Injury
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Standardized trauma protocols (STP) have reduced morbidity and in-hospital mortality in mature trauma systems. Most hospitals in low- and middle-income countries (LMICs) have not implemented STPs, often because of financial and logistic limitations. We report the impact of an STP designed for the care of trauma patients in the emergency department (ED) at an LMIC hospital on patients with severe traumatic brain injury (STBI). ⋯ An STP in an LMIC decreased in-hospital mortality, increased discharge GCS, and increased use of vital ED interventions for patients with STBI. An STP in an LMIC can be implemented and measured without a pre-existing trauma registry.
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Previous research found a positive effect of Level-I trauma centres on return to work outcomes for patients 18-64 years old who were mainly working before injury. Trauma centres were compared to hospitals that differed on average in characteristics such as size and staffing, among others. Thus, a portion of the effect found could be due to general differences in hospital variables rather than the special characteristics of Level I trauma centres. Comparing Level I trauma centres to other Teaching hospitals provides a more refined test of the effect of these centres on return-to-work outcomes. ⋯ A previous study found positive effects of treatment at a Level-I trauma centre on return-to-work outcomes, however, a portion of the effect found was due to general differences in hospital variables.
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Observational Study
Survey of patient and physician influences and decision-making regarding CT utilization for minor head injury.
Assess factors that influence both the patient and the physician in the setting of minor head injury in adults and the decision-making process around CT utilization. ⋯ Patients with low risk of intra-cranial injury continue to be evaluated by CT. Physician decision-making around the use of CT to evaluate minor head injury is multi-factorial. Shared decision-making between the patient and the physician in a low risk minor head injury encounter shows promise as a method to reduce CT utilization in this low risk cohort.
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Health care workers (HCWs) face constant risk of exposure to cuts and splashes as occupational hazard. Hence, a prospective observational study was conducted to observe the exposure of HCWs to various sharp injuries and splashes during health care and to work up a baseline injury rate among HCWs for future comparison in trauma care set ups. ⋯ High rates of exposure to sharp injuries and splashes among HCWs call for proper safety protocols. Proper methods to prevent it, encouraging voluntary reporting and an active surveillance team are the need of the hour.
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Management of liver injuries: Predictors for the need of operation and damage control surgery, ⋯ Overall MR of liver injury patients was 17.4%. NOM carried a low MR and should be, attempted in the absence of hemodynamic instability and peritonitis. Patients with low GCS, penetrating injury, tachycardia, and hypotension were more likely to require operation. DCS should be considered while operating on patients with high grade liver injury, tachycardia, and blunt mechanism.