Wednesday, December 18, 2013

Headache App



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Traumatic Brain Injury (TBI)



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External Validation of the Emergency Trauma Score for Early Prediction of Mortality in Trauma Patients*

External Validation of the Emergency Trauma Score for Early Prediction of Mortality in Trauma Patients*
Critical Care Medicine - Current Issue

imageObjectives:The Emergency Trauma Score has been developed for early estimation of mortality risk in adult trauma patients with an Injury Severity Score of 16 or higher. Emergency Trauma Score combines four early predictors available at the trauma resuscitation room: age, Glasgow Coma Scale, base excess, and prothrombin time. Our goal was to validate the Emergency Trauma Score in two large external cohorts. As the Injury Severity Score is not accurately known at the time patients present at the resuscitation room, we evaluated the performance of Emergency Trauma Score in all trauma patients. Design:External validation study using data from two prospectively collected trauma registries. Setting:Two academic level 1 trauma centers. Patients:Adult patients admitted to the hospital after treatment at the trauma resuscitation room. InterventionCalibration and discrimination of the original Emergency Trauma Score were assessed within each cohort separately. Measurement and Main Results:A total of 4,418 consecutive patients were evaluated. Discrimination was good in both validation cohorts, with areas under the receiver-operating curve curves that were even higher (0.94 and 0.92, respectively) than that in the original cohort (0.83). Predicted mortality was systematically too high compared with actual mortality in patients with low-to-medium expected risk (< 25%). Calibration improved in the lower expected risk range after exclusion of patients with Injury Severity Score less than 16. Conclusions:The Emergency Trauma Score model performs well in discriminating between trauma patients who will survive and who will not. If applied to all trauma patients, predicted mortality risks are too high in the low-risk category.

Original Article: http://journals.lww.com/ccmjournal/Fulltext/2014/01000/External_Validation_of_the_Emergency_Trauma_Score.11.aspx
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Advanced Airway Management Simulation Training in Medical Education: A Systematic Review and Meta-Analysis

Advanced Airway Management Simulation Training in Medical Education: A Systematic Review and Meta-Analysis
Critical Care Medicine - Current Issue

imageObjective:To perform a systematic review and meta-analysis of the literature on teaching airway management using technology-enhanced simulation. Data Sources:We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, and Scopus for eligible articles through May 11, 2011. Study Selection:Observational or controlled trials instructing medical professionals in direct or fiberoptic intubation, surgical airway, and/or supraglottic airway using technology-enhanced simulation were included. Two reviewers determined eligibility. Data Extraction:Study quality, instructional design, and outcome data were abstracted independently and in duplicate. Data Synthesis:Of 10,904 articles screened, 76 studies were included (n = 5,226 participants). We used random effects meta-analysis to pool results. In comparison with no intervention, simulation training was associated with improved outcomes for knowledge (standardized mean difference, 0.77 [95% CI, 0.19–1.35]; n = 7 studies) and skill (1.01 [0.68–1.34]; n = 28) but not for behavior (0.52 [–0.30 to 1.34]; n = 4) or patient outcomes (–0.12 [–0.41 to 0.16]; n = 4). In comparison with nonsimulation interventions, simulation training was associated with increased learner satisfaction (0.54 [0.37–0.71]; n = 2), improved skills (0.64 [0.12–1.16]; n = 5), and patient outcomes (0.86 [0.12–1.59]; n = 3) but not knowledge (0.29 [–0.28 to 0.86]; n = 4). We found few comparative effectiveness studies exploring how to optimize the use of simulation-based training, and these revealed inconsistent results. For example, animal models were found superior to manikins in one study (p = 0.004) using outcome of task speed but inferior in another study in terms of skill ratings (p = 0.02). Five studies comparing simulators of high versus low technical sophistication found no significant difference in skill outcomes (p > 0.31). Limitations of this review include heterogeneity (I2 > 50% for most analysis) and variation in quality among primary studies. Conclusions:Simulation-based airway management curriculum is superior to no intervention and nonsimulation intervention for important education outcomes. Further research is required to fine-tune optimal curricular design.

Original Article: http://journals.lww.com/ccmjournal/Fulltext/2014/01000/Advanced_Airway_Management_Simulation_Training_in.20.aspx
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Improved Cardiac and Neurologic Outcomes With Postresuscitation Infusion of Cannabinoid Receptor Agonist WIN55, 212-2 Depend on Hypothermia in a Rat Model of Cardiac Arrest*

Improved Cardiac and Neurologic Outcomes With Postresuscitation Infusion of Cannabinoid Receptor Agonist WIN55, 212-2 Depend on Hypothermia in a Rat Model of Cardiac Arrest*
Critical Care Medicine - Current Issue

imageObjectives:To investigate the mechanisms of improved myocardial and neurological function and survival following IV administration of cannabinoid receptor agonist, WIN55, 212-2 in a rat model of cardiac arrest. Design:Prospective randomized controlled experimental study. Setting:University-affiliated research institute. Subjects:Thirty male Sprague-Dawley rats. Interventions:Ventricular fibrillation was electrically induced in 30 male Sprague-Dawley rats weighing between 450 and 550 g. Cardiopulmonary resuscitation was initiated after 6 minutes of untreated ventricular fibrillation. The precordial compression was performed with a pneumatically driven mechanical chest compressor. No pharmacological agent was used during cardiopulmonary resuscitation. After 8 minutes of cardiopulmonary resuscitation, up to three 2-J defibrillations were attempted. The animals were then randomized into three groups: 1) WIN55, 212-2 hypothermia, 2) WIN55, 212-2 with normal body temperature, and 3) placebo control. Either WIN55, 212-2 (1.0 mg/kg/hr) or saline placebo was continuously infused for 2 hours. Except for the WIN55, 212-2 hypothermia group, the body temperature in the other two groups was maintained at 37.0 ± 0.2°C using an external heating lamp. Postresuscitation myocardial function was measured by echocardiogram. Neurological deficit scores and survival time were observed for up to 72 hours. Measurements and Main Results:Blood temperatures decreased from 37°C to 33°C in 4 hours in animals in WIN55, 212-2 hypothermia group. Myocardial function, as measured by cardiac output, ejection fraction, and myocardial performance index, was significantly impaired in all animals after successful resuscitation when compared with the baseline values. There was a significant improvement in myocardial function in the animals treated with WIN55, 212-2 hypothermia beginning at 1 hour after start of infusion. However, no improvement was observed in the groups of WIN55, 212-2 with normal body temperature and placebo control. WIN55, 212-2 hypothermia group was associated with significantly improved neurologic deficit scores and survival time when compared with placebo control group and WIN55, 212-2 with normal body temperature group. Conclusions:In a rat model of cardiac arrest, better postresuscitation myocardial function, neurological deficit scores, and longer duration of survival were observed by the pharmacologically induced hypothermia with WIN55, 212-2. The improved outcomes of cardiopulmonary resuscitation following administration of WIN55, 212-2 appeared to be the results from its temperature reduction effects.

Original Article: http://journals.lww.com/ccmjournal/Fulltext/2014/01000/Improved_Cardiac_and_Neurologic_Outcomes_With.50.aspx
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