Articles: mortality.
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Mortality in patients with acute onset of impaired consciousness is high: as many as 10% do not survive. The spectrum of differential diagnoses is wide, and more than one underlying condition is found in one-third of all cases. In this article, we describe a structured approach to patients with acute onset of impaired consciousness in the emergency department. ⋯ Acute onset of impaired consciousness is a medical emergency. Red flags must be rapidly recognized and treatment initiated immediately. Patients with severely impaired consciousness of new onset and uncertain cause, status epilepticus, lack of protective reflexes, or a new, acute neuro - logic deficit should be admitted via the resuscitation room.
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Observational Study
Risk factors and outcomes associated with systolic dysfunction following traumatic brain injury.
Systolic dysfunction has been observed following isolated moderate-severe traumatic brain injury (Ims-TBI). However, early risk factors for the development of systolic dysfunction after Ims-TBI and their impact on the prognosis of patients with Ims-TBI have not been thoroughly investigated. A prospective observational study among patients aged 16 to 65 years without cardiac comorbidities who sustained Ims-TBI (Glasgow Coma Scale [GCS] score ≤12) was conducted. ⋯ Lower GCS (OR: 0.66, 95% CI: 0.45-0.82; P = .001), lower admission oxygen saturation (OR: 0.82, 95% CI: 0.69-0.98; P = .025), and the development of systolic dysfunction (OR: 4.85, 95% CI: 1.36-17.22; P = .015) were independent risk factors for in-hospital mortality in patients with Ims-TBI. Heart rate, GCS, and serum Hs-cTnT level on admission were independent early risk factors for systolic dysfunction in patients with Ims-TBI. The combination of these 3 parameters can better predict the occurrence of systolic dysfunction.
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To identify if depression, resilience, and perceived control of health are related to 2.5-year mortality and instrumental activities of daily living (IADL) decline among older adults after surgery. ⋯ While depression confers greater risk of mortality and IADL decline, higher resilience and perceived control of health may be protective. Addressing psychosocial factors in the peri-operative period may improve outcomes among older adults.
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Eur J Trauma Emerg Surg · Jul 2024
Seasonal patterns of hip fracture incidence and mortality rates across age groups of older adults in Israel.
This study investigates the seasonal patterns of hip fracture occurrence and mortality rates in the elderly population of Israel. ⋯ While our study highlights significant seasonal variations in hip fracture occurrence and mortality rates among the elderly population in Israel, caution is warranted in interpreting the implications for post-fracture care and resource allocation. The observed heightened incidence of hip fractures during the spring, particularly among younger patients with shorter hospital stays, suggests the need for further investigation into potential risk factors and preventive measures specific to this season. Additionally, our identification of seasonal variations in hip fracture incidence across demographic factors underscores the importance of tailored interventions to address the diverse needs of different populations.
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Eur J Trauma Emerg Surg · Jul 2024
Trauma-related preventable death; data analysis and panel review at a level 1 trauma centre in Amsterdam, the Netherlands.
Trauma-related death is used as a parameter to evaluate the quality of trauma care and identify cases in which mortality could have been prevented under optimal trauma care conditions. The aim of this study was to identify trauma-related preventable death (TRPD) within our institute by an external expert panel and to evaluate inter-panel reliability. ⋯ Multidisciplinary panel review has a moderate inter-observer agreement regarding survivability and low agreement regarding categorical preventable death classification. A valid definition and classification of TRPD is required to improve inter-observer agreement and quality of trauma care.