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

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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1416 Trauma Laparotomy: Experience of a Newly Established Major Trauma Centre in Northern Ireland

British Journal of Surgery ◽

10.1093/bjs/znab259.532 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

F Lee ◽

B Bashabayev ◽

S Yoong

Keyword(s):

Northern Ireland ◽

Royal Victoria Hospital ◽

Major Trauma ◽

Trauma Centre ◽

Trauma Network ◽

Final Report ◽

Major Trauma Centre ◽

The Mean ◽

One Year ◽

Mean Time

Abstract Aim The aim of this study was to assess the perioperative pathway and outcomes of trauma laparotomy during a one-year period in a newly established Major Trauma Centre in Northern Ireland. Method Retrospective review of a trauma registry undertaken at the Belfast Royal Victoria Hospital between August 2019 and August 2020. Results During this one-year period, there were a total of 17 trauma laparotomies, with a female-to-male ratio of 6:11, and a mean age of 38.9 years. 15 of 17 cases were due to blunt trauma, with only 2 cases of penetrating trauma. Of trauma laparotomies, 8 were performed during day-time hours (0801-1800), 4 during evening-hours (1801-0000), and 5 during night-time hours (0001-0800). One perioperative death was recorded. The mean time to CT from arrival to ED was 34 minutes (national target of 30 minutes). The mean time until final report was 477 minutes (national target of < 24 hours). The decision to proceed to trauma laparotomy was made prior to the final report in 9 cases. The mean length of inpatient stay for trauma laparotomy patients was 23.3 days, with a mean of 8.9 days spent in critical care. Conclusions This review provides an overview of provision of care for patients who underwent trauma laparotomies in Royal Victoria Hospital MTC and identifies areas for improvement. We plan to prospectively review outcomes following the opening of the Major Trauma Ward on 7th September 2020 and the implementation of the Northern Ireland Major Trauma Network Bypass protocol on 26th October 2020.

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Falling down a flight of stairs: The impact of age and intoxication on injury pattern and severity

Trauma ◽

10.1177/1460408617720948 ◽

2017 ◽

Vol 20 (3) ◽

pp. 169-174 ◽

Cited By ~ 1

Author(s):

Hridesh Chatha ◽

Ian Sammy ◽

Michael Hickey ◽

Abdo Sattout ◽

John Hollingsworth

Keyword(s):

Older Patients ◽

Major Trauma ◽

Alcohol Intoxication ◽

Trauma Centre ◽

Injury Pattern ◽

Trauma Patients ◽

Severe Injuries ◽

Body Regions ◽

Major Trauma Centre ◽

The Impact

Background Falling down a flight of stairs is a common injury mechanism in major trauma patients, but little research has been undertaken into the impact of age and alcohol intoxication on the injury patterns of these patients. The aim of this study was to compare the impact of age and alcohol intoxication on injury pattern and severity in patients who fell down a flight of stairs. Methods This was a retrospective observational study of prospectively collected trauma registry data from a major trauma centre in the United Kingdom comparing older and younger adult patients admitted to the Emergency Department following a fall down a flight of stairs between July 2012 and March 2015. Results Older patients were more likely to suffer injuries to all body regions and sustained more severe injuries to the spine; they were also more likely to suffer polytrauma (23.6% versus 10.6%; p < 0.001). Intoxicated patients were more likely to suffer injuries to the head and neck (42.9% versus 30.5%; p = 0.006) and were significantly younger than sober patients (53 versus 69 years; p < 0.001). Conclusion Older patients who fall down a flight of stairs are significantly different from their younger counterparts, with a different injury pattern and a greater likelihood of polytrauma. In addition, alcohol intoxication also affects injury pattern in people who have fallen down a flight of stairs, increasing the risk of traumatic brain injury. Both age and intoxication should be considered when managing these patients.

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Falls downstairs: The impact on a UK major trauma centre

Trauma ◽

10.1177/14604086211002989 ◽

2021 ◽

pp. 146040862110029

Author(s):

Joshua Callon ◽

Daniel Thomas ◽

Simon J Mercer

Keyword(s):

Older Patients ◽

Major Trauma ◽

Average Length ◽

Trauma Team ◽

Trauma Centre ◽

Trauma Patients ◽

Mechanism Of Injury ◽

Younger Patients ◽

Major Trauma Centre ◽

The Impact

Introduction Major trauma centres are increasingly managing a significant injury burden in older patients, with falling downstairs being a prevalent mechanism of injury. Literature evaluating the impact of falls on stairs upon UK trauma networks is limited. Gaining a greater understanding of this may allow for more effective planning of services and improvements in training and education. This study evaluates the impact of falls downstairs on a UK major trauma centre. Methods A single centre retrospective service evaluation of local major trauma data over a 3-year period from 01/01/2017 to 31/12/2019. Included were patients who activated a trauma call whose mechanism of injury recorded at the time of admission was a fall downstairs. We excluded patients less than 16 years of age. Results There were 4480 major trauma patients who presented in the study period and of these, 860 (19.2%) sustained injuries following a fall downstairs. The most common age group presenting was 70–79 years; younger patients (<60 years) made up 43.3% with the majority (56.7%) being older. All but one patient were managed by a consultant-led trauma team, 6.4% of patients were admitted to critical care and 1% received an urgent operation. The overall mortality rate was 8.5%. Older patients made up 85% of those who died and had nearly four times longer average length of stay than younger patients (9.69 v 2.49 days). Conclusion Falls downstairs place a significant burden on the major trauma centre. There is a stark contrast in the use of hospital resources and outcomes between older and younger patients.

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The impact of COVID-19 infection on hip fracture 30-day mortality

Trauma ◽

10.1177/1460408620949725 ◽

2021 ◽

pp. 146040862094972

Author(s):

Ahmed Fadulelmola ◽

Rob Gregory ◽

Gavin Gordon ◽

Fiona Smith ◽

Andrew Jennings

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Hospital Admissions ◽

The Elderly ◽

Primary Outcome Measure ◽

Time To Death ◽

Significant Difference ◽

The Mean ◽

The Impact ◽

Mean Time

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65–98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% ( n = 6) contracted the COVID-19 infection in the community, and 70% ( n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

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Laparotomy for Abdominal Stab Wound With Combined Omental and Organ Evisceration: 10-Year Experience From a Major Trauma Centre in South Africa

The American Surgeon ◽

10.1177/00031348211031855 ◽

2021 ◽

pp. 000313482110318

Author(s):

Victor Kong ◽

Cynthia Cheung ◽

Nigel Rajaretnam ◽

Rohit Sarvepalli ◽

William Xu ◽

...

Keyword(s):

South Africa ◽

Small Bowel ◽

Large Bowel ◽

Major Trauma ◽

Stab Wound ◽

Length Of Hospital Stay ◽

Trauma Centre ◽

Major Trauma Centre ◽

The Mean ◽

Overall Mortality

Introduction Combined omental and organ evisceration following anterior abdominal stab wound (SW) is uncommon and there is a paucity of literature describing the management and spectrum of injuries encountered at laparotomy. Methods A retrospective study was undertaken on all patients who presented with anterior abdominal SW involving combined omental and organ evisceration who underwent laparotomy over a 10-year period from January 2008 to January 2018 at a major trauma centre in South Africa. Results A total of 61 patients were eligible for inclusion and all underwent laparotomy: 87% male, mean age: 29 years. Ninety-two percent (56/61) had a positive laparotomy whilst 8% (5/61) underwent a negative procedure. Of the 56 positive laparotomies, 91% (51/56) were considered therapeutic and 9% (5/56) were non-therapeutic. In addition to omental evisceration, 59% (36/61) had eviscerated small bowel, 28% (17/61) had eviscerated colon and 13% (8/61) had eviscerated stomach. A total of 92 organ injuries were identified. The most commonly injured organs were small bowel, large bowel and stomach. The overall complication rate was 11%. Twelve percent (7/61) required intensive care unit admission. The mean length of hospital stay was 9 days. The overall mortality rate for all 61 patients was 2%. Conclusions The presence of combined omental and organ evisceration following abdominal SW mandates laparotomy. The small bowel, large bowel and stomach were the most commonly injured organs in this setting.

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

Health Information Management Journal ◽

10.1177/18333583211037171 ◽

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.

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The impact of Major Trauma Centre (MTC) status on paediatric orthopaedic service delivery – 1 year after MTC status designation.

International Journal of Surgery ◽

10.1016/j.ijsu.2013.05.023 ◽

2013 ◽

Vol 11 (7) ◽

pp. 566

Author(s):

Assad Farooq ◽

Ravindran Visagan ◽

Yaser Jabber ◽

Raj Bhattacharya ◽

Sally Tennant ◽

...

Keyword(s):

Service Delivery ◽

Major Trauma ◽

Trauma Centre ◽

Major Trauma Centre ◽

Paediatric Orthopaedic ◽

The Impact

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The impact of alcohol intoxication in patients admitted due to assault at an Australian major trauma centre: a trauma registry study from 1999 to 2009

Emergency Medicine Journal ◽

10.1136/emermed-2012-202076 ◽

2013 ◽

Vol 31 (5) ◽

pp. 390-393 ◽

Cited By ~ 10

Author(s):

Michael M Dinh ◽

Kendall J Bein ◽

Susan Roncal ◽

Alexandra L C Martiniuk ◽

Soufiane Boufous

Keyword(s):

Major Trauma ◽

Trauma Registry ◽

Alcohol Intoxication ◽

Trauma Centre ◽

Registry Study ◽

Major Trauma Centre ◽

The Impact

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257 The Effect of the COVID-19 Pandemic on Mental Health Associated Trauma, Admissions and Fractures at a London Major Trauma Centre

British Journal of Surgery ◽

10.1093/bjs/znab259.979 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

M S Jamal ◽

D Hay ◽

K Al-Tawil ◽

A Petohazi ◽

V Gulli ◽

...

Keyword(s):

Mental Health ◽

Psychiatric Diagnosis ◽

Major Trauma ◽

Mental Health Problems ◽

Demographic Data ◽

Trauma Centre ◽

Related Factors ◽

Number Of Patients ◽

Major Trauma Centre ◽

The Impact

Abstract Aim Non-injury related factors have been extensively studied in major trauma and shown to have a significant impact on patient outcomes, with mental illness and associated medication use proven to have a negative effect on bone health and fracture healing. We report the epidemiological effect of COVID-19 pandemic on mental health associated Orthopaedic trauma, fractures, and admissions to our centre. Method We collated data retrospectively from the electronic records of Orthopaedic inpatients in an 8-week non-COVID and COVID period analysing demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient co-morbidities including psychiatric history. Results here were 824 Orthopaedic referrals and 358 admissions (6/day) in the non-COVID period with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared to 473 referrals and 195 admissions (3/day) in the COVID period with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) a fracture. 22/38 (57.9%) and 52/73 (71.2%) patients were known to mental health services, respectively. Conclusions Whilst total numbers utilising the Orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affected those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. It is imperative that adequate support is in place for vulnerable mental health patients, particularly as we are currently experiencing the “second wave” of COVID-19.

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

British Journal of Surgery ◽

10.1093/bjs/znab258.062 ◽

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.

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