Trauma unit management and outcomes at an urban tertiary hospital in sub-Saharan Africa: a descriptive study

Background: Injuries are a neglected burden despite accounting for 9% of deaths worldwide which is 1.7 times that of hiv, tb and malaria combined. Trauma remains overlooked as research and resources are focused on infectious diseases. Ugandawith limited trauma epidemiological data has one of the highest traumatic injury rates. This study describes demographics, management and outcomes of patients admitted to mulago hospital trauma unit. Materials and methods: This study was a retrospective record review from july 2012 to december 2015. A data collected included age, time and vitals of admission plus interventions, management and outcomes after which it was analyzed. Results: 834 patient records were reviewed. The predominant age group was 18-35 and 86% of the patients were male. 54% of the patients presented during day and majority of the admission had gcs of less than 8. Antibiotics were given to 467 patients with mechanical ventilation (301) and intubation (289) as the frequent interventions done. 52% of admitted patients were discharged and 40% died. Conclusion: Most admissions’ were of youthful age and had severe head injuries (gcs<8). 56% received antibiotics with frequent interventions beig mechanical ventilation and intubation. 52% of admitted patients were discharged and 40% died. Keywords: Trauma; trauma care; emergency care; head injury.

EPIDEMIOLOGICAL STUDY OF TRAUMA IN A TERTIARY CARE CENTRE IN NORTHWEST INDIA

Objective: Traumatic injuries are a matter of concern worldwide. However, the rapidly changing socio economical dynamics in a developing country like India deeply influence the epidemiology behind trauma. The aim of this study was to document and analyze the epidemiological parameters and characteristics behind trauma victims admitted to our tertiary care centre. Methods: The observational study was carried out over a period of one year (January 2019 to December 2019) enrolling a total of 300 trauma patients. The age, sex, locality, delay in hospitalization, mechanism of injury, sites of injury and outcomes were documented. Results: Injuries occurred predominantly in the 20-40 age group with males being the chief victims. There was a considerable amount of delay in hospitalization ranging from one hour to more than 24 hours while only 7 patients arrived to the emergency within one hour of trauma. Vehicular trauma (54%) was the most common mechanism of injury. Injuries to the extremities (38.6%) and head (28.6%) were the most common sites. A considerable number of patients (45.3%) required care in the intensive care unit. A total of 172 patients required surgical interventions of various kinds and there was a total mortality rate of 6%. Amongst the polytrauma cases, 54 patients (81.8%) required ICU admission, 42 patients (63.6%) required surgical intervention and 6 patients (9.1%) died after admission. Conclusion: The results of this study highlight some of the problems with our existing infrastructure bringing to light the need for stricter enforcement of traffic safety laws and improvement of infrastructure particularly the roadways in rural areas as well as the referral systems. Vehicular trauma should be seen as a public health problem and appropriate interventions should be implemented. Keywords: Trauma, Road Traffic Accidents, Epidemiology, Head injuries

The Trauma and Development Education Monitor (TANDEM): et nytt instrument for å måle traumekompetanse

There is a need to assess whether the resources invested in building trauma competence in services actually lead to higher levels of competence. For this purpose, we have developed an instrument called the Trauma and Development Education Monitor (TANDEM). The present article presents the process behind developing the instrument and an initial study of its psychometric properties. The tested version consisted of 59 items distributed across the domains of readiness, agency, reflexivity, knowledge, practice and culture at work. Based on responses from 415 professionals in relevant services, concept and criterion validity was examined through reliability analyses, factor analyses and regression analyses. Based on the analyses, the tested version was reduced to 54 items in the final version, distributed across the same six domains. As dimensions, the domains generally showed good scale reliability, and for the final version factor analyses confirmed a one-dimensional model for all domains. The instrument discriminated between respondents who reported more versus less previously received trauma competence building and showed specificity as a measure of trauma versus more general competence. The results indicate that TANDEM has the potential to become a useful tool in endeavours to implement trauma competence in services, as well as in research activities in this field. Keywords: trauma, competence, instrument, validity

Cervical trauma: Epidemiological, Diagnostic and Therapeutic aspects at the Adolphe SICE General Hospital in Pointe-Noire

Introduction: Cervical spine injuries are relatively rare, and caused by external sharp and vulnating agents. They can be potentially serious and life-threatening. The aim of this work was to describe the epidemiological, clinical and therapeutic aspects. Patients and Method: This was a descriptive, retrospective, cross-sectional study of the records of patients with neck trauma from January 1, 2005 to December 31, 2018, conducted in the ENT and Cervico-Facial Surgery Department of the Adolphe SICE Hospital in Pointe-Noire (Congo-Brazzaville). Results: The study included 30 patients from a total of 107 cases of cervicofacial trauma. The average annual incidence of cervical trauma was 2 cases per year, with a predominance of males, including 25 males (83.3%) and 5 females (16.6%), i.e. a sex ratio of 5:1. The average age was 34.4 years with extremes of 17 to 70 years. 50% of our patients were single. The circumstances of occurrence were represented by knives (83% of cases), followed by road traffic injuries (13%) and firearms (3%). Sharp objects were the most common cause of injury (83%). The mechanism of injury was a section in 87% and a contusion in 13%. Neck pain was the main symptom in 100% of cases. The wound represented 87% of the physical examination, followed by edema and hemorrhage in 33% and 20% respectively. The trauma was isolated in 80% of cases and in a context of polytrauma in 4%. Exploratory and reparative cervicotomy was the most common surgical procedure, 87%, followed by tracheotomy, 27%. The evolution was simple, in spite of the parietal suppuration noted in 10% of the cases. Conclusion: Despite their rarity, cervical trauma remains a worrying surgical emergency in our work context. These traumas are the prerogative of young adult males in connection with external vulnating agents with high traumatic risk. Keywords: Trauma ; penetrating wound; Neck; Cervicotomy

Implicações Biopsicossociais do Traumatismo Cranioencefálico: Revisão Integrativa da Literatura / Biopsychosocial Implications of Head Trauma: Integrative Literature Review

Resumo: O presente artigo tem por objetivo caracterizar a produção bibliográfica latino-americana atualizada sobre os aspectos biopsicossociais do traumatismo cranioencefálico (TCE). Para tanto, realizou-se uma revisão integrativa da literatura, a qual partiu de buscas nas bibliotecas da Scientific Electronic Library Online (SCIELO), Biblioteca Virtual em Saúde (BVS), nas bases de dados Literatura Latino Americana em Ciências da Saúde (LILACS) e Medical Literature Analysis and Retrieval System Online (MEDLINE). no Periódicos CAPES. Foram utilizadas as palavras-chaves "traumatismo" e "cranioencefálico", sem delimitação de período específico das publicações. Nesse sentido, a metodologia guiou-se através dos seguintes passos: 1. delimitação da temática; 2. pesquisa pelas publicações nas bases de dados mencionadas; 3. classificação dos artigos a partir do resumo; 4. análise das publicações. A coleta de dados resultou em 636 publicações, sendo apenas 15 considerados relevantes seguindo os critérios de inclusão e exclusão, após a leitura integral do material científico. As implicações biopsicossociais envolvem diretamente as sequelas presentes na vida das vítimas sobreviventes do TCE. Segundo os estudos, tais prejuízos podem ser de ordem física, cognitiva, funcional e/ou comportamental; dentre as principais funções cognitivas comprometidas avaliadas nos artigos, destaca-se a linguagem, memória e funções executivas.Palavras-chave: traumatismo cranioencefálico; implicações biopsicossociais; sequelas.Abstract:This article aims to characterize the updated Latin American bibliographic production on the biopsychosocial aspects of traumatic brain injury (TBI). To this end, an integrative literature review was carried out, based on searches in the Scientific Electronic Library Online (SCIELO), Virtual Health Library (VHL), in the Latin American Literature in Health Sciences (LILACS) databases. and Medical Literature Analysis and Retrieval System Online (MEDLINE). in CAPES Periodicals. The keywords "trauma" and "cranioencephalic" were used, without delimiting the specific period of the publications. In this sense, the methodology was guided through the following steps: 1. delimitation of the theme; 2. search for publications in the mentioned databases; 3. classification of articles from the abstract; 4. analysis of publications. Data collection resulted in 636 publications, only 15 of which were considered relevant following the inclusion and exclusion criteria, after the full reading of the scientific material. The biopsychosocial implications directly involve the sequelae present in the lives of TBI survivors. According to studies, such damage can be physical, cognitive, functional and/or behavioral; among the main impaired cognitive functions assessed in the articles, language, memory and executive functions stand out.Keywords: traumatic brain injury; biopsychosocial implications; cranioencephalic sequelae.

AN ANALYSIS OF PERSONAL AND COLLECTIVE TRAUMA IN KHALED HOSSEINI’S NOVEL SEA PRAYER

This research study is an attempt to explore the literary text of "Sea Prayer" written by Khaled Hosseini with the perspective of trauma study that includes personal trauma model of Cathy Caruth and collective trauma model of Kia Erikson. The theoretical framework focuses on both i.e., Caruth (1996) personal trauma discussed in "Unclaimed Experience: trauma, narrative and history" and Erikson (1991) collective trauma discussed in "Notes on Trauma and Community". This research study examines the elements of personal trauma of the Narrator's character through flashbacks, timelessness and unspeakablity. On the other hand, the elements of collective trauma are also investigated that are breakage of communal bond, distrust in future, mood of fear and depression on the collective level. In addition, the method used is the qualitative analysis. Through aforementioned elements, the researcher has discussed the collective trauma of Syrian community as a whole. Keywords: Trauma, Sea Prayer, textual analysis, Cathy Caruth.

A Simple Technique for Removal of Interlocking Screw from an Intramedullary Nail: A Case Report

Introduction: Difficulties encountered during removal of implants present a common technical challenge in orthopedic surgery, for which a number of factors have been implicated. A variety of techniques and instruments have been used to overcome this. However, some of these may prove to be time consuming, expensive, and inaccessible to many surgical setups. We describe a technique used for the removal of a jammed interlocking screw from an intramedullary nail that allows for minimal damage to the hardware, bone, and surrounding soft tissue, with the added advantage of being relatively quick and technically uncomplicated with the use of simple instruments. Case Report: We describe the case of an 81-year-old female with a history of surgical fixation for a left femur intertrochanteric fracture, who presented with groin pain 13 months post-fixation. Radiographs were suggestive of avascular necrosis of the femoral head with resultant cut-in of the blade, and the patient was eventually taken up for the removal of implants and total hip replacement. Intraoperatively, difficulties were encountered in the removal of the distal interlocking screw, with failure of conventional techniques initially. A high-speed burr was then employed to shape the screw head so as to achieve better grip with extraction devices, which facilitated smooth removal. Conclusion: We describe a simple method for difficult screw removal involving the use of a high-speed burr and vise grip pliers. This technique provides a quick and inexpensive option with commonly available surgical tools and may be considered when encountering difficulties with screw extraction. Keywords: Trauma, revision surgery, interlocking screw, screw removal.

MICROBIAL CHARACTERISTICS OF POST-TRAUMATIC OSTEOMYELITIS

Objective: The one of the most important issues in traumatology is prevention and treatment of purulent-septic complications of traumatic diseases. The aim of our study was to establish correlations between osteomyelitis caused by bacterial flora and immunological factors. Methods: On the basis of a comprehensive study of bacteriological and immunological data in 100 patients with various etiologies osteomyelitis, using correlation analysis was determined: that the types of microbial complications following trauma and the date of the body's immune system depends on etiological factors. The frequency of microbes is different and depends on the localization of the injury and the surgical intervention. Results: frequency of the etiological factors in the contingent we studied, was distributed as follows: S. aureus-36,9%, S.Epidermidis-52,4, Ps. aeruginosa 27,4%, E. coli- 13,1%, Proteus- 27,4%. Associated infection (or co-infection e.g. S. aureus+S. Epidermidis, or St.Epidermidisis+Ps. Aeruginosa and etc) occurred in 22.6% of cases. A significantly high correlation coefficient was observed in patients who came to the clinics spontaneously or with delay, as well as with the early onset of the infectious process (up to two weeks) and surgical treatment. It also correlates positively with a decrease of following immunological parameters: NK, CD4+, CD8+ and CD 19+, the leucocytes phagocytic index is reduced and the blast transformation reaction of lymphocytes rate was increased. There is a significant correlation with benign outcome of treatment, which indicates that, the patient was sent for outpatient treatment (R=0, 79). Keywords: Trauma, Osteomyelitis, Microorganism, Etiological factor, Immune system data.

War Traumata in Literature: From Homer to Sahar Khelifeh

In this paper, I identify and describe pain, its signs and symptoms, as manifested in various fictional combatants and noncombatants (civilians) in literary texts that span across few millennia and different cultures and literary genres. Since literature is imitation/representation/simulation of reality, it does give insight into the minds and souls of the characters populating it. From the writings of Homer in ancient Greece to the writings of Wilfred Owen, W.B. Yeats in Britain, Randal Jarrell in America, Ghassan Kanafani in Lebanon, Sahar Khalifeh in Palestine, and others, one can discern war tormented and traumatized characters exhibiting all sorts of symptoms, such as the Agamemnon and Achilles’ syndrome, and the Ulysses-Rambo syndrome. The symptoms exhibited by such tormented characters are similar to and go beyond those inscribed in the scholarly and professional literature in medicine and psychiatry. The paper affirms that war traumas, and pain in certain cases and under certain conditionality that involve occupation of territories and dislocation of civilians, become contagious and dangerous as the plague where the infected becomes either very sick and dies or very sick and lives. Keywords: trauma, war, identity, Homer, Sahar Khelifeh

Increasing the use of continuing professional development courses to strengthen trauma care in Ghana

Injury is a major cause of death and disability in Ghana. Strengthening care of the injured is essential to reduce this burden. Trauma continuing professional development (CPD) courses are an important component of strengthening trauma care. In many countries, including Ghana, their use needs to be more uniformly promoted. We propose lowcost strategies to increase the utilization of trauma CPD in Ghana, especially in district hospitals and higher need areas. These strategies include developing plans by regional health directorates and teaching hospitals for the regions for which they are responsible. Lists could be kept and monitored of which hospitals have doctors with which type of training. Those hospitals that need to have at least one doctor trained could be flagged for notice of upcoming courses in the area and especially encouraged to have the needed doctors attend. The targets should include at least one surgeon or one emergency physician at all regional or large district hospitals who have taken the Advanced Trauma Life Support (ATLS) (or locally-developed alternative) in the past 4 years, and each district hospital should have at least one doctor who has taken the Primary Trauma Care (PTC) or Trauma Evaluation and Management (TEAM) (or locally-developed alternatives) in the past 4 years. Parallel measures would increase enrollment in the courses during training, such as promoting TEAM for all medical students and ATLS for all surgery residents. It is important to develop and utilize more “home grown” alternatives to increase the long-term sustainability of these efforts, Keywords: trauma, injury, education, training, continuing professional developmentFunding: None