scholarly journals Impact of nationwide COVID-19 lockdown on the workload and injury patterns of major trauma cases in a regional trauma centre in Singapore

2021 ◽  
Author(s):  
ML Kang ◽  
WW Lim ◽  
DJK Lee ◽  
JTT Goo
Keyword(s):  
Length Of Stay ◽  
Interpersonal Violence ◽  
Traffic Accidents ◽  
Major Trauma ◽  
Road Traffic ◽  
Relative Increase ◽  
Trauma Centre ◽  
Tier 2 ◽  
Tier 1 ◽  
Community Facilities

Introduction: Singapore instituted lockdown measures from 7th February 2020 to 1st June 2020 in response to the COVID-19 pandemic. Methods: Retrospective analysis of cases from the national trauma registry was carried out comparing the lockdown period (7th February 2020 to 1st June 2020) to the pre-lockdown period (7th February 2019 to 1st June 2019). Data extracted included the volume of Tier 1 (ISS >15) and Tier 2 (ISS 9-15) cases and epidemiology. Subgroup analysis was performed for Tier 1 patient outcomes. Results: Trauma volume decreased by 19.5% with a 32% drop in Tier 1 cases. Road traffic and workplace accidents decreased by 50% (p<0.01) while interpersonal violence showed an increase of 37.5% (p=0.34). There was an 18.1% decrease in usage of trauma workflows (p=0.01), with an increase in time to intervention for Tier 1 patients from 88 to 124 minutes (p =0.22). Discharge to community facilities decreased from 31.4% to 17.1% (p < 0.05). There was no increase in inpatient mortality, length of stay in critical care, or length of stay overall. Conclusion: There was an overall decrease in major trauma cases during the lockdown period, particularly road traffic accidents and worksite injuries and a relative increase in interpersonal violence. Redeployment of manpower and hospital resources may have contributed to decreased usage of trauma workflows and community facilities. In the event of further lockdowns it is necessary to plan for trauma coverage and maintain use of workflows to facilitate early intervention.

scholarly journals 40 days and 40 nights: Clinical characteristics of major trauma and orthopaedic injury comparing the incubation and lockdown phases of COVID-19 infection

2020 ◽  
Vol 1 (7) ◽  
pp. 330-338 ◽  
Author(s):  
Bisola Ajayi ◽  
Alex Trompeter ◽  
Magnus Arnander ◽  
Philip Sedgwick ◽  
Darren F. Lui
Keyword(s):  
Clinical Characteristics ◽  
Traffic Accidents ◽  
Major Trauma ◽  
Road Traffic ◽  
Trauma Centre ◽  
Orthopaedic Patients ◽  
Major Trauma Centre ◽  
Group A ◽  
Group B ◽  
The Uk

Aims The first death in the UK caused by COVID-19 occurred on 5 March 2020. We aim to describe the clinical characteristics and outcomes of major trauma and orthopaedic patients admitted in the early COVID-19 era. Methods A prospective trauma registry was reviewed at a Level 1 Major Trauma Centre. We divided patients into Group A, 40 days prior to 5 March 2020, and into Group B, 40 days after. Results A total of 657 consecutive trauma and orthopaedic patients were identified with a mean age of 55 years (8 to 98; standard deviation (SD) 22.52) and 393 (59.8%) were males. In all, 344 (approximately 50%) of admissions were major trauma. Group A had 421 patients, decreasing to 236 patients in Group B (36%). Mechanism of injury (MOI) was commonly a fall in 351 (52.4%) patients, but road traffic accidents (RTAs) increased from 56 (13.3%) in group A to 51 (21.6%) in group B (p = 0.030). ICU admissions decreased from 26 (6.2%) in group A to 5 (2.1%) in group B. Overall, 39 patients tested positive for COVID-19 with mean age of 73 years (28 to 98; SD 17.99) and 22 (56.4%) males. Common symptoms were dyspnoea, dry cough, and pyrexia. Of these patients, 27 (69.2%) were nosocomial infections and two (5.1%) of these patients required intensive care unit (ICU) admission with 8/39 mortality (20.5%). Of the patients who died, 50% were older and had underlying comorbidities (hypertension and cardiovascular disease, dementia, arthritis). Conclusion Trauma admissions decreased in the lockdown phase with an increased incidence of RTAs. Nosocomial infection was common in 27 (69.2%) of those with COVID-19. Symptoms and comorbidities were consistent with previous reports with noted inclusion of dementia and arthritis. The mortality rate of trauma and COVID-19 was 20.5%, mainly in octogenarians, and COVID-19 surgical mortality was 15.4%. Cite this article: Bone Joint Open 2020;1-7:330–338.

scholarly journals 40 days and 40 nights: Clinical characteristics of major trauma and orthopaedic injury comparing the incubation and lockdown phases of COVID-19 infection

2020 ◽  
Vol 1 (7) ◽  
pp. 330-338 ◽  
Author(s):  
Bisola Ajayi ◽  
Alex Trompeter ◽  
Magnus Arnander ◽  
Philip Sedgwick ◽  
Darren F. Lui
Keyword(s):  
Clinical Characteristics ◽  
Traffic Accidents ◽  
Major Trauma ◽  
Road Traffic ◽  
Trauma Centre ◽  
Orthopaedic Patients ◽  
Major Trauma Centre ◽  
Group A ◽  
Group B ◽  
The Uk

Aims The first death in the UK caused by COVID-19 occurred on 5 March 2020. We aim to describe the clinical characteristics and outcomes of major trauma and orthopaedic patients admitted in the early COVID-19 era. Methods A prospective trauma registry was reviewed at a Level 1 Major Trauma Centre. We divided patients into Group A, 40 days prior to 5 March 2020, and into Group B, 40 days after. Results A total of 657 consecutive trauma and orthopaedic patients were identified with a mean age of 55 years (8 to 98; standard deviation (SD) 22.52) and 393 (59.8%) were males. In all, 344 (approximately 50%) of admissions were major trauma. Group A had 421 patients, decreasing to 236 patients in Group B (36%). Mechanism of injury (MOI) was commonly a fall in 351 (52.4%) patients, but road traffic accidents (RTAs) increased from 56 (13.3%) in group A to 51 (21.6%) in group B (p = 0.030). ICU admissions decreased from 26 (6.2%) in group A to 5 (2.1%) in group B. Overall, 39 patients tested positive for COVID-19 with mean age of 73 years (28 to 98; SD 17.99) and 22 (56.4%) males. Common symptoms were dyspnoea, dry cough, and pyrexia. Of these patients, 27 (69.2%) were nosocomial infections and two (5.1%) of these patients required intensive care unit (ICU) admission with 8/39 mortality (20.5%). Of the patients who died, 50% were older and had underlying comorbidities (hypertension and cardiovascular disease, dementia, arthritis). Conclusion Trauma admissions decreased in the lockdown phase with an increased incidence of RTAs. Nosocomial infection was common in 27 (69.2%) of those with COVID-19. Symptoms and comorbidities were consistent with previous reports with noted inclusion of dementia and arthritis. The mortality rate of trauma and COVID-19 was 20.5%, mainly in octogenarians, and COVID-19 surgical mortality was 15.4%. Cite this article: Bone Joint Open 2020;1-7:330–338.

scholarly journals Comparison of trauma management between two major trauma services in Riyadh, Kingdom of Saudi Arabia and Melbourne, Australia

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e045902
Author(s):  
Mohammad Alsenani ◽  
Faisal A Alaklobi ◽  
Jane Ford ◽  
Arul Earnest ◽  
Waleed Hashem ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Length Of Stay ◽  
Major Trauma ◽  
Road Traffic ◽  
Binary Logistic Regression ◽  
Trauma Centre ◽  
Hospital Death ◽  
Inpatient Mortality ◽  
Kingdom Of Saudi Arabia ◽  
Trauma Service

IntroductionThe burden of injury in the Kingdom of Saudi Arabia (KSA) has increased in recent years, but the country has lacked a consistent methodology for collecting injury data. A trauma registry has been established at a large public hospital in Riyadh from which these data are now available.ObjectivesWe aimed to provide an overview of trauma epidemiology by reviewing the first calendar year of data collection for the registry. Risk-adjusted analyses were performed to benchmark outcomes with a large Australian major trauma service in Melbourne. The findings are the first to report the trauma profile from a centre in the KSA and compare outcomes with an international level I trauma centre.MethodsThis was an observational study using records with injury dates in 2018 from the registries at both hospitals. Demographics, processes and outcomes were extracted, as were baseline characteristics. Risk-adjusted endpoints were inpatient mortality and length of stay. Binary logistic regression was used to measure the association between site and inpatient mortality.ResultsA total of 2436 and 4069 records were registered on the Riyadh and Melbourne databases, respectively. There were proportionally more men in the Saudi cohort than the Australian cohort (86% to 69%). The Saudi cohort was younger, the median age being 36 years compared with 50 years, with 51% of injuries caused by road traffic incidents. The risk-adjusted length of stay was 4.4 days less at the Melbourne hospital (95% CI 3.95 days to 4.86 days, p<0.001). The odds of in-hospital death were also less (OR 0.25; 95% CI 0.15 to 0.43, p<0.001).ConclusionsThis is the first hospital-based study of trauma in the kingdom that benchmarks with an individual international centre. There are limitations to interpreting the comparisons, however the findings have established a baseline for measuring continuous improvement in outcomes for KSA trauma services.

scholarly journals A profile of a major trauma centre of North West England between 2011 and 2018

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Raimundas Lunevicius ◽  
Mina Mesri
Keyword(s):  
Traffic Accidents ◽  
Major Trauma ◽  
Road Traffic ◽  
Survival Rates ◽  
Trauma Team ◽  
Trauma Centre ◽  
North West ◽  
Major Trauma Centre ◽  
Mortality Ratio ◽  
Expected Mortality

AbstractThis study examined the trends and patterns of major trauma (MT) activities, causes, mortality and survival at the Aintree Major Trauma Centre (MTC), Liverpool, between 2011 and 2018. The number of trauma team activations (TTAs) rose sharply over time (n = 699 in 2013; n = 1522 in 2018). The proportion of TTAs that involved MT patients decreased from 75.1% in 2013 to 67.4% in 2018. The leading cause of MT was a fall from less than 2 m (36%). There has been a fivefold increase in the overall number of trauma procedures between 2011 and 2018. Orthopaedic surgeons have performed 80% of operations (n = 7732), followed by neurosurgeons, oral and maxillofacial surgeons, and general trauma surgeons. Both types of fall (> 2 m and < 2 m) and road traffic accidents were the three leading causes of death during the study period. The observed mortality rates exceeded that of expected rates in years 2012, 2014, 2016 and 2017. The all-cause observed to expected mortality ratio was 1.08 between 2012 and 2018. A change in care for MT patients was not directly associated with improved survival, although the marginally ascending trend line in survival rates between 2012 and 2018 reflects a gradual positive change.

scholarly journals 1550 Experience from A Level-1 Major Trauma Centre in England of Trauma Epidemiology After Easing of Lockdown Restrictions

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Waseem ◽  
R Romann ◽  
J Lenihan ◽  
J Rawal ◽  
A Carrothers ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Major Trauma ◽  
Road Traffic ◽  
Trauma Centre ◽  
Research Network ◽  
Period 2 ◽  
Major Trauma Centre ◽  
Severity Of Injury ◽  
Self Harm ◽  
Allocation Decisions

Abstract Aim The COVID-19 pandemic transformed trauma care. We examined the effect of lockdown easing on trauma presentation and management. Method Data was retrospectively analysed from Trauma Audit and Research Network (TARN) on patients presenting to one Major Trauma Centre in the East of England with trauma. The first 47 days of lockdown (23rd March-9th May 2020, period 1) were compared with the next (10th May- 26th June 2020, period 2) and last 47 (27th June- 13th August 2020, period 3). Data collected included demographics, mechanism and severity of injury, management, and length of stay. Results 1,249 patients were included; 62.2% were male with a mean age of 57.73. Footfall declined in April 2020 compared with 2019 (56 vs 143) but rebounded by May (123 v 120 patients). Road traffic collisions increased over periods 1-3 (18.8% v 23% v 30.1%, p = 0.038); deliberate self-harm (DSH) increased in period 2 compared with 1 and 3 (6.3% v 3.4% v 1.4%, p = 0.03) respectively. The 2020 patient age was younger than 2019, with less trauma relating to alcohol (7.3% v 13.2%, p = 0.009). Compared with 2019 reductions in total length of stay (14.1 v 17.4 days, p = &lt;0.001), critical care length of stay (2.3 v 2.9 days, p = 0.04) and consultant driven care (54.9% v 64.9%, p &lt; 0.001) were noted in lockdown. Conclusions Our study suggests that after lockdown easing, trauma footfall rapidly rebounded to 2019 levels. This should be acknowledged in resource allocation decisions if future lockdowns are necessitated.

scholarly journals Delayed presentation of a patient with a ruptured diaphragm complicated by gastric incarceration and perforation after apparently minor blunt trauma

CJEM ◽  
2004 ◽  
Vol 6 (04) ◽  
pp. 277-280 ◽  
Author(s):  
Brian K.P. Goh ◽  
Andrew S.Y. Wong ◽  
Khoon-Hean Tay ◽  
Michael N.Y. Hoe
Keyword(s):  
Blunt Trauma ◽  
Nasogastric Tube ◽  
Traffic Accidents ◽  
Major Trauma ◽  
Road Traffic ◽  
Delayed Presentation ◽  
Road Traffic Accidents ◽  
Gastric Incarceration ◽  
Repeat Imaging ◽  
Ruptured Diaphragm

ABSTRACTRupture of the diaphragm is almost always due to major trauma and is most commonly associated with road-traffic accidents. We report a case of delayed presentation of a 35-year-old woman with a ruptured diaphragm, 11 days following apparent minor blunt trauma. This case illustrates how the diagnosis of ruptured diaphragm can be missed and demonstrates the importance of considering this diagnosis in all cases of blunt trauma to the trunk. It also demonstrates the potential pitfall of misinterpreting the chest radiograph, and the value of repeat imaging after insertion of a nasogastric tube.

scholarly journals Epidemiology of Maxillofacial Injuries in “Heratsi” No 1 University Hospital in Yerevan, Armenia: A Retrospective Study

2021 ◽  
Author(s):  
Lusine V. Aleksanyan ◽  
Anna Yu Poghosyan ◽  
Martin S. Misakyan ◽  
Armen M. Minasyan ◽  
Aren Yu Bablumyan ◽  
...  
Keyword(s):  
Interpersonal Violence ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Nasal Bone ◽  
Fracture Site ◽  
University Hospital ◽  
Maxillofacial Injuries ◽  
Cross Sectional ◽  
Injury Site ◽  
Maxillofacial Fractures

Abstract Background: The aim of this study was to perform a retrospective analysis of the prevalence, etiologies, and types of maxillofacial injuries (MFI) and sites of maxillofacial fractures (MFF) and their management in Yerevan, Armenia.Methods: A retrospective cross-sectional study was conducted. Data including age, sex, date of referral, mode of injury, etiology, radiology records and treatment methods were extracted. Study outcomes were measured using percentages, means, standard deviations and tests of proportions. P <.05 was considered significant.Results: A total of 204 patients had a mean age of 36.26 ±1.08 years (156 males and 48 females), and a total of 259 MFIs were recorded between 2017 and 2020. Interpersonal violence (IV) was found to be the most common etiology of MFFs in this study (42.1%), followed by road traffic accidents (RTAs) (27.9%) and falls (18.6%). The nasal bone was the most common injury site (47.5%), followed by the mandible (31.4%) and zygomatic complex (11.7%). The most common fracture site was the mandibular angle (37.9%), followed by the symphysis/parasymphysis (28.1%) and body (12.6%). The majority of MFFs were treated by open reduction and internal fixation.Conclusion: Interpersonal violence, followed by RTAs and falls, was the most common cause of MFIs. The nasal bone was the most common injury site, followed by the mandible and zygomatic complex. Social education with the objective of reducing aggression and interpersonal conflict should be improved, and appropriate RTA prevention strategies should be strengthened and implemented.

scholarly journals Vascular injuries and Their Management in Major Trauma from Road Traffic Collisions at a Major Trauma Centre

2019 ◽  
Vol 58 (6) ◽  
pp. e536-e537
Author(s):  
Rachael Bygate ◽  
Laurence Orchard ◽  
Michelle Wilkinson ◽  
Raghvinder Gambhir
Keyword(s):  
Major Trauma ◽  
Road Traffic ◽  
Trauma Centre ◽  
Vascular Injuries ◽  
Major Trauma Centre

scholarly journals A retrospective analysis of twenty two cases of floating knee

2020 ◽  
Vol 6 (4) ◽  
pp. 797
Author(s):  
Umesh Yadav ◽  
Ajay Sheoran ◽  
Mayank Dutta ◽  
Ashish Devgan ◽  
Amit Dahiya ◽  
...  
Keyword(s):  
Functional Assessment ◽  
Knee Injury ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Damage Control ◽  
Tertiary Care ◽  
Knee Injuries ◽  
Trauma Centre ◽  
Tertiary Care Centre ◽  
Floating Knee Injury

<p class="abstract"><strong>Background:</strong> With increase in road traffic accidents, incidence of floating knee injuries is increasing day by day. Along with bony injuries, multiorgan injuries are generally present which require urgent intervention. Despite advance in surgical management and implants, achieving a good functional knee still remains a challenge to the surgeons.</p><p class="abstract"><strong>Methods:</strong> This retrospective study was conducted to assess management, functional outcome and complications of patient presenting with floating knee injury to a tertiary care centre. 22 patients with floating knee injury admitted in trauma centre from 2017 to 2019 were analysed and functional assessment was done.<strong></strong></p><p class="abstract"><strong>Results:</strong> Males with mean age 33.5 years were exclusively victims of road traffic accident. 14 patients presented with multisystem injury. After stabilization fractures were fixed with nails/plates/screws. Knee stiffness was most common complication seen in 37% cases. Functional assessment was done using modified Karlstrom Olerud criteria which revealed excellent results in 22.7% cases while poor results in 18.2% cases.</p><p><strong>Conclusions:</strong>Floating knee injury is not merely bony injury but a multisystem injury and should be managed on principles of Damage control Orthopaedics. Regarding bony injuries, achieving union and acceptable range of motion remains the prime target. </p>

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