scholarly journals 92 Increased Proportion of Alcohol-Related Trauma in A South London Major Trauma Centre During Lockdown, A Cohort Study

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Brown ◽  
T Smith ◽  
A Gaukroger ◽  
P Tsinaslanidis ◽  
C Hing
Keyword(s):  
Major Trauma ◽  
Trauma Centre ◽  
Blood Alcohol ◽  
Regression Analyses ◽  
Electronic Patient Records ◽  
Staffing Levels ◽  
The United Kingdom ◽  
Major Trauma Centre ◽  
Significant Difference

Abstract Background Alcohol has been associated with 10-35% trauma admissions and 40% trauma-related deaths globally. In response to the Covid-19 pandemic, the United Kingdom (UK) entered a state of ‘lockdown’ on 23rd March 2020. Restrictions were most significantly eased on 1st June 2020, when shops and schools re-opened. The purpose of this study was to quantify the effect of lockdown on alcohol-related trauma admissions. Method All adult patients admitted as ‘trauma calls’ to a London Major Trauma Centre (MTC) during April 2018 and April 2019 (pre-lockdown; N = 316), and 1st April – 31st May 2020 (lockdown; N = 191) had electronic patient records analysed. Patients’ blood alcohol level and records of intoxication were used to identify alcohol-related trauma. Trauma admissions from pre- and post-lockdown cohorts were compared using multiple regression analyses. Results Alcohol-related trauma was present in a significantly higher proportion of adult trauma calls during lockdown (lockdown 60/191 (31.4%), versus pre-lockdown 62/316 (19.6%); (Odds Ratio (OR) 0.83, 95% CI 0.38 to 1.28, p < 0.001). Lockdown was also associated with increased weekend admissions of trauma (lockdown 125/191 weekend (65.5%) vs pre-lockdown 179/316 (56.7%); OR -0.40, 95% CI -0.79 to -0.02, p = 0.041). No significant difference existed in the age, gender, or mechanism between pre-lockdown and lockdown cohorts (p > 0.05). Conclusions UK lockdown was independently associated with an increased proportion of alcohol-related trauma. Trauma admissions were increased during the weekend when staffing levels are reduced. With the possibility of subsequent global ‘waves’ of Covid-19, the risk of long-term repercussions of dangerous alcohol-related behaviour to public health must be addressed.

Severe equestrian injuries: A seven-year review of admissions to a UK major trauma centre

Trauma ◽  
2021 ◽  
pp. 146040862110412
Author(s):  
Aref-Ali Gharooni ◽  
Fahim Anwar ◽  
Romann Ramdeep ◽  
Harry Mee
Keyword(s):  
United Kingdom ◽  
Major Trauma ◽  
Injury Severity ◽  
Trauma Centre ◽  
Common Mechanism ◽  
Mechanism Of Injury ◽  
The United Kingdom ◽  
Major Trauma Centre ◽  
Limb Injuries ◽  
Significant Difference

Background Equestrian sports are regaining popularity in the United Kingdom. Due to horses’ considerable weight and speed, serious injuries can occur. Riding style and equipment differ between North America and the United Kingdom with previous studies focusing on the former. Objective This study aims to assess the pattern of horse-related injury admissions to a major trauma centre in the United Kingdom. Methods A retrospective study of our hospital’s trauma registry between years 2012 and 2020 was performed. Cases included those admitted for severe horse-related injuries (irrespective of age/sex) with Injury Severity Score (ISS) of ≥ 4. Demographics, injury characteristics (ISS, Glasgow Coma Scale (GCS), injury region and operations), hospital stay and Glasgow Outcome Scale (GOS) on discharge were extracted. Four groups were formed based on mechanism of injury: fall from horse, fall and horse landing on top (FL group), kicked, and fall and kicked (FK group). Comparisons in injury and outcomes were analysed between these groups. Results 301 (2.8%) eligible cases were identified from 10,911 cases. 70.8% were female with mean (± SD) age of 42.7 (± 16.5) years. Most common mechanism of injury was fall (72.8%) then kicked (14.6%) with groups FL and FK forming < 10% each. No significant difference was found between the groups initial GCS, ISS, total or ICU length of stay and GOS ( p > 0.05). Most common regions of injury were orthopaedic (41.9%), spinal (26.2%), thoracic (20.1%) and head injuries (19.3%). 75% had good recovery on GOS though there were 3 fatalities relating to severe traumatic brain injury. Conclusion Orthopaedic limb injuries form the majority of horse-related injuries which contrasts the 1970s where head injury prevailed which is likely due to the widespread use of better head protection. Consideration should be given to enhanced limb safety equipment to prevent injury.

Comparison of routine blood alcohol tests and ICD-10-AM coding of alcohol involvement for major trauma patients

2021 ◽  
pp. 183335832110371
Author(s):  
Georgina Lau ◽  
Belinda J Gabbe ◽  
Biswadev Mitra ◽  
Paul M Dietze ◽  
Sandra Braaf ◽  
...  
Keyword(s):  
Administrative Data ◽  
Major Trauma ◽  
Blood Alcohol Concentration ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
Alcohol Involvement ◽  
Preventable Risk Factor ◽  
Major Trauma Centre ◽  
Icd 10

Background: Alcohol use is a key preventable risk factor for serious injury. To effectively prevent alcohol-related injuries, we rely on the accurate surveillance of alcohol involvement in injury events. This often involves the use of administrative data, such as International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) coding. Objective: To evaluate the completeness and accuracy of using administrative coding for the surveillance of alcohol involvement in major trauma injury events by comparing patient blood alcohol concentration (BAC) with ICD-10-AM coding. Method: This retrospective cohort study examined 2918 injury patients aged ≥18 years who presented to a major trauma centre in Victoria, Australia, over a 2-year period, of which 78% ( n = 2286) had BAC data available. Results: While 15% of patients had a non-zero BAC, only 4% had an ICD-10-AM code suggesting acute alcohol involvement. The agreement between blood alcohol test results and ICD-10-AM coding of acute alcohol involvement was fair ( κ = 0.33, 95% confidence interval: 0.27–0.38). Of the 341 patients with a non-zero BAC, 82 (24.0%) had ICD-10-AM codes related to acute alcohol involvement. Supplementary factors Y90 Evidence of alcohol involvement determined by blood alcohol level codes, which specifically describe patient BAC, were assigned to just 29% of eligible patients with a non-zero BAC. Conclusion: ICD-10-AM coding underestimated the proportion of alcohol-related injuries compared to patient BAC. Implications: Given the current role of administrative data in the surveillance of alcohol-related injuries, these findings may have significant implications for the implementation of cost-effective strategies for preventing alcohol-related injuries.

Consenting patients for orthopaedic surgery: Is there need for change?

2018 ◽  
Vol 29 (9) ◽  
pp. 300-305
Author(s):  
Epaminondas M Valsamis ◽  
Christopher Thornhill ◽  
Jay Watson ◽  
Shivun Khosla ◽  
Benedict Rogers ◽  
...  
Keyword(s):  
United Kingdom ◽  
Surgical Procedure ◽  
Orthopaedic Surgery ◽  
Major Trauma ◽  
Trauma Centre ◽  
Consent Forms ◽  
Mandatory Training ◽  
The United Kingdom ◽  
Major Trauma Centre ◽  
Level Of Understanding

An adequate consent form must be completed prior to a planned surgical procedure. Consent forms are mandatory, but the form itself does not reflect or quantify the adequacy of the discussion between surgeon and patient or the patient’s level of understanding. This study audited the adequate completion of consent forms for orthopaedic operations at a Major Trauma Centre in the United Kingdom. We also suggested recommendations regarding the completion of consent forms and proposed that tuition concerning the consent process be included as part of mandatory training for surgeons.

scholarly journals 1213 Cycling-related Trauma Admissions to the Major Trauma Centre in the Cycling Capital of the United Kingdom

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
Z Arshad ◽  
M majeed ◽  
A Thahir ◽  
F Anwar ◽  
J Rawal ◽  
...  
Keyword(s):  
United Kingdom ◽  
Major Trauma ◽  
Injury Severity ◽  
Trauma Centre ◽  
Vehicle Group ◽  
Mechanism Of Injury ◽  
Helmet Use ◽  
The United Kingdom ◽  
Body Regions ◽  
Major Trauma Centre

Abstract Aim The number of cyclists travelling on roads in the United Kingdom (UK) is increasing. The government has recently introduced initiatives to promote cycling uptake and so these numbers are likely to increase. This study aims to characterise cycling related injuries presenting to a major trauma centre located within a region with the highest rates of cycling in the UK. Method A retrospective review of cycling related trauma admissions occurring between January 2012 and June 2020 was performed. All patients were split into three groups based on the mechanism of injury. Our institution’s electronic patient record system was used to collect data including age, gender, mechanism of injury, Glasgow coma scale score on arrival, incident date and time, injured body regions, 30-day mortality, helmet use, and length of stay. Results A total of 606 cycling related trauma cases were identified, with 52 being excluded due to incomplete data. The ‘cyclist v vehicle’ group was associated with a significantly higher Injury Severity score (ISS), lower GCS and longer hospital stay than the other two groups. Helmet wearers were significantly older than non-wearers and helmet use was associated with a significantly reduced risk of head injury, lower ISS and higher GCS. Conclusions With a likely increase in future cycling uptake, it is crucial that effective interventions are put in place to improve the safety of cyclists. A multi-faceted strategy involving driver and cyclist education, road infrastructure changes and helmet promotion campaigns targeting the younger generation could be employed.

scholarly journals Comparison of outcomes of neurosurgical operations performed before and during the COVID-19 pandemic: a matched cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e047063
Author(s):  
Emma Toman ◽  
Wai Cheong Soon ◽  
Gopiga Thanabalasundaram ◽  
Daniel Burns ◽  
Vladimir Petrik ◽  
...  
Keyword(s):  
Major Trauma ◽  
Final Analysis ◽  
Trauma Centre ◽  
Pulmonary Complications ◽  
Matched Cohort ◽  
University Hospitals ◽  
Major Trauma Centre ◽  
Neurosurgical Patients ◽  
Significant Difference ◽  
Discharge Length

ObjectiveTo determine how the first wave of the COVID-19 pandemic affected outcomes for all operatively managed neurosurgical patients, not only those positive for SARS-CoV-2.DesignMatched cohort (pairwise method).SettingA single tertiary neurosurgical referral centre at a large UK Major Trauma Centre.ParticipantsDuring the first COVID-19 wave, 231 neurosurgical cases were performed. These cases were matched to cases from 2019. Cases were matched for age (±10 years), primary pathology and surgical procedure. Cases were excluded from analysis if either the age could not be matched to within 10 years, or the primary pathology or procedure was too unique. After exclusions, 191 cases were included in final analysis.Outcome measuresPrimary outcomes were 30-day mortality and postoperative pulmonary complications. Secondary outcomes included Glasgow Outcome Score (GOS) on discharge, length of stay (LoS), operative and anaesthetic times and grade of primary surgeon. An exploratory outcome was the SARS-CoV-2 status of patients.ResultsThere was no significant difference between the pandemic and matched cohorts in 30-day mortality, pulmonary complications, discharge GOS, LoS, operative or anaesthetic times. There was a significant difference in the variation of grade of primary surgeon. Only 2.2% (n=5) of patients had a SARS-CoV-2 positive swab.ConclusionDuring the first UK wave of the COVID-19 pandemic, the mortality, morbidity and functional outcomes of operatively managed neurosurgical patients at University Hospitals Birmingham were not significantly affected compared with normal practice. The grade of primary surgeon was significantly more senior and adds to the growing body of evidence that demonstrates how the pandemic has negatively impacted UK surgical training. Mixing COVID-19 positive, unknown and negative cases did not significantly impact on outcomes and indicates that further research is required to support the implementation of evidence-based surgical pathways, such as COVID-light sites, throughout the next stage of the pandemic.

Injured patients who would benefit from expedited major trauma centre care: a consensus-based definition for the United Kingdom

2021 ◽  
Vol 6 (3) ◽  
pp. 7-14
Author(s):  
Gordon Fuller ◽  
Samuel Keating ◽  
Janette Turner ◽  
Josh Miller ◽  
Chris Holt ◽  
...  
Keyword(s):  
United Kingdom ◽  
Major Trauma ◽  
Trauma Centre ◽  
Research Network ◽  
Future Research ◽  
Trauma Network ◽  
Reference Standard ◽  
The United Kingdom ◽  
Major Trauma Centre ◽  
The Right

Introduction: Despite the importance of treating the ‘right patient in the right place at the right time’, there is no gold standard for defining which patients should receive expedited major trauma centre (MTC) care. This study aimed to define a reference standard applicable to the United Kingdom (UK) National Health Service major trauma networks.Methods: A one-day facilitated roundtable expert consensus meeting was conducted at the University of Sheffield, UK, in September 2019. An expert panel of 17 clinicians was purposively sampled, representing all specialities relevant to major trauma management. A consultation process was subsequently held using focus groups with Public and Patient Involvement (PPI) representatives to review and confirm the proposed reference standard.Results: Four reference standard domains were identified, comprising: need for critical interventions; presence of significant individual anatomical injuries; burden of multiple minor injuries; and important patient attributes. Specific criteria were defined for each domain. PPI consultation confirmed all aspects of the reference standard. A coding algorithm to allow operationalisation in Trauma Audit and Research Network data was also formulated, allowing classification of any case submitted to their database for future research.Conclusions: This reference standard defines which patients would benefit from expedited MTC care. It could be used as the target for future pre-hospital injury triage tools, for setting best practice tariffs for trauma care reimbursement and to evaluate trauma network performance. Future research is recommended to compare patient characteristics, management and outcomes of the proposed definition with previously established reference standards.

P9 Impact of the relocation of a regional neuroscience service on major trauma patients

2019 ◽  
Vol 90 (3) ◽  
pp. e28.2-e28
Author(s):  
C Cabaret ◽  
M Nelson ◽  
M Foroughi
Keyword(s):  
Major Trauma ◽  
Strong Association ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Major Trauma Centre ◽  
Significant Difference ◽  
Ct Head ◽  
The Mean ◽  
The Impact ◽  
Mean Time

ObjectivesEvaluating the impact of relocating a regional neuroscience service on major trauma patients.DesignRetrospective analysis of prospectively collected data from 01/08/2013 to 31/07/2017.SubjectsPatients≥20 years with a TBI in the 2 years pre-relocation (cohort 1) and 2 years post-relocation (cohort 2).MethodsPatients were identified using the TARN registry. Comparison of the cohorts for demographics, type of neurosurgical input, site of first presentation and the times to first CT head and operation was conducted using cross-tabulation, percentages and statistical analysis (SPSS).Results30% of patients in cohort 1 (112 or 373) were admitted in neurosurgery. This increased to 40% of patients in cohort 2 (181 of 450). There was an increase in admissions for monitoring (70% vs 82%). Patients<60 years had a higher increment in admission (+16 points) than patients≥60 years (+8 points). A strong association was found between the relocation of the neuroscience service and the increase in proportion of patients first transported to the major trauma centre (63% vs 74%; p=0.037). There was a significant decrease in the mean time to operation (3.9 hour vs 2.0 hour; p=0.008) and no significant difference in the mean time to first CT head (1.3 hour vs 1.4 hour; p=0.689).ConclusionsThe relocation of neurosurgery has resulted in a significant increase in admission of patients<60 years with TBI in neurosurgery for monitoring, an increase in the proportion of patients first transported to the MTC and a reduction in the time to operation.

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