Primary Repair of Upper Extremity Peripheral Nerve Injuries: An NSQIP Analysis From 2010 to 2016

Background To identify the rate of 30-day complications after primary repair of upper extremity peripheral nerve injuries, associated diagnoses, and postoperative complication rate. Methods The American College of Surgeons National Surgical Quality Improvement Program database was reviewed from 2010 to 2016. Current Procedural Terminology codes consistent with primary nerve repair of the upper extremity were identified and included in the analysis. Patient demographics, comorbidities, type of procedure (elective/emergent), wound class, operative time, and 30-day complications were recorded. Patients with isolated upper extremity nerve injuries (isolated) were compared with those with peripheral nerve injuries in addition to bone, tendon, or soft tissue injuries (multiple). Results In all, 785 patients were identified as having upper extremity nerve repairs (0.16%). Of them, 64% were men and 36% were women; the average patient age was 40 years. The most common indication for surgery was injury to the digits (54% of cases). Thirty-day adverse events occurred in 3% of all cases. Isolated nerve injury occurred in 43% of patients, whereas 57% had additional injuries. The multiple injury group had a significantly higher complication rate compared with the isolated group (1% vs 4.5%) ( P = .007). Repair of tendon at forearm or wrist was the most common concurrent procedure performed. Conclusions Thirty-day complications among upper extremity peripheral nerve injuries are low, accounting for 3% of cases. Return to the operating room accounted for nearly half of all complications. Patients in the multiple injury group accounted for more than half of these and had a significantly higher complication rate compared with patients with isolated nerve injuries.

Non-Suicidal Self-Injury: An Observational Study in a Sample of Adolescents and Young Adults

Non-Suicidal Self-Injury (NSSI) is the self-inflicted destruction of body tissues without suicidal intent with a prevalence of 1.5% to 6.7% in the youth population. At present, it is not clear which emotional and behavioral components are specifically associated with it. Therefore, we studied NSSI in a clinical sample of youth using the Ottawa Self-injury Inventory and the Barratt Impulsiveness Scale 11. The Mann–Whitney test was used to compare the numerical responses provided to the tests. We found 54 patients with NSSI, with a mean age of 17 years. Scores were analyzed in the total sample and in four subgroups. In the total sample, Internal Emotion and External Emotion Regulation, Craving, Non-Planning and Total Impulsivity were significantly associated with NSSI. There were statistically significant differences in Craving between patients with multiple NSSI episodes, suicide attempts and multiple injury modes and patients of other corresponding subgroups, in Internal Emotion Regulation, Sensation Seeking and Motor Impulsivity between NSSI patients with suicide attempts and no suicide attempts, and in Cognitive Impulsivity between NSSI patients with multiple injury modes and one injury mode. It is necessary to carefully evaluate the components underlying NSSI in order to activate personalized treatment options.

Implementation of Clinical Nursing Practice Guideline for Treatment of Multiple Injury Patients Admitted to Emergency Department

Background: Trauma injury is the leading cause of death in Thailand. Multiple injury patients who receive nursing intervention according to the clinical nursing practice guideline for multiple injury patients are thought to be safer and less likely to experience complications. However, outcomes of using the guideline have yet to be systematically evaluated. Objective: The present study aimed to assess outcomes experienced by multiple injury patients after implementation of the clinical nursing practice guideline. Materials and Methods: The present study was a retrospective study. Patients enrolled in the study were over 18 years old and had been admitted to the Emergency Department of Srinagarind Hospital between January and December 2019 with an injury severity score (ISS) greater than or equal to 16. Results: A total of 83 patients were enrolled, 70 (84.34%) of whom were male. The mean age of the patients was 36.33 years. Most of the injuries were caused by blunt force trauma (98.80%). The mean ISS was 28.10+8.50. The clinical nursing practice guideline for multiple injury patients had a 96.71% adherence rate, with 5 activities that had a 100% adherence rate: triage, circulation with hemorrhage control, disability assessment, exposure & environment control, and evaluation. Conclusion: In practice, nurses followed the guideline to a high degree. Systolic blood pressure, pulse rate, body temperature, and oxygen saturation were improved factors after implementation of the clinical nursing practice guideline for multiple injury patients. Keywords: Clinical nursing practice guideline, Multiple injury patients, Nursing outcomes

Statistical Methods for Handling Observation Clustering in Sports Injury Surveillance

Context Advances in sports injury-surveillance methods have made it possible to accommodate non–time-loss (NTL) injury reporting; however, the analysis of surveillance data now requires careful consideration of the nuances of NTL injury records. Background Injury-surveillance mechanisms that record NTL injuries are more likely to contain multiple injury records per athlete. These must be handled appropriately in statistical analyses to make methodologically sound inferences. Methods We simulated datasets of NTL injuries using varying degrees of observation clustering and compared the inferences made using traditional techniques with those made after accounting for clustering in computations of injury proportion ratios. Results Inappropriate handling of even moderate clustering resulted in flawed inferences in 10% to 12% of our simulations. We observed greater bias in our estimates as the degree of clustering increased. Conclusions We urge investigators to carefully consider observation clustering and adapt analytical methods to accommodate the evolving sophistication of surveillance.