Traumatic Spinal Injuries in Saudi Arabia: A Retrospective Single-center Medical Record Review

Introduction: The aim of this retrospective medical record review was to describe the patterns and outcomes of traumatic spinal injuries (TSIs) in a tertiary care trauma center in Riyadh, Saudi Arabia. Methodology: Data of all patients who presented at a setting level-1 trauma center with any type of spinal trauma between February 1, 2016 and December 31, 2018 were review. The data obtained included age, gender, nationality (as Saudi and non-Saudi), date of presentation, site of fracture/injury, associated injuries, mechanism of injury, presence of neurological involvement, and hospital mortality. The main outcome of the review was frequencies of different types of TSI across various subgroups. Result: We identified 692 patients who presented with TSI during the study period. The mean age was 36.9 years. Males represented 83.2% (n = 576) of the sample size, and the most common mechanism of injury was motor vehicle collision (MVC), accounting for 66.8% of the cases (n = 462), while fall-related injuries were seen in 31.6% of the cases (n = 219). A total of 454 (65.6%) of all patients were Saudi, and 332 (73.1%) of the TSIs in Saudis were due to MVC. Non-Saudi cases accounted for 238 (34.4%) of all patients, and 89 (37.4%) of the non-Saudi injuries were due to falls from height, this association was statistically significant (p < 0.001). Conclusion: TSI was not thoroughly examined in Saudi Arabia; therefore, this study is considered the first to be done in the Kingdom using a representative sample. The fact that non-Saudi patients had a higher proportion of falls as a mechanism of injury should be taken into consideration in terms of raising awareness and taking more safety precautions, as most construction workers tend to be expatriates.

How to Measure Goal Concordant Care in Order to Evaluate Advance Care Planning with Integrity: A Literature Review

"Advance care planning is an effort to consider and communicate one’s values, goals, and preferences as they relate to future healthcare decisions to guide clinicians and loved ones when one is incapable of consenting, refusing, or requesting care. While generally accepted as valuable, advance care planning has proven challenging to evaluate. Goal concordant care is increasingly recognized as the target outcome, but there is no agreed-on methodology for assessment and some question if it can be meaningfully captured. It is ethically necessary to have a strong evidence base to guide practice. The current study is a literature review designed to support best practice for measuring goal concordant care. A database search of Pubmed, Embase, PsycINFO, CINAHL, and Cochrane was conducted in September 2020; articles were included that measured whether advance care planning, defined broadly to consider advance directives, use of proxies, POLSTs, etc., led to goal concordant care. 132 included articles were reviewed according to aim, methodology, and integrity. Common approaches included medical record review 51% (n = 36); questionnaire (36%, n = 48), notably the Decision Conflict Scale (15% of questionnaires, n = 7); and interview (31%, n = 42), often with loved ones after death (40% of interviews, n = 17). Studies, especially those employing medical record review, did not always present enough detail to be reproducible, a concerning limitation. Despite the many existing studies aiming to track whether advance care planning leads to goal concordant care, significant work remains to establish sound methodology to do so meaningfully. "

Characteristics and Injury Patterns of Road Traffic Injuries in Urban and Rural Uganda—A Retrospective Medical Record Review Study in Two Hospitals

In the ongoing Second Decade of Action for Road Safety, road traffic crashes pose a considerable threat especially in low-income countries. Uganda shows a vast burden of non-fatal injuries and resides at the top range of countries with the highest death rates due to unsafe roads. However, little is known about the differences in road traffic associated injuries between urban and rural areas and potential influence factors. Here, we used a cross-sectional study conducted by a retrospective medical record review from trauma cases admitted in 2016 to hospitals in rural and urban areas in Uganda. Injury severity scores were calculated and descriptive analysis was carried out while multivariate logistic regression was applied to assess significant covariates. According to the 1683 medical records reviewed, the mean age of trauma patients in the dataset under investigation was 30.8 years with 74% male. The trauma in-hospital mortality was 4% while prevalence of traumatic injuries is 56.4%. Motorcycle users (49.6%) and pedestrians (33.7%) were identified as the most vulnerable groups in both urban and rural setting while mild injuries of extremities (61.6%) and the head/neck-region (42.0%) were registered most. The frequency of road traffic injuries was homogenous in the urban and rural hospitals investigated in this study; interventions should therefore be intensified ubiquitously. The identification of significant differences in road traffic crash and injury characteristics provides the opportunity for specific programmes to decrease the socio-economic and health burden of unsafe roads. In addition to law enforcement and introduction of a Systems Thinking approach to road safety including infrastructural and educational concepts, the strengthening of trauma care and health resources is recommended.

Indications for and Utility of Tracheal Aspirate Cultures for the Diagnosis of VAI

Background: Tracheal aspirate bacterial cultures are routinely collected in mechanically ventilated children for the evaluation of ventilator-associated infections (VAIs). However, frequent bacterial colonization of endotracheal and tracheostomy tubes contribute to the marginal performance characteristics of the test for diagnosing VAI. Published literature characterizing drivers of culture collection and the predictive value of positive cultures are limited. Methods: This single-center, retrospective cohort study included children admitted to the pediatric intensive care unit who were receiving mechanical ventilation for at least 48 hours and had 1 or more semiquantitative tracheal aspirate cultures collected between September 1, 2019, and August 31, 2020. Indications for culture collection were determined through medical record review and included fever, hypothermia, tracheal secretion changes, radiographic pneumonia, increased oxygen requirement, and/or increased positive end-expiratory pressure (PEEP). A positive culture was defined as moderate or heavy growth of a noncommensal bacterial organism. A purulent Gram stain was defined as detection of moderate or many white blood cells. Diagnosis of VAI was based on treating-clinician documentation and was ascertained through medical record review. Logistic regression accounting for clustering by patient was performed to estimate the association between indications for culture collection and (1) culture positivity, (2) purulent Gram stain, and (3) diagnosis of VAI. Results: In total, 625 tracheal aspirate cultures were performed in 261 unique patients. Common indications for culture collection included isolated fever or hypothermia (n = 124, 20%), fever with an increase in oxygen requirement or PEEP (n = 71, 11%), isolated increase in oxygen requirement or PEEP (n = 67, 11%), or isolated secretion change (n = 54, 9%) (Figure 1). Overall, 230 cultures (37%) were positive and 218 (35%) Gram stains were purulent. There were no associations between culture indications and a positive culture. Presence of isolated fever was negatively associated with a purulent Gram stain (odds ratio [OR], 0.49; 95% CI, 0.30–0.81; P = .005); otherwise, there were no associations between indication and purulent Gram stain. Finally, in a multivariable model, odds of VAI diagnosis increased with both the number of indications for culture collection and purulent Gram stain, but not with positive culture (Figure 2). Conclusions: Number and type of clinical signs were not associated with tracheal aspirate culture positivity or purulence on Gram stain, but they were associated with a clinical diagnosis of VAI. These findings suggest that positive tracheal aspirate cultures may not aid clinicians in the diagnosis of VAI, and they highlight the opportunity for improved diagnostic stewardship.Funding: NoDisclosures: None

Tinjauan Pelaksanaan Review Rekam Medis dalam Rangka Persiapan Akreditasi Rumah Sakit Berdasarkan Standar Akreditasi SNARS-1 di RSUD Sultan Thaha Saifuddin Kabupaten Tebo Provinsi Jambi

Sultan Thaha Saifuddin Hospital is heading towards the implementation of SNARS-1. The first phase of accreditation in 2016 uses the 2012 version with only four services (SKP, HPK, KPS, PPI) so that there is no medical record review assessment as in the MIRM 13.4 SNARS-1 assessment element. Currently, Sultan Thaha Saifuddin Hospital must adjust the medical record review with the MIRM standard on SNARS-1. Field Study Practices at the Sultan Thaha Saifuddin Hospital, Tebo Jambi Regency on April 1, 2019 to April 20, 2019 with the aim of knowing the implementation of medical record reviews based on the SNARS-1 accreditation standard. Methods of data collection are carried out by observation and interviews using observation sheets and interview guides. The results of the field study practice are: there is a team responsible for reviewing medical records called the medical record committee; there is an SPO regarding medical record review; review of medical records using an open, closed, and recapitulation review form; There was an increase in the quality of medical records based on the results of reviews between period 1 and period 2, namely from 89.65% to 96.8% on timeliness, an increase from 95.4% to 97.6% in legibility, and an increase from 97, 6% to 99.2% on completeness of medical records. The implementation of reviewing medical records at Sultan Thaha Saifuddin Hospital is in accordance with the applicable SPO. The implementation of the review is also in accordance with the SNARS-1 assessment elements.Keyword: medical record, completness, Accreditation Assessment SNARS-1 AbstrakRSUD Sultan Thaha Saifuddin sedang menuju implementasi SNARS-1. Akreditasi tahap pertama tahun 2016 menggunakan versi 2012 baru sebatas empat pelayanan (SKP, HPK, KPS, PPI) sehingga belum ada penilaian review rekam medis seperti pada elemen penilaian MIRM 13.4 SNARS-1. Saat ini, RSUD Sultan Thaha Saifuddin harus menyesuaikan review rekam medis dengan standar MIRM pada SNARS-1. Praktik Belajar Lapangan dilakukan di RSUD Sultan Thaha Saifuddin Kabupaten Tebo Jambi pada tanggal 01 April 2019 sampai 20 April 2019 dengan tujuan untuk mengetahui pelaksanaan review rekam medis berdasarkan standar akreditasi SNARS-1. Metode pengumpulan data dilakukan dengan observasi dan wawancara menggunakan lembar observasi dan panduan wawancara. Hasil praktik belajar lapangan yaitu: terdapat tim yang bertanggung jawab pada review rekam medis disebut panitia rekam medis; terdapat SPO tentang review rekam medis; review rekam medis menggunakan form review terbuka, tertutup, serta rekapitulasi; terdapat kenaikan kualitas rekam medis berdasarkan hasil review antara periode 1 dan periode 2 yaitu dari 89,65% menjadi 96,8% pada ketepatan waktu, terjadi kenaikan dari 95,4% menjadi 97,6% pada keterbacaan, serta terjadi kenaikan dari 97,6% menjadi 99,2% pada kelengkapan rekam medis. Pelaksanaan review rekam medis di RSUD Sultan Thaha Saifuddin telah sesuai dengan SPO yang berlaku. Pelaksanaan review juga telah sesuai dengan elemen penilaian SNARS-1.Kata Kunci: rekam medis, kelengkapan, akreditasi SNARS-1