Trauma and Orthopedics in COVID-19 Pandemic: an Epidemiological Study in a Tertiary Center, South of Iran

Abstract Introduction: The novel COVID-19 disease was presented at first in Wuhan, China, in December 2019. During COVID-19 pandemic, approaching trauma patients, whom could have COVID-19, is a challenging issue required special consideration and healthcare setting.Methods and materials: This retrospective cohort study was conducted at Emtiaz hospital, the main trauma center of the south of Iran, between March 2020 and August 2020 from the beginning of the COVID-19 pandemic. Trauma-related data such as the mechanism of trauma, injury pattern, and surgical intervention procedure of all the suspicious COVID-19 patients were documented. ICU admission and mortality rate were investigated as outcome variables.Results: During six months of the pandemic period, 9248 patients were referred to our referral trauma center, with 222 patients suspicious of having COVID-19 infection. Among sixty-four cases, whom were confirmed to be positive, 33 orthopedic injured patients were observed. The mortality rate of COVID-19 positive cases was 15.6 % (10 patients out of 64) and COVID-19 negative ones was 10.1 % (16 patients out of 158) which was not statistically significant (p.value:0.25). Multivariate analysis of the effect of the baseline and trauma related factors on mortality rate, showed that older age (p. value: 0.001), COVID-19 infection (p. value: 0.033), and surgical procedure (p.value:0.038) are the poor prognostic factors associated with mortality rate.Conclusion: The mortality rate of trauma patients with COVID-19 positive infection was 15.6 % (10 patients). Older age, COVID-19 infection, and surgical procedure were observed as the statistically significant prognostic factors leading to more mortality rate.Level of Evidence: III

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Analyses of clinical outcomes after severe pelvic fractures: an international study

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2018-000238 ◽

2018 ◽

Vol 3 (1) ◽

pp. e000238 ◽

Cited By ~ 1

Author(s):

Kyoungwon Jung ◽

Shokei Matsumoto ◽

Alan Smith ◽

Kyungjin Hwang ◽

John Cook-Jong Lee ◽

...

Keyword(s):

Mortality Rate ◽

South Korea ◽

Trauma Center ◽

Data Bank ◽

Pelvic Fractures ◽

Older Age ◽

Inhospital Mortality ◽

Cox Regression Analysis ◽

Factors Associated ◽

The Usa

BackgroundThis study aimed to compare treatment outcomes between patients with severe pelvic fractures treated at a representative trauma center that was established in Korea since 2015 and matched cases treated in the USA.MethodsTwo cohorts were selected from a single institution trauma database in South Korea (Ajou Trauma Data Bank (ATDB)) and the National Trauma Data Bank (NTDB) in the USA. Adult blunt trauma patients with a pelvic Abbreviated Injury Scale >3 were included. Patients were matched based on covariates that affect mortality rate using a 1:1 propensity score matching (PSM) approach. We compared differences in outcomes between the two groups, performed survival analysis for the cohort after PSM and identified factors associated with mortality. Lastly, we analyzed factors related to outcomes in the ATDB dataset comparing a period prior to the implementation of the trauma center according to US standards, an interim period and a postimplementation period.ResultsAfter PSM, a total of 320 patients (160 in each cohort) were identified for comparison. Inhospital mortality was significantly higher in the ATDB cohort using χ2 test, but it was not statistically significant when using Kaplan-Meier survival curves and Cox regression analysis. Moreover, the mortality rate was similar comparing the NTDB cohort to ATDB data reflecting the post-trauma center establishment period. Older age, lower systolic blood pressure (SBP) and Glasgow Coma Scale (GCS) at admission were factors associated with mortality.DiscussionMortality rate after severe pelvic fractures was significantly associated with older age, lower SBP and GCS scores at admission. Efforts to establish a trauma center in South Korea led to improvement in outcomes, which are comparable to those in US centers.Level of evidenceLevel IV.

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The Burden of Trauma in Kosova: A Post Card Report from Prishtina

Panamerican Journal of Trauma, Critical Care & Emergency Surgery ◽

10.5005/jp-journals-10030-1082 ◽

2014 ◽

Vol 3 (1) ◽

pp. 29-32

Author(s):

Rifat Latifi ◽

Fransisco Mora ◽

Basri Lenjani ◽

Kalterina L Osmani ◽

Lirije Beqiri ◽

...

Keyword(s):

Mortality Rate ◽

Motor Vehicle ◽

Penetrating Trauma ◽

Injury Rate ◽

Public Health Issue ◽

Mortality Data ◽

Trauma Patients ◽

Post Card ◽

Tertiary Center ◽

Card Report

ABSTRACT Introduction Kosova, an independent country since 2008 in Southern Europe, has experienced increased urbanization and development. Despite this young country's advances, its healthcare infrastructure has progressed at a much slower rate and limitations are particularly notable in trauma care. This combination has made trauma a major public health issue in Kosova. The University Clinic Center of Kosova (UCCK) in Prishtina is the only tertiary center that serves the entire country. Materials and methods A retrospective review of data collected from a combination of local sources, as there is no one agency or department that has all the data. These sources include: (1) the emergency department (ED) of UCCK (data from 2007-2012), admissions hospital data from UCCK (2004- 2009), and motor vehicle collisions (MVC) data provided by the Prishtina police department (2008-2012). However, the main source of patients data analyzed in this study was provided from the ED. Throughout this study rate calculations are based on the population of Prishtina (198,330 inhabitants as reported in the last national census). Results Twenty-four thousand one hundred and ninety-nine trauma patients were treated at UCCK ED between 2007 and 2012, of which 93.5% were blunt trauma and 6.3% penetrating trauma. There were 285 fatalities with a mortality rate varying between 16.6 and 37.3 for 100,000 inhabitants. UCCK in-patient data from 2004 to 2009 reported 193 fatalities due to MVC, with a mortality rate between 10.08 and 23.1 per 100,000 inhabitants. Prishtina police reported 214 MVC-related deaths on the streets of Prishtina, with a mortality injury rate between 16.13 and 27.22 per 100,000 inhabitants from 2008 to 2012. However, combined mortality data for 2009 yields an MVC mortality rate of 61 per 100,000 inhabitants, the highest in the world. Conclusion Trauma burden remains a substantial public problem in Kosova, and needs to be addressed acutely. Furthermore, there is urgent need for a nationwide trauma registry, in order for policymakers to be able to recognize the gravity of the situation and to design and implement appropriate interventions and allocate already limited funding. How to cite this article Mora F, Lenjani B, Osmani KL, Beqiri L, Hoxha Z, Hajdari F, Latifi R. The Burden of Trauma in Kosova: A Post Card Report from Prishtina. Panam J Trauma Crit Care Emerg Surg 2014;3(1):29-32.

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Placement accuracy of resuscitative endovascular occlusion balloon into the target zone with external measurement

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000443 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000443 ◽

Cited By ~ 2

Author(s):

Shokei Matsumoto ◽

Tomohiro Funabiki ◽

Taku Kazamaki ◽

Tomohiko Orita ◽

Kazuhiko Sekine ◽

...

Keyword(s):

Trauma Center ◽

External Validation ◽

Patient Characteristics ◽

Balloon Occlusion ◽

Trauma Patients ◽

Target Zone ◽

Level Of Evidence ◽

Occlusion Balloon ◽

Abdominal Bleeding ◽

Placement Accuracy

BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) should be safely placed at zone 1 or 3, depending on the location of the hemorrhage. Ideally, REBOA placement should be confirmed via fluoroscopy, but it is not commonly available for trauma bays. This study aimed to evaluate the accuracy of REBOA placement using the external measurement method in a Japanese trauma center.MethodsA retrospective review identified all trauma patients who underwent REBOA and were admitted to our trauma center from 2008 to 2018. Patient characteristics, REBOA placement accuracy, and complications according to target zones 1 and 3 were reviewed.ResultsDuring the study period, 38 patients met our inclusion criteria. The in-hospital mortality rate was 57.9%. REBOA was mainly used for bleeding from the abdominal (44.7%) and pelvic (36.8%) regions. Of these, 30 patients (78.9%) underwent REBOA for target zone 1, and 8 patients (21.1%) underwent REBOA for target zone 3. The proportion of abdominal bleeding source in the target zone 1 group was greater than that in the target zone 3 group (56.7% vs. 0%). Overall, the proportion of REBOA placement was 76.3% in zone 1, 21.1% in zone 2, and 2.6% in zone 3. The total REBOA placement accuracy was 71.1%. At each target zone, the REBOA placement accuracy for target zone 3 was significantly lower than that for target zone 1 (12.5% vs. 86.7%, p<0.001). No significant associations between non-target zone placement and patient characteristics, complications, or mortality were found.ConclusionsThe REBOA placement accuracy for target zone 3 was low, and zone 2 placement accounted for 21.1% of the total, but no complications and mortalities related to non-target zone placement occurred. Further external validation study is warranted.Level of evidenceLevel IV.

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Implementing psychosocial programming at a level 1 trauma center: results from a 5-year period

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2019-000363 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000363 ◽

Cited By ~ 2

Author(s):

Natasha M Simske ◽

Trenton Rivera ◽

Mary A Breslin ◽

Sarah B Hendrickson ◽

Megen Simpson ◽

...

Keyword(s):

Support Groups ◽

Trauma Center ◽

Psychosocial Support ◽

Trauma Patients ◽

Post Traumatic Stress ◽

Educational Materials ◽

Level Of Evidence ◽

Victims Of Crime ◽

Level 1 ◽

Level 1 Trauma Center

BackgroundThe primary goal of the present study is to describe the psychosocial support services provided at our institution and the evolution of such programming through time. This study will also report the demographics and injury patterns of patients using available resources.MethodsTrauma Recovery Services (TRS) is a social and psychological support program that provides services and resources to patients and families admitted to our hospital. It includes a number of different services such as emotional coaching from licensed counselors, educational materials, peer mentorship from trauma survivors, monthly support groups, post-traumatic stress disorder (PTSD) screening and programming for victims of crime. Patients using services were prospectively recorded by hired staff, volunteers and students who engaged in distributing programming. Demographics and injury characteristics were retrospectively gathered from patient’s medical records.ResultsFrom May of 2013 through December 2018, a total of 4977 discrete patients used TRS at an urban level 1 trauma center. During the study period, 31.4% of the 15 640 admitted adult trauma patients were exposed to TRS and this increased from 7.2% in 2013 to 60.1% in 2018. During the period of 5.5 years, 3317 patients had ‘direct contact’ (coaching and/or educational materials) and 1827 patients had at least one peer visit. The average number of peer visits was 2.7 per patient (range: 2–15). Of the 114 patients who attended support groups over 4 years, 55 (48%) attended more than one session, with an average of 3.9 visits (range: 2–10) per patient. After the establishment of PTSD screening and Victims of Crime Advocacy and Recovery Program (VOCARP) services in 2017, a total of 482 patients were screened for PTSD and 974 patients used VOCARP resources during the period of 2 years, with substantial growth from 2017 to 2018.ConclusionsHospital-provided resources aimed at educating patients, expanding support networks and bolstering resiliency were popular at our institution, with nearly 5000 discrete patients accessing services during a period of 5.5 years. Moving forward, greater investigation of program usage, development, and efficacy is necessary.Level of evidenceLevel II therapeutic.

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Analysis of Helicopter-Transported Trauma Patients at a Regional Trauma Center

The American Surgeon ◽

10.1177/000313481808400647 ◽

2018 ◽

Vol 84 (6) ◽

pp. 952-959

Author(s):

Christina Sebastian ◽

Kevin Collopy ◽

Thomas V. Clancy ◽

Elizabeth Acquista

Keyword(s):

Mortality Rate ◽

Trauma Center ◽

Motor Vehicle ◽

Helicopter Emergency Medical Service ◽

Blunt Injury ◽

Trauma Patients ◽

High Incidence ◽

Timely Access ◽

Hospital Resources ◽

Injured Patients

Our medical center's regional helicopter emergency medical service (HEMS) serves southeastern North Carolina. Judicious HEMS use is vital to ensure that the resource is available for critically injured patients and to reduce morbidity and mortality by providing timely access to definitive care. We reviewed HEMS use, clinical outcomes, and overtriage rates. The data included airlifted trauma patients from January 2004 to December 2012. Of 1210 total patients, 733 were flown directly from the scene (FS) and 477 from referring hospitals (FH). The HEMS catchment area was a 100-mile radius of our trauma center. FS patients were younger and sustained more motor vehicle collisions. FH patients were older and sustained more falls. FS patients required more hospital resources including longer ventilator requirements, intensive care unit (ICU) stay, and hospital stay. For all HEMS patients, there was 92.2 per cent blunt injury, 47.5 per cent required Trauma I or II activation, 31 per cent required mechanical ventilation, and 50 per cent required ICU care. 59.5 per cent of HEMS trauma patients were critically injured (defined as requiring either immediate surgical intervention, immediate ICU admission, or immediate death). The overtriage rate was 1.8 per cent. The emergency department mortality rate was 2.3 per cent and the ultimate mortality rate was 7.5 per cent. Most of the airlifted trauma patients were critically injured, and therefore, HEMS transport was appropriate. However, overtriage was low, suggesting high incidence of undertriage. There should be a lower threshold for HEMS use for trauma patients in our region. More research is needed to determine ideal overtriage and undertriage rates.

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Geriatric Trauma Patients at a Suburban Level-I Trauma Center in Japan

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00027576 ◽

1999 ◽

Vol 14 (3) ◽

pp. 79-83 ◽

Cited By ~ 7

Author(s):

Katsuhiko Sugimoto ◽

Toru Aruga ◽

Mitsuhiro Hirata ◽

Masateru Shindo

Keyword(s):

Mortality Rate ◽

Emergency Medical Services ◽

Trauma Center ◽

Geriatric Trauma ◽

Control Group ◽

Trauma Patients ◽

Direct Transfer ◽

Emergency Center ◽

Revised Trauma Score ◽

Trauma Score

AbstractBackground:Despite the increases in the aged population in Japan, there are little data on geriatric patients with traumatic injuries. A prospective clinical study was carried out to evaluate the use of the emergency medical services (emergency medical services) system, mechanisms of injury, and prehospital assessment and triage of elderly victims of trauma.Patients and Methods:From July 1996 through June 1997, a group of geriatric trauma (Group G, n = 22) and a control group of younger trauma patients (n = 173) were compared with respect to transfer method to an Emergency Center (direct or indirect), Revised Trauma Scores on the scene of the accident (revised trauma score-l) and on admission to the Emergency Center (revised trauma score-2), and outcome (survival).Results:The mean values for revised trauma score-l in the Control Group (Group C) were not different from those in Group G, but revised trauma score-2 of the indirect-transfer patients (indirectly transported patients) in Group G were significantly lower than were those for Group C. Group G mortality rates were significantly higher than were the control rates (p = 0.0001). The mortality rate of the indirectly transported patients subgroup was significantly lower than that of the direct transfer subgroup (directly transported patients) (30/68 vs. 5/70, p<0.0001) in the Group C, but mortality rate of the indirectly transported patients subgroup exceeded that of the directly transported patients subgroup of Group G (8/14 vs. 5/8).Conclusion:The data suggest that in geriatric-age patients, direct transfer patients have a lower mortality rate than do indirect transfer patients when controlled for injury severity score. Therefore, it seems that a different set of triage criteria should be developed and implemented for geriatric-age victims with trauma-induced injuries and that those who meet these more stringent criteria should be transferred directly to a Trauma Center.

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Mortality in hypotensive trauma patients requiring laparotomy is related to degree of hypotension and provides evidence for focused interventions

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2021-000723 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000723

Author(s):

James W Davis ◽

Rachel C Dirks ◽

David R Jeffcoach ◽

Krista L Kaups ◽

Lawrence P Sue ◽

...

Keyword(s):

Mortality Rate ◽

Patient Group ◽

Injury Severity ◽

Balloon Occlusion ◽

Physiological Data ◽

Trauma Patients ◽

Level Of Evidence ◽

Management Level ◽

Level I ◽

Emergent Laparotomy

BackgroundMortality in hypotensive patients requiring laparotomy is reported to be 46% and essentially unchanged in 20 years. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been incorporated into resuscitation protocols in an attempt to decrease mortality, but REBOA can have significant complications and its use in this patient group has not been validated. This study sought to determine the mortality rate for hypotensive patients requiring laparotomy and to evaluate the mortality risk related to the degree of hypotension. Additionally, this study sought to determine if there was a presenting systolic blood pressure (SBP) that was associated with a sharp increase in mortality to target the appropriate patient group most likely to benefit from focused interventions such as REBOA.MethodsThe trauma registry at a level I trauma center was reviewed for patients undergoing emergent laparotomy from January 2007 to June 2020. Data included demographics, mechanism of injury, physiological data, Injury Severity Score, blood products transfused, and outcomes. Group comparisons were based on initial SBP (0 to 50 mm Hg, 60 to 69 mm Hg, 70 to 79 mm Hg, 80 to 89 mm Hg, and ≥90 mm Hg).ResultsDuring the study period, 52 016 trauma patients were treated and 1174 required laparotomy within 90 min of arrival; 424 had an initial SBP of <90 mm Hg. The overall mortality rate was 18%, but mortality increased as SBP decreased (≥90=9%, 80 to 89=20%, 70 to 79=21%, 60 to 69=48%, 0 to 59=66%). Mortality increased sharply with SBP of <70 mm Hg.DiscussionMortality rate increases with worsening hypotension and increases sharply with an SBP of <70 mm Hg. Further study on focused interventions such as REBOA should target this patient group.Level of evidenceTherapeutic/care management, level III.

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The Related Factors to the Behaviour of Pregnant Women in Maternity Planning and Complication Prevention Program

Indonesian Journal of Global Health Research ◽

10.37287/ijghr.v3i3.524 ◽

2021 ◽

Vol 3 (3) ◽

pp. 353-370

Author(s):

Elsa Surya ◽

Dewi Rahayu ◽

Aila Karyus

Keyword(s):

Pregnant Woman ◽

Mortality Rate ◽

Maternal Mortality ◽

Pregnant Women ◽

Prevention Program ◽

Health Facilities ◽

Infant Mortality Rate ◽

P Value ◽

Related Factors ◽

Maternal Mortality Rate

One of the breakthrough efforts that can reduce the maternal mortality rate as is Maternity Planning and Complication Prevention is expected to motivate the behavior of pregnant women in an effort to accelerate the reduction of maternal mortality. The high maternal mortality rate in Pringsewu regency is caused by a lack of screening for pregnant woman because it is suspected that there are still many high – risk pregnant woman who have not been found or have not come to health facilities. The aim of the research is knowledge of factors associated with behavior of pregnant women in childbirth planning and complication prevention programs. This research is a quantitative study with a cross sectional design. The data was collected by questionnaire tool. The population in this study were pregnant women who had an antenatal care in January 2021 at 3 public health centers that representing Pringsewu Regency, namely the community health center which had the highest moderate, and lowest coverage of Pregnancy visits 1 and 4 visits as many as 122 pregnant women. While the sample in this study was 96 pregnant women. Before the data collection, a questionnaire was tested on 30 respondents. The data analysis in this study is univariate test, bivariate test, and multivariate test. Based on the results of the study, it is known that some of pregnant women in Pringsewu regency have good behaviour, namely 62,5%. The results showed that there were 5 variables that had a significant relationship with the behavior of pragnant women in complication preventif program including knowledge (p value 0,030),attitudes (p value 0,000), availability of infrastructure (p value 0,033), distance to health facilities (p value 0,030) and husband’s support (p value 0,017). The most dominant variable related to the behaviour of pregnant women in complication prevention program is attitude where has the highest OR value of 5,881. In order to inprove the behavior of the community,especially pregnant women in complication prevention program, the Departement of Health needs to empower the community such as implementing the standby village, so that the community is able to independently fulfill the health facilities or infrastructure that are not yet available, namely village ambulances and village blood banks to support the implementation of complication prevention program so as to reduce maternal mortality rate (MMR) and infant mortality rate (IMR).

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EPIDEMIOLOGY AND MORTALITY OF THORACOLUMBOSACRAL SPINAL ARTHRODESIS IN BRAZIL: THE LAST 10 YEARS

Coluna/Columna ◽

10.1590/s1808-185120201902218933 ◽

2020 ◽

Vol 19 (2) ◽

pp. 120-122

Author(s):

DEIVID RAMOS DOS SANTOS ◽

DANTE BERNARDES GIUBILEI ◽

MARCIO OLIVEIRA PENNA DE CARVALHO ◽

ERIC DE SOUZA TEIXEIRA ◽

RODRIGO LIMA GOMES ◽

...

Keyword(s):

Mortality Rate ◽

Statistical Tests ◽

P Value ◽

Chi Square ◽

Level Of Evidence ◽

Unified Health System ◽

Spinal Arthrodesis ◽

Posterior Arthrodesis ◽

Using Data ◽

Epidemiological Profile

ABSTRACT Objective To describe the epidemiology and mortality of thoracolumbosacral arthrodesis surgery in Brazil in the last 10 years. Methods Study conducted using data from the SIH of the Unified Health System (SUS) covering the time period from 2008 to 2018 for all regions of Brazil. The data obtained were analyzed using the BioStat 5.3 program, using Chi-square statistical tests, observing a p-value <0.05 and a 95% confidence interval. Results A total of 66,631 anterior or posterior approach TLS surgeries were registered. The overall mortality rate was 9.37 deaths per thousand procedures. There are regions with mortality much higher than the national average. The mortality rate increases proportionally with the number of levels involved in posterior arthrodesis. Conclusions The study of the epidemiological profile of thoracolumbosacral arthrodesis is important, especially in a country whose population is heterogeneous but has different mortality rates among regions. Therefore, it is necessary to create measures that identify and prevent the factors that lead to the death of patients undergoing such a procedure. Level of evidence II; Retrospective, analytical, quantitative and descriptive study.

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Unseen Burden of Injury: Post-Hospitalization Mortality in Geriatric Trauma Patients

The American Surgeon ◽

10.1177/00031348211046886 ◽

2021 ◽

pp. 000313482110468

Author(s):

Ciara R. Huntington ◽

Angela M. Kao ◽

Ronald F. Sing ◽

Samuel W. Ross ◽

A. Britt Christmas ◽

...

Keyword(s):

Mortality Rate ◽

Social Security ◽

Trauma Center ◽

Older Patients ◽

Motor Vehicle ◽

Geriatric Trauma ◽

Common Mechanism ◽

Trauma Patients ◽

Social Security Death Index

Background/Objectives Older adults are at risk for adverse outcomes after trauma, but little is known about post-acute survival as state and national trauma registries collect only inpatient or 30-day outcomes. This study investigates long-term, out-of-hospital mortality in geriatric trauma patients. Methods Level I Trauma Center registry data were matched to the US Social Security Death Index (SSDI) to determine long-term and out-of-hospital outcomes of older patients. Blunt trauma patients aged ≥65 were identified from 2009 to 2015 in an American College of Surgeons Level 1 Trauma Center registry, n = 6289 patients with an age range 65-105 years, mean age 78.5 ± 8.4 years. Dates of death were queried using social security numbers and unique patient identifiers. Demographics, injury, treatments, and outcomes were compared using descriptive and univariate statistics. Results Of 6289 geriatric trauma patients, 505 (8.0%) died as an inpatient following trauma. Fall was the most common mechanism of injury (n = 4757, 76%) with mortality rate of 46.5% at long-term follow-up; motor vehicle crash (MVC) (n = 1212, 19%) had long-term mortality of 27.6%. Overall, 24.1% of patients died within 1 year of trauma. Only 8 of 488 patients who died between 1 and 6 months post-trauma were inpatient. Mortality rate varied by discharge location: 25.1% home, 36.4% acute rehabilitation, and 51.5% skilled nursing facility, P < .0001. Conclusion Inpatient and 30-day mortality rates in national outcome registries fail to fully capture the burden of trauma on older patients. Though 92% of geriatric trauma patients survived to discharge, almost one-quarter had died by 1 year following their injuries.

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