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Hlwatika P, Hardcastle TC. Concurrent cranial and cervical spine injuries by associated injury mechanisms in traumatic brain injury patients. SA J Radiol 2022. [DOI: 10.4102/sajr.v26i2.2321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Whitaker J, O'Donohoe N, Denning M, Poenaru D, Guadagno E, Leather AJM, Davies JI. Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments. BMJ Glob Health 2021; 6:e004324. [PMID: 33975885 PMCID: PMC8118008 DOI: 10.1136/bmjgh-2020-004324] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/07/2021] [Accepted: 02/04/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The large burden of injuries falls disproportionately on low/middle-income countries (LMICs). Health system interventions improve outcomes in high-income countries. Assessing LMIC trauma systems supports their improvement. Evaluating systems using a Three Delays framework, considering barriers to seeking (Delay 1), reaching (Delay 2) and receiving care (Delay 3), has aided maternal health gains. Rapid assessments allow timely appraisal within resource and logistically constrained settings. We systematically reviewed existing literature on the assessment of LMIC trauma systems, applying the Three Delays framework and rapid assessment principles. METHODS We conducted a systematic review and narrative synthesis of articles assessing LMIC trauma systems. We searched seven databases and grey literature for studies and reports published until October 2018. Inclusion criteria were an injury care focus and assessment of at least one defined system aspect. We mapped each study to the Three Delays framework and judged its suitability for rapid assessment. RESULTS Of 14 677 articles identified, 111 studies and 8 documents were included. Sub-Saharan Africa was the most commonly included region (44.1%). Delay 3, either alone or in combination, was most commonly assessed (79.3%) followed by Delay 2 (46.8%) and Delay 1 (10.8%). Facility assessment was the most common method of assessment (36.0%). Only 2.7% of studies assessed all Three Delays. We judged 62.6% of study methodologies potentially suitable for rapid assessment. CONCLUSIONS Whole health system injury research is needed as facility capacity assessments dominate. Future studies should consider novel or combined methods to study Delays 1 and 2, alongside care processes and outcomes.
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Affiliation(s)
- John Whitaker
- King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | | | - Max Denning
- Department of Surgery and Cancer, Imperial College London, London, UK
- Stanford Graduate School of Business, Stanford University, Stanford, California, USA
| | - Dan Poenaru
- Harvey E Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Andrew J M Leather
- King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, Western Cape, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Saaiman T, Filmalter CJ, Heyns T. Important factors for planning nurse staffing in the emergency department: A consensus study. Int Emerg Nurs 2021; 56:100979. [PMID: 33706044 DOI: 10.1016/j.ienj.2021.100979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Planning adequate nurse staffing in the emergency department (ED) is challenging. Although there are models to determine nurse staffing in EDs, these models do not consider all the factors. Inadequate nurse staffing causes overcrowding, poor quality of patient care, increased hospital costs, poor patient outcomes and high levels of burnout amongst nurses. In this paper, we report stakeholders' perceptions of important factors to be considered when planning ED nursing ratios. METHODS We applied a consensus research design. The data was generated from modified nominal group techniques followed by an e-Delphi with two rounds. The factors were generated during two nominal groups by 19 stakeholders which included management and healthcare professionals working in EDs. The generated factors were then put on a survey format for use in an e-Delphi. Using purposive and snowball sampling the survey was distributed to 74 national and international experts for consensus. RESULTS Ultimately, 43 experts agreed (a validity index of ≥ 80%) on four categories namely: hospital, staff, patient and additional categories which included 17 related factors. CONCLUSION Ideal nurse staffing ratios are influenced by the complexity of the environment and interactions between multiple factors. The categories and factors identified emphasised the need for extensive further research to ensure a financially viable model that will be accepted by both staff and patient, and thus promote optimal outcomes.
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Affiliation(s)
- Tania Saaiman
- University of Pretoria, Department of Nursing, South Africa
| | | | - Tanya Heyns
- University of Pretoria, Department of Nursing, South Africa
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Klopper J, Moola H, Venter J, Cheddie D, Luzulane S, Muchenje T, van Zyl J, Chambers J. Outcomes of patients with thoraco-abdominal gunshot wounds operatively managed at a district hospital in Cape Town, South Africa. Afr J Emerg Med 2021; 11:60-64. [PMID: 33489735 PMCID: PMC7808920 DOI: 10.1016/j.afjem.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/24/2020] [Accepted: 11/30/2020] [Indexed: 11/26/2022] Open
Abstract
AIM Trauma is a leading cause of morbidity and mortality in the first four decades of life. Thoracoabdominal gunshot wounds carry a significant risk of mortality. This risk of death is reduced if patients are managed in dedicated units. This study examines the outcome of these patients managed in a district level hospital. METHOD In this retrospective review, patients with thoracoabdominal gunshot wounds were identified from operating room registry for the period of January 2015 to December 2018. Data was collected retrospectively from folders and analysed for the primary outcome of mortality. RESULTS Sixty-eight thoracoabdominal gunshot wounds were managed operatively over the period described. Only six patients were female. The median age was 29.5 years. Fourteen patients required postoperative transfer to a level 1 trauma unit. Thirteen patients died, nine at the district hospital and four at the level 1 unit. Significant differences in organ injuries were noted in the patients that died compared to the survivors. DISCUSSION The in-hospital mortality rate of patients managed at the district hospital was 13.2% which is comparable to international rates of 12-18%. However, the subset of patients that required postoperative transfer to a level 1 trauma unit had a high mortality rate of 28.6%. The DH is committed to managing unstable and unresponsive patients once they present. Improved mortality rates will only occur with better prehospital transport policies and by equipping the DH to manage these patients postoperatively. CONCLUSION Management of these patients can be successful at a district hospital. However, significant obstacles exist to their optimal care, as demonstrated by the high mortality patients requiring postoperative transfer.
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Affiliation(s)
- Juan Klopper
- Department of Health, Western cape, Cape Town, South Africa
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Husna Moola
- Department of Health, Western cape, Cape Town, South Africa
| | - Jeremy Venter
- Department of Health, Western cape, Cape Town, South Africa
| | - Dylan Cheddie
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Samukele Luzulane
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Tinashe Muchenje
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Joshua van Zyl
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jessica Chambers
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Owusu Sekyere E, Hardcastle TC, Sathiram R, Tlou B. Overview of lower urinary tract symptoms post-trauma intensive care unit admission. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00027-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The study was undertaken to assess the incidence of lower urinary tract symptoms (LUTS) after short-term indwelling urethral catheter (IUC) in polytrauma patients admitted to a level one trauma unit using core lower urinary tract symptom score (CLSS). Data of patients admitted between January 2013 and December 2015 and meeting the study criteria were retrieved from the hospital informatics system. Chart review was done, and patients were subsequently interviewed telephonically.
Results
Ninety-four respondents comprising of 81.9% males and 18.1% females out of the 221 eligible patients were contacted. The most common LUTS reported was urethral pain, and 90% had mild to moderate symptoms. No severe LUTS were identified. There was a positive correlation between the duration of IUC and LUTS, but there was no statistically significant association between age and LUTS in our study population.
Conclusion
Short-term duration of IUC in the trauma ICU patient is associated with predominantly mild irritative LUTS which are mostly self-limiting and may not need further investigations and management. CLSS was found to be a useful screening tool. Further studies are needed to confirm findings in our study.
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Validation of the PRESTO score in injured children in a South-African quaternary trauma center. J Pediatr Surg 2020; 55:1245-1248. [PMID: 31515111 DOI: 10.1016/j.jpedsurg.2019.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/01/2019] [Accepted: 08/07/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The Pediatric RESuscitation and Trauma Outcome (PRESTO) model was developed for standardized risk-adjustment in pediatric trauma and is adapted to low-resource settings. It includes easily-accessible demographic and physiologic variables that are available at point of care in virtually any setting. The purpose of this study was to evaluate the PRESTO model's ability to predict in-hospital mortality in a South African pediatric trauma unit by comparing it to the widely used Injury Severity Score (ISS). METHODS Data prospectively collected between 2007 and 2017 in the Inkosi Albert Luthuli Central Hospital Trauma Registry were retrospectively reviewed. Injured children younger than 14 years were included if they were admitted to hospital or died as a result of their injury. We excluded patients with minor injuries who were treated and discharged home and patients with incomplete hospital disposition data. Receiver-Operating Characteristic (ROC) curves were constructed for PRESTO and ISS, and the areas under the curve (AUCs) were compared using Delong's test. The sensitivity and specificity of PRESTO were calculated at different prognostic threshold values identified through literature review. RESULTS We identified 419 patients; 67 died in hospital (16%). The AUCs for PRESTO and ISS were 0.82 (95% confidence interval CI [0.76-0.87]) and 0.75 (CI [0.68-0.81]), respectively. This difference trended towards statistical significance (p = 0.07). Using the optimal threshold of 0.13 described in the original publication, PRESTO had a 97% sensitivity and 37% specificity, while a threshold of 0.50 yielded 90% sensitivity and 54% specificity. The mean predicted probability of in-hospital death among patients who died was 0.79. Using this value as a threshold yielded the 57% sensitivity and 85% specificity. CONCLUSION This analysis has demonstrated the validity of the PRESTO model for in-hospital mortality prediction for pediatric trauma patients in the setting of a dedicated high-complexity trauma unit in a South African trauma referral center. LEVEL OF EVIDENCE Level III: Case-control.
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Zaidi AA, Dixon J, Lupez K, De Vries S, Wallis LA, Ginde A, Mould-Millman NK. The burden of trauma at a district hospital in the Western Cape Province of South Africa. Afr J Emerg Med 2019; 9:S14-S20. [PMID: 31073509 PMCID: PMC6497867 DOI: 10.1016/j.afjem.2019.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/19/2018] [Accepted: 01/05/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa bears a disproportionate burden of mortality from trauma. District hospitals, although not trauma centres, play a critical role in the trauma care system by serving as frontline hospitals. However, the clinical characteristics of patients receiving trauma care in African district hospitals remains under-described and is a barrier to trauma care system development. We aim to describe the burden of trauma at district hospitals by analysing trauma patients at a prototypical district hospital emergency centre. METHODS An observational study was conducted in August, 2014 at Wesfleur Hospital, a district facility in the Western Cape Province of South Africa. Data were manually collected from a paper registry for all patients visiting the emergency centre. Patients with trauma were selected for further analysis. RESULTS Of 3299 total cases, 565 (17.1%) presented with trauma, of which 348 (61.6%) were male. Of the trauma patients, 256 (47.6%) were ages 18-34 and 298 (52.7%) presented on the weekend. Intentional injuries (assault, stab wounds, and gunshot wounds) represented 251 (44.4%) cases of trauma. There were 314 (55.6%) cases of injuries that were unintentional, including road traffic injuries. There were 144 (60%) intentionally injured patients that arrived overnight (7pm-7am). Patients with intentional injuries were three times more likely to be transferred (to higher levels of care) or admitted than patients with unintentional injuries. CONCLUSION This district hospital emergency centre, with a small complement of non-EM trained physicians and no trauma surgical services, cared for a high volume of trauma with over half presenting on weekends and overnight when personnel are limited. The high volume and rate of admission/ transfer of intentional injuries suggests the need for improving prehospital trauma triage and trauma referrals. The results suggest strengthening trauma care systems at and around this resource-limited district hospital in South Africa may help alleviate the high burden of post-trauma morbidity and mortality.
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Affiliation(s)
- Ali A. Zaidi
- Indiana University, School of Medicine, Department of Emergency Medicine, Indianapolis, IN, United States
| | - Julia Dixon
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, CO, United States
| | - Kathryn Lupez
- Carolinas Medical Center, Department of Emergency Medicine, Charlotte, NC, United States
| | - Shaheem De Vries
- Western Cape Government EMS, Bellville, Western Cape Province, South Africa
| | - Lee A. Wallis
- University of Cape Town, Division of Emergency Medicine, Cape Town, Western Cape Province, South Africa
- Western Cape Government EMS, Bellville, Western Cape Province, South Africa
| | - Adit Ginde
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, CO, United States
| | - Nee-Kofi Mould-Millman
- University of Colorado, School of Medicine, Department of Emergency Medicine, Aurora, CO, United States
- University of Cape Town, Division of Emergency Medicine, Cape Town, Western Cape Province, South Africa
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Hardcastle TC, Faurie M, Muckart DJ. Endotracheal tube cuff pressures and tube position in critically injured patients on arrival at a referral centre: Avoidable harm? Afr J Emerg Med 2016; 6:24-29. [PMID: 30456060 PMCID: PMC6233239 DOI: 10.1016/j.afjem.2015.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/08/2015] [Accepted: 09/18/2015] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The consequences of excessive endotracheal tube (ETT) cuff pressure are known and have long-term effects; however less attention is placed upon cuff pressure and tube position pre-hospital and in emergency centre. The aim of this study was to evaluate the ETT cuff pressure and tube position on arrival of all patients admitted to the Trauma Unit at Inkosi Albert Luthuli Central Hospital, both from scene and inter-hospital transfers to determine the median cuff-pressure and if there were differences between the two groups. METHODS Data from Trauma Unit patients are entered into a prospective; UKZN approved (BE207-09) Trauma Database. Data on 65 admissions between April and December 2014 were reviewed to determine the arrival cuff pressure and tube position. Data captured included patient age, cuff pressure, where and who intubated the patient, and time since intubation to cuff pressure check. Data were analysed by descriptive statistics and Student's t-test for continuous data. RESULTS Most patients had sustained motor vehicle related trauma, with a male predominance. Equal numbers were intubated pre-hospital versus the in-hospital group. Eighty percent of ETT's were placed in the correct anatomical location, however only 23% of cuff pressures were found to be within the safe pressure limits. ETT cuff pressures were excessive in the pre-hospital ALS group more often than the facility-intubation group (p = 0.042). There were fatal complications related to supra-glottic intubations resulting in aspiration pneumonia, highlighting the need for X-ray confirmation of tube position. CONCLUSION Most patients, whether intubated on-scene or at hospital have ETT cuff pressures that are excessive, with the potential for ischaemic necrosis of the tracheal mucosa. ETT cuff manometry should be standard of care for all prehospital and in-hospital intubations where the tube will remain in situ for any prolonged period of time. Before inter-facility transfer ETT position should be confirmed radiologically.
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Affiliation(s)
- Timothy C. Hardcastle
- Trauma Service – Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Rd, Mayville, 4051 Durban, South Africa
- Department of Surgery, UKZN, 800 Vusi Mzimela Rd, Mayville, 4051 Durban, South Africa
| | - Michael Faurie
- Trauma Service – Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Rd, Mayville, 4051 Durban, South Africa
- Department of Surgery, UKZN, 800 Vusi Mzimela Rd, Mayville, 4051 Durban, South Africa
| | - David J.J. Muckart
- Trauma Service – Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Rd, Mayville, 4051 Durban, South Africa
- Department of Surgery, UKZN, 800 Vusi Mzimela Rd, Mayville, 4051 Durban, South Africa
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