scholarly journals A new ischemic grading system to aid combat extremity vascular injury decision making

2020 ◽  
Author(s):  
Amila S. Ratnayake ◽  
Viktor A Reva ◽  
Miklosh Bala ◽  
Achala Upendra Jayatilleke ◽  
Sujeewa PB Thalgaspitiya ◽  
...  
Keyword(s):  
Civil War ◽  
Limb Salvage ◽  
Limb Ischemia ◽  
Combat Trauma ◽  
Grading System ◽  
Trauma Patients ◽  
Sri Lankan ◽  
Primary Amputation ◽  
The Impact ◽  
Extremity Ischemia

Abstract Introduction In resource limited combat settings with frequent encounters of mass casualty incidents, the decision to attempt limb salvage versus primary amputation is refined over time based on experience. This experience can be augmented by grading systems and algorithms to assist in clinical decisions. Few investigators have attempted to explicitly grade limb ischemia according to clinical criteria and study the impact of limb ischemia on clinical outcome. We suggest a new ischemia grading system based on the Rutherford ischemic classification and the V.A. Kornilov classification which we adapted to apply to the combat setting. This new tool was then retrospectively applied to combat trauma patients from the Sri Lankan Civil War. Method We retrospectively queried a prospectively maintained, single surgeon registry containing 129 extremity vascular injuries managed at a Role 3 military base hospital (MBH) from 2008 December to June 2009 during the last phase of Sri Lankan Civil war. 89 patients were analyzed for early limb salvage according to the modified Kornilov extremity ischemia index (MKEII). Result According to the MKEII, subcohort analysis of C1 (viable), C2 (threatened), and C3 (irreversible) classified injuries demonstrated a statistically significant (P < 0.001) difference in limb salvage. Further statistical evaluation demonstrated injury to popliteal region (P=0.006), severe arterial injury (P=0.018) and venous injuries (P< 0.001) had statistically significant differences in distribution between C1, C2 and C3. Conclusion By application of the MKEII, combat surgeons can rapidly and correctly select and prioritize vascular injured extremities to optimally use limited resources to achieve realistic limb salvage goals. A rigid ankle was correlated with the worst index of extremity ischemia. Further investigation into this sign as an indication for primary amputation is warranted.

scholarly journals Not your mother’s culture : second generation Tamil women negotiating trauma and identity through art

2021 ◽  
Author(s):  
Ann Satkunam
Keyword(s):  
Civil War ◽  
Sri Lanka ◽  
Key Words ◽  
Young Women ◽  
Second Generation ◽  
Research Paper ◽  
Sri Lankan ◽  
The Impact ◽  
Tamil Diaspora ◽  
Tamil Women

This research paper focuses on the Tamil diaspora community in Canada that developed in the aftermath of the Civil War in Sri Lanka. This paper explores the impact of trauma on children of survivors, and how daughters in particular navigate these traumas. Furthermore, this paper analyzes how young women bear the trauma differently from their male counterparts, as women tend to be seen as carriers of culture. These ideas of women as carriers of culture do not afford Tamil women agency—instead they are left without choice in certain situations. Ultimately, this paper explores if art can be used as a mechanism to release the burden women feel. It uses the interview of eight Tamil women to understand their complex narratives, and to see if they use art as a means to reclaim agency. Key words: Diaspora, Sri Lankan, Art, Second-Generation Tamil Women, Identity, Cultural Purity

scholarly journals Impact of Establishing A Level-1 Trauma Center For Lower Extremity Trauma: A 4-Year Experience

2021 ◽  
Author(s):  
Min Ji Kim ◽  
Kyung Min Yang ◽  
Hyung Min Hahn ◽  
Hyoseob Lim ◽  
Il Jae Lee
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
External Fixator ◽  
Trauma Center ◽  
Emergency Operation ◽  
Trauma Patients ◽  
Soft Tissue Reconstruction ◽  
Primary Amputation ◽  
Level 1 ◽  
Level 1 Trauma Center

Abstract Purpose: A multidisciplinary approach is essential for trauma patients’ treatment, particularly for cases with open lower extremity fractures, which are considered major traumas requiring a comprehensive approach. Recently, the social demand for severe-trauma centers has increased. This study analyzed the clinical impact of establishing a trauma center for the treatment of open lower extremity fractures.Methods: A retrospective chart review was conducted for trauma patients admitted to our hospital. Patients were classified into two groups: before (January 2014–December 2015, 178 patients) and after establishment of a Level-1 trauma center (January 2017–December 2018, 125 patients). We included patients with open fracture below the knee level and Gustilo type II/III, but excluded those with life-threatening trauma that affected the treatment choice.Results: Total 273 patient were included in this study, initial infection was significantly more common and external fixator application significantly less in post-center establishment group. The time to emergency operation decreased significantly from 13.89 ± 17.48 to 11.65 ± 19.33 hours post-center setup. By multivariate analysis, the decreased primary amputation and increased limb salvage was attributed to establishment of the trauma center. Conclusion: With the establishment of the Level-1 trauma center, limbs of patients with open lower extremity fractures could be salvaged, and the need for primary amputation was decreased. Early control of initial open wound infection and minimizing external fixator use allowed early soft tissue reconstruction. The existence of the center ensured a shorter interval to emergency operation and facilitated interdepartmental cooperation, which promoted active limb salvage and contributed to patients’ quality of life.

scholarly journals Not your mother’s culture : second generation Tamil women negotiating trauma and identity through art

2021 ◽  
Author(s):  
Ann Satkunam
Keyword(s):  
Civil War ◽  
Sri Lanka ◽  
Key Words ◽  
Young Women ◽  
Second Generation ◽  
Research Paper ◽  
Sri Lankan ◽  
The Impact ◽  
Tamil Diaspora ◽  
Tamil Women

This research paper focuses on the Tamil diaspora community in Canada that developed in the aftermath of the Civil War in Sri Lanka. This paper explores the impact of trauma on children of survivors, and how daughters in particular navigate these traumas. Furthermore, this paper analyzes how young women bear the trauma differently from their male counterparts, as women tend to be seen as carriers of culture. These ideas of women as carriers of culture do not afford Tamil women agency—instead they are left without choice in certain situations. Ultimately, this paper explores if art can be used as a mechanism to release the burden women feel. It uses the interview of eight Tamil women to understand their complex narratives, and to see if they use art as a means to reclaim agency. Key words: Diaspora, Sri Lankan, Art, Second-Generation Tamil Women, Identity, Cultural Purity

scholarly journals Commentary on Pedal Revascularization: Extending the Limits of Endovascular or Surgical Means to Prevent Amputation

2021 ◽  
Vol 6 (2) ◽  
pp. 1-4
Author(s):  
Richard F Neville ◽  
Keyword(s):  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
State Of The Art ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Morbidity And Mortality ◽  
Significant Morbidity ◽  
Below The Knee ◽  
Recent Advances ◽  
Primary Amputation

Critical limb ischemia carries risk of significant morbidity and mortality and revascularization is particularly challenging in patients with tibial and pedal arterial disease. Recent advances in both endovascular therapies and open revascularization techniques have expanded our ability to treat patients with below the knee disease who may otherwise be subject to amputation. This commentary briefly reflects on emerging endovascular and open revascularization techniques for limb salvage in complex below knee arterial disease in order to raise awareness and minimize primary amputation without attempts at these “state of the art” modalities.

scholarly journals The impact of an angiosome-targeted revascularization on healing rate, limb salvage and survival in critical limb threatening ischemia

2021 ◽  
pp. 1-9
Author(s):  
Alexander Croo ◽  
Timothy Versyck ◽  
Alec Duinslaeger ◽  
Charlotte Harth ◽  
Frank Vermassen ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Healing Rate ◽  
The Impact

scholarly journals Validation of the BATT score for prehospital risk stratification of traumatic haemorrhagic death: usefulness for tranexamic acid treatment criteria

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Francois-Xavier Ageron ◽  
Timothy J. Coats ◽  
Vincent Darioli ◽  
Ian Roberts
Keyword(s):  
Tranexamic Acid ◽  
Acid Treatment ◽  
Injury Severity ◽  
External Validation ◽  
Research Network ◽  
Brier Score ◽  
Trauma Patients ◽  
Using Data ◽  
The Uk ◽  
The Impact

Abstract Background Tranexamic acid reduces surgical blood loss and reduces deaths from bleeding in trauma patients. Tranexamic acid must be given urgently, preferably by paramedics at the scene of the injury or in the ambulance. We developed a simple score (Bleeding Audit Triage Trauma score) to predict death from bleeding. Methods We conducted an external validation of the BATT score using data from the UK Trauma Audit Research Network (TARN) from 1st January 2017 to 31st December 2018. We evaluated the impact of tranexamic acid treatment thresholds in trauma patients. Results We included 104,862 trauma patients with an injury severity score of 9 or above. Tranexamic acid was administered to 9915 (9%) patients. Of these 5185 (52%) received prehospital tranexamic acid. The BATT score had good accuracy (Brier score = 6%) and good discrimination (C-statistic 0.90; 95% CI 0.89–0.91). Calibration in the large showed no substantial difference between predicted and observed death due to bleeding (1.15% versus 1.16%, P = 0.81). Pre-hospital tranexamic acid treatment of trauma patients with a BATT score of 2 or more would avoid 210 bleeding deaths by treating 61,598 patients instead of avoiding 55 deaths by treating 9915 as currently. Conclusion The BATT score identifies trauma patient at risk of significant haemorrhage. A score of 2 or more would be an appropriate threshold for pre-hospital tranexamic acid treatment.

Impact of 24/7 Onsite Emergency Radiology Staff Coverage on Emergency Department Workflow

2021 ◽  
pp. 084653712110238
Author(s):  
Francesco Macri ◽  
Bonnie T. Niu ◽  
Shannon Erdelyi ◽  
John R. Mayo ◽  
Faisal Khosa ◽  
...  
Keyword(s):  
Emergency Department ◽  
Major Trauma ◽  
Patient Flow ◽  
Interrupted Time Series ◽  
Trauma Patients ◽  
Linear Regression Models ◽  
High Acuity ◽  
Time Series Approach ◽  
Comparison Series ◽  
The Impact

Purpose: Assess the impact of 24/7/365 emergency trauma radiology (ETR) coverage on Emergency Department (ED) patient flow in an urban, quaternary-care teaching hospital. Methods: Patient ED visit and imaging information were extracted from the hospital patient care information system for 2008 to 2018. An interrupted time-series approach with a comparison group was used to study the impact of 24/7/365 ETR on average monthly ED length of stay (ED-LOS) and Emergency Physician to disposition time (EP-DISP). Linear regression models were fit with abrupt and permanent interrupts for 24/7/365 ETR, a coefficient for comparison series and a SARIMA error term; subgroup analyses were performed by patient arrival time, imaging type and chief complaint. Results: During the study period, there were 949,029 ED visits and 739,796 diagnostic tests. Following implementation of 24/7/365 coverage, we found a significant decrease in EP-DISP time for patients requiring only radiographs (-29 min;95%CI:-52,-6) and a significant increase in EP-DISP time for major trauma patients (46 min;95%CI:13,79). No significant change in patient throughput was observed during evening hours for any patient subgroup. For overnight patients, there was a reduction in EP-DISP for patients with symptoms consistent with stroke (-78 min;95%CI:-131,-24) and for high acuity patients who required imaging (-33 min;95%CI:-57,-10). Changes in ED-LOS followed a similar pattern. Conclusions: At our institution, 24/7/365 in-house ETR staff radiology coverage was associated with improved ED flow for patients requiring only radiographs and for overnight stroke and high acuity patients. Major trauma patients spent more time in the ED, perhaps reflecting the required multidisciplinary management.

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