A longitudinal study examining the relationship between prioritization scores and changes in impact on life scores in elective surgery patients.

BACKGROUND: Healthcare systems globally face the issue of resource constraints and need for prioritization of elective surgery. Inclusive, explicit prioritization tools are important in improving consistency and equity of access to surgery across health systems. The General Surgical Prioritization Tool developed by New Zealand's Ministry of Health scores patients for elective non-cancer surgery based on surgeon's clinical judgement and patient derived Impact on Life (IoL) scores. This study aims to measure the changes in patient derived IoL scores after common general surgical procedures to enable direct comparison and inform future prioritization. METHOD: This longitudinal observational study enrolled 322 participants who had undergone elective general surgical procedures. Participants were contacted 3 to 9 months after their procedures and requested to complete the IoL questionnaire. The primary endpoint was the change in IoL scores after surgery among the different procedures. RESULTS: Overall, 229/304 (75%) participants responded to the questionnaire and there were no significant baseline differences between responders and non-responders. Patients in the gallbladder treatment group had the greatest improvement in IoL scores. Patients across all ethnic groups had similar changes in IoL scores. Multivariate analysis showed that gallbladder surgery (relative to hernia surgery) and pre-surgery IoL scores significantly predicted improvement. CONCLUSION: The patient reported IoL score recorded at prioritization for surgery all reduced, albeit to varying amounts, after common general surgical procedures. This, combined with the fact that IoL scores predicted post-operative improvement support their inclusion in prioritization tools in addition to surgeon derived components.

Factors contributing to death of major trauma victims with haemorrhage: A retrospective case-control study.

OBJECTIVE: To identify factors associated with death secondary to haemorrhage following major trauma. METHODS: A retrospective case-control study was conducted on data from adult major trauma patients attending Christchurch Hospital ED between 1 June 2016 and 1 June 2020. Cases (those who died due to haemorrhage or multiple organ failure [MOF]), were matched to controls (those who survived) in a 1:5 ratio from the Canterbury District Health Board major trauma database. A multivariate analysis was used to identify potential risk factors for death due to haemorrhage. RESULTS: One thousand, five hundred and forty major trauma patients were admitted to Christchurch Hospital or died in ED during the study period. Of them, 140 (9.1%) died from any cause, most attributed to a central nervous system cause of death; 19 (1.2%) died from haemorrhage or MOF. After controlling for age and injury severity, having a lower temperature on arrival in ED was a significant modifiable risk factor for death. Additionally, intubation prior to hospital, increased base deficit, lower initial haemoglobin and lower Glasgow Coma Scale were risk factors associated with death. CONCLUSIONS: The present study reaffirms previous literature that lower body temperature on presentation to hospital is a significant potentially modifiable variable in predicting death following major trauma. Further studies should investigate whether all pre-hospital services have key performance indicators (KPIs) for temperature management, and causes for failure to reach these. Our findings should promote development and tracking of such KPIs where they do not already exist.

Paediatric exploratory ingestion presentations to Christchurch Hospital emergency department during 2019.

AIM: To quantify and describe presentations to a New Zealand tertiary hospital emergency department (ED) associated with paediatric exploratory ingestions (PEIs) during 2019 in comparison to 1999. METHODS: A retrospective descriptive study was conducted of PEI presentations by children under 7 years of age to Christchurch Hospital ED between 1 January and 31 December 2019. Data were studied for demographic and management details and compared to data from 1999. RESULTS: There were 111 PEI presentations in children under 7 years during 2019, out of 9,445 presentations for this age group (1.2%). The estimated incidence of PEIs was 223.8 per 100,000. PEI presentations relative to total paediatric presentations had reduced compared to 1999 (X2=94.7, p<0.001). Two year olds were most likely to have PEIs (odds ratio (OR)=15.01, 95% confidence interval (CI)=6.78, 33.22). Children of Asian (OR=0.50, 95% CI=0.26, 0.95) and Pacific (OR=0.34, 95% CI=0.12, 0.93) ethnicity were less likely to present with PEIs. Paracetamol was the most commonly ingested substance (15.3%), followed by opioids (11.7%). CONCLUSION: Paediatric presentations due to exploratory ingestions reduced between 1999 and 2019. However, there was a concerning increase in ingestions of medications like opioids that have a significant risk of toxicity at low doses.

Paediatric presentations to Christchurch Hospital Emergency Department during COVID-19 lockdown.

AIM: To describe the variation in volumes and types of paediatric presentations to a tertiary emergency department in New Zealand during the national level 4 lockdown for COVID-19. METHODS: A retrospective, comparative cohort study in Christchurch Hospital Emergency Department, New Zealand. RESULTS: There was a 37% reduction in all emergency presentations during the 33-day lockdown period. Paediatric presentations reduced significantly more than non-paediatric presentations (53% paediatric vs. 34% non-paediatric, P < 0.00001). The decrease in both overall and paediatric presentations was significantly different than similar periods in 2019 and 2018 (P < 0.00001). The proportion of New Zealand European paediatric presentations during lockdown increased by 6.09% (P = 0.01), while Pacific peoples decreased by 3.36% (P = 0.005). The proportion of <1-year-old presentations increased by 5.56% (P = 0.001), while 11-15 years decreased by 7.91% (P = 0.0001). Respiratory-related paediatric presentations decreased by 30% and proportional decreased by 4.92% (P = 0.001). CONCLUSION: This study has identified a significant reduction in paediatric presentations to a tertiary emergency department in New Zealand during the national Alert Level 4 Lockdown for COVID-19. The proportional increase in the <1-year-old group may suggest a greater need for community-based child health services during the COVID-19 pandemic. Mental health support services may also need to adapt and expand to provide adequate psychological support for children during this crisis. Recognising the needs of these vulnerable groups will be critical during the ongoing COVID-19 pandemic in addition to informing response plans for similar events in the future.