scholarly journals Impact of the SARS-COV-2 outbreak on epidemiology and management of major traumain France: a registry-based study (the COVITRAUMA study)

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Jean-Denis Moyer ◽  
◽  
Arthur James ◽  
Clément Gakuba ◽  
Mathieu Boutonnet ◽  
...  
Keyword(s):  
Health Care ◽  
Traffic Accidents ◽  
Major Trauma ◽  
Road Traffic ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Patient Demographics ◽  
Rescue Chain ◽  
Pandemic Wave

Abstract Background Emerging evidence suggests that the reallocation of health care resources during the COVID-19 pandemic negatively impacts health care system. This study describes the epidemiology and the outcome of major trauma patients admitted to centers in France during the first wave of the COVID-19 outbreak. Methods This retrospective observational study included all consecutive trauma patients aged 15 years and older admitted into 15 centers contributing to the TraumaBase® registry during the first wave of the SARS-CoV-2 pandemic in France. This COVID-19 trauma cohort was compared to historical cohorts (2017–2019). Results Over a 4 years-study period, 5762 patients were admitted between the first week of February and mid-June. This cohort was split between patients admitted during the first 2020 pandemic wave in France (pandemic period, 1314 patients) and those admitted during the corresponding period in the three previous years (2017–2019, 4448 patients). Trauma patient demographics changed substantially during the pandemic especially during the lockdown period, with an observed reduction in both the absolute numbers and proportion exposed to road traffic accidents and subsequently admitted to traumacenters (348 annually 2017–2019 [55.4% of trauma admissions] vs 143 [36.8%] in 2020 p < 0.005). The in-hospital observed mortality and predicted mortality during the pandemic period were not different compared to the non-pandemic years. Conclusions During this first wave of COVID-19 in France, and more specifically during lockdown there was a significant reduction of patients admitted to designated trauma centers. Despite the reallocation and reorganization of medical resources this reduction prevented the saturation of the trauma rescue chain and has allowed maintaining a high quality of care for trauma patients.

scholarly journals Impact of the SARS-COV-2 Outbreak on Epidemiology and Management of Major Trauma in France: Registry-Based Study. The COVITRAUMA Study

2021 ◽  
Author(s):  
Jean-Denis Moyer ◽  
Arthur James ◽  
Clément Gakuba ◽  
Mathieu Boutonnet ◽  
Emeline Angles ◽  
...  
Keyword(s):  
Health Care ◽  
Hospital Care ◽  
Traffic Accidents ◽  
Major Trauma ◽  
Road Traffic ◽  
Trauma Patients ◽  
Road Traffic Accidents ◽  
Patient Demographics ◽  
The Difference ◽  
Pandemic Wave

Abstract BackgroundEvidence increases to suggest that the reallocation of health care resources during considerable the COVID-19 pandemic impacts considerably any health system. This study describes the epidemiology and the outcome of major trauma patients admitted to centers in France during the first wave of the COVID-19 outbreak. MethodsThis retrospective observational study included all consecutive trauma patients aged 15 years and older admitted into 15 centers participating to the TraumaBase® registry in France during the first wave of the SARS-CoV-2 pandemic in France. ResultsOver a 4 years-study period, 5762 patients were admitted between the first week of February and mid-June. This cohort was split between patients admitted during the first 2020 pandemic wave in France (pandemic period, 1314 patients) and those admitted during the corresponding period in the three previous years (2017-2019, 4448 patients). Patient demographics changed substantially during the pandemic and more specifically during the lockdown period specially with a reduction in both absolute numbers admitted and the proportion of road traffic accidents (348 annually 2017-2019 [55.4 % of trauma admissions] vs 143 [36.8 %] in 2020 p<0.005). Mortality during the pandemic period and the difference between predicted and observed mortality was not different compared to the non-pandemic years. ConclusionsDuring this first wave of COVID-19 in France, management of trauma patients admitted to regional Traumacenters was not significantly altered, despite medical resources being reallocated and reorganized. Mortality as well as prehospital and in hospital care remained stable throughout the period of the first pandemic wave despite a massive increase in demand for acute care beds.

scholarly journals P014: Incidental findings in trauma whole-body CT scans: a systematic review

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S69-S69
Author(s):  
V. Tsang ◽  
K. Bao ◽  
J. Taylor
Keyword(s):  
Systematic Review ◽  
Incidental Findings ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Subsequent Treatment ◽  
Whole Body ◽  
Trauma Patients ◽  
Patient Demographics ◽  
Study Results

Introduction: Whole-body computed tomography scans (WBCT) are a mainstay in the work-up of polytrauma or multiple trauma patients in the emergency department. While incredibly useful for identifying traumatic injuries, WBCTs also reveal incidental findings in patients, some of which require further diagnostic testing and subsequent treatment. Although the presence of incidental findings in WBCTs have been well documented, there has been no systematic review conducted to organize and interpret findings, determine IF prevalence, and document strategies for best management. Methods: A systematic review was conducted using MEDLINE, PUBMED, and EMBASE. Specific journals and reference lists were hand-mined, and Google Scholar was used to find any additional papers. Data synthesis was performed to gather information on patient demographics, prevalence and type of incidental findings (IFs), and follow-up management was collected. All documents were independently assessed by the two reviewers for inclusion and any disagreements were resolved by consensus. Results: 1231 study results were identified, 59 abstracts, and 12 included in final review. A mean of 53.9% of patients had at least one IF identified, 31.5% had major findings, and 68.5% had minor findings. A mean of 2.7 IFs per patient was reported for articles that included number of total IFs. The mean age of patients included in the studies were 44 years old with IFs more common in older patients and men with more IFs than women. IFs were most commonly found in the abdominal/pelvic region followed by kidneys. Frequency of follow-up documentation was poor. The most common reported mechanisms of injury for patients included in the study were MVA and road traffic accidents (60.0%) followed by falls from >3m (23.2%). Conclusion: Although there is good documentation on the mechanism of injury, patient demographics, and type of IF, follow-up for IFs following acute trauma admission lacks documentation and follow-up and is an identified issue in patient management. There is great need for systematic protocols to address management of IFs in polytrauma patients.

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)

Thoracic trauma in small animals: road traffic accidents

2021 ◽  
Vol 12 (1) ◽  
pp. 15-19
Author(s):  
Kate Sheard
Keyword(s):  
Traffic Accidents ◽  
Thoracic Trauma ◽  
Road Traffic ◽  
Positive Outcome ◽  
Multiple Organ ◽  
Trauma Patients ◽  
Small Animals ◽  
Road Traffic Accidents ◽  
Blunt Force Trauma ◽  
Organ Systems

Thoracic trauma is common in small animals and can be caused by a variety of insults from penetrating wounds to blunt force trauma. Patients that have sustained any form of thoracic trauma require immediate attention and intensive nursing care in order to have a positive outcome for the patient. These cases can prove challenging as multiple organ systems can be affected and surgery is often required. However, combined with the appropriate medical care, the outcome can be successful.

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.

Intravenous ketamine as an analgesia in prehospital adult trauma patients

2022 ◽  
Vol 14 (1) ◽  
pp. 26-36
Author(s):  
Anya Critchley
Keyword(s):  
Pain Relief ◽  
Major Trauma ◽  
Trauma Patients ◽  
First Line ◽  
Exclusion Criteria ◽  
Adequate Pain Relief ◽  
Research Questions ◽  
Effective Pain Relief ◽  
Intravenous Ketamine

Background: Prehospital traumatic pain is common, but the quality of pain management in these patients is poor. Current practice recommends morphine as the first-line analgesia in major trauma but this carries high risks and is often contraindicated. Alternative paramedic-administered analgesia does not provide adequate pain relief or may be contraindicated. As a result, many patients remain in pain. Analgesic ketamine is used safely and effectively in international civilian and military settings and by paramedics with additional training, education and qualifications. Aim: The study had two aims. Namely, these were to find out whether intravenous ketamine: provides effective relief of prehospital traumatic pain in adults; and is safe for prehospital administration by non-specialist paramedics. Method: Three databases, CINAHL, MEDLINE and AMED, were searched to identify articles published between 2009 and 2021. Exclusion criteria were applied and results subjected to critical appraisal and evaluation. Findings: Four studies were included in the review. Two themes were identified for thematic analysis: therapeutic effectiveness; and the safety of IV ketamine administration by paramedics. The evidence drew predominantly homogenous conclusions, but was substandard regarding external validity, which limited the quality of these conclusions. Conclusion: Ketamine provides effective pain relief in line with morphine and is safe for paramedics to administer. However, clear gaps in the evidence mean the research questions are not fully answered, so changes to current paramedic practice cannot be recommended.

Abstract 183: Outcomes for Major Trauma Patients in Counties Without Trauma Centers Are Worse: Nationwide Population-Based Research in Taiwan

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Dorji Harnod ◽  
Chu Hui Chang ◽  
Ray E Chang
Keyword(s):  
Major Trauma ◽  
Injury Severity ◽  
Total Mortality ◽  
Data Bank ◽  
Claim Data ◽  
Population Based ◽  
Trauma Patients ◽  
Direct Transfer ◽  
Trauma Centers ◽  
Icu Admission

Background: Some articles proved indirect-transfer the major trauma patients to the trauma centers had non-significant different outcomes with the patients direct-transfer to the centers. But the outcomes for the major trauma patients in the counties without trauma centers still can be worse. So we did a population based research by using the NHIRD data for the results. Methods: From the claim data of one million beneficiaries of Taiwan National Health Insurance during the year of 2006 to 2008, all of the trauma patients were identified from the database by the ICD-9-CM system. ICDMAP-90 was used for calculating the Injury Severity Score (ISS) as the variable controlling the disease severity. The patients of major trauma were defined as ISS more than fifteen. We used the diagnosis one year before the trauma admission for calculating Charlson Comorbidity Index (CCI). The first hospitals and the second transferred hospitals that the major trauma patients admitted, and the areas of the first hospitals were recognized in our data bank. The condition of transfer, age, genders, intubation, ICU admission, ISS, CCI, and the triage classifications were adjusted in a logistic regression model for further analysis. Results: There were 2497 major trauma patients (ISS more then 15). The total mortality rate was 12.49%. The variables like age, intubation, ICU admission, ISS and CCI were significant for mortality, but the condition of transfer was not significant in our model. After controlling all the factors, the major trauma patients that first admitted in the areas with no trauma centers have a significant higher risk of mortality (OR=1.73, P=0.005). Conclusions: Our results hint that, although indirect-transfer for the major trauma patients have insignificant difference in mortality with the direct transfer patients, the counties with no trauma centers have significant higher mortality rates in major trauma patients. Further researches are needed for investigating the possible reasons.

scholarly journals Evaluation of maxillofacial injury in the central part of Nepal

2012 ◽  
Vol 7 (3) ◽  
pp. 11-16 ◽  
Author(s):  
G Biswari ◽  
A Khanal ◽  
P Gupta ◽  
P Bansal
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Physical Assault ◽  
Trauma Patients ◽  
Medical Sciences ◽  
Type Site ◽  
Dental Injuries ◽  
The Relationship ◽  
Animal Attack ◽  
Gender Type

An evaluation of dental and maxillofacial trauma in College of Medical Sciences, Teaching Hospital, Bharatpur, Nepal was carried out to assess the causes of trauma and the relationship between the injuries to the Patient's Age, Gender, Type, Site of injury and the Influence of Alcohol from June 1, 2008 to May 31, 2011. Files of 1986 trauma patients were reviewed. Maxillofacial or dental injuries were observed in 269 (13.54%) of the trauma patients, caused by road traffic accidents 173 (64.3%), fall injury 43 (16.0%), physical assault 25 (9.3%), animal attack 9 (3.3%) and sport injury 19 (7.1%) Men were hospitalized almost three times more than women, most common site of injury was dentoalveolar fracture 79(29.37%) young people were at greater risk. The most frequent age of trauma was 15-29 years (51.7%). DOI: http://dx.doi.org/10.3126/jcmsn.v7i3.6702 Journal of College of Medical Sciences-Nepal, 2011, Vol-7, No-3, 11-16  

scholarly journals The alcoholic individual and facial trauma: a 3 years survey

2020 ◽  
Vol 7 (12) ◽  
pp. 4003
Author(s):  
Manish Munjal ◽  
Sonika Kanotra ◽  
Shubham Munjal ◽  
Parth Chopra ◽  
Tullika Saggar ◽  
...  
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Health Care Facilities ◽  
Facial Trauma ◽  
Trauma Patients ◽  
Injury Incidence ◽  
Le Fort ◽  
Medical College ◽  
Drunken Driving ◽  
Le Fort I

Background: Road traffic accidents, under the influence of alcohol constitute a majority of patients in the emergency trauma services in tertiary health care facilities. The incidence of the same and the region predominantly involved was analysed.Methods: 61 subjects in the Otorhinolaryngology and Maxillofacial trauma services were studied, during a period of 2 years, at Dayanand medical college, Ludhiana, Punjab. In this prospective study the admission records were analysed in context to alcohol intake prior to the trauma.Results: The incidence of facial fractures, attributed to road-side accidents was the highest i.e. 72%. Other antecedent events were, assaults in 15%, fall from heights in 8% and due to sport injuries in 3.2%. 34% of our patients were under the influence of alcohol at the time of injury. Incidence of facial fracture in our series were fracture mandible, 39.3%, zygomatic 23.5%, Le Fort II 17.9% and nasoethmoid 12.3%. One case of Le Fort I, orbital and alveolar fracture was seen.Conclusions: Drunken driving in Punjab was behind one third i.e. 34% of the trauma patients in our casualty services.

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