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Cevik J, Read D, Putland M, Fazio T, Gumm K, Varma A, Santos R, Ramakrishnan A. The impact of electric scooters in Melbourne: data from a major trauma service. ANZ J Surg 2024; 94:572-579. [PMID: 38087881 DOI: 10.1111/ans.18814] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 04/17/2024]
Abstract
BACKGROUND The proliferation of electric scooters globally has been associated with an increase in related injuries and consequent economic burden. This study aims to assess the injury patterns and the economic impact associated with electric scooter use in Melbourne, Australia. METHODS A retrospective cohort study was conducted using hospital and registry data from January 2022 to January 2023. Data collected included demographic details, alcohol and helmet use, injury type and severity, operative treatment provided, and direct medical costs. The economic impact (in AUD) of the patient's emergency presentation and hospital admission was calculated. RESULTS During the study period, 256 electric scooter related injuries were recorded, comprising 247 riders and nine pedestrians. The majority of patients were males (69%) with a median age of 29.5 (15-78). Alcohol use was reported by 34% and helmet use by 33%. Injuries most commonly affected the upper limb (53%) and head (50%), with abrasions (75%) and fractures (48%) being the most common type of injury sustained. The total hospital cost was $1 911 062, and the median cost was $1321.66 per patient (IQR: $479.37-$5096.65). CONCLUSION Electric scooter usage, as observed through patient presentations to the Royal Melbourne Hospital, is associated with a considerable number of injuries, primarily among young males, and an ensuing substantial economic burden. The findings underscore the urgent need for improved safety measures to minimize electric scooter-related injuries and their clinical and economic repercussions.
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Affiliation(s)
- Jevan Cevik
- Department of Plastic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Read
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Putland
- Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy Fazio
- Health Intelligence Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kellie Gumm
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Amrita Varma
- Department of Plastic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Roselyn Santos
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anand Ramakrishnan
- Department of Plastic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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Woliansky J, Gumm K, Clark N, Knott J, Read DJ. Drug and alcohol intoxication in major trauma: Associations, trends and outcomes over a decade. Emerg Med Australas 2023; 35:792-798. [PMID: 37156569 DOI: 10.1111/1742-6723.14231] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Drug and alcohol intoxication is common among injured patients altering trauma presentation and characteristics. However, uncertainty exists regarding the effect of intoxication on injury severity, as well as outcomes. The present study aims to provide an update on substance-use patterns and their association with traumatic presentation and outcome within a contemporary Australian context. METHODS All major trauma patients captured in our centre's Trauma Registry between July 2010 and June 2020 were included. Demographic, injury characteristic, outcome and substance-use data were collected. Differences in injury severity and characteristics were explored using χ2 tests, while outcomes were modelled using adjusted binomial logistic regression. RESULTS Among 9700 patients, 9% were drug-intoxicated prior to injury, while 9.4% were alcohol-intoxicated. Drug use almost tripled between 2010 (4.8%) and 2020 (13.3%), while alcohol intoxication fell, from 11.7% to 7.3%, over the same period. Although there were significant differences in trauma mechanism among intoxicated patients, group comparison found no difference in Injury Severity Score for any group. Regarding outcomes, all intoxication resulted in significantly greater odds (odds ratio 1.62-2.41) of ICU admission. No difference in mortality was found among individual substance-use groups; however, polysubstance-intoxicated patients had 3.52 times greater odds of dying (95% confidence interval 1.21-10.23) compared to non-intoxicated patients. CONCLUSION Within this contemporary Australian population, we demonstrate escalating rates of drug intoxication and declining rates of alcohol intoxication prior to trauma. Intoxication was associated with more frequent violent and non-accidental injury, and despite no difference in severity, it was associated with worse outcomes.
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Affiliation(s)
- Jonathan Woliansky
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kellie Gumm
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Nico Clark
- Addiction Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jonathan Knott
- Department of Emergency Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David J Read
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Read DJ, Wong J, Liu R, Gumm K, Anderson D. Prehospital tourniquet use in civilian extremity trauma: an Australian observational study. ANZ J Surg 2023; 93:1896-1900. [PMID: 37150975 DOI: 10.1111/ans.18492] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/21/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Prehospital tourniquets (PHTQ) for trauma have been shown to be safe and effective in the military environment and in some civilian settings. However, the supporting civilian data are mostly from North America with a differing case mix and trauma system and may not be applicable to the Australian environment. The aim of this study is to describe our initial experience with PHTQ from safety and efficacy viewpoints. METHOD Retrospective review of all patients with PHTQ from 1 August 2016 to 31 December 2019 was conducted. Data were matched from the RMH Trauma Registry and Ambulance Victoria Registry. Clinical presentation including prehospital observations, PHTQ times, limb outcomes and complications are described. RESULTS Thirty-one cases met inclusion criteria, for whom median age was 37 (IQR: 23.9-66.3), median ISS 17 (13-34) and 80.6% were male. The majority (n = 19, 61.3%) were as a result of road traffic crash, and six (19.4%) from penetrating mechanisms, usually glass. Over a quarter (29.0%) suffered a traumatic amputation. The median prehospital SBP was 100 (IQR: 80-110), the median prehospital HR was 101 (IQR: 77.0-122.3) and was the median PHTQ time was 124 min (IQR: 47-243). Complications attributable to the tourniquet were seen in 4/30 cases (13.3%). CONCLUSION This Australian series differs from North American civilian PHTQ series with a lower penetrating trauma rate and longer PHTQ times. Despite this, complication rates are within the published literature's range. Concerns regarding limited transferability of overseas studies to the Australian context suggests that ongoing audit is required.
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Affiliation(s)
- David J Read
- The Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Jessica Wong
- The Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Raine Liu
- The Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kellie Gumm
- The Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Anderson
- Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care & Hyberbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
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Carroll J, Bennett L, Feng C, Gumm K, Hayes I, Read DJ. Acute colonic pseudo-obstruction following spinal fixation for trauma. World Neurosurg 2023:S1878-8750(23)00795-7. [PMID: 37327865 DOI: 10.1016/j.wneu.2023.06.028] [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] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Acute colonic pseudo-obstruction (ACPO) is a potentially highly morbid surgical complication. The incidence of ACPO following spinal trauma is unknown, but is likely higher than after elective spinal fusion. The purpose of this study was to establish the incidence of ACPO in patients with major trauma undergoing spinal fusion for unstable thoracic and lumbar fracture. Secondly, to characterise the nature of ACPO in this group, including treatment and complications. METHODOLOGY A metropolitan hospital prospective trauma database was utilised to identify all patients from November 2015 to December 2021 meeting major trauma criteria and undergoing thoracic or lumbar spinal fusion for fracture. Individual records were then evaluated for occurrence of ACPO. ACPO was defined as radiological evidence of colonic dilation without mechanical obstruction in symptomatic patients undergoing dedicated abdominal imaging. RESULTS After exclusions, 456 patients with major trauma undergoing thoracic or lumbar spinal fusion were identified. ACPO occurred in 34; an incidence rate of 7.5%. There was no evidence of difference in terms of the spinal fracture type, level, surgical approach or number of segments fused. There were no perforations; only two patients required colonoscopic decompression and none required surgical resection. CONCLUSION ACPO occurred at a high frequency in this group of patients, although it required relatively simple treatment. High vigilance for ACPO should be maintained in trauma patients requiring thoracic or lumbar fixation, with a view to early intervention. The aetiology driving the high rates of ACPO in this cohort is not understood and would benefit from further investigation.
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Affiliation(s)
- James Carroll
- Trauma Unit, Royal Melbourne Hospital, Grattan St, Parkville Vic Australia 3050; University of Queensland School of Medicine, Herston Road, Brisbane, Queensland Australia.
| | - Laura Bennett
- Trauma Unit, Royal Melbourne Hospital, Grattan St, Parkville Vic Australia 3050
| | - Cheng Feng
- Trauma Unit, Royal Melbourne Hospital, Grattan St, Parkville Vic Australia 3050
| | - Kellie Gumm
- Trauma Unit, Royal Melbourne Hospital, Grattan St, Parkville Vic Australia 3050
| | - Ian Hayes
- Trauma Unit, Royal Melbourne Hospital, Grattan St, Parkville Vic Australia 3050; Department of Surgery, University of Melbourne, Parkville Vic Australia 3050
| | - David J Read
- Trauma Unit, Royal Melbourne Hospital, Grattan St, Parkville Vic Australia 3050; Department of Surgery, University of Melbourne, Parkville Vic Australia 3050
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Li C, Green L, Wang J, Tully D, Woliansky J, Gumm K, Iseli C, Martin K, Read D. Factors associated with blunt internal carotid artery injury in petrous temporal bone fractures. Injury 2022; 53:2023-2027. [PMID: 35346507 DOI: 10.1016/j.injury.2022.03.031] [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: 12/24/2021] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Traumatic internal carotid artery (ICA) injuries are an uncommon complication of petrous temporal bone (PTB) fractures that can have devastating consequences of stroke, haemorrhage and death. Current guidelines suggest that all PTB fractures should be screened for blunt cerebrovascular injury, however clinical practice varies. The purpose of this study was to identify features associated with PTB fractures that increase the likelihood of ICA injury. METHODS A retrospective cohort study was performed on all patients with PTB fractures who were investigated with computed-tomography angiography (CTA) scan admitted to a Level One Trauma Service in Melbourne, Australia from 2015-2020. Patient demographic and injury data were obtained from The Royal Melbourne Hospital Trauma Registry and medical records. Multivariate binomial logistic regression was performed to identify features associated with ICA injury. RESULTS Out of 377 patients with 419 PTB fractures, 205 received a CTA scan and were included, identifying 22 ICA injuries (9.4%). The median age of ICA injuries was 33 (IQR 23-61), median Abbreviated Injury Scale (AIS) score for the head region was 5 (IQR 5-5) and the in-hospital mortality rate was 45.5%, mainly due to unsurvivable brain injury. Five patients (22.7%) developed ICA-specific complications of stroke or carotid-cavernous fistula. We identified five factors that were significantly associated with ICA injury. These included PTB fractures involving the carotid canal (OR 6.7, 95% CI 1.9-23.9, p=0.003), presenting with an initial GCS less than nine (OR 5.7, 95% CI 1.2-26.5, p=0.025) and increasing head AIS (OR 2.4, 95% CI 1.2-4.6, p=0.009). Mechanisms of injury that were associated with ICA injury were motor vehicle crash (OR 4.4, 95% CI 1.4-14.2, p=0.012) and motorbike crash (OR 4.6, 95% CI 1.2-18, p=0.029). CONCLUSION Patients with PTB fractures and an additional feature of carotid canal involvement, presenting GCS less than nine, increasing head AIS indicative of severe head trauma or mechanism of injury by motor vehicle or motorbike crash, are at an increased risk of ICA injury and should be screened with a CTA scan.
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Affiliation(s)
- Christine Li
- Department of General Surgical Specialities, The Royal Melbourne Hospital, Level 6 East, 300 Grattan Street, Melbourne, Victoria, 3050, Australia.
| | - Lorne Green
- Department of General Surgical Specialities, The Royal Melbourne Hospital, Level 6 East, 300 Grattan Street, Melbourne, Victoria, 3050, Australia
| | - Jennifer Wang
- Department of General Surgical Specialities, The Royal Melbourne Hospital, Level 6 East, 300 Grattan Street, Melbourne, Victoria, 3050, Australia
| | - Dylan Tully
- Department of General Surgical Specialities, The Royal Melbourne Hospital, Level 6 East, 300 Grattan Street, Melbourne, Victoria, 3050, Australia
| | - Jonathan Woliansky
- Department of General Surgical Specialities, The Royal Melbourne Hospital, Level 6 East, 300 Grattan Street, Melbourne, Victoria, 3050, Australia
| | - Kellie Gumm
- Trauma Service, The Royal Melbourne Hospital, Level 6 East, 300 Grattan Street, Melbourne, Victoria, 3050, Australia
| | - Claire Iseli
- Department of Surgery, The University of Melbourne, Grattan Street, Parkville, Victoria, 3010, Australia; Department of Otolaryngology Head & Neck Surgery, The Royal Melbourne Hospital, Level 2, 300 Grattan Street, Melbourne, Victoria, 3050, Australia; Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital, 32 Gisbourne Street, East Melbourne, Victoria, 3002, Australia
| | - Katherine Martin
- Department of General Surgical Specialities, The Royal Melbourne Hospital, Level 6 East, 300 Grattan Street, Melbourne, Victoria, 3050, Australia; Trauma Service, The Royal Melbourne Hospital, Level 6 East, 300 Grattan Street, Melbourne, Victoria, 3050, Australia; Department of Surgery, The University of Melbourne, Grattan Street, Parkville, Victoria, 3010, Australia; Australasian Trauma Society, PO Box 576, Crows Nest, New South Wales, 1585, Australia
| | - David Read
- Department of General Surgical Specialities, The Royal Melbourne Hospital, Level 6 East, 300 Grattan Street, Melbourne, Victoria, 3050, Australia; Trauma Service, The Royal Melbourne Hospital, Level 6 East, 300 Grattan Street, Melbourne, Victoria, 3050, Australia; Department of Surgery, The University of Melbourne, Grattan Street, Parkville, Victoria, 3010, Australia; Australasian Trauma Society, PO Box 576, Crows Nest, New South Wales, 1585, Australia
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Cocco AM, Ratnaraj V, Loveday BPT, Gumm K, Antippa P, McCormick JJ, Read D, Thomson B. Predictors of blunt diaphragm injury in Australia. Trauma 2021. [DOI: 10.1177/14604086211041857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Blunt diaphragm injury (BDI) is an uncommon, potentially fatal consequence of blunt torso injury. While associations between BDI and other factors such as mechanism of injury or other injuries have been described elsewhere, little recent research has been done in Australia into BDI. The aims of this study were to determine the incidence rate of BDI in our centre, identify how it was diagnosed, determine rates of missed injury and identify predictive factors for BDI. The hypothesis was that patients with BDI would significantly differ to those without BDI. Methods All major trauma patients with blunt torso injuries at our Level 1 major trauma service from 2010 to 2018 were included. Data for patient demographics, other injuries, diagnosis and treatment of BDI were extracted. Patients with BDI were compared with patients without BDI in order to identify differences that could be used to predict BDI in future patients. Results Of 5190 patients with a blunt torso injury, 51 (0.98%) had a BDI at a mean age of 53 ± 19.6 years, and median Injury Severity Score (ISS) of 27(IQR 21–38.5) compared with 5139 patients with a mean age of 48.2 ± 20.7 years and median ISS of 21.9(IQR 14–26) who did not have a BDI. The diagnosis of BDI was made at CT ( n = 35), surgery ( n = 14) or autopsy ( n = 2). Blunt diaphragm injury was missed on index imaging for 11 of 43 patients (25.6%). On multivariate analysis, each point increase in ISS (OR 1.03, p = 0.02); rib fractures (OR 4.65, p = 0.004); splenic injury (OR 2.60, p = 0.004); and liver injury (OR 2.78, p = 0.003) were independently associated with BDI. Conclusion Injury Severity Score, rib fractures and solid abdominal organ injury increase the likelihood of BDI. In patients with these injuries, BDI should be considered even in the presence of normal CT findings.
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Affiliation(s)
- Annelise M Cocco
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, QLD, Australia
| | - Vignesh Ratnaraj
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, QLD, Australia
| | - Benjamin PT Loveday
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, QLD, Australia
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Kellie Gumm
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, QLD, Australia
| | - Phillip Antippa
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, QLD, Australia
| | - Jacob J McCormick
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, QLD, Australia
| | - David Read
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, QLD, Australia
- University of Melbourne Department of Surgery, The Royal Melbourne Hospital, Parkville, QLD, Australia
| | - Benjamin Thomson
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, QLD, Australia
- University of Melbourne Department of Surgery, The Royal Melbourne Hospital, Parkville, QLD, Australia
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Saxon L, Fazio TN, Gumm K, Tong SYC, Read DJ. Quality of care was not compromised during the COVID-19 pandemic at a level 1 trauma centre. ANZ J Surg 2021; 92:172-179. [PMID: 34403202 PMCID: PMC8420582 DOI: 10.1111/ans.17154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/29/2021] [Accepted: 08/01/2021] [Indexed: 01/31/2023]
Abstract
Background The COVID‐19 pandemic has had a profound effect on the presentation and management of trauma at the Royal Melbourne Hospital, a level 1 adult major trauma service and a designated COVID‐19 hospital. This study compares the changes in epidemiology and trauma patient access to emergency imaging and surgery during the pandemic response. Methods The population of interest was all trauma patients captured in the hospital's trauma registry from 16 March 2016 to 10 September 2020. Regression modelling assessed changes in mechanism and severity of the injury, and mortality during two lockdowns compared with the proceeding 4 years. Cases were matched with hospital administrative databases to assess mean time from admission to emergency computed tomography (CT) scan, operating theatre, length of stay (LOS) and immediate surgery (OPSTAT). Results Throughout 2020, the hospital treated 525 COVID‐19 patients. Compared with previous years, there was up to 34% reduction in major trauma and a 28% reduction in minor trauma admissions during the pandemic (p < 0.05). Intensive care unit admissions were almost half of predicted. Some of the largest reductions were seen in motor vehicle crashes (49%) and falls (28%) (p < 0.05). Time to CT, surgery and immediate surgery (OPSTAT) showed no change and having a suspected COVID‐19 diagnosis did not prolong any of these times except for the LOS. Mortality was similar to previous years. Conclusion The COVID‐19 pandemic has had widespread societal changes, resulting in a substantial decrease in trauma presentations. Despite COVID's immense impact on the hospital's trauma service, the quality of care was not impaired.
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Affiliation(s)
- Leanne Saxon
- Melbourne Academic Centre for Health, Melbourne, Victoria, Australia
| | - Timothy N Fazio
- Department of General Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,Health Intelligence, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kellie Gumm
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Steven Y C Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - David J Read
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Hamilton J, Cocco A, Shakerian R, Wu M, Wang J, Gumm K, Read DJ. Venous thromboembolism prophylaxis practices and outcomes at an Australian level-one trauma service. Trauma 2021. [DOI: 10.1177/14604086211019535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major cause of potentially preventable morbidity and mortality amongst trauma patients. Venous thromboembolism prevalence varies from 1 to 58%, and traditionally, compliance with prophylaxis protocols is low in major trauma cohorts. This study aimed to describe VTE prevalence, prophylaxis practices and outcomes amongst VTE cases at an Australian level-one trauma centre. Methods A retrospective review of all VTE cases occurring in acute, major trauma admissions between 1 January 2010 and 30 June 2019 was conducted using prospectively collected registry data. Data regarding demographics, time to diagnosis, VTE prophylaxis, VTE risk assessment tool (RAT) usage and all-cause mortality were collected. Chemoprophylaxis was considered adequate if administered for 48 h prior to diagnosis. VTE cases diagnosed within 48 h of admission were excluded from prophylaxis compliance analysis. A subgroup analysis of patients with intracranial haemorrhage (ICH) was also completed. Results During the study period, 238 VTE events occurred in 237 patients from 7482 major trauma admissions, giving a VTE prevalence of 3.18%. The all-cause mortality rate was 8.0%. VTE chemoprophylaxis was administered for 109 of 211 eligible patients (51.7%). Of the remaining 102 VTE cases, 75 (73.5%) did not receive prophylaxis due to a documented contraindication, while 27 (26.5%) did not receive prophylaxis with no contraindication recorded. The VTE RAT was completed in 49.0% of cases. Conclusion Venous thromboembolism prevalence at our institution was consistent with published figures for comparable institutions. A review of compliance with prophylaxis protocols showed several potential areas for improvement.
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Affiliation(s)
- Jordan Hamilton
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Annelise Cocco
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rose Shakerian
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Michael Wu
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jennifer Wang
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kellie Gumm
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David J Read
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Lockie E, Shakerian R, Gregorevic K, Gumm K, Dimopoulos S, Read DJ. Frailty ‐ The strongest predictor of 12‐month mortality in minor and major elderly trauma. Trauma 2021. [DOI: 10.1177/14604086211019182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Elizabeth Lockie
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Victoria, Australia
| | - Rose Shakerian
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Victoria, Australia
| | - Katherine Gregorevic
- Aged Care and General Medicine, The Royal Melbourne Hospital, Victoria, Australia
| | - Kellie Gumm
- Trauma Service, The Royal Melbourne Hospital, Victoria, Australia
| | - Stephanie Dimopoulos
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Victoria, Australia
| | - David J Read
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Victoria, Australia
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Lockie E, Gumm K, Skandarajah A, Pascoe D, Read D, Thomson B, Shakerian R. Poor compliance with imaging guidelines in the pregnant trauma patient remains a challenge. Trauma 2021. [DOI: 10.1177/1460408620943486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Elizabeth Lockie
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia
- Trauma Service, The Royal Melbourne Hospital, Parkville, Australia
| | - Kellie Gumm
- Trauma Service, The Royal Melbourne Hospital, Parkville, Australia
| | - Anita Skandarajah
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia
- Trauma Service, The Royal Melbourne Hospital, Parkville, Australia
- Department of Surgery, University of Melbourne, Parkville, Australia
| | - Diane Pascoe
- Department of Radiology, The Royal Melbourne Hospital, Parkville, Australia
| | - David Read
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia
- Trauma Service, The Royal Melbourne Hospital, Parkville, Australia
| | - Benjamin Thomson
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia
- Trauma Service, The Royal Melbourne Hospital, Parkville, Australia
- Department of Surgery, University of Melbourne, Parkville, Australia
| | - Rose Shakerian
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia
- Trauma Service, The Royal Melbourne Hospital, Parkville, Australia
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Hoskins W, Bucknill A, Wong J, Britton E, Judson R, Gumm K, Santos R, Sheehy R, Griffin X. A prospective case series for a minimally invasive internal fixation device for anterior pelvic ring fractures. J Orthop Surg Res 2016; 11:135. [PMID: 27825365 PMCID: PMC5101701 DOI: 10.1186/s13018-016-0468-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/13/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND External fixation is commonly used as a means of definitive fixation of pelvic fractures. Pin site infection is common, with some cases of osteomyelitis and inpatient nursing can be challenging. The aim of this study is to report the outcomes and complications of an alternative minimally invasive technique, known as INFIX, utilising spinal pedicle screws inserted into the supra-acetabular bone and connected by a subcutaneous rod. METHODS A single-centre prospective case series was performed. The primary outcome measures were fracture stability and displacement at time of implant removal and intra- and post-operative complications. RESULTS Twenty-one patients were recruited, with 85.7 % of fractures being lateral compression type. Mean follow-up was 342 days. Mean application time was 51 min (range 44-65). Nineteen were removed electively, with mean time to removal 109 days. All cases were stable with no displacement. Two cases were removed emergently, one due to wound infection and the other due to lateral femoral cutaneous nerve neuropathic pain. Twelve patients sustained a lateral femoral cutaneous nerve palsy, with 20/42 nerves being affected. Improvement in all lateral femoral cutaneous nerve symptoms were reported with removal. Nine patients developed asymptomatic heterotopic ossification, and there were three deep infections and one symptomatic due to the bar. CONCLUSIONS Minimally invasive internal fixation with the INFIX for anterior pelvic ring fractures is an alternative to anterior external fixation. However, a higher rate of lateral femoral cutaneous nerve palsy is noted, and the implant is not well tolerated by all patients. Further studies are required to define fracture types and patients best suited to the technique and how LFCN complications may be minimised. TRIAL REGISTRATION ACTRN12616001421426 . Registered 12 October 2016. Retrospectively registered.
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Affiliation(s)
- Wayne Hoskins
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Grattan St, Parkville, VIC, 3052, Australia. .,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.
| | - Andrew Bucknill
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Grattan St, Parkville, VIC, 3052, Australia
| | - James Wong
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Grattan St, Parkville, VIC, 3052, Australia
| | - Edward Britton
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Grattan St, Parkville, VIC, 3052, Australia
| | - Rodney Judson
- Trauma Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Kellie Gumm
- Trauma Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Roselyn Santos
- Trauma Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Rohan Sheehy
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Grattan St, Parkville, VIC, 3052, Australia
| | - Xavier Griffin
- Nuffield Department of Orthopaedics, University of Oxford, Oxford, UK.,John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Headington, Oxford, UK
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Hammerschlag G, Cao J, Gumm K, Irving L, Steinfort D. Prevalence of incidental pulmonary nodules on computed tomography of the thorax in trauma patients. Intern Med J 2015; 45:630-3. [DOI: 10.1111/imj.12755] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 03/19/2015] [Indexed: 12/21/2022]
Affiliation(s)
- G. Hammerschlag
- Department of Respiratory and Sleep Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - J. Cao
- Department of Respiratory and Sleep Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - K. Gumm
- Royal Melbourne Hospital Trauma Service; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - L. Irving
- Department of Respiratory and Sleep Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - D. Steinfort
- Department of Respiratory and Sleep Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
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