scholarly journals Nosocomial infections: A further assault on patients in a high-volume urban trauma centre in South Africa

2020 ◽  
Vol 110 (2) ◽  
pp. 123
Author(s):  
A J Dell ◽  
P H Navsaria ◽  
S Gray ◽  
J C Kloppers
Keyword(s):  
South Africa ◽  
Nosocomial Infections ◽  
High Volume ◽  
Trauma Centre

Laparotomy for Abdominal Stab Wound With Combined Omental and Organ Evisceration: 10-Year Experience From a Major Trauma Centre in South Africa

2021 ◽  
pp. 000313482110318
Author(s):  
Victor Kong ◽  
Cynthia Cheung ◽  
Nigel Rajaretnam ◽  
Rohit Sarvepalli ◽  
William Xu ◽  
...  
Keyword(s):  
South Africa ◽  
Small Bowel ◽  
Large Bowel ◽  
Major Trauma ◽  
Stab Wound ◽  
Length Of Hospital Stay ◽  
Trauma Centre ◽  
Major Trauma Centre ◽  
The Mean ◽  
Overall Mortality

Introduction Combined omental and organ evisceration following anterior abdominal stab wound (SW) is uncommon and there is a paucity of literature describing the management and spectrum of injuries encountered at laparotomy. Methods A retrospective study was undertaken on all patients who presented with anterior abdominal SW involving combined omental and organ evisceration who underwent laparotomy over a 10-year period from January 2008 to January 2018 at a major trauma centre in South Africa. Results A total of 61 patients were eligible for inclusion and all underwent laparotomy: 87% male, mean age: 29 years. Ninety-two percent (56/61) had a positive laparotomy whilst 8% (5/61) underwent a negative procedure. Of the 56 positive laparotomies, 91% (51/56) were considered therapeutic and 9% (5/56) were non-therapeutic. In addition to omental evisceration, 59% (36/61) had eviscerated small bowel, 28% (17/61) had eviscerated colon and 13% (8/61) had eviscerated stomach. A total of 92 organ injuries were identified. The most commonly injured organs were small bowel, large bowel and stomach. The overall complication rate was 11%. Twelve percent (7/61) required intensive care unit admission. The mean length of hospital stay was 9 days. The overall mortality rate for all 61 patients was 2%. Conclusions The presence of combined omental and organ evisceration following abdominal SW mandates laparotomy. The small bowel, large bowel and stomach were the most commonly injured organs in this setting.

scholarly journals EP.WE.105Hand trauma during COVID pandemic: a tertiary trauma centre experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Amir Ghareib ◽  
Sylwia Oniska ◽  
Laura Karran ◽  
Jamil Moledina
Keyword(s):  
High Volume ◽  
Trauma Centre ◽  
Active Movement ◽  
Trauma Patients ◽  
University Hospitals ◽  
Hand Fractures ◽  
Good Movement ◽  
Hand Fracture ◽  
June July

Abstract Introduction St. George’s University Hospitals NHS Foundation Trust is a tertiary trauma centre. We receive a high volume of hand referrals from all over the south West London region. Closed hand fractures represent a significant number of our referrals. COVID-19 has put more burden in all health service endangering poor management of these trauma patients. Aim To assess management of close hand trauma patients during COVID pandemic. Methods Retrospective evaluation of closed hand fracture referrals during June, July, and August 2020. Clinical documentations, operative details and follow up visit notes have been reviewed. Results 106 patients have been included. 47 patients treated surgically with 81% of them were in need for metalwork insertion. Most of operations were done within 8 days. Number of hospital visits was variable with a mean of six days for adult and two days for children. Patient who was in need for hand therapy have been seen within the first 8 days of their surgery. At three months follow up, only three cases had infection. Only one case had osteomyelitis and the other two case had infected metalwork. Most of the patents reported good movement in ASSH Total Active Movement of Hand score (TAM) at the end of the three months. Conclusion Despite COVID 19 pandemic our service managed to achieve acceptable results in dealing with these cases. Yet, securing a reasonable number of operating sessions and clinic appointments remains a challenge.

scholarly journals Primary repair of duodenal injuries: a retrospective cohort study from a major trauma centre in South Africa

2019 ◽  
Vol 108 (4) ◽  
pp. 280-284 ◽  
Author(s):  
R. D. Weale ◽  
V. Y. Kong ◽  
W. Bekker ◽  
J. L. Bruce ◽  
G. V. Oosthuizen ◽  
...  
Keyword(s):  
South Africa ◽  
Primary Repair ◽  
Significant Risk ◽  
Trauma Centre ◽  
Duodenal Injury ◽  
Trauma Service ◽  
Retrospective Audit ◽  
Major Trauma Centre ◽  
Significant Difference ◽  
Duodenal Injuries

Background and Aims:The management of duodenal trauma remains controversial. This retrospective audit of a prospectively maintained database was intended to clarify the operative management of duodenal injury at our institution and to assess the risk factors for leak following primary duodenal repair.Materials and Methods:This was a retrospective study undertaken at the Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg, South Africa. Operative techniques used for duodenal repair were recorded. Our primary outcome was duodenal leak in the postoperative period. Patients from January 2012 to December 2016 were included. All duodenal injuries were graded according to the American Association for the Surgery of Trauma (AAST) grading. Only patients who had a primary repair were included in the final analysis.Results:During the five-year data collection period, a total of 562 patients underwent a trauma laparotomy; of which 94 patients sustained a duodenal injury. A primary pyloric exclusion and gastro-jejunostomy (PEG) was performed in three patients. These three were then excluded from further analysis. Of the 91 primary duodenal repairs, seven (8%) subsequently leaked. These were managed by PEG in three and by secondary repair and para-duodenal drainage in four. The two physiological parameters most associated with subsequent leak were lactate and pH level. There was a significantly higher mortality rate for those who leaked vs those who did not leak. Chi-squared test revealed a significant difference in the leak rate between AAST I (0%), AAST-II (1.6%) and AAST-3 (66.7%) grade injuries (p <0.01).Conclusion:The trend towards primary repair of duodenal injuries appears to be justified. However duodenal leak remains a significant risk in certain high risk patients and strategies to manage injuries in this subset requires further work.

scholarly journals A review of geriatric injuries at a major trauma centre in South Africa

2019 ◽  
Vol 110 (1) ◽  
pp. 44 ◽  
Author(s):  
J-P Da Costa ◽  
J Laing ◽  
V Y Kong ◽  
J L Bruce ◽  
G L Laing ◽  
...  
Keyword(s):  
South Africa ◽  
Major Trauma ◽  
Trauma Centre ◽  
Major Trauma Centre

scholarly journals The effect of systematic factors on the outcome of trauma laparotomy at a major trauma centre in South Africa

2017 ◽  
Vol 99 (7) ◽  
pp. 540-544 ◽  
Author(s):  
C Steenkamp ◽  
VY Kong ◽  
DL Clarke ◽  
B Sartorius ◽  
JL Bruce ◽  
...  
Keyword(s):  
South Africa ◽  
Electronic Medical Record System ◽  
Trauma Centre ◽  
Emergency Laparotomy ◽  
Record System ◽  
Trauma Service ◽  
Major Trauma Centre ◽  
Significant Difference ◽  
Medical Record System ◽  
Public Holidays

Introduction The aim of this study was to examine and interrogate outcomes in trauma laparotomy in a South African trauma centre to determine whether systematic factors were associated with any discrepancies in outcome. Methods This was a retrospective review of a prospectively entered trauma registry undertaken at the Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg, South Africa. The service has developed a hybrid electronic medical record system (HEMR) where clinical data were captured in real time, which were incorporated this into a database. Results During the period from December 2012 to July 2016, 562 patients underwent emergency laparotomy for trauma and the time and date of surgery was recorded in the HEMR. The mean age of all patients was 29.5 years. There were 256 operations during the weekend or over a public holiday, with a mortality of 8% (n = 21) compared with 306 during the week (mortality of 10%, n = 31). This difference was not statistically significant (P = 0.237). A total of 327 operations were performed at night (18:00 – 08:00) and 235 operations were performed during the day (08:00-18:00 Hours). This was a significant difference in mortality (10% (33) vs 7 % (16), P=0.013) These differences persisted if weekends and public holidays were separated out from normal working days. A total of 188 operations were performed on a week night, with a mortality of 11% (n = 20) and 121 operations were performed during a week day, with a mortality of 8% (n = 10). There were 139 operations on a weekend or public holiday night, with a mortality of 9% (n = 13). A total of 114 operations were performed on a weekend or public holiday day with a mortality of 7% (n = 8). A total of 208 procedures were performed with an consultant present. Of these, 32 patients (15%) died. A total of 368 procedures were performed without a consultant present and 8 (2%) died. Conclusions This study demonstrated a discrepancy in outcome for trauma laparotomy, depending on whether the operation was performed at night or during the day. The reasons for this are unclear, although the lack of consultant presence at night in comparison to during the day appears to be implicated.

scholarly journals The spectrum of animal related injuries managed at a major trauma centre in South Africa

2019 ◽  
Vol 57 (3) ◽  
pp. 54-58
Author(s):  
EU Wessels ◽  
VY Kong ◽  
J Buitendag ◽  
S Moffatt ◽  
R Weale ◽  
...  
Keyword(s):  
South Africa ◽  
Major Trauma ◽  
Trauma Centre ◽  
Major Trauma Centre
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