- Email: [email protected]
65: Patterns of Interpersonal Violence at a Urban South African Trauma Unit
ICEM 2008 Scientific Abstract Program would expedite emergency laparotomy in blunt abdominal trauma patient in emergency department. Methods: Focused abdominal ultrasonography was one of the methods to evaluate blunt abdominal trauma. The main focus of the examination was detection of free fluid in the abdomen secondary to injury of the abdominal organs. The examination took only a few minutes to perform and was non-invasive and the machine was readily available in most emergency department. This was a retrospective study including all the trauma team cases in a 36-month-period (01/01/ 2004 to 31/12/2006) in the emergency department (ED) of Tuen Mun Hospital in Hong Kong. Results: There were totally 259 cases in which 14 cases of penetrating abdominal injury were excluded. Bedside ultrasound, the Focused Abdominal Sonography for trauma (FAST), was performed in 242 cases. Thirty-three of them showed intraabdominal free fluid, twenty-seven cases with unstable hemodynamics were immediately taken to operation room for emergency laparotomy without undergoing other investigations such as CT scan or diagnostic peritoneal lavage (DPL). The other six cases with stable hemodynamics were further evaluated by CT scan. Four cases showed hemoperitoneum with liver, spleen or mesenteric laceration. Three of them underwent emergency laparotomy and one was treated conservatively. After CT scans, two cases were found to be false positive FAST scans. For those negative FAST scan cases, five cases were ultimately found to have haemoperitoneum by subsequence CT scans after admission. CT scans were done in these cases either because of change in clinical condition or experienced persistent abdominal pain. Four of them underwent emergency laparotomy and one was treated conservatively. In this study, the sensitivity and specificity of the FAST scan were 86% and 99% respectively. The negative predictive value was 0.97 while the positive predictive value was 0.93. The mean time of stay in ED for those unstable cases with positive FAST scan was 47.1 minutes (95% CI 42.33-51.82) while those needed CT/DPL to diagnose intraabdominal injury was 94.4 minutes (95% CI 85.1-103.7). The data was analyzed by student’s t-Test and was statistically significant with P⬍0.001. Conclusion: In conclusion, bedside USG, the FAST scan, was therefore found to be effectively expediting emergency laparotomy in blunt abdominal trauma patients which was statistically significant. The limitations of this study included small sample size; the time of stay in ED was not equal to the time of laparotomy. Also, it was a retrospective study and not a randomized controlled study. The difference in demographic data, injury severity score and hemodynamics status might also interfer with the timing of emergency laparotomy. The pitfalls of FAST scan and the ways of improvement were also discussed briefly in this study.
64
Injury Prevention and First Aid Awareness Camp, A South Indian Model: A New Paradigm In Emergency Care
Cattamanchi S, David SS, Thangam SP/Christian Medical College, Vellore, India
Study Objectives: To define injury problem, identify risks and enumerate preventable aetiological factors of injury. To project a viable and socially beneficial injury prevention program - a model for South India. To describe the various aspects and activities of the camp. To enumerate the number of camps and the population which benefited by these camps. Methods: Design: A prospective, descriptive, analytical study. Setting: Accident & Emergency department, tertiary care teaching hospital, S.India. Duration: 1 year 1st August 2006 to 31st July 2007. Population: All injured patients attending emergency department and population who attended 15 “First-aid and Injury Prevention Awareness Camps” conducted in and around Vellore District, Tamilnadu. India. Sampling: Consecutive sampling. Instrument: A Pre-formatted Injury Surveillance Questionnaire. Results: A total of 9,196 patients with injury were registered in the emergency department. A male dominance of 87.5% was observed and half of them belonged to 2nd & 3rd decade of life. Most of the injuries were accidental 92%. Motor Vehicle Accident (54%) was the major cause, Injury due to fall 20%, Industrial accidents 13% and 4% were due to assault. A death rate of 1.3% was observed. About 91% of patients didn’t receive out-of-hospital care or first aid measures on arrival to the ED. A time delay of 1 hour to 11/2 hour on average from time of injury to arrival at the emergency was noted, missing out “Golden Hour” of resuscitation. Only 5% of two wheeler accidents victims wore helmets, 1% of four wheeler accident victim wore seat belts and 30% motor vehicle accidents were due to drinking and driving. In case of non fatal injuries average hospital stay about 3 days to 5 days noted. A total of 15 camps were conducted over the period 1st August 2006 and 31st July 2007. Each camp consisted of an average of 200 people. A total of about 3,700 people have been
490 Annals of Emergency Medicine
covered which included 100 auto drivers, 300 teachers, 400 Police and home guards, 500 villagers, 1,100 leather industry workers and 1,300 students. Separate sessions were conducted for cardio pulmonary resuscitation, prevention of household injuries and injuries at the workplace, prevention of motor vehicle accidents, safety measures and traffic rules, common First Aid and Health issues pertinent to emergency medicine. The program was customized to suit the varying types of the benefit groups, which showed keen interest through their interaction and active participation via street plays, puppet shows, video show, health camp and finally basic life support and first aid training. Conclusion: Incidence of Injuries have risen recently in India due to rapid economic growth and increasing poverty levels, rapid industrialization, increasing pay scales, increasing number of motor vehicles on the road and increased stress at work and home. Injuries constitute a major burden not only on the individual family but also on the society as a whole. The study gave us a quantitative insight into injury load on the emergency department and on the society. This study was used to develop an Injury Registry for our Institution. This study also helped us develop a unique, mobile, first of its kind injury prevention program catering to both educated and uneducated public and addresses all age groups, the tribal villagers and common people in and around Vellore town through the “First Aid & Injury Prevention Awareness camps.” This study address the importance of dispelling myths about common medical problems, educating the public on prevention of injuries and the learning of basic First Aid and out-of-hospital care.
65
Patterns of Interpersonal Violence at a Urban South African Trauma Unit
Asbury S, Goosen J, Boffard KD/Johannesburg Hospital, Johannesburg, South Africa
Study Objective: Trauma and intentional injury form a major burden of disease in South Africa. This study examines the patterns of injury resulting from interpersonal violence presenting at a Level 1 trauma centre serving an urban population. Methods: A cross-sectional analysis of patients attending the Johannesburg Hospital Trauma Unit, the Level 1 trauma unit serving the population of Johannesburg, South Africa. Patient records from the trauma unit, resuscitations and hospital files were examined over a period of forty consecutive days during JulySeptember 2007 (midwinter). Attending medical personnel recorded site of injuries, weapons used as described by the patient, and all initial investigations and management (including admission or theatre within 24 hours). Exclusion criteria were non-intentional trauma, age under 16 years, old injuries and incomplete data. Results: 1304 patients attended the Trauma Unit during the study period and 806 were excluded (790 (60.6%) non-intentional injuries, 14 incomplete data, 2 patients under 16 years). Included subjects consisted of 427 male (29.3⫾7.7 years) and 59 female (28.6⫾8.6 years) and 12 where the age was not recorded. Gun shot (n⫽89; 17.8%), bottle (75; 15.1%) and knife wounds (n⫽70; 14.1%) comprised the majority of known weapon injuries. 51 incidents (10.2%) injuries were common assault and human bite related and did not involve weapons. Patients sustaining weapon-related injuries required theatre (20.8% of cases), radiological investigations other than X-ray (23.9% of cases) or admission (24.2%). The comparable data for the 51 incidents known not to involve a weapon were 9.8%, 5.9% and 2.0% respectively. Conclusion: In keeping with the worldwide experience of trauma care, this study shows the burden of trauma rests heavily upon young males in our community. A majority of the incidents involved a weapon, used for penetrating or blunt injury. In cases where the weapon was documented, it was more commonly a weapon carried by one of the individuals involved such as a firearm or knife, than an item obtained opportunistically during the conflict. Patients subjected to weapon-based violence were significantly more likely to require advanced or invasive radiology (CT scan, sonar or contrast studies) and inpatient management including theatre admission and operation. Although blunt assault without a weapon may cause multiple injuries, they tended to be superficial injuries either allowing for discharge from the emergency department immediately or following a period of observation. If a weapon was used by the assailant, the injury pattern caused increased damage requiring more intensive investigation and management. This study showed the presence of a weapon greatly increases the morbidity resulting from the event for the patient and increases the subsequent cost to the health care system. The ability to obtain and carry such weapons is shown here to impact directly on the high burden of trauma care experienced in our setting.
Volume , . : April
64
Injury Prevention and First Aid Awareness Camp, A South Indian Model: A New Paradigm In Emergency Care
Cattamanchi S, David SS, Thangam SP/Christian Medical College, Vellore, India
Study Objectives: To define injury problem, identify risks and enumerate preventable aetiological factors of injury. To project a viable and socially beneficial injury prevention program - a model for South India. To describe the various aspects and activities of the camp. To enumerate the number of camps and the population which benefited by these camps. Methods: Design: A prospective, descriptive, analytical study. Setting: Accident & Emergency department, tertiary care teaching hospital, S.India. Duration: 1 year 1st August 2006 to 31st July 2007. Population: All injured patients attending emergency department and population who attended 15 “First-aid and Injury Prevention Awareness Camps” conducted in and around Vellore District, Tamilnadu. India. Sampling: Consecutive sampling. Instrument: A Pre-formatted Injury Surveillance Questionnaire. Results: A total of 9,196 patients with injury were registered in the emergency department. A male dominance of 87.5% was observed and half of them belonged to 2nd & 3rd decade of life. Most of the injuries were accidental 92%. Motor Vehicle Accident (54%) was the major cause, Injury due to fall 20%, Industrial accidents 13% and 4% were due to assault. A death rate of 1.3% was observed. About 91% of patients didn’t receive out-of-hospital care or first aid measures on arrival to the ED. A time delay of 1 hour to 11/2 hour on average from time of injury to arrival at the emergency was noted, missing out “Golden Hour” of resuscitation. Only 5% of two wheeler accidents victims wore helmets, 1% of four wheeler accident victim wore seat belts and 30% motor vehicle accidents were due to drinking and driving. In case of non fatal injuries average hospital stay about 3 days to 5 days noted. A total of 15 camps were conducted over the period 1st August 2006 and 31st July 2007. Each camp consisted of an average of 200 people. A total of about 3,700 people have been
490 Annals of Emergency Medicine
covered which included 100 auto drivers, 300 teachers, 400 Police and home guards, 500 villagers, 1,100 leather industry workers and 1,300 students. Separate sessions were conducted for cardio pulmonary resuscitation, prevention of household injuries and injuries at the workplace, prevention of motor vehicle accidents, safety measures and traffic rules, common First Aid and Health issues pertinent to emergency medicine. The program was customized to suit the varying types of the benefit groups, which showed keen interest through their interaction and active participation via street plays, puppet shows, video show, health camp and finally basic life support and first aid training. Conclusion: Incidence of Injuries have risen recently in India due to rapid economic growth and increasing poverty levels, rapid industrialization, increasing pay scales, increasing number of motor vehicles on the road and increased stress at work and home. Injuries constitute a major burden not only on the individual family but also on the society as a whole. The study gave us a quantitative insight into injury load on the emergency department and on the society. This study was used to develop an Injury Registry for our Institution. This study also helped us develop a unique, mobile, first of its kind injury prevention program catering to both educated and uneducated public and addresses all age groups, the tribal villagers and common people in and around Vellore town through the “First Aid & Injury Prevention Awareness camps.” This study address the importance of dispelling myths about common medical problems, educating the public on prevention of injuries and the learning of basic First Aid and out-of-hospital care.
65
Patterns of Interpersonal Violence at a Urban South African Trauma Unit
Asbury S, Goosen J, Boffard KD/Johannesburg Hospital, Johannesburg, South Africa
Study Objective: Trauma and intentional injury form a major burden of disease in South Africa. This study examines the patterns of injury resulting from interpersonal violence presenting at a Level 1 trauma centre serving an urban population. Methods: A cross-sectional analysis of patients attending the Johannesburg Hospital Trauma Unit, the Level 1 trauma unit serving the population of Johannesburg, South Africa. Patient records from the trauma unit, resuscitations and hospital files were examined over a period of forty consecutive days during JulySeptember 2007 (midwinter). Attending medical personnel recorded site of injuries, weapons used as described by the patient, and all initial investigations and management (including admission or theatre within 24 hours). Exclusion criteria were non-intentional trauma, age under 16 years, old injuries and incomplete data. Results: 1304 patients attended the Trauma Unit during the study period and 806 were excluded (790 (60.6%) non-intentional injuries, 14 incomplete data, 2 patients under 16 years). Included subjects consisted of 427 male (29.3⫾7.7 years) and 59 female (28.6⫾8.6 years) and 12 where the age was not recorded. Gun shot (n⫽89; 17.8%), bottle (75; 15.1%) and knife wounds (n⫽70; 14.1%) comprised the majority of known weapon injuries. 51 incidents (10.2%) injuries were common assault and human bite related and did not involve weapons. Patients sustaining weapon-related injuries required theatre (20.8% of cases), radiological investigations other than X-ray (23.9% of cases) or admission (24.2%). The comparable data for the 51 incidents known not to involve a weapon were 9.8%, 5.9% and 2.0% respectively. Conclusion: In keeping with the worldwide experience of trauma care, this study shows the burden of trauma rests heavily upon young males in our community. A majority of the incidents involved a weapon, used for penetrating or blunt injury. In cases where the weapon was documented, it was more commonly a weapon carried by one of the individuals involved such as a firearm or knife, than an item obtained opportunistically during the conflict. Patients subjected to weapon-based violence were significantly more likely to require advanced or invasive radiology (CT scan, sonar or contrast studies) and inpatient management including theatre admission and operation. Although blunt assault without a weapon may cause multiple injuries, they tended to be superficial injuries either allowing for discharge from the emergency department immediately or following a period of observation. If a weapon was used by the assailant, the injury pattern caused increased damage requiring more intensive investigation and management. This study showed the presence of a weapon greatly increases the morbidity resulting from the event for the patient and increases the subsequent cost to the health care system. The ability to obtain and carry such weapons is shown here to impact directly on the high burden of trauma care experienced in our setting.
Volume , . : April