuous chain, NOK 37.000 could be saved and 4.06 DRS points gained. By means of probabilistic sensitivity analysis, the majority of ICER estimates (67% of the Monte Carlo simulations) indicated that a continuous chain of rehabilitation was less costly and more effective. These findings indicate that the trajectory of continuous rehabilitation represents a dominant strategy in that it reduces costs and improves outcomes after sTBI under reasonable assumptions.
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Journal of neurotrauma · Jul 2014
ReviewDiffusion Tensor Imaging Findings in Semi-Acute Mild Traumatic Brain Injury.
The past 10 years have seen a rapid increase in the use of diffusion tensor imaging to identify biomarkers of traumatic brain injury (TBI). Although the literature generally indicates decreased anisotropic diffusion at more chronic injury periods and in more severe injuries, considerable debate remains regarding the direction (i.e., increased or decreased) of anisotropic diffusion in the acute to semi-acute phase (here defined as less than 3 months post-injury) of mild TBI (mTBI). A systematic review of the literature was therefore performed to (1) determine the prevalence of different anisotropic diffusion findings (increased, decreased, bidirectional, or null) during the semi-acute injury phase of mTBI and to (2) identify clinical (e.g., age of injury, post-injury scan time, etc.) and experimental factors (e.g., number of unique directions, field strength) that may influence these findings. ⋯ Chi-squared analyses indicated that the total number of diffusion-weighted (DW) images was significantly associated with findings of either increased (DW ≥ 30) versus decreased (DW ≤ 25) anisotropic diffusion. Other clinical and experimental factors were not statistically significant for direction of anisotropic diffusion, but these results may have been limited by the relatively small number of studies within each domain (e.g., pediatric studies). In summary, current results indicate roughly equivalent number of studies reporting increased versus decreased anisotropic diffusion during semi-acute mTBI, with the number of unique diffusion images being statistically associated with the direction of findings.