Mahermccann1312

The strength of one's social support network is a potentially modifiable factor that may have a significant impact on recovery after injury. We sought to assess the association between one's perceived social support (PSS) and physical and mental health outcomes 6-12 months post-injury.

Moderate-to-severely injured patients admitted to one of three Level I trauma centers were asked to complete a phone-based survey assessing physical and mental health outcomes in addition to return to work and chronic pain 6-12 months post-injury. Patients were also asked to rate the strength of their PSS on a 5-point Likert scale. Multivariate linear and logistic regression models were built to determine the association between PSS and post-discharge outcome metrics.

Of 907 patients included in this study, 653 (72.0%) identified themselves as having very strong/strong, 182 (20.1%) as average, and 72 (7.9%) as weak/non-existent PSS. Patients who reported a weak/non-existent PSS were younger and were more likely to be maleerapeutic, diagnostic test, economic/decision.

Focused Assessment with Sonography for Trauma (FAST) has supplanted Diagnostic Peritoneal Lavage (DPL) as the preferred bedside evaluation for traumatic hemoperitoneum. Diagnostic Peritoneal Aspiration (DPA) is a simpler, faster modification of DPL with an unclear role in contemporary practice. This study delineated modern roles for DPA and defined its diagnostic yield.

All trauma patients presenting to our Level I center who underwent DPA were included (May 2015-May 2020). MLN0128 mTOR inhibitor Demographics, comorbidities, clinical/injury data, and outcomes were collected. The diagnostic yield and accuracy of DPA were calculated against the gold standard of hemoperitoneum at exploratory laparotomy or CT scan.

In total, 41 patients underwent DPA, typically after blunt trauma (n=37, 90%). Patients were almost exclusively hypotensive (n=20, 49%) or in arrest (n=18, 44%). Most patients had an equivocal or negative FAST and hypotension or return of spontaneous circulation after resuscitative thoracotomy (n=32, 78%); or had a positive FAST and known cirrhosis (n=4, 10%). In two patients (5%), one obese, the catheter failed to access the peritoneal cavity. DPA sensitivity, specificity, PPV, and NPV were 80%, 100%, 100%, and 90%, with an accuracy of 93%. One (2%) complication, a small bowel injury, occurred.

Despite near ubiquitous FAST availability, DPA remains important in diagnosing or excluding hemoperitoneum with exceedingly low rates of failure and complications. DPA is most conclusive when positive, without false positives in this study. DPA was utilized most among blunt hypotensive or post-arrest patients who had an equivocal or negative FAST, in whom the preliminary diagnosis of hemoperitoneum is a critically important decision-making branch point.

III.

Prognostic and Epidemiological.

Prognostic and Epidemiological.

Post Intensive Care Syndrome (PICS) has been identified in a large proportion of Medical Intensive Care Unit (ICU) survivors, however the occurrence Surgical ICU (SICU) survivors is unknown. We implemented a multidisciplinary Critical Care Outpatient Clinic (CCOC) to identify the occurrence of PICS in SICU survivors.

70 acute care surgery and trauma patients 18 or older who remained in the SICU for 72 hours or longer at a level 1 trauma center were seen in CCOC at 2, 12, and 24 weeks after hospital discharge. CCOC staffing included a nurse coordinator, social worker, critical care pharmacist, physical therapist, and acute care surgeon who identified PICS sequelae in their respective specialties by clinical criteria and screening questionnaires.

Of 82 eligible patients, 70 (85.4%) were seen at least once for 116 total visits. 43 (61.4%) patients suffered traumatic injuries and 27 (38.6%) underwent emergent general surgery. 95.7% (67) demonstrated at least one PICS criterion. Over all visits, 26 (37.1%) patients presented with one PICS criterion, 24 (34.3%) patients with two, and 17 (24.3%) with three. Cognitive impairment was observed in 29 (41.4%) patients, psychiatric in 30 (42.9%), and physical symptoms in 65 (92.9%). Activity Measure for Post-Acute Care scores improved from severe impairment at admission to full function by 12 weeks post-discharge, yet 6 Minute Walk Test scores remained below age-matched references through all visits. Patients expressed mild to moderate depression based on Patient Health Questionnaire-9 scores. A medication reconciliation was completed at 96.5% (112/116) of visits with 116 total medication recommendations. By 24 weeks following discharge, only 26.4% (14/53) of previously employed patients had resumed work.

Through the successful implementation of a multidisciplinary CCOC, this study identifies an exorbitant rate of PICS among SICU survivors.

Level IV, prospective observational feasibility study.

Level IV, prospective observational feasibility study.

Ocular injuries account for up to 13% of battle injuries, despite the implementation of advanced protective eyewear (PE). The aim of this study was to describe the extent of ocular injuries over the last years among Israel Defense Forces soldiers and to examine the change in PE policy introduced in 2013 and the effect of a high-intensity conflict on ocular injury characteristics.

This retrospective registry-based analysis derived data from the Israel Defense Forces Trauma Registry and included soldiers who sustained combat-related ocular injuries between the years 2013 and 2019. Demographic data and injury characteristics of casualties, as well as information regarding the use of PE, were collected and analyzed.

A total of 2,312 military casualties were available for this study; the incidence of combat-related ocular injuries was 8.9% (n = 113). Ocular injuries occurred among male soldiers (98.2%) with a mean ± SD age of 22.7 ± 4.6 years; mechanism of injury was penetrating in 59.3% of the casualties and blunt in 22.1% of the casualties, ocular injury was isolated in 51.3% of the casualties, and others sustained concomitant injuries including head (32.7%), upper extremity injury (17.7%), lower extremity (15.9%), torso (8.0%), neck (6.2%), and other (5.9%) injuries. Ocular injuries rate was similar among casualties who used PE (11.2%) and those who did not use PE (13.0%) while injured (p = 0.596). Rate of open globe injuries was 9.1% in casualties who used PE and 39.5% (p = 0.002) in casualties who did not.

Eye protection may significantly reduce ocular injuries severity. Education of the combatants on the use of PE and guidance of medical teams on proper assessment, initial treatment, and rapid evacuation of casualties are needed to improve visual outcomes of the casualties further.

Epidemiological study, level IV.

Epidemiological study, level IV.