Management of multiple traumas in emergency medicine department: A review

Incidence and predictors of mortality among adult trauma patients admitted to the intensive care units of comprehensive specialized hospitals in Northwest Ethiopia

BACKGROUND

Trauma is the leading cause of morbidity and mortality among adult population in the world. Despite many improvements in technology and care, mortality among trauma patients in the intensive care unit is still high particularly in Ethiopia. However, there is limited evidence on the incidence and predictors of mortality among trauma patients in Ethiopia. Therefore, this study aimed to assess the incidence and predictors of mortality among adult trauma patients admitted to intensive care units.

METHODS

Institutional-based retrospective follow-up study was conducted from January 9, 2019 to January 8, 2022. A total of 421 samples were chosen using simple random sampling. Data were collected with Kobo toolbox software and exported to STATA version 14.1 software for data analysis. Kaplan-Meier failure curve and log-rank test were fitted to explore the survival difference among groups. After the bivariable and multivariable Cox regression analysis, an Adjusted Hazard Ratio (AHR) with 95% Confidence Intervals (CI) was reported to declare the strength of association and statistical significance, respectively.

RESULT

The overall incidence rate of mortality was 5.47 per 100 person-day observation with a median survival time of 14 days. Did not get pre-hospital care (AHR = 2.00, 95%CI 1.13, 3.53), Glasgow Coma Scale (GCS) score < 9 (AHR = 3.89, 95%CI 1.67, 9.06), presence of complications (AHR = 3.71, 95%CI 1.29, 10.64), hypothermia at admission (AHR = 2.11, 95%CI 1.13, 3.93) and hypotension at admission (AHR = 1.93, 95%CI 1.01, 3.66) were found significant predictors of mortality among trauma patients.

CONCLUSION

The incidence rate of mortality among trauma patients in the ICU was high. Did not get pre-hospital care, GCS < 9, presence of complications, hypothermia, and hypotension at admission were significant predictors of mortality. Therefore, healthcare providers should give special attention to trauma patients with low GCS scores, complications, hypotension, and hypothermia and better to strengthen pre-hospital services to reduce the incidence of mortality.

Evaluation of a Web Application for Nursing Records of Multiple Trauma Patients in an Emergency Department

Introduction

Multiple traumatic injuries cause death among traumatized patients. Nurses at the emergency department (ED) must assess, provide nursing care, and record their interventions. Recording all patient information and nursing care procedures, however, is more challenging due to time constraints in emergency care.

Methods

The aim of this study was to evaluate the use of a web application for nursing records of multiple trauma patients in an ED and the user's satisfaction. A web application developed based on the guidelines of Advanced Trauma Life Support was implemented in a resuscitation room of a university hospital in Khon Kaen, Thailand, from January to March 2022. The quality of nursing records through the web application for 40 trauma patients was evaluated. Thirty-seven nurses were surveyed for their satisfaction. The data were analyzed using descriptive statistics.

Results

Overall, the comprehensive nursing process record through web application had 80.3% completeness. Some items were not recorded or partially recorded, including vital sign monitoring and patients' vital signs and symptoms summary records before discharge. Nurses expressed their satisfaction with the web application at a high level, with an average score of 3.99 (standard deviation [SD]: 0.68). They were most satisfied with the components of the nursing process for multiple trauma patients (mean: 4.14 and SD: 0.71).

Conclusions

The use of a web application ensures the completeness of nursing records. Nurses are satisfied with implementing the web application in their clinic. A study of its effectiveness in reducing documentation time and improving patient outcomes is needed in the future.

Profile and outcome of patients with ground-level falls

BACKGROUND

A ground-level fall is one of the most common modes of injury sustained across all age groups. For older adults, ground level falls can result in multiple injuries and are associated with significant morbidity and mortality.

METHODOLOGY

This retrospective observational study included all patients presenting with fall from a ground level to our emergency department (ED) from January 2018 to December 2018. Demographics, details of incident, severity of injury, and outcome were analyzed.

RESULTS

During the study period, 596 patients with a mean age of 40.9 (standard deviation [SD]: 25.9) years were included in the analysis. A quarter (23%) were aged less than 15 years, while the elderly (>60 years) comprised of 29.5%. Half the patients were triaged as priority 2 (53.8%). The lower limbs (36.6%), upper limbs (23.9%), and face (15.3%) were the body areas that were most commonly injured. The new injury severity score (NISS) was more than 8 in 28% of patients. Multivariate logistic regression analysis showed the elderly (>60 years) to have a higher odds (2.51 95% confidence interval [CI]: 1.57-4.02) of sustaining a fracture of a dislocation. One fifth of the patients (120/596; 20.1%) required hospital admission with only one fatality. Fifteen patients (2.5%) left the hospital against medical advice. Two-thirds (66.3%) required only conservative management, while 19.9% required major surgical intervention.

CONCLUSION

A ground-level fall is a common mode of injury in children (<15 years) and the elderly (>60 years). The extremities and face are the most common areas of the body that are prone to injuries. Age-friendly infrastructure modifications at home, work places, and in public areas for elders and ensuring playground safety for children are the needs of the hour to decrease falls on level ground.