A traumatic tale of two cities: does EMS level of care and transportation model affect survival in patients with trauma at level 1 trauma centres in two neighbouring Canadian provinces?

BACKGROUND: Two distinct Emergency Medical Services (EMS) systems exist in Atlantic Canada. Nova Scotia operates an Advanced Emergency Medical System (AEMS) and New Brunswick operates a Basic Emergency Medical System (BEMS). We sought to determine if survival rates differed between the two systems. METHODS: This study examined patients with trauma who were transported directly to a level 1 trauma centre in New Brunswick or Nova Scotia between 1 April 2011 and 31 March 2013. Data were extracted from the respective provincial trauma registries; the lowest common Injury Severity Score (ISS) collected by both registries was ISS≥13. Survival to hospital and survival to discharge or 30 days were the primary endpoints. A separate analysis was performed on severely injured patients. Hypothesis testing was conducted using Fisher's exact test and the Student's t-test. RESULTS: 101 cases met inclusion criteria in New Brunswick and were compared with 251 cases in Nova Scotia. Overall mortality was low with 93% of patients surviving to hospital and 80% of patients surviving to discharge or 30 days. There was no difference in survival to hospital between the AEMS (232/251, 92%) and BEMS (97/101, 96%; OR 1.98, 95% CI 0.66 to 5.99; p=0.34) groups. Furthermore, when comparing patients with more severe injuries (ISS>24) there was no significant difference in survival (71/80, 89% vs 31/33, 94%; OR 1.96, 95% CI 0.40 to 9.63; p=0.50). CONCLUSION: Overall survival to hospital was the same between advanced and basic Canadian EMS systems. As numbers included are low, individual case benefit cannot be excluded.

Delays to initial reduction attempt are associated with higher failure rates in anterior shoulder dislocation: a retrospective analysis of factors affecting reduction failure.

INTRODUCTION: Little is understood about the relationship between delay to treatment and initial reduction success for anterior shoulder dislocation. Our study examines whether delays to initial treatment, from injury and hospital presentation, are associated with higher reduction failure rates for anterior shoulder dislocation. METHODS: A retrospective database and chart review was performed for patients undergoing intravenous sedation for attempted reduction of anterior shoulder dislocation in the emergency department (ED). Stepwise regression analysis was performed to identify predictors of reduction failure. Key variables analysed were the duration of the wait in the ED, the interval between the time of injury and first intervention and the interval from time of injury to arrival at the ED. Possible confounding variables analysed included age, gender, dose of sedative agent, qualifications of the reducing physician and whether the dislocated shoulder was recurrent. RESULTS: The duration of the intervals from injury to first reduction attempt and from arrival at the ED to first reduction attempt were both independent predictors of a higher reduction failure rate (OR=1.07, 95% CI 1.02 to 1.13; OR=1.19, 95% CI 1.05 to 1.34). Every interval of 10 min increased the odds of a failed reduction attempt by 7% and 19%, respectively. Overall, shoulder reduction was successful during the initial sedation event in 97 cases (92%) and unsuccessful in nine cases (8%). CONCLUSIONS: Delays to first reduction attempt either from the time of injury or within the ED are associated with a lower reduction success rate for anterior shoulder dislocations.

Retrospective Use of the Pictorial Fit-Frail Scale for Determination of Frailty Level in Hospitalized Older Adults with a Hip Fracture.

The Pictorial Fit-Frail Scale (PFFS) is a frailty tool consisting of visual images to comprehensively assess frailty across 14 domains that can be completed by health professionals, patients, or caregivers. The objective of this study was to explore the feasibility of using the PFFS retrospectively to determine a patient's frailty level using data from the hospital electronic health records (EHRs) of older adults admitted with an isolated hip fracture. A random sample of 200 hip fracture patients admitted to a Level 1 Trauma Center hospital in New Brunswick was selected for review using the PFFS. The majority (94.5%) of hospital EHRs contained the clinical information needed to populate most of the 14 PFFS domains, allowing for determination of a frailty score. The mean raw PFFS frailty score was 9.7 (SD 6.6), consistent with moderate frailty. For all patients, a Frailty Index (FI) score was calculated, with the mean being 0.27 (SD 0.18), again consistent with moderate frailty. Comparing the PFFS score to the FI score, the percentage categorized as not frail or very mildly frail fell from 33.3% to 20.1%, and those considered severely frail rose from 30.7% to 34.9%. The PFFS can be successfully used retrospectively with hospital EHRs to determine the frailty level of older patients. When converted to the FI score, there was an increase in the frequency and severity of frailty. This tool may provide a useful way to stratify older adults by frailty that can be helpful in evaluating health outcomes based on frailty levels.

L-ascorbic acid ameliorates postnatal endosulfan induced testicular damage in rats.

The aim of the present study is to investigate the effect of L-ascorbic acid on postnatal exposure of endosulfan induced testis damage in the rat. Four groups of seven day old male Wistar rats were treated with 3, 6, 9 and 12 mg/kg endosulfan orally (10 pups/group), from postnatal day 7 to 60 at intervals of 24 h. For 2 more groups (n = 10/group), endosulfan (9 mg/kg and 12 mg/kg) was administered along with L-ascorbic acid (20 mg/kg). The sperm morphology, sperm count and sperm motility was analyzed in all the groups on postnatal day 70. Endosulfan significantly affected the testicular function enhancing the incidence of abnormal spermatozoa, decreasing the sperm count and sperm motility in a dose dependent manner. Abnormalities were of both head and tail and increase in their frequency was more than two-fold of the control value. Sperm count abruptly decreased in 12 mg/kg group and sperm motility decreased up to 50% of the control value. L-ascorbic acid has nullified the toxic effects of the pesticide significantly, but not to the control level. Endosulfan induces the testicular damage following postnatal exposure and L-ascorbic acid prevents the adverse effects considerably in the rat.

Controlled cooling versus rapid freezing of teratozoospermic semen samples: Impact on sperm chromatin integrity.

AIM: The present study evaluates the impact of controlled slow cooling and rapid freezing techniques on the sperm chromatin integrity in teratozoospermic and normozoospermic samples. SETTING: The study was done in a university infertility clinic, which is a tertiary healthcare center serving the general population. DESIGN: It was a prospective study designed in vitro. MATERIALS AND METHODS: Semen samples from normozoospermic (N=16) and teratozoospermic (N=13) infertile men were cryopreserved using controlled cooling and rapid freezing techniques. The sperm chromatin integrity was analyzed in fresh and frozen-thawed samples. STATISTICAL ANALYSIS USED: Data were reported as mean and standard error (mean ± SEM) of mean. The difference between two techniques was determined by a paired t-test. RESULTS: The freeze-thaw induced chromatin denaturation was significantly (P<0.01) elevated in the post-thaw samples of normozoospermic and teratozoospermic groups. Compared to rapid freezing, there was no difference in the number of red sperms (with DNA damage) by the controlled slow cooling method in both normozoospermic and teratozoospermic groups. Freeze-thaw induced sperm chromatin denaturation in teratozoospermic samples did not vary between controlled slow cooling and rapid freezing techniques. CONCLUSIONS: Since the controlled slow cooling technique involves the use of expensive instrument and is a time consuming protocol, rapid freezing can be a good alternative technique for teratozoospermic and normozoospermic samples when sperm DNA damage is a concern.

Physiological cost index in cerebral palsy: its role in evaluating the efficiency of ambulation.

The study was undertaken to evaluate whether the Physiological Cost Index (PCI) can be used as a reliable index of efficiency of gait and as an outcome measure in cerebral palsy (CP). Physiological Cost Index was calculated in normal subjects by recording the heart rate manually and with electrocardiograph recording, and the values compared. In another group of subjects, PCI was calculated after they walked 3 different distances (50, 100, and 150 m). The PCI of normal children and children with CP was then estimated by manual recording of the pulse, with the children walking 50 m indoors and 50 m on an uneven surface outdoors. The reproducibility of calculation of PCI was evaluated. The PCI value of each patient was compared to the corresponding Functional Mobility Score. In a group of children with CP, PCI was calculated before and after therapeutic intervention. The PCI values were comparable with either method of heart rate measurement and for the 3 distances walked. The reproducibility of measurement of PCI was satisfactory (Intraclass Correlation Coefficients, 0.80-0.88). The PCI of normal children was 0.1 beats per meter, whereas children with CP had 6 times higher values of PCI, with the highest values in children with a crouch gait. In normal children, 10% greater PCI values were noted when they walked outdoors compared to a 100% increase in children with CP. The higher the PCI values, the lower the Functional Mobility Scores. Therapeutic interventions altered PCI values, and interventions that effectively reduced energy consumption could be identified. We conclude that PCI may be used as a reliable outcome measure of gait efficiency in children with CP.