Text Size

Science Direct

Διεθνείς Δημοσιευσεις - Science Direct

Conservative treatment of thoracic outlet syndrome (TOS): Creating an evidence-based strategy through critical research appraisal

aFiloktitis Medical Center, Center of Excellence in Physical Medicine and Rehabilitation, Athens, Greece

bSchool of Health and Social Care, Oxford Brookes University, Oxfordshire, UK

cAcademic Department of Trauma & Orthopaedics, Leeds Teaching Hospitals, University of Leeds, Leeds, UK

Available online 28 January 2008.



Thoracic outlet syndrome (TOS) is initially treated non-operatively. Upon failure or unsatisfactory improvement surgical treatment is contemplated. The purpose of this review is to critically appraise available primary research on non-operative treatment of TOS, explore the effectiveness of non-operative treatment approaches and propose an evidence-based treatment strategy.

Keywords: Thoracic outlet syndrome; Conservative treatment; Rehabilitation; Compression Syndromes

Article Outline

Surgery and conservative treatment
Considerations regarding primary research studies on the conservative treatment of TOS
Constructing an evidence-based rehabilitation strategy
Conclusion and recommendations for future research

Corresponding author at: Orfeos 3, P.O. Box 16672, Vari, Athens, Greece. Tel.: +30 210 9654809.

Διεθνείς Δημοσιευσεις - Science Direct

Blood transfusion and outcome of the polytrauma patient

A.G. Angoules , N.K. Kanakaris and P.V. Giannoudisa

Leeds Teaching Hospitals, UK

Copyright © 2007 Published by Elsevier Ltd.

Available online 12 February 2008.

Keywords: Polytrauma; Transfusion; Outcome

Purpose: To determine the need for blood transfusion in the polytrauma patient in the accident and emergency department during resuscitation and its correlation with pattern of injury and outcome.

Methods: Over a period of 6 months, we reviewed the records of polytrauma patients that were transfused at the early stages of their admission—at the resuscitation room. Demographic details, injury pattern, injury severity scores (ISS), resuscitation requirements and mortality were prospectively documented and were analysed in a retrospective fashion.

Results: In total 38 patients were found eligible for participation in the study. There were 31 male and 7 female with a mean age of 38 years (range 13.3–88.4). They all required blood transfusion during the initial phase of their care. The mean ISS was 31 (range 9–54). The mean AIS was 3 for the head, 3 for the abdomen, 4 for the chest and 3 for the lower extremities. The GCS ranged 3–15 (mean 10.5). A total of 194 blood units were transfused. Blood transfusion ranged from 1 to 11 units per patient (mean = 4.737, S.D. = 2.575). Twenty patients finally died after 0–12 days from the initial injury (mortality 52.6%). For the rest of the patients the length of stay in the critical care unit was 0–39 days (mean = 30.16, S.D. = 14.5) whilst the total hospital stay in the wards was 1–83 days (mean = 13.36, S.D. = 21.04). A comparison between survivors and non-survivors illustrated a statistically significance difference in terms of AIS code and GCS. There was no statistically important correlation of the blood units transfused, the AIS codes and the GCS.

Conclusion: Mortality remains high in the multiple injured patients even with the modern techniques of treatment. Blood loss in the polytrauma patients leads into haemodynamic instability. No correlation was found between the number of blood units transfused and AIS scores.

Corresponding Author Contact Information

Injury Extra
Volume 39, Issue 5, May 2008, Page 158