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Laurel Omert

Publications and source records attributed to Laurel Omert.

4 recordsLinked to original sources
PubMed2004

Falling down and falling out: management and outcome analysis.

BACKGROUND: This study compares young (< 65 years old) and elderly (> or = 65 years old) patients who fall secondary to syncope and seeks to determine whether syncope workups are being appropriately performed and whether they contribute new information that results in a change in management. METHODS: A retrospective review of patients who fell and were admitted to a Level I trauma center was performed. Data included mechanism of injury, comorbidities, and severity scores in addition to details regarding a syncope workup in patients who had unclear reasons for falling. Outcome variables were mortality, intensive care unit and hospital lengths of stay, and whether each test resulted in a change in management. RESULTS: The data set included 387 patients. Elderly patients who fell (n = 157) had significantly higher Injury Severity Scores and mortality, lower Glasgow Coma Scale scores, and longer intensive care unit and hospital lengths of stay than the younger cohort (n = 230). When a fall occurred secondary to syncope, however, there was no difference in injury severity or outcome. Patients who fell secondary to syncope (n = 61) had zero to six of the recommended tests ordered. Nineteen tests in the young group and 79 tests in the elderly patients had abnormal results. Overall, 37.8% of patients had specific interventions performed because of the abnormal test results CONCLUSION: Syncope workups were erratically performed in both young and older groups. These workups frequently resulted in abnormal findings that required intervention. Protocols are currently being developed at our institution to ensure complete assessment of trauma patients who fall for unknown reasons.

Accidental Falls↗
PubMed2004

Chylous ascites after nephrectomy for trauma.

Chylous ascites has many etiologies including malignancy, infection, and inflammation. Management of this condition varies from conservative treatment to surgery. We present a case of chylous ascites after laparotomy for trauma and review the pathophysiology, etiology, diagnosis, and treatment options for this condition.

Accidents, Traffic↗
PubMed2003

Harbingers of poor outcome the day after severe brain injury: hypothermia, hypoxia, and hypoperfusion.

BACKGROUND: Traumatic brain injury (TBI) can be compounded by physiologic derangements that produce secondary brain injury. The purpose of this study is to elucidate the frequency with which physiologic factors that are associated with secondary brain injury occur in patients with severe closed head injuries and to determine the impact of these factors on outcome. METHODS: The records of 81 adult blunt trauma patients with Glasgow Coma Scale scores < or = 8 and transport times < 2 hours to a Level I trauma center were retrospectively reviewed searching for the following 11 secondary brain injury factors (SBIFs) in the first 24 hours postinjury: hypotension, hypoxia, hypercapnia, hypocapnia, hypothermia, hyperthermia, metabolic acidosis, seizures, coagulopathy, hyperglycemia, and intracranial hypertension. We recorded the worst SBIF during six time periods: hours 1, 2, 3, 4, 5 to 14, and 16 to 24. Occurrence of each SBIF was then correlated with outcome. RESULTS: Hypocapnia, hypotension, and acidosis occurred more frequently than other SBIFs (60-80%). Hypotension, hyperglycemia, and hypothermia were associated with increased mortality rate. Patients with episodes of hypocapnia, acidosis, and hypoxia had significantly longer intensive care unit length of stay (LOS). These three SBIFs and hyperglycemia related to longer hospital LOS as well. Hypotension and acidosis were associated with discharge to a rehabilitation facility rather than home. Finally, multivariate regression analysis revealed that hypotension, hypothermia, and Abbreviated Injury Scale score of the head were independently related to mortality, whereas other SBIFs, age, Injury Severity Score, and Glasgow Coma Scale score were not. Metabolic acidosis and hypoxia were related to longer intensive care unit and hospital LOS. CONCLUSION: Our early management of head-injured patients stresses avoidance and correction of SBIFs at all costs. Nonetheless, SBIFs occur frequently in the first 24 hours after traumatic brain injury. Six of the 11 factors studied are associated with significantly worse outcomes. Hypotension and hypothermia are independently related to mortality. Because these SBIFs are potentially preventable, protocols could be developed to decrease their frequency.

Abbreviated Injury Scale↗