Biomedical subjects

Howard R Champion

Publications and source records attributed to Howard R Champion.

10 recordsLinked to original sources

PubMed2007

The role of data and safety monitoring in acute trauma resuscitation research.

BACKGROUND: The role of data and safety monitoring boards (DSMBs) in clinical research in acute trauma resuscitation is not well documented. Many of the difficulties conducting acute resuscitation research are exacerbated because multiinstitutional studies are needed to adequately power such research. STUDY DESIGN: The purpose of the study was to demonstrate how a well-organized DSMB, explicitly required for these types of clinical trials by many funding agencies, can be a valuable resource in their safe and successful conduct by maximizing data integrity and striving to standardize care by monitoring the consistent and accurate collection of data and adherence to protocol. As an example, the work of an external DSMB in an international multicenter trial of recombinant activated coagulation factor VIIa (rFVIIa) in blunt and penetrating trauma patients is presented. The DSMB in this study was responsible for reviewing all serious adverse event (SAE) data, performing an extended review of SAEs, and reviewing results of analyses of 48-hour and 30-day mortality according to prespecified study stopping rules. RESULTS: Application by the DSMB of uniform definitions of SAEs substantially improved the integrity of the study data and facilitated analysis of events, such as disseminated coagulopathy, pulmonary complications, and multiple organ failure. As a result of the DSMB's efforts, important insights were gained to guide site selection and conduct of future trials of rFVIIa in trauma-induced hemorrhage. CONCLUSIONS: Based on our experience as members of the study DSMB and on a review of the literature, we recommend a strong role for DSMBs in multicenter trials in acute resuscitative care.

Acute Disease↗

PubMed2006

Virtual autopsy: preliminary experience in high-velocity gunshot wound victims.

PURPOSE: To retrospectively assess virtual autopsy performed with multidetector computed tomography (CT) for the forensic evaluation of gunshot wound victims. MATERIALS AND METHODS: The institutional review board approved this HIPAA-compliant study and did not require informed consent of the next of kin. Thirteen consecutive male gunshot wound victims (mean age, 27 years) were scanned with 16-section multidetector CT prior to routine autopsy. Retrospectively, the total-body nonenhanced scans were interpreted at a three-dimensional workstation by radiologists blinded to autopsy findings. Images were evaluated for lethal wound, number and location of wound tracks, injured structures, and metal fragment location. After image review, autopsy reports and photographs were compared with the images and interpretations to validate the multidetector CT determinations. RESULTS: Multidetector CT aided in correct identification of all lethal wounds, and metallic fragment location was always precise. In four cases, multidetector CT aided in accurate assessment of organ injuries and lethal wounds but led to underestimation of the number of wounds if comingling paths occurred. In two cases of a chest wound, multidetector CT aided in accurate assessment of the chest as having the lethal wound but failed to help identify specific sites of hemorrhage. In two cases of craniofacial injury, the path of the wound was not clear. Autopsy revealed a total of 78 wound tracks (mean, 6; range, 1-24). Ten (13%) wound tracks were not identified at multidetector CT (six upper extremity wounds and four thigh wounds). In two cases, findings missed at autopsy (fracture of the cervical spine, bullet fragments in the posterior area of the neck) were identified at multidetector CT. CONCLUSION: Multidetector CT can aid prediction of lethal wounds and location of metallic fragments.

Adult↗

PubMed2006

The state of US trauma systems: public perceptions versus reality--implications for US response to terrorism and mass casualty events.

BACKGROUND: Injury has long been identified as the number one killer of Americans under the age of 34, and establishment of regional trauma systems and centers incorporating primary, secondary, and tertiary care and injury-prevention strategies has proved to be a vital element in reducing injury-related sequelae, deaths, and even costs. Despite these facts, trauma system development has not been given priority for funding in many local and state governments and only intermittently at the federal level. Consequently, many of the nation's trauma centers are strapped for funds to provide emergency care to their patients. STUDY DESIGN: In response to a 2002 Health Resources and Services Administration (HRSA) report, which identified public support as a key element in the success of trauma system development in states and communities across the United States, a Harris Interactive study was undertaken in the fall of 2004 to determine the public's attitudes, awareness, and knowledge concerning the nature and availability of trauma care and systems of trauma care. Results of the poll were contrasted with current data on the state of US trauma systems to determine the degree of correspondence. RESULTS: Results of the poll indicated that fully 61% of the American public does not know that injury is the leading cause of death for those aged 1 to 34, and most believe that a trauma system is in place in every state. Almost two-thirds of the American public is confident of receiving the best medical care in the event of serious injury and would be seriously concerned if no trauma center were nearby. But only eight states have fully developed trauma systems, and most states have no federal funding or infrastructure in place for managing the aftermath of a natural disaster or terrorist event. These and other objective data reveal the mismatch between public perceptions and reality. CONCLUSIONS: Although almost 90% of Americans believe that state trauma systems and hospitals should have a coordinated trauma response, this has not been made a national priority. Trauma systems must be adequately developed and supported to fulfill the public's expectation to receive the best possible care if seriously injured, and to ensure readiness for mass casualty and terrorist incidents.

Disaster Planning↗

PubMed2006

Understanding combat casualty care statistics.

Maintaining good hospital records during military conflicts can provide medical personnel and researchers with feedback to rapidly adjust treatment strategies and improve outcomes. But to convert the resulting raw data into meaningful conclusions requires clear terminology and well thought out equations, utilizing consistent numerators and denominators. Our objective was to arrive at terminology and equations that would produce the best insight into the effectiveness of care at different stages of treatment, either pre or post medical treatment facility care. We first clarified three essential terms: 1) the case fatality rate (CFR) as percentage of fatalities among all wounded; 2) killed in action (KIA) as percentage of immediate deaths among all seriously injured (not returning to duty); and 3) died of wounds (DOW) as percentage of deaths following admission to a medical treatment facility among all seriously injured (not returning to duty). These equations were then applied consistently across data from the WWII, Vietnam and the current Global War on Terrorism. Using this clear set of definitions we used the equations to ask two basic questions: What is the overall lethality of the battlefield? How effective is combat casualty care? To answer these questions with current data, the three services have collaboratively created a joint theater trauma registry (JTTR), cataloging all the serious injuries, procedures, and outcomes for the current war. These definitions and equations, consistently applied to the JTTR, will allow meaningful comparisons and help direct future research and appropriate application of personnel.

Afghanistan↗

PubMed2005

Blast injuries.

Explore the source record for details and available documents.

Barotrauma↗

PubMed2004

Analysis of injury criteria to assess chest and abdominal injury risks in blunt and ballistic impacts.

BACKGROUND: The Viscous Criterion (VC) is an experimental measure developed by the automotive industry to assess injury risks for high-speed impacts. The Blunt Criterion (BC) is a prospective measure developed by the Department of Defense to predict injury from blunt projectiles. METHODS: The range of applicability of BC was extended and compared with VC for its ability to assess injury risk using published cadaver and animal data. Department of Defense projectiles were 0.05 to 0.43 kg mass at velocities up to 86 m/s. VC data were generated from impacts with 1.75 to 23.4 kg at 3.6 to 10.2 m/s. Chest and abdominal injuries ranged from Abbreviated Injury Scale scores of 1 to 6. RESULTS: Both criteria correlated very well with the experimental data, demonstrating correlation coefficients of R = 0.84 to 0.96. The correlation between VC and BC was R = 0.99. Logistic probability curves were derived to predict blunt impact injuries of Abbreviated Injury Scale scores of 1 to 6 for the chest and abdomen. CONCLUSION: BC and VC are virtually identical in their ability to assess blunt and ballistic impact injury risks. They are different measures of impact energy absorbed by the body. One is predictive using input parameters, and the other measures the impact response of the body.

Abbreviated Injury Scale↗

PubMed2003

Combat fluid resuscitation: introduction and overview of conferences.

Fluid resuscitation of injured combatants in a tactical setting has special challenges which standard civilian protocols do not address. Over a period of a year, four conferences on combat fluid resuscitation were held. The purpose of these conferences was to develop a consensus regarding contemporary practice and to identify and energize a research agenda. The conferees made specific recommendations for institution of, and endpoints for, resuscitation in the combat setting. They recommended that combat fluid resuscitation in these settings should be initiated with low volume colloid (for U.S. Forces) and hypertonic saline dextran (for those not constrained by U.S. Food and Drug Administration regulations). A specific research agenda was defined. Since that time, these recommendations have been implemented in many North Atlantic Treaty Organization (NATO) forces and a variety of other activities have served to provide expert support and research focus for the special needs of injured combatants.

Congresses as Topic↗

PubMed2003

A profile of combat injury.

Traumatic combat injuries differ from those encountered in the civilian setting in terms of epidemiology, mechanism of wounding, pathophysiologic trajectory after injury, and outcome. Except for a few notable exceptions, data sources for combat injuries have historically been inadequate. Although the pathophysiologic process of dying is the same (i.e., dominated by exsanguination and central nervous system injury) in both the civilian and military arenas, combat trauma has unique considerations with regard to acute resuscitation, including (1) the high energy and high lethality of wounding agents; (2) multiple causes of wounding; (3) preponderance of penetrating injury; (4) persistence of threat in tactical settings; (5) austere, resource-constrained environment; and (5) delayed access to definitive care. Recognition of these differences can help bring focus to resuscitation research for combat settings and can serve to foster greater civilian-military collaboration in both basic and transitional research.

Fluid Therapy↗

PubMed2003

A new "TRISS-like" probability of survival model for intubated trauma patients.

BACKGROUND: Prehospital trauma patient field intubations and paralyzations, using neuromuscular blocking agents before emergency department respiratory and neurologic assessments are made, bias assessments and outcome evaluations using probability-of-survival models, such as TRISS and A Severity Characterization of Trauma (ASCOT). We present a newly developed "TRISS-like" probability-of-survival model for intubated blunt- and penetrating-injured patient assessment. METHODS: From a population of 51397 consecutively admitted trauma patients, this study used all 5740 (11.2% of the total injured population) intubated patients with complete data from a statewide trauma registry from October 1, 1993, to September 30, 1996. Model performance was evaluated using standard calibration and discrimination measures and z and W statistics of significance. RESULTS: The new model accurately predicted survival for blunt- and penetrating-injured intubated patients and is applicable to 11 etiologic patient populations. CONCLUSION: Study findings suggest that the new TRISS-like model should be used to assess both blunt- and penetrating-injured intubated patients. Use of this new model provides an analytical method for addressing a significant limitation of both the standard TRISS and ASCOT models, which are not applicable to intubated injured patient assessment. In addition, use of this model will complement TRISS/ASCOT assessments of nonintubated trauma patients and thus permit appropriate assessments for both intubated and nonintubated injured patient study populations.

Adolescent↗

PubMed2002

A comparison of the abilities of nine scoring algorithms in predicting mortality.

OBJECTIVE: The purpose of this study was to compare the abilities of nine Abbreviated Injury Scale (AIS)- and (ICD-9)-based scoring algorithms in predicting mortality. METHODS: The scores collected on 76,871 incidents consist of four AIS-based algorithms (Injury Severity Score [ISS], New Injury Severity Score, Anatomic Profile Score [APS], and maximum AIS [maxAIS]), their four ICD to AIS mapped counterparts, and the ICD-9-based ISS (ICISS). A 10-fold cross-validation was performed and area under the receiver operating characteristic curve was used to determine algorithm discrimination. Hosmer-Lemeshow statistics were computed to gauge goodness-of-fit, and model refinement measured variance of predicted probabilities. RESULTS: Overall, the ICISS has the best discrimination and model refinement, whereas the APS has the best Hosmer-Lemeshow performance. ICD-9 to AIS mapped scores have worse discrimination than their AIS-based counterparts, but still show moderate performance. CONCLUSION: Differences in performance were relatively small. Complex scores such as the ICISS and the APS provide improvement in discrimination relative to the maxAIS and the ISS. Trauma registries should move to include the ICISS and the APS. The ISS and maxAIS perform moderately well and have bedside benefits.

Abbreviated Injury Scale↗