Validation of a novel prediction model for early mortality in adult trauma patients in three public university hospitals in urban India

Abstract Background Obesity has become a major contributor to the global burden of chronic disease and disability. Understanding the effect of obesity on the incidence of wound infections and other wound complications remains incomplete despite considerable attention to both the growing ‘‘epidemic’’ of obesity and the frequent occurrence of surgical site infection (SSI) after surgical procedures. Damage-control laparotomy specifically has been associated with a higher rate of infectious complications and a lower rate of primary fascial closure in obese patients. Aim of the work The aim of the study is to evaluate the correlation between obesity and surgical site infection (SSI) in patients undergoing exploratory laparotomy after abdominal trauma. Patients and methods A retrospective study performed on obese patients of both genders aged between 18 and 60 years old undergoing exploratory laparotomy after abdominal trauma at the surgery departments of Ain Shams University Hospitals, Al-Bank Al-Ahly Hospital, Al-Mataria Hospital and Al-Salam Hospital, Cairo, Egypt for two years (1st of January 2018 to 1st of January 2020). Patients with infected wounds, receiving antibiotic therapy at the time of injury, those with a known immunodeficiency, who died within 48 hours after injury, who had sustained burn injuries, who underwent surgery at another institution before admission to our hospital were excluded. The rate of 30-day SSI post-operatively among obese and non-obese patients were compared. Statistical analysis was also done. Results Out of 782 patients, only 480 of those patients for whom BMI data were available, 360 (75%) were males and 120 (25%) were females. Out of the 480 patients: 168 patients had BMI more than 30; 114 patients (67.8%) had SSI (P < 0.05), 312 patients had BMI less than 30; 61 patients (19.5%) had SSI. All of the included patients were fulfilling the inclusion and the exclusion criteria. On multivariate analysis, obesity was the strongest predictor of SSI (odds ratio = 1.59; 95% confidence interval, 1.32-1.91) after adjustment for sex and age. Obese patients with SSI compared with the non-obese had longer hospital stays (mean, 9.5 vs 8.1 days, respectively; P < .001) and markedly higher rates of hospital readmission (27.1% vs 6.5%, respectively; P < .001). Conclusion Obesity is considered as one of the risk factors in causing surgical site infection. Thus, this study showed the relation of BMI and obesity with surgical site infection in case of exploratory laparotomy after abdominal trauma.

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EP.WE.105Hand trauma during COVID pandemic: a tertiary trauma centre experience

British Journal of Surgery ◽

10.1093/bjs/znab308.016 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Amir Ghareib ◽

Sylwia Oniska ◽

Laura Karran ◽

Jamil Moledina

Keyword(s):

High Volume ◽

Trauma Centre ◽

Active Movement ◽

Trauma Patients ◽

University Hospitals ◽

Hand Fractures ◽

Good Movement ◽

Hand Fracture ◽

June July

Abstract Introduction St. George’s University Hospitals NHS Foundation Trust is a tertiary trauma centre. We receive a high volume of hand referrals from all over the south West London region. Closed hand fractures represent a significant number of our referrals. COVID-19 has put more burden in all health service endangering poor management of these trauma patients. Aim To assess management of close hand trauma patients during COVID pandemic. Methods Retrospective evaluation of closed hand fracture referrals during June, July, and August 2020. Clinical documentations, operative details and follow up visit notes have been reviewed. Results 106 patients have been included. 47 patients treated surgically with 81% of them were in need for metalwork insertion. Most of operations were done within 8 days. Number of hospital visits was variable with a mean of six days for adult and two days for children. Patient who was in need for hand therapy have been seen within the first 8 days of their surgery. At three months follow up, only three cases had infection. Only one case had osteomyelitis and the other two case had infected metalwork. Most of the patents reported good movement in ASSH Total Active Movement of Hand score (TAM) at the end of the three months. Conclusion Despite COVID 19 pandemic our service managed to achieve acceptable results in dealing with these cases. Yet, securing a reasonable number of operating sessions and clinic appointments remains a challenge.

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Effect of Under Triage on Early Mortality After Major Pediatric Trauma: A Registry-based Propensity Score Matching Analysis

10.21203/rs.3.rs-87401/v1 ◽

2020 ◽

Author(s):

François-Xavier Ageron ◽

Jordan Porteaud ◽

Jean-Noël Evain ◽

Anne Millet ◽

Jules Greze ◽

...

Keyword(s):

Propensity Score ◽

Trauma Care ◽

Pediatric Population ◽

Pediatric Trauma ◽

Trauma System ◽

Early Death ◽

Risk Difference ◽

Early Mortality ◽

Trauma Patients ◽

Risk Of Death

Abstract Backgroundlittle is known about the effect of under triage on early mortality in trauma in a pediatric population. Our objective is to describe the effect of under triage on 24 hour-mortality after major pediatric trauma in a regional trauma systemMethodsThis cohort study was conducted from January 2009 to December 2017. Data were obtained from the registry of the Northern French Alps Trauma System. The network guidelines triage pediatric trauma patients according to an algorithm shared with adult patients. Under triage was defined by the number of pediatric trauma patients that required specialized trauma care transported to a non-level I pediatric trauma center on the total number of injured patients with critical resource use. The effect of under triage on 24 hour-mortality was assessed with inverse probability treatment weighting (IPTW) and a propensity score (Ps) matching analysis. ResultsA total of 1 143 pediatric patients were included (mean [SD], age 10 [5] years), mainly after a blunt trauma (1130 [99%]). Of the children, 402 (35%) had an ISS higher than 15 and 547 (48%) required specialized trauma care. Nineteen (1.7%) patients died within 24 hours. Under triage rate was 33% based on the need of specialized trauma care. Under triage of children requiring specialized trauma care increased the risk of death in IPTW (risk difference: 6.0 [95% CI 1.3-10.7]) and Ps matching analyses (risk difference: 3.1 [95% CI 0.8-5.4]).ConclusionsIn a regional inclusive trauma system, under triage increased the risk of early death after pediatric major trauma.

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Ideology and discourse in the public sphere: A critical discourse analysis of public debates at a Brazilian public university

Discourse & Communication ◽

10.1177/1750481318757765 ◽

2018 ◽

Vol 12 (3) ◽

pp. 278-306 ◽

Cited By ~ 1

Author(s):

Erik Persson ◽

Luís Moretto Neto

Keyword(s):

Discourse Analysis ◽

Public Sphere ◽

Critical Discourse Analysis ◽

Public University ◽

Critical Discourse ◽

University Hospitals ◽

Staff Shortage ◽

Public Company ◽

The Public Sphere ◽

Set Up

Since 2013, several social actors of the Federal University of Santa Catarina (UFSC) community have formed a public sphere in order to deliberate and decide on the University Hospital’s (UH/UFSC) affiliation to the Brazilian Hospital Services Company (EBSERH), a public company set up in accordance with a private law which has been created by the Brazilian federal government in order to set up a management body for public university hospitals. Underpinned by critical discourse analysis, our purpose is to analyze the embedded ideologies in discursive practices within the UFSC/EBSERH public sphere, especially those perpetrated by the federal government’s bureaucratic means as to mystify reality, and also promote and legitimize dominant interests and actions with regard to the UH/UFSC’s affiliation to the EBSERH. We organized this analysis in five main categories: (1) staff shortage and the ideological use of the double standard policy, (2) the ideology of neo-liberalism and managerialism, (3) blame avoidance behavior and the ideological dispute between ideology and pragmatism, (4) the policy of terror and the fallacy of choice and (5) ideology of participationism.

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