EP.WE.105Hand trauma during COVID pandemic: a tertiary trauma centre experience

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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Epidemiology and patterns of care of intrahepatic cholangiocarcinoma (iCCA) in France: Real-life data from the French National Hospital‐Discharge Summaries Database System (PMSI).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e16624 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e16624-e16624

Author(s):

Cindy Neuzillet ◽

Corinne Emery ◽

Clément Teissier ◽

Stéphane Bouée ◽

Astrid Lièvre

Keyword(s):

Intrahepatic Bile Duct ◽

Real Life ◽

High Volume ◽

Cancer Registries ◽

Best Supportive Care ◽

Patterns Of Care ◽

University Hospitals ◽

Life Data ◽

Real Life Data

e16624 Background: Little is known about epidemiology and patterns of care of iCCA in daily clinical practice. The aims of this study were to estimate from real-life data the incidence of iCCA in France and to describe the healthcare pathways of these patients (pts). Methods: A retrospective analysis was carried out using the nationwide prospective French PMSI database. All pts with a new diagnosis of "carcinoma of the intrahepatic bile duct" who had a 1st hospital stay in Medicine, Surgery and Obstetrics departments (MSO) between 2014 and 2015 with a 2-year follow-up were included. Data related to the 1st identified stay (S1) in MSO and on all subsequent stays in MSO, Aftercare and Rehabilitation (SSR) or Home Hospitalizations (HAD) were analyzed. Results: A total of 3,650 new iCCA cases were identified. At S1 (admission via emergency room [ER] in 28%), median age of pts was 73y, 57% were male and 35% had metastases. Jaundice/anemia/ascites/cholangitis were reported in 17%/16%/12%/7%, respectively. Pts care at S1 was mainly provided in general hospitals (CHG, 60%), rather than university hospitals (CHU, 15%), private (20%) or cancer centers (CLCC, 6%). 896 (24%) pts died during S1: they were more frequently hospitalized via ER (48% vs 23%), metastatic (52% vs 35%) and symptomatic. Subsequent stays were identified for 2,507 pts (69%). Similarly to S1, most pts were managed in CHG during their follow-up (70% vs 20% in CHU and 12% in CLCC). Based on the number of pts treated over the study period, centers were classified as low (≤5 pts, 68%), intermediate (5-20 pts, 26%) and high volume ( > 20 pts, 6%). 47% of the high-volume centers were CHU/CLCC. Three healthcare pathways were defined: surgery (n = 519; 14%), chemotherapy (CT) without surgery (n = 812; 22%) and best supportive care (BSC) (n = 2,319; 63%). CT, surgery and BSC were most frequently performed in CLCC, CHU and CHG, respectively. Pts who received CT (mean time between S1 and start of CT: 1.9 months) were younger, less frequently hospitalized via ER and less symptomatic at S1. A palliative care code was associated with S1 in 25% of pts and with a subsequent MSO/SSR/HAD stay in 60%. Conclusions: This real-life, medico-administrative study, covering all hospitalized patients in France, reveals a higher incidence of iCCA than that previously reported by cancer registries. It also highlights the severity of this disease, the central role of CHG in the management of pts and the expertise of CHU and CLCC for surgery and CT, respectively.

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Discharge from the trauma centre: exposure to opioids, unmet information needs and lack of follow up—a qualitative study among physical trauma survivors

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00938-7 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Jeanette Finstad ◽

Olav Røise ◽

Leiv Arne Rosseland ◽

Thomas Clausen ◽

Ingrid Amalia Havnes

Keyword(s):

Mental Health ◽

Pain Management ◽

Trauma Care ◽

Information Needs ◽

Trauma Centre ◽

Trauma Survivors ◽

Trauma Patients ◽

Post Discharge ◽

Physical Trauma

Abstract Background Physical trauma is associated with mortality, long-term pain and morbidity. Effective pain management is fundamental in trauma care and opioids are indispensable for treating acute pain; however, the use and misuse of prescribed opioids is an escalating problem. Despite this, few studies have been directed towards trauma patients in an early phase of rehabilitation with focusing on experiences and perspectives of health and recovery including pain and persistent use of prescribed opioids with abuse potential. To explore pre- and post-discharge trauma care experiences, including exposure to opioids, physical trauma survivors were recruited from a major trauma centre in Norway that provides the highest level of surgical trauma care. Method Qualitative exploratory study. Individual semi-structured interviews were conducted among 13 trauma patients with orthopedic injuries, known to be associated with severe pain, six weeks post-discharge. The interviews were recorded, transcribed verbatim, and thematically analyzed with an interdisciplinary approach. Results The overarching theme was that discharge from the trauma centre and the period that immediately followed were associated with feelings of insecurity. The three main themes that were identified as contributing to this was (a) unmet information needs about the injury, (b) exposure to opioids, and (c) lack of follow-up after discharge from the hospital. Participants experienced to be discharged with prescribed opioids, but without information about their addictive properties or tapering plans. This, and lack of attention to mental health and psychological impact of trauma, gave rise to unmet treatment needs of pain management and mental health problems during hospitalization and following discharge. Conclusion The findings from this study suggest that in addition to delivery of high-quality biomedical trauma care, health professionals should direct more attention to psychosocial health and safe pain management, including post-discharge opioid tapering and individually tailored follow-up plans for physical trauma survivors.

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Long-term follow-up after severe suicide attempt by multiple blunt trauma

European Psychiatry ◽

10.1016/j.eurpsy.2004.10.003 ◽

2005 ◽

Vol 20 (2) ◽

pp. 115-120 ◽

Cited By ~ 11

Author(s):

Frank-Gerald Pajonk ◽

Steffen Ruchholtz ◽

Christian Waydhas ◽

Thomas Schneider-Axmann

Keyword(s):

Suicide Attempt ◽

Blunt Trauma ◽

Injury Severity ◽

Psychiatric Treatment ◽

Trauma Centre ◽

Trauma Patients ◽

Predictive Variables ◽

Long Term Follow Up ◽

Level I

AbstractBackgroundAfter parasuicide there is a high risk of reattempts. However, it seems that patients who survived severe suicidal trauma recover well. Therefore, the outcome of patients with severe multiple blunt trauma as a result of a suicide attempt was investigated with respect to psychiatric and somatic health, quality of life (QOL) and suicide reattempt rates.MethodsPatients who underwent a suicide attempt were isolated from a prospectively collected sample of trauma patients from a level I University Trauma Centre. Follow-up examination was performed 6.1 ± 3 years after the trauma. A physical and psychiatric examination was performed, using established psychiatric scales.ResultsTwelve percent of severely injured patients were identified as suicide attempters (male/female: 37/28, mean age 38 ± 18 years, mean Injury Severity Score (ISS) 40 ± 15 points). A psychiatric diagnosis was present in 90% at the time of the suicide attempt. Twenty-one patients died during the hospital stay (32%) and six subjects died thereafter, none due to suicide. Thirty-five individuals were eligible for examination. None of them had reattempted suicide. Seventeen (48%) had good outcomes reflected by absent or ambulatory psychiatric treatment, employment, normal psychiatric findings and good psychosocial ability. An indeterminate outcome was determined in 24%. Predictive variables for an adverse outcome (10 patients, 28%) were found to be a diagnosis of schizophrenia, continued psychiatric treatment and being without employment.ConclusionsDespite the seriousness of the suicide attempt, survivors recovered well in about half the cases with no further suicide attempt in any patient. An early psychiatric consultation already on the Intensive Care Unit (ICU) is recommended.

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Barriers and Facilitators to Implementation of a Telephone Follow-Up Program for Severely Injured Trauma Patients – A Process Evaluation

10.21203/rs.3.rs-722754/v1 ◽

2021 ◽

Author(s):

Elizabeth Wake ◽

Caitlin Brandenburg ◽

Kathy Heathcote ◽

Kate Dale ◽

Don Campbell ◽

...

Keyword(s):

Process Evaluation ◽

Qualitative Data ◽

Major Trauma ◽

Trauma Centre ◽

Successful Implementation ◽

Trauma Patients ◽

Clinical Patient ◽

Trauma Service ◽

Successful Recovery

Abstract Background: Survival rates following major trauma are increasing. Understanding the longitudinal outcomes of major trauma can promote successful recovery. A novel, hospital-led telephone follow-up program was implemented by a multi-disciplinary clinical trauma service team at a Level I trauma centre. This evaluation was conducted to examine what factors promoted or impeded the program’s implementation.Methods:A prospective mixed methods process evaluation was conducted alongside the implementation of the follow up program. Quantitative and qualitative data were collected across the evaluation domains: reach, dose, fidelity, context and sustainability and clinical data of program participants (patients); semi-structured interviews with staff delivering the program and patients and caregivers who had participated in the program and direct observations (by researchers) of the program delivery and dataDescriptive statistics and thematic analysis were applied to quantitative and qualitative data respectively.Results:274 major trauma patients (ISS ≥ 12) were eligible for follow up. A response rate of over 75% was achieved at both follow -up timepoints, with nurses responsible for the majority of calls. Limited time and competing clinical demands were identified as barriers to the timely completion of the calls, although over 75% of calls were completed within the designated timeframe. Staff and patients valued the pre-existing trauma service/patient relationship, and this facilitated program implementation. Clinicians were motivated to evaluate their patient’s recovery, whilst patients felt ‘cared for’ and ‘not forgotten’ post-hospital discharge. Teamwork and leadership were highly valued by the clinical staff throughout the implementation period as ongoing source of motivation and support. Although primarily designed as a data collection activity, staff spontaneously developed the program to incorporate clinical follow up processes by providing guidance, advice and referrals to patients who indicated ongoing issues such as pain or emotional problems.Conclusion: Telephone follow up within a clinical trauma service team is feasible, accepted by staff and valued by patients and families. Despite time constraints, the successful implementation of this program is reliant on existing clinical/patient relationships, staff teamwork and leadership support.

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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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Effect of a mindfulness intervention on patients admitted after multisystem trauma

Trauma ◽

10.1177/1460408619872593 ◽

2019 ◽

Vol 22 (3) ◽

pp. 208-212

Author(s):

Elizabeth Clement ◽

Jenny Yoon ◽

Tala Sutherland ◽

Bonnie Tsang ◽

Vanessa Fawcett ◽

...

Keyword(s):

Mental Health ◽

Trauma Centre ◽

Stress Disorders ◽

Trauma Patients ◽

Post Traumatic Stress ◽

Depression Anxiety Stress Scale ◽

Online Application ◽

Trauma Service ◽

State Of Mind

Background The incidence of depression, anxiety, and post-traumatic stress disorders is reported to be as high as 50% in trauma patients. The perpetual negative emotions and state of mind in these disorders predisposes patients to negative mental health outcomes. Mindfulness, on the other hand, helps people to process their experience and emotions in a non-judgmental manner, and recently, there has been increased utilization of mindfulness-based therapies for the treatment of mental health conditions. This proof-of-concept study evaluates the use of a mindfulness-based online application in patients admitted to the trauma service at a Level 1 Trauma Centre. Methods Trauma patients who were English speaking, over the age of 18, and without brain injury or pre-existing neurocognitive disorder were included. Participants completed the Depression Anxiety Stress Scale (DASS)-21 to assess level of depression, anxiety, and stress, and the Connor-Davidson Resilience Scale (CD-RISC) to assess level of resiliency. Then, after 28 consecutive days of practicing mindfulness using the app ‘Stop, Breathe, and Think,’ the questionnaires were repeated and an exit survey conducted. Results For this study, 13 participants were enrolled, 2 withdrew, and 5 were lost to follow-up. The mean DASS-21 score at time enrollment was 16.4 and was 11.2 at follow-up ( p = 0.10). There were no differences between the level of depression and stress from enrollment to follow-up, but there was significant decrease in anxiety symptoms from 7.2 to 3.0 (<0.05). CD-RISC scores at enrollment and follow-up were 77.8 and 81 ( p = 0.23), respectively. At the time of exit interview, 67% of patients continued to use the application three to four times a week and 67% responded they plan to continue using the application. In addition, 83% of patients always or often felt better after practicing mindfulness and stated they would recommend the application to others. Conclusions Mindfulness shows promising potential to decrease psychological distress in trauma patients.

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An Analysis of 30-Day in-Hospital Trauma Mortality in Four Urban University Hospitals Using the Australia India Trauma Registry

World Journal of Surgery ◽

10.1007/s00268-020-05805-7 ◽

2020 ◽

Vol 45 (2) ◽

pp. 380-389

Author(s):

Prashant Bhandarkar ◽

◽

Priti Patil ◽

Kapil Dev Soni ◽

Gerard M. O’Reilly ◽

...

Keyword(s):

Trauma Registry ◽

Vital Signs ◽

High Volume ◽

New Delhi ◽

Trauma Patients ◽

Process Of Care ◽

University Hospitals ◽

Care Indicator ◽

Trauma Mortality ◽

Trauma Deaths

Abstract Background India has one-sixth (16%) of the world’s population but more than one-fifth (21%) of the world’s injury mortality. A trauma registry established by the Australia India Trauma Systems Collaboration (AITSC) Project was utilized to study 30-day in-hospital trauma mortality at high-volume Indian hospitals. Methods The AITSC Project collected data prospectively between April 2016 and March 2018 at four Indian university hospitals in New Delhi, Mumbai, and Ahmedabad. Patients admitted with an injury mechanism of road or rail-related injury, fall, assault, or burns were included. The associations between demographic, physiological on-admission vitals, and process-of-care parameters with early (0–24 h), delayed (1–7 days), and late (8–30 days) in-hospital trauma mortality were analyzed. Results Of 9354 patients in the AITSC registry, 8606 were subjected to analysis. The 30-day mortality was 12.4% among all trauma victims. Early (24-h) mortality was 1.9%, delayed (1–7 days) mortality was 7.3%, and late (8–30 days) mortality was 3.2%. Abnormal physiological parameters such as a low SBP, SpO2, and GCS and high HR and RR were observed among non-survivors. Early initiation of trauma assessment and monitoring on arrival was an important process of care indicator for predicting 30-day survival. Conclusions One in ten admitted trauma patients (12.4%) died in urban trauma centers in India. More than half of the trauma deaths were delayed, beyond 24 h but within one week following injury. On-admission physiological vital signs remain a valid predictor of early 24-h trauma mortality.

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Change in Orthopedic Trauma Practice under Strict Lockdown due to COVID-19 Pandemic

The Open Public Health Journal ◽

10.2174/1874944502114010196 ◽

2021 ◽

Vol 14 (1) ◽

pp. 196-205

Author(s):

Anas A.R. Altamimi ◽

Ali A. Al-Omari ◽

Saeed Al-Naser ◽

Firas Al-Dabouby ◽

Mahmoud Al-Balas ◽

...

Keyword(s):

Response Rate ◽

Legal Aspects ◽

Trauma Patients ◽

Orthopedic Trauma ◽

University Hospitals ◽

Cross Sectional ◽

Femur Fractures ◽

Orthopedic Surgeons ◽

The Impact

Introduction: The COVID-19 pandemic has led to remarkable changes in several aspects of medical practice. Elective surgeries, including orthopedic surgery, were deferred worldwide, allowing hospitals to accommodate higher numbers of COVID-19 patients and reduce the possible risk of infection among healthcare workers. However, healthcare systems aimed to continue providing emergency services at similar standards. In this study, we aim to highlight the impact of lockdowns secondary to the pandemic on orthopedic trauma practice in a country that was described to have one of the strictest lockdowns worldwide. We aim to examine the trends of change in number and type of orthopedic trauma cases and the changes to decision making and patient care among orthopedic surgeons. Methods: This cross-sectional study is based on a survey that was designed and delivered to orthopedic surgeons from different health sectors i.e. governmental, military, private and university hospitals. The questionnaire was distributed through the official Jordan orthopedic association WhatsApp group by the end of the 4th week of strict lockdown. A total of 256 orthopedic surgeons were invited to participate and responses were limited to one per participant. 147 replies were received with a response rate of 57.4%. Data were analyzed using the Statistical Package for the Social Sciences Version 23 (SPSS Inc., Chicago, IL) statistical software. Results: A total of 147 surgeons participated in the study with a response rate of 57.4%. The mean age of the participants was 39.8 years, with the majority being between 30 and 40 years (n=70; 48%). There was a significant decline in the number of trauma cases admitted to the Emergency Departments (ER), especially cases with polytrauma. During this period, the most common reported fractures were proximal femur fractures (47.6%) followed by distal radius fracture (17%). 30% of participants used to perform more than 10 trauma operations per week. This percentage dropped to 7.5% during the pandemic lockdown. 25% did not operate at all during the lockdown period. Outpatients practice was significantly affected with almost 40% of orthopedic surgeons not managing any single patient. Regarding the use of Personal Protective Equipment (PPE), 85% of the surgeons used face masks and gloves only during their patient's encounter. Inside the operating room, only 9.5% of surgeons used fully protective PPEs. Regarding the changes in practice, 62% of surgeons reported an increased tendency toward non-operative management with a significant delay in follow up of patients. The use of telemedicine was effective in the management of less than 50% of patient encounters, according to our participants. Private practice respondents reported more than 50% drop in their income during the lockdown. Conclusion: Strict lockdown in Jordan led to significant changes to orthopedic trauma practice in terms of the number and type of cases. Emergency and outpatient services were similarly affected. Orthopedic surgeons developed a tendency towards more conservative management and less surgical treatment. There is a need for stricter implementation of guidelines regarding the use of PPE especially in the operating theatre. Telemedicine use in management and follow up of trauma patients needs further assessment in terms of its efficacy and efficiency to patients and to healthcare professionalswith regards to its medico-legal aspects.

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P014: Incidental findings in trauma whole-body CT scans: a systematic review

CJEM ◽

10.1017/cem.2020.222 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S69-S69

Author(s):

V. Tsang ◽

K. Bao ◽

J. Taylor

Keyword(s):

Systematic Review ◽

Incidental Findings ◽

Traffic Accidents ◽

Road Traffic ◽

Subsequent Treatment ◽

Whole Body ◽

Trauma Patients ◽

Patient Demographics ◽

Study Results

Introduction: Whole-body computed tomography scans (WBCT) are a mainstay in the work-up of polytrauma or multiple trauma patients in the emergency department. While incredibly useful for identifying traumatic injuries, WBCTs also reveal incidental findings in patients, some of which require further diagnostic testing and subsequent treatment. Although the presence of incidental findings in WBCTs have been well documented, there has been no systematic review conducted to organize and interpret findings, determine IF prevalence, and document strategies for best management. Methods: A systematic review was conducted using MEDLINE, PUBMED, and EMBASE. Specific journals and reference lists were hand-mined, and Google Scholar was used to find any additional papers. Data synthesis was performed to gather information on patient demographics, prevalence and type of incidental findings (IFs), and follow-up management was collected. All documents were independently assessed by the two reviewers for inclusion and any disagreements were resolved by consensus. Results: 1231 study results were identified, 59 abstracts, and 12 included in final review. A mean of 53.9% of patients had at least one IF identified, 31.5% had major findings, and 68.5% had minor findings. A mean of 2.7 IFs per patient was reported for articles that included number of total IFs. The mean age of patients included in the studies were 44 years old with IFs more common in older patients and men with more IFs than women. IFs were most commonly found in the abdominal/pelvic region followed by kidneys. Frequency of follow-up documentation was poor. The most common reported mechanisms of injury for patients included in the study were MVA and road traffic accidents (60.0%) followed by falls from >3m (23.2%). Conclusion: Although there is good documentation on the mechanism of injury, patient demographics, and type of IF, follow-up for IFs following acute trauma admission lacks documentation and follow-up and is an identified issue in patient management. There is great need for systematic protocols to address management of IFs in polytrauma patients.

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Prevalence and Course of IgA and IgG Antibodies against SARS-CoV-2 in Healthcare Workers during the First Wave of the COVID-19 Outbreak in Germany: Interim Results from an Ongoing Observational Cohort Study

Healthcare ◽

10.3390/healthcare9050498 ◽

2021 ◽

Vol 9 (5) ◽

pp. 498

Author(s):

Mark Reinwald ◽

Peter Markus Deckert ◽

Oliver Ritter ◽

Henrike Andresen ◽

Andreas G. Schreyer ◽

...

Keyword(s):

Cohort Study ◽

Healthcare Workers ◽

Significant Proportion ◽

Clinical Signs ◽

Signs And Symptoms ◽

Observational Cohort Study ◽

Igg Antibodies ◽

University Hospitals ◽

Observational Cohort

(1) Background: Healthcare workers (HCWs) are prone to intensified exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in the ongoing pandemic. We prospectively analyzed the prevalence of antibodies against SARS-CoV-2 in HCWs at baseline and follow up with regard to clinical signs and symptoms in two university hospitals in Brandenburg, Germany. (2) Methods: Screening for anti-SARS-CoV-2 IgA and IgG antibodies was offered to HCWs at baseline and follow up two months thereafter in two hospitals of Brandenburg Medical School during the first wave of the COVID-19 pandemic in Germany in an ongoing observational cohort study. Medical history and signs and symptoms were recorded by questionnaires and analyzed. (3) Results: Baseline seroprevalence of anti-SARS-CoV-2 IgA was 11.7% and increased to 15% at follow up, whereas IgG seropositivity was 2.1% at baseline and 2.2% at follow up. The rate of asymptomatic seropositive cases was 39.5%. Symptoms were not associated with general seropositivity for anti-SARS-CoV-2; however, class switch from IgA to IgG was associated with increased symptom burden. (4) Conclusions: The seroprevalence of antibodies against SARS-CoV-2 was low in HCWs but higher compared to population data and increased over time. Screening for antibodies detected a significant proportion of seropositive participants cases without symptoms.

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