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Opiro K, Amone D, Sikoti M, Wokorach A, Okot J, Bongomin F. Prehospital Emergency Care: A Cross-Sectional Survey of First-Aid Preparedness Among Layperson First Responders in Northern Uganda. Open Access Emerg Med 2024; 16:191-202. [PMID: 39050491 PMCID: PMC11268844 DOI: 10.2147/oaem.s464793] [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: 02/19/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024] Open
Abstract
Background Uganda has a high incidence of road traffic accidents and high mortality rates, yet lacks a mature prehospital emergency care system. Our study addresses this gap by assessing the experiences, training, and confidence in providing first aid (FA) among diverse layperson first responders in Northern Uganda, expanding beyond previous research, which was limited to Central Uganda and specific occupational groups. Methods We conducted a cross-sectional survey among layperson first responders of various occupations in Gulu City, Acholi sub-region, Uganda. Data on socio-demographics, training, experiences, knowledge, and confidence in FA were collected. Results We included 396 participants, of whom 81.6% (n=323) were male, 47.0.6% (n=186) were aged 21-30 years, 59.3% (n=235) had obtained a secondary level of education, 23.7% (n=94) were commercial motorcyclists, and 45.7% (n=181) had work experience of >5 years. The majority (85.4%, n=338) had witnessed acute illness/trauma. Accidents/bleeding were the most commonly witnessed cases (68.6%, n=232), followed by burn injuries (10.1%, n=34). Most participants (52.3%, n=207) had attended FA training. Only 20.5% (n=81) had obtained an above-average score (≥70%). The majority (67.9%, n=269) were confident in providing FA. Lack of knowledge and skills (61.4%, n=78), fear of taking health risks (18.9%, n=24), and legal implications (7.1%, n=9) were the major reasons for not being willing to confidently give FA. Factors associated with above-average knowledge were tertiary education and being confident in providing FA, while training in FA and prior experience in giving FA were associated with confidence in giving FA. Conclusion In this study, laypeople in Northern Uganda exhibited a high level of FA training. However, low confidence in providing FA is attributed to inadequate knowledge, fear of health risks, and legal concerns. Therefore, future efforts should focus on assessing FA practices in diverse regions and promoting formal FA training.
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Affiliation(s)
- Keneth Opiro
- Faculty of Medicine, Gulu University, Gulu, Uganda
| | | | - Margret Sikoti
- Department of Nursing, St. Mary’s Hospital Lacor, Gulu, Uganda
| | | | - Jerom Okot
- Faculty of Medicine, Gulu University, Gulu, Uganda
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Haag K, Halligan SL, Hiller R, Skeen S, Tomlinson M. Long-term associations between early attachment and parenting and adolescent susceptibility to post-traumatic distress in a South African high-risk sample. J Child Psychol Psychiatry 2024; 65:921-931. [PMID: 38111273 DOI: 10.1111/jcpp.13930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND It has been proposed that children and young people living in low- and middle-income countries (LMICs) are not only exposed more frequently to trauma but also have a higher likelihood of encountering traumas of greater severity than those living in high-income countries (HICs). This may lead to higher rates of post-traumatic stress symptoms (PTSS). However, developmental pathways to risk or resilience after trauma exposure in LMICs are underresearched. METHODS We examined early parenting and attachment as potentially important formative factors for later stress reactivity in a longitudinal cohort of South African children (N = 449). Parenting and attachment were assessed at child age 18 months, and interpersonal trauma exposure, PTSS and parenting stress were measured at 13 years (N = 333; core sample with data on all measures: N = 213). Following a vulnerability-stress approach, separate regression models were run to investigate whether parent-child attachment at 18 months, parental sensitivity and intrusiveness during play at 12 months, and current parenting stress at 13 years, interacted with adolescents' extent of interpersonal trauma exposure to predict their PTSS levels at 13 years. RESULTS We found no predictive effects of either early attachment or current parenting stress in relation to child PTSS. There was some evidence for predictive influences of parental early intrusiveness and sensitivity on adolescent outcomes, though associations were unexpectedly positive for the latter. No interaction effects supporting a vulnerability-stress model were found. CONCLUSIONS Overall, we found limited evidence that elements of the early parent-child environment predict child risk/resilience to trauma in LMIC children. Future studies should include more frequent assessments of relevant constructs to capture changes over time and consider further what comprises adaptive parenting in high-risk contexts.
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Affiliation(s)
| | - Sarah L Halligan
- Department of Psychology, University of Bath, Bath, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Rachel Hiller
- Department of Psychology, University of Bath, Bath, UK
| | - Sarah Skeen
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Mark Tomlinson
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
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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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Hakimzadeh Z, Vahdati SS, Ala A, Rahmani F, Ghafouri RR, Jaberinezhad M. The predictive value of the Kampala Trauma Score (KTS) in the outcome of multi-traumatic patients compared to the estimated Injury Severity Score (eISS). BMC Emerg Med 2024; 24:82. [PMID: 38745146 PMCID: PMC11094877 DOI: 10.1186/s12873-024-00989-w] [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: 11/16/2023] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
PURPOSE The classification of trauma patients in emergency settings is a constant challenge for physicians. However, the Injury Severity Score (ISS) is widely used in developed countries, it may be difficult to perform it in low- and middle-income countries (LMIC). As a result, the ISS was calculated using an estimated methodology that has been described and validated in a high-income country previously. In addition, a simple scoring tool called the Kampala Trauma Score (KTS) was developed recently. The aim of this study was to compare the diagnostic accuracy of KTS and estimated ISS (eISS) in order to achieve a valid and efficient scoring system in our resource-limited setting. METHODS We conducted a cross-sectional study between December 2020 and March 2021 among the multi-trauma patients who presented at the emergency department of Imam Reza hospital, Tabriz, Iran. After obtaining informed consent, all data including age, sex, mechanism of injury, GCS, KTS, eISS, final outcome (including death, morbidity, or discharge), and length of hospital stay were collected and entered into SPSS version 27.0 and analyzed. RESULTS 381 multi-trauma patients participated in the study. The area under the curve for prediction of mortality (AUC) for KTS was 0.923 (95%CI: 0.888-0.958) and for eISS was 0.910 (95% CI: 0.877-0.944). For the mortality, comparing the AUCs by the Delong test, the difference between areas was not statistically significant (p value = 0.356). The diagnostic odds ratio (DOR) for the prediction of mortality KTS and eISS were 28.27 and 32.00, respectively. CONCLUSION In our study population, the KTS has similar accuracy in predicting the mortality of multi-trauma patients compared to the eISS.
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Affiliation(s)
- Zahra Hakimzadeh
- Emergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Samad Shams Vahdati
- Emergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Ala
- Emergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzad Rahmani
- Emergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rouzbeh Rajaei Ghafouri
- Emergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehran Jaberinezhad
- Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Gupta J, Kshirsagar S, Naik S, Pande A. Comparative Evaluation of Mortality Predictors in Trauma Patients: A Prospective Single-center Observational Study Assessing Injury Severity Score Revised Trauma Score Trauma and Injury Severity Score and Acute Physiology and Chronic Health Evaluation II Scores. Indian J Crit Care Med 2024; 28:475-482. [PMID: 38738209 PMCID: PMC11080098 DOI: 10.5005/jp-journals-10071-24664] [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: 01/01/2024] [Accepted: 02/03/2024] [Indexed: 05/14/2024] Open
Abstract
Aim This prospective cohort study aimed to compare the predictive accuracy of outcome (survival/death) among trauma patients using various prognostic scores. Methods Over 3 months, 240 trauma patients in a tertiary care hospital were assessed for demographic details, trauma characteristics, vital signs, Glasgow coma scale, arterial blood gas values, and lab markers. Injury severity score (ISS), revised trauma score (RTS), trauma and injury severity score (TRISS), and acute physiology and chronic health evaluation II (APACHE II) were applied at admission, 24 hours, and 48 hours post-admission. Results Road traffic accidents (55.83%) were the primary cause of trauma, followed by falls (33.75%) and violence (10.41%). The all-cause mortality rate was 23.33%, with 34.16% requiring ICU admission. Head injuries (65.83%) were both the most frequent injury site and cause of mortality. Conclusion Analysis indicated that APACHE II outperformed other scores in predicting outcomes, with ISS following closely. The study concludes that trauma severity correlates with ICU admission and mortality, emphasizing APACHE II as a superior predictor, particularly for traumatic brain injuries leading to ICU admission and mortality. Clinical significance This study contributes to the existing body of knowledge by addressing the gap in comparing prognostic abilities among scoring systems for trauma patients. The unexpected superiority of APACHE II suggests its potential as a valuable tool in predicting outcomes in this specific patient population. How to cite this article Gupta J, Kshirsagar S, Naik S, Pande A. Comparative Evaluation of Mortality Predictors in Trauma Patients: A Prospective Single-center Observational Study Assessing Injury Severity Score Revised Trauma Score Trauma and Injury Severity Score and Acute Physiology and Chronic Health Evaluation II Scores. Indian J Crit Care Med 2024;28(5):475-482.
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Affiliation(s)
- Janhvi Gupta
- Department of Anaesthesiology, B. J. Govt. Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Sujit Kshirsagar
- Department of Anaesthesiology, B. J. Govt. Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Sanyogita Naik
- Department of Anaesthesiology, B. J. Govt. Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Anandkumar Pande
- Department of Anaesthesiology, B. J. Govt. Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
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Lim HJ, Park JH, Hong KJ, Song KJ, Shin SD. Association between out-of-hospital cardiac arrest quality indicator and prehospital management and clinical outcomes for major trauma. Injury 2024; 55:111437. [PMID: 38403567 DOI: 10.1016/j.injury.2024.111437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/24/2024] [Accepted: 02/13/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION It is unclear whether emergency medical service (EMS) agencies with good out-of-hospital cardiac arrest (OHCA) quality indicators also perform well in treating other emergency conditions. We aimed to evaluate the association of an EMS agency's non-traumatic OHCA quality indicators with prehospital management processes and clinical outcomes of major trauma. METHODS This retrospective cross-sectional study analyzed data from registers of nationwide, population-based OHCA (adult EMS-treated non-traumatic OHCA patients from 2017 to 2018) and major trauma (adult, EMS-treated, and injury severity score ≥16 trauma patients in 2018) in South Korea. We developed a prehospital ROSC prediction model to categorize EMS agencies into quartiles (Q1-Q4) based on the observed-to-expected (O/E) ROSC ratio for each EMS agency. We evaluated the national EMS protocol compliance of on-scene management according to O/E ROSC ratio quartile. The association between O/E ROSC ratio quartiles and trauma-related early mortality was determined in a multi-level logistic regression model by adjusted odds ratios (OR) and 95 % confidence intervals (95 % CI). RESULTS Among 30,034 severe trauma patients, 4,836 were analyzed. Patients in Q4 showed the lowest early mortality rate (5.6 %, 5.5 %, 4.8 %, and 3.4 % in Q1, Q2, Q3, and Q4, respectively). In groups Q1 to Q4, increasing compliance with the national EMS on-scene management protocol (trauma center transport, basic airway management for patients with altered mentality, spinal motion restriction for patients with spinal injury, and intravenous access for patients with hypotension) was observed (p for trend <0.05). Multivariable multi-level logistic regression analysis showed significantly lower early mortality in Q4 than in Q1 (adjusted OR [95 % CI] 0.56 [0.35-0.91]). CONCLUSION Major trauma patients managed by EMS agencies with high success rates in achieving prehospital ROSC in non-traumatic OHCA were more likely to receive protocol-based care and exhibited lower early mortality.
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Affiliation(s)
- Hyouk Jae Lim
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea.
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine and Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, South Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, South Korea
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Laeke T, Tirsit A, Moen BE, Lund-Johansen M, Sundstrøm T. Neurotrauma from fall accidents in Ethiopia. BRAIN & SPINE 2024; 4:102792. [PMID: 38983751 PMCID: PMC11231558 DOI: 10.1016/j.bas.2024.102792] [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: 06/05/2023] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 07/11/2024]
Abstract
Background Ethiopia is a fast-growing economy with rapid urbanization and poor occupational safety measures. Fall injuries are common and frequently result in traumatic brain injury (TBI) or spinal cord injury (SCI). Methods We prospectively included fall victims who were hospital-treated for neurotrauma or forensically examined in 2017 in Addis Ababa, Ethiopia. We registered sociodemographic factors, fall types, injuries, treatment, and outcome. Results We included 117 treated and 51 deceased patients (median age 27 vs. 40 years). Most patients were injured at construction sites (39.9%) and only one in three used protective equipment. TBI (64.7%) and SCI (27.5%) were the most common causes of death among the deceased patients, of which most died at the accident site (90.2%). Many patients suffered significant prehospital time delays (median 24 h). Among treated patients, SCI was more frequent than TBI (50.4% vs. 39.3%), and 10.3% of the patients had both SCI and TBI. Most SCIs were complete (49.3%), whereas most TBIs were mild (55.2%). Less than half of TBI patients and less than one in five SCI patients were operated. There were twice as many deaths among TBI patients as SCI patients. Among those discharged alive, at a median of 33 weeks, 50% of TBI patients had a good recovery whereas 35.5% of SCI patients had complete injuries. Conclusion Falls at construction sites with inadequate safety measures were common causes of SCI and TBI resulting in severe disability and death. These results support further development of prevention strategies and neurotrauma care in Ethiopia.
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Affiliation(s)
- Tsegazeab Laeke
- Neurosurgery Division, Department of Surgery, Addis Ababa University, College of Health Sciences, Ethiopia
- Department of Clinical Medicine, University of Bergen, Norway
| | - Abenezer Tirsit
- Neurosurgery Division, Department of Surgery, Addis Ababa University, College of Health Sciences, Ethiopia
- Department of Clinical Medicine, University of Bergen, Norway
| | - Bente E Moen
- Center for International Health, Department of Global, Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Morten Lund-Johansen
- Department of Clinical Medicine, University of Bergen, Norway
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Terje Sundstrøm
- Department of Clinical Medicine, University of Bergen, Norway
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
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Bhaumik S, Ryder C, Ivers RQ. Strengthening diversity, inclusiveness and justice in the injury community. Inj Prev 2024; 30:3-4. [PMID: 38272703 DOI: 10.1136/ip-2023-045165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 01/27/2024]
Affiliation(s)
- Soumyadeep Bhaumik
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health India, New Delhi, Delhi, India
| | - Courtney Ryder
- Flinders University, Adelaide, South Australia, Australia
| | - Rebecca Q Ivers
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Flinders University, Adelaide, South Australia, Australia
- School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
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Kuhn AW, Landes EK, Yu JK, Inclan PM, Hill JR, Aleem AW. Bilateral Anterior Shoulder Dislocation: A Systematic Review. THE ARCHIVES OF BONE AND JOINT SURGERY 2024; 12:306-327. [PMID: 38817413 PMCID: PMC11134261 DOI: 10.22038/abjs.2024.67743.3211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/07/2024] [Indexed: 06/01/2024]
Abstract
Objectives To compile the existing literature on bilateral anterior shoulder dislocation (BASD) and analyze patient demographics, mechanisms of injury, injury characteristics, management, and outcome. Methods This systematic review was conducted in accordance with Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines. Online databases, including Ovid Medline 1946-, Embase.com 1947-, Scopus 1960-, Cochrane Central, and Clinicaltrials.gov were systematically queried. Studies eligible for inclusion were case reports or case-series, documenting BASD. Two reviewers independently screened and applied a set of a priori exclusion criteria to each returned study. Data were extracted, compiled, and synthesized from each reported case of BASD. Contingency tables/Chi-Square Analyses, T-tests, and univariate regression analyses were conducted to assess relationships between different variables. Results Eighty-one studies (87 cases of BASD) were included. Patients were 41.1 (SD± 19.5) years old and most were male (n=63; 72.4%). Around a quarter of patients (28.7%) had a history of epilepsy/seizures or were being worked-up for such. Younger males were more likely to have BASD due to a seizure or electrocution (P<0.05). Close to a third of cases (n=27; 31.0%) were delayed in presentation. Those sustaining seizures or electrocutions were more likely to be delayed in presentation (P=0.013). Most events resulted in simple dislocations that were closed reduced successfully. BASD resulting from seizures or electrocutions were more likely to be fracture-dislocations (P=0.018); and in younger patients with fracture-dislocations, closed reduction was more often to fail or not be attempted (P<0.05). Median follow-up was 6 months (IQR: 3 months - 12 months). Seven patients (10.6%) had complications and 4 (2.3%) demonstrated recurrent instability. Conclusion In young males presenting with BASD without known trauma, suspicion should be high for a convulsant event. In patients with a known seizure disorder who present with chronic bilateral shoulder or arm pain, BASD should be considered and work-up should be expedited to avoid misdiagnosis.
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Affiliation(s)
- Andrew W. Kuhn
- Department of Orthopaedic Surgery, Washington University in St. Louis, MO, USA
| | - Emma K. Landes
- Washington University School of Medicine, St. Louis, MO, USA
| | - Justin K. Yu
- Washington University School of Medicine, St. Louis, MO, USA
| | - Paul M. Inclan
- Department of Orthopaedic Surgery, Washington University in St. Louis, MO, USA
| | - J. Ryan Hill
- Department of Orthopaedic Surgery, Washington University in St. Louis, MO, USA
| | - Alexander W. Aleem
- Department of Orthopaedic Surgery, Washington University in St. Louis, MO, USA
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Marzaleh MA, Ardakani MSZ. Disasters in pediatric dentistry: a systematic review. BMC Oral Health 2023; 23:984. [PMID: 38066572 PMCID: PMC10709838 DOI: 10.1186/s12903-023-03699-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Disasters can harm many people, especially children, in unpredictable and public ways. One of the neglected aspects of children's health in disasters is oral and dental hygiene, which can affect their physical and mental well-being. This systematic review explores how dentistry can help children in disasters, focusing on two aspects: providing oral health care and identifying disaster victims. METHODS A thorough search of databases, such as PubMed, Cochrane Library, Scopus, Embase, ProQuest, and Web of Science, was done to find English-language publications from 1930 to August 31, 2023. The screening, data collection, and quality assessment followed the PRISMA guidelines. RESULTS Out of 37,795 articles found in the databases, seven research articles were chosen. Five articles were retrospective, and two articles were prospective. The results showed that dentistry for children is very important in disasters by giving information about the oral and dental problems and identifying the victims. The results also showed some of the challenges and difficulties in giving dental care for children in disaster situations, such as changing control, referral systems, and parental fear of infection. CONCLUSION Dentistry for children can improve the health and well-being of children affected by disasters.
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Affiliation(s)
- Milad Ahmadi Marzaleh
- Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Gedeno K, Neme D, Jemal B, Aweke Z, Achule A, Geremu K, Bekele Uddo T. Evidence-based management of adult traumatic brain injury with raised intracranial pressure in intensive critical care unit at resource-limited settings: a literature review. Ann Med Surg (Lond) 2023; 85:5983-6000. [PMID: 38098558 PMCID: PMC10718354 DOI: 10.1097/ms9.0000000000001291] [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: 07/31/2023] [Accepted: 09/02/2023] [Indexed: 12/17/2023] Open
Abstract
Background In underdeveloped countries, there is a greater incidence of mortality and morbidity arising from trauma, with traumatic brain injury (TBI) accounting for 50% of all trauma-related deaths. The occurrence of elevated intracranial pressure (ICP), which is a common pathophysiological phenomenon in cases of TBI, acts as a contributing factor to unfavorable outcomes. The aim of this systematic review is to analyze the existing literature regarding the management of adult TBI with raised ICP in an intensive critical care unit, despite limited resources. Methods This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol. Search engines such as PubMed, the Cochrane database, and Google Scholar were utilized to locate high-level evidence that would facilitate the formation of sound conclusions. Result A total of 11 715 articles were identified and individually assessed to determine their eligibility for inclusion or exclusion based on predetermined criteria and outcome variables. The methodological quality of each study was evaluated using recommended criteria. Ultimately, the review consisted of 51 articles. Conclusion Physical examination results and noninvasive assessments of the optic nerve sheath diameter (ONSD) via sonography are positively associated with elevated ICP, and are employed as diagnostic and monitoring tools for elevated ICP in resource-limited settings. Management of elevated ICP necessitates an algorithmic approach that utilizes prophylactic measures and acute intervention treatments to mitigate the risk of secondary brain injury.
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Affiliation(s)
- Kanbiro Gedeno
- Department of Anesthesia, College of Medicine and Health Science, Arba Minch University, Arba Minch
| | | | | | - Zemedu Aweke
- Department of Anesthesia
- School of Clinical Science, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Astemamagn Achule
- Department of Anesthesia, College of Medicine and Health Science, Arba Minch University, Arba Minch
| | - Kuchulo Geremu
- Department of Anesthesia, College of Medicine and Health Science, Arba Minch University, Arba Minch
| | - Tesfanew Bekele Uddo
- Department of Surgery, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
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Merchant AAH, Shaukat N, Ashraf N, Hassan S, Jarrar Z, Abbasi A, Ahmed T, Atiq H, Khan UR, Khan NU, Mushtaq S, Rasul S, Hyder AA, Razzak J, Haider AH. Which curve is better? A comparative analysis of trauma scoring systems in a South Asian country. Trauma Surg Acute Care Open 2023; 8:e001171. [PMID: 38020857 PMCID: PMC10668242 DOI: 10.1136/tsaco-2023-001171] [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: 05/11/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives A diverse set of trauma scoring systems are used globally to predict outcomes and benchmark trauma systems. There is a significant potential benefit of using these scores in low and middle-income countries (LMICs); however, its standardized use based on type of injury is still limited. Our objective is to compare trauma scoring systems between neurotrauma and polytrauma patients to identify the better predictor of mortality in low-resource settings. Methods Data were extracted from a digital, multicenter trauma registry implemented in South Asia for a secondary analysis. Adult patients (≥18 years) presenting with a traumatic injury from December 2021 to December 2022 were included in this study. Injury Severity Score (ISS), Trauma and Injury Severity Score (TRISS), Revised Trauma Score (RTS), Mechanism/GCS/Age/Pressure score and GCS/Age/Pressure score were calculated for each patient to predict in-hospital mortality. We used receiver operating characteristic curves to derive sensitivity, specificity and area under the curve (AUC) for each score, including Glasgow Coma Scale (GCS). Results The mean age of 2007 patients included in this study was 41.2±17.8 years, with 49.1% patients presenting with neurotrauma. The overall in-hospital mortality rate was 17.2%. GCS and RTS proved to be the best predictors of in-hospital mortality for neurotrauma (AUC: 0.885 and 0.874, respectively), while TRISS and ISS were better predictors for polytrauma patients (AUC: 0.729 and 0.722, respectively). Conclusion Trauma scoring systems show differing predictability for in-hospital mortality depending on the type of trauma. Therefore, it is vital to take into account the region of body injury for provision of quality trauma care. Furthermore, context-specific and injury-specific use of these scores in LMICs can enable strengthening of their trauma systems. Level of evidence Level III.
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Affiliation(s)
| | - Natasha Shaukat
- Centre of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Naela Ashraf
- Centre of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Sheza Hassan
- Centre of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Zeerak Jarrar
- Department of Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Ayesha Abbasi
- Centre of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Tanveer Ahmed
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Sindh, Pakistan
| | - Huba Atiq
- Centre of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Sindh, Pakistan
- Department of Emergency Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Uzma Rahim Khan
- Department of Emergency Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Nadeem Ullah Khan
- Department of Emergency Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Saima Mushtaq
- Department of Emergency Medicine, Jinnah Postgraduate Medical Centre, Karachi, Sindh, Pakistan
| | - Shahid Rasul
- Department of Surgery, Jinnah Postgraduate Medical Centre, Karachi, Sindh, Pakistan
| | - Adnan A Hyder
- Center on Commercial Determinants of Health and Department of Global Health, George Washington University School of Public Health and Health Services, Washington, DC, USA
| | - Junaid Razzak
- Centre of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Sindh, Pakistan
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Adil H. Haider
- Dean's Office, The Aga Khan University, Karachi, Sindh, Pakistan
- Department of Surgery and Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
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13
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Tupper H, Oke R, Juillard C, Dissak-DeLon F, Chichom-Mefire A, Mbianyor MA, Etoundi-Mballa GA, Kinge T, Njock LR, Nkusu DN, Tsiagadigui JG, Carvalho M, Yost M, Christie SA. The CBS test: Development, evaluation & cross-validation of a community-based injury severity scoring system in Cameroon. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002110. [PMID: 37494346 PMCID: PMC10370767 DOI: 10.1371/journal.pgph.0002110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/06/2023] [Indexed: 07/28/2023]
Abstract
Injury-related deaths overwhelmingly occur in low and middle-income countries (LMICs). Community-based injury surveillance is essential to accurately capture trauma epidemiology in LMICs, where one-third of injured individuals never present to formal care. However, community-based studies are constrained by the lack of a validated surrogate injury severity metric. The primary objective of this bipartite study was to cross-validate a novel community-based injury severity (CBS) scoring system with previously-validated injury severity metrics using multi-center trauma registry data. A set of targeted questions to ascertain injury severity in non-medical settings-the CBS test-was iteratively developed with Cameroonian physicians and laypeople. The CBS test was first evaluated in the community-setting in a large household-based injury surveillance survey in southwest Cameroon. The CBS test was subsequently incorporated into the Cameroon Trauma Registry, a prospective multi-site national hospital-based trauma registry, and cross-validated in the hospital setting using objective injury metrics in patients presenting to four trauma hospitals. Among 8065 surveyed household members with 503 injury events, individuals with CBS indicators (CBS+) were more likely to report ongoing disability after injury compared to CBS- individuals (OR 1.9, p = 0.004), suggesting the CBS test is a promising injury severity proxy. In 9575 injured patients presenting for formal evaluation, the CBS test strongly predicted death in patients after controlling for age, sex, socioeconomic status, and injury type (OR 30.26, p<0.0001). Compared to established injury severity scoring systems, the CBS test comparably predicts mortality (AUC: 0.8029), but is more feasible to calculate in both the community and clinical contexts. The CBS test is a simple, valid surrogate metric of injury severity that can be deployed widely in community-based surveys to improve estimates of injury severity in under-resourced settings.
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Affiliation(s)
- Haley Tupper
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
| | - Rasheedat Oke
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
| | - Catherine Juillard
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
| | | | | | - Mbiarikai Agbor Mbianyor
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
| | | | - Thompson Kinge
- Hospital Administration, The Limbe Regional Hospital, Lime, Cameroon
| | - Louis Richard Njock
- Hospital Administration, The Laquintinie Hospital of Douala, Douala, Cameroon
| | - Daniel N Nkusu
- Hospital Administration, The Catholic Hospital of Pouma, Pouma, Cameroon
| | | | - Melissa Carvalho
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
| | - Mark Yost
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
| | - S Ariane Christie
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
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Hashmi MM, Akram MR, Naumeri F, Akram MF. Health Related Quality of Life (HRQOL) in pediatric population after surgical intervention in traumatic lower limb injuries: A prospective cohort. Pak J Med Sci 2023; 39:1134-1139. [PMID: 37492286 PMCID: PMC10364251 DOI: 10.12669/pjms.39.4.7128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 04/06/2023] [Accepted: 04/18/2023] [Indexed: 07/27/2023] Open
Abstract
Objective To assess health related quality of life (HRQOL) of children who had undergone surgical intervention after lower limb trauma. Methods A prospective observational study was conducted at KEMU and UCHS, from September 2021 to June 2022. Fifty children aged 5 to 12 years who had undergone surgical intervention for lower limb trauma were included. Patients whose parents couldn't understand Urdu or English, or with polytrauma, needing amputation and/or comorbidities were excluded. Another fifty-school going, age matched children were enrolled as controls. After informed consent, two responses from participants and parents on PedsQL questionnaires were recorded, first one week after discharge and second after six months, assessing age specific quality of life in four domains (physical, emotional, social, school). Impaired HRQOL was defined as a score that was more than 1SD below the mean of healthy sample. Results Baseline HRQOL scores were significantly lower in patients and parents reported data taken at one week, overall difference of 39.13 in total HRQOL scores (effect size, d 2.76). Difference of 39.86 was observed between baseline and follow-up data taken from parents with the highest effect size (d=3.34) in physical functioning scores. There was a significant difference of 10.07 between the total HRQOL scores of patients on follow up and controls, and HRQOL patients' scores were higher than controls across all domains. Parent reported scores were less than those reported by children in almost all cases. Conclusion HRQOL of children at discharge after management of lower limb trauma was lower than age-matched control group. It, however, significantly exceeded controls' scores after six months showing complete recovery.
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Affiliation(s)
| | | | - Fatima Naumeri
- Fatima Naumeri, MCPS, FCPS, CME. Department of Pediatric Surgery, Services Institute of Medical Sciences/Services Hospital. Lahore, Pakistan
| | - Muhammad Faizan Akram
- Muhammad Faizan Akram, MBSS. Pediatric and Neonatal Medicine Department, Manawan Hospital, Lahore, Pakistan
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15
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Howard A, Bolton W, Wood A, Hodgson H, Scott J, Jayne D, Bundu I. There is a great variety of orthopaedic conditions presenting to a large hospital in Sierra Leone: a 3-year prospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:581-585. [PMID: 36241914 PMCID: PMC10036420 DOI: 10.1007/s00590-022-03380-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/28/2022] [Indexed: 03/25/2023]
Abstract
PURPOSE In Sierra Leone there is a large void in orthopaedic research into the type of orthopaedic injuries, both acute and chronic. Improved data collection is essential in providing insight to guide health care planning and research. This study aims to outline the types of orthopaedic injury sustained. METHOD Data were prospectively collected by local surgeons in the Orthopaedic outpatient department at a large hospital between January 2016 and January 2019. RESULTS The orthopaedic department saw a mean 728 patients per year, with mean age 24.0 years. The workload comprised of 64.92% acute orthopaedic conditions or their complications, with 35.08% elective orthopaedics. Fractures made up the largest proportion of clinical appointments, annually 244.33 fractures; however there was a high incidence of osteomyelitis. CONCLUSION The study gives an important insight into the types and distribution of elective and trauma orthopaedic injuries sustained in Sierra Leone, which has not been previously reported, and highlights key areas where resources may be focused in order to improve clinical outcomes.
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Affiliation(s)
- Anthony Howard
- NDORMS, Oxford University, Oxford, UK.
- LIRMM, Academic Department, Leeds General Infirmary, University of Leeds, Leeds, UK.
| | - William Bolton
- Leeds Institute of Medical Research, St James, University of Leeds, Leeds, UK
| | | | - Harry Hodgson
- LIRMM, Academic Department, Leeds General Infirmary, University of Leeds, Leeds, UK
| | - Julian Scott
- Vascular Institute, Leeds General Infirmary, Leeds, UK
| | - David Jayne
- Leeds Institute of Medical Research, St James, University of Leeds, Leeds, UK
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16
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Song J, Shin SD, Jamaluddin SF, Chiang WC, Tanaka H, Song KJ, Ahn S, Park JH, Kim J, Cho HJ, Moon S, Jeon ET. Prediction of Mortality among Patients with Isolated Traumatic Brain Injury Using Machine Learning Models in Asian Countries: An International Multi-Center Cohort Study. J Neurotrauma 2023. [PMID: 36656672 DOI: 10.1089/neu.2022.0280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Traumatic brain injury (TBI) is a significant healthcare concern in several countries, accounting for a major burden of morbidity, mortality, disability, and socioeconomic losses. Although conventional prognostic models for patients with TBI have been validated, their performance has been limited. Therefore, we aimed to construct machine learning (ML) models to predict the clinical outcomes in adult patients with isolated TBI in Asian countries. The Pan-Asian Trauma Outcome Study registry was used in this study, and the data were prospectively collected from January 1, 2015, to December 31, 2020. Among a total of 6540 patients (≥ 15 years) with isolated moderate and severe TBI, 3276 (50.1%) patients were randomly included with stratification by outcomes and subgrouping variables for model evaluation, and 3264 (49.9%) patients were included for model training and validation. Logistic regression was considered as a baseline, and ML models were constructed and evaluated using the area under the precision-recall curve (AUPRC) as the primary outcome metric, area under the receiver operating characteristic curve (AUROC), and precision at fixed levels of recall. The contribution of the variables to the model prediction was measured using the SHapley Additive exPlanations (SHAP) method. The ML models outperformed logistic regression in predicting the in-hospital mortality. Among the tested models, the gradient-boosted decision tree showed the best performance (AUPRC, 0.746 [0.700-0.789]; AUROC, 0.940 [0.929-0.952]). The most powerful contributors to model prediction were the Glasgow Coma Scale, O2 saturation, transfusion, systolic and diastolic blood pressure, body temperature, and age. Our study suggests that ML techniques might perform better than conventional multi-variate models in predicting the outcomes among adult patients with isolated moderate and severe TBI.
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Affiliation(s)
- Juhyun Song
- Department of Emergency Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Hideharu Tanaka
- Graduate School of Emergency Medical Service System, Kokushikan University, Tokyo, Japan
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sejoong Ahn
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Jong-Hak Park
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Jooyeong Kim
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Han-Jin Cho
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Sungwoo Moon
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Eun-Tae Jeon
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
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17
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Choudhary SK, Sharma A. Comparative Study of Cerebral Perfusion in Different Types of Decompressive Surgery for Traumatic Brain Injury. INDIAN JOURNAL OF NEUROTRAUMA 2023. [DOI: 10.1055/s-0043-1760727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Abstract
Introduction Computed tomography perfusion (CTP) brain usefulness in the treatment of traumatic brain injury (TBI) is still being investigated. Comparative research of CTP in the various forms of decompressive surgery has not yet been reported to our knowledge. Patients with TBI who underwent decompressive surgery were studied using pre- and postoperative CTP. CTP findings were compared with patient's outcome.
Materials and Methods This was a single-center, prospective cohort study. A prospective analysis of patients who were investigated with CTP from admission between 2019 and 2021 was undertaken. The patients in whom decompressive surgery was required for TBI, were included in our study after applying inclusion and exclusion criteria. CTP imaging was performed preoperatively and 5 days after decompressive surgery to measure cerebral perfusion. Numbers of cases included in the study were 75. Statistical analysis was done.
Results In our study, cerebral perfusion were improved postoperatively in the all types of decompressive surgery (p-value < 0.05). But association between type of surgery with improvement in cerebral perfusion, Glasgow Coma Scale at discharge, and Glasgow Outcome Scale-extended at 3 months were found to be statistically insignificant (p-value > 0.05).
Conclusion CTP brain may play a role as a prognostic tool in TBI patients undergoing decompressive surgery.
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Affiliation(s)
- Suresh Kumar Choudhary
- Department of Neurosurgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Achal Sharma
- Department of Neurosurgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
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Sayyari Y, Kardar MH, Sadeghian F, Mirrezaie SM. The impact of socioeconomic status on hand injury severity. HAND SURGERY & REHABILITATION 2022; 41:695-700. [PMID: 36089214 DOI: 10.1016/j.hansur.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/28/2022] [Accepted: 08/31/2022] [Indexed: 01/04/2023]
Abstract
Socioeconomic status (SES) is an important factor affecting different aspects of human health, including self-care and healthcare service use. The relation between SES and hand injury severity is not well defined; therefore, the present study aimed to investigate the relation between SES and hand injury severity. This cross-sectional descriptive and analytical study included 215 patients with hand injury. Demographic, clinical, and SES-related factors were collected by questionnaire. Injury severity was assessed on Hand Injury Severity Score (HISS). Statistical analysis used the Student t-test, chi-square test and a multinomial regression model to calculate the odds ratio (OR) of each predictive factor. Mean age was 38.02 ± 13.49 years (range, 12-80 years). 73.5% of the participants were men. Patients with low SES were significantly more likely to develop severe hand injury (OR = 5.25 and 9.25 at HISS levels 3 and 4, respectively). In addition, there was a significant association between being born in rural areas and severe (HISS level 3, OR = 2.63) or major (HISS level 4, OR = 2.63) hand injury. Also, major (HISS level 4) hand injuries were significantly more prevalent in patients living in rural areas (OR = 4.23) and those injured in road accidents (OR = 1.98) or practicing sports (OR = 3.51). The study concluded that patients with low SES were 5-10-fold more likely to suffer from severe and major hand injuries, and thus provided valuable information for Iranian policymakers to take preventive measures for hand injuries. It is recommended to improve postoperative care in patients with low SES who underwent hand surgery, take the necessary measures to decrease the incidence of road accident injuries, facilitate early referral of patients with hand injury to trauma centers, and improve postoperative follow-up until full recovery. LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Y Sayyari
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, 7 Tir SQ, 36147-73943 Shahroud, Iran
| | - M H Kardar
- School of Medicine, Shahroud University of Medical Sciences, Plastic Reconstructive & Hand Surgery, 7 Tir SQ, 36147-73943 Shahroud, Iran
| | - F Sadeghian
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, 7 Tir SQ, 36147-73943 Shahroud, Iran
| | - S M Mirrezaie
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, 7 Tir SQ, 36147-73943 Shahroud, Iran; Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Ayatollah Tawhidi Street, 36169-51835 Shahroud, Iran.
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Orthopaedic injury patterns at a tertiary referral hospital in Ethiopia: a prospective observational study. Injury 2022; 53:3195-3200. [PMID: 35803745 DOI: 10.1016/j.injury.2022.06.047] [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] [Received: 06/16/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study aimed to identify the composition of orthopaedic injuries in Ethiopia. BACKGROUND Injuries are among the most common causes of death worldwide. This is especially true in developing countries, which lag in preventive efforts and have inadequate resources to treat injuries efficiently. As a result, understanding the trauma burden is crucial for future prevention and treatment accessibility initiatives. METHODS We conducted an observational study using prospectively collected emergency orthopaedic trauma data between January 2018 and December 2021 from Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. The incidence of all fractures, demographic data, trauma mechanisms, and injury types were examined by stratifying cases based on patients presenting from Addis Ababa, the capital city, or outside of Addis Ababa. These groups were chosen to account for the demographic differences that exist between individuals living in the capital city and other regions. RESULTS Our study included 4712 patients with similar distribution from Addis Ababa and outside of Addis. Overall, 70% were between 18 to 55 (median 30). Road traffic incidents accounted for the most overall injuries (41%), including 130 motorcycle injuries (2.8%), while falls were the predominant mechanism (51.3%) for patients from Addis. Injuries of the lower limb accounted for 66% of injuries (n=4262/6412), the femur being the most affected (22%), followed by the pelvis and acetabulum (16%). One-quarter presented with open fractures and another quarter had multiple injuries. Multivariate analysis further demonstrated patients outside of Addis were 37% more likely to have multiple fractures and 69% more likely to have open fractures. CONCLUSION Future directives should focus on preventive measures and address the management of complex injuries to overcome trauma injuries' health and economic impacts. The initiatives shall focus on the varying primary mechanisms of injury for the different population groups in the capital city and in rural regions outside of the capital city.
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Smith BG, Tumpa S, Mantle O, Whiffin CJ, Mee H, Solla DJF, Paiva WS, Newcombe VF, Kolias AG, Hutchinson PJ. Remote Follow-Up Technologies in Traumatic Brain Injury: A Scoping Review. J Neurotrauma 2022; 39:1289-1317. [PMID: 35730115 PMCID: PMC9529313 DOI: 10.1089/neu.2022.0138] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traumatic brain injury (TBI) remains a leading cause of death and disability worldwide. Motivations for outcome data collection in TBI are threefold: to improve patient outcomes, to facilitate research, and to provide the means and methods for wider injury surveillance. Such data play a pivotal role in population health, and ways to increase the reliability of data collection following TBI should be pursued. As a result, technology-aided follow-up of patients with neurotrauma is on the rise; there is, therefore, a need to describe how such technologies have been used. A scoping review was conducted and reported using the PRISMA extension (PRISMA-ScR). Five electronic databases (Embase, MEDLINE, Global Health, PsycInfo, and Scopus) were searched systematically using keywords derived from the concepts of "telemedicine," "TBI," "outcome assessment," and "patient-generated health data." Forty studies described follow-up technologies (FUTs) utilizing telephones (52.5%, n = 21), short message service (SMS; 10%, n = 4), smartphones (22.5%, n = 9), videoconferencing (10%, n = 4), digital assistants (2.5%, n = 1), and custom devices (2.5%, n = 1) among cohorts of patients with TBI of varying injury severity. Where reported, clinical facilitators, remote follow-up timing and intervals between sessions, synchronicity of follow-up instances, proxy involvement, outcome measures utilized, and technology evaluation efforts are described. FUTs can aid more temporally sensitive assessments and capture fluctuating sequelae, a benefit of particular relevance to TBI cohorts. However, the evidence base surrounding FUTs remains in its infancy, particularly with respect to large samples, low- and middle-income patient cohorts, and the validation of outcome measures for deployment via such remote technology.
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Affiliation(s)
- Brandon G. Smith
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Stasa Tumpa
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Orla Mantle
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - Charlotte J. Whiffin
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- College of Health, Psychology and Social Care, University of Derby, Derby, United Kingdom
| | - Harry Mee
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
- Division of Rehabilitation Medicine, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Davi J. Fontoura Solla
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Wellingson S. Paiva
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | | | - Angelos G. Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Peter J. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, United Kingdom
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
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Moussally J, Saha AC, Madden S. TraumaLink: A Community-Based First-Responder System for Traffic Injury Victims in Bangladesh. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100537. [PMID: 36041838 PMCID: PMC9426980 DOI: 10.9745/ghsp-d-21-00537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 06/01/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Road traffic injuries are a rapidly growing epidemic in low- and middle-income countries (LMICs). However, many countries lack formal prehospital emergency medical services, often leaving victims without access to first aid when it can be most effective in preventing death or disability. METHODS To address the lack of a dedicated prehospital emergency medical system in Bangladesh, we developed TraumaLink, a community-based network of volunteer first responders for traffic injury victims. The service uses an emergency hotline number and 24-hour call center with local first responders who are trained in basic trauma first aid, given essential medical supplies, and dispatched to crash scenes through mobile phone text message notifications. We designed the training curriculum to teach simple lifesaving skills that people with any level of education and no prior medical background could learn and perform. We retrospectively analyzed data originally collected for quality monitoring and evaluation to provide a descriptive analysis of the program's impact. RESULTS During the first 6 years, operations were expanded from a 14-km section of 1 highway to 135 km on 3 national highways, and free care was provided to 3,119 patients involved in 1,544 crashes. All calls to the service received a response, and in 88% of cases, first responders were at the scene in 5 minutes or less. Most patients were young adult men, and 76% of victims transported to the hospital arrived there within 30 minutes of the crash. Assessments of injury severity at the accident scene aligned closely with patient dispositions, reflecting the accuracy of these triage decisions. CONCLUSION The strong community support and rapid, reliable volunteer responses suggest that this flexible and scalable model could be expanded throughout Bangladesh and adapted for other LMICs that face similar challenges with traffic injury victims.
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Affiliation(s)
- Jon Moussally
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, MA, USA.
- TraumaLink, Dhaka, Bangladesh
| | | | - Susan Madden
- Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, MA, USA
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Guimaraes KAA, Costa MGF, Amorim RL, Filho CFFC. Comparing Prediction of Early TBI Mortality with Multilayer Perceptron Neural Network and Convolutional Neural Network. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:4457-4460. [PMID: 36085670 DOI: 10.1109/embc48229.2022.9871857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In this work, we compare the performance of a multilayer perceptron neural network and convolutional networks for the prediction of 14-day mortality in patients with TBI, using a database obtained in a low-and middle-income country, with 529 records and 16 predictor variables. The missing values of several variables were filled in with techniques such as decision tree, random forest, k-nearest-neighbor and linear regression. In the simulation of neural networks, several optimization methods were used, such as RMSProp, Adam, Adamax and SGDM. The best results obtained for the prediction rate were an accuracy of 0.845 and an area under the ROC curve of 0.911. Clinical Relevance- This proposes the prediction of early mortality in patients with TBI with an area under ROC curve of 0.911.
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Fonseca J, Liu X, Oliveira HP, Pereira T. Learning Models for Traumatic Brain Injury Mortality Prediction on Pediatric Electronic Health Records. Front Neurol 2022; 13:859068. [PMID: 35756926 PMCID: PMC9226580 DOI: 10.3389/fneur.2022.859068] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background Traumatic Brain Injury (TBI) is one of the leading causes of injury related mortality in the world, with severe cases reaching mortality rates of 30-40%. It is highly heterogeneous both in causes and consequences, complicating medical interpretation and prognosis. Gathering clinical, demographic, and laboratory data to perform a prognosis requires time and skill in several clinical specialties. Machine learning (ML) methods can take advantage of the data and guide physicians toward a better prognosis and, consequently, better healthcare. The objective of this study was to develop and test a wide range of machine learning models and evaluate their capability of predicting mortality of TBI, at hospital discharge, while assessing the similarity between the predictive value of the data and clinical significance. Methods The used dataset is the Hackathon Pediatric Traumatic Brain Injury (HPTBI) dataset, composed of electronic health records containing clinical annotations and demographic data of 300 patients. Four different classification models were tested, either with or without feature selection. For each combination of the classification model and feature selection method, the area under the receiver operator curve (ROC-AUC), balanced accuracy, precision, and recall were calculated. Results Methods based on decision trees perform better when using all features (Random Forest, AUC = 0.86 and XGBoost, AUC = 0.91) but other models require prior feature selection to obtain the best results (k-Nearest Neighbors, AUC = 0.90 and Artificial Neural Networks, AUC = 0.84). Additionally, Random Forest and XGBoost allow assessing the feature's importance, which could give insights for future strategies on the clinical routine. Conclusion Predictive capability depends greatly on the combination of model and feature selection methods used but, overall, ML models showed a very good performance in mortality prediction for TBI. The feature importance results indicate that predictive value is not directly related to clinical significance.
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Affiliation(s)
- João Fonseca
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal
| | - Xiuyun Liu
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Hélder P Oliveira
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal.,Faculty of Science, University of Porto, Porto, Portugal
| | - Tania Pereira
- Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal
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Baiden F, Anto-Ocrah M, Adjei G, Gyaase S, Abebrese J, Punguyire D, Owusu-Agyei S, Moresky RT. Head Injury Prevalence in a Population of Injured Patients Seeking Care in Ghana, West Africa. Front Neurol 2022; 13:917294. [PMID: 35812104 PMCID: PMC9266767 DOI: 10.3389/fneur.2022.917294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background/Significance: Much of the literature on head injury (HI) prevalence comes from high-income countries (HICs), despite the disproportionate burden of injuries in low to middle-income countries (LMICs). This study evaluated the HI prevalence in the Kintampo Injury Registry, a collaborative effort between Kintampo Health Research Centre (KHRC) in Ghana and the sidHARTe Program at Columbia University Mailman School of Public Health. In our first aim, we characterize the HI prevalence in the registry. In aim 2, we examine if there are any sex (male/female) differences in head injury outcomes in these populations for points of potential intervention. Methods Secondary analysis of data from the Kintampo Injury Registry which had 7,148 registered patients collected during January 2013 to January 2015. The definition of a case was adopted to ensure consistency with the International Statistical Classification of Diseases and Related Health Problems, revision 10 (ICD-10). A 3-page questionnaire was used to collect data from injured patients to include in the registry. The questions were designed to be consistent with the World Health Organization (WHO) guidelines on injury surveillance and were adapted from the questionnaire used in a pilot, multi-country injury study undertaken in other parts of Africa. The questionnaire collected information on the anatomic site of injury (e.g., head), mechanism of injury (e.g., road traffic injuries, interpersonal injuries (including domestic violence), falls, drowning, etc.), severity and circumstances of the injury, as well as precipitating factors, such as alcohol and drug use. The questionnaire consisted mainly of close-ended questions and was designed for efficient data entry. For the secondary data analyses for this manuscript, we only included those with “1st visit following injury” and excluded all transfers and follow-up visits (n = 834). We then dichotomized the remaining 6,314 patients to head injured and non-head injured patients based on responses to the variable “Nature of injury =Head Injury”. We used chi-square and Fisher's exact tests with p < 0.05 as cut-off for statistical significance. Logistic regression estimates were used for effect estimates. Results Of the 6,314 patients, there were 208 (3.3%) head-injured patients and 6,106 (96.7%) patients without head injury. Head-injured patients tended to be older (Mean age: 28.9 +/-13.7; vs. 26.1 +/- 15.8; p = 0.004). Seven in 10 head injured patients sustained their injuries via transport/road traffic accidents, and head-injured patients had 13 times the odds of mortality compared with those without head injuries (OR: 13.3; 95% CI: 8.05, 22.0; p < 0.0001) even though over half of them had mild or moderate injury severity scores (p < 0.001). Evaluation of sex differences amongst the head-injured showed that in age-adjusted logistic regression models, males had 1.4 times greater odds of being head injured (OR: 1.4; 95% CI: 1.04, 2.00; p = 0.03) and over twice the risk of mortality (OR: 2.7; 95% CI: 0.74, 10.00; p = 0.13) compared to females. Conclusion In these analyses, HI was associated with a higher risk of mortality, particularly amongst injured males; most of whom were injured in transport/road-traffic-related accidents. This study provides an impetus for shaping policy around head injury prevention in LMICs like Ghana.
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Affiliation(s)
- Frank Baiden
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Martina Anto-Ocrah
- Department of Medicine, Division of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- *Correspondence: Martina Anto-Ocrah
| | - George Adjei
- Department of Community Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Stephaney Gyaase
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Jacob Abebrese
- Institutional Care Division, Ghana Health Service, Accra, Ghana
| | - Damien Punguyire
- Upper West Regional Health Directorate, Ghana Health Service, Wa, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Rachel T. Moresky
- SidHARTe-Strengthening Emergency Systems Program, Heilbrunn Department of Population and Family Health Columbia University, Mailman School of Public Health, New York, NY, United States
- Department of Emergency Medicine Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, United States
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Chkhaberidze N, Burkadze E, Axobadze K, Pitskhelauri N, Kereselidze M, Chikhladze N, Coman MA, Peek-Asa C. Epidemiological characteristics of injury in Georgia: A one-year retrospective study. Injury 2022; 53:1911-1919. [PMID: 35305804 PMCID: PMC9167710 DOI: 10.1016/j.injury.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/15/2022] [Accepted: 03/05/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Injury is a major health problem worldwide and a leading cause of death and disability. Disability caused by traumatic injury is often severe and long-lasting. Injuries place a large burden on societies and individuals in the community, both in cost and lost quality of life. Progress in developing effective injury prevention programs in developing countries is hindered by the lack of basic epidemiological injury data regarding the prevalence of traumatic injuries. The aim of this research was to describe the epidemiological characteristics of injury in all hospitals in Georgia. METHODS The database of the National Center for Disease Control and Public Health of Georgia for 2018, which includes all hospital admissions, was used to identify injury cases treated in hospitals. Cases were included based on the S and T diagnosis coded of ICD-10. RESULTS A total of 25,103 adult patients were admitted for an injury, of whom 14,798 (59%) were males and 10,305 (41%) were females, between the ages of 18 and 108 years old. The highest prevalence was among the age group 25-44 years old (n = 8654; 34%), followed by 45-64 years old (n = 6852; 27%). The main mechanism of injury was falls (n = 13,932; 55%) and exposure to mechanical forces (n = 2701; 11%). Over 1,50% (n = 379) of injuries resulted in death after hospitalization. The median hospital length of stay (LOS) was 2 days. There was a significant association between age, mechanism of injury, type of injury, performed surgical interventions, and longer LOS. CONCLUSION Injuries are prevalent throughout the life course and cause substantial hospitalization time. This research can help focus prevention efforts can focus on the demographic and injury causes that are most prevalent.
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Affiliation(s)
- Nino Chkhaberidze
- Ivane Javakhishvili Tbilisi State University, Faculty of Medicine, 1 Ilia Chavchavadze Avenue, Tbilisi 0179, Georgia; National Center for Disease Control and Public Health, Kakheti Highway 99, Tbilisi 0198, Georgia.
| | - Eka Burkadze
- Ivane Javakhishvili Tbilisi State University, Faculty of Medicine, 1 Ilia Chavchavadze Avenue, Tbilisi 0179, Georgia
| | - Ketevan Axobadze
- Ivane Javakhishvili Tbilisi State University, Faculty of Medicine, 1 Ilia Chavchavadze Avenue, Tbilisi 0179, Georgia
| | - Nato Pitskhelauri
- Ivane Javakhishvili Tbilisi State University, Faculty of Medicine, 1 Ilia Chavchavadze Avenue, Tbilisi 0179, Georgia
| | - Maia Kereselidze
- National Center for Disease Control and Public Health, Kakheti Highway 99, Tbilisi 0198, Georgia
| | - Nino Chikhladze
- Ivane Javakhishvili Tbilisi State University, Faculty of Medicine, 1 Ilia Chavchavadze Avenue, Tbilisi 0179, Georgia
| | - Madalina Adina Coman
- Babes-Bolyai University, College of Political, Administrative and Communication Sciences, Department of Public Health, Pandurilor 7, 400376, Cluj-Napoca, Romania
| | - Corinne Peek-Asa
- Department of Occupational and Environmental Health, University of Iowa, College of Public Health, Iowa City, IA 52246, USA
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Designing a Driver’s Hazard Perception Test Based on the Neural Brain Images Analysis (fMRI). HEALTH SCOPE 2022. [DOI: 10.5812/jhealthscope-121471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Studies show that weakness in hazard perception is a major cause of traffic accidents, leading to high consequences. Objectives: This study aimed to design a valid and reliable driver’s Hazard Perception Test (HPT) based on neural imaging, reaction time, and miss rate in two groups of experienced and inexperienced drivers. Methods: Different roads, including urban, intercity, and rural, were filmed from drivers’ visual angles to examine the real road conditions. All videos were screened according to some quality factors. Then, hazard onset was determined for screened videos. The validity of the test was performed in three steps. Miss rates and reaction times to hazardous situations were measured. In the second step, 35 selected videos were broadcasted to 16 experienced and 16 novice drivers on a functional magnetic resonance imaging (fMRI). Finally, using 18 videos with statistically significant differences in neuro-cerebral neuronal activity, miss rate and reaction time were picked up for driver’s HPT. Results: The mean differences in reaction time, miss rate, and active neurons in the task of perceiving hazards in two groups of drivers were equal to 1.58 seconds, 29.55%, and 5248 neurons, respectively. There was a significant correlation between active neurons and miss rate (r = 0.556, P < 0.001). Eventually, the 18-videos of the valid test became HPT software. Conclusions: Application of this valid test is suggested for assessing the hazard perception of drivers, particularly those who are responsible for transporting staff and goods in the studied country.
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Juengst SB, Perrin PB, Klyce DW, O’Neil-Pirozzi TM, Herrera S, Wright B, Lengenfelder J, Lercher K, Callender L, Arango-Lasprilla JC. Caregiver Characteristics of Adults with Acute Traumatic Brain Injury in the United States and Latin America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5717. [PMID: 35565112 PMCID: PMC9102876 DOI: 10.3390/ijerph19095717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 12/04/2022]
Abstract
Objectives: To compare characteristics of caregivers of adults with acute traumatic brain injury (TBI) in the U.S. and Latin America (Mexico and Colombia). Design: Secondary data analysis of two cohorts. Cohort 1: English-speaking caregivers of adults with TBI in the U.S. (n = 80). Cohort 2: Spanish-speaking caregivers of adults with TBI in Mexico or Colombia (n = 109). Results: Similarities between the U.S. and Latin American caregiver groups, respectively, were: predominantly women (81.3%, 81.7%, respectively); spouses/domestic partners (45%, 31.2%); and motor vehicle accident (41.5%, 48.6%) followed by fall etiologies (40%, 21.1%). Differences between U.S. and Latin American caregivers were: age (49.5 years, 41.5 years, p < 0.001); employment status ((Χ52 = 59.63, p < 0.001), full-time employment (63.7%, 25.7%), homemaker (2.5%, 31.2%), and retired (17.5%, 1.8%)); violence-related etiology (2.5%, 15.6%); and severity of depressive symptoms (M = 7.9, SD = 5.8; M = 5.8, SD = 5.7; p = 0.014). Conclusions: TBI caregivers in the U.S. were older and employed full-time or retired more often than those in Latin America. Violence-related etiology was nearly five times more common in Latin America, raising concerns for potential implications of post-traumatic stress and family adjustment after injury. Although both groups likely could use mental health support, this was particularly true of the U.S. cohort, maybe due to differential demographics, mechanisms of injury, or family and community support.
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Affiliation(s)
- Shannon B. Juengst
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.H.); (B.W.)
- TIRR Memorial Hermann Brain Injury Research Center, Houston, TX 77030, USA
- Department of Physical Medicine & Rehabilitation, UT Health Sciences Center at Houston, Houston, TX 77030, USA
| | - Paul B. Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA;
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23284, USA
- Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA;
| | - Daniel W. Klyce
- Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA;
- Virginia Commonwealth University Health System, Richmond, VA 23284, USA
- Sheltering Arms Institute, Richmond, VA 23233, USA
| | - Therese M. O’Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA 02129, USA;
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA 02115, USA
| | - Susan Herrera
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.H.); (B.W.)
| | - Brittany Wright
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.H.); (B.W.)
| | - Jean Lengenfelder
- Department of Physical Medicine & Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ 07101, USA;
- Kessler Foundation, East Hanover, NJ 07936, USA
| | - Kirk Lercher
- Department of Physical Medicine & Rehabilitation, JFK Johnson Rehabilitation Institute, Hackensack Meridian Health, Edison, NJ 08820, USA;
| | - Librada Callender
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX 75246, USA;
| | - Juan Carlos Arango-Lasprilla
- BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain;
- IKERBASQUE, Basque Foundation for Science, 48009 Bilbao, Spain
- Department of Cell Biology and Histology, University of the Basque Country, 48940 Leioa, Spain
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Management of soft-tissue coverage of open tibia fractures in Latin America: Techniques, timing, and resources. Injury 2022; 53:1422-1429. [PMID: 35101259 DOI: 10.1016/j.injury.2022.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE This study examined soft-tissue coverage techniques of open tibia fractures, described soft-tissue treatment patterns across income groups, and determined resource accessibility and availability in Latin America. METHODS A 36-question survey was distributed to orthopaedic surgeons in Latin America through two networks: national orthopaedic societies and the Asociación de Cirujanos Traumatólogos de las Américas (ACTUAR). Demographic information was collected, and responses were stratified by income groups: high-income countries (HICs) and middle-income countries (MICs). RESULTS The survey was completed by 469 orthopaedic surgeons, representing 19 countries in Latin America (2 HICs and 17 MICs). Most respondents were male (89%), completed residency training (96%), and were fellowship-trained (71%). Only 44% of the respondents had received soft-tissue training. Respondents (77%) reported a strong interest in attending a soft-tissue training course. Plastic surgeons were more commonly the primary providers for Gustilo Anderson (GA) Type IIIB injuries in HICs than in MICs (100% vs. 47%, p<0.01) and plastic surgeons were more available (<24 h of patient presentation to the hospital) in HICs than MICs (63% vs. 26%, p = 0.05), demonstrating statistically significant differences. In addition, respondents in HICs performed free flaps more commonly than in MICs for proximal third (55% vs. 10%, p<0.01), middle third (36% vs. 9%, p = 0.02), and distal third (55% vs. 10%, p<0.01) lower extremity wounds. Negative Pressure Wound Therapy (NPWT or Wound VAC) was the only resource available to more than half of the respondents. Though not statistically significant, surgeons reported having more access to plastic surgeons at their institutions in HICs than MICs (91% vs. 62%, p = 0.12) and performed microsurgical flaps more commonly at their respective institutions (73% vs. 42%, p = 0.06). CONCLUSIONS The study demonstrated that most orthopaedic surgeons in Latin America have received no soft-tissue training, HICs and MICs have differences in access to plastic surgeons and expectations for flap type and timing to definitive coverage, and most respondents had limited access to necessary soft-tissue surgical resources. Further investigation into differences in the clinical outcomes related to soft-tissue coverage methods and protocols can provide additional insight into the importance of timing and access to specialists.
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Ye J, Bao Y, Zheng J, Liang J, Hu L, Tan L, Tan L. Epidemiology of unintentional injury in children admitted to ICU in China mainland: a multi-center cross-sectional study. Transl Pediatr 2022; 11:340-348. [PMID: 35378960 PMCID: PMC8976685 DOI: 10.21037/tp-21-387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 12/24/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To investigate the epidemiology of unintentional injury in children admitted to Intensive Care Unit (ICU) in China mainland. METHODS A total of 39 hospitals in 19 provinces contributed to the 1-day point prevalence study of serious unintentional injury in children aged 0-16 years admitted to ICU. RESULTS A total of 1,017 patients from the 39 participating ICUs on the study day were included. Among them, 56 pediatric patients were identified to be suffered from unintentional injury from 18 participating ICUs, accounting for 5.5% (56/1,017) of all the ICU patients. The percentage of boys was more than twice the percentage of girls. Most patients had an age of less than 6 years old (n=42, 75%). The leading cause of unintentional injury was fall (n=17, 30.4%). The patterns of unintentional injury in children were age-related. There were no urban-rural differences in our cohort. The injury happened on 12:00-18:00 PM in 27 cases (48.2%), and 28 patients (50%) had injuries happened at working day. 35 patients (62.5%) received primary treatment at local hospitals. Thirty-five patients (62.5%) needed resuscitation in the emergency department, 15 patients (26.8%) still needed resuscitation in ICU. These 56 children suffered from a total of 106 lesions corresponding to 1.89 lesions per patient. Respiratory failure was most commonly seen (n=18, 32.1%). There was no death in our cohort during the study. After effective treatment during their ICU stay, 45 (80.4%) patients showed improvement, with Glasgow Coma Scale (GCS), Pediatric Trauma Score (PTS) and Pediatric Risk of Mortality III (PRISM III) score significantly better than those before treatment (P<0.05). CONCLUSIONS Higher injury rates among children under 6 years old of age illustrate the need for preventive measures, especially programs and public policies targeting this high-risk group.
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Affiliation(s)
- Jing Ye
- Department of Surgical ICU, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yiyao Bao
- Department of Surgical ICU, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jicui Zheng
- Department of Neurosurgery, The Children's Hospital, Fudan University School of Medicine, Shanghai, China
| | - Jianfeng Liang
- Department of Medical Statistics, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lei Hu
- Department of Surgical ICU, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Linhua Tan
- Department of Surgical ICU, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Exploring Factors That Influence Injured Patients’ Outcomes following Road Traffic Crashes: A Multi-Site Feasibility Study. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Injuries arising from Road Traffic Crashes (RTCs) are a major health problem in Saudi Arabia (SA). The purpose of the study was to determine the feasibility of conducting a multi-center research study to explore factors that influence the mortality of RTC-related trauma patients in SA. Methods: A multi-center observational study was undertaken involving both prospective and retrospective data collected from three hospitals. In-hospital patient mortality thirty days post-crash was the primary outcome variable. The feasibility of the study methods including the quality of data were evaluated and pilot results pertaining to factors predicting mortality were examined. Results: The overall mortality rate (n = 572 RTC victims) was (7.5%). A logistic regression model identified four independent predictors of mortality following an RTC: treatment at a non-trauma center-based hospital, SBP ≤ 90 mmHg, GCS ≤ 8, and ISS ≥ 20. With respect to the assessment of the study method’s feasibility, missing data was problematic, especially for variables pertaining to crash characteristics and prehospital care. Conclusions: Collecting multi-center injury data in SA has logistic challenges, predominantly associated with the comparability and completeness of data sets as well as the need for manual screening and data collection at some institutions. Despite these limitations, this study has demonstrated the feasibility of a method that could be utilized in further large nationwide studies to understand and examine the factors that influence injured patients’ outcomes following RTCs.
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Global Survey of Demand-Side Factors and Incentives that Influence Advanced Trauma Life Support (ATLS) Promulgation. World J Surg 2022; 46:1059-1066. [DOI: 10.1007/s00268-022-06461-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
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Predicting early traumatic brain injury mortality with 1D convolutional neural networks and conventional machine learning techniques. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.100984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Peralta-Santos A, Gimbel S, Sorensen R, Covele A, Kawakatsu Y, Wagenaar BH, Augusto O, Ásbjörnsdóttir KH, Gloyd SS, Cuembelo F, Sherr K. The neglected epidemic-Risk factors associated with road traffic injuries in Mozambique: Results of the 2016 INCOMAS study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000163. [PMID: 36962258 PMCID: PMC10021512 DOI: 10.1371/journal.pgph.0000163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022]
Abstract
In 2019, 93% of road traffic injury related mortality occurred in low- and middle-income countries, an estimated burden of 1.3 million deaths. This problem is growing; by 2030 road traffic injury will the seventh leading cause of death globally. This study both explores factors associated with RTIs in the central region of Mozambique, as well as pinpoints geographical "hotspots" of RTI incidence. A cross-sectional, population-level survey was carried out in two provinces (Sofala and Manica) of central Mozambique where, in addition to other variables, the number of road traffic injuries sustained by the household within the previous six months, was collected. Urbanicity, household ownership of a car or motorcycle, and socio-economic strata index were included in the analysis. We calculated the prevalence rate ratios using a generalized linear regression with a Poisson distribution, as well as the spatial prevalence rate ratio using an Integrated Nested Laplace Approximation. The survey included 3,038 households, with a mean of 6.29 (SD 0.06) individuals per household. The road traffic injury rate was 6.1% [95%CI 7.1%, 5.3%]. Urban residence was associated with a 47% decrease in rate of injury. Household motorbike ownership was associated with a 92% increase in the reported rate of road traffic injury. Higher socio-economic status households were associated with a 26% increase in the rate of road traffic injury. The rural and peri-urban areas near the "Beira corridor" (national road N6) have higher rates of road traffic injuries. In Mozambique, living in the rural areas near the "Beira corridor", higher household socio-economic strata, and motorbike ownership are risk factors for road traffic injury.
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Affiliation(s)
- André Peralta-Santos
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sarah Gimbel
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Child, Family and Population Health Nursing, University of Washington, Seattle, Washington, United States of America
| | - Reed Sorensen
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | | | - Yoshito Kawakatsu
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Orvalho Augusto
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Health Alliance International, Beira, Mozambique
- Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Kristjana Hrönn Ásbjörnsdóttir
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Stephen S Gloyd
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
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Karim N, Mumporeze L, Nsengimana VJP, Gray A, Kearney A, Aluisio AR, Mutabazi Z, Baird J, Clancy CM, Lubetkin D, Uwitonze JE, Nyinawankusi JD, Nkeshimana M, Byiringiro JC, Levine AC. Epidemiology of Patients with Head Injury at a Tertiary Hospital in Rwanda. West J Emerg Med 2021; 22:1374-1378. [PMID: 34787565 PMCID: PMC8597684 DOI: 10.5811/westjem.2021.4.50961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/19/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction Traumatic injuries disproportionately affect populations in low and middle-income countries (LMIC) where head injuries predominate. The Rwandan Ministry of Health (MOH) has dramatically improved access to emergency services by rebuilding its health infrastructure. The MOH has strengthened the nation’s acute emergency response by renovating emergency departments (ED), developing the field of emergency medicine as a specialty, and establishing a prehospital care service: Service d’Aide Medicale Urgente (SAMU). Despite the prevalence of traumatic injury in LMIC and the evolving emergency service in Rwanda, data regarding head trauma epidemiology is lacking. Methods We conducted this retrospective cohort study at the University Teaching Hospital of Kigali (UTH-K) and used a linked prehospital database to investigate the demographics, mechanism, and degree of acute medical interventions amongst prehospital patients with head injury. Results Of the 2,426 patients transported by SAMU during the study period, 1,669 were found to have traumatic injuries. Data from 945 prehospital patients were accrued, with 534 (56.5%) of these patients diagnosed with a head injury. The median age was 30 years, with most patients being male (80.3%). Motor vehicle collisions accounted for almost 78% of all head injuries. One in six head injuries were due to a pedestrian struck by a vehicle. Emergency department interventions included intubations (6.7%), intravenous fluids (2.4%), and oxygen administration (4.9%). Alcohol use was not evaluated or could not be confirmed in 81.3% of head injury cases. The median length of stay (LOS) in the ED was two days (interquartile range: 1,3). A total of 184 patients were admitted, with 13% requiring craniotomies; their median in-hospital care duration was 13 days. Conclusion In this cohort of Rwandan trauma patients, head injury was most prevalent amongst males and pedestrians. Alcohol use was not evaluated in the majority of patients. These traumatic patterns were predominantly due to road traffic injury, suggesting that interventions addressing the prevention of this mechanism, and treatment of head injury, may be beneficial in the Rwandan setting.
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Affiliation(s)
- Naz Karim
- Warren Alpert School of Medicine, Brown University, Department of Emergency Medicine, Providence, Rhode Island, United States of America
| | - Lise Mumporeze
- University of Rwanda, College of Medicine and Health Sciences, Department of Anesthesia, Critical Care, and Emergency Medicine, Kigali, Rwanda
| | - Vizir J P Nsengimana
- University of Rwanda, College of Medicine and Health Sciences, Department of Anesthesia, Critical Care, and Emergency Medicine, Kigali, Rwanda
| | - Ashley Gray
- Warren Alpert School of Medicine, Brown University, Department of Emergency Medicine, Providence, Rhode Island, United States of America
| | - Alexis Kearney
- Warren Alpert School of Medicine, Brown University, Department of Emergency Medicine, Providence, Rhode Island, United States of America
| | - Adam R Aluisio
- Warren Alpert School of Medicine, Brown University, Department of Emergency Medicine, Providence, Rhode Island, United States of America
| | - Zeta Mutabazi
- University Teaching Hospital-Kigali (UTH-K), Department of Accident & Emergency Medicine, Kigali, Rwanda
| | - Janette Baird
- Warren Alpert School of Medicine, Brown University, Department of Emergency Medicine, Providence, Rhode Island, United States of America
| | - Camille M Clancy
- Warren Alpert School of Medicine, Brown University, Department of Emergency Medicine, Providence, Rhode Island, United States of America
| | - Derek Lubetkin
- Warren Alpert School of Medicine, Brown University, Department of Emergency Medicine, Providence, Rhode Island, United States of America
| | - Jean Eric Uwitonze
- Service d'Aide Médicale Urgente (SAMU), Rwanda Ministry of Health, Kigali Rwanda
| | | | - Menelas Nkeshimana
- University Teaching Hospital-Kigali (UTH-K), Department of Accident & Emergency Medicine, Kigali, Rwanda
| | - Jean Claude Byiringiro
- University Teaching Hospital-Kigali (UTH-K), Division of Clinical Education and Research, Kigali, Rwanda
| | - Adam C Levine
- Warren Alpert School of Medicine, Brown University, Department of Emergency Medicine, Providence, Rhode Island, United States of America
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Bajamal AH, Apriawan T, Ranuh IAR, Servadei F, Faris M, Al Fauzi A. Comparison of half-molar sodium lactate and mannitol to treat brain edema in severe traumatic brain injury: A systematic review. Chin J Traumatol 2021; 24:344-349. [PMID: 34344615 PMCID: PMC8606601 DOI: 10.1016/j.cjtee.2021.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 06/04/2021] [Accepted: 06/17/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Hypertonic fluids such as mannitol and half-molar sodium lactate are given to treat intracranial hypertension in patients with severe traumatic brain injury (TBI). In this study, sodium lactate was compared to mannitol in patients with TBI to investigate the efficacy in reducing intracranial pressure (ICP). METHODS This study was a systematic review with literature research on articles published in any year in the databases of PubMed, ScienceDirect, Asian Journal of Neurosurgery, and Cochrane Central Register of Controlled Trials. The keywords were "half-molar sodium lactate", "mannitol", "cerebral edema or brain swelling", and "severe traumatic brain injury". The inclusion criteria were (1) studies published in English, (2) randomized control trials or retrospective/prospective studies on TBI patients, and (3) therapies including half-molar sodium lactate and mannitol and (4) sufficient data such as mean difference (MD) and risk ratio (RR). Data analysis was conducted using Review Manager 5.3. RESULTS From 1499 studies, a total of 8 studies were eligible. Mannitol group reduced ICP of 0.65 times (MD 0.65; p = 0.64) and improved cerebral perfusion pressure of 0.61 times (MD 0.61; p = 0.88), better than the half-molar group of sodium lactate. But the half-molar group of sodium lactate maintained the mean arterial pressure level of 0.86 times, better than the mannitol group (MD 0.86; p = 0.09). CONCLUSION Half-molar sodium lactate is as effective as mannitol in reducing ICP in the early phase of brain injury, superior over mannitol in an extended period. It is able to prevent intracranial hypertension and give better brain tissue perfusion as well as more stable hemodynamics. Blood osmolarity is a concern as it increases serum sodium.
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Affiliation(s)
- Abdul Hafid Bajamal
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Tedy Apriawan
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - I.G.M. Aswin R. Ranuh
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Franco Servadei
- Department of Neurosurgery, Humanitas Clinical and Research Hospital, Humanitas University, Milan, Italy
| | - Muhammad Faris
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Asra Al Fauzi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia,Corresponding author.
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Taherinia A, Saba G, Ebrahimi M, Ahmadi K, Taleshi Z, Khademhosseini P, Soltanian A, Safaee A, Bahramian M, Gharakhani S, Nodoshan MAJ. Diagnostic value of intravenous oxygen saturation compared with arterial and venous base excess to predict hemorrhagic shock in multiple trauma patients. J Family Med Prim Care 2021; 10:2625-2629. [PMID: 34568146 PMCID: PMC8415661 DOI: 10.4103/jfmpc.jfmpc_2047_20] [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: 10/03/2020] [Revised: 12/03/2020] [Accepted: 05/07/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: In this study, with the help of peripheral vein sampling, Spvo2, and peripheral artery and vein sampling, we examined base excess (BE) in trauma patients and determined its diagnostic value for hemorrhagic shock. Methods: In this cross-sectional study, from 64 patients with abdominal, pelvic and chest Blunt trauma who have a score of 2 or higher trauma during treatment, blood samples were taken from peripheral vein to measure oxygen saturation and peripheral vein and artery for BE measurements and were compared in order to assess their diagnostic value in predicting the occurrence of hemorrhagic shock. Results: Out of 60 examined patients, 43 (71.67%) patients were diagnosed with hemorrhagic shock. The correlation for the percentage of oxygen saturation of the peripheral blood and the rate of arterial and venous BE for these r2patients were 17.0 and 09.0, respectively, with a P value greater than 0.005. In the case of the percentage of oxygen saturation of the peripheral blood, the sensitivity and specificity were 93.03 and 11.76%, respectively. The positive and negative likelihood ratios were 1.05 and 0.59, respectively. The positive and negative predictive values were 72.73 and 40%, respectively. Conclusion: In general, the results of this study showed that arterial and venous excess base levels had a proper correlation, specificity and sensitivity for diagnosing and predicting hemorrhagic shock, while the percentage of oxygen saturation of peripheral blood and BE arterial and venous levels had not proper correlation to detect and predict hemorrhagic shock.
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Affiliation(s)
- Ali Taherinia
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Ghazal Saba
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohsen Ebrahimi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Koorosh Ahmadi
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Zabihollah Taleshi
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Peyman Khademhosseini
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Ali Soltanian
- Department of Surgery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Atie Safaee
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Mashhad University of Medical Science, Mashhad, Iran
| | - Mehran Bahramian
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Shahin Gharakhani
- Researchers, General Practitioner, Alborz University of Medical Sciences, Karaj, Iran
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Sharifian S, Khani Jazani R, Khorasani-Zavareh D, Sadeghi-Bazargani H, Vaziri MH, Mohammadi R. A model to explain road traffic data collection and registry in Iran: a grounded theory. J Inj Violence Res 2021; 13. [PMID: 33875628 PMCID: PMC8435081 DOI: 10.5249/jivr.vo113i2.1406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Sufficient data should be gathered and analyzed to increase awareness and attention of the community and policymakers in the field of road traffic injury (RTI) prevention. While various organizations and stakeholders are involved in road traffic crashes, there is no clear lead agency for data collection system in RTIs. Exploring stakeholders' perspective is one of the key sources for understanding this system. The purpose of this study is to identify the process of RTI data collection system based on stakeholders’ experience. Methods: This qualitative study was conducted employing grounded theory approach since September 2017 to December 2018 in Iran. Participants in this study were the authorities of the Emergency organizations, police, Ministry of Health and Medical Education, faculty members, as well as executive staff and road users who were involved in collecting and recording data (n=15). Data collection was carried out through face-to-face interviews using purposeful and theoretical sampling. Data analysis was performed based on Strauss and Corbin 2008. Results: The core category was identified as “separated registration” explaining the process of collecting and recording road traffic injury data. Other variables obtained using the Strauss and Corbin Paradigm model were categorized as context, casual, intervening, strategies, and outcomes factors. The findings were classified into five groups including lack of trust in road safety promotion, process factors, management and organizational factors, failure of quality assurance, and administrative and organizational culture. Conclusions: The most important theory is “separated registration” and non-systematic registry system of road traffic injury data which is shown in a conceptual model. The findings of this study will help policymakers for better understanding the collecting and recording of RTI information.
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Affiliation(s)
- Sakineh Sharifian
- a Department of Nursing Management, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Reza Khani Jazani
- b Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Davoud Khorasani-Zavareh
- c Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
,
Corresponding Author at:
Davoud Khorasani-Zavareh: Safety Promotion and Injury Prevention Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail: (Khorasani-Zavareh D.) https://orcid.org/0000-0001-6265-8148
| | - Homayoun Sadeghi-Bazargani
- d Traffic Injury Research Center, Statistics and Epidemiology Department, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Hossein Vaziri
- e Workplace Health Promotion Research Center (WHPRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
,
Corresponding Author at:
Mohammad Hossein Vaziri: Workplace Health Promotion Research Center (WHPRC), School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail: (Vaziri MH.) https://orcid.org/0000-0002-9347-3223
| | - Reza Mohammadi
- f Department of Neurobiology, Care Sciences and Society (NVS), H1, Division of Family Medicine and Primary Care, Alfred Nobels Allé 23 141 83 Huddinge, Sweden.
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Boyke AE, Shlobin NA, Sharma V, Detchou DKE, Rolle M. Letter: Operationalizing Global Neurosurgery Research in Neurosurgical Journals. Neurosurgery 2021; 89:E171-E172. [PMID: 34114022 DOI: 10.1093/neuros/nyab199] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andre E Boyke
- Albert Einstein College of Medicine Bronx, New York, USA
| | - Nathan A Shlobin
- Northwestern University Feinberg School of Medicine Chicago, Illinois, USA
| | | | - Donald K E Detchou
- Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA.,Frazier Scholar Program Department of Neurosurgery Hospital of the University of Pennsylvania Philadelphia, Pennsylvania, USA
| | - Myron Rolle
- Program in Global Surgery and Social Change Harvard Medical School Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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Alharbi RJ, Lewis V, Shrestha S, Miller C. Effectiveness of trauma care systems at different stages of development in reducing mortality: a systematic review and meta-analysis protocol. BMJ Open 2021; 11:e047439. [PMID: 34083344 PMCID: PMC8183269 DOI: 10.1136/bmjopen-2020-047439] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION The introduction of trauma systems that began in the 1970s resulted in improved trauma care and a decreased rate of morbidity and mortality of trauma patients. Worldwide, little is known about the effectiveness of trauma care system at different stages of development, from establishing a trauma centre, to implementing a trauma system and as trauma systems mature. The objective of this study is to extract and analyse data from research that evaluates mortality rates according to different stages of trauma system development globally. METHODS AND ANALYSIS The proposed review will comply with the checklist of the 'Preferred reporting items for systematic review and meta-analysis'. In this review, only peer-reviewed articles written in English, human-related studies and published between January 2000 and December 2020 will be included. Articles will be retrieved from MEDLINE, EMBASE and CINAHL. Additional articles will be identified from other sources such as references of included articles and author lists. Two independent authors will assess the eligibility of studies as well as critically appraise and assess the methodological quality of all included studies using the Cochrane Risk of Bias for Non-randomised Studies of Interventions tool. Two independent authors will extract the data to minimise errors and bias during the process of data extraction using an extraction tool developed by the authors. For analysis calculation, effect sizes will be expressed as risk ratios or ORs for dichotomous data or weighted (or standardised) mean differences and 95% CIs for continuous data in this systematic review. ETHICS AND DISSEMINATION This systematic review will use secondary data only, therefore, research ethics approval is not required. The results from this study will be submitted to a peer-review journal for publication and we will present our findings at national and international conferences. PROSPERO REGISTRATION NUMBER CRD42019142842.
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Affiliation(s)
- Rayan Jafnan Alharbi
- School of Nursing and Midwifery, La Trobe University-Bundoora Campus, Melbourne, Victoria, Australia
- Department of Emergency Medical Service, Jazan University, Jazan, Jazan, Saudi Arabia
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, School of Nursing and Midwifery, La Trobe University-Bundoora Campus, Melbourne, Victoria, Australia
| | - Sumina Shrestha
- Australian Institute for Primary Care and Ageing, School of Nursing and Midwifery, La Trobe University-Bundoora Campus, Melbourne, Victoria, Australia
- Community Development and Environment Conservation Forum, Nepal, Nepal
| | - Charne Miller
- School of Nursing and Midwifery, La Trobe University-Bundoora Campus, Melbourne, Victoria, Australia
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Yadav SS, Edwards P, Porter J. Evaluation of first information reports of Delhi police for injury surveillance: Data extraction tool development & validation. Indian J Med Res 2021; 152:410-416. [PMID: 33380706 PMCID: PMC8061583 DOI: 10.4103/ijmr.ijmr_442_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background & objectives: Policymakers and health professionals need to know the distribution, patterns, trends and risk factors of injury occurrence to develop strategies that reduce the incidence of injuries. The first information report (FIR) of Indian police is one potential source of this information. The aims of this study were to identify the minimum data set (MDS) recommended for injury surveillance, to develop a tool for data extraction from FIRs, to evaluate whether FIRs contain this MDS and to assess the inter-rater reliability of the tool. Methods: This was a cross-sectional study of incidents reported to Delhi Police in 2017. A systematic literature search was conducted to identify the MDS recommended for injury surveillance. A tool was designed for extraction of data, and its inter-rater reliability was assessed using Cohen's kappa and the percentage availability of each MDS data item in the FIRs, was calculated. Results: The literature review identified 24 reports that recommended 12 MDS for injury surveillance. The FIRs contained complete information on the following five MDS: sex/gender (100%), date of injury (100%), time of injury (100%), place of injurious event (100%) and intent (100%). For the following seven MDS, information was not complete: name (93.1%), age (67.2%), occupation (32.8%), residence (86.2%), activity of the injured person (86.2%), cause of the injury (93.1%) and nature of the injury (41.4%). The inter-rater reliability of the data extraction tool was found to be almost perfect. Interpretation & conclusions: Information on injuries can be reliably extracted from FIRs. Although FIRs do not always contain complete information on the MDS, if missing data are imputed, these could form the basis of an injury surveillance system. However, use of FIRs for injury surveillance could be limited by the representativeness of injuries ascertained by FIRs to the population. FIRs thus have the potential to become an important component of an integrated injury surveillance system.
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Affiliation(s)
- Sajjan Singh Yadav
- Department of Expenditure, Ministry of Finance, Government of India, New Delhi, India; Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England
| | - Phil Edwards
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, England
| | - John Porter
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, England
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Windon MJ, Faniriko MBA, Bogale M, Acha E, Koch W. Otolaryngology burden of disease and surgical case triage in resource-limited settings: An example from Cameroon. Laryngoscope Investig Otolaryngol 2021; 6:177-182. [PMID: 33869748 PMCID: PMC8035949 DOI: 10.1002/lio2.522] [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: 12/13/2020] [Revised: 12/26/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Otolaryngology services worldwide faced an unprecedented demand for case triage during the SARS-CoV-2 pandemic. We propose and apply a novel case-leveling schema in a resource-limited setting. Describing the surgical burden of otolaryngologic disease in this setting may critically inform resource planning to address global surgical disparities. METHODS This is a retrospective study of otolaryngology cases performed over a 28-month period (1/2016-4/2018) at a hospital in rural Cameroon. Case details were collated and categorized as a surrogate measure of otolaryngologic disease in resource-limited settings. A case-levelling schema based on temporal urgency and anticipated impact on health was proposed and applied. RESULTS 1277 cases took place during the study. The largest proportion of cases were head and neck (517, 40%), followed by pediatrics (316, 25%). A four-tiered leveling system was generated: level 1 cases were immediately life-saving; level 2 cases were expected to result in a significant return to functions of daily living, or would prevent future death from cancer; level 3 cases aimed to significantly improve quality of life; level 4 cases were purely elective. Upon application of the schema, most cases were deemed to be level 2 (661, 52%). CONCLUSION We use our experience in a resource-limited setting to generate and apply a novel schema to be used for otolaryngology case triage in services facing unprecedented states of emergency such as the SARS-CoV-2 pandemic. This is the first study describing the surgical otolaryngologic disease burden in a resource-limited setting, data which may be used for future resource allocation. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Melina J. Windon
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Mesele Bogale
- Department of SurgeryAdama Hospital Medical CollegeAdamaEthiopia
| | - Everistus Acha
- Department of Ear, Nose, and Throat SurgeryMbingo Baptist HospitalMbingoCameroon
| | - Wayne Koch
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of Ear, Nose, and Throat SurgeryMbingo Baptist HospitalMbingoCameroon
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McDonald CL, Westcott-McCoy S, Weaver MR, Haagsma J, Kartin D. Global prevalence of traumatic non-fatal limb amputation. Prosthet Orthot Int 2021; 45:105-114. [PMID: 33274665 DOI: 10.1177/0309364620972258] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/12/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Reliable information on both global need for prosthetic services and the current prosthetist workforce is limited. Global burden of disease estimates can provide valuable insight into amputation prevalence due to traumatic causes and global prosthetists needed to treat traumatic amputations. OBJECTIVES This study was conducted to quantify and interpret patterns in global distribution and prevalence of traumatic limb amputation by cause, region, and age within the context of prosthetic rehabilitation, prosthetist need, and prosthetist education. STUDY DESIGN A secondary database descriptive study. METHODS Amputation prevalence and prevalence rate per 100,000 due to trauma were estimated using the 2017 global burden of disease results. Global burden of disease estimation utilizes a Bayesian metaregression and best available data to estimate the prevalence of diseases and injuries, such as amputation. RESULTS In 2017, 57.7 million people were living with limb amputation due to traumatic causes worldwide. Leading traumatic causes of limb amputation were falls (36.2%), road injuries (15.7%), other transportation injuries (11.2%), and mechanical forces (10.4%). The highest number of prevalent traumatic amputations was in East Asia and South Asia followed by Western Europe, North Africa, and the Middle East, high-income North America and Eastern Europe. Based on these prevalence estimates, approximately 75,850 prosthetists are needed globally to treat people with traumatic amputations. CONCLUSION Amputation prevalence estimates and patterns can inform prosthetic service provision, education and planning.
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Affiliation(s)
- Cody L McDonald
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Sarah Westcott-McCoy
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Marcia R Weaver
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Juanita Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Deborah Kartin
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Gwarzo IH, Perez-Patron M, Xu X, Radcliff T, Horney J. Traumatic Brain Injury Related Hospitalizations: Factors Associated with In-hospital Mortality among Elderly Patients Hospitalized with a TBI. Brain Inj 2021; 35:554-562. [PMID: 33749412 DOI: 10.1080/02699052.2021.1890822] [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] [Indexed: 10/21/2022]
Abstract
Background: This study aims to describe TBI-related hospitalizations for the whole population and identify factors associated with in-hospital mortality among elderly (≥65 years) patients hospitalized with TBI in Texas.Methods: Using Texas Hospital Discharge Data from 2012 to 2014, TBI-related hospitalizations were identified using International Classification of Diseases - Ninth Revision - Clinical Modification (ICD-9-CM) codes. Rates for age and gender were estimated using U.S. Census data. Univariate and multivariate analyses were used to identify factors associated with in-hospital mortality among those aged at least 65 years.Results: There were 51,419 TBI-related hospitalizations from 2012 to 2014 in Texas. Falls were the leading cause of TBI-related hospitalizations 6235 (36.64%), 6595 (38.40%), and 5412 (37.59%) for 2012, 2013, and 2014, respectively. Males had higher rates of hospitalizations while rates were highest for those above 80 years of age. Compared to Whites, Hispanics had 1.18 higher adjusted odds of in-hospital mortality [OR = 1.18: 95% CI (1.01-1.40)]. Similarly, adjusted odds of in-hospital mortality were higher among males [OR = 1.55: 95% CI (1.36-1.77)].Conclusion: This study provided evidence of demographic disparities in the burden and outcome of TBI in Texas, findings could serve as a foundation for targeted TBI prevention interventions.
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Affiliation(s)
- Ibrahim H Gwarzo
- Epidemiology & Biostatistics, College Station, Texas, United States
| | | | - Xiaohui Xu
- Epidemiology & Biostatistics, College Station, Texas, United States
| | - Tiffany Radcliff
- Health Policy & Management, College Station, Texas, United States
| | - Jennifer Horney
- Epidemiology, University of Delaware, Delaware, Newark, United States
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Blom L. mHealth for image-based diagnostics of acute burns in resource-poor settings: studies on the role of experts and the accuracy of their assessments. Glob Health Action 2021; 13:1802951. [PMID: 32814518 PMCID: PMC7480586 DOI: 10.1080/16549716.2020.1802951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Diagnostic assistance using mobile technology is instrumental to timely and adequate care in resource-scarce settings, particularly for acute burns. Little is known, however, as regards to how remote diagnostic consultation in burns affects the work process. This article reviews a doctoral thesis on this topic based on four studies conducted in the Western Cape, South Africa prior to and in a very early phase of the implementation of an app for burn remote diagnostic assistance. The aim was to increase knowledge on how remote diagnostic assistance for burn injuries can influence the role and work of medical experts in a resource-poor setting. The congruence model was used as a reference framework to study the ‘input’ (study 1), ‘tasks’ (studies 2 and 3) and ‘people’ (study 4) involved. The results show higher burn incidence in young children (75.4 per 10 000) and gender differences primarily among adults. The quality of images was considered by experts as better when viewed on smartphones and tablets than on computers. The accuracy of burn size assessments was high overall but low for burn depth (ICC = 0.82 and 0.53 respectively). Experts described four positions pertaining to remote consultations: clinical specialist, gatekeeper, mentor and educator. They perceived images as improving accuracy of consultation and stressed the need for verbal communication among clinicians during critical situations. In conclusion, experts are satisfied with the quality of images seen on handheld devices and can accurately assess burn size using these, yet burn depth assessment is more challenging without additional clinical information. mHealth for diagnostic assistance can benefit current image-based consultation by systematising information quality, introducing enhanced security and improved access to experts. Remaining challenges include the necessity of verbal communication in some instances and replacing existing informal organisational practices.
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Affiliation(s)
- Lisa Blom
- Department of Global Public Health, Karolinska Institutet , Stockholm, Sweden
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Burkadze E, Axobadze K, Chkhaberidze N, Chikhladze N, Coman MA, Dulf D, Peek-Asa C. Epidemiology of Traumatic Brain Injury in Georgia: A Prospective Hospital-Based Study. Risk Manag Healthc Policy 2021; 14:1041-1051. [PMID: 33737845 PMCID: PMC7966295 DOI: 10.2147/rmhp.s290175] [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: 12/04/2020] [Accepted: 02/25/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose Traumatic brain injury (TBI) is one of the major causes of morbidity and mortality worldwide, disproportionally affecting low- and middle-income countries (LMICs). Epidemiological characteristics of TBI at a national level are absent for most LMICs including Georgia. This study aimed to establish the registries and assess causes and outcomes in TBI patients presenting to two major trauma hospitals in the capital city –Tbilisi. Patients and Methods The prospective observational study was conducted at Acad. O. Gudushauri National Medical Center and M. Iashvili Children’s Central Hospital from March, 1 through August, 31, 2019. Patients of all age groups admitted to one of the study hospitals with a TBI diagnosis were eligible for participation. Collected data were uploaded using the electronic data collection tool –REDCap, analyzed through SPSS software and evaluated to provide detailed information on TBI-related variables and outcomes using descriptive statistics. Results Overall, 542 hospitalized patients were enrolled during the study period, about 63% were male and the average age was 17.7. The main causes of TBI were falls (58%) and struck by or against an object (22%). The 97% suffered from mild TBI (GCS 13–15). Over 23% of patients arrived at the hospital more than 1 hour after injury and 25% after more than 4-hours post-injury. Moderate and severe TBI were associated with an increased hospital length of stay. Mortality rate of severe TBI was 54%. Conclusion This study provides important information on the major epidemiological characteristics of TBI in Georgia, which should be considered for setting priorities for injury management.
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Affiliation(s)
- Eka Burkadze
- Department of Public Health, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Ketevan Axobadze
- Department of Public Health, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Nino Chkhaberidze
- Department of Public Health, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Nino Chikhladze
- Department of Public Health, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Madalina Adina Coman
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Diana Dulf
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Corinne Peek-Asa
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA, USA
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Robinson B, Purcell LN, Kajombo C, Gallaher J, Charles A. Outcomes of stab wounds presenting to Kamuzu Central Hospital in Malawi. Malawi Med J 2021; 33:1-6. [PMID: 34422227 PMCID: PMC8360291 DOI: 10.4314/mmj.v33i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Injuries are a leading cause of morbidity and mortality worldwide, necessitating that we understand the local burden of injury to improve injury-related trauma care and patient outcomes. The characteristics, outcomes, and risk factors for mortality following stab wounds in Malawi are poorly delineated. Methods This is a retrospective, descriptive analysis of patients presenting to Kamuzu Central Hospital in Lilongwe, Malawi, with stab wounds from February 2008 to May 2018. Univariate and bivariate analyses were performed to compare patient and injury characteristics based on mortality. We performed Poisson multivariate regression to predict the factors that increase the relative risk of mortality. Results During the study, 32,297 patients presented with assault. Of those patients, 2,352 (7.3%) presented with stab wounds resulting in a 3.2% (n=74) overall mortality. The majority of wounds were to the head or cervical spine (n=1,043, 44.6%), while injuries to the chest (n=319, 13.7%) were less frequent. We found an increased relative risk of mortality in patients who presented with an injury to the chest (RR 3.95, 95% CI 1.79-8.72, p=0.001) and who were brought in by the police (RR 33.24, 95% CI 11.23-98.35, p<0.001). Conclusion In this study, stab wounds accounted for 7.3% of all assault cases, with a 3.2% mortality. Though the commonest site of stab was the head, wounds to the chest conferred the highest relative risk of mortality. A multifaceted approach to reducing mortality is needed. Incorporating training of first responders in basic life support, including the police, may reduce stab-related mortality.
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Affiliation(s)
- Brittany Robinson
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Laura N Purcell
- Department of Surgery, University of North Carolina at Chapel Hill
| | | | - Jared Gallaher
- Department of Surgery, University of North Carolina at Chapel Hill
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill
- Kamuzu Central Hospital, Lilongwe, Malawi
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le Roux A, Du Plessis AM, Pitcher R. Yield of CT angiography in penetrating lower extremity trauma. Emerg Radiol 2021; 28:743-749. [PMID: 33619684 DOI: 10.1007/s10140-021-01902-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE CT angiography (CTA) has become a valuable tool in the assessment of suspected arterial injury in patients with penetrating lower extremity trauma. However, expensive imaging such as CTA should be judiciously utilized to ensure value-based care. We therefore assessed the yield of CTA in this setting at a level-1 trauma unit and correlated it with the clinical history provided. METHODS A retrospective descriptive study from 1 July 2013 to 31 June 2018 at a 1386-bed, tertiary-level, public-sector teaching hospital in Cape Town, South Africa.. All patients undergoing CTA for suspected arterial injury following penetrating lower extremity trauma were included. The imaging yield of clinically significant arterial injury and the predictive value of specific clinical signs were determined. RESULTS A total of 983 patients (median age 27 years, 91% male) were included; 90% (886/983) had gunshots, 9% (89/983) stabs, and 1% (8/983) other injuries. Despite an average 13% year-on-year increase in CTA performed, there was no change in the proportion demonstrating arterial injury. Thirty-four percent (23/68) of patients with strong (hard) signs of arterial injury (active pulsatile bleeding, rapidly expanding hematoma, absent pulse, palpable thrill, or audible bruit), 11% (49/459) with moderate (soft) signs (history of an arterial bleed, excessive non-pulsatile bleeding, large non-expanding hematoma, major neurological deficit, diminished but appreciable pulse, and arterial proximity), and 5% (24/456) with no indication for imaging had clinically significant arterial injuries. Significant positive correlations were rapidly expanding hematoma (p = 0.009), an absent pulse (p < 0.001), and a diminished pulse (p < 0.001). Significant negative correlations were proximity to a major artery (p = 0.005) and no clinical indication provided (p < 0.001). CONCLUSION There is poor correlation between clinical details provided and the presence of arterial injury at our institution. In this context, CTA serves a pivotal role in the definitive identification of arterial injury.
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Affiliation(s)
- Alwyn le Roux
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa.
| | - Anne-Marie Du Plessis
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - Richard Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
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Alharbi RJ, Lewis V, Miller C. A state-of-the-art review of factors that predict mortality among traumatic injury patients following a road traffic crash. Australas Emerg Care 2021; 25:13-22. [PMID: 33619002 DOI: 10.1016/j.auec.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/31/2021] [Accepted: 01/31/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Traffic related injuries are a major public health problem worldwide with millions of people dying every year. The objective of this state-of-the-art review was to identify the factors reported in the literature as being associated with mortality for trauma patients following road traffic crashes. METHOD A systematic search was undertaken of PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane Library databases to identify articles published in the past two decades (2000-2020). Of 8257 records, 4507 remained for title, abstract and full text screening after duplicates were removed. The level of evidence of selected studies was assessed using The National Health and Medical Research Council (NHMRC) guideline. RESULTS This review included eighty primary research studies examining mortality risk factors following a road traffic crash. The study identified factors in five categories; (i) demographic factors; (ii) behavioural factors; (iii) crash characteristics; (iv) environmental and timing factors; (v) injury severity and pre-injury/condition. The primary studies are summarised in a matrix. Included studies included level II to level IV levels of evidence based on the NHMRC criteria. CONCLUSION This study shows that there are a large number of factors associated with increased risk of mortality following diverse types of traffic crashes. Understanding these wide-ranging factors can strengthen injury and mortality prevention by guiding decision makers about where to focus strategy implementation.
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Affiliation(s)
- Rayan Jafnan Alharbi
- School of Nursing & Midwifery, La Trobe University, 1stfloor, HSB 1, Bundoora, 3086 Victoria, Australia; Department of Emergency Medical Service, Jazan University, Jazan, Saudi Arabia.
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, School of Nursing & Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Charne Miller
- School of Nursing & Midwifery, La Trobe University, 1stfloor, HSB 1, Bundoora, 3086 Victoria, Australia
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Nacoti M, Fazzi F, Biroli F, Zangari R, Barbui T, Kochanek PM. Addressing Key Clinical Care and Clinical Research Needs in Severe Pediatric Traumatic Brain Injury: Perspectives From a Focused International Conference. Front Pediatr 2021; 8:594425. [PMID: 33537259 PMCID: PMC7849211 DOI: 10.3389/fped.2020.594425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/06/2020] [Indexed: 12/28/2022] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children and adolescents. Survivors of severe TBI are more prone to functional deficits, resulting in poorer school performance, poor health-related quality of life (HRQoL), and increased risk of mental health problems. Critical gaps in knowledge of pathophysiological differences between children and adults concerning TBI outcomes, the paucity of pediatric trials and prognostic models and the uncertain extrapolation of adult data to pediatrics pose significant challenges and demand global efforts. Here, we explore the clinical and research unmet needs focusing on severe pediatric TBI to identify best practices in pathways of care and optimize both inpatient and outpatient management of children following TBI.
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Affiliation(s)
- Mirco Nacoti
- Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Francesco Fazzi
- Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Francesco Biroli
- Fondazione per la Ricerca dell'Ospedale di Bergamo Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Rosalia Zangari
- Fondazione per la Ricerca dell'Ospedale di Bergamo Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Tiziano Barbui
- Fondazione per la Ricerca dell'Ospedale di Bergamo Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Patrick M. Kochanek
- Department of Critical Care Medicine, Safar Center for Resuscitation Research, John G Rangos Research Center, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Tupetz A, Friedman K, Zhao D, Liao H, Isenburg MV, Keating EM, Vissoci JRN, Staton CA. Prevention of childhood unintentional injuries in low- and middle-income countries: A systematic review. PLoS One 2020; 15:e0243464. [PMID: 33373371 PMCID: PMC7771986 DOI: 10.1371/journal.pone.0243464] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/21/2020] [Indexed: 11/29/2022] Open
Abstract
Injuries are a leading cause of death and disability among children. Numerous injury prevention strategies have been successful in high-income countries, but the majority of unintentional injuries happen to children living in low- and middle-income countries (LMICs). This project aims to delineate the childhood injury prevention initiatives in LMICs. For inclusion, peer-reviewed articles needed to address unintentional injury, include children <18, assess a prevention-related intervention, contain a control group, and be published after 1988. Two pairs of reviewers evaluated articles independently to determine study eligibility. 74 articles were included. 30 studies addressed road traffic injuries, 11 drowning, 8 burns, 3 falls, 8 poisonings, and 21 an unspecified injury type. The findings show positive effects on injury outcome measures following educational interventions, the need for longer follow-up periods after the intervention, the need for effectiveness trials for behavior change, and the need for an increase in injury prevention services in LMICs. This is the first systematic review to summarize the prevention initiatives for all types of childhood unintentional injuries in LMICs. Increased attention and funding are required to go beyond educational initiatives with self-reported measures and little follow-up time to robust interventions that will reduce the global burden of unintentional injuries among children.
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Affiliation(s)
- Anna Tupetz
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Kaitlyn Friedman
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Duan Zhao
- Duke Kunshan University, Kunshan, Suzhou, Jiangsu, China
| | - Huipeng Liao
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Megan Von Isenburg
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Elizabeth M. Keating
- Division of Pediatric Emergency Medicine, Division of Public Health, University of Utah, Salt Lake City, Utah, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Catherine A. Staton
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
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