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Gyedu A, Stewart BT, Nakua E, Donkor P. Standardized trauma intake form with clinical decision support prompts improves care and reduces mortality for seriously injured patients in non-tertiary hospitals in Ghana: stepped-wedge cluster randomized trial. Br J Surg 2023; 110:1473-1481. [PMID: 37612450 PMCID: PMC10564400 DOI: 10.1093/bjs/znad253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/22/2023] [Accepted: 07/23/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND The WHO Trauma Care Checklist improved key performance indicators (KPIs) of trauma care at tertiary hospitals. A standardized trauma intake form (TIF) with real-time clinical decision support prompts was developed by adapting the WHO Trauma Care Checklist for use in smaller low- and middle-income country hospitals, where care is delivered by non-specialized providers and without trauma teams. This study aimed to determine the effectiveness of the TIF for improving KPIs in initial trauma care and reducing mortality at non-tertiary hospitals in Ghana. METHODS A stepped-wedge cluster randomized trial was conducted by stationing research assistants at emergency units of eight non-tertiary hospitals for 17.5 months to observe management of injured patients before and after introduction of the TIF. Differences in performance of KPIs in trauma care (primary outcomes) and mortality (secondary outcome) were estimated using generalized linear mixed regression models. RESULTS Management of 4077 injured patients was observed (2067 before TIF introduction, 2010 after). There was improvement in 14 of 16 primary survey and initial care KPIs after TIF introduction. Airway assessment increased from 72.9 to 98.4 per cent (adjusted OR 25.27, 95 per cent c.i. 2.47 to 258.94; P = 0.006) and breathing assessment from 62.1 to 96.8 per cent (adjusted OR 38.38, 4.84 to 304.69; P = 0.001). Documentation of important clinical data improved from 52.4 to 76.7 per cent (adjusted OR 2.14, 1.17 to 3.89; P = 0.013). The mortality rate decreased from 17.7 to 12.1 per cent among 302 patients (186 before, 116 after) with impaired physiology on arrival (hypotension or decreased level of consciousness) (adjusted OR 0.10, 0.02 to 0.56; P = 0.009). CONCLUSION The TIF improved overall initial trauma care and reduced mortality for more seriously injured patients. REGISTRATION NUMBER NCT04547192 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Surgery Unit, University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Emmanuel Nakua
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Peter Donkor
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Alao DO, Cevik AA, Abu-Zidan FM. Trauma deaths of hospitalized patients in Abu Dhabi Emirate: a retrospective descriptive study. World J Emerg Surg 2023; 18:31. [PMID: 37118764 PMCID: PMC10148441 DOI: 10.1186/s13017-023-00501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023] Open
Abstract
AIM To study the epidemiology and pattern of trauma-related deaths of hospitalized patients in Abu Dhabi Emirate, United Arab Emirates, in order to improve trauma management and injury prevention. METHODS The Abu Dhabi Trauma Registry prospectively collects data of all hospitalized trauma patients from seven major trauma centres in Abu Dhabi Emirate. We studied all patients who died on arrival or after admission to these hospitals from January 2014 to December 2019. RESULTS There were 453 deaths constituting 13.5% of all trauma deaths in the Abu Dhabi Emirate. The median (IQR) age of the patients was 33 (25-45) years, and 82% were males. 85% of the deaths occurred in the emergency department (ED) and the intensive care unit (ICU). Motor vehicle collision (63.8%) was the leading cause of death. 45.5% of the patients had head injury. Two of the seven hospitals admitted around 50% of all patients but accounted for only 25.8% of the total deaths (p < 0.001). Those who died in the ward (7%) were significantly older, median (IQR) age: of 65.5 (31.75-82.25) years, (p < 0.001), 34.4% of them were females (p = 0.09). The median (IQR) GCS of those who died in the ward was 15 (5.75-15) compared with 3 (3-3) for those who died in ED and ICU (P < 0.001). CONCLUSIONS Death from trauma predominantly affects young males with motor traffic collision as the leading cause. Over 85% of in-hospital deaths occur in the ICU and ED, mainly from head injuries. Injury prevention of traffic collisions through enforcement of law and improved hospital care in the ED and ICU will reduce trauma death.
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Affiliation(s)
- David O Alao
- Department of Internal Medicine, Section of Emergency Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
- The Department of Emergency Medicine, Tawam Hospital, Al-Ain, United Arab Emirates.
| | - Arif Alper Cevik
- Department of Internal Medicine, Section of Emergency Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
- The Department of Emergency Medicine, Tawam Hospital, Al-Ain, United Arab Emirates
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
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Abu-Zidan FM, Eid HO, Alao DO, Elbiss H. The changing epidemiology of trauma in child-bearing age women. World J Emerg Surg 2023; 18:25. [PMID: 36991466 DOI: 10.1186/s13017-023-00495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND In the last two decades, there have been major improvements in the trauma system in the United Arab Emirates (UAE). We aimed to study the changes in the incidence, type, severity, and outcome of trauma of hospitalized child-bearing age women in Al-Ain City, UAE, during that time. METHODS Data from two separate trauma registries of Al-Ain Hospital, which were prospectively collected from March 2003 to March 2006 and January 2014 to December 2017, were analyzed retrospectively. All women aged 15-49 years were studied. The two periods were compared. RESULTS Trauma incidence of hospitalized child-bearing age women was reduced by 47% during the second period. There were no significant differences in the mechanism of injury between the two periods. Road traffic collision was the main cause of injury (44% and 42%, respectively) followed by fall down (26.1% and 30.8%, respectively). The location of injury was significantly different (p = 0.018), with a strong trend of more home injuries in the second period (52.8% compared with 44%, p = 0.06). There was a strong statistical trend of mild traumatic brain injury (GCS 13-15) in the second period (p = 0.067, Fisher's Exact test). Those who had normal GCS of 15 were significantly higher in the second period compared with those in the first period (95.3% compared with 86.4%, p < 0.001, Fisher's Exact test) despite having more anatomical injury severity of the head (AIS 2 (1-5) compared with 1 (1-5), p = 0.025). The NISS was significantly higher in the second period (median (range) NISS 5 (1-45) compared with 4 (1-75), p = 0.02). Despite that, mortality was the same (1.6% compared with 1.7%, p = 0.99) while the length of hospital stay was significantly less (mean (SD) 5.6 (6.3) days compared with 10.6 (13.6) days, p < 0.0001). CONCLUSIONS The incidence of trauma in hospitalized child-bearing-age women was reduced by 47% over the last 15 years. Road traffic collisions and falls are the leading cause of injury in our setting. Home injuries increased over time. The mortality remained stable despite the increased severity of injured patients. More injury prevention efforts should target home injuries.
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Affiliation(s)
- Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
| | - Hani O Eid
- Rescue and Air Ambulance, Abu Dhabi Police Aviation, Abu Dhabi, United Arab Emirates
| | - David O Alao
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
- Emergency Department,, Tawam Hospital, Al-Ain, United Arab Emirates
| | - Hassan Elbiss
- The Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
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Abu-Zidan FM, Abdel-Kader S, Mousa H, Aiyan AA, Baguneid MS, Jawas A. Camel-related major vascular injuries: A 20-years' experience. Injury 2023; 54:138-144. [PMID: 35934569 DOI: 10.1016/j.injury.2022.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/15/2022] [Accepted: 07/27/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Majority of human animal-related injuries in the United Arab Emirates are caused by camels. These may involve major vessels and can be life-threatening. We aimed to study the biomechanism, injured regions, management, and outcome of major camel-related human vascular injuries. METHODS We retrospectively studied all patients who were admitted to Al-Ain Hospital with camel-related major vascular injury during January 2001 to January 2020. Studied variables included demography, mechanism of injury, injured structures, clinical presentation, vital signs on arrival, associated injuries, surgical management, ICU stay, length of hospital stay, complications, and outcome. RESULTS Seven patients were studied; all were males having a median age of 26 years. Five out of six bite injuries (83%) occured during the camel rutting season. The injuries were severe and life-threatening. A camel bite causes four small elliptical wounds of the canine teeth which resembles two stab wounds of 8 cm long, penetrating deeply and injuring major vessels. Four involved the carotid artery, one the femoral artery and vein, one the external iliac vein and one the aorta which was due to a fall from a camel. Although the standard of surgical care was high, the outcome was poor. Six patients were admitted to the ICU for a median of 5 days. One patient died, one became vegetative, and one had arm paralysis. CONCLUSIONS Major camel-related vascular injuries have a poor clinical outcome. This is related to the biomechanism of injury which combines penetrating, crushing and blunt trauma. Neck wounds of camel bites can be closed primarily after debridement.
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Affiliation(s)
- Fikri M Abu-Zidan
- Department of Surgery, CMHS, United Arab Emirates University, Al-Ain, United Arab Emirates.
| | - Saleh Abdel-Kader
- Department of Surgery, Al-Ain Hospital, Al-Ain, United Arab Emirates
| | - Hussam Mousa
- Department of Surgery, CMHS, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Ahmad Al Aiyan
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, United Arab Emirates University, Al-Ain, United Arab Emirates
| | | | - Ali Jawas
- Department of Surgery, CMHS, United Arab Emirates University, Al-Ain, United Arab Emirates
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Cevik AA, Alao DO, Alyafei E, Abu-Zidan F. Those who speak survive: the value of the verbal component of GCS in trauma. Eur J Trauma Emerg Surg 2022; 49:837-842. [PMID: 36335514 PMCID: PMC10175383 DOI: 10.1007/s00068-022-02153-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/21/2022] [Indexed: 11/08/2022]
Abstract
Abstract
Aim
To evaluate the value of the individual components of GCS in predicting the survival of trauma patients in the Emergency Department.
Methods
Trauma patients who were admitted for more than 24 h or died after arrival at Al-Ain Hospital from January 2014 to December 2017 were studied. Children < 16 years, elderly > 80 years, patients with facial injuries, those intubated in the ER, and those with missing primary outcomes were excluded. Demography, vital signs, Glasgow Coma Scale (GCS), GCS components, Injury Severity Score (ISS), head AIS, and death were compared between those who died and those who survived. Factors with a p value of < 0.1 were entered into a backward likelihood logistic regression model to define factors that predict death.
Results
A total of 2548 patients were studied, out of whom 11 (0.4%) died. The verbal component of GCS (p < 0.001) and the ISS (p = 0.047) were the only significant predictors for death in the logistic regression model. The AUC (95% CI) of the GCS-VR was 0.763 (0.58–0.95), p = 0.003. The best point of GCS-VR that predicted survival was 5, having a sensitivity of 97%, a specificity of 54.5%, positive predictive value of 99. 8%, negative predictive value of 7.3%, and likelihood ratio of 2.13.
Conclusion
In general trauma patients, acute trauma care professionals can use GCS-VR to predict survival when clinical condition permits instead of the total GCS score or ISS.
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Yasin YJ, Eid HO, Alao DO, Grivna M, Abu-Zidan FM. Reduction of motorcycle-related deaths over 15 years in a developing country. World J Emerg Surg 2022; 17:21. [PMID: 35488275 PMCID: PMC9051744 DOI: 10.1186/s13017-022-00426-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There have been major improvements in the trauma system and injury prevention in Al-Ain City. We aimed to study the impact of these changes on the incidence, pattern, injury severity, and outcome of hospitalized motorcycle-related injured patients in Al-Ain City, United Arab Emirates. METHODS This is a retrospective analysis of two separate periods of prospectively collected data which were retrieved from Al-Ain Hospital Trauma Registry (March 2003 to March 2006 compared with January 2014 to December 2017). All motorcycle-injured patients who were admitted to Al-Ain Hospital for more than 24 h or died in the Emergency Department or after hospitalization were studied. RESULTS The incidence of motorcycle injuries dropped by 37.1% over the studied period. The location of injury was significantly different between the two periods (p = 0.02, Fisher's exact test), with fewer injuries occurring at streets/highways in the second period (69.1% compared with 85.3%). The anatomical injury severity of the head significantly increased over time (p = 0.03), while GCS on arrival significantly improved (p < 0.0001), indicating improvements in both prehospital and in-hospital trauma care. The mortality of the patients significantly decreased (0% compared with 6%, p = 0.002, Fisher's exact test). CONCLUSIONS The incidence of motorcycle injuries in our city dropped by almost 40% over the last 15 years. There was a significant reduction in the mortality of hospitalized motorcycle-injured patients despite increased anatomical severity of the head injuries. This is attributed to improvements in the trauma care system, including injury prevention, and both prehospital and in-hospital trauma care.
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Affiliation(s)
- Yasin J Yasin
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.,Department of Environmental Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Hani O Eid
- Rescue and Air Ambulance, Abu Dhabi Police Aviation, Abu Dhabi, United Arab Emirates
| | - David O Alao
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.,Emergency Department, Al-Ain Hospital, Al-Ain, United Arab Emirates
| | - Michal Grivna
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.,Department of Public Health and Preventive Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
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Alao DO, Cevik AA, Yasin YJ, Jaiganesh T, Abu-Zidan F. The COVID-19 pandemic reduced the trauma incidence and modified its pattern in Al-Ain City, United Arab Emirates. Eur J Trauma Emerg Surg 2022; 48:3011-3016. [PMID: 35178582 PMCID: PMC8853936 DOI: 10.1007/s00068-022-01897-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/30/2022] [Indexed: 11/03/2022]
Abstract
AIM We aimed to study the impact of the COVID-19 pandemic on the pattern of injury and outcome of hospitalized trauma patients in Al-Ain City, United Arab Emirates, to use this information in the preparedness for future pandemics. METHODS We retrospectively compared the trauma registry data of all hospitalised trauma patients, who were treated at the two main trauma centres in Al-Ain City (Al-Ain Hospital and Tawam Hospital); those who were treated over 1 year before the pandemic (n = 2002) and those who were treated at the first year of the COVID-19 pandemic (n = 1468). RESULTS There was a 26.7% reduction in the overall incidence of trauma admissions in the COVID-19 pandemic period. The mechanism of injury significantly differed between the two periods (p < 0.0001, Fisher's exact test). There was an absolute increase in the number of injuries, due to machinery and falling objects during the pandemic (39.7% and 54.1% respectively, p < 0.001). In contrast, road traffic collisions and falls were reduced by 33.5% and 31.3%, respectively. Location significantly differed between the two periods (p < 0.0001, Fisher's exact test). There was an absolute increase of 18.4% in workplace injuries and a reduction of 39.3% in home injuries over the study period. In addition, we observed relatively more workplace injuries and fewer home injuries during the pandemic (11.3% and 42.8% compared with 7.1% and 52.4%, respectively). Mortality was similar between the two periods (1.8% compared with 1.2%, p = 0.16, Fisher's exact test). CONCLUSIONS The COVID-19 pandemic has modified the trauma risk exposure in our population. It reduced trauma hospital admissions by around 27%. Work-related injuries, including falling objects and machinery injuries, were relatively higher during the pandemic. Prevention of work-related injuries should be an important component of preparedness for future pandemics.
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Affiliation(s)
- David Olukolade Alao
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates. .,Emergency Department, Tawam Hospital, Al-Ain, United Arab Emirates.
| | - Arif Alper Cevik
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.,Emergency Department, Tawam Hospital, Al-Ain, United Arab Emirates
| | - Yasin Jemal Yasin
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
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Wang CJ, Yang TH, Hung KS, Wu CH, Yen ST, Yen YT, Shan YS. Regular feedback on inter-hospital transfer improved the clinical outcome and survival in patients with multiple trauma: a retrospective cohort study. BMC Emerg Med 2021; 21:150. [PMID: 34861821 PMCID: PMC8641219 DOI: 10.1186/s12873-021-00543-y] [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: 09/07/2020] [Accepted: 11/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background Undertriage of major trauma patients is unavoidable, especially in the trauma system of rural areas. Timely stabilization and transfer of critical trauma patients remains a great challenge for hospitals with limited resources. No definitive measure has been proven to improve the outcomes of patients transferred with major trauma. The current study hypothesized that regular feedback on inter-hospital transfer of patients with major trauma can improve quality of care and clinical outcomes. Method This retrospective cohort study retrieved data of transferred major trauma patients with an injury severity score (ISS) > 15 between January 2010 and December 2018 from the trauma registry databank of a tertiary medical center. Regular monthly feedback on inter-hospital transfers was initiated in 2014. The patients were divided into a without-feedback group and a with-feedback group. Demographic data, management before transfer, and outcomes after transfer were collected and analyzed. Results A total of 178 patients were included: 69 patients in the without-feedback group and 109 in the with-feedback group. The with-feedback group had a higher ISS (25 vs. 27; p = 0.049), more patients requiring massive transfusion (14.49% vs. 29.36%, p = 0.036), and less patients with Glasgow Coma Scale ≤8 (30.43% vs. 23.85%, p < 0.001). After adjusting for confounding factors, the with-feedback group was associated with a higher rate of blood transfusion before transfer (adjusted odds ratio [aOR]: 2.75; 95% confidence interval [CI]: 1.01–7.52; p = 0.049), shorter time span before blood transfusion (− 31.80 ± 15.14; p = 0.038), and marginally decreased mortality risk (aOR: 0.43; 95% CI: 0.17–1.09; p = 0.076). Conclusion This study revealed that regular feedback on inter-hospital transfer improved the quality of blood transfusion.
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Affiliation(s)
- Chih-Jung Wang
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, Taiwan
| | - Tsung-Han Yang
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, Taiwan
| | - Kuo-Shu Hung
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, Taiwan
| | - Chun-Hsien Wu
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shu-Ting Yen
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, Taiwan
| | - Yi-Ting Yen
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, Taiwan.
| | - Yan-Shen Shan
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Yasin YJ, Alao DO, Grivna M, Abu-Zidan FM. Impact of the COVID-19 Pandemic on road traffic collision injury patterns and severity in Al-Ain City, United Arab Emirates. World J Emerg Surg 2021; 16:57. [PMID: 34798873 PMCID: PMC8602977 DOI: 10.1186/s13017-021-00401-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/02/2021] [Indexed: 11/14/2022] Open
Abstract
Background The COVID-19 Pandemic lockdowns restricted human and traffic mobility impacting the patterns and severity of road traffic collisions (RTCs). We aimed to study the effects of the COVID-19 Pandemic on incidence, patterns, severity of the injury, and outcomes of hospitalized RTCs trauma patients in Al-Ain City, United Arab Emirates. Methods We compared the data of two cohorts of patients which were collected over two periods; the Pandemic period (28 March 2020 to 27 March 2021) and the pre-pandemic period (28 March 2019 to 27 March 2020). All RTCs trauma patients who were hospitalized in the two major trauma centers (Al-Ain and Tawam Hospitals) of Al-Ain City were studied. Results Overall, the incidence of hospitalized RTC trauma patients significantly reduced by 33.5% during the Pandemic compared with the pre-pandemic period. The mechanism of injury was significantly different between the two periods (p < 0.0001, Fisher’s Exact test). MVCs were less during the Pandemic (60.5% compared with 72%), while motorcycle injuries were more (23.3% compared with 11.2%). The mortality of hospitalized RTC patients was significantly higher during the Pandemic (4.4% compared with 2.3%, p = 0.045, Fisher’s Exact test). Logistic regression showed that the significant factors that predicted mortality were the low GCS (p < 0.0001), admission to the ICU (p < 0.0001), and the high ISS (p = 0.045). COVID-19 Pandemic had a very strong trend (p = 0.058) for increased mortality. Conclusions Our study has shown that the numbers of hospitalized RTC trauma patients reduced by 33.5% during the COVID-19 Pandemic compared with the pre-pandemic period in our setting. This was attributed to the reduced motor vehicle, pedestrian and bicycle injuries while motorcycle injuries increased. Mortality was significantly higher during the Pandemic, which was attributed to increased ISS and reduced GCS.
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Affiliation(s)
- Yasin J Yasin
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.,Department of Environmental Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - David O Alao
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.,Emergency Department, Tawam Hospital, Al-Ain, United Arab Emirates
| | - Michal Grivna
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.,Department of Public Health and Preventive Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
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Grivna M, AlKatheeri A, AlAhbabi M, AlKaabi S, Alyafei M, Abu-Zidan FM. Risks for bicycle-related injuries in Al Ain city, United Arab Emirates: An observational study. Medicine (Baltimore) 2021; 100:e27639. [PMID: 34871233 PMCID: PMC8568463 DOI: 10.1097/md.0000000000027639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/12/2021] [Indexed: 01/05/2023] Open
Abstract
Traffic-related injuries are a serious health problem. Traffic safety is a priority reflected in the United Nations Sustainable Development Goals. Data on current hazards for bicycle-related injuries from the United Arab Emirates are lacking. The aim of our observational study was to assess the behavior of bicyclists on the roads in Al Ain City, United Arab Emirates and compare our current results with a previous study from 2004.We adapted and tested a structured data collection form. Different sectors of Al Ain were randomly selected to cover the whole city during different times. Bicyclists were observed without direct contact.Out of 1129 bicyclists, 97.6% were males and 13.2% children. 39.4% were cycling on main roads with high-density traffic, 33.1% were cycling against the traffic, 39.3% were cycling at night, and 96.8% of them were not using lights. Only 2.1% of the bicyclists used helmets. A higher proportion of female than male cyclists used helmets (25.9% vs 1.5%; P < .001, Fisher exact test). There was an increase in cycling with the traffic (P < .001) and in use of helmets (P < .025) compared with the previous study.Unsafe practices of bicyclists and low use of helmets despite legislation persist in Al Ain. There is a need to raise bicycle safety awareness and improve enforcement of bicycle helmet legislation. This should be directed toward expatriate workers, children, parents, and maids. Environmental changes, namely building separate bicycle lanes, can increase safety for cycling.
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Affiliation(s)
- Michal Grivna
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ahmed AlKatheeri
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mohammed AlAhbabi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Saeed AlKaabi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mohammed Alyafei
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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11
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Current changes in the epidemiology of fall-related injuries in Al Ain City, United Arab Emirates. PLoS One 2021; 16:e0257398. [PMID: 34529683 PMCID: PMC8445427 DOI: 10.1371/journal.pone.0257398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/01/2021] [Indexed: 12/03/2022] Open
Abstract
Background Falls in the Gulf countries are the second most common cause of injuries. The United Arab Emirates government implemented various preventive measures to decrease injuries in the country. We aimed to evaluate the changes in the epidemiology of fall-related injuries in Al-Ain City over the last decade. Methods Data of hospitalized patients who presented with fall-related injuries to the Al-Ain Hospital during the two periods of March 2003 to March 2006 and January 2014 to December 2017 were compared. This included patients’ demographics, mechanism, location, anatomical distribution and parameters related to injury severity. Non-parametric tests were used for the statistical analysis. Results 882 in the first and 1358 patients in the second period were studied. The incidence of falls decreased by 30.5% over ten years. The number of elderly, female patients, and UAE nationals increased, (p < 0.001, p = 0.004, and p < 0.001). Falls from height decreased by 32.5% (p < 0.001) while fall on the same level increased by 22.5% (p < 0.001). Fall-related injuries at home have increased significantly by 22.6% (p <0.001), while falls in workplaces decreased by 24.4% (p <0.001). Conclusions Our study showed that the overall incidence of falls decreased compared to a decade ago. The preventive measures were effective in reducing falls from height and workplace injuries. Future preventive measures should target falls at the same level and homes.
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Alharbi RJ, Shrestha S, Lewis V, Miller C. The effectiveness of trauma care systems at different stages of development in reducing mortality: a systematic review and meta-analysis. World J Emerg Surg 2021; 16:38. [PMID: 34256793 PMCID: PMC8278750 DOI: 10.1186/s13017-021-00381-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/23/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Traumatic injury remains the leading cause of death, with more than five million deaths every year. Little is known about the comparative effectiveness in reducing mortality of trauma care systems at different stages of development. The objective of this study was to review the literature and examine differences in mortality associated with different stages of trauma system development. METHOD A systematic review of peer-reviewed population-based studies retrieved from MEDLINE, EMBASE, and CINAHL. Additional studies were identified from references of articles, through database searching, and author lists. Articles written in English and published between 2000 and 2020 were included. Selection of studies, data extraction, and quality assessment of the included studies were performed by two independent reviewers. The results were reported as odds ratio (OR) with 95 % confidence intervals (CI). RESULTS A total of 52 studies with a combined 1,106,431 traumatic injury patients were included for quantitative analysis. The overall mortality rate was 6.77% (n = 74,930). When patients were treated in a non-trauma centre compared to a trauma centre, the pooled statistical odds of mortality were reduced (OR 0.74 [95% CI 0.69-0.79]; p < 0.001). When patients were treated in a non-trauma system compared to a trauma system the odds of mortality rates increased (OR 1.17 [95% CI 1.10-1.24]; p < 0.001). When patients were treated in a post-implementation/initial system compared to a mature system, odds of mortality were significantly higher (OR 1.46 [95% CI 1.37-1.55]; p < 0.001). CONCLUSION The present study highlights that the survival of traumatic injured patients varies according to the stage of trauma system development in which the patient was treated. The analysis indicates a significant reduction in mortality following the introduction of the trauma system which is further enhanced as the system matures. These results provide evidence to support efforts to, firstly, implement trauma systems in countries currently without and, secondly, to enhance existing systems by investing in system development. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019142842 .
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Affiliation(s)
- Rayan Jafnan Alharbi
- School of Nursing & Midwifery, La Trobe University, 1st floor, HSB 1, La Trobe University, Bundoora, VIC, 3086, Australia. .,Department of Emergency Medical Service, Jazan University, Jazan, Saudi Arabia.
| | - Sumina Shrestha
- Australian Institute for Primary Care and Ageing, School of Nursing & Midwifery, La Trobe University, Bundoora, VIC, Australia.,Community Development and Environment Conservation Forum, Chautara, Nepal
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, School of Nursing & Midwifery, La Trobe University, Bundoora, VIC, Australia
| | - Charne Miller
- School of Nursing & Midwifery, La Trobe University, 1st floor, HSB 1, La Trobe University, Bundoora, VIC, 3086, Australia
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Alao DO, Cevik AA, Grivna M, Eid HO, Abu-Zidan FM. Epidemiological changes of geriatric trauma in the United Arab Emirates. Medicine (Baltimore) 2021; 100:e26258. [PMID: 34087916 PMCID: PMC8183772 DOI: 10.1097/md.0000000000026258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT We aimed to study the epidemiological changes in geriatric trauma in Al-Ain City, United Arab Emirates, in the past decade to give recommendations on injury prevention.Trauma patients aged 65 years and above who were hospitalized at Al-Ain Hospital for more than 24 hours or died in the hospital after their arrival regardless of the length of stay were studied. Data were extracted from the Al-Ain Hospital trauma registry. Two periods were compared; March 2003 to March 2006 and January 2014 to December 2017. Studied variables which were compared included demography, mechanism of injury and its location, and clinical outcome.There were 66 patients in the first period and 200 patients in the second period. The estimated annual incidence of hospitalized geriatric trauma patients in Al-Ain City was 8.5 per 1000 geriatric inhabitants in the first period compared with 7.8 per 1000 geriatric inhabitants in the second period. Furthermore, mortality was reduced from 7.6% to 2% (P = 0.04). There was a significant increase in falls on the same level by14.9% (62.1%-77%, P = 0.02, Pearson χ2 test). This was associated with a significant increase of injuries occurring at home (55.4%-78.7% P = 0.0003, Fisher Exact test). There was also a strong trend in the reduction of road traffic collision injuries which was reduced by 10.8% (27.3%-16.5%, P = 0.07, Fisher Exact test).Although the incidence and severity of geriatric trauma did not change over the last decade, in-hospital mortality has significantly decreased over time. There was a significant increase in injuries occurring at homes and in falls on the same level. The home environment should be targeted in injury prevention programs so as to reduce geriatric injuries.
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Affiliation(s)
- David O. Alao
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University
- Emergency Department, Al-Ain Hospital
| | - Arif Alper Cevik
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University
| | - Michal Grivna
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain
| | - Hani O. Eid
- Emergency Department, Mediclinic Airport Road Hospital, Abu Dhabi
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
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