The changing epidemiology of trauma in child-bearing age women

BACKGROUND

In the last two decades, there have been major improvements in the trauma system in the United Arab Emirates (UAE). We aimed to study the changes in the incidence, type, severity, and outcome of trauma of hospitalized child-bearing age women in Al-Ain City, UAE, during that time.

METHODS

Data from two separate trauma registries of Al-Ain Hospital, which were prospectively collected from March 2003 to March 2006 and January 2014 to December 2017, were analyzed retrospectively. All women aged 15-49 years were studied. The two periods were compared.

RESULTS

Trauma incidence of hospitalized child-bearing age women was reduced by 47% during the second period. There were no significant differences in the mechanism of injury between the two periods. Road traffic collision was the main cause of injury (44% and 42%, respectively) followed by fall down (26.1% and 30.8%, respectively). The location of injury was significantly different (p = 0.018), with a strong trend of more home injuries in the second period (52.8% compared with 44%, p = 0.06). There was a strong statistical trend of mild traumatic brain injury (GCS 13-15) in the second period (p = 0.067, Fisher's Exact test). Those who had normal GCS of 15 were significantly higher in the second period compared with those in the first period (95.3% compared with 86.4%, p < 0.001, Fisher's Exact test) despite having more anatomical injury severity of the head (AIS 2 (1-5) compared with 1 (1-5), p = 0.025). The NISS was significantly higher in the second period (median (range) NISS 5 (1-45) compared with 4 (1-75), p = 0.02). Despite that, mortality was the same (1.6% compared with 1.7%, p = 0.99) while the length of hospital stay was significantly less (mean (SD) 5.6 (6.3) days compared with 10.6 (13.6) days, p < 0.0001).

CONCLUSIONS

The incidence of trauma in hospitalized child-bearing-age women was reduced by 47% over the last 15 years. Road traffic collisions and falls are the leading cause of injury in our setting. Home injuries increased over time. The mortality remained stable despite the increased severity of injured patients. More injury prevention efforts should target home injuries.

Reduction of motorcycle-related deaths over 15 years in a developing country

BACKGROUND

There have been major improvements in the trauma system and injury prevention in Al-Ain City. We aimed to study the impact of these changes on the incidence, pattern, injury severity, and outcome of hospitalized motorcycle-related injured patients in Al-Ain City, United Arab Emirates.

METHODS

This is a retrospective analysis of two separate periods of prospectively collected data which were retrieved from Al-Ain Hospital Trauma Registry (March 2003 to March 2006 compared with January 2014 to December 2017). All motorcycle-injured patients who were admitted to Al-Ain Hospital for more than 24 h or died in the Emergency Department or after hospitalization were studied.

RESULTS

The incidence of motorcycle injuries dropped by 37.1% over the studied period. The location of injury was significantly different between the two periods (p = 0.02, Fisher's exact test), with fewer injuries occurring at streets/highways in the second period (69.1% compared with 85.3%). The anatomical injury severity of the head significantly increased over time (p = 0.03), while GCS on arrival significantly improved (p < 0.0001), indicating improvements in both prehospital and in-hospital trauma care. The mortality of the patients significantly decreased (0% compared with 6%, p = 0.002, Fisher's exact test).

CONCLUSIONS

The incidence of motorcycle injuries in our city dropped by almost 40% over the last 15 years. There was a significant reduction in the mortality of hospitalized motorcycle-injured patients despite increased anatomical severity of the head injuries. This is attributed to improvements in the trauma care system, including injury prevention, and both prehospital and in-hospital trauma care.

It's time for a minimum synoptic operation template in patients undergoing laparoscopic cholecystectomy: a systematic review

BACKGROUND

Despite the call to enhance accuracy and value of operation records few international recommended minimal standards for operative notes documentation have been described. This study undertook a systematic review of existing operative reporting systems for laparoscopic cholecystectomy (LC) to fashion a comprehensive, synoptic operative reporting template for the future.

METHODS

A search for all relevant articles was conducted using PubMed version of Medline, Scopus and Web of Science databases in June 2021, for publications from January 1st 2011 to October 25th 2021, using the keywords: laparoscopic cholecystectomy AND operation notes OR operative notes OR proforma OR documentation OR report OR narrative OR audio-visual OR synoptic OR digital. Two reviewers (NOC, GMC) independently assessed each published study using a MINORS score of ≥ 16 for comparative and ≥ 10 for non-comparative for inclusion. This systematic review followed PRISMA guidelines and was registered with PROSPERO. Synoptic operative templates from published data were assimilated into one "ideal" laparoscopic operative report template following international input from the World Society of Emergency Surgery board.

RESULTS

A total of 3567 articles were reviewed. Following MINORS grading 25 studies were selected spanning 14 countries and 4 continents. Twenty-two studies were prospective. A holistic overview of the operative procedure documentation was reported in 6/25 studies and a further 19 papers dealt with selective surgical aspects of LC. A unique synoptic LC operative reporting template was developed and translated into Chinese/Mandarin, French and Arabic.

CONCLUSION

This systematic review identified a paucity of publications dealing with operative reporting of LC. The proposed new template may be integrated digitally with hospitals' medical systems and include additional narrative text and audio-visual data. The template may help define new OR (operating room) recording standards and impact on care for patients undergoing LC.

Epidemiological changes of geriatric trauma in the United Arab Emirates

ABSTRACT

We aimed to study the epidemiological changes in geriatric trauma in Al-Ain City, United Arab Emirates, in the past decade to give recommendations on injury prevention.Trauma patients aged 65 years and above who were hospitalized at Al-Ain Hospital for more than 24 hours or died in the hospital after their arrival regardless of the length of stay were studied. Data were extracted from the Al-Ain Hospital trauma registry. Two periods were compared; March 2003 to March 2006 and January 2014 to December 2017. Studied variables which were compared included demography, mechanism of injury and its location, and clinical outcome.There were 66 patients in the first period and 200 patients in the second period. The estimated annual incidence of hospitalized geriatric trauma patients in Al-Ain City was 8.5 per 1000 geriatric inhabitants in the first period compared with 7.8 per 1000 geriatric inhabitants in the second period. Furthermore, mortality was reduced from 7.6% to 2% (P = 0.04). There was a significant increase in falls on the same level by14.9% (62.1%-77%, P = 0.02, Pearson χ2 test). This was associated with a significant increase of injuries occurring at home (55.4%-78.7% P = 0.0003, Fisher Exact test). There was also a strong trend in the reduction of road traffic collision injuries which was reduced by 10.8% (27.3%-16.5%, P = 0.07, Fisher Exact test).Although the incidence and severity of geriatric trauma did not change over the last decade, in-hospital mortality has significantly decreased over time. There was a significant increase in injuries occurring at homes and in falls on the same level. The home environment should be targeted in injury prevention programs so as to reduce geriatric injuries.

Hey surgeons! It is time to lead and be a champion in preventing and managing surgical infections!

Appropriate measures of infection prevention and management are integral to optimal clinical practice and standards of care. Among surgeons, these measures are often over-looked. However, surgeons are at the forefront in preventing and managing infections. Surgeons are responsible for many of the processes of healthcare that impact the risk for surgical site infections and play a key role in their prevention. Surgeons are also at the forefront in managing patients with infections, who often need prompt source control and appropriate antibiotic therapy, and are directly responsible for their outcome. In this context, the direct leadership of surgeons in infection prevention and management is of utmost importance. In order to disseminate worldwide this message, the editorial has been translated into 9 different languages (Arabic, Chinese, French, German, Italian, Portuguese, Spanish, Russian, and Turkish).

A Global Declaration on Appropriate Use of Antimicrobial Agents across the Surgical Pathway

This declaration, signed by an interdisciplinary task force of 234 experts from 83 different countries with different backgrounds, highlights the threat posed by antimicrobial resistance and the need for appropriate use of antibiotic agents and antifungal agents in hospitals worldwide especially focusing on surgical infections. As such, it is our intent to raise awareness among healthcare workers and improve antimicrobial prescribing. To facilitate its dissemination, the declaration was translated in different languages.

Distraction-related road traffic collisions

OBJECTIVES

We aimed to prospectively study distraction-related road traffic collision injuries, their contributory factors, severity, and outcome.

METHODS

Data were prospectively collected on all hospitalized road traffic collision trauma patients in Al-Ain City who were drivers at the collision time over one and half years. Driver's inattentive behaviors preceding the collision were collected by interviewing the admitted drivers.

RESULTS

There were 444 drivers, 330 of them were fully oriented patients, out of them only 44 (13%) were distracted. Nineteen (5.8%) drivers were distracted by using mobile phones, 12 (3.6%) were pre-occupied with deep thinking, six (1.8%) were talking with other passengers, four (1.2%) were picking things in the vehicle, and three (0.9%) were using entertainment systems. The maximum distraction occurred during the time of 6 am - 12 noon when the traffic was crowded. There were no significant differences between distracted and non-distracted drivers in demographical and physiological factors, injured regions, and outcomes.

CONCLUSION

Distraction of alert drivers causes 13% of road traffic collisions in Al-Ain city. About 40 percent of the distracted drivers involved in road traffic collisions (RTC) were using mobile phones. Our study supports the ban of use of cell phones while driving.

Youth traffic-related injuries: a prospective study

Background

Traffic-related injuries are the most common cause of morbidity and mortality of the youth. Our aim was to study epidemiology, risk factors and outcome of hospitalized youth patients injured in road traffic collisions in order to give recommendations for prevention.

Methods

We prospectively studied all youth (15–24 years) patients having traffic-related injuries who were admitted to Al Ain or Tawam Hospitals, Al Ain City, or who died after arrival to these hospitals during an 18 months period. Demography, location and time of injury, injured body regions, severity, hospital and intensive care unit (ICU) stay and outcome were analyzed.

Results

Three hundred thirty-three patients having a mean age (SD) of 20 years (2.5) were studied. 87% were males and 72% were UAE nationals. Majority of injured patients were drivers or front-seat passengers (70%), followed by back seat passengers (16%), motorcyclists (5%) and pedestrians (4%). Rollover was the most common crash mechanism (35%), followed by front crash (34%). Twenty seven patients (8%) were ejected during the crash, 14 during roll-over, 7 from quadribikes and three during front crash. 20% of the patients were admitted to the ICU. Median Glasgow Coma Scale was 15 (range 3–15), median Injury Severity Score was 5 (range 1–41), and median total hospital stay was 3 days (range 1–73). Nine (3%) patients died.

Conclusions

Young UAE-national males are at a higher risk of being injured at traffic. Rollover crash was frequent with high risk of ejection. Promotion of traffic safety and enforcement of safety legislation is necessary.

Epidemiology of isolated hand injuries in the United Arab Emirates

AIM

To provide suggestions for hand injury prevention by study the demography and risk factors of casualties suffering from isolated hand injuries.

METHODS

All trauma patients with isolated hand injuries who were admitted to Al Ain Hospital for more than 24 h during a period of 3 years were studied. Patient demographics, location, mechanism/time of injury, and length of hospital stay were all analyzed.

RESULTS

Two hundred and ten patients were studied. Their mean age was 29.7 years. Males constituted 92%. Sixty-five point one percent of all cases were from the Indian subcontinent. The workplace was the most common location of injury (67.1%), followed by the home (17.1%) and road (6.2%). Machinery caused 36.2% of all injuries, followed by heavy object (20.5%) and fall (11%). Cases injured at home were young (P < 0.0001) with an associated higher incidence of females (P < 0.0001).

CONCLUSION

Male workers in Al Ain city are at greater risk of sustaining hand injuries, predominantly from machinery. Safety education, personal protection, and the enforcement of safety standards are essential to the prevention and avoidance of hand injury.

Epidemiology of animal-related injuries in a high-income developing country

BACKGROUND

The objective of this study was to investigate the incidence, mechanisms, types, anatomical distribution, and outcome of animal related-injuries in Al-Ain, the United Arab Emirates in order to improve preventive measures.

METHODS

The study included all patients admitted to Al-Ain Hospital with animal-related injuries for more than 24 hours or the patients who died in the Emergency Department between March 2003 and March 2007.

RESULTS

There were eighty-nine (2.3%) patients, of whom 99% were males. The median age of the patients was 30 (range, 5-89) years. Camel-related injuries were the most common (84.3%) injuries followed by cow-related injuries (6.7%). 88.7% of the injuries occurred at work. Animal kick was the most common mechanism of injury (32.6%) followed by falls (30.3%). Upper extremity was the most commonly injured region. The median Injury Severity Score (ISS) was 4 (range, 1-13) and the median hospital stay was 6 (range, 1-53) days.

CONCLUSION

The majority of animal-related injuries were caused by camels. Experience in handling the animals, a good knowledge of animal behavior along with using safety devices and prevention education can reduce the toll of animal-related injuries.

Lower limb and associated injuries in frontal-impact road traffic collisions

OBJECTIVES

To study the relationship between severity of injury of the lower limb and severity of injury of the head, thoracic, and abdominal regions in frontal-impact road traffic collisions.

METHODS

Consecutive hospitalised trauma patients who were involved in a frontal road traffic collision were prospectively studied over 18 months. Patients with at least one Abbreviated Injury Scale (AIS) ≥3 or AIS 2 injuries within two AIS body regions were included. Patients were divided into two groups depending on the severity of injury to the head, chest or abdomen. Low severity group had an AIS < 2 and high severity group had an AIS ≥ 2. Backward likelihood logistic regression models were used to define significant factors affecting the severity of head, chest or abdominal injuries.

RESULTS

Eighty-five patients were studied. The backward likelihood logistic regression model defining independent factors affecting severity of head injuries was highly significant (p =0.01, nagelkerke r square = 0.1) severity of lower limb injuries was the only significant factor (p=0.013) having a negative correlation with head injury (Odds ratio of 0.64 (95% CI: 0.45-0.91).

CONCLUSION

Occupants who sustain a greater severity of injury to the lower limb in a frontal-impact collision are likely to be spared from a greater severity of head injury.

Pedestrian injuries-related deaths: a global evaluation

OBJECTIVE

Pedestrians are vulnerable road users who are at risk of injuries and death on the roads. We aimed to define factors affecting pedestrian injuries-related deaths worldwide and to give recommendations regarding their prevention priorities.

METHODS

Data on pedestrian injuries-related deaths for years 2007 and 2010 were retrieved from the WHO global status reports on road safety. These included the country population, gross national income (GNI), number of registered vehicles, estimated pedestrian deaths rate, effectiveness of enforcement of law, and the presence of policies to promote walking or cycling. Correlations between studied variables were done using Spearman rank correlation. General linear models were used to define factors affecting pedestrian injuries-related deaths.

RESULTS

The median (range) pedestrian death rates of different countries per 100,000 population significantly decreased in year 2010 compared with year 2007 [3.9 (0-13.5) compared with 4.2 (0-23.6), (p = 0.004, Wilcoxon signed rank test)]. There was a reduction of 8.1% of the global pedestrian death rate between 2007 and 2010. The estimated pedestrian lives saved annually worldwide of a population of 6.8 billion were 23,120 persons. A general linear model has shown that GNI (p = 0.001) and population density (p = 0.01) were the best predictors of pedestrian death rates in 2007, while national legislation (p = 0.03) was the best predictor of pedestrian death rates in 2010.

CONCLUSIONS

There is a change in the factors affecting pedestrian mortality worldwide over time. GNI and population density became less significant than national legislation enforcement. Legislation and its enforcement are important to achieve the UN mission of reducing road traffic deaths by 5 million over the next decade.

Epidemiology of spinal injuries in the United Arab Emirates

Aim

To assess the risk factors, mechanism of injury, and clinical outcome of hospitalized patients with spinal injuries in order to recommend preventive measures.

Methods

Patients with spinal injuries admitted to Al Ain Hospital, United Arab Emirates (UAE) for more than 24 h or who died after arrival to the hospital were studied over 3 years. Demography, location and time of injury, affected body regions, hospital and ICU stay, and outcome were analyzed.

Results

239 patients were studied, 90 % were males, and 84 % were in the productive years of 25–54. Majority were from the Indian subcontinent (56 %). Road was the most common location for spinal injury (47 %), followed by work (39 %). The most common mechanism of injury was traffic collisions (48 %) followed by fall from height (39 %) and fall from the same level (9 %). UAE nationals were often injured at road and home compared with non-UAE nationals, who were more injured at work (p < 0.0001). Patients falling from the same level were older (p = 0.001) and predominantly females (p < 0.0001) when compared with other mechanisms. Spinal fractures were more common in the lumbar region (57 %). Eleven patients (5 %) sustained paraplegia and five (4 %) patients died.

Interpretation

Traffic injuries and falls were the leading causes for spinal injuries in the UAE. Expatriate males are at high risk for fall from height, UAE national males for traffic injuries and females for falls at the same level at homes. Prevention should focus on traffic and home injuries for UAE nationals and occupational safety for expatriate workers.

Factors affecting injury severity of vehicle occupants following road traffic collisions

AIM

We aimed to define factors affecting injury severity of vehicle occupants following road traffic collisions (RTC).

PATIENTS AND METHODS

422 vehicle occupants (343 males, 81.3%) with RTC-related injuries were prospectively studied over 18 months. General linear model was used to test the effect of age, gender, alcohol and drug use, time of injury, mechanism of injury, size and speed of the vehicle, position in the vehicle, seatbelt usage, and air bag deployment on the Injury Severity Score (ISS) of the vehicle occupants.

RESULTS

The mean (range) age of patients was 28.2 (1-78) years and the mean (range) ISS was 7.9 (1-50). Front impact was the most common mechanism of injury (32.9%) followed by rollover (25.6%) and side impact (22.3%). 18.2% used seatbelts. The general linear model was highly significant and showed that mechanism of injury (p<0.0001), speed of the vehicle (p=0.02), and age of the vehicle occupant (p=0.03) significantly affected the Injury Severity Score.

CONCLUSIONS

The mechanism of the RTC, the vehicle speed, and age of the vehicle occupant are the most important factors affecting the severity of road traffic collision injuries. A detailed history of the mechanism of injury is important for alerting clinicians to severity of injury, the need for admission, and workup of the patients. Furthermore, strict speed limit enforcement is an injury prevention priority in our community.

Alcohol-related road traffic injuries in Al-Ain City, United Arab Emirates

OBJECTIVE

We aimed to prospectively study the demography, severity of injury and outcome of alcohol-related road traffic collision (RTC) injuries in the United Arab Emirates.

METHODS

Data of RTC Registry of Al-Ain City were prospectively collected from Al-Ain and Tawam hospitals during the period of April 2006 to October 2007. It included all RTC trauma patients who were admitted or those who died after arrival to these hospitals. Car occupants with complete data on alcohol use were included in the study. Patients were divided into two groups, those who reported using alcohol and those who did not.

RESULTS

Out of the 771 car occupants, sixteen (16) used alcohol (2.1%), 15 (94%) of them were males. The median (range) age of the alcohol group was significantly higher than those without alcohol (35 (15-53) years compared with 26 (1-78) years, p = 0.02). The UAE nationals were significantly more (P = 0.01) and the revised trauma score was significantly less in the alcohol group (P = 0.03). Head/face was the most commonly injured region in the alcohol group (94%).

CONCLUSION

Self reported alcohol-related car collisions in Al-Ain City had a low incidence. It affected older Emirati male nationals and was associated with lower revised trauma score, mainly due to head injury. There is a need for a national registry with data on alcohol abuse so as to assess its effects and strategies for its prevention.

Epidemiology, morbidity and mortality from fall-related injuries in the United Arab Emirates

Background

Unintentional falls are a major cause of morbidity and mortality with a significant burden on victims, families, and societies. We aimed to study the mechanism, risk factors, and outcome of hospitalized patients with fall-related injuries in order to propose preventive measures.

Methods

Fall-related injured patients who were admitted to Al Ain Hospital, United Arab Emirates (UAE) for more than 24 hours or who died after arrival to the hospital, were studied over 3 years. Demography, location and time of injury, affected body regions, hospital and ICU stay, and outcome were analyzed.

Results

882 patients were studied, 82% were males, and 22% were less than 19 years old. Majority were from the Indian subcontinent. The most common location for fall injuries was work. Patients injured at work were older and mainly non-UAE nationals (p < 0.0001) when compared with those injured at home. Patients falling from height, when compared with those falling from same level, were older (p = 0.017), had more males (p < 0.001), were mainly from the Indian subcontinent (p < 0.001), had higher ISS (p = 0.011) and longer total hospital stay (p < 0.001).

Conclusions

Falls are a major health problem in the UAE. Falls at work can be prevented by safety education tailored to different ethnic groups, and proper legislation and regulation. Environmental modification using evidence-based architectural design may prevent falls among vulnerable risk groups.

Pedestrian injuries in the United Arab Emirates

We aimed to study the anatomical distribution, severity, and outcome of hospitalised trauma pedestrian patients in Al Ain, United Arab Emirates (UAE), so as to improve preventive measures. All pedestrian trauma patients who were involved with a road traffic collision and admitted to Al Ain Hospital for more than 24 hours or who died in the hospital were included in the study. Data were prospectively collected during March 2003-October 2007. Three hundred and eighteen patients were studied, 279 (87.7%) were males. Median (range) age was 31 (1-75) years. UAE nationals were significantly younger than non-nationals (median (range) age of 14 (2-75) years compared with 33 (1-75) years, p = 0.001, Mann-Whitney U-test). The lower limb (57.2%) was the most common injured region followed by the head (46.9%). The median (range) Injury Severity Score of patients was 5 (1-45). The median (range) total hospital stay was 11.3 (1-130) days. Thirty patients died (overall mortality 9.4%). In conclusion, mortality of pedestrian injured patients in the UAE is high. Severe head injury was the main cause of death. Measures to improve pedestrian safety should be adopted so as to reduce morbidity and mortality. These include educating drivers and pedestrians on road safety and enforcement of traffic safety laws.

Epidemiology of head injury in the United Arab Emirates

BACKGROUND

Head injury increases mortality in trauma patients. We aimed to study the epidemiological and clinical features of head injury in Al-Ain city, United Arab Emirates (UAE).

METHODS

Trauma patients with head injury who were admitted to Al- Ain Hospital for more than 24 hours and those who died in the hospital were included in the study. Data were prospectively collected from March 2003 - March 2006.

RESULTS

589 patients were studied, and 521 were males (88.3%). The median (range) age was 30 (1-89) years. The most common mechanism of injury was road traffic collision (67.1%) followed by fall from height (11.9%). Head injury was mild in 82.2% of patients, moderate in 5.7%, and severe in 12.1%. 20.9% of patients were admitted to the intensive care unit. 35 patients died (overall mortality 5.9%). Patients who died had significantly higher Injury Severity Score (p<0.0001), lower Glasgow Coma Scale (p<0.0001), and higher Abbreviated Injury Scale of the head (p<0.0001).

CONCLUSION

Motor vehicle collision was the main mechanism of head injury in the UAE followed by fall from height. Legislation for compulsory seatbelt usage and helmet usage by bicyclists and motorcyclists should be adopted. A safe work environment and preventive measures at work should be introduced.

Injuries from falling objects in the United Arab Emirates

Our aim was to study the demography, anatomical regions injured, severity, and outcome of hospitalised trauma patients who were injured by falling objects in order to give recommendations regarding their prevention in the UAE. All trauma patients who were injured by falling objects and were admitted to Al Ain Hospital for more than 24 hours, or died after arrival to the hospital were studied for over 3 years. One hundred forty nine patients having a mean age (SD) > 34 (12.1) years were studied. The annual incidence of hospitalisation was 10.7/100,000 persons per year. Majority (97.3%) were males and 73.2% from the Indian subcontinent. The most common location for injury was work (88.6%), followed by home (9.4%). Patients injured at home were younger (p < 0.0001), and were more females (p < 0.0001). Extremities and head/neck were the most common injured regions; 1.3% of patients died. Males from the Indian subcontinent are at a higher risk of being injured by falling objects especially at work. Safety education and programs, environmental changes, use of protective devices including helmets or special shoes, and proper enforcement of the safety guidelines could reduce hospitalisations, disability, and death from these injuries.

Epidemiology of burns in the United Arab Emirates: lessons for prevention

PURPOSE

To study mechanism, risk factors and outcome of hospitalized burns so as to give recommendations for prevention.

METHODS

Burn patients admitted to Al Ain hospital for more than 24h or who died after arrival were studied over 4 years. Demographics, burn type, location and time of injury, total body burned surface area (TBSA), body region, hospital and ICU stay and outcome were analyzed.

RESULTS

203 patients were studied, 69% were males and 25% were children under 5 years old. The most common location for burn was home. Women were burned more at home (p<0.0001). 28% of patients were injured at work with more men (p<0.0001) and non-UAE nationals (p<0.01). Scalds from water, tea were the major hazard at home, while majority of burns at work were from gas and flame. Burns caused by gas and flame had larger TBSA and longer ICU stay. Six (3%) patients died and nine (4%) were transferred to the specialized burn center.

CONCLUSIONS

Safety education for caregivers and close supervision of young children is important to reduce pediatric burns. Occupational safety education of young men could prevent burns caused by gas and flame.

Factors affecting mortality of critical care trauma patients

BACKGROUND

Critically-ill trauma patients have a high mortality.

OBJECTIVE

To study the factors affecting the mortality of ICU trauma patients treated at Al-Ain Hospital, United Arab Emirates (UAE).

METHODS

All trauma patients who were admitted to the ICU were prospectively collected over three years (2003-2006). Univariate and multivariate analysis were used to compare patients who died and who did not. Gender, age, nationality, mechanism of injury, systolic blood pressure and GCS on arrival, the need for ventilation, presence of head or chest injuries, AIS for the chest and head injuries and the ISS were studied.

RESULTS

There were 202 patients (181 males). The most common mechanism of injury was road traffic collisions (72.3 %). The overall mortality was 13.9%. A direct logistic regression model has shown that factors that affected mortality were decreased GCS (p < 0.0001), mechanism of injury (p = 0.004) with burns having the highest mortality, increased age (p = 0.004), and increased ISS (p = 0.02). The best GCS that predicted mortality was 5.5 while the best ISS that predicted mortality was 13.5.

CONCLUSION

Road traffic collision is the most common cause of serious trauma in UAE followed by falls. Decreased GCS was the most significant factor that predicted mortality in the ICU trauma patients.

Pediatric and youth traffic-collision injuries in Al Ain, United Arab Emirates: a prospective study

Aim

To study the mechanism of road traffic collisions (RTC), use of safety devices, and outcome of hospitalized pediatric and youth RTC injured patients so as to give recommendations regarding prevention of pediatric RTC injuries.

Methods

All RTC injured children and youth (0–19-year-olds) who were admitted to Al Ain City’s two major trauma centers or who died after arrival to these centers were prospectively studied from April 2006 to October 2007. Demography of patients, road-user and vehicle types, crash mechanism, usage of safety devices, injured body regions, injury severity, Revised Trauma Score, Glasgow Coma Scale, intensive care unit admissions, hospital stay and mortality were analyzed.

Results

245 patients were studied, 69% were vehicle occupants, 15% pedestrians, 9% motorcyclists and 5% bicyclists. 79% were males and 67% UAE citizens. The most common mechanism of RTC was rollover of vehicle (37%) followed by front impact collision (32%). 32 (13%) of vehicle occupants were ejected from car. 63% of ejected occupants and 70% of motorcyclists sustained head injuries. Only 2% (3/170) vehicle passengers used seatbelts and 13% (3/23) motorcyclists a helmet.

Conclusions

Male drivers and UAE nationals were at high risk of RTC as drivers and as motorcyclists. Ejection rate was high because safety restraint use was extremely low in our community. More education and law enforcement focusing especially on car/booster seat use is needed.

Interpersonal violence in the United Arab Emirates

We aimed to study the anatomical distribution, severity and outcome of hospitalised interpersonal violence-related injured patients in Al-Ain, United Arab Emirates so as to give recommendations regarding the magnitude of this problem, its causes and priorities of prevention. Data were retrieved from Al-Ain Hospital Trauma Registry, which was prospectively collected over three years. There were 75 patients (males = 85.3%) having a mean age of 30 years. Eighty-one percent had blunt trauma. The estimated annual injury hospitalisation of interpersonal violence in Al-Ain city was 6.7 per 100,000 population. Females were significantly more injured by a family member (p = 0.02), at home (p = 0.005), and had more severe injuries (p = 0.003). There was a trend for children less than 18 years old to have more penetrating trauma (p = 0.06) and to be injured by a family member (p = 0.09). There was only one case of woman sexual assault and two cases of child abuse. The mean (SD) hospital stay was 7.87 (14.1) days. Less than 3% (n = 2) were admitted to the intensive care unit with no deaths. In conclusion, the majority of patients in our study had minor injuries. Nevertheless, the psychological impact may be major. This highlights the need to develop suitable mental health services in support of victims of interpersonal violence.

Camel-related injuries: prospective study of 212 patients

BACKGROUND

Camel-related injuries have been less well studied than other animal-related injuries. We aimed to study prospectively the incidence, mechanism, distribution of injury, and outcome of patients admitted to hospital with camel-related injuries in Al-Ain, United Arab Emirates.

METHODS

All patients who were admitted to Al-Ain Hospital with a camel-related injury were prospectively studied during the period of October 2001 to January 2010. Patient's demography, time of injury, mechanism of injury, and distribution and severity of injury were studied.

RESULTS

A total of 212 patients, all male, with a median age of 28 years (5-89 years) were studied. The estimated incidence of hospitalized camel-related injured patients in Al-Ain City was 6.88 per 100,000 population per year. Camel kicks were most common (36.8 %) followed by a fall from a camel (26.4 %) and camel bites (25.0 %). Camel kicks and falling from a camel were more common during the hot month of August, and camel bites were more common during the rutting season (November to February). Patients with a kick-related injury had a significantly higher rate of maxillofacial fractures compared with other mechanisms. Spinal injuries occurred significantly more often in vehicle occupants who collided with camels compared with other mechanisms (3/7 compared with 7/205, p = 0.0022, Fisher's exact test). Twelve patients (5.7 %) were admitted to the intensive care unit. The mean hospital stay was 8.6 days (1-103 days). Two patients died (overall mortality 1 %).

CONCLUSIONS

Understanding the biomechanisms and patterns of injury and correlating them with the behavior of the camel is important for identification and prevention of camel-related injuries.

Sleep-related collisions in United Arab Emirates

INTRODUCTION

Road traffic collisions (RTC) are a major health problem in UAE. Sleep as a contributing factor to RTC is not well-studied in the Middle East.

OBJECTIVE

We aimed to study to the proportion of RTC caused by sleep behind the wheel and the factors contributing to sleep related collisions (SRC).

METHODS

Data of all hospitalized drivers who were involved in RTC in Al-Ain city were prospectively collected during the period of April 2006-October 2007. Variables studied included, driver's demographic data, time, date, location, mechanism of collision, speed at collision and whether sleepiness was a contributing factor as reported by the drivers. A direct logistic regression model was performed to define factors related to sleep while driving.

RESULTS

444 drivers (92% males) were involved in RTC during the study period. Sleepiness of drivers was a contributing factor in 5%. Most of the drivers experiencing SRC (79%) reported speeds of 100km/h or more during the collision. SRC was strongly over-represented during the month of Ramadan (42%) and in driving on highways (83%). A logistic regression model has shown that driving during the lunar month of Ramadan (p<0.0001, OR=6.36) and on highways (p=0.037, OR=3.75) were the most significant independent contributors to increasing the odds of SRC.

CONCLUSION

Sleep is an important contributing factor to RTC in UAE. Drivers should be advised to discontinue driving when feeling sleepy especially during the lunar month of Ramadan and while driving on highways.

Child and youth traffic-related injuries: use of a trauma registry to identify priorities for prevention in the United Arab Emirates

OBJECTIVE

Traffic-related injuries are the main cause of death during childhood and youth in the United Arab Emirates (UAE), use of safety restraints by citizens is uncommon, rollovers are frequent, and current legislation does not protect rear-seat occupants. Because little was known about the circumstances of hospitalizations for traffic injuries to guide prevention, a trauma registry was used to assess causes and determinants for traffic-related injuries during childhood and youth (<19 years) and its value for prevention.

METHODS

One hundred ninety-three children and youth with traffic injuries were admitted for more than 24 h at surgical wards of the main trauma hospital in the Al-Ain region during a 36-month period (2003-2006). Injuries were analyzed by age, nationality, road user and vehicle types, severity, anatomical region, and the presence of head injury using Injury Severity Scores (ISS) and the Abbreviated Injury Scale (AIS).

RESULTS

Traffic injuries represented 40 percent (n = 193) of injuries to 0- to 19-year-olds, followed by falls (39 percent). Among 15- to 19-year-olds, who accounted for 46 percent of child and youth victims, the incidence was 150/100,000 person years, compared to an incidence of 15 to 51 for younger age groups. Overall, 53 percent were vehicle occupants, 23 percent were pedestrians, 14 percent were bicyclists, 6 percent were motorcyclists, with 4 percent other. The ratio of male-to-female victims was 6.7:1; for drivers it was 33:0; and for pedestrians, bicyclists, and motorcyclists it was between 10:1 and 12:1; injured females were mainly rear-seat passengers and the male: female ratio was 1.4:1. Seventy-one percent of pedestrians were ≤9 years old. Although the ratio of UAE children to foreign children was estimated at 0.7:1 in the community, 58 percent of the injured were UAE citizens. The ratio of injured UAE: non-UAE citizens was 1.4:1 overall but 5.6:1 for drivers and 4.5:1 for motorcyclists. Forty-one percent of citizens were injured in 4-wheel drive sport utility vehicles compared to 13 percent of non-citizens. Head injuries occurred in 68 percent of vehicle occupants and 51 percent of nonoccupants, with AIS ≥ 3 injuries in 23 percent of occupants and 26 percent of nonoccupants. Sixty-seven percent of rear occupants had head injuries.

CONCLUSIONS

Male drivers and vulnerable road users were at an unusually high risk relative to females. A relatively high frequency of traffic-related head injuries among UAE children and youth, including rear-seat passengers and other vehicle occupants, suggests that considerable preventable morbidity is associated with nonuse of safety restraints and/or other factors such as excess speed and rollovers of 4-wheel drive vehicles. Trauma registries can be useful for prevention; inclusion of data on safety restraints and helmet use by road user type is essential.

Motorcycle-related injuries in the United Arab Emirates

OBJECTIVES

To study the anatomical distribution, severity, outcome, and age by nationality of hospitalized motorcycle-related injured patients in Al-Ain, United Arab Emirates so as to improve preventive measures.

METHODS

All motorcycle riders involved in a road traffic collision and admitted to Al-Ain Hospital for more than 24 h or who died in hospital after arrival were studied. Patient data were retrieved from Al-Ain Hospital Trauma Registry. Data had been prospectively collected during four and half years (March 2003-October 2007). Demography of patients, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Hospital stay, mortality, nationality, time, day of week, and month of occurrence were analyzed.

RESULTS

There were 95 patients (93 males). Mean (SD) age was 29.8 (11.5) years. 35% were United Arab Emirates (UAE) nationals. Upper limbs were most frequently involved (54%) followed by lower limbs (48%), head (41%), and face (30%). On arrival at hospital, median (range) ISS was 4.5 (1-36) and median (range) GCS was 15 (3-15). Mean (range) hospital stay was 8.8 (1-79) days. 14 patients (15%) were admitted to the Intensive Care Unit. In-hospital mortality was 6%. UAE national victims were significantly younger and had more abdominal injuries than expatriates, who had lower limb injuries.

CONCLUSIONS

The most common mechanism of motorcycle crashes was hitting a moving vehicle. Young UAE national motorcyclists are at a higher risk of being injured compared with non UAE nationals. This may be due to risk-taking behavior of young motorcyclists who are mainly riding for leisure. Extremities were the most common injured body region. Severe head injury was the main cause of death. This signifies the need for effective application of motorcycle helmet law in the UAE along with other preventive measures that might include increasing the licensing age.

Camel bite injuries in United Arab Emirates: a 6 year prospective study

PURPOSE

To prospectively study the incidence, mechanism, distribution of injury, and outcome of patients admitted to Al-Ain Hospital with camel bite injuries in Al-Ain, United Arab Emirates.

METHODOLOGY

All patients admitted to Al-Ain Hospital with a camel bite were prospectively studied during the period of October 2001-October 2007. Patient's demography, mechanism of injury including behaviour of the camel, distribution and severity of injury, and outcome were studied.

RESULTS

33 patients were studied having a median (range) age of 27 (10-58), all were males. 97% were from the Indian subcontinent. A majority of injuries (73%) occurred during the camel rutting season (November-March). Twenty-five patients were camel caregivers whilst five were camel jockeys. All camel jockeys were children. Seven patients were raised up by the camel's mouth and thrown to the ground whilst 26 patients were only bitten. Most injuries were in the upper limb (64%) and head and face (15%). 48% of upper limb injuries had associated fractures. Two patients who were bitten at the neck were admitted to the ICU. One of these died due to massive left-brain infarction and the other had complete quadriplegia due to spinal cord injury. The median hospital stay was 6 days. There was only one death (3%).

CONCLUSION

The behaviour of the camel is occasionally unpredictable, especially during the rutting season. The mechanism of camel bite injuries, which are usually severe, are complex including penetrating and crushing injuries by the camel jaw and blunt injuries when patients are picked up and thrown away. Care should be taken when handling camels, particularly in the rut.

Bicycle-related injuries requiring hospitalization in the United Arab Emirates

OBJECTIVES

To study the anatomical distribution, severity, and outcome of bicycle-related injuries requiring hospitalization in Al-Ain city, United Arab Emirates in order to improve preventive measures.

METHODS

All patients with bicycle-related injuries who were admitted to Al-Ain Hospital or who died after arrival were studied. Data were prospectively collected over a period of six years (October 2001-October 2007). Demography of patients, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), hospital stay, and mortality were analysed.

RESULTS

There were 130 patients (126 males). Mean (SD) age was 27.1 (14.5) years. 17.7% were United Arab Emirates (UAE) nationals. None of the patients was wearing a helmet. The percentage of UAE nationals of less than 15 years old was significantly higher (65.2%) than non-UAE nationals (14.3%) (p<0.0001, Fisher's Exact Test). The most common mechanism of injury for UAE nationals was falling from a bicycle (73.7%) whilst for non-UAE nationals was hitting a moving vehicle (66.7%). 96 (73.9%) patients had head and face injuries whilst 91 patients (70%) had extremity injuries. On arrival to the hospital, the median (range) ISS was 4 (1-41) and the median (range) GCS was 15 (3-15). The median (range) of total hospital stay was 4 (1-95) days. 17 patients (13.1%) were admitted to the Intensive Care Unit. Two patients died because of head injury (overall mortality was 1.5%).

CONCLUSIONS

The majority of hospitalized injured cyclists in our study were low income adults using cycling as a cheap transportation method. Compulsory helmet use by bicycle riders and subsidising helmet cost should be adopted so as to reduce morbidity and mortality of bicycle-related injuries.

Trauma in women of child-bearing age in a high-income developing country

BACKGROUND

We aimed to study the distribution and causes of trauma in women of child-bearing age.

METHODS

Data were collected from Al-Ain Hospital (United Arab Emirates-UAE) Trauma Registry. Females aged 16 to 45 years (child-bearing age) who were admitted with trauma between March 2003 and March 2006 were included in the study.

RESULTS

Females represented 9% (n=171) of all trauma patients (n=1809) of the same age group, of which 29% were UAE nationals. The mean age for females was 30.5 years. Road traffic collision (RTC) was the main mechanism of injury (n=78, 46%). Burns were significantly higher in females than males (p=0.001). Cervical fractures were significantly higher in females (p=0.04), while lumbar fractures were significantly higher in males (p=0.03). In females, pelvic fractures were diagnosed in 6.4%, spinal fractures in 7%, and both injuries in 1.2%. Three females died (1.7%), and all were due to RTC.

CONCLUSION

The majority of females involved in trauma were aged 20- 34 years. RTC is the main mechanism of injury and fatality. Female trauma is associated with a high incidence of pelvic fractures. A higher rate of cervical injuries was observed in females in contrast to lumbar injuries in males.

Effects of seat belt usage on injury pattern and outcome of vehicle occupants after road traffic collisions: prospective study

BACKGROUND

Injury and death from road traffic collisions (RTCs) is a major health problem worldwide. The seat belt is the most important RTC safety innovation to reduce injury severity and death from RTCs. We aimed to study the effects of seat belt usage on injury patterns and outcomes of restrained vehicle occupants compared with unrestrained occupants after RTCs.

METHODS

RTC trauma patients who were vehicle occupants and admitted to Al-Ain and Tawam Hospitals, or who died after arrival at the emergency departments were prospectively studied during the period of April 2006 to October 2007. Demography of patients, position in the vehicle, usage of seat belts, injury severity markers, Glasgow Coma Scale (GCS), hospital stay, need for surgery, injured body regions, and mortality were analyzed.

RESULTS

Of 783 vehicle occupants, 766 (98%) patients with known seat belt status were studied. Among them, the 631 (82.4%) who were unrestrained were significantly younger than the restrained patients (P < 0.0001). The Abbreviated Injury Scale (AIS) scores for the thorax, back, and lower extremity were significantly higher in unrestrained than in restrained patients (P = 0.001, P = 0.036, and P = 0.045 respectively). The GCS was significantly lower in unrestrained than in restrained patients (P = 0.006). More surgical operations were performed in the unrestrained patients (P = 0.027).

CONCLUSIONS

Seat belt usage reduces the severity of injury, hospital stay, and number of operations in injured patients. Seat belt compliance is low in our community. More legal enforcement of seat belt usage is mandatory to reduce the severity of injury caused by RTCs.

Home and other nontraffic injuries among children and youth in a high-income Middle Eastern country: a trauma registry study

A trauma registry in the United Arab Emirates was used to ascertain nontraffic injuries of 0- to 19-year-olds. The registry's value for prevention was assessed. A total of 292 children and youth with nontraffic injuries were admitted for >24 hours at surgical wards of the main trauma hospital in Al Ain region during 36 months in 2003-2006. Injuries were analyzed by external cause, location, body part, and severity. Nontraffic represented 60% (n = 292) of child and youth injuries. Incidence/100 000 person-years was 91 for males, 43 for females. Unintentional included falls 65% (n = 191), burns 17% (n = 49), animal-related (mainly camel) 3% (n = 10), and others 10% (n = 29). Intentional accounted for 4% (n = 13). Falls affected all ages, burns mainly 1- to 4-year-olds. Of the injuries, 70% occurred at home. Most frequent and severe injuries measured by the Injury Severity Score and Abbreviated Injury Scale involved extremities. Prevention of home falls for all ages and burns of 1- to 4-year-olds are priorities. Registries should cover pediatric wards and include data on fall locations and hazardous products.

Profiling genitourinary injuries in United Arab Emirates

Background:

The epidemiology of genitourinary (GU) organ injury following general trauma is not well-studied especially in the Middle East.

Patients and Methods:

All patients with GU injuries from the Trauma Registry of Al-Ain Hospital were studied. The registry data was prospectively collected from March 2003 to March 2006.

Results:

Out of 2573 patients in the registry, 22 had GU injuries (incidence: 0.9%, 2.0 per 100,000 inhabitants per year). Road traffic collision was the most frequent mechanism of injury (50% of all cases). 41% of injuries were renal. In 73% of patients, GU injuries were associated with other organ injuries, the most frequent of which were injuries to the other abdominal and pelvic organs (94%). The mean Injury Severity Score, mean total hospital stay, the percentage of patients who required intensive care unit (ICU) admission were higher in patients with GU injuries compared to non-GU patients (17.1 vs. 5.5 (P 0.001), 15.4 vs. 9.2 days (P 0.040) and 43% vs. 8%, (P 0.0001), respectively.

Conclusions:

The incidence of trauma-related GU injuries in the current study appears to be comparable to those reported from the West. Patients with GU organ injuries tend to have more severe trauma compared to other patients. Road traffic collision was the most common mechanism of injury and the kidney was the most frequently injured organ.

Towards a national trauma registry for the United Arab Emirates

BACKGROUND

Trauma is a major health problem in the United Arab Emirates (UAE) as well as worldwide. Trauma registries provide large longitudinal databases for analysis and policy improvement. We aim in this paper to report on the development and evolution of a national trauma registry using a staged approach by developing a single-center registry, a two-center registry, and then a multi-center registry. The three registries were established by developing suitable data collection forms, databases, and interfaces to these databases. The first two registries collected data for a finite period of time and the third is underway. The steps taken to establish these registries depend on whether the registry is intended as a single-center or multi-center registry.

FINDINGS

Several issues arose and were resolved during the development of these registries such as the relational design of the database, whether to use a standalone database management system or a web-based system, and the usability and security of the system. The inclusion of preventive medicine data elements is important in a trauma registry and the focus on road traffic collision data elements is essential in a country such as the UAE. The first two registries provided valuable data which has been analyzed and published.

CONCLUSIONS

The main factors leading to the successful establishment of a multi-center trauma registry are the development of a concise data entry form, development of a user-friendly secure web-based database system, the availability of a computer and Internet connection in each data collection center, funded data entry personnel well trained in extracting medical data from the medical record and entering it into the computer, and experienced personnel in trauma injuries and data analysis to continuously maintain and analyze the registry.

Vascular injuries following road traffic collisions in a high-income developing country: a prospective cohort study

BACKGROUND

The mechanism and pattern of vascular injury vary between different populations. The commonest mechanism of vascular injury in civilian practice is road traffic collisions. We aimed to prospectively study the incidence, detailed mechanism and anatomical distribution of hospitalized vascular trauma patients following road traffic collisions in a high-income developing country.

METHODS

Data were collected prospectively on road traffic collision injuries in the whole city of Al-Ain, United Arab Emirates, from April 2006 to October 2007 with full details of mechanism of injury and its relation to sustained injuries.

RESULTS

Out of 1008 patients in the registry, 13 patients had vascular injury, a calculated incidence of 1.87 cases/100 000 inhabitants per year. There were eight car occupants, four pedestrians, and one motorcyclist. Upper limb vascular injuries were the most common anatomical site (n = 4) followed by thoracic aorta (n = 3). All thoracic aortic injuries were acceleration injuries (pedestrians hit by a moving vehicle). None of the eight car occupants was wearing a seatbelt and the majority sustained a front impact deceleration injuries. The median injury severity score, hospital stay, and ICU stay were significantly higher in the vascular injury group compared with nonvascular group (P < 0.0001). Three patients died (23%); two due to severe liver trauma and one due to rupture thoracic aorta.

CONCLUSIONS

The incidence of hospitalized vascular injury due to road traffic collisions in Al-Ain city is 1.87 cases/100 000 inhabitants. These injuries occurred mainly in the upper part of the body. Seatbelt compliance of car occupants having vascular injuries was very low. Compliance with safety measures needs more enforcement in our community.

Epidemiology of foot injury in a high-income developing country

OBJECTIVES

To study the epidemiology of foot injuries and factors predicting their severity in a high-income developing country so as to define prevention priorities.

PATIENTS AND METHODS

All patients admitted to Al-Ain Hospital with foot injury between March 2003 and March 2006 were identified from a prospectively collected Trauma Registry. Injuries were scored using foot and ankle severity scale (FASS). Bilateral, multiple or segmental injuries, open fractures or those with FASS score higher than 3 were included in severe foot injury group and compared with simple foot injury group regarding patients' demography, co-morbidities, trauma mechanism and energy, incident location, number of associated injuries, Injury Severity Score (ISS) and hospital stay using a univariate analysis. A logistic regression model was then used to study factors predicting severity of foot injury.

RESULTS

171 patients (156 males) were studied. The average (range) age was 34 (2-75). 95 had right foot injury, 66 had left, and 10 had both. Fall from height was the most common mechanism. 105 (61%) had work-related injuries. 130 (76%) had isolated foot injury. 151 (88%) had 212 foot fractures. 20 (12%) had soft tissue injuries. 70 (41%) had severe injuries while 101 (59%) had simple ones. The multiple logistic model was highly significant (p=0.002). Number of associated injuries (p=0.025) and location of trauma (p=0.044) were significant while the amount of energy (p=0.054) showed a strong trend to predict severity.

CONCLUSIONS

Fall from height is the most common mechanism of foot injury in United Arab Emirates. The number of associated injuries, high-energy trauma, and being work related are predictors of foot injury severity. Prevention priorities include counteractions against falling from height and falling heavy objects as occupational hazards.

Blast injuries of large tyres: case series

BACKGROUND

Severe blast injuries of large tyres are similar to those resulting from landmine explosions with neither thermal nor chemical effects. Little has been written about the destructive nature of these blasts.

AIMS

To evaluate our clinical management of patients involved in large tyre blasts.

PATIENTS AND METHODS

All patients who had tyre blast injuries and were admitted to Al-Ain or Tawam Hospitals between March 2003 and September 2009 were retrospectively studied. Clinical presentation, mechanism of injury, management, and outcome were reviewed.

RESULTS

Seven male patients were studied. They had a median (range) age of 38 (20-53) years. Four patients (57%) were inflating the tyre when it suddenly exploded. On arrival to the hospital, two patients were unconscious with GCS of 3/15. Six patients (86%) had head/face trauma. Three patients had multiple injuries to different body parts (43%). The median (range) injury severity score was 14 (10-33). Four patients (57%) were operated on. Five patients were admitted to the ICU with a median (range) ICU stay of 2 (1-2) days. The median (range) total hospital stay was 3 (1-14) days. Two patients died (overall mortality 29%).

CONCLUSIONS

The high energy produced by large tyre blasts may cause severe injuries leading to high morbidity and mortality. Preventive occupational methods should be adopted and implemented at the work place.

Severe tyre blast injuries during servicing

BACKGROUND

The destructive potential of the tyre explosions has received little attention in the medical literature. Fatal and severely deforming injuries have been reported. These blasts mainly affect the personnel servicing big vehicle tyres such as trucks and buses. We aimed to review the relevant literature on tyre blast injuries so as to define the mechanism of injury, outcome, and its methods of prevention.

METHODS

A search of the English literature on tyre blast injuries was performed through Medline. Different studies were retrieved, analysed and combined together.

RESULTS

A total of 763 patients were studied in the literature. Most of the patients were young aged male mechanics and the explosions usually occur during tyre servicing especially during inflation. Injury is caused by the pressure impact of the explosion or by direct hit of the rim. The head and face are the most commonly affected regions (48%) followed by the upper limbs (20%). About 25% of patients had multi-trauma. The overall mortality is high (19%) and is mainly caused by head injuries.

CONCLUSION

Inflated large tyres contain a tremendous amount of potential energy. Tyre blast injuries during servicing have a high morbidity and mortality. Preventive occupational methods should be implemented.

Trauma research in the United Arab Emirates: reality and vision

INTRODUCTION

Trauma is a major health problem in the United Arab Emirates, and it is the second leading cause of death. Research can help us find solutions for this problem. We evaluated the published literature on trauma from United Arab Emirates to define research areas which need improvement.

METHODS

A MEDLINE search for articles on trauma and injury from the United Arab Emirates covering the period 1960-2005 was performed. The content of articles was studied, classified and summarised.

RESULTS

32 articles were found, of which 18 were published in the last six years. 18 articles were on prevention and epidemiology, ten on clinical management and four on education. The first author was affiliated to the university in 19 articles. There were no articles on pre-hospital care, experimental work, trauma systems, trauma registry or post-hospital rehabilitation.

CONCLUSION

There is a need for a strategic plan to support research in areas like pre-hospital care, implementation of trauma systems, trauma registries and post-hospital rehabilitations to reduce the socioeconomic impact of trauma in the United Arab Emirates.

Non-traumatic perforation of the small bowel

BACKGROUND

Non-traumatic perforation of the small bowel is an uncommon serious complication associated with high morbidity and mortality. Diseases that cause small bowel perforation vary in different areas of the world.

OBJECTIVE

To highlight difficulties in the diagnosis and management of non-traumatic perforation of small bowel.

MATERIAL AND METHODS

The medical records of four patients who have presented with non-traumatic perforation of the small bowel and were treated at Al-Ain Hospital during the last 5 years were studied retrospectively.

RESULTS

The presenting symptoms of all patients were similar. Erect chest X-ray has shown free air under diaphragm in 3 patients. Leukocytosis was present in only one patient. HIV was confirmed in one patient. Patients were diagnosed to have typhoid, HIV, hook worms and tuberculosis. Only the HIV patient died while the others were discharged home in a good condition.

CONCLUSION

Clinical findings of small bowel perforation are usually non specific and diagnosis is usually reached after surgery. The Histopathological examination of the small bowel ulcer were non conclusive in three patients. We have made our management plan according to the clinical findings. Non traumatic perforation in developing countries can be due to typhoid, HIV, tuberculosis and possibly hook worms.

Epidemiology of geriatric trauma in United Arab Emirates

The mechanisms and outcome of trauma in hospitalized elderly patients were studied. The data of Al-Ain Hospital Trauma Registry were prospectively collected over a period of 3 years (2003-2006). All elderly trauma-patients above 60 years who were admitted to surgical ward or who died on arrival were studied. Demography of patients, mechanism of injury, Injury Severity Score (ISS), hospital stay and mortality were analyzed. There were 121 patients (70 males and 51 females). Mean (range) age was 69 years (60-100), 42% were United Arab Emirates (UAE) nationals. The two most common mechanisms of injury were falls (55%) followed by road traffic collisions (RTC) (32%). The median (range) ISS of the group was 5 (1-34). The ISS median (interquartile range) of falling down, RTC, and fall from height were 4 (4-9), 6 (4-10), and 8 (5-9), respectively (p=0.31). Forty-one percentage of injuries occurred at home. The mean (range) hospital stay was 12.4 (1-150) days. Six patients (5%) were admitted to the intensive care unit. Overall mortality was 6% (7 patients), of whom 5 were pedestrians hit by cars. We concluded that low-energy trauma from falls was the most common cause of injury in the elderly. Mortality was high mainly from pedestrian injuries.

Bicycle-related injuries: a prospective study of 200 patients

INTRODUCTION

This study aims to evaluate the magnitude, mechanism, distribution and outcome of bicycle-related injuries managed at the Emergency Department, Al-Ain Hospital, United Arab Emirates.

METHODS

200 patients, who were treated at the emergency department of Al-Ain Hospital during the period of October 2001 to January 2003, were prospectively studied. A hard copy protocol was designed and data was collected on a daily basis.

RESULTS

175 patients (87.5 percent) were males. The average age was 16.1 +/- 13.7 years. Only two were wearing helmets (one percent). The majority of injuries occurred in the evening and was due to a fall from a bicycle in 163 patients (81.5 percent). 88 patients had lower limb injuries (44 percent), and 72 had head and neck injuries (36 percent). Only 31 patients (15.5 percent) needed hospitalisation. Of these, four (12.9 percent) were admitted to the intensive care unit. The mean (range) hospital stay was 6.3 (1-23) days. Patients who were admitted to the hospital were older males, involved in motor vehicle collisions, and had more head injuries. Three patients (1.5 percent) died.

CONCLUSION

Bicyclists' head injuries, caused by a motor vehicle collision, are a main cause of hospital admission. Helmet compliance in our community is alarmingly low, indicating the need for legislation and education on the use of helmets.

Biomechanics of road traffic collision injuries: a clinician's perspective

Understanding the biomechanics of road traffic collision injuries is important for diagnosing and managing road traffic injured patients. As road traffic collisions may entail high-energy trauma, the degree of injury will depend on the mass and speed of the collided vehicles. Collisions can be front impact, back impact, side impact; the vehicle may turn over or the patient may be ejected from the vehicle. Each of these mechanisms has a specific pattern of injury. The injury will vary depending on whether the passenger was restrained with a seat belt or not. Seat belts tend to reduce head injuries and increase the abdominal injuries. Compression injuries of the intestines and urinary bladder tend to be more severe, causing rupture of these hollow organs if pressure within these organs was high. Pedestrian injuries consist of three phases: the bumper impact, hood and windscreen impact, and ground impact. The injury pattern and impact of motor vehicle collisions with large animals will depend on the size, height and weight of the animal. Clinical examples of road traffic collision patients will highlight the value of understanding biomechanics in patient management.

Necrotizing fasciitis: a challenging diagnosis

The objective of the study was to evaluate our recent experience in diagnosis and management of necrotizing fasciitis. Records of patients who were diagnosed as having necrotizing fasciitis at Al-Ain Hospital in the period between March 2003 and August 2005 were studied retrospectively with regard to clinical features, risk factors, diagnosis, causative organisms, treatment, and outcome. Eleven patients, eight of whom were men of low socio-economic status, were studied. The median age (range) was 46 (8-65) years. The main risk factor was diabetes mellitus in seven patients (64%). The provisional clinical diagnosis was incorrect in seven patients (64%). Pure beta-hemolytic streptococcus group A or B was the causative organism in five patients (46%). Most of our patients underwent multiple surgical debridements with a median range of two (1-11) operations. Two patients died (overall mortality rate 18%). High clinical suspicion is essential for the diagnosis of necrotizing fasciitis. Accurate early diagnosis, aggressive resuscitation, using proper antibiotics, and extensive surgical debridement are essential for a favorable outcome.