Biochemical markers in emergency thoracic surgery in penetrating trauma.

BACKGROUND: Violent interpersonal acts account for a large proportion of unnatural deaths in South Africa. A significant proportion of unnatural deaths are due to penetrating thoracic trauma and preventable haemorrhage. Current indications for emergent thoracotomy are unreliable. We propose the use of lactate, shock index (SI) and base deficit (BD) as a triage tool in patients with penetrating thoracic injuries to identify those requiring surgical intervention. METHODS: A review of the trauma registry of the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) was carried out between March 2011 and March 2016. Four hundred and ninety (490) patients were collected consisting of a non-operative group of 246 patients and an operative group of 244 patients. We compared lactate, SI and BD independently and within panels to ascertain which would best predict the need for operative intervention in these patients. Abnormal was defined as lactate ≥ 4 mmol/l, SI ≥ 0.8 and BD ≤ -4 mmol/l. RESULTS: Of the 490 patients, lactate (p < 0.001), SI (p < 0.001) and BD (p < 0.001) differed significantly between operative and non-operative groups. Statistical significance was lost (p = 0.34) once BD was analysed in combination with lactate and SI. Lactate alone was a strong predictor of the need for intervention (area under the curve (AUC) = 0.814). The strongest predictor was a combined panel of lactate and SI (AUC = 0.8308, p < 0.001). CONCLUSION: Lactate and SI in combination are useful as triage tools, and could assist in decision making, by predicting which patients are more likely to require surgical intervention.

An analysis of air-crash injury patterns presenting at a level 1 trauma unit in Johannesburg, a retrospective cohort study.

BACKGROUND: In the twenty-first century, transportation disasters and subsequent injuries are on the rise, in particular air travel, and, thus, contributing significantly to the morbidity and mortality. Aviation injuries are not common in South Africa, injuries and outcomes of patients involved in aircraft crashes are unknown. We aimed to describe the injury patterns, and mortality rate resulting from air crashes presenting at a level 1 trauma centre in Johannesburg, South Africa. METHODS: Data was collected between January 2011 and December 2019. The hospital trauma database was used to obtain data related to patients who were involved in aircraft crashes. Their demographics, type of related aircraft, injuries sustained, injury severity score (ISS), new injury severity score (NISS), revised trauma score (RTS) surgical intervention carried out, length of stay in ICU, length of hospital stay, morbidities, 28-day mortality and outcomes (discharge/death). RESULTS: Fifty-two (52) patients (mean age was 44,8 years) were identified. The mean ISS was 9, and NISS was 11. Patients were occupants of civilian, non-commercial, powered aircraft. Fixed wing constituted 63,46%, followed by helicopters 21,15% and 7,69%. Spinal injuries were the most common injury in our patients, followed by soft tissue injuries and rib fractures. The median hospital stay was 10 ± 22 days. The overall in-hospital mortality rate was 7.7. CONCLUSION: Majority of patients sustained musculoskeletal injuries. We suggest that these injured patients should be managed at a Level 1 facility in view of combined multiple injuries sustained during the crash.