The epidemiology of operations performed by the National Sea Rescue Institute of South Africa over a 5-year period

Background: Injuries remain a major contributor of morbidity and mortality worldwide, with drowningaccounting for 7% of all injury-related deaths with rates of between 4 and 8 per 100,000. The Africanregion has death rates comparable to most low-income countries. Non-fatal drowning in Africa remainsunquantified but it is estimated to be ten times higher than the fatal drowning rate. Timely search andrescue, initial resuscitation and rapid transportation to definitive care play a crucial role in preventing injury-related morbidity and mortality. The National Sea Rescue Institute (NSRI) of South Africa is a non-profitorganisation responsible for ~97% of maritime search and rescue operations in South Africa (includinginland navigable waters). The aim of the study was to describe the epidemiology of operations performedby the NSRI of South Africa over a 5-year period.Materials and methods: The NSRI operational database was analysed from 1 January 2010 to 31 December2014. Summary statistics are presented.Results: The NSRI launched 3281 operations over the study period. Marked seasonal variation were noticeablewith peak periods in December and January, corresponding to the South African summer holidayseason. Water-based operations (67.6%) were the most frequent operation performed. The NSRI assisted3399 individuals of which 77% were male. The mean age of rescued persons was 42 years. Eight hundredand thirty-six (25%) individuals had non-fatal injuries or illnesses requiring medical assistance. Medicalemergencies (35%), traumatic injuries (32.8%), and non-fatal drownings (23%) were the most commontypes of injury and illness. The majority of the 184 (18%) deaths recorded were due to drowning (75%).Conclusions: Injury and illness, specifically drowning utilise a large proportion of search and rescue services.The results suggest further preventative measures and public health strategies be implemented tominimise traumatic and medical incident severity and subsequent casualties at sea

The epidemiology of operations performed by the National Sea Rescue Institute of South Africa over a 5-year period

CITATION: Erasmus, E., Robertson, C. & Van Hoving, D. J. 2018. The epidemiology of operations performed by the National Sea Rescue Institute of South Africa over a 5-year period. International Maritime Health, 69(1): 1–7, doi:10.5603/IMH.2018.0001.The original publication is available at https://journals.viamedica.pl/international_maritime_healthBackground: Injuries remain a major contributor of morbidity and mortality worldwide, with drowning accounting for 7% of all injury-related deaths with rates of between 4 and 8 per 100,000. The African region has death rates comparable to most low-income countries. Non-fatal drowning in Africa remains unquantified but it is estimated to be ten times higher than the fatal drowning rate. Timely search and rescue, initial resuscitation and rapid transportation to definitive care play a crucial role in preventing injury- related morbidity and mortality. The National Sea Rescue Institute (NSRI) of South Africa is a non-profit organisation responsible for ~97% of maritime search and rescue operations in South Africa (including inland navigable waters). The aim of the study was to describe the epidemiology of operations performed by the NSRI of South Africa over a 5-year period. Materials and methods: The NSRI operational database was analysed from 1 January 2010 to 31 December 2014. Summary statistics are presented. Results: The NSRI launched 3281 operations over the study period. Marked seasonal variation were noticeable with peak periods in December and January, corresponding to the South African summer holiday season. Water-based operations (67.6%) were the most frequent operation performed. The NSRI assisted 3399 individuals of which 77% were male. The mean age of rescued persons was 42 years. Eight hundred and thirty-six (25%) individuals had non-fatal injuries or illnesses requiring medical assistance. Medical emergencies (35%), traumatic injuries (32.8%), and non-fatal drownings (23%) were the most common types of injury and illness. The majority of the 184 (18%) deaths recorded were due to drowning (75%). Conclusions: Injury and illness, specifically drowning utilise a large proportion of search and rescue services. The results suggest further preventative measures and public health strategies be implemented to minimise traumatic and medical incident severity and subsequent casualties at sea.https://journals.viamedica.pl/international_maritime_health/article/view/IMH.2018.0001Publisher's versio

Appendicitis risk prediction models in children presenting with right iliac fossa pain (RIFT study): a prospective, multicentre validation study.

Background Acute appendicitis is the most common surgical emergency in children. Differentiation of acute appendicitis from conditions that do not require operative management can be challenging in children. This study aimed to identify the optimum risk prediction model to stratify acute appendicitis risk in children. Methods We did a rapid review to identify acute appendicitis risk prediction models. A prospective, multicentre cohort study was then done to evaluate performance of these models. Children (aged 5\u201315 years) presenting with acute right iliac fossa pain in the UK and Ireland were included. For each model, score cutoff thresholds were systematically varied to identify the best achievable specificity while maintaining a failure rate (ie, proportion of patients identified as low risk who had acute appendicitis) less than 5%. The normal appendicectomy rate was the proportion of resected appendixes found to be normal on histopathological examination. Findings 15 risk prediction models were identified that could be assessed. The cohort study enrolled 1827 children from 139 centres, of whom 630 (34\ub75%) underwent appendicectomy. The normal appendicectomy rate was 15\ub79% (100 of 630 patients). The Shera score was the best performing model, with an area under the curve of 0\ub784 (95% CI 0\ub782\u20130\ub786). Applying score cutoffs of 3 points or lower for children aged 5\u201310 years and girls aged 11\u201315 years, and 2 points or lower for boys aged 11\u201315 years, the failure rate was 3\ub73% (95% CI 2\ub70\u20135\ub72; 18 of 539 patients), specificity was 44\ub73% (95% CI 41\ub74\u201347\ub72; 521 of 1176), and positive predictive value was 41\ub74% (38\ub75\u201344\ub74; 463 of 1118). Positive predictive value for the Shera score with a cutoff of 6 points or lower (72\ub76%, 67\ub74\u201377\ub74) was similar to that of ultrasound scan (75\ub70%, 65\ub73\u201383\ub71). Interpretation The Shera score has the potential to identify a large group of children at low risk of acute appendicitis who could be considered for early discharge. Risk scoring does not identify children who should proceed directly to surgery. Medium-risk and high-risk children should undergo routine preoperative ultrasound imaging by operators trained to assess for acute appendicitis, and MRI or low-dose CT if uncertainty remains. Funding None