scholarly journals Geriatric presentation to the emergency department-spectrum of illness and co-relation with social factors

2018 ◽  
Vol 5 (1) ◽  
pp. 77
Author(s):  
Ramesh Gorghatta Hanumanthaiah ◽  
Sheerin Farhath ◽  
Panchakshari Prasanna Bangalore Krishnappa ◽  
Dheemantha P. ◽  
T. S. Ranganath
Keyword(s):  
Emergency Department ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Clinical Symptoms ◽  
Demographic Data ◽  
The Elderly ◽  
Trauma Patients ◽  
Prime Concern ◽  
One Year ◽  
Population Segment

Background: Increase in the elderly population presenting to Emergency Department is a prime concern as it has maximum implications on the delivery of health care. Older patients account for 12%-24% of all ED patients worldwide. A need for this study is to understand and analyze the current and future of Emergency department (ED) and examines the presentation of geriatric patient to emergency department in our institute in an urban setup of the fastest growing population segment in the city.Methods: An observational study over a period of one year from 2015 to 2016. All patients aged 60 years and above, visiting the Emergency Medicine. The following data were obtained. (I) Demographics, (II) Urban and Rural population (III) Presence of co-morbidities, (IV) Common conditions (V) Clinical symptoms and Diagnoses, Socio-demographic data collected directly from patient or immediate caregiver.Results: Total No of patients included during the study were 5489. Data was assessed male patient, predominance was found with 61%, 39% female. The urban population 74.8% was more predominant. Rural being at 25.2%, 1620 (29.2%) poisoning cases,1322 (24.1%) trauma cases,318 (5.8%) cancer cases, 247(4.5%) COPD cases and 230 (4.2%) stroke cases were encountered. Male72.58%, females 27.42%. CCU 58.5% male, 41.55% females. ICU 55.21% males and 44.79 % females. The average time was 3.75 to 4.25.Conclusions: Road Traffic accidents and poisoning together contributed to many cases. Observation was inadequate training amongst ED doctors and nurses in assessing and managing Trauma patients who lack ATLS protocols in stabilizing geriatric emergencies. Hence ED staff should be well trained to facilitate management of an ageing patients. Hazmat bay should be well organized with specific antidotes to the commonly available poisons. Atypically presentation was common in ED. Considerable overlapping of symptoms were commonly encountered in patients presenting to Emergency department.

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

scholarly journals Prevalence and Factors Predicting Preventable Trauma Induced Mortality

2021 ◽  
Author(s):  
Abbas Hajian ◽  
Abdoulhossein Davoodabadi ◽  
Esmail Abdourrahim Kashi ◽  
Mojtaba Sehat ◽  
Shahrzad Ale Mohammad
Keyword(s):  
Traffic Accidents ◽  
Injury Severity ◽  
Road Traffic ◽  
Demographic Data ◽  
Vital Signs ◽  
Trauma Patients ◽  
Preventable Death ◽  
Probability Of Survival ◽  
Trauma Victims ◽  
Mechanism Of Trauma

Abstract Introduction: Trauma is one of the most common causes of morbidity and mortality worldwide. Since the definition of preventable death has been described many studies, like current one, were conducted to evaluate this issue.Materials and Methods: This cohort retrospective study investigated archived medical files of trauma victims from 2017 to 2020 in a referral single-center trauma hospital. Registered demographic data, vital signs, Glasgow coma scale (GCS), timing of trauma and death, executed interventions, type and mechanism of trauma in addition to time errors, clinical mismanagements and missed injuries were extracted. Injury severity score (ISS), revised trauma score (RTS) and probability of survival (Ps) based on TRISS method for each case were calculated. Eventually preventable and non-preventable death groups were compared.Results: Finally from the all 413 trauma victims 246(54.9%) files were enrolled. Victims aged from 18 to 95 years. Of all 189(76.8%) were males. Analysis manifested 135(54.9%) of all deaths were potentially and 2(0.08%) were certainly preventable; while the other 49.1% were non-preventable for expiration(p=0.001). Data showed that from all variables systolic blood pressure (SBP) ≥80mmHg, respiratory rate (RR) ≥20 per minute, GCS ≥8, higher RTS, road traffic accidents and control of external bleeding were contribute to prediction of preventable trauma related mortality.Conclusion: This study implied on frequency of trauma related preventable death was regionally high and associated factors that could be lessen the number of these mortalities including of SBP, RR, GCS, RTS, mechanism of trauma and external bleeding of trauma patients should be paid more attention.Trial registration: Retrospectively registered.

scholarly journals Geriatric head injuries: impact and outcomes

2019 ◽  
Vol 7 (9) ◽  
pp. 3461
Author(s):  
Vallabh B. Nagocha ◽  
Manish Yadav ◽  
Divyam Sharma ◽  
Sunil Garg
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Treatment Options ◽  
Head Injuries ◽  
Diffuse Axonal Injury ◽  
The Elderly ◽  
Trauma Patients ◽  
Post Injury ◽  
Factors Affecting ◽  
The Impact

Background: Elderly trauma patients present unique challenges and face  more  significant obstacles in  recovery  than  their younger  counterparts. They usually experience higher morbidity and mortality and slower recovery trajectories and have, on average, worse functional, cognitive, and psychosocial outcomes months or years post-injury than do younger patients.Methods: Authors conducted a study of elderly head injury patients to understand the epidemiology of geriatric TBI, the impact of comorbidities and management issues and  outcomes in such patients. Authors had a total of 110 patients who presented with traumatic brain injury and were admitted in this hospital over 2 years. Authors also reviewed the literatures to study the factors affecting outcome after geriatric TBI and studied the role of aggressive neurosurgical management in geriatric TBI.Results: Among 68%(n=75) of the patients were male and 32% females. Age group of 60-65 years was the highest with 60.9% patients. Patients with GCS of 8 and below had the highest mortality rates of 68 %. Overall  mortality  rate  was  32.72%  and  9.09 %  of  the patients survived in a vegetative condition. The proportion of injury secondary to fall was the largest single group in 50.9% patients, and Chronic SDH was the most common pathology seen in 36.45 % patients. Highest mortality was seen in patients with Diffuse Axonal Injury (69.23 %). Out of the 110 patients , 57 patients underwent surgery for various pathologies. Chronic SDH were the most common operated pathology followed by acute SDH. Glassgow outcome scale was used as the measure of outcome in these series of patients.  32.72 % patients had a GOS score of 1 and 9.09 % had a score of 2. 18.18 % patients remained severely disabled with a score of 3 and nine patients (8.18 %) had a score of 4 and thirty five patients had good recovery (GOS-5).Conclusions: Due to the better treatment options there is an increase in the number of elderly around the world. Thus, the number of eldery individuals presenting with TBI to the emergency department is also on the rise more commonly due to falls than road traffic accidents. There is a need for specific prognostic and management guidelines for the elderly which can lead to better diagnosis, care and recovery and eventual short- and long-term outcomes in the elderly.

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.

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.

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 ASSESSMENT OF INJURIES IN ROAD TRAFFIC ACCIDENTS ADMITTED TO EMERGENCY DEPARTMENT OF GMCH, BETTIAH, WEST CHAMPARAN, BIHAR

2020 ◽  
Vol 4 (5) ◽  
Author(s):  
Arun Kumar Singh
Keyword(s):  
Emergency Department ◽  
Low Income ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Head Injuries ◽  
Health Sector ◽  
Road Traffic Accidents ◽  
Road Traffic Crashes ◽  
Pattern Of Injury ◽  
Traffic Rules

Majority of the world's fatalities on the roads occur in low-income and middle-income countries, even though these countries have approximately half of the world's vehicles. India is no exception and data showed that more than 1.3 lakh people died on Indian roads, giving India the dubious honour of topping the global list of fatalities from road crashes. Road traffic injuries have been neglected from the global health agenda for many years, despite being predictable and largely preventable. Evidence from many countries shows that dramatic successes in preventing road traffic crashes can be achieved through concerted efforts that involve, but are not limited to, the health sector. Hence based on above findings the present study was planned for Assessment of Injuries in Road Traffic Accidents Admitted to Emergency Department of GMCH, Bettiah, West Champaran, Bihar. The present study was planned in Department of Forensic Medicine, Government Medical College, Bettiah, West Champaran, Bihar, India from jan 2018 to Dec 2018.In the present study 20 cases suffered from the road traffic accidents were evaluated for the pattern of injury. A predesigned and pretested questionnaire especially designed for this purpose was used for interviewing the accident victims, either in the emergency itself or in the wards. In India, there are ample risk factors for RTAs to occur because of lack of proper infrastructural facilities, poor designs of roads, improper implementation of traffic rules and a high load of variety of vehicles on the roads.  Road traffic accidents with head injuries are much more common in young working males as compared to females and that to in those who were pedestrians and motor cyclists. The rate of incidence is higher in India because of bad traffic patterns and possibly the lack of awareness about traffic rules and also lack of good hospital services to our victims of RTAs. Keywords: Injuries, Road Traffic Accidents, Emergency Department, GMCH, Bettiah, West Champaran, Bihar, etc.  

scholarly journals P083: Why do older adults in assisted living facilities use the emergency department: are all these visits necessary?

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S106-S106
Author(s):  
E. Losier ◽  
A. McCollum ◽  
P. Jarrett ◽  
R. McCloskey ◽  
P. Nicholson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Assisted Living ◽  
Demographic Data ◽  
Care Home ◽  
Functional Decline ◽  
Retrospective Chart Review ◽  
Community Services ◽  
Level 3 ◽  
Ed Visits ◽  
One Year

Introduction: Special Care Home (SCH) residents require supervision for activities of daily living but not regular nursing care. Emergency Department (ED) use by seniors in SCHs is poorly studied. A recent study in Nova Scotia found seniors represented over 20% of ED visits. We studied SCH resident ED visits in a community with a population of 30,000 aged over 65 years and with 785 SCH beds, to define reasons for ED visits to a tertiary ED, and if these could be avoided. Methods: We performed a retrospective chart review of SCH residents’ visits to an ED (SCH-ED) which has 56,000 total ED (TED) visits over one year. Reasons for visit, admission data, and avoidability were collected. A geriatrician and ED physician independently reviewed visits. Initial disagreement on avoidability (27%) was adjudicated through case discussion. Results: Demographic data revealed 344 ED visits by 111 SCH residents over one year; 37% of visits resulted in admission. 13.9% of residents visited the ED on at least one occasion (average 3.1 visits); mean age 78.4 years; female 66.7%; ambulance arrival 91.0%. The three most common chief complaints were shortness of breath, weakness and abdominal pain. Most SCH-ED visits were Canadian Triage and Acuity Scale (CTAS) Level 3 (63.4%, TED 53.3%). Of CTAS Level 3 visits, 35.3% were admitted (TED 12.9%). SCH-ED visits were avoidable in 40.6% of cases. Gastrointestinal (18%), pain (16.5%), falls, functional decline or injury (14%) and respiratory (12%) were the most common avoidable diagnostic groups, accounting for 57% of total SCH visits. Conclusion: ED visits by SCH residents demonstrated increased acuity and admission rates with a high number of repeat visits. Of all SCH-ED visits, 40% were potentially avoidable. Further study may determine if improved community services reduces ED visits or hospital admission. Gastrointestinal, respiratory, falls and pain diagnoses may be important areas of focus.

scholarly journals Ten-year survival of Finnish lower limb amputees

1998 ◽  
Vol 22 (1) ◽  
pp. 10-16 ◽  
Author(s):  
T. Pohjolainen ◽  
H. Alaranta
Keyword(s):  
Median Survival ◽  
Lower Limb ◽  
Social Insurance ◽  
Age Groups ◽  
Vascular Diseases ◽  
The Elderly ◽  
Limb Amputation ◽  
Diabetic Patients ◽  
Trauma Patients ◽  
One Year

Data on mortality for the ten years following lower limb amputation were obtained from all the 16 surgical units in Southern Finland and the National Social Insurance Institution. In Southern Finland during the period 1984-1985, amputations of the lower limb were performed on 705 patients, of whom 382 (54%) were women and 323 (46%) men. The majority of the amputations, 47%, were performed for vascular diseases and 41% were performed for diabetes mellitus. The overall survival was 62% at one year after amputation, 49% at two years, 27% at five years and 15% at ten years. The median survival after amputation was 1 yr 5 mth for the women and 2 yr 8 mth for the men. Of the arteriosclerotics, 43% died within one postoperative year while 43% lived longer than two years and 23% longer than five years. The median survival of arteriosclerotics was 1 yr 6 mth. The corresponding figure for patients with diabetes was 1 yr 11 mth. Of the diabetics, 38% died within one postoperative year while 47% lived longer than two years and 20% longer than five years. Of the trauma patients, 86% lived longer than five years and 71% longer than ten years. Of the trans-femoral amputees, 54% lived longer than one year, 36% over two years, 18% over five years and 8% over ten years. The corresponding figures for trans-tibial amputees were 70%. 53%, 21% and 4%. Many elderly vascular and diabetic patients undergoing amputation have a reduced physiological reserve and high mortality. The more proximal the amputation, the greater the risk that the patient will never be able to walk or that the duration of use of the prosthesis will be short. If a prosthesis seems to be a reasonable option for the elderly amputee, any delays in prosthetic fitting should be avoided in older age groups.

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  

Sign in / Sign up

Export Citation Format

Share Document