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Biomedical subjects

M Sugrue

Publications and source records attributed to M Sugrue.

At least 19 recordsLinked to original sources
PubMed2006

Prospective study to evaluate the influence of FAST on trauma patient management.

BACKGROUND: Previous studies have concentrated on the accuracy of Focused Assessment with Sonography in Trauma (FAST), but evaluation of whether FAST changes subsequent management has not been fully assessed. METHODS: This prospective study compared 419 trauma admissions in two groups, FAST and no-FAST, for demographics, time of resuscitation, and action after resuscitation. The 194 patients undergoing FAST had their management plan specified before, and confirmed after, FAST was performed to assess for change in management. To ensure scan consistency and to minimize bias, criteria were established to define an adequate FAST. RESULTS: FAST was performed in 194 patients (46%), assessing for free fluid. Management was changed in 59 cases (32.8%) after FAST. Laparotomy was prevented in 1 patient, computed tomography was prevented in 23 patients, and diagnostic peritoneal lavage was prevented in 15 patients. Computed tomography rates were reduced from 47% to 34% and diagnostic peritoneal lavage rates were reduced from 9% to 1%. CONCLUSIONS: FAST plays a key role in trauma, changing subsequent management in an appreciable number of patients.

Adolescent↗
PubMed2006

Potential cervical spine injury and difficult airway management for emergency intubation of trauma adults in the emergency department--a systematic review.

BACKGROUND: Emergency airway management for trauma adults is practised by physicians from a range of training backgrounds and with differing levels of experience. The indications for intubation and technique employed are factors that vary within EDs and between hospitals. OBJECTIVES: To provide practical evidence based guidance for airway management in trauma resuscitation: first for the trauma adult with potential cervical spine injury and second the management when a difficult airway is encountered at intubation. SEARCH STRATEGY AND METHODOLOGY: Full literature search for relevant articles in Medline (1966-2003), EMBASE (1980-2003), and the Cochrane Central Register of Controlled Trials. Relevant articles relating to adults and written in English language were appraised. English language abstracts of foreign articles were included. Studies were critically appraised on a standardised data collection sheet to assess validity and quality of evidence. The level of evidence was allocated using the methods of the Australian National Health and Medical Research Council.

Adult↗
PubMed2004

Damage control surgery and the abdomen.

There is a complex interplay between primary injury, particularly major abdominal injury in the multi-system trauma patient, and secondary injury, which relate to patient physiology, decision making and surgical technique. Analysis of outcomes is further confounded by the variety of surgical techniques used. The challenge is to match the correct operation, for a critically injured patient, with the patient's physiology. Excellence in general surgery does not equate with excellence in trauma surgery, and a clear understanding of damage control is essential.

Abdominal Injuries↗
PubMed2002

Initial management of the poly-trauma patient: a practical approach in an Australian major trauma service.

The initial management of the poly-trauma patient is of vital importance to minimizing both patient morbidity and mortality. We present a practical approach to the early management of a severely injured patient as practiced at Liverpool Hospital in Sydney, Australia. Specific attention is paid to innovations in care and specific controversies in early management as well as local solutions to challenging problems.

Australia↗
PubMed2001

Clinical pathways--can they be used in trauma care. An analysis of their ability to fit the patient.

This study prospectively evaluated the appropriateness and ability of clinical pathways to fit trauma patients in five key conditions, severe head injury, fractured ribs, fractured pelvis, fractured femur and blunt abdominal trauma, who were admitted to a single Level 1 Trauma Centre, between February and July 1999. Each pathway consisted of 14 elements of care divided into observable outcomes. Failure to achieve an outcome resulted in a variance or deviation from the pathway, which was assessed by the number of non-applicable variances. Appropriateness of clinical pathways was assessed by the applicability index (the number of non-applicable variances divided by the potential variances). Critical mismatches occurred when non-applicable variances exceeded 50% of potential variances. 146 patients, with the mean age 41.9 years (S.D. 20.7), mean ISS 11.1 (S.D. 10.7) were enrolled; 18 with severe head injury, 59 with fractured ribs, 13 with fractured pelvis, 20 with fractured femur and 36 with blunt abdominal trauma. Critical mismatch occurred in seven patients. Applicability indexes were 87 for head, 93 for ribs, 92 for blunt abdominal trauma, 91 for femur and 92 for the pelvic pathway. Patient assessment, pain management, skin integrity and patient education were the most appropriate key elements of care, discharge planning, patient satisfaction, treatment and activity were least applicable. This study identified, for the first time, that clinical pathways are clinically appropriate for major trauma conditions.

Abdominal Injuries↗
PubMed2001

Trauma case management and clinical pathways: prospective evaluation of their effect on selected patient outcomes in five key trauma conditions.

BACKGROUND: This study evaluated the implementation of clinical pathways and case management between July 1998 and July 1999 in five key trauma conditions: severe head injury, fractured ribs, fractured pelvis, blunt abdominal trauma, and fractured femurs presenting to a single trauma service. METHODS: Thirteen key elements of care with expected outcomes were defined for each key trauma condition. Deviations from expected outcome were defined as variances. Attainment of the expected outcomes was measured before (stage 1) and after introduction (stages 2 and 3) of clinical pathways and case management. Nonattained outcomes were quantified and categorized into time of occurrence, and relationship to staff, patient, or system. RESULTS: Two hundred thirty-five patients were studied, with a mean age of 41.8 (SD, 20.6) years and mean Injury Severity Score (ISS) of 11.7 (SD, 11.0). The mean number of observed variances per patient for stage 1 was 51.7 (SD, 43.5); stage 2, 42.3 (SD, 32.9); and stage 3, 23.2 (SD, 21.7) (p = 0.0001 for both stage 1 and stage 2 compared with stage 3). There was a significant improvement in outcomes achieved from stage 1 (92.7%; 95% confidence interval, 92.5-92.9%), to stage 3 (96.7%; 95% confidence interval, 96.5-96.9%). Of the total number of variances seen, 0.2% related to system errors, 25% related to patient factors, and 75.8% related to staff. The proportion of staff-related variances was significantly reduced in stage 3. CONCLUSION: Clinical pathways and case management identified areas in need of remedial action and improved the delivery of patient care to our trauma population. It has set a template for the future management of our trauma service.

Abdominal Injuries↗
PubMed2000

An evaluation of trauma team response in a major trauma hospital in 100 patients with predominantly minor injuries.

BACKGROUND: A prospective study of trauma team response and performance at a major trauma service was undertaken between June and September 1998. METHODS: Following activation of the trauma team, the timing of the trauma team's arrival, the subsequent early management of the patient, time to monitoring, X-ray investigation and procedures performed were documented. RESULTS: The study evaluated 100 activations, 76% male, mean age 32 years and 65% were due to road trauma. The team leader, airway doctor and surgical registrar were present on patient arrival in 96%, 90% and 76% of cases, respectively. The airway, procedure and scribe nurses were present on patient arrival in 77%, 97% and 95% of cases, respectively. The radiographer was present in 69% of cases. Comparison between normal and after-hour response revealed little difference in medical and radiographer response, but the after-hour nurse response was significantly worse (P < 0.001). The median time to achieve electrocardiogram monitoring, blood pressure reading, and oxygen saturation tracing was 3 (range: 1-13), 4 (range: 2-20) and 3 (range: 1-21) min, respectively. Intravenous cannulation, phlebotomy and dispatch of bloods occurred at median times of 5 (range: 2-22), 6 (range: 3-23) and 17 (range: 7-40) min. The median times for intubation, chest tube and splintage of fracture were 10 (range: 3-19), 10 (range: 6-14) and 26 (range: 19-55) min, respectively. CONCLUSIONS: The present study identified an excellent multidisciplinary trauma response and provides a template to improve performance in early trauma management.

Accidents, Traffic↗
PubMed1999

Intra-abdominal hypertension is an independent cause of postoperative renal impairment.

HYPOTHESIS: Intra-abdominal hypertension exerts an effect on renal function independent of other confounding variables. DESIGN: A prospective study of all patients admitted to an intensive care unit following abdominal surgery was undertaken between September 1, 1994, and July 31, 1997, in a single university hospital. MAIN OUTCOME MEASURES: Intra-abdominal pressure (IAP) was measured every 8 hours (normal IAP, 0-17 mm Hg); 18 mm Hg or higher was considered increased. Forward stepwise logistic regression determined whether intra-abdominal hypertension is an independent cause of renal impairment. RESULTS: A total of 263 patients (174 after emergency surgery), whose mean +/- SD age was 61.0 +/- 18.7 years and Acute Physiology and Chronic Health Evaluation II score was 14.6 +/- 7.7, were studied. Intra-abdominal pressure was increased in 107 (40.7%) of the 263 patients. Renal impairment occurred in 35 (32.7%) of the 107 patients with intra-abdominal hypertension and in 22 (14.1%) of the 156 with a normal IAP (odds ratio, 1.62-5.42). Using the Wald maximizing model, renal impairment was independently associated with 4 antecedent factors: hypotension (P= .09), sepsis (P = .006), age older than 60 years (P = .03), and increased IAP (P = .004). CONCLUSIONS: To our knowledge, for the first time in a large clinical study, IAP has been shown to be an independent cause of renal impairment, and it ranks in importance after hypotension, sepsis, and age older than 60 years. Surgeons need to be aware of the importance of intra-abdominal hypertension in patients postoperatively.

Abdomen↗
PubMed1999

Comparison of autologous peripheral blood stem cell dosing by ideal vs actual body weight.

In this retrospective study, we evaluated the predictability of PBSC dose for hematopoietic engraftment comparing that calculated by ideal body weight (IBW) vs another calculated by actual body weight (ABW) for each patient. Sixty-three consecutive patients treated similarly using one transplant protocol were analyzed. While all patients had data available on CFU-GM and nucleated cells (NC), data on CD34+ enumeration was present only in 34 patients. We found that 49% of the patients were greater than 25% over their IBW. In addition, least-squares linear regression was used to assess the strength of the linear relationship between the inverse of cell dose/kg of ABW or IBW and time to AGC or platelet engraftment and showed no difference in r2 values for platelet engraftment, while using dose/kg of IBW greatly improved the ability of NC (r2 improved from 0.19 for ABW to 0.35 for IBW) and CFU-GM (r2 improved from 0.35 for ABW to 0.53 for IBW) to predict time to AGC engraftment, but did not change the CD34 r2. Hazard ratios were estimated using Cox proportional hazards regression and in all instances were found greater than 1.0 indicating that the probability of engraftment increased as cell dose/kg ABW or IBW increased. Finally, our data showed that 10 patients (16%) could have had one less apheresis procedure performed to obtain their set target stem cell dose calculated per kg IBW rather than ABW. In conclusion, PBSC dose per kg IBW is as good or better predictor of engraftment of AGC and may lead to cost savings in a certain subset of patients.

Adolescent↗
PubMed1999

Trauma during pregnancy.

Injury to the pregnant woman evokes a certain amount of anxiety because of its infrequent occurrence and the complex implications. By definition, it constitutes a multitrauma and, throughout the resuscitation and assessment of the woman, it is important to remember that there are two patients. Of particular importance is that one of these patients must be resuscitated aggressively to save the other and, very occasionally, the baby has to be delivered to save the mother. Early transfer to an urban environment should be considered. The aim of the present paper is to provide an overview of the current management and issues in relation to trauma in pregnancy.

Abdominal Injuries↗
PubMed1999

Lessons from analysis of World Wide Web server activity data: http://www.swsahs.nsw.gov.au/livtrauma.

OBJECTIVE: To establish visiting patterns and use of resources within an educational world wide web site, to develop strategies for its more effective use as a teaching medium. DESIGN: Prospective descriptive study. SETTING: A web site maintained by a major Australian metropolitan trauma service. SUBJECTS: All visitors to the web site over a 40 day period. MAIN OUTCOME MEASURES: Number of visitors, requests for pages, and transfer of files; timing and duration of visits; first and last pages viewed during visits; pages viewed most often; source of referral and country of origin of visitors. RESULTS: There were 2237 visits, and a mean of 5.8 pages/visit were viewed. Mean duration of each visit was 4 minutes 35 seconds, and only half the visitors entered through the home page. The collection of radiographs was most commonly consulted. Visitors came from 26 different countries, 42% from Australia. CONCLUSIONS: Factors that influenced the use of the site were identified and have altered our plans for development.

Australia↗
PubMed1998

Risk factors, prevention methods, and wound care for patients with pressure ulcers.

The purposes of this study about patients with pressure ulcers were to: (a) examine demographic characteristics, laboratory values, Braden Scale scores, and presence of pressure ulcer prevention methods and (b) examine pressure ulcers in terms of classification, stage, wound care, and documentation. The investigation was a prospective, descriptive study; the methods used were patient observations and data recordings from the medical record. Of the patients followed (n = 694), 71 had pressure ulcers. Patients with pressure ulcers were significantly older, with longer lengths of stay, more comorbid conditions, lower blood hemoglobin, lower serum albumin, higher white blood cell counts, and lower Braden Scale scores than patients without pressure ulcers. The presence of pressure ulcer prevention methods was greatly lacking. Nosocomial pressure ulcers tended to be a lower stage compared with pressure ulcers present on admission. Dressings used for wound care were generally gauze or a hydrocolloid. Nurses' charting about pressure ulcers was complete for only 35% of notations. The results of this study indicate that advanced practice nurses have a critical role in caring for patients with pressure ulcers and educating care providers.

Aged↗
PubMed1998

Prospective evaluation of early missed injuries and the role of tertiary trauma survey.

BACKGROUND: This study prospectively evaluated the prevalence, clinical significance, and contributing factors to early missed injuries and the role of tertiary survey in minimizing frequency of missed injuries in admitted trauma patients. Missed injury, clinically significant missed injury, tertiary survey, and contributing factors were defined. Tertiary survey was conducted within 24 hours. RESULTS: Of 206 patients, 134 patients (65%) had 309 missed injuries composing 39% of all 798 injuries seen. Tertiary trauma survey detected 56% of early missed injuries and 90% of clinically significant missed injuries within 24 hours. Clinically significant missed injuries occurred in 30 patients with complications in 11 patients and death in two patients. Of 224 contributing errors, 123 errors were in clinical assessment, 83 errors were in radiology, 14 errors were patient related, and four errors were technical. The missed injury rate was significantly higher in patients with multiple injuries and in those involved in road crashes. CONCLUSIONS: Secondary trauma survey is not a definitive assessment and should be supplemented by tertiary trauma survey.

Adolescent↗
PubMed1998

Temporary abdominal closure: a prospective evaluation of its effects on renal and respiratory physiology.

This study prospectively analyzed outcomes in 49 consecutive patients undergoing temporary abdominal closure (TAC) between 1993 and 1996 at a single university hospital. There were 37 males and 12 females, mean age was 57 years (range, 25-79 years), mean Acute Physiology and Chronic Health Evaluation score was 27 (+7.8 SD), and mean Simplified Acute Physiology II score was 53.0 (+/-15.4). The reason for TAC was decompression in 22 patients, inability to close the abdomen in 10 patients, to facilitate reexploration for sepsis in 8 patients, and multifactorial in 9 patients. After TAC, there was a significant reduction in intra-abdominal pressure from 24.2+/-9.3 to 14.1+/-5.5 mm Hg and improvement in lung dynamic compliance from 24.1+/-7.9 to 27.6+/-9.4 mL/cm H2O (p < 0.05). Although 10 patients experienced brisk diuresis, there was no significant improvement in renal function; in fact, serum creatinine increased. The median length of stay was 35 days (range, 1-232 days). The mean number of abdominal operations after mesh insertion was 2.6+/-2.4. There were 21 deaths, for a standardized mortality rate of 0.80. Although it achieved significant reductions in abdominal pressures and improved lung dynamic compliance, TAC did not result in improved renal function or patient oxygenation.

APACHE↗