MINI: In this study, respiratory function at the time of extubation can be useful optimal clinical guidelines for weaning and extubation attempts in patients with acute cervical spinal cord injury. ...Serum thiobarbituric acid-reactive substances level at admission can be a useful predictor for severity in acute cervical patients with spinal cord injury.
Patients who had suffered from acute blunt cervical spinal cord injury (SCI) and admitted our hospital within 24 hours after injury were included in the study.
We compared the respiratory function and serum reactive oxidative stress (ROS) after acute cervical SCI, and tried to find out the valuable predictors of weaning in patients with acute cervical SCI.
Ventilation impairment is a major complication of acute cervical SCI. Evidence of oxygen radical formation in secondary injury from animal SCI models demonstrates an immediate postinjury increase in ROS production after SCI. We hypothesize that the serum ROS is associated with the severity of patients with acute cervical SCI.
Thirty-eight adult patients who had acute cervical SCI and 58 healthy volunteers were enrolled. Respiratory function at admission, at the time of extubation and at 48 hours after extubation, serum oxidative stress, Injury Severity Score and Japanese Orthopaedic Association score at admission were compared.
The most notable predictor of mechanical ventilation more than 48 hours was serum thiobarbituric acid-reactive substances (TBARS) level at admission (P = 0.027), and the cut-off value of serum TBARS level was 731.7 μmol/L (sensitivity 87.5% and specificity 78.9%). For the reventilation ≤5 days, the notable predictors were respiratory function at the time of extubation (maximal inspiratory pressure, P = 0.040; maximal expiratory pressure, P = 0.020; and tidal volume, P = 0.036) and serum TBARS level at admission (P = 0.013), the cut-off value of serum TBARS level at admission was 762.3 μmol/L (sensitivity 100% and specificity 90.0%).
In this study, respiratory function (maximal inspiratory pressure, maximal expiratory pressure, and tidal volume) at the time of extubation can be useful optimal clinical guidelines for weaning and extubation attempts in patients with acute cervical SCI. Serum TBARS level at admission can be a useful predictor for severity in acute cervical SCI patients.
3.
Highlights • A systematic review concerning prevalence and determinants of burn scar contractures. • The few available studies demonstrate a prevalence at discharge of 38–54%. • With longer time ...after burn, the prevalence of contractures was lower. • Determinants: severe burns, flame burns, children, female patients, cervical spine, upper extremity. • Longitudinal studies are needed to improve prevention and treatment of contractures.
Traumatic cervical neck injuries are relatively uncommon, but given the close anatomic location of the aerodigestive tract and vascular anatomy, patients are at significant risk of life-threatening ...injury and a high index of suspicion must be maintained. In younger patients, though dependent on specific age, the neck mainly differs from that of an adult with the larynx resting at a higher position (C3-C5), while the laryngeal cartilage is more flexible and is at less risk of injury. 2 However, although this case demonstrates an isolated esophageal injury, patients are at significant risk of airway compromise when presenting with soft tissue edema or hematoma, massive subcutaneous emphysema, or fracture.² In addition to trauma, esophageal injuries are most commonly related to foreign body ingestion or iatrogenic injury. Surgical intervention is reserved for patients with hard signs of aerodigestive tract injury (active hemorrhage, airway compromise, air bubbling in the wound, expanding/pulsatile hematoma, hematemesis, hemiparesis, massive subcutaneous emphysema, pulse deficit, respiratory distress, shock), whereas soft signs (neck bruit, chest tube air leak, dysphagia, dyspnea, hemoptysis, laceration >2 cm, minor hemoptysis, nonpulsatile/nonexpanding hematoma, paresthesias, stridor, venous oozing, voice changes) may typically at first be managed nonoperatively. 3 Careful attention to airway status should be paid, with a low threshold for flexible fiberoptic intubation if available, or establishing a surgical airway should the need arise.
During the pandemic of coronavirus disease 2019, it is possible for rehabilitation physicians and personnel to take care of patients with concurrent spinal cord injury and coronavirus disease 2019. ...Here, we describe a case of acute cervical spinal cord injury resulting in complete tetraplegia C5 American Spinal Injury Association Impairment Scale A with unrecognized, severe acute respiratory syndrome coronavirus 2 infection. This resulted in large-scale quarantines of related surgical and rehabilitation staff, and the unexpected death of the patient despite receiving the treatments according to the standard guideline. Rehabilitation personnel who take care of acute spinal cord injury patients with coronavirus disease 2019 should consider the effect of spinal cord injury on the course of coronavirus disease 2019, the effect of coronavirus disease 2019 and its treatments on the course of spinal cord injury, and risks of severe acute respiratory syndrome coronavirus 2 transmission between patients and rehabilitation staff, to continue providing safe and effective rehabilitation programs.
The frequency of intimate partner violence (IPV) is much lower in males than females. Data regarding IPV-related injuries patterns and characteristics in males are scant. The purpose of this study ...was to characterize and compare patterns of IPV-related head and neck injuries between men and women.
This cross-sectional study reviewed cases of IPV at Grady Memorial Hospital in Atlanta, Georgia from January 2016 to August 2019. The study sample was collected from electronic medical records by identifying IPV subjects using a natural language processing algorithm and then cross-referencing the trauma registry to identify patients who sustained head and neck injuries. The primary analyses of interest were to measure the association between gender and the following covariates: age, race, insurance status, setting of injury, day of injury, social history, report of physical abuse, mechanism of injury, injury location, brain injuries, soft tissue injuries, facial fractures, other associated injuries, Glasgow Coma Scale, Injury Severity Score, hospital length of stay, intensive care unit length of stay, and discharge status. Univariate and bivariate analyses were calculated. Statistical significance was P < .05.
One hundred fifty six patients met inclusion criteria. There were 120 (76.9%) female patients with a mean age of 34.5 years (range, 16 to 67 years). There were 36 (23%) male patients with a mean age of 43.8 years (range, 18 to 77 years). Women were statistically more likely than men to have government-subsidized insurance (47 39.2% vs 7 19.4%; P = .03), positive alcohol exposure (27 22.5% vs 19 52.8%; P = .0001), positive illicit drugs toxicology screen (25 20.8% vs 13 36.1%; P < .02), report physical abuse (24 20% vs 0; P = .004), have subarachnoid hemorrhage (14 11.7% vs 0; P = .04), and/or lower extremity injuries (39 32.5% vs 5 13.9%; P = .03).
Males tend not to report physical abuse; this behavior contributes to IPV under-reporting in males.
Penetrating neck trauma comprises 5%-10% of all traumatic injuries in adults and carries up to a 10% mortality rate for those affected. Management of penetrating neck trauma can be challenging and ...often requires a multidisciplinary approach. A case of penetrating neck trauma via self-inflicted gunshot wound to zones 1-3 of the neck in an intoxicated, suicidal 60-year-old man is presented. Immediately after stabilization by the trauma surgery team, surgical reconstruction using a pectoralis major pedicled myocutaneous flap was completed by the plastic and reconstructive surgery team. The patient’s hospital course was complicated by injury to the left phrenic nerve, oropharyngeal swallowing dysfunction, and left diaphragmatic dysfunction. The trauma team initiated prompt multidisciplinary responses to each of these complications as they arose by involving the plastic and reconstructive surgery, otolaryngology, gastroenterology, and speech language pathology teams. Early involvement of the physical medicine and rehabilitation, psychiatry, dietary, and pharmacy teams allowed for early optimization and monitoring of the patient’s mobility, psychological, and nutritional statuses. The timely initiation of multidisciplinary care in this patient’s case allowed for the patient to not only to survive a potentially fatal penetrating neck trauma, but to be discharged to a rehabilitation facility with an independent level of function. Given the complications due to severe penetrating neck trauma of zones 1-3 in this case, it is essential for early involvement of the appropriate subspecialty teams in order to achieve the best possible outcome for the patient.
Penetrating neck trauma poses a significant risk to multiple vital structures, which if not treated immediately may lead to devastating consequences. Our patient presented after sustaining ...self-inflicted stab wounds to the neck. He was taken to the operating room for a left neck exploration and median sternotomy, revealing a distal tracheal injury. Following repair of the tracheal injury, an intraoperative esophagogastroduodenoscopy demonstrated a full-thickness esophageal injury 15 cm proximal to the tracheal injury. Both injuries were the result of separate stab entries originating from the same external midline wound. To our knowledge, this case report is unique in bringing this circumstance to the literature, demonstrating the importance of full intraoperative examination to assess for concomitant wounds in stab injuries after the initial pathology has been found and the initial stab trajectory understood.
Objective
The aims of this study were (1) to provide an overview of craniocervical magnetic resonance imaging (MR) findings following nonfatal strangulation (NFS), (2) to detect the time dependency ...of the presence of these findings, and (3) to explore the additional value of MR with regard to the forensic interpretation of NFS.
Methodology
All 633 victims of manual strangulation between October 2011 and March 2018 were examined, including the case history and external findings. Following written consent, 114 cases were included in the study. The duration between the event, clinical forensic examination, and MR was noted. Radiologic images were reviewed by a clinical and a forensic radiologist.
Results
The case group consisted of 90 women and 24 men with a mean age of 32.5 years. Delimitable external findings were present in 93% (
N
= 106) of cases. MR yielded a positive finding in 43% of cases (
N
= 49). There was no significant difference in the mean time interval between examinations between MR-positive and MR-negative cases. Perilaryngeal fluid accumulation was associated with difficulty swallowing and victims put in a chokehold. All cerebral MR were unremarkable, except for one patient with edema of the corpus callosum.
Conclusions
The role of craniocervical MR following NFS is currently limited, particularly with regard to the forensic interpretation of NFS. MR may reveal internal injury in victims who report subjective symptoms of airway compression and in those who were placed in a chokehold. The presence of MR findings is not dependent on immediate examinations following the assault.
Key Points
• Magnetic resonance imaging does not currently provide additional value for the estimation of the severity of nonfatal manual strangulation.
• Magnetic resonance imaging of the neck may reveal internal injury in cases without external findings, particularly in victims placed in a chokehold and with symptoms of airway compression.
• The incidence of carotid artery dissections and laryngeal fractures is low in victims of nonfatal manual strangulation.
Pediatric cervical spine injuries (CSI) are uncommon events, but can be devastating injuries. Facial fractures have been associated with injuries to the cervical spine in children, but may be deemed ...isolated facial fractures and bypass the standard trauma pathway. The objective of this study is to describe the mechanisms, associated injuries and outcomes of pediatric cervical spine injuries in patients with known maxillofacial trauma at a level 1 trauma center. An analysis was performed of all patients under the age of 18 with maxillofacial trauma admissions to a single level 1 trauma center, from 2006 to 2015. Patients were stratified based on the presence or absence of a cervical spine injury. Data was abstracted to include demographic, mechanism and clinical outcomes data. There were 1274 patients who were admitted with maxillofacial trauma during the study period. Of these, 72 (5.7%) experienced a cervical spine injury. Factors associated with cervical spine injuries include older age and penetrating mechanism. Cervical spine injuries were associated with concomitant traumatic brain injuries and skull fractures. Patients with spine injuries were more like to experience a longer length of stay and death. On multivariate analysis, only increased age predicted CSI. Our database demonstrated a 5.7% incidence of pediatric cervical spine injuries in patients with maxillofacial trauma. This incidence is higher than previously published reports of smaller cohorts. Clinicians must take care to stabilize the cervical spine in any patient with facial fractures, especially during work up and diagnostic maneuvers performed before spinal injuries are ruled out.
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