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Aims Pneumomediastinum is a known radiological finding after major thoracic trauma; however, its significance and required investigative workup are not standardized. Furthermore, there is little evidence to suggest that traumatic pneumomediastinum is indicative of oesophageal injury. Our study sets out to investigate the incidence of oesophageal injury for these patients at our centre, and the relevant investigative workup is required. Methods Medical records were retrieved from our trust (Major Trauma Centre: 2012 to present, Upper Gastro-Intestinal (UGI) Centre: 2009 to present) to include trauma patients with radiological pneumomediastinum admitted between 2010 and 2021. Demographics, mechanism of injury, length of stay, and other significant findings were collected retrospectively using the electronic patient record. Results The data search retrieved 37 patients with traumatic pneumomediastinum. One patient was excluded due to incomplete records. Road traffic collisions were the most common presentation (18 patients), followed by falls (13 patients), penetrating trauma (three patients), assault (two patients), and workplace injury (one patient). The median length of stay was six days, with two inpatient deaths. One patient had a confirmed tracheobronchial injury on initial imaging which was managed conservatively, while six other patients underwent further oral contrast CT for suspected oesophageal injury. No patients in our dataset had a confirmed oesophageal injury. Conclusion Oesophageal injury is rarely seen in traumatic pneumomediastinum and is usually secondary to other chest injuries causing an air leak into the mediastinum. Oral contrast CT is the recommended investigation to exclude oesophageal injury.
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PURPOSE: The daily surgical ward round (WR) is a complex process. Key aspects of patient assessment can be missed or not be documented in case notes. Safety checklists used outside of medicine help standardize performance and minimize errors. Its implementation has been beneficial in the National Health Service. A structured WR checklist standardizes key aspects of care that need to be addressed on a daily surgical WR. To improve patient safety and documentation, we implemented a surgical WR checklist for daily surgical WRs at our hospital. We describe our experience of its implementation within the general surgical department of a teaching hospital in the UK. METHODS: A retrospective review of case note entries from surgical WRs (including Urology and Vascular surgery) was conducted between April 2015 and January 2016. WR entries of 72 case notes were audited for documentation of six parameters from the surgical WR checklist. A WR checklist label with the parameters was designed for use for each WR entry. A post-checklist implementation audit of 61 case notes was performed between Jan 2016 and August 2016. To assess outcome on patient safety, adverse events relating to these six parameters reported to the local clinical governance team were reviewed pre - and post-checklist implementation. RESULTS: Overall documentation of the six parameters improved following implementation of the WR checklist (pre-checklist=26% vs post-checklist=79%). Documentation of assessment of fluid balance improved from 8% to 76%. Subsequent audit at 3 months post-checklist implementation maintained improvement with documentation at 72%. CONCLUSION: The introduction of the surgical WR checklist has improved documentation of key aspects of patient care. The WR checklist benefits patient safety. It improves communication, documentation and ensures that key issues are not missed at patient assessment on WRs. A crucial factor for successful documentation is engagement by the senior clinicians and nursing staff on its benefits which ensures appropriate use of WR checklist labels occurs as doctors rotate through the surgical placement.