Management of Orthopaedic Injuries following 2015 Gorkha Earthquake: Our Experience in Public Health Concern Trust Nepal

2021 ◽  
Vol 3 (2) ◽  
pp. 43-48
Author(s):  
Shikshya Prakash Shrestha ◽  
Umesh Bahadur Bogatee ◽  
Roshan Lal Shrestha ◽  
Ganesh Dangal ◽  
Anil Shakya ◽  
...  
Keyword(s):  
Injury Severity ◽  
Economic Consequences ◽  
Lower Limbs ◽  
Health Concern ◽  
Common Procedure ◽  
Trauma Severity ◽  
Central Nepal ◽  
2015 Gorkha Earthquake ◽  
Fracture Tibia ◽  
Hospitalised Patient

Background: On April 25 2015, a magnitude of 7.8 earthquake struck in central Nepal, causing a huge physical and social disturbances. Physical impacts comprised casualties with deaths and injuries and damage to infrastructure, cultural heritage and natural environment while social impacts are demographic, psychological and economic consequences. We report our experience in treating victims who were brought at our centre via different means.Objectives: to provide an overview the caseload and provide analysis of earthquake victims for improving the future strategies in similar scenarios.Methods: A retrospective study of the clinical characteristics and patterns of hospitalised patient after the 2015 earthquake was conducted. Demographic evaluation, surgical procedures and morbidities were reviewed. The patients were followed up for an average of 24 months, detail records were kept on their recovery and function.Results: A total of 85 patients were treated with subsequent follow-up. The proportion of males admitted was similar to that of females (49.4% and 50.5% respectively). The highest number of admitted age group ranges (17- 45) was about 37.64%. Most injured site was lower limbs (68.23%) where fracture tibia and fibula had the highest incidence (56.89%). Out of all, 14.11% of cases were open fractures. Trauma severity was assessed with injury severity score and most of them categorized as mild one (95.29%). The most common procedure performed was closed reduction and pinning (n=28), followed by open reduction and fixation (n=24). Overall, mortality rate was 2.35% (2 of 85). Total 25 implants were removed within three years of period and 28.6% of patients were not returned to date.Conclusions: The injury epidemiology reported in this study showed quite congruence with most other earthquake related studies. Analysis profiles of injuries and clinical features of earthquake victims will definitely impact rescue efforts and treatment of fracture injuries in possible future natural calamities.

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).

A Detailed Injury Severity Scale for Lower Limbs Based on Analysis of Injuries Sustained by Pedestrians

1983 ◽  
Author(s):  
J. Farisse ◽  
J. Bonnoit ◽  
B. Seriat-Gautier ◽  
C. Brunet ◽  
N. Daon ◽  
...  
Keyword(s):  
Injury Severity ◽  
Lower Limbs ◽  
Severity Scale

scholarly journals Measuring trauma severity using the 1998 and 2005 revisions of the Abbreviated Injury Scale

2014 ◽  
Vol 48 (4) ◽  
pp. 641-648 ◽  
Author(s):  
Maria Carolina Barbosa Teixeira Lopes ◽  
Iveth Yamaguchi Whitaker
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Sao Paulo ◽  
São Paulo ◽  
Abbreviated Injury Scale ◽  
New Injury Severity Score ◽  
Trauma Severity

Objetivo: Comparar a gravidade das lesões e do trauma mensurada pelas versões da Abbreviated Injury Scale 1998 e 2005 e verificar a mortalidade nos escores Injury Severity Score e New Injury Severity Score nas duas versões.Método: Estudo transversal e retrospectivo analisou lesões de pacientes de trauma, de três hospitais universitários do município de São Paulo, Brasil. Cada lesão foi codificada com Abbreviated Injury Scale 1998 e 2005. Os testes estatísticos aplicados foram Wilcoxon, McNemar-Bowker, Kappa e teste Z.Resultados: A comparação das duas versões resultou em discordância significante de escores em algumas regiões corpóreas. Com a versão 2005 os níveis de gravidade da lesão e do trauma foram significantemente reduzidos e a mortalidade foi mais elevada em escores mais baixos. Conclusão: Houve redução da gravidade da lesão e do trauma e alteração no percentual de mortalidade com o uso da Abbreviated Injury Scale 2005.





scholarly journals (P2-91) EMS Trauma Triage: Does the Red-Blue Criteria Enable Overtriage?

2011 ◽  
Vol 26 (S1) ◽  
pp. s166-s166
Author(s):  
D.M. Higgins ◽  
R.E. Thaxton
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Initial Assessment ◽  
Trauma Patients ◽  
Minor Trauma ◽  
Trauma Severity ◽  
Physician Assessment ◽  
Assessment Skills ◽  
Trauma Triage ◽  
Level 1

IntroductionWith the current need for effective trauma center utilization, understanding how current trauma triage criteria may promote overtriage will enable both field and hospital teams to provide the most appropriate patient care. It is hypothesized that current Southwest Texas trauma criteria promote overtriage by prehospital emergency medical services (EMS) of patients in favor of a Level 1 trauma facility when compared to physician assessment and Injury Severity Score (ISS).MethodsThis prospective, observational study at a Southwest Texas military Level 1 trauma center compared adult trauma patients' prehospital status noted by EMS personnel with the triage criteria documented by the treating emergency physician. The patients were divided into four groups: Prehospital Criteria Met or Not Met; Arrival Criteria Met or Not Met. Each patient's ISS and mechanism of injury were also collected and compared to initial assessment for predictive value. Descriptive statistics were used.ResultsThe study enrolled 278 adult trauma patients. EMS reported Level 1 trauma status similar to physician assessment (60.1% vs. 59.7%, respectively). The rates patients met Level 1 trauma status corresponded with trauma severity when compared to the ISS. Assessment between EMS and physicians for ISSs were similar among the four groups. Comparisons using multivariate analysis of the four groups found similar ISSs, except for the Prehospital Criteria Met/Arrival Criteria Not Met group. Seventy-five percent of these patients were assigned an ISS in the Minor (ISS < 9) category (p = 0.013).ConclusionTrauma triage criteria assessment skills were similar between EMS personnel and emergency physicians except for identifying minor trauma patients. While the criteria generally led to overtriage, EMS crews appear to overtriage minor trauma patients at a much higher rate.

scholarly journals Analysis of the Risk Factors Affecting the Severity of Traffic Accidents on Spanish Crosstown Roads: The Driver’s Perspective

2020 ◽  
Vol 12 (6) ◽  
pp. 2237 ◽  
Author(s):  
Natalia Casado-Sanz ◽  
Begoña Guirao ◽  
Maria Attard
Keyword(s):  
Traffic Accidents ◽  
Injury Severity ◽  
Road Traffic ◽  
Fatal Outcome ◽  
Policy Support ◽  
Health Concern ◽  
Contributing Factors ◽  
Factors Affecting ◽  
Traffic Volumes ◽  
New Vision

Globally, road traffic accidents are an important public health concern which needs to be tackled. A multidisciplinary approach is required to understand what causes them and to provide the evidence for policy support. In Spain, one of the roads with the highest fatality rate is the crosstown road, a particular type of rural road in which urban and interurban traffic meet, producing conflicts and interference with the population. This paper contributes to the previous existing research on the Spanish crosstown roads, providing a new vision that had not been analyzed so far: the driver’s perspective. The main purpose of the investigation is to identify the contributing factors that increment the likelihood of a fatal outcome based on single-vehicle crashes, which occurred on Spanish crosstown roads in the period 2006-2016. In order to achieve this aim, 1064 accidents have been analyzed, applying a latent cluster analysis as an initial tool for the fragmentation of crashes. Next, a multinomial logit (MNL) model was applied to find the most important factors involved in driver injury severity. The statistical analysis reveals that factors such as lateral crosstown roads, low traffic volumes, higher percentages of heavy vehicles, wider lanes, the non-existence of road markings, and finally, infractions, increase the severity of the drivers’ injuries.

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.

Topographic and geologic controls on landslides induced by the 2015 Gorkha earthquake and its aftershocks: an example from the Trishuli Valley, central Nepal

Landslides ◽  
2017 ◽  
Vol 15 (5) ◽  
pp. 953-965 ◽  
Author(s):  
Ching-Ying Tsou ◽  
Masahiro Chigira ◽  
Daisuke Higaki ◽  
Go Sato ◽  
Hiroshi Yagi ◽  
...  
Keyword(s):  
Gorkha Earthquake ◽  
Central Nepal ◽  
2015 Gorkha Earthquake ◽  
Geologic Controls

scholarly journals Associations of Trauma Severity with Mean Platelet Volume and Levels of Systemic Inflammatory Markers (IL1β, IL6, TNFα, and CRP)

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Baris Alper ◽  
Baris Erdogan ◽  
Mehmet Özgür Erdogan ◽  
Korkut Bozan ◽  
Murat Can
Keyword(s):  
Mean Platelet Volume ◽  
Injury Severity ◽  
Serum Levels ◽  
Study Group ◽  
Platelet Volume ◽  
Trauma Severity ◽  
Severity Scores ◽  
Severity Of Injury ◽  
Significant Difference ◽  
The Mean

We investigated the associations of injury severity scores (ISSs) with the mean platelet volume, the serum levels of two interleukins (IL1βand IL6), and the serum levels of tumour necrosis factor-α(TNFα) and C-reactive protein (CRP). We sought to identify biochemical parameters that could be used as components of a new biochemical parameter-based ISS system. The levels of CRP, TNFα, IL1β, and IL6 differed significantly (allpvalues < 0.05) between severely injured patients and controls. The mean platelet volume (MPV) did not correlate with the ISSs (p> 0.05). The TNFαand IL6 levels were useful for determining the severity of injury, and the CRP level was elevated in all trauma patients but did not correlate with the ISS. The IL1βlevel was higher in the study group but did not increase as the ISS increased. IL6 and TNFαlevels were higher in the study group and increased as the ISS increased. We found no significant difference between the trauma group and healthy individuals in terms of MPV values. IL6 and TNFαlevels can be used to assess trauma severity. However, neither the MPV nor the CRP or IL1βlevel is useful for this purpose.

scholarly journals A comparative study of designated trauma team leaders on trauma patient survival and emergency department length-of-stay

CJEM ◽  
2007 ◽  
Vol 9 (02) ◽  
pp. 105-110 ◽  
Author(s):  
Garnet E. Cummings ◽  
Damon C. Mayes
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Injury Severity ◽  
Patient Survival ◽  
Negative Impact ◽  
Trauma Team ◽  
Regression Modeling ◽  
Outcome Variable ◽  
Trauma Patients ◽  
Trauma Severity

ABSTRACT Objectives: There is controversy over who should serve as the Trauma Team Leader (TTL) at trauma-receiving centres. This study compared survival and emergency department (ED) length-of-stay between patients cared for by 3 different groups of TTLs: surgeons, emergency physicians (EPs) on call for trauma cases and EPs on shift in the ED. Methods: We performed a retrospective cohort study involving all adult major blunt trauma patients (aged 17 and older) who were admitted to 2 level I trauma centres and who were entered into a provincial Trauma Registry between March 2000 and April 2002. The study was designed to compare the effect of TTL-type on survival and ED length-of-stay, while controlling for sex, age, and trauma severity as defined by the Injury Severity Score (ISS) and the Revised Trauma Score (RTS). Analysis was performed using linear regression modeling (for the ED lenght-of-stay outcome variable), and logistic regression modeling (for the surivial outcome variable). Results: There were 1412 patients enrolled in the study. The study population comprised 74% men and 26% women, with a mean age of 44.7 years (43.1, 46.6 and 42.8 years for surgeons, on-call EPs and on-shift EPs, respectively). The overall mean ISS was 23.2 (23.7 for surgeons, 22.9 for on-call EPs and 23.3 for on-shift EPs) and the overall average RTS was 7.6 (7.6 for surgeons, 7.6 for on-call EPs and 7.5 for on-shift EPs). The overall median ED length-of-stay was 5.3 hours (4.5, 5.3 and 5.6 hours for surgeons, on-call EPs and on-shift EPs, respectively; p = 0.07) and the overall survival was 87% (86% surgeon, 88% on-call EP, 87% on-shift EP; p = 0.08). No statistically significant relationship was found between TTL-type and ED length-of-stay (p = 0.42) or survival (p = 0.43) using multivariate modeling. Conclusion: Our results suggest that surgeons, on-call EPs, or on-shift EPs can act as the TTL without a negative impact on patient survival or ED length-of-stay.

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