Injury
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New direct oral anticoagulants (DOACs) are commonly used in the management of atrial fibrillation and VTE. Currently, there is no strong evidence to support the current practice of routinely repeating computed tomography (CT) head in anticoagulated patients within 24 hours after their first negative CT scan to assess for new and delayed intracranial hemorrhage (ICH). Our hypothesis is that the vast majority will not have new CT scan findings of ICH and those who do would not require any further intervention. ⋯ 498 Patient encounters met inclusion criteria. Only 19 patients (3.8%) had positive traumatic ICH on the initial CT head. Those had a higher ISS. 420 out of 479 initial negative CT encounters received a second CT head. Only 2 (0.5%) had delayed positive second CT scan for ICH. 95%CI [0.06%, 1.7%] Patients who developed a new ICH on the second CT head after an initial negative CT scan had a lower Glasgow Coma Scale (GCS) on presentation and a higher ISS. None of those patients required neurosurgical intervention CONCLUSION: Our data suggests that the risk of developing a new or delayed traumatic ICH for patients on DOAC on a second CT head within 24 hours following an initial negative CT is very low and when present did not require neurosurgical intervention and thus does not support routinely obtaining a repeat CT head within 24 hours after a negative initial CT scan. Patients presenting with lower GCS and higher ISS had a higher chance of having a delayed ICH.
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Aim To review the indications, complications and outcomes of extracorporeal membrane oxygenation (ECMO) in major trauma patients. Methods Single centre, retrospective, cohort study. Results Over a ten year period, from 13,420 major trauma patients, 11 were identified from our institutional trauma registry as having received ECMO. ⋯ Overall survival to discharge was 45%, and was higher with VV ECMO (64%), than other configurations (25%). Conclusion ECMO was rarely used in major trauma, the most common indication being severe hypoxaemic respiratory failure secondary to lung injury. In this severely injured cohort, overall survival was poor but better in VV compared to VA and better if initiated early (<72 hours), compared to late.
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Despite the ubiquity of motorized vehicular transport, non-motorized transportation continues to be common in sub-Saharan Africa. ⋯ Non-motorized vehicular trauma remains a significant proportion of morbidity and mortality resulting from road traffic injuries. The injury severity and incidence rate ratio of mortality did not differ between motorized and non-motorized trauma groups. Health care providers should not underestimate the severity of injuries from non-motorized trauma.
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Household economic impact of road traffic injury versus routine emergencies in a low-income country.
Road traffic injuries (RTIs) are increasing and have disproportionate impact on residents of low- and middle-income countries (LMICs) where 90% of deaths occur. RTIs are a leading cause of death for those aged 15 - 29 years with costs estimated to be up to 3% of GDP. Despite this fact, little primary research has been done on the household economic impact of these events. ⋯ Ugandan emergency care patients suffered significant personal and household economic hardship. In addition to the need for policy and infrastructural changes to improve road safety, these findings highlight the need for basic emergency care systems to secure economic gains in vulnerable households and prevent medical impoverishment of marginal communities.
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The aim of this study was to perform MIPO of the distal tibia from a dorsomedial and dorsolateral approach and to evaluate their feasibility and risk of injury to adjacent anatomical structures. ⋯ In conclusion, MIPO from the dorsomedial and dorsolateral approach are both safe procedures as indicated by our study.