Biomedical subjects

E J MacKenzie

Publications and source records attributed to E J MacKenzie.

70 records · Page 4Linked to original sources

PubMed1988

Functional recovery and medical costs of trauma: an analysis by type and severity of injury.

This study was designed to delineate the factors that influence the extent and rate of recovery as related to the characteristics and duration of functional limitations resulting from trauma. The study population was 597 surviving trauma patients aged 16-45 years from two trauma centers in a single state system which follow similar care protocols, and included patients with extremity, abdomen, thorax, brain, and spinal cord injuries. Of 479 trauma patients (80% of the total) who were followed for a full year, 57% had no activity restrictions, 16% had some limitation with either a major or minor physical activity, but did not have any difficulty with mobility or self care, and 27% were limited in either mobility or one of the five basic self-care activities. Further analyses show that of the 262 individuals who were working full-time before the injury, 57% had actually returned to full-time employment within the year. Factors in addition to type and severity of trauma that influence return to work were higher educational level, white collar employment, higher preinjury income, and the presence of supportive individuals among family or friends. Recovery as defined by functional status and return to full-time work is analyzed by body region and severity of the principal injury sustained.

Activities of Daily Living↗

PubMed1987

Factors influencing return to work following hospitalization for traumatic injury.

This paper describes the employment experience of 266 individuals one year after traumatic injury severe enough to require hospitalization. Of those working full-time prior to their injury, 56 per cent were employed full-time at one year; an additional 5 per cent were working part-time. Those sustaining a severe head or spinal cord injury were at highest risk of not returning to work (only 43 per cent and 21 per cent, respectively, had returned within the year). Low one-year employment rates (58 per cent) were also noted for individuals whose most severe injury was to one or more extremities. The extent and rate of return to work was examined in relation to selected socioeconomic and personal characteristics. Findings indicate that after controlling for type and severity of injury, personal income, and educational level of the injured person, as well as the identification of a strong social network as defined by the presence of one or more confidants, were important correlates of post-injury employment status.

Adolescent↗

PubMed1986

Predicting posttrauma functional disability for individuals without severe brain injury.

The utility of the Abbreviated Injury Scale (AIS), the most widely used anatomic scale for rating severity of injuries, and its derivative for assessing the combined effect of multiple injuries, the Injury Severity Score (ISS), were tested for their ability to predict functional disability at time of discharge from the hospital and 6 months after discharge. The ISS has been shown to correlate well with mortality and length of stay, but the relationship to levels of subsequent disability has not been examined. Five hundred and ninety-seven patients (aged 16-45 years) were interviewed at time of discharge and 6 months after discharge to ascertain functional disability along three dimensions: activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility. The authors report on the relationship between severity and functional disability at time of discharge and 6 months after discharge for a subset of 473 patients who did not suffer a severe brain injury. The results show that the relationship between ISS and status at discharge and 6 months after discharge is not monotonically increasing, as it is with mortality and length of stay (LOS). Rather, the proportion of people with severe injuries who report limitations is lower than for those with moderately severe injuries as defined by the ISS. Further, it is shown that the AIS of the most severe extremity and spinal cord injury carry considerably more weight when predicting functional status at discharge and 6 months after discharge than do the AIS scores of injuries to any other body region, although the relative explanatory power of each type of injury varies with the nature of the functional disability and the time interval between the initial insult and assessment.

Activities of Daily Living↗

PubMed1985

Placement accuracy of percutaneous transthoracic pacemakers.

Experience has shown that the frequency of electrical capture of the heart with percutaneous transthoracic pacemakers is disappointingly low. The authors sought to determine whether the accuracy of ventricular placement could help to explain this observation. Six approaches were used in each of twenty adult patients who were examined at autopsy. Three parasternal approaches used the fifth intercostal space (5ICS). One pacing wire was inserted immediately to the left of the sternum along the parasternal line (5ICS-PS), one wire was inserted 4.0 cm to the left of the midsternal line (5ICS-4), and the third wire was inserted 6.0 cm to the left of the midsternal line (5ICS-6). All parasternal needle insertions were directed medially, dorsally, and cephalad toward the second right costrochondral junction at an angle of 30 degrees to the skin. Three subxiphoid approaches were performed through the left xyphocostal notch at an angle of 30 degrees to the skin. One pacing wire was directed toward the right shoulder (SXRS), one toward the sternal notch (SXSN) and one toward the left shoulder (SXLS). Accuracy of ventricular placement was assessed at autopsy. The success rates for the three parasternal approaches were as follows: 5ICS-PS = 0.85; 5ICS-4 = 0.80; 5ICS-6 = 0.90. For the three subxiphoid approaches success rates were as follows: SXRS = 0.25; SXSN = 0.50; SXLS = 0.65. All three parasternal approaches had higher success rates than the SXRS approach (P less than 0.05). In addition, the 5ICS-PS and 5ICS-6 approaches were more successful than the SXSN approach (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Autopsy↗

PubMed1985

Injuries associated with percutaneous placement of transthoracic pacemakers.

Injuries associated with the percutaneous placement of transthoracic pacemakers are poorly documented. We prospectively sought to determine any injuries associated with various placement routes. Six different approaches were used in each of 20 adult patients examined at autopsy. Three parasternal approaches utilized the fifth intercostal space (5ICS). One pacing wire was inserted immediately to the left of the sternum along the parasternal line (5ICS-PS), one pacing wire was inserted 4 cm to the left of the midsternal line (5ICS-4), and the third wire was inserted 6 cm from the midsternal line (5ICS-6). All parasternal needle insertions were directed medially, dorsally, and cephalad toward the right second costochondral junction at an angle of 30 degrees to the skin. Three subxiphoid approaches were inserted through the left xyphocostal notch at an angle of 30 degrees to the skin. One pacing wire was directed toward the right shoulder, one toward the sternal notch, and one toward the left shoulder (SXLS). Injuries were assessed by autopsy, postmortem coronary angiography, and stereoscopic radiography. The 5ICS-PS approach resulted in fewer injuries when compared to all other approaches. Because previous work has demonstrated that the 5ICS-PS, 5ICS-6, and SXLS approaches are more accurate than the other approaches for transthoracic pacemaker insertion, the 5ICS-PS represents an approach that combines reasonable accuracy with the least likelihood for injury in the placement of percutaneous transthoracic pacing wires.

Adult↗

PubMed1985

Rating AIS severity using emergency department sheets vs. inpatient charts.

To determine whether sufficiently accurate estimates of injury severity can be based on limited data as would be available from an Emergency Department (ED) Sheet, Abbreviated Injury Severity (AIS) scores were derived for 166 trauma patients using two different sources of data--the ED sheet and inpatient medical chart. These severity scores were compared by type of person assigning the scores and by external cause of the injury. Results indicate that in general, the ED sheet is not a suitable alternative to the complete inpatient chart when coding severity for individuals who sustain injuries severe enough to result in hospital admission.

Diagnosis-Related Groups↗

PubMed1985

The utility of synthetic and regression estimation. Techniques for local health planning.

Health planning agencies have long had a need for local area data on issues such as health status, utilization, and preventive care. Synthetic estimation and regression techniques have been advanced for use in adjusting national or regional data from the NCHS Health Interview Survey (HIS) to the local area based on demographic and other pertinent variables. To evaluate the accuracy and utility of these techniques for local health planning, estimates of certain key HIS variables were obtained from a telephone survey of 2,500 randomly selected households located in the Central Maryland Health Systems Agency (CMHSA). This paper presents results of the comparison between these telephone estimates and the corresponding estimates derived from the national HIS. The techniques are evaluated on the basis of data generally available to local planning agencies.

Catchment Area, Health↗

PubMed1985

The Abbreviated Injury Scale and Injury Severity Score. Levels of inter- and intrarater reliability.

Given the wide usage and proven value of the Abbreviated Injury Scale (AIS) in rating severity of trauma, it is essential that certain reliability issues concerning its application be resolved. This article describes a study designed to address these reliability issues. Each of 15 raters with varying qualifications was asked to identify AIS code injuries sustained by 375 trauma patients admitted to four Baltimore area hospitals. Results showed that as a group, physicians and nurses tend to be more reliable in their ratings than either emergency medical technicians (EMTs) or nonclinical technicians, although a research assistant who is well trained in AIS coding and is a diligent worker can use the AIS to code severity as reliably as the physicians when sufficient information is provided in the medical chart. Reliability of AIS scoring was somewhat higher for blunt (vehicular and nonvehicular) versus penetrating injuries.

Costs and Cost Analysis↗

PubMed1984

Injury severity scales: overview and directions for future research.

The utility of the AIS for classifying trauma patients according to the nature and extent of tissue damage is well documented. The development of the ISS has enhanced the utility of the AIS by making it possible to assess the overall severity of multiple injuries sustained by an individual. Several studies have confirmed the validity of the ISS as a predictor of mortality and length of hospital stay. When the ISS is used in conjunction with a physiological index such as the Trauma Score, its power to predict mortality increases significantly. The inter-rater reliability of the AIS derived from medical records was shown to be substantial for both clinicians as well as nonclinicians. It is important, however, that raters be properly trained and standardized prior to using the scale. Petrucelli et al have developed a training manual for use by crash investigators of the National Highway Traffic Safety Administration of the U.S. Department of Transportation. This manual can easily be adapted for use by those involved in EMS evaluation. With the development of an ICD-9-CM to AIS 80 conversion table, the application of the AIS to large computerized data bases will also become tenable. As more attention is focused on issues of long-term consequences of injury, however, it may become necessary to fine-tune existing scales or construct new ones. As discussed earlier in this paper, there is evidence that the AIS can be used to classify patients according to levels of disability and costs of medical care. The few studies that provide this evidence, however, are limited in scope and generalizability, as they focus on vehicular trauma only. In addition, most of these studies are based on small cross-sectional samples and do not use standardized measurements of functional status. Currently under way as a collaborative study between The Johns Hopkins Medical Institutions and the Maryland Institute for Emergency Medical Services System is a longitudinal study of 600 young adult patients (ages 16-45) who sustained injuries severe enough to require hospitalization. One of the objectives of this study is to test the utility of the AIS/ISS in conjunction with measures of functional status at the time of hospital discharge for predicting changes in physical,mental, and social functioning of trauma patients up to one year following discharge and with direct costs associated with goods and services purchased as a result of the injury.(ABSTRACT TRUNCATED AT 400 WORDS)

Accidents, Traffic↗

PubMed1980

Cardiac dysrhythmias during the treatment of acute asthma. A comparison of two treatment regimens by a double blind protocol.

The frequency and type of dysrhythmias observed in asthmatic patients treated with epinephrine alone, and those given epinephrine and intravenous aminophylline, were compared. Forty-one patients with 44 episodes of acute asthma were evaluated. Nine subjects had cardiac dysrhythmias related to treatment, principally those receiving epinephrine and aminophylline. Supraventricular and ventricular dysrhythmias occurred with approximately equal frequency. Three patients had complex ventricular ectopy. The mean age of dysrhythmic patients receiving combination treatment (39.8 years), was significantly greater than those treated similarly, but without dysrhythmias (23.5 years). The difference in theophylline levels between dysrhythmic and nondysrhythmic patients was not significant, and there was no relationship between dysrhythmogenicity and initial severity of asthmatic attacks, or improvement in peak expiratory flow over a 90-minute treatment period.

Acute Disease↗

PubMed1979

Emergency treatment of asthma. A comparison of two treatment regimens.

The effectiveness of epinephrine was compared to that of a combination of epinephrine and aminophylline in the initial treatment of acute asthma. Forty-four patients with 51 episodes of acute asthma were evaluated. Peak flow spirometry served as an objective measure of airway resistance, and theophylline levels were determined at fixed intervals throughout the study. Epinephrine and aminophylline were not found to be superior to epinephrine alone. There was no correlation between mean serum theophylline levels and the magnitude of improvement. Rapidity of emergency department discharge and frequency of admission was independent of treatment method. The failure of epinephrine-aminophylline to effect more rapid or profound improvement in pulmonary function might suggest that epinephrine alone, or an equivalent sympathomimetic is a rational choice in the initial treatment of acute asthma.

Acute Disease↗

PubMed1979

Education for self-treatment by adult asthmatics.

A prospective experimental design evaluated the ability of a series of educational and motivational interventions to enhance self-treatment by adult asthmatics and to reduce use of emergency department services for asthma attacks. After treatment for an asthma attack, subjects were randomly assigned to the following sequential interventions: (1) reinforcement by interpersonal similarity at the time of the emergency visit, (2) recepit of positive written appeals, and (3) follow-up telephone reinforcement. The asthmatic nurse educator was generally more effective in achieving short-term reduction of emergency department visits. Although the usefulness of the positive written appeal increased when employed by the asthmatic nurse, there were no substantive independent effects of the written message on emergency department use.

Activities of Daily Living↗

PubMedDate not supplied

Determinants of use of outpatient rehabilitation services following upper extremity injury.

This study documents the utilization of outpatient therapy services following upper extremity injury and identifies factors that influence the use of services. One hundred twelve patients admitted to a hand center for treatment of upper extremity injury were followed prospectively for 7 months to determine their utilization of therapy services and their perceptions of unmet need. Eighty percent of the patients used therapy services following their injury Those who were more severely injured, were female, had health insurance, or obtained disability compensation made more visits than other subjects. One third of the patients reported that they did not have an adequate number of therapy visits. Subjects cited various reasons (e.g., lack of insurance, transportation difficulties) for unmet need. These findings suggest that the variation in utilization of rehabilitation services depends on not only the severity of the injury but other patient characteristics and resources as well.

Adolescent↗

PubMedDate not supplied

Effect of trauma and pelvic fracture on female genitourinary, sexual, and reproductive function.

OBJECTIVES/HYPOTHESIS: To evaluate the impact of a pelvic fracture on a woman's physical, sexual, and reproductive functioning. DESIGN: Retrospective review. SETTING: Level one trauma center. PATIENTS: Two groups of female multitrauma patients: those with pelvic fractures (subjects) and those with extremity fractures but no pelvic fracture (controls). MAIN OUTCOME MEASUREMENTS: Of the 302 women eligible for participation in this study, 255 (80%; 123 subjects, 118 controls) were interviewed by blinded professional interviewers regarding genitourinary symptoms, sexual function, and reproductive history. RESULTS: Urinary complaints occurred significantly more frequently in subjects than in controls (21 versus 7%, respectively; p = 0.003), in subjects with residual pelvic fracture displacement > or = 5 mm than in those without displacement (33 versus 14%, respectively; p = 0.018), and in subjects with residual lateral (60%) or vertical (67%) displacement than in those with medially displaced fractures (21.4%) (p = 0.04). Although both groups reported increased rates of cesarean section, this increase was statistically significant only in the subject group: 14.5% preinjury versus 48% postinjury (p < 0.0001). Adjusting for previous cesarean sections, cesarean section was significantly more frequent in subjects with fractures initially displaced > or = 5 mm (80%) than in those with fractures initially displaced < 5 mm (15%) (p = 0.02). There was no difference in the incidence of miscarriage or infertility between the groups. Problems with physiologic arousal or orgasm were rare. Pain during sex (dyspareunia) was more common in subjects with fractures displaced > or = 5 mm than in those with nondisplaced fractures (43 versus 25%, respectively; p = 0.04). CONCLUSIONS: We found that pelvic trauma negatively affected the genitourinary and reproductive function of female patients. The increased rate of cesarean section in women after pelvic trauma may be multifactorial in origin and warrants further investigation.

Adolescent↗

PubMedDate not supplied

Characterization of patients with high-energy lower extremity trauma.

PURPOSE: (a) to report the demographic, socioeconomic, behavioral, social, and vocational characteristics of patients enrolled in a study to examine outcomes after high-energy lower extremity trauma (HELET) and to compare them with the general population; (b) to determine whether characteristics of patients undergoing limb salvage versus amputation after HELET are significantly different from each other. DESIGN AND STUDY POPULATION: A prospective study of 601 patients admitted with high-energy lower extremity trauma to eight Level I trauma centers. PROCEDURES: Patients were evaluated during the initial hospitalization. They are being followed up for 24 months postinjury. Study patients are compared with the general population by using census information, population survey data, and published norms. Characteristics of patients undergoing limb salvage versus amputation are also compared. RESULTS: Most patients were male (77 percent), white (72 percent), and between the ages of twenty and forty-five years (71 percent). Seventy percent graduated from high school (compared with 86 percent nationally) (p < 0.05). One fourth lived in households with incomes below the federal poverty line, compared with 16 percent nationally (p < 0.05). The percentage with no health insurance (38 percent) was also higher than in the general population (20 percent) (p < .05). The percentage of heavy drinkers was over two times higher than reported nationally (p < 0.01). Study patients were slightly more neurotic and extroverted and less open to new experiences. When patient characteristics were compared for those undergoing amputation versus limb salvage, no significant differences were found among any of the variables (p > 0.05). CONCLUSION: In conclusion, LEAP patients differ in important ways from the general population. However, the decision to amputate verus reconstruct does not appear to be significantly influenced by patient characteristics.

Adolescent↗

PubMedDate not supplied

A new model for category-scaling data with an application to the development of health-status measures.

Category rating is used to assess patient, family-member, provider, and societal preferences for health outcomes. Often, it is of interest to compare ratings obtained from different groups. Standard methods for making comparisons, such as regressions, correlations, and multiple t-tests, do not account for the dependency among ratings. The authors propose a new model for category ratings that does consider their relative dependency. This model provides a profile of ratings for a single group and facilitates comparisons across groups. It was applied to category ratings for four levels of Bending and Lifting function as defined by the recently developed Functional Capacity Index (FCI). Differences in ratings were observed across groups with different personal experiences of functional limitations and across groups with different degrees of clinical knowledge. These differences were not observed when standard methods were used. Thus, ignoring the relative nature of category ratings can lead to different conclusions about group preferences for health outcomes. When the ratings are being used to scale a health-status measure, this discrepancy has implications for the application of the measure in resource allocation.

Activities of Daily Living↗