Trauma Victims Research Articles

Management of bleeding in trauma victims by Portuguese nurses in prehospital setting.

Introduction: External bleeding is the leading preventable cause of death from traumatic injuries. Implementation of guidelines for its control have been associated with a significant reduction in mortality. The objectives of this study were to provide a characterisation of trauma patients with external bleeding and to compare the outcomes from specific autonomous interventions applied by nurses in prehospital care. Methods: A non-randomised prospective study was conducted in the Immediate Life Support Ambulances in Portugal, from 1 March 2019 to 30 April 2020. Patients were divided into two groups according to whether external bleeding was controlled or not on their arrival at the emergency room. Results: A total of 189 patients were included in this study (73.0% men; mean age of 53.6 years). Among these patients, 140 (74.1%) had their external bleeding controlled by prehospital nurse’s intervention. The average time of assistance at the incident site was 31.5 min. Patients with uncontrolled bleeding had a higher average rescue time (30.8 ±15.2 vs 33.7 ±13.0). Cryotherapy was administered to 15.9% of all patients and 93.3% of these patients arrived at the emergency room with controlled bleeding (p=0.01). Discussion: Despite the substantial reduction in the number of patients who keep bleeding after prehospital care, it was observed that one fifth of patients have external bleeding on arrival at the emergency room. Cryotherapy has been shown to be effective in controlling external bleeding. Failure to use haemostatic agents may explain the ineffective control of more complex external bleeding. Contribution to Emergency Nursing Practice: The current literature on management of bleeding in trauma patients is scarce and contradictory, especially in terms of interventions provided by prehospital teams led by a registered nurse. In addition, interventions vary from country to country. This article increases awareness of autonomous interventions implemented by prehospital nurses to manage external bleeding. Key implications for emergency nursing practice identified in this study suggest greater fluid therapy appears harmful while cryotherapy achieved the best results (control of the bleeding on emergency room arrival). This may contribute to the review of institutional algorithms and training in this area.

Post Traumatic Stress Disorder (PTSD) Following Craniomaxillofacial Trauma - A Five Year Retrospective Study

Introduction: The psychological and psychiatric derangements as well as psychosocial impact that craniomaxillofacial trauma can have upon patients, often goes undetected, ignored and unaddressed. This can adversely affect the mental and physical well-being of the patient, leading to a lifetime of severe debility and incapacitation. Methods: This retrospective study examined the incidence, severity, predictors and likely predisposing factors for development of PTSD among 378 patients treated for craniomaxillofacial trauma at a tertiary care centre, over a five-year period. It correlated the likelihood of development of PTSD with the mode of injury sustained and analysed the management protocols employed and outcomes achieved. Results: 31% of the patients demonstrated a positive diagnosis for PTSD and were managed for the same. Self-inflicted maxillofacial trauma patients exhibited the highest risk for developing PTSD, followed by victims of natural disasters, combat associated trauma victims (blast and ballistic injuries), followed thereafter by physical assault and RTA victims. Depending upon the severity of PTSD exhibited by the different patients, counselling, psychotherapy, and/or pharmacotherapy were employed. Discussion: Careful screening of craniomaxillofacial trauma victims for features of PTSD cannot be overemphasized. Timely and effective management of the same can go a long way towards successful rehabilitation of these vulnerable group of patients. Surgical management of orofacial injuries should integrate case management that addresses psychosocial sequelae as it is not only necessary to restore the integrity of the anatomy and function, but also to provide psychiatric support and therapy for patients experiencing symptoms of PTSD caused by traumatic events.

Insecure attachment styles as predictors of posttraumatic growth in a South African student sample

South Africa, as a developing country, is characterized by high levels of crime, partner violence, and other traumatic experiences. Exposure to these traumas may lead to the development of post-traumatic stress disorder or, conversely, post-traumatic growth. Citizens in developing African countries appear to be at risk for the development of insecure attachment styles due to the cumulative effects of socio-economic risk factors. The prevalence of many possible traumatic experiences along with the risk of more insecure attachments set the stage for investigating the impact of insecure attachment on post-traumatic growth. The aim of this study was thus to determine whether two insecure attachment styles, namely anxious and avoidant attachment, were significant predictors of post-traumatic growth. The sample consisted of 233 undergraduate students from a South African university who had experienced a traumatic event. Participants’ ages ranged from 18 to 33 years ( M = 21 years) and were from various ethnic backgrounds (81.5% Black African, 7.7% White, 9% Coloured, and 3.9% Asian/Indian). Two self-report measures were administered via an online survey to assess attachment styles and post-traumatic growth. Results showed that an anxious attachment style was a significant negative predictor of post-traumatic growth. Furthermore, individuals with an avoidant attachment style were significantly less likely to experience post-traumatic growth through relating to others, than along the other domains of post-traumatic growth. The findings contribute by highlighting the importance of considering how insecure attachment styles may impact post-traumatic growth, as this could inform the treatment of trauma victims.

Predicting Outcomes in Trauma Patients With Cirrhosis Using Model for End-Stage Liver Disease Score: A Retrospective Study.

Liver cirrhosis is associated with increased mortality in trauma victims. We stratified the impact of cirrhosis on trauma mortality by Model for End-stage Liver Disease (MELD) score. Trauma center database was accessed for patients with established diagnosis of cirrhosis presenting 2014 - 2018, matched to control patients without cirrhosis in a 2:1 ratio by age, sex, and TRISS. Primary outcome was mortality, secondary outcomes were length of stay, intensive care unit days, and ventilator dependent days. Cirrhosis was present in 182 (1.5%) trauma patients. Mortality difference between 12 (7%) deaths in cirrhosis cohort versus 14 (4%) in control was not statistically significant (p = 0.38). No difference was found in secondary outcomes. Categorization of cirrhosis severity by MELD score range (MELD 6-7, 8-10, 11-14, 15-20, 21-30) showed a 1.9 fold increase in the odds of mortality for every increase in MELD score category (OR = 1.91, p = 0.03, 95% CI = 1.08 - 3.37). Mortality effects of cirrhosis in trauma patients can be estimated using MELD score.

Effects of extremity trauma on physiological responses and survival to hemorrhage in conscious rats

BackgroundUnder most circumstances of battlefield injuries, trauma accompanies hemorrhage. Interestingly, there are few experimental animal models of trauma and hemorrhage. The compensatory cardiovascular responses during hemorrhage are well documented, and serve to maintain adequate perfusion of vital organs during conditions of loss of blood volume. While trauma alone has been shown to increase heart rate (HR) and vascular resistance, the effects of trauma on compensatory cardiovascular responses and the ability to survive hemorrhage have not been clearly defined. The purpose of this study is to determine the effects of an extremity injury that combines hard (bone) and soft (skeletal muscle) tissue trauma, on blood pressure (BP) and HR responses, and survival to hemorrhage in conscious rats. We hypothesized that trauma would impair compensatory cardiovascular responses, and decrease survival after hemorrhage.MethodsAll rats (male; ~ 350grams) were surgically implanted with a telemetry transmitter for measurement of BP and HR, and allowed to recover for 2 weeks prior to the experiment. A carotid catheter was inserted one day before the experiment. There were two experimental groups: hemorrhage with no trauma (n=20); and hemorrhage with trauma (n=20). On the day of experiment, rats were anesthetized briefly (10 min) to undergo trauma (crushing of the right gastrocnemius and semimembranosus muscles for 30 sec with forceps) and fibula fracture. No trauma groups were only anesthetized for 10 min without manipulation of the extremity. Rats were allowed to awaken, and 90 min later the rats underwent a conscious hemorrhage (~50% of blood volume during 25 min) via the indwelling carotid catheter. BP and HR measures were collected over 1 min intervals for 240 minutes after hemorrhage and analyzed via Data Sciences International software. Survival time and survival ratio to 240 minutes were determined. Data were analyzed via multi‐way analysis of variance for repeated measures and Kaplan‐Meier procedure using the Statistical Analysis System. Data are shown as mean ± standard deviation.ResultsCompared with no trauma, trauma increased HR during hemorrhage (P = 0.03), but had no effect on BP (P = 0.88). After hemorrhage completion, trauma decreased BP for approximately one hour (P = 0.032), but only transiently decreased HR. After hemorrhage, survival time (Trauma: 156.8 ± 80.7 and No Trauma: 210.6 ± 61.8 min, p = 0.022), and survival ratio (Trauma: 9/20 and No Trauma: 16/20, p=0.048), were significantly lower in animals with trauma compared to no trauma.ConclusionsOur results show that the presence of trauma affects compensatory mechanisms to maintain BP, and negatively impacts the ability to survive hemorrhage. These findings indicate the importance of including both trauma and hemorrhage in the development of animal models to study treatments for hemorrhage in wounded Soldiers on the battlefield or civilian trauma victims.

Translation, validation and exploration of the factor structure in the French version of the Posttraumatic Cognitions Inventory (PTCI).

Le Posttraumatic Cognitions Inventory (PTCI) is one of the most used instruments to assess posttraumatic cognitions. Since its release, many studies have tried to validate and translate this questionnaire, but they had difficulty to confirm its structure and then suggested alternatives. Faced with no consensus, a short version in nine statements was developed and showed good psychometric properties. To date, no French version of the PTCI has been validated, thereby preventing studies from investigating the role of posttraumatic cognitions in French speaking populations.ObjectivesIn order to validate a French version of the PTCI, this study investigates two objectives using two French speaking samples: (1) test 10 factor structures identified in prior studies, and (2) assess the other psychometric properties of the best fitting factor structure.MethodThe PTCI was translated in French using a reverse translation method and administered to 202 university students and 114 aid workers. Suitability indexes of the appropriate factor structures previously identified in prior studies were examined. Internal consistency, correlations between subscales and convergent, divergent and discriminant validities in the most appropriate structure were evaluated.ResultsResults support that only Wells et al.'s short 9-item version of the PTCI and three factors shows excellent suitability indexes. This version also outlines an excellent internal consistency and solid convergent, divergent, and discriminant validities.ConclusionsThis study confirms the empirical validity, fidelity, and utility of Wells et al.'s short version of the PTCI. This is the first PTCI French validation, which is a major advantage when it comes to assess posttraumatic cognitions in French trauma victims.

The Relationship between Social Support and Secondary Posttraumatic Growth among Health Care Providers Working with Trauma Victims-The Mediating Role of Cognitive Processing.

Background: Individuals, who help trauma victims as part of their professional responsibilities, may experience positive effects of their work, occurring in the form of Secondary Posttraumatic Growth (SPTG). Its determinants include environmental factors such as social support, and individual characteristics, particularly cognitive processing of the trauma. The purpose of this study was to determine the associations between SPTG and social support and cognitive processing of trauma, also considered as a mediator, in a group of medical personnel exposed to secondary trauma. Methods: The results of 408 participants, paramedics and nurses, were analyzed. Three measurement tools were used: the Secondary Posttraumatic Growth Inventory, the Social Support Scale measuring four sources of support and the Cognitive Trauma Processing Scale to assess five cognitive coping strategies. Results: The results indicated that SPTG was positively related to social support and cognitive coping strategies. Cognitive coping strategies act as a mediator in the relationship between social support and SPTG. Conclusions: Despite their exposure to secondary traumatization, paramedics and nursing staff experience positive consequences of their work related to helping injured people. In order to promote growth after trauma, it is advisable to encourage medical representatives to use social support and primarily positive coping strategies.

Longitudinal PTSD symptom trajectories: Relative contributions of state anxiety, depression, and emotion dysregulation

BackgroundProspective research on the development and trajectory of PTSD symptoms after a traumatic event is crucial for assessment and early intervention. Further, examining predictors of PTSD pathology provides a better conceptualization of the temporal course of PTSD in trauma victims. MethodsThe present study examined PTSD symptom severity in individuals presenting to the emergency department (ED) following a traumatic event. Participants (N = 147) were assessed at four timepoints: 2-weeks, 3-months, between 6 and 9 months, and 12-months after ED admission. Growth curve modeling was conducted to examine changes in PTSD symptom severity over time. Age, sex, state anxiety, trait anxiety, emotion dysregulation, depression, and trauma type (motor vehicle accident [MVA] and assault), and PTSD diagnosis were included as covariates in the model. ResultsResults demonstrated that baseline PTSD symptom severity was positively associated with severity of depression and state (but not trait) anxiety, emotion dysregulation, and PTSD diagnosis. Results also revealed significant associations with PTSD symptom changes over time; greater state anxiety and depression symptoms at baseline were associated with steeper declines in PTSD symptoms over time. LimitationsData were collected at only four timepoints over the course of 12-months. Results may be different with more measurement points over longer periods and inclusion of pre-, peri- and post-trauma risk factors. ConclusionsResults illustrate the relevance of assessing state anxiety, depression, and emotion dysregulation in following trauma victims for trauma-related psychopathology over the course of time to alleviate the negative impact of the same.

Evaluation of follow-up and long-term outcomes of gunshot and stab wounds in a French civilian population

PurposeThe data concerning long-term follow-up and outcomes of penetrating trauma are poorly detailed in the literature. The main objective of our study was to analyze the hospital and extra-hospital follow-up of penetrating trauma victims and to evaluate the late complications and long-term consequences of these traumas. MethodsThis work was a retrospective longitudinal monocentric observational study conducted at Laveran Military Hospital, from January 2007 to January 2017. All patients hospitalized for gunshot wound or stab wound management during this period were identified via a retrospective systematic query in the hospital information system using the ICD-10 codes. Epidemiological data, traumatism characteristics, hospital management, follow-up and traumatism consequences (i.e., persistent disability) were analyzed. To improve evaluation of traumatism long-term consequences, extra-hospital follow-up data from general physicians (GP) were collected by phone call. During this interview, 9 closed questions were asked to the GP. The survey evaluated: the date of the last consultation related to injury with the GP, the specific follow-up carried out by the GP, traumatism consequences, and recurrence of traumatism. Descriptive, univariate and multivariate with regression analysis were used for statistical analysis. ResultsA total number of 165 patients were included. Median (Q1, Q3) of hospital follow-up was 28 (4, 66) days. One hundred one patients (61.2%) went to their one-month consultation at hospital. GP follow-up was achieved for 76 patients (55.2%). Median (Q1, Q3) of GP follow-up was 47 (21, 75) months. Twenty-four patients (14.5%) have been totally lost to follow up. The overall follow-up identified 54 patients (32.7%) with long-term consequences, 20 being psychiatric disorders and 30 organic injuries. Organic consequences were mainly peripheral nerve damages (n = 20; 12.1%). Most of the psychiatric consequences were diagnosed during GP follow-up (n = 14; 70%). Seventeen cases (10.3%) of recurrence were found and late mortality occurred in 4 patients (2.4%). High injury severity score, older age and gunshot wound were significantly linked to long-term consequences. Data collection and analysis were carried out in accordance with MR004 reference methodology. ConclusionThis study showed a high rate of long-term consequences among patients managed for penetrating injury. If all organic lesions are diagnosed during hospital follow-up and jointly managed by hospital and extra-hospital physicians, most socio-psychiatric consequences were detected and followed by extra-hospital workers. However, for half of the patients, the extra-hospital follow-up could not be assessed. Thus, these consequences are very probably underestimated. It appears imperative to strengthen the compliance and adherence of these patients to the care network. Awareness and involvement of medical, paramedical teams and GP role seems essential to screen and manage these consequences.

Performance comparison of intraosseous devices and setups for infusion of whole blood in a cadaveric swine bone model.

Intraosseous (IO) access can provide a critical bridge for blood product infusion when peripheral venous access is not obtainable. Successful pressurized IO infusion requires flow rates sufficient to preserve life, but with infusion pressures low enough to avoid clinical complications (e.g., hemolysis, bone damage, fat emboli). However, the optimal method for pressured IO delivery of blood was unknown. Three trained physicians infused 500 mL of whole blood through a 15-gauge, 45 mm IO catheter into fresh, high bone density cadaveric swine proximal humeri. Participants applied eight different pressure infusion strategies: (1) gravity, (2) pressure bag, (3) pressure bag actively maintained at or above 300 mmHg, (4) hand pump, (5) hand pump with pressure bag, (6) push-pull with 10 mL syringe, (7) push-pull with 60 mL syringe, and a (8) Manual Rapid Infuser in a randomized within-subjects design (30 trials per method, 240 trials total). The primary outcomes of flow rates, mean and peak pressures, and user ratings were contrasted using ANOVA at p < 0.05. The Manual Rapid Infuser conferred the highest flow rates (199 ± 3 mL/min) and most favorable user ratings, but also the highest mean and peak pressures. Push-pull conferred the next highest flow rates (67 ± 5 mL/min for 60 mL, 56 ± 2 mL/min for 10 mL) and pressures, with intermediate-to-high user ratings. Hand pump flow rates were essentially identical with (45 ± 4 mL/min) or without (44 ± 3 mL/min) pressure bag, with high user ratings without a pressure bag. Pressure bag and gravity methods conferred low flow rates and user ratings. Some pressured IO infusion methods can achieve flow rates adequate to serve as a resuscitative bridge in the massively hemorrhaged trauma victim, but flow rates and pressures vary greatly across IO pressurized infusion methods. Manual Rapid Infuser and push-pull methods conferred high flow rates but also relatively high pressures, highlighting the importance of using in vivo models in future research to assess the possible clinical complications of using these promising methods. Combined, present findings highlight the importance of studying pressurized IO methods towards preserving the life of the critically injured trauma victim.

Traumatic pediatric shoulder fracture-dislocation in a 14-year-old child

Proximal humerus fractures is often encountered in pediatric traumatology, while scapulohumeral dislocation is rare, and its association with the fracture of the proximal humerus is exceptional. This makes its management subject to discussion. We report the case of a fracture of the upper end of the humerus associated with scapulohumeral dislocation in a 14-year-old child, the victim of shoulder trauma with direct shock, treated by open-air reduction.

Audit of Motor Vehicle Accidents at a Trauma Center.

BackgroundMotor vehicle accidents (MVAs) are the leading cause of accidental deaths in India. An audit of trauma cases is required in order to improve hospital policy and patient care, as well as to change the attitude and perspective of healthcare staff.MethodsA retrospective observational study was performed on MVA trauma victims admitted to a tertiary trauma care center. Parameters included mean age with range, gender distribution, length of hospital stay (LOS), anatomical location of injuries, and the percentage of age groups and number of patients undergoing a nonoperative approach versus those with exploration and intervention. The correlation of body mass index (BMI) and co-morbidities with trauma, whole-body CT scan (WBCT) versus selective scanning, readmissions and revisits, and blood transfusion requirements were studied.ResultsThe majority of patients were young male adults and females having a higher LOS than males. Prolonged hospitalization is linked to a higher risk of complications and a higher expense. Individuals who suffered severe injuries recovered more slowly 12 months after the accident. The majority of patients had a brief hospitalization. Sixty-two point three (62.3) percent of patients suffered a head injury, with men accounting for the majority. Men were worst-affected, necessitating surgery. Obesity and BMI, regardless of gender, are not associated with trauma outcomes. Our studies found no link between co-morbidities and length of stay in MVA patients. Although the majority of patients did not require surgery, 28.8% required a blood transfusion. Our research found no link between BMI and injury severity score (ISS).ConclusionObese people sustaining MVAs had the same injured body regions as patients who were normal weight. They had a lower ISS than normal-weight individuals but a lengthier in-hospital stay.

PREVALENCE OF POSTTRAUMATIC STRESS DISORDER AMONG TRAUMA SURVIVORS IN KHYBER PAKHTUNKHWA

The objective of the study was to assess the level and prevalence of trauma and its impact on individuals who faced trauma in their life. Cross sectional survey comprised of 153 trauma survivors with an age range of 18 to 67 years selected through purposive sampling. The demographics of trauma survivors were gender, age, family system, marital status, occupation, and nature of trauma survivors. PTSD Check List – Civilian Version (PCL-C) was used to measure posttraumatic stress disorder among trauma survivors. The trauma survivors' sample consisted of 54.9 percent males and 45.1 percent females. In relation to the nature of trauma, 29.4% had an accident in their family, 27.5 % faced trauma due to the death of a family member, 14.4 % faced trauma due to sexual abuse, 8.5% faced trauma due to an incident in the family, 5.9% encountered trauma due to earthquake, 5.2% faced trauma due to fire, 2.6% faced trauma due to loss in body parts, 2.0 percent faced trauma due to miscarriage and remaining 4.8% faced trauma due to others. The findings of the current study showed the male accident trauma survivors experienced 41% mild, 35% moderate and 24% severe PTSD symptoms while female exhibited 63% moderate and 37% severe PTSD symptoms. Female sexual abuse trauma survivors experienced 27% mild, 67% moderate, and 6% severe PTSD symptoms while male experienced moderate PTSD symptoms only. Males who experienced the death of a family member exhibited 20% mild, 65 % moderate, and 15% severe PTSD symptoms while females experienced 59 % moderate and 41% severe PTSD symptoms. In case of death of friend males 5% moderate, 5% severe PTSD symptoms and 4 % of females showed Moderate PTSD symptoms due to domestic violence. 5% of males revealed Moderate,10% severe while female revealed 4% mild,12 % moderate 8% severe symptoms of PTSD due to earthquake. 4 % of females showed mild and 8% severe PTSD symptoms due to miscarriage. 10% of males revealed mild,10% severe while female revealed 16% severe symptoms of PTSD due to fire. 5% of males revealed Moderate,5% severe due to occupation incidents. 5% of males revealed mild PTSD symptoms,15% moderate while females revealed 12.5% moderate, and 5% severe PTSD symptoms due to occupational incidents in the family. Among the trauma survivors of loss of business males showed 10% moderate and 10% severe PTSD symptoms. Among the trauma survivors of blast 5% of males showed mild and 4% of females showed severe PTSD symptoms. A demographic survey of the Hazara Division revealed females were more victims of trauma as compared to their male counterparts (t = 4.67, p &lt; .001). Keywords: Prevalence, Posttraumatic Stress Disorder Nature of Trauma, Gender

Insufficient Supply, Diagnostic Services, and Lack of Trained Personnel in Primary Hospitals in North-West Ethiopia Worsened Trauma Care: A Mixed-Method Study.

Although there has been a massive expansion of hospitals in Ethiopia in the last 2 decades, most are primary-level hospitals. Assessing the capability of the hospitals in managing trauma victims is essential to strengthening the hospitals. We employed a mixed-method approach using quantitative descriptive design triangulated with qualitative research. We audited 10 hospitals using WHO essential trauma care checklist. We interviewed 37 health care professionals, 9 hospital managers, and 12 decision-makers using a semi-structured interview guide. We used the COREQ checklist to report the qualitative finding. The physical structures of the hospitals were good in all cases. Airway, breathing and circulation management were partially available, with a score ranging from 0 - 3. The extent of injury, lack of radiology service, and scarcity of drugs and supplies were common causes for the referral of trauma victims to Gondar University hospital. Unavailability of drugs and supplies, lack of diagnostic services, inability to recruit specialist professionals, lack of training, and inconvenient working and living environment were stated as the main barriers to providing trauma care. In the study area, the gaps in trauma care in the primary hospitals can be improved by further commitment of the hospitals, the district, zonal administrators, and the regional health bureau.

The Effects of Mindfulness-Based Stress Reduction on Trauma in Victims of Gun Violence: a Pilot Study

ObjectivesGun violence is a significant problem in the United States of America. Gun violence produces lifelong psychological adversity, trauma, and grief. In the face of this epidemic, efficacious therapies that assuage gun violence-based trauma and negative health are lacking.MethodsThe proposed, longitudinal pilot experiment examined the effects of an 8-week mindfulness-based stress reduction (MBSR) program on traumatized individuals as a direct consequence of gun violence. Twenty-four victims of gun violence (median age = 53 years; 21 female) completed measures of the primary outcome: trauma. Secondary outcomes were characterized as grief, depression, sleep quality, life satisfaction, and mindfulness. All assessments were administered before, after 5, and 8 weeks of MBSR training. It was hypothesized that trauma and other comorbidities would improve following MBSR. It was also predicted that outcomes would be significantly stronger from baseline to 5 weeks of MBSR training than from 5 to 8 weeks of training.ResultsBefore MBSR, volunteers exhibited high levels of trauma, depression, sleep difficulty, and grief. Participation in MBSR was associated with improved trauma, depression, sleep difficulty, and life satisfaction. The most pronounced improvements in psychological disposition were exhibited within the first 5 weeks of MBSR. However, these benefits were largely preserved after completion of the course. Importantly, increases in dispositional mindfulness predicted lower trauma, complicated grief, and sleep difficulties.ConclusionsThe present findings should be interpreted with caution because they were derived from an uncontrolled, non-randomized trial. However, said findings suggest that MBSR may reduce trauma and improve overall well-being in gun violence victims.

Management of Advanced Aged Patients with Rib Fractures: Current Evidence and Review of the Literature

Elderly patients (age &gt; 60 years old) represent the majority of the victims of major trauma, and rib fractures account for 10% of all trauma admissions. Due to the growing interest in surgical rib fixation and the lack of evidence on the best treatment available, we aimed to compare the conservative and operative approaches among the elderly population with multiple rib fractures. The systematic review identified seven eligible studies from over 321 papers collected through the database screening process. The mortality rate, considered the primary outcome, was higher in the conservative-treated group than the operatively-treated patients (8.3% vs. 3%). Considering the secondary outcomes investigated, the overall intensive care unit stay and in-hospital length of stay were longer in the operatively-treated patients (6.3 and 13.3 vs. 4.7 and 7.7, respectively). Conversely, the operative treatment showed favorable results regarding the pneumonia complication rate (5.8% vs. 9.6%), while the duration of mechanical ventilation was similar for both treatments. Surgical stabilization of rib fractures in the elderly population appears to be associated with a survival advantage and avoiding pulmonary complications. However, the individual contribution of operative and conservative treatment in reducing morbidity and mortality in the elderly with multiple rib fractures remains unclear.

The effects of Pre-hospital Trauma Life Support (PHTLS) training program on the on-scene time interval

BackgroundRecent studies have shown that reducing pre-hospital time could improve the outcomes of trauma victims. Due to the importance of pre-hospital time management, this study aims to determine the effects of the Pre-hospital Trauma Life Support (PHTLS) training program on the on-scene time interval reduction.MethodsThe PHTLS training program was implemented based on global standards for pre-hospital emergency technicians. The research tool was a questionnaire designed by the Ministry of Health and Medical Education in Iran. The mean on-scene time interval was calculated before, after and one month after the intervention in the control (n = 32) and experimental group (n = 32). The data were analyzed using SPSS.ResultsThe mean on-scene time interval in the target group (one month after intervention) has been significantly lower than that of the control group. Moreover, the mean and standard deviation from the on-scene time interval in the target group has been reduced from 17.6 ± 5.5 (before intervention) to 12 ± 3.8 min (one month after intervention) which was statistically significant.ConclusionThe implementation of the PHTLS training program can lead to the reduction of on-scene time interval. Therefore, considering the role of reducing on-scene time intervals on victims’ survival, the integration of the PHTLS training programs with pre-hospital emergency medical service systems seems inevitable.

707 RESEARCH PRIORITIES FOR PREHOSPITAL CARE OF OLDER PATIENTS WITH INJURIES: SCOPING REVIEW

Abstract Introduction The use of ambulance services by older patients with injuries increases within the impacts of ageing-related changes leading to adverse patient outcomes. There is increasing recognition of the importance of prehospital trauma care for older patients, but little systematic research to guide practice. We aimed to review the published evidence on prehospital trauma care for older patients, determine the scope of existing research and identify research gaps in the literature. Methods A systematic scoping review guided by the Arksey and O’Malley framework reported in line with the PRISMA-ScR checklist. A systematic search was conducted of Scopus, CINAHL, MEDLINE, PubMed and Cochrane library databases to identify articles published between (2001–2021) years. Inclusion and exclusion criteria were applied independently by two reviewers. Data were extracted, charted and summarised from eligible articles. Results 65 studies were identified and reviewed, and 25 included. Five categories were identified: ‘field triage, “ageing impacts”, ‘decision-making’, ‘paramedic’ awareness’ and ‘paramedic’s behaviour’. Undertriage &amp; overtriage (sensitivity &amp; specificity) were commonly cited as poorly investigated field-triage subthemes. Ageing-related physiologic changes, comorbidities and polypharmacy were the most widely researched. Inaccurate decision-making and poor early identification of major injuries were identified as potentially influencing patient outcomes. More research is required into paramedic knowledge of geriatric care &amp; ageing changes and the potential impact of paramedic care. Conclusion This is the first study reviewing the published evidence on prehospital trauma care for older patients and identifying research priorities for future research. This review has identified the prehospital triage for older trauma victims and studies of paramedic knowledge of older trauma care as key priorities. Investigating and understanding these can improve providing prehospital trauma care of older patients.

Tracheal intubation practices and adverse events in trauma victims on arrival to trauma triage: A single centre prospective observational study.

Background and Aims:Trauma is one of the leading causes of global disease burden. Data on airway management in trauma patients from developing countries, particularly India is sparse. Hence, we planned a prospective observational study to assess the airway management practice patterns and associated complications.Methods:The study was conducted in trauma triage of a tertiary care hospital. Data was collected on all tracheal intubations occurring in trauma victims requiring definitive airway control, a detailed proforma including patient details, mode of injury, drugs used, intubation procedure, and complications were filled out for each patient.Results:We observed that the airway in trauma patients was primarily managed by non-anaesthesia speciality residents (426 patients); anaesthesia residents were primarily called for deferred or difficult intubations. The first attempt success rate of intubation by anaesthesia residents was significantly higher than speciality residents (P = 0.0001; 95% CI 9.02-24.66). Non-anaesthesia residents used midazolam in varying doses (3-12 mg) for intubation, whereas, rapid sequence intubation was the most common technique used by anaesthesia residents. Airway injuries were the most frequent complication observed in 32.8% of patients intubated by specialty residents compared to 5.9% of patients intubated by anaesthesia residents.Conclusion:The trauma triage is a high-volume area for frequent tracheal intubations which are manned by non-anaesthesia speciality teams. A number of factors related to the patient, staff, availability of airway equipment and unfavourable surroundings impact airway management and may explain the high incidence of airway complications, such as airway injuries in these trauma victims.

The burden of road traffic accidents in trauma in low-resource settings: a retrospective cohort analysis of patient admissions to 2 Médecins Sans Frontières trauma facilities

Introduction: Medecins Sans Frontieres (MSF) is known for its work providing surgical care for victims of violent trauma (VT) in conflict zones. However, the trauma centers also deal with road traffic accidents (RTAs) which may require different staffing, facilities and supplies as compared with those required for VT. This study aimed to compare differences in types of injuries, clinical outcomes, and resources needed to properly operate trauma centers in low and middle-income countries. Material and methods: This was a retrospective analysis of routine program data of &gt;70,000 patient presentations in the emergency, in-patient, and operating departments of 2 of MSF’s major trauma centers, in Kunduz (Afghanistan) and Bujumbura (Burundi), using data from 2011 to 2018. Results: RTAs comprised a significant proportion of overall presentations to these centers (23% in Kunduz and 56% in Bujumbura). RTA patients presented with different patterns of injury, with higher rates of fractures, extremity injuries, and traumatic brain injury. RTA patients were 2.3 times more likely to have a peripheral injury (extremities and head) as VT patients, and 12.5 times more likely to undergo an orthopedic procedure. VT patients had higher rates of abdominal injury. However, there was no statistically significant difference in overall mortality and length of stay between the 2 groups. Conclusion: This study demonstrates that trauma centers, even in zones of conflict, need to be prepared and resourced to manage RTA cases. Policy-makers in such centers should be aware of the different injury patterns associated with this patient group and have appropriate, sustainable capacity to manage RTA trauma, particularly in terms of management of orthopedic injuries.