Epidemiology of pelvic and acetabular fractures across 12-mo at a level-1 trauma centre

BACKGROUND Despite motor-vehicle safety advancements and increasingly rigorous workplace safety regulations,trauma/suicide remains the leading cause of death under the age of 45 in the United Kingdom.To promote centralisation of care and optimisation of major trauma outcomes,in 2012 the National Health Service introduced the Trauma Network System.To our knowledge,this is the first study to analyse the epidemiology of pelvic and acetabular trauma over a one-year period at a level-1 trauma centre in the United Kingdom,since nationwide introduction of the Trauma Network System.AIM To characterize the epidemiology of high-energy pelvic and acetabular fractures over a one-year period at a level-1 trauma centre,and explore both resources required to care for these patients and opportunities for future research and injury prevention initiatives.METHODS 227 consecutive patients at a level-1 trauma centre with pelvic and acetabular fractures were analysed between December 2017-December 2018.Paediatric patients(<18 years)and fragility fractures were excluded,leaving 175 patients for inclusion in the study.Statistical analysis was performed using Fisher’s exact test for categorical variables.RESULTS 72%of pelvic and acetabular fractures occurred in male patients at a median age of 45 years.15%were the result of a suicide attempt.48%of patients required pelvic or acetabular surgery,with 38%undergoing further surgery for additional orthopaedic injuries.43%of patients were admitted to intensive care.The median inpatient stay was 13 days,and the 30-day mortality was 5%.Pelvic ring trauma was more commonly associated with abdominal injury(P=0.01)and spine fractures(P<0.001)than acetabular fractures.Vertical shear pelvic ring fractures were associated with falls(P=0.03)while lateral compression fractures were associated with road traffic accidents(P=0.01).CONCLUSION High energy pelvic and acetabular fractures are associated with concomitant orthopaedic fractures(most commonly spine and lower limb),intensive care admission and prolonged inpatient stays.Most pelvic ring injuries secondary to road traffic accidents are lateral compression type,demonstrating the need for future research to drive advancements in lateral impact vehicle safety along with mental health surveillance for those deemed to be potential suicide risks.

Comprehensive Level One Trauma Center Could Lower In-hospital Mortality of Severe Trauma in China

Trauma is a major health and social problem in the US and China, It constitutes the main cause of death in people aged 45 or under in both countries112]. There is clear evidence from clinical studies that a large percentage of these deaths are needless and preventable if better treatment and prevention programs are available12-3].

Two surgical pathways for isolated hip fractures:A comparative study

BACKGROUND Hip fractures(HF)are common among the aging population,and surgery within 48 h is recommended.Patients can be hospitalized for surgery through different pathways,either trauma or medicine admitting services.AIM To compare management and outcomes among patients admitted through the trauma pathway(TP)vs medical pathway(MP).METHODS This Institutional Review Board-approved retrospective study included 2094 patients with proximal femur fractures(AO/Orthopedic Trauma Association Type 31)who underwent surgery at a level 1 trauma center between 2016-2021.There were 69 patients admitted through the TP and 2025 admitted through the MP.To ensure comparability between groups,66 of the 2025 MP patients were propensity matched to 66 TP patients by age,sex,HF type,HF surgery,and American Society of Anesthesiology score.The statistical analyses included multivariable analysis,group characteristics,and bivariate correlation comparisons with theχ^(2)test and t-test.RESULTS After propensity matching,the mean age in both groups was 75-years-old,62%of both groups were females,the main HF type was intertrochanteric(TP 52%vs MP 62%),open reduction internal fixation was the most common surgery(TP 68%vs MP 71%),and the mean American Society of Anesthesiology score was 2.8 for TP and 2.7 for MP.The majority of patients in TP and MP(71%vs 74%)were geriatric(≥65-years-old).Falls were the main mechanism of injury in both groups(77%vs 97%,P=0.001).There were no significant differences in pre-surgery anticoagulation use(49%vs 41%),admission day of the week,or insurance status.The incidence of comorbidities was equal(94%for both)with cardiac comorbidities being dominant in both groups(71%vs 73%).The number of preoperative consultations was similar for TP and MP,with the most common consultation being cardiology in both(44%and 36%).HF displacement occurred more among TP patients(76%vs 39%,P=0.000).Time to surgery was not statistically different(23 h in both),but length of surgery was significantly longer for TP(59 min vs 41 min,P=0.000).Intensive care unit and hospital length of stay were not statistically different(5 d vs 8 d and 6 d for both).There were no statistical differences in discharge disposition and mortality(3%vs 0%).CONCLUSION There were no differences in outcomes of surgeries between admission through TP vs MP.The focus should be on the patient’s health condition and on prompt surgical intervention.

Application of trauma time axis management in the treatment of severe trauma patients

Purpose This study aimed at exploring the application of trauma time axis management in the treatment of severe trauma patients by using the Medicalsystem trauma system.Methods We performed a retrospective cohort study involving patients with severe trauma.Patients who were admitted before the application of the Medicalsystem trauma system were divided into before system group;patients who were admitted after the application of the system were divided into after system group.Comparison was made between the two groups.For normally distributed data,means were reported along with standard deviation,and comparisons were made using the independent samples t test.Categorical data were compared using the Chi-square test.The Mann-Whitney U test was used to compare nonparametric variables.Results There were 528 patients admitted to the study during the study period.There was no significant statistical difference in the time from the start of trauma team to arrive at the resuscitation room between the two groups.The time from arrival at hospital to endotracheal intubation,to ventilator therapy,to blood transfusion,to completion of CT scan,to completion of closed thoracic drainage,to the start of operation,as well as the length of stay in resuscitation room and hospital were significantly lower after the application of the Medicalsystem trauma system.The mortality was decreased by 8.6%in the after system group compared with that in the before system group,but there was no statistical difference.Conclusion The Medicalsystem trauma system can optimize diagnosis and treatment process for trauma patients,and accordingly improve the treatment efficiency and shorten the treatment time.Therefore,the Medicalsystem trauma system deserves further popularization and promotion.

Situation analysis of trauma based on Arizona trauma center standards in university hospitals of Tehran, Iran

Objective: Injuries are common and important problem in Tehran, capital of Iran. Although therapeutic centers are not essentially established following the constructional principles of developed countries, the present opportunities and equipments have to be used properly. We should recognize and reduce the deficits based on the global standards.This study deliberates the trauma resources and capacities in university hospitals of Tehran based on Arizona trauma center standards, which are suitable for the assessment of trauma centers.Methods: Forty-one university hospitals in Tehran were evaluated for their conformity with "Arizona trauma center standards" in 2008. A structured interview was arranged with the "Educational Supervisor" of all hospitals regarding their institutional organization, departments, clini-cal capabilities, clinical qualifications, facilities and resources, rehabilitation services, performance improvement, continuing education, prevention, research and additional requirements for pediatric trauma patients. Relative frequencies and percentages were calculated and Student's t test was used to compare the mean values.Results: Forty-one hospitals had the average of 77.7 (50.7%) standards from 153 Arizona trauma center standards and these standards were present in 97.5 out of 153 (63.7%) in 17 general hospitals. Based on the subgroups of the standards, 64.8% items of hospital resources and capabilities were considered as a subgroup with the maximum criteria, and 17.7% items of research section as another subgroup with the minimum standards.Conclusions: On the basis of our findings, no hospital meet all the Arizona trauma center standards completely. The hospitals as trauma centers at different levels must be promoted to manage trauma patients desirably.

The national major trauma system within the United Kingdom: inclusive regionalized networks of care

The United Kingdom has a population of 67 million people and is divided into 4 nations:England,Wales,Scotland,and the North of Ireland.Healthcare is provided free to all within each nation via the National Health Service(NHS),which is funded by taxes and national insurance payments.Each year,there are approximately 22,000 casesof“major trauma”in the UK across the four nations.Prior to 2010,trauma patients in the UK were managed at any acute hospital with an Emergency Department,irrespective of resource availability or clinical experience and expertise.In the late 2000s,national reports identified significant variation or serious failings in the organization of UK trauma care.These reports,together with political drivers for centralized services,led to the formation of the national major trauma system made up of regional trauma networks.England was the first nation to implement the systemin 2012 and this re-organization of major trauma care was asso ciated with a 19% increase in the odds of survivalfor patients who reached hospital alive.This paper will provide an overview of the positive attributes and challenges within 6 key components of the national trauma system:pre-hospital care,facility-based care,trauma networks,the trauma registries,rehabilitation and governance,financing,and quality assurance.