Non-severe Trauma Research Articles

Characteristics and Effectiveness of Mobile- and Web-Based Tele-Emergency Consultation System between Rural and Urban Hospitals in South Korea: A National-Wide Observation Study.

(1) Background: The government of South Korea has established a nationwide web- and mobile-based emergency teleconsultation network by designating urban and rural hospitals. The purpose of this study is to analyze the characteristics and effectiveness of the tele-emergency system in South Korea. (2) Methods: Tele-emergency consultation cases from May 2015 to December 2018 were analyzed in the present study. The definition of a tele-emergency in the present study is an emergency consultation between doctors in rural and urban hospitals via a web- and mobile-based remote emergency consultation system (RECS). Consultations through an RECS are grouped into three categories: medical procedure or treatment guidance, image interpretation, and transportation requests. The present study analyzed the characteristics of the tele-emergency system and the reduction in unnecessary transportation (RUT). (3) Results: A total of 2604 cases were analyzed in the present study from 2985 tele-emergency consultation cases. A total of 381 cases were excluded for missing data. Consultations for image interpretation were the most common in trauma cases (71.3%), while transfer requests were the most common in non-trauma cases (50.3%). Trauma patients were more frequently admitted to rural hospitals or discharged and followed up with at rural hospitals (20.3% vs. 40.5%) after consultations. In terms of disease severity, non-severe cases were statistically higher in trauma cases (80.6% vs. 59.4%; p < 0.001). The RUT was statistically highly associated with trauma cases (60.8% vs. 42.8%; p < 0.001). In an analysis that categorized cases by region, a statistically higher proportion of transportation was used in island regions (69.9% vs. 49.5%; p < 0.003). More RUT was associated with non-island regions (30.1% vs. 50.5%; p = 0.001). (4) Conclusions: The tele-emergency system had a great role in reducing unnecessary patient transportation in non-severe trauma cases and non-island rural area emergency cases. Further research is needed for a cost/benefit analysis and clinical outcomes.

Clinico-anatomical characteristic of the traffic-transport trauma in the megapolic environment. The third report: severity of injury

Objective. Formation of unified clinical characteristic of damages in participants of traffic, who were injured due to traffic-transport accidents in the megapolis environment.&#x0D; Materials and methods. Retrospective analysis of data, concerning 1139 injured persons, who were traumatized due to traffic-transport accidents and stationary treated in the Kyiv’s Clinical Hospital of Emergent Medical Help in the 2019 - 2020 yrs period, was accomplished.&#x0D; Results. The persons, suffering relatively nonsevere trauma – 83.67% - dominated in general investigated massive, while extremely severe and severe damages have been encountered in 7.97% injured persons only. Positive result of the traumatic process course was noted also in the biggest quantity of the injured persons with the trauma severity up to 16 points – in 74.56%, and among the dead individuals the first place was occupied by injured persons with the damage severity more than 45 points – in 44.0%. While the injury severity constituting more than 45 points, the part of the injured persons survived was 55.10%. All the injured participants of the traffic with nonsignificant (up to 16 points) injury severity score have had occupied first places, but the value of such an index was different in all of them. Among pedestrians there was a biggest part of the injured persons, owing the damage severity more than 45 points in accordance to the NISS scale – 7.62%. In these participants of traffic such damages occur in 3.2 times more frequently, than in the injured persons, who were inside of the vehicle (drivers, passangers). The injury severity essentially impacts the result of the traumatic process course in all participants of traffic.&#x0D; Conclusion. The trauma of severity up to 16 points in accordance to the NISS scale are obtaining 71.29% of the persons, injured due to the traffic-transport accidents. The severest traumas are obtained by the pedestrians. There was established, that the damage severity trustfully depends on factors of participation in traffic and impacts occurrence of negative result of the traumatic process course.

Trauma severity and mandibular fracture patterns in a regional trauma center.

Background Mandibular fractures are one of the most common types of facial fractures, the treatment of which can be delayed due to the severity of the trauma resulting in an increase of complications; thus, early evaluation of trauma severity at the time of visit is important. In South Korea, trauma patients are triaged and intensively treated in designated regional trauma centers. This study aimed to analyze the relationship between trauma severity and mandibular fracture patterns.Methods A medical records review was performed on patients who visited the regional trauma center at our hospital for mandibular fracture between 2009 and 2018. Epidemiologic data and mandibular fracture patterns were analyzed and compared with the conventional facial injury severity scale (FISS).Results Among 73 patients, 51 were classified as non-severe trauma patients and 22 as severe trauma patients. A higher trauma severity was associated with older age (odds ratio [OR], 1.164; 95% confidence interval [CI], 1.057–1.404) and lower risk was associated with fractures located in the angle (OR, 0.001; 95% CI, 0–0.022), condylar process (OR, 0.001; 95% CI, 0–0.28), and coronoid process (OR, 0.004; 95% CI, 0–0.985). The risk was lower when the injury mechanism was a pedestrian traffic accident (OR, 0.004; 95% CI, 0–0.417) or fall (OR, 0.004; 95% CI, 0–0.663) compared with an in-car traffic accident. Higher FISS (OR, 1.503; 95% CI, 1.155–2.049) was associated with a higher trauma severity. The proposed model was found to predict the trauma severity better than the model using FISS (p< 0.001).Conclusion Age, location of mandibular fractures, and injury mechanism showed significant relationships with the trauma severity. Epidemiologic data and patterns of mandibular fractures could predict the trauma severity better than FISS.

Multimodal oral analgesia for non-severe trauma patients: evaluation of a triage-nurse directed protocol combining methoxyflurane, paracetamol and oxycodone.

Insufficient analgesia affects around 50% of emergency department patients. The use of a protocol helps to reduce the risk of oligoanalgesia in this context. Our objective was to describe the feasibility and efficacy of a multimodal analgesia protocol (combining paracetamol, oxycodone, and inhaled methoxyflurane) initiated by triage nurse. We performed a prospective, observational study in an emergency department (Grenoble Alpes University Hospital, France) between December 2017 and April 2018. Adult non-severe trauma patients with a numerical pain rating scale (NRS) score ≥ 4 were included. The primary efficacy criterion was the proportion of patients with an NRS score ≤ 3 at 15min. Pain intensity was measured for 60min and during radiography. Data on adverse events and satisfaction were recorded. A total of 200 adult patients were included (median [interquartile range (IQR)] age: 32 [23-49] years; 126 men (63%)). Sixty-six patients (33%) reported an NRS score ≤ 3 at 15min. The time required to achieve a decrease of at least 2 points in the NRS score was 10 (5-20) min. The median [IQR] pain intensity was 4 [2-5] before radiography and 4 [2-6] during radiography. Adverse events were frequent (n = 128, 64%). No serious adverse events were reported. The patients and caregivers reported good levels of satisfaction. The administration of a nurse-driven multimodal analgesia protocol (combining paracetamol, oxycodone, and methoxyflurane) was feasible on admission to the emergency department. It rapidly produced long-lasting analgesia in adult trauma patients.Trial registration: NCT03380247.

Pathophysiological substantiation of medical evacuation of the wounded persons, suffering injuries of the extremities on the levels of medical support

Onbjective. To determine the optimal scheme of medical evacuation for the wounded persons, suffering the combat trauma of the extremities, bаsing on clinic-statistical analysis of changes in the homeostasis indices.&#x0D; Маterials and methods. Complex pathophysiologic investigation, concerning 378 wounded persons, suffering a combat traumas of the extremities in accordance to 26 indices of homeostasis, was conducted. Dynamic physician’s control with determination of the trauma severity in accordance to the AdTS (Admission trauma Scale) on all levels of medical support was accomplished.&#x0D; Results. There was established, that in a case of organization of a consequent delivery of traumatological help to the wounded persons, suffering severe and extremely severe combat trauma of the extremities, estimated by the AdTS as 5 points and more, on levels of medical support due to timely conducted antishock measures and the operative interventions performed a severe respiratory-circulatory disorders - (5.2 ± 0.6) standard units - have had changed steadily towards moderate - (7.7 ± 0.2) standard units. Меdical evacuation of a wounded persons through one or two levels leads to development of definite respiratory-circulatory disorders - (2.8 ± 0.9) standard units, significant lowering of a one-time and a minute productivity of the heart with tendency for cardio-vascular and respiratory insufficiency occurrence: a power іndex - (19.0 ± 4.1) ml/m2, the heart іndex - (2.1 ± 0.3) l/min/m2. In a wounded persons, suffering nonsevere trauma, estimated using a AdTS lesser than 5 points, the shortening of quantity of the medical support levels do not influence the patients’ general state, аnd a respiratory-circulatory disorders owes a moderate character - (8.16 ± 1.37) standard units.&#x0D; Conclusion. Меdical evacuation of wounded persons, suffering nonsevere trauma (lesser than 5 points in accordance to AdTS) must be conducted in accordance to a shortened scheme; while in a severe one (5-9 points in accordance to AdTS) and in extremely severe trauma (more than 9 points in accordance to AdTS) - after conduction of the antishock measures and stabilization of state on every level of medical support.

Surgical tactics of treatment of the wounded persons with the gun-shot injuries of the hip on all levels of medical support

Objective. To substantiate the introduction of differentiated surgical tactics, taking into account the trauma severity for improvement of the treatment results in the wounded persons, suffering the gun-shot injuries of the hip (GSIH).&#x0D; Маterials and methods. Differentiated surgical tactics was substantiated by the authors, using as a measure for trauma severity estimation the AdTS (Admission trauma Scare) on different levels of medical support, and introduced in 57 wounded persons, suffering the GSIH. Medical efficacy of the tactics and treatment elaborated for the wounded persons was compared in accordance to conventional methods without application of the AdTS scale.&#x0D; Results. There was reduced the mortality from 7.3 tо 1.8%, the extremities amputation performance rate - from 24.4 tо 8.8%, the local complications quantity, calculated for one wounded person, - from 1.07 tо 0.58 (рα &lt; 0.05), relative quantity of poor functional results - from 34.1 tо 19.3% (рα &lt; 0.05), while the specific weight of good functional results increased - from 29.3 to 47.4 due to introduction of differentiated surgical tactics, taking into account the trauma severity on various levels of medical support.&#x0D; Conclusions. In the wounded persons, suffering nonsevere trauma (lesser, than 5 points) it is necessary to perform a complete volume of surgical aid; while in severe one (5 - 9 points) and in extremely high (more than 9 points) trauma the help must be delivered in a shortened volume, using the damage control principle.

P089: Multimodal oral analgesia for non-severe trauma patients: feasibility and evaluation of a triage-nurse directed protocol combining low-dose methoxyflurane, paracetamol and oxycodone

Introduction: Insufficient analgesia affects around 50% of emergency department patients. The use of a protocol helps to reduce the risk of oligoanalgesia in this context. Our objective was to describe the feasibility and efficacy of a multimodal analgesia protocol (combining paracetamol, oxycodone, and inhaled low-dose methoxyflurane) initiated by triage nurse. Methods: We performed a prospective, observational study in the emergency department at Grenoble Alpes University Hospital (Grenoble, France) between October 2017 and April 2018. Non severe adult trauma patients with a numerical pain rating scale (NRS) score ≥4 and receiving MEOF were included. The primary efficacy criterion was the proportion of patients with an NRS score ≤3 at 15min post-administration. Pain intensity was measured for 60 min as well as during radiography. Data on adverse events and satisfaction were also recorded. Data are presented as median [interquartile (IQR)] and were compared using non parametric tests. Results: A total of 200 adult patients were included (age: 32 [IQR: 23–49] years; 126 men (63%)). Patients presented at triage with a pain score of 7 [IQR: 6-8]. Sixty-six patients (33%) reported an NRS score ≤3 at 15 min post-administration. The time required to achieve a decrease of at least 2 points in the NRS score was 10 [IQR 5–20] min. The pain intensity was 4 [IQR: 2–5] before radiography and 4 [IQR: 2–6] during radiography. Adverse events were frequent (n = 128, 64%), mainly dizziness. No serious adverse events were reported and 89% of minor adverse events resolved at one hour. Both patients and health care providers reported good levels of satisfaction. Conclusion: The administration of a nurse-driven multimodal analgesia protocol combining paracetamol, oxycodone, and low-dose methoxyflurane was feasible on triage. It rapidly produced long-lasting analgesia in adult trauma patients.

Neurobehavioural outcome in 6-18 year old children after trauma in pregnancy: Case-control study.

Maternal trauma complicates pregnancy in approximately 7%. Long-term development of children exposed to maternal trauma is unknown. To determine neurobehavioural outcome of children (6-18 years) born after maternal trauma in pregnancy compared to a matched control group. Case-control study performed at a tertiary medical centre. All consecutive children born after maternal hospitalization for trauma during pregnancy between 1995 and 2005. Controls were children born at the same hospital and period after an uneventful pregnancy. Trauma type and severity (Injury Severity Score, ≥9: severe); information from medical files at admission (cases). All mothers filled out two questionnaires about the infant; 1. concerning health, motor development and educational level, 2. concerning behavioural development through the validated Dutch version of the Child Behavior Checklist (CBCL). Questionnaires were returned by 34 cases and 28 controls. The traumas concerned mainly motor vehicle accidents and falls, and 3/34 had severe injuries. No differences in health, motor development, educational level and CBCL was found between the cases and controls, except for more hospitalization in the cases (p=0.009). Long-term follow-up of a limited population of children 6-18 years after exposure of mainly non-severe trauma before birth is similar to a control population except for unexplained more hospitalization in the cases.

Age and frailty index are independent factors for mortality with blunt non-severe trauma: a review of 575,033 patients from the National Trauma Databank (NTDB)

Age and frailty index are independent factors for mortality with blunt non-severe trauma: a review of 575,033 patients from the National Trauma Databank (NTDB)

The Completeness of Documentation in Non-Severe Trauma Patients: A Forensic Aspect

The Completeness of Documentation in Non-Severe Trauma Patients: A Forensic Aspect The main objectives of this study are to evaluate the completeness of wound documentation and to evaluate missed injury from the Emergency Department (ED) in non-severe trauma patients for quality improvement in both clinical and forensic purposes. The medical records were retrospectively reviewed to compare the injury documentation between the ED and Clinical Forensic Medicine (CFM) unit. The injury documentation rate (IDR) was calculated to represent the adequacy of total number of wounds recorded.

Injury-induced "switch" from GTP-regulated to novel GTP-independent isoform of tissue transglutaminase in the rat spinal cord.

We recently found that alternative transcripts of tissue transglutaminase (tTG or TG2) were present in hippocampal brain regions of Alzheimer's disease (AD), but not in control, non-demented, age-matched brains. Since antecedent non-severe trauma has been implicated in AD and other neurodegenerative diseases, such as Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS), we were interested in whether alternative transcripts might be detected in a model of neurotrauma, controlled-contusion spinal cord injury (SCI) in the rat. Implicated in diverse roles from growth and differentiation to apoptotic cell death, only bifunctional tTG, of the nine member TG family, has dual catalytic activities: guanine trinucleotide (GTP) hydrolyzing activity (GTPase), as well as protein cross-linking. These functions imply two physiological functions: programmed cell life and death. These may have profound roles in the nervous system since studies in cultured astrocytes found tTG short (S) mRNA transcripts induced by treatment with injury-related cytokines. In the developing rat spinal cord, tTG activity is concentrated in ventral horn alpha motoneurons, but neither studies of spinal cord tTG gene expression, nor evaluation of the GTP-regulated isoforms in tissues, have been reported. We now report increased tTG protein and gene expression occurring rapidly after SCI. In parallel, novel appearance of a second, short form transcript, in addition to the normal long (L) isoform, occurs by 8 h of injury. Up-regulation of tTG message and activity following neural injury. with appearance of a truncated GTP-unregulated S form, may represent new approaches to drug targets in neurotrauma.