Tag Archives: outcome

The outcome in critically ill patients admitted for thoracic trauma – A single center analysis over one year

DOI: 10.2478/amma-2023-0046

Objective: The main objective of the current study was to examine the outcome of critically ill patients in relation to clinical and thoracic injuries. The secondary objectives were to assess the role of CT in the evaluation of the diaphragm and to provide an analysis of prognostic abilities with respect to diaphragm changes.
Methods: This single-center retrospective observational cohort study was conducted in the ICU of Târgu Mureș County Emergency Clinical Hospital, Romania. This study identified 52 critically ill blunted or penetrating chest trauma patients admitted to the ICU from 01 January 2021 to 31 December 2021. CT scan was used to identify thorax injuries and diaphragm thickness. The outcome of all patients was analyzed.
Results: Most of the patients experienced traffic accidents (44.23%) or falls (26.93%). The predominant characteristics associated with chest trauma were rib fractures (92.30%), lung contusions (63.50%), and pneumothorax (53.80%). The most common injury seen in the study was rib fractures, accounting for 92.30% of cases. This was followed by lung contusions, which were present in 63.50% of patients, and pneumothorax, which occurred in 53.80% of cases. It was examined ROC AUC for thickness of the right and the left diaphragm and severity scores. When assessing the thickness of the diaphragm in deceased and survivors, no statistically significant differences were found.
Conclusion: Although no significant differences were found regarding the prognosis between the survivors and the deceased, diaphragm thickness might potentially serve as a predictor for the severity of the injury.

Full text: PDF

The Impact of Modifiable Risk Factors on the Short-term Outcome of Stroke

Objective: The high stroke morbidity and related mortality in Central-Eastern European countries might be related to several factors. In this study we used a large, database from Tîrgu Mureș (Romania) to investigate the impact of risk factors on the short-term outcome of stroke. We opted for this method as hospital databases usually provide more detailed information on risk factors, stroke severity and correlated outcome than population based registries.
Methods: We analyzed the data of 1478 consecutively hospitalized stroke patients during a period of one year, regardless of the ward they were admitted to. We recorded risk factors, stroke severity and correlated with the short-term outcome (i.e. in-hospital outcome, assessed by Glasgow Outcome Scale) of stroke.
Results: Significantly more men and patients with a lower age than the European average were admitted. 26% of admitted patients had a previous cerebrovascular disease in their history. The prevalence of modifiable risk factors such as hypertension, diabetes, hyperlipidaemia, smoking, etc was higher than in other European countries. Overall case fatality was 10.4% and 75% of discharged patients had some degree of disability. Outcome at discharge was worse with higher systolic and diastolic blood pressure, increased heart rate, higher serum glucose, higher white blood cell count as well as decreased consciousness and increased age.
Conclusions: In this large hospital based database we found an alarming number of untreated and frequently aggregated risk factors. Our findings emphasize the role of modifiable risk factors as well as indicate major opportunities for more efficient stroke prevention.

Full text: PDF

The Impact of Fetal Echocardiography on Outcome of Patients with Pulmonary Atresia with Ductal-dependent Pulmonary Flow

Objective: Pulmonary atresia is a relative rare critical congenital heart defect with ductal-dependent pulmonary circulation. Echocardiography is the gold standard in diagnoses congenital heart defect in newborns, but also is the only diagnostic modality of congenital heart defect in the fetus. The purpose of this study is to demonstrate the impact of fetal echocardiography on outcome of patients with pulmonary atresia with ductal-dependent pulmonary flow.
Methods: A single-institution observational study was made on 19 children diagnosed by echocardiography with ductal-dependent pulmonary atresia in Pediatric Cardiology Department from 1997 to 2010, from which four were diagnosed prenatally by fetal echocardiography. We compared a series of clinical data between the prenatally (group 1) and postnatally diagnosed group (group 2), respectively.
Results: All of the infants diagnosed prenatally were delivered in a center for pediatric cardiology. The prostaglandine infusion, to maintain the patency of arterial duct, was initiated in the first 48 h after birth in every cases of the first group comparing to the second group (range3 h – 37 days) (26.66%) (p=0.03). Also, a significantly higher percent of group 1 managed to get in the cardiac unit in the first 48 h after birth comparing to the second group (range 1–37 days) (p=0.03).
Conclusions: We suggest that fetal diagnosis might improve neonatal outcome because of earlier appropriate therapeutic intervention.

Full text: PDF

The Influence of Acute Phase Blood Pressure on Stroke Outcome: To Treat Or Not To Treat?

Romania ranks third in stroke mortality among countries reporting vascular statistics. Acute phase blood pressure has a major influence on stroke outcome. This review aims to give an overview of available data regarding the prevalence of extreme (both low and high) values of blood pressure in acute phase of stroke, impact of blood pressure on stroke prognosis, recommendations on the management of blood pressure, available national data, large ongoing internationl trials with possible impact on stroke guidelines.
The consensus of the EUSI panel is that “emergency administration of antihypertensive agents should be withheld unless the diastolic blood pressure is >120 mm Hg or unless the systolic blood pressure is >220 mm Hg. The panel remains concerned by the evidence that aggressive lowering of blood pressure among patients may cause neurological worsening, and the goal is to avoid overtreating patients with stroke until definitive data are available”.

Full text: PDF