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S Morad Hameed

Publications and source records attributed to S Morad Hameed.

16 recordsLinked to original sources
PubMed2006

Population-based analysis of severe injuries from nonmotorized wheeled vehicles.

BACKGROUND: Bicycling, skateboarding, and inline skating are popular recreational activities, with the potential of causing severe injury. METHODS: A retrospective, population-based, trauma registry analysis of severe injuries and deaths from nonmotorized wheeled vehicles (NMWV) over a 10-year period was performed. RESULTS: During the study period, 1475 cyclists, 141 skateboarders, and 112 inline skaters sustained injury meeting registry criteria (length of stay > or = 3 days or death). The majority were male. Lone crashes were the most common mechanism of injury, although collisions with motor vehicles accounted for 63.6% (n = 44) of observed deaths. Thoracic trauma and head injuries were more common in nonsurvivors. CONCLUSION: NMWV injuries pose a public health concern. We recommend enforcement of mandatory helmet laws and expansion of the existing law to include skateboarders and inline skaters. Education initiatives should also be expanded to include the adult population. NMWV should be separated from motorized vehicles as much as possible.

Adolescent↗
PubMed2006

Distribution and determinants of critical illness among status Aboriginal Canadians. A population-based assessment.

PURPOSE: The aim of the study is to determine the incidence, demographic risk factors, and outcomes of critical illness among all adult status Aboriginal Canadians (SACs) admitted to intensive care units (ICUs). PATIENTS AND METHODS: A population-based cohort was conducted among adult residents of the Calgary Health Region admitted to ICUs between May 1999 and April 2002. Patients were classified as SAC based on an alternate premium arrangement field within their Alberta personal health number. RESULTS: The annual incidence of critical illness among SACs of 620.6 per 100,000 was significantly higher than the non-SAC population of 302.6 per 100,000 (RR, 2.1; 95% CI, 1.78-2.35); this was due to a 3-fold higher admission rate to the multisystem ICUs among SAC (579.6 per 100,000/y) as compared with non-SAC patients (210.7 per 100,000/y; RR, 2.75; 95% confidence interval [CI], 2.37-3.17). The highest risk for ICU admission among SAC patients was observed in those aged 20 to 49 years, and the incidence was higher in males than females (772.3 vs 479.8 per 100,000/y; RR, 1.6; 95% CI, 1.21-2.14). Although the in-hospital case-fatality rate was only slightly higher among SAC (18%, 38/212) as compared with non-SAC patients (922/7,159; 13%; RR, 1.39; 95% CI, 1.04-1.87), the annual mortality rate was much higher (146.4 per 100,000 for SAC vs 60.9 per 100,000 for non-SAC; RR, 2.40; 95% CI, 1.78-3.19). CONCLUSION: This study demonstrates that SACs have an increased burden of critical illness as compared with the general non-SAC population and supports further research aimed at exploring means to reduce its adverse impact in this population.

Adolescent↗
PubMed2006

The impact of multiple casualty incidents on clinical outcomes.

BACKGROUND: Multiple casualty incidents (MCI) highlight discrepancies between patient needs and available resources. It is generally thought that heavy patient loads adversely affect trauma health care delivery. The purpose of this study was to identify the impact of multiple casualty situations on the clinical outcomes of injured patients. METHODS: All severely injured trauma patients (Injury Severity Score [ISS] > or = 12) who presented during a 12-month period to a regional trauma center were retrospectively reviewed. MCIs were defined as treating and admitting three or more trauma patients within a maximum of 3 hours. This cohort was compared with all other patients who did not meet MCI criteria. RESULTS: Ten percent (88/861) of all trauma patients were treated in an MCI setting. Groups did not vary among sex, age, ISS, or mechanism of injury (p > 0.05). MCI patients displayed a greater length of hospital stay, time to first surgical procedure, time to emergency laparotomy, and time spent in the emergency room (p < 0.05). MCI and non-MCI patients did not differ in ICU length of stay, postadmission morbidity, or mortality (p > 0.05). CONCLUSION: The impact of a MCI on the quality of trauma care has not been previously defined. MCI events delay definitive care and prolong a patient's length of stay. This is particularly concerning in the emergency department where a trauma center's ability to treat MCI patients effectively via an increased surge capacity relies on swift patient triage and flow. We are now investigating these issues in other trauma centers.

Adult↗
PubMed2005

Factors related to the failure of radiographic recognition of occult posttraumatic pneumothoraces.

PURPOSE: Although posttraumatic pneumothoraces (PTXs) are common and potentially life threatening, the supine chest radiograph (CXR) is an insensitive test for their detection. Computed tomography (CT) often identifies occult pneumothoraces (OPTXs). Previous descriptions of OPTX topography have been poor. Our purpose was to define their distribution and aid in the targeting of thoracic ultrasound. METHODS: Posttraumatic supine CXRs and CTs were reviewed for occult, overt, and residual PTXs. PTXs were compared according to their apical, basal, anterior, lateral, medial, and posterior components. A comparative size index was calculated. RESULTS: Among 761 patients, 338 CT scans revealed 103 PTXs in 89 patients; 55% were OPTXs. OPTXs were apical (57%), basal (41%), anterior (84%), lateral (24%), and medial (27%), with 0% posterior. CONCLUSIONS: CXR missed over half of all PTXs. OPTXs had a greater anterior versus lateral (nearly 4-fold) and both basal and apical versus lateral (2-fold) distribution. OPTXs are often located at easily accessible sonographic windows.

Female↗
PubMed2005

A population-based assessment of major trauma in a large Canadian region.

BACKGROUND: The cause of major trauma has not been well defined using population-based methodologies. METHODS: We performed a population-based surveillance of major traumatic injuries in adult residents of the Calgary Health Region over a period of 3 years. RESULTS: A total of 1,475 victims of major trauma were identified (69.5 per 100,000/y). Males were at significantly higher risk as compared with females (104.5 vs. 35.2 per 100,000; relative risk = 3.0, 95% confidence interval = 2.64-3.35), as were urban as compared with rural residents (70.7 vs. 49.0 per 100,000; relative risk = 1.4; 95% confidence interval = 1.11-1.91). A strikingly high incidence rate of major trauma was observed among those aged 85 years or more at 242.3 per 100,000 per year; elderly men were at 16.8-fold (95% confidence interval = 11.04-24.79) higher risk than young females. The majority were unintentional (53.9 per 100,000/y). Suicide, assault, and homicide occurred at annualized rates of 8.5, 4.8, and 1.6 per 100,000, respectively. Motor vehicle-related injuries (39%), falls or jumps (33%), and being struck by an object or animal (10%) were responsible for the majority of traumas. Firearm injuries were relatively uncommon (2.0 per 100,000/y). The annual mortality rate was 20.0 per 100,000. CONCLUSIONS: This study provides rigorous, population-based data on the cause of severe injury in the Calgary Health Region. It is hoped that ongoing work in this area will be useful in the development of effective injury prevention and health resource allocation strategies.

Adolescent↗
PubMed2005

Severe traumatic brain injury in a large Canadian health region.

BACKGROUND: Although severe traumatic brain injury (sTBI) is a devastating condition with tremendous public health implications, the epidemiology of this disease has not previously been described in Canada. We sought to define the incidence, risk factors and outcome of patients suffering sTBI in a large Canadian region. METHODS: A population-based surveillance cohort design was utilized to identify all Calgary Heath Region residents who were victims of trauma with an injury severity score > or = 12. Subsequent application of a specific sTBI case definition defined the final cohort. RESULTS: The annual incidence of sTBI was 11.4 per 100,000 population. The incidence of sTBI was significantly higher for males as compared to females [17.1 vs. 5.9 per 100,000; relative risk (RR) = 2.91, 95% confidence interval; 2.17, 3.94; p<0.0001]. There was a striking increase in the annual age specific population incidence of sTBI observed among those older than 74 years of age. The relative risk among the highest risk group of elderly (>85 years) males as compared to the lowest risk female group (50-64 years) was 19.78 (95% CI; 6.27, 62.3; p<0.0001). One hundred and eight patients died prior to hospital discharge for a mortality rate of 5.1 per 100,000 per year. CONCLUSIONS: Severe traumatic brain injury is common among residents of the Calgary Health Region and is associated with a high mortality rate. Males and the elderly are at the highest risk for acquiring sTBI and may represent target groups for preventive efforts.

Adolescent↗
PubMed2005

Incidence, risk factors, and outcomes for occult pneumothoraces in victims of major trauma.

BACKGROUND: The supine anteroposterior chest radiograph (CXR) is an insensitive test for posttraumatic pneumothoraces (PTXs). Computed tomographic (CT) scanning often detects PTXs that were not diagnosed on CXR (occult PTXs [OPTXs]). The purpose of this study was to define the incidence, predictors, and outcomes for OPTXs after trauma. METHODS: Thoracoabdominal CT scans and corresponding CXRs of all trauma patients entered into a regional database were reviewed. Patients with OPTXs were compared with those with overt, residual, and no PTXs regarding incidence, demographics, associated injuries, early resuscitative predictors, treatment, and outcomes. RESULTS: Paired CXRs and CT scans were available for 338 of 761 (44%) patients (98.5% blunt trauma). One hundred three PTXs were present in 89 patients, 57 (55%) of which were occult; 6 (11%) were seen only on thoracic CT scan. Age, sex, length of stay, and survival were similar between all groups. OPTXs and PTXs were similar in comparative size index and number of images. Subcutaneous emphysema, pulmonary contusion, rib fracture(s), and female sex were independent predictors of OPTXs. Seventeen (35%) patients with OPTXs were ventilated, of whom 13 (76%) underwent thoracostomy. No complications resulted from observation, although 23% of patients with thoracostomy had tube-related complications or required repositioning. CONCLUSION: OPTXs are commonly missed both by CXR and even abdominal CT scanning in seriously injured patients. Basic markers available early in resuscitation are highly predictive for OPTXs and may guide management before CT scanning. Further study of OPTX detection and management is required.

Adult↗
PubMed2005

Population-based study of severe trauma due to electrocution in the Calgary Health Region, 1996-2002.

BACKGROUND: Severe trauma arising from electrocution is uncommon, and we wished to study the incidence, risk factors and outcome to identify potential areas of prevention. We therefore studied an active population of adult victims of severe electrical trauma in a large area of Canada (the Calgary Health Region [CHR]). METHODS: From 3 databases, we collected data on all adult (> or = 18 yr) residents of the CHR who suffered electrical injury associated with an Injury Severity Score of 12 or greater or died as a result of electrocution between Apr. 1, 1996, and Mar. 1, 2002. Of particular interest were the incidence, the age and sex of the victims, the mechanism, the type of electrical power and the outcome. RESULTS: Ten cases of severe electrical trauma were identified (2.4 per 1 million population annually). Victims' ages were a mean (and standard deviation) of 38.2 (10.3) years. All 10 victims were male for an annual sex-specific incidence of 4.9 per 1 million people. Men aged 18-49 years were nearly 3 times more likely to be victims of electrocution than older men, although this result was not statistically significant (6.1 v. 2.1 per 1 million annually; relative risk 2.9; 95% confidence interval 0.4-127.5). All episodes of electrocution were unintentional, and 7 were occupationally related. All 10 electrocutions resulted from domestically generated current, and 9 were related to power-line exposure. Overall, 6 patients died for a death rate due to severe electrical trauma of 1.4 per 1 million people annually. CONCLUSION: This population-based study demonstrates that severe electrocution is rare but is associated with death in the majority of cases in this large Canadian region.

Adult↗
PubMed2004

Recent experiences with a multidisciplinary approach to complex hepatic trauma.

BACKGROUND: The selection of an appropriate time to terminate damage control efforts when faced with haemorrhagic shock from severe hepatic trauma can be challenging. At our centre, trauma surgeons have increasingly been favouring an operative approach simply involving early perihepatic packing (without extensive use of intraoperative measures aimed at achieving definitive haemostasis) and temporary abdominal closure. This is often followed by hepatic arteriography with angioembolization, resuscitation, and early re-exploration under more optimal physiological conditions. This study describes the initial outcomes of this approach. MATERIALS AND METHODS: All patients with high-grade liver injury requiring operative intervention due to refractory haemodynamic instability, presenting to our trauma centre between 1995 and 2001 were reviewed. Two treatment groups: definitive laparotomy (DL), and early packing (EP) with angioembolization and re-exploration were compared, using a retrospective audit. RESULTS: Thirty-seven patients were identified with severe liver injuries requiring operative intervention (DL 30, EP 7). Patient demographics between groups were similar. The EP group was found to have lower mortality (0% versus 36.7%), but increased length of hospital stay, transfusion requirements, and complication rates. CONCLUSIONS: A multidisciplinary approach to complex hepatic trauma involving brief damage control laparotomy with perihepatic packing only, followed by angioembolization, and early re-exploration may confer a survival benefit over early operative attempts at definitive haemostasis but is associated with complications.

Adolescent↗
PubMed2004

The epidemic of pediatric traffic injuries in South Florida: a review of the problem and initial results of a prospective surveillance strategy.

This study identified specific regional risk factors for the high rate of pediatric pedestrian trauma in Florida. Of the 29 cases studied prospectively, 3 (10%) occurred near ice cream trucks and 13 (45%) involved "dart-outs"; mean hospital charges were 24,478 +/- 43,939 US dollars. Recommendations included an engineering change for a dangerous intersection, and a population-based recommendation was to equip ice cream trucks with extending stop signs.

Accident Prevention↗
PubMed2004

Enteral nutrition and mucosal immunity: implications for feeding strategies in surgery and trauma.

Systemic inflammatory responses to severe trauma and surgical illnesses may be partly responsible for numerous complications, including sepsis, multiple organ failure and unregulated hypermetabolism leading to protein-calorie malnutrition. The integrity of the gastrointestinal tract appears to be an important factor in the pathogenesis of the systemic inflammatory response and sepsis. Resuscitation and nutrition support strategies for preserving gut mucosal integrity have therefore been strongly promoted. This review summarizes the scientific rationale for emphasizing enteral nutritional support of surgical patients, discusses some important limitations of enteral feeding and argues for a flexible approach to nutrition support for these complex patients.

Critical Illness↗
PubMed2004

Bloodstream infection complicating trauma.

BACKGROUND: Bloodstream infection (BSI) is recognized as an important infectious complication of major trauma. However, its occurrence, the risk factors contributing to its development, and its outcomes have not been well described. DESIGN: Cohort with linkage of regional trauma and microbiology databases. PATIENTS: Adult trauma patients with injury severity score (ISS) > or = 12 admitted to a regional trauma centre during a 33-month period. RESULTS: Of 1797 victims of acute trauma identified (median ISS 20; interquartile range [IQR] 16-25), 71 (4%) had 77 episodes of BSI, for an overall rate of 2.9 per 1000 hospital days. BSI in the majority of patients (37 of 72, or 52%) had onsets within the first week of hospitalization; 7 (10%) patients had community-acquired BSI (onset within 2 d). Independently associated with the development of nosocomial BSI were higher ISSs (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02-1.07); requirement for ICU admission (OR 7.06, CI 3.38-14.75); and burns (OR 5.75, CI 2.16-15.30). Although trauma-related BSI was a predictor of increased in-hospital case fatality (15/71 v. 208/1726; relative risk 1.75, CI 1.10-2.78), it was not an independent predictor of death. CONCLUSION: In our series, 1 in 25 major trauma cases was complicated by BSI. The infection occurred within the first week after injury in over half of our cases. Knowledge of the epidemiology of these infections will be important for planning preventive or early therapeutic efforts.

Alberta↗
PubMed2003

Gastric tonometry: the role of mucosal pH measurement in the management of trauma.

Effective management of hemorrhagic shock depends on titration of therapies against reliable resuscitation end points. Conventional clinical and laboratory indexes of shock are often slow to respond to progressive circulatory compromise. GI mucosal ischemia resulting from redistribution of blood flow may, however, precede uncompensated shock and may compound the initial hemorrhagic insult by touching off cascades of inflammatory responses. Trauma patients with evidence of subclinical GI ischemia have been shown to have poor outcomes. Gastric tonometry, by detecting the presence of gastric intramucosal acidosis as a proxy of splanchnic hypoperfusion, may facilitate more timely and rational shock resuscitation. This article reviews the development and validation of gastric tonometry and summarizes the clinical studies that have used this modality to guide the management of shock in trauma patients.

Carbon Dioxide↗
PubMed2003

Occult pneumothorax in the mechanically ventilated trauma patient.

The term occult pneumothorax (OP) describes a pneumothorax that is not suspected on the basis of clinical examination or plain radiography but is ultimately detected with thoracoabdominal computed tomography (CT). This situation is increasingly common in trauma care with the increased use of CT. The rate is approximately 5% in injured people presenting to hospital, with CT revealing at least twice as many pneumothoraces as suspected on plain radiography. Whereas pneumothorax is a common and treatable cause of mortality and morbidity, there is substantial disagreement regarding the appropriate treatment of OP. The greatest controversy is in patients in the critical care unit who require positive-pressure ventilation. There is little current evidence to direct the proper management of ventilated trauma patients with OP, and no studies have focussed specifically on these patients. Future randomized trials will need to consider the potential effects of OP on pulmonary mechanics and potential influences on the known risks of ventilator-induced lung injury associated with mechanical ventilation.

Adult↗