Department Of Trauma Surgery Research Articles

Evaluation of Inpatient Surgical Wards' Performance at the Hospitals Affiliated with Tehran University of Medical Sciences in 2018

Background: Surgery wards account for a significant portion of hospital costs, followed by patient costs. Improving surgery wards' performance plays a major role in enhancing the accountability and efficiency of the hospital. This study aimed to evaluate the performance of inpatient surgical wards at the hospitals affiliated with Tehran University of Medical Sciences(TUMS). Methods: A descriptive, cross-sectional, retrospective study was performed at all hospitals affiliated with TUMS in 2018. To measure the efficiency of these wards, three indicators have been considered; bed occupancy rate, the average length of stay, and bed turnover. Data have been analyzed using Excel software based on the Pabon Lasso model . Results: Among the 15 active surgical departments, 5 (33.31 %) were categorized in quadrant three, including ophthalmology, obstetrics and gynecology, vascular and trauma surgery, plastic surgery, and infertility department. The oral and maxillofacial surgery and general surgery departments were the poorest in their performance and located in quadrant one. Ten surgical wards out of 38 (26.33 %) have reported a satisfactory performance. Conclusion: Understanding and comparing the performance of clinical departments is also useful in making decisions for standardizing the patterns of health services delivery, evidence-based management in health care centers, and enhancing accountability in the health system. It is suggested that managers revise the departments in the inefficient area to reduce the number of inefficient departments or attract more patients by marketing, diversifying services, and increasing the quality of services.

Preparation of hospitals for mass casualty incidents in Bavaria, Germany: care capacities for penetrating injuries and explosions in TerrorMASCALs

BackgroundIn a terror attack mass casualty incident (TerrorMASCAL), compared to a “normal” MASCAL, there is a dynamic course that can extend over several hours. The injury patterns are penetrating and perforating injuries. This article addresses the provision of material and personnel for the care of special injuries of severely injured persons that may occur in the context of a TerrorMASCAL.MethodsTo answer the research question about the preparation of hospitals for the care of severely injured persons in a TerrorMASCAL, a survey of trauma surgery departments in Bavaria (Germany) was conducted using a questionnaire, which was prepared in three defined steps based on an expert consensus. The survey is divided into a general, neurosurgical, thoracic, vascular and trauma surgery section. In the specialized sections, the questions relate to the implementation of and material and personnel requirements for special interventions that are required, particularly for injury patterns following gunshot and explosion injuries, such as trepanation, thoracotomy and balloon occlusion of the aorta.ResultsIn the general section, it was noted that only a few clinics have an automated system to notify off-duty staff. When evaluating the data from the neurosurgical section, the following could be established with regard to the performance of trepanation: the regional trauma centers do not perform trepanation but nevertheless have the required material and personnel available. A similar result was recorded for local trauma centers. In the thoracic surgery section, it could be determined that almost all trauma centers that do not perform thoracotomy have the required material available. This group of trauma centers also stated that they have staff who can perform thoracotomy independently. The retrograde endovascular aortic occlusion procedure is possible in 88% of supraregional, 64% of regional and 10% of local trauma centers. Pelvic clamps and external fixators are available at all trauma centers.ConclusionThe results of the survey show potential for optimization both in the area of framework conditions and in the care of patients. Consistent and specific training measures, for example, could improve the nationwide performance of these special interventions. Likewise, it must be discussed whether the abovementioned special procedures should be reserved for higher-level trauma centers.

Serum Level of Parathyroid Hormone, Alkaline Phosphatase, Calcium and Ionized Calcium After Forearm Fractures

Abstract Background During the last two decades, our understanding of fracture healing has evolved rapidly. Bone is one of the few body tissues that can heal without forming a fibrous scar and, as such, the process of fracture healing recapitulates bone development and may be considered a form of tissue regeneration. The complex cell and tissue proliferation and differentiation processes involved in fracture healing are regulated by growth factors, inflammatory cytokines, antioxidants, hormones, amino acids, and other nutrients. Objective: To identify changes in serum level of calcium, ionized calcium, alkaline phosphatase and parathyroid hormone according to mode of trauma (low and high energy) in forearm fractures and their role in fracture healing. Patients and Methods 50 Patients with forearm fracture were prospectively recruited from the Accident and Emergency Department of Trauma Surgery, El Zaitoun specialized hospital within 48 hours of sustaining the fracture. Patients included in the study were asked to avoid calcium supplementation during fracture healing. Results Mean PTH was elevated in both groups at Day 1 with low energy group was insignificantly higher than high energy group, whereas after 8 weeks mean PTH level decreased in both groups but in low energy group mean PTH level was significantly higher than high energy group. Mean ALP level increased in both groups at Day 1 whereas in low energy group it was insignificantly higher than that of high energy group, After 8 weeks mean ALP level insignificantly decreased to normal level in both groups. Mean serum calcium level was below normal level in both groups where it was insignificantly higher in high energy group than that of low energy group which increased after 8 weeks in both groups but remained elevated in high energy than low energy group. Mean serum ionized calcium level was below normal level at Day 1 in both groups whereas it was insignificantly higher in high energy group than low energy group which after 8 weeks increased in both groups but remained elevated in high energy group than low energy group. Conclusion Serial monitoring of these physiological markers reflect the actual status of bone resorption, and bone formation respectively over a short period. Thus, they can be used as an adjunct to clinical and radiological evidence of fracture healing.

Efficiency changes in orthopaedic trauma surgery and implications for resource allocation.

The trauma and orthopaedic surgery department needed to modify practices as a result of the COVID-19 pandemic. This study quantitatively assessed the effects of changes in resource allocation on the efficiency of trauma, specifically the number of operations performed per defined trauma session. Trauma lists were reviewed pre-COVID, at the peak and at the tail of the first wave of COVID-19 infections at a hospital in the UK. Efficiency was calculated before and after the reallocation of resources and this was defined as the number of cases per trauma session as well as turnaround times for each part of the surgical patient journey. The mean trauma list efficiency was 1.73 cases per session in February 2020 compared to 1.89 in February 2019. It reduced to 1.21 during the COVID peak in April 2020 compared to 1.90 in April 2019 and improved to 1.48 per session in June 2020 vs 1.82 in June 2019. Measures introduced at the start of the pandemic are likely to continue for the foreseeable future. Increased allocation of resources would be needed to allow urgent trauma surgery to provide a timely and efficient service.

The Molding Hands of Time: Remodeling of Sagittal Plane Malunion After Pediatric Supracondylar Humerus Fractures.

*Department of Pediatric Orthopaedics and Foot and Ankle Surgery Orthopaedic Hospital Speising, Vienna †Department of Orthopedics and Trauma Surgery, Medical University Vienna Austria No external fund was received. S.F. and P.S.: manuscript preparation. The authors declare no conflicts of interest.

Letter to the Editor: Swinging the pendulum in prehospital trauma mortality needs a more holistic approach.

Departments of Emergency Medicine and Critical Care Perelman School of Medicine University of Pennsylvania Philadelphia, PA Division of Trauma, Acute Care and Critical Care Surgery Department of Surgery Tulane University New Orleans, LA

Do the successful revision surgery for humeral nonunion solve all the effects on health\u2010related quality of life? A retrospective cohort study

BackgroundThe aim of this study is to evaluate the effects of successful revision operation on health quality of life(QoL) and functional outcome in humeral nonunion patients.MethodsThis retrospective study included 62 patients with humeral nonunion from Northwest China, who were admitted to the Department of Trauma Surgery, Honghui Hospital between March 2013 and September 2019. The following data were retrospectively evaluated: demographic data, clinical data, imaging findings, and treatment methods. The QoL assessment indicators for humeral nonunion patients included the SF-12 mental component summary (MCS) and physical component summary (PCS),brief pain inventory-severity(BPI-S) and brief pain inventory-interference (BPI-I). The mayo elbow performance score (MEPS) was used to assess the elbow function of the patients.ResultsSuccessful revision surgery significantly improved the patient's PCS, MCS, BPI-S and BPI-I scores (p<0.001). According to the MEPS criteria, the excellent and good rates were 95.16% in this study. The impact of humeral nonunion on mental health was comparable with the reported impact of stroke and type II diabetes (p>0.05).The impact of post-op on physical health was comparable with the reported impact of COPD, silicosis, hypertension, barrentt’s esophagus and lower urinary tract symptoms(p>0.05).ConclusionHumeral nonunion is a devastating chronic medical condition that negatively affects both physical and mental health as well as quality of life. Although the effects of pain in the body can be completely relieved by treatment, the entire medical process may cause everlasting psychological trauma to the patient.

Lessons from lockdown: Virtual Clinics and service reorganisation in fracture management during COVID 19 experience of an Irish Regional Trauma Unit

BackgroundTrauma places a burden on healthcare services accounting for a large proportion of Emergency Department presentations. COVID-19 spread rapidly affecting over 30 million worldwide. To manage trauma presentations the Department of Trauma & Orthopaedic Surgery reorganised service delivery. AimTo assess the impact of service reorganisation and Virtual Clinics on patients in a Regional Unit in Ireland. MethodsA retrospective review of trauma activity following introduction of Virtual Fracture Clinics and Theatre COVID Pathways for a 10 week period in comparison with the same 2019 period. All patients underwent both nasopharyngeal and oropharyngeal swabs PCR testing prior to operations. Theatre and outpatient activity were evaluated. Clinic data were accumulated using the Integrated Patient Management System. ResultsTheatre Activity: 242 patients underwent surgery in our trauma unit (mean 2.98 per list) during the COVID- 19 period. 29 cases were performed in repurposed elective hospital giving a total of 271 during the 2020 study period. 371 cases were performed in the same 2019 period (mean 4.58 per list). Outpatient Activity: We noted a 25.86% fracture clinic referral reduction during the COVID 19 period compared to 2019. There was a 150.77% increase in patients managed through Trauma Assessment Clinic. 639 patients were managed through the Virtual Fracture Clinic Pathway during COVID 19 period. ConclusionsOver one in four fracture clinic patients can be managed virtually. A new dedicated Acute Fracture Unit within our institution permitted streamlining of care and social distancing. The “Non-COVID” pathway for ambulatory trauma was essential in managing the growing presentations of these injuries.

Mass Casualty Mini Drills on Trauma Surgery Department Staff Knowledge: An Educational Improvement Study.

Over the last decade, the United States has witnessed an increase in mass casualty incidents (MCIs). The outcome of an MCI depends upon hospital preparedness, yet many hospitals are unfamiliar with their facility MCI procedure. Educational training drills may be one method to improve staff knowledge of policy and procedure. This study aimed to improve knowledge gained through educational MCI mini drills of institutional mass casualty policy and procedure in surgery department staff at a level II trauma center. A pre-/posttest design was utilized. The hospital implemented MCI mini training drills as a quality improvement project using Plan-Do-Study-Act iterative cycles with prospective data collection. Knowledge scores were measured using a 12-item surgery department MCI policy and procedure questionnaire that was developed by the author and leadership. A one-way analysis of covariance analysis in participants that mini drilled more than once indicated significant effect on mean cycle score differences among three cycles F(2,21) = 12.96, p = .00. Multiple comparison using Games-Howell indicated the mean score for Cycle 4 (M = 96.15, SD = 6.54) was significantly different from Cycle 3 (M = 59.71, SD = 25.15). Gender, shift, and credentials of participants influenced knowledge improvement. Implementation of hospital MCI mini drills improved staff knowledge of institutional mass casualty policy and procedure in the surgery department and may be applied to surgery departments with similar policy, procedure, and participant characteristics. Hospital mass casualty response education and preparation is essential to saving lives.

Socio-demographic analysis of injury pattern among road traffic accident victims admitted in a tertiary care hospital

Background: Injuries and deaths due to road traffic accidents (RTAs) are one of the major public health problems across the globe especially in developing countries due to lack of comprehensive legislative measures. This loss of lives has immeasurable impact on the socio-economic output of the society. This study aimed to assess the factors and patterns of injuries related to RTAs.Materials and Methods: This is a hospital based retrospective cross sectional study conducted in the Department of Trauma Surgery in a tertiary care hospital. Victims of road traffic accidents attending casualty from 1st July to 31st December 2019 were studied.Results: Of 1442 RTA victims, maximum (29.47%) was in the age group of 20 to 29 years and 75.93% were male. 37.73% victims were using two wheelers while 26.05% using four wheeler. Most of the accidents (36.21%) took place in the evening (6 pm to 12 midnight). Most common site of injury was head, face & neck (35.64%) followed by lower limb (33.49%). 31.27% of involved drivers were under influence of alcohol during accident.Conclusion: Being in younger age group, male gender, evening time, drunk driving and driving hours on the road were positively associated with RTA. Preventive measures to reduce the burden of mortality and morbidity due to road accidents should be strengthened.

Outcomes of plate-screw fixation of humeral shaft fractures in three hospitals of the city of Yaoundé

Background: Surgical management of humeral fractures involves several methods including plate-screw fixation, intramedullary nailing, external fixation, and pinning. Nowadays, the most used surgical method is plate-screw fixation. Objective: The aim of this study was to present the short-, medium- and long-terms outcomes of plate-screw fixation of humeral fractures in three hospitals in the city of Yaoundé. Material and Methods: This was a descriptive and retrospective study with prospective evaluation carried out in the orthopedic and trauma surgery departments of three hospitals in the city of Yaoundé, over a period of 6 years and 4 months. We analyzed the medical records of the operated patients and did a physical reevaluation of the patients using a pre-conceived tested data sheet. The following variables were studied: socio-demographic characteristics, fracture profile, clinical and radiological profile, and the functional prognosis of the shoulder and elbow joints (using the Constant and Murley score, and the Mayo elbow performance score respectively). Data analysis was done using the software Statistical Package for Social Sciences (SPSS) version 23.0. Results: Eighty-two cases of osteosynthesis were recorded. The mean age of the patients was 37.9 ± 11.5 [16 – 71] years and there was a male predominance (sex ratio of 2.7). The dominant humerus was most involved (96.4%). Closed fractures were predominant (65.8%), and the majority (47%) of them were simple fractures. The diaphysis was the most affected bone part (69.5%). Road traffic accidents accounted for 70.7% of the fractures. Two patients had a polytrauma, 26 had multiple fractures, and 54 had an isolated humeral fracture. The mean operating time (for the osteosynthesis) was 122 min and the mean blood loss volume during surgery was 296 cc. There was a significant correlation between these two variables. Postoperative complications included 8 cases of postoperative radial palsies (who recovered within an average of 4 months), 06 cases of superficial skin infections, 05 cases of secondary displacements, 03 cases of implant damage and 02 cases of vicious callus. The bone reductions were sub-anatomical in 79% and cortical fixation was good in 72.6% of cases. Consolidation was achieved within an average of 18 weeks. The consolidation time significantly varied according to the type of fracture line and the type of reduction obtained. Functional recovery of the shoulder and elbow was nearly normal in all patients. The mean Constant and Murley score was 96.9 while the mean Mayo elbow performance score of 97.3. Conclusions: Plate-screw fixation enables an adequate management of humeral fractures with acceptable clinical and radiological results, low complication rates, and good functional outcomes.

Development and validation of a ready-to-use score to prioritise medication reconciliation at patient admission in an orthopaedic and trauma department

ObjectiveMedication reconciliation (MR) is recognised as an important tool in preventing medication errors such as unintentional discrepancies (UDs). The aim of this study was to identify independent predictive factors of...

Analysis of the incidence of surgical site infections after open reposition of long bone fractures and closed fracture settings in a 7-year follow-up in an orthopedic and trauma ward in southern Poland.

Surgical Site Infection (SSI) is the most common clinical form of Healthcare-Associated Infections (HAI) in orthopedic and trauma wards. A retrospective study was conducted at the Department of Orthopedics and Trauma Surgery in Tarnów in 2012-2018. 3 155 patients treated for bone fractures were analyzed, including 1961 Open Reduction of Fracture (FX) and 1 194 Closed Reduction of Fracture with Internal Fixation (CR) surgeries. The study was conducted in accordance with the methodology recommended by the Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC). The aim of the study was to assess the incidence of SSI in patients undergoing the FX and CR procedures. 28 SSIs were identified in the examined ward; 16 SSI cases related to the FX procedure and 12 cases related to CR. The incidence for FX was 0.8% and for CR 1%. In patients with diagnosed SSI, the stay in the ward was longer (p <0.001) than in patients without SSI. In FX operations, the standardized risk index (SIR) did not exceed the value of one. Staphylococcus aureus was the most common organism isolated from materials from patients with SSI. In the examined period, the median age of women was higher than that of men, which may indicate a higher incidence of fractures in women. Patients with diagnosed SSI had a longer stay in the ward than patients without SSI. The incidence of SSI in FX and CR has been reduced compared to previous studies in the same ward.

Mobile App for Monitoring 3-Month Postoperative Functional Outcome After Hip Fracture: Usability Study.

BackgroundAs a result of an aging population, there has been an increasing incidence of hip fractures worldwide. In the Netherlands, in order to improve the quality of care for elderly patients with hip fractures, the multidisciplinary Centre for Geriatric Traumatology was established in 2008 at the Department of Trauma Surgery at Ziekenhuisgroep Twente hospital (located in Almelo and Hengelo in the Netherlands).ObjectiveThough the Dutch Hip Fracture audit is used to monitor the quality of care for patients with fractures of the hip, only 30.7% of patients complete registration in the 3-month follow-up period. Mobile apps offer an opportunity for improvement in this area. The aim of this study was to investigate the usability and acceptance of a mobile app for gathering indicators of quality of care in a 3-month follow-up period after postoperative treatment of hip fracture.MethodsFrom July 2017 to December 2017, patients who underwent surgical treatment for hip fracture were recruited. Patients and caregivers, who were collectively considered the participant cohort, were asked to download the app and answer a questionnaire. Participants were divided into two groups—those who downloaded the app and those who did not download the app. A telephone interview that was based upon the Unified Theory of Acceptance and Use of Technology was conducted with a subset of participants from each group (1:1 ratio). This study was designated as not being subject to the Dutch Medical Research Involving Human Subjects Act according to the appropriate medical research ethics committees.ResultsOf the patients and caregivers who participated, 26.4% (29/110) downloaded the app, whereas 73.6% (81/110) did not. Telephone interviews with the subset of participants (n=24 per group) revealed that 54.0% (13/24) of the group of participants who did not download the app had forgotten the study. Among the group who downloaded the app, 95.8% (23/24) had the intention of completing the questionnaire, but only 4.2% (1/24) did so. The reasons for not completing the questionnaire included technical problems, cognitive disorders, or patient dependency on caregivers. Most participants in the group who downloaded the app self-reported a high level of expertise in using a smartphone (22/24, 91.7%), and sufficient facilitating conditions for using a smartphone were self-reported in both groups (downloaded the app: 23/24, 95.8%; did not download the app: 21/24, 87.5%), suggesting that these factors were not barriers to completion.ConclusionsDespite self-reported intention to use the app, smartphone expertise, and sufficient facilitating conditions for smartphone use, implementation of the mobile app was infeasible for daily practice. This was due to a combination of technical problems, factors related to the implementation process, and the population of interest having cognitive disorders or a dependency on caregivers for mobile technology.

A Hospital Protocol for Decision Making in Emergency Admission for Acute Diverticulitis: Initial Results from Small Cohort Series.

Background and objectives: We present initial results from a small cohort series for a hospital protocol related to the emergency hospitalization decision-making process for acute diverticulitis. We performed a retrospective analysis of 53 patients with acute diverticulitis admitted to the Department of Emergency and Trauma Surgery of the “Azienda Ospedaliero Universiaria-Ospedali Riuniti” in Ancona and to the Department of General and Emergency Surgery of the “Azienda Ospedaliera-Universitaria” in Perugia. Materials and Methods: All patients were evaluated according to hemodynamic status: stable or unstable. Secondly, it was distinguished whether patients were suffering from complicated or uncomplicated forms of diverticulitis. Finally, each patient was assigned to a risk class. In this way, we established a therapeutic/diagnostic process for each group of patients. Results: Non-operative treatment (NonOP) was performed in 16 patients, and it was successful in 69% of cases. This protocol primarily considers the patient’s clinical condition and the severity of the disease. It is based on a multidisciplinary approach, in order to implement the most suitable treatment for each patient. In stable patients with uncomplicated diverticulitis or complicated Hinchey grade 1 or 2 diverticulitis, the management is conservative. In all grade 3 and grade 4 forms, patients should undergo urgent surgery. Conclusions: This protocol, which is based on both anatomical damage and the severity of clinical conditions, aims to standardize the choice of the best diagnostic and therapeutic strategy for the patient in order to reduce mortality and morbidity related to this pathology.

Effect of Prednicarbate On the Hyper Proliferation of the Granulation Tissue of Traumatic Wounds During Directed Healing: A Prospective Observational Study

Background: The directed scarring of traumatic wounds in a surgical department often encounters drifts. During the proliferation phase, the granulation tissue can become excessive, blocking re-epithelialization and dooming a skin graft. To cope with this, healthcare teams often use topical corticosteroids such as Prednicarbate which is a nonhalogenated corticosteroid which does not pass into the systemic circulation. Purpose: The aim of this study is to describe the in vivo effect of Prednicarbate on the hyper proliferation of granulation tissue in trauma wounds and burns during directed scarring. Methods: A prospective observational study was carried out on patients admitted consecutively to the Orthopaedic and Trauma Surgery Department of Aristide le Dantec Hospital in Dakar. The application of 0.25% prednicarbate was twice daily on the hyperprofiltration areas of the wound bed of consenting patients. Demographic, clinical, therapeutic data and changes in granulation tissue were collected. Results: 12 patients participated with an average age 41.5 ± 18.94 years and a female to male sex ratio of 3/1. Domestic accidents were the most common wound occurrence in 7 cases. After at least 3 applications, the modifications observed were as follows: the proportion of hyper-budding surface was reduced by 3% on average. In 8 cases, the bed turned pink, with a texture changing from smooth to granite in 10 cases. A regression of the edema of the bed was observed in all the cases and the level of the bed of the wound which initially known epidermal, became epidermal in 10 cases. In 10 cases, the start of epidermal migration was observed from the skin edges. In 9 cases, or 75% of cases, it took just 1 tube to see a reduction in granulation tissue. Conclusion: Prednicarbate is a non-halogenated corticosteroid which is of interest in reducing the excessive proliferation of granulation tissue in traumatic wounds. By normalizing the level of granulation tissue, it promotes epidermal migration and the epithelialization phase.

A study on the quality of life of patients awaiting knee replacement in the population of central Poland

Introduction. Quality of life is a multidimensional and subjectively perceived concept. One of the main reasons for its decrease is osteoarthritis. Aim. The aim of this study was to analyze factors affecting the quality of life in the group of patients with knee osteoarthritis while waiting for TKA surgery. Material and methods. The study was conducted on 66 patients living in central Poland with diagnosed osteoarthritis of the knee (M17.0). The quality of life was assessed with the use of EQ-5D 5L instrument, EQ-VAS and the author’s questionnaire. The research was carried out at the Department of Trauma and Orthopaedic Surgery in Belchatow. The following variables were statistically analyzed: body weight (BMI), the need for orthopaedic aids (elbow crutches or a walker), condition of the other knee (healthy, after endoprosthesis, degenerated). Results. All patients with knee osteoarthritis have lower assessment of their own health. Body mass index (BMI) and the need for orthopaedic aids do not affect the quality of life. Statistically significant differences were found in the condition of the other knee- in patients with healthy joint or after knee arthroplasty quality of life was higher mainly in terms of self-care, mobility and general health assessment than in the case of a joint with osteoarthritis. Conclusions. The quality of life in population awaiting for TKA due to osteoarthritis is markedly reduced and correlates with the condition of the other knee joint, whereas it shows no relationship with body weight or the need for orthopedic aids.

Impact of the COVID-19 Pandemic on Orthopaedic and Trauma Surgery in University Hospitals in Germany: Results of a Nationwide Survey.

The purpose of the present study was to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on orthopaedic and trauma surgery departments in university hospitals in Germany in order to clarify current challenges. In this cross-sectional study, an online-based anonymous survey was conducted within the Convention of University Professors of Orthopaedic and Trauma Surgery in Germany from April 3 to April 11, 2020. A bipolar 5-point Likert scale (with possible responses of "totally disagree," "rather disagree," "neutral," "rather agree," and "totally agree") was applied. Fifty-two (69.3%) of 75 clinic directors participated. Communication and cooperation with the government, hospital administration, and other departments during the COVID-19 pandemic were mainly perceived as appropriate. However, only 7 respondents (13.7%) totally agreed or rather agreed with the statement that the authorities are supporters of orthopaedic and trauma surgery departments. Substantial financial and personnel changes in orthopaedic and trauma surgery departments of university hospitals were reported, resulting in an average reduction of 49.4% in operating room capacity and an expected 29.3% loss of revenue. In addition, 14.7% of physicians were reallocated from orthopaedic and trauma surgery to other care-delivery environments. Our study demonstrated that the COVID-19 pandemic has had a substantial impact on orthopaedic and trauma surgery departments in German university hospitals. Distinct structural and financial effects were noted. Nevertheless, the present study demonstrates the commitment of our specialty to overcome the pandemic by providing competent personnel as well as close cooperation with the hospital administration and other departments. To our knowledge, this is the first Germany-wide survey among the heads of orthopaedic and trauma surgery departments in university hospitals on the impact of the COVID-19 pandemic. The survey results may help to inform system-wide decision-making in Germany, in Europe, and beyond.

Practicing Mass Casualty Scenarios: Experience From a Developing Level 1 Trauma Center in the Himalayan Foothills.

Uttarakhand is an Indian state in the Himalayan foothills, a favored adventure destination in the country due to abundant natural beauty. However, the terrain has also conferred an increased risk of earthquakes, flash floods, and major road tragedies, resulting in as many as 8 major natural disasters in the state in the preceding 20 years. AIIMS Rishikesh, an autonomous central institute, has been entrusted to build a Level 1 Trauma Center in Uttarakhand, which would help improve the response, coordination, and hence outcome in mass casualty scenarios (MCSs). As a step toward the achievement of this larger goal, a workshop on MCS and management was conducted by the Department of Trauma Surgery in collaboration with Rambam Hospital, Haifa. We hereby present our template for conducting MCS drills in low resource settings like ours and the lessons learnt. Process, logistics, limitations, workforce, scheduling, overview, and report of the MCS drill conducted are discussed hereafter. This template may be replicated by hospitals that intend to conduct similar MCS drills in low resource settings, realizing the real threat of MCS occurrence in our country at anytime.

Cross-sectional study of the educational background and trauma knowledge of trainees in the \u201cChina trauma care training\u201d program

BackgroundSince the trauma knowledge of trauma providers correlates with the outcomes of injured patients, this study aims to assess the socio-demographic characteristics and levels of trauma knowledge of trainees in the China trauma care training (CTCT) program in addition to their post-course test results to provide support for the development of trauma care training programs and trauma systems in China.MethodsA cross-sectional study was conducted by collecting demographic information, hospital-related information and trauma knowledge of the trainees from 19 regions in China. All participants were assessed by questionnaires collecting the socio-demographic data, the trauma care knowledge levels and the information of the hospitals.ResultsThere were 955 males (78.9%) and 256 females (21.1%) enrolled. Among them, 854 were physicians (70.5%), 357 were registered nurses (29.5%). In addition, 64 of them also played an administrative role in the hospitals (5.3%). The score of the trainees who were members of the emergency department staff (72.59 ± 14.13) was the highest among the scores of all the personnel surveyed, followed by those of the trainees from the intensive care unit (ICU) (71.17 ± 12.72), trauma surgery department (67.26 ± 13.81), orthopedics department (70.36 ± 14.48), general surgery department (69.91 ± 14.79) and other departments (69.93 ± 16.91), P = 0.031. The score of the professors (73.09 ± 15.05) was higher than those of the associate professors (72.40 ± 14.71), lecturers (70.07 ± 14.25) and teaching assistants (67.58 ± 15.16), P < 0.0001. The score of the individuals who attended experts’ trauma lectures (72.22 ± 14.45) was higher than that of individuals who did not attend the lectures (69.33 ± 15.17), P = 0.001. The mean scores before and after the training were 71.02 ± 14.82 and 84.24 ± 13.77, respectively, P < 0.001. The mean score of trauma knowledge after the training of trainees from different provinces and with different educational backgrounds was higher than that before the training, with a statistically significant difference (P < 0.05).ConclusionsThe level of trauma knowledge of trauma care providers was associated with their department, professional position and previous participation in related academic conferences. Trauma care experience and participation in academic lectures and training program including CTCT may effectively improve individuals’ level of trauma knowledge.