Feasibility study for implementation of resuscitative balloon occlusion of the aorta in peri‐arrest, exsanguinating trauma at an adult level 1 Australian trauma centre

2019 ◽  
Vol 32 (1) ◽  
pp. 127-134 ◽  
Author(s):  
Mark Fitzgerald ◽  
Robbie Lendrum ◽  
Stephen Bernard ◽  
John Moloney ◽  
De Villiers Smit ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Balloon Occlusion ◽  
Trauma Centre ◽  
Adult Level ◽  
Level 1

scholarly journals The management and outcome of paediatric splenic injuries in the Netherlands

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Maike Grootenhaar ◽  
Dominique Lamers ◽  
Karin Kamphuis-van Ulzen ◽  
Ivo de Blaauw ◽  
Edward C. Tan
Keyword(s):  
The Netherlands ◽  
Hospital Stay ◽  
Operative Management ◽  
Trauma Centre ◽  
Management Approach ◽  
Haemodynamic Instability ◽  
Low Grade ◽  
High Grade ◽  
Level 1 ◽  
Non Operative Management

Abstract Background Non-operative management (NOM) is generally accepted as a treatment method of traumatic paediatric splenic rupture. However, considerable variations in management exist. This study analyses local trends in aetiology and management of paediatric splenic injuries and evaluates the implementation of the guidelines proposed by the American Paediatric Surgical Association (APSA) in a level 1 trauma centre. Methods The charts of paediatric patients with blunt splenic injury (BSI) who were admitted or transferred to a level 1 trauma centre between 2003 and 2020 were retrospectively assessed. Information pertaining to demographics, mechanism of injury, injury description, associated injuries, intervention and outcomes were analysed and compared to international literature. Results There were 130 patients with BSI identified (63.1% male), with a mean age of 11.3 ± 4.0 and a mean Injury Severity Score (ISS) of 21.6 ± 13.7. Bicycle accidents were the most common trauma mechanism (23.1%). Sixty-four percent were multi-trauma patients, 25% received blood transfusions, and 31% were haemodynamically unstable. Mean injury grade was 3.0, with 30% of patients having a high-grade injury. In total, 75% of patients underwent NOM with a 100% efficacy rate. Total splenectomy rate was 6.2%. Four patients died due to brain damage. Patients with a high-grade BSI (grades IV–V) had a significantly higher ISS and longer bedrest and more often presented with an active blush on computed tomography (CT) scans than patients with a low-grade BSI (grades I–III). Non-operative management was mainly the choice of treatment in both groups (76.6% and 79.5%, respectively). Haemodynamic instability was a predictor for operative management (OM) (p = 0.001). Predictors for a longer length of stay (LOS) included concomitant injuries, haemodynamic instability and OM (all p < 0.02). Interobserver agreement in the grading of BSI is moderate, with a Cohens Kappa coefficient of 0.493. Conclusion Non-operative management has proven to be a realistic management approach in both low- and high-grade splenic injuries. Consideration for operative management should be based on haemodynamic instability. Compared to the anticipated length of bedrest and hospital stay outlined in the APSA guidelines, the Netherlands can reduce the length of bedrest and hospital stay through their non-operative management. Level of evidence Therapeutic study, level III

scholarly journals Development and temporal external validation of a simple risk score tool for prediction of outcomes after severe head injury based on admission characteristics from level-1 trauma centre of India using retrospectively collected data

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040778
Author(s):  
Vineet Kumar Kamal ◽  
Ravindra Mohan Pandey ◽  
Deepak Agrawal
Keyword(s):  
Hospital Mortality ◽  
External Validation ◽  
Trauma Centre ◽  
Unfavourable Outcome ◽  
Motor Score ◽  
Validation Data ◽  
Data Set ◽  
Development Data ◽  
Level 1 ◽  
Pupillary Reactivity

ObjectiveTo develop and validate a simple risk scores chart to estimate the probability of poor outcomes in patients with severe head injury (HI).DesignRetrospective.SettingLevel-1, government-funded trauma centre, India.ParticipantsPatients with severe HI admitted to the neurosurgery intensive care unit during 19 May 2010–31 December 2011 (n=946) for the model development and further, data from same centre with same inclusion criteria from 1 January 2012 to 31 July 2012 (n=284) for the external validation of the model.Outcome(s)In-hospital mortality and unfavourable outcome at 6 months.ResultsA total of 39.5% and 70.7% had in-hospital mortality and unfavourable outcome, respectively, in the development data set. The multivariable logistic regression analysis of routinely collected admission characteristics revealed that for in-hospital mortality, age (51–60, >60 years), motor score (1, 2, 4), pupillary reactivity (none), presence of hypotension, basal cistern effaced, traumatic subarachnoid haemorrhage/intraventricular haematoma and for unfavourable outcome, age (41–50, 51–60, >60 years), motor score (1–4), pupillary reactivity (none, one), unequal limb movement, presence of hypotension were the independent predictors as its 95% confidence interval (CI) of odds ratio (OR)_did not contain one. The discriminative ability (area under the receiver operating characteristic curve (95% CI)) of the score chart for in-hospital mortality and 6 months outcome was excellent in the development data set (0.890 (0.867 to 912) and 0.894 (0.869 to 0.918), respectively), internal validation data set using bootstrap resampling method (0.889 (0.867 to 909) and 0.893 (0.867 to 0.915), respectively) and external validation data set (0.871 (0.825 to 916) and 0.887 (0.842 to 0.932), respectively). Calibration showed good agreement between observed outcome rates and predicted risks in development and external validation data set (p>0.05).ConclusionFor clinical decision making, we can use of these score charts in predicting outcomes in new patients with severe HI in India and similar settings.

Clinical and economic effects of selective radiological evaluation of high-energy trauma patients: a prospective experience of a level 1 busy trauma centre

2014 ◽  
Vol 32 (7) ◽  
pp. 535-538 ◽  
Author(s):  
Shahram Paydar ◽  
Armin Ahmadi ◽  
Behnam Dalfardi ◽  
Alireza Shakibafard ◽  
Hamidreza Abbasi ◽  
...  
Keyword(s):  
High Energy ◽  
Trauma Centre ◽  
Economic Effects ◽  
Trauma Patients ◽  
Radiological Evaluation ◽  
High Energy Trauma ◽  
Level 1

Treatment outcomes of injured children at adult level 1 trauma centers: are there benefits from added specialized care?

2011 ◽  
Vol 201 (4) ◽  
pp. 445-449 ◽  
Author(s):  
Tolulope A. Oyetunji ◽  
Adil H. Haider ◽  
Stephanie R. Downing ◽  
Oluwaseyi B. Bolorunduro ◽  
David T. Efron ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Trauma Centers ◽  
Adult Level ◽  
Specialized Care ◽  
Level 1

Midface trauma in the over 65's: A Level 1 Trauma Centre Experience

2016 ◽  
Vol 54 (10) ◽  
pp. e161
Author(s):  
Lewis Hua ◽  
Arif Razzak ◽  
Cristina Frezzini ◽  
Nabeela Ahmed ◽  
Dilip Srinivasan
Keyword(s):  
Trauma Centre ◽  
Level 1

scholarly journals Pelvic binders – To use or not use? A review of their use in a level 1 trauma centre

Injury Extra ◽  
2012 ◽  
Vol 43 (10) ◽  
pp. 86
Author(s):  
E. Ali ◽  
L. Smith ◽  
J. Lee
Keyword(s):  
Trauma Centre ◽  
Level 1

Analysis of usage and associated cost of external fixators at an urban level 1 trauma centre

Injury ◽  
2014 ◽  
Vol 45 (10) ◽  
pp. 1611-1613 ◽  
Author(s):  
George W. Chaus ◽  
Chase Dukes ◽  
David J. Hak ◽  
Cyril Mauffrey ◽  
E. Mark Hammerberg
Keyword(s):  
Trauma Centre ◽  
External Fixators ◽  
Urban Level ◽  
Level 1

scholarly journals Assessing the need for resuscitative endovascular balloon occlusion of the aorta (REBOA) for management of non-compressible hemorrhage at a Canadian urban trauma centre

2021 ◽  
Author(s):  
Elizabeth Purssell ◽  
Sean Patrick ◽  
Joseph Haegert ◽  
Vesna Ivkov ◽  
John Taylor
Keyword(s):  
Injury Severity ◽  
Retrospective Chart Review ◽  
Balloon Occlusion ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Potential Candidate ◽  
Study Objective ◽  
Resuscitative Thoracotomy ◽  
Less Invasive ◽  
Endovascular Balloon Occlusion

Abstract Introduction Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less invasive alternative to resuscitative thoracotomy (RT) for life threatening, infra-diaphragmatic, non-compressible hemorrhage from trauma. Existing evidence surrounding the efficacy of REBOA is conflicting; nevertheless, expert consensus suggests that REBOA should be considered in select trauma patients. There has been a paucity of studies that evaluate the potential utility of REBOA in the Canadian setting. The study objective was to evaluate the percentage of trauma patients presenting to a Level 1 Canadian trauma centre that would have met criteria for REBOA. Methods We conducted a retrospective chart review of patients recorded in the British Columbia Trauma Registry who warranted a trauma team activation (TTA) at our institution. We identified REBOA candidates using pre-defined criteria based on published guidelines. Each TTA case was screened by a reviewer, and then each Potential Candidate was reviewed by a panel of trauma physicians for determination of final candidacy. Results Fourteen patients were classified as Likely REBOA Candidates (2.2% of TTAs, median age 46.1 years, 64.3% female). These patients had a median Injury Severity Score of 31.5 (IQR 26.8). The main sources of hemorrhage in these patients were from abdominal injuries (71.4%) and pelvic fractures (42.9%). Conclusion The percentage of patients who met criteria for REBOA is similar to that of RTs performed at our Canadian institution. While REBOA would be performed infrequently, it is a less-invasive alternative to RT, which could be a potentially life-saving procedure in a small group of the most severely injured trauma patients.

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