scholarly journals Incidence of emergency neurosurgical TBI procedures: a population-based study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Cathrine Tverdal ◽  
Mads Aarhus ◽  
Pål Rønning ◽  
Ola Skaansar ◽  
Karoline Skogen ◽  
...  
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Incidence Rates ◽  
University Hospital ◽  
Neurosurgical Procedures ◽  
Trauma Centers ◽  
Pressure Monitor ◽  
Severe Injuries ◽  
Neurosurgical Procedure ◽  
Standard Population

Abstract Background The rates of emergency neurosurgery in traumatic brain injury (TBI) patients vary between populations and trauma centers. In planning acute TBI treatment, knowledge about rates and incidence of emergency neurosurgery at the population level is of importance for organization and planning of specialized health care services. This study aimed to present incidence rates and patient characteristics for the most common TBI-related emergency neurosurgical procedures. Methods Oslo University Hospital is the only trauma center with neurosurgical services in Southeast Norway, which has a population of 3 million. We extracted prospectively collected registry data from the Oslo TBI Registry – Neurosurgery over a five-year period (2015–2019). Incidence was calculated in person-pears (crude) and age-adjusted for standard population. We conducted multivariate multivariable logistic regression models to assess variables associated with emergency neurosurgical procedures. Results A total of 2151 patients with pathological head CT scans were included. One or more emergency neurosurgical procedure was performed in 27% of patients. The crude incidence was 3.9/100,000 person-years. The age-adjusted incidences in the standard population for Europe and the world were 4.0/100,000 and 3.3/100,000, respectively. The most frequent emergency neurosurgical procedure was the insertion of an intracranial pressure monitor, followed by evacuation of the mass lesion. Male sex, road traffic accidents, severe injury (low Glasgow coma score) and CT characteristics such as midline shift and compressed/absent basal cisterns were significantly associated with an increased probability of emergency neurosurgery, while older age was associated with a decreased probability. Conclusions The incidence of emergency neurosurgery in the general population is low and reflects neurosurgery procedures performed in patients with severe injuries. Hence, emergency neurosurgery for TBIs should be centralized to major trauma centers.

scholarly journals Incidence of emergency neurosurgical TBI procedures: A population-based study

2021 ◽  
Author(s):  
Cathrine Tverdal ◽  
Mads Aarhus ◽  
Pål Rønning ◽  
Ola Skaansar ◽  
Karoline Skogen ◽  
...  
Keyword(s):  
Road Traffic ◽  
Direct Method ◽  
University Hospital ◽  
Neurosurgical Procedures ◽  
Trauma Centers ◽  
Pressure Monitor ◽  
Severe Injuries ◽  
Neurosurgical Procedure ◽  
Standard Population ◽  
European Standard Population

Abstract Background The rates of emergency neurosurgery in traumatic brain injury (TBI) patients vary between populations and trauma centers. In planning acute TBI treatment, knowledge about rates and incidence of emergency neurosurgery at the population level is of importance. This study aimed to present incidence rates and patient characteristics for the most common TBI-related emergency neurosurgical procedures. Methods Oslo University Hospital is the only trauma center with neurosurgical services in Southeast Norway, which has a population of 3 million. We extracted prospectively collected registry data from the Oslo TBI Registry – Neurosurgery over a five-year period (2015–2019). For age-adjusted incidence according to the direct method, we used the 2013 European standard population (ESP) and 2000–2025 WHO World standard population distributions. We conducted multivariate logistic regression models to assess variables associated with emergency neurosurgical procedures. Results A total of 2151 patients with pathological head CT scans were included. One or more emergency neurosurgical procedure was performed in 27% of patients. The crude incidence was 3.9/100 000 person-years. The age-adjusted incidences in the standard population for Europe and the world were 4.0/100 00 and 3.3/100 000, respectively. The most frequent emergency neurosurgical procedure was the insertion of an intracranial pressure monitor, followed by evacuation of the mass lesion. Male sex, road traffic accidents, severe injury (low GCS) and CT characteristics such as midline shift and compressed/absent basal cisterns were significantly associated with an increased probability of emergency neurosurgery, while older age was associated with a decreased probability. Conclusions The incidence of emergency neurosurgery in the general population is low and reflects neurosurgery procedures performed in patients with severe injuries. Hence, emergency neurosurgery for TBIs should be centralized to major trauma centers.

Children and Terror Casualties Receive Preference in ICU Admissions

2012 ◽  
Vol 6 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Kobi Peleg ◽  
Michael Rozenfeld ◽  
Eran Dolev ◽  
Keyword(s):  
Traffic Accidents ◽  
Injury Severity ◽  
Road Traffic ◽  
Age Groups ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Severe Injuries ◽  
Level I ◽  
Hospital Emergency Departments ◽  
Trauma Type

ABSTRACTObjective: Trauma casualties caused by terror-related events and children injured as a result of trauma may be given preference in hospital emergency departments (EDs) due to their perceived importance. We investigated whether there are differences in the treatment and hospitalization of terror-related casualties compared to other types of injury events and between children and adults injured in terror-related events.Methods: Retrospective study of 121 608 trauma patients from the Israel Trauma Registry during the period of October 2000-December 2005. Of the 10 hospitals included in the registry, 6 were level I trauma centers and 4 were regional trauma centers. Patients who were hospitalized or died in the ED or were transferred between hospitals were included in the registry.Results: All analyses were controlled for Injury Severity Score (ISS). All patients with ISS 1-24 terror casualties had the highest frequency of intensive care unit (ICU) admissions when compared with patients after road traffic accidents (RTA) and other trauma. Among patients with terror-related casualties, children were admitted to ICU disproportionally to the severity of their injury. Logistic regression adjusted for injury severity and trauma type showed that both terror casualties and children have a higher probability of being admitted to the ICU.Conclusions: Injured children are admitted to ICU more often than other age groups. Also, terror-related casualties are more frequently admitted to the ICU compared to those from other types of injury events. These differences were not directly related to a higher proportion of severe injuries among the preferred groups.(Disaster Med Public Health Preparedness. 2012;6:14–19)

scholarly journals Foreign and national experience in organizing tertiary medical care for injured in road accidents

2019 ◽  
Vol 100 (3) ◽  
pp. 464-468
Author(s):  
D A Bugayev
Keyword(s):  
Medical Care ◽  
Russian Federation ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Trauma Centers ◽  
Road Traffic Accidents ◽  
Road Accidents ◽  
Severe Injuries ◽  
The Russian Federation ◽  
The Creation

As a result of road accidents in the Russian Federation, up to 30 thousand people are killed every year, which causes significant demographic and socio-economic damage to the state. The World Health Organization considers road traffic injuries as one of the global problems associated with 1.25 million deaths. In many countries, the leading direction of development of medical care for victims of road traffic accidents is the creation of trauma systems. The main volume of medical care for victims of road traffic accidents and those with severe injuries under other circumstances is provided by trauma centers of the 2nd and 1st levels. The implementation of the federal targeted programs «Improving road safety in 2006-2012» allowed the creation of a network of trauma centers in a number of subjects of the Russian Federation, whose work reduced mortality and disability among victims with severe injuries, but the problem cannot be considered solved because there are no national database of the victims of road accidents (register), system for assessing the severity of injuries and recording long-term results of non-fatal injuries, which excludes the possibility to compare the clinical effectiveness of the Russian trauma centers among themselves and with foreign counterparts.

Teens on Wheels and Consequences: A Six-Year Population-Based Study of Bicycle and Moped Injuries

2020 ◽  
Author(s):  
Jani Unkuri ◽  
Päivi Salminen ◽  
Pentti Kallio ◽  
Silja Kosola
Keyword(s):  
Injury Risk ◽  
Traffic Accidents ◽  
Injury Severity ◽  
Road Traffic ◽  
Age Groups ◽  
Population Based ◽  
Incidence Rates ◽  
Severe Injuries ◽  
Severity Scores ◽  
Study Population

Abstract Introduction Road traffic accidents are a major contributor to morbidity and mortality in the pediatric and adolescent population. Among adolescents, bicycles and light motorized two wheelers are popular means of transportation and increase adolescents' autonomy. Most previous studies on injury risk and incidence have pooled different vehicles and age groups together but more distinct data are required to guide policy. Materials and Methods We gathered data on all 1,432 children and adolescents (age 7–15) who had been treated for injuries from bicycle(n = 841) or moped/motorized scooter (n = 591) accidents at our study centers during a 6-year period (2008–2013). In addition to clinical data, we reviewed Injury Severity Scores (ISS) and calculated incidence estimates for the population of 15-year-olds in the study area. Results Most bicyclists were injured after a fall (72%), whereas most moped/scooter riders were injured in a collision (51%), most often with a heavier motorized vehicle. Internal injuries, multiple injuries, and severe injuries (ISS >15) were more common among moped/scooter riders than bicyclists (p < 0·001 for all). Moped/scooter riders were more often hospitalized and underwent more operations than bicyclists (p < 0·001 for both). The annual estimated incidence rates of injury were roughly eightfold for 15-year-old moped/scooter riders compared to bicyclists of the same age. Conclusion Cycling is in general a safe mode of transportation and rider safety could be further increased with the proper use of helmets. Although no patient deaths occurred in this study population, mopeds and motorized scooters led to significant morbidity.

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.

Alcohol in Medicolegal Cases Seen at Jordan University Hospital

1998 ◽  
Vol 38 (1) ◽  
pp. 70-73 ◽  
Author(s):  
K A Hadidi ◽  
A H Battah ◽  
S Hinnawi
Keyword(s):  
Traffic Accidents ◽  
Alcohol Intake ◽  
Road Traffic ◽  
The Other ◽  
University Hospital ◽  
Blood Alcohol ◽  
Road Traffic Accidents

The magnitude of alcohol-associated incidents in relation to medicolegal cases, including road traffic accidents and acts of violence, has not been evaluated in Jordan. Between 1993 and 1995, 825 such cases received at Jordan University Hospital were screened for the presence of alcohol. Blood alcohol was positive in 9.1% of vehicle passengers, 9.6% of pedestrians, 12.4% of cases involving violence, 13.6% of drivers, 65% of cases brought by police and in 12.5% of other cases. Blood alcohol concentrations (BAC) ranged from 10–350 mg/dL. BAC of more than 50 mg/dL was found in 65% and 55% of driver and violence cases respectively, and in 33% to 69% of the other categories. Alcohol may have contributed to some of these incidents. In cases with positive BAC, prior alcohol intake was frequently denied. There was no association between cases with positive BAC and a particular time, date or occasion.

scholarly journals Organizational Aspects of Providing Emergency Care to Victims in Road Transportation Accidents with Damage to the Facial Skeleton

2021 ◽  
pp. 65-67
Author(s):  
V.V. Maslyakov ◽  
◽  
Yu.E. Barachevsky ◽  
O.N. Pavlova ◽  
A.V. Pimenov ◽  
...  
Keyword(s):  
Medical Care ◽  
Traffic Accidents ◽  
Road Traffic ◽  
The Body ◽  
Trauma Centers ◽  
Road Traffic Accidents ◽  
Road Accidents ◽  
Emergency Medical Care ◽  
Facial Skeleton ◽  
Emergency Medical

The aim of the study is to investigate the organizational aspects of providing emergency medical care to victims of road traffic accidents with injuries of the facial skeleton. Materials and research methods. The study included 75 victims of road accidents that occurred in the city of Saratov in 2010–2019. In the total number of injured men – 42 (56.0%), women – 33 (44.0%). The age of the victims is 18–70 years, the average age is (37.5 ± 6.0) years. The study did not include: victims under the age of 18; victims with neck trauma, damage to the cerebral section of the skull and to other parts of the body. All the victims got medical assistance from the personnel of the ambulance brigades. Covering sheets, outpatient cards and medical records were used as primary documentation. Study criteria: time during which the ambulance was provided; who provided emergency medical care; correctness of its rendering. Research results and their analysis. Analysis of injuries to the facial skeleton showed: injuries of the facial skeleton are an actual pathology in victims of road traffic accidents in Saratov; victims of road accidents got open and closed injuries of the facial skeleton. With closed injuries, moderate and severe injuries were found in 23 (30.7%) victims, with open injuries — in 19 (23.3%) victims; majority (90.7%) of victims of road accidents got high-quality emergency medical aid in a timely manner. In 9.3% of cases, the quality of care was insufficient due to an incorrect assessment of severity of the victims’ condition and, as a consequence, due to non-fulfillment of anti-shock measures; scope of the provision of emergency medical care to victims of road accidents included temporary hemostasis, treatment of wounds and anti-shock measures; from the accident site were evacuated: to level III trauma centers — 24.0% of victims; to level II — 48.0; to level I trauma centers — 28.0% of victims; complications in the form of purulent-septic processes were observed in 16.0% of victims; competent and timely implementation of anti-shock measures determined an insignificant mortality rate — 4.0%.

scholarly journals On the expediency to organize monitoring of the medical and sanitary consequences of road traffic accidents

2021 ◽  
pp. 31-39
Author(s):  
S. F. Goncharov ◽  
A. V. Baranov ◽  
E. A. Mordovsky
Keyword(s):  
Medical Care ◽  
Information Exchange ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Social Consequences ◽  
Economic Losses ◽  
Trauma Centers ◽  
Road Traffic Accidents ◽  
Road Accidents ◽  
Health Consequences

Relevance. Road traffic accidents are a source of significant medical, demographic, social and economic losses. To reduce the volume of medical and sanitary consequences of road accidents, to achieve the targets of the national project “Safe and High-Quality Roads”, it is necessary to further improve the technologies for providing medical care to victims of road accidents at all stages, including their adaptation to the regional characteristics of road traffic traumatism, and the mechanism of interaction between medical organizations performing the functions of trauma centers. This task can be solved provided that a system of information exchange between trauma centers is created, as well as the organization of monitoring of health consequences in road accidents on its basis. To accumulate and analyze information, a polynosological register, a type of distributed database, is to be used.Intention – to substantiate the expediency to organize monitoring of the health consequences of road traffic accidents.Methodology. Regulatory documents were reviewed as well as results of Russian and foreign scientific research of organizational approaches to the provision of specialized medical care to victims of road accidents at the hospital stage, and also algorithms of introducing information technologies into the activities of medical organizations. The search for sources was performed in specialized scientific search systems (eLibrary, National Library of Medicine – PubMed, Scopus etc.).Results and Discussion. The organization of monitoring of the medical and social consequences of road traffic accidents at the level of the territories of the Russian Federation has been substantiated (including its purpose, tasks, coordinators and implementers). The directions of using the monitoring results were determined.Conclusion. Monitoring of medical and social consequences of road traffic accidents will provide a reliable assessment of their scope in the regions of the country. Besides, health authorities will get reliable information to develop effective measures for reducing medical, demographic, social and economic losses associated with road traffic accidents.

scholarly journals Efficiency analysis of the early years of the first level trauma center in the Chelyabinsk region

2015 ◽  
Vol 96 (1) ◽  
pp. 100-104
Author(s):  
E V Shishkin
Keyword(s):  
Trauma Center ◽  
Traffic Accidents ◽  
Brain Injuries ◽  
Road Traffic ◽  
Early Years ◽  
Trauma Centers ◽  
Body Regions ◽  
Working Age ◽  
Isolated Injury ◽  
Chelyabinsk Region

Aim. To assess the efficiency of first level trauma center on the base of «Chelyabinsk Regional Hospital». Methods. The data were copied out from the medical charts of road accidents victims. The majority of patients who were admitted to the first level trauma center are young people of reproductive and working age, mostly males. In most of the cases, patients suffered from combined injuries involving multiple body regions (T00-T07). Results. Admission in every fourth patient of the trauma center was inappropriate, as patients had isolated injury not accompanied by shock. In 26.8% of the studied group, no surgery was performed, also stressing inappropriate admission. Spinal and brain injuries requiring neurosurgical aid were detected only in 36.8% of cases. The analysis showed miscommunication between trauma centers of levels I and II. Significant violations of road traffic accidents victims’ hospitalization orders, as well as the presence of inappropriate patients, were discovered. Conclusion. The findings highlight problems associated with trauma centers low functioning as a whole system, requiring introduction of real-time monitoring of their activities, as well as management decisions aimed at optimizing the communicative process between trauma centers, as well as with other medical institutions, which include trauma centers.

scholarly journals A Comparative Study on Epidemiology, Spectrum and Outcome Analysis of Physical Trauma cases Presenting to Emergency Department of Dhulikhel Hospital, Kathmandu University Hospital and its Outreach Centers in Rural Area

2015 ◽  
Vol 11 (3) ◽  
pp. 241-246 ◽  
Author(s):  
R Shrestha ◽  
SK Shrestha ◽  
SR Kayastha ◽  
N Parajuli ◽  
D Dhoju ◽  
...  
Keyword(s):  
Emergency Department ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Outcome Evaluation ◽  
University Hospital ◽  
Mortality And Morbidity ◽  
Physical Trauma ◽  
Fall From Height ◽  
Set Up ◽  
One Year

Background Physical trauma is one of the major cause of mortality and morbidity among young and active age group and its increasing trend is of main concern. There are only few studies concerning the spectrum of physical trauma in Nepal. Objective This study aims to evaluate the epidemiological spectrum, the extent, severity of the physical trauma and the outcome evaluation of patients with physical trauma over a period of one year in the emergency department of the Kathmandu University Hospital and compare the same parameters with those patients presenting to the various outreach centers of the hospital in the community. Methods Patient treatment files from the emergency department and the reports from various outreach centers were retrieved for a period of one year (May 2011 to April 2012). Epidemiological information, mode, type and anatomic location of injuries were recorded. Outcome evaluation was assessed by number of patients discharged from emergency department of the hospital or the outreach centers after the treatment, patients admitted for inpatient management and referred to other centers for further specialty management. Result In a period of one year, total 2205 (20%) of physical trauma cases presented to the emergency department and 1994 (6.12%) in the outreach centres. Most commonly involved age group in physical trauma both in Hospital set up and in Community set up were the young adults (15 to 49 years). Fall from height was the commonest mode of injury followed by road traffic accidents among the patients coming to the hospital while significant number of trauma patients coming to outreach centers were due to fall from height. In the hospital set up, 1525 (69.2%) of the cases were discharged while 537 (24.4%) needed inpatient management and 85 (3.8%) needed referral to other centers for the specialty management. In case of outreaches, half of the patients were discharged after the primary treatment and almost another half were referred to the hospital, mainly for need of further investigations. Conclusion Fall related injuries and road traffic accidents are the most common mode of trauma in the hospital set up and fall related injuries are the single most important mode of trauma seen in the outreaches. Mostly young adults in their active period of life are involved in physical trauma so appropriate preventive measures through public health approach should be included in comprehensive trauma management for reducing mortality and morbidity rates related to physical trauma. DOI: http://dx.doi.org/10.3126/kumj.v11i3.12513 Kathmandu Univ Med J 2013; 43(3):241-246

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