A Profile of Traumatic Brain Injury within Hospital Emergency Departments—A Retrospective Study in the Republic of Moldova

Background: Traumatic brain injury (TBI) is a critical public health and socio-economic problem throughout the world, making epidemiological monitoring of incidence, prevalence, and outcome of TBI necessary. TBI is a major cause of mortality and morbidity in adolescents, young adults, and the elderly, one of the leading causes being road traffic accidents. Methods: A retrospective study was conducted among patients with TBI within 2 medical institutions in Chisinau municipality: Emergency Medicine Institute (EMI) and Valentin Ignatenco Municipal Children’s Hospital (MCH). A questionnaire was applied, completed on the basis of medical records according to the International Classification of Diseases (ICD) 10 codes. The collection period was August 1-October 31, 2018. Data were uploaded using the existing electronic data collection tool—Red Cap and analyzed through Microsoft Excel. Data collection was performed by a resident neurosurgery and a scientific researcher. The ethics committee’s approval has been obtained. Results: There have been identified 150 patients: 57 cases (38.5%) of TBI among children and 93 cases (61.5%) among adults aged between 18 - 73 years old. A large majority (62%) of head injuries were among patients from the urban area (most in adults—60% and males—74%). The most common mechanisms of head injury were falls (53.3%) and road traffic injuries (24%), followed by assault (14.7%) and struck by/or against (8%). The distributions by place of occurrence highlighted that most injuries occurred at home (33.4%) and in transport area (25.3%). Most head injuries were registered among men 121 (81.2%) with a predominance of minor Glasgow Coma Scale (GCS) (65.1%), followed by moderate GCS (9.4%), while in women all cases with GCS minor (18.8%). Conclusion: The data obtained could be useful for the hospital administration in managing the necessary resources and for conducting information campaigns among the high-risk groups.

Epidemiology of shoulder dislocations presenting to United States emergency departments:An updated ten-year study

BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability.However,there is a paucity of current data available regarding the epidemiological trends of this injury.AIM To provide an updated,comparative assessment of the epidemiology of shoulder dislocations presenting to emergency departments in the United States.We also sought to analyze patient demographic risk factors and consumer products associated with dislocation events.METHODS Data were obtained from the national electronic injury surveillance system database for glenohumeral dislocations between 2012 and 2021.Incidence,age,sex,and injury characteristics were analyzed using weighted population statistics as well as incidence rates and 95%confidence intervals(CI).RESULTS In total,an estimated 773039 shoulder dislocations(CI:640598-905481)presented to emergency rooms across the United States during the study period.The annual incidence rate was 23.96 per 100000 persons and the average patient age at the time of injury was 37.1 years.Significantly more male patients sustained dislocations than female patients(537189,69.5%,vs 235834,30.5%,P<0.001).With regard to associated consumer products,sports and recreation equipment were involved in the highest proportion of incidents(44.31%),followed by home structures and construction materials(21.22%),and home furnishings,fixtures,and accessories(21.21%).Regarding product sub-groups,stairs,ramps,landings,floors was cited in the greatest number of cases(131745).CONCLUSION The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons.Male adolescents sustained the highest proportion of dislocations,with a peak incidence in age group 15-20 years,predominantly secondary to participation in sporting and recreational activities.Conversely,women experienced a relatively consistent incidence of dislocation throughout their lifespan.After age 63,the incidence rate of dislocations in females was found to surpass that observed in males.

Clinical Effect of Intelligent Emergency Nursing Mode in Patients with Severe Traumatic Brain Injury

Objective: Severe traumatic brain injury (sTBI) is one of the common acute and critical diseases in neurosurgery. So we aim to explore the clinical effectiveness of an intelligent emergency care model in patients with severe traumatic brain injury. Methods: Eighty patients with severe traumatic brain injury (sTBI) who were treated in Zhuji People’s Hospital of Zhejiang Province from January 2019 to December 2021 were selected as the study subjects. The patients were divided into an observation group and a control group with 40 patients in each group according to the random number table method. Patients in the control group received conventional first-aid nursing mode intervention, and the intelligent emergency nursing mode was used for the observation group based on the control group. Comparisons were conducted between the two groups on the time of arrival to the emergency room, the time from the emergency room to the operating room, Glasgow Coma Scale (GCS) score before surgery, GCS score when leaving the Intensive Care Unit (ICU), the average length of ICU stay, the average length of hospital stay, the total hospital costs. Results: The time of arrival to the emergency room, the time from the emergency room to the operating room, the average length of ICU stay, the average length of hospital stay, and the total hospital costs in the observation group were significantly lower than those in the control group, and the differences were statistically significant (All P Conclusion: Intelligent emergency nursing mode can shorten the time of sTBI rescue, the length of ICU stay, and the average length of hospital stay, reduce the total hospitalization cost, improve the prognosis, with good efficacy, reduce the total cost of hospitalization, and improve the prognosis with better efficacy.

The Buffering analysis to identify common geographical factors within the vicinity of severe injury related to motor vehicle crash in Malaysia

BACKGROUND:The main objective was to identify common geographical buildup within the100-meter buffer of severely injured based on injury severity score(ISS) among the motor vehicle crash(MVC) victims in Malaysia.METHODS:This was a prospective cohort study from July 2011 until June 2013 and involved all MVC patients attending emergency departments(ED) of two tertiary centers in a district in Malaysia.A set of digital maps was obtained from the Town Planning Unit of the district Municipal Office(local district map).Vector spaces were spanned over these maps using GIS software(ARCGIS 10.1licensed to the study center),and data from the identified severe injured cases based on ISS of 16 or more were added.Buffer analysis was performed and included all events occurring within a 100-meter perimeter around a reference point.RESULTS:A total of 439 cases were recruited over the ten-month data collection period.Fifty two(11%) of the cases were categorized as severe cased based on ISS scoring of 16 and more.Further buffer analysis looking at the buildup areas within the vicinity of the severely injured locations showed that most of the severe injuries occurred at locations on municipal roads(15,29%),straight roads(16,30%) and within villages buildup(suburban) areas(18,35%).CONCLUSION:This study has successfully achieved its objective in identifying common geographical factors and buildup areas within the vicinity of severely injured road traffic cases.

Current pre-hospital traumatic brain injury management in China

BACKGROUND: Traumatic brain injury(TBI) is associated with most trauma-related deaths. Secondary brain injury is the leading cause of in-hospital deaths after traumatic brain injury. By early prevention and slowing of the initial pathophysiological mechanism of secondary brain injury, prehospital service can signifi cantly reduce case-fatality rates of TBI. In China, the incidence of TBI is increasing and the proportion of severe TBI is much higher than that in other countries. The objective of this paper is to review the pre-hospital management of TBI in China.DATA SOURCES: A literature search was conducted in January 2014 using the China National Knowledge Infrastructure(CNKI). Articles on the assessment and treatment of TBI in pre-hospital settings practiced by Chinese doctors were identified. The information on the assessment and treatment of hypoxemia, hypotension, and brain herniation was extracted from the identifi ed articles.RESULTS: Of the 471 articles identified, 65 met the selection criteria. The existing literature indicated that current practices of pre-hospital TBI management in China were sub-optimal and varied considerably across different regions.CONCLUSION: Since pre-hospital care is the weakest part of Chinese emergency care, appropriate training programs on pre-hospital TBI management are urgently needed in China.

Traumatic brain injury:A case-based review

BACKGROUND:Traumatic brain injuries are common and costly to hospital systems.Most of the guidelines on management of traumatic brain injuries are taken from the Brain Trauma Foundation Guidelines.This is a review of the current literature discussing the evolving practice of traumatic brain injury.DATA SOURCES:A literature search using multiple databases was performed for articles published through September 2012 with concentration on meta-analyses,systematic reviews,and randomized controlled trials.RESULTS:The focus of care should be to minimize secondary brain injury by surgically decompressing certain hematomas,maintain systolic blood pressure above 90 mmHg,oxygen saturations above 93%,euthermia,intracranial pressures below 20 mmHg,and cerebral perfusion pressure between 60-80 mmHg.CONCLUSION:Much is still unknown about the management of traumatic brain injury.The current practice guidelines have not yet been sufficiently validated,however equipoise is a major issue when conducting randomized control trials among patients with traumatic brain injury.

Bicycle-related traumatic injuries: a retrospective study during COVID-19 pandemic

BACKGROUND:This study aimed to review bicycle-related injuries during the COVID-19 pandemic to assist with reinforcement or implementation of new policies for injury prevention.METHODS:This is a retrospective descriptive analysis of injuries sustained during cycling for patients 18 years old and above who presented to Singapore General Hospital from January to June 2021.Medical records were reviewed and consolidated.Descriptive analyses were used to summarize patient characteristics,and differences in characteristics subgrouped by triage acuity and discharge status were analyzed.RESULTS:The study included 272 patients with a mean age of 43 years and a male predominance(71.7%).Most presented without referrals(88.2%)and were not conveyed by ambulances(70.6%).Based on acuity category,there were 24(8.8%)Priority 1(P1)patients with 7 trauma activations,174(64.0%)and 74(27.2%)P2 and P3 patients respectively.The most common injuries were fractures(34.2%),followed by superficial abrasion/contusion(29.4%)and laceration/wound(19.1%).Thirteen(4.8%)patients experienced head injury and 85 patients(31.3%)were documented to be wearing a helmet.The majority occurred on the roads as traffic accidents(32.7%).Forty-two patients(15.4%)were admitted with a mean length of stay of 4.1 d and 17(6.3%)undergone surgical procedures.Out of 214(78.7%)discharged patients,no re-attendances or mortality were observed.In the subgroup analysis,higher acuity patients were generally older,with higher proportions of head injuries leading to admission.CONCLUSION:Our study highlights significant morbidities in bicycle-related injuries.There is also a high proportion of fractures in the young healthy male population.Injury prevention is paramount and we propose emphasizing helmet use and road user safety.

Inflammation-related gene expression profiles of salivary extracellular vesicles in patients with head trauma

At present,there is no reliable biomarker for the diagnosis of traumatic brain injury(TBI).Studies have shown that extracellular vesicles released by damaged cells into biological fluids can be used as potential biomarkers for diagnosis of TBI and evaluation of TBI severity.We hypothesize that the genetic profile of salivary extracellular vesicles in patients with head trauma differs from that in uninjured subjects.Findings from this hypothesis would help investigate the severity of TBI.This study included 19 subjects,consisting of seven healthy controls who denied history of head trauma,six patients diagnosed with concussion injury from an outpatient concussion clinic,and six patients with TBI who received treatment in the emergency department within 24 hours after injury.Real-time PCR analysis of salivary extracellular vesicles in participants was performed using TaqMan Human Inflammation array.Gene expression analysis revealed nine upregulated genes in emergency department patients(LOX5,ANXA3,CASP1,IL2RG,ITGAM,ITGB2,LTA4H,MAPK14,and TNFRSF1A)and 13 upregulated genes in concussion clinic patients compared with healthy participants(ADRB1,ADRB2,BDKRB1,HRH1,HRH2,LTB4R2,LTB4R,PTAFR,CYSLTR1,CES1,KLK1,MC2R,and PTGER3).Each patient group had a unique profile.Comparison between groups showed that 15 inflammation-related genes had significant expression change.Our results indicate that inflammation biomarkers can be used for diagnosis of TBI and evaluation of disease severity.This study was approved by the Institutional Review Board on December 18,2015(approval No.0078-12)and on June 9,2016(approval No.4093-16).

基于哈贝马斯交往行为理论的沟通模式在急诊脑外伤患者中的应用

目的探讨基于哈贝马斯交往行为理论的沟通模式在急诊脑外伤患者中的应用效果。方法回顾性分析2021年1月—2022年12月在西安交通大学第一附属医院进行救治的106例脑外伤患者的临床资料,根据护理干预方法不同分为观察组和对照组,每组53例。对照组患者采用常规脑外伤急救护理干预,观察组患者采用基于哈贝马斯交往行为理论的沟通模式进行干预。比较2组患者的确诊时间、手术准备时间、住院时间等急诊救治效果指标及家属护理满意度,同时比较2组患者的神经功能缺损状况、日常生活能力等指标以及并发症发生情况。结果干预前,2组患者美国国立卫生研究院卒中量表(NIHSS)评分比较,差异无统计学意义(P>0.05);干预后,观察组患者的NIHSS评分低于对照组,日常生活能力量表(ADL)评分高于对照组,差异均有统计学意义(P<0.05)。干预前,2组患者神经行为认知状态检查(NCSE)量表及格拉斯哥昏迷评分量表(GCS)评分比较,差异均无统计学意义(P>0.05);干预后,观察组患者的NCSE和GCS评分均高于对照组,差异均有统计学意义(P<0.05)。观察组患者的确诊时间、手术准备时间、住院时间均短于对照组,差异均有统计学意义(P<0.05)。观察组患者家属对护理人员沟通能力、健康宣教水平、操作技能、服务态度4项护理满意度评分均高于对照组,差异均有统计学意义(P<0.05)。观察组与对照组患者术后并发症发生率分别为5.67%和15.09%,差异无统计学意义(χ^(2)=2.536,P=0.111)。结论基于哈贝马斯交往行为理论的沟通模式应用于急诊脑外伤患者护理中,有助于减轻患者神经功能受损程度,改善患者神经认知功能,提升急诊救治效率和家属护理满意度。

Efficacy of new scoring system for diagnosis of abdominal injury after blunt abdominal trauma in patients referred to emergency department

Purpose: The blunt abdominal trauma (BAT) is a common emergency and is significantly associated with morbidity and mortality. Our study was conducted to achieve the goal that a new scoring system could be used for the BAT patients.Methods: The statistical population of this study was 1000 patients with BAT referred to emergency department of Imam Hossein Hospital, Tehran, Iran. Sampling was carried out in a convenience non-random manner and continued to reach the required sample size. All the patients with BAT due to road traffic accidents, falls, and other direct blunt traumas such as punctures and kickbacks were included in the study. Exclusion criteria were after 3 months of pregnancy, under the age of 18, warfarin taking, no reliable medical history providing and penetrating trauma. The study questionnaire was based on BAT scoring system. The data were analyzed by SPSS V20 software. The receiver operating characteristic curve was used to analyze the effectiveness of the new scoring system in predicting the BAT patients’ outcome.Results: The mean age of the patients (n = 1000) was (35.79 ± 13.09) years. The mean score of patients was (6.29 ± 5.80). Based on this scoring system, the patients were divided into three categories. The first group was patients at low risk with score of less than 8, the second group was patients at moderate risk with score of 8-12 and the third group was patients at high risk with score of 12-24. The score of 661 (66.1%) patients were low, 109 (10.9%) were moderate and 230 (23%) had a high score. The association between hip fracture and abdominal tenderness with abdominal injury was significant (p < 0.001). Cronbach’s alpha was 0.76 showing the reliability of this questionnaire to predict the future of patients.Conclusions: The study tool has a sensitivity to predict the BAT patients’ outcome, and has a proper specificity that can be used to reduce the use of harmful modalities such as computed tomography scan.

基于危机管理理念的精细化护理在急诊脑外伤术后患者中的应用效果

目的 探讨基于危机管理理念的精细化护理在急诊脑外伤术后患者中应用效果。方法 选取2022年1月至2023年1月我院收治的100例急诊脑外伤患者作为研究对象,根据护理干预不同将患者分为两组,对照组采用常规急诊护理,研究组采用基于危机管理理念的精细化护理,比较患者术后神经功能、昏迷程度、功能障碍情况、护理质量、护理满意度情况。结果 护理前,两组神经功能评分、昏迷程度评分对比差异无统计学意义(P>0.05)。护理后,研究组神经功能评分低于对照组(P<0.05)。研究组功能障碍发生率低于对照组(P <0.05)。研究组护理质量评分高于对照组低(P<0.05)。研究组护理满意度高于对照组(P<0.05)。结论 基于危机管理理念的精细化护理在急诊脑外伤术后患者中的应用效果显著,患者神经功能得到显著改善,同时昏迷程度较轻,而且功能障碍发生率较少,通过临床精细化护理的开展,护理质量明显提升,得到医护患认可。

损伤控制联合外伤急救在急诊创伤性颅脑损伤中的应用效果

目的探讨急诊创伤性颅脑损伤外伤急救与损伤控制联合干预的效果。方法选取2020年2月至2023年2月厦门大学附属第一医院收治的急诊创伤性颅脑损伤患者100例,依据干预方法分为研究组和对照组各50例。研究组采取院前外伤急救联合院内损伤控制干预,对照组采取常规干预,比较两种患者的治疗效果。结果研究组患者的抢救时间短于单独干预组,D-D、TT、PT、APTT、NLR水平均低于单独干预组,rScO2、PAV、RAGE水平均高于单独干预组,APACHEⅡ评分、ISS评分、DIC评分均低于单独干预组,GCS评分、GOS评分、KPS评分均高于单独干预组,NDS评分、NIHSS评分均低于单独干预组,LOTCA评分、FMA评分、BI评分、SF-36评分均高于单独干预组,总有效率高于单独干预组,并发症发生率低于单独干预组(P值均<0.05)。结论急诊创伤性颅脑损伤外伤急救与损伤控制联合干预的效果较外伤急救单独干预好。

危机理论指导下的创伤急救护理对颅脑外伤患者急救时间、神经功能及生命体征的影响

目的:探讨危机理论指导下的创伤急救护理对颅脑外伤患者急救时间、神经功能和生命体征的影响。方法:选择2020年9月—2023年9月在连云港市中医院接受颅脑外伤急救治疗的102例患者作为研究对象,根据随机数表法将患者分为对照组和观察组,各51例。对照组接受常规急救护理,观察组在对照组基础上接受危机理论指导下的创伤急救护理。比较两组急救时间(有效抢救时间、确诊时间和急诊至手术时间)、神经功能[美国国立卫生研究院脑卒中量表(National Institutes of Health stroke scale,NIHSS)评分和格拉斯哥昏迷指数(Glasgow coma scale,GCS)]、生命体征(呼吸频率、心率、收缩压和舒张压)及并发症(缺血性痉挛、电解质紊乱和肢体功能障碍)发生情况。结果:观察组有效抢救时间、确诊时间、急诊至手术时间短于对照组,差异有统计学意义(P<0.05);观察组护理后NIHSS评分低于对照组,GCS评分高于对照组,差异有统计学意义(P<0.05);观察组护理后呼吸频率、心率、收缩压、舒张压低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:危机理论指导下的创伤急救护理可有效缩短颅脑外伤患者急救时间,改善神经功能和生命体征,降低并发症发生率。

急诊手术应急接诊系统在颅脑创伤急诊手术中的设计与应用

目的构建急诊手术应急接诊系统,探讨其在颅脑创伤急诊手术中的应用效果。方法采用Java、HTML、CSS等开发语言,以IntelliJ IDEA、Java JDK1.8为开发工具,以Java EE分布式微服务架构平台为技术框架构建急诊手术应急接诊系统,实现手术申请、大屏通知、手术前评估、手术患者跟踪、患者转运记录、手术查询、术中语音提醒等功能。选取我院收治的160例颅脑创伤急诊手术患者为研究对象,验证系统的应用效果。结果相较于系统应用前,系统应用后的术前等待时间、手术备皮时间、术前交接时间、术前转运时间、术前评估时间均明显缩短,差异有统计学意义(P<0.001);手术室不良事件发生率从38.75%降低至11.25%,差异有统计学意义(P<0.001);医护人员满意度从75.00%提升至96.88%,差异有统计学意义(P<0.05)。结论通过构建急诊手术应急接诊系统并将其应用于颅脑创伤急诊手术中,可有效提高手术室工作效率,降低手术室不良事件发生率,医护满意度上升,进而提高手术室管理质量,值得进一步在临床推广使用。

医疗失效模式与效应分析在颅脑创伤急诊手术护理风险管理中的应用

目的探讨医疗失效模式与效应分析(HFMEA)在颅脑创伤(TBI)急诊手术护理风险管理中的应用效果。方法以HFMEA模型为理论框架,对TBI急诊手术流程进行分析,并绘制流程图,分析潜在的风险因素。针对高危失效模式采取相应管理方案,其中2022年11月—2023年4月的80例患者接受HFMEA实施前的常规管理(对照组),2023年5—10月的80例患者接受HFMEA实施后的管理(观察组)。比较2组手术效率(术前等待时间、手术准备时间、麻醉诱导时间、术后交接时间)、手术室不良事件发生率(物品准备不全、手术铺巾污染、术中器械不足或不良、护理记录单书写错误、交接信息传递错误或缺项)、围术期并发症发生率(术中低体温、压力性损伤、术中生命体征异常波动、切口感染、肺部感染)以及手术医生对当台护士(巡回护士、器械护士)的满意度。结果观察组术前等待时间、手术准备时间、麻醉诱导时间、术后交接时间均短于对照组,差异有统计学意义(P<0.01)。观察组手术室不良事件发生率为16.25%,低于对照组的46.25%,差异有统计学意义(P<0.01)。观察组并发症发生率为8.75%,低于对照组的26.25%,差异有统计学意义(P<0.01)。观察组手术医生对当台护士满意度高于对照组手术医生,差异有统计学意义(P<0.05)。结论将HFMEA模型应用于TBI急诊手术患者手术护理管理中可有效提高手术效率,降低护理不良事件及并发症发生率,提高手术医生对手术室护士的满意度。

损伤控制联合外伤急救对创伤性颅脑损伤抢救效率及评分改善研究

目的探究分析损伤控制联合外伤急救对急诊创伤性颅脑损伤患者进行抢救所产生的效果.方法随机选取2020年5月至2021年5月莆田市第一医院收治的80例急诊创伤性颅脑损伤患者作为受试者,以数字表法的规则将他们分为对照组和观察组.其中,40例对照组的患者采用常规的外伤急救,40例观察组的患者则在对照组的基础上另外采用损伤控制.比较评估两组患者经过对应模式干预后的抢救效率、神经功能缺损评分(National Institute of Health Stroke Scale,NIHSS)、神经残疾评分(Neurological Disability Score,NDS)以及患者满意度情况.结果观察组干预后的抢救成功率(95.00%)比对照组的(72.50%)高(P<0.05);在NIHSS评分上,与对照组相比,观察组干预后的意识水平、肢体共济运动以及构音障碍的评分均较低(P<0.05);在NDS评分上,通过对比可知,观察组干预后的脑神经、肌无力以及反射与感觉的评分比对照组低(P<0.05);经过干预后,观察组患者的满意度比对照组高(P<0.05).结论应用损伤控制联合外伤急救能够提高急诊创伤性颅脑损伤患者的抢救效率,有助于患者各方面功能的恢复,同时改善了患者的预后结果,增加其对抢救工作的满意度,具有较明显的效果.

Current status and development of traumatic brain injury treatments in China

由于它的高发生，高残疾率，和高死亡率，创伤的大脑损害(TBI ) 形成严肃的威胁到人的健康。这张手稿描述当前在中国的 TBI 治疗存在的迫切问题并且建议一个全国性的合作平台的一个计划让 TBI 的治疗以便在中国改进 TBI 治疗的全面水平，并且在 TBI 病人减少残疾和死亡率。

Traumatic central cord syndrome in a 2-year-old child: minor trauma but major complication

BACKGROUND: Traumatic central cord syndrome(TCCS) is the most frequently encountered incomplete spinal cord injury, and it is a relatively rare situation in children younger than 15 years, but may have serious consequences.METHODS: We report the case of a 2-year-old female child with upper extremity weakness following a simple fall. All vitals and systemic examination findings were normal, except for 2/5 muscular strength in the upper extremities. While radiographic imaging showed no pathologic fi ndings, MRI exposed spinal injury. The patient was treated conservatively with medication only. The medical treatment of the patient consisted of anti-edema treatment with methylprednisolone in the first 24 hours; 330 mg of methylprednisolone infused in the first hour, followed by 59 mg per hour during the next 23 hours. Along with pharmacological treatment, she received physiotherapy sessions during her 11-day hospitalization period.RESULTS: The child had full recovery within 6 months after conservative treatment.CONCLUSION: Neurological deficit without plain radiographic evidence in pediatric spinal trauma patients is a rare but signifi cant incident.

基于急诊实验室指标建立重型颅脑损伤患者早期死亡的临床预测模型

目的基于急诊实验室指标建立重型颅脑损伤(sTBI)患者早期死亡的个体化预警模型。方法回顾性分析2020年1月—2022年6月苏北人民医院急诊路径收治的249例sTBI患者的临床资料。基于患者急诊实验室指标,采用最小绝对收缩和选择算子(LASSO)算法,筛选sTBI早期死亡的最大相关特征,并进一步使用二元Logistic回归模型建立个体化急诊指标列线图。采用决策曲线分析,判断急诊实验室指标及其所构建的列线图的临床价值。结果LASSO算法所保留的急诊实验室预测指标的预测价值为:碱剩余的曲线下面积(AUC)为0.711,血红蛋白的AUC为0.718,凝血酶原时间的AUC为0.754,活化凝血酶原时间的AUC为0.804,纤维蛋白原的AUC为0.656,D-二聚体的AUC为0.804,输注浓缩红细胞的AUC为0.796。由上述7个实验室指标构建的列线图的预测能力高(AUC为0.975)。结论传统急诊实验室指标可实现对sTBI患者死亡的早期预测,由7个急诊实验室指标构建的列线图预测sTBI患者早期死亡的准确性较高。

自动紧急制动对公交车内儿童乘员颅脑损伤影响

目的研究自动紧急制动(autonomous emergency braking,AEB)对公交车内儿童乘员的颅脑损伤影响。方法使用Prescan软件搭建公交车AEB测试场景,通过仿真得到60 km/h初速度下公交车AEB制动工况下的减速度曲线。基于已经验证的公交车模型和具有详细解剖学头部结构的6岁儿童混合有限元模型,选取车内儿童乘员典型的4个乘坐位置,使用LS-DYNA软件对公交车有、无AEB制动工况下儿童乘员头部损伤进行仿真。以儿童乘员头部损伤指标HIC_(15)、大脑灰质处压力、脑组织von Mises应力及剪切应力作为损伤评价指标,对儿童乘员的颅脑损伤进行分析。结果各组仿真试验中,位置1和2前方设置挡板时,儿童乘员大脑灰质处压力超过其损伤阈值,其余各位置儿童乘员的各项损伤指标均远小于对应的损伤阈值。结论AEB能有效降低公交车内儿童乘员头部碰撞损伤,公交车内位置3处的儿童容易发生碰撞损伤风险,位置1、2处设置广告牌挡板会增加儿童乘员的颅脑损伤风险。