The measured effect magnitude of co-morbidities on burn injury mortality

The ability to better prognosticate burn injury outcome is challenging and historically, most center use the Baux or revised Baux score to help prognosticate burn outcome, however, the weighted contribution of comorbidity on burn mortality has traditionally not been accounted for nor adequately studied. We therefore sought to determine the effect of comorbidities, using the Charlson comorbidity index (CCI) on burn mortality

Ecological Risk Assessment for Highways in the Chesapeake Bay Watershed

The population of coastal counties in the United States is over six-fold higher than non-coastal counties and population density along the Atlantic coast is much greater than all other coasts in the nation. Many areas around the Chesapeake Bay watershed are participating in this growth and extensive interstate construction is planned for this region. A wide array of primary ecological risks to the Chesapeake Bay exists, and may be classified as biological, physical, or chemical. Biological risks range from physical threats to motorists and animals to genetic risks to local flora and fauna populations. Island biogeography theory can be used to predict species losses associated with highway construction and resultant limits to migration. Introduction of exotic species and loss of ecologically significant areas (e.g. wetlands) are included as biological risks. Physical risks are primarily associated with hydrology, erosion, and related water quality considerations. Chemical concerns can be described as either chronic, such as certain airborne pollutants, or acute, such as accidental or illegal discharges. Secondary risks associated with highway construction result from facilitated traffic flow. Included are a variety of effects resulting from urban sprawl, strip development, and economic development of adjacent areas. Some ecological risks have received legislative, and subsequently transportation department attention. However, most ecological risks do not affect the decision-making process.https://scholarworks.wm.edu/vimsbooks/1179/thumbnail.jp

Management and Outcome of Abdominal Shotgun Wounds Trauma Score and the Role of Exploratory Laparotomy

OBJECTIVE: The management and outcome of 138 abdominal shotgun wounds were examined over a 5-year period. SUMMARY BACKGROUND DATA: It has been proposed that exploratory laparotomy may be unnecessary and even overused in a subset of patients with abdominal shotgun wounds. METHODS: Data on shotgun wound patients from October 1987 through March 1992 from a statewide trauma registry were examined. Patients with abdominal shotgun wounds were identified and compared with patients with nonabdominal shotgun wounds. RESULTS: Of 516 shotgun wound patients, 138 (26.7%) had abdominal wounds and 88 (63.8%) had exploratory laparotomies. Abdominal shotgun wounds resulted in significantly longer number of intensive care unit days (4.3 vs. 2.5, p < 0.05), a greater number of blood units transfused (7.8 vs. 2.4, p < 0.05), and a higher mortality (15.9% vs. 4.8%, p < 0.05) when compared with nonabdominal shotgun wounds. When stratified for trauma score, the mortality for abdominal shotgun wounds always was significantly greater than for nonabdominal shotgun wounds. All abdominal shotgun wound patients with trauma scores less than ten died. The negative laparotomy rate for abdominal shotgun wound patients with normal trauma scores was 9.4%. No patient with a negative laparotomy died. CONCLUSION: Abdominal shotgun wounds are a particularly lethal subset of shotgun wounds. Although some abdominal shotgun wound patients can be managed without laparotomy, the morbidity and mortality for these injuries are substantial, even in patients with normal trauma score. Clinical judgment is an excellent predictor of the need for laparotomy

Road traffic collisions in Malawi: Trends and patterns of mortality on scene

Background: Worldwide, 90% of injury deaths occur in low- and middle-income countries (LMIC). Road traffic collisions (RTCs) are increasingly common and result in more death and disability in the developing world than in the developed world. We aimed to examine the prehospital case fatality rate from RTCs in Malawi.Material and Methods: A retrospective study was performed utilizing the Malawian National Road Safety Council (NRSC) registry from 2008-2012. The NRSC data were collected at the scene by police officers. Victim, vehicle, and environmental factors were used to describe the characteristics of fatal collisions. Case fatality rate was defined as the number of fatalities divided by the number of people involved in RTCs each year. Logistic regression analysis was used to determine predictors of crash scene fatality.Results: A total of 11,467 RTCs were reported by the NRSC between 2008 and 2012. Of these, 34% involved at least one fatality at the scene. The average age of fatalities was 32 years and 82% were male. Drivers of motor vehicles had the lowest odds of mortality following RTCs. Compared to drivers; pedestrians had the highest odds of mortality (OR 39, 95% CI 34, 45) followed by bicyclists (OR 26, 95% CI 22, 31). The average case fatality rate was 17% / year, and showed an increased throughout the study period.Conclusions: RTCs are a common cause of injury in Malawi. Approximately one-third of RTCs involved at least one death at the scene. Pedestrians were particularly vulnerable, exhibiting very high odds of mortality when involved in a road traffic collision. We encourage the use of these data to develop strategies in LMIC countries to protect pedestrians and other road users from RTCs

Combining Head-Mounted and Projector-Based Displays for Surgical Training

We introduce and present preliminary results for a hybrid display system combining head-mounted and projector-based displays. Our work is motivated by a surgical training application, where it is necessary to simultaneously provide both a high-fidelity view of a central close-up task (the surgery) and visual awareness of objects and events in the surrounding environment. In particular, for trauma surgeons it would be valuable to learn to work in an environment that is realistically filled with both necessary and distracting objects and events

Effect of direct and indirect transfer status on trauma mortality in sub Saharan Africa

Traumatic injuries account for the greatest portion of global surgical burden particularly in low-and middle-income countries (LMICs). To assess effectiveness of a developing trauma system, we hypothesize that there are survival differences between direct and indirect transfer of trauma patients to a tertiary hospital in sub Saharan Africa

Variations in injury characteristics among paediatric patients following trauma: A retrospective descriptive analysis comparing pre-hospital and in-hospital deaths at Kamuzu Central Hospital, Lilongwe, Malawi

Background: Trauma is a major cause of paediatric mortality in sub-Saharan Africa. In absence of pre-hospital care, the injury mechanism and cause of death is difficult to characterise. Injury characteristics of pre-hospital deaths (PHD) versus in-hospital deaths (IHD) were compared.Methods: Using our trauma surveillance database, a retrospective, descriptive analysis of children (&lt;18 years) presenting to Kamuzu Central Hospital in Lilongwe, Malawi from 2008 to 2013 was performed. Patient and injury characteristics of pre-hospital and in-hospital deaths were compared with univariate and bivariate analysis.Results: Of 30,462 paediatric trauma patients presenting between 2008 and 2013, 170 and 173 were PHD and IHD, respectively. In PHD and IHD patients mean age was 7.3±4.9 v 5.2±4.3 (p&lt;0.001), respectively. IHD patients were more likely transported via ambulance than those PHD, 51.2% v 8.3% (p&lt;0.001). The primary mechanisms of injury for PHD were road traffic injuries (RTI) (45.8%) and drowning (22.0%), with head injury (46.7%) being the predominant cause of death. Burns were the leading mechanism of injury (61.8%) and cause of death (61.9%) in IHD, with a mean total body surface area involvement of 24.7±16.0%.Conclusions: RTI remains Malawi’s major driver of paediatric mortality. A majority of these deaths attributed to head injury occur prior to hospitalisation; therefore the mortality burden is underestimated if accounting for IHD alone. Death in burn patients is likely due to under-resuscitation or sepsis. Improving pre-hospital care and head injury and burn management can improve injury related paediatric mortality

Illuminating Collaboration in Emergency Helath Care Situations: Paramedic-Physician Collaboration and 3D Telepresence Technology

Introduction. This paper focuses on paramedics' perspectives regarding paramedic-physician collaboration today, and their perspectives regarding the potential of 3D telepresence technology in the future. Method. Interviews were conducted with forty practicing paramedics. Analysis. The interview data were analysed using open and axial coding. An agreement of 0.82 using Cohen's kappa inter-coder reliability measure was reached. After coding was completed themes and relationships among codes were synthesised using topic memos. Results. Paramedics expressed concern about the lack of respect and trust exhibited towards them by other medical professionals. They discussed how they paint the picture for physicians and the importance of the physician trusting the paramedic. They further reported 3D telepresence technology would make their work visible in ways not previously possible. They also reported the technology would require additional training, changes to existing financial models used in emergency health care, and increased access to physicians. Conclusions. Teaching collaboration skills and strategies to physicians and paramedics could benefit their collaboration today, and increase their readiness to effectively use collaboration technologies in the future