Emergency Trauma Unit Research Articles

Evaluating the benefit of medical adjustment on the predictive accuracy of the revised trauma index

In the early 1970s, data from emergency trauma units was used to develop the trauma index (TI) as a triage tool for non-physicians. Over the next two decades several modifications were made to the TI, and in 1990 a revised trauma index (RTI) was published. Throughout the 1990s, modifications to the RTI concerning pre-existing medical conditions (PEC) have been studied. Our study incorporated a PEC scoring system into the RTI, and evaluated its performance against using the RTI alone. The addition of PECs to the trauma index improved its accuracy in predicting overall outcome as shown by the increase in the kappa score from 0.42 to 0.73. Based on this finding, we suggest incorporating a PEC scoring system into the revised trauma index to better predict patient outcomes.

Electric Scooter-related Craniofacial Injuries.

Injuries associated with the use of electric scooters are a serious problem in modern society and traffic in relation to their increasing frequency of use. Although injuries involving all body parts are seen in such injuries, craniofacial ones are also very common. The aim of this study was to evaluate the craniofacial and other accompanying injuries in electric scooter-related accidents in Istanbul. Between January 2020 and December 2022, patients with electric scooter-related trauma among the patients admitted to the emergency unit for trauma were evaluated retrospectively. All electronic medical records, CT scans, other examinations, and treatments were retrospectively reviewed, and craniofacial fractures and other injuries seen in the patients were classified. A total of 20.358 patients were admitted to the trauma unit between January 2020 and December 2022. Two hundred ten patients (142 male, 68 female) had electric scooter-related trauma and 58.1 % of them had craniofacial injuries. Thirty patients (14.3 %) (23 male, 7 female) had craniofacial fractures, whereas 43.8 % of them had craniofacial soft tissue injuries. The nasal fracture was the most common craniofacial fracture (14 patients, 46.7%). Orbital wall and zygomaticomaxillary complex fractures were found to be the second most common fractures. The rate of electric scooter-related injuries among all trauma patients admitted to the emergency trauma unit during the mentioned period was 1.03%. The results of this study were found to be in accordance with the data in the literature. The craniofacial region is the most frequently injured body part in patients with electric scooter-related trauma, and patients should be comprehensively evaluated for possible soft tissue injuries, craniofacial fractures, and other accompanying system injuries.

Factors Affecting Nurses Compliance Regarding the Care of Patients with Chest Trauma

Background: Chest trauma remains to show a high incidence in the emergency room among trauma patients. The Nurse is involved with the care of the trauma patient from arrival in the emergency department to follow-up in the trauma clinic. The aim of this study was to assess Factors Affecting Nurses Compliance Regarding the Care of Patients with Chest Trauma. Design: a Descriptive Study. Setting: This study was carried out in the emergency trauma unit at Assuit University Hospital. A sample: of this study were all available nurses working in the emergency trauma unit at an Assuit University Hospital (40). (Tools): two tools used in this study Tool I: nurses self-administer question part: I demography data part: II Factors Affecting Compliance Tool II: Nurses Compliance Assessment sheet. Results: all of the studied stated that didn’t have with (clear job description, oriented or continuous training courses, also no written information such as (poster, brochure). not have library equipped new books, Journal websites to update their knowledge and practical skill regarding the care of patients with chest trauma. not receiving any Undergraduates courses and no financial resources in the chest trauma unit. Conclusion: all of the nurses did not have clear job descriptions, oriented or continuous training courses. Recommendations: Provide the nurse with a clear job description Update their knowledge and practical skill nurses about chest trauma, Undergraduates courses about chest trauma continue, and financial advantages in the trauma unit.

The Role of Ultrasound for Detecting Occult Penetrating Cardiac Wounds in Hemodynamically Stable Patients.

There is evidence in favor of using the ultrasound as the primary screening tool in looking for an occult cardiac injury. We report on a prospective single-center study to determine the diagnostic accuracy of chest ultrasound for the diagnosis of occult penetrating cardiac wounds in a low-resource hospital from a middle-income country. Data were collected prospectively. We included all consecutive patients 14years and older who presented to the Emergency Trauma Unit with (1) penetrating injuries to the precordial area and (2) a systolic blood pressure ≥ 90mmHg (hemodynamically stable). The main outcome measures were sensitivity, specificity, and positive and negative predictive values of ultrasound compared with those of the pericardial window, which was the standard test. A total of 141 patients met the inclusion criteria. Our results showed that for diagnosing an occult cardiac injury, the sensitivity of the chest ultrasonography was 79.31%, and the specificity was 92.86%. Of the 110 patients with a normal or negative ultrasound, six had a positive pericardial window. All of these patients had left hemothoraces. None of them required further cardiac surgical interventions. We found that ultrasound was 79% sensitive and 92% specific for the diagnosis of occult penetrating cardiac wounds. However, it should be used with caution in patients with injuries to the cardiac zone and simultaneous left hemothorax.

Acil Travma Ünitelerinde Travma Şiddetine Göre Ağrı Giderme Yaklaşımlarının Retrospektif İncelenmesi

Acil Travma Ünitelerinde Travma Şiddetine Göre Ağrı Giderme Yaklaşımlarının Retrospektif İncelenmesi

A Rare Injury in Children: Sternum Fractures.

Although there are a lot of data on intrathoracic and extrathoracic injuries associated with adult sternal fractures and how to manage them; but there is not much data on diagnosis and treatment protocols, since they are rare in children. If the child patient has a sternal fracture, he/she probably had a high-energy trauma, so it should be carefully examined whether if there is an accompanying intrathoracic or extrathoracic injury. In this study, we aimed to determine the demographic data, accompanying injuries, treatment modalities and results in children who were admitted to the emergency trauma unit of our hospital and diagnosed with sternal fracture.

Assessment of Nurses' Performance Regarding Care Of Chest Trauma Patients at Trauma Emergency Unit

Background: The nurse is involved with the care of the trauma patient from arrival in the emergency department to follow-up in the trauma clinic. Chest injuries can be penetrating or the blunt type, depending on the nature and severity of the causative impact. The aim of this study was to assess nurses' performance regarding care of Chest Trauma patients at Trauma Emergency Unit. Design: Descriptive research designs were utilized in this study. Setting: This study was carried out in the emergency trauma unit at an assuit university hospital. A sample: of this study were all available nurses working in the emergency trauma unit at assuit university hospital (40). (Tools) two main tools used in this study Tool I: - ((Nurses Knowledge Questioner)). Tool II: ((Nurses Practice observation checklist ) Results: the result revealed Level of nurses Knowledge regards total score that the majority of the nurses (70%) had an unsatisfactory Level total scores about chest trauma. The present study also revealed Nurses practice about chest trauma; that the majority of the nurses (95%) had an unsatisfactory. Level total scores about chest trauma. There was no a ststistical significant difference between nurses’ Knowledge and practice. The Conclusion the majority of the nurses was having an unsatisfactory level regarding nurses' knowledge and practice. There was no a ststistical significant difference between nurses’ Knowledge and practice. Recommendations: Regular continuous educational program plan about chest trauma Encouraging nurses to attend national and international congresses, seminars, symposia, and workshops regularly about chest trauma.

P17 Evaluation of new orleans criteria for cranial CT scan in mild traumatic brain injury at an emergency trauma unit of a developing country

ObjectivesTo assess compliance to New Orleans Criteria for cranial CT scan and its predictive value for intracranial pathology in mild TBI.DesignA retrospective review.SubjectsAll patients with mild traumatic brain injury presenting at the emergency unit of a National Trauma Centre of a Developing Country over 24 months.MethodsPatients information were retrieved from medical record and entered into SPSS spreadsheet. The New Orleans Criteria (NOC) was used to determine indications for brain CT scan. Compliance to the criteria was determined. The CT scan findings were evaluated in all patients that had scan and the findings were compared between those met NOC and those who did not.ResultsOne-hundred and eighteen patients were studied. Majority were males 92 (82%) with mean age of 27 year. Most injuries (66.9%) resulted from road traffic crashes. Among 65 (55.1%) patients who met NOC only 41 (63.1%) had CT scan while 25 (47.2%) patients who did not had CT giving a compliance rate of 58.5%. Twenty three (56.1%) patients who met NOC had abnormal CT compared to 9 (36%) patients that did not. The most common abnormal CT findings in both groups were skull vault fractures (9 for NOC group and 2 for non NOC group) only two patients had surgical intervention and both met NOC criteria.ConclusionsThe compliance for NOC guideline was below average in our Centre. NOC guideline is useful in predicting abnormal CT findings. There is a need for continuous education of emergency physicians to ensure optimal CT scan utilisation in mild TBI.

Nurses’ care and management actions in emergency trauma cases


 Objective. To analyze the nurse’s care and management actions in an emergency trauma hospital unit. 
 Methodology. A qualitative, exploratory-descriptive multiple case study was undertaken in an emergency trauma unit in a public teaching hospital in a town in the state of São Paulo, Brazil. The data was collected through participant observation and semi-structured interviews with the nurses. 
 Results. It was observed that the dimensions of care and management are interwoven in the nurse’s practice, which, based in the service users’ heath needs, uses specific knowledge referent to the prediction and provision of human and material resources and to actions articulating the team, to organize and guarantee the care, so as to offer integral care. 
 Conclusion. The practice of the nurse in an emergency trauma service is close to the perspective of care management, articulating the work’s care and management dimensions.

CARACTERIZAÇÃO DAS AGRESSÕES E FERIMENTOS ATENDIDOS PELO SIATE NA CIDADE DE LONDRINA-PR

Para compreender a relação entre agressões e ferimentos e o dia-a-dia, este estudo busca caracterizar as agressões, os ferimentos por arma branca e de fogo ocorridos em 2007. É um estudo descritivo, retrospectivo, com análise das ocorrências atendidas pelo Serviço de Atendimento ao Trauma em Emergência, na cidade de Londrina-Paraná. Entre elas, (54,1%) eram agressões; (32,5%), ferimentos por arma de fogo e (13,4%), ferimentos por arma branca, todas mais prevalentes em vítimas do sexo masculino e em idade reprodutiva. Os períodos mais críticos foram o noturno (65,6%) e os finais de semana. As principais lesões encontradas foram, nas agressões, ferimentos corto – contusos em crânio (35,2%); e nos ferimentos por arma branca e arma de fogo, os penetrantes em tórax (9,9% e 26%, respectivamente). O estudo sugere ações de prevenção de violência nas áreas mais afetadas da cidade, além de ações educativas para a diminuição do consumo de álcool.

Impact of Elevated per Cent Carbohydrate-deficient Transferrin at Hospital Admission on Outcomes in Trauma Patients

Chronic alcohol consumption has been linked to increased morbidity and mortality in the intensive care unit setting. The purpose of our study was to assess outcomes in trauma patients admitted to our institutional university-affiliated, Level I emergency trauma unit (ETU) with and without per cent carbohydrate-deficient transferrin (%CDT) elevations over a 12-week timeframe. Markers for alcohol consumption including %CDT, gamma glutamyl transferase, and serum osmolality were measured along with the standard trauma laboratory panel on arrival to the ETU. Intensive care unit length of stay (LOS), length of time requiring ventilator support, hospital LOS, total hospital charges as well as incidences of postoperative complications were collected on all patients with a LOS greater than or equal to 48 hours. Demographics between the groups were similar. Drinking histories were more significant in the elevated %CDT group (P = 0.0006). Patients with elevated %CDT had significantly longer ICU and hospital LOS (5.1 vs. 3.9, P = 0.01; 8.7 vs. 7.1 days, P = 0.0052) and ventilator days (2 vs. 1.5 days, P = 0.0286). Complications and hospital charges were similar between groups. Trauma patients presenting to the ETU with %CDT elevations appear to be at risk for longer ICU and hospital LOS.

Recognizing an Opportunity: Screening for Alcohol Disorders After Motor Vehicle Crashes

Recognizing an Opportunity: Screening for Alcohol Disorders After Motor Vehicle Crashes