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1.
Am J Disaster Med ; 16(1): 25-34, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33954972

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic is a slow-moving global disaster with unique challenges for maintaining trauma center operations. University Medical Center New Orleans is the only level 1 trauma center in New Orleans, LA, which became an early hotspot for COVID-19. Intensive care unit surge capacity, addressing components including space, staff, stuff, and structure, is important in maintaining trauma center operability during a high resource-strain event like a pandemic. We report management of the trauma center's surge capacity to maintain trauma center operations while assisting in the care of critically ill COVID-19 patients. Lessons learned and recommendations are provided to assist trauma centers in planning for the influx of COVID-19 patients at their centers.


Asunto(s)
Centros Traumatológicos , Cuidados Críticos , Humanos , Pandemias/prevención & control
2.
Complement Ther Clin Pract ; 43: 101365, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33819832

RESUMEN

BACKGROUND AND PURPOSE: Traumatic psychological events are thought to alter brain physiology, notably regions such as the thalamus and the limbic system, affecting personal choice, autonomy, and behavior. Innovative therapies are needed to address the diverse, mental and physical consequences of these changes. Trauma Center-Trauma Sensitive Yoga (TC-TSY) has shown promising results in clinical trials among individuals experiencing posttraumatic symptomatology. MATERIALS AND METHODS: Using a qualitative, descriptive design, we examined the impact of TC-TSY training on the professional practice of seven practitioners who were certified yoga instructors and/or registered psychologists. RESULTS: The findings suggest TC-TSY training enriched their practices, chiefly through its choice-based, widely applicable approach; invitation- and mindfulness-based language; and building of therapeutic trust and attunement. Some participants questioned the accessibility and suitability of the training, as well as the rigidity of TC-TSY terminology. CONCLUSION: More research is needed to examine potential outcomes of TC-TSY practice related to self-efficacy, coping, quality of life, and stress reduction among traumatized individuals.


Asunto(s)
Trastornos por Estrés Postraumático , Yoga , Humanos , Salud Mental , Práctica Profesional , Calidad de Vida , Trastornos por Estrés Postraumático/terapia , Centros Traumatológicos
3.
Artículo en Inglés | MEDLINE | ID: mdl-33803979

RESUMEN

BACKGROUND: Studies have suggested that trauma centre-related risk factors, such as distance to the nearest trauma hospital, are strong predictors of fatal injuries among motorists. Few studies have used a national dataset to study the effect of trauma centre-related risk factors on fatal injuries among motorists and motorcyclists in a country where traffic is dominated by motorcycles. This study investigated the effect of distance from the nearest trauma hospital on fatal injuries from two-vehicle crashes in Taiwan from 2017 to 2019. METHODS: A crash dataset and hospital location dataset were combined. The crash dataset was extracted from the National Taiwan Traffic Crash Dataset from 1 January 2017 through 31 December 2019. The primary exposure in this study was distance to the nearest trauma hospital. This study performed a multiple logistic regression to calculate the adjusted odds ratios (AORs) for fatal injuries. RESULTS: The multivariate logistic regression models indicated that motorcyclists involved in crashes located ≥5 km from the nearest trauma hospital and in Eastern Taiwan were approximately five times more likely to sustain fatal injuries (AOR = 5.26; 95% CI: 3.69-7.49). CONCLUSIONS: Distance to, level of, and region of the nearest trauma centre are critical risk factors for fatal injuries among motorcyclists but not motorists. To reduce the mortality rate of trauma cases among motorcyclists, interventions should focus on improving access to trauma hospitals.


Asunto(s)
Dispositivos de Protección de la Cabeza , Centros Traumatológicos , Accidentes de Tránsito , Humanos , Motocicletas , Taiwán/epidemiología
4.
Emerg Med Clin North Am ; 39(2): 257-271, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33863458

RESUMEN

Geriatric trauma patients will continue to increase in prevalence as the population ages, and many specific considerations need to be made to provide appropriate care to these patients. This article outlines common presentations of trauma in geriatric patients, with consideration to baseline physiologic function and patterns of injury that may be more prevalent in geriatric populations. Additionally, the article explores specific evidence-based management practices, the significance of trauma team and geriatrician involvement, and disposition decisions.


Asunto(s)
Heridas y Traumatismos/epidemiología , Accidentes por Caídas , Anciano , Envejecimiento/fisiología , Enfermedades Cardiovasculares/fisiopatología , Comorbilidad , Fragilidad/fisiopatología , Geriatras , Accesibilidad a los Servicios de Salud , Humanos , Enfermedades Pulmonares/fisiopatología , Enfermedades Musculoesqueléticas/fisiopatología , Trastornos Neurocognitivos/fisiopatología , Manejo del Dolor , Alta del Paciente , Centros Traumatológicos , Signos Vitales , Heridas y Traumatismos/fisiopatología
5.
Dimens Crit Care Nurs ; 40(3): 192-201, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33792279

RESUMEN

BACKGROUND: Massive transfusion (MT) in trauma is initiated on the basis of factors of different natures and depending on protocols and scales used both in prehospital and in-hospital care areas. OBJECTIVE: The main goal was to analyze and relate factors and predictive variables for MT requirements considering both health care areas. METHOD: This was a retrospective cohort study that included patients who were treated either at the emergency department of a large hospital or through prehospital care before arrival at the hospital. The patients included were adults who received MT, defined as a blood bank request of 10 or more units of red cells in the first 24 hours or 5 or more within 4 hours of trauma, from January 1, 2009, to January 1, 2017. The variables included were individual characteristics and those associated with the trauma, clinical-analytical assessment, resuscitation, timing, and survival. RESULTS: A total of 52 patients who received MT were included. The average age of the patients was 41.23 ± 16.06 years, a mean of 19.56 ± 12.77 units was administered, and the mortality rate was 21.2%. DISCUSSION: Injury mechanism, clinical-analytical variables, and resuscitation strategies have a significant influence on the need for MT; therefore, early identification is fundamental for performing quality management and addressing avoidable factors during MT processes.


Asunto(s)
Urgencias Médicas , Heridas y Traumatismos , Adulto , Transfusión Sanguínea , Hospitales , Humanos , Puntaje de Gravedad del Traumatismo , Persona de Mediana Edad , Estudios Retrospectivos , Centros Traumatológicos , Heridas y Traumatismos/terapia
6.
Arch Osteoporos ; 16(1): 68, 2021 04 12.
Artículo en Inglés | MEDLINE | ID: mdl-33846869

RESUMEN

This study analyzed the outcome of orthogeriatric patients with hip fracture 4 months after surgery. The overall mortality rate was 12.2%. Sixty-five percent presented a degradation in walking ability, and 16% had to move to a nursing home. Early geriatric rehabilitation reduces the mortality rate and increases the rate of anti-osteoporotic treatment. PURPOSE: Hip fractures are increasingly common with severe consequences. Therefore, the German Trauma Society (DGU) implemented an orthogeriatric co-management and developed the concept for certified Centre for Geriatric Trauma DGU. The patients' treatment data and the optional 120 days of follow-up were collected in the Registry for Geriatric Trauma DGU (ATR-DGU). This study analyzed these 4-month treatment results. METHODS: A retrospective analysis of the ATR-DGU was conducted. Outcome parameters were the rate of readmission, rate of re-surgery, anti-osteoporotic therapy, housing, mortality, walking ability, and quality of life (QoL) 120 days post-surgery. The influence of the early geriatric rehabilitation (EGR) was evaluated using a regression analysis. RESULTS: The follow-up data from 9780 patients were included. After 120 days, the mortality rate was 12.2%, the readmission rate 4%, and the re-surgery rate 3%. The anti-osteoporotic treatment increased from 20% at admission to 32%; 65% of the patients had a degradation in walking ability, and 16% of the patients who lived in their domestic environment pre-surgery had to move to a nursing home. QoL was distinctly reduced. The EGR showed a positive influence of anti-osteoporotic treatment (p<0.001) and mortality (p=0.011) but led to a slight reduction in QoL (p=0.026). CONCLUSION: The 4-month treatment results of the ATR-DGU are comparable to international studies. The EGR led to a significant rise in anti-osteoporotic treatment and a reduction in mortality with a slight reduction in QoL.


Asunto(s)
Fracturas del Fémur , Fracturas de Cadera , Anciano , Fracturas del Fémur/cirugía , Fémur , Fracturas de Cadera/cirugía , Humanos , Calidad de Vida , Estudios Retrospectivos , Centros Traumatológicos
7.
J Orthop Surg Res ; 16(1): 237, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33794939

RESUMEN

BACKGROUND: Concerns of contracting the highly contagious disease COVID-19 have led to a reluctance in seeking medical attention, which may contribute to delayed hospital arrival among traumatic patients. The study objective was to describe differences in time from injury to arrival for patients with traumatic hip fractures admitted during the pandemic to pre-pandemic patients. MATERIALS AND METHODS: This retrospective cohort study at six level I trauma centers included patients with traumatic hip fractures. Patients with a non-fall mechanism and those who were transferred in were excluded. Patients admitted 16 March 2019-30 June 2019 were in the "pre-pandemic" group, patients were admitted 16 March 2020-30 June 2020 were in the "pandemic" group. The primary outcome was time from injury to arrival. Secondary outcomes were time from arrival to surgical intervention, hospital length of stay (HLOS), and mortality. RESULTS: There were 703 patients, 352 (50.1%) pre-pandemic and 351 (49.9%) during the pandemic. Overall, 66.5% were female and the median age was 82 years old. Patients were similar in age, race, gender, and injury severity score. The median time from injury to hospital arrival was statistically shorter for pre-pandemic patients when compared to pandemic patients, 79.5 (56, 194.5) min vs. 91 (59, 420), p = 0.04. The time from arrival to surgical intervention (p = 0.64) was statistically similar between groups. For both groups, the median HLOS was 5 days, p = 0.45. In-hospital mortality was significantly higher during the pandemic, 1.1% vs 3.4%, p = 0.04. CONCLUSIONS: While time from injury to hospital arrival was statistically longer during the pandemic, the difference may not be clinically important. Time from arrival to surgical intervention remained similar, despite changes made to prevent COVID-19 transmission.


Asunto(s)
/epidemiología , Fracturas de Cadera/epidemiología , Admisión del Paciente , Tiempo de Tratamiento , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Fracturas de Cadera/cirugía , Mortalidad Hospitalaria , Humanos , Tiempo de Internación/estadística & datos numéricos , Cuidados a Largo Plazo , Masculino , Pandemias , Alta del Paciente , Estudios Retrospectivos , Instituciones de Cuidados Especializados de Enfermería , Centros Traumatológicos , Estados Unidos/epidemiología
9.
Ars pharm ; 62(1): 75-84, ene.-mar. 2021. tab
Artículo en Español | IBECS | ID: ibc-199702

RESUMEN

INTRODUCCIÓN: Identificar las discrepancias existentes entre la medicación prescrita al ingreso en el servicio de traumatología y la medicación habitual de los pacientes, determinar la prevalencia de errores de conciliación y analizar el grado de aceptación de las intervenciones farmacéuticas realizadas para su resolución. MÉTODO: Estudio prospectivo de dos años de duración en un hospital comarcal público de España donde se seleccionaron los pacientes ingresados en traumatología con algún medicación domiciliario prescrito. Tras 24-48 horas del ingreso, el farmacéutico realizó la conciliación de la medicación, comparando la orden médica prescrita al ingreso con el tratamiento domiciliario. Se identificaron las discrepancias comunicándose al médico y se analizó el grado de aceptación de las recomendaciones. RESULTADOS: Se incluyeron 756 pacientes, con un total de 834 episodios de hospitalización; 66,1% mujeres, edad media: 72 ± 12,3 años, media de medicamentos domiciliarios por paciente: 8,1 ± 4,3. Se analizaron 8422 prescripciones, identificándose un 57,5% de discrepancias. La mayoría de las discrepancias no justificadas se debieron a omisión de medicamento (75%) seguido de la modificación de la posología o vía de un medicamento (19,1%). En el 87,4% de los episodios se encontró al menos una discrepancia. Las recomendaciones propuestas por el farmacéutico fueron aceptadas en el 69,9% de los casos. CONCLUSIONES: Existe un alta prevalencia de errores de conciliación al ingreso en el servicio de traumatología. Esta metodología ha permitido la coordinación del farmacéutico con el resto de profesionales implicados en la conciliación de la medicación, con el fin de detectar y resolver las discrepancias de medicación y reducir así los errores


INTRODUCTION: We aim to describe a method that would ensure continuity of patient care as regards drug therapy at admission to the orthopaedic surgery and traumatology department, identify the reconciliation discrepancies, determine the prevalence of reconciliation errors and analyse the acceptance of the pharmacist interventions. METHODS: Prospective observational study was conducted for two years in a regional public hospital in Spain. The study included patients hospitalized in the Orthopaedic Surgery and Traumatology Department with chronic medi¬cation prescribed. At 24-48 hours after hospital admission, the pharmacist compared the pre-admission pharmaco¬logical treatment of patients with the medication received in hospital to identify and reconciliation discrepancies. They were communicated and we analysed the acceptance of the pharmacist interventions. RESULTS: The study included 756 patients, with a total of 834 hospitalization episodes, 66,1% of whom were women, mean age: 72±12,3 years and a mean of 8,1±4,3 drugs. We analysed 8422 prescriptions, 57,5% reconciliation discrep¬ancies. The most frequent unjustified discrepancies were drug omission (75,2%), following by modification of the dose or route of administration (19,1%). There was at least one medication reconciliation discrepancy in 87,4% of hospitalization episodes. Pharmacist recommendations were accepted in 69,9% of cases. CONCLUSIONS: There was a high prevalence of reconciliation errors among patients admitted to the Orthopaedic Surgery and Traumatology Department. This methodology has allowed a workflow to be established that facilitates coordination between the pharmacist and others healthcare providers, to identify and resolve medication discrepancies to reduce medication errors


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Admisión del Paciente/estadística & datos numéricos , Conciliación de Medicamentos/estadística & datos numéricos , Prescripción Inadecuada/estadística & datos numéricos , Centros Traumatológicos/estadística & datos numéricos , Estudios Prospectivos , Conciliación de Medicamentos/métodos
10.
J Spec Oper Med ; 21(1): 49-54, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33721307

RESUMEN

BACKGROUND: The utility of prehospital thoracic needle decompression (ND) for tension physiology in the civilian setting continues to be debated. We attempted to provide objective evidence for clinical improvement when ND is performed and determine whether technical success is associated with provider factors. We also attempted to determine whether certain clinical scenarios are more predictive than others of successful improvement in symptoms when ND is performed. METHODS: Prehospital ND data acquired from one air ambulance service serving 79 trauma centers consisted of 143 patients (n = 143; ND attempts = 172). Demographic and clinical outcome data were retrospectively reviewed. Patients were stratified by prehospital characteristics and indications. Objective outcomes were measured as improvement in vital signs, subjective patient assessment, and physical examination findings. Univariate analysis was performed using chi-square for variable proportions and unpaired Student's t-test for variable means; p < .05 was considered statistically significant. RESULTS: The success rate of ND performed for hypoxia (70.5%) was notably higher than ND performed for hemodynamic instability (20.3%; p < .01) or cardiac arrest (0%; p < .01). Compared to vital sign parameters, clinical examination findings as part of the indication for ND did not reliably predict technical success (p > .52 for all indications). No difference was observed comparing registered nurse versus paramedic (p = .23), diameter of catheter (p > .13 for all), or length of catheter (p = .12). CONCLUSION: Prehospital ND should be considered in the appropriate clinical setting. Outcomes are less reliable in cases of cardiopulmonary arrest or hypotension with respiratory symptoms; however, this should not deter prehospital providers from attempting ND when clinically indicated. Additionally, the success rate of prehospital ND does not appear to be related to catheter type or the role of the performing provider.


Asunto(s)
Ambulancias Aéreas , Servicios Médicos de Urgencia , Descompresión , Humanos , Estudios Retrospectivos , Centros Traumatológicos
11.
Prehosp Disaster Med ; 36(3): 251-259, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33641689

RESUMEN

INTRODUCTION: Injury patterns are closely related to changes in behavior. Pandemics and measures undertaken against them may cause changes in behavior; therefore, changes in injury patterns during the coronavirus disease 2019 (COVID-19) outbreak can be expected when compared to the parallel period in previous years. STUDY OBJECTIVE: The aim of this study was to compare injury-related hospitalization patterns during the overall national lockdown period with parallel periods of previous years. METHODS: A retrospective study was completed of all patients hospitalized from March 15 through April 30, for years 2016-2020. Data were obtained from 21 hospitals included in the national trauma registry during the study years. Clinical, demographic, and circumstantial parameters were compared amongst the years of the study. RESULTS: The overall volume of injured patients significantly decreased during the lockdown period of the COVID-19 outbreak, with the greatest decrease registered for road traffic collisions (RTCs). Patients' sex and ethnic compositions did not change, but a smaller proportion of children were hospitalized during the outbreak. Many more injuries were sustained at home during the outbreak, with proportions of injuries in all other localities significantly decreased. Injuries sustained during the COVID-19 outbreak were more severe, specifically due to an increase in severe injuries in RTCs and falls. The proportion of intensive care unit (ICU) hospitalizations did not change, however more surgeries were performed; patients stayed less days in hospital. CONCLUSIONS: The lockdown period of the COVID-19 outbreak led to a significant decrease in number of patients hospitalized due to trauma as compared to parallel periods of previous years. Nevertheless, trauma remains a major health care concern even during periods of high-impact disease outbreaks, in particular due to increased proportion of severe injuries and surgeries.


Asunto(s)
/epidemiología , Hospitalización , Heridas y Traumatismos/epidemiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Puntaje de Gravedad del Traumatismo , Israel/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Sistema de Registros , Estudios Retrospectivos , Centros Traumatológicos
12.
J Trauma Acute Care Surg ; 90(4): 738-743, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33740785

RESUMEN

INTRODUCTION: As the prevalence of geriatric trauma patients has increased, protocols are being developed to address the unique requirements of this demographic. However, categorical definitions for geriatric patients vary, potentially creating confusion concerning which patients should be cared for according to geriatric-specific standards. The aim of this study was to identify data-driven cut points for mortality based on age to support implementation of age-driven guidelines. METHODS: Adults aged 18 to 100 years with blunt or penetrating injury were selected from 95 hospitals' trauma registries. Change point analysis techniques were used to detect inflection points in the proportion of deaths at each age. Based on these calculated points, patients were allocated into age groups, and their characteristics and outcomes were compared. Logistic regression was used to estimate risk-adjusted in-hospital mortality controlling for sex, race, Injury Severity Score, Glasgow Coma Scale, and number of comorbidities. RESULTS: A total of 255,099 patients were identified (female, 45.7%; mean age, 59.3 years; mean Injury Severity Score, 8.69; blunt injury, 92.6%). Statistically significant increases in mortality rate were noted at ages 55, 77, and 82 years. Compared with the referent group (age, <55 years), adjusted odds ratios (AORs) showed increases in mortality if age 55 to 76 years (AOR, 2.42), age 77 to 81 years (AOR, 4.70), or age 82 years or older (AOR, 6.43). National Trauma Data Standard-defined comorbidities significantly increased once age surpassed 55 years, as the rate more than doubled for each of the older age categories (p < 0.001). As age increased, each group was more likely to be female, have dementia, sustain a ground level fall, and be discharged to a skilled nursing facility (p < 0.001). CONCLUSION: This large multicenter analysis established a clinically and statistically significant increase in mortality at ages 55, 77, and 82 years. This research strongly suggests that trauma patients older than 55 years be considered for inclusion in geriatric trauma protocols. The other age inflection points identified (77 and 82 years) may also warrant additional specialized care considerations. LEVEL OF EVIDENCE: Epidemiological study, level III; Care management, level IV.


Asunto(s)
Heridas no Penetrantes/mortalidad , Heridas Penetrantes/mortalidad , Accidentes por Caídas/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Evaluación Geriátrica , Escala de Coma de Glasgow , Hospitalización , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Tasa de Supervivencia , Centros Traumatológicos , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/terapia , Heridas Penetrantes/diagnóstico , Heridas Penetrantes/terapia , Adulto Joven
13.
ANZ J Surg ; 91(4): 633-638, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33656252

RESUMEN

BACKGROUND: The New Zealand government implemented restrictive public health interventions to eradicate Covid-19. Early reports suggest that one downstream ramification is a change in trauma presentations. The aim of this study is to evaluate the effect these public health measures had on major trauma admissions in the Northern Region, New Zealand. METHODS: A retrospective comparative cohort study was performed. Two cohorts were identified: 16 March to 8 June 2020 and the same period in 2019. Data was extracted from the New Zealand Major Trauma Registry which prospectively collects data on all major trauma in New Zealand. All patients who presented to a hospital in the Northern Region with major trauma and met the Registry inclusion criteria were included. RESULTS: There were 163 major trauma admissions in 2019 and 123 in 2020, a reduction of 25% (rate ratio 0.75, 95% confidence interval 0.6-0.95; P = 0.018). There was no significant difference in mechanism of injury (P = 0.442), type of injury (P = 0.062) or intent of injury (P = 0.971). There was a significant difference in place of injury (P = 0.004) with 20% of injuries happening at home in 2019 compared with 35% in 2020. CONCLUSION: This study has shown that public health interventions to prevent the spread of COVID-19 reduced major trauma admissions in the Northern Region of New Zealand. There was a variation in effect a between institutions within the region and a change in pattern of injury.


Asunto(s)
Hospitalización/estadística & datos numéricos , Salud Pública , Heridas y Traumatismos/epidemiología , Estudios de Cohortes , Humanos , Puntaje de Gravedad del Traumatismo , Nueva Zelanda/epidemiología , Estudios Retrospectivos , Centros Traumatológicos/estadística & datos numéricos
14.
Ann R Coll Surg Engl ; 103(3): 218-222, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33645281

RESUMEN

BACKGROUND: Cauda equina syndrome, a rare but disabling spinal surgical emergency, requires prompt investigation, ideally using magnetic resonance imaging as patients may require decompressive surgery. Out of hours access to magnetic resonance imaging is only routinely available in major trauma centres and neurosurgical units. Patients in regional hospitals with suspected cauda equina syndrome may require transfer for diagnostic imaging. We retrospectively studied the proportion of patients referred with suspected cauda equina syndrome who required out of hours transfer for magnetic resonance imaging and decompressive surgery. MATERIALS ANDS METHODS: Retrospective cohort study of patients referred using online referral platforms with suspected acute cauda equina syndrome and transferred out of hours between 6pm to 8am on weekdays and all day on weekends to two of the largest neurosurgical units in the UK in Birmingham and Cambridge. RESULTS: A total of 441 patients were referred across both sites with a suspicion of acute cauda equina syndrome; 339 patients were transferred for diagnostic scans and only 16 of them (4.7%) were positive for cauda equina compression, necessitating prompt decompressive surgery. Of the patients with negative magnetic resonance scans, 50% had their discharge or transfer back to referring hospitals delayed by more than 24 hours. CONCLUSIONS: Over 95% of patients who were transferred for imaging did not undergo emergency decompression. The authors propose a greater role for the provision of out of hours magnetic resonance imaging in all hospitals admitting emergency patients to streamline management.


Asunto(s)
Atención Posterior , Síndrome de Cauda Equina/diagnóstico por imagen , Descompresión Quirúrgica , Imagen por Resonancia Magnética , Procedimientos Neuroquirúrgicos , Transferencia de Pacientes , Derivación y Consulta , Centros Traumatológicos , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Síndrome de Cauda Equina/cirugía , Femenino , Hospitales de Distrito , Hospitales Generales , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Reino Unido
15.
Wien Klin Wochenschr ; 133(7-8): 336-343, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33656596

RESUMEN

OBJECTIVE: The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) and its associated illness, coronavirus disease 2019 (COVID-19), has led to a global health crisis burdening frontline emergency departments, including orthopedic and trauma units. The aim of this study was to provide an overview of the impact of the lockdown secondary to the pandemic on patient numbers and pattern of injuries at the department of traumatology of the Medical University of Vienna. METHODS: This retrospective, descriptive study identified all patients admitted and enrolled onto the trauma registry at a level I trauma center, between 15 March 2020 and 30 April 2020 (lockdown) and compared them to those between 15 March 2019 and 30 April 2019 (baseline). Variables collected included patient age, sex, reason for hospital admission, place of injury, death, injury severity score (ISS), as well as American Society of Anaesthesiologists (ASA) score. RESULTS: A total of 10,938 patient visits to the trauma emergency department were analyzed, 8353 presentations during the baseline period and 2585 during lockdown. Only 1869 acutely injured and 716 follow-up patients presented during lockdown, compared to 6178 and 2175, respectively, during baseline. Throughout the COVID-19 lockdown there were significant reductions in both workplace and traffic accidents, sports injuries, number of hospitalized patients, and overall visits to the trauma emergency department; however, the number of major traumas and hip fractures remained similar. Furthermore, there was a significant increase in the frequency of injuries at home as well as hospital admissions due to attempted suicide. CONCLUSION: Despite the reduction in total number of patients, trauma departments should continue to provide adequate service during lockdown considering that severe injuries showed no change. Conditions such as breakdown of social networks and limited access to mental health care and support might account for the significant rise in hospital admissions due to suicides. We recommend that more attention and effort should be made to prevent this excess of suicide deaths.


Asunto(s)
Centros Traumatológicos , Control de Enfermedades Transmisibles , Humanos , Pandemias , Estudios Retrospectivos
17.
Scand J Trauma Resusc Emerg Med ; 29(1): 51, 2021 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-33752728

RESUMEN

BACKGROUND: Emerging evidence suggests that the reallocation of health care resources during the COVID-19 pandemic negatively impacts health care system. This study describes the epidemiology and the outcome of major trauma patients admitted to centers in France during the first wave of the COVID-19 outbreak. METHODS: This retrospective observational study included all consecutive trauma patients aged 15 years and older admitted into 15 centers contributing to the TraumaBase® registry during the first wave of the SARS-CoV-2 pandemic in France. This COVID-19 trauma cohort was compared to historical cohorts (2017-2019). RESULTS: Over a 4 years-study period, 5762 patients were admitted between the first week of February and mid-June. This cohort was split between patients admitted during the first 2020 pandemic wave in France (pandemic period, 1314 patients) and those admitted during the corresponding period in the three previous years (2017-2019, 4448 patients). Trauma patient demographics changed substantially during the pandemic especially during the lockdown period, with an observed reduction in both the absolute numbers and proportion exposed to road traffic accidents and subsequently admitted to traumacenters (348 annually 2017-2019 [55.4% of trauma admissions] vs 143 [36.8%] in 2020 p < 0.005). The in-hospital observed mortality and predicted mortality during the pandemic period were not different compared to the non-pandemic years. CONCLUSIONS: During this first wave of COVID-19 in France, and more specifically during lockdown there was a significant reduction of patients admitted to designated trauma centers. Despite the reallocation and reorganization of medical resources this reduction prevented the saturation of the trauma rescue chain and has allowed maintaining a high quality of care for trauma patients.


Asunto(s)
/epidemiología , Control de Enfermedades Transmisibles/organización & administración , Prestación de Atención de Salud/métodos , Manejo de la Enfermedad , Pandemias/prevención & control , Sistema de Registros , Centros Traumatológicos/estadística & datos numéricos , Adulto , Femenino , Francia/epidemiología , Hospitalización/tendencias , Humanos , Masculino , Estudios Retrospectivos
18.
Medicine (Baltimore) ; 100(13): e25334, 2021 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-33787631

RESUMEN

ABSTRACT: Cervical spine (C-spine) fractures in young children are very rare, and little information on treatment modalities and functional, radiographic, and patient-reported outcome exists. In this 2-center, retrospective case series, we assessed subjective and functional mid-term outcomes in children aged ≤5 years whose C-spine fractures were treated nonoperatively.Between 2000 and 2018, 6 children (median age at injury: 23.5 months; range: 16-31 months) with C1 or C2 injuries were treated with Minerva cast/brace or soft collar brace at 1 of the 2 study centers. Two patients suffered C1 fractures, and 4 patients had lysis of the odontoid synchondrosis. Overall, 3 children had sustained polytrauma. One child died due to the consequences of massive head injury.For the primary outcome parameter, we recorded subjective symptoms such as pain and functional restrictions due to the sequelae of C-spine injuries at follow-up.Based on medical records, we also assessed the causes of injury, diagnostic procedures, treatments and complications, and time to fracture consolidation.Median follow-up of the 5 surviving children was 51 months (range: 36-160 months). At the latest follow-up, 4 of 5 children did not complain of any pain. One child who sustained an open head injury in combination with a subluxation of the odontoid and undisplaced fracture of the massa lateralis reported occasional headache. All patients experienced complete fracture healing and normal range of motion of the cervical spine.Median duration of cast/brace treatment was 8.5 weeks. Fracture healing was confirmed by computed tomography in all patients.All C-spine injuries were managed with either Minerva cast/Halo brace or soft collar brace without complications.In our retrospective case series, nonoperative treatment of atlas fractures and dislocations or subluxations of the odontoid in young children using Minerva casts or prefabricated Halo braces resulted in good subjective and functional outcomes at mid-term. We observed no complications of conservative treatment of C1 and C2 injuries in young children.


Asunto(s)
Tirantes/efectos adversos , Atlas Cervical/lesiones , Tratamiento Conservador/métodos , Apófisis Odontoides/lesiones , Fracturas de la Columna Vertebral/terapia , Atlas Cervical/diagnóstico por imagen , Preescolar , Tratamiento Conservador/efectos adversos , Tratamiento Conservador/instrumentación , Femenino , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Incidencia , Lactante , Masculino , Apófisis Odontoides/diagnóstico por imagen , Estudios Retrospectivos , Fracturas de la Columna Vertebral/diagnóstico , Fracturas de la Columna Vertebral/epidemiología , Tomografía Computarizada por Rayos X , Centros Traumatológicos/estadística & datos numéricos , Resultado del Tratamiento
19.
Ann R Coll Surg Engl ; 103(3): 155-159, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33645272

RESUMEN

INTRODUCTION: The COVID-19 pandemic has had a huge impact on all our lives, both personally and professionally, and in many ways has been a catalyst for change. Limitations on social gathering have called the wisdom of a conventional trauma meeting into question. We have initiated our virtual trauma meeting and report our early results. MATERIALS AND METHODS: Daily morning trauma meetings are now conducted online. Following instigation, we collated the results of a feedback form completed online to assess the relative merits of a virtual trauma meeting. RESULTS: There were 27 responses received to the electronically administered virtual trauma meeting evaluation survey, from a range of trauma and orthopaedic department personnel. There were no concerns regarding patient safety or decision making and, apart from the quality of the audio (63% dissatisfied or very dissatisfied) positive feedback outweighed negative feedback in every category. At 74%, the majority of respondents were satisfied or very satisfied overall with the virtual trauma meeting. CONCLUSION: Trauma meetings can be safely conducted in a virtual environment with high standards of patient care maintained. Virtual trauma meeting offers service enhancements such as early subspecialty input and enhanced cross-site communication and rapid solution development to logistical difficulties. Adapting to conference call etiquette will enhance user experience and opportunity for training opportunities, but adequate investment in high-quality equipment is essential.


Asunto(s)
Actitud del Personal de Salud , Ortopedia/organización & administración , Centros Traumatológicos , Comunicación por Videocoferencia , Comunicación , Humanos , Encuestas y Cuestionarios , Reino Unido
20.
Ann R Coll Surg Engl ; 103(3): 160-166, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33645278

RESUMEN

INTRODUCTION: The COVID-19 pandemic resulted in reconfiguration of the NHS. Elective services were stopped and trauma services focused on decreasing patient-clinician interactions and managing injuries nonoperatively wherever possible. The everyday life of the general public changed dramatically with the introduction of a national lockdown to prevent the spread of COVID-19. This paper looks at the experience of a South West London trauma unit. MATERIALS AND METHODS: All patients reviewed in fracture clinic and by the orthopaedic on-call team between 23 March to 23 April 2020 were included. Data on the mechanism of injury and whether this was a usual activity, the injury sustained and its management were collected. RESULTS: A total of 167 trauma injuries were seen, compared with 735 new patients with injuries in the previous month. The number of trauma operations completed decreased by 38%; 55% of injuries occurred inside the home and 44% outside the home during daily exercise. Some 31% of injuries were secondary to a new activity taken up during lockdown. Three open fractures and two polytrauma cases were seen that would have normally been managed at the local major trauma centre. CONCLUSION: Overall, both the number of injuries seen and trauma operations completed during the enforced lockdown decreased. This is probably due to a change in the way the general public are living their lives, and the reconfigurations within the NHS in response to the COVID-19 pandemic. This is an interesting time within trauma and orthopaedic departments, as they continue to adapt to the changing injuries and working environment.


Asunto(s)
Accidentes Domésticos/estadística & datos numéricos , Ejercicio Físico , Fracturas Óseas/epidemiología , Centros Traumatológicos , Accidentes por Caídas/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ciclismo/lesiones , Niño , Preescolar , Control de Enfermedades Transmisibles , Femenino , Fracturas del Cuello Femoral/epidemiología , Fracturas del Cuello Femoral/etiología , Fracturas del Cuello Femoral/cirugía , Fijación Interna de Fracturas , Fracturas Óseas/etiología , Fracturas Óseas/cirugía , Jardinería , Humanos , Lactante , Londres/epidemiología , Masculino , Persona de Mediana Edad , Fracturas del Radio/epidemiología , Fracturas del Radio/etiología , Fracturas del Radio/cirugía , Adulto Joven
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