MANAGEMENT DEFICIENCIES AND DEATH PREVENTABILITY IN 120 VICTORIAN ROAD FATALITIES (1993–1994)

Background : In 1992 a multidisciplinary committee was established to identify problems in the management of road fatalities in Victoria, Australia, to assess their contribution to death, and to identify preventable deaths (preventable: survival probability more than 75%; potentially preventable: survival probability between 25 and 75%). Methods : For 1993–94, 120 consecutive fatality cases surviving until arrival of ambulance services were evaluated by analysis and discussion of their complete pre-hospital, hospital and autopsy records. Results : A total of 1175 problems were identified in 455 admissions to the various areas of care. A total of 949 problems (81%) were found to be management errors and 123 (11%) were found to be system inadequacies. Technique errors (35 (3%)), diagnosis delays (27 (2%)) and diagnosis errors (41 (4%)) were less frequent. The emergency department (ED) accounted for 662 (56%) problems, followed by 191 (16%) pre-hospital problems and 140 (12%) intensive care unit (ICU) problems. There were 598 (51%) problems that were assessed as contributing to death. A total of 308 (52%) problems occurred in the ED, 106 (18%) were pre-hospital problems and 71 (12%) occurred in ICU. Management errors comprised 465 (78%) problems contributing to death, and system inadequacies comprised 76 (13%) problems. Resuscitation problems accounted for 101 (40%) of the 254 ED management errors contributing to death. A total of 79 (66%) deaths were assessed as non-preventable, five (4%) were assessed as preventable and 36 (30%) were assessed as potentially preventable. Conclusions : Organizational and educational countermeasures are required to reduce the high frequency of problems in emergency services and clinical management.     

Evidence of an association between Chlamydia pneumoniae and cerebrovascular accidents

The authors report results of a retrospective pilot study showing a strong association between patients with stroke/TIA and the presence of circulating IgG and IgA antibodies to Chlamydia pneumoniae. These results support the hypothesis that chronic active or persistent infection may play a role in the mechanism of thrombosis. The risk for stroke associated with Chlamydial circulating antibodies appeared to be independent of other risk factors such as diabetes and hypercholesterolemia.     

Epilepsy and Driving: An International Perspective

Summary: Individuals with a history of seizures may be granted driving privileges if the risks of future seizure while driving are relatively low. Different nations have defined these risks in a wide variety of ways. Some countries, e.g., Japan, Greece, Brazil, India, and Russia, preclude driving after a single seizure. Other countries, suchas Canada and the United States, allow driving 3 months after certain types of seizures. A Joint Commission of the International Bureau for Epilepsy/International League Against Epilepsy has summarized regulations in several countries. From a consideration of med-ical literature and existing practices, a series of proposedguidelines for driving and epilepsy is recommended. Ingeneral, these guidelines suggest use of a seizure-free interval, generally 1–2 years but less in particular instances, to determine fitness to drive. Required physician reporting is discouraged, but physicians should report patientswhom they believe pose a danger to themselves and topublic safety. Individualized consideration should begiven to special circumstances that may modify a generaldriving prohibition. Education and information programsare necessary for medical and regulatory authorities to develop a rational approach to driving and epilepsyworldwide.     

Mortality among danish merchant seamen from 1970 to 1985

A retrospective cohort study was performed to analyze the mortality patterns of Danish merchant seamen in the period 1970-1985. The population census in 1970 in Denmark was the source of information on individual occupation, age, and marital status. All men aged 20-64 years and economically active in 1970 were included. Computerized linkage with the Danish Mortality Register gave information about the deceased persons' date and cause of death. An increased overall mortality among all groups of seamen was found, being highest for deck and engine crew members. The overall mortality was strongly dependent on age and marital status. The highest mortality rate ratios (MRR) were found among young seamen and unmarried seamen. MRRs of 1.90 and 2.47 for cancer of the respiratory system were found among engine officers and crew. The MRRs for accidents and suicide were increased for all seamen, and were highest for crew members, among whom the MRR from accidents was stable within age groups but fell for suicide with increasing age. The same pattern was found with cirrhosis of the liver, although this was positively associated with increasing age. Excess mortality from ischemic heart disease was only found among engine crew (MRR = 1.43). This study confirms earlier findings of high mortality among seafarers. Negative selection into the occupation, occupational environmental factors, and lack of health and safety promotion programs and education could be causes of the high mortality.     

1985—1986年乌鲁木齐地区道路机动车交通事故描述流行病学研究

车祸已成为乌鲁木齐地区一个突出的社会医学问题。作者根据1985～1986年该地区发生的5129起道路机动车交通事故,进行了描述流行病学研究并分析了肇事原因。     

Accidents following extradural analgesia in children. The results of a retrospective study

A retrospective multicentre study of the complications observed after regional anaesthesia in children was undertaken in 1991 at the request of the association of Anesthésistes-Réanimateurs Pédiatriques d'Expression Française (ADARPEF). The incidence of accidents seen in the study was comparable to that found in the literature. Five cases which were exceptional due to the severity of the sequelae have been analysed separately. Different pathophysiological mechanisms are proposed.     

A population survey of childhood accidents in Andalusia (Spain)

The aim of this study was to quantify the incidence of childhood accidents and to describe the morbidity profile of accidents in the autonomous region of Andalusia, Spain, for a three-month period (January to March) in 1990. For that purpose, a population survey based on a stratified multiphase sample design was carried out. We collected information about the most serious accident each child had suffered during the study period according to the opinion of the person interviewed (the mother in most of the cases). The cumulative incidence of childhood accidents in Andalusia for a three-month period was 19.4%, higher in urban areas than in rural ones, and lower as the age of the age group increased. As had occurred in previous studies, a higher number of accidents was observed among the male population, however, this result was not statistically significant. During the same period of time, the incidence of traffic accidents for population 0 to 14 years was 0.8%. Accidents among younger children (0 to 4 years of age) occurred mainly at home, while for children of a higher age (5 to 9 and 10 to 14) they took place, in a larger number of cases, either outdoors or at school. When the accident happened, those from the first group were mainly in the presence of their parents or other adults; in the other two groups, there were more friends or schoolmates present. Fractures and injuries, of minor severity, mainly on the head and the extremities and with no sequelae, were the most frequent types of accident. The fact that in less than 9% of the accidents the child was taken to a health centre and had received some kind of previous treatment shows the need for knowledge about first aid measures. Both parents and educators would benefit from an adequate preparation to act in the child's usual environment in the case of an accident. It also seems convenient to implement preventive measures to inform parents, relatives and educators about the risks of childhood accidents, since a high number of the accidents, especially among younger children, occurred in their presence.     

Socioeconomic status and adolescent injuries

Injuries are the major cause of morbidity among children and adolescents in developed countries, but there is a lack of consensus on the relationship between socioeconomic status and risk of injuries. A self-complete questionnaire survey, to gather information on non-fatal injuries and sociodemographic details, was administered in schools during April–June 1994 to a national sample of 4710 Scottish adolescents aged 11, 13 and 15 years. Although there was no evidence of a socioeconomic gradient in the total incidence of medically attended injuries among adolescents, based on the Registrar General's classifications of paternal occupation and a composite measure of family affluence, marked socioeconomic variation in the circumstances in which injuries occurred was observed. There were also socioeconomic differences in the extent and type of risk behaviours reported by adolescents, indicating differential rates of risk exposure. The finding that socioeconomic status affects the kinds of injury events adolescents experience and levels of risk behaviour has implications for the design of injury prevention strategies.     

The "oligoanalgesia problem" in the emergency care

INTRODUCTION: Pain is a common occurrence in trauma victims that provokes harmful effects on the body. However, there is a gap in the literature about this problem, which is still underevaluated and undertreated in Brazil, especially concerning the use of opioids. OBJECTIVES: To estimate pain intensity and the use of analgesia in traffic accident victims. MATERIALS AND METHODS: A prospective study, involving 100 accident victims (traffic accidents), who were interviewed at 2 separate posttraumatic moments, in a reference hospital of the city of S?o Paulo. All the medications used for these victims were recorded. All patients displayed a Glasgow Coma Scale (ECGl) of 15, had stable hemodynamic parameters, and were brought directly from the scene of the accident. RESULTS: Pain of moderate and severe intensity (in 90% of cases) was the most noted. After a 3-hour period, a significant number of patients with pain (48%) continued without analgesia, and few opioids were used. CONCLUSION: Pain is a common event associated with trauma. It is still undertreated and underevaluated in Brazil, and the use of opioids for admittedly very severe pain is not frequently employed in the Emergency Service even in hemodynamically stable patients and with a Glasgow Coma Scale of 15.