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Time related admissions and outcomes of trauma patient at an emergency department  [PDF]
Nurettin Kahramansoy,Hayri Erkol,Necla Gürbüz,Feyzi Kurt
Medical Journal of Bakirk?y , 2012,
Abstract: Objective: Admission time of patients to emergency department (ED) vary. In certain times patient density increases and may have negative effect on morbidity and mortality of the patients. The aim of this study is to investigate the distribution of trauma characteristics and outcomes of the patients admitted to the ED with respect to elements of time. Material and Methods: This is a retrospective, cross-sectional study, which includes all the trauma patients admitted to an ED at eastern Turkey between January 2006 and December 2007. Results: The daily average of the total patients per physician was about 230. There were 6185 trauma patients analyzed. The number of patients and the percents of injured body regions per month increased towards summer. The highest percent was 31.9 for head-neck injury in August. The daily distribution of strike (68%) and motor vehicle injury (25.5%) were high in Thursday and Friday respectively. Only thoracodorsal injury (9.2%) in Sunday was significantly high. Frequencies of outcomes did not show difference in days. Number of admissions were low between 5:00-7:59 (≤1.3%) and increased from 08:00 onwards, peaked at 17 (8.6%), and decreased again at later hours of the day. The distribution of trauma mechanisms followed a similar trend. The percents of hospitalized and transferred patients were found to be significantly low between 00:00-06:59. However, distribution of mortality was regular. However 42.6% of the mortalities occurred between 13:00-18:59. Conclusion: There is high patient load in the ED. It is highest in summer and also in the afternoon and evening. Furthermore the transfers and the hospitalizations are remarkably high in these times. The ED needs to be supported with all types of personnel and technical equipment at the times indicated above.
Consenting Operative Orthopaedic Trauma Patients: Challenges and Solutions  [PDF]
Amin Kheiran,Purnajyoti Banerjee,Philip Stott
ISRN Surgery , 2014, DOI: 10.1155/2014/354239
Abstract: Guidelines exist to obtain informed consent before any operative procedure. We completed an audit cycle starting with retrospective review of 50 orthopaedic trauma procedures (Phase 1 over three months to determine the quality of consenting documentation). The results were conveyed and adequate training of the staff was arranged according to guidelines from BOA, DoH, and GMC. Compliance in filling consent forms was then prospectively assessed on 50 consecutive trauma surgeries over further three months (Phase 2). Use of abbreviations was significantly reduced ( ) in Phase 2 (none) compared to 10 (20%) in Phase 1 with odds ratio of 0.04. Initially, allocation of patient’s copy was dispensed in three (6% in Phase 1) cases compared to 100% in Phase 2, when appropriate. Senior doctors (registrars or consultant) filled most consent forms. However, 7 (14%) consent forms in Phase 1 and eleven (22%) in Phase 2 were signed by Core Surgical Trainees year 2, which reflects the difference in seniority amongst junior doctors. The requirement for blood transfusion was addressed in 40% of cases where relevant and 100% cases in Phase 2. Consenting patients for trauma surgery improved in Phase 2. Regular audit is essential to maintain expected national standards. 1. Introduction Health professionals have a legal and ethical obligation to obtain valid informed consent before any procedure to be performed. Consent is as fundamental as any other basic principle on which surgical practice relies, and its use in patient care is a clinical skill [1]. Guidelines have been developed by professional bodies highlighting the importance of the principles and the process of seeking consent [2–4]. The importance of establishing informed consent form is to reflect the requirement to ensure that essential and sufficient information has been imparted between patient and health professional (surgeon) [4]. Consent is a two-way process. The health professional should know the patient’s history and problems. The patient must be given time to ask relevant questions. The health professional must check understanding and offer alternative treatments. They must explain relevant risks and benefits. This combination will ensure that the correct procedure is being performed on the correct patient [5]. The requirement for consent has now explicitly been extended to the disposal of human tissue and the management of personal data. Although these extensions are not a central issue for surgeons,they obviously include massive implications during the consent process. Hence, the other members of the
The orthopaedic trauma literature: an evaluation of statistically significant findings in orthopaedic trauma randomized trials
Jinsil Sung, Judith Siegel, Paul Tornetta, Mohit Bhandari
BMC Musculoskeletal Disorders , 2008, DOI: 10.1186/1471-2474-9-14
Abstract: We conducted a comprehensive search (PubMed, Cochrane) for all randomized controlled trials between 1/1/95 to 12/31/04. Eligible studies include those that focused upon orthopaedic trauma. Baseline characteristics and treatment effects were abstracted by two reviewers. Briefly, for continuous outcome measures (ie functional scores), we calculated effect sizes (mean difference/standard deviation). Dichotomous variables (ie infection, nonunion) were summarized as absolute risk differences and relative risk reductions (RRR). Effect sizes >0.80 and RRRs>50% were defined as large effects.Using regression analysis we examined the association between the total number of outcome events and treatment effect (dichotomous outcomes).Our search yielded 433 randomized controlled trials (RCTs), of which 76 RCTs with statistically significant findings on 184 outcomes (122 continuous/62 dichotomous outcomes) met study eligibility criteria. The mean effect size across studies with continuous outcome variables was 1.7 (95% confidence interval: 1.43–1.97). For dichotomous outcomes, the mean risk difference was 30% (95%confidence interval:24%–36%) and the mean relative risk reduction was 61% (95% confidence interval: 55%–66%; range: 0%–97%). Fewer numbers of total outcome events in studies was strongly correlated with increasing magnitude of the treatment effect (Pearson's R = -0.70, p < 0.01). When adjusted for sample size, the number of outcome events revealed an independent association with the size of the treatment effect (Odds ratio = 50, 95% confidence interval: 3.0–1000, p = 0.006).Our review suggests that statistically significant results in orthopaedic trials have the following implications-1) On average large risk reductions are reported 2) Large treatment effects (>50% relative risk reduction) are correlated with few number of total outcome events. Readers should interpret the results of such small trials with these issues in mind.Evidence-based medicine posits that health ca
The epidemiology and cost of trauma to the orthopaedic department at a secondary-level hospital
EE Lutge, D Muirhead
South African Journal of Surgery , 2005,
Abstract: Trauma in South Africa is indeed a \'malignant epidemic\'. Approximately 70 000 South Africans die every year, and a further 3.5 million seek care at health care facilities, as a result of trauma. From 1990 to 2020 there is likely to be a significant increase in the injury-related burden of disease in sub-Saharan Africa unless effective prevention measures are put in place. Approximately 9 000 people are killed on South Africa\'s roads every year, and 33 000 seriously injured. Our road traffic death rate of 11.7 per 100 million kilometres travelled ranks in the top 10 in the world. Nationally, 39% of those killed on the road are pedestrians, although this figure has decreased from 47% in 1987. This study attempted to outline the epidemiological pattern of trauma and the costs of this trauma over a year in the orthopaedic department at a single secondary-level urban hospital in Durban. For the purposes of this study, trauma was defined as injury arising from assault, gunshot or motor vehicle accidents (MVAs). South African Journal of Surgery Vol. 43(3) 2005: 74-77
Trauma admissions to the Intensive care unit at a reference hospital in Northwestern Tanzania
Phillipo L Chalya, Japhet M Gilyoma, Ramesh M Dass, Mabula D Mchembe, Michael Matasha, Joseph B Mabula, Nkinda Mbelenge, William Mahalu
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2011, DOI: 10.1186/1757-7241-19-61
Abstract: Between January 2008 and December 2010, a descriptive prospective study of all trauma admissions to a multidisciplinary intensive care unit (ICU) of Bugando Medical Centre in Northwestern Tanzania was conducted.A total of 312 cases of major trauma were admitted in the ICU, representing 37.1% of the total ICU admissions. Males outnumbered females by a ratio of 5.5:1. Their median age was 27 years. Trauma admissions were almost exclusively emergencies (95.2%) and came mainly from the Accident and Emergency (60.6%) and Operating room (23.4%). Road traffic crash (RTC) was the most common cause of injuries affecting 70.8% of patients. Two hundred fourteen patients (68.6%) required surgical intervention. The overall ICU length of stay (LOS) for all trauma patients ranged from 1 to 59 days (median = 8 days). The median ICU length of hospital stay (LOS) for survivors and non-survivors were 8 and 5 days respectively. (P = 0.002). Mortality rate was 32.7%. Mortality rate of trauma patients was significantly higher than that of all ICU admissions (32.7% vs. 18.8%, P = 0.0012). According to multivariate logistic regression analysis, multiple injuries, severe head injuries and burns were responsible for a longer mean ICU stay (P < 0.001) whereas admission Glasgow Coma Score < 9, systolic blood pressure < 90 mmHg, injury severity core >16, prolonged duration of loss of consciousness, delayed ICU admission (0.028), the need for ventilatory support and finding of space occupying lesion on computed tomography scan significantly influenced mortality (P < 0.001).Trauma resulting from road traffic crashes is a leading cause of intensive care utilization in our hospital. Urgent preventive measures targeting at reducing the occurrence of RTCs is necessary to reduce ICU trauma admissions in this region. Improved pre- and in-hospital care of trauma victims will improve the outcome of trauma patients admitted to our ICU.Major or severe trauma constitutes a global public health problem and p
Etiology of surgical site infections at the orthopaedic trauma units  [PDF]
Markovi?-?eni? Lj.,Maksimovi? J.,Le?i? A.R.A.,Stefanovi? S.
Acta Chirurgica Iugoslavica , 2009, DOI: 10.2298/aci0902081m
Abstract: Objectives: The aim of the study was to analyze the epidemiological and microbiological analysis of surgical site infections in the orthopedic wards. Materials and methods: A 6-month prospective cohort study was conducted at the major teaching hospital in Belgrade. Patient's basic demographic data and data about surgical site infections were collected. Bacteria cultured from the surgical site were also analyzed. Results: A total of 277 patients operated in the Institute of Orthopedics and trauma surgery, Clinical Center of Serbia. Sixty-three cases of SSI were detected, and the overall incidence rate was 22.7% (95% IP=17.8- 27.6). Fifty-three (84.1%) SSIs had microbiological confirmation and overall 82 bacterial strains were isolated. The most frequent isolated bacteria were Staphylococcus aureus, Acinetobacter sp, Klebsiella pp, Pseudomonas sp and Enterococcus sp. Nineteen (79.2%) strains of Staphylococcus aureus isolated from infected surgical sites were meticillin- resistant. Conclusion: This study suggests that it is necessary to maintain continuous surveillance of surgical site infections. It is important to emphasize the need for implementation the measures of contact isolation in order to prevent the nosocomial transmission of resistant bacteria.
Trauma Patient Unplanned Hospital Re-Admissions  [PDF]
Thomas J. Esposito, Evelyn Clark-Kula, Melissa Crowe, Linda Galambos, Loubna Salameh, Janice Gillespie
Surgical Science (SS) , 2012, DOI: 10.4236/ss.2012.38076
Abstract: Introduction: Performance monitoring and performance improvement (PI) are increasingly important. Little is known regarding unplanned re-admission (UPR) in trauma patients. This study characterizes UPRs at one institution. Methods: Retrospective descriptive review of UPR to a Level I Trauma Center Information was obtained on: initial trauma diagnoses, diagnosis precipitating UPR, discharge interval, treatment rendered and length of stay (LOS) during both encounters, and PI committee judgments. Characteristics of UPR patients were determined and compared to those of all discharged patients. Descriptive statistics were applied. Results: Over 2.5 years there were 2827 discharges and 58 UPR(2%). The majority of original diagnoses were related to blunt trauma and head injuries. UPR occurred at a median of 3 days, with 54% re-admitted to the trauma service. Operative rate for UPR patients during the initial admission was 48% with 28%requiring operation on the UPR. Headache and wound issues were responsible for 42% of UPR. Diagnosis precipitating UPR was primarily related to post-operative complications in 26% of all UPR and 57% of those undergoing operation on the initial admission. Median LOS for UPR was 3days with ICU care being required by 13%. Of all UPRs,33% were attributable to opportunities for improved care (OFI) during the first admission. Identified OFIs were related to errors in technique (53%), errors in judgment (27%), and system issues (20%). Of UPR without OFI, 87% were related to disease and13% systems issues. Conclusion: UPR at a Level I trauma center is rare, occurs shortly after discharge, is brief in duration and usually related to postoperative wound issues or headache. Post operative patients seem at greater risk for UPR. While most UPR are considered non-preventable, attention to discharge instructions,patient education, resident education and supervisionand outpatient support, may obviate a number of preventable UPRs.
Microstructure and biomechanical characteristics of bone substitutes for trauma and orthopaedic surgery
Esther MM Van Lieshout, Gerdine H Van Kralingen, Youssef El-Massoudi, Harrie Weinans, Peter Patka
BMC Musculoskeletal Disorders , 2011, DOI: 10.1186/1471-2474-12-34
Abstract: Seven calcium phosphate cements (BoneSource?, Calcibon?, ChronOS?, Eurobone?, HydroSet?, Norian SRS?, and Ostim?), one calcium sulphate cement (MIIG? X3), and one bioactive glass cement (Cortoss?) were tested. Structural characteristics were measured by micro-CT scanning. Compression strength and stiffness were determined following unconfined compression tests.Each bone substitute had unique characteristics. Mean total porosity ranged from 53% (Ostim?) to 0.5% (Norian SRS?). Mean pore size exceeded 100 μm only in Eurobone? and Cortoss? (162.2 ± 107.1 μm and 148.4 ± 70.6 μm, respectively). However, 230 μm pores were found in Calcibon?, Norian SRS?, HydroSet?, and MIIG? X3. Connectivity density ranged from 27/cm3 for HydroSet? to 0.03/cm3 for Calcibon?. The ultimate compression strength was highest in Cortoss? (47.32 MPa) and lowest in Ostim? (0.24 MPa). Young's Modulus was highest in Calcibon? (790 MPa) and lowest in Ostim? (6 MPa).The bone substitutes tested display a wide range in structural properties and compression strength, indicating that they will be suitable for different clinical indications. The data outlined here will help surgeons to select the most suitable products currently available for specific clinical indications.Treatment of bone defects is a continuous challenge in skeletal trauma and orthopaedic trauma surgery. Bone graft represents the second most common transplanted tissue, with blood being number one [1]. Worldwide, more than 2.2 million bone grafting procedures are performed annually for the repair of bone defects in orthopaedic traumatology, neurosurgery, and dentistry [2-4]. Approximately 10% of all skeletal reconstructive surgical interventions require bone grafting [4]. Large defects resulting from, among others, trauma, infection, or tumor resection often do not heal spontaneously, and require surgical intervention. In addition, the treatment of posttraumatic skeletal complications such as delayed unions, nonunions, or malunions freque
Epidemiology of paediatric trauma admissions at Queen Elizabeth Central Hospital, Blantyre
T Nga’mbi, ES Borgstein
Malawi Medical Journal , 2005,
Abstract: We conducted an audit of paediatric trauma admissions to QECH, Blantyre, in September 2003. There were 107 trauma cases representing 8.8% of all paediatric admissions and mean age was 6 years. The commonest cause of trauma was falls (42.9%) followed by burns (31.8%) and road traffic accidents (14.9%). Of the road traffic accidents, only one case was a passenger, the rest were pedestrians hit by moving vehicles. Fracture of limbs was the commonest injury sustained (44.9%) and burns the second commonest injury (31.8%). Most (52.6%) children were brought into hospital within 24 hours of injury while 26.3% came in between 24 hours and 48 hours and 21.1% after 48 hours or more. Death occurred in 7.5% of cases. The mean number of days in hospital was 8.9 days. Malawi Medical Journal Vol.17(1) 2005: 5-6
Comparison of published orthopaedic trauma trials following registration in Clinicaltrials.gov
Rajiv Gandhi, Meryam Jan, Holly N Smith, Nizar N Mahomed, Mohit Bhandari
BMC Musculoskeletal Disorders , 2011, DOI: 10.1186/1471-2474-12-278
Abstract: We searched Clinical Trials.gov for all trials related to orthopaedic trauma. We excluded active trials and trials not completed by July 2009, and performed a systematic search for publications resulting from registered closed trials. Information regarding primary and secondary outcomes, intervention, study sponsors, and sample size were extracted from registrations and publications.Of 130 closed trials, 37 eligible trials resulted in 16 publications (43.2%). We found no significant differences in publication rates between funding sources for industry sponsored studies and nongovernment/nonindustry sponsored studies (p > 0.05). About half the trials (45%) did not include the NCT ID in the publication. Two (10%) publications had major changes to the primary outcome measure and ten (52.6%) to sample size.Registration of orthopaedic trauma trials does not consistently result in publication. When trials are registered, many do not cite NCT ID in the publication. Furthermore, changes that are not reflected in the registry of the trial are frequently made to the final publication.ClinicalTrials.gov (CTG) was developed by the U.S. National Institutes of Health in collaboration with the Food and Drug Administration (FDA) in February 2000 [1]. It was established after the FDA Modernization Act of 1997, which made it a requirement for the Department of Health and Human Services to establish a registry of all clinical trials of experimental treatments for serious or life-threatening diseases or conditions [2]. It offers current information on clinical trials for a wide range of diseases and conditions, allowing doctors, researchers, and patients to locate clinical trials conducted worldwide. CTG currently contains over 94,000 registered trials from 174 countries [3].The database summarizes each registered trial and gives information including but not limited to the purpose of the study, recruiting status, criteria for patient participation, and location of the trial and specif
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