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Study objective: Aero medical crews offer
an advanced level of practice and rapid transport to definitive care;
however, their efficacy remains unproven. Previous studies have used relatively
small sample sizes or have been unable to adequately control the effect
of other potentially influential variables. Here we explore the impact of aeromedical response in patients with moderate to severe traumatic brain injury. Methods: This was a
cross-sectional study using our county trauma registry.
All patients with trauma injury, who referred to our emergency department by
helicopter or car, were included. The impact of aeromedical response was determined
using logistic regression, adjusting for age, sex, mechanism, preadmissionGlasgowComa Scale score and Injury Severity Score. Finally, the aeromedical patients undergoing field intubation
were compared with ground patients undergoing emergency department (ED)
intubation. Results: A total of 243 patients meeting all
inclusion and exclusion criteria and with complete data sets were identified.
Overall mortality was 25% in the air- and ground-transported cohorts, but outcomes
were not significantly better for the aeromedical patients when adjusted for
age, sex, mechanism of injury, hypotension, Glasgow Coma Scale score, head
Abbreviated Injury Score, and Injury Severity Score (adjusted odds ratio [OR]
1.90; 95% confidence interval [CI] 1.60 to 2.25; P: 0001). Good outcomes
(discharge to home, jail, psychiatric facility, rehabilitation, or leaving against medical advice) were also higher in aeromedical patients (adjusted OR 1.36;
95% CI 1.18 to 1.58; P: 0001).
Pericardial rupture following blunt chest trauma is rare and
associated with high mortality rate ranging from 30% to 64%. We review 42 cases
which have been reported in the literature in last 17 years and report a case
of our own. We have found that 83% of the cases were men with a mean age of 49
years. The most frequent cause was traffic accidents (79%). Preoperative
diagnosis of traumatic rupture of the pericardium has been improved in recent
17 years, and the result is satisfactory. Early detection, timely treatment is
the key. Pneumopericardium may be a valuable radiographic clue for diagnosis.
The management of pericardial rupture is mainly to avoid the risk of cardiac strangulation
or acute tamponade. If the injury is recognized timely, treatment is simple and
S100B protein is released by astrocytes into the brain extracellular fluid following acute brain injury and elevated levels in CSF and serum have been shown to correlate with patient outcome following traumatic brain injury. A prospective study of brain extracellular fluid (ECF) and serum S100B levels in 12 patients with severe head injury (GCS ≤ 8) was undertaken using intracerebral microdialysis to investigate whether a correlation with ECF S100B and outcome could be confirmed. Patient outcomes were assessed at 6 months using the Glasgow Outcome Scale (GOS) and divided into two outcome groups: group A, 8 survivors with either a good recovery or moderate disability (GOS scores of 4 or 5); and group B, 4 patients who died (GOS 1). Peak serum levels of S100B were significantly greater in group B (mean 6.03 ng/ml) compared with group A (mean 0.73 ng/ml) (P = 0.009). Group A had a mean peak S100B in the extracellular compartment of 186 ng/ml compared to 150 ng/ml in group B. There was no significant difference between the mean peak brain ECF S100B concentrations for the 2 outcome groups (P = 0.932). We confirm that intracerebral microdialysis can be used to sample S100B concentrations from brain extracellular fluid and our results suggest that the ECF S100B levels were variable and that there was no significant difference between the good outcome and poor outcome groups. In contrast, the serum levels of S100B of patients with a poor outcome were significantly higher than those with a good outcome.