No correlation between lower extremity deep vein thrombosis and pulmonary embolism proportions in trauma: a systematic literature review.
Humans; chemoprophylaxis; Deep vein thrombosis; Mechanical prophylaxis; Pulmonary embolism; Ultrasound surveillance; Venous thromboembolism; Lower Extremity; Wounds and Injuries/*complications; Multiple Trauma/*complications; Pulmonary Embolism/etiology/*mortality; Venous Thrombosis/etiology/*mortality
PURPOSE: To assess the effect of surveillance on deep vein thrombosis (DVT) and pulmonary embolism (PE) rates, the efficacy of chemoprophylaxis and mechanical prophylaxis, and the relationship between DVT and PE. METHODS: A 23 year, systematic literature review was performed in PubMed. Twenty publications with > 13,000 patients were reviewed. Analyzed traits included: DVT surveillance utilization, the total number of patients included in each study, the number of patients developing DVT and/or PE, chemoprophylaxis and mechanical prophylaxis utilization. When event proportions from individual studies were combined, a weighted mean proportion was computed based on the size of each individual cohort. Combined event proportions were compared with other combined event proportions, according to differences in intervention. Inter-group event proportions were compared using Chi-Square or Fisher's exact test, as appropriate. RESULTS: DVT rates increase with surveillance (10.7% vs. 2.5%, p < 0.001). PE rates were similar regardless of surveillance (p = 1.0). Chemoprophylaxis lowered both DVT rates (8.2% vs. 10.7%; p < 0.0001) and PE rates (1.2% vs. 1.9%; p = 0.0050). Mechanical prophylaxis did not decrease DVT rates (10.2% vs. 11.5%; p = 0.2980) or PE rates (1.7% vs. 1.6%; p = 1.0). In patients with neither chemoprophylaxis nor mechanical prophylaxis, DVT rate was 11.5%, PE was 1.6%. When chemoprophylaxis and/or mechanical prophylaxis were given, DVT rate was 8.6% (p < 0.0189) and PE was 1.3% (p = 0.4462). PE proportions were not decreased with mechanical prophylaxis or surveillance. DVT and PE rates were not associated (p = 0.7574). CONCLUSIONS: The results suggest that PE is not associated with lower extremity DVT in adult trauma patients.
Aziz Hiba Abdel; Hileman Barbara M; Chance Elisha A
European journal of trauma and emergency surgery : official publication of the European Trauma Society
2018
2018-12
<a href="http://doi.org/10.1007/s00068-018-1043-3" target="_blank" rel="noreferrer noopener">10.1007/s00068-018-1043-3</a>
The utility of hair cortisol concentrations in the prediction of PTSD symptoms following traumatic physical injury.
*Acute physical injury; *Avoidance; *Hair cortisol concentrations; *Numbing; *PTSD; *PTSD symptoms; 80 and over; Adult; Aged; Biological Markers; Female; Hair Analysis; Hair/*chemistry; Human; Humans; Hydrocortisone; Hydrocortisone/*analysis; Male; Middle Aged; Midwestern United States; Post-Traumatic – Risk Factors; Post-Traumatic/*diagnosis/*etiology; Prospective Studies; Regression; Retrospective Design; Retrospective Studies; Risk Factors; Saliva; Stress Disorders; Trauma Centers – Midwestern United States; Wounds and Injuries/*complications
RATIONALE: Although cortisol alterations have been associated with posttraumatic stress disorder (PTSD) and PTSD symptoms (PTSS), the direction of association is mixed. Cortisol which is measured in blood, saliva, or urine is subject to transient factors that may confound results. Recent advances in cortisol sampling techniques provide novel opportunities to address these inconsistencies. Hair cortisol sampling is a non-invasive method for the retrospective assessment of long-term integrated cortisol, yet its utility at predicting PTSS has not been assessed in acute injury victims. OBJECTIVE: The aim of this prospective study was to examine whether higher levels of hair cortisol concentrations (HCC) were associated with increases in PTSS following traumatic physical injury. METHOD: From January 2012 to May 2013, injury victims admitted to a level-1 Midwestern trauma center were recruited during their routine trauma clinic appointment within 30-days post-injury. Thirty participants had sufficient hair length to obtain 3-cm hair samples for cortisol assay. These participants completed PTSS assessments in relation to their recent injury at both the baseline and follow-up assessments (within 30- and 60-days post-injury, respectively). RESULTS: Hierarchical regression analyses - which controlled for baseline PTSS, age, and sex - revealed that higher HCC predicted significant increases in overall PTSS at follow-up. Higher HCC also predicted increases in the avoidance/numbing subscale symptoms of PTSS. Dividing the avoidance symptoms and numbing symptoms into two separate clusters (consistent with the 4-factor DSM-5 model of PTSD) revealed that HCC was only marginally associated with numbing, but not with avoidance symptoms. CONCLUSION: Hair sampling is a feasible method for assessing integrated cortisol levels soon after traumatic physical injury. This study suggests that elevated HCC may serve as a biomarker of risk for the development of posttraumatic symptomatology, and identifies specific symptoms that may be targeted for intervention in those with high HCC in the aftermath of injury.
Pacella Maria L; Hruska Bryce; Steudte-Schmiedgen Susann; George Richard L; Delahanty Douglas L
Social science & medicine (1982)
2017
2017-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.socscimed.2016.12.046" target="_blank" rel="noreferrer noopener">10.1016/j.socscimed.2016.12.046</a>