Articles: trauma.
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Assessing the impact of perioperative anticoagulant continuation on DVT/PE rates in trauma patients.
In the United States, deep vein thrombosis (DVT) and pulmonary embolism (PE) ranked high in terms of possibly preventable hospital deaths. Victims of trauma were at a higher risk of developing thromboembolic complications, and thus various agents were used for prophylaxis. Multiple studies recommended holding these agents in the perioperative period to decrease the potential complications of additional bleeding, wound issues, hematoma etc. However, the data regarding the timing and duration of withholding these agents was not consistent and at times surgeon specific. The aim of this study was to compare the incidence of DVT/PE in trauma patients before and after a June 2022 policy intervention to operate through prophylactic anticoagulation at an academic trauma center. ⋯ Findings suggested that DVT/PE rates have significantly decreased post policy change without a significant increase in mortality and bleeding risk.
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Nearly 30 million, mostly rurally located Americans lack timely access to level I or II trauma center care, resulting in inefficient resource use and potentially preventable death. Although significant progress has been made in the care of the injured patient during the last few decades, rural trauma patients continue to face significant challenges in accessing high-quality trauma care with resultant outcomes disparities and increased expenditures associated with potentially avoidable interfacility transfers. ⋯ Although telehealth has been used in trauma with some success, it remains underused. Members of a 2023 American College of Surgeons Committee on Trauma Spotlight Session on the role of teletrauma present an introduction to the applications, potential benefits, and future directions for telehealth use in trauma care.
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Collecting patient-reported outcome measures (PROMs) has been a longstanding priority for the Burns Registry of Australia and New Zealand (BRANZ). An earlier pilot of hospital-led PROM collection encountered low participation rates and high loss to follow-up, indicating consideration for an alternative model was warranted. ⋯ Collecting PROMs from burns patients in the first 12 months after injury via a centralised approach was shown to be feasible, with higher participation rates and low missingness.
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Multicenter Study
Paediatric falls: An analysis of patterns of injury and associated mortality in urban India.
Falls are some of the most common childhood injuries. However, for vulnerable children in low- and middle-income countries (LMICs) such as India, mortality from a fall is nearly three times that of high-income countries. Despite fall being a leading cause of paediatric injury, detailed data from LMICs remain sparse. This study aims to assess fall-related patterns of injury and mortality in children in urban India. ⋯ The majority of paediatric patients admitted to urban hospitals in India after a fall were between the ages of two-to-five years, with isolated TBI and male sex associated with greater mortality. These findings have the potential to aid age-specific fall prevention strategies and resource allocation towards targeted initiatives to improve access to care, and consequently, mortality from fall in urban India.
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Comparative Study
Assessing the evolution of pre-hospital combat casualty care: A comparative study of two conflicts a decade apart.
Combat casualty care has advanced significantly with the implementation of evidence-based protocols designed to lower combat-related mortality. Over the last decade, two major urban conflicts in southern Israel have challenged the evolving military trauma system. This study aimed to assess differences in prehospital care and compare the outcomes of aeromedically evacuated casualties from the 2014 and 2023 conflicts. ⋯ Over the past decade, there has been a decline in prehospital airway interventions and thoracostomies, coupled with an increase in early blood transfusions. Despite greater injury severity, mortality rates have remained stable. Although not statistically significant, lower mortality rates were recorded among the severely and critically injured. These findings support the "less is more" approach in modern prehospital combat casualty care.