scholarly journals A perspective of extremity vascular trauma epidemiology and its management in a resource limited set up

2021 ◽  
Vol 5 (3) ◽  
pp. 27-34
Author(s):  
Dawit Gebregiorgis ◽  
◽  
Berhanu Nega ◽  
Nebyou Seyoum ◽  
◽  
...  

Background: Extremity vascular injuries are one of the major causes of limb loss and potentially preventable deaths after trauma. Although it is a major challenge, especially in countries with a less established trauma center, early diagnosis, and intervention are important for a better outcome. The aim of this study was to describe the epidemiology, management strategies, and outcomes of extremity vascular trauma in the Ethiopian setting. Methods: A retrospective observational study was conducted among all extremity vascular trauma patients who were admitted and treated at Tikur Anbessa Specialized Hospital (TASH) Between June 2015 and May 2020. Result: A total of 85 patients with extremity vascular trauma, predominantly male (90.6%), were included in the study. The mean age was 27 ± 9 years. Penetrating trauma caused 89.4% of extremity vascular injuries. The majority of the injuries are caused by stab/sharp (40%), bullet (29.4%) and road traffic accidents (17.7%). The brachial artery was the commonest vessel injured accounting for 36.5% followed by femoral artery injury of (22.4%). The commonest types of vascular injuries were complete transection (74.1%), laceration (15.3%), and partial transection (8.2%). The most commonly used method of vascular reconstruction was reverse interposition venous graft accounting for 45.9%. Other methods were ligation & hemostasis (20%), primary repair with End-to-End Anastomosis (17.7%), primary simple repair (15.3%), and venous patch (1.2%). A limb salvage rate of 91.8% was achieved despite a 67.1% of late presentation (>6 hours). Conclusion: Vascular injuries are mainly due to violence and road traffic accidents. Limb loss and mortality due to this injury can be mitigated by improving health policies, implementing emergency ambulatory systems, and provision of vascular services with better training centers.

2006 ◽  
Vol 5 (4) ◽  
pp. 271-276 ◽  
Author(s):  
Raafat Shalabi ◽  
Yoysifh Al Amri ◽  
Elham khoujah

OBJECTIVE: This study analyzes the causes of injuries, presentations, surgical approaches, outcome and complications of vascular trauma of the upper limbs, in spite of limited hospital resources. METHODS: A 5-year retrospective analysis. From 01/01/2001 to 31/12/2005, 165 patients were operated for vascular injuries at King Fahd Hospital, Medina, Saudi Arabia. Of all peripheral vascular trauma patients (115), upper limb trauma was present in 58. Diagnosis was made by physical examination and hand-held Doppler alone or in combination with Doppler scan/angiography. Primary vascular repair was performed whenever possible; otherwise, the interposition vein graft was used. Fasciotomy was considered when required. Patients with unsalvageable lower extremity injury requiring primary amputation were excluded from the study. RESULTS: Fifty patients were male (86%) and eight were female (14%), aged between 2.5-55 years (mean 23 years). Mean duration of presentation was 8 h after the injury. The most common etiological factor was road traffic accidents, accounting for 50.5% in the blunt trauma group and 33% among all penetrating and stab wound injuries. Incidence of concomitant orthopedic injuries was very high in our study (51%). The brachial artery was the most affected (51%). Interposition vein grafts were used in 53% of the cases. Limb salvage rate was 100%. CONCLUSION: Patients who suffer vascular injuries of the upper extremities should be transferred to vascular surgery centers as soon as possible. Decisive management of peripheral vascular trauma will maximize patient survival and limb salvage. Priorities must be established in the management of associated injuries, and delay must be avoided when ischemic changes are present.


2021 ◽  
Vol 12 (1) ◽  
pp. 15-19
Author(s):  
Kate Sheard

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.


2020 ◽  
Vol 7 (3) ◽  
pp. 710
Author(s):  
Vinod Bhandari ◽  
Mahak Bhandari

Background: Blunt injury abdomen is the leading cause of morbidity and mortality in all age groups. Blunt trauma differs from penetrating trauma as different organs are characteristically injured by compression from blunt straining. Focused assessment with sonography for trauma (FAST) and computed tomography (CT) abdomen are very beneficial to detect those patients with minimal and clinically undetectable signs of abdominal injury. Objective of the study was to evaluate the incidence of blunt injury abdomen, mode of injury, organs involved in patients.Methods: A retrospective study was done on blunt injury abdomen. 48 patients were enrolled in this study.Results: Out of 48, 35 (72.9%) male patients more commonly encountered blunt injury to the abdomen. 28 (58.3%) was the highest incidence for age group 21-40 years. The most common mode of injury was road traffic accidents 36 (75.0%). Grade III splenic injuries were encountered in majority 19 cases and 13 cases involved laceration of parenchyma >3 cm depth and 6 cases were subcapsular hematoma (>50%). Spleen was the most common injured organ accounting for 25 (52.0%) and second most common injury was Ileal perforation 6 (12.5%), liver injury 6 (12.5%) of the cases.Conclusions: Blunt injury abdomen mainly affected male and the younger population between the age group 21-40 years. The most common mode of injury is road traffic accidents. In this study the spleen was found to be the most common organ injured in blunt injury abdomen.


2021 ◽  
Author(s):  
Jean-Denis Moyer ◽  
Arthur James ◽  
Clément Gakuba ◽  
Mathieu Boutonnet ◽  
Emeline Angles ◽  
...  

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.


2010 ◽  
Vol 17 (02) ◽  
pp. 325-327
Author(s):  
IRFAN ZAFAR HAIDER ◽  
TAHIR AHMAD KHAN ◽  
TAHIR AHMAD KHAN

Objective: To emphasize upon the frequency of fractures of clavicle due to indirect blunt trauma caused by road traffic accidents and falls from heights and their sequalae. Design: Observational descriptive study. Place and Duration of Study: Combined Military Hospital Bannu during a period of two years from June 2003 to May 2005. Patients and Methods: Patients included in the study were the trauma patients brought to Combined Military Hospital Bannu during a civil –military conflict in tribal areas of North and South  aziristan . Patients had sustained multiple injuries mostly due to road traffic accidents in hilly terrain , falls from heights and combat scuffles. Out of these trauma victims, 746 patients fractures of the clavicle were grouped, analyzed, treated with standard treatment methods and patients were followed up for the varying periods of time. Results: Out of 746 patients treated at our hospital, 84 were having fracture of clavicle(10.8%). 53 patients (63.1%) with clavicle fracture had fracture involving middle third of the clavicle , 20 patients (23.8%)had fracture of lateral third, and 11patients (13.1%) had fractures involving medial third of the clavicle. Conclusion: Clavicle is a bone which is at risk of fracture in cases of indirect blunt traumabecause the first human reaction in any violence or assault is to protect oneself by using the upper limbs. Its peculiar development and anatomical shape makes it vulnerable to fracture in most physical insults. However , it usually unites by conservative methods and even considerable non-union does not significantly affect function. 


Author(s):  
Angli Manhas ◽  
Rameshwar S. Manhas ◽  
Gaurav S. Manhas ◽  
Rishabh Sharma ◽  
Dinesh Gupta

Background: One of the delicate structure in the human body is eye and trauma to the eye is essentially a very grave matter. Major cause of preventable monocular blindness and visual impairment in the world is ocular trauma. So any injury to the eye must be deemed to be an ocular emergency and should be handled with utmost care. Despite its public health importance, there is relatively less population based data on the magnitude and risk factors for ocular trauma specially from developing countries. The objective of the study was to find out the epidemiological pattern of ocular trauma.Methods: The present study was 5 year retrospective study of all the patients who reported directly with ocular injury or referred from the casualty to the department of ophthalmology from January 2013 to January 2018. Various parameters like age, sex, mode of injury, type of injury etc. of all patients seen during this period were analyzed.Results: Total of 4192 ocular trauma patients were seen during study period. Maximum number of ocular trauma patients i.e. 1146 were seen in age group of 21-30 years. Males i.e. 3490 outnumbered females in the present study. Road traffic accidents were the most common cause of ocular trauma and accounts for 1760 cases. Most common reported ocular trauma was periorbital oedema/ecchymosis followed by laceration. Surgical intervention was done in 1660 cases whereas 2532 were managed medically.Conclusions: From present study, we may conclude that the maximum number of ocular trauma patients were seen in the age group of 21-30 years with more preponderance in males. Road traffic accidents were the most common cause of ocular trauma. The fact that the lifetime prevalence of ocular trauma is higher than that of eye diseases, which can be decreased by implementing the traffic rules with strict force and imposing heavy fine and license cancellation for drunken driving.


2019 ◽  
pp. 360-401
Author(s):  
Anjali Gupta ◽  
Jordan Harp ◽  
Desiree Crane

Trauma is the leading cause of death for individuals in the United States younger than 45 years, and globally it is anticipated to become the third largest contributor to the burden of disease by 2020. Road traffic accidents account for most deaths worldwide; however, injuries and death due to firearms are a unique concern in the United States. Emergency clinicians play a vital role in the stabilization, diagnosis, and treatment of trauma patients and must be able to manage a full spectrum of patients, from those presenting with isolated, minor trauma to patients with severe multisystem trauma.


Author(s):  
A Singh ◽  
ASM Lim ◽  
BPH Lau ◽  
G O’Neill

Introduction: Pelvic and acetabular fractures (PAFs) usually result from high-energy, potentially life-threatening accidents. They are one of the major injuries that lead to death in patients involved in such accidents. We studied the recent epidemiology of these injuries in Singapore. Methods: This is a retrospective data analysis of all trauma patients who underwent surgery for PAFs from 2008 to 2016 in a tertiary trauma centre in Singapore. Data including patient demographics, mechanism of injury and associated injuries was collected. Results: A total of 169 patients were admitted for PAFs over the eight-year period. The majority (79.3%) were male. The mean age was 41 (range 13–79) years. Most patients (51.5%) were Chinese. The most common mechanisms of injury were road traffic accidents (53.8%), falls (33.1%) and crush injuries (13.0%). 46.2% sustained acetabular fractures, while 44.4% sustained pelvic fractures. PAFs were most commonly associated with upper and lower limb injuries, followed by spinal and thoracic injuries. Average of length of stay in hospital was 24 (range 2–375) days. Conclusion: PAF predominantly affects young working males. Compared to previously published local data, there has been a significant reduction in the incidence of PAFs, likely due to improved road and work safety. The demographics of PAFs have changed, with fewer injuries in females (20.7% vs. 33.3%), a reduction in the proportion of injuries in the Chinese (51.5% vs. 70.1%). While road traffic accidents remain the most common cause, crush injuries are now more prevalent (13.0%).


Author(s):  
DOAA M ABDEL-SALAM ◽  
RAWAN R ALRUWAILI ◽  
FARAH S ALHABLANI ◽  
NOUR H ALFAHEL ◽  
ANWAR A ALBLAWI

Objectives: This study aimed to determine the types, characteristics, and associated factors of trauma in Al-Jouf Region which is located in Northern part of Saudi Arabia. Methods: The present study was conducted in the Emergency Department of Prince Meteb Hospital in Al-Jouf Region. A total number of 382 patients were enrolled in the present study. A pre-organized data form were designed for each patient attended the Emergency Department of Prince Meteb Hospital from January 2017 to January 2018. It included data about sociodemographic characteristics, type of trauma, and trauma characteristics. Results: The mean age of the patients was 24.4±13.4 years. Most of the patients (75%) were <30 years old. Males (86.9%) were influenced by trauma more common than females. Most of the patients (84.8%) were from urban areas. Blunt trauma constituted 58.9% while, penetrating trauma 41.1%. The most common cause of trauma was road traffic accidents, which occurred among 40% of patients. The most frequent trauma site was head trauma (49%). Most of the patients (47.9%) reached the hospital within 30 min. Regarding the fate of patients, 46.1% discharged after management, 42.1% admitted to intensive care units, and only 11.8% died. Blunt trauma was significantly higher than penetrating trauma among the young age group. Patients with blunt trauma arrived hospital significantly earlier than patients with penetrating trauma. The fate of patients is significantly better in blunt trauma than penetrating trauma. Conclusion: Trauma is considered to be a major public health problem, particularly in the young population in Saudi Arabia. Blunt trauma is more common than penetrating trauma, with road traffic accidents representing the majority.


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