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Li Y, Li X, Wang W, Guo R, Huang X. Spatiotemporal evolution and characteristics of worldwide life expectancy. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:87145-87157. [PMID: 37418193 DOI: 10.1007/s11356-023-28330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 06/14/2023] [Indexed: 07/08/2023]
Abstract
Exploring global differences in life expectancy can facilitate the development of strategies to narrow regional disparities. However, few researchers have systematically examined patterns in the evolution of worldwide life expectancy over a long time period. Spatial differences among 181 countries in 4 types of worldwide life expectancy patterns from 1990 to 2019 were investigated via geographic information system (GIS) analysis. The aggregation characteristics of the spatiotemporal evolution of life expectancy were revealed by local indicators of spatial association. The analysis employed spatiotemporal sequence-based kernel density estimation and explored the differences in life expectancy among regions with the Theil index. We found that the global life expectancy progress rate shows upward then downward patterns over the last 30 years. Female have higher rates of spatiotemporal progression in life expectancy than male, with less internal variation and a wider spatial aggregation. The global spatial and temporal autocorrelation of life expectancy shows a weakening trend. The difference in life expectancy between male and female is reflected in both intrinsic causes of biological differences and extrinsic causes such as environment and lifestyle habits. Investment in education pulls apart differences in life expectancy over long time series. These results provide scientific guidelines for obtaining the highest possible level of health in countries around the world.
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Affiliation(s)
- Yaxing Li
- Research Institute for Smart Cities, School of Architecture and Urban Planning, Shenzhen University, Shenzhen, 518060, China
- College of Design and Engineering, National University of Singapore, Singapore, 119077, Singapore
| | - Xiaoming Li
- Research Institute for Smart Cities, School of Architecture and Urban Planning, Shenzhen University, Shenzhen, 518060, China
- Shenzhen Key Laboratory of Spatial Smart Sensing and Services & MNR Technology Innovation Center of Territorial & Spatial Big Data & Guangdong-Hong Kong-Macau Joint Laboratory for Smart Cities, Shenzhen, 518060, China
| | - Weixi Wang
- Research Institute for Smart Cities, School of Architecture and Urban Planning, Shenzhen University, Shenzhen, 518060, China
- Shenzhen Key Laboratory of Spatial Smart Sensing and Services & MNR Technology Innovation Center of Territorial & Spatial Big Data & Guangdong-Hong Kong-Macau Joint Laboratory for Smart Cities, Shenzhen, 518060, China
| | - Renzhong Guo
- Research Institute for Smart Cities, School of Architecture and Urban Planning, Shenzhen University, Shenzhen, 518060, China.
- Shenzhen Key Laboratory of Spatial Smart Sensing and Services & MNR Technology Innovation Center of Territorial & Spatial Big Data & Guangdong-Hong Kong-Macau Joint Laboratory for Smart Cities, Shenzhen, 518060, China.
| | - Xiaojin Huang
- Research Institute for Smart Cities, School of Architecture and Urban Planning, Shenzhen University, Shenzhen, 518060, China
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Chui JN, Kotecha K, Gall TMH, Mittal A, Samra JS. Surgical management of high-grade pancreatic injuries: Insights from a high-volume pancreaticobiliary specialty unit. World J Gastrointest Surg 2023; 15:834-846. [PMID: 37342855 PMCID: PMC10277947 DOI: 10.4240/wjgs.v15.i5.834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/22/2023] [Accepted: 03/16/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND The management of high-grade pancreatic trauma is controversial.
AIM To review our single-institution experience on the surgical management of blunt and penetrating pancreatic injuries.
METHODS A retrospective review of records was performed on all patients undergoing surgical intervention for high-grade pancreatic injuries [American Association for the Surgery of Trauma (AAST) Grade III or greater] at the Royal North Shore Hospital in Sydney between January 2001 and December 2022. Morbidity and mortality outcomes were reviewed, and major diagnostic and operative challenges were identified.
RESULTS Over a twenty-year period, 14 patients underwent pancreatic resection for high-grade injuries. Seven patients sustained AAST Grade III injuries and 7 were classified as Grades IV or V. Nine underwent distal pancreatectomy and 5 underwent pancreaticoduodenectomy (PD). Overall, there was a predominance of blunt aetiologies (11/14). Concomitant intra-abdominal injuries were observed in 11 patients and traumatic haemorrhage in 6 patients. Three patients developed clinically relevant pancreatic fistulas and there was one in-hospital mortality secondary to multi-organ failure. Among stable presentations, pancreatic ductal injuries were missed in two-thirds of cases (7/12) on initial computed tomography imaging and subsequently diagnosed on repeat imaging or endoscopic retrograde cholangiopancreatography. All patients who sustained complex pancreaticoduodenal trauma underwent PD without mortality. The management of pancreatic trauma is evolving. Our experience provides valuable and locally relevant insights into future management strategies.
CONCLUSION We advocate that high-grade pancreatic trauma should be managed in high-volume hepato-pancreato-biliary specialty surgical units. Pancreatic resections including PD may be indicated and safely performed with appropriate specialist surgical, gastroenterology, and interventional radiology support in tertiary centres.
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Affiliation(s)
- Juanita Noeline Chui
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney 2065, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney 2006, NSW, Australia
| | - Krishna Kotecha
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney 2065, NSW, Australia
| | - Tamara MH Gall
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney 2065, NSW, Australia
| | - Anubhav Mittal
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney 2065, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney 2006, NSW, Australia
- Department of Surgery, University of Notre Dame, Sydney 2006, NSW, Australia
| | - Jaswinder S Samra
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney 2065, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney 2006, NSW, Australia
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Werner K, Kak M, Herbst CH, Lin TK. Emergency care in post-conflict settings: a systematic literature review. BMC Emerg Med 2023; 23:37. [PMID: 37005602 PMCID: PMC10068156 DOI: 10.1186/s12873-023-00775-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 01/09/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Emergency care systems (ECS) organize and provide access to life-saving care both during transport and at health facilities. Not enough is known about ECS in uncertain contexts such as post-conflict settings. This review aims to systematically identify and summarize the published evidence on the delivery of emergency care in post-conflict settings and to guide health sector planning. METHODS We searched five databases (PubMed MEDLINE, Web of Science, Embase, Scopus, and Cochrane) in September 2021 to identify relevant articles on ECS in post-conflict settings. Included studies (1) described a context that is post-conflict, conflict-affected, or was impacted by war or crisis; (2) examined the delivery of an emergency care system function; (3) were available in English, Spanish, or French; and (4) were published between 1 and 2000 and 9 September 2021. Data were extracted and mapped using the essential system functions identified in the World Health Organization (WHO) ECS Framework to capture findings on essential emergency care functions at the scene of injury or illness, during transport, and through to the emergency unit and early inpatient care. RESULTS We identified studies that describe the unique burden of disease and challenges in delivering to the populations in these states, pointing to particular gaps in prehospital care delivery (both during scene response and during transport). Common barriers include poor infrastructure, lingering social distrust, scarce formal emergency care training, and lack of resources and supplies. CONCLUSION To our knowledge, this is the first study to systematically identify the evidence on ECS in fragile and conflict-affected settings. Aligning ECS with existing global health priorities would ensure access to these critical life-saving interventions, yet there is concern over the lack of investments in frontline emergency care. An understanding of the state of ECS in post-conflict settings is emerging, although current evidence related to best practices and interventions is extremely limited. Careful attention should be paid to addressing the common barriers and context-relevant priorities in ECS, such as strengthening prehospital care delivery, triage, and referral systems and training the health workforce in emergency care principles.
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Affiliation(s)
- Kalin Werner
- Department of Social and Behavioral Sciences, Institute for Health & Aging, University of California, San Francisco, CA, San Francisco, USA.
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.
| | - Mohini Kak
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Christopher H Herbst
- Health, Nutrition and Population Global Practice, The World Bank, Washington, DC, USA
| | - Tracy Kuo Lin
- Department of Social and Behavioral Sciences, Institute for Health & Aging, University of California, San Francisco, CA, San Francisco, USA
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International Perspectives of Prehospital and Hospital Trauma Services: A Literature Review. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2030037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Evidence suggests that reductions in the incidence in trauma observed in some countries are related to interventions including legislation around road and vehicle safety measures, public behaviour change campaigns, and changes in trauma response systems. This study aims to briefly review recent refereed and grey literature about prehospital and hospital trauma care services in different regions around the world and describe similarities and differences in identified systems to demonstrate the diversity of characteristics present. Methods: Articles published between 2000 and 2020 were retrieved from MEDLINE and EMBASE. Since detailed comparable information was lacking in the published literature, prehospital emergency service providers’ annual performance reports from selected example countries or regions were reviewed to obtain additional information about the performance of prehospital care. Results: The review retained 34 studies from refereed literature related to trauma systems in different regions. In the U.S. and Canada, the trauma care facilities consisted of five different levels of trauma centres ranging from Level I to Level IV and Level I to Level V, respectively. Hospital care and organisation in Japan is different from the U.S. model, with no dedicated trauma centres; however, patients with severe injury are transported to university hospitals’ emergency departments. Other similarities and differences in regional examples were observed. Conclusions: The refereed literature was dominated by research from developed countries such as Australia, Canada, and the U.S., which all have organised trauma systems. Many European countries have implemented trauma systems between the 1990s and 2000s; however, some countries, such as France and Greece, are still forming an integrated system. This review aims to encourage countries with immature trauma systems to consider the similarities and differences in approaches of other countries to implementing a trauma system.
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Zhou J, Wang T, Belenkiy I, Hardcastle TC, Rouby JJ, Jiang B. Management of severe trauma worldwide: implementation of trauma systems in emerging countries: China, Russia and South Africa. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:286. [PMID: 34372903 PMCID: PMC8352140 DOI: 10.1186/s13054-021-03681-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/06/2021] [Indexed: 12/04/2022]
Abstract
As emerging countries, China, Russia, and South Africa are establishing and/or improving their trauma systems. China has recently established a trauma system named “the Chinese Regional Trauma Care System” and covered over 200 million populations. It includes paramedic-staffed pre-hospital care, in-hospital care in certified trauma centers, trauma registry, quality assurance, continuous improvement and ongoing coverage of the entire Chinese territory. The Russian trauma system was formed in the first decade of the twenty-first century. Pre-hospital care is region-based, with a regional coordination center that determines which team will go to the scene and the nearest hospital where the victim should be transported. Physician-staffed ambulances are organized according to three levels of trauma severity corresponding to three levels of trauma centers where in-hospital care is managed by a trauma team. No national trauma registry exists in Russia. Improvements to the Russian trauma system have been scheduled. There is no unified trauma system in South Africa, and trauma care is organized by public and private emergency medical service in each province. During the pre-hospital care, paramedics provide basic or advanced life support services and transport the patients to the nearest hospital because of the limited number of trauma centers. In-hospital care is inclusive with a limited number of accredited trauma centers. In-hospital care is managed by emergency medicine with multidisciplinary care by the various specialties. There is no national trauma registry in South Africa. The South African trauma system is facing multiple challenges. An increase in financial support, training for primary emergency trauma care, and coordination of private sector, need to be planned.
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Affiliation(s)
- Jing Zhou
- National Center for Trauma Medicine, Trauma Center, Department of Orthopedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Tianbing Wang
- National Center for Trauma Medicine, Trauma Center, Department of Orthopedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Igor Belenkiy
- Department of the Trauma and Orthopedics, Pavlov First Saint-Petersburg State Medical University, St. Petersburg, Russia.,Department of Trauma and Orthopedics , St. Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia
| | - Timothy Craig Hardcastle
- Trauma and Burns Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.,Department of Surgery, Nelson R Mandela School of Clinical Medicine, UKZN, Durban, South Africa
| | - Jean-Jacques Rouby
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Sorbonne University, La Pitié-Salpêtrière Hospital, Assistance-Publique-Hôpitaux-de-Paris, Paris, France.
| | - Baoguo Jiang
- National Center for Trauma Medicine, Trauma Center, Department of Orthopedics and Traumatology, Peking University People's Hospital, Beijing, China.
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Marle T, Mash R. Trauma patients at the Helderberg District Hospital emergency centre, South Africa: A descriptive study. Afr J Emerg Med 2021; 11:315-320. [PMID: 33996422 PMCID: PMC8100500 DOI: 10.1016/j.afjem.2021.03.012] [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] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/01/2021] [Accepted: 03/28/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Trauma is a substantial component of South Africa's burden of disease. District hospitals provide primary trauma care for a large proportion of this trauma burden, although most studies are in specialised or tertiary settings. The aim was to evaluate the profile of physical trauma patients attending the emergency centre at Helderberg District Hospital, Cape Town. METHODS An observational descriptive study was conducted between 1 January and 30 April 2019. Patients with trauma were identified from a register and systematically sampled to achieve a sample size of 377. Retrospective data from medical records was collected and analysed in the Statistical Package for Social Sciences. RESULTS Of the 14,873 patients attending the emergency centre 24.6% were trauma related and 381 folders were analysed. Of these patients 30.4% were female and 69.6% male with an average age of 27.8 years. Over 60% of patients used an ambulance to get to the hospital. Sundays were the busiest days with 23.9% of all cases. Intentional trauma accounted for 45.4% of cases and accidental injuries 49.1%. The commonest mechanisms were sharp injuries (27.6%), falls (22.0%) and blunt trauma (19.4%). Intentional trauma made up more than half of all trauma in males, was more prevalent than accidental trauma between 20 and 60 years and resulted in a higher proportion of admissions. CONCLUSION There were high levels of intentional trauma, especially involving young males over the weekend, mostly with sharp objects. This trauma burden resulted in high numbers of admissions and transfer to tertiary hospitals. Family physicians and other generalists need to be well trained in trauma resuscitation and stabilisation. District hospital need to be appropriately equipped and supplied to manage trauma. Further research is needed to identify underlying modifiable factors that can be addressed through community-orientated interventions.
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The gap in operative exposure in trauma surgery: quantifying the benefits of an international rotation. Surg Open Sci 2020; 2:46-50. [PMID: 32754707 PMCID: PMC7391879 DOI: 10.1016/j.sopen.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 09/16/2019] [Accepted: 09/25/2019] [Indexed: 12/04/2022] Open
Abstract
Background International rotations with hands-on experience are commonly cited as a potential supplement to the current experience of surgical trainees in trauma; however, quantification of this experience remains unclear. Methods A link to an online survey was distributed by electronic mail to physicians who rotated for any period of time at the Trauma Unit of the Groote-Shuur Hospital of the University of Cape Town from January 1, 2006, to December 2016. Results Of 160 participants, 75 (47%) completed the survey. A high proportion (45%) had performed less than 25 trauma-related surgical procedures during their previous training. Most (56%) performed ≥ 10 trauma laparotomies and sternotomies/thoracotomies during their rotation, whereas 43% performed ≥ 5 vascular procedures. The level of perceived confidence in managing trauma patients increased significantly from a median of 3/10 to 7/10 (P < .05). Conclusion Rotations at large-volume trauma centers abroad offer the opportunity for a hands-on operative experience and may enhance the confidence of surgical trainees. Further standardization of these opportunities may result in a larger-scale participation of graduate residents and fellows. This is a survey of physicians who participated in an international rotation at the Groote Schuur Hospital of the University of Cape Town. With this survey, we found that most participants performed in excess of 10 trauma laparotomies and thoracotomies/sternotomies. A large proportion performed 5 or more peripheral vascular procedures. These findings are combined with a significantly increased confidence in managing trauma patients. This report may serve in the planning of sponsored international rotations to increase the operative exposure in trauma surgery.
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Utilization of age-adjusted shock index in a resource-strained setting. J Pediatr Surg 2019; 54:2621-2626. [PMID: 31521372 DOI: 10.1016/j.jpedsurg.2019.08.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 08/24/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Identification of injury severity and appropriate triage are critical to effective surgical care, especially where medical and surgical resources are strained. We hypothesized that pediatric age-adjusted shock index (SIPA) would outperform traditional shock index (SI) in a middle-income country (MIC) setting. METHODS Injured children hospitalized in two trauma centers (South Africa and the United States) from 2012 to 2017 were reviewed. Maximum heart rate and minimum systolic blood pressure defined SI. SI > 0.9 defined elevation. SIPA elevation was based on SI stratified by age: 1-6 years (SI > 1.22), 7-12 years (SI > 1.0), and 13-17 years (SI > 0.9). SI and SIPA were compared using univariate analyses and area under the receiver operating characteristic curves (AUROC). RESULTS 1648 patients (741 MIC and 907 high-income country (HIC)) were evaluated with a median [IQR] age of 11 [6-15] years. SI was elevated in 377 (51%) MIC children, whereas SIPA was elevated in 248 (34%). In both the HIC and MIC, elevated SIPA was more associated with ISS ≥ 25, ICU admission, and mortality. In MIC patients specifically, elevated SIPA improved discrimination for in-hospital mortality (AUROC 0.66 vs AUROC 0.57, p < 0.01). CONCLUSION In a multinational cohort including MIC patients, SIPA facilitated identification of injured children with altered physiology, reflecting greater injury severity and poorer outcomes. Use of SIPA has the potential for more effective resource utilization in MICs. LEVEL OF EVIDENCE Level III.
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Edem IJ, Dare AJ, Byass P, D'Ambruoso L, Kahn K, Leather AJM, Tollman S, Whitaker J, Davies J. External injuries, trauma and avoidable deaths in Agincourt, South Africa: a retrospective observational and qualitative study. BMJ Open 2019; 9:e027576. [PMID: 31167869 PMCID: PMC6561452 DOI: 10.1136/bmjopen-2018-027576] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Injury burden is highest in low-income and middle-income countries. To reduce avoidable deaths, it is necessary to identify health system deficiencies preventing timely, quality care. We developed criteria to use verbal autopsy (VA) data to identify avoidable deaths and associated health system deficiencies. SETTING Agincourt, a rural Bushbuckridge municipality, Mpumalanga Province, South Africa. PARTICIPANTS Agincourt Health and Socio-Demographic Surveillance System and healthcare providers (HCPs) from local hospitals. METHODS A literature review to explore definitions of avoidable deaths after trauma and barriers to access to care using the 'three delays framework' (seeking, reaching and receiving care) was performed. Based on these definitions, this study developed criteria, applicable for use with VA data, for identifying avoidable death and which of the three delays contributed to avoidable deaths. These criteria were then applied retrospectively to the VA-defined category external injury deaths (EIDs-a subset of which are trauma deaths) from 2012 to 2015. The findings were validated by external expert review. Key informant interviews (KIIs) with HCPs were performed to further explore delays to care. RESULTS Using VA data, avoidable death was defined with a focus on survivability, using level of consciousness at the scene and ability to seek care as indicators. Of 260 EIDs (189 trauma deaths), there were 104 (40%) avoidable EIDs and 78 (30%) avoidable trauma deaths (41% of trauma deaths). Delay in receiving care was the largest contributor to avoidable EIDs (61%) and trauma deaths (59%), followed by delay in seeking care (24% and 23%) and in reaching care (15% and 18%). KIIs revealed context-specific factors contributing to the third delay, including difficult referral systems. CONCLUSIONS A substantial proportion of EIDs and trauma deaths were avoidable, mainly occurring due to facility-based delays in care. Interventions, including strengthening referral networks, may substantially reduce trauma deaths.
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Affiliation(s)
- Idara J Edem
- Department of Surgery, Division of Neurosurgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Anna J Dare
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Peter Byass
- Umeå Centre for Global Health Research, Umea Universitet, Umeå, Sweden
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia D'Ambruoso
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen School of Medicine and Dentistry, Aberdeen, UK
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Andy J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Stephen Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - John Whitaker
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Justine Davies
- Centre for Applied Health Research, University of Birmingham, Birmingham, UK
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Dippenaar E, Wallis L. Pre-hospital intercostal chest drains in South Africa: A modified Delphi study. Afr J Emerg Med 2019; 9:91-95. [PMID: 31193823 PMCID: PMC6543074 DOI: 10.1016/j.afjem.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 10/24/2018] [Accepted: 01/04/2019] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Trauma is one of the most common causes of death in low- and middle-income countries, with thoracic injury accounting for 20-25% of these deaths worldwide. The current management of a life-threatening pre-hospital pneumothorax is with a needle chest decompression, however, definitive care for a pneumothorax and/or haemothorax is still the insertion of an intercostal chest drain. The aim of this study was to seek expert opinion and consensus on the placement of ICDs in the pre-hospital emergency care setting in South Africa. METHODS A three-round modified Delphi study was undertaken with an expert panel drawn from local emergency care experts consisting of physicians and emergency medical service practitioners. Participants supplied opinion statements in round 1 under headings derived from common emerging themes found in the literature. During round 2 participants used a 9-point Likert scale to rate their consensus on each statement and in round 3 they were able to change their position based on the earlier panel distributions. A consensus percentage of 60% was set within a narrow margin of 'strongly agree' or 'strongly disagree'. RESULTS A total of 22 experts took part as panel members. There were 123 opinion statements produced from round 1, of which 21 (17%) reached consensus in round 2. At the end of round 3 another four statements reached consensus, bringing the total up to 25 (20%). CONCLUSION Definitive care of a life-threating pneumothorax and/or haemothorax must be sought emergently. The insertion of an ICD, under select conditions, may be required in the pre-hospital setting in South Africa.
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Raj LK, Creaton A, Phillips G. Improving emergency department trauma care in Fiji: Implementing and assessing the trauma call system. Emerg Med Australas 2019; 31:654-658. [PMID: 30690872 DOI: 10.1111/1742-6723.13225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/19/2018] [Accepted: 12/01/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The trauma team process was recently implemented at the Colonial War Memorial (CWM) Hospital, Suva. This study audits the trauma call procedure at the hospital over a period of 12 months. METHOD Retrospective descriptive study of trauma calls from August 2015 to July 2016 at CWM Hospital. Data relating to patient demographics, time of presentation, time to team assembly and time to computed tomography (CT) scan were extracted from the ED trauma call database. Disposition from the ED and status at hospital discharge was extracted from the hospital patient information system. RESULTS There were 38 trauma calls for 46 patients. Seventy-two per cent were male. Eighty-two per cent occurred when the CT radiographer was off site (16.00-08.00 h), including 47% that occurred between midnight and 08.00 h. Fifty-two per cent of patients were intubated, 43% went to ICU, 26% went directly to the operating theatre, and 37% died. Benchmarks for time to trauma team assembly and time to CT scan were met in 50% of cases. CONCLUSION This was a severely injured cohort of patients with a high mortality rate. The rate of missed calls was not assessed in this study. Time to CT scan could be improved with an onsite radiographer. Time to team assembly could be improved with trauma team training and early notification from pre-hospital providers. There is a need to continue to monitor and refine the trauma call process and to extend data capture to measure injury severity and outcomes.
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Affiliation(s)
- Lavinesh Kumar Raj
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Anne Creaton
- West Gippsland Healthcare Group, Melbourne, Victoria, Australia.,Fiji National University, Suva, Fiji
| | - Georgina Phillips
- Emergency Practice and Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Caregiver experiences of public services following child trauma exposure: a qualitative study. Int J Ment Health Syst 2018; 12:15. [PMID: 29651301 PMCID: PMC5894141 DOI: 10.1186/s13033-018-0190-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/22/2018] [Indexed: 11/23/2022] Open
Abstract
Background Many children in low and middle income countries (LMIC) are exposed to trauma. Contact with public services are a potential influence on parent–child reactions and coping post-trauma. Little is known about how caregivers perceive these interactions. Methods The aim of this study was to explore caregivers’ experiences of accessing and interacting with public services post-trauma and perceptions of needed improvements to public services in a LMIC context. Qualitative interviews were conducted with 20 female caregivers from a high-risk settlement in South Africa after child trauma exposure. Results Three themes and seven sub-themes were identified regarding caregivers’ perceptions of interactions with public services post-trauma. The key themes identified related to (1) communication and exchanges with law enforcement, (2) consequences of an under-resourced justice system and (3) importance of communication and empathy in the healthcare system. Interactions with police were often positive. However, caregivers explained that police-family communication post-trauma could be improved and may help to lessen caregiver anxiety and concerns for the child’s safety post-trauma. Caregivers perceived the judicial system to be under-resourced as contact with the judicial system was often protracted and caused child anxiety and distress. Medical treatment was reportedly rushed, with extensive waiting times and little information provided to caregivers regarding the child’s injuries or treatment. Some medical staff were perceived as unsympathetic during the child’s treatment which was found to exacerbate caregiver and child distress post-trauma. Conclusions This study provides insight into caregiver experiences of accessing public services following child trauma exposure in a high-risk LMIC context. Public services were perceived as oversubscribed and under-resourced and negative interactions often influenced caregiver responses and appraisals of child safety. Given the impact of poor interactions with public services on families post-trauma, additional research is needed to investigate feasible improvements to public services in LMIC. Electronic supplementary material The online version of this article (10.1186/s13033-018-0190-6) contains supplementary material, which is available to authorized users.
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Allgaier RL, Laflamme L, Wallis LA. Operational demands on pre-hospital emergency care for burn injuries in a middle-income setting: a study in the Western Cape, South Africa. Int J Emerg Med 2017; 10:2. [PMID: 28124200 PMCID: PMC5267612 DOI: 10.1186/s12245-017-0128-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Burns occur disproportionately within low-socioeconomic populations. The Western Cape Province of South Africa represents a middle-income setting with a high rate of burns, few specialists and few burn centres, yet a well-developed pre-hospital system. This paper describes the burn cases from a viewpoint of operational factors important to pre-hospital emergency medical services. METHODS A retrospective, cross-sectional study of administrative and patient records was conducted. Data were captured for all pre-hospital burn patients treated by public Emergency Medical Services over a continuous 12-month period. Data were captured separately at each site using a standardised data collection tool. Described categories included location (rural or urban), transport decision (transported or remained on scene), age (child or adult) and urgency (triage colour). RESULTS EMS treated 1198 patients with confirmed burns representing 0.6% of the total EMS caseload; an additional 819 potential burn cases could not be confirmed. Of the confirmed cases, 625 (52.2%) were located outside the City of Cape Town and 1058 (88.3%) were transported to a medical facility. Patients from urban areas had longer mission times. Children accounted for 37.5% (n = 449) of all burns. The majority of transported patients that were triaged were yellow (n = 238, 41.6% rural and n = 182, 37.4% urban). CONCLUSIONS Burns make up a small portion of the EMS caseload. More burns occurred in areas far from urban hospitals and burn centres. The majority of burn cases met the burn centre referral criteria.
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Affiliation(s)
- Rachel L. Allgaier
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Division of Emergency Medicine, Department of Interdisciplinary Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Lucie Laflamme
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- University of South Africa, Pretoria, South Africa
| | - Lee A. Wallis
- Division of Emergency Medicine, Department of Interdisciplinary Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Soogun S, Naidoo M, Naidoo K. An evaluation of the use of the South African Triage Scale in an urban district hospital in Durban, South Africa. S Afr Fam Pract (2004) 2017. [DOI: 10.1080/20786190.2017.1307908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | - M Naidoo
- Discipline of Family Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - K Naidoo
- Discipline of Family Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Affiliation(s)
- Peter Shirley
- Consultant, Intensive Care Unit, Royal London Hospital
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Amashnee S, Guinevere G, Indiran G. Non-fatal injuries of interpersonal violence at the Leratong Provincial Hospital, South Africa. S Afr Fam Pract (2004) 2016. [DOI: 10.1080/20786190.2016.1167311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Adeloye D, Thompson JY, Akanbi MA, Azuh D, Samuel V, Omoregbe N, Ayo CK. The burden of road traffic crashes, injuries and deaths in Africa: a systematic review and meta-analysis. Bull World Health Organ 2016; 94:510-521A. [PMID: 27429490 PMCID: PMC4933140 DOI: 10.2471/blt.15.163121] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/17/2016] [Accepted: 01/18/2016] [Indexed: 11/27/2022] Open
Abstract
Objective To estimate the burden of road traffic injuries and deaths for all road users and among different road user groups in Africa. Methods We searched MEDLINE, EMBASE, Global Health, Google Scholar, websites of African road safety agencies and organizations for registry- and population-based studies and reports on road traffic injury and death estimates in Africa, published between 1980 and 2015. Available data for all road users and by road user group were extracted and analysed. We conducted a random-effects meta-analysis and estimated pooled rates of road traffic injuries and deaths. Findings We identified 39 studies from 15 African countries. The estimated pooled rate for road traffic injury was 65.2 per 100 000 population (95% confidence interval, CI: 60.8–69.5) and the death rate was 16.6 per 100 000 population (95% CI: 15.2–18.0). Road traffic injury rates increased from 40.7 per 100 000 population in the 1990s to 92.9 per 100 000 population between 2010 and 2015, while death rates decreased from 19.9 per 100 000 population in the 1990s to 9.3 per 100 000 population between 2010 and 2015. The highest road traffic death rate was among motorized four-wheeler occupants at 5.9 per 100 000 population (95% CI: 4.4–7.4), closely followed by pedestrians at 3.4 per 100 000 population (95% CI: 2.5–4.2). Conclusion The burden of road traffic injury and death is high in Africa. Since registry-based reports underestimate the burden, a systematic collation of road traffic injury and death data is needed to determine the true burden.
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Affiliation(s)
- Davies Adeloye
- Demography and Social Statistics and the e-Health Research Cluster, Covenant University, Canaan land, PMB 1023, Ota, Ogun State, Nigeria
| | - Jacqueline Y Thompson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Moses A Akanbi
- Demography and Social Statistics and the e-Health Research Cluster, Covenant University, Canaan land, PMB 1023, Ota, Ogun State, Nigeria
| | - Dominic Azuh
- Demography and Social Statistics and the e-Health Research Cluster, Covenant University, Canaan land, PMB 1023, Ota, Ogun State, Nigeria
| | - Victoria Samuel
- Department of Computer and Information Sciences and the e-Health Research Cluster, Covenant University, Ota, Nigeria
| | - Nicholas Omoregbe
- Department of Computer and Information Sciences and the e-Health Research Cluster, Covenant University, Ota, Nigeria
| | - Charles K Ayo
- Department of Computer and Information Sciences and the e-Health Research Cluster, Covenant University, Ota, Nigeria
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Ortega-Gonzalez MDC, Monzon-Torres BI. Value and impact of massive blood transfusion protocols in the management of trauma patients. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2011.10872792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- MDC Ortega-Gonzalez
- Department of Anaesthesia, Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg
| | - BI Monzon-Torres
- Department of Trauma Directorate, Division of Surgery, Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg
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Leading by example: the role of international trauma organizations in global trauma initiatives. J Orthop Trauma 2014; 28 Suppl 1:S22-5. [PMID: 24857992 DOI: 10.1097/bot.0000000000000109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
As road traffic fatalities have emerged among the leading global threats to human health and safety, there is an imminent need for the mobilization of large medical organizations and private companies. Collectively, these partnerships can have a tremendous impact on road traffic safety through garnering funding for important initiatives, lobbying governments for policy reforms, and implementing organizational frameworks that foster the transfer of health-care knowledge to optimize trauma care in developing countries. In particular, concerted efforts by major orthopaedic associations can directly enable overwhelmed health-care systems to improve upon their prehospital care, emergency triage systems, trauma care protocols, and rehabilitation programs. The "SIGN" and "Broken Earth" programs serve as prime examples of the powerful impact international trauma organizations can have on global trauma initiatives.
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An assessment of the hospital disease burden and the facilities for the in-hospital care of trauma in KwaZulu-Natal, South Africa. World J Surg 2014; 37:1550-61. [PMID: 23250389 DOI: 10.1007/s00268-012-1889-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Trauma is a significant cause of morbidity and mortality in South Africa. The present study was designed to review the hospital trauma disease burden in light of the facilities available for the care of the injured in KwaZulu-Natal (KZN), South Africa's most populous province. The primary outcomes were the annual hospital burden of trauma in KZN, determined through data extrapolation, and evaluation of the data in light of available hospital facilities within the province of KZN, a developing province. The data were obtained through review of the trauma load in relation to all emergency cases at all levels of hospitals. METHODS Hospital administrators in KZN were requested to submit trauma caseloads for the months of March and September 2010. Caseloads were reviewed to determine the trauma load for the province per category using two extrapolation methods to determine the predicted range of annual incidence of trauma, intentional versus non-intentional trauma ratios and population-related incidence of trauma. The results were GIS mapped to demonstrate variations across districts. Hospital data were obtained from assessments of structure, process, and personnel undertaken prior to a major sporting event. These were compared to the ideal facilities required for accreditation of trauma care facilities of the Trauma Society of South Africa and other established documents. RESULTS Data were obtained from 36 of the 47 public hospitals in KZN that manage acute emergency cases. The predicted annual trauma incidence in KZN ranges from 124,000 to 125,000, or 12.9 per 1,000 population. This would imply a national public hospital trauma load on the order of at least 750,000 cases per year. Most hospitals are required to treat trauma; however, within KZN many hospitals do not have adequate personnel, medical equipment, or structural integrity to be formally accredited as trauma care facilities in terms of existing criteria. CONCLUSIONS There is a significant trauma load that consumes vital emergency center resources. Most hospitals will need extensive upgrading to provide appropriate care for trauma. An inclusive trauma system needs to be formalized and funded, especially in light of the planned National Health Insurance for South Africa.
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Hardcastle TC, Finlayson M, van Heerden M, Johnson B, Samuel C, Muckart DJJ. The Prehospital Burden of Disease due to Trauma in KwaZulu-Natal: The Need for Afrocentric Trauma Systems. World J Surg 2012. [DOI: 10.1007/s00268-012-1852-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gouse H, Thomas KGF, Solms M. Neuropsychological, functional, and behavioral outcome in South African traumatic brain injury litigants. Arch Clin Neuropsychol 2012; 28:38-51. [PMID: 23151324 DOI: 10.1093/arclin/acs100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Few studies address the extent to which, during the process of litigation, individuals with moderate-to-severe traumatic brain injury might malinger in their performance on neuropsychological assessment batteries. This study explored whether financial settlement influenced neuropsychological test performance and activities of daily living in litigants (N = 31) who were tested and interviewed both during litigation and 1 year or more after case settlement. Results showed that neuropsychological test scores did not change from assessment during forensic proceedings to assessment after settlement. Although some improvement was evident in activities of daily living, the gains were small and their clinical significance questionable. We found no evidence that individuals with moderate-to-severe TBI, despite clear potential for secondary gain, malingered or delivered sub-optimal effort during neuropsychological evaluation taking place in the context of litigation.
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Affiliation(s)
- Hetta Gouse
- Department of Psychology, University of Cape Town, Cape Town, South Africa.
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Dimitriou R, Calori GM, Giannoudis PV. Polytrauma – new horizons for management. TRAUMA-ENGLAND 2012. [DOI: 10.1177/1460408611418766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The management of polytrauma has evolved considerably in the last century. Advances have been made in all disciplines involved in trauma care from pre-hospital care and resuscitation protocols to diagnostics, surgical techniques, administration of novel pharmacological agents and late reconstruction procedures. Improved understanding of the altered physiology and the induced response at the molecular level offers the potential for novel management strategies and prevention of post-traumatic complications.
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Affiliation(s)
- Rozalia Dimitriou
- Academic Department of Trauma and Orthopaedic Surgery, Leeds General Infirmary, Leeds, UK
| | - Giorgio M Calori
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Milan, Milan, Italy
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds General Infirmary, Leeds, UK
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Schuurman N, Cinnamon J, Matzopoulos R, Fawcett V, Nicol A, Hameed SM. Collecting injury surveillance data in low- and middle-income countries: the Cape Town Trauma Registry pilot. Glob Public Health 2011; 6:874-89. [PMID: 20938854 DOI: 10.1080/17441692.2010.516268] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Injury is a major public health issue, responsible for 5 million deaths each year, equivalent to the total mortality caused by HIV, malaria and tuberculosis combined. The World Health Organisation estimates that of the total worldwide deaths due to injury, more than 90% occur in low- and middle-income countries (LMIC). Despite the burden of injury sustained by LMIC, there are few continuing injury surveillance systems for collection and analysis of injury data. We describe a hospital-based trauma surveillance instrument for collection of a minimum data-set for calculating common injury scoring metrics including the Abbreviated Injury Scale and the Injury Severity Score. The Cape Town Trauma Registry (CTTR) is designed for injury surveillance in low-resource settings. A pilot at Groote Schuur Hospital in Cape Town was conducted for one month to demonstrate the feasibility of systematic data collection and analysis, and to explore challenges of implementing a trauma registry in a LMIC. Key characteristics of the CTTR include: ability to calculate injury severity, key minimal data elements, expansion to include quality indicators and minimal drain on human resources based on few fields. The CTTR provides a strategy to describe the distribution and consequences of injury in a high trauma volume, low-resource environment.
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Affiliation(s)
- Nadine Schuurman
- Department of Geography, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.
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Georgoff P, Meghan S, Mirza K, Stein SC. Geographic Variation in Outcomes from Severe Traumatic Brain Injury. World Neurosurg 2010; 74:331-45. [DOI: 10.1016/j.wneu.2010.03.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 03/13/2010] [Indexed: 01/01/2023]
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Gross T, Huettl T, Audigé L, Frey C, Monesi M, Seibert FJ, Messmer P. How comparable is so-called standard fracture fixation with an identical implant? A prospective experience with the antegrade femoral nail in South Africa and Europe. Injury 2010; 41:388-95. [PMID: 19900673 DOI: 10.1016/j.injury.2009.10.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 07/01/2009] [Accepted: 10/12/2009] [Indexed: 02/02/2023]
Abstract
BACKGROUND The utilisation and consequences of standardised operative procedures may importantly differ between different healthcare systems. This is the first investigation comparing the treatment and outcome of femoral shaft fractures stabilised with an identical implant between trauma centres in 2 continents (Europe, EU and South Africa, SA). METHODS Following standardised introduction of the technique, the prospective, observational multicentre study enrolled 175 patients who underwent intramedullary fracture fixation using the antegrade femoral nail (AFN) for femoral shaft fractures. Eleven EU hospitals recruited 86 patients and 1 SA centre 89 patients in the study period. Comparison of epidemiologic data, operative characteristics as well as subjective (e.g., pain, SF-36) and objective (e.g., X-ray, range of motion [ROM]) 3-month and 1-year outcomes were performed (p<0.05). RESULTS Compared to EU centres, several significant differences were observed in SA: (1) on average, patients operated on were younger, had less concomitant diseases and had more severe open fractures; (2) operative stabilisation was more often undertaken by young, unsupervised residents, with shorter operating and intraoperative fluoroscopy times; (3) mean hospital stay was shorter, with less recorded complications, but a higher loss to follow-up rate. Non- or malunion rates and subjective outcomes were similar for both groups, with the physical component of the SF-36 at the 1-year follow-up not fully restoring to baseline values. CONCLUSIONS Our investigation demonstrates the importance of several major differences between 2 different regions of the world in the treatment of femoral shaft fractures, despite involving only high level trauma centres and using an identical implant. The intercontinental comparison of results from clinical studies should be interpreted very carefully considering the heterogeneity of populations and clinical settings.
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Affiliation(s)
- Thomas Gross
- Computer Assisted Radiology & Surgery, University Hospital Basel, Realpstrasse 54, CH-4057 Basel, Switzerland.
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Placing emergency care on the global agenda. Ann Emerg Med 2010; 56:142-9. [PMID: 20138398 DOI: 10.1016/j.annemergmed.2010.01.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 11/26/2009] [Accepted: 01/11/2010] [Indexed: 11/20/2022]
Abstract
Emergency care serves a key function within health care systems by providing an entry point to health care and by decreasing morbidity and mortality. Although primarily focused on evaluation and treatment for acute conditions, emergency care also serves as an important locus of provision for preventive care with regard to injuries and disease progression. Despite its important and increasing role, however, emergency care has been frequently overlooked in the discussion of health systems and delivery platforms, particularly in developing countries. Little research has been done in lower- and middle-income countries on the burden of disease reduction attributable to emergency care, whether through injury treatment and prevention, urgent and emergency treatment of acute conditions, or emergency treatment of complications from chronic conditions. There is a critical need for research documenting the role of emergency care services in reducing the global burden of disease. In addition to applying existing methodologies toward this aim, new methodologies should be developed to determine the cost-effectiveness of these interventions and how to effectively cover the costs of and demands for emergency care needs. These analyses could be used to emphasize the public health and clinical importance of emergency care within health systems as policymakers determine health and budgeting priorities in resource-limited settings.
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Evans C, Howes D, Pickett W, Dagnone L. Audit filters for improving processes of care and clinical outcomes in trauma systems. Cochrane Database Syst Rev 2009; 2009:CD007590. [PMID: 19821431 PMCID: PMC7197044 DOI: 10.1002/14651858.cd007590.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Traumatic injuries represent a considerable public health burden with significant personal and societal costs. The care of the severely injured patient in a trauma system progresses along a continuum that includes numerous interventions being provided by a multidisciplinary group of healthcare personnel. Despite the recent emphasis on quality of care in medicine, there has been little research to direct trauma clinicians and administrators on how optimally to monitor and improve upon the quality of care delivered within a trauma system. Audit filters are one mechanism for improving quality of care and are defined as specific clinical processes or outcomes of care that, when they occur, represent unfavorable deviations from an established norm and which prompt review and feedback. Although audit filters are widely utilized for performance improvement in trauma systems they have not been subjected to systematic review of their effectiveness. OBJECTIVES To determine the effectiveness of using audit filters for improving processes of care and clinical outcomes in trauma systems. SEARCH STRATEGY Our search strategy included an electronic search of the Cochrane Injuries Group Specialized Register, the Cochrane EPOC Group Specialized Register, CENTRAL (The Cochrane Library 2008, Issue 4), MEDLINE, PubMed, EMBASE, CINAHL, and ISI Web of Science: (SCI-EXPANDED and CPCI-S). We handsearched the Journal of Trauma, Injury, Annals of Emergency Medicine, Academic Emergency Medicine, and Injury Prevention. We searched two clinical trial registries: 1) The World Health Organization International Clinical Trials Registry Platform and, 2) Clinical Trials.gov. We also contacted content experts for further articles. The most recent electronic search was completed in December 2008 and the handsearch was completed up to February 2009. SELECTION CRITERIA We searched for randomized controlled trials, controlled clinical trials, controlled before-and-after studies, and interrupted time series studies that used audit filters as an intervention for improving processes of care, morbidity, or mortality for severely injured patients. DATA COLLECTION AND ANALYSIS Two authors independently screened the search results, applied inclusion criteria, and extracted data. MAIN RESULTS There were no studies identified that met the inclusion criteria for this review. AUTHORS' CONCLUSIONS We were unable to identify any studies of sufficient methodological quality to draw conclusions regarding the effectiveness of audit filters as a performance improvement intervention in trauma systems. Future research using rigorous study designs should focus on the relative effectiveness of audit filters in comparison to alternative quality improvement strategies at improving processes of care, functional outcomes, and mortality for injured patients.
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Affiliation(s)
- Christopher Evans
- Queen's UniversityDepartment of Emergency MedicineEmpire 3, Kingston General Hospital, 76 Stuart St.KingstonOntarioCanadaK7L 2V7
| | - Daniel Howes
- Queen's UniversityDepartment of Emergency MedicineEmpire 3, Kingston General Hospital, 76 Stuart St.KingstonOntarioCanadaK7L 2V7
| | - William Pickett
- Queen's UniversityDepartment of Community Health and EpidemiologyAngada 3, Kingston General Hospital, 76 Stuart St.KingstonOntarioCanadaK7L 2V7
| | - Luigi Dagnone
- Queen's UniversityDepartment of Emergency MedicineEmpire 3, Kingston General Hospital, 76 Stuart St.KingstonOntarioCanadaK7L 2V7
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Evans C, Howes D, Pickett W, Dagnone L. Audit filters for improving processes of care in trauma systems. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2009. [DOI: 10.1002/14651858.cd007590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Trauma systems have been shown to provide the best trauma care for injured patients. A trauma system developed for Indigenous people should take into account many factors including geographical remoteness and cultural diversity. Indigenous people suffer from a significant intentional and non-intentional burden of injury, often greater than non-Indigenous populations, and a public health approach in dealing with trauma can be adopted. This includes transport issues, prevention and control of intentional violence, cultural sensitization of health providers, community emergency responses, community rehabilitation and improving resilience. The ultimate aim is to decrease the trauma burden through a trauma system with which indigenous people can fully identify.
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Affiliation(s)
- Frank Plani
- Trauma Surgery, Royal Darwin Hospital, Darwin, NT, Australia.
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Ens CDL, Gwyther L, Chochinov HM, Moses S, Jackson C, Harding R. Access to hospice care: multi-professional specialist perspectives in South Africa. Int J Palliat Nurs 2008; 14:169-74. [PMID: 18681344 DOI: 10.12968/ijpn.2008.14.4.29227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Research addressing the nature of hospice referrals focuses primarily on the effect of late referral and the majority of studies are based in North America. Using health care professionals as key informants, the goal was to describe the hospice referral system used in the Western Cape Province of South Africa from the perspective of nursing sisters, medical doctors, and social workers. Semi-structured interviews with 29 such individuals were conducted at 15 rural, urban and peri-urban sites, exploring their perceptions towards, and experiences with, patient referral to hospice programmes. Interpretative descriptive design allowed for a comprehensive description of the referral process as well as an extension of the data based on the perspectives of the three stakeholder groups. The majority of hospice referrals originated from either community-based clinics or state hospitals. Three main themes, centring around the process of referring, (lack of) standardization, and (lack of) knowledge, arose from the analysis of the transcripts. An interpretation of the themes led to the development of a model describing the ideal hospice referral system for South Africa.
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Affiliation(s)
- Carla D L Ens
- Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
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Abstract
Patients with major trauma present a challenge, often using large quantities of banked blood both at the time of injury and during their hospital stay. Blood transfusion is not without risk and is associated with high costs; it is immunosuppressive, rendering patients more susceptible to infection. In the western world, banked blood is fully screened and relatively safe; the same is not true in parts of the developing world, where high rates of HIV carriage make blood transfusion a risky undertaking. Additionally, blood transfusion as a vector for transmission of illnesses such as prion disease is a distinct possibility, for both the developed and developing world alike. The introduction of artificial blood substitutes would ameliorate some risk and also remove the cost of extensive blood testing. For trauma outside hospital, blood substitutes could compete directly with fluid resuscitation as donated blood is not usually available. Patients with prolonged transport times would appear to be the most obvious beneficiaries and volume expansion, along with improvement in oxygen-carrying capacity would be the ultimate goal. All clinicians confronted with the need for transfusion of homologous blood would welcome the development of a safe and reliable alternative to red blood cells in order to ensure oxygen transport to the tissues. However, even though research on red cell substitutes started more than 100 years ago, even now none of the heavily investigated compounds based on haemoglobin or perfluorocarbons has been released in Europe or the USA for routine clinical use.
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Affiliation(s)
- Peter J Shirley
- Intensive Care and Anaesthesia, Royal London Hospital, Whitechapel, London, E1 1BB, UK,
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Brysiewicz P, Bruce J. Emergency nursing in South Africa. Int Emerg Nurs 2008; 16:127-31. [PMID: 18519064 DOI: 10.1016/j.ienj.2008.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 12/23/2007] [Accepted: 01/06/2008] [Indexed: 11/25/2022]
Abstract
The role of the emergency nurse in South Africa is a challenging one due to a variety of reasons. This article describes the healthcare system of South Africa with particular attention to the emergency medical system as well as the reason why most emergency clients present to the emergency departments. The actual experience of working as an emergency nurse in South Africa is highlighted.
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Affiliation(s)
- Petra Brysiewicz
- School of Nursing, University of KwaZulu-Natal, Durban 4041, South Africa.
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McDonald EM, MacKenzie EJ, Teitelbaum SD, Carlini AR, Teter H, Valenziano CP. Injury prevention activities in U.S. trauma centres: are we doing enough? Injury 2007; 38:538-47. [PMID: 17313948 DOI: 10.1016/j.injury.2006.11.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Revised: 11/29/2006] [Accepted: 11/30/2006] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite the requirement for and endorsement of injury prevention efforts among U.S. trauma centres, little is known about the breadth and depth of their current activities. METHODS A survey was sent to eligible institutions in the National Inventory of Trauma Centres to better describe how level I and II centres are fulfilling their injury prevention requirement, to identify the barriers to conducting prevention activities, and to determine trauma centre personnel's interest in enhancing their prevention role. RESULTS A total of 268 trauma centres (60%) completed the survey. Only 19% reported having an injury prevention director/coordinator but more than half of centres reported participating in 9 of 11 injury prevention activities, including participating in community events (97%), sending speakers to local schools (89%), and preparing or distributing educational materials (84%). Lack of time (68%), dedicated funding (68%), and an injury prevention specialist (45%) were the most frequently cited barriers to conducting injury prevention activities. Injury prevention collaborations were reported with safety groups (24%) and with emergency medical services, fire and police (23%). Trauma centres partnered less frequently with academic institutions (11%) and local or state health departments (16%). Topics and formats for injury prevention training as well as training barriers were also explored. CONCLUSIONS Improved partnerships and linkages with established agencies and organisations at the local and state levels could assist trauma centres in leveraging their more limited resources and expertise to offer state-of-the-art injury prevention programs and policies. As low- and middle-income countries are developing or strengthening their trauma systems, they should be encouraged to view injury prevention as a fundamental responsibility.
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Affiliation(s)
- Eileen M McDonald
- Johns Hopkins Bloomberg School of Public Health, Center for Injury Research and Policy, Baltimore, MD 21205, USA.
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Hofman K, Primack A, Keusch G, Hrynkow S. Addressing the growing burden of trauma and injury in low- and middle-income countries. Am J Public Health 2005; 95:13-7. [PMID: 15623852 PMCID: PMC1449844 DOI: 10.2105/ajph.2004.039354] [Citation(s) in RCA: 231] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Low- and middle-income countries suffer disproportionately from reduced life expectancy and quality of life. Injuries are overlooked as contributors to global inequities in health, yet the long-term disabilities they frequently produce represent a significant burden. The Fogarty International Center of the National Institutes of Health convened a panel of experts in trauma and injury from the United States and low- and middle-income nations to identify research gaps in this area and opportunities to create new knowledge. Panel members identified sustainable programs of research established through stable linkages between institutions in high-income nations and those in low- and middle-income nations as a priority. The resulting benefits of addressing the growing burden of trauma and injury to communities in resource-constrained settings around the world would be substantial.
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Affiliation(s)
- Karen Hofman
- Division of Advanced Studies and Policy Analysis, Fogarty International Center, National Institutes of Health, 16 Center Drive, Room 202, Bethesda, MD 20892-6705, USA.
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MacFarlane C, van Loggerenberg C, Kloeck W. International EMS systems in South Africa: past, present, and future. Resuscitation 2005; 64:145-8. [PMID: 15680521 DOI: 10.1016/j.resuscitation.2004.11.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Accepted: 11/02/2004] [Indexed: 12/01/2022]
Abstract
Emergency medical services (EMS) in South Africa have developed rapidly over the last 20 years. However, there is inequitable distribution of services, with many rural areas being poorly resourced. This is partly as a result of the historical inequalities prevalent in the South African society of the past; efforts are being made to address this. EMS training is provided at basic, intermediate and advanced levels. The advanced level of training is comparable with the best in the world. Emergency care practitioners are registered with the Health Professions Council of South Africa and are thereby subject to the regulations, scope of practice and disciplinary structures of the council. Response times vary from 15 min in sophisticated urban systems to 40 min or longer in some rural services. Emergency departments (ED) are very busy, usually overloaded with patients, often poorly resourced and are similar to "Casualty Departments" that existed in the UK in the past. Facilities, staff and equipment are variable, and until recently there has been no formal career structure for emergency doctors. The introduction of emergency medicine as a new full speciality in 2004 will transform emergency care in Southern Africa, and appropriate training programmes are already being developed, together with progressive upgrading of emergency departments. EMS personnel face a vast spectrum of clinical cases, particularly all forms of trauma. Recent improvements in organisation, education and resources, coupled with better distribution of services, upgraded emergency departments and the development of emergency medicine as a speciality, should provide a significant boost for emergency care for the community.
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Affiliation(s)
- Campbell MacFarlane
- Netcare Foundation Chair of Emergency Medicine, University of the Witwatersrand, Johannesburg, South Africa
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