scholarly journals Motorcycle crashes resulting in hospital admissions in South Australia: Crash characteristics and injury patterns

2020 ◽  
Vol 31 (1) ◽  
pp. 10-19
Author(s):  
James Thompson ◽  
Matthew Baldock ◽  
Tori Lindsay
Keyword(s):  
Injury Severity ◽  
Hospital Admissions ◽  
Blood Alcohol Concentration ◽  
South Australia ◽  
Adelaide Hospital ◽  
Alcohol Concentration ◽  
Royal Adelaide Hospital ◽  
Vehicle Crashes ◽  
Body Regions ◽  
Severity Of Injury

Motorcycle riders have a high risk of serious injury if they crash. To assist with identification of countermeasures, the present study examined records from the Royal Adelaide Hospital (RAH) in South Australia for 763 motorcyclists (including scooter riders) admitted between January 2008 and November 2010 and between April 2014 and December 2016. Records were linked with police-reported crash data and results of forensic blood tests for alcohol and drugs. When compared with 1617 car drivers admitted to the RAH over the same periods, motorcyclists were younger, were more commonly male, more likely to hold a learner permit, less likely to hold a provisional licence, less likely to be over the legal alcohol limit and less likely to be at-fault in multiple vehicle crashes. Their crashes were more likely to be single vehicle crashes (specifically roll over, left road – out of control and hit object/animal/pedestrian on road crashes) and were more common on weekends, during the afternoon, on sloping roads, on curved roads, on roads with speed limits of 50 and 80 km/h, during daylight hours, in dry weather and on dry roads. They had a higher severity of injury than car drivers, spent longer in hospital, and were more likely to sustain injuries to multiple body regions. Linear regression showed that older age, higher blood alcohol concentration and higher speed limit increased injury severity for motorcyclists. Based on present findings, motorcycling safety can be improved through countermeasures related to Graduated Licensing Systems, infrastructure, motorcycle technology and protective clothing.

scholarly journals Moderate and severe traumatic brain injury: effect of blood alcohol concentration on Glasgow Coma Scale score and relation to computed tomography findings

2015 ◽  
Vol 122 (1) ◽  
pp. 211-218 ◽  
Author(s):  
Nils Petter Rundhaug ◽  
Kent Gøran Moen ◽  
Toril Skandsen ◽  
Kari Schirmer-Mikalsen ◽  
Stine B. Lund ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Severity ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Dependent Manner ◽  
Blood Alcohol ◽  
Severe Tbi ◽  
Gcs Score ◽  
Dose Dependent

OBJECT The influence of alcohol is assumed to reduce consciousness in patients with traumatic brain injury (TBI), but research findings are divergent. The aim of this investigation was to study the effects of different levels of blood alcohol concentration (BAC) on the Glasgow Coma Scale (GCS) scores in patients with moderate and severe TBI and to relate the findings to brain injury severity based on the admission CT scan. METHODS In this cohort study, 265 patients (age range 16–70 years) who were admitted to St. Olavs University Hospital with moderate and severe TBI during a 7-year period were prospectively registered. Of these, 217 patients (82%) had measured BAC. Effects of 4 BAC groups on GCS score were examined with ordinal logistic regression analyses, and the GCS scores were inverted to give an OR > 1. The Rotterdam CT score based on admission CT scan was used to adjust for brain injury severity (best score 1 and worst score 6) by stratifying patients into 2 brain injury severity groups (Rotterdam CT scores of 1–3 and 4–6). RESULTS Of all patients with measured BAC, 91% had intracranial CT findings and 43% had BAC > 0 mg/dl. The median GCS score was lower in the alcohol-positive patients (6.5, interquartile range [IQR] 4–10) than in the alcohol-negative patients (9, IQR 6–13; p < 0.01). No significant differences were found between alcohol-positive and alcohol-negative patients regarding other injury severity variables. Increasing BAC was a significant predictor of lower GCS score in a dose-dependent manner in age-adjusted analyses, with OR 2.7 (range 1.4–5.0) and 3.2 (range 1.5–6.9) for the 2 highest BAC groups (p < 0.01). Subgroup analyses showed an increasing effect of BAC group on GCS scores in patients with Rotterdam CT scores of 1–3: OR 3.1 (range 1.4–6.6) and 6.7 (range 2.7–16.7) for the 2 highest BAC groups (p < 0.01). No such relationship was found in patients with Rotterdam CT scores of 4–6 (p = 0.14–0.75). CONCLUSIONS Influence of alcohol significantly reduced the GCS score in a dose-dependent manner in patients with moderate and severe TBI and with Rotterdam CT scores of 1–3. In patients with Rotterdam CT scores of 4–6, and therefore more CT findings indicating increased intracranial pressure, the brain injury itself seemed to overrun the depressing effect of the alcohol on the CNS. This finding is in agreement with the assumption of many clinicians in the emergency situation.

Higher Blood Alcohol Concentration is Related to Less Severe Injury Amongst Intoxicated Trauma Patients

2020 ◽  
Author(s):  
Nikathan Kumar ◽  
Kartik Prabhakaran ◽  
Matthew K. McIntyre ◽  
David J. Samson ◽  
Rifat Latifi
Keyword(s):  
Injury Severity ◽  
Motor Vehicle ◽  
Alcohol Intoxication ◽  
Blood Alcohol Concentration ◽  
Alcohol Ingestion ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
Severity Scores ◽  
Severity Of Injury ◽  
Level 1

Abstract Background Previous studies show varied results regarding the protective effects of alcohol intoxication upon injury and mortality in the setting of trauma. Our study aimed to determine the effects of blood alcohol content (BAC) amongst trauma patients with alcohol ingestion, upon injury type and severity, as well as outcomes. Methods This 4-year retrospective study (2013–2017) used an institutional trauma database to capture all Level 1 and 2 trauma patients (≥14 years old) with BAC > 10 mg/dL presenting to the emergency department at a Level 1 trauma center. Demographic variables including mechanism of injury (MOI) were collected. Patients’ BAC was compared to their calculated injury severity scores (ISS) and abbreviated injury scale (AIS) scores. Analysis included linear regression, T-tests and ANOVAs with Tukey’s post-hoc analysis for continuous variables and Fisher’s exact test for binary variables. Multivariate regression analysis was performed to determine independent predictors of injury severity. Results 332 intoxicated patients were identified (mean BAC: 210.2±87.14 mg/dL, range 12.7–460.0; 74.1% male; median age 35; range: 16–90). The median ISS was 6 (range: 1–48). Patients in motor vehicle collisions had lower BACs (186.0±5.59 mg/dL) than those who fell (233.8±10.42 mg/dL, p = 0.0002), were assaulted (230.4±14.04 mg/dL, p = 0.0261), or were pedestrians struck (259.4±14.17 mg/dL, p = 0.004). Overall, patients with higher BAC had lower GCS, lower ISS, and shorter intensive care unit (ICU) length of stay, but no differences in hospital stay, or ventilator days. Conclusions Trauma patients with higher BAC have lower ISS, less severe chest injury, and shorter ICU stays. These findings suggest that higher levels of alcohol ingestion may portend a protective effect in the setting of trauma with respect to severity of injury that does not mitigate the importance of education and injury prevention but warrants further study into the physiology of alcohol and trauma.

The Acute Pain Service in Australia

2000 ◽  
Vol 1 (1) ◽  
pp. 24-25
Author(s):  
Jill Day
Keyword(s):  
Acute Pain ◽  
South Australia ◽  
Adelaide Hospital ◽  
Acute Pain Service ◽  
Royal Adelaide Hospital

Last November I was fortunate enough to be given the opportunity to visit the Royal Adelaide Hospital (RAH), South Australia. I had been invited by Dr Pam Macintyre who had spoken at the 1997 South Thames Acute Pain Conference. I spent two interesting weeks observing the Acute Pain Team to see how their service was managed.

scholarly journals Medical Record Documentation: The Quality of Physiotherapy Entries

2006 ◽  
Author(s):  
Anna Phillips ◽  
Kathy Stiller ◽  
Marie Williams
Keyword(s):  
Medical Record ◽  
South Australia ◽  
Adelaide Hospital ◽  
Patient Characteristics ◽  
Primary Diagnosis ◽  
Royal Adelaide Hospital ◽  
Physiotherapy Department ◽  
The Impact ◽  
Medical Record Documentation

This study evaluated the standard of in-patient medical record documentation by physiotherapists at the Royal Adelaide Hospital (RAH), Adelaide, South Australia, during 2003. The impact of patient characteristics (ie primary diagnosis and length of stay in hospital) and physiotherapist features (eg employment classification level and years of employment at the RAH) on the standard of documentation was also explored. One hundred medical records were randomly selected for review and 224 physiotherapy entries were audited. The audit tool was based on the RAH Physiotherapy Department Guidelines for Documentation, which was comprised of five sections. Each section contained several items, which were scored as complete, incomplete, absent or not applicable. The total number of completed scores was calculated for each section of the audit form. A standard of 100 per cent completed was expected for the two sections containing those requirements considered mandatory according to the RAH Physiotherapy Department Guidelines, whereas a lower completion rate was considered acceptable for the remaining sections. The standard of documentation varied considerably, with only five items (4.3%) achieving a rate of 100 per cent completion, namely ‘date’, ‘heading physiotherapy’, ‘signature’, ‘page includes patient details’ and ‘after the first attendance’. In total, 94 items (81.7%) were at least 50 per cent completed, which was considered a reasonable overall standard. The patient diagnosis was the only patient or physiotherapist characteristic that significantly affected the standard of documentation (p = 0.03). While the overall standard of documentation was deemed acceptable, it was clear there was room for improvement.

A Turbo Pascal Program to Convert Icd-9Cm Coded Injury Diagnoses into Injury Severity Scores: Icdtoais

1994 ◽  
Vol 78 (3) ◽  
pp. 915-930 ◽  
Author(s):  
Johannes Kingma ◽  
Elisabeth Tenvergert ◽  
Hinke Anja Werkman ◽  
Henk Jan Ten Duis ◽  
Henk J. Klasen
Keyword(s):  
Injury Severity ◽  
Data File ◽  
International Classification Of Diseases ◽  
Body Region ◽  
Pascal Program ◽  
Body Regions ◽  
Severity Scores ◽  
Severity Of Injury ◽  
Classification Of Diseases

Diagnoses of injuries as a result of trauma are commonly coded by means of the International Classification of Diseases (9th rev.) Clinical Modification (ICD-9CM). The Abbreviated Injury Scale (AIS) is frequently employed to assess the severity of injury per body region. The Injury Severity Score (ISS) is an over-all index or summary of the severity of injury. To compute one of these two types of scores the entire medical record of each patient must be examined. The program ICDTOAIS replaces the manual coding or translation between the two scores. The program converts the ICD-9CM coded diagnoses into AIS and ISS scores. The program also computes the maximum AIS (MAXAIS) per body region, enabling the researcher to assess the relative impact of the severity of trauma of different body regions in both morbidity and mortality studies. The program locates invalid ICD-9CM rubrics in the data file. ICDTOAIS may be employed as a program alone or as a procedure in database management systems (e.g., DBase III plus, DBase IV, or the different versions of FOXPRO). The program is written in Turbo Pascal, Version 6.

Does Level of Blood Alcohol Content Affect Clinical Outcomes After Trauma in Older Adult Patients?

2020 ◽  
Vol 86 (9) ◽  
pp. 1106-1112
Author(s):  
Mary K. Bryant ◽  
Katherine Reynolds ◽  
Connor Brittain ◽  
Zachery Patel ◽  
Trista D.S. Reid ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Older Patients ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
Matched Cohort ◽  
Poor Outcomes

Introduction Preinjury alcohol use and older age have independently been associated with poor outcomes. This study examined whether higher levels of blood alcohol concentration (BAC) correlated with an increased likelihood of poor outcomes in older trauma patients. Methods This was a retrospective cohort study of injured patients ≥65 years with BAC testing presenting to a Level 1 trauma center between 2015 and 2018. Patients were stratified by BAC at 4 thresholds of intoxication: BAC ≧10 mg/dL, BAC ≧80 mg/dL, BAC ≧150 mg/dL, and BAC ≧200 mg/dL. Propensity score matching using inverse probability of treatment weighting was used to estimate outcomes. Logistic and Poisson regression models were performed for each threshold of the BAC level with the matched cohort to assess clinical outcomes. Results Of all older patients (n = 3112), 32.5% (n = 1012) had BAC testing. In the matched cohort of 883 patients (76.7 ± 8.2 years; 48.1% female), 111 (12.5%) had BAC ≧10 mg/dL, 83 (74.8%) had BAC ≧80 mg/dL, 60 (54.1%) had BAC ≧150 mg/dL, and 37 (33.3%) had BAC ≧200 mg/dL. Falls (60.5%) and motor vehicle crashes (28.9%) were the most common mechanisms of injury. Median (IQR) of Injury Severity Score (ISS) was 5 (1-10). The risk of severe injury (ISS ≧15) was similar between alcohol-positive and alcohol-negative patients (9.9% vs 15.0%, P = .151). BAC ≧10 g/dL was not associated with length of stay, intensive care unit admission, or in-hospital complication, nor was any of the other 3 analyzed BAC thresholds. Conclusion Overall, any detectable BAC along and increasing thresholds of BAC was not associated with poor in-hospital outcomes of older patients after trauma. Alcohol screening was low in this population, and intoxication may bias injury assessment, leading to mistriage of older trauma patients.

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