Objective To observe the variation of mortality and discharge against medical advice in major trauma patients admitted to the ICU and thus to improve the level of trauma care.Methods A retrospective analysis was performed on major trauma patients who died or discharged against medical advice in the emergency 1CU from 2003 to 2011.Patients were categorized as the dying,worse,and improved according to their situation at discharge.The dying was included into the death group.Annual variation of mortality and discharge against medical advice were analyzed in these 9 years.These parameters were also compared among three diverse periods (2003-2005,2006-2008 and 2009-2011).Results Ultimately,452 patients were recruited from the 3,343 major trauma patients admitted to the emergency ICU from 2003 to 2011.There were 231 deaths occupying 6.91％ (135 patients died in hospital and 96 patients were dying at discharge) and 221 discharges against medical advance occupying 6.61％ (175 patients deteriorated and 46 patients improved).Within the 9 years,a significant decrease was found in the annual rate of inhospital death,dying at discharge,and total death.Meanwhile,there was an increase in the rate of deterioration at discharge (x2 =15.305,P ＞0.05).However,no significant difference was found in the rate of total death plus deterioration at discharge.During the three periods of 2003 to 2005,2006 to 2008,and 2009 to 2011,number of patients admitted to the emergency ICU was 687,1,143,and 1,513 respectively.Age and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) of the dead,the patients with deterioration at discharge,and the dead plus the patients with deterioration were gradually higher through the three periods; on the contrary,GCS lowered.Total mortality decreased from 11.06％ to 4.63％ (x2 =31.174,P ＜0.01) ; rate of deterioration at discharge increased continuously from 2.77％ to 6.35％ (x2 =12.203,P ＜0.01) ; rate of death plus deterioration at discharge was declined from 13.83％ to 10.97％ (x2 =4.09,P ＞ 0.05).Conclusions From 2003 to 2011,the level of severe trauma care in emergent ICU is obviously improved.Ratio of deterioration at discharge increases with more aged patients.Discharge against medical advance interferes with the accurate assessment of trauma care and should be paid more attention.

Objective:To investigate the sex differences in severe traumatic death patients of different ages.Methods:A total of 408 patients with severe trauma who received treatment in The Second Affiliated Hospital of Zhejiang University School of Medicine and Taizhou First People's Hospital from June 2017 to June 2022 were retrospectively analyzed. These patients were divided into the children group (≤ 14 years old, n = 47), the adult group (14-50 years old, n = 171), and the older adult group (> 50 years old, n = 90). Multivariate logistic regression was used to evaluate the difference in sex-based mortality among the groups. Nonlinear regression was used to evaluate the mutual interaction of increasing age and sex on the predicted survival rate. Results:Traffic accidents were the most common cause of death among men in the adult group (58.93%, χ2 = 7.95, P = 0.027). Falls were the most common cause of death among men in the older adult group (57.36%, χ2 = 8.63, P = 0.001). The Injury Severity Score of women in the adult and older adult groups was significantly higher in women than that of men in the same group [adult group: men: (24.39 ± 4.17) points, women: (26.32 ± 4.31) points, t = 2.84, P = 0.005). The incidence of post-traumatic complications in the older adult group was very higher in men than in women (respiratory failure: 28.68% in men, 14.75% in women, χ2 = 4.37, P = 0.036; circulatory failure: men: 27.13%, women: 13.11%, χ2 = 4.64, P=0.031; neuropsychiatric disorders: men: 20.93%, women: 8.20%, χ2 = 4.79, P = 0.029; respiratory infection: men: 31.78%, women: 18.03%, χ2 = 5.55, P = 0.047; other infectious diseases: men: 28.68%, women: 13.11%, χ2 = 0.69, P = 0.018). After adjusting for covariates, the mortality rate of men in the older adult group was significantly higher than that of women in the same group ( OR: 1.261, 95% CI: 1.185-1.343, P < 0.001). With the increase of age, the predicted survival rate after the trauma in patients of different sexes also decreased, in particular in men aged > 50 years (interaction P = 0.051). Among patients with blunt and severe head trauma, age-related mortality decline in patients aged > 50 years had a strong interaction with sex (interaction P = 0.002). In patients with penetrating trauma, there was a weak interaction between the predicted survival rate of different sexes (interaction P = 0.192). Conclusion:There is no significant difference in age-related change in post-traumatic mortality between different sexes. In the population aged > 50 years, men have a relatively higher risk of death than women.

Non-bifurcating cervical carotid artery(NBCCA)is a very rare anatomical variation of the cervical carotid artery,which may be related to the abnormal development of internal carotid artery(ICA)and external carotid artery in embryonic period.Neither carotid bulb nor a true carotid bifurcation can be observed on the ultrasound of carotid artery while a"stump-like"change was showed at the expected bifurcation level of carotid artery on DSA.Few cases has been reported in China and abroad so far.This article reported a middle-aged male with a history of hypertension and type 2 diabetes and was admitted to the hospital due to dizziness for one month.The left NBCCA accompanied with severe stenosis of the right ICA was confirmed by cerebral angiography.The patient received the right ICA stent implantation surgery as well as antihypertensive and glucose-control treatment and was discharged as his symptoms improved.Clinical data of this case and related literatures were reviewed,in order to improve clinicians'especially imaging diagnostic physicians'understanding on NBCCA to avoid misdiagnosis and related complications.

Objective To explore the risk factors of aseptic meningitis (AM) after microvascular decompression (MVD) to provide evidence for preventing the occurrence of AM. Methods One hundred and forty-one patients diagnosed as having trigeminal neuralgia or hemifacial spasm, admitted to our hospital from January 2014 to December 2016, were chosen. A retrospective analysis was performed on these clinical data. Eighteen related factors of AM were analyzed by Logistic regression model. Results The result of single analysis of related factors showed that gender, age, diabetes, operation time, skill level of the operator, injection of dexamethasone, and postoperative dressing time were related to AM after MVD (P<0.05). Multifactor Logistic regression analysis showed that gender (OR=2.920, P=0.015), diabetes (OR=0.200, P=0.026), and non-injection of dexamethasone (OR=7.970, P=0.002) were independent risk factors of postoperative AM. Conclusion The male or diabetic patients have high rate of postoperative AM; and the risk of postoperative AM would be reduced if we inject dexamethasone to the cerebellopontine angle cistern at the end of MVD.

Objective:To analyze the epidemiological characteristics and influencing factors of venous thrombosis in elderly patients with severe trauma.Methods:A retrospective study was conducted to collect and statistically analyze general information[sex, age, body mass index(BMI)], causes of trauma, injury severity score(ISS), Glasgow coma score(GCS), coagulation function[prothrombin time(PT), international normalized ratio(INR), D-dimer], B-type natriuretic peptide(BNP), liver function(alanine aminotransferase, aspartate aminotransferase), creatinine, Caprini score, surgical approach, immobilization mode, days of hospitalization, and treatment cost.Results:Totally 179 elderly patients with severe trauma were enrolled, including 130 men(72.6%), aged(67.6±6.4)years.The BMI, ISS and GCS scores of elderly patients with severe trauma were(22.9±3.4)kg/m 2, 28.4±10.5 and 10.2±4.6, respectively.The Caprini score was 11.7±4.0.Of these patients, 32(17.9%)had VTE events.Compared with the VTE negative group, the VTE positive group was older( t=-2.214, P=0.028), with a higher Caprini score( t=-2.684, P=0.008)and more lower limb fractures( P=0.008)and pelvic fractures( P=0.001). There were no significant differences in coagulation function, liver function, atrial natriuretic peptide levels, creatinine levels and surgical approaches between the VTE negative group and the VTE positive group(all P<0.05). No significant difference was found in the proportion of patients receiving surgical treatment between the two groups( P=0.563). In the VTE positive group, 18.8% had no fracture, 50.0% had one fracture, and 31.2% had two or more fractures, and the difference was statistically significant compared with the VTE negative group( P=0.029). However, VTE events had no significant effect on the average length of stay and hospitalization costs in elderly trauma patients(all P<0.05). Conclusions:For elderly patients with severe trauma, VTE is more likely to occur with increased age, a high Caprini score, multiple fracture sites and pelvic fracture.In addition, pelvic fracture is an independent risk factor for VTE in very old trauma patients.Attention should be paid to prevention and treatment to achieve steady improvement in the overall prognosis of trauma in these patients.