Accurate completion of tertiary trauma survey for inpatients at a non-trauma centre following significant trauma.

INTRODUCTION: A tertiary trauma survey (TTS) is a structured, comprehensive top-to-toe examination following major trauma [1]. Literature suggests that the ideal time frame for the initial TTS should be completed within 24-hours of a patient's admission and repeated at important moments [2-4]. Evidence suggests that formal TTS reduces the rate of missed injuries by up to 38% [2]. AIMS: To determine the rate of TTS being conducted in trauma patients in a tertiary hospital without an admitting trauma service. METHODS: We performed a retrospective analysis of adult trauma patients admitted to Middlemore Hospital (MMH) over six months. To be included, patients were either deemed to have a significant mechanism of injury or triggered a trauma call when arriving in the Emergency Department. RESULTS: We identified 246 patients who met our criteria for requiring a TTS. 74 (30%) had a TTS completed. Of those completed, 22 (30%) were documented using a standardised form. 35 (47%) were done within the ideal timeframe (24 h); a further 21 (28%) were done within 48 h. House Officers (Junior Medical Officers) conducted the majority (80%), with the remainder being done by final-year medical students (12%), Registrars (Residents) (4%) and Consultants (Attendings) (4%). Of the 74 TTS that were completed, 21 (28%) detected a possible new injury, with 22% leading to further investigations being ordered. 14 (19%) were found to have a previously undetected, clinically significant injury on TTS (defined as 'injuries requiring further clinical intervention'). Most patients (90%) were admitted to either General Surgery or Orthopaedics. Sixty-two (54%) of patients admitted to General Surgery received a TTS; compared to just 11 (10%) admitted under Orthopaedics and 1 of 24 (4%) admitted to other specialities (including Hands, Plastics, Maxillo-Facial, Gynaecology and Medicine). CONCLUSION: 30% of patients requiring a TTS received one. 19% of TTS conducted detected clinically significant injuries.

Reduced connectivity of the auditory cortex in patients with auditory hallucinations: a resting state functional magnetic resonance imaging study.

BACKGROUND: Previous research has reported auditory processing deficits that are specific to schizophrenia patients with a history of auditory hallucinations (AH). One explanation for these findings is that there are abnormalities in the interhemispheric connectivity of auditory cortex pathways in AH patients; as yet this explanation has not been experimentally investigated. We assessed the interhemispheric connectivity of both primary (A1) and secondary (A2) auditory cortices in n=13 AH patients, n=13 schizophrenia patients without auditory hallucinations (non-AH) and n=16 healthy controls using functional connectivity measures from functional magnetic resonance imaging (fMRI) data. METHOD: Functional connectivity was estimated from resting state fMRI data using regions of interest defined for each participant based on functional activation maps in response to passive listening to words. Additionally, stimulus-induced responses were regressed out of the stimulus data and the functional connectivity was estimated for the same regions to investigate the reliability of the estimates. RESULTS: AH patients had significantly reduced interhemispheric connectivity in both A1 and A2 when compared with non-AH patients and healthy controls. The latter two groups did not show any differences in functional connectivity. Further, this pattern of findings was similar across the two datasets, indicating the reliability of our estimates. CONCLUSIONS: These data have identified a trait deficit specific to AH patients. Since this deficit was characterized within both A1 and A2 it is expected to result in the disruption of multiple auditory functions, for example, the integration of basic auditory information between hemispheres (via A1) and higher-order language processing abilities (via A2).

Optimizing electrode and filter selection in cochlear implant speech processor maps.

This study examined two hypotheses: that speech understanding of cochlear implantees could be improved by removing electrodes that exhibit nontonotopic percepts from the speech processor map and that speech understanding could be improved by extending the range of high frequencies that are mapped to the electrodes. Electrodes producing nontonotopic percepts were identified using a multidimensional scaling procedure with seven users of the Nucleus CI22 implant and Spectra processor. Two experimental maps were created with those electrodes removed: the first using the same set of filters as their clinical map and the second using the complete set of filters available. After periods of take-home experience, speech perception was tested and compared for the two experimental maps and their own clinical map. It was found that removing nontonotopic electrodes did not improve speech perception, possibly due to the deleterious side effect of shifting the frequency-to-electrode allocation. Also, extending the high-frequency range of the map did not improve speech perception, possibly due to the poor sensitivity of this processor to high-frequency sounds.