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Biomedical subjects

C C Branas

Publications and source records attributed to C C Branas.

At least 19 recordsLinked to original sources
PubMed2006

Determining objective injury prevention priorities.

BACKGROUND AND OBJECTIVE: Finite injury prevention resources make the establishment of prevention priorities essential. Toward this end, the US National Trauma Data Bank (NTDB) for 2000 to 2004 was accessed and four injury prevention priority scores (one previously defined and three new scores) were computed. METHODS: An injury prevention priority score (IPPS) was calculated based on the frequency of an injury mechanism and the median injury severity score. In addition, a mortality priority score (Mort-PS), a hospital charge priority score (Charge-PS), and a years of potential life lost (YPLL-PS) priority score were calculated for the 13 most common injury mechanisms. RESULTS: There was variability across the four scores, but motor vehicle traffic, firearm related, and fall injuries ranked high on all four of the priority criteria. Multiple criteria should be considered when assessing injury burden. CONCLUSIONS: The methods presented here can help prioritize injuries and support more objective public policies.

Health Policy↗
PubMed2004

Racial segregation and county level intentional injury in Pennsylvania: analysis of hospital discharge data for 1997-1999.

STUDY OBJECTIVE: This study examined whether high levels of racial segregation are associated with high county level intentional injury rates. DESIGN: Multiple linear regression was used to assess the association between county racial segregation (measured by the Gini coefficient) and intentional injury rates. Multicollinearity was assessed with Eigenvalues and condition indices. SETTING: State of Pennsylvania. PATIENTS: County level intentional injury rates for 1995 to 1997 were calculated from hospital discharge data. MAIN RESULTS: After controlling for other known county level risk factors, higher levels of racial segregation in a county were significantly related to higher intentional injury rates. Multicollinearity was not a problem. Population size and density, family stability and median income, together with the percentage male, unemployed, in poverty, divorced men, and high school graduates of the county were controlled. CONCLUSIONS: Racial segregation is an important factor in the rate of intentional injury in a community. These results may be important for municipal and state agencies when developing public policies to prevent violence and promote racial integration.

Adult↗
PubMed2001

Helmet laws and motorcycle rider death rates.

We investigated motorcycle rider death rates between states with full motorcycle helmet laws and those without. This was done using both unadjusted bivariate analyses and multivariate random-effects generalized least squares regression models of rider death rates. Multivariate models were adjusted for the competing influences of several explanatory variables, including the existence of a motorcycle helmet law. From 1994 to 1996, states with helmet laws experienced a median death rate of 6.20 riders per 10000 registered motorcycles and states without helmet laws experienced a median death rate of 5.07 riders per 10000 registered motorcycles (P = 0.008). After controlling for other factors that affect motorcycle rider fatalities (most notably population density and temperature), death rates in states with full helmet laws were shown to be lower on average than deaths rates in states without full helmet laws (P = 0.740). Our study weakens the claim that rider death rates are significantly lower in states without full motorcycle helmet laws.

Accidents, Traffic↗
PubMed2001

State helmet laws and motorcycle rider death rates.

Motorcycles are the most dangerous form of motorized transportation. Per vehicle miles traveled, motorcyclists are about 3 times as likely as passenger car occupants to be injured in a crash, and 16 times as likely to die. Because the majority of these deaths are caused by head injury, safety advocates have recommended mandatory use of motorcycle helmets. Others contend that state laws mandating helmet use infringe on motorcyclists' rights, and question whether such laws really reduce motorcycle deaths and injury. Scientific evidence cannot address the appropriate balance between personal freedom and public safety, but it can address the effectiveness of mandatory helmet laws. This Issue Brief summarizes a new analysis of the effects of motorcycle helmet laws on death rates, and points out the need to account for other potential factors when comparing death rates across states.

Accidents, Traffic↗
PubMed2000

A trauma resource allocation model for ambulances and hospitals.

OBJECTIVE: To develop a mathematical model for the location of trauma care resources. DATA SOURCES/STUDY SETTING: Severely injured patients queried from Maryland hospital discharge and vital statistics data. A spatial injury profile was created by parsing these patients into ZIP codes. STUDY DESIGN: The Trauma Resource Allocation Model for Ambulances and Hospitals (TRAMAH) was formulated using integer and heuristic programming. To maximize coverage of severely injured patients, trauma centers and aeromedical depots were simultaneously sited using TRAMAH. A severe injury was considered covered if at least one trauma center was sited within a time standard by ground, or if an aeromedical depot-trauma center pair was sited in such a way that the sum of the flying time from the aeromedical depot to the scene of injury plus the flying time from the scene of injury to the trauma center was within the same time standard. PRINCIPAL FINDINGS: From 1992 to 1994, 26,774 severe injuries were considered for coverage. Across Maryland, 94.8 percent of severely injured residents had access to trauma system resources within 30 minutes and 70.3 percent had access within 15 minutes. For the same number of resources as the existing Maryland Trauma System, TRAMAH achieved a coverage objective of 99.97 percent within 30 minutes. This translated into an additional 461 severely injured people covered each year. Holding in place the trauma centers of the existing system, approximately the same percentage of coverage as that of the existing system was achieved within 15 minutes by optimally locating six fewer aeromedical depots. CONCLUSIONS: TRAMAH will allow trauma systems planners to better locate their resources with respect to spatial needs and response times.

Air Ambulances↗
PubMed2000

To the rescue: optimally locating trauma hospitals and helicopters.

Injury (trauma) is the leading cause of death in the United States for people younger than 45 years of age. Each day, more than 170,000 men, women, and children are injured severely enough to seek medical care. About 400 of these people will die and another 200 will sustain a long-term disability as a result of their injuries. An estimated 20-40% of trauma-related deaths could be prevented if all Americans lived in communities that were served by a well-organized system of trauma care. This Issue Brief describes a new computer model that can help State and regional policymakers decide where to place designated trauma hospitals and helicopter depots to maximize their residents' access to trauma care.

Air Ambulances↗
PubMed1999

Fatal nontraffic injuries involving alcohol: A metaanalysis.

STUDY OBJECTIVE: Estimates of alcohol involvement in fatal injuries vary widely. For injuries other than those involving motor vehicles, no national data exist and the quality of regional data is limited. This study synthesizes US medical examiner studies of nontraffic fatalities for the purpose of estimating alcohol involvement by injury mechanism and intent. METHODS: We reviewed 331 medical examiner studies published between 1975 and 1995 that reported nontraffic injury fatalities. These studies were identified from computerized bibliographic databases and by hand searching of reference lists from 26 review publications and the subject indices of 7 prominent journals. A final total of 65 articles (19.6%) met our inclusion criteria for analysis. National data on motor vehicle fatalities were used for comparison. RESULTS: A total of 7,459 unintentional injury deaths, 28,696 homicide cases, and 19,347 suicide cases were aggregated. The aggregate percentage tested for blood alcohol concentration (BAC) was highest among homicide cases (88.2%), followed by unintentional injury deaths (84.0%) and suicide cases (81.7%). The aggregate percentage determined to be intoxicated (BAC, >/=100 mg/dL) was highest among homicide cases (31.5%), followed by unintentional injury deaths (31.0%) and suicide cases (22.7%). Mean and median comparisons produced comparable findings. Fewer than one quarter of the 65 articles reported gender- and age-specific rates. Inconsistent reporting of gender and age-specific rates in fatal nontraffic injuries prevented their analysis by cause of death. Fatally injured motor vehicle drivers, however, demonstrated distinct variation in alcohol involvement by age and gender. CONCLUSION: This metaanalysis is the first systematic attempt to estimate alcohol involvement in fatal nontraffic injuries at the national level. It demonstrates that alcohol is an important factor in many fatal injuries and that its importance varies by cause of injury.

Accidents↗
PubMed1998

A population-based study of trauma recidivism.

BACKGROUND: Patients with repeat presentations to acute care hospitals for new injuries are trauma recidivists. Prospective identification of those patients at greatest risk will permit focusing of limited hospital prevention resources. METHODS: A population-based analysis of patients with recurrent trauma presenting to all hospitals in Nevada during a 5-year period was conducted. Records of 10,355 presentations representing 10,137 patients were analyzed. RESULTS: Recidivist trauma patients were younger than non-recidivists, with patients aged 20 to 24 years having significantly higher rates of recidivism. Males were 1.53 times more likely than females to become recidivists. Cutting/piercing and machinery-related injuries were most frequently associated with recidivism. Cutting/piercing wound survivors were 7.06 times more likely to be recidivists than were gunshot wound survivors. Recidivists in motor vehicles crashes were 1.92 times less likely to wear seat belts than nonrecidivists. Recidivism was also significantly associated with positive blood alcohol levels and longer initial hospital stays. CONCLUSION: The rate of trauma recidivism in this study was 2.0%. Population-based data can be used to identify cohorts at risk of recidivism.

Adolescent↗
PubMed1997

Shotgun wounds in children. Not just accidents.

OBJECTIVE: To characterize the demographic characteristics of shotgun wounds in children and adolescents across various regions within a state. DESIGN: Retrospective case study. SETTING: Accredited trauma centers in Pennsylvania. PATIENTS: All patients less than 18 years old who sustained shotgun wounds. DATA COLLECTION: Patient data were collected from the Pennsylvania Trauma Systems Foundation statewide trauma registry for January 1987 through December 1994. Data reviewed included age, race, sex, region, nature of injury, assailant, location of incident, length of stay in the hospital and intensive care unit, Injury Severity Score, organs injured, death, and discharge disposition. RESULTS: Over 8 years there were 95 shotgun wounds in patients with a mean +/- SD age of 14.0 +/- 3.7 years; the male-to-female ratio was 5.8:1. The incidence of shotgun wounds in urban areas increased threefold during the second half of the study; the incidence in nonurban regions was unchanged. Eighteen deaths (19%) occurred, 17 (94%) within 24 hours and 10 (56%) because of intracranial injury. Overall, unintentional shotgun wounds were most common (n = 46 [48%]), followed by assaults (n = 37 [39%]) and suicides (n = 8 [8%]). The highest per capita incidence of shotgun wounds occurred in urban areas, typically the result of an assault (n = 30 [73%]). In nonurban areas, shotgun wounds were usually unintentional (n = 36 [67%]); 34 (63%) occurred in the home. In contrast, in urban areas, 26 shotgun wounds (63%) occurred on the street. Overall, 14 fatal shotgun wounds (78%) occurred in the home. Operative intervention was required for 57 patients (60%). Ultimately, 67 patients (71%) were discharged to home. CONCLUSIONS: In urban areas, shotgun wounds are increasing in incidence, often occur on the street, and often result from assault. In nonurban areas, shotgun wounds are usually unintentional, often occur in the home, and are more often lethal than shotgun wounds in urban areas. Multiple-organ injury, surgery, and lengthy hospital stays are common.

Accidents↗
PubMed1997

Geographic variation in serious nonfatal firearm injuries in Pennsylvania.

OBJECTIVE: The purpose of this study was to characterize the geographic epidemiology of serious nonfatal firearm injuries (NFFI) within Pennsylvania during a 6-year period. METHODS: A historical review of data from the Pennsylvania Trauma System Foundation trauma registry was completed using county-level data. Based on a format adapted from the United States Department of Agriculture, NFFI in Pennsylvania were classified by their county of occurrence: central city counties, metropolitan counties, nonmetropolitan counties, or rural counties. Population-based rates of NFFI were then calculated, as were NFFI as a proportion of the number of injuries within each region. These rates were stratified by intent of injury, scene of injury, and type of firearm. RESULTS: A total of 100,703 trauma cases were reported to the Pennsylvania Trauma System Foundation from 1988 through 1993, of which 5,847 were serious NFFI. Nonfatal firearm assaults increased from rural counties to central city counties, whereas unintentional NFFI decreased (p < 0.05). A 225% increase in the number of NFFI, from 445 cases in 1988 to 1,004 cases in 1993, was noted in the central city counties. Comparatively, the increase in the noncity regions was 145%, from 182 cases in 1988 to 263 in 1993. Nonfatal firearm injuries occurred most often at home in noncity counties (rural, nonmetropolitan, and metropolitan counties) (47.9%). This is in contrast to central city counties, where NFFI occurred significantly more often in the street (53.5%) (p < 0.05). Handgun NFFI increased, whereas rifle NFFI decreased, from rural counties to central city counties (p < 0.05). Relative to population size, the risk of shotgun injuries was greatest in central city counties and lowest in rural counties. Shotgun injuries also accounted for a significantly longer hospital stay (15.06 days) compared with handgun injuries (10.38 days) and rifle injuries (11.81 days) (p < 0.05). CONCLUSION: Significant variation in NFFI was observed across population-based regions in Pennsylvania. Rural areas demonstrated relatively high risks of NFFI committed unintentionally, in the home, and with rifles. As regional populations increase, relatively high risks of NFFI, committed as assaults, in the street, and by handguns, are highlighted. Although handguns were the most prominent firearm associated with NFFI, nonfatal shotgun injuries produced substantially longer hospital stays and may be an underappreciated cause of nonfatal firearm assaults in the urban setting.

Humans↗
PubMed1996

A correlation of air plethysmography and color-flow-assisted duplex scanning in the quantification of chronic venous insufficiency.

PURPOSE: Air plethysmography has been useful in assessing patients who have chronic venous insufficiency. Limb reflux times determined by color-flow-assisted duplex scanning have been shown to correlate with the severity of chronic venous insufficiency. The purpose of this study was to compare air plethysmographic measurements with reflux times obtained by color-flow-assisted duplex scanning in patients with chronic venous insufficiency. METHODS: One hundred twenty-two limbs in 61 consecutive patients with various stages of chronic venous insufficiency were evaluated; air plethysmographic and color-flow-assisted duplex scans were performed at the same sitting. Fifty-nine of the patients had venous ulceration. Values obtained by air plethysmographic scans included venous filling index, ejection volume, residual volume, ejection fraction, and residual volume fraction. Color-flow-assisted duplex scan values included reflux times in the deep and superficial venous segments and total and mean limb reflux times. RESULTS: Using the Pearson correlation, the venous filling index was found to correlate significantly with total limb venous reflux times, mean total limb reflux times, and venous reflux times in the deep venous system, as determined by color-flow-assisted duplex scans (p < 0.001). CONCLUSIONS: Limb reflux time as determined by color-flow-assisted duplex scans correlated significantly with the air plethysmographic variable accepted as a measure of the severity of venous reflux, the venous filling index. This study confirms the validity of total limb reflux times in the quantification of chronic venous insufficiency.

Adult↗
PubMed1995

Urban trauma transport of assaulted patients using nonmedical personnel.

OBJECTIVE: To describe one urban trauma transport system to clarify the impact of transport by nonmedical personnel on patient outcome. METHODS: Retrospective data were assembled over a six-year period through the use of the state trauma registry for an urban county served by seven state-accredited trauma centers. A subset of 4,767 consecutive assaulted patients was analyzed using the TRISS method to estimate survival probability. An unexpected death index (UDI), calculated as the difference between expected (TRISS method) and observed death rates, also was determined. Outcomes for patients transported by fire medics (FMs) vs nonmedical, police personnel (NPs) were compared. RESULTS: FMs transported 2,108 (44%) and NPs transported 1,356 (29%) of the injured assault victims. The FM-transported patients had a lower expected probability of survival than had the NP-transported patients (p < 0.001). This also was true within the penetrating-injury subgroup (p < 0.001), but not the blunt-injury subgroup. The observed death rate was higher for all the FM-transported patients than it was for the NP-transported patients (15% vs 11%; p < 0.01). The UDIs were not different overall, although the NP-transported patients who had blunt trauma had a significantly lower UDI (p < 0.01). CONCLUSIONS: NP transport of assaulted patients is generally associated with equivalent outcomes in comparison with FM transport in this urban environment. However, these data also provide evidence of an on-scene implicit triage with more severely injured patients generally transported by FMs.

Adolescent↗
PubMed1995

Fatal venous air embolism after removal of a central venous catheter.

Venous air embolism is an infrequent, but potentially disastrous, occurrence after the insertion or removal of central venous catheters. The authors describe fatal venous air embolism after removal of a central venous catheter in a 43-year-old man recovering from coronary artery bypass surgery. They discuss the pathophysiology, diagnosis, treatment, and prevention. Several practical considerations are necessary to prevent this complication of central venous catheterization, a procedure commonly delegated to junior house officers.

Adult↗
PubMed1994

Examination of carotid arteries with quantitative color Doppler flow imaging.

The results of conventional duplex scanning were compared with QCDFI. A total of 224 consecutive patients comprising 442 unilateral carotid systems were examined by conventional duplex techniques. MPSV, as determined by QCDFI, were recorded for each of the 442 carotid segments and grouped according to the previously determined degrees of stenosis. The predictive value of QCDFI was confirmed by angiography with an overall accuracy of 91%. Results obtained by duplex scanning correlated with angiography 89% of the time. Based on QCDFI data, a scale to grade carotid stenosis was developed.

Aged↗
PubMed1993

Distribution and quantification of venous reflux in lower extremity chronic venous stasis disease with duplex scanning.

PURPOSE: The purpose of this study was to use color-flow duplex scanning to identify the anatomic distribution of venous reflux and to quantify venous reflux times in patients with various stages of chronic venous insufficiency (CVI). METHODS: Color-flow-assisted duplex scanning was used to identify the anatomic distribution of venous reflux and to quantify reflux times in the deep and superficial venous systems of patients with symptomatic (CVI). Two hundred two patients with class I to III CVI were examined. RESULTS: Only 11% (22 patients) had a documented history of phlebothrombosis. Of the 403 limbs evaluated, 192 had venous ulcers whereas 211 were classified as having class I or II CVI. Nonocclusive venous obstruction was found in only 16 limbs (4%). Venous ulceration was significantly associated with reflux in multiple venous segments as opposed to reflux in isolated venous segments (p < 0.001). Total limb reflux time (Rt) was determined by summing the reflux times of all the venous segments in a limb. The mean Rt of patients with venous ulcerations was significantly longer than the mean Rt of limbs with class I and II CVI (p < 0.01). A total limb reflux time of greater than 9.66 seconds was predictive of ulceration. Total limb deep segment reflux time and total limb superficial segment reflux time were also determined by summing the reflux times of the appropriate segments in the limb. The mean deep segment reflux time was prolonged in limbs with venous ulcers when compared with limbs with class I and II CVI disease. The mean superficial segment reflux time of limbs with class I and II CVI and limbs with venous ulcers could not be used to distinguish between the two groups. In assessing the contribution of segments of the deep system to ulceration, reflux times of different segments were compared with wound duration and area. Reflux in the common femoral vein was significantly associated with wound area and duration (p < 0.05) whereas reflux time in the distal posterior tibial vein was associated with wound duration (p < 0.05).

Adult↗
PubMed1993

Neuroleptic malignant syndrome in the intensive care unit.

The authors describe the postoperative course of a 43-year-old man. Haloperidol was administered for agitation while the patient was in the intensive care unit. After administration of this drug, neuroleptic malignant syndrome developed. The authors review the literature as it relates to the use of haloperidol and the associated adverse effect of neuroleptic malignant syndrome. This report of a case demonstrating haloperidol's potential toxicity is intended to increase awareness within the critical care community and thereby prompt early diagnosis and aggressive management to prevent haloperidol-associated morbidity and mortality.

Adult↗