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Alabdallat M, Strandvik G, Afifi I, Peralta R, Parchani A, El-Menyar A, Rizoli S, Al-Thani H. Occult Perforation of the Esophagus during Removal of an Enteral Feeding Tube: A Case Report and Literature Review. Case Rep Surg 2023; 2023:4230158. [PMID: 37034008 PMCID: PMC10076110 DOI: 10.1155/2023/4230158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023] Open
Abstract
Background. The use of oral or nasal route for enteral feeding is a standard practice in intensive care patients with a safe profile in general. However, complications associated with the insertion of a nasogastric (NGT) or orogastric tube (OGT) are common in the medical literature compared to the removal of such tubes. Case presentation. We presented a 38-year-old male who was involved in a motor-vehicle collision and found with low Glasgow Coma Scale outside his vehicle. He had polytrauma and was intubated—and commenced on enteral feeding via an OGT. Esophageal bezoar developed within a few days around the feeding tube, resulting in significant force being required to remove it, which was complicated by esophageal perforation. The esophageal injury was treated conservatively with uneventful recovery. Discussion and conclusions. Although limited case reports of esophageal enteral feeding bezoar formation do exist in the literature, we believe that this is the first case report of esophageal perforation due to the forceful removal of a wedged OGT secondary to esophageal bezoar formation. Morbidity associated with OGT/NGT is not common and may require a high index of suspicion to be identified. This is especially true if resistance is appreciated while removing the NGT/OGT. Gastroenterology consultation is recommended as early as possible to detect and manage any complications, however, their role was very limited in such stable case. In addition, early computed tomography (CT) can be considered for timely recognition of esophageal perforation. Non-operative management may be considered in stable patients, especially if the leak is in the cervical portion of the esophagus. Finally, prevention is better than cure, so being diligent in confirming NGT/OGT position, both radiologically and by measuring the tube length at the nostril/mouth, is the key to avoid misplacement and complication. This case raises the awareness of physician for such preventable iatrogenic event.
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Asim M, El-Menyar A, Parchani A, Nabir S, Ahmed MN, Ahmed Z, Ramzee AF, Al-Thani A, Al-Abdulmalek A, Al-Thani H. Rotterdam and Marshall Scores for Prediction of in-hospital Mortality in Patients with Traumatic Brain Injury: An observational study. Brain Inj 2021; 35:803-811. [PMID: 34076543 DOI: 10.1080/02699052.2021.1927181] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: We aimed to assess the prognostic value of Rotterdam and Marshall scoring systems to predict in-hospital mortality in patients with traumatic brain injury (TBI).Methods: A retrospective analysis was conducted for patients with TBI who underwent head computerized tomography (CT) scan at a Level I trauma center between 2011 and 2018. Receiver operating characteristic (ROC) curves were used to determine the cutoff values for predicting in-hospital mortality.Results: A total of 1035 patients with TBI were included with a mean age of 30 years. The mean Rotterdam and Marshall scores were higher among non-survivors (p = .001). Patients with higher Rotterdam (>3) or Marshall (>2) CT scores were older, had higher injury severity scores and in-hospital mortality and had lower GCS and blood ethanol levels than those with lower scores. The cutoff point of Rotterdam score was 3.5 (sensitivity, 61.2%; specificity, 85.6%) and Marshall score was 2.5 (74.3% sensitivity and 76.3% specificity). Multivariable logistic regression analyses showed that Marshall and Rotterdam scoring systems were independent predictors of mortality (odds ratio 8.4; 95% confidence interval 4.95-14.17 and odds ratio 4.4; 95% confidence interval 2.36-9.39, respectively).Conclusion: Rotterdam and Marshall CT scores have independent prognostic values in patients with TBI even in alcoholic patients.
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Affiliation(s)
- Mohammad Asim
- Trauma and Vascular Surgery Section, Clinical Research, Hamad General Hospital (HGH), Doha, Qatar
| | - Ayman El-Menyar
- Trauma and Vascular Surgery Section, Clinical Research, Hamad General Hospital (HGH), Doha, Qatar.,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Ashok Parchani
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Syed Nabir
- Department of Radiology, Hamad General Hospital (HGH), Doha, Qatar
| | | | - Zahoor Ahmed
- Department of Radiology, Hamad General Hospital (HGH), Doha, Qatar
| | | | | | | | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
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3
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Al-Thani H, Mekkodathil A, Consunji R, Mollazehi M, Ammar AA, Parchani A, Jogol H, Hakim SY, Kanbar A, El-Menyar A. Traumatic injuries associated with suicide attempts: A retrospective study from single national level 1 trauma center. Int J Crit Illn Inj Sci 2020; 10:92-98. [PMID: 32904460 PMCID: PMC7456287 DOI: 10.4103/ijciis.ijciis_64_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/20/2020] [Accepted: 02/21/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Suicide is a complex phenomenon involving several risk factors. We aimed to describe the frequency, pattern, and outcomes of patients with traumatic injuries following suicide attempts admitted to a level 1 trauma center. Methods: We conducted a retrospective analysis of data obtained from Qatar National Trauma Registry and mortuary database. The study included all patients with traumatic injuries following suicide attempts, admitted to the Hamad Trauma Center (HTC) from April 2008 to March 2018. Results: During this 10–year period, 206 patients were admitted to the HTC for injuries associated with suicide attempts. The majority were males (76%), young age (mean age 31 years), and expatriates specifically from South Asia (55%). The most common injury was due to self-inflicted cutting and piercing (51%) followed by jumping from height (30%). Females chose jumping from high place more often as a method of suicide attempt (59% vs. 20%), while males chose self-stabbing or cutting their throat (59% vs. 25%) (P = 0.001). Most of the patients had head injuries (30%) that was severe in terms of abbreviated injury scale score (3.6 ± 0.9). More than half (54%) of the patients required psychiatric consultations. The in-hospital mortality was 8% which was comparable in both genders. Conclusions: The present study revealed that 1.8% of trauma admissions at HTC were related to suicidal attempts. Better understanding of risk factors is important in devising preventive strategies.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahammed Mekkodathil
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Rafael Consunji
- Department of Surgery, Trauma Surgery, Hamad Injury Prevention Program, Hamad General Hospital, Doha, Qatar
| | - Monira Mollazehi
- Department of Surgery, Trauma Surgery, National Trauma Registry, Hamad General Hospital, Doha, Qatar
| | - Adham A Ammar
- Laboratory Department, Clinical Services Unit, Hamad General Hospital, Doha, Qatar
| | - Ashok Parchani
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Hisham Jogol
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Suhail Y Hakim
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahad Kanbar
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar.,Department of Clinical Medicine, Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
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Mahmood I, Younis B, Ahmed K, Mustafa F, El-Menyar A, Alabdallat M, Parchani A, Peralta R, Nabir S, Ahmed N, Al-Thani H. Occult Pneumothorax in Patients Presenting with Blunt Chest Trauma: An Observational Analysis. Qatar Med J 2020; 2020:10. [PMID: 32206592 PMCID: PMC7075257 DOI: 10.5339/qmj.2020.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/21/2019] [Indexed: 12/02/2022] Open
Abstract
Background: We aimed to assess the management and outcome of occult pneumothorax and to determine the factors associated with failure of observational management in patients with blunt chest trauma (BCT). Methods: Patients with BCT were retrospectively identified from the trauma database over 4 years. Data were analyzed and compared on the basis of initial management (conservative vs. tube thoracostomy). Results: Across the study period, 1928 patients were admitted with BCT, of which 150 (7.8%) patients were found to have occult pneumothorax. The mean patient age was 32.8 ± 13.7 years, and the majority were male (86.7%). Positive-pressure ventilation (PPV) was required in 32 patients, and bilateral occult pneumothorax was seen in 25 patients. In 85.3% (n = 128) of cases, occult pneumothorax was managed conservatively, whereas 14.7% (n = 22) underwent tube thoracostomy. Five patients had failed observational treatment requiring delayed tube thoracostomy. Pneumonia was reported in 12.8% of cases. Compared with those who were treated conservatively, patients who underwent tube thoracostomy had thicker pneumothoraxes and a higher rate of lung contusion, rib fracture, pneumonia, prolonged ventilatory days, and prolonged hospital length of stay. Overall mortality was 4.0%. The deceased had more polytrauma and were treated conservatively without a chest tube. Patients who failed conservative management had a higher frequency of lung contusion, greater pneumothorax thickness, higher Injury Severity Scores (ISS), and required more PPV. Conclusions: Occult pneumothorax is not uncommon in BCT and can be successfully managed conservatively with a close clinical follow-up. Intervention should be limited to patients who have an increase in size of the pneumothorax on follow-up or become symptomatic under observation. Patients who fail conservative management may have a greater pneumothorax thickness and higher ISS. However, large prospective studies are warranted to support these findings and to establish the institutional guidelines for the management of occult pneumothorax.
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Affiliation(s)
- Ismail Mahmood
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Basil Younis
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Khalid Ahmed
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Fuad Mustafa
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohammad Alabdallat
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Ashok Parchani
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Syed Nabir
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Nadeem Ahmed
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
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Chughtai T, Parchani A, Strandvik G, Verma V, Arumugam S, El-Menyar A, Rizoli S, Al-Thani H. Trauma intensive care unit (TICU) at Hamad General Hospital. Qatar Med J 2020; 2019:5. [PMID: 32076594 PMCID: PMC7003060 DOI: 10.5339/qmj.2019.qccc.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 11/25/2022] Open
Abstract
Trauma is a leading cause of mortality and morbidity worldwide, and thus represents a great global health challenge. The World Health Organization (WHO) estimated that 9% of deaths in the world are the result of trauma.1 In addition, approximately 100 million people are temporarily or permanently disabled every year.2 The situation is no different in Qatar, and injury related morbidity and mortality is increasing in the entire region, with road traffic collisions (RTCs) being the most common mechanism.1 It is well recognized now that trauma care provided in high-volume, dedicated, level-one trauma centers, improves outcome. Studies have also looked at what are the components of a trauma system that contribute to their effectiveness2. However, in general, it usually implies a high-volume of cases, dedicated full-time trauma qualified professionals, a solid pre-hospital system, a multidisciplinary team, and excellent rehabilitation services. Similarly, critically injured trauma patients managed in a dedicated trauma intensive care unit (TICU), has been shown to improve outcomes, especially for polytrauma patients with traumatic brain injury (TBI).3 In fact, the American College of Surgeons (ACS) Committee on Trauma requires verified trauma centers to have a designated ICU, and that a trauma surgeon be its director.4 Furthermore, studies have shown that for TBI, it is not necessary for this ICU to be a neurocritical care unit, but rather it should be a unit that is dedicated to trauma, that has standardized protocols for TBI management.5,6 In fact, the outcomes are better in the latter, with lower mortality in multiple-injured patients with TBI, when admitted to a TICU (versus a medical-surgical ICU or neurocritical care unit).3 These benefits were shown to increase, with increased injury severity. The proposed reason for this is thought to be due to the associated injuries being managed better.7 The aim of this editorial is to describe the TICU at Hamad General Hospital (HGH), at Hamad Medical Corporation (HMC), including a comparison of its data and outcomes with other similar trauma centers in the world. The Qatar Trauma Registry, as well as previous publications from our Trauma Center,1,8 were used to obtain HGH TICU and worldwide Level-1 Trauma Center standards, respectively. With respect to HGH, the TICU is part of an integrated trauma program, the only level-1 trauma centre in Qatar. It provides the highest standard of care for critically-ill trauma patients admitted at HGH, striving to achieve the best outcomes, excellence in evidence-based patient care, up to date technology, and a high level of academics in research and teaching. This integrated program includes an excellent pre-hospital unit, emergency and trauma resuscitation unit, TICU, trauma step-down unit (TSDU), inpatient ward, and rehabilitation unit. The new TICU is a closed 19-bed unit, that was inaugurated in 2016, is managed 24/7 by highly qualified and experienced intensivists (9 senior consultants and consultants), along with 24 well-trained and experienced associate consultants or specialists, and fellows and residents in training, as well as expert nursing staff (1:1 nurse to patient ratio) and allied health professionals (respiratory therapists, pharmacists, dieticians, physiotherapists, occupational therapists, social workers, case managers, and psychologists). It is supported by all medical and surgical subspecialty services. It is equipped with the latest state-of-the-art technology and equipment, including 'intelligent ventilators", neuro-monitoring devices, ultrasound, point-of-care testing such as arterial blood gas and rotational thromboelastrometry (ROTEM), and video airway devices. The TICU is a teaching unit, linked to the HMC Medical Education department, with presence of fellows, and residents (see below for details). Medical students (Clerkship level) from Weill-Cornell Medicine Qatar also complete a one-week rotation in the TICU, as part of their exposure to critical care. The first batch of clerks from Qatar University College of Medicine are expected to start rotating in the TICU soon. The Trauma Critical Care Fellowship Program (TCCFP) is an ACGME (Accreditation Council for Graduate Medical Education) fellowship that was established over seven years ago. To date, over 40 physicians from both within, and out of, the trauma department have completed the program. Up to seven fellows, including international candidates, are trained each year. A number of physicians have succeeded in gaining the European Diploma of Intensive Care Medicine (EDIC). The program continues to attract many applicants from various specialties including surgery, anesthesia, and emergency medicine. An increasing number of international physicians from Europe and South America have expressed interest in applying for our fellowship. The first international fellows are likely to join us from early 2020. Residents (from general surgery, ER, ENT, plastics, orthopedics, and neurosurgery) rotate (one to three months' rotations) in the TICU, and are actively part of the clinical team. There were 568 admissions to the TICU in 2018. The patients admitted were either mainly polytrauma patients with varying degrees and combinations of head, chest, abdominal, pelvic, spine, and orthopedic injuries, or isolated-TBI. Of these patients, 378 were severely injured with an injury severity score (ISS)9 greater than 16. According to previously published data from our Trauma Centre,1,8 our mortality rates (overall approximately 6-7%, as well as when looked at in terms of early and late deaths) compare favorably with other trauma centers around the world, when looking at similarly sized retrospective studies. The TICU continues to be an active member of the Critical Care Network of HMC.10 This network involves all of the ICU's in all the HMC facilities. The main processes that the TICU is presently involved in as part of this network are: patient flow, clinical practice guidelines, evaluation and procurement of technologies, HMC sepsis program, and in general, taking part in any process that pertains to critical care at HMC. A number of quality improvement projects are being undertaken in the TICU. Examples of such projects include: - Decreasing rates of infection in TICU- Score-guided sedation orders to decrease sedation use, ventilator days and length of stay- Reducing blood taking and associated costs- Sepsis alert response and bundle compliance- Medical and surgical management of rib fracturesA multidisciplinary team of physicians, nurses, and allied health professionals participate in these projects, and meet once a month to review all projects. Similarly, many research projects are taking place in the TICU, in coordination with the Trauma Research program, and often in collaboration with other departments (local and international). Examples of some of the research projects include: - The "POLAR" study (RCT on Hypothermia in TBI)11- B-blockers in TBI (RCT-ongoing)- Tranexamic acid (TXA) for bleeding in trauma (RCT-ongoing) The team is also involved in conducting systematic reviews in relation to the role of transcranial doppler in TBI,12 sepsis in TBI patients (ongoing), self-extubation in TBI patients,13 safety and efficacy of phenytoin in TBI (ongoing), and optic nerve diameter for predicting outcome in TBI (submitted). The TICU at HGH is a high-volume, high acuity unit that manages all the severely injured trauma patients in Qatar. It is well staffed with highly trained and qualified personnel, and utilizes the latest in technology and state-of-the-art equipment. It performs very well, when compared to other similar units in the world, and achieves a comparable, or even lower mortality rate. With continued great support from the hospital, corporation administration, and Ministry of Public Health, the future goals of the TICU will be to maintain and improve upon the high standards of clinical care it provides, as well as perform a high quality and quantity of research, quality improvement initiatives, and educational work, in order for it to be amongst the best trauma critical care units in the world.
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Affiliation(s)
- Talat Chughtai
- Trauma Intensive Care Unit (TICU), Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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El-Menyar A, Consunji R, Asim M, Mekkodathil A, Latifi R, Smith G, Parchani A, Al-Thani H. Traumatic brain injury in patients screened for blood alcohol concentration based on the mechanism of injury. Brain Inj 2019; 33:419-426. [DOI: 10.1080/02699052.2018.1553065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ayman El-Menyar
- Clinical Research, Trauma &Vascular Surgery, Hamad General Hospital, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Rafael Consunji
- Injury Prevention, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Mohammed Asim
- Clinical Research, Trauma &Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahammed Mekkodathil
- Clinical Research, Trauma &Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Gordon Smith
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ashok Parchani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
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Al-Thani H, Jabbour G, El-Menyar A, Wahlen BM, Asim M, Abdelrahman H, Nabir S, Al-Jogol H, Mahmood I, El-Faramawy A, Parchani A, Afifi I, Peralta R. Traumatic sternal injury in patients with rib fracture: A single-center experience. Int J Crit Illn Inj Sci 2019; 9:75-81. [PMID: 31334049 PMCID: PMC6625325 DOI: 10.4103/ijciis.ijciis_67_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose: We aimed to assess the pattern and impact of sternal injury with rib fracture in a Level 1 trauma center. Patients and Methods: We conducted a retrospective review of trauma registry data to identify patients who presented with sternal fracture between 2010 and 2017. Data were analyzed and compared in patients with and without rib fracture. Results: We identified 212 patients with traumatic sternal injury, of them 119 (56%) had associated rib fractures. In comparison to those who had no rib fracture, patients with rib fractures were older (40.1 ± 13.6 vs. 37.8 ± 14.5), were frequently involved in traffic accidents (75% vs. 71%), had higher chest abbreviated injury scale (AIS 2.8 ± 0.6 vs. 2.2 ± 0.5) and Injury Severity Score ( ISS 17.5 ± 8.6 vs. 13.3 ± 9.6), were more likely to be intubated (33% vs. 19%), required chest tube insertion (13.4% vs. 4.3%), and received blood transfusion (29% vs. 17%). Rates of spine fracture, head injury, and solid organ injury were comparable in the two groups. Manubrium, clavicular and scapular fractures, lung contusion, hemothorax, and pneumothorax were significantly more evident in those who had rib fractures. Hospital length of stay was prolonged in patients with rib fractures (P = 0.008). The overall mortality was higher but not statistically significant in patients with rib fractures (5.0% vs. 3.2%). Conclusions: Sternal fractures are rare, and detection of associated injuries requires a high index of suspicion. Combined sternal and rib fractures are more evident in relatively older patients after chest trauma. This combination has certain clinical implications that necessitate further prospective studies.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Gaby Jabbour
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar.,Department of Medicine, Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Bianca M Wahlen
- Department of Anesthesia, Hamad General Hospital, Doha, Qatar
| | - Mohammad Asim
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Syed Nabir
- Radiology, Hamad General Hospital, Doha, Qatar
| | - Hisham Al-Jogol
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ismail Mahmood
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahmed El-Faramawy
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ashok Parchani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ibrahim Afifi
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
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Al-Thani H, El-Menyar A, Asim M, Mollazehi M, Abdelrahman H, Parchani A, Consunji R, Castle N, Ellabib M, Al-Hassani A, El-Faramawy A, Peralta R. Evolution of The Qatar Trauma System: The Journey from Inception to Verification. J Emerg Trauma Shock 2019; 12:209-217. [PMID: 31543645 PMCID: PMC6735200 DOI: 10.4103/jets.jets_56_19] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Traumatic injuries accounted for substantial burden of morbidity and mortality (M and M) worldwide. Despite better socioeconomic conditions and living standards, the incidence of trauma is rising in the Eastern Mediterranean Region (EMR). Road traffic injuries are the leading cause of the high fatality rate in young economically productive adults in our region. The provision of trauma care at high-volume, accredited trauma center by a team of dedicated full-time professional health-care providers has been shown to improve the quality of care and the outcomes for trauma victims. With persistent hard work and effective leadership, in Qatar, the Trauma Section has evolved into a well-reputed and internationally recognized Center of Excellence in Trauma Care, Hamad Level 1 Trauma Center. In 2014, Qatar Trauma System was accredited with Trauma Distinction Award by the Accreditation Canada International, for high-quality trauma care of severely injured patients; first in the Middle East. The Hamad Trauma Center is committed to the advancement of trauma care in different aspects right from the immediate prehospital care to the subsequent hospital-based care, involving diagnosis, treatment, support, rehabilitation, and community reintegration of the patients and injury prevention. Our trauma system has gradually embedded with a structured and matured research unit with dedicated clinicians and academic researchers. The trauma team embodies the 21st-century paradigm of translational research and injury prevention by going well beyond the bedside, out into the populations that need it most. The trauma system's future vision relies on the evidence-based health-care service and better outcomes; state-of-the-art infrastructure and multidimensional collaborations with health care and governmental services to minimize the burden of M and M caused by traumatic injury in the State of Qatar and to fulfill the population health enhancement strategy.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Clinical Research, Hamad General Hospital, Doha, Qatar.,Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | - Mohammad Asim
- Department of Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Monira Mollazehi
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ashok Parchani
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Rafael Consunji
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Nicholas Castle
- Hamad Medical Corporation Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Ellabib
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ammar Al-Hassani
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahmed El-Faramawy
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Universidad Nacional Pedro Henriquez Urena, School of Medicine, Santo Domingo, Dominican Republic
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Afifi I, Parchani A, Al-Thani H, El-Menyar A, Alajaj R, Elazzazy S, Latifi R. Base deficit and serum lactate concentration in patients with post traumatic convulsion. Asian J Neurosurg 2016; 11:146-50. [PMID: 27057221 PMCID: PMC4802936 DOI: 10.4103/1793-5482.145117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: Traumatic brain injury is a major cause of morbidity and mortality worldwide, and has been reported to be one of the risk factors for epileptic seizures. Abnormal blood lactate (LAC) and base deficit (BD) reflects hypoperfusion and could be used as metabolic markers to predict the outcome. The aim of this study is to assess the prognostic value of BD and LAC levels for post traumatic convulsion (PTC) in head injury patients. Materials and Methods: All head injury patients with PTC were studied for the demographics profile, mechanism of injury, initial vital signs, and injury severity score (ISS), respiratory rates, CT scan findings, and other laboratory investigations. The data were obtained from the trauma registry and medical records. Statistical analysis was done using SPSS software. Results: Amongst 3082 trauma patients, 1584 were admitted to the hospital. Of them, 401 patients had head injury. PTC was observed in 5.4% (22/401) patients. Out of the 22 head injury patients, 10 were presented with the head injury alone, whereas 12 patients had other associated injuries. The average age of the patients was 25 years, comprising predominantly of male patients (77%). Neither glasgow coma scale nor ISS had correlation with BD or LAC in the study groups. The mean level of BD and LAC was not statistically different in PTC group compared to controls. However, BD was significantly higher in patients with associated injuries than the isolated head injury group. Furthermore, there was no significant correlation amongst the two groups as far as LAC levels are concerned. Conclusion: Base deficit but not lactic acid concentration was significantly higher in head injury patients with associated injuries. Early resuscitation by pre-hospital personnel and in the trauma room might have impact in minimizing the effect of post traumatic convulsion on BD and LAC.
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Affiliation(s)
- Ibrahim Afifi
- Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ashok Parchani
- Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar; Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Raghad Alajaj
- Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | | | - Rifat Latifi
- Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar; Department of Surgery, Arizona University, Tucson, AZ, USA
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El-Menyar A, Asim M, Zarour A, Abdelrahman H, Peralta R, Parchani A, Al-Thani H. Trauma research in Qatar: a literature review and discussion of progress after establishment of a trauma research centre. East Mediterr Health J 2016; 21:811-8. [PMID: 26857718 DOI: 10.26719/2015.21.11.811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 06/28/2015] [Indexed: 11/09/2022]
Abstract
A structured research programme is one of the main pillars of a trauma care system. Despite the high rate of injury-related mortalities, especially road traffic accidents, in Qatar, little consideration has been given to research in trauma. This review aimed to analyse research publications on the subject of trauma published from Qatar and to discuss the progress of clinical research in Qatar and the Gulf Cooperation Council countries with special emphasis on trauma research. A literature search using PubMed and Google Scholar search engines located 757 English-language articles within the fields of internal medicine, surgery and trauma originating from Qatar between the years 1993 and 2013. A steep increase in the number of trauma publications since 2010 could be linked to the setting up of a trauma research centre in Qatar in 2011. We believe that establishing a research unit has made a major impact on research productivity, which ultimately benefits health care.
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Affiliation(s)
- A El-Menyar
- Department of Surgery, Clinical Research, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar; Department of Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - M Asim
- Department of Surgery, Clinical Research, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - A Zarour
- Trauma Surgery Section, Clinical Research, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - H Abdelrahman
- Trauma Surgery Section, Clinical Research, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - R Peralta
- Trauma Surgery Section, Clinical Research, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - A Parchani
- Trauma Surgery Section, Clinical Research, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - H Al-Thani
- Trauma Surgery Section, Clinical Research, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Arumugam S, Al-Hassani A, El-Menyar A, Abdelrahman H, Parchani A, Peralta R, Zarour A, Al-Thani H. Frequency, causes and pattern of abdominal trauma: A 4-year descriptive analysis. J Emerg Trauma Shock 2015; 8:193-8. [PMID: 26604524 PMCID: PMC4626935 DOI: 10.4103/0974-2700.166590] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/30/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The incidence of abdominal trauma is still underreported from the Arab Middle-East. We aimed to evaluate the incidence, causes, clinical presentation, and outcome of the abdominal trauma patients in a newly established trauma center. MATERIALS AND METHODS A retrospective analysis was conducted at the only level I trauma center in Qatar for the patients admitted with abdominal trauma (2008-2011). Patients demographics, mechanism of injury, pattern of organ injuries, associated extra-abdominal injuries, Injury Severity Score (ISS), Abbreviated Injury Scale, complications, length of Intensive Care Unit, and hospital stay, and mortality were reviewed. RESULTS A total of 6888 trauma patients were admitted to the hospital, of which 1036 (15%) had abdominal trauma. The mean age was 30.6 ± 13 years and the majority was males (93%). Road traffic accidents (61%) were the most frequent mechanism of injury followed by fall from height (25%) and fall of heavy object (7%). The mean ISS was 17.9 ± 10. Liver (36%), spleen (32%) and kidney (18%) were most common injured organs. The common associated extra-abdominal injuries included chest (35%), musculoskeletal (32%), and head injury (24%). Wound infection (3.8%), pneumonia (3%), and urinary tract infection (1.4%) were the frequently observed complications. The overall mortality was 8.3% and late mortality was observed in 2.3% cases mainly due to severe head injury and sepsis. The predictors of mortality were head injury, ISS, need for blood transfusion, and serum lactate. CONCLUSION Abdominal trauma is a frequent diagnosis in multiple trauma and the presence of extra-abdominal injuries and sepsis has a significant impact on the outcome.
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Affiliation(s)
- Suresh Arumugam
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ammar Al-Hassani
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma Surgery Section, Clinical Research, HMC, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ashok Parchani
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ahmad Zarour
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation (HMC), Doha, Qatar
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Peralta R, Jabbour G, El Menyar A, Consunji R, El-Matbouly M, Abdelrahman H, Parchani A, Al Hasssani A, Zarour A, Al Thani H. A comparison of standard hematologic testing and fibrinogen levels as predictors of mortality in severe traumatic brain injury. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.08.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Peralta R, Vijay A, El-Menyar A, Consunji R, Abdelrahman H, Parchani A, Afifi I, Zarour A, Al-Thani H, Latifi R. Trauma resuscitation requiring massive transfusion: a descriptive analysis of the role of ratio and time. World J Emerg Surg 2015; 10:36. [PMID: 26279672 PMCID: PMC4536606 DOI: 10.1186/s13017-015-0028-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/23/2015] [Indexed: 11/10/2022] Open
Abstract
Objective We aimed to evaluate whether early administration of high plasma to red blood cells ratios influences outcomes in injured patients who received massive transfusion protocol (MTP). Methods A retrospective analysis was conducted at the only level 1 national trauma center in Qatar for all adult patients(≥18 years old) who received MTP (≥10 units) of packed red blood cell (PRBC) during the initial 24 h post traumatic injury. Data were analyzed with respect to FFB:PRBC ratio [(high ≥ 1:1.5) (HMTP) vs. (low < 1:1.5) (LMTP)] given at the first 4 h post-injury and also between (>4 and 24 h). Mortality, multiorgan failure (MOF) and infectious complications were studied as well. Results During the study period, a total of 4864 trauma patients were admitted to the hospital, 1.6 % (n = 77) of them met the inclusion criteria. Both groups were comparable with respect to initial pH, international normalized ratio, injury severity score, revised trauma score and development of infectious complications. However, HMTP was associated with lower crude mortality (41.9 vs. 78.3 %, p = 0.001) and lower rate of MOF (48.4 vs. 87.0 %, p = 0.001). The number of deaths was 3 times higher in LMTP in comparison to HMTP within the first 30 days (36 vs. 13 cases). The majority of deaths occurred within the first 24 h (80.5 % in LMTP and 69 % in HMTP) and particularly within the first 6 h (55 vs. 46 %). Conclusions Aggressive attainment of high FFP/PRBC ratios as early as 4 h post-injury can substantially improve outcomes in trauma patients.
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Affiliation(s)
- Ruben Peralta
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Adarsh Vijay
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, HMC, PO Box 3050, Doha, Qatar ; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Rafael Consunji
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Husham Abdelrahman
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Ashok Parchani
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Ibrahim Afifi
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Ahmad Zarour
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar ; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Hassan Al-Thani
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Rifat Latifi
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar ; Department of Surgery, University of Arizona, Tucson, AZ USA
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Al-Thani H, El-Menyar A, Mathew S, Khawar M, Asim M, Abdelrahman H, Peralta R, Parchani A, Zarour A. Patterns and outcomes of traumatic neck injuries: A population-based observational study. J Emerg Trauma Shock 2015; 8:154-8. [PMID: 26229299 PMCID: PMC4520029 DOI: 10.4103/0974-2700.160723] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We aimed to analyze the pattern and outcome of traumatic neck injury (TNI) in a small population. MATERIALS AND METHODS It is a retrospective analysis of all TNI patients who were admitted to the trauma center between 2008 and 2012. Patients' demographics, details of TNI, associated injuries, hospital course, and mortality were analyzed. RESULTS A total of 51 TNI cases were included revealing an overall incidence of 0.61/100,000 population. The mean age was 31 ± 9 years. The most frequent mechanism of injury was motor vehicle crash (29.4%) followed by stab (17.6%), machinery injury (17.6%), fall (9.8%), and assault (7.8%). Larynx, thyroid gland, trachea, jugular veins, and carotid were the commonly injured structures. The majority of cases had Zone II TNI whereas isolated injury was observed in 11 cases. TNI were mainly presented with active bleeding (38%), hypovolemic shock (16%) and respiratory distress (16%). Surgical interventions mainly included simple repair and closure (53%), vein ligation (12%), repair of major arteries (4%), tracheal repair (6%), larynx and hypopharynx repair (4%), and repair of parotid gland (2%). Neck exploration was performed in 88%, and emergency tracheostomy was required in 18% of cases. Overall mortality rate was 11.8%, of which five patients had associated injuries, and one had isolated TNI. CONCLUSION TNI are not frequent but represent an alarming serious entity in Qatar. Patients with persistent signs of major injuries should undergo early operative interventions. Moreover, the effective injury prevention program should be developed to minimize these preventable injuries in the majority of cases.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Ayman El-Menyar
- Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar ; Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Sharon Mathew
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Mahwish Khawar
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad Asim
- Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Ashok Parchani
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Zarour
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar ; Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
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El-Menyar A, Consunji R, Asim M, Abdelrahman H, Zarour A, Parchani A, Peralta R, Al-Thani H. Underutilization of occupant restraint systems in motor vehicle injury crashes: A quantitative analysis from Qatar. Traffic Inj Prev 2015; 17:284-291. [PMID: 26168211 DOI: 10.1080/15389588.2015.1069820] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 07/01/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Restraint systems (seat belts and airbags) are important tools that improve vehicle occupant safety during motor vehicle crashes (MVCs). We aimed to identify the pattern and impact of the utilization of passenger restraint systems on the outcomes of MVC victims in Qatar. METHODS A retrospective study was conducted for all admitted patients who sustained MVC-related injuries between March 2011 and March 2014 inclusive. RESULTS Out of 2,730 road traffic injury cases, 1,830 (67%) sustained MVC-related injuries, of whom 88% were young males, 70% were expatriates, and 53% were drivers. The use of seat belts and airbags was documented in 26 and 2.5% of cases, respectively. Unrestrained passengers had greater injury severity scores, longer hospital stays, and higher rates of pneumonia and mortality compared to restrained passengers (P = .001 for all). There were 311 (17%) ejected cases. Seat belt use was significantly lower and the mortality rate was 3-fold higher in the ejected group compared to the nonejected group (P = .001). The overall mortality was 8.3%. On multivariate regression analysis, predictors of not using a seat belt were being a front seat passenger, driver, or Qatari national and young age. Unrestrained males had a 3-fold increase in mortality in comparison to unrestrained females. The risk of severe injury (relative risk [RR] = 1.82, 95% confidence interval [CI], 1.49-2.26, P = .001) and death (RR = 4.13, 95% CI, 2.31-7.38, P = .001) was significantly greater among unrestrained passengers. CONCLUSION The nonuse of seat belts is associated with worse outcomes during MVCs in Qatar. Our study highlights the lower rate of seat belt compliance in young car occupants that results in more severe injuries, longer hospital stays, and higher mortality rates. Therefore, we recommend more effective seat belt awareness and education campaigns, the enforcement of current seat belt laws, their extension to all vehicle occupants, and the adoption of proven interventions that will assure sustained behavioral changes toward improvements in seat belt use in Qatar.
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Affiliation(s)
- Ayman El-Menyar
- a Clinical Research, Hamad Trauma Center, Hamad General Hospital (HGH) , Doha , Qatar
- b Clinical Medicine, Weill Cornell Medical College , Doha , Qatar
- c Trauma Surgery Section , Department of Surgery , HGH , Doha , Qatar
| | - Rafael Consunji
- c Trauma Surgery Section , Department of Surgery , HGH , Doha , Qatar
- d Injury Prevention Program, Hamad Trauma Center , HGH , Doha , Qatar
| | - Mohammad Asim
- a Clinical Research, Hamad Trauma Center, Hamad General Hospital (HGH) , Doha , Qatar
- c Trauma Surgery Section , Department of Surgery , HGH , Doha , Qatar
| | | | - Ahmad Zarour
- c Trauma Surgery Section , Department of Surgery , HGH , Doha , Qatar
| | - Ashok Parchani
- c Trauma Surgery Section , Department of Surgery , HGH , Doha , Qatar
| | - Ruben Peralta
- c Trauma Surgery Section , Department of Surgery , HGH , Doha , Qatar
| | - Hassan Al-Thani
- c Trauma Surgery Section , Department of Surgery , HGH , Doha , Qatar
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Consunji R, Peralta R, Mollazehi MR, El-Menyar A, Abdelrahman H, Zarour A, Parchani A, Al-Thani H. 78 The pattern of road traffic deaths in the ramadan: the effect of multi-disciplinary road safety programs in QATAR. Inj Prev 2015. [DOI: 10.1136/injuryprev-2015-041654.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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El-Menyar A, Al-Thani H, Consunji R, Peralta R, Asim M, Abdelrahman H, Parchani A, Zarour A. 31 Use of protective devices among motor vehicle crashes. Inj Prev 2015. [DOI: 10.1136/injuryprev-2015-041654.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Roizblatt D, Eamer G, Roberts D, Ball C, Banfield J, Greene B, Veigas P, Moore L, Schellenberg M, Ali J, Ali J, Xiao J, Babul S, Goeres P, Babsail AM, Rice T, MacGillivray S, Addioui A, Tardif PA, Porgo TV, Matar M, Tze N, Rae R, Alali A, Da Luz LT, Vogt K, Da Luz LT, Murphy P, Ali J, Mador B, Muakkassa F, Faidim S, Kirkpatrick A, Kirkpatric A, Laviolette M, Taylor S, Engels P, Hossri S, Snider C, Kortbeek J, Green R, Green R, Green R, Snider C, Green R, Lee C, Green R, Driedger M, Clement J, Charan NKD, Sowers N, Neuhaus N, Hardy I, Younus M, Ibrahim-Zada I, Marrer AMP, Bailey K, Bennett S, Gillman L, Hossri S, Cyr K, Yanchar N, Hinton M, Bernal E, Chisholm A, Hogan A, Watson I, Hogan A, Hogan A, Hewitson L, Rouse C, Rouse C, Al-Thani H, Masson-Trottier M, Mydeen MF, Sne N, Peralta R, Bracco D, Bracco D, Bekdache O, Bracco D, Bracco D, Padim P, Omar M, Yazdani S, Hussein Z, Zargaran E, Fong D, Almaawali A, Tien H, Alshlwi S, Moffat B, Biswas S, Hassan ME, Biswas S, Biswas S, LaLande A, Al Rawahi A, Min A, Phelan B, Harrington J, Mucciaccio M, Alhinai F, Knight H, Young D, Alam A, Waggott M, McKee J, Al-Masrouri S, Al Hinai A, McKee J, Mckee J, Semprun C, Collins D, Kim D, Grenier T, Curtis S, Dufrsne P, Curtis S, Khan S, Curtis S, Appel J, Appel J, Stewart TC, Keenan A, Thakore J, Younus A, Marrero AMP, Mapiour D, Hamadani F, Nascimento B, McGowan M, Kokoski C, Logsetty S, Lawless B, McBeth P, Di Battista A, Rao J, Alhabboubi M, Neto JR, Alhabboubi M, Neto JR, Rao J, Neto JR, Menezes A, Gillard K, Almansoori K, Nash N, Babsail A, Alhabboubi M, Hamadani F, Benyayer D, Malo C, Deckelbaum D, Khwaja K, Beckett A, Razek T, Fata P, Bratu I, Craig J, Faris P, Ball C, Tiruta C, Xiao J, McBeath P, Kubes P, Doig C, Kirkpatrick A, Lampron J, Rizoli S, Callum J, Nascimento B, Da Luz LT, Lauzier F, Berthelot S, Stelfox HT, Kortbeek J, Simons R, Bourgeois G, Clement J, Stevens K, Mehmood A, Gautam S, Zafarm I, Sorvari A, Adam R, Ondiveeran H, Bedaysie H, Ali E, Sorvari A, Briggs S, Wilson C, Robertson HL, Roberts D, Kirkpatrick A, Zeiler F, Unger B, Gillman L, Alhadhrami B, Elhusseini M, Alhalbboubi M, Abdulla M, Chughtai T, Fata P, Khwaja K, Razek T, Beckett A, Sne N, Rice J, Reid S, Li J, Baillie F, Somers A, Robinson T, Boone A, Sandhu N, Wishart I, Saint-Vil D, Crevier L, Beaudinn M, Moore L, Moore L, Lavoie A, Nshimyumukiza L, Turgeon A, Bourgeois G, Lapointe J, Cisse B, Duplantie J, Tran A, Margie O, Yelle JD, Pagliarello G, Lampron J, Grenier T, Lampron J, Bakry H, Malla A, Faidi S, Coates A, Engels P, Neto AC, DaCosta LD, Inaba K, Rhind S, Nascimento B, Rizoli S, Moffat B, Leeper W, Charyk-Stewart T, Malthaner R, Gray D, Parry N, Pena CES, Tien H, Nathens A, Nascimento B, Parry N, Sothilingam N, Vogt K, Moffat B, Gray D, Batey B, Charyk-Stewart T, Sovari A, Henry S, Nascimento B, Rizoli S, Marley R, Salvator A, Yetmar Z, Horattas I, Erck D, Landry BA, Coates A, Patlas M, Tien H, LaPorta A, McKee J, Wright-Beatty H, Keillorn J, Brien S, Roberts D, Wong J, Beckett A, Mador B, Ball C, Louw D, McKee I, McKee J, Panebianco N, Parfitt RJ, Roberts D, Hamilton D, Sevcik B, Lampron J, Waggott M, Stelfox HT, Boyd J, Erdogan M, Widder S, Butler M, Kureshi N, Martin K, Green R, Fasanya C, Barrett N, Cyr K, Camorlinga P, Quigley S, Kureschi N, Erdogan M, Butler M, Kureshi N, Erdogan M, Butler M, Kureshi N, Erdogan M, Longsetty S, Jian D, Fergusson D, Turgeon A, McIntyre L, Kovacs G, Griesdale D, Butler M, McLeod S, Klingel M, Van Aarsen K, Franc J, Peddle M, Fergusson D, Turgeon A, McIntyre L, Kovacs G, Griesdale D, Butler M, Gupta A, Wells B, Dixon E, Ball C, Moore L, Rajaram K, Froese P, Erdogan M, Green R, Younus M, Torres D, Widom K, Leonard D, Baro S, Dove J, Blansfield J, Shabahang M, Timmons S, Wild J, McFaull S, Beaudin M, Saint-Vil D, Torres D, Widom K, Leonard D, Baro S, Dove J, Blansfield J, Shabahang M, Wild J, Friese R, Rhee P, Veercruysse G, Joseph B, Wang A, Coates A, Pelletier H, Calligan D, Amath A, Knight H, Lampron J, Brindley P, Paton-Gay D, Engels P, Park J, Widder S, Fasanya C, Snider C, Barrett N, Cheng A, Mikrogianakis A, Dhanani S, Bhanji F, Lalani A, Al-Harthi F, Mehta S, Wolf S, Arnoldo B, Kowalske K, Phelan H, Benjamin S, Hogan A, Woodford S, Watson I, Woodford S, Watson I, Hogan A, Woodford S, Chisholm A, Louis R, St. Pierre E, Louis R, Woodford S, Watson I, Atkinson P, Mekwan J, Verheul G, Lewis D, Hayre J, French J, Watson I, Benjamin S, Fraser J, Chisholm A, Sealy B, Erdogan M, Green R, Atkinson P, Hayre J, French J, Watson I, Benjamin S, Fraser J, Chisholm A, Sealy B, Erdogan M, Green R, Atkinson P, El-Menyar A, Consunji R, Zarour A, Abdulrahman H, Parchani A, Peralta R, Cyr CE, Arbour C, Gosselin N, Marcotte K, Johnson A, Rice T, Rice J, Passos E, Fan J, Baillie F, Jichici D, Healey A, Consunji R, El Menyar A, Shaltout H, Abdi H, Tarakieh H, Abdulrahman H, Parchani A, Zarour A, Al Thani H, Deckelbaum D, Grenier T, Razek T, Boniface R, Museru L, Lalande A, Deckelbaum D, Razek T, Deckelbaum D, Grenier T, Razek T, Marcoux J, Maleki M, Deckelbaum D, Razek T, Canestrini S, Tuma M, McFarlan A, Neto JR, Veigas P, Rizoli S, Belmont CCG, Moore L, Tardif PA, Dufresne P, Bonaventure PL, McFarlan A, Veigas P, Neto JR, Rizoli S, Lakha N, Simons R, Ramsey D, Hameed M, Nicol A, Spence R, Navsaria P, Lakha N, Hussein Z, Wong H, Martinez R, Shangguan E, Asselstine J, Nascimento B, Brenneman F, Alhadhrami B, Bracco D, Razek T, Grush J, Vogt K, Ahghari M, Parry N, MacDonald R, Gray D, Iqbal S, Fong N, Grushka J, Deckelbaum D, St-Laurent L, Eckert E, Razek T, Khwaja K, Boniface R, Munthali V, Bracco D, Deckelbaum D, Museru L, Razek T, Kirkpatrick A, Roberts D, Doig C, Alhinai F, Xiao J, Kortbeek J, Rizoli S, Perez A, Shek P, Grodecki R, Veigas P, Peng H, Fraser J, Pishe T, Middeton J, Chisholm A, Benjamin S, Watson I, Atkinson P, Stewart TC, Penney A, McLeod S, Klingel M, Van Aarsen K, Hedges C, Dukelow A, Bradford P, Levy D, Kirkpatrick A, Doig C, Roberts D, Xiao J, Al Rawahi A, Keenan A, Waggott M, Lally S, Xiao J, Rados A, Williams A, Vis C, Perlman R, Callum J, Nascimento B, Tien H, Keenan A, Knight H, Tien H, Wright-Beatty H, Keillor J, LaPorta A, Brien S, Roberts D, Ball C, Louw D, Kirkpatrick A, Garraway N, Smith T, Simons R, Hameed M, Ball C, Roberts D, Filips D, Kirkpatrick A, Mckee I, Bouclin M, Atkinson I, Roberts D, McKee I, Kirkpatrick A, Tien H, Alam A, Nathens A, Nascimento B, Kim G, Putnam B, de Virgilio C, Maciel J, Neville A, Bongard F, Bricker S, Plurad D, Tze N, Odenbach J, Grokiert R, Falconer C, Courchesne C, Campbell S, Newton A, Moore L, Clement J, Falconer C, Sevcik B, VanRiper L, Wilkes H, Hussein A, Newton A, Alisc E, Hoysted C, Landolt M, Parri N, Lytle M, Stanley R, Kharbanda A, Babl F, Kassam-Adams N, Fichter K, Rao J, Harris Y, Nahachewsky D, Rao J, Parry N, Batey B, Fleiszer T, Fraser DD, Klassen B, Waggott M, Briereley Y, McMillan J, Robinson S, Williams D, Wild J, Widder S, Qosa H, Khwaja K, Razek T, Perez A, Rizoli S, Trpcic S, Adhikari N, Lamontagne F, Cumyn A, Burns K, Scales D, Duffett M, Henry B, McFarlan A, Zakrison T, Young A, MacKinnon D, Dainty K, Denbok J, Mcgowan M, Blight A, Bakker A, Barratt L, Butorac E, Gaunt K, Gawaziuk J, Lim S, Chateau D, Khan S, Doupe M, Sareen J, Sekhon M, Hameed M, Schuurman N, Dodek P, Ayas N, Vu E, Griesdale D, Rhind S, Hassan S, Perez A, Topolovec-Vranic J, Da Luz LT, Kenjilnaba, Neto AC, Trpcic S, Da Costa LD, Baker A, Rizoli S, Appel J, Lyster K, Grushka J, Hassan ME, Baabsail A, Khwaja K, Deckelbaum D, Razek T, Fata P, Ahmed N, Rotstein O, Rizoli S, Gao ZH, Duong M, Deckelbaum D, Razek T, Shum-Tim D, Khwaja K, Rizoli S, Abreu E, Rotstein O, Appel J, Fichter K, Abreu E, Machado C, Neto MP, Godinho J, Bernardes A, Rizoli S, Fry N, Liang M, Khwaja K, Brenneman F, Bleszynski M, Buczkowski A, Parry N, Martindale R, Evans D, Fraser S, Stephens M, Rao J, Kirkpatrick A, Knowlton L, Hameed M, Almansorri D, Mutiso V, Saleh A, Hawes H, Hogan J, Kromm J, Menon M, Benns M. Trauma Association of Canada Annual Scientific Meeting, Westin Calgary Calgary, Alberta, Apr. 10–11, 2015Outcomes and opportunities for improvement in self-inflicted blunt and penetrating traumaAbdominal compartment syndrome in the childActive negative pressure peritoneal therapy after abbreviated laparotomy: The intraperitoneal vacuum randomized controlled trialUse of a novel combined RFA/saline energy instrument for arresting ongoing hemorrhage from solid organ injuriesHealth care costs of burn patients from homes without fire sprinklersPenetrating trauma in eastern Ontario: a descriptive analysisThresholds of rotational thrombelastometry (ROTEM) used for the diagnosis and management of bleeding trauma patients: a systematic reviewA quality indicator to measure hospital complications for injury admissionsThromboelastography (TEG) in the management of trauma: implications for the developing worldPotential role of the rural trauma team development course (RTTDC) in the United Arab Emirates (UAE)Applicability of the advanced disaster medical response (ADMR) course, Trinidad and TobagoInflammatory mediators in intra-abdominal sepsis or injury: a scoping reviewEvaluation of the online Concussion Awareness Training Toolkit (CATT) for parents, players and coachesUltrasound assessment of optic nerve sheath diameter (ONSD) in healthy volunteersThe benefits of epidural analgesia in flail chest injuriesMandatory reporting rates of injured alcohol-impaired drivers with suspected alcohol dependence in a level 1 Canadian trauma centre: a single institution’s experienceSimulation implementation in a new pediatric residency program in Haiti: trauma specificsManagement of skull fractures in children younger than 1 year of ageResource use in patients who have sustained a traumatic brain injury within an integrated Canadian trauma system: a multicentre cohort studyResource use intensity in a mature, integrated Canadian trauma system: a multicentre cohort studyRates and determinants of unplanned emergency department visits and readmissions within 30 days following discharge from the trauma service — the Ottawa Hospital experienceAlcohol — screening, brief intervention and referral to treatment (SBIRT): Is it readily available in Canadian trauma centres?Management of traumatic occult hemothorax: a survey among trauma providers in CanadaAn audit of venous thromboembolism prophylaxis: a quality assurance project at our level 1 trauma centreCatecholamines as outcome markers in traumatic brain injuryAre we missing the missed injury? The burden of traumatic missed injuries diagnosed after hospital dischargeThe use of fibrinogen concentrate in trauma: a descriptive systematic reviewVery early initiation of chemical venous thromboembolism prophylaxis after solid organ injury is safe: a call for a national prospective multicentre studyThe 2 student to 1 faculty (2:1) model of teaching the Advanced Trauma Operative Management (ATOM) courseTrauma transfusion in the elderlyCocaine and benzodiazepines are more predictive of an injury severity score greater than 15 compared to alcohol or tetrahydrocannabinol in trauma patients under 18 years oldAre we missing traumatic bowel and mesenteric injuries?The marriage of surgical simulation and telementoring for damage control surgical training of operational first-respondersAdding remote ultrasound control to remote just-in-time telementored trauma ultrasound: a pilot studyDescriptive analysis of morbidity and mortality associated with falls at a level 1trauma centreDevelopment of an ICU transition questionnaire: evaluating the transfer process from ICU, ward, and patient/family stakeholder perspectivesUse of IO devices in trauma: A survey of trauma practitioners in Canada, Australia and New ZealandTime to reversal of medication-induced coagulopathy in traumatic intracranial hemorrhageMeta-analysis of randomized control trials of hospital based violence interventions on repeat intentional injuryBlunt injury of a horseshoe kidney, case report and review of the literatureLegal consequences for alcohol-impaired drivers involved in motor vehicle collisions: a systematic reviewA characterization of major adult sport-related trauma in Nova Scotia, 2000–2013Is hockey the most dangerous pediatric sport? An evaluation of pediatric sport-related injuries treated in Nova ScotiaInterim results of a pilot randomized control trial of an ED-based violence intervention programPre-intubation resuscitation by Canadian physicians: results of a national surveyFirst-responder accuracy using SALT during mass-casualty incident simulationEmergent endotracheal intubation: medications and device choices by Canadian resuscitation physicians“Oh the weather outside is frightful”: Severe injury secondary to falls while installing residential Christmas lightsCan we speak the same language? Understanding Quebec’s inclusive trauma systemAn unusual segmental clavicle fracture treated with titanium elastic nailImpact of the age of stored blood on trauma patient mortality: a systematic reviewInterhospital transfer of traumatic brain injury: utilization of helicopter transportCheerleading injuries: a Canadian perspectivePre-hospital mode of transport in a rural trauma system: air versus groundAnalysis of 15 000 patient transfers to level 1 trauma centre: Injury severity does not matter — just drive, drive, drive!The effects of legislation on morbidity and mortality associated with all-terrain vehicle and motorcycle crashes in Puerto RicoAssessing how pediatric trauma patients are supported nutritionally at McMaster Children’s HospitalOutcomes of conservative versus operative management of stable penetrating abdominal traumaS.T.A.R.T.T. — Evolution of a true multidisciplinary trauma crisis resource management simulation courseDevelopment of criteria to identify traumatic brain injury patients NOT requiring intensive care unit monitoringAssigning costs to visits for injuries due to youth violence — the first step in a cost-effectiveness analysisThere’s no TRIK to it — development of the Trauma Resuscitation in Kids courseResilient despite childhood trauma experiencesA five-year, single-centre review of toxic epidermal necrolysis managementAll in the family: creating and implementing an inclusive provincial trauma registryLessons learned from a provincial trauma transfer systemThe NB Trauma Program: 5 years laterProvincial coordination of injury prevention: the New Brunswick (NB) experienceImproving access and uptake of trauma nursing core course (TNCC): a provincial approachULTRASIM: ultrasound in trauma simultation. Does the use of ultrasound during simulated trauma scenarios improve diagnostic abilities?Traumatic tale of 2 cities, part 1: Does being treated by different EMS affect outcomes in trauma patients destined for transport to level 1 trauma centres in Halifax and Saint John?Traumatic tale of 2 cities, part 2: Does being treated by different hospitals affect outcome in trauma patients destined for transport to Level 1trauma centres in Halifax and Saint John?Protective devices use in road traffic injuries in a developing countryFunctional and anatomical connectivity and communication impairments in moderate to severe traumatic brain injuryCaring and communicating in critical cases: Westlock trauma form, a resource for rural physiciansMonitoring of ocular nerve sheath in traumatic raised intracranial pressure (Moonstrip Study): a prospective blinded observational trialEstablishing an alcohol screening and brief intervention for trauma patients in a multicultural setting in the Middle East: challenges and opportunitiesThe poor compliance to seat belt use in Montréal: an 18 461 road user iPhone-based studyAn iPad-based data acquisition for core trauma registry data in 6 Tanzanian hospitals: 1 year and 13 462 patients later“The Triple-Q Algorithm”: a practical approach to the identification of liver topographyA pan-Canadian bicycle helmet use observational studyDoor to decompression: the new benchmark in trauma craniotomiesAre missed doses of pharmacological thromboprophylaxis a risk factor for thromboembolic complications?Complications following admission for traumatic brain injuryExcessive crystalloid infusion in the first 24 hours is not associated with increased complications or mortalitySBIRT: plant, tend, growReal time electronic injury surveillance in an African trauma centreSBIRT in concert: establishing a new initiativeReview of the current knowledge of the pathophysiology of acute traumatic coagulopathy: implications for current trauma resuscitation practicesFactors associated with primary fascial closure rates in patients undergoing damage control laparotomyFree intraperitoneal fluid on CT abdomen in blunt trauma: Is hospital admission necessary?The need for speed — the time cost of off-site helipadsEndovascular management of penetrating Zone III retroperitoneal injuries in selective patients: a case reportMeasured resting energy expenditure in patients with open abdomens: preliminary data of a prospective pilot studyTraumatic inferior gluteal artery pseudoaneurysm: case report and review of literaturePancreatico duodenectomy, SMA, SMV repair and delayed reconstruction following blunt abdominal trauma. A case report with discussion of trauma whipple and complex pancreatico duodenal injuriesA retrospective evaluation of the effect of the Trauma Team Training program in TanzaniaDoes procalcitonin measurement predict clinical outcomes in critically ill/injured adults managed with the open abdomen technique?In trauma, conventional ROTEM and TEG results are not interchangeable but are similar in clinical applicabilitySevere trauma in the province of New Brunswick: a descriptive epidemiological studyPartnering for success — a road safety strategy for London and regionEvaluation of a patient safety initiative of rapid removal of backboards in the emergency departmentActive negative pressure peritoneal therapy and C-reactive protein levels after abbreviated laparotomy for abdominal trauma or intra-abdominal sepsisA comparison of outcomes: Direct admissions vs. interhospital transfers April 2009–March 2014YEE HA or YEE OUCH! A 5-year review of large animal-related incidentsEarly goal-directed therapy for prevention of hypothermia-related transfusion, morbidity and mortality in severely injured trauma patientsImproving care of adolescent trauma patients admitted to adult trauma centres by fostering collaboration between adult and pediatric partnersExpediting operational damage control laparotomy closure: iTClam v. suturing during damage control surgical simulation trainingAre conventional coagulation tests inadequate in the assessment of acute traumatic coagulopathy?Predictors of long-term outcomes in patients admitted to emergency general surgery services: a systematic review of literatureUse of the iTClamp versus standard suturing techniques for securing chest tubes: A randomized cadaver studyiTClamp application for control of simulated massive upper extremity arterial hemorrhage by tactical policeAssessing performance in the trauma roomThe deadly need for methadone/opiate educationTrends in the management of major abdominal vascular injuries: 2000–2014Addressing high school seniors’ risky behaviours through a hospital-based and peer teaching outreach programScreening for risk of post-traumatic stress disorder after injury in acutely injured children: a systematic reviewThe impact of trauma centre designation levels on surgical delay, mortality and complications: a multicentre cohort studyHow many acutely injured children report subsequent stress symptoms?The frequency of coagulopathy and its significance in an emergency neurotrauma facilityPsychosocial care for injured children: The views of 2500 emergency department physicians and nurses from around the worldDevelopment of the Trauma Electronic Document (TED)Development of trauma team activation criteria for an urban trauma centreBrains and brawn: evaluation of a sports skills and concussion awareness campRegional trauma networks: a tale of 2 pilotsContinuous data quality improvement in a provincial trauma registryDoes the Rural Trauma Team Development Course shorten transfer time?Epidemiology of trauma in Puerto RicoCT scans facilitate early discharge of trauma patientsFeasibility of data collection in a conflict zone to assess the impact on emergency health care deliveryConsent for Emergency Research (CONfER): a national survey of Canadian research ethics board practicesMaking handover safer for our trauma patients through the lens of trauma team leadersChallenges and opportunities to improve trauma transitions of care from emergency to intensive care nursingPhysical disorder following major injury: a population-based studyToward an inclusive trauma system: regional trauma system development in OntarioTraumatic brain injury in British Columbia: current incidence, injury patterns and risk factorsAcute cytokine and chemokine profiles in brain-injured patients: relationship to sympathetic activation and outcomeMultidisciplinary trauma simulation training in a tertiary care centreNon-operative management of blunt splenic injuries: routine radiologic follow-up may reduce the time of activity restrictionModified triple layer peritoneal-aponeurotic transposition: a new strategy to close the open abdomenMesenchymal stem cells locate and differentiate to the trauma site in a blunt rat liver trauma model: preliminary resultsThree indications for the “open abdomen”, anatomical, logistical and physiological: How are they different?Development of an urban trauma centre using lean methodologyThe impact of standardized care in 191 patients with chest tube thoracostomyComplex abdominal wall reconstruction: recommendations from the Canadian Abdominal Wall Reconstruction GroupCompensatory behaviours and cognitions in persons with history of traumaDevelopment of the Kenyatta National Hospital — University of Alberta Orthopedic Trauma Assessment Tool: phase 1 resultsRisk-taking behaviour negatively affects outcome in burn patients. Can J Surg 2015. [DOI: 10.1503/cjs.003415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Mahmood S, Parchani A, El-Menyar A, Zarour A, Al-Thani H, Latifi R. Utility of bispectral index in the management of multiple trauma patients. Surg Neurol Int 2014; 5:141. [PMID: 25317356 PMCID: PMC4192905 DOI: 10.4103/2152-7806.141890] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 07/02/2014] [Indexed: 11/23/2022] Open
Abstract
Background: Bispectral index (BIS) monitoring in multiple trauma patients has become a common practice in monitoring the sedation levels. We aimed to assess the utility of BIS in the trauma intensive care unit (ICU). Methods: A prospective observational study was conducted in the trauma ICU at Hamad General Hospital in Qatar between 2011 and 2012. Patients were divided in two groups: Group I (without BIS monitoring) and Group II (with BIS monitoring). The depth of sedation was clinically evaluated with Ramsey Sedation Scale, changes in vital signs and Glasgow Coma Scale (GCS) level. Use of sedatives, analgesics, and muscle relaxants were also recorded. Data were compared using Chi-square and Student t-tests. Results: A total of 110 mechanically ventilated trauma patients were enrolled with a mean age of 36 ± 14 years. The rate of head injury was greater in Group I when compared with Group II (94% vs. 81%, P = 0.04). In comparison to Group I, patients in Group II had lower GCS and higher mean Injury Severity Score (ISS) (6.3 ± 2.5 vs. 7.4 ± 2.7 and 25.5 ± 8.5 vs. 21.2 ± 4.7, respectively, P = 0.03). The used midazolam dose was less in Group II in comparison to Group I (5.2 ± 2.3 vs. 6.1 ± 2.1, P = 0.03). Also, fentanyl dose was less in Group II (152 ± 58 vs. 187 ± 59, P = 0.004). The rate of agitation, failure of extubation and tracheostomy in Group II were lower than those in Group I, P = 0.001. The length of stay for patients Group I was longer (14.6 ± 7.1 vs. 10.2 ± 5.9 days) in comparison to group II, P = 0.001. Conclusion: Management of multiple trauma patients in the trauma ICU with BIS monitoring was found to be associated with better outcomes. BIS monitoring is a guide for adjusting the dosage of sedative agents. It can also minimize agitation, failure of extubation, and length of stay in ICU.
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Affiliation(s)
- Saeed Mahmood
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ashok Parchani
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Clinical Research, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar ; Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | - Ahmad Zarour
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Rifat Latifi
- Department of Surgery, University of Arizona, Tucson, AZ, USA
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El-Menyar A, Abdelrahman H, Al-Thani H, Zarour A, Parchani A, Peralta R, Latifi R. Compartmental anatomical classification of traumatic abdominal injuries from the academic point of view and its potential clinical implication. J Trauma Manag Outcomes 2014; 8:14. [PMID: 25332723 PMCID: PMC4202251 DOI: 10.1186/1752-2897-8-14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 09/12/2014] [Indexed: 11/14/2022]
Abstract
Background The mechanism and outcome of traumatic abdominal injury (TAI) varies worldwide. Moreover, data comparing TAIs in each abdominal compartment are lacking. We aimed to assess from the academic point of view, TAI based on its anatomical compartments. Patients & methods We conducted a retrospective study for TAI patients between 2008 and 2011 in Qatar. Patients were categorized according to the involved anatomical compartment (C): intrathoracic (ITC), retroperitoneal (RPC), true abdomen (TAC), and pelvic abdomen (PAC) group. Chi Square test, One-Way ANOVA and multivariate regression analysis were appropriately performed. Results Of 6,888 patients admitted to the trauma unit, 1,036 (15%) had TAI that were grouped as ITC (65%), RPC (15%), TAC (13%), and PAC (7%). The mean age was lowest in ITC (29 ± 13) and highest in TAC (34 ± 11) group, (P = 0.001). Motor vehicle crash was the main mechanism of injury in all groups except for PAC, in which fall dominated. Vast majority of expatriates had PAC and TAC injuries. The main abdominal injuries included liver (35%; ITC), spleen (32%; ITC) and kidneys (18%; RPC). Extra-abdominal injuries involved the head in RPC and ITC, lung in ITC and RPC and extremities in PAC. Mean ISS was higher in RPC and ITC. Abdominal AIS was higher in TAC injuries. Overall hospital mortality was 10%: RPC (15%), TAC (11%), ITC (9.4%) and PAC (1.5%). Concurrent traumatic brain injury (OR 5.3; P = 0.001) and need for blood transfusion (OR 3.03; P = 0.003) were the main independent predictors of mortality. Conclusion In addition to its academic value, the anatomical approach of TAI would be a complementary tool for better understanding and prediction of the pattern and outcome of TAI. This would be possible if further research find accurate, early diagnostic tool for this anatomical classification.
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Affiliation(s)
- Ayman El-Menyar
- Clinical Research Unit, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar ; Clinical Medicine, Weill Cornell Medical School, Doha, Qatar ; Internal Medicine, Ahmed Maher teaching Hospital, Cairo, Egypt
| | | | - Hassan Al-Thani
- Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahmad Zarour
- Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ashok Parchani
- Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Rifat Latifi
- Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar ; Department of Surgery, University of Arizona, Tucson, AZ, USA
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El-Hennawy H, El-Menyar A, Al-Thani H, Tuma M, Parchani A, Abdulrahman H, Peralta R, Asim M, Zarour A, Latifi R. Epidemiology, causes and prevention of car rollover crashes with ejection. Ann Med Health Sci Res 2014; 4:495-502. [PMID: 25221693 PMCID: PMC4160669 DOI: 10.4103/2141-9248.139279] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Rollover crashes (ROCs) are responsible for almost a third of all highway vehicle occupant fatalities. Although ROCs are common and serious mechanism of injury, ROCs are under-reported. To analyze the causes, mechanism, impact and prevention of ROCs, we reviewed the literature between 1984 and 2013. By utilizing the search engines PubMed, MEDLINE and EMBASE by using key words “ROCs” “Ejection” and “vehicle” the initial search yielded 241 abstracts, of which 58 articles were relevant. Most of the articles were either retrospective or experimental studies funded by automobile companies. All vehicles are susceptible to rollovers to certain extents. Despite continuing innovation in vehicles’ safety, human factor is pivotal in prevention of ROCs. Distracted driving, speeding and drinking escalate the chances of rollover crashes. Wearing a seatbelt greatly improves the chances of surviving a ROC.
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Affiliation(s)
- Hm El-Hennawy
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - A El-Menyar
- Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar ; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - H Al-Thani
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - M Tuma
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - A Parchani
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - H Abdulrahman
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - R Peralta
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - M Asim
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - A Zarour
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - R Latifi
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar ; Department of Surgery, Arizona University, Tucson, AZ, USA
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El-Menyar A, El-Hennawy H, Al-Thani H, Asim M, Abdelrahman H, Zarour A, Parchani A, Peralta R, Latifi R. Traumatic injury among females: does gender matter? J Trauma Manag Outcomes 2014; 8:8. [PMID: 25089153 PMCID: PMC4118222 DOI: 10.1186/1752-2897-8-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/22/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Trauma remains one of the leading causes of morbidity and mortality worldwide. Generally, the incidence of traumatic injuries is disproportionately high in males. However, trauma in females is underreported. AIM To study the epidemiology and outcome of different mechanisms and types of traumatic injuries in women. METHODS We conducted a traditional narrative review using PubMed, MEDLINE and EMBASE, searching for English-language publications for gender-specific trauma between January 1993 and January 2013 using key words "trauma", "gender", "female" and "women". RESULTS Among 1150 retrieved articles, 71 articles were relevant over 20 years. Although it is an important public health problem, traumatic injuries among females remain under-reported. CONCLUSION There is a need for further research and evaluation of the exact burden of traumatic injuries among females together with the implementation of effective community based preventive programs.
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Affiliation(s)
- Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, PO Box 3050, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
- Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | | | | | - Mohammad Asim
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | | | - Ahmad Zarour
- Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Ashok Parchani
- Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Rifat Latifi
- Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
- Department of Surgery, Arizona University, Tucson, AZ, USA
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Tuma M, El-Menyar A, Abdelrahman H, Al-Thani H, Zarour A, Parchani A, Khoshnaw S, Peralta R, Latifi R. Prehospital intubation in patients with isolated severe traumatic brain injury: a 4-year observational study. Crit Care Res Pract 2014; 2014:135986. [PMID: 24527211 PMCID: PMC3914516 DOI: 10.1155/2014/135986] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 10/08/2013] [Accepted: 10/19/2013] [Indexed: 11/17/2022] Open
Abstract
Objectives. To study the effect of prehospital intubation (PHI) on survival of patients with isolated severe traumatic brain injury (ISTBI). Method. Retrospective analyses of all intubated patients with ISTBI between 2008 and 2011 were studied. Comparison was made between those who were intubated in the PHI versus in the trauma resuscitation unit (TRU). Results. Among 1665 TBI patients, 160 met the inclusion criteria (105 underwent PHI, and 55 patients were intubated in TRU). PHI group was younger in age and had lower median scene motor GCS (P = 0.001). Ventilator days and hospital length of stay (P = 0.01 and 0.006, resp.) were higher in TRUI group. Mean ISS, length of stay, initial blood pressure, pneumonia, and ARDS were comparable among the two groups. Mortality rate was higher in the PHI group (54% versus 31%, P = 0.005). On multivariate regression analysis, scene motor GCS (OR 0.55; 95% CI 0.41-0.73) was an independent predictor for mortality. Conclusion. PHI did not offer survival benefit in our group of patients with ISTBI based on the head AIS and the scene motor GCS. However, more studies are warranted to prove this finding and identify patients who may benefit from this intervention.
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Affiliation(s)
- Mazin Tuma
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital (HGH), P.O. Box 3050, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Section of Trauma Surgery, HGH, P.O. Box 3050, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical School, P.O. Box 24144, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital (HGH), P.O. Box 3050, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital (HGH), P.O. Box 3050, Doha, Qatar
| | - Ahmad Zarour
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital (HGH), P.O. Box 3050, Doha, Qatar
| | - Ashok Parchani
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital (HGH), P.O. Box 3050, Doha, Qatar
| | - Sherwan Khoshnaw
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital (HGH), P.O. Box 3050, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital (HGH), P.O. Box 3050, Doha, Qatar
| | - Rifat Latifi
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital (HGH), P.O. Box 3050, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical School, P.O. Box 24144, Doha, Qatar
- Department of Surgery, University of Arizona, P.O. Box 245005, Tucson, AZ, USA
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24
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Latifi R, El-Menyar A, Al-Thani H, Zarour A, Parchani A, Abdulrahman H, Asim M, Peralta R, Consunji R. Traffic-related pedestrian injuries amongst expatriate workers in Qatar: a need for cross-cultural injury prevention programme. Int J Inj Contr Saf Promot 2014; 22:136-42. [PMID: 24392875 DOI: 10.1080/17457300.2013.857693] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Qatar is a rapidly developing country in which expatriate workers constitute the majority of population. Also, Qatar is an example of right-sided road driving convention (RDC) country. The aim of our study is to analyse the traffic-related pedestrian injuries (TRPI) amongst expatriates in relation to RDC. A retrospective analysis of prospectively collected data of TRPI patients who were admitted to the only Level I trauma centre in Qatar between 2009 and 2011 was performed. Demographics, country of origin, time of injury, injury severity score (ISS), RDC, morbidity and mortality were analysed. Of the 4997 injured patients, 601 (12%) were pedestrians. Of these, 92% were expatriates. The mean age was 31.8 ± 17 and 64% of them were 18-45 years old. Mean ISS was higher in those who were injured on weekends (15.4 ± 10) in comparison to working days (13.5 ± 10) (p = 0.04). The overall mortality was 15%. Sixty-seven percent of those who died were from left RDC countries. Expatriate workers, originally from left RDC countries are disproportionately affected by TRPI. This group of injured patients requires focused injury prevention programmes that are culture and language appropriate.
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Affiliation(s)
- Rifat Latifi
- a Section of Trauma Surgery, Hamad General Hospital , Doha , Qatar
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25
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Parchani A, Peralta R, El-Menyar A, Tuma M, Zarour A, Kumar S, Abdulrahman H, AbdulRahman Y, Al-Thani H, Latifi R. Percutaneous dilatational tracheostomies in a newly established trauma center: a report from Qatar. Eur J Trauma Emerg Surg 2013; 39:507-10. [PMID: 26815448 DOI: 10.1007/s00068-013-0299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 05/19/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Percutaneous dilatational tracheostomy (PDT) is a routine surgical procedure for critically ill patients who require prolonged ventilatory support. METHODS We conducted a retrospective cohort study of all PDTs performed at the adult Trauma Intensive Care Unit (TICU) of Hamad Medical Corporation in Doha, Qatar, from January 2009 through September 2012. For all adult patients, we analyzed the demographic characteristics, mean ventilator time before the procedure, injury severity score (ISS), complications, and outcomes. RESULTS Of the 1,442 trauma patients admitted to the adult TICU during our study period, 124 (8.5 %) underwent PDT using the Ciaglia Blue Rhino technique. The vast majority were male (94.3 %). The mean age was 35 ± 15.6 years; mean ventilator time before the procedure, 12 ± 3 days; and mean ISS, 24.2 ± 9.3. More than half of patients had head injury (56 %), followed by chest and abdomen (26 %) and cervical spine injuries (18 %). Early complications included difficult tube placement (0.8 %), hypoxemia (0.8 %), minor bleeding (1.6 %), and hypotension (0.8 %), but the vast majority (93 %) of patients had no complications. The procedure-related mortality rate was 0 %. CONCLUSION PDT is safe and can be performed with minimal complications even in a newly established trauma center.
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Affiliation(s)
- A Parchani
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - R Peralta
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - A El-Menyar
- Weill Cornell Medical College, Doha, Qatar.,Clinical Research, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - M Tuma
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - A Zarour
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - S Kumar
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - H Abdulrahman
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Y AbdulRahman
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - H Al-Thani
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - R Latifi
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar. .,Weill Cornell Medical College, Doha, Qatar. .,Department of Surgery, University of Arizona, Tucson, AZ, USA.
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Parchani A, El-Menyar A, Al-Thani H, Tuma M, Zarour A, Abdulrahman H, Peralta R, Asim M, Latifi R. Recreational-related head injuries in Qatar. Brain Inj 2013; 27:1450-3. [DOI: 10.3109/02699052.2013.823664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mahmood I, Mahmood S, Parchani A, Kumar S, El-Menyar A, Zarour A, Al-Thani H, Latifi R. Intra-abdominal hypertension in the current era of modern trauma resuscitation. ANZ J Surg 2013; 84:166-71. [PMID: 23574113 DOI: 10.1111/ans.12169] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to determine the incidence and outcome of post-traumatic (PT) intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) after the advances in haemostatic resuscitation. METHODS This is a prospective cohort study from January 2009-December 2011 involving patients with PT haemorrhagic shock. Patients' demographics, fluid resuscitation (<24 h) and damage control laparotomy (DCL), morbidity and mortality were assessed. Patients were divided into group 1 (no DCL) and group 2 (DCL needed). Further, group 1 was subdivided into three subgroups (IA pressure (IAP) <12, 12-20 and >20 mmHg). RESULTS One hundred seventeen patients enrolled in the study (102 in group 1 and 15 in group 2) with a mean age of 35 ± 14, injury severity score (ISS) of 23 ± 10, base deficit of -8.7 ± 2.7 mmol/L, serum lactate of 4.6 ± 2.5 mg/dL and haemoglobin level of 8.8 ± 2. Patients received 7 ± 5 red blood cell units, 6 ± 4.7 fresh frozen plasma units and 8.3 ± 3 L of crystalloid per 24 h. There were significant difference between the two groups regarding crystalloid volume, blood transfusion, base deficit and intensive care unit length of stay. However, mortality was higher in group 2 (20% versus 6%). IAP ≥ 20 mmHg was reported in 16.7% patients, while 25.5% had IAP < 12 and 57.8% had IAP of 12-20 mmHg. Patients with IAP > 20 had worse metabolic acidosis and received more blood compared with other groups. One patient died because of ACS (0.9%). Overall multiorgan failure and mortality were 5 and 7.7%, respectively. CONCLUSION With current practice of minimal fluid resuscitation and liberal use of damage control strategies among trauma patients, the IAH was common transient phenomena but the incidence of ACS is remarkably low.
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Affiliation(s)
- Ismail Mahmood
- Trauma Intensive Care Unit, Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
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28
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El-Menyar A, Latifi R, AbdulRahman H, Zarour A, Tuma M, Parchani A, Peralta R, Al Thani H. Age and traumatic chest injury: a 3-year observational study. Eur J Trauma Emerg Surg 2013; 39:397-403. [DOI: 10.1007/s00068-013-0281-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 03/18/2013] [Indexed: 10/27/2022]
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El-Faramawy A, El-Menyar A, Zarour A, Maull K, Riebe J, Kumar K, Mathew J, Parchani A, Al-Thani H, Latifi R. Presentation and outcome of traumatic spinal fractures. J Emerg Trauma Shock 2012; 5:316-20. [PMID: 23248500 PMCID: PMC3519044 DOI: 10.4103/0974-2700.102381] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 04/10/2012] [Indexed: 11/09/2022] Open
Abstract
Background: Motor vehicle crashes and falls account for most of the spine fractures with subsequent serious disability. Aim: To define the incidence, causes, and outcome of spinal fractures. Materials and Methods: Data were collected retrospectively from trauma registry database of all traumatic spinal injuries admitted to the section of trauma surgery in Qatar from November 2007 to December 2009. Results: Among 3712 patients who were admitted to the section of trauma surgery, 442 (12%) injured patients had spinal fractures with a mean age of 33.2 ± 12 years. The male to female ratio was 11.6:1. Motor vehicle crashes (36.5%) and falls from height (19.3%) were the leading causes of cervical injury (P = 0.001). The injury severity score ranged between 4 and 75. Nineteen percent of cases with cervical injury had thoracic injury as well (P = 0.04). Lumber injury was associated with thoracic injury in 27% of cases (P < 0.001). Combined thoracic and lumber injuries were associated with cervical injury in 33% of cases (P < 0.001). The total percent of injuries associated with neurological deficit was 5.4%. Fifty-three cases were managed surgically for spine fractures; 14 of them had associated neurological deficits. Overall mortalityrate was 5%. Conclusions: Spine fractures are not uncommon in Qatar. Cervical and thoracic spine injuries carry the highest incidence of associated neurological deficit and injuries at other spinal levels. Young males are the most exposed population that deserves more emphasis on injury prevention programs in the working sites and in enforcement of traffic laws.
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Affiliation(s)
- Ahmed El-Faramawy
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
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El-Menyar A, Thani HA, Zakaria ER, Zarour A, Tuma M, AbdulRahman H, Parchani A, Peralta R, Latifi R. Multiple Organ Dysfunction Syndrome (MODS): Is It Preventable or Inevitable? ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ijcm.2012.37a127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Pyrexia is an elevation of body temperature above the normal range due to an increase in the hypothalamic thermoregulatory set point. Hyperpyrexia is an extreme elevation of body temperature equal to or greater than 41.5°C (106.7°F). (1) Malignant hyperpyrexia is a rare and idiopathic extreme elevation of core body temperature above 42°C characterized by the acute onset of hyperthermia, coagulopathy and shock. (2) It is potentially life-threatening and can rapidly progress to severe liver and renal impairment, acidosis and encephalopathy. Reported here is a case of malignant hyperpyrexia in a patient with injury of the cervical spine.
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Affiliation(s)
| | - S. Balakrishnan
- **Department of Anesthesia, Hamad Medical Corporation, Doha, Qatar
| | - A. Parchani
- *Trauma Surgery Section, Department of Surgery
| | - N. Sheikh
- *Trauma Surgery Section, Department of Surgery
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Abstract
Fat embolism syndrome (FES) is a serious clinical disorder occurring after trauma, orthopedic procedures and rarely in non-traumatic patients. Fat emboli develop in nearly all patients with bone fractures, but they are usually asymptomatic. Small number of patients develop signs and symptoms of various organ system dysfunction due to either mechanical obstruction of capillaries by fat emboli or due to hydrolysis of fat to fatty acids. A triad of lung, brain and skin involvement develop after an asymptomatic period of 24 to 72 hours. This symptom complex is called FES. The incidence reported is up to 30%, but many mild cases may recover unnoticed. Diagnosis of fat embolism is clinical with nonspecific, insensitive diagnostic test results. Treatment of fat embolism syndrome remains supportive and in most cases can be prevented by early fixation of large bone factures. Here we report two cases of traumatic fat embolism, which were diagnosed initially by Gurd's criteria and subsequently confirmed by typical appearance on magnetic resonance imaging (MRI) of the brain in these patients. These patients were successfully treated with supportive management. In conclusion, diagnosis of FES needs high index of suspicion, exclusion of other conditions and use of clinical criteria in combination with imaging. Magnetic resonance imaging of the brain is of great importance in diagnosis and management of these patients.
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Affiliation(s)
- Nissar Shaikh
- Department Anesthesia/ICU and Pain Management, Hamad Medical Corporation, Doha-Qatar.
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