National Trauma Center Research Articles

Beyond American College of Surgeons Verification: Quality Metrics Associated with High Performance at Level I and II Trauma Centers.

The American College of Surgeons (ACS) Committee on Trauma has established a framework for trauma center quality improvement. Despite efforts, recent studies show persistent variation in patient outcomes across national trauma centers. We aimed to investigate whether risk-adjusted mortality varies at the hospital level and if high-performing centers demonstrate better adherence to ACS Verification, Review, and Consultation (VRC) program quality measures. We analyzed data from the 2018 to 2021 ACS TQIP Participant Use Files, focusing on adult admissions at ACS-verified level I or II trauma centers for blunt, penetrating, or isolated traumatic brain injury. We used mixed-effects models to assess center-specific risk-adjusted mortality and identified high-performing centers (HPTCs), defined as those with the lowest decile of overall risk-adjusted mortality. We compared patient and hospital characteristics, outcomes, and adherence to ACS-VRC quality measures between HPTC and non-HPTC. During the study period, 1,498,602 patients across 442 level I and II trauma centers met inclusion criteria: 65.3% presenting with blunt injury, 9.3% with penetrating injury, and 25.4% with isolated TBI. Management at HPTC was associated with lower odds of major complications, failure to rescue, and takeback. Additionally, HPTC status was associated with increased odds of adherence to several ACS-VRC quality measures, including balanced resuscitation (odds ratio [OR] 1.40, 95% CI 1.29 to 1.51), appropriate pediatric admissions (OR 1.88, 95% CI 1.07 to 3.68), and substance abuse screening (OR 1.14, 95% CI 1.12 to 1.16). Significant variation in risk-adjusted mortality persists across trauma centers. Given the association between adherence to quality measures and high performance, multidisciplinary efforts to refine and implement guidelines are warranted.

Antimicrobial Resistance in Bacterial Species Causing Orthopaedic Surgical Site Infections at a National Trauma Center, Kathmandu, Nepal.

Hospital-acquired infections, including surgical site infections (SSIs), pose a concerning challenge because of the growing resistance to multiple drugs, largely influenced by extensive prophylactic antimicrobial therapy. Although SSIs are well documented in advanced hospitals in developed nations, their prevalence and bacterial profiles are inadequately reported in low- and middle-income nations such as Nepal. This retrospective cohort study explored the prevalence of orthopaedic SSIs in relation to bacterial etiology and antimicrobial resistance. We examined the surgical and bacteriological records of patients suffering SSIs (clean or clean-contaminated wounds) within a month of their surgical procedures between January 2020 and June 2022 at the National Trauma Center, Kathmandu, Nepal. The prevalence of orthopaedic SSIs among hospital-visiting patients was 31.2% (448/1,438; 95% CI: 28.8-33.5). There were 341 (76.1%) males and 361 (80.6%) adults with SSIs. Knee/joint infections (n = 141, 31.5%) were predominant. An SSI typically occurs 7 days after surgery. Enterobacterales were dominated by Escherichia coli (n = 54, 40.9%), whereas nonfermenters gram-positive cocci (GPC) were dominated by Pseudomonas aeruginosa (n = 69, 81.2%) and Staphylococcus aureus (n = 216, 93.5%), respectively. Enterobacterales, nonfermenters, and GPC exhibited penicillin resistance at 74.5%, 29.8%, and 65.1%, respectively, whereas cephalosporin resistance was exhibited at 48.3%, 57.1%, and 49.6%; fluoroquinolone resistance at 25.9%, 40.5%, and 25.7%; and aminoglycoside resistance at 21.5%, 43.2%, and 17.3%. One-third of orthopaedic surgeries resulted in SSIs, mainly caused by S. aureus. Fluoroquinolones and aminoglycosides were moderately effective in treating bacterial SSIs, whereas penicillins and cephalosporins were the least effective. Nonfermenters exhibited higher antimicrobial resistance compared with Enterobacterales and GPC.

Clinico-demographic Profile of Patients Presenting with Road Traffic Accidents at National Trauma Center of Nepal: An Observational Study

Introduction: Road traffic accidents are a major global health concern, accounting for 1.35 million fatalities and countless impairments every year. The number of road traffic accidents in Nepal is rising, which has a significant effect on the country's economy and healthcare system. Over a period of five years, the study aimed to analyze the clinico-demographic characteristics of patients admitted for injuries due to road traffic accidents in the National Trauma Center of Nepal.Methods: This is an observational study conducted by reviewing a five-year admission data from 2018 to 2023 A.D. of a tertiary care trauma center. The study was conducted following approval from the Ethical Review Board of Nepal Health Research Council (Reference number: 969). All patients admitted to the trauma centre following injuries due to road traffic accidents were included in the study. The results were summarised using descriptive statistics.Results: Out of 20,843 admissions, 3,810 (18.28%) were due to RTAs. The male-to-female ratio was 4.44:1, with a median age of 31.00 (24.00 to 43.00) years. Age distribution was as follows: <18 years (6.75%), 18-39 years (62.13%), 40-59 years (23.62%), and ≥60 years (7.50%). The median hospital stay was 8.00 (3 to 16) days. The most common injuries were lower limb 2386 (62.62%), upper limb 958 (25.14%), and head injuries 890 (23.36%). The mortality rate was 72 (1.89%).Conclusions: Injuries due to road traffic accidents constitute a significant portion of admissions at the National Trauma Center in Nepal, predominantly affecting young males. Lower limb injuries were most common.

Functional outcomes of Total Hip Replacement using modified Harris Hip Score

Background: Total hip replacement (THR) is a common surgery for relieving pain and improving the quality of life in patients with moderate to severe hip arthritis. The primary reason for THR is severe hip osteoarthritis, when conservative measures fail to relieve pain. The objective of the study was to examine functional outcomes, indications, and complications of THR using mHHS at different stages.Methods: A prospective observational study was carried out at the Department of Orthopedics, National Trauma Center, NAMS, from September 2019 to December 2020. The study included first 35 hips of 35 patients who underwent Total Hip Replacement at our hospital and met the inclusion criteria. Follow-up assessments were conducted at 6 weeks, 3 months, and 6 months after the surgery. Each visit involved thorough clinical and radiological examinations, as well as documentation of the mHHS chart. All continuous variables were expressed as mean ± standard deviation and two sample t test was used to compare means of two sub groups.Results: The study enrolled participants aged 26 to 66, with 60% male and 40% female. Right sided involvement was observed in 55% of cases, while the left side was affected in 45%. The most common reason for surgery was osteoarthritis caused by avascular necrosis of the femoral head. The average preoperative mHHS was 28, which increased to 64 at six weeks, 86 at three months, and 92 at six months. The study found that 80% of participants achieved excellent results. Complications, including a 2.85% dislocation rate, were reported.Conclusion: THR is a safe and effective procedure, providing excellent functional outcomes and minimal complications when performed carefully and precisely. Long-term studies are needed to investigate late complications and further establish the efficacy of the implants and the procedure.

Hight return-to-sport rate following traumatic spine injury in amateur athletes

IntroductionData on the resumption of sporting activity (return-to-sport, RTS) after traumatic spine injuries are mainly available for elite athletes. This study aimed to determine the RTS rate in amateurs after spine injury and to identify factors possibly influencing RTS.MethodsFirst, a retrospective analysis of clinical data of patients with traumatic spine injuries receiving inpatient treatment at a national trauma center from 2016 to 2020 was performed. Patients up to the age of 60 who were active in sports before the injury were included. Patients with the following relevant concomitant injuries were excluded: spinal cord injury, pelvic injury, extremity injuries, as well as craniocerebral trauma grade 2 or higher. A telephone interview on participants’ RTS within the first year after the injury was conducted. Participants with early and those with late or no RTS were compared in univariate analysis regarding potential influencing factors. The level of significance was set to p < .05.ResultsThirty-seven women (39%) and 57 men (61%) were included. The mean age was 44 years (16–60). The numbers of patients per injured segment of the spine were: cervical 15 (16%), thoracic 28 (30%), lumbar 33 (35%), multiple spine segments 18 (19%). Thirty patients (32%) were treated conservatively and 64 (68%) surgically. The RTS rate after six months was 62%, corresponding to 57 patients. Compared to patients with late or no RTS, patients with RTS within six months had a significantly lower BMI (24.6 vs. 27.4 kg/qm, p = .004), had isolated cervical spine injuries significantly more often (24% vs. 6%, p = .020), and had undergone outpatient or inpatient rehabilitation significantly less often (35% vs. 72%, p < .001). There were non-significant trends regarding mean age (42 vs. 46 years, p = .175), surgical therapy (66% vs. 75%, p = .333), and the proportion of patients who, before the injury, had been physically active for at least five hours per week (50% vs. 33%, p = .113). Patients with RTS within six months had sustained their spinal injury in a sports accident twice as often (28% vs. 14%, p = .121). Gender, preexisting medical or spinal conditions, severe injuries (types A4, B or C according to AO Spine), and surgical therapy were not significantly associated with RTS. The RTS rate within twelve months was 81% (76 patients).ConclusionThe RTS rate in amateur athletes after an isolated spinal injury without spinal cord injury was high, with 62% after six and 81% after twelve months. This reflects the effectiveness of the existing treatment and posttreatment concepts. Normal-weight patients and isolated cervical injury are favorable factors for RTS. The use of inpatient rehabilitation as a marker of protracted healing is associated with delayed or no RTS.

A Five-year Study of Spinal Disorders among Patients Presenting to the National Trauma Center of Nepal: An Observational Study

Introduction: Spinal cord injuries result in severe neurological impairments and disabilities. With an estimated 15.4 million cases globally in 2021, spinal cord injuries are more common in low- and middle-income countries, yet research in these areas is limited. This study aimed to find the pattern of spinal injuries and outcomes associated with spine injuries over a five-year duration at a tertiary trauma care center. Methods: This observational cross-section study was conducted at the National Trauma Center, Kathmandu from 2075 to 2080 B.S. with ethical clearance from the Nepal Health Research Council (Reference number: 968). Total-population sampling was used. A structured proforma was employed as the primary data collection tool. Data was analyzed using SPSS. Results: Of the 20843 patients, 2070 (9.93%) had spinal injuries. The median age was 43 (IQR 32-56) years, with 1391 (67.20%) male patients. The median hospital stay was 12 (IQR 7-20) days. Falls accounted for 1221 (58.99%) cases, and road traffic accidents for 195 (9.42%). Spinal fractures were present in 1076 (51.98%) patients with 456 (42.38%) in lumbar vertebra. There were 225 (10.87%) cases of subluxation with 214 (95.11%) in cervical level. Conclusions: The study provides insights into the patterns and outcomes of spinal injuries over five years of time. The mortality rate and cases of patients leaving against medical advice highlight areas for improvement in patient care and follow-up.

Comparison of Surgical Outcomes Following Percutaneous Pedicle Screw Fixation and Traditional Open Pedicle Screw Fixation for Thoracolumbar Fractures Without Neurological Deficit.

Traumatic thoracolumbar fractures are frequently encountered in blunt trauma patients. The Open pedicle screw fixation has been proven to be effective in stabilizing fractures, deformity correction, early mobilization and improving long term quality of life of patients with thoracolumbar fracture. Percutaneous pedicle screw fixation is a minimally invasive approach that minimizes the tissue injury, enhances early recovery and facilitates rehabilitation program. To compare the surgical outcomes of percutaneous versus open pedicle screw fixation for thoracolumbar fractures without neurological deficit. Single center, Prospective, Comparative study Methods: A total of 34 patients with thoracolumbar fractures with intact neurology were treated with either percutaneous or open pedicle screw fixation between February 1st 2023 to March 1st 2024 at the National trauma center , Kathmandu. There were 17 patients in each group. The perioperative clinical and radiological parameters were collected using a preformed pro forma. Postoperatively follow-up was conducted at post op day 1, during discharge and 3 months. The clinical and radiological outcomes of percutaneous and open pedicle screw fixation were analyzed and compared. This study included 24(70.6%) males and 10(29.4%) females. The mean age was 40.73 ±15.44 years. There was a statistically significant difference between percutaneous and open pedicle screw with regard to intraoperative blood loss, fluoroscopy time, operative duration, deambulation day and overall hospital stay (p<0.05). Overall, there was a statistically significant improvement in overall pain perception at discharge and three month follow up in both groups. The kyphosis correction in percutaneous group was similar to open pedicle screw fixation technique (mean cobbs angle correction of 4.7 degree). The percutaneous approach has several advantages over the open pedicle screw fixation with regard to less intraoperative blood loss, less postoperative pain, early deambulation, no was a statistically complications and shorter hospital stay Keywords: Open pedicle screw; percutaneous pedicle screw fixation; thoracolumbar fracture.

Risk factors and predictors of prolonged hospital stay in the clinical course of major amputations of the upper and lower extremity a retrospective analysis of a level 1-trauma center.

The objective was to analyze the treatment and complications of the patients after a major amputation of the upper and lower extremities. Risk factors and predictors of a prolonged hospital stay should be outlined. This is a retrospective study of a national Level-1 Trauma center in Germany. In a 10-year period, patients were identified by major amputations in the upper and lower extremities. The medical reports were considered and the results were split into four main groups with analysis on basic-, clinical data, the course on intensive care unit and the outcome. A recovery index was established. The patients' degree of recovery was summed up. Statistical analysis was performed. 81 patients were included. A total of 39 (48.1%) major amputations were carried out on the lower leg and 34 (42.0%) involved the thigh. There were two instances (2.5%) of hip joint disarticulation. 6 major amputations were done on the upper extremities (n = 3 on the upper arm, n = 3 on the forearm). 13.83 ± 17.10 days elapsed between hospital admission and major amputation. The average length of hospital stay was 38.49 ± 26,75 days with 5.06 ± 11.27 days on intensive care unit. Most of the patients were discharged home followed by rehabilitation. A significant correlation was found between the hospital length of stay and the increasing number of operations performed (p = 0.001). The correlation between the hospital length of stay and the CRP level after amputation was significant (p = 0.003). Major amputations in trauma patients lead to a prolonged stay in hospital due to severe diseases and complications. Especially infections and surgical revisions cause such lengthenings.

Correlation Between Radiological Grading and Clinical Scoring in Knee Osteoarthritis Patients.

Osteoarthritis is characterized by mechanical joint abnormalities, primarily involving articular cartilage and subchondral bone degradation. Diagnosis of knee osteoarthritis relies on American College of Rheumatology criteria, and severity assessment utilizes the Western Ontario and McMaster Universities Osteoarthritis Index score and Kellgren and Lawrence grading. Despite reported associations, discrepancies persist in the correlation between Western Ontario and McMaster Universities Osteoarthritis Index and Kellgren and Lawrence grade. Descriptive cross-sectional study was conducted at the National Trauma Centre, over six months with consecutive convenience sampling. Demographic and clinico-radiological data were collected. Mean, SD and correlation coefficient was calculated. Consecutive convenient sampling yielded 80 participants meeting American College of Rheumatology criteria, aged 52-81 years, predominantly female (67.50%). Significant positive correlations were identified between age, Western Ontario and McMaster Universities Osteoarthritis Index score, and KL grade. Results showed most cases with Kellgren and Lawrence grade III and strong correlations (r=0.73, p=0.00) between total Western Ontario and McMaster Universities Osteoarthritis Index scores and Kellgren and Lawrence grading. Notably, pain, stiffness and physical functions individually exhibited a significant possitive correlation with Kellgren and Lawrence grading. The study affirms age-related influences on osteoarthritis, emphasizes female predilection, and underscores the importance of assessing both clinical and radiological parameters. In conclusion, this study supports Western Ontario and McMaster Universities Osteoarthritis Index efficacy in dynamic disease assessment and management, especially in settings where radiological examinations may be impractical, thus establishing Western Ontario and McMaster Universities Osteoarthritis Index as a versatile tool for systematic monitoring and intervention in knee osteoarthritis.

Predictors of long-term mortality in older patients with hip fractures managed by hemiarthroplasty: a 10-year study based on a population registry in Saxony, Germany.

Mortality of patients with a femoral neck fracture is high, especially within the first year after surgery, but also remains elevated thereafter. The aim of this study was to identify factors potentially associated with long-term mortality in patients homogeneously treated with hemiarthroplasty for femoral neck fracture. This retrospective cohort study was performed at a single level 1 national trauma center at the university hospital of Leipzig (Saxony, Germany). The study time-window was January 1, 2010 to December 31, 2020. Primary outcome measure was mortality depending on individual patient-related characteristics and perioperative risk factors. Inclusion criteria was a low-energy femoral neck fracture (Garden I-IV) in geriatric patients 60 years of age or older that were primarily treated with bipolar hemiarthroplasty. Date of death or actual residence of patients alive was obtained from the population register of the eastern German state of Saxony, Germany. The outcome was tested using the log-rank test and plotted using Kaplan-Meier curves. Unadjusted and adjusted for other risk factors such as sex and age, hazard ratios were calculated using Cox proportional hazards models and presented with 95% confidence intervals (CI). The 458 included patients had a median age of 83 (IQR 77-89) years, 346 (75%) were female and 113 (25%) male patients. Mortality rates after 30 days, 1, 5 and 10 years were 13%, 25%, 60% and 80%, respectively. Multivariate regression analysis revealed age (HR = 1.1; p < 0.001), male gender (HR = 1.6; p < 0.001), ASA-Score 3-4 vs. 1-2 (HR = 1.3; p < 0.001), dementia (HR = 1.9; p < 0.001) and a history of malignancy (HR = 1.6; p = 0.002) as independent predictors for a higher long-term mortality risk. Perioperative factors such as preoperative waiting time, early surgical complications, or experience of the surgeon were not associated with a higher overall mortality. In the present study based on data from the population registry from Saxony, Germany the 10-year mortality of older patients above 60 years of age managed with hemiarthroplasty for femoral neck fracture was 80%. Independent risk factors for increased long-term mortality were higher patient age, male gender, severe comorbidity, a history of cancer and in particular dementia. Perioperative factors did not affect long-term mortality.

Adverse events after surgery for injuries to the subaxial cervical spine: analysis of incidence and risk factors

PurposeTo determine the incidence of severe surgical adverse events (sSAE) after surgery of patients with subaxial cervical spine injury (sCS-Fx) and to identify patient, treatment, and injury-related risk factors.MethodsRetrospective analysis of clinical and radiological data of sCS-Fx patients treated surgically between 2010 and 2020 at a single national trauma center. Baseline characteristics of demographic data, preexisting conditions, treatment, and injury morphology were extracted. Incidences of sSAEs within 60 days after surgery were analyzed. Univariate analysis and binary logistic regression for the occurrence of one or more sSAEs were performed to identify risk factors. P-values < .05 were considered statistically significant.ResultsTwo hundred and ninety-two patients were included. At least one sSAE occurred in 49 patients (16.8%). Most frequent were sSAEs of the surgical site (wound healing disorder, infection, etc.) affecting 29 patients (9.9%). Independent potential risk factors in logistic regression were higher age (OR 1.02 [1.003–1.04], p = .022), the presence of one or more modifiers in the AO Spine Subaxial Injury Classification (OR 2.02 [1.03–3.96], p = .041), and potentially unstable or unstable facet injury (OR 2.49 [1.24–4.99], p = .010). Other suspected risk factors were not statistically significant, among these Injury Severity Score, the need for surgery for concomitant injuries, the primary injury type according to AO Spine, and preexisting medical conditions.ConclusionsSAE rates after treatment of sCS-Fx are high. The identified risk factors are not perioperatively modifiable, but their knowledge should guide intra and postoperative care and surgical technique.

Prevalence of operable intracranial lesions from mild traumatic brain injury in a National Trauma Centre

BackgroundMild traumatic brain injury (TBI) occupies majority of head traumas in most emergency units. Although patients with mild TBI can be reviewed and discharged on head injury advice, a sizeable number require admission for observation or intervention due to operable intracranial lesions. The aim of the study was to establish the prevalence of operable lesions in patients with mild TBI.Materials and methodsThis was a prospective study of consecutive adult patients with mild TBI who had cranial computerized tomography (CT) done at the National Trauma Centre, Abuja. All participants gave informed consent and the study had ethical clearance in the Hospital.ResultsOne hundred and three mild TBI patients with cranial CTs were recruited aged 16–76 years with mean age of 32.25±\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\pm$$\\end{document}12.35 years. With intention to treat, twenty (20.4%) of them were diagnosed with operable intracranial lesions on CT scans, 19 males and 2 females. Majority of them (14; 66.7%) were young adults within 20–40 years of age. The lesions were 16 extradural haematomas (76.2%), 3 subdural haematomas (14.3%) and 2 depressed skull fractures (9.5%) of the operable cohort.ConclusionsSignificant number of patients with mild TBI had operable intracranial lesions. Therefore, there is need to screen patients with mild TBI appropriately in order to avoid missed operable lesions.

Effectiveness of Dexamethasone as an Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Block

Supraclavicular Brachial Plexus block is a simple and effective technique of providing anesthesia for elbow, forearm and hand surgery. This study investigated the onset of sensory and motor blockade and duration of analgesia after addition of dexamethasone with bupivacaine in supraclavicular brachial plexus block. An observational, comparative study was performed at Bir Hospital and National Trauma Center, Kathmandu. Forty patients undergoing surgery of elbow, forearm and hand under Supraclavicular Brachial Plexus Block, with 0.25% bupivacaine with dexamethasone (n = 20) in group I versus 0.25% bupivacaine with normal saline (n = 20) in group II with equal volume of 30 ml in each group. Randomization was done with lottery system using sealed envelope. Onset of sensory and motor blockade and duration of analgesia was compared in both the groups. The rescue analgesia injection diclofenac 75 mg was given if Visual Analogue Score was five or more. Each patient was assessed postoperatively by a blinded investigator at regular intervals of 15 minutes in first hour, 30 minutes in next hour and then hourly till the time to first rescue analgesia. SPSS version 24.0 software was used. Continuous variables like onset of sensory and motor block and time to first rescue analgesia was assessed with student’s t-test and Chi square test was applied to asses categorical variable like VAS score. The time to onset of sensory block in bupivacaine only group (505.50±72.52) seconds compared to bupivacaine with dexamethasone group (249.75±78.36) seconds. Time to onset of motor block in bupivacaine only group (792.00±89.94) seconds compared to bupivacaine with dexamethasone group (506.25±94.35) seconds. Time to first rescue analgesia in bupivacaine only group (537.00±162.25) minutes compared to bupivacaine with dexamethasone group (1371.00±282.95) minutes. Time to onset of sensory and motor block was significantly faster and duration of analgesia was significantly prolonged in bupivacaine with dexamethasone group compared to bupivacaine only group in patient undergoing surgery of arm, forearm, and hand surgery under supraclavicular brachial plexus block.

Treatment of the wounded from the war in Ukraine in the trauma networks of the DGU-Requirement, reality and motivation over the course of 18months…

The war in Ukraine and the medical treatment of the wounded in hospitals in Germany has now represented achallenge for more than 15months. The majority of trauma patients were distributed via the general holding center (GMLZ) at the Federal Office of Civil Protection and Disaster Assistance (BBK) by the cloverleaf concept and the trauma networks. Initially, numerous offers of assistance were promoted with great solidarity. For documentation of the current motivation situation and also for identification of the potential for improvement, a2-stage survey of senior physicians in the organized and certified hospitals in the trauma networks was carried out. An online survey of senior physicians of the trauma network hospitals was carried out with asemistructured written questionnaire in December 2022 and afollow-up survey during the Trauma Network Meeting (TNT) Congress in September 2023 in Frankfurt. Of the questionnaires 113 could be evaluated in December 2022 and 70completed questionnaires in September 2023. The answers came from national trauma centers (ÜTZ), regional trauma centers (RTZ) and local trauma centers (LTZ) each with approximately one third. On average 2.7patients were treated in all participating hospitals up to December and up to September no more than 5in more than half of the hospitals overall. The main challenges for all participants at both points in time were the long hospital stay, the demanding pathogen status and sometimes unclarified or not completely covered reimbursement of costs. Nevertheless, more than 80% of the specialist departments received backing from their hospital sponsors as well as their personnel for the continuing treatment of the wounded from Ukraine. The medical and professional challenges in the treatment of the wounded from Ukraine are, as expected, characterized by the demanding injury patterns of the musculoskeletal system and the colonization with multidrug-resistant pathogens. This results in along course of treatment, where the remuneration does not always cover the costs. Despite these challenges the solidarity in the hospitals of the trauma networks is unbroken. Simultaneously, there are numerous possibilities for improvement in order to enhance the prerequisites for future comparable humanitarian assistance jointly with politics.

Trauma Quality Improvement Program: A Retrospective Analysis from A Middle Eastern National Trauma Center.

The Trauma Quality Improvement Program (American College of Surgery (ACS-TQIP)) uses the existing infrastructure of the Committee on Trauma programs and provides feedback to participating hospitals on risk-adjusted outcomes. This study aimed to analyze and compare the performance of the Level I Hamad Trauma Centre (HTC) with other TQIP participating centers by comparing TQIP aggregate database reports. The primary goal was to pinpoint the variations in adult trauma outcomes and quality measures, identify areas that need improvement, and leverage existing resources to facilitate quality improvement. A retrospective analysis was performed for the TQIP data from April 2019-March 2020 to April 2020-March 2021. We used the TQIP methodology, inclusion and exclusion criteria, and outcomes. There were 915 patients from Fall 2020 and 884 patients from Fall 2021 that qualified for the TQIP database. The HTC patients' demographics differed from the TQIP's aggregate data; they were younger, more predominantly male, and had significantly different mechanisms of injury (MOI) with more traffic-related blunt trauma. Penetrating injuries were more severe in the other centers. During the TQIP Fall 2020 report, the HTC was a low outlier (good performer) in one cohort (all patients) and an average performer in the remaining cohorts. However, during Fall 2021, the HTC showed an improvement and was a low outlier in two cohorts (all patients and severe TBI patients). Overall, the HTC remained an average performer during the report cycles. There was an improvement over time in the risk-adjusted mortality, which reflects the continuous and demanding effort put together by the trauma team. The ACS-TQIP for the external benchmarking of quality improvement could be a contributor to better monitored patient care. Evaluating the TQIP data with emphases on appropriate methodologies, quality measurements, corrective measures, and accurate reporting is warranted.

Norcia and the central italian earthquake: Challenges and lessons learned from the italian psychiatric reform movement

Salvatore and colleagues wrote a brilliant Target Article (2022) in this journal on the state of Italian psychology and recommendations for change.&amp;nbsp; In this contribution, we look at the failure of Italian psychology to address the suffering of the affected population of the Central Italian earthquake in Norcia in 2016.&amp;nbsp; The Italian National Trauma Center centered in Orvieto, Umbria has been on the ground assisting local health care practitioners in caring for the mental health impact of the earthquake and the COVID pandemic lockdown.&amp;nbsp; Absent Italian psychologists walk hand in hand with a political system that has had limited response to the mental health needs of earthquake survivors.&amp;nbsp; Lessons learned from the historic revolution in Italian Psychiatry led by Professor Franco Basaglia are presented to help understand the current reality in Norcia.&amp;nbsp; Many of the barriers to mental health reform that existed for Basaglia and his colleagues still exist today.&amp;nbsp; This contribution strongly supports Salvatore and colleagues' recommendations for the transformation of Italian psychology.

Epidemiology of traumatically injured Yemeni civilians treated at the Omani National Trauma Centre over a 2-year period: a retrospective cohort study

IntroductionArmed conflict is a growing global cause of death, posing a significant threat to the resilience of global health systems. However, the burden of disease resulting from the Yemeni Civil...

Keeping the big picture in Terror-MASCAL-A new hospital concept

Two key positions have been defined for the in-house management of patients in the context of aterrorism-related mass casualty incident (Terror-MASCAL). The senior triage coordinator (LArS) categorizes the injured according to injury severity using algorithms. The central operational and medical coordinator (ZONK) disposes and prioritizes the injured for treatment measures, considering the injury severity and the available treatment capacities. The dynamics and complexity of aTerror-MASCAL combined with the high number of patients requires comprehensible documentation. The evaluation of an incident exercise of aTerror-MASCAL revealed deficits in its documentation. Based on the deficits identified, requirements have been defined. The article presents the management and documentation aids of aGerman national trauma center. The hospital with its currently available resources is abstractly represented via the Trauma Tactics Board (TTB). Patients with their individual injuries are represented by identification cards on the TTB. The ZONK can prioritize and dispose further treatment based on the information about the available resources and the patient-specific injury pattern. The patient registry continues to document the patient's other medical findings. Important external and internal information is noted in an event register. The entire documentation process on the TTB is documented by camera. Documentation aids are required to fulfil the core tasks of the ZONK. By using the documentation aids, ahospital can prepare for aTerror-MASCAL within ashort time. Lack of daily practical application of the documentation aids should be compensated for by regular practice and interdisciplinary exchange of experience.

Geospatial analysis of mortality risk from road traffic crashes in Federal Capital Territory, Nigeria

The objective of the study was to present a novel analytical approach using Nigerian trauma registry data to determine risks and of road traffic crash-related mortality for patients treated at National Trauma Centre, Abuja. Patient characteristics were compared between those who died at the hospital (n = 118) and those who survived (n = 2018). Multiple logistic regression and cluster analyses were used to identify risks of mortality and of high mortality and injury rates. The patient’s status as pedestrian (p &lt; .0001), and whether the crash occurred on an expressway or transition zone between expressways and local roads (p = 0.0045) were significantly associated with mortality. Cluster analysis further isolated significant of mortality rate (Moran’s I = 0.31), pedestrian injury rate (Moran’s I = 0.34), and expressway/transition zone injury rate (Moran’s I = 0.18). For patients who survived to hospitalization at National Hospital Abuja, pedestrians involved in a crash and those whose crashes occurred on expressways/transition zones were at higher risk of mortality. High mortality and pedestrian and expressway/transition zone injury rates isolated to five contiguous administrative wards in Abuja. These analysis methods can be applied to determine risks and hotspots of crashes, injuries, and mortality in various settings.

Morphometric Study of Sub Axial Cervical Spine Pedicles in Nepalese Population.

Mal-positioning of cervical screws risks neurovascular injury so, it is necessary to understand cervical pedicle morphology for pedicle screw fixation in the region. The risks of pedicle screw insertion in the cervical spine can be mitigated by a three-dimensional appreciation of pedicle anatomy. The study aims to determine the morphology of the sub axial cervical spine pedicles in Nepalese Population based on computerized tomography. A cross-sectional study using computerized tomography scans of the spine was made among the randomly selected 87 patients who had visited National Trauma center, Kathmandu, Nepal with vertebral fracture other than cervical vertebrae. Patient was examined as per Advanced Trauma Life support protocol and neurological assessment. Measurement was done from the third cervical vertebra down to the seventh cervical vertebra in computer with standard software in the department of radiology from where all the computerized tomography scan reporting are done. The mean pedicle length ranged from 4.41 mm at C3 to 4.96 mm at C7 where mean pedicle height ranged from 4.64 at C3 to 5.12 at C7. Pedicle length, pedicle height and pedicle width were observed to be statistically significant with gender. The pedicle axial length of C3 and C7 vertebra were found significant with gender. All parameters were found to be greater in male compared to female. The study revealed that pedicle length, pedicle height, pedicle width, pedicle axial length increased from third to seventh cervical however, transverse angulation increased up to fifth vertebra and decreased to seventh vertebra.