ABSTRACT
BACKGROUND: Trauma patients are known to be at increased risk of venous thromboembolism (VTE), and pulmonary embolism (PE) is one of the preventable causes of mortality in trauma patients. The incidence of VTE in Asian populations was believed to be lower than in Caucasians, but the recent literature suggests that this is not the case. The purpose of this study was to assess the incidence of VTE in Asian major trauma patients and to examine the manner of presentation, use of prophylaxis and risk factors for VTE. While other studies of VTE have addressed general and high-risk populations within Asia, our study is one of the few to examine Asian major trauma patients. METHODS: Data for all patients with VTE were extracted from the Singapore General Hospital trauma database over a 10-year period from 1998 to 2007. Patient profiles and clinical factors were compared to patients without a diagnosis of VTE admitted with injuries in the same time period. RESULTS: There were 8,615 patients entered into our database in this 10-year period. Thirty-four patients had VTE, with an overall incidence of 0.39 %. Thirteen patients had pulmonary embolism, an incidence of 0.15 %. Of note, 30 % of patients with deep vein thrombosis (DVT) presented with fever alone without limb symptoms. Almost all 34 patients who developed VTE had either head injury, a spinal cord injury or a pelvic/extremity injury. Eighteen patients had head injury, 22 patients sustained pelvic or extremity injury, and three patients had spinal cord injury with paraplegia. Head injury and spinal cord injury with neurologic sequelae were statistically significant risk factors for VTE (p < 0.05). CONCLUSION: The incidence of symptomatic VTE in the Asian trauma population is no lower than in the West. The incidence found in this study is similar to the incidence of VTE according to a study using data from the American national trauma data bank using similar study methods and with a similar study population. It is also higher than the incidence in the literature for general post-surgical Asian patients. Fever was the presenting factor in some patients and screening for VTE should not be forgotten when assessing fever in the trauma patient. The strong association between head injury, spinal cord injury and VTE confirms that we should pay special attention to VTE prophylaxis for our patients with these injuries.
ABSTRACT
BACKGROUND: Trauma morbidity and mortality outcome is better in high-volume trauma centers. However, there are few publications investigating the experience of high-volume centers with high non-trauma emergency load but seeing a relatively low incidence of trauma. The objective of this study is to review the presentation and outcomes for the low volume of patients presenting with penetrating injuries in a high-volume hospital. METHODS: Data were extracted from the Singapore General Hospital database between 1998 and 2007. There were 1,233 patients who sustained penetrating injuries and were brought to the hospital during the 10-year period. Of these, only 78 patients had injury severity score (ISS) values of 16 or more. In the same period, there were 1,270 patients with ISS > 15 who were admitted with blunt injury. SPSS 10.1 was used to conduct univariate and multivariate analyses to elucidate risk factors for mortality. RESULTS: Age, ISS, and trauma injury severity score (TRISS) were significant predictors of mortality. Gender and type of injury were not predictive of mortality. Mortality outcomes were independently predicted by age, TRISS, and ISS. The most common site of injury was the chest, followed closely by the head and neck. The abdomen/pelvis was the third most common site of injury. There was no significant difference in anatomical site injury pattern between the survivors and non-survivors. For both groups, chest injuries and head and neck injuries dominated, with maximal abdominal/pelvic injuries a distant third. CONCLUSION: With a trauma system in place, high-volume centers with a low volume of penetrating injury patients can still manage uncommon injuries without jeopardizing patient care.
ABSTRACT
Falls from a height are a common problem in Singapore. However, there has been no analysis of the injury patterns and outcomes of patients who survived initial resuscitation after falls from a height in Singapore. One hundred and thirty-nine patients admitted over a two-and-a-half year period after falls of greater than one storey were studied. The higher the fall, the greater the likelihood of hypotension and neurological injury. The length of stay in hospital, the number of operative procedures and mortality also correlated with the height of the fall. The overall mortality rate was 11% but rose to 47% among patients who were hypotensive on admission. About half of the deaths were due to head injury with haemorrhage being the second most common cause. The majority of patients who fell from five or more storeys did so intentionally, and had more severe torso and extremity injuries compared with those who fell accidentally. These findings suggest that efforts in injury prevention and aggressive evaluation and treatment of fall victims arriving alive at the hospital continue to be important.