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Ghamri N, Brand MKR, Henshall K, MacCormick AD. Accurate completion of tertiary trauma survey for inpatients at a non-trauma centre following significant trauma. Injury 2023; 54:112-118. [PMID: 35985855 DOI: 10.1016/j.injury.2022.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A tertiary trauma survey (TTS) is a structured, comprehensive top-to-toe examination following major trauma [1]. Literature suggests that the ideal time frame for the initial TTS should be completed within 24-hours of a patient's admission and repeated at important moments [2-4]. Evidence suggests that formal TTS reduces the rate of missed injuries by up to 38% [2]. AIMS To determine the rate of TTS being conducted in trauma patients in a tertiary hospital without an admitting trauma service. METHODS We performed a retrospective analysis of adult trauma patients admitted to Middlemore Hospital (MMH) over six months. To be included, patients were either deemed to have a significant mechanism of injury or triggered a trauma call when arriving in the Emergency Department. RESULTS We identified 246 patients who met our criteria for requiring a TTS. 74 (30%) had a TTS completed. Of those completed, 22 (30%) were documented using a standardised form. 35 (47%) were done within the ideal timeframe (24 h); a further 21 (28%) were done within 48 h. House Officers (Junior Medical Officers) conducted the majority (80%), with the remainder being done by final-year medical students (12%), Registrars (Residents) (4%) and Consultants (Attendings) (4%). Of the 74 TTS that were completed, 21 (28%) detected a possible new injury, with 22% leading to further investigations being ordered. 14 (19%) were found to have a previously undetected, clinically significant injury on TTS (defined as 'injuries requiring further clinical intervention'). Most patients (90%) were admitted to either General Surgery or Orthopaedics. Sixty-two (54%) of patients admitted to General Surgery received a TTS; compared to just 11 (10%) admitted under Orthopaedics and 1 of 24 (4%) admitted to other specialities (including Hands, Plastics, Maxillo-Facial, Gynaecology and Medicine). CONCLUSION 30% of patients requiring a TTS received one. 19% of TTS conducted detected clinically significant injuries.
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Affiliation(s)
- N Ghamri
- Department of Orthopaedics, Middlemore Hospital, Counties Manukau District HEalth Board, Auckland, Aotearoa New Zealand.
| | - M K R Brand
- Department of Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, Aotearoa New Zealand
| | - K Henshall
- Department of Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, Aotearoa New Zealand
| | - A D MacCormick
- Department of Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, Aotearoa New Zealand; Department of Surgery, University of Auckland, Auckland, Aotearoa New Zealand
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Tuck NL, Teo K, Kuhlmann L, Olesen SS, Johnson M, Bean DJ, Rashid U, MacCormick AD, Srikumar G, Drewes AM, Windsor JA. Pain patterns in chronic pancreatitis and chronic primary pain. Pancreatology 2022; 22:572-582. [PMID: 35562269 DOI: 10.1016/j.pan.2022.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 04/12/2022] [Accepted: 04/28/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Abdominal pain is the most distressing symptom of chronic pancreatitis (CP), and current treatments show limited benefit. Pain phenotypes may be more useful than diagnostic categories when planning treatments, and the presence or absence of constant pain in CP may be a useful prognostic indicator. AIMS This cross-sectional study examined dimensions of pain in CP, compared pain in CP with chronic primary pain (CPP), and assessed whether constant pain in CP is associated with poorer outcomes. METHODS Patients with CP (N = 91) and CPP (N = 127) completed the Comprehensive Pancreatitis Assessment Tool. Differences in clinical characteristics and pain dimensions were assessed between a) CP and CPP and b) CP patients with constant versus intermittent pain. Latent class regression analysis was performed (N = 192) to group participants based on pain dimensions and clinical characteristics. RESULTS Compared to CPP, CP patients had higher quality of life (p < 0.001), lower pain severity (p < 0.001), and were more likely to use strong opioids (p < 0.001). Within CP, constant pain was associated with a stronger response to pain triggers (p < 0.05), greater pain spread (p < 0.01), greater pain severity, more features of central sensitization, greater pain catastrophising, and lower quality of life compared to intermittent pain (all p values ≤ 0.001). Latent class regression analysis identified three groups, that mapped onto the following patient groups 1) combined CPP and CP-constant, 2) majority CPP, and 3) majority CP-intermittent. CONCLUSIONS Within CP, constant pain may represent a pain phenotype that corresponds with poorer outcomes. CP patients with constant pain show similarities to some patients with CPP, potentially indicating shared mechanisms.
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Affiliation(s)
- N L Tuck
- The Health and Rehabilitation Research Institute, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology (AUT), Auckland, New Zealand; The Auckland Regional Pain Service (TARPS), Auckland District Health Board (ADHB), Auckland, New Zealand; The Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Waitematā District Health Board (WDHB), Auckland, New Zealand.
| | - K Teo
- Department of Surgery, School of Medicine, Faculty of Medical and Health Science, University of Auckland, New Zealand
| | - L Kuhlmann
- Centre for Pancreatic Diseases & Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - S S Olesen
- Centre for Pancreatic Diseases & Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - M Johnson
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, New Zealand
| | - D J Bean
- The Health and Rehabilitation Research Institute, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology (AUT), Auckland, New Zealand; The Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Waitematā District Health Board (WDHB), Auckland, New Zealand
| | - U Rashid
- The Health and Rehabilitation Research Institute, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology (AUT), Auckland, New Zealand
| | - A D MacCormick
- Department of Surgery, School of Medicine, Faculty of Medical and Health Science, University of Auckland, New Zealand; Department of General Surgery, Counties Manukau District Health Board (CMDHB), Auckland, New Zealand
| | - G Srikumar
- Department of General Surgery, Counties Manukau District Health Board (CMDHB), Auckland, New Zealand
| | - A M Drewes
- Centre for Pancreatic Diseases & Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - J A Windsor
- Department of Surgery, School of Medicine, Faculty of Medical and Health Science, University of Auckland, New Zealand
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Thorell A, MacCormick AD, Awad S, Reynolds N, Roulin D, Demartines N, Vignaud M, Alvarez A, Singh PM, Lobo DN. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World J Surg 2017; 40:2065-83. [PMID: 26943657 DOI: 10.1007/s00268-016-3492-3] [Citation(s) in RCA: 327] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND During the last two decades, an increasing number of bariatric surgical procedures have been performed worldwide. There is no consensus regarding optimal perioperative care in bariatric surgery. This review aims to present such a consensus and to provide graded recommendations for elements in an evidence-based "enhanced" perioperative protocol. METHODS The English-language literature between January 1966 and January 2015 was searched, with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded. After critical appraisal of these studies, the group of authors reached a consensus recommendation. RESULTS Although for some elements, recommendations are extrapolated from non-bariatric settings (mainly colorectal), most recommendations are based on good-quality trials or meta-analyses of good-quality trials. CONCLUSIONS A comprehensive evidence-based consensus was reached and is presented in this review by the enhanced recovery after surgery (ERAS) Society. The guidelines were endorsed by the International Association for Surgical Metabolism and Nutrition (IASMEN) and based on the evidence available in the literature for each of the elements of the multimodal perioperative care pathway for patients undergoing bariatric surgery.
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Affiliation(s)
- A Thorell
- Karolinska Institutet, Department of Clinical Sciences, Danderyds Hospital & Department of Surgery, Ersta Hospital, 116 91, Stockholm, Sweden.
| | - A D MacCormick
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Surgery, Counties Manukau Health, Auckland, New Zealand
| | - S Awad
- The East-Midlands Bariatric & Metabolic Institute, Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, DE22 3NE, UK.,School of Clinical Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
| | - N Reynolds
- The East-Midlands Bariatric & Metabolic Institute, Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, DE22 3NE, UK
| | - D Roulin
- Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland
| | - M Vignaud
- Département d'anesthésie reanimation Service de chirurgie digestive, CHU estaing 1, place Lucie et Raymond Aubrac, Clermont Ferrand, France
| | - A Alvarez
- Department of Anesthesia, Hospital Italiano de Buenos Aires, Buenos Aires University, 1179, Buenos Aires, Argentina
| | - P M Singh
- Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - D N Lobo
- Gastrointestinal Surgery, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
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Lemanu DP, Singh PP, Berridge K, Burr M, Birch C, Babor R, MacCormick AD, Arroll B, Hill AG. Randomized clinical trial of enhanced recovery versus standard care after laparoscopic sleeve gastrectomy. Br J Surg 2013; 100:482-9. [PMID: 23339040 DOI: 10.1002/bjs.9026] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Optimized perioperative care within an enhanced recovery after surgery (ERAS) protocol is designed to reduce morbidity after surgery, resulting in a shorter hospital stay. The present study evaluated this approach in the context of sleeve gastrectomy for patients with morbid obesity. METHODS Patients were allocated to perioperative care according to a bariatric ERAS protocol or a control group that received standard care. These groups were also compared with a historical group of patients who underwent laparoscopic sleeve gastrectomy at the same institution between 2006 and 2010, selected using matched propensity scores. The primary outcome was median length of hospital stay. Secondary outcomes included readmission rates, postoperative morbidity, postoperative fatigue and mean cost per patient. RESULTS Of 116 patients included in the analysis, 78 were allocated to the ERAS (40) or control (38) group and there were 38 in the historical group. There were no differences in baseline characteristics between groups. Median hospital stay was significantly shorter in the ERAS group (1 day) than in the control (2 days; P < 0·001) and historical (3 days; P < 0·001) groups. It was also shorter in the control group than in the historical group (P = 0·010). There was no difference in readmission rates, postoperative complications or postoperative fatigue. The mean cost per patient was significantly higher in the historical group than in the ERAS (P = 0·010) and control (P = 0·018) groups. CONCLUSION The ERAS protocol in the setting of bariatric surgery shortened hospital stay and was cost-effective. There was no increase in perioperative morbidity. REGISTRATION NUMBER NCT01303809 (http://www.clinicaltrials.gov).
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Affiliation(s)
- D P Lemanu
- Department of Surgery, South Auckland Clinical School, Auckland, New Zealand.
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