Evaluation of Trauma and Critical Care Training Courses on the Knowledge and Confidence of Participants in Kenya and Zambia

Background  

Trained health-care personnel are essential for improved outcomes for injured and critically ill patients. The highest injury-related mortality is seen in sub-Saharan Africa, where there is a paucity of skilled personnel. Therefore, the College of Surgeons of East, Central, and Southern Africa (COSECSA) along with Emory University provided an acute trauma care (ATC) and fundamental critical care support course (FCCS). This study evaluates the impact of American-derived courses on the knowledge and confidence of participants from resource-limited countries.     

Celebrity traumatic deaths: Are gangster rappers really “gangsta”?

Background

Celebrity injury-related deaths are a common topic of conversation and receive wide media coverage. Despite stereotypes and broad generalizations, it is unclear if the mechanisms of demise echo those of the general population. The objective of this study was to evaluate the epidemiology underlying celebrity traumatic deaths.

Methods

We evaluated all known injury-related deaths in celebrities (musicians, athletes, actors, politicians and celebrity socialites) that occurred between Jan. 1, 2000, and Sept. 1, 2011. Exclusion criteria were drug/alcohol overdoses and suicides. We used standard statistical methodology.

Results

Among 389 celebrities who died because of their injuries, motor vehicle collisions remained the most common mechanism overall. Rappers and politicians had a higher proportion of deaths due to interpersonal violence than all other celebrities. Gunshot wounds were most common in these cohorts (83% and 63%, respectively). Rappers and athletes also died at a younger mean age than other celebrities. Sport-related deaths were most common in boxing and mixed martial arts. Additional mechanisms included airplane crashes, animal interactions and recreational activities.

Conclusion

Despite occasionally exotic scenarios, most celebrities die of injury mechanisms similar to those of the general population. It is also apparent that rappers and politicians die by violent means at young and middle ages, respectively, more commonly than all other celebrities.     

Psychosocial Outcomes Among Youth with Spinal Cord Injury and Their Primary Caregivers

Background:

Past research has found youth with disabilities to experience poor psychosocial outcomes, but little is known about factors related to psychosocial health among youth with spinal cord injury (SCI).

Objective:

To describe psychosocial health among youth with SCI, examine relationships between psychosocial outcomes and demographic and injury-related factors, and examine relationships between aspects of psychosocial health. Youth activity, participation, quality of life (QOL), coping, anxiety and depression, and caregiver mental health were included.

Methods:

Data were collected as part of a prospective study of 420 youth with SCI ages 1-18 and their primary caregivers. Activity data were also presented from a study developing a computerized adaptive testing (CAT) platform with 226 youth with SCI ages 8-21.

Results:

Although relationships varied by factor, youth outcomes were related to youth age, sex, age at injury/injury duration, and level/extent of injury. Caregiver mental health related to child age and age at injury. Further, relationships were uncovered between aspects of psychosocial health: aspects of youth mental health were related to youth participation and QOL, youth coping was related to youth mental health, participation, and QOL, and caregiver mental health was related to child mental health and QOL.

Conclusion:

Psychosocial outcomes relate to each other and vary by child and injury-related factors and should be understood in a comprehensive, developmental context. Identifying best measures of activity and psychosocial functioning among youth with SCI and understanding factors related to their psychosocial health is critical to improving outcomes for the pediatric-onset SCI population.     

The relationship between functional levels and fear-avoidance beliefs following anterior cruciate ligament reconstruction

Background

The purpose of this study is to assess the relationship between functional levels in activities of daily living and sports and fear-avoidance beliefs in patients with a history of anterior cruciate ligament reconstruction (ACLR), after controlling for injury-related variables and physical impairment measures.

Patients and methods

Forty-eight subjects (34 men, 14 women; age 20.6 ± 1.2 years), at a mean of 31.7 ± 16.2 months following ACLR, participated in this study. Functional levels in activities of daily living and sports were assessed with the Knee Outcome Survey (KOS) Activities of Daily Living Scale (ADLS) and Sports Activity Scale (SAS). Fear-avoidance beliefs were assessed with the physical activity subscale of the fear-avoidance beliefs questionnaire (FABQ), which was adapted for use in patients with knee pathology. Injury-related variables included whether or not additional knee surgery was performed after the initial ACLR and the number of months from the most recent ACLR to participation in this study. Physical impairment measures included single-leg hop capabilities, quadriceps strength, and anterior knee joint laxity.

Results

Hierarchical linear regression analysis revealed that scores on the physical activity subscale of the FABQ contributed significantly to KOS ADLS and SAS scores after accounting for injury-related variables and physical impairment measures. The final regression model accounted for 61% of the variance in KOS ADLS and SAS scores (P < 0.001).

Conclusion

These results suggest that fear-avoidance beliefs following ACLR can potentially adversely influence functional levels in activities of daily living and sports.     

The epidemiology of infant injuries and alarming health disparities

Purpose

Injury epidemiology is the underappreciated foundation of injury prevention and control strategies. Given the substantial disparity of infant injury-related mortality between African Americans (AA) and whites in our region, we sought to better understand the epidemiology of infant injury-related mortality rates.

Methods

Our trauma database was reviewed for all infant injuries over a 10-year period. The mortality rates were analyzed based on race, mechanism, and health insurance type.

Results

From 1995 to 2004, 1270 infants were identified. Sixty-nine percent were white, 26% AA, and 5% were other. Overall mortality was 4.8%. There were significant disparities in mortality comparing AA to whites: overall, 9.6% vs 2.8%*; abuse, 15% vs 4%*; suffocation, 100% vs 55%* (*P < .05). Although 75% of AA vs 40% of whites were insured by Medicaid, when separated by insurance type, the disparity in mortality rates between races remained significant.

Conclusions

African-American infants have 3.5 times increased risk of death from preventable injuries compared to white infants. This disparity persists despite controlling for type of health insurance, a surrogate for socioeconomic status. Understanding these disparities and developing injury-prevention programs targeting high-risk mechanisms of injury such as abuse and suffocation among AA is critical toward eventually eliminating these preventable deaths.     

Severity of injury does not have any impact on posttraumatic stress symptoms in severely injured patients

Background

Due to improved surgical techniques and more efficient decision making in treating severely injured patients, survival rates have increased over the years. This study was initiated to evaluate the incidence and identify risk factors for developing posttraumatic stress symptoms, using both extensive trauma-related data and data assessing the psychological trauma, in a population of severely injured patients.

Patients and methods

79 patients admitted to the Department of Multitrauma and Spinal Cord Injury at Sunnaas Rehabilitation Hospital from 2003 to 2005, prospectively completed semistructured psychological interviews and questionnaires, such as Impact of Event Scale-Revised. In addition, extensive injury-related data, such as injury severity score (ISS), new injury severity score (NISS), and probability of survival (PS) were collected.

Results

39% had multiple trauma, 34% had multiple injuries including spinal cord injuries, and 27% had isolated spinal cord injuries. Mean NISS was 31.5 (S.D. 13.7). 6% met diagnostic criteria for posttraumatic stress disorder (PTSD) and 9% met the criteria for subsyndromal PTSD. Injury-related data did not influence the prevalence of posttraumatic stress symptoms, however, some psychosocial variables did have a significant impact.

Conclusions

We found a low incidence of PTSD and subsyndromal PTSD. No significant differences were found between the patients suffering from posttraumatic stress symptoms and the non-symptoms group in relation to injury-related data such as ISS/NISS, PS, or multiple trauma versus spinal cord injury. The most evident risk factors for developing posttraumatic stress symptoms were symptoms of anxiety, female gender and negative attitudes toward emotional expression.     

Evaluation of bone mineral loss in patients with chronic traumatic spinal cord injury in Iran

Objectives

We described the associations between demographic and injury-related factors on bone mineral density (BMD) of the spine and the hip among adult patients with chronic spinal cord injury (SCI).

Design

BMD in spinal and femoral bone sites were assessed. Multivariate analysis was performed to evaluate the relationship between anthropometric and injury-related factors with BMD. Serum level and amount of dietary intake of calcium, phosphor, and 25-hydroxy vitamin D were measured.

Setting

A referral tertiary rehabilitation center in Iran.

Participants

Patients with SCI who had no previous history of endocrine disorders and were not on specific medications entered the investigation. Those with non-traumatic SCI, pregnant, or with substance dependency were excluded as well.

Interventions

No interventions were applied.

Main study outcome measures

Dual X-ray absorptiometry was performed to estimate BMD. Body mass index was positively associated with higher femoral (P < 0.01, r = 0.56) and hip (P < 0.0001, r = 0.82) BMD only in female participants. The high prevalence of vitamin D deficiency (60%) was noticeable.

Results

Older male patients revealed lower BMD only in spinal vertebrae (P < 0.02, r = −0.21). A significant higher BMD loss in lumbar vertebras in male patients with complete spinal cord lesion (P < 0.009) was detected. Spinal reduction of BMD was more severe when the level of injury was above T6 (P < 0.02).

Conclusion

Along with the clarification of age, gender, post injury duration, and the other factors'' effect on the BMD in the SCI patients, here we have also shown the noticeable prevalence of the 25-hydoxy vitamin D deficiency in these patients which needs attention.     

American association for the surgery of trauma prevention committee topical overview: national trauma data bank,geographic information systems,and teaching injury prevention

Background

Injury is the leading cause of death for all Americans aged 1 to 35 years, and injury-related costs exceed $100 billion per year in the United States. Trauma centers can be important resources for risk identification and prevention strategies. The authors review 3 important resources for injury prevention education and research: the National Trauma Data Bank, geographic information systems, and an overview of injury prevention education.

Data Sources

The National Trauma Data Bank and the Trauma Quality Improvement Program are available through the Web site of the American College of Surgeons. Links to research examples using geographic information systems software and the National Trauma Data Bank are provided in the text. Finally, resources for surgical educators in the area of injury prevention are summarized and examples provided.

Conclusions

Database research, geographic information systems, and injury prevention education are important tools in the field of injury prevention. This article provides an overview of current research and education strategies and resources.     

Coping and Participation in Youth With Spinal Cord Injury

Background:

Coping and participation are important adjustment outcomes of youth with spinal cord injury (SCI). Research addressing how these outcomes are related is limited.

Objective:

This cross-sectional study examined relationships between coping and participation in youth with SCI.

Method:

Youth ages 7 to 18 years were recruited from 3 hospitals specializing in rehabilitation of youth with SCI. The Kidcope assessed coping strategies, and the Children’s Assessment of Participation and Enjoyment (CAPE) examined participation patterns. Point biserial and Pearson correlations assessed relationships among variables, and hierarchical multiple regression analyses examined whether coping significantly contributed to participation above and beyond significant demographic and injury-related factors.

Results:

The sample included 294 participants: 45% female, 65% Caucasian, 67% with paraplegia. Mean age was 13.71 years (SD = 3.46), and mean duration of injury was 5.39 years (SD = 4.49). Results indicated that higher levels of social support and lower levels of self-criticism predicted higher participation in informal activities, lower levels of social withdrawal predicted participation in informal activities with a greater diversity of individuals, lower levels of blaming others predicted higher enjoyment of informal activities, and higher levels of cognitive restructuring predicted participation in formal activities with a greater diversity of individuals and in settings further from home.

Conclusion:

Results suggest higher levels of social support and cognitive restructuring and lower levels of self-criticism, social withdrawal, and blaming others predicted favorable participation outcomes. Interventions for youth with SCI that encourage higher levels of positive coping strategies and lower levels of negative and avoidant strategies may promote positive participation outcomes.     

The UK military experience of thoracic injury in the wars in Iraq and Afghanistan

Introduction

Thoracic injury during warfare is associated with a high incidence of morbidity and mortality. This study examines the pattern and mortality of thoracic wounding in the counter-insurgency conflicts of Iraq and Afghanistan, and outlines the operative and decision making skills required by the modern military surgeon in the deployed hospital setting to manage these injuries.

Methods

The UK Joint Theatre Trauma Registry was searched between 2003 and 2011 to identify all patients who sustained battle-related thoracic injuries admitted to a UK Field Hospital (Role 3). All UK soldiers, coalition forces and local civilians were included.

Results

During the study period 7856 patients were admitted because of trauma, 826 (10.5%) of whom had thoracic injury. Thoracic injury-related mortality was 118/826 (14.3%). There were no differences in gender, age, coalition status and mechanism of injury between survivors and non-survivors. Survivors had a significantly higher GCS, Revised Trauma Score and systolic blood pressure on admission to a Role 3 facility. Multivariable regression analysis identified admission systolic blood pressure less than 90, severe head or abdominal injury and cardiac arrest as independent predictors of mortality.

Conclusions

Blast is the main mechanism of thoracic wounding in the recent conflicts in Iraq and Afghanistan. Thoracic trauma in association with severe head or abdominal injuries are predictors of mortality, rather than thoracic injury alone. Deploying surgeons require training in thoracic surgery in order to be able to manage patients appropriately at Role 3.     

Manipulator‐driven selection of semi‐active MR‐visible markers

Background

A method for the identification of semi‐active fiducial magnetic resonance (MR) markers is presented based on selectively optically tuning and detuning them.

Methods

Four inductively coupled solenoid coils with photoresistors were connected to light sources. A microcontroller timed the optical tuning/detuning of coils and image collection. The markers were tested on an MR manipulator linking the microcontroller to the manipulator control to visibly select the marker subset according to the actuated joint.

Results

In closed‐loop control, the average and maximum were 0.76° ± 0.41° and 1.18° errors for a rotational joint, and 0.87 mm ± 0.26 mm and 1.13 mm for the prismatic joint.

Conclusions

This technique is suitable for MR‐compatible actuated devices that use semi‐active MR‐compatible markers.     

Evaluation and application of CO2 laser fiber delivery for single port transoral robotic surgery

Background

Transoral robotic surgery (TORS) using the Single-Port system (SPS) relies on electrocautery, limiting its applications in the upper aerodigestive tract. We evaluated the feasibility of a CO₂ delivery system for the SPS.

Methods

Otolaryngology residents performed a cutting exercise using a handheld CO₂ laser and participated in a cadaveric oropharyngeal dissection using the SPS with monopolar cautery (SP + EC) and CO₂ laser (SP + CO₂). Residents completed the System Usability Scale (SUS) questionnaire to evaluate these techniques.

Results

The same laser fiber was used for all combined dissections. The handheld CO₂ laser, SP + EC, and SP + CO₂ demonstrated similar SUS scores. On individual domain scores, SP + CO₂ received less favorable ratings compared to the handheld CO₂ laser for complexity, integration, and cumbersome experience (p < 0.05). On subgroup stratification, less TORS experience was associated with worse SUS scores.

Conclusion

SP-guided CO₂ laser delivery is a viable alternative to electrocautery in robotic surgery, and should be considered when performing TORS.     

Improving pancreas graft utilization through importation

Background

We analyze our outcomes utilizing imported allografts as a strategy to shorten wait list time for pancreas transplantation.

Methods

This is an observational retrospective cohort of 26 recipients who received either a locally procured (n = 16) or an imported pancreas graft (n = 10) at our center between January 2014 and May 2017. Wait list times of this cohort were compared to UNOS Region 9 (New York State and Western Vermont). Hospital financial data were also reviewed to analyze the cost‐effectiveness of this strategy.

Results

Imported pancreas grafts had significantly increased cold ischemia times (CIT) and peak lipase (PL) levels compared to locally procured grafts (CIT 827 vs 497 minutes; P = .001, PL 563 vs 157 u/L; P = .023, respectively). There were no differences in graft or patient survival. The median wait time was significantly lower for simultaneous kidney‐pancreas transplants at our center (518 days, n = 21) compared to Region 9 (1001 days, n = 65) P = .038. Despite financial concerns, the cost of transport for imported grafts was offset by lower standard acquisition costs.

Conclusions

Imported pancreas grafts may be a cost‐effective strategy to increase organ utilization and shorten wait times in regions with longer waiting times.     

Surgery of the alimentary tract for benign and malignant disease with the novel robotic platform HUGOTM RAS. A first world report of safety and feasibility

Introduction

As robotic surgery increases its reach, novel platforms are being released. We present the first 17 consecutive cases of alimentary tract surgery performed with the Hugo^TM RAS (Medtronic).

Methods

patients were selected to undergo surgery from February through April 2023. Exclusion criteria were age <16 years, BMI>60, ASA IV.

Results

17 patients underwent ileocaecal resection for Chrons disease (2 M and 1 F) and pseudo-obstruction of the terminal ileum (1 M), cholecystectomy (3 M and 5 F), subtotal gastrectomy with D2 lymphadenectomy (1 F), sleeve gastrectomy (1 F), hiatal hernia repair with Nissen fundoplication (1 M), right hemicolectomy (1 M) and sigmoidectomy (1 M). No conversion to an open approach or any arm collisions requiring corrective actions were reported.

Conclusions

Our preliminary experience with the Hugo^TM RAS point to safety and feasibility for a rather wide spectrum of surgical procedures of the alimentary tract.     

The accuracy of a novel self-tapping bone fiducial marker for frameless robot-assisted stereo-electro-encephalography implantation and registration techniques

Background

We aimed to evaluate the accuracy and safety of a novel self-tapping bone fiducial as a registration technique for stereoelectroencephalography (SEEG) implantation.

Methods

Each patient was installed with five bone fiducial markers. All procedures were performed using the same Sinovation robot system. The accuracy was determined by calculating the target point error (TPE) and the entry point error (EPE) of electrodes.

Results

Fourteen patients underwent SEEG implantation surgery; and the average installation time of the markers per patient was 86.1 s. In the operating theatre, the average registration time was 206.6 s, and the average registration error was 0.18 mm. The average TPE of 174 electrodes was 1.98 mm and the average EPE was 0.88 mm.

Conclusion

Our study provided a bone fiducial marker installation and registration technique that was convenient and fast, highly accurate in registration, and highly tolerated by patients.     

Assessing the utility of ultrasound-guided vascular access placement with longer catheters in critically ill pediatric patients

Background

Critically ill pediatric patients can have difficulty with establishing and maintaining stable vascular access. A long-dwelling peripheral intravenous catheter placement decreases the need for additional vascular interventions.

Aim

The study sought to compare longevity, catheter-associated complications, and the need for additional vascular interventions when using ultrasound-guided longer peripheral intravenous catheters comparing to a traditional approach using standard-sized peripheral intravenous catheters in pediatric critically ill patients with difficult vascular access.

Methods

This single-center retrospective cohort study included children 0–18 years of age with difficult vascular access admitted to the pediatric intensive care unit between 01/01/2018–06/01/2021.

Results

One hundred and eighty seven placements were included in the study, with 99 ultrasound-guided long intravenous catheters placed and 88 traditionally placed standard-sized intravenous catheters. In the univariate analysis, patients in the traditional approach were at a higher risk of intravenous failure compared to those in the ultrasound-guided approach (HR = 2.20, 95% CI [1.45–3.34], p = .001), with median intravenous survival times of 108 and 219 h, respectively. Adjusting for age, patients in the traditional approach remained at higher risk of intravenous failure (HR = 1.99, 95% CI: [1.28–3.08], p = .002). Adjusting for hospital length of stay, patients in the ultrasound-guided approach were less likely to have additional peripheral intravenous access placed during hospitalization (OR = 0.39, 95% CI [0.18–0.85] p = .017).

Conclusion

In critically ill pediatric patients with difficult vascular access, ultrasound-guided long peripheral intravenous catheters provide an alternative to traditional approach standard-sized intravenous catheters with improved longevity, lower failure rates, and reduced need for additional vascular interventions.     

The epidemiology of inpatient pediatric trauma in United States hospitals 2000 to 2011

Background

This study provides important updates to the epidemiology of pediatric trauma in the United States.

Overcoming barriers to population-based injury research: development and validation of an ICD-10�Cto�CAIS algorithm

Background

Hospital administrative databases are a useful source of population-level data on injured patients; however, these databases use the International Classification of Diseases (ICD) system, which does not provide a direct means of estimating injury severity. We created and validated a crosswalk to derive Abbreviated Injury Scale (AIS) scores from injury-related diagnostic codes in the tenth revision of the ICD (ICD-10).

Methods

We assessed the validity of the crosswalk using data from the Ontario Trauma Registry Comprehensive Data Set (OTR-CDS). The AIS and Injury Severity Scores (ISS) derived using the algorithm were compared with those assigned by expert abstractors. We evaluated the ability of the algorithm to identify patients with AIS scores of 3 or greater. We used κ and intraclass correlation coefficients (ICC) as measures of concordance.

Results

In total, 10 431 patients were identified in the OTR-CDS. The algorithm accurately identified patients with at least 1 AIS score of 3 or greater (κ 0.65), as well as patients with a head AIS score of 3 or greater (κ 0.78). Mapped and abstracted ISS were similar; ICC across the entire cohort was 0.83 (95% confidence interval 0.81–0.84), indicating good agreement. When comparing mapped and abstracted ISS, the difference between scores was 10 or less in 87% of patients. Concordance between mapped and abstracted ISS was similar across strata of age, mechanism of injury and mortality.

Conclusion

Our ICD-10–to–AIS algorithm produces reliable estimates of injury severity from data available in administrative databases. This algorithm can facilitate the use of administrative data for population-based injury research in jurisdictions using ICD-10.     

Influence of surgical gloves on haptic perception thresholds

Background

Impairment of haptic perception by surgical gloves could reduce requirements on haptic systems for surgery. While grip forces and manipulation capabilities were not impaired in previous studies, no data is available for perception thresholds.

Methods

Absolute and differential thresholds (20 dB above threshold) of 24 subjects were measured for frequencies of 25 and 250 Hz with a Ψ‐method. Effects of wearing a surgical glove, moisture on the contact surface and subject's experience with gloves were incorporated in a full‐factorial experimental design.

Results

Absolute thresholds of 12.8 dB and ?29.6 dB (means for 25 and 250 Hz, respectively) and differential thresholds of ?12.6 dB and ?9.5 dB agree with previous studies. A relevant effect of the frequency on absolute thresholds was found. Comparisons of glove‐ and no‐glove‐conditions did not reveal a significant mean difference.

Conclusions

Wearing a single surgical glove does not affect absolute and differential haptic perception thresholds.