Biomedical subjects

Arie B van Vugt

Publications and source records attributed to Arie B van Vugt.

13 recordsLinked to original sources

PubMed2006

Impact of additional extracranial injuries on outcome after mild traumatic brain injury.

Many patients with mild traumatic brain injury (MTBI) concurrently sustain extracranial injuries; however, little is known about the impact of these additional injuries on outcome. We assessed the impact of additional injuries on the severity of postconcussional symptoms (PCS) and functional outcome 6 months post-injury. A questionnaire (including the Rivermead Post-Concussion Questionnaire and SF-36) was sent to consecutive MTBI patients (hospital admission Glasgow Coma Score 13-15; age range 18-60 years) admitted to the emergency department of a level-I trauma center, and, to serve as a baseline for PCS, a control group of minor-injury patients (ankle or wrist distortion). Of the 299 MTBI respondents (response rate 52%), 89 had suffered additional injuries (mean Injury Severity Score [ISS] of 14.5 +/- 7.4). After 6 months, 44% of the patients with additional injuries were still in some form of treatment, compared to 14% of patients with isolated MTBI and 5% of the controls. Compared to patients with isolated injury, MTBI patients with additional injuries had resumed work less frequently and reported more limitations in physical functioning. Overall, they did not report higher levels of PCS, despite somewhat more severe head injury. Regardless of the presence of additional injuries, patients that were still in treatment reported significantly more severe PCS, with highest rates in patients with isolated MTBI. In conclusion, many patients with additional extracranial injuries are still in the process of recovery at 6 months after injury. However, despite more severe impact to the head and inferior functional outcomes, these patients do not report more severe PCS.

Adult↗

PubMed2006

Emergency department patient characteristics: Potential impact on emergency medicine residency programs in the Netherlands.

OBJECTIVES: We set out to study emergency department patient characteristics at a busy level-2 trauma center, to gain insight into the practise of emergency medicine, which is not yet recognized as a specialty in the Netherlands. METHODS: From May 27 to July 4 2001, the following data were recorded from the charts of all patients presenting to the emergency department: age, time and form of presentation, diagnostics, treatment, disposition and the single best diagnosis (International Classification of Disease-10 classification). RESULTS: The majority (84%) of the 5234 patients (134/day) patients seen were self-referred and treated by the emergency department physician. The remaining 16% were referred, usually by their general practitioner, directly to a specialty service, which saw them in the emergency department. Self-referred patients tended to be younger (average 33 years), with minor trauma, and infrequently required diagnostics (37%), treatment (49%) or admission (4%). The referred patients were older (average 50 years), with 41% needing admission. Only 16% of all patients were under 16 years of age. In all, there were five deaths (referred patients), 12 resuscitations, seven intubations, seven chest tube insertions and no lumbar punctures performed during the study period. CONCLUSION: The acuity of self-referred patients seen by the emergency physicians is low, with little diagnostic testing and few interventions and resuscitations, even in a busy center. This has both training and practise implications and it may be inappropriate to take an emergency medicine practise model or curriculum from another country based on its emergency department population.

Adolescent↗

PubMed2005

Comparison of current injury scales for survival chance estimation: an evaluation comparing the predictive performance of the ISS, NISS, and AP scores in a Dutch local trauma registration.

BACKGROUND: Prediction of survival chances for trauma patients is a basic requirement for evaluation of trauma care. The current methods are the Trauma and Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOT). Scales for scoring injury severity are part of these methods. This study compared three injury scales, the Injury Severity Score (ISS), the New ISS (NISS), and the Anatomic Profile (AP), in three otherwise identical predictive models. METHODS: Records of the Rotterdam Trauma Center were analyzed using logistic regression. The variables used in the models were age (as a linear variable), the corrected Revised Trauma Score (RTS), a denominator for blunt or penetrating trauma, and one of the three injury scales. The original TRISS and ASCOT models also were evaluated. The resulting models were compared in terms of their discriminative power, as indicated by the receiver-operator characteristic (ROC), and calibration (Hosmer-Lemeshow [HL]) for the entire range of injury severity. RESULTS: For this study, 1,102 patients, with an average ISS of 15, met the inclusion criteria. The TRISS and ASCOT models, using original coefficients, showed excellent discriminative power (ROC, 0.94 and 0.96, respectively), but insufficient fits (HL, p = 0.001 and p = 0.03, respectively). The three fitted models also had excellent discriminative abilities (ROC, 0.95, 0.97, and 0.96, respectively). The custom ISS model was unable to fit the entire range of survival chances sufficiently (p = 0.01). Models using the NISS and AP scales provided adequate fits to the actual survival chances of the population (HL, 0.32 and 0.12, respectively). CONCLUSIONS: The AP and NISS scores particularly both managed to outperform the ISS score in correctly predicting survival chances among a Dutch trauma population. Trauma registries stratifying injuries by the ISS score should evaluate the use of the NISS and AP scores.

Adolescent↗

PubMed2005

Cyclic loading of sacroiliac screws in Tile C pelvic fractures.

BACKGROUND: To investigate the stiffness and strength of completely unstable pelvic fractures fixated both anteriorly and posteriorly under cyclic loading conditions, the authors conducted a randomized, comparative, cadaveric study. METHODS: In 12 specimens, a Tile C1 pelvic fracture was created. The authors compared the intact situation to anterior plate fixation combined with one or two sacroiliac screws. In 2,000 measurements, each pelvis was loaded with a maximum of 400 N. The translation and rotation stiffness of the fixations were measured using a three-dimensional video system. Furthermore, the load to failure and the number of cycles before failure were determined. RESULTS: Both translation and rotation stiffness of the intact pelvis were superior to the fixated pelvis. No difference in stiffness was found between the techniques with one or two sacroiliac screws. However, a significantly higher load to failure and significantly more loading cycles before failure could be achieved using two sacroiliac screws compared with one screw. CONCLUSION: Although the combination of anterior plate fixation combined with two sacroiliac screws is not as stable as the intact pelvis, in this study, embalmed aged pelves could be loaded repeatedly with physiologic forces. Given the fact that the average trauma patient is younger and given the fact that the quality (or grip) of the fixation was a significant covariable for longer endurance of the fixation, this suggests that direct postoperative weight bearing could be possible if these results are confirmed in further research.

Bone Screws↗

PubMed2005

Acute ankle trauma: value of a short dedicated extremity MR imaging examination in prediction of need for treatment.

PURPOSE: To assess predictive value of a short magnetic resonance (MR) imaging examination with or instead of radiography performed in patients with acute ankle trauma to identify those who require additional treatment versus those who do not and can be discharged without further follow-up. MATERIALS AND METHODS: Informed consent was obtained from all participating patients, and the institutional review board approved the randomized controlled trial and use of data to create prediction models. In a prospective controlled trial, 197 patients with recent ankle trauma (92 women, 105 men) were randomized into two groups: those who underwent radiography and those who underwent a combination of radiography and MR imaging. Data about side of injury, trauma mechanism, and results of radiography and MR imaging were collected. Additional treatment was necessary in 109 of 197 patients after their initial hospital visit. With univariable and multivariable regression analysis, four models were created for prediction of treatment. RESULTS: In univariable analysis, age (odds ratio [OR], 1.02; 95% confidence interval: 1.00, 1.04), radiographic results (OR, 7.92; 95% confidence interval: 3.17, 19.8), and positive or uncertain results in patients who underwent MR imaging versus patients who did not (OR, 2.42; 95% confidence interval: 1.25, 4.70) were predictive of treatment. In the multivariable analysis, positive or uncertain MR imaging results (OR, 2.61; 95% confidence interval: 1.28, 5.30) contributed significantly to prediction of subsequent treatment. Negative MR imaging results did not contribute significantly (OR, 0.66; 95% confidence interval: 0.27, 1.61). CONCLUSION: A limited MR imaging examination in initial evaluation of acute ankle injury with radiography has additional predictive value in identification of patients who need treatment but does not add significant information in identification of those who can be discharged without further follow-up. A limited MR imaging examination cannot replace radiography for prediction of need for additional treatment.

Adult↗

PubMed2005

Acute knee trauma: value of a short dedicated extremity MR imaging examination for prediction of subsequent treatment.

PURPOSE: To assess the predictive value of a short magnetic resonance (MR) imaging examination, in addition to or instead of radiography, performed in patients with acute knee trauma to identify those who require additional treatment versus those who do not and can be discharged without further follow-up. MATERIALS AND METHODS: The randomized controlled trial and use of collected data for prediction modeling were approved by the institutional review board; informed consent was obtained. Patients with recent knee injury were included in the trial if radiography was ordered. They were randomized into a group undergoing only radiography and a group undergoing radiography plus immediate MR imaging. A 0.2-T dedicated extremity MR imager and four short pulse sequences were used. Univariable and multivariable logistic regression analysis was used to evaluate patient characteristics, trauma mechanism, and findings at radiography and MR imaging for their value in prediction of need for subsequent treatment within the 6-month follow-up. RESULTS: Data in 189 patients (123 male patients, 66 female patients; mean age, 33.4 years), 109 of whom underwent treatment after their initial visit, were analyzed. Age of 30 years or older, indirect trauma mechanism, radiographic results, and MR imaging results were significant predictors of need for treatment in univariable and multivariable analyses (P < .05). In the multivariable analysis, only abnormal MR imaging results were significantly predictive of need for treatment, and only when MR imaging replaced radiography (odds ratio, 2.61; 95% confidence interval: 1.12, 6.06). CONCLUSION: Implementation of a dedicated extremity MR imaging examination, in addition to or instead of radiography, performed in patients with traumatic knee injury improves prediction of the need for additional treatment but does not significantly aid in identification of patients who can be discharged without further follow-up. Value of a short MR imaging examination in the initial stage after knee trauma is limited.

Adult↗

PubMed2005

Acute wrist trauma: value of a short dedicated extremity MR imaging examination in prediction of need for treatment.

PURPOSE: To assess predictive value of a short magnetic resonance (MR) imaging examination in addition to or instead of radiography in patients with acute wrist trauma to identify patients who require additional treatment versus those who do not and can be discharged without further follow-up. MATERIALS AND METHODS: Informed consent was obtained from all participating patients; the institutional review board approved the randomized controlled trial and use of data to create prediction models. Of 90 patients (37 female, 53 male; mean age, 40.0 years), 87 with acute wrist trauma were randomized to undergo radiography (n = 43) or radiography and a short MR imaging examination with low-field-strength dedicated extremity MR system (n = 44). Age, sex, trauma mechanism, presence of tenderness of the anatomic snuffbox, radiographic results, MR imaging results, and treatment data were collected. Univariable and multivariable logistic regression analysis was used to create four models for prediction of treatment need. RESULTS: Thirty-six patients had one or more fractures; one patient had a marked soft-tissue lesion. In univariable analysis, age (odds ratio, 1.02; 95% confidence interval: 1.00, 1.05), anatomic snuffbox tenderness (odds ratio, 2.31; 95% confidence interval: 0.90, 5.96), radiographic results (odds ratio, 31.2; 95% confidence interval: 8.90, 109), and positive MR imaging results versus MR imaging not performed (odds ratio, 1.86; 95% confidence interval: 0.57, 6.06) were significantly predictive of treatment need. In multivariable analysis, radiographic results (odds ratio, 24.7; 95% confidence interval: 6.59, 93.1) and positive MR imaging results (odds ratio, 6.28; 95% confidence interval: 1.27, 31.0) were significantly predictive of treatment need. Negative MR imaging results were not significantly predictive (odds ratio, 0.87; 95% confidence interval: 0.20, 3.82). CONCLUSION: A short MR imaging examination with a low-field-strength MR imaging system following radiography in initial evaluation of patients with acute wrist trauma has additional value in prediction of treatment need; it does not have value in identification of patients who can be discharged without further follow-up.

Adolescent↗

PubMed2005

Acute peripheral joint injury: cost and effectiveness of low-field-strength MR imaging--results of randomized controlled trial.

PURPOSE: To assess prospectively if a short imaging examination performed with low-field-strength dedicated magnetic resonance (MR) imaging in addition to radiography is effective and cost saving compared with the current diagnostic imaging strategy (radiography alone) in patients with recent acute traumatic injury of the wrist, knee, or ankle. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. Patients with recent trauma of the wrist, knee, or ankle were randomized across two diagnostic strategies: radiography alone (reference group) or radiography followed by a short MR imaging examination (intervention group). Measures of effectiveness included the number of additional diagnostic procedures, time to last diagnostic procedure, and number of days absent from work. Measures of effectiveness were analyzed by using an exact Wilcoxon-Mann-Whitney test. Time to convalescence and quality of life were analyzed by using a t test. Cost analysis was performed from a societal perspective and analyzed by using a t test. RESULTS: Five hundred patients (207 women, 293 men; mean age, 34.8 years) with acute injury of the wrist, knee, or ankle were randomized. In the intervention group, quality of life for patients with knee injuries was significantly higher during the first 6 weeks, and time to completion of diagnostic work-up was significantly shorter (mean, 3.5 days for intervention group vs 17.3 days for reference group). The number of additional diagnostic procedures was significantly lower in the intervention group versus the reference group (nine vs 35, respectively) for patients with knee injuries. Patients with knee injuries showed the largest difference in costs (intervention group, 1820 [$1966]; reference group, 2231 [$2409]) owing to a reduction in productivity loss. Costs were higher in patients with wrist injuries and almost equal in patients with ankle injuries. All cost differences, however, were not significant. CONCLUSION: Compared with radiography, MR imaging in patients with acute wrist or ankle injuries is neither cost saving nor effective in expediting diagnostic work-up or improving quality of life. In patients with knee injuries, a short MR imaging examination shortens the time to completion of diagnostic work-up, reduces the number of additional diagnostic procedures, improves quality of life in the first 6 weeks, and may reduce costs associated with lost productivity.

Adult↗

PubMed2004

Triple pelvic ring fixation in patients with severe pregnancy-related low back and pelvic pain.

STUDY DESIGN: Single-group prospective follow-up study. OBJECTIVES: To assess the functional outcome of internal fixation of the pelvic ring in patients with severe pregnancy-related low back and pelvic pain (PLBP) in whom all other treatments failed. BACKGROUND DATA: More than half of all pregnant women experience PLBP. In most cases, the pain disappears after childbirth. In some, however, the pain becomes chronic and patients may be wheelchair-bound or bedridden. After failure of all conservative treatment, surgical fixation of the pelvic ring seems to be the only remaining option for those severe cases. MATERIALS AND METHODS: The postsurgical functional outcome of 58 severe PLBP patients was evaluated with the Majeed score and endurance of walking, sitting, and standing. Inclusion criteria were serious disability and failure of all conservative treatment. The surgical technique consisted of a symphysiodesis and bilateral percutaneous placement of two sacroiliac screws under fluoroscopic guidance. RESULTS: With a follow-up of an average of 2.1 years, the difference between preoperative and postoperative Majeed score indicated that an improvement of more than 10 points was achieved in 69.8% and 89.3% of the patients at 12 and 24 months, respectively. The most important complications were irritation of nerve roots (8.6%), nonunion of the symphysis (15.5%), failure of the symphyseal plate (3.4%), and pulmonary embolism (1.7%). CONCLUSIONS: In this preliminary study, surgical fixation of the pelvic ring yielded satisfactory results in severe PLBP patients in terms of pain relief and improvement in ADL functions. These results should be confirmed in a randomized clinical trial.

Adult↗

PubMed2004

Computer-assisted versus conventional surgery for insertion of 96 cannulated iliosacral screws in patients with postpartum pelvic pain.

BACKGROUND: The purpose of this study was to assess the value of fluoroscopy-based computer-assisted surgery (CAS) for the insertion of iliosacral screws. The results of CAS were compared with the results of a conventionally operated prospective control group. Endpoints of this study were fluoroscopy time, guide wire insertion time, operation time and complication rate. METHODS: The study group consisted of 24 patients with postpartum pelvic pain syndrome. All patients were treated with a stabilization of the pelvic ring by means of an anterior plate fixation and autologous tricortical bone graft as well as two iliosacral screws bilaterally. Consequently, the results of 48 versus 48 iliosacral screw fixations could be evaluated. Conventionally operated patients were turned from the supine to the prone position intraoperatively, whereas CAS operated patients were operated in the supine position. One surgeon performed all operations. RESULTS: The fluoroscopy time in the CAS group was 0.7 minutes versus 1.8 minutes in the conventionally treated group (p < 0.01). The mean insertion time for four guide wires was 20.2 minutes in the CAS versus 19.4 minutes in the conventionally operated group (p = 0.6). The mean operation time in the CAS group was 97 minutes; 116 minutes in the conventional group (p = 0.03). In the CAS group one patient had pain and a sensory deficit of S2 postoperatively. The Fisher's exact test showed no difference in complication rate between the two groups (p = 0.26). CONCLUSIONS: The fluoroscopy time is decreased with a factor 2.5 using CAS. Guide wire insertion time was similar in both groups. The reduction in operation time using CAS was due to fact that patients were operated in the supine position during the whole procedure. This study shows that CAS is a save technique for insertion of iliosacral screws.

Adult↗

PubMed2003

Trauma resuscitation time.

Documenting the timing and organisation of trauma resuscitation can be utilised to assess performance standards, and to ensure a high quality of trauma resuscitation procedures. Since there is no European literature available on trauma resuscitation time (TRT) in the emergency room, the aim of this descriptive study is to evaluate TRT in the Netherlands. The introduction of an ATLS-trained prehospital mobile medical team (MMT) in the Nijmegen area initiated the on-site advanced trauma life-support for the prehospital management of trauma patients. We studied TRT in two groups of patients, one with, the other without on-site care by a MMT. In the emergency room the use of videotape recording was chosen to document trauma resuscitation (22 actions) and TRT. A specially flow-chart was used to define the TRT-procedures. We studied 43 patients; 27 without MMT treatment and 16 with MMT treatment. The activities were divided into the ABCDE's of trauma care. Significant more patients of the MMT group were intubated before arrival in the hospital (12/16 (75%) versus 2/27 (2%), P<0.05). Eleven definitive airway management interventions (intubation) and one thoracic drainage in the non-MMT group were demanded by the protocol, but not performed before arrival in the hospital. Sixteen out of 22 actions that were documented were carried out at an earlier stage in the MMT group. There was no significant difference between the resuscitation times; in both groups the recorded median time was approximately 43 min. This prospective analysis demonstrates the timing of resuscitation procedures in a resuscitation room and provides some insight into the timing of ATLS initial assessment.

Adult↗

PubMed2003

Sacroiliac screw fixation for tile B fractures.

BACKGROUND: The purpose of this comparative cadaveric study was to investigate whether the stability of partially unstable pelvic fractures can be improved by combining plate fixation of the symphysis with a posterior sacroiliac screw. METHODS: In six specimens, a Tile B1 (open-book) pelvic fracture was created. We compared the intact situation with isolated anterior plate fixation and plate with sacroiliac screw fixation. Using a three-dimensional video system, we measured the translation and rotation stiffness of the fixations and the load to failure. RESULTS: Neither absolute displacements at the os pubis or at the sacroiliac joint nor stiffness of the ilium with respect to the sacrum were significantly different for the techniques with or without sacroiliac screw or the intact situation. Load to failure was reached in only one of the six cases. In all other cases, the fixation of the pelvis to the frame failed before failure of the fixation itself. In these cases, a load of approximately 1,000 N or more could be applied. CONCLUSION: The addition of a sacroiliac screw in a Tile B1 fracture does not provide significant additional stability. Although cyclic loading was not tested, in these experiments forces could be applied that were similar to full body weight. Clinical experiments into direct postoperative weight bearing are recommended to examine the clinical situation.

Aged↗

PubMed2002

Fluoroscopic positioning of sacroiliac screws in 88 patients.

BACKGROUND: Fluoroscopic placement of guided sacroiliac screws is a well-established method of fixation of the posterior pelvic ring, leading to biomechanical results similar to an intact pelvic ring. The main problem remains the risk of neurologic injury resulting from the penetration of the intervertebral root or the vertebral canal. METHODS: Eighty-eight patients in whom the posterior pelvic ring was stabilized for several indications were reviewed retrospectively. On perioperative and direct postoperative radiographs and postoperative computed tomographic (CT) scans, positioning was scored for 285 screws and compared with clinical results. RESULTS: Depending on the type of imaging (radiography or CT scan), only 2.1% to 6.8% of the screws showed malpositioning. In several cases, the malpositioned screws did not cause any complaints. Postoperative radiographs did not show any additional value above perioperative radiographs in predicting malpositioning. Seven of 88 patients had neurologic complaints and underwent reoperation. All complaints resolved completely, and no permanent neurologic damage occurred. Positioning both sacroiliac screws in the first vertebral body had a significantly lower rate of neurologic complaints compared with the lower screw in the second vertebral body. CT scanning was able to predict neurologic complaints most accurately. CONCLUSION: Percutaneous sacroiliac screws can be positioned safely, in experienced hands, using perioperative fluoroscopic techniques. A position in the first vertebral body had a significantly lower incidence of neurologic injury compared with a position in the second. In case of postoperative neurologic deficit, only CT scan can predict the clinical outcome. Further research toward improving the perioperative imaging technique must be undertaken.

Adolescent↗