Trauma care

OBJECTIVES: Challenge current practices and misconceptions in treating recreational SCUBA (Self-contained underwater breathing apparatus) divers. Differentiate patients who are fit to dive and those with relative and absolute contraindications. Redefine the standard of care for fitness to dive parameters based on the most up-to-date evidence. METHODS: We conducted a review of the available medical and diving literature in English, German, Spanish, Italian, Turkish, and French to determine the degree of evidence or lack thereof behind recommendations for treating SCUBA divers...

Objectives: To describe the clinical utility of the Manchester triage scale adapted for orthopedic emergency departments and to evaluate its validity in identifying patients with the need for hospital care and its reliability when reproduced by different professionals. Methods: Five triage flowcharts were developed based on the Manchester scale for the following orthopedic disorders: traumatic injuries, joint pain, vertebral pain, postoperative disorders, and musculoskeletal infections...

No abstract text is available yet for this article.

BACKGROUND/PURPOSE: Our objective was to evaluate hospital factors, including children's hospital status, associated with higher costs for blunt solid organ pediatric abdominal trauma. METHODS: We queried the 2012 Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Database (KID) for patients 18 years or younger with low-grade and high-grade blunt abdominal trauma. We calculated total hospital costs and adjusted cost ratios (CR) controlling for patient and hospital-level characteristics...

BACKGROUND: We previously demonstrated that unidentified aliased patients, John Doe's (DOEs), are one of the highest risk and most medically fragile populations of injured patients. Aliasing can result in misplaced information and confusion that must be overcome by health care professionals. DOE alias use is institutionally dependent and not uniform, which may lead to significant variation in perception of confusion and error. We sought to determine if health care practitioners experience confusion that may result in compromised care when caring for injured DOE patients...

BACKGROUND: Acute compartment syndrome (ACS) is characterised by abnormal pressure inside a compartment, resulting in ischemia of muscles and nerves. Most orthopaedic surgeons, especially those who work in major trauma centres, have been or will be facing a case of ACS in their clinical activity. Fortunately, complications related to untreated compartment syndrome have become less frequent thanks to a better understanding of pathogenesis and to early recognition and prompt surgical treatment...

BACKGROUND: A medical-psychiatric unit (MPU) is a special ward where staff is trained in caring for patients with psychiatric or behavioural problems that need hospitalisation for physical health problems. It is well known that these patients are at higher risk of complications and have a longer length of stay resulting in higher costs than patients without psychiatric comorbidity. The objective of this study was to analyse the trauma patient population of the first 10 years of existence of the MPU in a level I trauma center...

PURPOSE: The purpose of this study was to describe the epidemiology and evaluate the clinical significance of traumatic sternal fractures. METHODS: Patients age ≤18 years with sternal fractures in the National Trauma Database research datasets from 2007-2014 were identified. Patient demographics, injuries, procedures, and outcomes were analyzed using descriptive statistics and logistic regression. RESULTS: Three thousand one hundred sixty patients with sternal fracture were identified...

INTRODUCTION: The epidemiology of penile fractures in the emergency setting is not well described. AIM: Examine the incidence, evaluation, management, risk factors predicting surgical repair or hospital transfer, and use of financial resources in patients presenting with penile fractures to the emergency departments (ED) nationwide in the Unites States. METHODS: ED visits with a primary diagnosis of penile fractures (International Classification of Diseases, Ninth Edition codes) between 2010-2014 were abstracted from the Nationwide Emergency Department Sample...

OBJECTIVES: The removal of a child from their parents is traumatising, particularly in Aboriginal communities where a history of child removals has led to intergenerational trauma. This study will determine where disparities in child protection involvement exist among Aboriginal and non-Aboriginal children and characteristics associated with infant removals. Challenges faced by child protection and other agencies, and opportunities for overcoming these, are discussed. METHODS: Data from both the Australian Institute of Health and Welfare and linked Western Australian government data was used to examine disparities between Aboriginal and non-Aboriginal children in the child protection and out-of-home care system...

BACKGROUND: Readiness Costs are real expenses incurred by trauma centers to maintain essential infrastructure to provide emergent services on a 24/7 basis. Although the components for readiness are well described in the American College of Surgeon's Resources for Optimal Care of the Injured Patient, the cost associated with each component is not well defined. We hypothesized that meeting the requirements of the 2014 Resources for Optimal Care of the Injured Patient would result in significant costs for trauma centers...

BACKGROUND: Traumatized patients are at risk of developing Deep Vein Thrombosis (DVT) and DVT prophylaxis is the standard of care. The Centers for Medicare and Medicaid Services classifies DVT as a Hospital Acquired Condition and can deny payment for treatment of DVT and, in addition, place financial penalties on hospitals with higher than acceptable rates of DVT, unless the DVT was pre-existing. We sought to determine the rate of pre-existing chronic DVT among symptomatic traumatized inpatients at our ACS-verified Level 1 trauma center...

BACKGROUND: The Israeli Defense Force Medical Corps (IDF-MC) is routinely collecting pre-hospital data to establish a pre-hospital registry. Since February 2013, Israel has been providing medical care to Syrian refugees. This unique humanitarian aid begins in pre-hospital settings and typically culminates in Israeli civilian hospitals. This report describes the accumulated experience of the IDF-MC to provide Syrian refugees with prehospital treatment. METHODS: Care provided by IDF-MC medical teams, including pre-hospital casualty care, is regularly documented and after-action reports are conducted...

Trauma-informed care has emerged as an important model to address the pervasiveness of traumatic experiences across the life cycle and their association with significant adverse medical and psychiatric consequences. To achieve health equity, in which all people have the opportunity for health, it is crucial for physicians to become comfortable with a neurobiopsychosocial understanding of trauma and how to provide optimal trauma-informed care. Given the pervasiveness of trauma exposure, and its impact on individual and community health, this paradigm shift in adult health care delivery systems requires physician engagement at every stage of development and implementation...

With aging populations and the increased incidence of cerebrovascular disease, diabetes, and other diseases, more and more patients suffer from pressure injuries. Pressure injuries are often difficult to heal because of the presence of sinus tracts, which make it difficult to clean and change dressings. Sinus wounds are common in patients with pressure injuries, but also occur after abdominal wall incision and in patients who have experienced a physical trauma that created a wound. It is difficult for clinicians to observe, evaluate, and repair sinus wounds because of the small surface defect and large and deep basement of each wound...

We report a case of acute pancreatitis after an elective screening colonoscopy. A 51-year-old male with a left ventricular assist device for end-stage nonischemic cardiomyopathy and a family history of colorectal cancer was admitted for an expedited heart transplant evaluation. He underwent screening colonoscopy during this admission which was technically uncomplicated apart from requiring slight maneuvering at the splenic flexure. The following day, the patient developed acute epigastric pain and one episode of emesis...

Between October 2013 and July 2016, over 156,000 children traveling without their guardians were apprehended at the US-Mexico border and transferred to the care of the Office of Refugee Resettlement (ORR). During that same period, ORR placed over 123,000 unaccompanied migrant youth-predominantly from Central America-with a parent or other adult sponsor residing in the US. Following placement, local communities are tasked with integrating migrant youth, many of whom experience pre- and in-transit migration traumas, family separation, limited/interrupted schooling, and unauthorised legal status, placing them at heightened risk for psychological distress, academic disengagement, maltreatment, and human trafficking...

Background: Traumatic brain injury (TBI) will be the third largest killer by the year 2020 in the world. It creates the great amount of morbidity, disability, mortality, and reduces the psychosocial well-being of the patients and their caregivers. Hence, the current paper aimed to explore the psychosocial distress and caregivers' concerns in emergency and trauma care (ETC) setting. Methodology: This study adopted qualitative research design. All caregivers of TBI survivors were considered as a universe of the study...

Severe traumatic brain injury is a leading cause of morbidity and mortality in children. In 2003 the Brain Trauma Foundation released guidelines that have since been updated (2010) and have helped standardize and improve care. One area of care that remains controversial is whether the placement of an intracranial pressure monitor is advantageous in the management of traumatic brain injury. Another aspect of care that is widely debated is whether management after traumatic brain injury should be based on intracranial pressure-directed therapy, cerebral perfusion pressure-directed therapy, or a combination of the two...

No abstract text is available yet for this article.