Profile of ocular injuries amongst various trauma patients presenting to tertiary care centre of Punjab

To study the epidemiology and clinical profile of ocular trauma patients presenting to tertiary care centre. Prospective study. All patients of ocular trauma in OPD/Emergency were assessed for detail between 1/1/17 to 31/6/18 and data on demographic profile was established as per guidelines of Ocular Trauma Society of India. Patients were categorized in different segments and assessed/followed for visual impairment in particular. A total of 246 cases were examined out of which 87% were males. The most common mode of ocular injury was Road Traffic Accidents. Pediatric eye trauma constituted 16.7% of the total cases. 26.8% cases arrived to our centre between 4-24 hours and 62.6% cases presented after 24 hours. Amongst 131 cases of Road Traffic Accidents, none of them were using protective measures like helmets or goggles. Of these, 17.1% were under the influence of alcohol. 28.5% were involved in medicolegal proceedings. Majority of the cases comprised of monocular trauma (78.1%). Closed globe injuries constituted 88.94% of the total cases of which most cases presented with lid edema and ecchymosis. Chemical injuries were reported in 4.5% cases. 9 patients lost vision completely and 71 cases had vision from light perception to 6/18. Ocular trauma is one of the common causes of ocular morbidity. It has been seen predominantly in male population. Public needs to be educated about safety measurements and education about prompt need to specialised care to reduce ocular trauma related visual morbidity.

The place and role of scientific knowledge in risk and trauma society: The analysis of modern Russian sociologists’ concepts

The article refers to the works of O. N. Yanitskiy, Zh. T. Toschenko and S. A. Kravchenko that are focused on modern world social processes, particularly in modern Russia. The purpose of the article is to identify the general and specific views of modern Russian sociologists on the role of scientific knowledge in developing Russian society. The importance of scientific knowledge in the political processes (O. N. Yanitskiy), in the process of developing and implementing the national government strategy (Zh. T. Toshchenko) and, in the most general sense, at the level of social dynamics (S. A. Kravchenko) is out of question. All three authors agree that the progressive development of society is largely determined by the development of the institute of science. Zh. T. Toshchenko hightlights the important role of scientific knowledge in trauma society. O. N. Yanitskiy shows specific mechanisms for the production of social and scientific knowledge and its inclusion in political processes. S. A. Kravchenko focuses on comprehending new qualities and new ways of becoming a scientist and an expert in risk and trauma society.

Comparison of Ocular Trauma Between Normalized and The COVID-19 Epidemic Periods in China: A Multi-Center Cross-Sectional Study

Background: To compare the feature of ocular trauma between normalized period and the COVID-19 epidemic period in China, to provide a scientific basis for prevention and control eye injuries in special times in future.Methods: This study is a multi-center cross-sectional study with 30 participated hospitals involving the China Ocular Trauma Society members. All hospitalized cases who visited the ophthalmology department in participated hospitals with eye injuries during the normalized period (2019) and the COVID-19 epidemic period (2020) were included in this study. Demographic characteristic of cases, date of injury, sites and types of injury were collected.Results: This study involved 13525 (61cases with both eyes) injured cases. There were 7269 (53.74%) eye-injured cases and 6256 (46.26%) eye-injured cases in 2019 and 2020 separately. Compared with 2019, the incidence of ocular trauma in retirees, housewives and unemployed increased with year-on-year of 4.96%, 102.67% and 11.64% among all occupations. In 2020, the incidence of eye injuries decreased in all injury sites except for an increase in home (30.29% year-on-year). The incidence of mechanical eye injuries decreased, while that of non-mechanical eye injuries (Chemical/Thermal/Radiation) increased (47.45% year-on-year). There were 255 (3.50%, 255/7269) and 376 (6.01%, 376/6256) non-mechanical injured cases in 2019 and 2020 (Pearson chi2 = 47.33, P < 0.001) separately.Conclusions: During the COVID-19 epidemic period, the incidence of eye injuries decreased. The prevention and control measures should be focused on the non-mechanical injuries, and the retirees, unemployed and housewives during public events period in future.

Barriers and facilitators to answering clinical questions in the Americas: a cross-sectional study of surgical trauma care providers

BackgroundWe aimed to understand how surgical trauma providers in the Americas acquire answers to clinical questions and what barriers and facilitators they face in efforts to practice according to recommendations for common surgical cases. We hypothesized that increased English proficiency and country income improved providers’ acquisition and application of clinical knowledge.MethodsA 23-question survey evaluated reported confidence in interpretation of evidence, perceived language fluency, and access to and application of recommendations on sepsis and appendicitis. Electronic surveys were distributed across the Americas to Pan American Trauma Society members.Results108 participants from 21 countries completed this survey. 59% had ≥21 years of provider experience. 38% reported their English reading comprehension as less than or equal to “limited working proficiency.” 44% endorsed using Google Translate; 35% reported they did not need translation tools to evaluate medical literature. 59% felt uncertainty regarding clinical care at least weekly. 65% reported inability to answer their clinical questions at least once per month. 86% felt confident in their ability to interpret and apply evidence for their practice. To answer clinical questions, participants listed guidelines (76%), full-text peer-reviewed journal articles (61%), and meta-analyses (49%) as their most used resources. 25% answered all five clinical questions correctly, whereas 43% answered three or fewer correctly. 79% felt they had adequate access to resources to answer the five clinical questions. When controlling for individual demographic characteristics, decreased age (p<0.01) and increased country income level (p=0.03) positively impacted correct answers to questions.DiscussionUncertainties in clinical care are unavoidable. Language, age, and country income level impacted provider acquisition and application of knowledge relevant to select clinical scenarios. These findings highlight disparities in access and training and add urgency to the movement for improved dissemination and implementation approaches for evidence-based practice in surgery.Level of evidenceIV.

Penetrating injuries in Germany – epidemiology, management and outcome an analysis based on the TraumaRegister DGU®

Background The management of penetrating wounds is a rare challenge for trauma surgeons in Germany and Central Europe as a result of the low incidence of this type of trauma. In Germany, penetrating injuries are reported to occur in 4–5 % of the severely injured patients who are enrolled in the TraumaRegister DGU® (trauma registry of the German Trauma Society). They include gunshot injuries, knife stab injuries, which are far more common, and penetrating injuries of other origin, for example trauma caused by accidents. The objective of this study was to assess the epidemiology and outcome of penetrating injuries in Germany, with a particular focus on the level of care provided by the treating trauma centre to gain more understanding of this trauma mechanism and to anticipate the necessary steps in the initial treatment. Materials and methods Since 2009, the TraumaRegister DGU® has been used to assess not only whether a trauma was penetrating but also whether it was caused by gunshot or stabbing. Data were taken from the standard documentation forms that participating German hospitals completed between 2009 and 2018. Excluded were patients with a maximum abbreviated injury scale (MAIS) score of 1 with a view to obtaining a realistic idea of this injury entity, which is rare in Germany. Results From 2009 to 2018, there were 1123 patients with gunshot wounds, corresponding to a prevalence rate of 0.5 %, and 4333 patients with stab wounds (1.8 %), which were frequently caused by violent crime. The high proportion of intentionally self-inflicted gunshot wounds to the head resulted in a cumulative mortality rate of 41 % for gunshot injuries. Stab wounds were associated with a lower mortality rate (6.8 %). Every fourth to fifth patient with a gunshot or stab wound presented with haemorrhagic shock, which is a problem that is seen during both the prehospital and the inhospital phase of patient management. Of the patients with penetrating injuries, 18.3 % required transfusions. This percentage was more than two times higher than that of the basic group of patients of the TraumaRegister DGU®, which consists of patients with a MAIS ≥ 3 and patients with a MAIS of 2 who died or were treated on the intensive care unit. Conclusions In Germany, gunshot and stab wounds have a low incidence and are mostly caused by violent crime or attempted suicides. Depending on the site of injury, they have a high mortality and are often associated with major haemorrhage. As a result of the low incidence of these types of trauma, further data and analyses are required in order to provide the basis for evaluating the long-term quality of the management of patients with stab or gunshot wounds.

Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures—Results from the Registry for Geriatric Trauma of the German Trauma Society

Background and Objectives: Appropriate timing of surgery for periprosthetic femoral fractures (PFFs) in geriatric patients remains unclear. Data from a large international geriatric trauma register were analyzed to examine the outcome of patients with PFF with respect to the timing of surgical stabilization. Materials and Methods: The Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie (DGU)) (ATR-DGU) was analyzed. Patients treated surgically for PFF were included in this analysis. As outcome parameters, in-house mortality rate and mortality at the 120-day follow-up as well as mobility, the EQ5D index score and reoperation rate were analyzed in relation to early (<48 h) or delayed (≥48 h) surgical stabilization. Results: A total of 1178 datasets met the inclusion criteria; 665 fractures were treated with osteosynthesis (56.4%), and 513 fractures were treated by implant change (43.5%). In contrast to the osteosynthesis group, the group with implant changes underwent delayed surgical treatment more often. Multivariate logistic regression analysis of mortality rate (p = 0.310), walking ability (p = 0.239) and EQ5D index after seven days (p = 0.812) revealed no significant differences between early (<48 h) and delayed (≥48 h) surgical stabilization. These items remained insignificant at the follow-up as well. However, the odds of requiring a reoperation within 120 days were significantly higher for delayed surgical treatment (OR: 1.86; p = 0.003). Conclusions: Early surgical treatment did not lead to decreased mortality rates in the acute phase or in the midterm. Except for the rate of reoperation, all other outcome parameters remained unaffected. Nevertheless, for most patients, early surgical treatment should be the goal, so as to achieve early mobilization and avoid secondary nonsurgical complications. If early stabilization is not possible, it can be assumed that orthogeriatric co-management will help protect these patients from further harm.

Penetrating injuries in Germany – Epidemiology, management and outcome - An analysis based on the TraumaRegister DGU®

Background The management of penetrating wounds is a rare challenge for trauma surgeons in Germany and Central Europe as a result of the low incidence of this type of trauma. In Germany, penetrating injuries are reported to occur in 4–5% of the severely injured patients who are enrolled in the TraumaRegister DGU® (trauma registry of the German Trauma Society). They include gunshot injuries, knife stab injuries, which are far more common, and penetrating injuries of other origin, for example trauma caused by accidents. The objective of this study was to assess the epidemiology and outcome of penetrating injuries in Germany, with a particular focus on the level of care provided by the treating trauma centre to gain more understanding of this trauma mechanism and to anticipate the necessary steps in the initial treatment. Materials and methods Since 2009, the TraumaRegister DGU® has been used to assess not only whether a trauma was penetrating but also whether it was caused by gunshot or stabbing. Data were taken from the standard documentation forms that participating German hospitals completed between 2009 and 2018. Excluded were patients with a maximum abbreviated injury scale (MAIS) score of 1 with a view to obtaining a realistic idea of this injury entity, which is rare in Germany. Results From 2009 to 2018, there were 1123 patients with gunshot wounds, corresponding to a prevalence rate of 0.5%, and 4333 patients with stab wounds (1.8%), which were frequently caused by violent crime. The high proportion of intentionally self-inflicted gunshot wounds to the head resulted in a cumulative mortality rate of 41% for gunshot injuries. Stab wounds were associated with a lower mortality rate (6.8%). Every fourth to fifth patient with a gunshot or stab wound presented with haemorrhagic shock, which is a problem that is seen during both the prehospital and the inhospital phase of patient management. Of the patients with penetrating injuries, 18.3% required transfusions. This percentage was more than two times higher than that of the basic group of patients of the TraumaRegister DGU®, which consists of patients with a MAIS ≥ 3 and patients with a MAIS of 2 who died or were treated on the intensive care unit. Conclusions In Germany, gunshot and stab wounds have a low incidence and are mostly caused by violent crime or attempted suicides. Depending on the site of injury, they have a high mortality and are often associated with major haemorrhage. As a result of the low incidence of these types of trauma, further data and analyses are required in order to provide the basis for evaluating the long-term quality of the management of patients with stab or gunshot wounds.

Penetrating Injuries in Germany – Epidemiology, Management and Outcome - An Analysis Based on The TraumaRegister DGU®

BackgroundThe management of penetrating wounds is a rare challenge for trauma surgeons in Germany and Central Europe as a result of the low incidence of this type of trauma. In Germany, penetrating injuries are reported to occur in 4–5% of the severely injured patients who are enrolled in the TraumaRegister DGU® (trauma registry of the German Trauma Society). They include gunshot injuries, knife stab injuries, which are far more common, and penetrating injuries of other origin, for example trauma caused by accidents. The objective of this study was to assess the epidemiology and outcome of penetrating injuries in Germany, with a particular focus on the level of care provided by the treating trauma centre to gain more understanding of this trauma mechanism and to anticipate the necessary steps in the initial treatment.Materials and methodsSince 2009, the TraumaRegister DGU® has been used to assess not only whether a trauma was penetrating but also whether it was caused by gunshot or stabbing. Data were taken from the standard documentation forms that participating German hospitals completed between 2009 and 2018. Excluded were patients with a maximum abbreviated injury scale (MAIS) score of 1 with a view to obtaining a realistic idea of this injury entity, which is rare in Germany. ResultsFrom 2009 to 2018, there were 1123 patients with gunshot wounds, corresponding to a prevalence rate of 0.5%, and 4333 patients with stab wounds (1.8%), which were frequently caused by violent crime. The high proportion of intentionally self-inflicted gunshot wounds to the head resulted in a cumulative mortality rate of 41% for gunshot injuries. Stab wounds were associated with a lower mortality rate (6.8%). Every fourth to fifth patient with a gunshot or stab wound presented with haemorrhagic shock, which is a problem that is seen during both the prehospital and the inhospital phase of patient management. Of the patients with penetrating injuries, 18.3% required transfusions. This percentage was more than two times higher than that of the basic group of patients of the TraumaRegister DGU®, which consists of patients with a MAIS ≥ 3 and patients with a MAIS of 2 who died or were treated on the intensive care unit.ConclusionsIn Germany, gunshot and stab wounds have a low incidence and are mostly caused by violent crime or attempted suicides. Depending on the site of injury, they have a high mortality and are often associated with major haemorrhage. As a result of the low incidence of these types of trauma, further data and analyses are required in order to provide the basis for evaluating the long-term quality of the management of patients with stab or gunshot wounds.