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- Prins, Jonne T H, et al.
(författare)
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Outcome after surgical stabilization of rib fractures versus nonoperative treatment in patients with multiple rib fractures and moderate to severe traumatic brain injury (CWIS-TBI).
- 2021
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Ingår i: The journal of trauma and acute care surgery. - 2163-0763. ; 90:3, s. 492-500
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Tidskriftsartikel (refereegranskat)abstract
- Outcomes after surgical stabilization of rib fractures (SSRF) have not been studied in patients with multiple rib fractures and traumatic brain injury (TBI). We hypothesized that SSRF, as compared to nonoperative management, is associated with favorable outcomes in patients with TBI.A multicenter, retrospective cohort study was performed in patients with rib fractures and TBI between January 2012 and July 2019. Patients who underwent SSRF were compared to those managed nonoperatively. The primary outcome was mechanical ventilation-free days. Secondary outcomes were Intensive Care Unit (ICU-LOS) and hospital length of stay (HLOS), tracheostomy, occurrence of complications, neurologic outcome, and mortality. Patients were further stratified into moderate (GCS 9-12) and severe (GCS ≤8) TBI.The study cohort consisted of 456 patients of which 111 (24.3%) underwent SSRF. SSRF was performed at a median of 3 days and SSRF-related complication rate was 3.6%. In multivariable analyses, there was no difference in mechanical ventilation-free days between the SSRF and nonoperative groups. The odds of developing pneumonia (OR 0.59 (95% CI 0.38-0.98), p=0.043) and 30-day mortality (OR 0.32 (95% CI 0.11-0.91), p=0.032) were significantly lower in the SSRF group. Patients with moderate TBI had similar outcome in both groups. In patients with severe TBI, the odds of 30-day mortality was significantly lower after SSRF (0.19 (95% CI 0.04-0.88), p=0.034).In patients with multiple rib fractures and TBI, the mechanical ventilation-free days did not differ between the two treatment groups. In addition, SSRF was associated with a significantly lower risk of pneumonia and 30-day mortality. In patients with moderate TBI, outcome was similar. In patients with severe TBI a lower 30-day mortality was observed. There was a low SSRF-related complication risk. These data suggest a potential role for SSRF in select patients with TBI.Therapeutic, level IV.
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- Scott, Alister, et al.
(författare)
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UK National Ecosystem Assessment Follow-on : Work Package Report 10: Tools, Applications, Benefits and Linkages for Ecosystem Science (TABLES)
- 2014
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Over an 18 month period, the Tools: Applications, Benefits and Linkages for Ecosystems (TABLES) project has worked at the interface of research, policy and practice, crossing different disciplines, sectors and professions, to embed the value of nature more effectively into policies, programmes, plans or projects and thus improve decision -making processes and outcomes.Our main focus has been on translating the 12 principles of the Ecosystem Approach into comprehensive advice within which a set of tools can utilise an Ecosystem Services Framework . The interdisciplinary TABLES team, consisting of academics, professionals in practice, community members and policy makers, championed co-production and social learning strategies using member expertise and experience within diverse case studies. These span the environment, business, local community and planning sectors; all of which are trying to mainstream an Ecosystem Approach to some extent.The project addresses the recommendations of the UK National Ecosystem Assessment (UK NEA, 2011a, 1303) to integrate ecosystem services and the wider values of the natural environment within a context of policy and decision-making and tools leading to a superior basis for future decision-making.
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