Abstract:
BACKGROUND:Recent studies on the impact of rib fractures after blunt trauma have shown a linear relationship between age, increasing number of rib fractures, and complications, including mortality. Others have documented that age-related morbidity increases before age 65 in trauma patients. We hypothesize that patients as young as age 45 demonstrate increased morbidity with injuries similar to older patients. METHODS:We performed a retrospective cohort study involving all blunt trauma patients with rib fractures, excluding those with severe head and abdominal injuries and those dying within 24 hours, admitted between January 2001 and December 2004. Outcome parameters included pulmonary complications, ICU length of stay, hospital and ICU length of stay, Injury Severity Score (ISS), number of vent days, number of rib fractures, mechanism of injury, and discharge disposition. RESULTS:Of the 3,094 patients admitted, 307 met the inclusion criteria (9.9%). Based on statistical analysis of age, number of rib fractures, and adverse outcome variables, patients were separated into 4 groups: Group 1: younger than 44 years old with 1 to 4 rib fractures, Group 2: younger than 44 years with greater than 4 rib fractures, Group 3: 45 years or older with 1 to 4 rib fractures, and Group 4: 45 years or older with more than 4 rib fractures. Age groups and outcome variables were compared with chi-square, analysis of variance and multiple regression analysis. Respiratory failure, pneumonia, and associated thoracic injuries were increased in Group 4 patients compared with other groups (P < 0.05). Mortality and length of stay were not different between groups. CONCLUSIONS:Patients as young as 45 with more than 4 rib fractures are at increased risk for adverse outcomes. Efforts to improve outcomes in rib fracture patients should focus not only on elderly patients, but on those as young as 45 years. Based on these data, we established a rib fracture clinical pathway focusing on patients 45 years and older with more than 4 rib fractures.
journal_name
South Med Jjournal_title
Southern medical journalauthors
Testerman GMdoi
10.1097/01.smj.0000203815.29757.d3subject
Has Abstractpub_date
2006-04-01 00:00:00pages
335-9issue
4eissn
0038-4348issn
1541-8243journal_volume
99pub_type
杂志文章abstract::We reviewed our experience with thyroid sonography of 60 patients with nonfunctioning (cold) solitary thyroid nodules proven by iodine 123 scan. Twenty-two patients had surgery; the remaining 38 had thyroid scan and ultrasound only. In the first group, the echograms did not demonstrate the surgically proven nodules in...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198409000-00024
更新日期:1984-09-01 00:00:00
abstract::Most patients with intestinal obstruction have had previous surgery. Rarely, the development of adhesions and resulting small bowel obstruction is attributed to previous intra-abdominal trauma. We present the case of a young man, without a history of surgery, who had been a restrained driver in a motor vehicle crash. ...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2001-05-01 00:00:00
abstract::Although recent increases in the incidence of syphilis are well known to public health officials, the general medical community is less well informed regarding the dramatic rise in cases. We present trend data from Nashville and Tennessee over the past decade. These statistics emphasize specific factors, such as drug ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199208000-00002
更新日期:1992-08-01 00:00:00
abstract:BACKGROUND:In recent years, more and more discussions have arisen with regard to the role of (partially) hydrolyzed formulas as standard feedings for infants with a high risk to have allergy. METHODS:This review is based on an extensive overview of the literature dealing with the subjects of allergy prevention and hyd...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-199712000-00002
更新日期:1997-12-01 00:00:00
abstract::For over a decade there has been concern about hepatitis related to halothane anesthesia. No dose relationship or other direct cause has ever been established, and jaundice has been found to occur after other anesthetics for surgical operations. Enflurane is a newer halogenated compound with a remarkable record of saf...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197807000-00012
更新日期:1978-07-01 00:00:00
abstract::We retrospectively analyzed experience with total gastrectomy (TG) for gastric carcinoma in 23 patients. The TNM stage was I in one patient, II in one patient, III in eight patients, and IV in 13. Linitis plastica was found in ten patients. The operation was considered curative in only eight patients (35%). There were...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-198908000-00011
更新日期:1989-08-01 00:00:00
abstract::Sucralfate is an unabsorbed antiulcer drug that binds to gastrointestinal tissue and protects it from acid and pepsin. Twenty-two arthritic patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) were given sucralfate concomitantly for two weeks in an attempt to lessen gastrointestinal side effects. Changes from...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198508000-00011
更新日期:1985-08-01 00:00:00
abstract:OBJECTIVES:Transcranial Doppler ultrasound (TCD) effectively identifies children with sickle cell anemia (SCA) who are at increased risk of stroke. We evaluated a low-cost quality improvement (QI) intervention to increase the proportion of children screened by TCD. METHODS:We measured the proportion of children with S...
journal_title:Southern medical journal
pub_type: 临床试验,杂志文章
doi:10.14423/SMJ.0000000000000517
更新日期:2016-09-01 00:00:00
abstract::A variant of hereditary hemorrhagic telangiectasia may be gastrointestinal bleeding with no other classical symptoms. This case demonstrates the effectiveness of surgical resection as treatment of duodenal bleeding from telangiectatic lesions. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198703000-00024
更新日期:1987-03-01 00:00:00
abstract:BACKGROUND:Pulmonary contusion (PC) is the most common injury identified in pediatric blunt chest trauma. The disagreement over management principles of children with PC may complicate care of these patients. METHODS:We reviewed the literature and our institutional experience. RESULTS:Pulmonary contusion is most ofte...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-199812000-00002
更新日期:1998-12-01 00:00:00
abstract::The results of radiation therapy of 79 patients with early carcinoma of the vocal cord are reported. Nine (13%) of the 69 patients with stage I disease had local recurrence, and two (20%) of the ten patients with stage II disease had local recurrence without local node metastasis. Subsequent control of radiation failu...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197901000-00004
更新日期:1979-01-01 00:00:00
abstract:OBJECTIVES:Osteopenia is considerably more common than osteoporosis and accounts for most of the fracture burden in women older than 50 years. It is uncertain when to initiate treatment in osteopenia. We sought to determine in women with osteopenia what effect transitioning to lower categories had on subsequent fractur...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.14423/SMJ.0000000000000410
更新日期:2016-02-01 00:00:00
abstract::Eighty-five overriding tibial shaft fractures (46 open, 39 closed) were treated at Ochsner Foundation Hospital between 1960 and 1972. Nine different treatment methods were employed by seven orthopedic surgeons. The best results were obtained in the nine patients treated by open reduction and either compression plating...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197601000-00014
更新日期:1976-01-01 00:00:00
abstract::Psoriasis treatments range from topical treatments and phototherapy to oral systemic medications and injections. Despite good control of the disease when applying appropriate treatments (according to disease severity, insurance parameters, patient preference, and patients' ability to adhere), continued advancements wi...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.14423/SMJ.0000000000000596
更新日期:2017-01-01 00:00:00
abstract::A rare case of alveolar rhabdomyosarcoma of the urinary bladder, manifested as a systemic disease in a 51-year-old woman, was diagnosed at necropsy. Diffuse lytic bone lesions and extensive bone marrow involvement with a leukoerythroblastic blood picture led to an initial clinical diagnosis of a hematologic malignancy...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198704000-00031
更新日期:1987-04-01 00:00:00
abstract:BACKGROUND:This study examined patient perceptions and attitudes toward various aspects of the male and female physician's professional appearance in the family practice setting. METHODS:Four hundred ninety-six patients from two family practice clinics in Knoxville, Tennessee, completed a valid and reliable questionna...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.SMJ.0000077011.58103.C1
更新日期:2003-12-01 00:00:00
abstract::Reported is the fifth known case of Addison's disease due to adrenal involvement by North American blastomycosis (Blastomyces dermatitidis infection). The fact that amphotericin B therapy precipitated an addisonian crisis suggests that patients with disseminated blastomycosis should have their adrenal function and res...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197707000-00028
更新日期:1977-07-01 00:00:00
abstract:OBJECTIVE:Older adults who may not complain of balance problems may nevertheless be developing subtle balance problems that may affect future functioning. This study sought to determine whether subtle problems could be predicted by standard balance testing. METHODS:At the geriatric medicine clinic at an academic terti...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.14423/SMJ.0000000000001138
更新日期:2020-09-01 00:00:00
abstract:OBJECTIVES:Cystic fibrosis (CF) is associated with vitamin D deficiency, which can lead to adverse effects including recurrent pulmonary infections and osteoporosis. We longitudinally investigated calcifediol or 25-hydroxyvitamin D (25(OH)D) levels for our pediatric patients with CF based on the time of year as well as...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.14423/SMJ.0000000000000254
更新日期:2015-03-01 00:00:00
abstract::Most of the surgical procedures proposed for the treatment of fecal incontinence associated with prolapse are associated with considerable morbidity and mortality. We used a modified Thiersch procedure with a Silastic mesh implant (Dow-Corning 501-3) on a series of 12 patients over a period of 2 1/2 years. Nine patien...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198603000-00012
更新日期:1986-03-01 00:00:00
abstract:OBJECTIVES:In this study, we determined patients' attitudes toward discussing firearms and issues of firearms safety with emergency department physicians. We assessed whether patients feel discriminated against should physicians discuss firearms safety, and whether they believed that physician counseling may change how...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.14423/SMJ.0000000000000915
更新日期:2019-01-01 00:00:00
abstract::Implantation of automatic internal cardiac defibrillators (AICD) for management of arrhythmias necessitates the induction of ventricular fibrillation (VF) to test the device adequately. The profound hypotension associated with induced arrhythmia and subsequent circulatory arrest may result in cerebral ischemia. To cha...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199305000-00009
更新日期:1993-05-01 00:00:00
abstract:OBJECTIVES:To assess the relation between renal function and delirium and to assess and compare the relation between cerebral white matter lesion (WML) and renal function as estimated by three formulas for the estimated glomerular filtration rate (eGFR) in older adult hospitalized veterans with and without delirium. M...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.14423/SMJ.0000000000001132
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Use of health services in rural communities has not been well studied. We explored how black and white children used health services in a rural Mississippi community. METHODS:Data were prospectively collected for 396 children attending a private practice to determine if race was associated wi...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.smj.0000232966.81950.a4
更新日期:2006-09-01 00:00:00
abstract::Range-gated pulsed Doppler echocardiography has been reported to be a useful noninvasive bedside technic for detecting ductal left-to-right shunting in premature infants. We studied 30 premature infants with a birth weight of less than 1,500 gm, using a 5 MHz system developed by Advanced Technology Laboratories. An um...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198109000-00023
更新日期:1981-09-01 00:00:00
abstract:OBJECTIVES:This study evaluated the role of ankle-brachial index (ABI) as an effective screening test of coronary artery disease (CAD) in the Hispanic population. METHODS:This was an observational cross-sectional study, based on a retrospective review of the medical management of the study patients using already avail...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/SMJ.0b013e318189aabc
更新日期:2008-11-01 00:00:00
abstract::We retrospectively studied 125 patients treated for carcinoma in situ of the vulva from 1961 through 1984, with follow-up ranging from one to 24 years. Patients' ages ranged from 24 to 90 years, with a mean age of 53 years. Multifocal disease was more common in women under age 40. Pruritus was the most common complain...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198805000-00012
更新日期:1988-05-01 00:00:00
abstract::Seizures are common in acute exacerbations of hepatic porphyria, even though the etiology is not identified in most cases. We have reported a case of normeperidine-induced seizures in a patient with hereditary coproporphyria. Although meperidine is commonly used for pain control during acute attacks in these patients,...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199011000-00020
更新日期:1990-11-01 00:00:00
abstract::Esophagogastric variceal hemorrhage is a common cause of upper gastrointestinal bleeding in patients with portal hypertension. In addition, it is now recognized that patients with alcohol-induced chronic liver disease and portal hypertension frequently bleed from acute mucosal lesions. Since alcohol can cause these le...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198304000-00015
更新日期:1983-04-01 00:00:00
abstract::We describe two patients who had tuberculomas that were initially misdiagnosed as neurosarcoidosis, leading to prolonged steroid therapy before initiation of antituberculous medications. Neither patient was infected with the human immunodeficiency virus, and one of the patients had a negative tuberculosis skin test. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.SMJ.0000048150.02504.99
更新日期:2003-05-01 00:00:00