Injury
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As life expectancy improves globally, the burden of elderly trauma continues to increase. Sub-Saharan Africa is projected to have the most rapid growth in its elderly demographic. Consequently, we sought to examine the trends in characteristics and outcomes of elderly trauma in a tertiary care hospital in Malawi. ⋯ At KCH, the proportion of elderly trauma patients is slowly increasing. Although healthcare resource utilization has increased over time, the overall trend in mortality has not improved. As the quality of care for the most vulnerable populations is a benchmark for the success of a trauma program, further work is needed to improve the trend in outcomes of the elderly trauma population in Malawi.
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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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Mass Casualty Incidents (MCIs) are rare but devastating events that require extensive planning in order to minimize morbidity and mortality. There are two broad categories limiting a hospital's response: physical assets (e.g., critical care beds, operating rooms, food, communication devices) as well as operating procedures (e.g., MCI committees, regional coordination, provider training). The purpose of this study is to provide an examination of MCI preparedness according to these categories in Level 1 Trauma Centre across Canada. ⋯ This study demonstrated that physical assets are generally less limiting than operating procedures. Four key areas of potential improvement have been identified: 1) provider training (especially physicians), 2) coordination with small hospitals, 3) mechanical ventilator availability, and 4) MCI committees with explicit Strategic Emergency Management Plans.
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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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Prolonged extrication of entrapped patients after road traffic accidents increases the risk of sustained hypothermia. Accident-related hypothermia increases mortality in severely injured patients, and prehospital efforts to prevent hypothermia are essential. We evaluated various warming measures regarding their preclinical suitability and efficacy for patient warming, tested in realistically-simulated road traffic accident scenarios under cold ambient conditions in a climate chamber. ⋯ The increased mortality associated with hypothermia in severely injured crash victims during prolonged vehicle extrication has intensified efforts to prevent sustained hypothermia. The use of a CWB, FAW or IRR are in principle all suitable for reducing or compensating for heat loss. The ongoing cooling of those body parts not directly exposed to the heat source was interpreted as a steal phenomenon in regional blood flow. However, the practicality and effectiveness of these measures, combined with their logistical requirements, must be evaluated in real extrication scenarios.