Making trauma registries more useful for improving patient care: A survey of trauma care and trauma registry stakeholders across Australia and New Zealand

IntroductionInjury is a major global health burden. Trauma registries have been used for decades to monitor the burden of injury and inform trauma care. However, the extent to which trauma registries have fulfilled their potential remains uncertain. The aims of this study were to determine the current and priority uses of trauma registries across Australia and New Zealand and to establish the priority clinical outcomes, the probability for which, if known for an individual trauma patient, would better inform that same patient's care, during hospital admission.MethodsA prospective observational study using survey methodology was conducted. Participants were sourced from the Australia New Zealand Trauma Registry (ATR) participating hospitals. The survey questions included: the current uses and priorities for both single-site trauma registries and the binational trauma registry; the five top-ranked priority outcomes for which knowing the probability, for an individual patient, would inform care; and the priority timepoints for applying patient-level outcome prediction models.ResultsOf the 26 ATR-participating hospitals, 25 were represented by a total of 54 participants in the survey, including trauma service directors and trauma nurse coordinators. The main trauma registry use and priority for the single site registries was to inform the quality improvement program; for the ATR, the main use was periodic reporting and the main priority was benchmarking. For each potential purpose of the registry, the future priority level was ranked more highly than the current level of utilisation. The most highly ranked priority patient-level outcomes requiring prediction were: preventable death, missed injury, quality of life, admission costs, pulmonary embolism, post-traumatic stress disorder, length of hospital stay, errors in decision-making and deep venous thrombosis. The time period between leaving the emergency department and the 24 h mark following presentation was considered the preferred time for patient-level priority outcome prediction.ConclusionThere is a mismatch between current trauma registry uses and future priorities. The priority outcomes demanding prediction in the first 24 h of a trauma patient's stay are preventable death, missed injury, quality of life, hospital costs, thromboembolism, post-traumatic stress disorder, length of hospital stay and errors in clinical decision-making.     

Enhanced osseointegration of grit-blasted,NaOH-treated and electrochemically hydroxyapatite-coated Ti–6Al–4V implants in rabbits

Osseointegration, in terms of the bone apposition ratio (BAR) and the new bone area (NBA), was measured by backscattered electron imaging. The results were compared for four implant types: grit-blasted and NaOH-treated Ti–6Al–4 V (Uncoated-NaOH), electrodeposited with hydroxyapatite without alkali treatment (ED-HAp), electrodeposited with hydroxyapatite after alkali treatment (NaOH-ED-HAp), and plasma sprayed with hydroxyapatite (PS-HAp). No heat treatment was done after soaking in NaOH. The implants were press fitted into the intramedullary canal of mature New Zealand white rabbits and analyzed, both at the diaphyseal and at the metaphyseal zones, either 1 week or 12 weeks after surgery. NaOH-ED-HAp already exhibited a higher BAR value than the ED-HAp at 1 week, and was as good as the commercial PS-HAp at 12 weeks. The NBA value for NaOH-ED-HAp at 12 weeks was the highest. The higher content of octacalcium phosphate in NaOH-ED-HAp, as evident from the X-ray photoelectron spectroscopy analysis of the oxygen shake-up peaks, and the associated increase in the solubility of this coating in vivo are considered responsible for the enhanced osseointegration. Taking into account also the reduced occurrence of delamination and the inherent advantages of the electrodeposition process, electrodeposition of HAp following soaking in NaOH may become an attractive alternative for the traditional plasma-sprayed process for coating of orthopedic and dental implants.     

Simvastatin locally applied from a biodegradable coating of osteosynthetic implants improves fracture healing comparable to BMP-2 application

Many clinical and experimental investigations address the influence of statins on bone formation and fracture healing. Simvastatin was shown to increase the expression of Bone morphogenetic protein (BMP-2), which is one of the most potent growth factors targeting bone formation. In this study, the effect of simvastatin locally applied from a bioactive polymer coating of implants on fracture healing was investigated. A closed fracture of the right tibia of 5-month-old Sprague–Dawley rats was performed. Intramedullary stabilization was achieved with uncoated vs. polymer-only coated vs. polymer plus drug coated titanium Kirschner wires. Test substances (either simvastatin low- or high dosed or BMP-2) were incorporated into a biodegradable layer of poly(d,l-lactide). Tibiae were harvested after 28 or 42 days, respectively and underwent biomechanical testing (torsional stiffness and maximum load) and histomorphometric analysis. Radiographic results demonstrated progressed callus consolidation in the BMP-2- and simvastatin-treated groups compared to the uncoated group at both timepoints. The simvastatin-high-dosed group revealed an increased torsional stiffness and significantly elevated maximum load (d 28) compared to control group as well as a significant increase in both parameters at d 42. BMP-2-treated animals showed significantly elevated maximum load and stiffness at the early timepoint and elevated torsional stiffness after d 42.The histomorphometric analysis revealed a significantly decreased cartilage area for BMP-2 treated animals at d 28. Even though an increase of mineralized areas among periosteal callus was found at d 42 for simvastatin-high as well as BMP-2 treated animals, no significant difference could be detected at both timepoints compared to the uncoated group. However, simvastatin-high treated animals revealed significantly reduced cartilage areas within the periosteal callus at d 42. The present study revealed a dose-dependent effect and improved fracture healing under local application of simvastatin. Biomechanical, radiographic and histomorphometric properties showed comparable results to BMP-2- treated animals in this study.     

三种克氏针张力带治疗尺骨鹰嘴骨折的疗效比较

目的：比较3种常见的克氏针张力带治疗尺骨鹰嘴骨折的临床效果。方法：回顾分析2016年3月至2020年5月克氏针张力带固定治疗64例尺骨鹰嘴骨折患者的临床资料,克氏针髓内置钉组（A组）19例,男8例,女11例;年龄（48.2±18.3）岁,Mayo分型Ⅰ型3例,Ⅱ型16例。克氏针双皮质置钉组（B组）20例,男13例,女7例;年龄（43.5±20.4）岁,Mayo分型Ⅰ型3例,Ⅱ型17例。带孔克氏针组（C组）25例,男15例,女10例;年龄（55.2±17.5）岁,Mayo分型Ⅰ型4例,Ⅱ型21例。比较3组患者的手术时间,术中出血量、透视次数、骨折愈合时间及并发症情况。术后3 d采用视觉模拟评分（visual analogue scale,VAS）进行疼痛程度评价,末次随访采用Mayo肘关节功能评分标准进行肘关节功能评价。结果：3组病例手术时间、术中透视次数、术后VAS、软组织激惹情况比较,差异有统计学意义（P<0.05）。A、C组患者在手术时间、术中透视次数优于B组（P<0.05）;C组在术后VAS、术后软组织激惹情况优于B组（P<0.05）。3组末次随访Mayo肘关节功能评分比较,差异有统计学意义（P<0.05）,A、C组均高于B组（P<0.05）。结论：较之传统的双皮质置钉方式,克氏针髓内置钉和带孔克氏针张力带固定,操作简单,固定牢靠,软组织激惹少,手术并发症少,效果满意。