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Thiery C, Jost D, Scannavino M, Lemoine F, Travers S. Epidemiology and prehospital medical management of railroad victims in Paris and its suburbs: a retrospective study. Eur J Emerg Med 2023; 30:379-380. [PMID: 37650743 DOI: 10.1097/mej.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Christophe Thiery
- Intensive Care Unit, Emile Durkheim Hospital, Epinal
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Daniel Jost
- Paris Fire Brigade Medical Emergency Department, Paris, France
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Ho J, Mansour M, Gomez D. Subway-related trauma at a level 1 trauma centre in Toronto, Ontario. Can J Surg 2021; 64:E588-E593. [PMID: 34728524 PMCID: PMC8565880 DOI: 10.1503/cjs.020219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Given the rising prevalence of subways in combination with an increasing incidence of subway-related injuries, understanding subway-related trauma is becoming ever more relevant. The aim of this study was to characterize the potential causes, injury characteristics and outcomes of subway-related trauma at a level 1 adult trauma centre in Toronto, Ontario. Methods: We conducted a retrospective cohort study to identify patients who presented to the emergency department a level 1 adult trauma centre with a subway-related injury between Jan. 1, 2010, and Dec. 31, 2018. Patients were identified via International Statistical Classification of Diseases and Related Health Problems, 10th Revision E-codes (X81, Y02, V050, V051 and W17). We then further screened for descriptions of subway-related injuries. Patients whose injuries did not involve a moving subway train were excluded. Results: We identified 51 patients who presented to the emergency department after being hit by a moving subway train. The majority of incidents (39 [76%]) were due to self-harm, 10 (20%) were unintentional injuries, and 2 (4%) were due to assault. The presence of alcohol was detected in 8 patients (80%) with unintentional injuries and 3 (8%) of those with self-inflicted injuries. Thirteen patients (25%) had a systolic blood pressure less than 90 mm Hg. The median Injury Severity Score was 17 (interquartile range 9–29). Seventeen patients (33%) presented with severe injuries (Abbreviated Injury Scale score ≥ 3) in 1 body region, and 19 (37%) had severe injuries in 2 or more body regions. The most common isolated severe injury was in the lower extremity, and the most common combinations of severe injuries were in the head and lower extremity, and head and thorax. Ten patients (20%) were declared dead in the emergency department. Of the 41 patients who survived their initial presentation, 12 (29%) went directly to the operating room, and 17 (41%) were transferred to the intensive care unit. The overall mortality rate was 29%. Conclusion: Patients with subway-related injuries experienced high mortality rates and severe injuries. Most incidents were due to self-harm or alcohol-related. Further research into early identification of those at risk and optimal prevention strategies is necessary to curb further incidents.
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Affiliation(s)
- Jordan Ho
- From the Schulich School of Medicine and Dentistry, Western University, London, Ont. (Ho); the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont. (Ho, Mansour, Gomez); the Department of Surgery A, Galilee Medical Center, Nahariya, Israel (Mansour); the Azrieli Faculty of Medicine of the Galilee, Bar-Ilan University, Safed, Israel (Mansour); the Division of General Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont. (Gomez); and the Division of General Surgery, Department of Surgery, University of Toronto, Ont. (Gomez)
| | - Muhammad Mansour
- From the Schulich School of Medicine and Dentistry, Western University, London, Ont. (Ho); the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont. (Ho, Mansour, Gomez); the Department of Surgery A, Galilee Medical Center, Nahariya, Israel (Mansour); the Azrieli Faculty of Medicine of the Galilee, Bar-Ilan University, Safed, Israel (Mansour); the Division of General Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont. (Gomez); and the Division of General Surgery, Department of Surgery, University of Toronto, Ont. (Gomez)
| | - David Gomez
- From the Schulich School of Medicine and Dentistry, Western University, London, Ont. (Ho); the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont. (Ho, Mansour, Gomez); the Department of Surgery A, Galilee Medical Center, Nahariya, Israel (Mansour); the Azrieli Faculty of Medicine of the Galilee, Bar-Ilan University, Safed, Israel (Mansour); the Division of General Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont. (Gomez); and the Division of General Surgery, Department of Surgery, University of Toronto, Ont. (Gomez)
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Kontoghiorghe CN, Graham SM, Rodriguez J, Matzopoulos R, Maqungo S. Train related injuries: A descriptive analysis highlighting orthopaedic injuries and management. SICOT J 2021; 7:43. [PMID: 34402792 PMCID: PMC8370016 DOI: 10.1051/sicotj/2021038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/04/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Orthopaedic injuries constitute a major aspect of morbidity and mortality following train accidents. The pattern of orthopaedic/musculoskeletal injuries sustained following these accidents has not been fully characterised. The main aim of this study is to describe the range of orthopaedic injuries reported in a major trauma centre and evaluate their management, as well as reporting mortality and amputation rates. Further aims are to identify the social and demographic background of the patients to suggest treatment and prevention strategies. Methods: This study is a retrospective observation of all clinical files of patients presented to Level 1 Trauma Centre in Cape Town, South Africa, as “train casualty” from January 2013 to July 2019, which were reviewed and evaluated. A total of 174 patients were included, of which 92 were orthopaedic referrals. The average age was 29 years, and 87% were male. Results: Tibial fractures were most common (N = 19), 38% of patients sustained open fractures, and 68% of patients (in total) underwent surgery. Wound debridement was the most common operation, followed by open reduction internal fixation (ORIF). Twelve patients (13%) underwent amputation to 14 body parts. Eight patients (4.6%) (in total) died in the trauma unit. Discussion: This study provides insight into train accident victims and their orthopaedic injuries and management patterns. The victims are largely young males. The majority of orthopaedic injuries require surgical intervention, and those who make it to the hospital have a good chance of survival and limb salvage. It appears that in addition to early hospital access and specialised updated treatments, morbidity and mortality in train accidents could be reduced by improving safety measures and social awareness to reduce railway violence and accidents.
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Affiliation(s)
- Christina Niovi Kontoghiorghe
- Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa - University College London Hospitals NHS Foundation Trust, NW1 2BU London, UK
| | - Simon Matthew Graham
- Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa - Institute of Population Health Sciences, University of Liverpool, L69 3BX Liverpool, UK - Department of Orthopaedic and Trauma Surgery, Liverpool University Teaching Hospital Trust, L9 7AL Liverpool, UK
| | - Joel Rodriguez
- Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa - University of Texas Southwestern Medical Center, Dallas, 75390 TX, USA
| | - Richard Matzopoulos
- Burden of Disease Research Unit, South African Medical Research Council, 7505 Cape Town, South Africa - School of Public Health and Family Medicine, University of Cape Town, 7925 Cape Town, South Africa
| | - Sithombo Maqungo
- Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa - Division of Global Surgery, University of Cape Town, 7925 Cape Town, South Africa
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