The impact of helmets on motorcycle head trauma at a tertiary hospital in Jamaica.

BACKGROUND: Although the Jamaica road traffic act mandates motorcycle riders to wear approved helmets, opponents suggest that the local road conditions obviate any benefits from helmet use that have been proven in Developed countries. They suggest that the narrow, winding, poorly surfaced, congested local highways do not allow motorcyclists to sustain high velocity travel. The accidents then tend to occur at lower speeds and are accompanied by less severe injuries. This study was carried out to determine the impact of helmet use on traumatic brain injuries from motorcycle collisions in patients admitted to a tertiary referral hospital in Jamaica. METHODS: A prospectively collected trauma registry maintained by the Department of Surgery at the University Hospital of the West Indies in Jamaica was accessed to identify all motorcycle collision victims from January 2000 to January 2007. The therapeutic outcomes of traumatic brain injuries were compared between helmeted and un-helmeted riders. The data was analyzed using SPSS Version 12. RESULTS: Of 293 motorcycle collision victims, 143 sustained brain injuries. There were 9 females (6.3%) with an average age of 23 +/- 7.3 years and 134 males (93.7%) at an average age of 33.4 +/- 11.2 years (mean +/- SD). Only 49 (34.3%) patients wore a helmet at the time of a collision. Helmet use at the time of a collision significantly reduced the severity of head injuries (28.6% vs 46.8%, P = 0.028) and the likelihood of sustaining intra-cranial lesions (26.5% vs 44.7%, P = 0.03) from head injuries. CONCLUSION: Wearing a helmet at the time of a motorcycle collision reduces the severity of head injuries. However, the prevalence of helmet use at the time of a collision is unacceptably low.

Wound healing in the Accident and Emergency Unit at the University Hospital of the West Indies, Jamaica - abstract

During a three-month period, data on all wounds sutured primarily in the Accident and Emergency Unit at the University Hospital of the West Indies were collected. This study was made to determine healing rates of these wounds treated in segregated area in the Unit without the use of aseptic conditions. During the study period, 205 patient were sutured, of whom 179 cases with 189 wounds returned for review. Lacerations formed the largest group (164 wounds). The healing rate for all wounds was 93.6 percent. Twelve wounds failed to heal satisfactorily. Five of the eleven contusions in the study fell into this group. It was concluded that operating theatre conditions were not necessary for good healing and that contusions might be better treated by delayed primary suture(AU)

Accident and Emergency Unit at the University of the West Indies the initial experience - abstract

In July 1987, an Accident and Emergency Unit (A & E Unit) was established at the University Hospital of the West Indies (UHWI), Kingston Jamaica. The aim was to collect and analyse data on emergency and trauma cases presenting at the hospital. This information could then be used to provide a basis for planning as well as to improve teaching in this area of the medical curriculum. This study analyses the experience of the first two years. Of a total of 24,087 patients who attended the Unit during the study period, adequate data for analysis were obtained in 21,894 cases (90.8 percent). Of these, 12,498 (57 percent) were caused by trauma. The average age of the injured patients was 24 years while that for non-trauma emergencies was 37 years. Medical emergencies accounted for 19.8 per cent of cases, the largest single group being patients with acute asthmatic attacks. The results of this study emphasise that trauma is a major public health problem in Jamaica. Continued research is needed not only to improve the care of and teaching about these patients but also to provide a scientific basis for proper preventative measures (AU)

Setting up practice

Careful planning is essential for the setting up of a successful medical practice. After qualification there is need for further experience and training. The location of the practice and the preparation of the physical plant are discussed. Being a service industry, all the ingredients necessary for good quality service and patient care must be put in place from the start. Attention must be paid to establishing a proper accounting system and the ability to retrieve data for reporting one's experience must also be put in place.(AU)

Ruptured rectal prolapse

Rectal prolapse is not a common surgical disorder. The complication reported here, of evisceration of small bowel through a prolapsed rectum, is extremely rare and is the first case reported in the West Indies. Some of the features of rectal prolapse are described, and the surgical management of this particular complication is discussed (AU)

Spontaneous rupture of the normal colon

A case of spontaneous rupture of the colon in a previously asymptomatic patient is herein reported. At laparotomy, apart from the tear in the sigmoid colon, no other pathological problem was present. An awareness of the existence of this condition will lead to early diagnosis and management with improved morbidity and mortality. (AU)

Preventable trauma deaths at the University Hospital of the West Indies - abstract

TRISS methodology is a statistical method for detecting unexpected outcome in trauma patients. Unexpected deaths can then be audited to determine the Preventable Trauma Death Rate (PDT), which is a good indicator of the quality of trauma care. This method was utilized to assess trauma care at the University Hospital of the West Indies (UHWI) and to identify areas of treatment failures. All trauma deaths at the UHWI during the calender year 1993 were reviewed. The Probability of Survival (PS) was calculated for each patient, using the Revised Trauma Score and the Injury Severity Score. Unexpected deaths (patients with PS > 0.5) were audited to detect inadequate trauma care. In 40 patients there were 15 unexpected deaths of which 7 were deemed potentially salvageable. Six of these were related to either inadequate resuscitation or delayed surgical intervention. The other was due to surgical inexperience. This represents a PTD rate of 22.5 percent which is similar to that in North America more than a decade ago. Most deaths occurred within the first 12 hours of hospitalization with another peak at approximately 9 days. Improvement in trauma care at UHWI can be achieved by the introduction of relatively cheap countermeasures rather than by acquiring expensive medical equipment. Continuing Medical Education programmes like the Advanced Trauma Life Support course should be introduced and may result in improvement in trauma care similar to that of developed countries (AU)

Patterns of trauma injuries in rural versus urban Jamaica

Trauma admissions to St. Ann's Bay Hospital and the University Hospital of the West Indies (UHWI) in the capital city of Kingston are compared. Trauma accounted for 19 percent and 22 percent of surgical admissions to UHWI and the St. Ann's Bay Hospital, respectively. Sixty-three percent of trauma cases admitted to St. Ann's Bay Hospital and 56 percent to the UHWI were due to unintentional injuries (95 percent CI, -0.05, 0.19). The main cause of unintentional injuries at both hospitals was motor vehicle accidents, accounting for 43 percent and 37 percent at UHWI and St. Ann's Bay Hospital respectively (95 percent CI, -0.04, 0.17). The prevalence of falls was significantly higher in St. Ann's Bay hospital compared with UHWI, 41 percent and 26 percent respectively (95 percent CI, 0.10, 0.21). Intentional injuries accounted for 37 percent of cases in St. Ann's Bay Hospital and 44 percent at UHWI (95 percent CI, -0.20, 0.04). The prevalence of firearm injuries was significantly higher at the UHWI than in St. Ann's Bay Hospital, 55 percent and 18 percent respectively (95 percent CI, -0.15, -0.05). There was no significant difference in age and injury severity scores in the two hospitals but patients remained in hospital significantly longer at UHWI. (AU)

Thoracic outlet syndrome

A case of thoracic outlet syndrome (TOS) treated at the University Hospital of the West Indies, Jamaica is presented. The diagnosis, investigation and management of TOS are discussed.

Thoracic outlet syndrome

A case of thoracic outlet syndrome (TOS) treated at the University Hospital of the West Indies, Jamaica is presented. The diagnosis, investigation and management of TOS are discussed. (AU)

Plexiform neurofibroma: a rare cause of obstructive jaundice

A case of obstructive jaundice secondary to a neurofibroma in the common hepatic duct is presented. The histological appearance was that of a plexiform neurofibroma. The clinicopathological features are discussed (AU)

Cholecystectomy in Jamaican children with homozygous sicke-cell disease

Twenty-seven children aged 18 years and under with homozygous sickle-cell disease had open cholecystectomy for symptomatic gallstones over the 12 year period 1985-1997. Emergency procedures (done during period of acute exacerbation of symptoms) were performed on 16 patients. Four with haemoglobin levels greater than 1g/dl below their steady state received a simple blood transfusion preoperatively designed to raise haemoglobin levels to 10g/dl. All had acute or acute on chronic cholecystitis based on histological examination of gallbladder specimens. Twelve had common bile duct stones. In two patients calculi were missed intraoperatively but these subsequently passed into the duodenum after a period saline irrigation via an in-situ t-tube. Six developed the acute chest syndrome (aetiology not determined) and this progressed to multi system failure and death in one. This high level of postoperative mobility and mortality may in part be due to the high proportion of emergency procedures. (AU)

Granulomatous lobular mastitis. A case report and review of the literature

Granulomatous labour mastitis is a rare, benign, inflammatory breast condition of unknown aetiology that can clinically mimic breast cancer. Awareness of this condition is important, as the appropriate specimens must be taken to confirm the diagnosis and to rule out an infectious aetiology. While surgical exclusion has been the traditional therapeutic modality, the most appropriate therapy seems to involve the use of corticosteriods, even in the case of recurrence. (AU)

Predictions and outcome of patients with skull fractures - Poster abstract

OBJECTIVE: To determine the clinical outcome of patients presenting to the University Hospital of the West Indies with head injuries including skull fractures. DESIGN AND METHODS: Data was retrieved from the Hospital trauma database for the period January 15, 1998 to October 9, 1999. RESULTS: Of 2126 injured patients admitted to the University Hospital of the West Indies over a 21 month period, 706 patients (32.2 percent) had head injuries, of whom 141 had skull fractures. The predominantly male group had an average age of 30 years. Overall, road traffic accidents were responsible for the majority of injuries, but intentional injuries were most common (48.2 percent) in those with skull fractures. A skull fracture was associated with a longer period of unconsciousness, a lower Glasgow coma scale, a higher injury severity score, longer hospital stay, higher probability of intracranial complications, a five times more frequent rate of operative intervention, and a worse outcome. Skull X-rays are readily available in most hospitals in the Caribbean compared to CT scanning for which access is often restricted due to cost and distance. CONCLUSIONS: The early identification of a skull fractue can identify patients at high risk for the development of intracanial complications after a head injury. These patients need urgent neurosurgical and neuroradiological assessment so that appropriate, prompt intervention can take place. Prevention of injury and early, effective assessment and treatment are the only ways in which this common problem can be mimimized.(AU)

Admissions for trauma at the University Hospital of the West Indies

Trauma accounted for 20 percent of all admissions to the general surgery wards of this University Hospital in a developing country. It was the most common reason for admission. This condition affects the young, males more commonly than females, and results in the need for operation in almost 40 percent of admitted trauma patients. Trauma surgery accounts for 17 percent of all operations done. Hospital stay and age are significantly greater in those requiring operation. The head, chest and abdomen are, in order of frequency, the most commonly affected areas of the body, and injury is mainly the result of interpersonal violence (52 percent), accidental injuries including burns (20 percent), and road traffic accidents (20 percent). In-patient mortality was 4.5 percent, significantly higher in older patients and mainly in those with head injuries and burns. Scarce resources and resource allocation mandate preventive measures to minimize the human and economic waste (AU)

Hydrops of the gallbladder

Hydrops of the gallbladder is an uncommon condition of infants and children. There is acute distension of the gallbladder in the absence of calculi without evidence of inflammation in the early stages of the disease. A case of hydrops of the gallbladder in a 4-year-old male child is presented. The literature is reviewed and the diagnosis and treatment of the condition discussed. (AU)

The prevalence of cannabis abuse in trauma patients presenting to the University Hospital of the West Indies

During a three-month period patients aged 16 years and over, admitted to the University Hospital of the West Indies (UHWI) via the emergency room, were screened for the metabolites of cannabis in the urine. Forty-six per cent were positive for cannabis. Patients testing positive were significantly younger than those who tested negative (p<0.001), the mean ages (95 percent confidence interval CF) being 28 (25-30) years and 35 (29-39) years, respectively. Patients were placed into one of three groups depending on whether they were victims of motor vehicle accidents, interpersonal violence or "other accidents". The prevalence of cannabis abuse was significantly less in the "other accidents" group compared with victims of motor vehicle accidents and interpersonal violence. Fifty per cent of the road traffic accident victims (95 percent CI, 35-52 percent), 55 per cent due to interpersonal violence (95 percent CI, 39-69 percent) and 16 per cent of the "other accidents" group (95 percent CI, 4-38 percent) tested positive for cannabis. There was no significant difference in hospital stay (HS), Revised Trauma Score (RTS) or Injury Severity Score (ISS) between cannabis abusers and nonusers. We conclude that there is a high incidence of cannabis abuse among trauma victims in Jamaica and postulate that it may play an important role in the aetiology of motor vehicle accidents and interpersonal violence (AU)

Cavernous haemangioma of the duodenum: a rare case of gastrointestinal bleeding

Vascular malformations (VMs), including haemangioma, of the upper gastrointestinal tract, are rare causes of bleeding. Bleeding from these lesions is often recurrent and diagnosis is often delayed for months to years. A patient with severe, recurrent upper gastrointestinal bleeding requiring repeated hospitalization and blood transfusions is presented. Upper endoscopy, barium meal and small bowel enteroclysis were negative. Selective mesenteric angiography revealed a VM in the second part of the duodenum. Segmental resection of the duodenum was performed and microscopial examination showed cavernous haemangioma. VM should be considered in patients with recurrent gastrointestinal bleeding and negative conventional investigations. Mesenteric angiography may be the only investigation which will identify these leisons. Results after excision are excellent.

Hydrops of the gallbladder

Hydrops of the gallbladder is an uncommon condition of infants and children. There is acute distension of the gallbladder in the absence of calculi without evidence of inflammation in the early stages of the disease. A case of hydrops of the gallbladder in a 4-year-old male child is presented. The literature is reviewed and the diagnosis and treatment of the condition discussed.

Admissions for trauma at the University Hospital of the West Indies

Trauma accounted for 20 per cent of all admissions to the general surgery wards of this University Hospital in a developing country. It was the most common reason for admission. This condition affects the young, males more commonly than females, and results in the need for operation in almost 40 per cent of admitted trauma patients. Trauma surgery accounts for 17 per cent of all operations done. Hospital stay and age are significantly greater in those requiring operation. The head, chest and abdomen are, in order of frequency, the most commonly affected areas of the body, and injury is mainly the result of interpersonal violence (52 per cent ), accidental injuries including burns (20 per cent ), and road traffic accidents (20 per cent ). In-patient mortality was 4.5 per cent , significantly higher in older patients and mainly in those with head injuries and burns. Scarce resources and resource allocation mandate preventive measures to minimize the human and economic waste