Geriatric Trauma in a High-Volume Trauma Centre in Cape Town: How Do We Compare?

Abstract Introduction St. George’s University Hospitals NHS Foundation Trust is a tertiary trauma centre. We receive a high volume of hand referrals from all over the south West London region. Closed hand fractures represent a significant number of our referrals. COVID-19 has put more burden in all health service endangering poor management of these trauma patients. Aim To assess management of close hand trauma patients during COVID pandemic. Methods Retrospective evaluation of closed hand fracture referrals during June, July, and August 2020. Clinical documentations, operative details and follow up visit notes have been reviewed. Results 106 patients have been included. 47 patients treated surgically with 81% of them were in need for metalwork insertion. Most of operations were done within 8 days. Number of hospital visits was variable with a mean of six days for adult and two days for children. Patient who was in need for hand therapy have been seen within the first 8 days of their surgery. At three months follow up, only three cases had infection. Only one case had osteomyelitis and the other two case had infected metalwork. Most of the patents reported good movement in ASSH Total Active Movement of Hand score (TAM) at the end of the three months. Conclusion Despite COVID 19 pandemic our service managed to achieve acceptable results in dealing with these cases. Yet, securing a reasonable number of operating sessions and clinic appointments remains a challenge.

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Surgical outcome of brain contusions treated by decompressive craniotomy with or without lobectomy at high volume tertiary care trauma centre

Indian Journal of Neurotrauma ◽

10.1016/j.ijnt.2013.12.003 ◽

2014 ◽

Vol 11 (1) ◽

pp. 5-9

Author(s):

Sumit Sinha ◽

Yashpal S. Rathore ◽

Ashok K. Mahapatra ◽

Bhawani S. Sharma

Keyword(s):

Surgical Outcome ◽

Tertiary Care ◽

High Volume ◽

Trauma Centre ◽

Decompressive Craniotomy

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In-Hospital Clinical Outcomes in Patients with Fragility Fractures of the Lumbar Spine, Thoracic Spine, and Pelvic Ring: A Comparison of Data before and after Certification as a DGU® Geriatric Trauma Centre

Medicina ◽

10.3390/medicina57111197 ◽

2021 ◽

Vol 57 (11) ◽

pp. 1197

Author(s):

Markus Laubach ◽

Laura Christine Gruchow ◽

Tobias Hafner ◽

Filippo Migliorini ◽

Matthias Knobe ◽

...

Keyword(s):

Lumbar Spine ◽

Thoracic Spine ◽

Pelvic Ring ◽

Fragility Fractures ◽

Trauma Centre ◽

Geriatric Trauma ◽

Trauma Patients ◽

Initial Management ◽

Before And After ◽

Management Plans

Background and Objectives: The implementation of orthogeriatric co-management (OGCM) reflects the demand for interdisciplinary collaborations due to the increasing comorbidities of geriatric trauma patients. This study aimed to assess clinical in-hospital outcomes in lumbar spine, thoracic spine, and pelvic ring fragility fracture patients before and after the implementation of a Geriatric Trauma Centre (GTC) certified by the German Trauma Society (DGU®). Materials and Methods: In this observational, retrospective cohort study, geriatric trauma patients (>70 years of age) were stratified into either a pre-GTC group (hospital admission between 1 January 2012 and 31 December 2013) or a post-GTC group (hospital admission between 1 January 2017 and 31 December 2018). Patients’ pre-injury medical complexity was measured by ASA class (American Society of Anaesthesiologists classification), the use of anticoagulant medication, and the ACCI (Age-adjusted Charlson Comorbidity Index). Outcome parameters were patients’ in-hospital length of stay (LOS) and mortality rates, as well as new in-hospital findings and diagnoses. Further, the necessity of deviation from initial management plans due to complications was assessed using the Adapted Clavien–Dindo Scoring System in Trauma (ACDiT score of ≥1). Results: Patients in the post-GTC group (n = 111) were older (median age 82.0 years) compared to the pre-GTC group (n = 108, median age 80.0 years, p = 0.016). No differences were found in sex, body mass index, ASA class, or ACCI (all p > 0.05). Patients in the post-GTC group used vitamin K antagonists or direct oral anticoagulants more frequently (21.3% versus 10.8%). The incidence of non-surgical treatment and mortality was comparable between groups, while LOS tended to be shorter in the post-GTC group (7.0 days versus 9.0 days, p = 0.076). In the post-GTC group, the detection of urinary tract infections (UTI) increased (35.2% versus 16.2%, p = 0.001), and the delirium diagnoses tended to increase (13.0% versus 6.3%, p = 0.094), while an ACDiT score of ≥1 was comparable between groups (p = 0.169). Conclusions: In this study including lumbar spine, thoracic spine, and pelvic ring geriatric fragility fractures, patients in the post-GTC group were more medically complex. More UTIs and the tendency for increased delirium detection was observed in the post-GTC group, likely due to improved diagnostic testing. Nonetheless, the necessity of deviation from initial management plans (ACDiT score of ≥1) was comparable between groups, potentially a positive result of OGCM.

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Full-Body X-Ray Imaging to Facilitate Triage: A Potential Aid in High-Volume Emergency Departments

Emergency Medicine International ◽

10.1155/2013/437078 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

S. P. Whiley ◽

H. Alves ◽

S. Grace

Keyword(s):

South African ◽

Emergency Departments ◽

Clinical Decision Making ◽

Traumatic Injury ◽

High Volume ◽

Trauma Centre ◽

Trauma Patients ◽

X Ray ◽

X Ray Imaging ◽

Full Body

The levels of traumatic injury seen in South African emergency departments (EDs) are epidemic. This is coupled with a severe lack of resources and adequately trained emergency staff. The Lodox Statscan (LS) is an X-ray scanner capable of producing rapid, low-dose, and full-body X-ray images. In this paper, a new trauma protocol—the Johannesburg trauma protocol—that implements LS scanning on entry to the ED as a triage tool is reported. A case study illustrating the use of LS to triage 63 patients in a single Saturday shift at a level 1 Trauma Centre is also presented. Because of the ability to rapidly and safely provide X-ray imaging information to support clinical decision making, the LS could be a useful tool to aid in resource allocation to improve treatment of the high levels of trauma patients that present to South African EDs daily.

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ANALYSIS OF SURGICAL PATIENT FLOW AT WINNIPEG HEALTH SCIENCES CENTRE

Proceedings of the Canadian Engineering Education Association (CEEA) ◽

10.24908/pceea.v0i0.3784 ◽

2011 ◽

Author(s):

Y. Y. Tan ◽

T. Y. El Mekkawy ◽

Q. Peng ◽

B. Wright

Keyword(s):

Patient Flow ◽

Quality Care ◽

High Volume ◽

Careful Analysis ◽

Health Sciences ◽

Trauma Centre ◽

Surgical Patient ◽

Flow Process ◽

Effective Manner ◽

Major Trauma Centre

The Health Sciences Centre (HSC) in Winnipeg is the major trauma centre serving the entire province of Manitoba, Northwestern Ontario, and Nunavut. Therefore, it has to handle a high volume of both elective and emergent surgical patients. Because the facility always strives to provide quality care in a fast and effective manner, it initiated a research project to analyze its surgical patient flow and generate ideas on how it could be redesigned to improve the systems performance. After a year of careful analysis, all of the problems identified were grouped into six major categories, showcasing how various departments are affected by each problem. Based on this analysis, the true impact of each problem in the surgical patient flow process can be understood. Steps can now be taken to identify which problems need to be addressed, what changes should be made, and how this will benefit the entire system.

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An Unorthodox Skin Traction Technique for the Initial Management of Distal Femur Fractures in a High-volume Trauma Centre: A Technical Review

Cureus ◽

10.7759/cureus.7106 ◽

2020 ◽

Author(s):

Andrea Mc Carthy ◽

Eoghan Meagher ◽

Mark Dolan

Keyword(s):

Distal Femur ◽

High Volume ◽

Trauma Centre ◽

Initial Management ◽

Technical Review ◽

Femur Fractures ◽

Skin Traction

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How do deployed general surgeons acquire relevant skill sets and competencies and mitigate skill fade?

BMJ Military Health ◽

10.1136/bmjmilitary-2020-001641 ◽

2020 ◽

pp. bmjmilitary-2020-001641

Author(s):

Matthew Robert Cant ◽

D N Naumann ◽

T C König ◽

D M Bowley

Keyword(s):

Simulation Training ◽

Armed Forces ◽

High Volume ◽

Trauma Centre ◽

High Fidelity ◽

High Fidelity Simulation ◽

Surgical Skill ◽

Skill Sets ◽

Skill Gaps ◽

General Surgeons

There are recognised difficulties internationally with acquisition and retention of skills among deployed military general surgeons. These are compounded by reduced trauma workload in non-deployed roles or during low tempo or limited activity deployments, and the winding-down of combat operations in Iraq and Afghanistan. We summarise the relevant military-run courses, military-civilian collaborations and potential future strategies that have been used to address skill sets and competencies of deployed surgeons. We use examples from the American, British, Danish, French, German and Swedish Armed Forces. There is variation between nations in training, with a combination of didactic lectures, simulation training and trauma placements in civilian settings at home and overseas. Data regarding effectiveness of these techniques are sparse. It is likely that combat surgical skill-set acquisition and maintenance requires a combination of employment at a high-volume trauma centre during a surgeon’s non-deployed role, together with military-specific courses and high-fidelity simulation to fill skill gaps. There are multiple newer modalities of training that require further evaluation if they are to prove effective in the future. We aimed to summarise the current methods used internationally to ensure acquisition and retention of vital skill sets for these surgeons.

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