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Performance of pre-hospital evaluations in ruling out invasive chest stab wounds.

ABSTRACT: BACKGROUND:Some guidelines advocate for managing patients with penetrating thoracic wounds in trauma centres with cardiothoracic surgery. This systematic approach is questionable. Only 15% of these patients require surgery. It is known that clinical examination fails to detect hemopneumothorax in penetrating trauma. However, no studies have evaluated the combined diagnostic performance of vital signs and the clinical evaluation of wounds. The clinical characteristics of wounds have not been investigated. We aimed to evaluate the ability of combinations of pre-hospital signs to rule out invasive chest stab trauma. METHODS:This was a prospective observational study. All consecutive adult patients hospitalized in the perioperative acute care unit of a tertiary university hospital were included. Injury diagnoses were provided by exploratory surgery and imaging tests. Patients with a final diagnosis of invasive wounds (IWs) and patients with only superficial wounds were compared. Data regarding management and outcome were analysed. RESULTS:A total of 153 patients were included. After imaging or surgery, 58 (38%) patients were diagnosed with only superficial wounds, and 95 (62%) were diagnosed with thoracic or abdominal IWs. The false-negative rate of pre-hospital evaluations in the diagnosis of IWs was 42% [31-51]IQR25-75. In stable patients, pre-hospital data could not rule out IWs, with a negative predictive value of 58% and a positive predictive value of 70%. Twenty-nine (19%) patients required early emergent cardiothoracic surgery. Among these patients, 8 (28%) had no evidence of IWs in the pre-hospital period. Among the 59 patients without pre-hospital signs of IWs, 19 (33%) underwent at least one emergent procedure. CONCLUSIONS:The combination of pre-hospital vital signs, visual evaluation of wounds, and physical examination failed to rule out IWs in patients with chest stab wounds. This implies that caution is needed in triage decision-making.

SUBMITTER: Augustin P

PROVIDER: S-EPMC7201546 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Performance of pre-hospital evaluations in ruling out invasive chest stab wounds.

Augustin Pascal P Guivarch Elise E Pellenc Quentin Q Castier Yves Y Boudinet Sandrine S Tanaka Sebastien S Montravers Philippe P Tran-Dinh Alexy A

Scandinavian journal of trauma, resuscitation and emergency medicine 20200505 1

<h4>Background</h4>Some guidelines advocate for managing patients with penetrating thoracic wounds in trauma centres with cardiothoracic surgery. This systematic approach is questionable. Only 15% of these patients require surgery. It is known that clinical examination fails to detect hemopneumothorax in penetrating trauma. However, no studies have evaluated the combined diagnostic performance of vital signs and the clinical evaluation of wounds. The clinical characteristics of wounds have not b ...[more]

PMID: 32370808

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Project description:BACKGROUND:Minorities' Diminished Returns (MDRs) refer to systemically weaker effects of socioeconomic status (SES) indicators on various developmental, behavioral, and health outcomes of ethnic minorities compared to non-Hispanic (non-Latino) Whites. Similar MDRs also exist for the effects of parental education on the school performance of ethnic minority youth. AIM:To assess whether regression toward the mean (RTM) has any role in explaining the diminished effects of parental education on the school performance of Black and Hispanic youth relative to non-Hispanic White youth. MATERIALS AND METHODS:Data for this cross-sectional study came from the Monitoring the Future survey (MTF, 2017), a nationally representative survey of American youth in 12th grade. The sample included 10,262 youth who were 12th graders (typically 17-18 years old). The independent variable was parental education with five categories: Some high school, High school graduate, Some college, College graduate, and Graduate school. The outcome was self-reported school performance measured as grade point average (GPA). Ethnicity was the effect modifier. Analysis of variance (ANOVA) and the Tukey Post Hoc test was used to analyze the data. Data visualization (line graphs) was used to visualize the shape of youth GPA as a function of parental education levels across ethnic groups. RESULTS:While a perfect stepwise increase was seen in youth school performance as a result of parental education improvement, this pattern differed considerably across ethnic groups. Such a perfect stepwise increase in youth school performance as a result of the incremental increase in parental education was missing for Black and Hispanic youth. The shape of the association between parental education and youth school performance ruled out regression toward the mean (RTM) as an explanation for the observed diminished effects of parental education on the school performance of Black and Hispanic youth. CONCLUSION:Diminished returns of parental education on the school performance of Black and Hispanic youth cannot be explained by regression toward the mean. Other factors and contextual processes, such as segregation, discrimination, racism, and poor quality of schools in urban areas, should be investigated in future research.

Project description:BackgroundLarge-scale deworming programs have, to date, mostly targeted preschool- and school-age children. As community-based deworming programs become more common, deworming will be offered to women of reproductive age. The World Health Organization recommends preventive chemotherapy be administered to pregnant women only after the first trimester. It is therefore important for deworming programs to be able to identify women in early pregnancy. Our objective was to validate a short questionnaire which could be used by deworming program managers to identify and screen out women in early pregnancy.Methodology/principal findingsIn May and June 2018, interviewers administered a questionnaire, followed by a pregnancy test, to 1,203 adult women living in the Peruvian Amazon. Regression analyses were performed to identify questions with high predictive properties (using the pregnancy test as the gold standard). Test parameters were computed at different decision tree nodes (where nodes represented questions). With 106 women confirmed to be pregnant, the positive predictive value of asking the single question 'Are you pregnant?' was 100%, at a 'cost' of a false negative rate of 1.9% (i.e. 21 women were incorrectly identified as not pregnant when they were truly pregnant). Additional questions reduced the false negative rate, but increased the false positive rate. Rates were dependent on both the combination and the order of questions.Conclusions/significanceTo identify women in early pregnancy when deworming programs are community-based, both the number and order of questions are important. The local context and cultural acceptability of different questions should inform this decision. When numbers are manageable and resources are available, pregnancy tests can be considered at different decision tree nodes to confirm pregnancy status. Trade-offs in terms of efficiency and misclassification rates will need to be considered to optimize deworming coverage in women of reproductive age.

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Performance of pre-hospital evaluations in ruling out invasive chest stab wounds.

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Performance of pre-hospital evaluations in ruling out invasive chest stab wounds.

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