E-bike and classic bicycle-related traumatic brain injuries presenting to the emergency department

2021 ◽  
pp. emermed-2019-208811
Author(s):  
Anna J M Verbeek ◽  
Janneke de Valk ◽  
Ditmar Schakenraad ◽  
Jan F M Verbeek ◽  
Anna A Kroon
Keyword(s):  
Emergency Department ◽  
Brain Injuries ◽  
Injury Severity ◽  
Surgical Intervention ◽  
Alcohol Intoxication ◽  
Trauma Centre ◽  
Abbreviated Injury Scale ◽  
Independent Risk Factors ◽  
Level 1 ◽  
Main Determinants

BackgroundE-bike usage is increasingly popular and concerns about e-bike-related injuries and safety have risen as more injured e-bikers attend the emergency department (ED). Traumatic brain injury (TBI) is the main cause of severe morbidity and mortality in bicycle-related accidents. This study compares the frequency and severity of TBI after an accident with an e-bike or classic bicycle among patients treated in the ED.MethodsThis was a prospective cohort study of patients with bicycle-related injuries attending the ED of a level 1 trauma centre in the Netherlands between June 2016 and May 2017. The primary outcomes were frequency and severity of TBI (defined by the Abbreviated Injury Scale head score ≥1). Injury Severity Score, surgical intervention, hospitalisation and 30-day mortality were secondary outcomes. Independent risk factors for TBI were identified with multiple logistic regression.ResultsWe included 834 patients, of whom there were 379 e-bike and 455 classic bicycle users. The frequency of TBI was not significantly different between the e-bike and classic bicycle group (respectively, n=56, 15% vs n=73, 16%; p=0.61). After adjusting for age, gender, velocity, anticoagulation use and alcohol intoxication the OR for TBI with an e-bike compared with classic bicycle was 0.90 (95% CI 0.56 to 1.45). Independent of type of bicycle, TBI was more likely if velocity was 26–45 km/hour, OR 8.14 (95% CI 2.36 to 28.08), the patient was highly alcohol intoxicated, OR 7.02 (95% CI 2.88 to 17.08) or used anticoagulants, OR 2.18 (95% CI 1.20 to 3.97). TBI severity was similar in both groups (p=0.65): eight e-bike and seven classic bicycle accident victims had serious TBI.ConclusionThe frequency and severity of TBI among patients treated for bicycle-related injuries at our ED was similar for e-bike and classic bicycle users. Velocity, alcohol intoxication and anticoagulant use were the main determinants of the risk of head injury regardless of type of bicycle used.

Emergency Department Trauma Redesign in a Level 1 Trauma Centre

2011 ◽  
Vol 14 (1) ◽  
pp. 50-58 ◽  
Author(s):  
Margaret M. Murphy ◽  
Carla M. Edwards ◽  
Julie Z.J. Seggie ◽  
Kate Curtis
Keyword(s):  
Emergency Department ◽  
Trauma Centre ◽  
Level 1

scholarly journals (A138) Duration of Emergency Department Stay and Injury Profile of Homeless Patients in a Level-1 Trauma Center

2011 ◽  
Vol 26 (S1) ◽  
pp. s39-s39
Author(s):  
S. Chauhan ◽  
S. Bhoi ◽  
D.T. Sinha ◽  
M. Rodha ◽  
L. Alexender ◽  
...  
Keyword(s):  
Emergency Department ◽  
Head Injury ◽  
Trauma Center ◽  
Injury Severity ◽  
Road Traffic ◽  
Road Traffic Crash ◽  
Emergency Department Stay ◽  
Level 1 ◽  
Gcs Score ◽  
Level 1 Trauma Center

Background and ObjectiveImmediate resuscitation and early disposition to definitive care improves outcomes. Homeless patients are neglected in emergency department (ED). The duration of ED stay and profile of injury of homeless patients at a Level-1 Trauma center were measured.MethodsThe study was performed from October 2008 to September 2009. Homeless patients were defined as patients who had no attendant and did not have any shelter. Duration of ED stay was noted from the ED arrival time to entry time at the definitive care (intensive care unit/ward). Clinical and demographic details were recorded. Subjects who had: (1) an attendant; (2) were discharged from the ED; or (3) expired in the ED were excluded.ResultsForty-one homeless patients were admitted. The mode of injury was road traffic crash in 73.2%; assault in 7.3%; fall from height in 7.3%; and in 12.2%, the mode of injury unknown. The average Injury Severity Score (ISS) was 6.76, with a maximum of 34 and minimum of 1. A total of 24 subjects (59%) had a Glasgow Coma Scale (GCS) score of ≤ 8 (severe head injury), 10 patients (24%) had GCS score 9–12 (moderate head injury), and seven subjects (17%) had GCS score 13–15 (minor head injury). Breath alcohol test was positive in 13%. The average duration of ED stay was 35 (3–173) hours in the homeless group and 12 (0.5–18) hours for patients with an attendant. Twenty-one subjects were admitted to neurosurgery (51.2%) with an average ED stay of 22.4 hours, five to surgery (12.20%) with average ED stay of 56.6 hours, and 15 to orthopedics (36.6%) with average ED stay of 45.3 hours.ConclusionsThe emergency department stay of homeless patients was 35 hours. Orthopedic trauma subjects had a prolonged disposal time. This addresses serious patient safety concerns and immediate remedial measures.

Patterns of CT use and surgical intervention in upper limb periarticular fractures at a level-1 trauma centre

Injury ◽  
2013 ◽  
Vol 44 (4) ◽  
pp. 471-474 ◽  
Author(s):  
William Lumsdaine ◽  
Natalie Enninghorst ◽  
Benjamin M. Hardy ◽  
Zsolt J. Balogh
Keyword(s):  
Upper Limb ◽  
Surgical Intervention ◽  
Trauma Centre ◽  
Level 1

Higher Blood Alcohol Concentration is Related to Less Severe Injury Amongst Intoxicated Trauma Patients

2020 ◽  
Author(s):  
Nikathan Kumar ◽  
Kartik Prabhakaran ◽  
Matthew K. McIntyre ◽  
David J. Samson ◽  
Rifat Latifi
Keyword(s):  
Injury Severity ◽  
Motor Vehicle ◽  
Alcohol Intoxication ◽  
Blood Alcohol Concentration ◽  
Alcohol Ingestion ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
Severity Scores ◽  
Severity Of Injury ◽  
Level 1

Abstract Background Previous studies show varied results regarding the protective effects of alcohol intoxication upon injury and mortality in the setting of trauma. Our study aimed to determine the effects of blood alcohol content (BAC) amongst trauma patients with alcohol ingestion, upon injury type and severity, as well as outcomes. Methods This 4-year retrospective study (2013–2017) used an institutional trauma database to capture all Level 1 and 2 trauma patients (≥14 years old) with BAC > 10 mg/dL presenting to the emergency department at a Level 1 trauma center. Demographic variables including mechanism of injury (MOI) were collected. Patients’ BAC was compared to their calculated injury severity scores (ISS) and abbreviated injury scale (AIS) scores. Analysis included linear regression, T-tests and ANOVAs with Tukey’s post-hoc analysis for continuous variables and Fisher’s exact test for binary variables. Multivariate regression analysis was performed to determine independent predictors of injury severity. Results 332 intoxicated patients were identified (mean BAC: 210.2±87.14 mg/dL, range 12.7–460.0; 74.1% male; median age 35; range: 16–90). The median ISS was 6 (range: 1–48). Patients in motor vehicle collisions had lower BACs (186.0±5.59 mg/dL) than those who fell (233.8±10.42 mg/dL, p = 0.0002), were assaulted (230.4±14.04 mg/dL, p = 0.0261), or were pedestrians struck (259.4±14.17 mg/dL, p = 0.004). Overall, patients with higher BAC had lower GCS, lower ISS, and shorter intensive care unit (ICU) length of stay, but no differences in hospital stay, or ventilator days. Conclusions Trauma patients with higher BAC have lower ISS, less severe chest injury, and shorter ICU stays. These findings suggest that higher levels of alcohol ingestion may portend a protective effect in the setting of trauma with respect to severity of injury that does not mitigate the importance of education and injury prevention but warrants further study into the physiology of alcohol and trauma.

scholarly journals Injury coding in a national trauma registry: a one-year validation audit in a level 1 trauma centre

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Anna Bågenholm ◽  
Ina Lundberg ◽  
Bjørn Straume ◽  
Rune Sundset ◽  
Kristian Bartnes ◽  
...  
Keyword(s):  
Injury Severity ◽  
Trauma Registry ◽  
Improve Patient Safety ◽  
Head Injuries ◽  
Trauma Team ◽  
Trauma Centre ◽  
Registry Data ◽  
Reference Standard ◽  
National Trauma ◽  
Level 1

Abstract Background Hospitals must improve patient safety and quality continuously. Clinical quality registries can drive such improvement. Trauma registries code injuries according to the Abbreviated Injury Scale (AIS) and benchmark outcomes based on the Injury Severity Score (ISS) and New ISS (NISS). The primary aim of this study was to validate the injury codes and severities registered in a national trauma registry. Secondarily, we aimed to examine causes for missing and discordant codes, to guide improvement of registry data quality. Methods We conducted an audit and established an expert coder group injury reference standard for patients met with trauma team activation in 2015 in a Level 1 trauma centre. Injuries were coded according to the AIS. The audit included review of all data in the electronic health records (EHR), and new interpretation of all images in the picture archiving system. Validated injury codes were compared with the codes registered in the registry. The expert coder group’s interpretations of reasons for discrepancies were categorised and registered. Inter-rater agreement between registry data and the reference standard was tested with Bland–Altman analysis. Results We validated injury data from 144 patients (male sex 79.2%) with median age 31 (inter quartile range 19–49) years. The total number of registered AIS codes was 582 in the registry and 766 in the reference standard. All injuries were concordantly coded in 62 (43.1%) patients. Most non-registered codes (n = 166 in 71 (49.3%) patients) were AIS 1, and information in the EHR overlooked by registrars was the dominating cause. Discordant coding of head injuries and extremity fractures were the most common causes for 157 discordant AIS codes in 74 (51.4%) patients. Median ISS (9) and NISS (12) for the total population did not differ between the registry and the reference standard. Conclusions Concordance between the codes registered in the trauma registry and the reference standard was moderate, influencing individual patients’ injury codes validity and ISS/NISS reliability. Nevertheless, aggregated median group ISS/NISS reliability was acceptable.

scholarly journals Maintaining Medical Resources to Treat Paediatric Injuries during COVID-19 Lockdown Is Essential—An Epidemiological Analysis of a Level 1 Trauma Centre in Central Europe

2021 ◽  
Vol 18 (11) ◽  
pp. 5829
Author(s):  
Stephan Payr ◽  
Andrea Schuller ◽  
Theresia Dangl ◽  
Philipp Scheider ◽  
Thomas Sator ◽  
...  
Keyword(s):  
Brain Injuries ◽  
Trauma Surgery ◽  
Paediatric Population ◽  
Traumatic Brain Injuries ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Medical Resources ◽  
Acute Injuries ◽  
Mild Traumatic Brain Injuries ◽  
Level 1

Background: This study examined the effect of the COVID-19 pandemic and the resulting decrease in the incidence of various categories of injuries, with the main focus on fractures and mild traumatic brain injuries in a paediatric population. Methods: This retrospective cohort study evaluated all children from 0 to 18 years of age presenting with an injury at the level 1 trauma centre of the University Clinic of Orthopaedics and Trauma Surgery in Vienna during the lockdown from 16 March to 29 May 2020 compared to records over the same timeframe from 2015 to 2019. Results: In total, 14,707 patients with injuries were included. The lockdown did not lead to a significant decrease in fractures but, instead, yielded a highly significant increase in mild traumatic brain injuries when compared to all injuries that occurred (p = 0.082 and p = 0.0001) as well as acute injuries (excluding contusions, distortions and miscellaneous non-acute injuries) (p = 0.309 and p = 0.034). Conclusions: The percentage of paediatric fractures did not decrease at the level 1 trauma centre, and a highly significant proportional increase in paediatric patients with mild traumatic brain injuries was observed during the COVID-19 lockdown. Therefore, medical resources should be maintained to treat paediatric trauma patients and provide neurological monitoring during pandemic lockdowns.

scholarly journals Impaired driving charges in injured impaired drivers requiring treatment in an emergency department

CJEM ◽  
2012 ◽  
Vol 14 (05) ◽  
pp. 290-294 ◽  
Author(s):  
Warren Fieldus ◽  
Ed Cain
Keyword(s):  
Emergency Department ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Trauma Centre ◽  
Motor Vehicle Crash ◽  
Impaired Driving ◽  
Legal Limit ◽  
Vehicle Crash ◽  
Police Records ◽  
The Mean

ABSTRACTObjective:To determine the percentage of injured impaired drivers brought to the only trauma centre in Nova Scotia who were charged with impaired driving.Methods:This retrospective observational study identified alcohol impaired drivers involved in a motor vehicle crash (MVC) brought to the emergency department (ED). Patients were selected based on blood alcohol concentrations (BACs) found to be above the legal limit. Medical records were examined to determine if the patient was the driver in an MVC. Patient records were then cross-referenced with a police database to determine the percentage of injured impaired drivers who were charged with impaired driving.Results:Between April 1, 2006, and April 1, 2008, 1,102 patients brought to the QEII Health Sciences Centre (QEII HSC) ED were found to have BACs over the legal limit. Of these patients, only 57 (5.2%) were found to have been the driver in an MVC. The majority of patients were male (49; 86%), with an average age of 32 years. Most injuries (51; 89.5%) were the result of a single-vehicle crash. The mean Glasgow Coma Scale score was 12.6, and the mean Injury Severity Score was 14.4. Cross-referencing with police records showed that only 22.8% (13 of 57) of injured drivers were charged with impaired driving. Those drivers not charged with impaired driving had a significantly lower median BAC and median age.Conclusion:During the study, the majority of alcoholimpaired drivers injured in an MVC who were brought to the QEII HSC ED for assessment of their injuries were not charged with impaired driving.

scholarly journals Acute trauma coagulopathy: prevalence and outcome in trauma patients presenting to the Emergency Department SMBB Trauma Centre, Civil Hospital Karachi.

2021 ◽  
Author(s):  
Fariha Ashraf ◽  
Mohammad Faisal Ibrahim ◽  
Rabia Feroz ◽  
Abdul Wasey ◽  
Muhammad Arsalan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Injury Severity ◽  
Trauma Centre ◽  
P Value ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Acute Trauma ◽  
Civil Hospital ◽  
Injured Patients

Abstract PURPOSE To determine the prevalence of Acute Trauma Coagulopathy (ATC) in severely injured patients presenting to the emergency department of SMBB Trauma Centre of Civil Hospital Karachi and to investigate its impact on these patient's outcome. Early recognition using initial coagulation profile (PT/APTT) accompanied by adequate management of ATC and prevention of bleeding may substantially reduce mortality and improve outcomes in severely injured patients in resource limited environments. MATERIAL AND METHODS This descriptive cross sectional study was carried out in Surgical unit 4, Dr Ruth K.M. Pfau Civil hospital Karachi from 27 th July 2019 to 28 th January 2020. After approval from institutional review board, 80 patients aged between 14 to 60 years with injury severity score more than 15 were enrolled using non probability consecutive sampling technique and their coagulation profile (PT, APTT and INR) was done at presentation and followed for in hospital mortality. Data was collected and analyzed using SPSS 24. RESULTS In our study total 80 patients were enrolled, the mean age of patients was 27.28±12.18. Trauma coagulopathy was present in 12.5% patients. In hospital mortality was found to be 16.3%. The in hospital mortality was compared in patients with coagulopathy and patients without coagulopathy and p value was significant 0.00. Data stratification was significant for age with p value 0.016. Data stratification for gender, mode of injury, mechanism of injury, amount of fluid given at presentation and injury severity score was not significant. CONCLUSION Acute trauma coagulopathy is associated with increased risk of mortality.

Is Field Hypotension a Reliable Indicator of Significant Injury in Trauma Patients who are Normotensive on Arrival to the Emergency Department?

2005 ◽  
Vol 71 (9) ◽  
pp. 768-771 ◽  
Author(s):  
Panna Codner ◽  
Amal Obaid ◽  
Diana Porral ◽  
Stephanie Lush ◽  
Marianne Cinat
Keyword(s):  
Emergency Department ◽  
Head And Neck ◽  
Injury Severity ◽  
Trauma Patients ◽  
Neck Injuries ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Significant Injury ◽  
Overall Mortality ◽  
Critical Injury

There is a subset of trauma patients who are hypotensive in the field but normotensive on arrival to the emergency department (ED). Our objective was to evaluate the presence, type, and severity of injuries in these patients. Data were retrospectively reviewed from patients treated at a level 1 trauma center over 1 year. Hypotension was defined as systolic blood pressure (SBP) less than 90 mm Hg. Forty-seven patients were included. The mechanism of injury was blunt in 37 patients and penetrating in 10. The average field SBP was 76 ± 11 mm Hg. The average SBP on arrival to the ED was 120 ± 19 mm Hg. The average injury severity score (ISS) was 16.3 ± 10.3 (range, 1–43). Twenty-four patients (51%) had significant injury (ISS ≥ 16). Nine patients (19%) had critical injury (ISS ≥ 25). Twenty-six patients (55%) required surgery, and 43 (91%) required ICU admission. Common injury sites included the head and neck (57%), thorax (44%), pelvis and extremities (40%), and abdomen (34%). Overall mortality was 10 per cent (n = 5). All patients that died had significant head and neck injuries (AIS ≥ 3). Field hypotension was a significant marker for potential serious internal injury requiring prompt diagnostic workup.

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