https://nova.newcastle.edu.au/vital/access/ /manager/Index en-au 5 https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:51659 Wed 13 Sep 2023 10:02:28 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:13964 Wed 11 Apr 2018 16:27:43 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:54906  15), the risk of dying is less than 10%. This group contains critical polytrauma patients (ISS 50–75), with high risks of death. We hypothesized that the reduction in trauma mortality was driven by reduction in moderate injury severity and that death from critical polytrauma remained persistently high. Methods: A 20-year retrospective analysis ending December 2021 of a Level-1 trauma center’s registry was performed on all trauma patients admitted with ISS > 15. Patients’ demographics, injury severity and outcomes were collected. Multivariate logistic regression analysis was performed. Mortality was examined for the entire study group and separately for the subset of critical polytrauma patients (ISS 50–75). Results: A total of 8462 severely injured (ISS > 15) trauma patients were identified during the 20-year period. Of these 238 (2.8%) were critical polytrauma patients (ISS 50–75). ISS > 15 mortality decreased from 11.3 to 9.4% over the study period (Adjusted OR 0.98, 0.97–0.99). ISS 50–75 mortality did not change significantly (46.2–60.0%), adjusted OR 0.96, 0.92–1.00). Conclusion: The improvement in trauma mortality over the past 20 years has not been experienced equally. The ISS50-75 critical polytrauma mortality is a practical group to capture. It could be a group for deeper study and reporting to drive improvement.]]> Thu 21 Mar 2024 11:55:42 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:53750 Thu 11 Jan 2024 12:14:38 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:10753 24 hours). Demographics, Injury Severity Score, pelvic Abbreviated Injury Score, first 24-hour transfusions, physiologic parameters, time to operating room (OR), angiography requirement, length of stay (LOS), and mortality were recorded. Data are presented as mean ± SD or percentages. Statistical significance was determined at p < 0.05 based on univariate analysis. Results: Forty-five patients met inclusion criteria, 18 patients had acute definitive ORIF (5.5 hours to OR) and 27 had late definitive ORIF (5 days to OR). Acute and late ORIF patients had comparable demographics (age: 48 ± 22 years vs. 40 ± 14 years, gender: 82% vs. 79% men) and injury severity (Injury Severity Score: 30 ± 18 vs. 24.5 ± 13, pelvic Abbreviated Injury Score: 3.7 ± 1 vs. 3.4 ± 1.1). Initial shock parameters were significantly worse in the acute ORIF group (systolic blood pressure, 69.7 ± 17 mm Hg vs. 108 ± 21 mm Hg; BD, −7.4 ± 4 vs. −4.9 ± 2 mEq/L, lactate 6.67 ± 7 mmol/L vs. 2.51 ± 1.3 mmol/L). Angiography was used in 18% (3/18) vs. 21% (6 of 27) of the cases. All early ORIF patients survived and one (3%) of the late ORIF patients died. There was a trend to shorter hospital LOS (25 ± 24 days vs. 37 ± 32 days) and a decreased 24-hour red cell transfusion rate (4.7 ± 5 U vs. 6.6 ± 4 U) in the early ORIF group. The intensive care unit admission rate (12 of 18 vs. 15 of 27) and LOS was comparable (2.9 ± 2.5 days vs. 3.7 ± 3.6 days). Conclusion: Acute ORIF of unstable pelvic ring fractures within 6 hours could be safely performed even in severely shocked patients with multiple injuries. The procedure did not lead to increased rates of transfusion, mortality, intensive care unit LOS, or overall LOS. Furthermore, all these parameters showed a trend toward benefit compared with a staged approach.]]> Sat 24 Mar 2018 08:08:21 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:19101 Sat 24 Mar 2018 08:05:15 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:18143 Sat 24 Mar 2018 08:04:45 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:18140 18 years) admitted to a Level 1 trauma center. Demographics, mechanism, Injury Severity Score, fracture type/grade, local contamination, time to debridement, time to antibiotics, and interventions were prospectively recorded. Outcome measures were as follows: length of stay, deep infection, secondary procedures, and presence of union at 6 months and 12 months. Univariate, multivariate, and logistic regression analyses were performed. Results: Eighty-nine consecutive patients (74% male, age 41 years ±17 years, Injury Severity Score 15 ±3, and 37% multiple injured) met inclusion criteria. The mean time to surgical debridement and operative stabilization was 8 hours ±4 hours (48% within 6 hours). The average length of stay was 21 days ±13 days. Fifteen patients (17%) had deep infection and 5 (6%) required amputation (1 acute and 4 late because of the infection). The 6-month and 12-month union rates were 39% and 67%, respectively. Fifty-six patients (63%) required further procedures (a total of 312). The multivariate regression model (18 variables) showed no independent significant predictors for deep infection or nonunion at 6 months and 12 months (multiple injuries and smoking were closest to reach significance, p = 0.08). Conclusion: Timely management of open tibia fractures (mean, 8 hours) eliminates time to debridement and contamination as predictors of poor outcome. Patient factors and local and general injury severity determine the outcomes. Aiming for the earliest safe time to debridement minimizes the negative effects of modifiable factors on the outcome.]]> Sat 24 Mar 2018 08:04:45 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:18916 Sat 24 Mar 2018 08:03:13 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:20345 120) or GCS < 14 on arrival were excluded. Momentary pain scores were measured on an 11-point verbal numerical rating scale by paramedics during prehospital management. Patients were evaluated within 48 h of injury on the recall of their initial pain, pain during transport, and lowest pain score achieved by prehospital analgesia. Spearman's rank correlation and Bland–Altman tests were used to compare ambulance and hospital data. Results: 88 trauma resuscitation patients (mean age 44 years ± 18 SD, male 74%, mean ISS: 7 ± 5 SD) were enrolled over a 5 month study period. Comparison of immediate and recalled pain scores produced Spearman's correlation coefficients of 0.71 for initial pain, 0.56 for pain during transport, and 0.45 for minimum pain scores. Discussion: In our study patients did not accurately recall their pain levels 1–2 days after acute trauma. The results suggest that retrospective pain ratings are not reliable in trauma patients.]]> Sat 24 Mar 2018 08:02:56 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:17326 120) or Glasgow Coma Scale score <14 on arrival were excluded. Nausea, vomiting, and antiemetic use were recorded. RESULTS: Convenience sample of 196 trauma resuscitation patients (68% men; age, 42 ± 18 years, mean Injury Severity Score 8 ± 7) were interviewed over the 5-month study period, of a total 369 admitted trauma patients (53%). Seventy-five (38%) patients reported some degree of nausea, 57 (29%) moderate or severe nausea, and 15 (8%) vomited. Older age and female gender were associated with vomiting (p < 0.01). Seventy-nine patients (40%) received a prophylactic antiemetic. Of these, four became nauseous (5%), compared with 71 of 117 (61%) for patients not given an antiemetic (p < 0.0001). CONCLUSIONS: Prehospital nausea and vomiting are more common in our cohort of trauma patients than the reported rates in the literature for nontrauma patients transported to hospital by ambulance. Only 40% of patients receive prophylactic antiemetics, but those patients are less likely to develop symptoms.]]> Sat 24 Mar 2018 08:01:47 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:21784 Sat 24 Mar 2018 08:00:40 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:18955 Sat 24 Mar 2018 07:58:57 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:19109 Sat 24 Mar 2018 07:55:59 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:19102 =10 units of PRBC. Average PRBC use was 7.2 ± 6.6 units and fresh frozen plasma use 4.3 ± 5.2 units. Thirty-nine percent (25/64) had a pelvic ring injury or acetabular fracture. Thirty-seven percent (24/64) had at least one femoral shaft fracture. Twenty patients had a total of 23 tibia fractures. Conclusions: Orthopaedic trauma patients consume the majority of the blood products <24 hours among blunt trauma patients. This resource-intensive group requires frequent urgent surgical interventions and intensive care unit admission.]]> Sat 24 Mar 2018 07:55:50 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:18382 Sat 24 Mar 2018 07:52:42 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:20178 110 g/l). Conclusion: The prospective evaluation of acutely transfused trauma patients showed a distinct pattern of transfusion triggers as the patient passes from ED to the OT and arrives to the ICU. The conventional transfusion trigger (haemoglobin level) is not appropriate in ET as early transfusion triggers are based on vital signs, blood gas results, injury patterns and anticipated major bleeding.]]> Sat 24 Mar 2018 07:51:40 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:23722 Sat 24 Mar 2018 07:16:58 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:23620 Sat 24 Mar 2018 07:13:28 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:23498 Sat 24 Mar 2018 07:13:04 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:23600 Sat 24 Mar 2018 07:12:21 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:42278 20 mSv). The study cohort included 428 patients (193 male and 235 female) with an average age of 44 years (±28). There were 447 procedures performed, i.e., all involved operative fluoroscopy, 116 involved computed tomography, and 397 involved X-ray. The mean cumulative effective dose per patient was 1.96 mSv (±4.98, 45.12). The mean cumulative effective dose for operative fluoroscopy was 0.32 mSv (±0.73, 5.91), for X-ray was 1.12 mSv (±3.6, 39.23) and for computed tomography was 2.22 mSv (±4.13, 20.14). The mean cumulative effective dose of 1.96 mSv falls below the recommended maximum annual exposure of 20 mSv. This study can serve as a guide for informing clinicians and patients of the acceptable radiation risk in the context of isolated extremity trauma.]]> Fri 19 Aug 2022 14:51:21 AEST ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:53085 Fri 17 Nov 2023 12:03:48 AEDT ]]> https://nova.newcastle.edu.au/vital/access/ /manager/Repository/uon:51520 Fri 08 Sep 2023 12:02:44 AEST ]]>