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Hawkins and Martin C. WeinrichElizabeth G. NeSmith, Sally P. Weinrich, Jeannette O. Andrews, Regina S. All rights reserved. Fax: By Elizabeth g. Weinrich, phDBackground Demographic differences in health outcomes havebeen reported for chronic diseases, but few data exist on thesedifferences in trauma defined as acute, life-threatening injuries. Methods A retrospective chart review of patients from alevel I trauma center was conducted. Inclusioncriteria were age 18 to 44 years, Injury Severity Score 15 orgreater, and admission to an intensive care unit.
Systemic inflammatoryresponse syndrome was measured by using the systemicinflammatory response syndrome score. Race was self-reported. Socioeconomic status was defined by insuranceand employment. Descriptive statistics, Wilcoxon rank sum,Kruskal-Wallis, and c2 tests were used for analysis. Conclusions Demographic differences exist in the systemicinflammatory response syndrome score after trauma.
Addi-tional studies in larger populations of patients are needed aswell as basic science and translational research to determinepotential mechanisms that may explain the differences. American Journal of Critical Care. Describe systemic inflammatory response syn-drome SIRS. Identify and correlate variables that increaserisk of SIRS response. Examine implications for practice changes inthe care of trauma patients. To read this article and take the CE test online,visit www. Demographic variables such as age and sexinfluence SIRS after trauma.
Criticalcare research16,17 nonspecific to trauma has shownthat African Americans and persons oflow socioeconomic status have nearlytwice the rates of sepsis, organ dysfunc-tion, and sepsis-related mortality as dowhites. Low socioeconomic status hasbeen associated with high levels ofbaseline inflammation,18a findingrelated to early organ dysfunction. In theVulnerable populations Conceptual Framework VpCF ,23race and socioeconomic status are 2 theo-retical variables that contribute to increased relativerisk for poor health outcomes.
Stress can affect baseline inflammatory func-tion. Trauma is a leading cause of morbidity and mortality for persons from birth to 44years of age in the United States. Regina S. Medeiros is direc-tor of the trauma program and Michael L. Sebastian Way, Augusta, GA e-mail:bnesmith georgiahealth. Low socio-economic statushas been associ-ated with highlevels of baselineinflammation.
A score of 0 or 1 indicatesno occurrence of SIRS. Scores of 2,3, and 4 indicate mild, moderate,and severe SIRS, respectively. Temperatureand other vital signs data were col-lected from the ICU admissionassessment.
Statistical analyses were developed and conductedby one of the study subinvestigators, who is a statis-tician and epidemiologist. Wilcoxon rank sums, Kruskal-Wallistests, and c2 tests were used to analyze data. SASsoftware, version 9. Significant differences existed between AfricanAmericans and whites. Differences in SIRS severity byrace and by socioeconomic status were not significant.
Significant differences also existed by age and sex. Specific methods for data collection have beenreported elsewhere. Charts wereidentified by using the trauma registry database. Trauma registry databases are required in all desig-nated trauma centers and contain demographic andinjury-related data on patients evaluated at theseinstitutions.
The Injury SeverityScore is a system used by clinicians and researchersto assess severity of injury. Race was defined as American Indian or AlaskanNative; Asian or pacific Islander; African American,not of hispanic origin; hispanic; and white, not ofhispanic origin. Ethnicity was defined as hispanicor Latino. Socioeconomic status was defined by insurance andemployment status. Income data were not available. Insurance status has been used as a proxy for socioe-conomic status when income data is not available.
Conditions ofchronic stresscan result inloss of biologicnegative feed-back loops. Median SIRS severity was mild score of 2 for women and moderate score of 3 for men. DiscussionThe findings that African Ameri-cans had fewer occurrences of SIRSand lower WBC counts than did whitessuggest the possibility of an overallreduced systemic inflammatory responseto trauma in this sample.
The AfricanAmericans in their sample also had a slight survivaladvantage. The investigators42explained theirfindings by presuming that the pretrauma WBCcounts for African Americans were lower than thanthe counts for whites.
Because our study is one of few similar studies intrauma patients, additional studies are needed toconfirm the results. Our results are consistent with the VpCF con-ceptual framework upon which our research wasbased.
Our findings can be further explained by psy-choneuroimmunology, a scientific term used toexplain biobehavioral connections between stressand inflammatory responses. During stress, cortisolreceptors on immune cells are activated, triggering anacute-phase inflammatory response characterizedby increases in the serum levels of proinflammatorycytokines.
The patients in the study by Bochic-chio et al51were also significantly older than thepatients in our study mean, 43 years; SD, 21 yearsvs mean, 29 years; SD, 8 years , a difference thatcould increase the likelihood of comorbid conditionsthat affect the immune response.
Increased age hasalso been associated with immuno-suppression,52a relationship indi-rectly supported by our results, whichshowed that older patients had sig-nificantly fewer occurrences of SIRSthan did younger patients. Clinical and Scientific ImportanceOur findings raise importantquestions that challenge existingclinical and research models intrauma care.
Currently, clinicalguidelines for trauma do not differ-entiate between vulnerable and nonvulnerablepatients, except for elderly patients, most likelybecause so few trauma studies address this topic. We found only 1 other similar study51con-ducted in a trauma population. In that study,Bochicchio et al51evaluated persistent SIRS as a pre-dictor of nosocomial infection in trauma patients andfound no significant differences by race in the occur-rence of SIRS.
More research is needed to validatethe findings of both our study and the research ofBochicchio et al,51but differences in study methodsand sample characteristics could explain these find-ings. Because of rounding, not all percentages total VariablesNone,score Mild,score 2Moderate,score 3Severe,score 4 TotalSystemic inflammatory response syndromeOlder patients hadsignificantly feweroccurrences ofsystemic inflam-matory responsesyndrome than didyounger patients.
Like current clinical guidelines, the majority oftrauma research also has not addressed vulnerableand nonvulnerable populations of patients. Conse-quently, science may lack important explanationsfor why differences exist in the incidence of deadlycomplications of trauma that have inflammatoryorigins, such as sepsis and organ failure.
Implications for Research and PracticeInterdisciplinary translational research teamscomposed of basic and clinical scientists are neededto investigate the specific underlying physiologicaland biobehavioral mechanisms responsible for ourfindings and for the results of other similar reportsand how the mechanisms might translate to clinicaloutcomes and practices.
Limited and costly healthcare resources mandate that clinicians know whichpatients are at increased risk for poor health out-comes of trauma, such as sepsis and organ failure.
Traitement De L'amygdalite Lacunaire Chronique Par La Discission Des Amygdales
Translation of "tonsillitis" in French
Bouchons de mucus se formant sans cesse dans les cryptes -- Calc. Brillantes ou vernies, blanches ou jaunes plaques -- Lac c. Gangreneux -- Bapt. Plaques sur les amygdales -- Kali m. Gonflement Amygdalite. Induration -- Alumen, Ars.