bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome Analysis of Surgical Stabilization of Rib Fractures in Trauma Patients
Authors: Fokin Alexander A. , Wycech Joanna , Weisz Russell , Puente Ivan 
Published: October 2018

Objectives:
To compare outcomes in patients with rib fractures (RFX) who underwent surgical stabilization of rib fractures (SSRF) to those treated nonoperatively.

Design:
Retrospective cohort study.

Setting:
Two Level 1 Trauma Centers.

Patients:
One hundred seventy-four patients with multiple RFX divided into 2 groups: patients with surgically stabilized RFX (n = 87) were compared with nonoperatively managed patients in the matched control group (MCG) (n = 87).

Intervention:
SSRF.

Outcome Measurements:
Age, sex, injury severity score, RFX, mortality, hospital length of stay (HLOS) and intensive care unit length of stay (ICULOS), duration of mechanical ventilation (DMV), co-injuries, and time to surgery. Patients were further stratified by presence or absence of flail chest and pulmonary contusion (PC).

Results:
Flail chest, displaced RFX, and PC were present significantly more often in SSRF patients compared with the MCG. Mortality was lower in SSRF group. HLOS and ICULOS were longer in SSRF group compared with the corresponding MCG patients regardless of timing to surgery (P < 0.01 for all). SSRF patients with flail chest had comparable HLOS, ICULOS, and DMV to MCG patients with flail chest (P > 0.3 for all). SSRF patients without flail chest had significantly longer HLOS and ICULOS than MCG patients without flail chest (P < 0.001 for both). Presence of PC did not affect lengths of stay.

Conclusions:
SSRF patients had reduced mortality compared with nonoperatively managed patients. HLOS, ICULOS, and DMV were longer in SSRF patients than in MCG. When flail chest was present, lengths of stay were comparable. PC did not seem to affect the surgical outcome.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Decreased Lean Psoas Cross-Sectional Area Is Associated With Increased 1-Year All-Cause Mortality in Male Elderly Orthopaedic Trauma Patients
Authors: Touban Basel M. , Pavlesen Sonja , Smoak Jason B. , Sayegh Michael J. , Wang Jiefei , Zhao Jiwei , Anders Mark J. 
Published: October 2018

Objectives:
To investigate the association between lean psoas cross-sectional area (CSA) and 1-year all-cause mortality in elderly patients sustaining pelvic and long bone fractures.

Design:
Retrospective cohort.

Setting:
Level I trauma center.

Patients:
Elderly trauma patients admitted from 2007 to 2014.

Methods:
We reviewed demographic and clinical data, injury mechanism, fracture OTA/AO classification, and mortality. Axial computed tomography images were used to measure lean psoas CSA at the L3-L4 disk space. Cox proportional hazard regression analysis was used to estimate 1-year mortality association with psoas CSA in crude and adjusted for age, body mass index, Injury Severity Score, medical comorbidities, and discharge destination in total population and stratified by sex.

Main Outcome Measurement:
One-year all-cause mortality defined as death within 12 months from date of hospitalization.

Results:
Five hundred fifty-eight patients (54% female, 46% male) were analyzed. The pelvis was most commonly fractured (37.81%). A statistically significant association was observed between decreased lean psoas CSA and 1-year mortality in total population {hazard ratio [HR] = 0.93 [95% confidence interval (CI) = 0.90–0.96], P < 0.0001}. Stratification by gender revealed a statistically significant mortality HR in male patients [HR = 0.89 (95% CI = 0.84–0.96), P = 0.002]. We did not find a statistically significant mortality HR in female patients [HR = 0.95 (95% CI = 0.89–1.01), P = 0.103].

Conclusions:
In this cohort of elderly orthopaedic trauma patients, decreased lean psoas CSA was associated with increased 1-year all-cause mortality in total population and males. Further investigation of the association of sarcopenia with mortality in the elderly is warranted.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Nail Plate Combination Technique for Native and Periprosthetic Distal Femur Fractures
Authors: Liporace Frank A. , Yoon Richard S. 
Published: October 2018

Summary:
In the elderly, low-energy distal femur fractures (native or periprosthetic) can be devastating injuries, carrying high rates of morbidity and mortality, comparable with the hip fracture population. Poor, osteoporotic bone quality facilitates fracture in a vulnerable anatomical region, and as a result, operative fixation can be challenging. With goals of early mobilization to reduce subsequent complication risk, using the nail plate combination technique can offer stable, balanced fixation allowing for immediate weight bearing and early mobilization. We outline the rationale, technical steps, and early clinical outcomes after nail plate combination in the treatment of osteoporotic distal femur (native or periprosthetic) fractures.
Knee Pain and Functional Scores After Intramedullary Nailing of Tibial Shaft Fractures Using a Suprapatellar Approach
Authors: Serbest Sancar , Tiftikçi Uğur , Çoban Mehmet , Çirpar Meriç , Dağlar Bülent 
Published: October 2018

Objectives:
To evaluate the effects of intramedullar nailing of the tibia using a suprapatellar (SP) approach with respect to pain and function of the knee.

Design:
Prospective clinical investigation.

Setting:
Academic level I trauma center.

Patients/Participants:
Twenty-one patients with tibial shaft fractures (Orthopaedic Trauma Association 42A-B-C) with a minimum of 12-month follow-up.

Intervention:
Locked intramedullary nailing using a SP approach.

Main Outcome Measurements:
Radiographic evaluation for nail position proximally, tibial shaft alignment and union, anterior knee pain using the visual analog scale, and knee function evaluation using the Lysholm and SF-36 scores. Examination of intra-articular damage was performed using intraoperative patellofemoral arthroscopy before and after nail insertion.

Results:
The mean age of the patients was 35.4 ± 12.4 years (range, 18–63 years), and the mean follow-up period was 15.62 ± 3.2 months (range, 12–21 months). The visual analog scale score for anterior knee pain was a mean of 1.0 ± 1.3 (range, 0–4). The SF-36 physical score was mean 45.1 ± 9, and the SF-36 mental score was a mean of 51.7 ± 9.9. The knee joint range of movement was measured as 133.1 ± 87 degrees on the affected extremity side and 134.05 ± 8.4 degrees on the unaffected side. The mean Lysholm knee score was 95.76 ± 4. No intra-articular pathology was seen on arthroscopy after nail insertion.

Conclusions:
The SP approach for intramedullar nailing for tibial shaft fractures was not associated with either anterior knee pain or functional limitations of the knee in our series.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Risk Factors for Persistent Cognitive Impairment After Critical Illness, Nested Case-Control Study
Authors: Sakusic Amra , Gajic Ognjen , Singh Tarun D. , O’Horo John C. , Jenkins Gregory , Wilson Gregory A. , Petersen Ronald , Fryer John D. , Kashyap Rahul , Rabinstein Alejandro A. 
Published: October 2018

Objectives:
Persistent cognitive impairment after critical illness is an important healthcare problem forecasted to worsen in the near future. However, the epidemiology is insufficiently explored. We aimed to determine potentially modifiable risk factors during ICU hospitalization that play a significant role in developing persistent cognitive impairment.

Design:
An observational case-control study.

Settings:
Mayo Clinic ICUs between July 1, 2004, and November 20, 2015.

Patients:
We conducted a study nested in a large cohort of 98,227 adult critically ill patients. Using previously validated computable phenotypes for dementia and cognitive impairment, we determined the onset of cognitive impairment relative to ICU hospitalization and associated risk factors. The primary endpoint of the study was new and persistent cognitive impairment documented between 3 and 24 months after ICU discharge.

Interventions:
Unadjusted and adjusted analyses were performed to identify potentially modifiable risk factors during ICU hospitalization.

Measurements and Main Results:
Among 21,923 unique patients identified as cognitively impaired (22% of the entire ICU cohort), 2,428 (2.5%) developed incident new and persistent cognitive dysfunction after the index ICU admission. Compared with age- and sex-matched ICU controls (2,401 pairs), cases had higher chronic illness burden (Charlson Comorbidity Index, 6.2 vs 5.1; p < 0.01), and were more likely to have multiple ICU stays (22% vs 14%; p < 0.01). After adjustment for baseline differences, new and persistent cognitive dysfunction was associated with higher frequency of acute brain failure in the ICU, a higher exposure to severe hypotension, hypoxemia, hyperthermia, fluctuations in serum glucose, and treatment with quinolones or vancomycin. Association with sepsis observed in univariate analysis did not persist after adjustment.

Conclusions:
Cognitive dysfunction is highly prevalent in ICU patients. Incident new and persistent cognitive impairment is less common but important, potentially preventable problem after critical illness. Chronic comorbidities and number of ICU stays increase the risk of post-ICU cognitive dysfunction irrespective of age. Modifiable ICU exposures were identified as potential targets for future prevention trials.
Opioid Use After ICU Admission Among Elderly Chronic Opioid Users in Ontario: A Population-Based Cohort Study
Authors: Wang Han Ting , Hill Andrea D. , Gomes Tara , Wijeysundera Duminda N. , Pinto Ruxandra , Scales Damon C. , Fowler Robert , Wunsch Hannah 
Published: October 2018

Objectives:
Critical illness is often associated with painful procedures and prolonged opioid infusions, raising the concern that chronic opioid users may be exposed to escalating doses that are continued after hospital discharge. We sought to assess patterns of opioid use after intensive care among elderly patients identified as chronic opioid users prior to hospitalization.

Design:
Population-based cohort study.

Setting:
All adult ICUs in the province of Ontario, Canada.

Participants:
Elderly patients (> 65 yr) admitted to ICUs between April 2002 and March 2015 who also survived to day 180 after hospital discharge, identified as chronic opioid users prior to hospitalization.

Exposure:
Chronic opioid use in the year before hospital admission, as well as a filled opioid prescription with a duration covering the day of hospital admission.

Measurements and Main Results:
The primary outcome was the proportion of patients who filled an opioid prescription with a duration covering day 180 after hospital discharge; secondary outcome was the difference in morphine equivalent daily dosage at day 180 after discharge compared with the amount prescribed prior to hospital admission. Of 496,985 elderly admissions to ICUs, 19,584 (3.9%) were chronic opioid users before hospitalization who also survived to day 180 after hospital discharge. The median daily dose of opioid prescriptions filled before hospital admission was 32.1 mg morphine equivalent (interquartile range, 17.5–75.0 mg morphine equivalent). Among these survivors, 63.3% had at least one opioid prescription filled with a duration covering day 180; 22.0% had filled prescriptions for a higher daily morphine equivalent dose compared with prehospitalization, 19.8% were unchanged, 21.5% had a lower dose, and 36.7% had no prescription filled. The majority of reduction was in prescriptions for codeine and oxycodone.

Conclusions:
Among chronic opioid users, hospitalization with critical illness was not associated with substantial increases in opioids prescribed in the 6 months following hospitalization.
Long-Term Mortality and Hospital Resource Use in ICU Patients With Alcohol-Related Liver Disease*
Authors: Lone Nazir I. , Lee Robert , Walsh Timothy S. 
Published: October 2018

Objectives:
Data describing long-term outcomes following ICU for patients with alcohol-related liver disease are scarce. We aimed to report long-term mortality and emergency hospital resource use for patients with alcohol-related liver disease and compare this with two comparator cohorts.

Design:
Retrospective cohort study linking population registry data.

Setting:
All adult general Scottish ICUs (2005–2010) serving 5 million population.

Patients:
ICU patients with alcohol-related liver disease were compared with an unmatched cohort with Acute Physiology and Chronic Health Evaluation defined diagnoses of severe cardiovascular, respiratory, or renal comorbidity and a matched general ICU cohort.

Interventions:
None.

Measurements and Main Results:
Outcomes were 5-year mortality, emergency hospital resource use, and emergency hospital readmission. Multivariable regression was used to identify risk factors and adjust for confounders. Of 47,779 ICU admissions, 2,463 patients with alcohol-related liver disease and 3,590 patients with severe comorbidities were identified; 2,391(97.1%) were matched to a general ICU cohort. The alcohol-related liver disease cohort had greater 5-year mortality than comorbid (79.2% vs 75.3%; p < 0.001) and matched general (79.8% vs 63.3%; p < 0.001) cohorts. High liver Sequential Organ Failure Assessment score and three-organ support were associated with 90% 5-year mortality in alcohol-related liver disease patients. After confounder adjustment, alcohol-related liver disease patients had 31% higher hazard of death (adjusted hazard ratio, 1.31; 95% CI, 1.17–1.47; p < 0.001) and used greater resource than the severe comorbid comparator group. Findings were similar compared with the matched cohort.

Conclusions:
ICU patients with alcohol-related liver disease have higher 5-year mortality and emergency readmission rates than ICU patients with other severe comorbidities and matched general ICU patients. These data can contribute to shared decision-making for alcohol-related liver disease patients.
Extracorporeal CO2 Removal: The Minimally Invasive Approach, Theory, and Practice*
Authors: Duscio Eleonora , Cipulli Francesco , Vasques Francesco , Collino Francesca , Rapetti Francesca , Romitti Federica , Behnemann Tim , Niewenhuys Julia , Tonetti Tommaso , Pasticci Iacopo , Vassalli Francesco , Reupke Verena , Moerer Onnen , Quintel Michael , Gattinoni Luciano 
Published: October 2018

Objectives:
Minimally invasive extracorporeal CO2 removal is an accepted supportive treatment in chronic obstructive pulmonary disease patients. Conversely, the potential of such technique in treating acute respiratory distress syndrome patients remains to be investigated. The aim of this study was: 1) to quantify membrane lung CO2 removal (Vco
2ML) under different conditions and 2) to quantify the natural lung CO2 removal (Vco
2NL) and to what extent mechanical ventilation can be reduced while maintaining total expired CO2 (Vco
2tot = Vco
2ML + Vco
2NL) and arterial Pco
2 constant.

Design:
Experimental animal study.

Setting:
Department of Experimental Animal Medicine, University of Göttingen, Germany.

Subjects:
Eight healthy pigs (57.7 ± 5 kg).

Interventions:
The animals were sedated, ventilated, and connected to the artificial lung system (surface 1.8 m2, polymethylpentene membrane, filling volume 125 mL) through a 13F catheter. Vco
2ML was measured under different combinations of inflow Pco
2 (38.9 ± 3.3, 65 ± 5.7, and 89.9 ± 12.9 mm Hg), extracorporeal blood flow (100, 200, 300, and 400 mL/min), and gas flow (4, 6, and 12 L/min). At each setting, we measured Vco
2ML, Vco
2NL, lung mechanics, and blood gases.

Measurements and Main Results:
Vco
2ML increased linearly with extracorporeal blood flow and inflow Pco
2 but was not affected by gas flow. The outflow Pco
2 was similar regardless of inflow Pco
2 and extracorporeal blood flow, suggesting that Vco
2ML was maximally exploited in each experimental condition. Mechanical ventilation could be reduced by up to 80–90% while maintaining a constant Paco
2.

Conclusions:
Minimally invasive extracorporeal CO2 removal removes a relevant amount of CO2 thus allowing mechanical ventilation to be significantly reduced depending on extracorporeal blood flow and inflow Pco
2. Extracorporeal CO2 removal may provide the physiologic prerequisites for controlling ventilator-induced lung injury.
Impact of Mean Arterial Pressure Fluctuation on Mortality in Critically Ill Patients
Authors: Gao Ya , Wang Qinfen , Li Jiamei , Zhang Jingjing , Li Ruohan , Sun Lu , Guo Qi , Xia Yong , Fang Bangjiang , Wang Gang 
Published: October 2018

Objective:
The purpose of this study was to investigate the association between mean arterial pressure fluctuations and mortality in critically ill patients admitted to the ICU.

Design:
Retrospective cohort.

Setting:
All adult ICUs at a tertiary care hospital.

Patients:
All adult patients with complete mean arterial pressure records were selected for analysis in the Multiparameter Intelligent Monitoring in Intensive Care II database. Patients in the external cohort were newly recruited adult patients in the Medical Information Mart for Intensive Care III database.

Interventions:
None.

Measurements and Main Results:
The records of 8,242 patients were extracted. Mean arterial pressure fluctuation was calculated as follows: (mean nighttime mean arterial pressure – mean daytime mean arterial pressure)/mean arterial pressure. Patients were divided into two groups according to the degree of mean arterial pressure fluctuation: group A (between –5% and 5%) and group B (<–5% and >5%). The endpoints of this study were ICU and hospital mortality. Patients in group A (n = 4,793) had higher ICU and hospital mortality than those in group B (n = 3,449; 11.1% vs 8.1%, p < 0.001 and 13.8% vs 10.1%, p < 0.001, respectively). After adjusting for other covariates, the mean arterial pressure fluctuations between –5% and 5% were significantly correlated with ICU mortality (odds ratio, 1.296; 95% CI, 1.103–1.521; p = 0.002) and hospital mortality (odds ratio, 1.323; 95% CI, 1.142–1.531; p < 0.001). This relationship remained remarkable in patients with low or high Sequential Organ Failure Assessment scores in the sensitive analysis. Furthermore, external validation on a total of 4,502 individuals revealed that patients in group A still had significantly higher ICU (p < 0.001) and hospital mortality (p < 0.001) than those in group B.

Conclusions:
The reduced mean arterial pressure fluctuation (within –5% and 5%) may be associated with ICU and hospital mortality in critically ill patients.
Estimating the False Positive Rate of Absent Somatosensory Evoked Potentials in Cardiac Arrest Prognostication
Authors: Amorim Edilberto , Ghassemi Mohammad M. , Lee Jong W. , Greer David M. , Kaplan Peter W. , Cole Andrew J. , Cash Sydney S. , Bianchi Matthew T. , Westover M. Brandon 
Published: October 2018

Objectives:
Absence of somatosensory evoked potentials is considered a nearly perfect predictor of poor outcome after cardiac arrest. However, reports of good outcomes despite absent somatosensory evoked potentials and high rates of withdrawal of life-sustaining therapies have raised concerns that estimates of the prognostic value of absent somatosensory evoked potentials may be biased by self-fulfilling prophecies. We aimed to develop an unbiased estimate of the false positive rate of absent somatosensory evoked potentials as a predictor of poor outcome after cardiac arrest.

Data Sources:
PubMed.

Study Selection:
We selected 35 studies in cardiac arrest prognostication that reported somatosensory evoked potentials.

Data Extraction:
In each study, we identified rates of withdrawal of life-sustaining therapies and good outcomes despite absent somatosensory evoked potentials. We appraised studies for potential biases using the Quality in Prognosis Studies tool. Using these data, we developed a statistical model to estimate the false positive rate of absent somatosensory evoked potentials adjusted for withdrawal of life-sustaining therapies rate.

Data Synthesis:
Two-thousand one-hundred thirty-three subjects underwent somatosensory evoked potential testing. Five-hundred ninety-four had absent somatosensory evoked potentials; of these, 14 had good functional outcomes. The rate of withdrawal of life-sustaining therapies for subjects with absent somatosensory evoked potential could be estimated in 14 of the 35 studies (mean 80%, median 100%). The false positive rate for absent somatosensory evoked potential in predicting poor neurologic outcome, adjusted for a withdrawal of life-sustaining therapies rate of 80%, is 7.7% (95% CI, 4–13%).

Conclusions:
Absent cortical somatosensory evoked potentials do not infallibly predict poor outcome in patients with coma following cardiac arrest. The chances of survival in subjects with absent somatosensory evoked potentials, though low, may be substantially higher than generally believed.
A Comparison of Mortality From Sepsis in Brazil and England: The Impact of Heterogeneity in General and Sepsis-Specific Patient Characteristics*
Authors: Ranzani Otavio T. , Shankar-Hari Manu , Harrison David A. , Rabello Lígia S. , Salluh Jorge I. F. , Rowan Kathryn M. , Soares Marcio 
Published: October 2018

Objectives:
To test whether differences in both general and sepsis-specific patient characteristics explain the observed differences in sepsis mortality between countries, using two national critical care (ICU) databases.

Design:
Cohort study.

Setting:
We analyzed 62 and 164 ICUs in Brazil and England, respectively.

Patients:
Twenty-two–thousand four-hundred twenty-six adult ICU admissions from January 2013 to December 2013.

Interventions:
None.

Measurements and Main Results:
After harmonizing relevant variables, we merged the first ICU episode of adult medical admissions from Brazil (ORganizational CHaractEeriSTics in cRitical cAre study) and England (Intensive Care National Audit & Research Centre Case Mix Programme). Sepsis-3 definition was used, and the primary outcome was hospital mortality. We used multilevel logistic regression models to evaluate the impact of country (Brazil vs England) on mortality, after adjustment for general (age, sex, comorbidities, functional status, admission source, time to admission) and sepsis-specific (site of infection, organ dysfunction type and number) patient characteristics. Of medical ICU admissions, 13.2% (4,505/34,150) in Brazil and 30.7% (17,921/58,316) in England met the sepsis definition. The Brazil cohort was older, had greater prevalence of severe comorbidities and dependency compared with England. Respiratory was the most common infection site in both countries. The most common organ dysfunction was cardiovascular in Brazil (41.2%) and respiratory in England (85.8%). Crude hospital mortality was similar (Brazil 41.4% vs England 39.3%; odds ratio, 1.12 [0.98–1.30]). After adjusting for general patient characteristics, there was an important change in the point-estimate of the odds ratio (0.88 [0.75–1.02]). However, after adjusting for sepsis-specific patient characteristics, the direction of effect reversed again with Brazil having higher risk-adjusted mortality (odds ratio, 1.22 [1.05–1.43]).

Conclusions:
Patients with sepsis admitted to ICUs in Brazil and England have important differences in general and sepsis-specific characteristics, from source of admission to organ dysfunctions. We show that comparing crude mortality from sepsis patients admitted to the ICU between countries, as currently performed, is not reliable and that the adjustment for both general and sepsis-specific patient characteristics is essential for valid international comparisons of mortality amongst sepsis patients admitted to critical care units.