The Acute Impact of the COVID-19 Pandemic on Patients Presenting with Orthopaedic Injuries Across a Canadian Academic, Orthopaedic Trauma System: A Multi-Centre, Pre-Post Observational Cohort Study

OrthoMedia ◽  
2022 ◽  
Author(s):  
Kenneth Thorsen ◽  
Jon Kristian Narvestad ◽  
Kjell Egil Tjosevik ◽  
Johannes Wiik Larsen ◽  
Kjetil Søreide

Abstract Background The aim of this study was to compare the effect of the change in TTA protocol from a two-tier to one-tier, with focus on undertriage and mortality. Material and methods A before–after observational cohort study based on data extracted from the Stavanger University Hospital Trauma registry in the transition period from two-tier to a one-tier TTA protocol over two consecutive 1-year periods (2017–2018). Comparative analysis was done between the two time-periods for descriptive characteristics and outcomes. The main outcomes of interest were undertriage and mortality. Results During the study period 1234 patients were included in the registry, of which 721 (58%) were in the two-tier and 513 (42%) in the one-tier group. About one in five patients (224/1234) were severely injured (ISS > 15). Median age was 39 in the two-tier period and 43 years in the one-tier period (p = 0.229). Median ISS was 5 for the two-tier period vs 9, in the one-tier period (p = 0.001). The undertriage of severely injured patients in the two-tier period was 18/122 (15%), compared to 31/102 (30%) of patients in the one-tier period (OR = 2.5; 95% CI 1.8–4.52). Overall mortality increased significantly between the two TTA protocols, from 2.5 to 4.7% (p = 0.033), OR 0.51 (0.28–0.96) Conclusion A protocol change from two-tiered TTA to one-tiered TTA increased the undertriage in our trauma system. A two-tiered TTA may be beneficial for better patient care.


2016 ◽  
Vol 18 (1) ◽  
pp. 73-78 ◽  
Author(s):  
Sofie Thorn ◽  
Marlene Aagaard Hansen ◽  
Erik Sloth ◽  
Lars Knudsen

Introduction Peripheral ultrasound (US)-guided vascular access is gaining popularity. Though studies have demonstrated that US-guided vascular access has several advantages, the procedure is challenging to even the most experienced operator. The aim of this observational cohort study was to investigate whether adding guidance markers on a US system would increase the accuracy of US-guided needle tip placement compared to no guidance markers. Methods A total of 18 physicians and 12 nurses familiar with US-guided vascular access volunteered to participate. Two identical US systems were used. System A was as manufactured. System B included three guide markers drawn on the transducer and screen. The participants performed six needle insertions in a gelatin phantom with three imbedded targets. First participants used US system A and then US system B. Primary endpoint was horizontal distance between needle tip and target. Secondary endpoint was participant's subjective feeling of advantage of the guidance markers measured on a Likert scale. Results Guidance markers on the US system significantly increased the accuracy of needle placement on all three targets individually (p = 0.00) and on overall placement, (inter-quartile range 3.21 mm vs. 0.49 mm, p = 0.00). In addition, the use of guidance markers eliminated the difference in accuracy between physicians and nurses, respectively. All participants evaluated the guidance markers to be helpful during the needle insertions. Conclusions Adding guidance markers to the US system significantly increased the accuracy of needle placement in the horizontal plane during simulated US-guided vascular access using a phantom.


2017 ◽  
Author(s):  
Khaled Al-Tarrah ◽  
Carl Jenkinson ◽  
Martin Hewison ◽  
Naiem Moiemen ◽  
Janet Lord

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 131-OR
Author(s):  
VASILEIOS LIAKOPOULOS ◽  
ANN-MARIE SVENSSON ◽  
INGMAR NASLUND ◽  
BJORN ELIASSON

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