Biomedical subjects

S Rasslan

Publications and source records attributed to S Rasslan.

At least 19 recordsLinked to original sources

PubMed2001

Increases in fines and driver licence withdrawal have effectively reduced immediate deaths from trauma on Brazilian roads: first-year report on the new traffic code.

Road accidents are a major cause of death in Brazil, with rates increasing steadily for years. Our objective here is to report the impact of the new Brazilian Traffic Code, introduced in 1998. Its main new features include a large increase in fines and a rigid penalty scoring system that leads to driver license withdrawal. Speed limits have actually been raised on many roads, but adherence to the rules has been monitored more closely. We compare the incidence of injured patients and immediate deaths in road accidents and emergency room admissions to a level I trauma centre in downtown São Paulo between January and December 1998 with corresponding data from between January and December 1997. There was an overall 21.3% reduction in the number of accidents and a 24.7% reduction in immediate deaths, saving 5962 lives on Brazilian highways. Tickets issued fell by 49.5% (601977 during 1997 to 304785 during 1998). Motor vehicle accident-related emergency room admissions decreased by 33.2%. We conclude that very costly tickets and threatened driver licences have proved very effective in decreasing immediate deaths from trauma. Further advances in educational programmes associated with road and vehicle safety measures are likely to provide the much needed further reduction in the still high trauma mortality on Brazilian roads and streets.

Accidents, Traffic↗

PubMed2001

Blunt gastric injury. A multicentre experience.

A multicentre retrospective analysis of blunt gastric injuries from four trauma centres in Brazil was performed. From January 1982 to May 1996, 33 patients were found to have blunt gastric injury: 26 were male and the mean age was 26.2 years. The most frequent mechanism of injury was automobile versus pedestrian (17) followed by motor vehicle accidents (seven). Abdominal pain was the most common finding (29) and peritoneal signs were present in 14. There were 21 grade I, seven grade II, four grade III and one grade IV blunt gastric injuries. Simple suture was the treatment of choice in 24 patients, eight required no treatment, and only one patient underwent gastric resection. The liver and spleen were the most commonly associated injured organs. Two patients had isolated gastric injury. There were two gastric fistulae and both patients died. Overall morbidity and mortality was 12 (36%) and nine (27%), respectively. The ISS was higher in the non-survivor group (P=0.03) and the gastric organ injury score did not reach statistical significance when comparing survivors and non-survivors. We conclude that blunt gastric injury is uncommon and is associated with other injuries of greater magnitude, which generally influence mortality.

Abdominal Injuries↗

PubMed2000

The role of associated injuries on outcome of blunt trauma patients sustaining pelvic fractures.

In order to identify the prognostic factors and to evaluate the impact of associated injuries in the outcome of patients with pelvic fractures, a retrospective review of the medical records of patients admitted with a pelvic fracture during a 42-month period was carried out. Demographic data, the mechanism of injury, the physiologic status on admission, associated injuries, pelvic fracture classification, complications and mortality were analysed. One hundred and three patients were included in the study. Fifty-nine were male, and the mean age was 34. The mean Revised Trauma Score (RTS) and Injury Severity Score (ISS) were 7.1 and 20, respectively. Pedestrian vs vehicle (59%), was the most frequent mechanism of injury. Twenty patients died (19%) most frequently due to "shock". Complications developed in 37 patients (36%), pneumonia being the most frequent. Age greater than 40 years (p=0.02), "shock" upon admission (p=0.002), a Glasgow Coma Scale (GCS)<9, Head AIS>2 (p<0. 001), Chest AIS>2 (p=0.007), and abdominal AIS>2 (p=0.03) all correlated with increased mortality. No correlation between pelvic fracture classification or fracture stability with mortality was observed. The outcome of patients with pelvic fractures due to blunt trauma correlates with the severity of associated injuries and physiological derangement on admission rather than with characteristics of or the type of fracture.

Accidents, Traffic↗

PubMed1999

Trauma in pregnant women: analysis of maternal and fetal mortality.

Twenty-seven traumatised pregnant women were analysed retrospectively over a period of 9 years. Mean age was 23.7 years (16-42 years). Gestational age ranged from 10 to 40 weeks (mean, 21.5 weeks), with most victims (46.1%) being in the second trimester. The predominant mechanism (65.3%) was blunt abdominal injury due to an automobile accident (the patient being run over or collision). At admission, 8 (30.7%) patients had haemodynamic alterations. 6 patients (23.0%) presented vaginal bleeding and 4 of these were haemodynamically normal. We analysed maternal mortality, fetal mortality and their causes. We also compared the median RTS and TRISS values for the groups with maternal-fetal survival and the group with maternal-fetal death. Fetal death occurred in all pregnant women admitted with vaginal bleeding. Maternal mortality due to haemorrhagic shock was 11.5%. Fetal mortality was 30.7%, with 37.5% of these deaths being caused by maternal death. The major cause of fetal mortality was a detached placenta (50.0%). The trauma indices, RTS and TRISS, were significantly lower (p = 0.0025 and p < 0.0001) in the group of maternal-fetal death but they were not of prognostic value in terms of fetal mortality.

Adolescent↗

PubMed1995

Factors related to the occurrence of postoperative complications following penetrating gastric injuries.

The aim of this study was to determine the relationship between diaphragmatic injury and gross contamination of the peritoneal cavity caused by gastric injuries and the occurrence of postoperative complications, especially those related to the pleural cavity. Charts of 73 patients sustaining gastric injuries due to penetrating trauma were retrospectively reviewed. There were 66 males and mean age was 28 years. Stab wounds were the most frequent mechanism of injury, occurring in 46 cases. Most of the injuries were treated using simple suture and minor debridement. Postoperative morbidity rate was 30 per cent and thoracic complications occurred in 11 patients. Twenty-six patients had diaphragmatic injuries; 54 per cent of them developed postoperative complications. Of the remaining 47 patients without diaphragmatic injuries, only eight developed complications. Of the 26 patients with diaphragmatic injuries, seven developed pleuropulmonary complications compared with 4 of 47 without diaphragmatic injury. Of sixteen patients who had gross contamination secondary to gastric injury, characterized by the presence of food or great amounts of gastric contents in the peritoneal cavity, 10 developed postoperative complications compared with 12 of 57 without gross contamination. Overall mortality rate was 11 per cent mostly due to sepsis. In conclusion, the presence of a diaphragmatic injury as well as gross contamination of the abdominal cavity are important factors related to the development of postoperative infections particularly in the pleural space.

Adolescent↗

PubMed1995

Penetrating cardiac wounds: predictive value of trauma indices and the necessity of terminology standardization.

The authors evaluated the usefulness of different trauma indices in the prediction of outcome following penetrating cardiac wounds. Sixty-three patients were retrospectively reviewed. Age, mechanism of injury, Physiologic Index (PI) on admission, site of injury, associated injuries, ISS, RTS, Penetrating Cardiac Trauma Index (PCTI), Penetrating Thoracic Trauma Index (PTTI), Penetrating Trauma Index (PTI), TRISS and mortality rate were reviewed. There were 34 patients with a gunshot wound (GSW) and 29 with a stab wound (SW). Shock was present on admission in 88.9 per cent. Mortality was 83 per cent for GSW, 44 per cent for SW, and 39 per cent for patients arriving the hospital with measurable blood pressure. RTS, PI, PCTI, PTTI, PTI, and ISS reached statistical significance when comparing survivors and nonsurvivors. The probability of survival (PS) based on the TRISS methodology was 37.84 +/- 5.14. The observed survival rate was 38 per cent. Fourteen patients were considered "fatal" on admission and underwent an emergency thoracothomy. Mortality rate for this selected group was 100 per cent. We conclude that physiologic impairment, shock, and GSW are variables with high significance on mortality. Trauma indices such as PI, RTS, PCTI, PTTI, PTI, and ISS are good predictors of outcome. Trauma indices are an important tool to objectively compare results among different institutions.

Adolescent↗

PubMed1984