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injury audit

Susan Yoong, Ravi Kothari, Adam Brooks
INTRODUCTION: Whole body computed tomography has become standard practice in many centres in the management of severely injured trauma patients, however, the evidence for it's diagnostic accuracy is limited. AIM: To assess the sensitivity of whole body CT in major trauma. METHOD: Retrospective review of all patients with injury severity score (ISS) > 15 presenting with blunt trauma to a UK Major Trauma Centre between May 2012 and April 2014...
March 8, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Darius Ashrafi, Therese Rey-Conde, John B North, Arkadiusz P Wysocki
BACKGROUND: Trauma remains the most frequent cause of death for patients under 35 years of age. Head injury and catastrophic haemorrhage account for the majority of early deaths. A trauma laparotomy is often necessary to arrest haemorrhage. METHODS: All patients who died in Queensland hospitals between 2011 and 2016 having had a trauma laparotomy were identified from the Queensland Audit of Surgical Mortality. RESULTS: About 69.0% of the 84 deaths were male with a median age of 47...
March 6, 2018: ANZ Journal of Surgery
Candace Haddock, Al Ghalgya Al Maawali, Joseph Ting, Julie Bedford, Kourosh Afshar, Erik D Skarsgard
BACKGROUND/PURPOSE: Elimination of unnecessary practice variation through standardization creates opportunities for improved outcomes and cost-effectiveness. A quality improvement (QI) initiative at our institution used evidence and consensus to standardize management of gastroschisis (GS) from birth to discharge. METHODS: An interdisciplinary team utilized best practice evidence and expert opinion to standardize GS care. Following stakeholder engagement and education, care standardization was implemented in September 2014...
February 7, 2018: Journal of Pediatric Surgery
W Bekker, V Y Kong, G L Laing, J L Bruce, V Manchev, D L Clarke
Introduction This audit focused on patients who sustained enteric injury following blunt abdominal trauma. Methods Our prospectively maintained electronic registry was interrogated retrospectively, and all patients who had sustained blunt abdominal trauma between December 2011 and January 2016 were identified. Results Overall, 2,045 patients had sustained blunt abdominal trauma during the period under review. Seventy per cent were male. The median age was 28 years. Sixty patients (2.9%) sustained a small bowel injury (SBI)...
February 27, 2018: Annals of the Royal College of Surgeons of England
Jennifer Yeung, Anna Stecher, Catrina C Crisp, Donna Mazloomdoost, Benjamin Smith, Steven D Kleeman, Rachel N Pauls
OBJECTIVES: Obstetric anal sphincter injuries (OASISs) are a devastating postpartum complication; reducing rates is paramount to improving quality of care. In Norway, implementation of a perineal protection program decreased the incidence of OASIS by 48%. We sought to assess impact on OASIS rates following a similar program. METHODS: This institutional review board-approved, retrospective cohort study was performed in an academic hospital system. The periods of analysis were November 2014 through October 2015 for the preintervention arm and November 2015 through October 2016 for the postintervention arm...
March 2018: Female Pelvic Medicine & Reconstructive Surgery
A Cook, T Osler, L Glance, F Lecky, O Bouamra, J Weddle, B Gross, J Ward, F O Moore, F Rogers, D Hosmer
BACKGROUND: The Trauma Audit and Research Network (TARN) in the UK publicly reports hospital performance in the management of trauma. The TARN risk adjustment model uses a fractional polynomial transformation of the Injury Severity Score (ISS) as the measure of anatomical injury severity. The Trauma Mortality Prediction Model (TMPM) is an alternative to ISS; this study compared the anatomical injury components of the TARN model with the TMPM. METHODS: Data from the National Trauma Data Bank for 2011-2015 were analysed...
February 21, 2018: British Journal of Surgery
J Swieton, R Hawes, S Avery, H Watson, Y Scott, M Lannon, J P Wallis
OBJECTIVES: The aim of this study is to improve practice in the management of major haemorrhage, particularly in red cell to plasma transfusion ratios. BACKGROUND: A review of the management of major haemorrhage in trauma in Newcastle Hospitals Trust in 2012-2013 showed good mortality outcomes but found that red cell : plasma transfusion ratios could be improved. Human factors techniques transferable from industry and the military were identified, and a package of interventions was implemented, including an intensive multidisciplinary team training programme and a new major haemorrhage prescription template...
February 2, 2018: Transfusion Medicine
Agc Hay-David, T Stacey, I Pallister
Introduction We aimed to identify population demographics of motorcyclists and pillion passengers with isolated open lower-limb fractures, to ascertain the impact of the revised 2009 British Orthopaedic Association/British Association of Plastic Reconstructive and Aesthetic Surgeons joint standards for the management of open fractures of the lower limb (BOAST 4), in terms of time to skeletal stabilisation and soft-tissue coverage, and to observe any impact on patient movement. Methods Retrospective cohort data was collected by the Trauma Audit and Research Network (TARN)...
January 24, 2018: Annals of the Royal College of Surgeons of England
Yun-Hee Jeon, Anne-Nicole Casey, Kha Vo, Kris Rogers, Belinda Poole, Judith Fethney
Objectives To ascertain Australian multistate prevalence and incidence of five commonly collected clinical indicators of aged-care home quality and to measure associations between these clinical indicators and levels of care needs and consumer and staff satisfaction.Methods A retrospective analysis of national audit data collected from 426 facilities between 2015 and 2016 was performed. Regression models were used to examine associations between five clinical indicators (falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy) and level of care needs measured by the Aged Care Funding Instrument (ACFI) and consumer and care staff survey responses...
January 16, 2018: Australian Health Review: a Publication of the Australian Hospital Association
Jacqueline Francis-Coad, Christopher Etherton-Beer, Caroline Bulsara, Nicole Blackburn, Paola Chivers, Anne-Marie Hill
BACKGROUND: Falls are a major socio-economic problem among residential aged care (RAC) populations resulting in high rates of injury including hip fracture. Guidelines recommend that multifactorial prevention strategies are implemented but these require translation into clinical practice. A community of practice (CoP) was selected as a suitable model to support translation of the best available evidence into practice, as it could bring together like-minded people with falls expertise and local clinical knowledge providing a social learning opportunity in the pursuit of a common goal; falls prevention...
January 15, 2018: BMC Health Services Research
Kevin Verhoeff, Rachelle Saybel, Pamela Mathura, Bonnie Tsang, Vanessa Fawcett, Sandy Widder
Ensuring adequate vascular access in major trauma patients prior to decompensative physiological processes is crucial to patient outcomes. Most protocols suggest achieving two 18-gauge or larger intravenous lines immediately in patients with major trauma. We discuss a quality improvement approach to ensure that >90% of patients with major trauma (as defined by an injury severity score ≥12) at a level one trauma centre receive timely and adequate fluid access. Applying Donabedian principles for process improvement, we used the Alberta Trauma Registry to perform a 4-month chart audit on patients with major trauma at the University of Alberta Hospital...
2018: BMJ open quality
Shaw Bronner, Caroline McBride, Allison Gill
We analysed work-related musculoskeletal injuries (WMSI) in two modern dance companies to determine whether injury rates decreased and patterns altered compared to previous 3-yr and 6-yr audits (0.48 and 0.25/1000-hrs exposure respectively). In this prospectively designed 15-yr cohort study, data were collected in 30-dancer Company-1 and 12-dancer Company-2. In-house physical therapists tracked WMSI and time-loss-injuries for 159 dancers (42 dancers/yr). 15-yrs were grouped into five 3-yr blocks for comparison with prior audits...
January 10, 2018: Journal of Sports Sciences
C Talbot, N Davis, I Majid, M Young, O Bouamra, F E Lecky, S Jones
AIMS: The aim of this study was to describe the epidemiology of closed isolated fractures of the femoral shaft in children, and to compare the treatment and length of stay (LOS) between major trauma centres (MTCs) and trauma units (TUs) in England. PATIENTS AND METHODS: National data were obtained from the Trauma and Audit Research Network for all isolated, closed fractures of the femoral shaft in children from birth to 15 years of age, between 2012 and 2015. Age, gender, the season in which the fracture occurred, non-accidental injury, the mechanism of injury, hospital trauma status, LOS and type of treatment were recorded...
January 2018: Bone & Joint Journal
Kenji Yoshitani, Kenichi Masui, Masahiko Kawaguchi, Mikito Kawamata, Manabu Kakinohana, Shinya Kato, Kyoko Hasuwa, Michiaki Yamakage, Yusuke Yoshikawa, Kimitoshi Nishiwaki, Tadashi Aoyama, Yoshimi Inagaki, Kazumasa Yamasaki, Mishiya Matsumoto, Kazuyoshi Ishida, Atsuo Yamashita, Katsuhiro Seo, Shinichi Kakumoto, Hironobu Hayashi, Yuu Tanaka, Satoshi Tanaka, Takashi Ishida, Hiroyuki Uchino, Takayasu Kakinuma, Yoshitsugu Yamada, Yoshiteru Mori, Shunsuke Izumi, Kunihiro Nishimura, Michikazu Nakai, Yoshihiko Ohnishi
BACKGROUND: Spinal cord ischemic injury is the most devastating sequela of descending and thoracoabdominal aortic surgery. Motor-evoked potentials (MEPs) have been used to intraoperatively assess motor tract function, but it remains unclear whether MEP monitoring can decrease the incidence of postoperative motor deficits. Therefore, we reviewed multicenter medical records of patients who had undergone descending and thoracoabdominal aortic repair (both open surgery and endovascular repair) to assess the association of MEP monitoring with postoperative motor deficits...
March 2018: Anesthesia and Analgesia
Joao Ricardo Nickenig Vissoci, Julian Hertz, Deena El-Gabri, José Roberto Andrade Do Nascimento, Leonardo Pestillo De Oliveira, Blandina Theophil Mmbaga, Mark Mvungi, Catherine A Staton
Aims: To develop Swahili versions of the Alcohol Use Disorders Identification Test (AUDIT) and CAGE questionnaires and evaluate their psychometric properties in a traumatic brain injury (TBI) population in Tanzania. Methods: Swahili versions of the AUDIT and CAGE were developed through translation and back-translation by a panel of native speakers of both English and Swahili. The translated instruments were administered to a sample of Tanzanian adults from a TBI registry...
January 1, 2018: Alcohol and Alcoholism: International Journal of the Medical Council on Alcoholism
G V Oosthuizen, J De Wet, J L Bruce, D L Clarke
BACKGROUND: Rib fractures and flail chests have traditionally been treated nonoperatively. Current literature suggests that it is not only safe and feasible but also desirable to perform fixation of severe rib fractures. Our unit in the Pietermaritzburg public sector adopted rib fracture fixation in 2014 and in this audit we assess its feasibility in our setting. METHODS AND RESULTS: We audited our first nine cases of rib fracture fixation performed to date, of which seven were males...
November 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
J Herron, R Hutchinson, F Lecky, O Bouamra, A Edwards, M Woodford, W G P Eardley
AIMS: To compare the early management and mortality of older patients sustaining major orthopaedic trauma with that of a younger population with similar injuries. PATIENTS AND METHODS: The Trauma Audit Research Network database was reviewed to identify eligible patients admitted between April 2012 and June 2015. Distribution and severity of injury, interventions, comorbidity, critical care episodes and mortality were recorded. The population was divided into young (64 years or younger) and older (65 years and older) patients...
December 2017: Bone & Joint Journal
A Alam, Rafael Olarte, Jeannie Callum, Arsham Fatahi, B Nascimento, Claude Laflamme, Robert Cohen, Avery B Nathens, Homer Tien
BACKGROUND: Hypothermia (<36°C) exacerbates trauma-induced coagulopathy and worsens morbidity and mortality among severely injured trauma patients; there is a paucity of published data describing how well trauma centres adhere to standards regarding measurement of temperature, and best practices for preventing and treating hypothermia. METHODS: We completed a retrospective quality audit of all severely injured trauma patients (Injury Severity Score (ISS≥20)) who had urgent surgery at Sunnybrook Health Sciences Centre (SHSC) between 2010 and 2014...
January 2018: Injury
Chongthawonsatid Sukanya
Objectives: This study examined the validity of the principal diagnoses on discharge summaries and coding assessments. Methods: Data were collected from the National Health Security Office (NHSO) of Thailand in 2015. In total, 118,971 medical records were audited. The sample was drawn from government hospitals and private hospitals covered by the Universal Coverage Scheme in Thailand. Hospitals and cases were selected using NHSO criteria. The validity of the principal diagnoses listed in the "Summary and Coding Assessment" forms was established by comparing data from the discharge summaries with data obtained from medical record reviews, and additionally, by comparing data from the coding assessments with data in the computerized ICD (the data base used for reimbursement-purposes)...
October 2017: Healthcare Informatics Research
Brandon J Teng, Shawn H Song, Jelena N Svircev, Jason A Dominitz, Stephen P Burns
STUDY DESIGN: Retrospective chart audit. OBJECTIVES: To compare adequacy of colonoscopy bowel preparation and diagnostic findings between persons with SCI receiving an extended inpatient bowel preparation and the general population. SETTING: Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA. METHODS: We reviewed an electronic database of all colonoscopies performed at a tertiary Veterans Affairs medical center between 7/12/13 and 15/10/15...
November 24, 2017: Spinal Cord
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