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Biomedical subjects

F E Lecky

Publications and source records attributed to F E Lecky.

9 recordsLinked to original sources
PubMed2006

Predictors of persistent neck pain after whiplash injury.

OBJECTIVE: To establish the aetiological influences of persistent neck pain following a motor vehicle collision and to construct a model for use in the emergency department for identifying patients at high risk of persistent symptoms. DESIGN: Prospective cohort study. Patients recruited from hospital emergency departments were sent a questionnaire to gather information on various exposures. They were followed up at 1, 3, and 12 months to identify those with persistent symptoms. MAIN OUTCOME MEASURE: Persistent neck pain (pain at 1, 3, and 12 months after collision). RESULTS: The baseline survey included 765 patients. Subsequently, 480 completed a questionnaire at each follow up time point, of whom 128 (27%) reported neck pain on each occasion. Few collision specific factors predicted persistent neck pain. In contrast, a high level of general psychological distress, pre-collision history of widespread body pain, type of vehicle, whiplash associated symptoms, and initial neck disability best predicted the persistence of symptoms. Furthermore, these factors, in combination, accounted for more than a fivefold increase in the risk of persistent neck pain. CONCLUSION: The greatest predictors of persistent neck pain following a motor vehicle collision relate to psychological distress and aspects of pre-collision health rather than to various attributes of the collision itself. With these factors, and those relating to initial injury severity, it is possible to identify a subgroup of patients presenting with neck pain with the highest risk of persistent symptoms. Thus, it is possible to identify whiplash patients with a poor prognosis and to provide closer follow up and specific attention to management in these individuals.

Accidents, Traffic↗
PubMed2006

Ocular injuries in patients with major trauma.

AIM: To study the epidemiology of ocular injuries in patients with major trauma in the UK, determining the incidence and causes of ocular injuries, and their association with facial fractures. METHODS: A retrospective analysis of the Trauma Audit Research Network database from 1989 to 2004, looking at data from 39,073 patients with major trauma. RESULTS: Of the 39,073 patients with major trauma, 905 (2.3%) patients had associated ocular injuries and 4082 (10.4%) patients had a facial fracture (zygoma, orbit or maxilla). The risk of an eye injury for a patient with a facial fracture is 6.7 times as that for a patient with no facial fracture (95%, confidence interval 5.9 to 7.6). Of the patients with major trauma and an eye injury, 75.1% were men, and the median age was 31 years. 57.3% of ocular injuries were due to road traffic accidents (RTAs). CONCLUSION: The incidence of ocular injuries in patients with major trauma is low, but considerable association was found between eye injuries and facial fractures. Young adults have the highest incidence of ocular injury. RTAs are the leading cause of ocular injuries in patients with major trauma. It is vital that all patients with major trauma are examined specifically for an ocular injury.

Adult↗
PubMed2004

Patterns and risks in spinal trauma.

BACKGROUND: Spinal injury in children is rare, and poses many difficulties in management. AIMS: To ascertain the prevalence of spinal injury within the paediatric trauma population, and to assess relative risks of spinal injury according to age, conscious level, injury severity score (ISS), and associated injuries. METHODS: Spine injured children were identified from the UK Trauma Audit & Research Network Database from 1989 to 2000. Relative risks of injury were calculated against the denominator paediatric trauma population. RESULTS: Of 19 538 on the database, 527 (2.7%) suffered spinal column fracture/dislocation without cord injury and 109 had cord injury (0.56% of all children; 16.5% of spine injured children). Thirty children (0.15% of all children; 4.5% of spine injured children) sustained spinal cord injury without radiological abnormality (SCIWORA). Cord injury and SCIWORA occurred more commonly in children aged < or =8. The risk of spine fracture/dislocation without cord injury was increased with an ISS >25 and with chest injuries. The risk of cord injury was increased with reduced GCS, head injury, and chest injury. CONCLUSIONS: Spinal cord injury and SCIWORA occur more frequently in young children. Multiple injuries and chest injuries increase the risk of fracture/dislocation and of cord injury. Reduced GCS and head injuries increase the risk of cord injury.

Age Distribution↗
PubMed2002

Lack of change in trauma care in England and Wales since 1994.

UNLABELLED: To demonstrate trends in trauma care in England and Wales from 1989 to 2000. STUDY POPULATION: Database of the Trauma Audit and Research Network that includes hospital patients admitted for three days or more, those who died, were transferred or admitted to an intensive care or high dependency area. METHOD: To demonstrate trends in outcome, severity adjusted odds of death per year of admission to hospital were calculated for all hospitals (n=99) and 20 hospitals who had participated since 1989 (adjustments are for Injury Severity Score, age, and Revised Trauma Score). The grade of doctor initially seeing the injured patient in accident and emergency and median prehospital times per year of admission were calculated to demonstrate trends in the process of care. Trend analyses were carried out using simple linear regression (odds ratio versus year). RESULTS: The analysis shows a significant reduction in the severity adjusted odds of death of 3% per year over the 1989-2000 time period (p=0.001). During the period 1989-1994 the odds of death declined most steeply (on average 6% per year p=0.004). Between 1994 to 2000 no significant change occurred (p=0.35). This pattern was mirrored by the 20 permanent members where the odds of death also declined more steeply over the 1989-1994 period. The percentage of severely injured patients (ISS >15) seen by a consultant increased from 29 to 40 from 1989-1994 but has remained static subsequently. Median prehospital times for severely injured patients have not changed significantly since 1994 (51 to 45 minutes). CONCLUSION: Most of the case fatality reduction for trauma patients reaching hospital over the 1989-2000 time period occurred before 1995 when there was most marked change in the initial care of severely injured patients.

Adult↗
PubMed1996

The use and misuse of meta-analysis.

OBJECTIVE: To demonstrate how the results of a meta-analysis can confuse rather than clarify therapeutic dilemmas if clinical heterogeneity among trials is ignored. Then to further discuss the qualities emergency physicians should expect from published meta-analyses if they are to affect clinical practice. SUBJECTS AND METHODS: The data and results were examined from 23 randomised controlled trials of selective decontamination of the digestive tract (SDD), which have been combined in a previous meta-analysis. These were reviewed to take account of clinical heterogeneity, particularly with regard to severity of patient illness. RESULTS: Severity of patient illness predicts degree of reduction in mortality with SDD in a regression analysis: log odds ratio (OR) of death with SDD = -0.0074 - (0.0035 x control group mortality rate), P = 0.017. This is also true when trials are stratified into more and less severely ill patients: pooled OR (a) for CMR > 41% = 0.69 (0.54 to 0.89), with (b) CMR < 3% = 1.02 (0.86 to 1.21). This difference was not suggested by the original meta-analysis result. CONCLUSIONS: Failure to take account of clinical heterogeneity between trials can mean a meta-analysis result ignores important differences in the effect of a treatment on different groups of patients. The discussion indicates how emergency physicians might guard against basing clinical practice on misleading meta-analysis results.

Anti-Bacterial Agents↗
PubMedDate not supplied

Trends in head injury outcome from 1989 to 2003 and the effect of neurosurgical care: an observational study.

BACKGROUND: Case fatality rates after all types of blunt injury have not improved since 1994 in England and Wales, possibly because not all patients with severe head injury are treated in a neurosurgical centre. Our aims were to investigate the case fatality trends in major trauma patients with and without head injury, and to establish the effect of neurosurgical care on mortality after severe head injury. METHODS: We analysed prospectively collected data from the Trauma Audit and Research Network database for patients presenting between 1989 and 2003. Mortality and odds of death adjusted for case mix were compared for patients with and without head injury, and for those treated in a neurosurgical versus a non-neurosurgical centre. FINDINGS: Patients with head injury (n=22,216) had a ten-fold higher mortality and showed less improvement in the adjusted odds of death since 1989 than did patients without head injury (n=154,231). 2305 (33%) of patients with severe head injury (presenting between 1996 and 2003) were treated only in non-neurosurgical centres; such treatment was associated with a 26% increase in mortality and a 2.15-fold increase (95% CI 1.77-2.60) in the odds of death adjusted for case mix compared with patients treated at a neurosurgical centre. INTERPRETATION: Since 1989 trauma system changes in England and Wales have delivered greater benefit to patients without head injury. Our data lend support to current guidelines, suggesting that treatment in a neurosurgical centre represents an important strategy in the management of severe head injury.

Adolescent↗