Missing patient registrations in the Dutch National Trauma Registry of Southwest Netherlands:Prevalence and epidemiology

Introduction: Health care patient records have been digitalised the past twenty years, and registries have been automated. Missing registrations are common, and can result in selection bias. Objective: To assess the prevalence and characteristics of missed registrations in a Dutch regional trauma registry. Methods: An automatically generated trauma registry export was done for ten out of eleven hospitals in trauma region Southwest Netherlands, between June 1 and August 31, 2020. Second, lists were checked for being falsely flagged as ‘non-trauma’. Finally, a list was generated with trauma tick box flagged as ‘trauma’ but were not automatically in the export due to administrative errors. Automated and missed registration datasets were compared on patient characteristics and logistic regression models were run with random intercepts and missed registration as outcome variable on the complete dataset. Results: A total of 2,230 automated registrations and 175 (7.3 %) missed registrations were included for the Dutch National Trauma Registry, ranging from 1 to 14 % between participating hospitals. Patients of the missed registration dataset had characteristics of a higher level of care, compared with patients of automated registrations. Level of trauma care (level II OR 0.464 95 % CI 0.328–0.666, p &lt; 0.001; level III OR 0.179 95 % CI 0.092–0.325, p &lt; 0.001), major trauma (OR 2.928 95 % CI 1.792–4.65, p &lt; 0.001), ICU admission (OR 2.337 95 % CI 1.792–4.650, p &lt; 0.001), and surgery (OR 1.871 95 % CI 1.371–2.570, p &lt; 0.001) were potential predictors for missed registrations in multivariate logistic regression analysis. Conclusion: Missed registrations occur frequently and the rate of missed registrations differs greatly between hospitals. Automated and missed registration datasets display differences related to patients requiring more intensive care, which held for the major trauma subset. Checking for missed registrations is time consuming, automated registration lists need a human touch for validation and to be complete.</p

Deferred consent in emergency trauma research:A qualitative study assessing the healthcare professional's opinions

Introduction: Severely injured patients are often incapacitated to provide informed consent for clinical studies. Deferred consent could facilitate unbiased enrollment in studies involving these patients. Little is known about how healthcare professionals (HCPs) perceive deferred consent and how this impacts patient enrollment. The aim of this study was to identify factors that could influence HCPs decision-making during recruitment of patients for interventional studies in (pre)hospital emergency trauma research. Methods: This was a qualitative study in which physicians and nurses working in prehospital or in-hospital care were interviewed using a semi-structured interview guide. Interviews were audio-recorded, transcribed, and analyzed according to thematic analysis as described by Braun and Clarke. Results: Ten semi-structured interviews were conducted with six physicians and four nurses. Eight themes were identified as being relevant consent related factors influencing HCPs’ decision-making during patient recruitment in studies using deferred consent: (1) HCPs’ lack of knowledge; (2) Patients’ and proxies’ inability to be informed; (3) Practical (im)possibilities for informed consent; (4) Nature of intervention; (5) HCPs’ personal beliefs; (6) Importance of emergency care research; (7) HCPs’ trust in legal base; and (8) Communication and collaboration. Conclusions: Eight consent-related factors influencing HCPs’ decision making were identified. Insufficient knowledge about consent procedures among HCPs leads to significant negative attitudes towards deferred consent.</p

Extramedullary versus intramedullary fixation of unstable trochanteric femoral fractures (AO type 31-A2):a systematic review and meta-analysis

Objective: The aim of this systematic review was to compare extramedullary fixation and intramedullary fixation for AO type 31-A2 trochanteric fractures in the elderly, with regard to functional outcomes, complications, surgical outcomes, and costs. Methods: Embase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for randomized controlled trials (RCTs) and observational studies. Effect estimates were pooled across studies using random effects models. Results are presented as weighted risk ratio (RR) or weighted mean difference (MD) with corresponding 95% confidence interval (95% CI). Results: Fourteen RCTs (2039 patients) and 13 observational studies (22,123 patients) were included. Statistically superior results in favor of intramedullary fixation were found for Harris Hip Score (MD 4.09, 95% CI 0.91–7.26, p = 0.04), Parker mobility score (MD − 0.67 95% CI − 1.2 to − 0.17, p = 0.009), lower extremity measure (MD − 4.07 95% CI − 7.4 to − 0.8, p = 0.02), time to full weight bearing (MD 1.14 weeks CI 0.92–1.35, p &lt; 0.001), superficial infection (RR 2.06, 95% CI 1.18–3.58, p = 0.01), nonunion (RR 3.67, 95% CI 1.03–13.10, p = 0.05), fixation failure (RR 2.26, 95% CI 1.16–4.44, p = 0.02), leg shortening (MD 2.23 mm, 95% CI 0.81–3.65, p = 0.002), time to radiological bone healing (MD 2.19 months, 95% CI 0.56–3.83, p = 0.009), surgery duration (MD 11.63 min, 95% CI 2.63–20.62, p = 0.01), operative blood loss (MD 134.5 mL, 95% CI 51–218, p = 0.002), and tip-apex distance &gt; 25 mm (RR 1.73, 95% CI 1.10–2.74, p = 0.02). No comparable cost/costs-effectiveness data were available.Conclusion: Current literature shows that several functional outcomes, complications, and surgical outcomes were statistically in favor of intramedullary fixation when compared with extramedullary fixation of AO/OTA 31-A2 fractures. However, as several of the differences found appear not to be clinically relevant and for many outcomes data remains sparse or heterogeneous, complete superiority of IM fixation for AO type 31-A2 fractures remains to be confirmed in a detailed cost-effectiveness analysis.</p

Extramedullary versus intramedullary fixation of unstable trochanteric femoral fractures (AO type 31-A2):a systematic review and meta-analysis

Objective: The aim of this systematic review was to compare extramedullary fixation and intramedullary fixation for AO type 31-A2 trochanteric fractures in the elderly, with regard to functional outcomes, complications, surgical outcomes, and costs. Methods: Embase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for randomized controlled trials (RCTs) and observational studies. Effect estimates were pooled across studies using random effects models. Results are presented as weighted risk ratio (RR) or weighted mean difference (MD) with corresponding 95% confidence interval (95% CI). Results: Fourteen RCTs (2039 patients) and 13 observational studies (22,123 patients) were included. Statistically superior results in favor of intramedullary fixation were found for Harris Hip Score (MD 4.09, 95% CI 0.91–7.26, p = 0.04), Parker mobility score (MD − 0.67 95% CI − 1.2 to − 0.17, p = 0.009), lower extremity measure (MD − 4.07 95% CI − 7.4 to − 0.8, p = 0.02), time to full weight bearing (MD 1.14 weeks CI 0.92–1.35, p &lt; 0.001), superficial infection (RR 2.06, 95% CI 1.18–3.58, p = 0.01), nonunion (RR 3.67, 95% CI 1.03–13.10, p = 0.05), fixation failure (RR 2.26, 95% CI 1.16–4.44, p = 0.02), leg shortening (MD 2.23 mm, 95% CI 0.81–3.65, p = 0.002), time to radiological bone healing (MD 2.19 months, 95% CI 0.56–3.83, p = 0.009), surgery duration (MD 11.63 min, 95% CI 2.63–20.62, p = 0.01), operative blood loss (MD 134.5 mL, 95% CI 51–218, p = 0.002), and tip-apex distance &gt; 25 mm (RR 1.73, 95% CI 1.10–2.74, p = 0.02). No comparable cost/costs-effectiveness data were available.Conclusion: Current literature shows that several functional outcomes, complications, and surgical outcomes were statistically in favor of intramedullary fixation when compared with extramedullary fixation of AO/OTA 31-A2 fractures. However, as several of the differences found appear not to be clinically relevant and for many outcomes data remains sparse or heterogeneous, complete superiority of IM fixation for AO type 31-A2 fractures remains to be confirmed in a detailed cost-effectiveness analysis.</p

Elleboogluxatie: Snel oefenen voor beste resultaat

An elbow dislocation with ligament damage only is called a simple elbow dislocation. A complex elbow dislocation is associated with fractures. Early mobilisation exercises may prevent elbow stiffness. Case one is a 27yearold woman with a simple elbow dislocation. The patient was started on early mobilisation exercises immediately. Case two is a 58yearold man with a complex elbow dislocation. Following open reduction and internal fixation, a hinged elbow fixator was applied and the patient was immediately started on active mobilisation exercises. Case three is a 49yearold woman with elbow stiffness and joint incongruence following persistent joint instability after a simple elbow dislocation. After arthrolysis, a hinged elbow fixator was mounted. In conclusion, early mobilisation exercises after an elbow dislocation are mandatory for full functional recovery. Immobilisation in a plaster cast should not be used. In cases of persistent instability a hinged elbow fixator is indicated

Collagen synthesis in rat skin and ileum fibroblasts is affected differently by diabetes-related factors

Untreated diabetes reduces wound strength: a concomitant reduction in collagen deposition has been found in cutaneous wounds but not in intestinal anastomoses. This raises the question if collagen synthesis in fibroblasts from skin and intestine reacts differently to the diabetic state. Fibroblast lines were established from healthy rat skin and ileum. Diabetic rat serum was collected from hyperglycaemic rats 3 days after intravenous injection of streptozotocin (200 mg/kg). Fibroblast cultures were grown to confluency in foetal calf serum and maintained in various concentrations of glucose, insulin, normal or diabetic rat serum. Collagen synthesis was measured by incorporation of [3H]-proline into Collagenase-Digestible-Protein

Missing patient registrations in the Dutch National Trauma Registry of Southwest Netherlands:Prevalence and epidemiology

Introduction: Health care patient records have been digitalised the past twenty years, and registries have been automated. Missing registrations are common, and can result in selection bias. Objective: To assess the prevalence and characteristics of missed registrations in a Dutch regional trauma registry. Methods: An automatically generated trauma registry export was done for ten out of eleven hospitals in trauma region Southwest Netherlands, between June 1 and August 31, 2020. Second, lists were checked for being falsely flagged as ‘non-trauma’. Finally, a list was generated with trauma tick box flagged as ‘trauma’ but were not automatically in the export due to administrative errors. Automated and missed registration datasets were compared on patient characteristics and logistic regression models were run with random intercepts and missed registration as outcome variable on the complete dataset. Results: A total of 2,230 automated registrations and 175 (7.3 %) missed registrations were included for the Dutch National Trauma Registry, ranging from 1 to 14 % between participating hospitals. Patients of the missed registration dataset had characteristics of a higher level of care, compared with patients of automated registrations. Level of trauma care (level II OR 0.464 95 % CI 0.328–0.666, p &lt; 0.001; level III OR 0.179 95 % CI 0.092–0.325, p &lt; 0.001), major trauma (OR 2.928 95 % CI 1.792–4.65, p &lt; 0.001), ICU admission (OR 2.337 95 % CI 1.792–4.650, p &lt; 0.001), and surgery (OR 1.871 95 % CI 1.371–2.570, p &lt; 0.001) were potential predictors for missed registrations in multivariate logistic regression analysis. Conclusion: Missed registrations occur frequently and the rate of missed registrations differs greatly between hospitals. Automated and missed registration datasets display differences related to patients requiring more intensive care, which held for the major trauma subset. Checking for missed registrations is time consuming, automated registration lists need a human touch for validation and to be complete.</p