Injury
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Skateboard injuries have been described in the media and scientific journals as a problem prevalent among children and adolescents. Skateboarding popularity has continued to grow since the 1970s with ridership increasing to include all age groups. Recently, surgeons at one trauma centre at an urban hospital noted an increase in the number of older skateboarders with life-threatening injuries. We hypothesise that the clinical and epidemiological features of skateboard-related injuries from one trauma centre (TC) will be different from injured skateboarders identified in the U.S. National Trauma Data Bank (NTDB). We also sought to identify factors related to poor outcomes in the TC and NTDB patient groups. ⋯ From our Trauma Centre we describe an older injured skateboarding population, clinically and epidemiologically different from injured patients identified in the NTDB as well as those described in the literature. The greater severity of injury, including traumatic brain injury, has direct implications for preventive and educational measures and the planning of emergency surgical response.
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Review Meta Analysis
Do compensation processes impair mental health? A meta-analysis.
Victims who are involved in a compensation processes generally have more health complaints compared to victims who are not involved in a compensation process. Previous research regarding the effect of compensation processes has concentrated on the effect on physical health. This meta-analysis focuses on the effect of compensation processes on mental health. ⋯ Being involved in a compensation process is associated with higher mental health complaints but three-quarters of the difference appeared to be already present at baseline. The findings of this study should be interpreted with caution because of the limited quality of evidence. The difference at baseline may be explained by a selection bias or more anger and blame about the accident in the compensation group. The difference between baseline and follow-up may be explained by secondary gain and secondary victimisation. Future research should involve assessment of exposure to compensation processes, should analyse and correct for baseline differences, and could examine the effect of time, compensation scheme design, and claim settlement on (mental) health.
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Multicenter Study Comparative Study
Evaluation of TEG(®) and RoTEM(®) inter-changeability in trauma patients.
Massive haemorrhage is a leading cause of preventable deaths in trauma. Traumatic coagulopathy is frequently present early after trauma, and is associated with increased mortality. A number of recent trials suggest that viscoelastic haemostatic assays (VHA), such as thromboelastography and thromboelastometry, are useful tools in guiding transfusion. Treatment algorithms exist for the use of VHAs but are not validated in traumatic haemorrhage. In this study we examined the inter-changeability of two commonly used VHAs, TEG(®) and RoTEM(®). ⋯ Inter-changeability between TEG(®) and RoTEM(®) is limited in the trauma setting. Agreement seems poorer when clinicians operate the devices. Development and validation of separate treatment algorithms for the two devices is required.
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Multicenter Study Comparative Study
Liver cirrhosis but not alcohol abuse is associated with impaired outcome in trauma patients - a retrospective, multicentre study.
Liver cirrhosis has been shown to be associated with impaired outcome in patients who underwent elective surgery. We therefore investigated the impact of alcohol abuse and subsequent liver cirrhosis on outcome in multiple trauma patients. ⋯ Patients suffering from liver cirrhosis presented impaired outcome after multiple injuries. Pre-existing condition such as cirrhosis should be implemented in trauma scores to assess the individual mortality risk profile.
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The importance of health service planning for major incident management has been recognised since the World Trade Centre attacks of September 2001 and is highly relevant to planning for the 2012 Olympics. UK national Major Incident guidance stipulates the use of a system of triage for casualties to prioritise treatment and ensure "the greatest good for the greatest number". However, at least three triage systems are in use worldwide and no evidence exists to demonstrate their relative efficacy. The transport bombings in London on 7th July 2005 caused the largest number of casualties on mainland UK soil since World War 2. We aimed to validate three major incident triage systems using patient data from the 7th July bombings. ⋯ Systematic triage of mass casualties is effective but the amount of missing data seriously compromises any attempt to evaluate systems of trauma care in a major incident.