Major Trauma Cases Research Articles

“For the Care of the Underserved” A Descriptive Analysis of MTOA Admitted Under the Non-Trauma Specialties in a MTC

Abstract Background The recent NOCA report highlights a significant portion of major trauma cases resulting from falls among older adults, who often face limited access to trauma centres and age-related biases in treatment. Existing protocols and services for older trauma patients are lacking. This study aimed to audit the incidence and outcomes of MTOA admitted under the non-trauma specialties at a Major Trauma Centre. Methods Data from handover documents between January 2019 and December 2023 were screened for cases of “older trauma” (patients >65 with new trauma injuries) and analysed using Microsoft Excel. Results Between 2019 and 2023, 992 older patients were admitted under non-trauma specialties, with a mean age of 83 years and a majority being female 73% (N=170). The mean length of stay was 14 days, with pelvis injuries being most common 31% (N=307). Falls from standing height accounted for 83% (N=823) of injuries. Only 28% (N=217) of patients at immediate risk of further fragility fractures received bone protection. Most patients were discharged home 49% (N=456), while 6% (N=55) were institutionalized. The total mortality rate in hospital was 7% (N=66). The total mortality at one year was 17% (N=121). The injury with the highest mortality in hospital 24% (N=21) and at one year 40% (N=35) was traumatic brain injuries. Conclusion This audit reveals disparities in trauma care for older patients, despite advances in the field. While initiatives like the hip fracture database have improved care for specific injuries, pathways for older trauma patients not requiring surgery are lacking. Given the excess morbidity and mortality among this population, establishing a Geriatric Trauma Service is imperative. This is in line with literature supporting the idea that older trauma patients demand specialist attention; they are not just older adults.

Adherence to New Zealand's Major Trauma Destination Policy: an audit of current practice.

To evaluate adherence to the New Zealand Major Trauma Destination Policy (MTDP). This audit assessed if, based on their injuries, Emergency Medical Services (EMS) attended major trauma cases were taken to the MTDP determined appropriate hospital. Findings will guide and further improve pre-hospital trauma care and associated patient outcomes. A retrospective evaluation of adherence to the New Zealand MTDP for a random sample of 100 cases (ISS >12) injured between 31 November 2017-30 November 2018 who survived to hospital. The EMS electronic patient record (ePRF) was reviewed for each case. Adherence was indicated by the transport of injured patients from the scene to the appropriate initial destination based on meeting the respective regional MTDPs. Overall, there was a 94% adherence rate to the MTDP. For patients that were not classified as requiring transport to an advanced-level trauma centre, there was a 98.9% (n=86/87) adherence compared to 61.5% (n=8/13) adherence in those that did require transport to an advanced-level trauma centre. There was high adherence to the MTDP, with 94% of cases being taken to the appropriate destination directly from the incident scene. There is scope for improvement in cases whereby the nearest hospital should be bypassed in favour of a more distant advanced-level trauma centre.

Analysis of serious trauma injury patterns in Navarre (Spain) (2010-2019)

The aim of this study is to describe major trauma cases in Navarre and analyze differences based on mortality groups, sex, and mode of injury. Cross-sectional study of major traumas (severity =3) registered in Navarre between 2010 and 2019. We analyzed the type of trauma, intentionality, the mode of injury, and the affected anatomical area. The odds ratio for major trauma associated with different variables was calculated. The study included 2,609 patients; mean age was 54.7 years (0-101) and 70.9% were male. A predominance of accidental (84%) / blunt (94.7%) major traumas was recorded, primarily resulting from falls (46.5%) and car accidents (18.4%). Women experienced more falls and pedestrian accidents, while men had more motorcycle, bicycle, knife/firearm accidents, and contusions. Most major traumas affected the head and thorax. Head trauma was significantly more common in deceased individuals and women, while thoracic trauma was more frequent in patients who died on-site and in men. Head injuries were caused by falls from low heights and firearms, whereas thoracic injuries resulted from car accidents and falls from height. The risk of major trauma decreased with age; deceased patients were between two and three times more likely to present lesions in all anatomical areas. Gender differences are observed in intentionality, type, and mode of injury. Head and thoracic injuries are potentially life-threatening and abdominal and extremity/pelvic ring injuries are associated with early deaths. This suggests that the extent and severity of these injuries complicate treatment and management.

Airway breathing circulation dengue: a case of multifactorial shock due to major trauma and severe dengue infection

BackgroundDengue is the most common arboviral illness reported globally, endemic to most tropical and sub-tropical regions of the world. Dengue Shock Syndrome is a rare complication of severe Dengue infection resulting in haemorrhagic complications and refractory hypotension. We report on a case of severe dengue diagnosed in a patient with major trauma and illustrate some of the potential challenges and considerations in the clinical management of such cases.Case PresentationA 49-year-old female presented following a road trauma incident with multiple abdominal injuries requiring urgent laparotomy. Her recovery in Intensive Care Unit was complicated by the development of Dengue Shock Syndrome characterised by a falling haemoglobin and platelet count, multiorgan dysfunction and prolonged hospital stay.ConclusionsDengue Shock Syndrome may complicate fluid management and bleeding control in major trauma cases. Awareness of Dengue, particularly in endemic areas and returned travellers may help facilitate early diagnosis and management of complications.

Ocular injuries among patients with major trauma in England and Wales from 2004 to 2021

BackgroundOcular trauma is a significant cause of blindness and is often missed in polytrauma. No contemporary studies report eye injuries in the setting of severe trauma in the UK. We investigated ocular injury epidemiology and trends among patients suffering major trauma in England and Wales from 2004 to 2021.MethodsWe conducted a retrospective study utilising the Trauma Audit and Research Network (TARN) registry. Major trauma cases with concomitant eye injuries were included. Major trauma was defined as Injury Severity Score >15. Ocular injuries included globe, cranial nerve II, III, IV, and VI, and tear duct injuries. Orbital fractures and adnexal and lid injuries were not included. Demographics, injury profiles, and outcomes were extracted. We report descriptive statistics and 3-yearly trends.ResultsOf 287 267 major trauma cases, 2368 (0.82%) had ocular injuries: prevalence decreased from 1.87% to 0.66% over the 2004–2021 period (P < 0.0001). Males comprised 72.2% of ocular injury cases, median age was 34.5 years. The proportion of ocular injuries from road traffic collisions fell from 43.1% to 25.3% while fall-related injuries increased and predominated (37.6% in 2019/21). Concomitant head injury occurred in 86.6%. The most common site of ocular injury was the conjunctiva (29.3%). Compared to previous TARN data (1989–2004), retinal injuries were threefold more prevalent (5.9% vs 18.5%), while corneal injuries were less (31.0% vs 6.6%).ConclusionsWhilst identifying eye injuries in major trauma is challenging, it appears ocular injury epidemiology in this setting has shifted, though overall prevalence is low. These findings may inform prevention strategies, guideline development and resource allocation.

The Role of Large Language Models (LLMs) in Providing Triage for Maxillofacial Trauma Cases: A Preliminary Study.

In the evolving field of maxillofacial surgery, integrating advanced technologies like Large Language Models (LLMs) into medical practices, especially for trauma triage, presents a promising yet largely unexplored potential. This study aimed to evaluate the feasibility of using LLMs for triaging complex maxillofacial trauma cases by comparing their performance against the expertise of a tertiary referral center. Utilizing a comprehensive review of patient records in a tertiary referral center over a year-long period, standardized prompts detailing patient demographics, injury characteristics, and medical histories were created. These prompts were used to assess the triage suggestions of ChatGPT 4.0 and Google GEMINI against the center's recommendations, supplemented by evaluating the AI's performance using the QAMAI and AIPI questionnaires. The results in 10 cases of major maxillofacial trauma indicated moderate agreement rates between LLM recommendations and the referral center, with some variances in the suggestion of appropriate examinations (70% ChatGPT and 50% GEMINI) and treatment plans (60% ChatGPT and 45% GEMINI). Notably, the study found no statistically significant differences in several areas of the questionnaires, except in the diagnosis accuracy (GEMINI: 3.30, ChatGPT: 2.30; p = 0.032) and relevance of the recommendations (GEMINI: 2.90, ChatGPT: 3.50; p = 0.021). A Spearman correlation analysis highlighted significant correlations within the two questionnaires, specifically between the QAMAI total score and AIPI treatment scores (rho = 0.767, p = 0.010). This exploratory investigation underscores the potential of LLMs in enhancing clinical decision making for maxillofacial trauma cases, indicating a need for further research to refine their application in healthcare settings.

30-Day Mortality among Very Old Patients Admitted to European Intensive Care Units for Major Trauma

Introduction: Cases of major trauma in the very old (over 80 years) are increasingly common in the intensive care unit (ICU). Predicting outcome is challenging in this group of patients as chronological age is a poor marker of health and poor predictor of outcome. Increasingly, decisions are guided by the use of organ dysfunction scores of both acute conditions (e.g., sequential organ failure assessment [SOFA] score) and chronic health issues (e.g., clinical frailty scale [CFS]). Recent work suggests that increased CFS is associated with a worse outcome in elderly major trauma patients. We aimed to test whether this association held true in the very old (over 80) or whether SOFA had a stronger association with 30-day outcome. Methods: Data from the very elderly intensive care patient (VIP)-1 and VIP-2 studies for patients over 80 years old with major trauma admissions were merged. These participants were recruited from 20 countries across Europe. Baseline characteristics, level of care provided, and outcome (ICU and 30-day mortality) were summarised. Uni- and multivariable regression analyses were undertaken to determine associations between CFS and SOFA score in the first 24 h, type of major trauma, and outcomes. Results: Of the 8,062 acute patients recruited to the two VIP studies, 498 patients were admitted to intensive care because of major trauma. Median age was 84 years, median SOFA score was 6 (IQR 3, 9), and median CFS was 3 (IQR 2, 5). Survival for 30 days was 54%. Median and interquartile range of CFS were the same for survivors and non-survivors. In the logistic regression analysis, CFS was not associated with increased mortality. SOFA score (p < 0.001) and trauma with head injury (p < 0.01) were associated with increased mortality. Conclusions: Major trauma admissions in the very old are not uncommon, and 30-day mortality is high. We found that CFS was not a helpful predictor of mortality. SOFA and trauma with head injury were associated with worse outcomes in this patient group.

Blunt solid organ injury: Resident operative experience on the decline

Introduction Duty-hour restrictions, improved non-operative management of injured patients, new or expanded fellowship programs, and the coronavirus disease 2019 (COVID-19) pandemic have hindered resident exposure to operative trauma in the United States. In this study, we investigated trends in resident operative experience in blunt trauma over a 22-year period. Methods Accreditation Council for Graduate Medical Education (ACGME) logs from 1999 to 2021 were reviewed. The yearly number of major trauma cases, trauma splenectomies (TS), and liver drainage/repairs (LDR) were extracted. We used the non-parametric Mann–Kendall test to analyze trends. Data are reported as mean ± standard deviation or median (estimated interquartile range, eIQR); alpha = 0.05. Results Records from 24,062 respondents were examined. The average number of trauma cases performed by all residents decreased from 42 ± 22 in 1999–2000 to 31 ± 18 in 2020–2021 ( p &lt; .01); median number of cases decreased from 36 (30, 47) to 27 (22, 36). The proportion of TS performed by chief and junior residents among all trauma cases decreased from 9.5% to 7.1% (trend test, p &lt; .01), and from 6.6% to 6.1% (trend test, p = .03) respectively. The proportion of LDR performed by chief and junior residents decreased from 6.9% to 4.7% (trend test, p &lt; .01), and from 4.3% to 3.9% (trend test, p = .03) respectively. Conclusions Number of major trauma cases and two common procedures for blunt solid organ injury decreased significantly over the past two decades. These findings should serve as an indicator that structural changes in surgery residency training programs in the United States may be necessary to safeguard resident exposure to operative trauma cases.

Secular trends in the incidence and severity of injuries sustained by riders of electric bikes and powered scooters: The experience of a level 1 adult trauma center

BackgroundThe incidence of injuries caused by electric bicycles (E-bikes) and powered scooters (P-scooters) continues to increase. Data on the severity of those injuries is conflicting. The purpose of this study was to explore secular trends in the incidence and severity characteristics of patients following E-bike and P-scooter injuries and predictors for major trauma. MethodsA retrospective cohort study of patients aged ≥16 years following E-bike and P-scooter injuries was performed at a level 1-trauma center between 2017 and 2022. We explored secular trends in major trauma cases (primary outcome), emergency department (ED) visits, hospitalizations, and surgical interventions (secondary outcomes). Major trauma was defined by either an injury severity score (ISS) >15 or the patient's need for acute care, defined by any of the following: Intensive care unit admission, direct disposition to the operating room, acute interventions performed in the trauma room, and in-hospital death. Primary and secondary outcomes were compared between two time frames (2017–2018 vs.2019–2022). ResultsIn total, 9748 patients were presented following P-scooter and E-bike injuries. Of them, 1183 patients (12.1%) were hospitalized (854 males [72.2%],median age 33 years, median ISS 9).During the study period, the number of ED visits increased by 21-fold, with a parallel increase hospitalizations and surgical interventions numbers, which increased by 3.4-and 3.8-fold, respectively. Numbers of patients with ISSs >15 and patients who required acute care sharply increased during the study period, but no significant differences were found in the percentages of patients with ISSs >15 (p = 0.78) or patients’ need for acute care (p = 0.32) between early and late periods. A severity analysis revealed that male sex (adjusted odds ratio [aOR] 1.7 [95% confidence interval (CI): 1.2–2.4], p = 0.001) and E-bike riders compared to P-scooter riders (aOR 1.5 [95% CI:1.1–2.0], p = 0.005) were independent predictors for severe trauma. ConclusionsThe incidence of E-bike and P-scooter injuries sharply increased over time, with a parallel elevation in numbers of hospitalizations, surgical interventions, and major trauma cases. Major trauma percentages did not increase during the study period. Male sex and E-bikes emerged as independent predictors for major trauma.

The ABCDE approach: Evaluation of adherence in a low-income country

BackgroundEarly recognition and initial treatment of trauma patients prevents deterioration and buys time for making a definitive diagnosis. The “Airway, Breathing, Circulation, Disability and Exposure” (ABCDE) approach should be used whenever an injury is suspected. It provides quick identification and management of life-threatening problems. Still, there is limited knowledge regarding adherence to the ABCDE approach. This research aims to assess the adherence of the trauma team members to the ABCDE approach in the management of major trauma patients and the factors affecting it. MethodThe study is a cross-sectional hospital-based study conducted in the trauma and resuscitation rooms of major governmental hospitals in Khartoum in the period from Jan.30, 2022, to Mar.29, 2022. It was done among the medical staff dealing with major trauma cases. Data were collected by observation using a modified standardized checklist for assessing the ABCDE approach and via a self-administered questionnaire for identifying the factors affecting adherence. Total coverage of all major trauma cases resuscitation (n = 50) was done. Also, a sample size of 158 medical staff was covered for the questionnaire. The data was analyzed in Statistical Package for the Social Science (SPSS) V.23. ResultsThe mean percentage of adherence to the ABCDE approach was 37.9 % (SD 15.44). When the ABCDE sequence was not followed, the ACB was the commonest sequence. Also, adherence had no significant relation with any patient or staff-related factor. The main present obstacles to adherence to the ABCDE approach were overcrowding in the room and unprepared facilities. While the major present facilitator was the clinical experience. ConclusionThe adherence rate was low, but initiation of the ABCDE approach was rapid. The factors participating in low adherence rates were usually facility or population-based factors. We recommend further studies, further training and embedment of guidelines, and the provision of larger trauma rooms with adequate supplies.

EGS P07 Upper GI Injury trends, rates, and mortality in major trauma centre

Abstract Background Trauma is one of the leading causes of death in UK. Moderate and severe trauma presents with multi-organ / multi cavity involvement. Robust resuscitation, methodical approach, prompt diagnosis and early surgical intervention have an impact on mortality. Injury severity score (ISS) is widely used across trauma centres to estimate severity. It is found to be linked with mortality and outcome. An ISS of 9-15 classes as moderate and an ISS of &amp;gt; 15 is considered severe trauma. In this study we aimed to evaluate the mortality associated with upper GI injuries I.e., oesophagus, stomach, duodenum, liver, pancreas, spleen and diaphragm. Methods Retrospective analysis was carried out on prospectively maintained trauma data base in an urban major trauma centre (MTC) with tertiary upper GI surgical cover. All patients presenting with moderate or severe trauma based on ISS between 1st of January 2012 to 31st of Dec 2022 were included in this study. Proportion of upper GI injuries in reference to overall major trauma cases were analysed. All cause index-admission mortality associated with upper GI injuries was calculated. Results A total of 8984 patients presented in this centre with moderate - severe trauma (ISS&amp;gt;9) during study period. Overall mortality was found to be 8.6% (n=780). Liver injuries were seen in 228 (2.5%), splenic injuries in 226 (2.5%), diaphragmatic rupture in 26 (0.29%), oesophago-gastric (OG) trauma in 16 (0.2%) and duodenum and pancreatic injuries in 15 (0.17%) patients. Highest mortality was found in OG trauma with 31.2%, followed by diaphragmatic injures with 19%, liver injuries with 12.7%, splenic injuries with 9.3%. Upper GI injuries are associated with high median ISS of 28.5 and present as polytrauma spectrum. Conclusions Although oesophago-gastric injuries are rare but, have relatively high mortality. Early aggressive resuscitation, involvement of oesophago-gastric or HPB surgeons, and multidisciplinary approach is required to deal with such complex injuries to get the best outcome. Robust national collaborative mechanisms across MTCs should be encouraged to share experiences, learn lessons and promote research.

107 OPEN to Change: Can District General Hospitals Deal with Open Fractures Too?

Abstract Introduction Fractures compromising soft tissues puts patients at risk of significant morbidity, therefore require timely multidisciplinary management. The British Orthopaedic Association Standard for Trauma (BOAST) Guidelines, updated December 2017, state “Patients with open fractures of long bones, hind foot or midfoot should be taken directly or transferred to a specialist centre that can provide Orthoplastic care.” Northern Ireland’s population is estimated at 1.8 million, within this there are between 370 and 500 cases of major trauma each year. Method This review looks at patients presenting to Craigavon Area Hospital in Northern Ireland, between October 2021 to October 2022, with open fractures. Results Over the study period, 41 Open fractures presented, 12 meeting criteria for transfer to a major trauma centre with orthopastic’s present as per BOAST Guidelines point 1. However, 11 patients were managed in Craigavon Area Hospital and 1 patient required transfer to a site with plastics available. Conclusions Can we learn from this same subgroup of patients? There is an ever-growing demand to major trauma centres in Northern Ireland some of the burden on which can be dealt with by DGH’s. This data should help contribute to any future updates of BOAST’s guidelines.

WTP1.7 Long-term Outcomes After Repair of Paediatric Traumatic Lower Limb Arterial Injury: Systematic Review

Abstract Aims Paediatric vascular injuries account for 1% of paediatric major trauma cases with 30% of arterial injuries located in the lower limb. Current management of paediatric lower limb arterial injuries have been extrapolated from adult injuries. The aim was to review studies specific to paediatric population due to the anatomical and physiological differences, particularly limb length discrepancy (LLD) following injury. Methods A literature review was conducted. Study PICOS - Population: Patients &amp;lt;18 years old with traumatic lower limb arterial injury. Intervention: Surgical, endovascular or no intervention. Comparison: Primary repair or Conduit repair using autologous vein or synthetic material or endovascular repair. Outcomes: Rate of success of revascularisation, amputation, graft infection, long term limb function, LLD, mortality. Results 7 studies were included for data extraction, resulting in 15 male patients, aged 4-14. The popliteal artery was most commonly injured (60%), followed by the femoral (40%). The most common repair was with reversed Great Saphenous Vein graft (GSV)(13/15) for which good long-term outcomes were reported (85% success rate). One endovascular repair was identified which was successful and one with synthetic material which resulted in a minor complication. Conclusions There is a preference for the use of autologous vein grafts in paediatric lower limb arterial repair with good outcomes. Endovascular procedures are becoming more common whereas synthetic grafts are not favoured due to their inability to lengthen as vessels grow. Further research is required to evaluate the long-term outcomes as the current reported cases are scarce.

The first hour of trauma reception is critical for patients with major thoracic trauma: A retrospective analysis from the TraumaRegister DGU.

Up to 25% of trauma deaths are related to thoracic injuries. The primary goal was to analyse the incidence and time distribution of death in adult patients with major thoracic injuries. The secondary goal was to determine if potentially preventable deaths occurred within this time distribution and, if so, identify an associated therapeutic window. Retrospective observational analysis. TraumaRegister DGU. Major thoracic injury was defined as an Abbreviated Injury Scale (AIS) 3 or greater. Patients with severe head injury (AIS ≥ 4) or injuries to other body regions with AIS being greater than the thoracic injury (AIS other >AIS thorax) were excluded to ensure that the most severe injury described was primarily thoracic related. Incidence and time distribution of mortality were considered the primary outcome measures. Patient and clinical characteristics and resuscitative interventions were analysed in relation to the time distribution of death. Among adult major trauma cases with direct admission from the accident scene, 45% had thoracic injuries and overall mortality was 9.3%. In those with major thoracic trauma ( n = 24 332) mortality was 5.9% ( n = 1437). About 25% of these deaths occurred within the first hour after admission and 48% within the first day. No peak in late mortality was seen. The highest incidences of hypoxia and shock were seen in non-survivors with immediate death within 1 h and early death (1 to 6 h). These groups received the largest number of resuscitative interventions. Haemorrhage was the leading cause of death in these groups, whereas organ failure was the leading cause of death amongst those who survived the first 6 h after admission. About half of adult major trauma cases had thoracic injuries. In non-survivors with primarily major thoracic trauma, most deaths occurred immediately (<1h) or within the first 6 h after injury. Further research should analyse if improvements in trauma resuscitation performed within this time frame will reduce preventable deaths. The present study is reported within the publication guidelines of the TraumaRegister DGU® and registered as TR-DGU project ID 2020-022.

Optimizing Trauma Systems: A Geospatial Analysis of the Victorian State Trauma System.

The aim of this study was to develop a data-driven approach to assessing the influence of trauma system parameters and optimizing the configuration of the Victorian State Trauma System (VSTS). Regionalized trauma systems have been shown to reduce the risk of mortality and improve patient function and health-related quality of life. However, major trauma case numbers are rapidly increasing and there is a need to evolve the configuration of trauma systems. A retrospective review of major trauma patients from 2016 to 2018 in Victoria, Australia. Drive times and flight times were calculated for transport to each of 138 trauma receiving hospitals. Changes to the configuration of the VSTS were modeled using a Mixed Integer Linear Programming algorithm across 156 simulations. There were 8327 patients included in the study, of which 58% were transported directly to a major trauma service (MTS). For adult patients, the proportion of patients transported directly to an MTS increased with higher transport time limit, greater probability of helicopter emergency medical service utilization, and lower hospital patient threshold numbers. The proportion of adult patients transported directly to an MTS varied from 66% to 90% across simulations. Across all simulations for pediatric patients, only 1 pediatric MTS was assigned. We have developed a robust and data-driven approach to optimizing trauma systems. Through the use of geospatial and mathematical models, we have modeled how potential future changes to trauma system characteristics may impact on the optimal configuration of the system, which will enable policy makers to make informed decisions about health service planning into the future.

Demographics and Patterns of Injury in Patients with Sharp Penetrating Trauma admitted to a Greater Manchester Major Trauma Centre: A Retrospective Five-Year Study

Background: Sharp penetrating trauma represents 4.1%-6.9% of all major trauma cases in the UK. The incidence of Sharp penetrating trauma is rising, with 47,000 offences in England and Wales in 2019. There has been limited published data on the victims of sharp penetrating trauma. Methods: We performed a single centre retrospective case note review of patients admitted to an urban major trauma centre following an assault with a sharp object from 1st January 2014 to the 31st December 2018. Data was collected on demographics, injury pattern, management, and outcome. Results: In total, 686 patients were included in the study. There was a year-on-year increase of admissions with sharp penetrating trauma from 100 admissions in 2014, to 194 in 2018. The majority of patients were male, with a mean age of 31, and 73% of our patients were of Caucasian ethnicity. Patients presented most frequently on weekends (53%). The length of stay increased over the study period from 2.3 days in 2014 to 4.0 days in 2018. The thorax was the most commonly injured body region, involved in 29% of presentations, followed by the abdomino-pelvis (21%). 51% of patients presented with multiple injuries, and the average number of stab wounds per patient increased from 1.95 in 2014 to 2.40 in 2018. Conclusion: Our study has demonstrated the incidence and severity of sharp penetrating trauma is increasing in central Manchester. The authors advocate the creation of a national knife crime database to further the implementation of prevention strategies.

Disability-Adjusted Life Years and cost of health loss of hospitalised major trauma patients in New Zealand.

The aims of this study were to quantify the burden, and the cost of health loss, following hospitalisation for major trauma in New Zealand. Hospitalised major trauma patients injured between July 2017 and June 2020 were extracted from the New Zealand Trauma Registry. Case-mix of major trauma in each year was summarised using descriptive statistics. Disability-adjusted life years (DALYs) were calculated for the cohort. A cost per DALY was applied to estimate the cost of health loss. A total of 6,629 major trauma cases were recorded, rising from 2,072 in 2017-2018 to 2,191 in 2019-2020. The patient case-mix remained relatively consistent over the timeframe while the in-hospital mortality rate declined from 9.2% to 7.3%. Hospitalised major trauma patients accrued 22,718 DALYs (average 7,573 DALYs per year) at an estimated health loss cost of $1.02 billion ($341 million per year). The cost of health loss per case declined from $162,747 in 2017-2018 to $143,577 in 2019-2020. The burden of major trauma is high. As injury is a preventable condition, the findings highlight the need for dedicated investment in both primary prevention and trauma care in New Zealand to reduce these avoidable costs.

Impact of comorbidities on survival following major injury across different types of road users

BackgroundWhile comorbidities and types of road users are known to influence survival in people hospitalised with injury, few studies have examined the association between comorbidities and survival in people injured in road traffic crashes. Further, few studies have examined outcomes across different types of road users with different types of pre-existing comorbidities. This study aims to examine differences in survival within 30 days of admission among different road user types with and without different pre-existing comorbidities. MethodRetrospective cohort study using data for all major road trauma cases were extracted from the NSW Trauma Registry Minimum Dataset (1 January 2013 – 31 July 2019) and linked to the NSW Admitted Patient Data Collection, and the NSW Registry of Births, Deaths and Marriages - death dataset. Pre-existing comorbidities and road user types were identified by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes and Charlson Comorbidity Index in the Trauma Registry, hospital admission, and death datasets. Logistic regression was used to assess the associations between six types of road users (pedestrian, pedal cycle, two- and three-wheel motorcycle, car and pick-up truck, heavy vehicle and bus, and other types of vehicle) and death within 30 days of hospital admission while controlling for comorbidities. All models used ‘car and pick-up truck driver/passenger’ as the road user reference group and adjusted for demographic variables, injury severity, and level of impaired consciousness. ResultsWithin 6253 traffic injury person-records (all aged ≥15 years old, ISS>12), and in final models, injured road users with major trauma who had a history of cardiovascular diseases (including stroke), diabetes mellitus, and higher Charlson Comorbidity Index score, were more likely to die, than those without pre-existing comorbidities. Furthermore, in final models, pedestrians were more likely to die than car occupants (OR: 1.68 – 1.77, 95CI%: 1.26 – 2.29 depending on comorbidity type). ConclusionsThis study highlights the need to prioritize enhanced management of trauma patients with comorbidities, given the increasing prevalence of chronic medical conditions globally, together with actions to prevent pedestrian crashes in strategies to reach Vision Zero.

Sports injuries: a 5-year review of admissions at a major trauma center in the United Kingdom.

Sports offer several health benefits but are not free of injury risk. Activity dynamics vary across sports, impacting the injury profile and thereby influencing healthcare resource utilization and health outcomes. The purpose of this study was to investigate sports-related major trauma cases and compare differences across sports and activity groups. A retrospective case notes review of sports-related major traumas over a 5-year period was conducted. Demographic, hospital episode-related, and health outcome-related data were analyzed, and differences were compared across sports and activity groups. The Glasgow Outcome Scale (GOS) at discharge was used as the primary outcome measure and the length of hospital stay as the secondary outcome measure. In total, 76% of cases had good recovery at discharge (GOS, 5), 19% had moderate disability (GOS, 4), and 5% had severe disability (GOS, 3). The mean length of hospital stay was 11.2 days (range, 1-121 days). The most severely injured body region was the limbs (29.1%) and vertebral/spinal injuries were most common (33%) in terms of location. A significant difference (P<0.05) existed in GOS across sports groups, with motor sports having the lowest GOS. However, no significant differences (P>0.05) were found in other health-outcome variables or injury patterns across sports or activity groups, although more competitive sports cases (67%) required admission than recreational sports cases (33%). Spinal injuries are the most frequent sports injuries, bear the worst health outcomes, and warrant better preventive measures. Head injuries previously dominated the worst outcomes; this change is likely due to better preventive and management modalities. Competitive sports had a higher injury frequency than recreational sports, but no difference in health outcomes or injury patterns.

Complex Sacral Fracture and Associated Soft Tissue Injuries: A Case of Multidisciplinary Management in Polytrauma

Treatment of high-energy trauma of the lumbosacral region is a challenging entity for clinicians. They are complex and often associated with other injuries such as active bleeding and substantial soft tissue injuries. Therefore, good wound healing is reliant on multiple local and systemic factors. Only a multidisciplinary approach between the trauma team and subspecialists will dictate the most appropriate management for these patients, and recent data has shown that best outcomes are obtained when these lesions are cared for at level 1 trauma centers. We present a case of complex major trauma involving rachis, thorax, abdomen, pelvis and lower limbs.