scholarly journals Experiences from a non-COVID hub referral orthopedic trauma hospital during the COVID-19 pandemic in Turkey

2021 ◽  
Vol 7 (2) ◽  
pp. 183
Author(s):  
Ferdi Dırvar ◽  
Sevda Uzun Dırvar ◽  
Alper Köksal ◽  
Osman Çimen ◽  
Anıl Erbaş ◽  
...  
Keyword(s):  
Treatment Strategies ◽  
Trauma Patients ◽  
Orthopaedic Trauma ◽  
Hub And Spoke ◽  
Trauma Severity ◽  
Patient Profile ◽  
Training And Research ◽  
Admission Type ◽  
Length Of Hospitalization ◽  
Type Of Anaesthesia

<p><strong>Background:</strong> During the COVID-19 pandemic period, resources should be reorganized to treat the increased burden of COVID-positive patients under the best conditions while simultaneously providing non-deferrable treatment to patients with no suspicion of COVID-19. In this study, we aimed to analyse the trauma patient profile and treatment strategies that emerged in the regional orthopaedic and traumatology hospital during the pandemic period after the implementation of “hub and spoke” organization among the orthopaedic and traumatology clinics.</p><p><strong>Methods:</strong> This cross-observational study was conducted in a training and research hospital in the field of orthopaedics and traumatology that was converted to a non-COVID referral orthopaedic trauma center during the pandemic. Gender, age, length of hospitalization, duration of trauma, place of trauma, severity of trauma, type of admission, type of anaesthesia and site of trauma were evaluated in the patients that presented between March 16 and May 16, 2020.</p><p><strong>Results:</strong> Of the orthopaedic trauma patients requiring surgery, 169 (62.6%) were men and 101 (37.4%) were women. In comparison of the data with that of the last year, significant increases were observed in the number of home traumas (241.5%), low-energy traumas (87.4%), patients referred from other institutions (328.9%), regional anaesthesia patients (124.2%) and patients with hip traumas (226.7%). The length of hospitalization decreased significantly (p&lt;0.05).</p><p><strong>Conclusions:</strong> The creation of hub and spoke organization through the cooperation of orthopaedics and traumatology clinics in the region can reduce the burden on pandemic hospitals by isolating trauma patients requiring orthopaedic surgery who were not suspected of COVID-19 and directing them to dedicated orthopaedics and traumatology hospital.</p>

scholarly journals The self-assessment INTERMED predicts healthcare and social costs of orthopaedic trauma patients with persistent impairments

2020 ◽  
pp. 026921552094917
Author(s):  
Cyrille Burrus ◽  
Philippe Vuistiner ◽  
Bertrand Léger ◽  
Friedrich Stiefel ◽  
Gilles Rivier ◽  
...  
Keyword(s):  
Injury Severity ◽  
Social Costs ◽  
The Self ◽  
Study Cohort ◽  
Trauma Patients ◽  
Orthopaedic Trauma ◽  
Self Assessment ◽  
Trauma Severity ◽  
Education And Employment ◽  
Fitness To Work

Objective: To use the self-assessment INTERMED questionnaire to determine the relationship between biopsychosocial complexity and healthcare and social costs of patients after orthopaedic trauma. Design: Secondary prospective analysis based on the validation study cohort of the self-assessment INTERMED questionnaire. Setting: Inpatients orthopaedic rehabilitation with vocational aspects. Subjects: In total, 136 patients with chronic pain and impairments were included in this study: mean (SD) age, 42.6 (10.7) years; 116 men, with moderate pain intensity (51/100); suffering from upper ( n = 55), lower-limb ( n = 51) or spine ( n = 30) pain after orthopaedic trauma; with minor or moderate injury severity (severe injury for 25). Main measures: Biopsychosocial complexity, assessed with the self-assessment INTERMED questionnaire, and other confounding variables collected prospectively during rehabilitation. Outcome measures (healthcare costs, loss of wage costs and time for fitness-to-work) were collected through insurance files after case settlements. Linear multiple regression models adjusted for age, gender, pain, trauma severity, education and employment contract were performed to measure the influence of biopsychosocial complexity on the three outcome variables. Results: High-cost patients were older (+3.6 years) and more anxious (9.0 vs 7.3 points at HADS-A), came later to rehabilitation (+105 days), and showed higher biopsychosocial complexity (+3.2 points). After adjustment, biopsychosocial complexity was significantly associated with healthcare (ß = 0.02; P = 0.003; expß = 1.02) and social costs (ß = 0.03; P = 0.006, expß = 1.03) and duration before fitness-to-work (ß = 0.04; P < 0.001, expß = 1.04). Conclusion: Biopsychosocial complexity assessed with the self-assessment INTERMED questionnaire is associated with higher healthcare and social costs.

scholarly journals Expression of HO1 and PER2 can predict the incidence of delirium in trauma patients with concomitant brain injury

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Matti Steimer ◽  
Sandra Kaiser ◽  
Felix Ulbrich ◽  
Johannes Kalbhenn ◽  
Hartmut Bürkle ◽  
...  
Keyword(s):  
Brain Injury ◽  
Injury Severity ◽  
Kidney Injury ◽  
Diagnostic Tools ◽  
Heme Oxygenase 1 ◽  
Trauma Patients ◽  
Independent Manner ◽  
Equal Distribution ◽  
Expression Levels ◽  
Trauma Severity

AbstractIntensive care unit (ICU)-acquired delirium is associated with adverse outcome in trauma patients with concomitant traumatic brain injury (TBI), but diagnosis remains challenging. Quantifying circadian disruption by analyzing expression of the circadian gene period circadian regulator 2 (PER2) and heme oxygenase 1 (HO1), which determines heme turnover, may prove to be potential diagnostic tools. Expression of PER2 and HO1 was quantified using qPCR from blood samples 1 day and 7 days after trauma. Association analysis was performed comparing mRNA expression levels with parameters of trauma (ISS—injury severity score), delirium, acute kidney injury (AKI) and length of ICU stay. 48 polytraumatized patients were included (equal distribution of TBI versus non-TBI) corrected for ISS, age and gender using a matched pairs approach. Expression levels of PER2 and HO1 were independent of age (PER2: P = 0.935; HO1: P = 0.988), while expression levels were significantly correlated with trauma severity (PER2: P = 0.009; HO1: P < 0.001) and longer ICU length of stay (PER2: P = 0.018; HO1: P < 0.001). High expression levels increased the odds of delirium occurrence (PER2: OR = 4.32 [1.14–13.87]; HO1: OR = 4.50 [1.23–14.42]). Patients with TBI showed a trend towards elevated PER2 (OR = 3.00 [0.84–9.33], P = 0.125), but not towards delirium occurrence (P = 0.556). TBI patients were less likely to develop AKI compared to non-TBI (P = 0.022). Expression levels of PER2 and HO1 correlate with the incidence of delirium in an age-independent manner and may potentially improve diagnostic algorithms when used as delirium biomarkers.Trial registration: German Clinical Trials Register (Trial-ID DRKS00008981; Universal Trial Number U1111-1172-6077; Jan. 18, 2018).

Which orthopaedic trauma patients need psychiatry consultation? A single institution pilot survey study

2018 ◽  
pp. 1
Author(s):  
Sean T. Campbell ◽  
Blake J. Schultz ◽  
Amanda M. Franciscus ◽  
Divy Ravindranath ◽  
Julius A. Bishop
Keyword(s):  
Survey Study ◽  
Trauma Patients ◽  
Orthopaedic Trauma ◽  
Single Institution ◽  
Pilot Survey

Do orthopaedic trauma patients develop higher rates of cardiac complications? An analysis of 56,000 patients

2016 ◽  
Vol 43 (3) ◽  
pp. 329-336 ◽  
Author(s):  
A. C. Dodd ◽  
N. Lakomkin ◽  
V. Sathiyakumar ◽  
W. T. Obremskey ◽  
M. K. Sethi
Keyword(s):  
Cardiac Complications ◽  
Trauma Patients ◽  
Orthopaedic Trauma

Presentation Coagulopathy and Persistent Acidosis Predict Complications in Orthopaedic Trauma Patients

2017 ◽  
Vol 31 (12) ◽  
pp. 617-623 ◽  
Author(s):  
Benjamin R. Childs ◽  
Daniel R. Verhotz ◽  
Timothy A. Moore ◽  
Heather A. Vallier
Keyword(s):  
Trauma Patients ◽  
Orthopaedic Trauma

Serum Vitamin D Levels in Orthopaedic Trauma Patients Living in the Northwestern United States

2013 ◽  
Vol 27 (5) ◽  
pp. e103-e106 ◽  
Author(s):  
Carson R. Bee ◽  
Daniel V. Sheerin ◽  
Thomas K. Wuest ◽  
Daniel C. Fitzpatrick
Keyword(s):  
United States ◽  
Vitamin D ◽  
Serum Vitamin ◽  
Trauma Patients ◽  
Orthopaedic Trauma ◽  
Serum Vitamin D ◽  
Vitamin D Levels

scholarly journals Consenting Operative Orthopaedic Trauma Patients: Challenges and Solutions

ISRN Surgery ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Amin Kheiran ◽  
Purnajyoti Banerjee ◽  
Philip Stott
Keyword(s):  
Phase 1 ◽  
Operative Procedure ◽  
Trauma Surgery ◽  
National Standards ◽  
Junior Doctors ◽  
Trauma Patients ◽  
Orthopaedic Trauma ◽  
Phase 2 ◽  
Consent Forms ◽  
Surgical Trainees

Guidelines exist to obtain informed consent before any operative procedure. We completed an audit cycle starting with retrospective review of 50 orthopaedic trauma procedures (Phase 1 over three months to determine the quality of consenting documentation). The results were conveyed and adequate training of the staff was arranged according to guidelines from BOA, DoH, and GMC. Compliance in filling consent forms was then prospectively assessed on 50 consecutive trauma surgeries over further three months (Phase 2). Use of abbreviations was significantly reduced (P=0.03) in Phase 2 (none) compared to 10 (20%) in Phase 1 with odds ratio of 0.04. Initially, allocation of patient’s copy was dispensed in three (6% in Phase 1) cases compared to 100% in Phase 2, when appropriate. Senior doctors (registrars or consultant) filled most consent forms. However, 7 (14%) consent forms in Phase 1 and eleven (22%) in Phase 2 were signed by Core Surgical Trainees year 2, which reflects the difference in seniority amongst junior doctors. The requirement for blood transfusion was addressed in 40% of cases where relevant and 100% cases in Phase 2. Consenting patients for trauma surgery improved in Phase 2. Regular audit is essential to maintain expected national standards.

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