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Naus A, Carroll M, Gerk A, Mooney DP, Yanchar NL, Ferreira J, Poenaru D, Gripp KE, Ouellet C, Botelho F. Implementation of a Global Pediatric Trauma Course in an Upper Middle-Income Country: A Pilot Study. J Surg Res 2024; 298:355-363. [PMID: 38663262 DOI: 10.1016/j.jss.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/25/2024] [Accepted: 03/22/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Over 90% of pediatric trauma deaths occur in low- and middle-income countries (LMICs), yet pediatric trauma-focused training remains unstandardized and inaccessible, especially in LMICs. In Brazil, where trauma is the leading cause of death for children over age 1, we piloted the first global adaptation of the Trauma Resuscitation in Kids (TRIK) course and assessed its feasibility. METHODS A 2-day simulation-based global TRIK course was hosted in Belo Horizonte in October 2022, led by one Brazilian and four Canadian instructors. The enrollment fee was $200 USD, and course registration sold out in 4 d. We administered a knowledge test before and after the course and a postcourse self-evaluation. We recorded each simulation to assess participants' performance, reflected in a team performance score. Groups received numerical scores for these three areas, which were equally weighted to calculate a final performance score. The scores given by the two evaluators were then averaged. As groups performed the specific simulations in varying orders, the simulations were grouped into four time blocks for analysis of performance over time. Statistical analysis utilized a combination of descriptive analysis, Wilcoxon signed-rank tests, Kruskal-Wallis tests, and Wilcoxon rank-sum tests. RESULTS Twenty-one surgeons (19 pediatric, one trauma, one general) representing four of five regions in Brazil consented to study participation. Women comprised 76% (16/21) of participants. Overall, participants scored higher on the knowledge assessment after the course (68% versus 76%; z = 3.046, P < 0.001). Participants reported improved knowledge for all tested components of trauma management (P < 0.001). The average simulation performance score increased from 66% on day 1% to 73% on day 2, although this increase was not statistically significant. All participants reported they were more confident managing pediatric trauma after the course and would recommend the course to others. CONCLUSIONS Completion of global TRIK improved surgeons' confidence, knowledge, and clinical decision-making skills in managing pediatric trauma, suggesting a standardized course may improve pediatric trauma care and outcomes in LMICs. We plan to more closely address cost, language, and resource barriers to implementing protocolized trauma training in LMICs with the aim to improve patient outcomes and equity in trauma care globally.
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Affiliation(s)
- Abbie Naus
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Lahey Hospital and Medical Center, Beth Israel Lahey, Burlington, MA. https://twitter.com/abbieEnaus
| | - Madeleine Carroll
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Surgery, Yale New Haven Hospital, New Haven, CT
| | - Ayla Gerk
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA; Department of Pediatric Surgery, McGill University, Montreal, QC, Canada
| | - David P Mooney
- Department of Surgery, Boston Children's Hospital, Boston, MA
| | - Natalie L Yanchar
- Department of Surgery, Alberta Children's Hospital, Calgary, AB, Canada
| | - Julia Ferreira
- Department of Pediatric Surgery, McGill University, Montreal, QC, Canada
| | - Dan Poenaru
- Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, QC, Canada
| | - Karen E Gripp
- Emergency Department, The Children's Hospital of Winnipeg, Winnipeg, MB, Canada
| | - Caroline Ouellet
- Emergency Department, Montreal Children's Hospital, Montreal, QC, Canada
| | - Fabio Botelho
- Department of Pediatric Surgery, McGill University, Montreal, QC, Canada.
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Palinrungi MA, Faruk M, Christeven R. Traumatic Kidney Injury: A 6-Year Retrospective Study in Childhood and Adolescence. Res Rep Urol 2023; 15:415-424. [PMID: 37750086 PMCID: PMC10518142 DOI: 10.2147/rru.s424273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/12/2023] [Indexed: 09/27/2023] Open
Abstract
Background Traumatic kidney injuries are the most common urinary tract injuries. Pediatric patients are more susceptible to renal injury from blunt trauma than adults because of anatomic factors. The aim of this publication was to provide a reference for traumatic kidney injury in the pediatric group based on the study in our center. Methods A retrospective study was conducted from January 2014 to December 2019 to review medical records of children admitted with renal trauma. Relevant findings including demographics, mechanisms and grades of injury, clinical parameters, interventions, and outcomes were recorded. Results Thirty-three pediatric patients were investigated. Males experienced traumatic kidney injury more often than the females with a ratio of 10:1. Most cases occurred during the adolescent (12-18) years (81.82%). Left-side kidney injury (63.64%) was more frequent than right side (36.36%). Most cases (96.97%) were caused by blunt trauma, mainly traffic accidents (81.82%). Most patients (90.91%) had stable hemodynamics. Grade IV kidney injury was the most frequently found injury (39.39%). The cause of renal function disturbance was based on the blood urea nitrogen/creatinine (BUN/Cr) ratio with 21.87% of patients suffering from intra-renal causes and 12.5% from pre-renal causes. No significant association between different grades and BUN/creatinine ratio was found. Isolated renal injuries were found in 54.54% of patients. Most patients were treated conservatively (87.88%), and survival was 96.97%. Conclusion Non-operative management is safe and yields good outcomes in kidney trauma patients with stable hemodynamics. Renal trauma severity is not associated with the BUN/Cr ratio.
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Affiliation(s)
- Muhammad Asykar Palinrungi
- Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia
- Department of Urology, Universitas Hasanuddin Hospital, Makassar, Indonesia
| | - Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia
| | - Robert Christeven
- Department of Surgery, Faculty of Medicine, Universitas Hasanuddin, Makassar, Indonesia
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Gheshlaghi LA, Rastegar A, Binabaj MM, Shoraka HR, Fallahi M. Analysis of the Home Accidents and Their Risk Factors in Iran: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:1855-1865. [PMID: 38033829 PMCID: PMC10682592 DOI: 10.18502/ijph.v52i9.13568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/19/2022] [Indexed: 12/02/2023]
Abstract
Background Home accident is among the most common type of trauma, in the second place after traffic accident. We aimed to determine the prevalence and factors affecting the occurrence of home accidents in Iran. Methods PubMed, Scopus, Web of Science, and national Persian databases including SID, MagIran, and Medical Articles Bank were searched for articles published until September 12, 2021. The pooled prevalence and factors affecting the occurrence of home accidents were calculated. Results Twenty articles were included in the meta-analysis. The pooled prevalence of home accident was 44% (95%CI: 32% to 56%). The pooled prevalence of foreign object/fall, stab or cut, suffocation, burn, poisoning and were 15% (95%CI: 10% to 20%), 24% (95%CI: 10% to 38%), 1% (95%CI:0.7% to 1.3%), 31% (95%CI:19% to 42.2%), and 6.8% (95%CI:4.2% to 429.4%), respectively. Conclusion The prevalence of home accidents in Iran is moderate but higher than in other countries. The findings of this review highlight the need for more attention to home accident in children and elderly in the South and Southeast regions of Iran.
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Affiliation(s)
| | - Ayoob Rastegar
- Department of Environmental Health, School of Health and Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Maryam Moradi Binabaj
- Department of Biochemistry and Nutrition, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Hamid Reza Shoraka
- Department of Public Health, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
| | - Majid Fallahi
- Department of Occupational Health, School of Health and Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
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Cunha SC, DE-Oliveira Filho AG, Miranda ML, Silva MACPDA, Pegolo PTDEC, Lopes LR, Bustorff-Silva JM. Analysis of the efficacy and safety of conservative treatment of blunt abdominal trauma in children: retrospective study. Conservative treatment of blunt abdominal trauma in children. Rev Col Bras Cir 2023; 50:e20233429. [PMID: 36995834 PMCID: PMC10519698 DOI: 10.1590/0100-6991e-20233429-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/06/2022] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION in Brazil, trauma is responsible for 40% of deaths in the age group between 5 and 9 years old, and 18% between 1 and 4 years, and bleeding is the leading cause of preventable death in the traumatized child. Conservative management of blunt abdominal trauma with solid organs injury - started in the 60s - is the current world trend, with studies showing survival rates above 90%. The objective was to assess the efficacy and safety of conservative treatment in children with blunt abdominal trauma treated at the Clinical Hospital of the University of Campinas, in the last five years. METHODS retrospective analysis of medical records of patients classified by levels of injury severity, in 27 children. RESULTS only one child underwent surgery for initial failure of conservative treatment (persistent hemodynamic instability), resulting in a 96% overall success rate of the conservative treatment. Five other children (22%) developed late complications that required elective surgery: a bladder injury, two cases of infected perirenal collections (secondary to injury of renal collecting system), a pancreatic pseudocyst and a splenic cyst. Resolution of the complications was attained in all children, with anatomical and functional preservation of the affected organ. There were no deaths in this series. CONCLUSION the conservative initial approach in the treatment of blunt abdominal trauma was effective and safe with high resolution and low rate of complications leading to a high preservation rate of the affected organs. Level of evidence III - prognostic and therapeutic study.
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Affiliation(s)
- Sarah Crestian Cunha
- - Universidade Estadual de Campinas (UNICAMP), Cirurgia - Campinas - SP - Brasil
| | | | - Marcio Lopes Miranda
- - Universidade Estadual de Campinas (UNICAMP), Cirurgia - Campinas - SP - Brasil
| | | | | | - Luiz Roberto Lopes
- - Universidade Estadual de Campinas (UNICAMP), Cirurgia - Campinas - SP - Brasil
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CUNHA SARAHCRESTIAN, DE-OLIVEIRA FILHO ANTONIOGONÇALVES, MIRANDA MARCIOLOPES, SILVA MARCIAALESSANDRACAVALAROPEREIRADA, PEGOLO PATRÍCIATRABALLIDECARVALHO, LOPES LUIZROBERTO, BUSTORFF-SILVA JOAQUIMMURRAY. Análise de eficácia e segurança do tratamento conservador do trauma abdominal contuso em crianças: estudo retrospectivo. Tratamento conservador de trauma abdominal contuso em crianças. Rev Col Bras Cir 2023. [DOI: 10.1590/0100-6991e-20233429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
RESUMO Introdução: no Brasil, o trauma é responsável por 40% dos óbitos na faixa etária entre 5 e 9 anos, e 18% entre 1 e 4 anos, e o sangramento é a principal causa de prevenção morte na criança traumatizada. O manejo conservador de trauma abdominal contuso com lesão de órgãos sólidos - iniciado na década de 60 - é a tendência mundial atual, com estudos mostrando taxas de sobrevivência acima de 90%. O objetivo do presente trabalho foi avaliar a eficácia e segurança do tratamento conservador em crianças com trauma abdominal contuso tratado no Hospital das Clínicas da Universidade de Campinas, nos últimos cinco anos. Métodos: análise retrospectiva de prontuários de pacientes classificados por níveis de gravidade da lesão, em 27 crianças. Resultados: apenas uma criança foi submetida a cirurgia por falha inicial do tratamento conservador (instabilidade hemodinâmica persistente), resultando em uma taxa de sucesso global de 96% do tratamento conservador inicial. Outras cinco crianças (22%) desenvolveram complicações tardias que exigiram cirurgias eletivas: lesão na bexiga, dois casos de coleção perirenal infectada (secundária à lesão de sistema de coleta renal), um pseudocisto pancreático e um cisto esplênico. Resolução da complicação foi atingida em todas as crianças, com preservação anatômica e funcional do órgão afetado. Não houve mortes nesta série. Conclusão: a abordagem inicial conservadora no tratamento de trauma abdominal contundente foi eficaz e segura com alta resolução e baixa taxa de complicações levando a uma alta taxa de preservação dos órgãos afetados. Nível de evidência III - estudo prognóstico e terapêutico.
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Ben Abderrahim S, Belhaj A, Bellali M, Hmandi O, Gharbaoui M, Harzallah H, Naceur Y, Ben Khelil M, Allouche M. Patterns of Unnatural Deaths Among Children and Adolescents: Autopsy Study (2011-2018). Pediatr Dev Pathol 2022; 25:635-644. [PMID: 36503303 DOI: 10.1177/10935266221132884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS The problem of unnatural death in children is still relevant because of their vulnerability. This work aimed to describe the epidemiological profile and patterns of these medicolegal deaths in children and adolescents in northern Tunisia. METHODS We conducted a retrospective study from January 2011 to December 2018, within the Forensic Department of Charles Nicolle Hospital in Tunis. All children who died of unnatural causes were included (767 cases). RESULTS An overall male predominance was observed (sex ratio = 2.4). Accidental deaths represent the most common manner of death (81.4%) involving most frequently domestic accidents occurring in children aged between 1 and 4 years. In cases of suicide, the highest risk profile was a female child aged between 15 and 18 years. The suicide occurred most often in the victim's home with hanging representing the common means of suicide. For the criminal form, the most common means in those cases were stabbing and blunt injuries. CONCLUSION Our study delivered a broad picture of unnatural deaths among children in Tunisia. These deaths, largely absent from child survival initiatives presently on the global agenda, can be prevented if they are addressed strategically, as their injury prevention strategies differ from adults.
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Affiliation(s)
- Sarra Ben Abderrahim
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia
| | - Azza Belhaj
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.,University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia
| | - Mohamed Bellali
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.,University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia
| | - Ons Hmandi
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.,University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia
| | - Meriem Gharbaoui
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.,University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia
| | - Hana Harzallah
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia.,Department of Forensic Medicine, Habib Bougatfa University Hospital, Bizerte, Tunisia
| | - Yomn Naceur
- University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia.,Regional Hospital Béja, Béja, Tunisia
| | - Mehdi Ben Khelil
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.,University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia
| | - Mohamed Allouche
- Department of Forensic Medicine, Charles Nicolle University Hospital, Tunis, Tunisia.,University of Tunis El Manar, Tunis Faculty of Medicine, Tunis, Tunisia
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Ohayi SR, Onyishi NT, Ezeme MS. Injury-related deaths in Enugu, Nigeria from 2010 to 2016: a descriptive review. Pan Afr Med J 2020; 36:266. [PMID: 33088395 PMCID: PMC7545974 DOI: 10.11604/pamj.2020.36.266.25273] [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: 07/30/2020] [Accepted: 08/06/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction death from injuries is a global public health problem. Ninety percent occur in low- and middle-income countries like Nigeria. This study aimed to determine the burden and demographic characteristics of injury-related death in Enugu, Nigeria. Methods this is a retrospective study of injury-related deaths in Enugu over a 7-year period. Standardized forms were used to collect data from autopsy reports archived in the Forensic Unit of Enugu State University Teaching Hospital, Enugu and a descriptive analysis of collected data performed. Results of the Coroner deaths examined in the period reviewed, 1,067 (86.9%) were injury-related. The male-to-female ratio was 5.2: 1. Mean age of victims was 34.2 ± 14.3years and range was 8 months to 86 years. Most victims (56.7%) aged 21-40 years. Accidents accounted for most deaths (53.2%) followed by homicide (44.3%). Road traffic deaths (51.4%), cult/gang violence (20.8%) and robbery (14.7%) were the commonest. Suicide (0.5%) and domestic violence (0.7%) were the least. More females died in domestic incidents while more males died in all other circumstances. Firearm (56.7%) was the most common weapon followed by knife (19%). Knife and wood (28.7% each) were the commonest weapons in domestic violence. Generally, fatal incidents occurred more in the day-time (65.5%). Most robberies (80.4%) occurred at night. Most cult/gang killings (75.2%) and robberies (81.7%) occurred in public places and at homes respectively. Conclusion injury is the highest source of Coroner's death in Enugu. Efforts to curb it are insufficient. A definitive policy on the prevention and management of injury-related deaths is needed.
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Affiliation(s)
- Samuel Robsam Ohayi
- Department of Pathology, Enugu State University Teaching Hospital and College of Medicine, Park Lane, Enugu, Nigeria
| | - Nnaemeka Thaddeus Onyishi
- Department of Pathology, Enugu State University Teaching Hospital and College of Medicine, Park Lane, Enugu, Nigeria
| | - Mark Sunday Ezeme
- Department of Psychiatry, Enugu State University Teaching Hospital and College of Medicine, Park Lane, Enugu, Nigeria
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Botelho F, Truche P, Mooney DP, Caddell L, Zimmerman K, Roa L, Alonso N, Bowder A, Drumond D, Abib SDCV. Pediatric trauma primary survey performance among surgical and non-surgical pediatric providers in a Brazilian trauma center. Trauma Surg Acute Care Open 2020; 5:e000451. [PMID: 32724859 PMCID: PMC7375395 DOI: 10.1136/tsaco-2020-000451] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/05/2020] [Accepted: 06/13/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Trauma is the leading cause of death and disability among Brazilian children and adolescents. Trauma protocols such as those developed by the Advanced Trauma Life Support course are widely taught, but few studies have assessed the degree to which the use of protocolized trauma assessment improves outcomes. This study aims to quantify the adherence of trauma assessment protocols among different types of frontline trauma providers. METHODS A prospective observational study of pediatric trauma care in one of the busiest Latin American trauma centers was conducted during 6 months. Trauma primary survey assessments were observed and adherence to each step of a standardized primary assessment protocol was recorded. Adherence to the assessment protocol was compared among different types of providers, the time of presentation and severity of injury. The relationship between protocol adherence and clinical outcomes including mortality, length of hospital stay, admission to pediatric intensive care unit, use of blood components, mechanical ventilation and number of imaging exams performed in the first 24 hours were also assessed. RESULTS Emergency department evaluations of 64 patients out of 274 pediatric admissions were observed over a period of 6 months. 50% of the primary assessments were performed by general surgeons, 34.4% by residents in general surgery and 15.6% by pediatricians. There was an average adherence rate of 34.1% to the trauma protocol. Adherence among each specific step included airway: 17.2%; breathing: 59.4%; circulation: 95.3%; disability: 28.8%; exposure: 18.8%. No differences between specialties were observed. Patients with a more thorough primary assessment underwent fewer CT scans (receiver operating characteristic curve area: 0.661; p=0.027). CONCLUSIONS Our study demonstrates that trauma assessment protocol adherence among trauma providers is low. Thorough initial assessment reduced the use of CT scans suggesting that standardized pediatric trauma assessments may be a way to reduce unnecessary radiological imaging among children. LEVEL OF EVIDENCE IV. STUDY TYPE Pediatric and global trauma.
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Affiliation(s)
- Fabio Botelho
- Cirurgia Pediatrica, Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Paul Truche
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - David P Mooney
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Luke Caddell
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathrin Zimmerman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Lina Roa
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Nivaldo Alonso
- Cirurgia Plastica, Universidade de São Paulo, São Paulo, Brazil
| | - Alexis Bowder
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
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Ul Haq ME, Khan AS. A retrospective study of causes, management, and complications of pediatric facial fractures. Eur J Dent 2020; 12:247-252. [PMID: 29988232 PMCID: PMC6004801 DOI: 10.4103/ejd.ejd_370_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objectives: The objective of this study was to report causes, management options, and complications of facial fractures among children. Materials and Methods: The groups were defined on the basis of age, gender, cause of injuries, location, and type of injuries. The treatment modalities ranged from no intervention, closed reduction alone or with open reduction internal fixation (ORIF). Statistical Analysis: Descriptive statistics were generated by using SPSS software for the entire range of the variables under study. Results: Records of 240 pediatric patients were obtained and a total of 322 fractures were found among a study sample. Among these, one-thirds were due to road traffic accidents (RTAs) (37.26%) and fall injuries (36.64%), making them the leading causes of facial fractures. Mandibular fractures were the most common and they accounted for 46% (n = 148) of all fractures. The highest number of RTA (n = 27) was found in adolescents and fall injuries were more prevalent in preschool children (n = 34). Forty-two percent of the fractures (n = 101) were treated with close treatment using arch bars and splints, followed by ORIF (n = 68). The rest, 29.6% (n = 71), received conservative treatments. Postoperative complications were observed in 18.33% (n = 44) of cases, of which jaw deviation, growth disturbance, and trismus were more frequently encountered. Conclusion: Pediatric facial fractures if not managed properly can cause severe issues; therefore, injury prevention strategies should be strictly followed to reduce pediatric injuries in low socioeconomic countries.
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Affiliation(s)
- Muhammad Ehsan Ul Haq
- Department of Oral and Maxillofacial Surgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Abdul Samad Khan
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Beraldo RF, Forlin E. Firearm-Related Musculoskeletal Injuries in Brazilian Children and Teenagers. Rev Bras Ortop 2019; 54:685-691. [PMID: 31875067 PMCID: PMC6923644 DOI: 10.1055/s-0039-1697021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/08/2018] [Indexed: 01/04/2023] Open
Abstract
Objective
To evaluate and describe musculoskeletal injuries by firearms in children and adolescents attended in a major trauma center.
Methods
This was a retrospective study that evaluated the medical records of < 18 years old patients who were victims of injuries by firearms and who presented to the emergency department of our hospital, from January 2014 to December 2016. A total of 51 patients were excluded for not showing musculoskeletal injures or for other reasons, while 126 were included. The collected data were: gender; age; way of admission; body site hit; fractures; complications and sequelae; associated injures; hospitalization time; surgeries; deaths.
Results
Out of 126 patients included, 107 were male (84.9%) and 19 were female (15.1%). The mean age was 15 years and 5 months old (range: 2y + 8 months to 17y + 11 months years old). A total of 70 patients were hospitalized (55.6%), with a mean hospital stay of 9.6 days, and 21 patients were hospitalized in the intensive care unit (ICU) for a mean of 14.7 days. A total of 37 patients needed orthopedic surgery (29.4%). There were 6 deaths (4.8%). The thigh was the most hit region, in 43 injuries (24.7%). Six patients had spinal cord sequelae, and eight patients had peripheral nerves injuries. A total of 58 patients (46%) had 71 fractures, and the femur was the most hit (15.5%). A total of 52 (41.3%) patients presented with associated injuries. In the 71 fractures, the treatment was conservative in 45 (63.4%), surgical in 23 (32.4%). Three injuries resulted in death (4.2%).
Conclusion
Adolescents and males are at-risk groups for firearms injuries, and the lesions are mainly on the lower limbs. Less than half of the patients had fractures, but many had complex lesions with potential for severe sequelae.
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Affiliation(s)
| | - Edilson Forlin
- Departamento de Ortopedia e Traumatologia, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brasil
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Trends in trauma-related mortality among adolescents: A 6 year snapshot from a teaching hospital's post mortem data. J Clin Orthop Trauma 2017; 8:S1-S5. [PMID: 29339839 PMCID: PMC5761691 DOI: 10.1016/j.jcot.2017.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/11/2016] [Accepted: 02/23/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The aim is to explore the trends in trauma mortality in children aged 0-18 years can help to co-ordinate resources toward research and programs to reduce the burden. METHODS This is a retrospective study carried out on adolescents ≤18 years of age autopsied according to the attorney request at Forensic Medicine & Toxicology department of King George's Medical University, Lucknow, India in the period from January 1st, 2009 to December 31st, 2014. RESULTS There were 9160 deaths from all causes in children ≤18 years old, 7747 of which were due to trauma related causes, with a female predominance of 1.3:1. The age distribution revealed that 65.8% of deaths occurred in the 10-18 age group. Road traffic accidents (RTA) was the most prevalent cause (3635 deaths - 46.92%), followed by asphyxia (1128 deaths - 14.56%) and sexual assault (649 deaths - 8.37%). Asphyxia/suffocation was the major cause of injury with 31.96% of deaths within group <1 year; asphyxia (28.66%) and transport-related injuries (32.27%) were more predominant in the 1-4 age group; transport-related deaths were frequent in the 5-9 age group (45.14%), 10-14 age group (55.68%) and in the group 15-18 age group (51.69%). Regarding times of death, 61% occurred at the scene, 5.6% during pre-hospital care, 26.2% occurred at the hospital within the first 24 h after admission, and the remaining 7.6% of deaths occurred after 24 h after admission to the hospital. When we analyzed the deaths according to the intent, homicides occurred in 16% of cases. Unintentional injuries occurred in 69% of deaths and self-inflicted injuries were identified in 15% cases. CONCLUSIONS Findings show that there was a predominance of deaths in children and adolescents males, between 15 and 18 years old, mainly from road traffic accidents. This study highlights the burden of trauma caused mortalities in children, which requires instant action.
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Carreiro PRL, Drumond DAF, Starling SV, Moritz M, Ladeira RM. Implementation of a trauma registry in a brazilian public hospital: the first 1,000 patients. Rev Col Bras Cir 2014; 41:251-5. [DOI: 10.1590/0100-69912014004005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/12/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: Show the steps of a Trauma Registry (TR) implementation in a Brazilian public hospital and evaluate the initial data from the database.METHODS: Descriptive study of the a TR implementation in João XXIII Hospital (Hospital Foundation of the state of Minas Gerais) and analysis of the initial results of the first 1,000 patients.RESULTS: The project was initiated in 2011 and from January 2013 we began collecting data for the TR. In January 2014 the registration of the first 1000 patients was completed. The greatest difficulties in the TR implementation were obtaining funds to finance the project and the lack of information within the medical records. The variables with the lowest completion percentage on the physiological conditions were: pulse, blood pressure, respiratory rate and Glasgow coma scale. Consequently, the Revised Trauma Score (RTS) could be calculated in only 31% of cases and the TRISS methodology applied to 30.3% of patients. The main epidemiological characteristics showed a predominance of young male victims (84.7%) and the importance of aggression as a cause of injuries in our environment (47.5%), surpassing traffic accidents. The average length of stay was 6 days, and mortality 13.7%.CONCLUSION: Trauma registries are invaluable tools in improving the care of trauma victims. It is necessary to improve the quality of data recorded in medical records. The involvement of public authorities is critical for the successful implementation and maintenance of trauma registries in Brazilian hospitals.
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