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Biomedical subjects

L Aharonson-Daniel

Publications and source records attributed to L Aharonson-Daniel.

11 recordsLinked to original sources
PubMed2006

Unilateral flail chest is seldom a lethal injury.

BACKGROUND: The chest cage is a common target for traumatic damage. Although relatively rare, it is considered to be a serious condition with significant reported mortalities. As most flail injuries are accompanied by severe extrathoracic injuries, it is often difficult to pinpoint a single injury responsible for the patient's death. AIM: To investigate the factors related to mortality when flail injury is diagnosed. METHODS: Data from the Israel National Trauma Registry between 1998 and 2003 included 11,966 chest injuries (262 flail chest injuries) out of a total of 118,211 trauma hospitalisations. Mortality figures were analysed to determine which factors, singly or in combination, influenced flail chest mortality. RESULTS: Road crashes accounted for most flail injuries (76%). The total mortality was 54 (20.6%) of 262 patients with flail chest injuries. 13 (20.4%) of the deaths occurred soon after admission to the emergency room and 37 (68.5%) within the first 24 h. Mortality in moderate to severe injuries (injury severity score (ISS) 9-24) was 3.6% and that in critical injuries 28.5% (ISS >24). Mortality increased with age: 17% in those aged <45 years, 22.1% in those between 45 and 64 years and 28.8% in those >65 years. Age remained a risk for inpatient death when adjusted for severity. Mortality in isolated unilateral flail injury was not more than 6%. Total mortality for traumatic brain injury (TBI) and flail was 34%. Flail, TBI and other major injuries increased the mortality to 61.1%. CONCLUSIONS: Advanced age is associated with higher mortality. Isolated unilateral bony cage instability infrequently leads to death in patients who make it to the emergency department but rather its combination with additional extrathoracic trauma.

Accidents, Traffic↗
PubMed2005

Gaps in injury statistics: multiple injury profiles reveal them and provide a comprehensive account.

OBJECTIVE: To demonstrate the benefit of using multiple injury profiles (MIP) as an alternative to "primary diagnosis," for the presentation and analysis of multiple injuries in populations. METHODS: Retrospective analysis of national trauma registry data in Israel between 1 January 1998 and 31 December 2002. Multiple diagnoses per patient were recorded. A primary diagnosis was selected for each patient and data were presented twice: first by selecting a primary diagnosis and then using multiple injury profiles. RESULTS: 23 909 transport casualties were included. Findings show that MIP enable the identification of all patients with a specific injury, even where secondary. The proportion of additional injuries recorded when using MIP ranged from 12% in head injuries to 270% for facial injuries. Based on the primary diagnosis patients with head, chest, and abdominal injuries had a 5-6% inpatient death rate each. Multiple injury profiles of the same population reveal that an isolated head injury has a 3% inpatient death rate, isolated chest and isolated abdomen have a 1% inpatient death rate, while combined head and chest casualties have a 21% inpatient death rate. CONCLUSIONS: Multiple injury profiles are a new approach that enables presenting an improved picture of injury in a population.

Abdominal Injuries↗
PubMed2005

Secondhand smoke and respiratory ill health in current smokers.

BACKGROUND: Numerous studies have concluded that secondhand smoke (SHS) is harmful to non-smokers but controversy persists regarding its effects on smokers. The impact of SHS exposure on the acute respiratory health of current active smokers was examined using a cross sectional design. METHODS: 9923 uniformed staff in the Hong Kong Police Force completed a standardised questionnaire on current and past smoking, SHS exposure at home and at work, acute respiratory symptoms, and recent physician consultation. 3999 male current smokers were included in the analysis. RESULTS: About 5% of the smokers were exposed to SHS at home only, 53% were exposed at work only, and 30% were exposed both at home and at work. The prevalence ratios for respiratory symptoms (throat and nasal problems, cough, phlegm, and wheeze), physician consultation, and self medication were higher for those who were exposed to SHS at home or at work. The odds ratios of reporting one or more respiratory symptoms, for SHS exposures at home or at work, were 1.33 (95% confidence interval (CI) 1.12 to 1.59) and 1.66 (95% CI 1.36 to 2.02) respectively, after adjusting for age, marital status, education, rank and duties, exposure to self perceived dusty or polluted environment in previous job, and total dose of active smoking. The adjusted odds ratios showed significant positive dose-response gradients with SHS exposure at home, at work, and at both places combined. CONCLUSIONS: SHS exposure is strongly associated with increased acute respiratory symptoms and recent outpatient service utilisation in current smokers. If the association is causal, public health action to limit SHS exposure could also benefit smokers.

Acute Disease↗
PubMed2003

A new approach to the analysis of multiple injuries using data from a national trauma registry.

OBJECTIVE: To present a new systematic approach for summarizing multiple injury diagnosis data into patient injury profiles. DESIGN: International Classification of Diseases, ninth revision, clinical modification injury diagnosis codes were classified using a modification of the Barell body region by nature of injury diagnosis matrix, then grouped by body region, injury nature, or a combination of both. Profiles were built which describe patients' injury combinations based on matrix units, enabling the analysis of patients, and not only the study of injuries. SETTING: The Israeli national trauma registry was used to retrieve patient demographic data, injury details, and information on treatment and outcome. Patients or subjects: All hospitalized patients injured in road traffic accidents and included in the trauma registry from January 1997 to December 2000 were included. MAIN OUTCOME MEASURES: Patient profiles consisting of body regions, injury natures, their combination, and their clinical outcomes. RESULTS: The study population comprised 17459 patients. Head and neck injuries were the most frequent in all subpopulations except for motorcyclists who sustained most injuries in the extremities. Fractures were the most common injury nature (60%). Pedestrians and drivers had the highest proportion of multiple injuries in both profiles. Forty eight percent of the patients had a single cell profile. The most frequent conditions as a sole condition were extremity fractures (14%), internal injuries to the head (11%), and injuries of other nature to the torso (6%). Mortality, length of stay, and intensive care unit treatment varied dramatically between profiles and increased for multiple injury profiles. Inpatient death was an outcome for 3.3% overall; however, in patients with an internal injury to the head and torso, inpatient death rate was nine times higher, at 31%. CONCLUSIONS: Profiles maintain information on body region and nature of injury. The use of injury profiles in describing the injured improves the understanding of casemix and can be useful for efficient staffing in multidisciplinary trauma teams and for various comparisons.

Accidents, Traffic↗
PubMed2002

An introduction to the Barell body region by nature of injury diagnosis matrix.

INTRODUCTION: The Barell body region by nature of injury diagnosis matrix standardizes data selection and reports, using a two dimensional array (matrix) that includes all International Classification of Diseases (ICD)-9-CM codes describing trauma. AIM: To provide a standard format for reports from trauma registries, hospital discharge data systems, emergency department data systems, or other sources of non-fatal injury data. This tool could also be used to characterize the patterns of injury using a manageable number of clinically meaningful diagnostic categories and to serve as a standard for casemix comparison across time and place. CONCEPT: The matrix displays 12 nature of injury columns and 36 body region rows placing each ICD-9-CM code in the range from 800 to 995 in a unique cell location in the matrix. Each cell includes the codes associated with a given injury. The matrix rows and columns can easily be collapsed to get broader groupings or expanded if more specific sites are required. The current matrix offers three standard levels of detail through predefined collapsing of body regions from 36 rows to nine rows to five rows. MATRIX DEVELOPMENT: This paper presents stages in the development and the major concepts and properties of the matrix, using data from the Israeli national trauma registry, and from the US National Hospital Discharge Survey. The matrix introduces new ideas such as the separation of traumatic brain injury (TBI), into three types. Injuries to the eye have been separated from other facial injuries. Other head injuries such as open wounds and burns were categorized separately. Injuries to the spinal cord and spinal column were also separated as are the abdomen and pelvis. Extremities have been divided into upper and lower with a further subdivision into more specific regions. Hip fractures were separated from other lower extremity fractures. FORTHCOMING DEVELOPMENTS: The matrix will be used for the development of standard methods for the analysis of multiple injuries and the creation of patient injury profiles. To meet the growing use of ICD-10 and to be applicable to a wider range of countries, the matrix will be translated to ICD-10 and eventually to ICD-10-CM. CONCLUSION: The Barell injury diagnosis matrix has the potential to serve as a basic tool in epidemiological and clinical analyses of injury data.

Data Collection↗
PubMed2001

[Road traffic accidents, circumstances, diagnoses and severity of injury--data from the Israeli National Trauma Registry].

The Israeli National Trauma Registry includes data on road traffic accidents from eight trauma centers. The investigation of registry data adds a new dimension to the analysis of road injuries. This dimension includes health information such as the type and severity of injury, treatment provided and outcomes. This article summarizes data on 4,328 patients injured in traffic accidents and included in the National Trauma Registry in 1999. We describe diagnoses and injury severity for road traffic accident casualties and link the injury outcomes to the type of accident. Findings indicate high risk for severe or fatal injuries among pedestrians, particularly among the young and the elderly. Children on bicycles and young car drivers are also at risk. This information will serve as a basis for prevention intervention and education programs.

Accidents, Traffic↗
PubMed2000

Environmental tobacco smoke exposure among police officers in Hong Kong.

CONTEXT: Few epidemiological studies have examined the relationship between chronic respiratory symptoms and exposure to environmental tobacco smoke (ETS) at work in adults, and none have shown clear dose-response relationships. OBJECTIVE: To examine the respiratory effects of ETS exposure at home and at work among never-smoking adults. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional, self-administered questionnaire survey conducted in December 1995 and January 1996 among 4468 male and 728 female police officers in Hong Kong who were never-smokers. MAIN OUTCOME MEASURES: Respiratory symptoms and physician consultation in the previous 14 days for such symptoms by presence and amount of ETS exposure at work. RESULTS: Eighty percent of both men and women reported ETS exposure at work. Significant odds ratios (ORs) for respiratory symptoms were found among men with ETS exposure at work (for any respiratory symptoms, difference in absolute rate, 20.4%; OR, 2.33; 95% confidence interval [CI], 1.97-2.75; attributable risk, 57%) and physician consultation (difference in absolute rate, 4.5%; OR, 1.30; 95% CI, 1. 05-1.61; attributable risk, 23%). Trends were similar among women for any respiratory symptoms (difference in absolute rate, 15.4%; OR, 1.63; 95% CI, 1.04-2.56; attributable risk, 39%) and for physician consultation (difference in absolute rates, 2.8%; OR, 1.45; 95% CI, 0.87-2.41; attributable risk, 31%). Positive dose-response relationships with number of coworkers smoking nearby and amount of ETS exposure in the work place were found. CONCLUSIONS: This study provides further evidence of the serious health hazards associated with ETS exposure at work. The findings support a ban on smoking in the workplace to protect all workers in both developed and developing countries. JAMA. 2000;284:756-763

Adult↗
PubMed1996

Time studies in A&E departments--a useful tool for management.

A time and motion study was conducted in an accident and emergency (A&E) department in a Hong Kong Government hospital in order to suggest solutions for severe queuing problems found in A&E. The study provided useful information about the patterns of arrival and service; the throughput; and the factors that influence the length of the queue at the A&E department. Plans for building a computerized simulation model were dropped as new intelligence generated by the study enabled problem solving using simple statistical analysis and common sense. Demonstrates some potential benefits for management in applying operations research methods in busy clinical working environments. The implementation of the recommendations made by this study successfully eliminated queues in A&E.

Appointments and Schedules↗
PubMed1996

Management of queues in out-patient departments: the use of computer simulation.

Notes that patients attending public outpatient departments in Hong Kong spend a long time waiting for a short consultation, that clinics are congested and that both staff and patients are dissatisfied. Points out that experimentation of management changes in a busy clinical environment can be both expensive and difficult. Demonstrates computerized simulation modelling as a potential tool for clarifying processes occurring within such systems, improving clinic operation by suggesting possible answers to problems identified and evaluating the solutions, without interfering with the clinic routine. Adds that solutions can be implemented after they had proved to be successful on the model. Demonstrates some ways in which managers in health care facilities can benefit from the use of computerized simulation modelling. Specifically, shows the effect of changing the duration of consultation and the effect of the application of an appointment system on patients' waiting time.

Appointments and Schedules↗