Articles: injury.
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Randomized Controlled Trial Multicenter Study Observational Study
Association between biomarkers of endothelial injury and hypocoagulability in patients with severe sepsis: a prospective study.
Patients with severe sepsis often present with concurrent coagulopathy, microcirculatory failure and evidence of vascular endothelial activation and damage. Given the critical role of the endothelium in balancing hemostasis, we investigated single-point associations between whole blood coagulopathy by thrombelastography (TEG) and plasma/serum markers of endothelial activation and damage in patients with severe sepsis. ⋯ In our cohort of patients with severe sepsis, higher circulating levels of biomarkers of mainly endothelial damage were independently associated with hypocoagulability assessed by TEG and FF. Endothelial damage is intimately linked to coagulopathy in severe sepsis.
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Acute stroke is a leading cause of brain injury and death and requires rapid and accurate diagnosis. Noncontrast head computed tomography (CT) is the first line for diagnosis in the emergency department (ED). Complicating rapid triage are presenting conditions that clinically mimic stroke. There is an extensive literature reporting clinical utility of brain electrical activity in early diagnosis and management of acute stroke. However, existing technologies do not lend themselves to easily acquired rapid evaluation. This investigation used an independently derived classifier algorithm for the identification of traumatic structural brain injury based on brain electrical activity recorded from a reduced frontal montage to explore the potential clinical utility of such an approach in acute stroke assessment. ⋯ Despite a small population and the use of a classifier without the benefit of training on a stroke population, these data suggest that a rapidly acquired, easy-to-use system to assess brain electrical activity at the time of evaluation of acute stroke could be a valuable adjunct to current clinical practice.
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Behavioural neurology · Jan 2015
Multicenter StudyMortality and One-Year Functional Outcome in Elderly and Very Old Patients with Severe Traumatic Brain Injuries: Observed and Predicted.
The aim of the present study was to evaluate mortality and functional outcome in old and very old patients with severe traumatic brain injury (TBI) and compare to the predicted outcome according to the internet based CRASH (Corticosteroid Randomization After Significant Head injury) model based prediction, from the Medical Research Council (MRC). Methods. Prospective, national multicenter study including patients with severe TBI ≥ 65 years. ⋯ The CRASH models predicted unfavorable outcome in all patients. Conclusion. The CRASH model overestimated mortality and unfavorable outcome in old and very old Norwegian patients with severe TBI.
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Journal of neurotrauma · Jan 2015
Multicenter Study Observational StudyAssociation between serum malondialdehyde levels and mortality in patients with severe brain trauma injury.
There is a hyperoxidative state in patients with trauma brain injury (TBI). Malondialdehyde (MDA) is an end-product formed during oxidative stress, concretely lipid peroxidation. In small studies (highest sample size 50 patients), higher levels of MDA have been found in nonsurviving than surviving patients with TBI. ⋯ Logistic regression analysis showed that serum MDA levels were associated with 30-day mortality (odds ratio [OR] = 4.662; 95% confidence interval [CI] = 1.466-14.824; p = 0.01), controlling for Glasgow Coma Score, age, and computed tomography findings. Survival analysis showed that patients with serum MDA levels higher than 1.96 nmol/mL presented increased 30-day mortality than patients with lower levels (hazard ratio = 3.5; 95% CI = 1.43-8.47; p < 0.001). Thus, the most relevant new finding of our study, the largest to date on serum MDA levels in patients with severe TBI, was an association between serum MDA levels and early mortality.
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Multicenter Study Comparative Study
Injury Outcomes in African American and African Caribbean Women: The Role of Intimate Partner Violence.
Intimate partner violence has been linked to increased and repeated injuries, as well as negative long-term physical and mental health outcomes. This study examines the prevalence and correlates of injury in women of African descent who reported recent intimate partner violence and control subjects who were never abused. ⋯ Injuries related to intimate partner violence may be part of the explanation for the negative long-term health outcomes. In this study, partner violence was associated with past-year ED use, hospitalization, and multiple injuries. Emergency nurses need to assess for intimate partner violence when women report with an injury to ensure that the violence is addressed in order to prevent repeated injuries and negative long-term health outcomes.