Work-related injuries in Qatar for 1 year: an initial report from the work-related injury unified registry for Qatar.

BACKGROUND: The Ministry of Public Health National Health Strategy 2018-2022 has recognized the need for accurate, updated, and representative data that truly reflects the occupational health and safety status in Qatar. In 2015, the Hamad Trauma Center received a research grant to create a unified registry for work-related injuries in Qatar [WURQ], whose processes and research findings have been reported earlier. This paper shall describe the findings from the initial 1-year collection of data on work-related injuries [WRIs] and deaths in Qatar for the year 2020 through the WURQ database. METHODS: The WURQ database was queried for all WRIs from January 1 to December 31, 2020. These data were classified by date of injury, age, sex, nationality, mechanism of injury, severity of injury, location of medical consultation, and clinical outcome. RESULTS: Out of a total worker population of 2,174,828 [2.29 occupational fatalities per 100,000 workers, there were 50 deaths caused by WRIs]. The majority of WRI deaths were in the prehospital setting [60%] with the majority of fatal injuries occurring at the worksite [64%] and 22% due to falls. Five hundred six workers sustained severe WRIs [23.26 severe occupational injuries per 100,000 workers], and 37,601 workers sustained mild to moderate WRIs [1,728.91 mild to moderate occupational injuries per 100,000 workers]. The severe WRIs were most commonly due to falls [226 out of 506] from height [45%] and falling heavy objects [80 out of 506] [16%]. Road traffic injuries [RTI] make up one-fourth [133 out of 506] of all severe WRIs. CONCLUSION: WURQ has described WRIs in Qatar using a purpose-built and nationally linked occupational injury registry. Occupational injury and injury fatality statistics, for Qatar in 2020, are lower than or comparable with those from other high-income countries. This data can be used to inform worksite inspections, investigations, worker safety education, environmental improvements, and injury prevention programs to make Qatar safer for all its workers.

Patterns and Effects of Admission Hyperglycemia and Inflammatory Response in Trauma Patients: A Prospective Clinical Study.

BACKGROUND: The constellation of the initial hyperglycemia, proinflammatory cytokines and severity of injury among trauma patients is understudied. We aimed to evaluate the patterns and effects of on-admission hyperglycemia and inflammatory response in a level 1 trauma center. We hypothesized that higher initial readings of blood glucose and cytokines are associated with severe injuries and worse in-hospital outcomes in trauma patients. METHODS: A prospective, observational study was conducted for adult trauma patients who were admitted and tested for on-admission blood glucose, hemoglobin A1c, interleukin (IL)-6, IL-18 and hs-CRP. Patients were categorized into four groups [non-diabetic normoglycemic, diabetic normoglycemic, diabetic hyperglycemic (DH) and stress-induced hyperglycemic (SIH)]. The inflammatory markers were measured on three time points (admission, 24 h and 48 h). Generalized estimating equations (GEE) were used to account for the correlation for the inflammatory markers. Pearson's correlation test and logistic regression analysis were also performed. RESULTS: During the study period, 250 adult trauma patients were enrolled. Almost 13% of patients presented with hyperglycemia (50% had SIH and 50% had DH). Patients with SIH were younger, had significantly higher Injury Severity Score (ISS), higher IL-6 readings, prolonged hospital length of stay and higher mortality. The SIH group had lower Revised Trauma Score (p = 0.005), lower Trauma Injury Severity Score (p = 0.01) and lower GCS (p = 0.001). Patients with hyperglycemia had higher in-hospital mortality than the normoglycemia group (12.5% vs 3.7%; p = 0.02). A significant correlation was identified between the initial blood glucose level and serum lactate, IL-6, ISS and hospital length of stay. Overall rate of change in slope 88.54 (95% CI:-143.39-33.68) points was found more in hyperglycemia than normoglycemia group (p = 0.002) for IL-6 values, whereas there was no statistical significant change in slopes of age, gender and their interaction. The initial IL-6 levels correlated with ISS (r = 0.40, p = 0.001). On-admission hyperglycemia had an adjusted odds ratio 2.42 (95% CI: 1.076-5.447, p = 0.03) for severe injury (ISS > 12) after adjusting for age, shock index and blood transfusion. CONCLUSIONS: In trauma patients, on-admission hyperglycemia correlates well with the initial serum IL-6 level and is associated with more severe injuries. Therefore, it could be a simple marker of injury severity and useful tool for patient triage and risk assessment. TRIAL REGISTRATION: This study was registered at the ClinicalTrials.gov (Identifier: NCT02999386), retrospectively Registered on December 21, 2016. https://clinicaltrials.gov/ct2/show/NCT02999386 .

Prehospital administration of tranexamic acid in trauma patients: A 1:1 matched comparative study from a level 1 trauma center.

PURPOSE: The purpose of this study was to test the efficacy of prehospital administration of tranexamic acid (TXA) to injured patients on mortality, thromboembolic events and need for blood transfusion in a level 1 trauma center. METHODS: We conducted a retrospective study comparing adult trauma patients receiving or not receiving prehospital TXA between January 2017 and September 2018. Patients not receiving TXA but transfused within 4 h of admission were 1:1 matched to TXA-treated patients for age, sex, injury severity score, head abbreviated injury score, prehospital heart rate and systolic blood pressure. RESULTS: In total 204 patients were included (102 TXA and 102 control), with a mean age of 31 years. On admission, shock index (p = 0.03) and serum lactate (p = 0.001) were greater in the control group, whereas the initial base deficit, hemoglobin levels and EMS time were comparable in both groups. The odd ratio (OR) for shock index ≥0.9 after TXA administration was 0.44 (95% CI 0.23-0.84). The median amount of blood transfusion was greater in the control group [eight units (range 1-40) vs three (range 0-40), p = 0.01] as well as the use of massive blood transfusion [OR 0.35 (95% CI 0.19-0.67)]. In the TXA group, VTE was higher [OR 2.0 (95% CI 0.37-11.40)]; whereas the overall mortality was lower [OR 0.78 (95% CI 0.42-1.45)] without reaching statistical significance. CONCLUSIONS: Prehospital TXA administration is associated with less in-hospital blood transfusion and massive transfusion protocol (MTP). There is no significant increase in the thromboembolic events and mortality, however, further evaluation in larger clinical trials is needed.

Traumatic Kidney Injury: An Observational Descriptive Study.

BACKGROUND: Trauma is a major cause of death and disability worldwide. Renal injuries account for 8-10% of abdominal trauma. We aimed to describe the incidence, presentation, and management of traumatic kidney injury in our institution. METHODS: This is a retrospective analysis of all patients admitted with traumatic kidney injury at a level 1 trauma center between January 2014 and December 2017. RESULTS: During a period of 3 years, a total of 152 patients with blunt renal trauma were admitted to a level 1 trauma center; 91% of these were males, with a mean age of 32.8 ± 13.7 years. Motor vehicle crashes accounted for 68% of cases, followed by fall from height (23%). Seventy-one percent of patients had associated chest injuries, 38% had pelvis injuries, and 32% had head injury. Associated abdominal injuries included the liver (35%) and spleen (26%). The mean abdominal abbreviated injury scale was 2.8 ± 1.0; and for those with severe renal injury, it was 3.9 ± 0.9. The mean injury severity score was 24.9 ± 13.7 (31.8 ± 14.2 with renal vs. 21.9 ± 12.9 without renal injury, p = 0.004). Most of the patients were treated conservatively (93%), including severe renal injuries (grades IV and V), and 7% had surgical exploration, mainly those with severe injuries (grades IV and V). The mortality rate was 11%. CONCLUSIONS: High-grade renal injuries in hemodynamically stable patients can be managed conservatively. A multidisciplinary approach coordinated by trauma, urology, and radiology services facilitates the care of these patients in our trauma center.

Pediatric road traffic injuries in Qatar: Evidence for a developmental stage approach to road safety.

Road traffic injuries are the leading cause of death in Qatar but their epidemiology in children has not been fully described. This paper will describe the epidemiology of pediatric road traffic injuries (pRTIs) in Qatar, in order to understand the relationships among risk factors, mechanisms of injury, use of safety equipment, and according to child developmental stages. The primary sample for this study was drawn from all pRTIs (0-18 years) from January 2010 to December 2012-motor vehicle occupants, passengers and drivers, pedestrians, cyclists, motorcyclists, and all-terrain vehicle (ATV) drivers and passengers-seen at the trauma registry of the Hamad Trauma Center, the national Level I Trauma Referral Center of Qatar. During those two years, the Trauma Center attended to 4864 patients, 443 (9.1%) of whom were pRTIs, 83% were male, and 71% were non-Qatari. Only 1.2% of injured passengers and drivers were restrained. All fatalities were passengers or drivers; the overall mortality rate was 3.4%. The motor vehicle crash (MVC) mortality rate was 6.2%, with the longest mean length of hospital stay 10.5 days and highest Intensive Care Unit (ICU) admission rate 35.7%. Older adolescents (15-18 years) comprised 56.4% of total MVC mortality. One-in-four (25%) pedestrian victims was Qatari. They had the lowest mean Injury Severity Score (9.6); 73% were nine years or younger. ATV victims had a 27% ICU admission rate; 48.4% were 10-14 years old. Older adolescents made up only 17% of the pediatric population of Qatar, yet 40% of pRTI victims and 80% of pRTI deaths. Forty-two percent of injured older adolescents were drivers, with half (21%) of those underage. There are clear and distinct age and mechanism-specific patterns of pRTIs among children in Qatar that must be used to guide road safety policy and program formulation for underage pedestrians and drivers. Proven interventions that increase seatbelt and child restraint use and graduated driver licensing must be considered.

Occult Pneumothorax in Patients Presenting with Blunt Chest Trauma: An Observational Analysis.

Background: We aimed to assess the management and outcome of occult pneumothorax and to determine the factors associated with failure of observational management in patients with blunt chest trauma (BCT). Methods: Patients with BCT were retrospectively identified from the trauma database over 4 years. Data were analyzed and compared on the basis of initial management (conservative vs. tube thoracostomy). Results: Across the study period, 1928 patients were admitted with BCT, of which 150 (7.8%) patients were found to have occult pneumothorax. The mean patient age was 32.8 ± 13.7 years, and the majority were male (86.7%). Positive-pressure ventilation (PPV) was required in 32 patients, and bilateral occult pneumothorax was seen in 25 patients. In 85.3% (n = 128) of cases, occult pneumothorax was managed conservatively, whereas 14.7% (n = 22) underwent tube thoracostomy. Five patients had failed observational treatment requiring delayed tube thoracostomy. Pneumonia was reported in 12.8% of cases. Compared with those who were treated conservatively, patients who underwent tube thoracostomy had thicker pneumothoraxes and a higher rate of lung contusion, rib fracture, pneumonia, prolonged ventilatory days, and prolonged hospital length of stay. Overall mortality was 4.0%. The deceased had more polytrauma and were treated conservatively without a chest tube. Patients who failed conservative management had a higher frequency of lung contusion, greater pneumothorax thickness, higher Injury Severity Scores (ISS), and required more PPV. Conclusions: Occult pneumothorax is not uncommon in BCT and can be successfully managed conservatively with a close clinical follow-up. Intervention should be limited to patients who have an increase in size of the pneumothorax on follow-up or become symptomatic under observation. Patients who fail conservative management may have a greater pneumothorax thickness and higher ISS. However, large prospective studies are warranted to support these findings and to establish the institutional guidelines for the management of occult pneumothorax.

Coagulopathy in the surgical patient: trauma-induced and drug-induced coagulopathies.

PURPOSE OF REVIEW: Coagulopathy is the derangement of hemostasis that in surgical patients may result in excessive bleeding, clotting or no measurable effect. The purpose of this review is to provide an overview of the most current evidence and practical approach to trauma- and drug-induced coagulopathy in surgical patients. RECENT FINDINGS: Early identification and timely correction of coagulopathy in surgical patients with significant bleeding is paramount to prevent death and other consequences of hemorrhage. Trauma-induced coagulopathy is managed by protocols recommending fibrinogen replacement, FFP, platelets, TXA and frequent lab monitorization including viscoelastic tests. For warfarin- or DOAC-induced coagulopathy, the management follows similar principles plus drug reversal. Warfarin is diagnosed by prolonged international normalized ratio and reversed by PCC or FFP. DOACs are inconsistently diagnosed by routine coagulation tests, and reversed by a combination of TXA, PCC and specific antidotes (if available). SUMMARY: Despite different understandings of the pathophysiology, trauma- and drug-induced coagulopathies are managed following similar protocols. In most of cases of significant surgical bleeding, timely and protocolized approach to correct the coagulopathy is likely to improve patients' outcome.

A rapid market survey on the availability of car seats in Qatar: Implications for child passenger safety.

Introduction: Despite the high income level in Arabian Gulf countries, people in the region need to improve their use of child restraint systems (CRSs) to reduce the incidence of preventable injuries to child automobile passengers. Anecdotal reports have attributed the resistance to using CRSs to the expense and unavailability of the systems, prompting car seat giveaway programs. Previous studies have not assessed the adoption of CRS. This study reports the results of a rapid market survey (RMS) to understand the availability, characteristics, and affordability of CRSs in Qatar and recommend future child restraint policies and legislation. Methods: The RMS identified all retail outlets that sell CRSs in Qatar and collected standard data on each restraint system: brand, model number, age/weight limits, compliance with standards, availability, and language of the owner's manual. A previously utilized metric for child safety devices was used to measure affordability. Results: The RMS showed a sufficient number (83) and variety (five types) of car seat models at 15 retail outlets, selling at a wide price range of $14-$1,399. All the car seats complied with the European standard. Only 2% showed a manufacturing or expiry date. A user manual was available for 71% of the seats and in different languages, but only 28% appeared in Arabic. The median CRS price was equivalent to the wages for less than one day of work. Conclusion: The RMS demonstrates the availability, variety, and affordability of CRSs in Qatar. Unavailability and expense cannot be cited as barriers to use CRS, and the market is prepared for legislation requiring car seats for children in Qatar. Areas for improvement include requiring user manuals for all seats, especially in Arabic; requiring that all car seats comply with globally accepted safety standards, especially for expiry/manufacturing dates, given the harsh local climate; and encouraging further varieties of CRSs in the local market.

Blunt liver trauma: a descriptive analysis from a level I trauma center.

BACKGROUND: We aimed to review liver injury experience in a level 1 trauma center; namely clinical presentation, grading, management approach and clinical outcomes. METHODS: It is a retrospective analysis to include all blunt liver injury patients who were admitted at the Level 1 trauma center over a 3-year period. Data were compared and analyzed based on the liver injury grades and management approaches. RESULTS: Blunt liver injury accounted for 38% of the total blunt abdominal trauma cases with a mean age of 31 ± 13 years. Liver injury grade II (44.7%) was most common followed by grade I (28.8%), grade III (19.1%), grade IV (7.0%) and grade V (0.4%). Blood transfusion was more frequently required in patients with grade IV (p = 0.04). Out of 257 patients with blunt liver trauma, 198 were initially treated conservatively, that was successful in 192 (97%), whereas it failed in 6 (3%) patients due to delayed bleeding from hepatic hematoma, associated splenic rupture and small bowel injury which mandate surgical intervention. Fifty-nine patients (23%) underwent emergent surgery in terms of packing, resection debridement, left lobe hepatectomy and splenectomy. Hepatic complications included biloma, pseudoaneurysm and massive liver necrosis. Subanalysis of data using the World Society of Emergency Surgery (WSES) classification revealed 19 patients were categorized as a WSES grade IV who needed surgical intervention without having an initial computerized tomography scanning. The overall mortality was 7.8% which was comparable among the conservative and operative group. CONCLUSIONS: In our center, low grade liver injury in young males prevails. NOM is successful even for high graded injuries. All conservatively treated patients with high-grade liver injuries should be closely monitored for signs of failure of the non-operative management. Introducing the new WSES classification makes clear how is important the hemodynamic status of the patients despite the lesion. However, further larger prospective and multicenter studies are needed to support our findings.

Single Versus Multiple Solid Organ Injuries Following Blunt Abdominal Trauma.

BACKGROUND: We aimed to describe the pattern of solid organ injuries (SOIs) and analyze the characteristics, management and outcomes based on the multiplicity of SOIs. METHODS: A retrospective study in a Level 1 trauma center was conducted and included patients admitted with blunt abdominal trauma between 2011 and 2014. Data were analyzed and compared for patients with single versus multiple SOIs. RESULTS: A total of 504 patients with SOIs were identified with a mean age of 28 ± 13 years. The most frequently injured organ was liver (45%) followed by spleen (30%) and kidney (18%). One-fifth of patients had multiple SOIs, of that 87% had two injured organs. Patients with multiple SOIs had higher frequency of head injury and injury severity scores (p < 0.05). The majority of SOIs were treated nonoperatively, whereas operative management was required in a quarter of patients, mostly in patients with multiple SOIs (p = 0.01). Blood transfusion, sepsis and hospital stay were greater in multiple than single SOIs (p < 0.05). The overall mortality was 11% which was comparable between the two groups. In patients with single SOIs, the mortality was significantly higher in those who had pancreatic (28.6%) or hepatic injuries (13%) than the other SOIs. CONCLUSION: SOIs represent one-tenth of trauma admissions in Qatar. Although liver was the most frequently injured organ, the rate of mortality was higher in pancreatic injury. Patients with multiple SOIs had higher morbidity which required frequent operative management. Further prospective studies are needed to develop management algorithm based on the multiplicity of SOIs.

Alcohol Screening in a National Referral Hospital: An Observational Study from Qatar.

BACKGROUND Alcohol consumption is a high-risk factor for several medical disorders and traffic accidents and poses a burden on outpatient clinics and emergency units. We aimed to assess the pattern of alcohol screening among patients in a multicultural setting in a national referral hospital in an Arab Middle-Eastern country. MATERIAL AND METHODS A retrospective analysis was conducted for patients who were screened with blood alcohol concentration (BAC) in the Emergency Department (ED) in the period from January 2009 to December 2012. BAC positive and negative patients were compared, and BAC positive patients were classified into mmol/L (Group 1: BAC 0.1-10.8 (less intoxicated); Group 2: BAC 10.9-21.7 (intoxicated), and Group 3: >21.7 mmol/L (intoxicated at CNS depression level). RESULTS A total of 9417 patient visits were screened for BAC during the study period (an average of 4.87 per 1000 ED visits); 38% of these tested positive. Most screened persons were males (97%) with a mean age of 37.5±11.6 years. There was a steady increase in BAC screening initially (3.18 per 1000 ED visits in 2009 and 7.47 in 2012). However, the proportion of BAC-positives per total screened decreased steadily over the years, from 50% in 2008 to 33% in 2012. There were more BAC positives (92% vs. 81%, p<0.05) in patients seeking medical vs. non-medical assessment. Among BAC positives, Group 3 patients had higher HLOS (p=0.001), but the ICU-LOS was comparable. CONCLUSIONS Despite the absence of a clinical protocol for alcohol screening, this study shows that alcohol consumption has a serious impact in ED visits and hospitalizations, even in a country that partially prohibits alcohol drinking. Implementing a protocol for the screening of alcohol misuse among select hospitalized patients should be considered in the ED.

Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience.

BACKGROUND Splenic injury is the leading cause of major bleeding after blunt abdominal trauma. We examined the clinical and radiological presentations, management, and outcome of blunt splenic injuries (BSI) in our institution. MATERIAL AND METHODS A retrospective study of BSI patients between 2011 and 2014 was conducted. We analyzed and compared management and outcome of different splenic injury grades in trauma patients. RESULTS A total of 191 BSI patients were identified with a mean (SD) age of 26.9 years (13.1); 164 (85.9%) were males. Traffic-related accident was the main mechanism of injury. Splenic contusion and hematoma (77.2%) was the most frequent finding on initial computerized tomography (CT) scans, followed by shattered spleen (11.1%), blush (11.1%), and devascularization (0.6%). Repeated CT scan revealed 3 patients with pseudoaneurysm who underwent angioembolization. Nearly a quarter of patients were managed surgically. Non-operative management failed in 1 patient who underwent splenectomy. Patients with grade V injury presented with higher mean ISS and abdominal AIS, required frequent blood transfusion, and were more likely to be FAST-positive (p=0.001). The majority of low-grade (I-III) splenic injuries were treated conservatively, while patients with high-grade (IV and V) BSI frequently required splenectomy (p=0.001). Adults were more likely to have grade I, II, and V BSI, blood transfusion, and prolonged ICU stay as compared to pediatric BSI patients. The overall mortality rate was 7.9%, which is mainly association with traumatic brain injury and hemorrhagic shock; half of the deaths occurred within the first day after injury. CONCLUSIONS Most BSI patients had grade I-III injuries that were successfully treated non-operatively, with a low failure rate. The severity of injury and presence of associated lesions should be carefully considered in developing the management plan. Thorough clinical assessment and CT scan evaluation are crucial for appropriate management of BSI.

Blunt splenic trauma: Assessment, management and outcomes.

BACKGROUND: The approach for diagnosis and management of blunt splenic injury (BSI) has been considerably shifted towards non-operative management (NOM). We aimed to review the current practice for the evaluation, diagnosis and management of BSI. METHODS: A traditional narrative literature review was carried out using PubMed, MEDLINE and Google scholar search engines. We used the keywords "Traumatic Splenic injury", "Blunt splenic trauma", "management" between December 1954 and November 2014. RESULTS: Most of the current guidelines support the NOM or minimally approaches in hemodynamically stable patients. Improvement in the diagnostic modalities guide the surgeons to decide the timely management pathway Though, there is an increasing shift from operative management (OM) to NOM of BSI; NOM of high grade injury is associated with a greater rate of failure, prolonged hospital stay, risk of delayed hemorrhage and transfusion-associated infections. Some cases with high grade BSI could be successfully treated conservatively, if clinically feasible, while some patients with lower grade injury might end-up with delayed splenic rupture. Therefore, the selection of treatment modalities for BSI should be governed by patient clinical presentation, surgeon's experience in addition to radiographic findings. CONCLUSION: About one-fourth of the blunt abdominal trauma accounted for BSI. A high index of clinical suspicion along with radiological diagnosis helps to identify and characterize splenic injuries with high accuracy and is useful for timely decision-making to choose between OM or NOM. Careful selection of NOM is associated with high success rate with a lower rate of morbidity and mortality.

The implications of the relative risk for road mortality on road safety programmes in Qatar.

The epidemiology of road deaths and in particular the relative risk for road mortality (RRRM) in Qatar has not been fully defined. This study will analyse and compare the proportionate mortality and age-specific death rates from road traffic injuries (RTIs) and make recommendations for targeted injury prevention programmes for road safety in Qatar. Data from the Qatar Statistics Authority (QSA), for the year 2010, was collected and analysed. All deaths classified as 'ICD-10 (V89) Motor- or Nonmotor-Vehicle, Accident Type of Vehicle Unspecified' were included. There were 247 RTI related deaths in Qatar in 2010. An overall death rate was computed at 14.4 deaths per 100 000 population. The RRRM varied over 10 times among different populations with Qatari males (QM) having an increased RRRM from 10 years of age, those aged 20-29 years had the highest RRRM of 10.2. The lowest RRRM was for Qatari females who did not have a single reported road fatality in 2010. Populations with a significantly elevated RRRM (ie, RRRM>1.0) were non-Qatari men older than 50 years and Qatari males from the age of 10 onward. Proven and definite programmes must be implemented to reduce these unnecessary deaths among the populations at the highest risk. Multidisciplinary approaches must be implemented and their efficacy evaluated.

Tramadol in traumatic brain injury: Should we continue to use it?

BACKGROUND AND AIMS: Tramadol is commonly used to treat moderate to moderately-severe pain in adults. We aimed to analyze the clinical relevance of tramadol use during weaning and extubation in patients with traumatic brain injury (TBI). MATERIAL AND METHODS: A retrospective observational study was conducted and included all the intubated TBI patients at the level I trauma center between 2011 and 2012. Data included patient's demographics, mechanism of injury (MOI), Glasgow Coma Scale (GCS), injury severity score, length of Intensive Care Unit (ICU) stay length of stay (LOS), agitation scale, analgesics, failure of extubation and tracheostomy. Patients were divided into two groups based on whether they received tramadol (Group 1) or not (Group 2) during ventilatory weaning. Chi-square and Student's t-tests were used for categorical and continuous variables; respectively. Logistic regression analysis was performed for predictors of agitation in ICU. RESULTS: The study included 393 TBI patients; the majority (96%) was males with a mean age of 33.6 ± 14 years. The most common MOI were motor vehicle crash (39%), fall (29%) and pedestrian (17%). The associated injuries were mainly chest (35%) and abdominal (16%) trauma. Tramadol was administered in 51.4% of TBI patients. Tracheostomy was performed in 12.4% cases. Agitation was observed in 34.2% cases. Group 1 patients had significantly lower age (31.6 ± 12.4 vs. 35.7 ± 15.6; P = 0.005) and head AIS (3.5 ± 0.8 vs. 3.9 ± 0.9; P = 0.001) compared to Group 2. The incidence of agitation, ICU and hospital LOS were higher in Group 1. Failure of extubation and tracheostomy were reported more frequently in Group 1 (P = 0.001). On multivariate analysis, tramadol use was an independent predictor for agitation (adjusted odds ratio 21; P = 0.001), followed by low GCS. CONCLUSION: Patients with TBI who received tramadol are more likely to develop agitation, undergo tracheostomy and to have longer hospital LOS. Therefore, an extensive risk-benefit assessment would help to attain maximum efficacy of the drug in TBI patients.

Time-based trauma-related mortality patterns in a newly created trauma system.

BACKGROUND: Data on time-based trauma mortality (TTM) patterns in developing countries are lacking. OBJECTIVE: Our objective was to analyze the TTM in a newly established trauma center. METHODS: A retrospective analysis of all trauma-related mortality between 2010 and 2012 was conducted in Qatar. Based on the time of injury, deceased cases were categorized into immediate (pre-hospital), early (first 24 h), and late (>24 h) groups. TTM was analyzed and compared. RESULTS: A total of 4,966 trauma patients were admitted to the trauma center over 3 years; of them, 333 trauma-related deaths (6.8 %) were documented and reviewed. The death pattern peaked immediately post-trauma (n = 142), followed by 96 deaths within the first 24 h, 19 deaths within the time period >24 to 48 h, 50 deaths within the 3rd and 7th day (second peak), and 26 deaths after the 1st week. The majority of the deceased were males, with a mean age of 36 ± 17 years. Motor vehicle crashes (43.5 %) were the commonest mechanism of injury. At presentation, median injury severity score (ISS) was 32 (range 9-75). Bleeding, abdominal, and pelvic injuries were higher in the early group, whereas head injuries were observed more in the late mortality group. Co-morbidities and in-hospital complications were predominantly encountered in the late group. Head injury (odds ratio [OR] 3.760; 95 % confidence interval [CI] 1.311-10.797) was an independent predictor for late death, whereas the need for blood transfusion was a predictor for early death (OR 3.233; 95 % CI 1.125-9.345). CONCLUSION: The distribution of mortality shows a bimodal pattern. The high rate of death at the scene highlights the importance of pre-hospital care and the need for injury prevention programs.

Significance of computed tomography finding of intra-abdominal free fluid without solid organ injury after blunt abdominal trauma: time for laparotomy on demand.

BACKGROUND: Optimal management of patients with intra-abdominal free fluid found on computed tomography (CT) scan without solid organ injury remains controversial. OBJECTIVE: The purpose of this study was to determine the significance of CT scan findings of free fluid in the management of blunt abdominal trauma patients who otherwise have no indications for laparotomy. METHODS: During the 3-year study period, all patients presenting with blunt abdominal trauma who underwent abdominal CT examination were retrospectively reviewed. All hemodynamically stable patients who presented with abdominal free fluid without solid organ injury on CT scan were analyzed for radiological interpretation, clinical management, operative findings, and outcome. RESULTS: A total of 122 patients were included in the study, 91 % of whom were males. The mean age of the patients was 33 ± 12 years. A total of 34 patients underwent exploratory laparotomy, 31 of whom had therapeutic interventions. Small bowel injuries were found in 12 patients, large bowel injuries in ten, and mesenteric injuries in seven patients. One patient had combined small and large bowel injury, and one had traumatic gangrenous appendix. In the remaining three patients, laparotomy was non-therapeutic. A total of 36 patients had associated pelvic fractures and 33 had multiple lumbar transverse process fractures. CONCLUSION: Detection of intra-peritoneal fluid by CT scan is inaccurate for prediction of bowel injury or need for surgery. However, the correlation between CT scan findings and clinical course is important for optimal diagnosis of bowel and mesenteric injuries.

Can "Stop The Bleed" training courses for laypersons improve hemorrhage control knowledge, skills, and attitudes? A systematic review.

BACKGROUND: In many regions of the world, most trauma deaths occur within 1-2 h of injury due to uncontrolled bleeding. For this reason, training lay first-person responders in trauma care, focusing on hemorrhage control, has been recommended. We hypothesized that STOP THE BLEED (STB) training courses that teach laypersons how to stop traumatic compressible bleeding immediately are needed to potentially prevent deaths due to hemorrhage. This systematic review will analyze the effect of the STB training course on the knowledge, skill, and attitudes of lay first-person responders for hemorrhage control. METHODS: PubMed and Google Scholar databases were used to identify relevant peer-reviewed research articles describing evaluations of STB courses for laypersons from December 1 2013 to October 31 2022. In addition, a hand search of article references was undertaken. Studies were included if they implemented the STB course; trainees were laypersons, and the study had some outcome measures such as knowledge, skill, confidence gained, and willingness to provide or utilization of care provided to and outcomes of trauma patients. RESULTS: The database searches yielded 2,893 unique papers. We retained 33 articles for full-text review, resulting in 24 eligible papers. Gray literature and manual searches yielded 11 additional publications for a total of 35 studies. The most reported finding was a statistically significant increase in hemorrhage control knowledge or tourniquet application skills in 26 studies. Twenty-two studies reported statistically significant improvements in willingness, confidence, comfort, and likelihood to respond to a bleeding patient, and 6 studies reported substantial reductions in the retention of bleeding control knowledge or skills. Only one study reported on the effect on patient outcomes. CONCLUSION: STB courses for laypersons have demonstrated significant improvements in knowledge, skill, confidence, and willingness to intervene to stop traumatic exsanguination. The evaluation of clinically relevant patient outcomes, specifically their effect on preventable deaths from traumatic exsanguination, is needed to strengthen further the evidence behind the recommendations for more widespread teaching of "STB" courses.