A pilot study of a trauma registry at the Georgetown Public Hospital, Georgetown, Guyana

OBJECTIVE: To complete a pilot study to initiate a trauma registry in Guyana. DESIGN AND METHODS: A trauma registry form was developed and customized locally, based on the Kampala trauma score. A convenience sample of trauma patients was collected over a 49 day period. The inclusion criteria were international code of diseases (ICD) 9 codes 800 to 957. The form recorded triage vital signs, Injury severity score (ISS), details of the event, alcohol and drug use. The forms were completed by the treating physician at the time of the encounter and the data was entered in a spreadsheet. RESULTS: Data from 34 patients were analyzed. The most common causes of injuries were due to falls (26.5%) and road traffic accidents (14.8%), with 38% of injuries occurring on roadways. Bony pelvis and extremities (62%) were the most common site of serious injuries, followed by the head/neck/face (15%). Only 3 persons admitted to alcohol use. No IPV (intimate partner violence) cases were detected. There were 4 stab wounds and no guns shot wounds recorded. CONCLUSION: A trauma registry can capture data that can lead to improved trauma care. However, there were numerous limitations, most notably the low number of forms completed compared to the study population. To implement a working trauma registry we will need to capture all cases. Suggestions to increase the number of patients include converting the form into a mobile telephone application or training data entry clerks. Successful implementation would require support from all stakeholders.

Intravenous adenosine (adenoscan) versus exercise in the noninvasive assessment of coronary artery disease by SPECT.

Fifteen patients at a mean age of 58 underwent adenosine and maximal exercise thallium SPECT imaging. All scans were performed 1 week apart and within 4 weeks of cardiac catheterization. SPECT imaging was performed after the infusion of 140 micrograms/kg/min of adenosine for 6 minutes. Mean heart rate increment during adenosine administration was 67 +/- 3.7 to 77 +/- 4.1. Mean blood pressure was 136 +/- 7.2 to 135 +/- 6.2 systolic and 78 +/- 1.8 to 68 +/- 2.6 diastolic. No adverse hemodynamic effects were observed. There were no changes in PR or QRS in intervals. Five stress ECGs were ischemic. No ST changes were observed with adenosine. Although 68% of the patients had symptoms of flushing, light-headedness, and dizziness during adenosine infusion, symptoms resolved within 1 minute of dosage adjustment or termination of the infusion in all but one patient, who required theophylline. Sensitivity for coronary artery detection was 77% and specificity 100%. Concordance between adenoscans and exercise thallium scintigraphy was high (13/15 = 87%). In two patients, there were minor scintigraphic differences. The authors conclude that adenosine is a sensitive, specific, and safe alternative to exercise testing in patients referred for thallium imaging and may be preferable to dipyridamole.