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Trauma Registry (trauma + registry)

Distribution by Scientific Domains
Medical Sciences100%

Kinds of Trauma Registry

  • state trauma registry
    		•

    Selected Abstracts

    Dento-alveolar and maxillofacial injuries: a 5-year multi-center study.

    DENTAL TRAUMATOLOGY, Issue 1 2008
    Part 2: Severity, location
    These injuries may cause morbidity and demand meticulously planned treatment. Part 1 of this study focused on the incidence of general trauma injuries, as well as facial or dental trauma. The aim of part 2 is to evaluate the severity and location of the dento-alveolar and maxillofacial injuries over 5 years. A retrospective cohort study was conducted based on data from the Israel National Trauma Registry. Patients admitted and hospitalized due to trauma injuries during the years 2000,2004, totaled 111 010 in which 5886 (5.3%) were maxillofacial or dental injuries. Most of these injuries were traffic-related (54.5%), followed by events at home (18.7%). Facial injuries combined with injuries to other organs involved occurred in 3721 (63.2%) of the patients. Most minor injuries were noted when no other organs were involved, while severe injuries were more common when multiple organs were involved. More than 25% of facial injuries required surgery. Meticulous epidemiologic studies are needed to support the leading role, extent, and severity of maxillofacial trauma. [source]

    The Validity of Using Multiple Imputation for Missing Out-of-hospital Data in a State Trauma Registry

    ACADEMIC EMERGENCY MEDICINE, Issue 3 2006
    Craig D. Newgard MD
    Objectives: To assess 1) the agreement of multiply imputed out-of-hospital values previously missing in a state trauma registry compared with known ambulance values and 2) the potential impact of using multiple imputation versus a commonly used method for handling missing data (i.e., complete case analysis) in a typical multivariable injury analysis. Methods: This was a retrospective cohort analysis. Multiply imputed out-of-hospital data from 1998 to 2003 for four variables (intubation attempt, Glasgow Coma Scale score, systolic blood pressure, and respiratory rate) were compared with known values from probabilistically linked ambulance records using measures of agreement (,, weighted ,, and Bland,Altman plots). Ambulance values were assumed to represent the "true" values for all analyses. A hypothetical multivariable regression model was used to demonstrate the impact (i.e., bias and precision of model results) of handling missing out-of-hospital data with multiple imputation versus complete case analysis. Results: A total of 6,150 matched ambulance and trauma registry records were available for comparison. Multiply imputed values for the four out-of-hospital variables demonstrated fair to good agreement with known ambulance values. When included in typical multivariable analyses, multiple imputation increased precision and reduced bias compared with using complete case analysis for the same data set. Conclusions: Multiply imputed out-of-hospital values for intubation attempt, Glasgow Coma Scale score, systolic blood pressure, and respiratory rate have fair to good agreement with known ambulance values. Multiple imputation also increased precision and reduced bias compared with complete case analysis in a typical multivariable injury model, and it should be considered for studies using out-of-hospital data from a trauma registry, particularly when substantial portions of data are missing. [source]

    Motorcycle-related major trauma: On-road versus off-road incidence and profile of cases

    EMERGENCY MEDICINE AUSTRALASIA, Issue 5 2010
    Antonina Mikocka-Walus
    Abstract Objective: To describe and compare the incidence and profile of on- and off-road motorcycle-related major trauma (including death) cases across a statewide population. Methods: A review of prospectively collected data on adult, motorcycle-related major trauma cases from 2001 to 2008 was conducted. Major trauma survivors were identified from the population-based Victorian State Trauma Registry, and deaths were extracted from the National Coroners Information System. Poisson regression was used to test for increasing incidence using two measures of exposure: population of Victoria aged ,16 years, and registered motorcycles. Results: There were 1157 major trauma survivors and 344 deaths with motorcycle-related injuries over the study period. There was no change in the incidence of motorcycle-related major trauma (both survivors plus deaths) (Incident Rate ratio [IRR]= 1.14, 95% confidence interval [CI] 0.94,1.37) over the study period. Similarly, there was no change over time in the incidence of on-road motorcycle-related injury (survivors plus deaths) per 100 000 population (IRR = 1.03, 95% CI 0.84,1.27). However, the incidence of off-road motorcycle-related injury (survivors plus deaths) increased over the study period (IRR = 1.69, 95% CI 1.10,2.60). Among survivors and deaths, 882 (76%) and 301 (87.5%) cases, respectively, occurred on road. Conclusions: Off-road motorcycle-related major trauma has increased and this has not been targeted in injury prevention campaigns in Australia. The incidence of on-road motorcycle-related death in adults has decreased. Preventive strategies to address on-road injuries have been enforced and these are expected to lead to further reduction of on-road motorcycle crashes in the future. [source]

    Epidemiology of major paediatric chest trauma

    JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 11 2009
    Sumudu P Samarasekera
    Aim: Paediatric chest trauma is a marker of severe injury and a significant cause of morbidity and mortality. However, current trends in the Australian population are unknown. This study aims to outline the profile and management of major paediatric chest trauma in Victoria. Methods: Prospectively collected data of patients from the Victorian State Trauma Registry from July 2001 to June 2007 were retrospectively reviewed. Data on fatalities were obtained from the National Coroners Information System. Descriptive statistics were used to summarise the profiles of major trauma cases and coroners' cases. Results: Overall, 204 cases with serious paediatric chest injuries were reported by the Victorian State Trauma Registry (n = 158) and National Coroners Information System (n = 46) (excluding overlapping cases) in 2001,2007. Paediatric chest trauma was more common in males. The Injury Severity Score ranged from 16 to 25 in most patients. Blunt trauma was responsible for 96% of cases, of which motor vehicle collisions accounted for 75%. Median hospitalisation was 9 days, and 64% of patients were admitted to intensive care. Common injuries included lung contusion (66%), haemo/pneumothorax (32%) and rib fracture (23%). Multiple organ injury occurred in 99% of cases, with head (62%) and abdominal (50%) injury common. Management was conservative, with only 11 cases (7%) treated surgically. The highest mortality was in the 10,15-year age group. In 52 (79%) fatalities, injury was transport related. Conclusion: Australian paediatric chest trauma trends are similar to international patterns. Serious injury requiring surgical intervention is rare. This limited exposure may lead to difficulty in maintaining surgical expertise in this highly specialised area. [source]

    Long-term outcomes of seriously injured children: A study using the Child Health Questionnaire

    JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5-6 2005
    Tamzyn M Davey
    Objective:, To assess the health-related quality of life (HRQoL) in children 1,2 years after they had sustained an injury. Methods:, Parents of all children who were identified by the Queensland Trauma Registry during their admission to either of the two paediatric specialty hospitals in Brisbane, Australia, for the treatment of an injury, were invited to participate in this study. Parents who consented to participation received a copy of the Child Health Questionnaire (CHQ) that required them to provide information regarding their child's HRQoL following injury. The CHQ scores for the study respondents were compared with those of the Australian norms. This study was approved by the relevant ethics committees. Results:, Two hundred and forty-one completed questionnaires were returned. The majority of cases were male (65%) and there was even representation across all age groups. The majority of injuries were considered to be minor (81%) and were predominantly the result of falls and cycling accidents causing mainly fractures and intracranial injury. On the majority of subscales of the CHQ, study participants recorded scores that were statistically significantly below those of the Australian norms. None of the relevant variables collected by the Queensland Trauma Registry were found to predict scores on the CHQ in this study (for those children hospitalized for >24 h). Conclusion:, Injured children are worse off than their Australian counterparts in terms of HRQoL even up to 2 years following an injury. Further research needs to be undertaken to identify factors that predict lower HRQoL in order to reduce the burden of injury on children and their families. [source]

    A comparison of severely injured trauma patients admitted to level 1 trauma centres in Queensland and Germany

    ANZ JOURNAL OF SURGERY, Issue 3 2010
    Johanna M. M. Nijboer
    Abstract Background:, The allocation of a trauma network in Queensland is still in the developmental phase. In a search for indicators to improve trauma care both locally as state-wide, a study was carried out comparing trauma patients in Queensland to trauma patients in Germany, a country with 82.4 million inhabitants and a well-established trauma system. Methods:, Trauma patients ,15 years of age, with an Injury Severity Score (ISS) , 16 admitted to the Princess Alexandra Hospital (PAH) and to the 59 German hospitals participating in the Trauma Registry of the German Society for Trauma Surgery (DGU-G) during the year 2005 were retrospectively identified and analysed. Results:, Both cohorts are comparable when it comes to demographics and injury mechanism, but differ significantly in other important aspects. Striking is the low number of primary admitted patients in the PAH cohort: 58% versus 83% in the DGU-G cohort. PAH patients were less physiologically deranged and less severely injured: ISS 25.2 ± 9.9 versus 29.9 ± 13.1 (P < 0.001). Subsequently, they less often needed surgery (61% versus 79%), ICU admission (49% versus 92%) and had a lower mortality: 9.8% versus 17.9% of the DGU-G cohort. Conclusions:, Relevant differences were the low number of primary admissions, the lesser severity of injuries, and the low mortality of the patients treated at the PAH. These differences are likely to be interrelated and Queensland's size and suboptimal organization of trauma care may have played an important role. [source]

    Management of spleen injuries: the current profile

    ANZ JOURNAL OF SURGERY, Issue 3 2010
    Antonina Mikocka-Walus
    Abstract Background:, There has been a shift from operative to conservative management of splenic injuries in the last two decades, but the current practice in Australia is not known. This study aims to determine the profile of splenic injury in major trauma victims and the approach to treatment in Victoria for the last 2 years. Methods:, A review of prospectively collected data from the Victorian State Trauma Registry (VSTR) from July 2005 to June 2007 was conducted. Demographic data, details of the event, clinical observations, management and associated outcomes were extracted from the database. The patients were categorized into four groups according to management (conservative, splenectomy, embolization and repair) and were compared accordingly. Multivariate binary logistic regression was performed to identify predictors of treatment (conservative versus splenectomy) on arrival. Results:, Of the 318 major trauma patients with splenic injuries, 186 (59%) were treated conservatively, 103 (32%) with splenectomy, 17 (5%) with arterial embolization and 12 (4%) with repair. Of these, 14 (14%) splenectomy cases and 2 (12%) embolization cases did not receive their respective treatments within 24 h. The severity of the spleen injury (as measured by the Abbreviated Injury Scale (AIS)) and age were identified as significant independent predictors of the form of treatment provided. Conclusion:, In Victoria, conservative management is the preferred approach in patients with minor (AIS = 2) to moderate (AIS = 3) splenic injuries. The low rates of embolization warrant further research into whether splenectomy is overused. [source]

    Popliteal artery injury: Royal Perth experience and literature review

    ANZ JOURNAL OF SURGERY, Issue 10 2005
    Mazri M. Yahya
    Background: Popliteal artery injury is uncommon but poses a significant challenge in Australian trauma care. Blunt trauma and knee dislocations appear to be associated with higher amputation rates. The aim of the present study was to review the authors' experience with this condition and discuss the best approach to investigation and management. Methods: The medical records of all patients with popliteal artery injury (n = 19) who were entered prospectively onto the Royal Perth Hospital Trauma Registry from 1995 to 2003 were reviewed. Their demographic data, investigations, primary operative procedures, fasciotomy, primary and secondary amputation rates and mortality were determined. Results: There were 17 male and two female patients with a median age of 34 years (range 17,62 years). Most patients (84%) were under 40 years in age. Blunt trauma was the commonest cause of popliteal artery injury (68.4%), and 84.6% of the patients had associated skeletal injury. The amputation rate in the present study was 26.3% (5/19). There were no intraoperative or in-hospital deaths. Three of 13 patients (23%) with blunt trauma underwent amputation, compared to two of six (33.3%) with penetrating injury. Two of three amputee patients in the blunt trauma group had dislocated knees. Conclusion: Despite technical improvements in management of popliteal artery injury, a high amputation rate is still seen, especially in patients with one or more of the following factors: extensive soft-issue injury, associated skeletal trauma, knee dislocation, and prolonged ischaemia time. Measures to reduce the amputation rate, ranging from more prompt diagnosis to modified surgical treatment techniques, are discussed. [source]

    The Impact of Injury Coding Schemes on Predicting Hospital Mortality After Pediatric Injury

    ACADEMIC EMERGENCY MEDICINE, Issue 7 2009
    Randall S. Burd MD
    Abstract Objectives:, Accurate adjustment for injury severity is needed to evaluate the effectiveness of trauma management. While the choice of injury coding scheme used for modeling affects performance, the impact of combining coding schemes on performance has not been evaluated. The purpose of this study was to use Bayesian logistic regression to develop models predicting hospital mortality in injured children and to compare the performance of models developed using different injury coding schemes. Methods:, Records of children (age < 15 years) admitted after injury were obtained from the National Trauma Data Bank (NTDB) and the National Pediatric Trauma Registry (NPTR) and used to train Bayesian logistic regression models predicting mortality using three injury coding schemes (International Classification of Disease-9th revision [ICD-9] injury codes, the Abbreviated Injury Scale [AIS] severity scores, and the Barell matrix) and their combinations. Model performance was evaluated using independent data from the NTDB and the Kids' Inpatient Database 2003 (KID). Results:, Discrimination was optimal when modeling both ICD-9 and AIS severity codes (area under the receiver operating curve [AUC] = 0.921 [NTDB] and 0.967 [KID], Hosmer-Lemeshow [HL] h-statistic = 115 [NTDB] and 147 [KID]), while calibration was optimal when modeling coding based on the Barell matrix (AUC = 0.882 [NTDB] and 0.936 [KID], HL h-statistic = 19 [NTDB] and 69 [KID]). When compared to models based on ICD-9 codes alone, models that also included AIS severity scores and coding from the Barell matrix showed improved discrimination and calibration. Conclusions:, Mortality models that incorporate additional injury coding schemes perform better than those based on ICD-9 codes alone in the setting of pediatric trauma. Combining injury coding schemes may be an effective approach for improving the predictive performance of empirically derived estimates of injury mortality. [source]

    The Validity of Using Multiple Imputation for Missing Out-of-hospital Data in a State Trauma Registry

    ACADEMIC EMERGENCY MEDICINE, Issue 3 2006
    Craig D. Newgard MD
    Objectives: To assess 1) the agreement of multiply imputed out-of-hospital values previously missing in a state trauma registry compared with known ambulance values and 2) the potential impact of using multiple imputation versus a commonly used method for handling missing data (i.e., complete case analysis) in a typical multivariable injury analysis. Methods: This was a retrospective cohort analysis. Multiply imputed out-of-hospital data from 1998 to 2003 for four variables (intubation attempt, Glasgow Coma Scale score, systolic blood pressure, and respiratory rate) were compared with known values from probabilistically linked ambulance records using measures of agreement (,, weighted ,, and Bland,Altman plots). Ambulance values were assumed to represent the "true" values for all analyses. A hypothetical multivariable regression model was used to demonstrate the impact (i.e., bias and precision of model results) of handling missing out-of-hospital data with multiple imputation versus complete case analysis. Results: A total of 6,150 matched ambulance and trauma registry records were available for comparison. Multiply imputed values for the four out-of-hospital variables demonstrated fair to good agreement with known ambulance values. When included in typical multivariable analyses, multiple imputation increased precision and reduced bias compared with using complete case analysis for the same data set. Conclusions: Multiply imputed out-of-hospital values for intubation attempt, Glasgow Coma Scale score, systolic blood pressure, and respiratory rate have fair to good agreement with known ambulance values. Multiple imputation also increased precision and reduced bias compared with complete case analysis in a typical multivariable injury model, and it should be considered for studies using out-of-hospital data from a trauma registry, particularly when substantial portions of data are missing. [source]

    The Association Between Hypothermia, Prehospital Cooling, and Mortality in Burn Victims

    ACADEMIC EMERGENCY MEDICINE, Issue 4 2010
    Adam J. Singer MD
    Abstract Objectives:, Hypothermia is associated with increased morbidity and mortality in trauma victims. The prognostic value of hypothermia on emergency department (ED) presentation in burn victims is not well known. The objective of this study was to determine the incidence of hypothermia in burn victims and its association with mortality and hospital length of stay (LOS). The study also examined the potential causative role of prehospital cooling in hypothermic burn patients. Methods:, This was a retrospective review of a county trauma registry. The county was both suburban and rural, with a population of 1.5 million and with one burn center. Burn patients between 1994 and 2007 who met trauma registry criteria were included. Demographic and clinical data including prehospital cooling, burn size and depth, and presence of inhalation injury were collected. Hypothermia was defined as a core body temperature of less than or equal to 35°C. Data analysis consisted of univariate associations between patient characteristics and hypothermia. Results:, There were 1,215 burn patients from 1994 to 2007. Mean age (±standard deviation [±SD]) was 29 (±24) years, 67% were male, 248 (26.7%) had full-thickness burns, and 24 (2.6%) had inhalation injury. Only 17 (1.8%) had a burn larger than 70% total body surface area (TBSA). A total of 929 (76%) patients had an initial ED temperature recorded. Only 15/929 (1.6%) burn patients had hypothermia on arrival, and all were mild (lowest temperature was 32.6°C). There was no association between sex, year, and presence of inhalation injury with hypothermia. Hypothermic patients were older (44 years vs. 29 years, p = 0.01), and median Injury Severity Score (ISS) was higher (25 vs. 4, p = 0.002) than for nonhypothermic patients. Hypothermia was present in 6/17 (35%) patients with a TBSA of 70% or greater and in 8/869 (0.9%) patients with a TBSA of <70% (p < 0.001). Mortality was higher in hypothermic patients (60% vs. 3%, p < 0.001). None of the hypothermic patients received prehospital cooling. Conclusions:, Hypothermia on presentation to the ED was noted in 1.6% of all burn victims in this trauma registry. Hypothermia was more common in very large burns and was associated with high mortality. In this series, prehospital cooling did not appear to contribute to hypothermia. ACADEMIC EMERGENCY MEDICINE 2010; 17:456,459 © 2010 by the Society for Academic Emergency Medicine [source]

    Possibilities and challenges in occupational injury surveillance of day laborers

    AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 2 2010
    Sarah J. Lowry MPH
    Abstract Background Day laborers in the US, comprised largely of undocumented immigrants from Mexico and Central America, suffer high rates of occupational injury according to recent estimates. Adequate surveillance methods for this highly transient, largely unregulated group do not currently exist. This study explores chart abstraction of hospital-based trauma registry records as a potential injury surveillance method for contingent workers and day laborers. We sought to determine the degree of completeness of work information in the medical records, and to identify day laborers and contingent workers to the extent possible. Methods Work-related injury cases from a hospital-based trauma registry (2001,2006) were divided by ethnicity (Hispanic vs. non-Hispanic origin) and presence of social security number (SSN: yes, no), resulting in four groups of cases. Medical records were abstracted for 40 cases from each group; each case was assigned values for the variables "day labor status" (yes, no, probably not, probable, unknown) and "employment type" (contingent, formal, unknown). Results Work information was missing for 60% of Hispanic cases lacking SSN, as compared with 33,47% of the other three groups. One "probable" day laborer was identified from the same group. Non-Hispanics with SSN were less frequently identified as contingent workers (5% as compared with 15,19%). Conclusions This method revealed severe limitations, including incomplete and inconsistent information in the trauma registry and medical records. Approaches to improve existing resources for use in surveillance systems are identified. The potential of an active surveillance approach at day labor hiring centers is also briefly discussed. Am. J. Ind. Med. 53:126,134 2010. © 2009 Wiley-Liss, Inc. [source]

    Diagnosis of blunt traumatic ruptured diaphragm: is it still a difficult problem?

    ANZ JOURNAL OF SURGERY, Issue 3 2010
    Li Hsee
    Abstract Background:, Blunt traumatic rupture of the diaphragm (BTRD) is uncommon. The diagnosis can be easily overlooked, and radiological findings misinterpreted. In a 15-year experience at the two major trauma hospitals in Brisbane reported in 1991, 85 patients with BTRD were treated, and the diagnosis not always made expeditiously. With the introduction of mandatory Early Management of Severe Trauma course training in the 90s and newer diagnostic tools, it might be expected that BTRD would be a less problematic diagnosis. The aim of this study was to review the incidence, diagnosis and outcome of BTRD at Auckland City Hospital over the last 10 years. Methods:, Retrospective review of Auckland City hospital trauma registry between 1996 and 2005. Demographics include age, gender, injury severity score (ISS), length of stay, ICU admission days, methods of diagnosis and patient outcomes were reviewed Results:, Twenty-eight patients had TRD as result of blunt injury. Median ISS was 28.5. Most of the patients were diagnosed at the time of laparotomy for other associated injuries. Road traffic crash was the most common cause. Twenty-one out of 28 patients were discharged alive. Conclusion:, Diagnosis of BTRD remains difficult. It is rarely isolated. It requires a high index of suspicion. If suspected, chest X-ray (CXR) and other more advanced imaging modalities can be used as confirmatory tools. [source]

    PAEDIATRIC MOTORBIKE INJURIES: DO CHILDREN RIDING MOTORBIKES GET THE SAME INJURIES AS THOSE RIDING BICYCLES?

    ANZ JOURNAL OF SURGERY, Issue 7 2008
    Jonathon Robertson
    Background: Health workers have the impression that injuries sustained by children on motorcycles are more severe and debilitating than those of children on bicycles. This was not reflected by data collected for a statewide trauma registry: the two groups looked very similar at first glance. Methods: A retrospective chart review audit was carried out to further collect clinical data that might be deemed to be consequential to patients, their families and the health system, to see if this initial finding was reproduced. Results: Registry outcomes such as length of stay and mortality were no different, but number of procedures required, number of injuries and functional injuries were very different. Conclusions: Showing that children are more severely injured when riding motorcycles rather than bicycles is needed to promote cultural and legislative change. [source]

    COST, DEMOGRAPHICS AND INJURY PROFILE OF ADULT PEDESTRIAN TRAUMA IN INNER SYDNEY

    ANZ JOURNAL OF SURGERY, Issue 1-2 2006
    Timothy J. Small
    Background: Pedestrian accidents are associated with substantial morbidity, mortality and cost; however, there has been very little published work on this topic in Australasia over recent years. The objective of this study was to examine the demographics, injury profile, outcomes and cost of pedestrian versus motor vehicle accidents in a central city hospital in Sydney. Methods: Consecutive pedestrians injured by motor vehicles and admitted as inpatients during the years 2002,2004 were identified from our prospective trauma registry. A retrospective review included patient profiles (age, sex, time of injury and blood alcohol), injury pattern, cost, morbidity and mortality. Results: A total of 180 patients (64% men and 36% women) with a mean age of 46 and mean injury severity score of 14.1 were identified. Two peak injury periods were observed: one between 17.00 and 18.00 hours (P < 0.01) and the other between 20.00 and 22.00 hours (P < 0.01). Significantly more injuries occurred on Friday (P < 0.01) and during autumn months (P < 0.05). Musculoskeletal (34.3%), head (31.8%) and external (20.2%) injuries predominated. Forty-nine per cent of patients tested positive for consuming alcohol, with an average blood alcohol concentration (BAC) of 0.22%. Alcohol consumption was associated with a worse outcome in terms of hospital and intensive care unit stay, morbidity and mortality. The average length of stay was 13.4 days costing $A16320 per admission. Sixteen patients died (mortality rate of 8.9%), with the highest rate in the elderly group (22.7%) (P < 0.001). Conclusions: Pedestrian accidents in inner Sydney are common with injuries predominating in intoxicated adult males. Mortality was higher in the elderly group. Injuries to the head and lower extremities predominate. Hospital stays are lengthy, resulting in a high cost for each admission. [source]

    SEVERE TRAUMA CAUSED BY STABBING AND FIREARMS IN METROPOLITAN SYDNEY, NEW SOUTH WALES, AUSTRALIA

    ANZ JOURNAL OF SURGERY, Issue 4 2005
    Kenneth Wong
    Background: Stabbing and firearm trauma causing severe injuries (injury severity score (ISS) >15) and death is uncommon in Australia. The present study describes the experience with stabbings and firearm trauma causing severe injuries at a major Australian urban trauma centre. Methods: Data from a prospectively generated trauma registry regarding all patients presenting to Royal Prince Alfred Hospital (RPAH), Sydney, Australia with penetrating trauma causing severe injuries from July 1991 to June 2001 was retrospectively analysed. Results: Of all patients presenting to RPAH with stabbing and firearms wounds over the 11 year study period, 28% received an ISS >15. One hundred and forty patients were identified. 94% were male. The mean age was 34 years (15,82 years). The number of cases/year has not shown an increasing trend. Thirty per cent of patients sustained firearm related injuries, with the remainder mainly caused by knives or machetes. Fifteen per cent of injuries were self inflicted. The most common location of injury was on a public street. Fifty-two per cent of patients were injured in more than one anatomical region, with the abdomen being the most common site of injury (53%). On hundred and seventy-four operations were performed , laparotomies (43%), thoracotomies (26%), craniotomies (5%) and orthopaedic, vascular, wound explorations and other procedures (26%). Twenty-eight per cent of patients suffered at least one complication during their admission, with coagulopathy being the most common complication (20%). Mean length of stay was 10.4 days (1,107 days). The total mortality rate for the severely injured patients was 21%, with gun-related injuries having a higher mortality rate than stabbing injury (36%vs 15%). Sixty per cent of deaths were related to exsanguination. Conclusions: Stabbings and firearm trauma are associated with significant morbidity, mortality and utilization of hospital resources in metropolitan Sydney. Overall mortality rates are similar to institutions with higher volumes of penetrating trauma. [source]

    Age differences in fall-related injury hospitalisations and trauma presentations

    AUSTRALASIAN JOURNAL ON AGEING, Issue 3 2010
    Rebecca Mitchell
    Aim:, To examine fall-related hospitalised morbidity in New South Wales (NSW) and to describe the pattern of fall-related major trauma presentations at a Level 1 Trauma Centre in NSW for younger and older fallers. Methods:, Fall-related injuries were identified in the NSW Admitted Patients Data Collection during 1 July 1999,30 June 2008 and the trauma registry of the NSW St George Public Hospital during 1 January 2006,6 December 2008. Results:, There were 434 138 hospitalisations and 862 fall-related trauma presentations. Older fallers had a higher incidence of hospitalisation, being more likely to fall on the same level during general activities at home, injuring their hip or thigh. Older fallers were also more likely to have an Injury Severity Score > 9, undergo physiotherapy and stay in hospital for >1 day than younger fallers. Conclusion:, Falls, particularly for older individuals, are an important cause of serious injury, representing a considerable burden in terms of hospitalised morbidity. [source]

    Are All Trauma Centers Created Equally?

    ACADEMIC EMERGENCY MEDICINE, Issue 7 2010
    A Statewide Analysis
    ACADEMIC EMERGENCY MEDICINE 2010; 17:701,708 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, Prior work has shown differences in mortality at different levels of trauma centers (TCs). There are limited data comparing mortality of equivalently verified TCs. This study sought to assess the potential differences in mortality as well as discharge destination (discharge to home vs. to a rehabilitation center or skilled nursing facility) across Level I TCs in the state of Ohio. Methods:, This was a retrospective, multicenter, statewide analysis of a state trauma registry of American College of Surgeons (ACS)-verified Level I TCs from 2003 to 2006. All adult (>15 years) patients transferred from the scene to one of the 10 Level I TCs throughout the state were included (n = 16,849). Multivariable logistic regression models were developed to assess for differences in mortality, keeping each TC as a fixed-effect term and adjusting for patient demographics, injury severity, mechanism of injury, and emergency medical services and emergency department procedures. Outcomes included in-hospital mortality and discharge destination (home vs. rehabilitation center or skilled nursing facility). Adjusted odds ratios (ORs) for each TC were also calculated. Results:, Considerable variability existed in unadjusted mortality between the centers, from 3.8% (95% confidence interval [CI] = 3.7% to 3.9%) to 24.2% (95% CI = 24.1% to 24.3%), despite similar patient characteristics and injury severity. Adjusted mortality had similar variability as well, ranging from an OR of 0.93 (95% CI = 0.47 to 1.84) to an OR of 6.02 (95% CI= 3.70 to 9.79). Similar results were seen with the secondary outcomes (discharge destination). Conclusions:, There is considerable variability in the mortality of injured patients at Level I TCs in the state of Ohio. The patient differences or care processes responsible for this variation should be explored. [source]