The journey from traffic offender to severe road trauma victim: Destiny or preventive opportunity?

Background Road trauma is a leading cause of death and injury in young people. Traffic offences are common, but their importance as a risk indicator for subsequent road trauma is unknown. This cohort study assessed whether severe road trauma could be predicted by a history of prior traffic offences. Methodology and Principal Findings Clinical data of all adult road trauma patients admitted to the Western Australia (WA) State Trauma Centre between 1998 and 2013 were linked to traffic offences records at the WA Department of Transport. The primary outcomes were alcohol exposure prior to road trauma, severe trauma (defined by Injury Severity Score > 15), and intensive care admission (ICU) or death, analyzed by logistic regression. Traffic offences directly leading to the road trauma admissions were excluded. Of the 10,330 patients included (median age 34 years-old, 78% male), 1955 (18.9%) had alcohol-exposure before road trauma, 2415 (23.4%) had severe trauma, 1360 (13.2%) required ICU admission, and 267 (2.6%) died. Prior traffic offences were recorded in 6269 (60.7%) patients. The number of prior traffic offences was significantly associated with alcohol-related road trauma (odds ratio [OR] per offence 1.03, 95% confidence interval [CI] 1.02-1.05), severe trauma (OR 1.13, 95% CI 1.14-1.15), and ICU admission or death (OR 1.10, 95% CI 1.08-1.11). Drink-drinking, seat-belt, and use of handheld electronic device offences were specific offences strongly associated with road trauma leading to ICU admission or death-all in a 'dose-related' fashion. For those who recovered from road trauma after an ICU admission, there was a significant reduction in subsequent traffic offences (mean difference 1.8, 95% CI 1.5 to 2.0) and demerit points (mean difference 7.0, 95% CI 6.5 to 7.6) compared to before the trauma event. Significance Previous traffic offences were a significant risk factor for alcohol-related road trauma and severe road trauma leading to ICU admission or death

An injury awareness education program on outcomes of juvenile justice offenders in Western Australia: an economic analysis

Background: Injury is a major cause of mortality and morbidity of young people and the cost-effectiveness of many injury prevention programs remains uncertain. This study aimed to analyze the costs and benefits of an injury awareness education program, the P.A.R.T.Y. (Prevent Alcohol and Risk-related Trauma in Youth) program, for juvenile justice offenders in Western Australia. Methods: Costs and benefits analysis based on effectiveness data from a linked-data cohort study on 225 juvenile justice offenders who were referred to the education program and 3434 who were not referred to the program between 2006 and 2011. Results: During the study period, there were 8869 hospitalizations and 113 deaths due to violence or traffic-related injuries among those aged between 14 and 21 in Western Australia. The mean length of hospital stay was 4.6 days, a total of 320 patients (3.6%) needed an intensive care admission with an average length of stay of 6 days. The annual cost saved due to serious injury was $3,765 and the annual net cost of running this program was$33,735. The estimated cost per offence prevented, cost per serious injury avoided, and cost per undiscounted and discounted life year gained were $3,124,$42,169, $8,268 and$17,910, respectively. Increasing the frequency of the program from once per month to once per week would increase its cost-effectiveness substantially. Conclusions: The P.A.R.T.Y. injury education program involving real-life trauma scenarios was cost-effective in reducing subsequent risk of committing violence or traffic-related offences, injuries, and death for juvenile justice offenders in Western Australia

Women entrepreneurs : jumping the corporate ship or gaining new wings.

Paper originally presented at the 30th International Conference of the Institute for Small Business and Entrepreneurship, 7-9 November 2007, Glasgow,UK. Awarded Best Paper ‘Women’s Enterprise and Family Enterprise Development’ track, ISBE Conference 2007 (£500). Advances field through empirical investigation of push-pull dichotomy in career transition literature for women leaving corporate employment for entrepreneurship. Argues women’s motivations for entrepreneurship remain unsatisfied until businesses evolved and they gained personal and professional development

Extracranial injuries are important in determining mortality of neurotrauma

Objective: This study aimed to assess the significance of extracranial injuries, as measured by Injury Severity Score, on 6-mo and 9-yr mortality of neurotrauma. Design: Retrospective linked data cohort study. Setting: A major neurotrauma center in Western Australia. Patients: Six hundred eighty-three adult neurotrauma patients. Measurements and main results: Data were first used to validate the largest published international neurotrauma "extended" mortality prognostic model, in which extracranial injuries are considered significant if the patient has hypoxemia or hypotension on admission. Logistic and Cox regression, incorporating bootstrap techniques to adjust for overfitting, were used to assess the significance of Injury Severity Score in determining 6-mo and 9-yr mortality, respectively. Among a total of 683 patients admitted between 1994 and 2002, 636 (93.1%) had extracranial injuries. The international neurotrauma "extended" mortality prognostic model was poorly calibrated and underestimated the observed mortality (slope and intercept of the calibration curve were 2.14 and 0.35, respectively) when applied to our patients. Incorporating Injury Severity Score into the model improved its calibration. Injury Severity Score accounted for 11% of the variability and was the third most important factor after Marshall computed tomographic grading (17.8%) and pupil reactivity (14.5%) in determining 6-mo mortality. There was a notable increase in mortality between 6-mo (19.2%) and 24-mo follow-up (25.8%). Injury Severity Score remained important and accounted for 9.2% of the variability in determining 9-yr mortality after the injury. Conclusions: Hypotension and hypoxemia on admission were inadequate markers of extracranial injuries; incorporating more comprehensive extracranial injury assessment by the Injury Severity Score to the standard neurologic prognostic factors improved the accuracy of predictions on mortality after neurotrauma

Validation of the geriatric trauma outcome scores in predicting outcomes of elderly trauma patients

Background: Using three patient characteristics, including age, Injury Severity Score (ISS) and transfusion within 24 h of admission (yes vs. no), the Geriatric Trauma Outcome Score (GTOS) and Geriatric Trauma Outcome Score II (GTOS II) have been developed to predict mortality and unfavourable discharge (to a nursing home or hospice facility), of those who were ≥65 years old, respectively. Objectives: This study aimed to validate the GTOS and GTOS II models. For the nested-cohort requiring intensive care, we compared the GTOS scores with two ICU prognostic scores – the Acute Physiology and Chronic Health Evaluation (APACHE) III and Australian and New Zealand Risk of Death (ANZROD). Methods: All elderly trauma patients admitted to the State Trauma Unit between 2009 and 2019 were included. The discrimination ability and calibration of the GTOS and GTOS II scores were assessed by the area under the receiver-operating-characteristic (AUROC) curve and a calibration plot, respectively. Results: Of the 57,473 trauma admissions during the study period, 15,034 (26.2%) were ≥65 years-old. The median age and ISS of the cohort were 80 (interquartile range [IQR] 72–87) and 6 (IQR 2–9), respectively; and the average observed mortality was 4.3%. The ability of the GTOS to predict mortality was good (AUROC 0.838, 95% confidence interval [CI] 0.821–0.855), and better than either age (AUROC 0.603, 95%CI 0.581–0.624) or ISS (AUROC 0.799, 95%CI 0.779–0.819) alone. The GTOS II's ability to predict unfavourable discharge was satisfactory (AUROC 0.707, 95%CI 0.696–0.719) but no better than age alone. Both GTOS and GTOS II scores over-estimated risks of the adverse outcome when the predicted risks were high. The GTOS score (AUROC 0.683, 95%CI 0.591–0.775) was also inferior to the APACHE III (AUROC 0.783, 95%CI 0.699–0.867) or ANZROD (AUROC 0.788, 95%CI 0.705–0.870) in predicting mortality for those requiring intensive care. Conclusions: The GTOS scores had a good ability to discriminate between survivors and non-survivors in the elderly trauma patients, but GTOS II scores were no better than age alone in predicting unfavourable discharge. Both GTOS and GTOS II scores were not well-calibrated when the predicted risks of adverse outcome were high

Venous thrombotic, thromboembolic, and mechanical complications after retrievable inferior vena cava filters for major trauma

Background The ideal thromboprophylaxis in patients at risk of bleeding is uncertain. This retrospective cohort study assessed the risk factors for complications after using retrievable inferior vena cava (IVC) filters for primary or secondary thromboembolism prophylaxis in patients after major trauma. Methods Using data from radiology, trauma and death registries, the incidence of and risk factors for subsequent deep venous thrombosis (DVT), venous thromboembolism (VTE), and mechanical complications related to retrievable IVC filters in patients, admitted between 2007 and 2012, were assessed in a single trauma centre. Results Of the 2940 major trauma patients admitted during the study period, a retrievable IVC filter was used in 223 patients (7.6%). Thirty-six patients (16%) developed DVT or VTE subsequent to placement of IVC filters (median 20 days, interquartile range 9-33), including 27 with lower limb (DVT), 8 upper limb DVT, and 4 pulmonary embolism. A high Injury Severity Score, tibial/fibular fractures, and a delay in initiating pharmacological thromboprophylaxis after insertion of the filters (14 vs 7 days, P=0.001) were significant risk factors. Thirty patients were lost to follow-up (13%) and their filters were not retrieved. Mechanical complications - including filters adherent to the wall of IVC (4.9%), IVC thrombus (4.0%), and displaced or tilted filters (2.2%) - were common when the filters were left in situ for >50 days. Conclusions A delay in initiating pharmacological thromboprophylaxis or filter removal were associated with an increased risk of subsequent DVT, VTE, and mechanical complications of retrievable IVC filters in patients after major trauma

Renal transplantation and hepatitis B viral (HBV) replication

K.M. Fock, C.J. Burrell, T. Mathew, G. Russ, A. Disney and M.J. Lawso