The Experts below are selected from a list of 6036 Experts worldwide ranked by ideXlab platform
Falco Hietbrink - One of the best experts on this subject based on the ideXlab platform.
-
associated thoracic injury in patients with a clavicle fracture a retrospective analysis of 1461 Polytrauma patients
European Journal of Trauma and Emergency Surgery, 2019Co-Authors: J J E M Van Laarhove, Steven Ferree, Amy C Gunning, Roderick M Houwe, E J M M Verleisdonk, Falco Hietbrink, L P H LeeneAbstract:During primary survey the main goal is to ascertain life-threatening injuries. A chest X-ray is recommended in all Polytrauma patients as thoracic injury plays an important role in mortality. However, treatment-dictating injuries are often missed on the chest X-ray. In contrast, clavicle fractures should be relatively easy to diagnose on a chest X-ray. We previously showed that clavicle fractures occur in approximately 10 % of all Polytrauma patients in our population. The aim was to compare Polytrauma patients, with and without a clavicle fracture, to investigate if a clavicle fracture is associated with concomitant thoracic injury. A retrospective cohort study of Polytrauma patients (ISS ≥ 16) from 2007 until 2011. Thoracic injuries were defined as: ribfracture, pneumothorax, lung contusion, sternum fracture, hemothorax, myocardial contusion, thoracic aorta injury and thoracic spine injury. Of 1461 Polytrauma patients in 160 patients a clavicle fracture was diagnosed, and 95 % was diagnosed on chest X-ray. Patients with a clavicle fracture had a higher mean Injury Severity Score (ISS) (29.2 ± 10.1 vs. 24.9 ± 9.1; P < 0.001). Additional thoracic injuries were more prevalent in patients with a clavicle fracture (76 vs. 47 %; OR 3.6; 95 % CI 2.45–5.24) and they had a higher rate of thoracic injury with an AIS ≥ 3 (66 vs. 41 %; OR 2.8; 95 % CI 1.97–3.93). The clavicle can be seen as the gatekeeper of the thorax. In Polytrauma patients, a clavicle fracture is easily diagnosed during primary survey and may indicate underlying thoracic injury, as the rate and extent of concomitant thoracic injury are high.
-
epidemiology of distal radius fractures in Polytrauma patients and the influence of high traumatic energy transfer
Injury-international Journal of The Care of The Injured, 2018Co-Authors: Steven Ferree, Quirine M J Van Der Vliet, Luke Peter Hendrik Leenen, Roderick M. Houwert, Femke Nawijn, Abhiram R Bhashyam, Falco HietbrinkAbstract:Abstract Introduction For several extremity fractures differences in morphology, incidence rate and functional outcome were found when Polytrauma patients were compared to patients with an isolated injury. This is not proven for distal radius fractures (DRF). Therefore, this study aimed to analyse fracture morphology in relation to energy transfer in both poly- and mono-trauma patients with a DRF. Methods This was a retrospective cohort study. All patients aged 16 years and older with a DRF were included. Patients with an Injury Severity Score of 16 or higher were classified as Polytrauma patients. Injuries were defined as high or low energy. All DRFs were classified using the AO/OTA fracture classification system. Results A total of 830 patients with a DRF were included, 12% were Polytrauma. The incidence rate of DRF in Polytrauma patients was 3.5%. Ipsilateral upper extremity injury was found in >30% of Polytrauma and high-energy monotrauma patients, compared to 5% in low-energy monotrauma patients. More type C DRF were found in Polytrauma and high-energy monotrauma patients versus low-energy monotrauma patients. Operative intervention rates for all types of DRF were similar for Polytrauma and high-energy monotrauma patients. Non-union rates were higher in Polytrauma patients. Conclusion Higher energy mechanisms of injury, in Polytrauma and high-energy monotrauma patients, were associated with more severe complex articular distal radius fractures and more ipsilateral upper extremity injuries. Polytrauma and high-energy monotrauma patient have a similar fracture morphology. However, Polytrauma patients have in addition to more injured body regions also more non-union related interventions than high-energy monotrauma patients.
-
fractures and dislocations of the hand in Polytrauma patients incidence injury pattern and functional outcome
Injury-international Journal of The Care of The Injured, 2017Co-Authors: Steven Ferree, Quirine M J Van Der Vliet, Luke Peter Hendrik Leenen, Roderick M. Houwert, Mark Van Heijl, Falco HietbrinkAbstract:INTRODUCTION: Injuries of the hand can cause significant functional impairment, diminished quality of life and delayed return to work. However, the incidence and functional outcome of hand injuries in Polytrauma patients is currently unknown. The aim of this study was to determine the incidence, distribution and functional outcome of fractures and dislocation of the hand in Polytrauma patients. METHODS: A single centre retrospective cohort study was performed at a level 1 trauma centre. Polytrauma was defined as patients with an Injury Severity Score of 16 or higher. Fractures and dislocations to the hand were determined. All eligible Polytrauma patients with hand injuries were included and a Quick Disability of Arm, Shoulder and Hand questionnaire (QDASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) were administered. Patients were contacted 1-6 years after trauma. RESULTS: In a cohort of 2046 Polytrauma patients 72 patients (3.5%) suffered a hand injury. The functional outcome scores of 52 patients (72%) were obtained. The Metacarpal (48%) and carpal (33%) bones were the most frequently affected. The median QDASH score for all patients with hand injury was 17 (IQR 0-31) and the PRWHE 14 (IQR 0-41). Patients with a concomitant upper extremity injury (p=0.002 for PRWHE, p0.006 for QDASH) and those with higher ISS scores (p=0.034 for PRWHE, QDASH not significant) had worse functional outcome scores. As an example, of the 5 patients with the worst outcome scores 3 suffered an isolated phalangeal injury, all had concomitant upper extremity injury or neurological injuries (3 plexus injuries, 1 severe brain injury). CONCLUSION: The incidence of hand injuries in Polytrauma patients is 3.5%, which is relatively low compared to a general trauma population. Metacarpal and carpal bones were most frequently affected. The functional extremity specific outcome scores are highly influenced by concomitant injuries (upper extremity injuries, neurological injuries and higher ISS).
-
tertiary survey in Polytrauma patients should be an ongoing process
Injury-international Journal of The Care of The Injured, 2016Co-Authors: Steven Ferree, Luke Peter Hendrik Leenen, Roderick M. Houwert, Jacqueline Jem Van Laarhoven, Diederik P J Smeeing, Falco HietbrinkAbstract:Abstract Introduction Due to prioritisation in the initial trauma care, non-life threatening injuries can be overlooked or temporally neglected. Polytrauma patients in particular might be at risk for delayed diagnosed injuries (DDI). Studies that solely focus on DDI in Polytrauma patients are not available. Therefore the aim of this study was to analyze DDI and determine risk factors associated with DDI in Polytrauma patients. Methods In this single centre retrospective cohort study, patients were considered Polytrauma when the Injury Severity Score was ≥16 as a result of injury in at least 2 body regions. Adult Polytrauma patients admitted from 2007 until 2012 were identified. Hospital charts were reviewed to identify DDI. Results 1416 Polytrauma patients were analyzed of which 12% had DDI. Most DDI were found during initial hospital admission after tertiary survey (63%). Extremities were the most affected regions for all types of DDI (78%) with the highest intervention rate (35%). Most prevalent DDI were fractures of the hand (54%) and foot (38%). In 2% of all patients a DDI was found after discharge, consisting mainly of injuries other than a fracture. High energy trauma mechanism (OR 1.8, 95% CI 1.2–2.7), abdominal injury (OR 1.5, 95% CI 1.1–2.1) and extremity injuries found during initial assessment (OR 2.3, 95% CI 1.6–3.3) were independent risk factors for DDI. Conclusion In Polytrauma patients, most DDI were found during hospital admission but after tertiary survey. This demonstrates that the tertiary survey should be an ongoing process and thus repeated daily in Polytrauma patients. Most frequent DDI were extremity injuries, especially injuries of the hand and foot.
Steven Ferree - One of the best experts on this subject based on the ideXlab platform.
-
associated thoracic injury in patients with a clavicle fracture a retrospective analysis of 1461 Polytrauma patients
European Journal of Trauma and Emergency Surgery, 2019Co-Authors: J J E M Van Laarhove, Steven Ferree, Amy C Gunning, Roderick M Houwe, E J M M Verleisdonk, Falco Hietbrink, L P H LeeneAbstract:During primary survey the main goal is to ascertain life-threatening injuries. A chest X-ray is recommended in all Polytrauma patients as thoracic injury plays an important role in mortality. However, treatment-dictating injuries are often missed on the chest X-ray. In contrast, clavicle fractures should be relatively easy to diagnose on a chest X-ray. We previously showed that clavicle fractures occur in approximately 10 % of all Polytrauma patients in our population. The aim was to compare Polytrauma patients, with and without a clavicle fracture, to investigate if a clavicle fracture is associated with concomitant thoracic injury. A retrospective cohort study of Polytrauma patients (ISS ≥ 16) from 2007 until 2011. Thoracic injuries were defined as: ribfracture, pneumothorax, lung contusion, sternum fracture, hemothorax, myocardial contusion, thoracic aorta injury and thoracic spine injury. Of 1461 Polytrauma patients in 160 patients a clavicle fracture was diagnosed, and 95 % was diagnosed on chest X-ray. Patients with a clavicle fracture had a higher mean Injury Severity Score (ISS) (29.2 ± 10.1 vs. 24.9 ± 9.1; P < 0.001). Additional thoracic injuries were more prevalent in patients with a clavicle fracture (76 vs. 47 %; OR 3.6; 95 % CI 2.45–5.24) and they had a higher rate of thoracic injury with an AIS ≥ 3 (66 vs. 41 %; OR 2.8; 95 % CI 1.97–3.93). The clavicle can be seen as the gatekeeper of the thorax. In Polytrauma patients, a clavicle fracture is easily diagnosed during primary survey and may indicate underlying thoracic injury, as the rate and extent of concomitant thoracic injury are high.
-
epidemiology of distal radius fractures in Polytrauma patients and the influence of high traumatic energy transfer
Injury-international Journal of The Care of The Injured, 2018Co-Authors: Steven Ferree, Quirine M J Van Der Vliet, Luke Peter Hendrik Leenen, Roderick M. Houwert, Femke Nawijn, Abhiram R Bhashyam, Falco HietbrinkAbstract:Abstract Introduction For several extremity fractures differences in morphology, incidence rate and functional outcome were found when Polytrauma patients were compared to patients with an isolated injury. This is not proven for distal radius fractures (DRF). Therefore, this study aimed to analyse fracture morphology in relation to energy transfer in both poly- and mono-trauma patients with a DRF. Methods This was a retrospective cohort study. All patients aged 16 years and older with a DRF were included. Patients with an Injury Severity Score of 16 or higher were classified as Polytrauma patients. Injuries were defined as high or low energy. All DRFs were classified using the AO/OTA fracture classification system. Results A total of 830 patients with a DRF were included, 12% were Polytrauma. The incidence rate of DRF in Polytrauma patients was 3.5%. Ipsilateral upper extremity injury was found in >30% of Polytrauma and high-energy monotrauma patients, compared to 5% in low-energy monotrauma patients. More type C DRF were found in Polytrauma and high-energy monotrauma patients versus low-energy monotrauma patients. Operative intervention rates for all types of DRF were similar for Polytrauma and high-energy monotrauma patients. Non-union rates were higher in Polytrauma patients. Conclusion Higher energy mechanisms of injury, in Polytrauma and high-energy monotrauma patients, were associated with more severe complex articular distal radius fractures and more ipsilateral upper extremity injuries. Polytrauma and high-energy monotrauma patient have a similar fracture morphology. However, Polytrauma patients have in addition to more injured body regions also more non-union related interventions than high-energy monotrauma patients.
-
fractures and dislocations of the hand in Polytrauma patients incidence injury pattern and functional outcome
Injury-international Journal of The Care of The Injured, 2017Co-Authors: Steven Ferree, Quirine M J Van Der Vliet, Luke Peter Hendrik Leenen, Roderick M. Houwert, Mark Van Heijl, Falco HietbrinkAbstract:INTRODUCTION: Injuries of the hand can cause significant functional impairment, diminished quality of life and delayed return to work. However, the incidence and functional outcome of hand injuries in Polytrauma patients is currently unknown. The aim of this study was to determine the incidence, distribution and functional outcome of fractures and dislocation of the hand in Polytrauma patients. METHODS: A single centre retrospective cohort study was performed at a level 1 trauma centre. Polytrauma was defined as patients with an Injury Severity Score of 16 or higher. Fractures and dislocations to the hand were determined. All eligible Polytrauma patients with hand injuries were included and a Quick Disability of Arm, Shoulder and Hand questionnaire (QDASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) were administered. Patients were contacted 1-6 years after trauma. RESULTS: In a cohort of 2046 Polytrauma patients 72 patients (3.5%) suffered a hand injury. The functional outcome scores of 52 patients (72%) were obtained. The Metacarpal (48%) and carpal (33%) bones were the most frequently affected. The median QDASH score for all patients with hand injury was 17 (IQR 0-31) and the PRWHE 14 (IQR 0-41). Patients with a concomitant upper extremity injury (p=0.002 for PRWHE, p0.006 for QDASH) and those with higher ISS scores (p=0.034 for PRWHE, QDASH not significant) had worse functional outcome scores. As an example, of the 5 patients with the worst outcome scores 3 suffered an isolated phalangeal injury, all had concomitant upper extremity injury or neurological injuries (3 plexus injuries, 1 severe brain injury). CONCLUSION: The incidence of hand injuries in Polytrauma patients is 3.5%, which is relatively low compared to a general trauma population. Metacarpal and carpal bones were most frequently affected. The functional extremity specific outcome scores are highly influenced by concomitant injuries (upper extremity injuries, neurological injuries and higher ISS).
-
tertiary survey in Polytrauma patients should be an ongoing process
Injury-international Journal of The Care of The Injured, 2016Co-Authors: Steven Ferree, Luke Peter Hendrik Leenen, Roderick M. Houwert, Jacqueline Jem Van Laarhoven, Diederik P J Smeeing, Falco HietbrinkAbstract:Abstract Introduction Due to prioritisation in the initial trauma care, non-life threatening injuries can be overlooked or temporally neglected. Polytrauma patients in particular might be at risk for delayed diagnosed injuries (DDI). Studies that solely focus on DDI in Polytrauma patients are not available. Therefore the aim of this study was to analyze DDI and determine risk factors associated with DDI in Polytrauma patients. Methods In this single centre retrospective cohort study, patients were considered Polytrauma when the Injury Severity Score was ≥16 as a result of injury in at least 2 body regions. Adult Polytrauma patients admitted from 2007 until 2012 were identified. Hospital charts were reviewed to identify DDI. Results 1416 Polytrauma patients were analyzed of which 12% had DDI. Most DDI were found during initial hospital admission after tertiary survey (63%). Extremities were the most affected regions for all types of DDI (78%) with the highest intervention rate (35%). Most prevalent DDI were fractures of the hand (54%) and foot (38%). In 2% of all patients a DDI was found after discharge, consisting mainly of injuries other than a fracture. High energy trauma mechanism (OR 1.8, 95% CI 1.2–2.7), abdominal injury (OR 1.5, 95% CI 1.1–2.1) and extremity injuries found during initial assessment (OR 2.3, 95% CI 1.6–3.3) were independent risk factors for DDI. Conclusion In Polytrauma patients, most DDI were found during hospital admission but after tertiary survey. This demonstrates that the tertiary survey should be an ongoing process and thus repeated daily in Polytrauma patients. Most frequent DDI were extremity injuries, especially injuries of the hand and foot.
Thomas R Stelmack - One of the best experts on this subject based on the ideXlab platform.
-
visual function in patients followed at a veterans affairs Polytrauma network site an electronic medical record review
Optometry - Journal of The American Optometric Association, 2009Co-Authors: Joan A Stelmack, Theresa Frith, Denise Van Koevering, Stephen Rinne, Thomas R StelmackAbstract:Abstract Background This observational study describes the “Polytrauma System of Care” used by the Veterans Health Administration to guide medical care and rehabilitation of injured military personnel serving in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) and reports the visual function of patients with Polytrauma and/or traumatic brain injury (TBI) at the Hines, Illinois, Polytrauma Network Site (PNS). Methods A retrospective medical record review was performed for 103 patients with Polytrauma seen at the Hines PNS from October 2005 through March 2008 and 88 patients with TBI seen in the Hines TBI Clinic from December 2007 through March 2008. Results Visual symptoms were self-reported by 76% of patients with Polytrauma and 75% of the patients with TBI. Problems with reading (Polytrauma 60% and TBI 50%) and accommodation (Polytrauma 30% and TBI 47%) were frequently found on eye examinations. Spectacles were the treatment most frequently prescribed (Polytrauma 62% and TBI 78%). Conclusions It is important for optometrists to be aware of the high rates of self-reported symptoms and visual problems in military personnel returning from deployment to the wars in Iraq and Afghanistan. Post-traumatic stress disorder and depression may complicate optometric evaluation and management.
Henry L Lew - One of the best experts on this subject based on the ideXlab platform.
-
program development and defining characteristics of returning military in a va Polytrauma network site
Journal of Rehabilitation Research and Development, 2007Co-Authors: Henry L Lew, Gregory L Goodrich, Rodney D Vanderploeg, John H Poole, Sharon Dekelboum, Sylvia B Guillory, Barbara J Sigford, David X CifuAbstract:The conflicts in Iraq and Afghanistan have resulted in a new generation of combat survivors with complex physical injuries and emotional trauma. This article reports the initial implementation of the Polytrauma Network Site (PNS) clinic, which is a key component of the Department of Veterans Affairs (VA) Polytrauma System of Care and serves military personnel returning from combat. The PNS clinic in Palo Alto, California, is described to demonstrate the VA healthcare system's evolving effort to meet the clinical needs of this population. We summa- rize the following features of this interdisciplinary program: (1) sequential assessment, from initial traumatic brain injury screening throughout our catchment area to evaluation by the PNS clinic team, and (2) clinical evaluation results for the first 62 clinic patients. In summary, this population shows a high prevalence of postconcussion symptoms, posttraumatic stress, poor cognitive performance, head and back pain, auditory and visual symptoms, and problems with dizziness or balance. An anonymous patient feedback survey, which we used to fine-tune the clinic process, reflected high satisfaction with this new pro- gram. We hope that the lessons learned at one site will enhance the identification and treatment of veterans with Polytrauma across the country.
-
visual function in patients of a Polytrauma rehabilitation center a descriptive study
Journal of Rehabilitation Research and Development, 2007Co-Authors: Gregory L Goodrich, Jennine Kirby, Glenn C Cockerham, Shanida P Ingalla, Henry L LewAbstract:Little is known about the visual function deficits associated with Polytrauma injury. In this retrospective descriptive study, we examined the records of a clinic established to assess visual function in patients experiencing deployment-related Polytrauma. We describe the clinical findings and present a vision examination protocol that may be useful for screening Polytrauma patients in other settings. Data from our sample suggested that self-reported vision complaints were common (74%) and confirmed that visual impairment occurred in 38% of all cases. When examining the mechanism of injury, we found that Polytrauma due to blast injuries appeared to more than double the risk of visual impairment compared with all other Polytrauma causes (i.e., motor vehicle accidents, gunshot and/or shrapnel, assault, falls, or anoxia). The rate of visual impairment in blast-related injury was 52% compared with 20% for all other sources of injury. Visual complaints and impairments were common in the Polytrauma patients studied. This finding suggests that comprehensive eye examinations should be routinely administered, particularly when the mechanism of injury involves a blast.
Chen Pin Wang - One of the best experts on this subject based on the ideXlab platform.
-
deployment suicide and overdose among comorbidity phenotypes following mild traumatic brain injury a retrospective cohort study from the chronic effects of neurotrauma consortium
PLOS ONE, 2019Co-Authors: Mary Jo Pugh, Alicia A Swan, Megan E Amuan, Blessen C Eapen, Carlos A Jaramillo, Roxana E Delgado, David F Tate, Kristine Yaffe, Chen Pin WangAbstract:Mild traumatic brain injury in the Veteran population is frequently comorbid with pain, post-traumatic stress disorder, and/or depression. However, not everyone exposed to mild traumatic brain injury experiences these comorbidities and it is unclear what factors contribute to this variability. The objective of this study was to identify comorbidity phenotypes among Post-9/11 deployed Veterans with no or mild traumatic brain injury and examine the association of comorbidity phenotypes with adverse outcomes. We found that Veterans with mild traumatic brain injury (n = 93,003) and no brain injury (n = 434,378) were mean age of 32.0 (SD 9.21) on entering Department of Veterans Health Administration care, were predominantly Caucasian non-Hispanic (64.69%), and served in the Army (61.31%). Latent class analysis revealed five phenotypes in each subcohort; Moderately Healthy and Mental Health phenotypes were common to both. The Healthy phenotype was found only in no brain injury. Unique phenotypes in mild traumatic brain injury included Moderately Healthy+Decline, Polytrauma, and Polytrauma+Improvement. There was substantial variation in adverse outcomes. The Polytrauma+Improvement phenotype had the lowest likelihood of adverse outcomes. There were no differences between Moderately Healthy+Decline and Polytrauma phenotypes. Phenotypes of comorbidity vary significantly by traumatic brain injury status including divergence in phenotypes (and outcomes) over time in the mild traumatic brain injury subcohort. Understanding risk factors for the divergence between Polytrauma vs. Polytrauma+Improvement and Moderately Healthy vs. Moderately Healthy+Decline, will improve our ability to proactively mitigate risk, better understand the early patterns of comorbidity that are associated with neurodegenerative sequelae following mild traumatic brain injury, and plan more patient-centered care.