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Siddiqui T, Peralta R, Ibnas M, El‐Menyar A, Al‐Thani H, Rizoli S. Pneumoscrotum with extensive subcutaneous emphysema in traumatic perineal injury: A case report. Clin Case Rep 2023; 11:e7932. [PMID: 38028111 PMCID: PMC10675100 DOI: 10.1002/ccr3.7932] [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: 08/18/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message We present a rare case of pneumoscrotum with subsequent subcutaneous emphysema in penetrating perineal injury with a tangential wound. It is important to diagnose the underlying disease and treat the cause. An examination under anesthesia is crucial for the diagnosis and management of the set of injuries. Abstract Pneumoscrotum with subcutaneous emphysema in traumatic perineal injuries is an alarming sign and may indicate life-threatening intraabdominal injuries or necrotizing fasciitis. We reported a case of pneumoscrotum and extensive subcutaneous emphysema of the abdomen and chest 2 days after admission. Pneumoscrotum was not seen on the initial Computerized tomographic scan.
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Affiliation(s)
- Tariq Siddiqui
- Department of Surgery, Trauma SurgeryHamad Medical CorporationDohaQatar
| | - Ruben Peralta
- Department of Surgery, Trauma SurgeryHamad Medical CorporationDohaQatar
- Department of SurgerySchool of Medicine Universidad Nacional Pedro Henríquez Ureña Santo DomingoSanto DomingoDominican Republic
| | - Muhamed Ibnas
- Department of Surgery, Trauma and Vascular Surgery, Clinical ResearchHamad Medical CorporationDohaQatar
| | - Ayman El‐Menyar
- Department of Surgery, Trauma and Vascular Surgery, Clinical ResearchHamad Medical CorporationDohaQatar
- Department of Clinical MedicineWeill Cornell Medical CollegeAr‐RayyanQatar
| | - Hassan Al‐Thani
- Department of Surgery, Trauma SurgeryHamad Medical CorporationDohaQatar
| | - Sandro Rizoli
- Department of Surgery, Trauma SurgeryHamad Medical CorporationDohaQatar
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Al-Thani H, El-Menyar A, Khan NA, Consunji R, Mendez G, Abulkhair TS, Mollazehi M, Peralta R, Abdelrahman H, Chughtai T, Rizoli S. Trauma Quality Improvement Program: A Retrospective Analysis from A Middle Eastern National Trauma Center. Healthcare (Basel) 2023; 11:2865. [PMID: 37958008 PMCID: PMC10649144 DOI: 10.3390/healthcare11212865] [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: 09/13/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The Trauma Quality Improvement Program (American College of Surgery (ACS-TQIP)) uses the existing infrastructure of the Committee on Trauma programs and provides feedback to participating hospitals on risk-adjusted outcomes. This study aimed to analyze and compare the performance of the Level I Hamad Trauma Centre (HTC) with other TQIP participating centers by comparing TQIP aggregate database reports. The primary goal was to pinpoint the variations in adult trauma outcomes and quality measures, identify areas that need improvement, and leverage existing resources to facilitate quality improvement. METHODS A retrospective analysis was performed for the TQIP data from April 2019-March 2020 to April 2020-March 2021. We used the TQIP methodology, inclusion and exclusion criteria, and outcomes. RESULTS There were 915 patients from Fall 2020 and 884 patients from Fall 2021 that qualified for the TQIP database. The HTC patients' demographics differed from the TQIP's aggregate data; they were younger, more predominantly male, and had significantly different mechanisms of injury (MOI) with more traffic-related blunt trauma. Penetrating injuries were more severe in the other centers. During the TQIP Fall 2020 report, the HTC was a low outlier (good performer) in one cohort (all patients) and an average performer in the remaining cohorts. However, during Fall 2021, the HTC showed an improvement and was a low outlier in two cohorts (all patients and severe TBI patients). Overall, the HTC remained an average performer during the report cycles. CONCLUSIONS There was an improvement over time in the risk-adjusted mortality, which reflects the continuous and demanding effort put together by the trauma team. The ACS-TQIP for the external benchmarking of quality improvement could be a contributor to better monitored patient care. Evaluating the TQIP data with emphases on appropriate methodologies, quality measurements, corrective measures, and accurate reporting is warranted.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar; (H.A.-T.); (R.C.); (G.M.); (T.S.A.); (M.M.); (R.P.); (H.A.); (T.C.); (S.R.)
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery Section, Hamad Medical Corporation, Doha 3050, Qatar;
- Department of Clinical Medicine, Weill Cornell Medicine, Doha 3050, Qatar
| | - Naushad Ahmad Khan
- Clinical Research, Trauma & Vascular Surgery Section, Hamad Medical Corporation, Doha 3050, Qatar;
| | - Rafael Consunji
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar; (H.A.-T.); (R.C.); (G.M.); (T.S.A.); (M.M.); (R.P.); (H.A.); (T.C.); (S.R.)
| | - Gladys Mendez
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar; (H.A.-T.); (R.C.); (G.M.); (T.S.A.); (M.M.); (R.P.); (H.A.); (T.C.); (S.R.)
| | - Tarik S. Abulkhair
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar; (H.A.-T.); (R.C.); (G.M.); (T.S.A.); (M.M.); (R.P.); (H.A.); (T.C.); (S.R.)
| | - Monira Mollazehi
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar; (H.A.-T.); (R.C.); (G.M.); (T.S.A.); (M.M.); (R.P.); (H.A.); (T.C.); (S.R.)
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar; (H.A.-T.); (R.C.); (G.M.); (T.S.A.); (M.M.); (R.P.); (H.A.); (T.C.); (S.R.)
- Department of Surgery, Universidad Nacional Pedro Henriquez Urena, Santo Domingo 10100, Dominican Republic
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar; (H.A.-T.); (R.C.); (G.M.); (T.S.A.); (M.M.); (R.P.); (H.A.); (T.C.); (S.R.)
| | - Talat Chughtai
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar; (H.A.-T.); (R.C.); (G.M.); (T.S.A.); (M.M.); (R.P.); (H.A.); (T.C.); (S.R.)
| | - Sandro Rizoli
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar; (H.A.-T.); (R.C.); (G.M.); (T.S.A.); (M.M.); (R.P.); (H.A.); (T.C.); (S.R.)
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Khoschnau S, Ramzee AF, El-Menyar A, Peralta R, Consunji R, Kloub A, Ajaj A, Abdelrahman H, Al-Thani H. Airbag-related penetrating injuries: A case series from a level 1 trauma center. Trauma Case Rep 2023; 47:100890. [PMID: 37592953 PMCID: PMC10429267 DOI: 10.1016/j.tcr.2023.100890] [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] [Accepted: 08/06/2023] [Indexed: 08/19/2023] Open
Abstract
Background Airbags have significantly reduced the morbidity and mortality associated with trauma following motor vehicle crashes. However, airbags can also be associated with unusual and complex patterns of injuries which could be fatal in some cases. Methods We collected data and described a series of six cases of penetrating injuries related to airbag deployment that were treated at the Hamad Trauma Center (HTC) of Hamad Medical Corporation which is the only level 1 trauma center in the country. Results The penetrating injuries were caused by a metal fragment from the inflator component of the airbag which acted as a projectile and was associated with two fatalities. Four of the victims were involved in head on collisions. Most injuries were directly attributable to the airbag projectile, and they occurred in vehicles that were 9 years or more since manufacture. Conclusion This case series would help the trauma healthcare providers to better understand the airbag-related injuries which influence the management approach for road traffic injuries associated with penetrating trauma. Also, it would bring attention to injury prevention teams as well as state and industrial authorities to reevaluate safety standards in vehicles. Sharing this information with local authorities who govern product safety standards and recalls is essential to ensure that more safety actions are taken to prevent further airbag deployment injuries.
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Affiliation(s)
- Sherwan Khoschnau
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed F. Ramzee
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Rafael Consunji
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Kloub
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Ajaj
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
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Peralta R, Strandvik GF. Post-Operative Analgesics Score, Another Tool in the Quest for a Better Pain Management. World J Surg 2023; 47:2444-2445. [PMID: 37400613 PMCID: PMC10474170 DOI: 10.1007/s00268-023-07101-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad General Hospital & Hamad Medical Corporation, Doha, Qatar.
- Department of Surgery, Universidad Nacional Pedro Henriquez Urena, School of Medicine, Santo Domingo, Dominican Republic.
| | - Gustav Frans Strandvik
- Department of Surgery, Trauma Surgery, Hamad General Hospital & Hamad Medical Corporation, Doha, Qatar
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Ramzee AF, Bakhsh Z, Peralta R, Rizoli S, El-Menyar A, Al-Thani H, Chughtai T. Traumatic lung laceration secondary to avulsed lung adhesion - A case report. Trauma Case Rep 2023; 46:100862. [PMID: 37347010 PMCID: PMC10279908 DOI: 10.1016/j.tcr.2023.100862] [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] [Accepted: 06/03/2023] [Indexed: 06/23/2023] Open
Abstract
Background Pulmonary lacerations caused by an avulsion force on an adhesion between the lung and chest wall following blunt thoracic injury are very rare. They may result in pneumothorax and/or hemothorax and may not be immediately apparent clinically or radiologically. Case presentation We present the case of a healthy 34-year-old male who sustained blunt thoracic injury. He was clinically stable, and his initial routine images were unremarkable. The patient was discharged home on the same day. He presented a week later with a massive hemothorax requiring surgical intervention which revealed bleeding from an avulsed adhesion between the lung and chest wall. Bleeding was successfully controlled by hemostatic agent, and the patient had an uneventful recovery. Conclusion Hemothorax requiring intervention from an avulsed adhesion may occur following blunt thoracic trauma. Initial imaging and clinical finding may be misleading. Close follow up and adequate patient education should be ensured prior to discharge following seemingly trivial trauma.
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Affiliation(s)
- Ahmed F. Ramzee
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Zeenat Bakhsh
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Sandro Rizoli
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ayman El-Menyar
- Trauma and Vascular Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar
- Clinical medicine, Weill Cornell Medical college, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Talat Chughtai
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of Surgery, Qatar University, Hamad Medical Corporation, Doha, Qatar
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Abdelrahman H, El-Menyar A, Peralta R, Al-Thani H. Application of indocyanine green in surgery: A review of current evidence and implementation in trauma patients. World J Gastrointest Surg 2023; 15:757-775. [PMID: 37342859 PMCID: PMC10277941 DOI: 10.4240/wjgs.v15.i5.757] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/18/2023] [Accepted: 03/27/2023] [Indexed: 05/26/2023] Open
Abstract
Background: Modern surgical medicine strives to manage trauma while improving outcomes using functional imaging. Identification of viable tissues is crucial for the surgical management of polytrauma and burn patients presenting with soft tissue and hollow viscus injuries. Bowel anastomosis after trauma-related resection is associated with a high rate of leakage. The ability of the surgeon’s bare eye to determine bowel viability remains limited, and the need for a more standardized objective assessment has not yet been fulfilled. Hence, there is a need for more precise diagnostic tools to enhance surgical evaluation and visualization to aid early diagnosis and timely management to minimize trauma-associated complications. Indocyanine green (ICG) coupled with fluorescence angiography is a potential solution for this problem. ICG is a fluorescent dye that responds to near-infrared irradiation. Methods: We conducted a narrative review to address the utility of ICG in the surgical management of patients with trauma as well as elective surgery. Discussion: ICG has many applications in different medical fields and has recently become an important clinical indicator for surgical guidance. However, there is a paucity of information regarding the use of this technology to treat traumas. Recently, angiography with ICG has been introduced in clinical practice to visualize and quantify organ perfusion under several conditions, leading to fewer cases of anastomotic insufficiency. This has great potential to bridge this gap and enhance the clinical outcomes of surgery and patient safety. However, there is no consensus on the ideal dose, time, and manner of administration nor the indications that ICG provides a genuine advantage through greater safety in trauma surgical settings. Conclusions: There is a scarcity of publications describing the use of ICG in trauma patients as a potentially useful strategy to facilitate intraoperative decisions and to limit the extent of surgical resection. This review will improve our understanding of the utility of intraoperative ICG fluorescence in guiding and assisting trauma surgeons to deal with the intraoperative challenges and thus improve the patients’ operative care and safety in the field of trauma surgery.
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Affiliation(s)
| | - Ayman El-Menyar
- Trauma and Vascular Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Ruben Peralta
- Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Hassan Al-Thani
- Trauma and Vascular Surgery, Hamad Medical Corporation, Doha 3050, Qatar
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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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Ramzee AF, Bakhsh ZK, Al Jogol H, Rizoli S, Peralta R, El-Menyar A, Al-Thani H, AlMadani A. Trouble in Tiger country: isolated traumatic pancreatic transection - a case report. J Surg Case Rep 2023; 2023:rjad071. [PMID: 36846847 PMCID: PMC9950715 DOI: 10.1093/jscr/rjad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/30/2023] [Indexed: 03/01/2023] Open
Abstract
Isolated pancreatic transection is a rare surgical condition that occurs more commonly following blunt abdominal trauma. It carries a high degree of morbidity and mortality, and the management remains a source of debate as universally accepted guidelines are not well established owing to the paucity in clinical experience and large series. We presented a case of an isolated pancreatic transection following blunt abdominal trauma. The surgical management of pancreatic transection has evolved over the decades from aggressive approaches to more conservative measures. Given the lack of large series and clinical experience, no universal consensus exists, except for applying damage control surgery and resuscitation principles in critically unstable patients. For transections of the main pancreatic duct, most recommend excision of the distal pancreas. Concerns over the iatrogenic complications of wide excisions, particularly diabetes mellitus, have led to reconsideration and more conservative approaches, but it may fail in some cases.
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Affiliation(s)
- Ahmed Faidh Ramzee
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Zeenat Khuda Bakhsh
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hisham Al Jogol
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sandro Rizoli
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ayman El-Menyar
- Correspondence address. Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital & Weill Cornell Medical College, Doha, Qatar. Tel: +97444396130; E-mail:
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ammar AlMadani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Alansari AN, Mekkodathil A, Peralta R, Baykuziyev T, Alhussaini NWZ, Asim M, El-Menyar A. Patterns, mechanism of injury and outcome of pediatric trauma at a level 1 trauma centre: a descriptive retrospective analysis. Front Pediatr 2023; 11:1084715. [PMID: 37187584 PMCID: PMC10175573 DOI: 10.3389/fped.2023.1084715] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Background There is a gap in knowledge on the epidemiology of pediatric trauma in the developing countries. We aimed to describe the injury pattern, mechanism of injury (MOI), and outcomes of pediatric trauma in a level 1 trauma centre in one of the Arab Middle Eastern countries. Methods A retrospective analysis of pediatric injury data was conducted. All trauma patients (<18 years old) requiring hospitalization between 2012 and 2021 were included. Patients were categorized and compared based on the MOI, age-group and injury severity. Results A 3,058 pediatric patients (20% of the total trauma admissions) were included in the study. The incidence rate in 2020 was 86 cases per 100,000 pediatric population in Qatar. The majority were male (78%) and the mean age was 9.3 ± 5.7 years. Nearly 40% had head injuries. The in-hospital mortality rate was 3.8%. The median injury severity score (ISS) (interquartile range; IQR) was 9 (4-14) and Glasgow coma scale (GCS) was 15 (IQR 15-15). Almost 18% required Intensive Care admission. Road Traffic Injuries (RTI) were more frequent in 15-18 years old whereas ≤4 years group was mostly injured by falling objects. The case fatality rate was higher among females (5.0%), and in 15-18 years (4.6%) and <4 years (4.4%) group. Pedestrian injuries were more lethal among the MOI. One fifth had severe injury with a mean age of 11 ± 6 and 9.5% had ISS of ≥25. Predictors of severe injury were age (10 years old and above) and RTI. Conclusion Almost one-fifth of the trauma admissions at the level 1 trauma centre in Qatar is due to traumatic injuries among the pediatric population. Developing strategies that are based on understanding the age- and mechanism-specific patterns of traumatic injuries among the pediatric population remains crucial.
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Affiliation(s)
- Amani N. Alansari
- Department of Pediatric Surgery & Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ahammed Mekkodathil
- Clinical Research, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ruben Peralta
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
- Department of Surgery, Universidad Nacional Pedro Henriquez Urena, Santo Domingo, Dominican Republic
| | - Temur Baykuziyev
- Department of Anesthesiology, ICU and Peri-operative Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohammad Asim
- Clinical Research, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- Correspondence: Ayman El-Menyar
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Consunji R, El-Menyar A, Hirani N, Abeid A, Al-Thani H, Hardan MS, Chauhan S, Kasem H, Peralta R. Work-related injuries in Qatar for 1 year: an initial report from the work-related injury unified registry for Qatar. Qatar Med J 2022; 2022:58. [PMID: 37064780 PMCID: PMC10100584 DOI: 10.5339/qmj.2022.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/11/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The Ministry of Public Health National Health Strategy 2018-2022 has recognized the need for accurate, updated, and representative data that truly reflects the occupational health and safety status in Qatar. In 2015, the Hamad Trauma Center received a research grant to create a unified registry for work-related injuries in Qatar [WURQ], whose processes and research findings have been reported earlier. This paper shall describe the findings from the initial 1-year collection of data on work-related injuries [WRIs] and deaths in Qatar for the year 2020 through the WURQ database. METHODS The WURQ database was queried for all WRIs from January 1 to December 31, 2020. These data were classified by date of injury, age, sex, nationality, mechanism of injury, severity of injury, location of medical consultation, and clinical outcome. RESULTS Out of a total worker population of 2,174,828 [2.29 occupational fatalities per 100,000 workers, there were 50 deaths caused by WRIs]. The majority of WRI deaths were in the prehospital setting [60%] with the majority of fatal injuries occurring at the worksite [64%] and 22% due to falls. Five hundred six workers sustained severe WRIs [23.26 severe occupational injuries per 100,000 workers], and 37,601 workers sustained mild to moderate WRIs [1,728.91 mild to moderate occupational injuries per 100,000 workers]. The severe WRIs were most commonly due to falls [226 out of 506] from height [45%] and falling heavy objects [80 out of 506] [16%]. Road traffic injuries [RTI] make up one-fourth [133 out of 506] of all severe WRIs. CONCLUSION WURQ has described WRIs in Qatar using a purpose-built and nationally linked occupational injury registry. Occupational injury and injury fatality statistics, for Qatar in 2020, are lower than or comparable with those from other high-income countries. This data can be used to inform worksite inspections, investigations, worker safety education, environmental improvements, and injury prevention programs to make Qatar safer for all its workers.
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Affiliation(s)
- Rafael Consunji
- Trauma and Vascular Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar. Email and ORCID ID: & https://orcid.org/0000-0002-9854-3585
| | - Ayman El-Menyar
- Trauma and Vascular Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar. Email and ORCID ID: & https://orcid.org/0000-0002-9854-3585
| | - Nazia Hirani
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar. Email and ORCID ID: & https://orcid.org/0000-0002-9854-3585
| | - Aisha Abeid
- Trauma and Vascular Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar. Email and ORCID ID: & https://orcid.org/0000-0002-9854-3585
| | - Hassan Al-Thani
- Trauma and Vascular Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar. Email and ORCID ID: & https://orcid.org/0000-0002-9854-3585
| | | | | | | | - Ruben Peralta
- Department of Surgery, Universidad Nacional Pedro Henriquez Urena, Santo Domingo, Dominican Republic
- Trauma and Vascular Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar. Email and ORCID ID: & https://orcid.org/0000-0002-9854-3585
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11
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Irfan FB, Consunji RIGDJ, Peralta R, El-Menyar A, Dsouza LB, Al-Suwaidi JM, Singh R, Castrén M, Djärv T, Alinier G. Comparison of in-hospital and out-of-hospital cardiac arrest of trauma patients in Qatar. Int J Emerg Med 2022; 15:52. [PMID: 36114456 PMCID: PMC9479227 DOI: 10.1186/s12245-022-00454-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Cardiac arrests in admitted hospital patients with trauma have not been described in the literature. We defined “in-hospital cardiac arrest of a trauma” (IHCAT) patient as “cessation of circulatory activity in a trauma patient confirmed by the absence of signs of circulation or abnormal cardiac arrest rhythm inside a hospital setting, which was not cardiac re-arrest.” This study aimed to compare epidemiology, clinical presentation, and outcomes between in- and out-of-hospital arrest resuscitations in trauma patients in Qatar. It was conducted as a retrospective cohort study including IHCAT and out-of-hospital trauma cardiac arrest (OHTCA) patients from January 2010 to December 2015 utilizing data from the national trauma registry, the out-of-hospital cardiac arrest registry, and the national ambulance service database. Results There were 716 traumatic cardiac arrest patients in Qatar from 2010 to 2015. A total of 410 OHTCA and 199 IHCAT patients were included for analysis. The mean annual crude incidence of IHCAT was 2.0 per 100,000 population compared to 4.0 per 100,000 population for OHTCA. The univariate comparative analysis between IHCAT and OHTCA patients showed a significant difference between ethnicities (p=0.04). With the exception of head injury, IHCAT had a significantly higher proportion of localization of injuries to anatomical regions compared to OHTCA; spinal injury (OR 3.5, 95% CI 1.5–8.3, p<0.004); chest injury (OR 2.62, 95% CI 1.62–4.19, p<0.00), and abdominal injury (OR 2.0, 95% CI 1.0–3.8, p<0.037). IHCAT patients had significantly higher hypovolemia (OR 1.66, 95% CI 1.18–2.35, p=0.004), higher mean Glasgow Coma Scale (GCS) score (OR 1.4, 95% CI 1.3–1.6, p<0.00), and a greater proportion of initial shockable rhythm (OR 3.51, 95% CI 1.6–7.7, p=0.002) and cardiac re-arrest (OR 6.0, 95% CI 3.3–10.8, p=<0.00) compared to OHTCA patients. Survival to hospital discharge was greater for IHCAT patients compared to OHTCA patients (OR 6.3, 95% CI 1.3–31.2, p=0.005). Multivariable analysis for comparison after adjustment for age and gender showed that IHCAT was associated with higher odds of spinal injury, abdominal injury, higher pre-hospital GCS, higher occurrence of cardiac re-arrest, and better survival than for OHTCA patients. IHCAT patients had a greater proportion of anatomically localized injuries indicating solitary injuries compared to greater polytrauma in OHTCA. In contrast, OHTCA patients had a higher proportion of diffuse blunt non-localizable polytrauma injuries that were severe enough to cause immediate or earlier onset of cardiac arrest. Conclusion In traumatic cardiac arrest patients, IHCAT was less common than OHTCA and might be related to a greater proportion of solitary localized anatomical blunt injuries (head/abdomen/chest/spine). In contrast, OHTCA patients were associated with diffuse blunt non-localizable polytrauma injuries with increased severity leading to immediate cardiac arrest. IHCAT was associated with a higher mean GCS score and a higher rate of initial shockable rhythm and cardiac re-arrest, and improved survival rates.
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12
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Scherer J, Coimbra R, Mariani D, Leenen L, Komadina R, Peralta R, Fattori L, Marzi I, Wendt K, Gaarder C, Pape HC, Pfeifer R. Standards of fracture care in polytrauma: results of a Europe-wide survey by the ESTES polytrauma section. Eur J Trauma Emerg Surg 2022:10.1007/s00068-022-02126-3. [PMID: 36227354 DOI: 10.1007/s00068-022-02126-3] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/01/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Fixation of major fractures plays a pivotal role in the surgical treatment of polytrauma patients. In addition to ongoing discussions regarding the optimal timing in level I trauma centers, it appears that the respective trauma systems impact the implementation of both, damage control and safe definitive surgery strategies. This study aimed to assess current standards of polytrauma treatment in a Europe-wide survey. METHODS A survey, developed by members of the polytrauma section of ESTES, was sent online via SurveyMonkey®, between July and November 2020, to 450 members of ESTES (European Society of Trauma and Emergency Surgery). Participation was voluntary and anonymity was granted. The questionnaire consisted of demographic data and included questions about the definition of "polytrauma" and the local standards for the timing of fracture fixation. RESULTS In total, questionnaires of 87 participants (19.3% response rate) were included. The majority of participants were senior consultants (50.57%). The mean work experience was 19 years, and on average, 17 multiple-injured patients were treated monthly. Most of the participants stated that a polytrauma patient is defined by ISS ≥ 16 (44.16%), followed by the "Berlin Definition" (25.97%). Systolic blood pressure < 90 mmHg, tachycardia or vasopressor administration (86.84%), pH deviation, base excess shift (48.68%), and lactate > 4 mmol (40.79%) or coagulopathy defined by ROTEM (40.79%) were the three most often stated indicators for shock. Local guidelines (33.77%) and the S-3 Guideline by the DGU® (23.38%) were mostly stated as a reference for the treatment of polytrauma patients. Normal coagulation (79.69%), missing administration of vasopressors (62.50%), and missing clinical signs of "SIRS" (67.19%) were stated as criteria for safe definite secondary surgery. CONCLUSION Different definitions of polytrauma are used in the clinical setting. Indication for and the extent of secondary (definitive) surgery are mainly dependent on the polytrauma patient`s physiology. The «Window of Opportunity» plays a less important role in decision making.
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Affiliation(s)
- Julian Scherer
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Raemistr. 100, 8091, Zurich, Switzerland.
| | - Raul Coimbra
- Riverside University Health System and Loma Linda University, Riverside, CA, USA
| | - Diego Mariani
- Department of Emergency General Surgery, Legnano Hospital, ASST Ovest Milanese, Legnano, MI, Italy
| | - Luke Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Radko Komadina
- Department of Traumatology, General and Teaching Hospital Celje, Medical Faculty Ljubljana University, 3000, Celje, Slovenia
| | - Ruben Peralta
- Surgical Department (Hamad General Hospital), Hamad Medical Corporation, HMC, Doha, Qatar
| | - Luka Fattori
- Department of Surgery, San Gerardo Hospital, University of Milan Bicocca, G.B. Pergolesi 33, Monza, Italy
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Klaus Wendt
- Department of Trauma Surgery, University Medical Center Groningen (UMCG), Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Christine Gaarder
- Department of Traumatology, Oslo University Hospital Ullevål, Kirkeveien 166, 0450, Oslo, Norway
| | - Hans-Christoph Pape
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Raemistr. 100, 8091, Zurich, Switzerland
| | - Roman Pfeifer
- Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Raemistr. 100, 8091, Zurich, Switzerland
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13
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Hietbrink F, Mohseni S, Mariani D, Naess PA, Rey-Valcárcel C, Biloslavo A, Bass GA, Brundage SI, Alexandrino H, Peralta R, Leenen LPH, Gaarder T. What trauma patients need: the European dilemma. Eur J Trauma Emerg Surg 2022:10.1007/s00068-022-02014-w. [PMID: 35798972 DOI: 10.1007/s00068-022-02014-w] [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: 02/25/2022] [Accepted: 05/23/2022] [Indexed: 11/03/2022]
Abstract
There is a need for implementation and maturation of an inclusive trauma system in every country in Europe, with patient centered care by dedicated surgeons. This process should be initiated by physicians and medical societies, based on the best available evidence, and supported and subsequently funded by the government and healthcare authorities. A systematic approach to organizing all aspects of trauma will result in health gain in terms of quality of care provided, higher survival rates, better functional outcomes and quality of life. In addition, it will provide reliable data for both research, quality improvement and prevention programs. Severely injured patients need surgeons with broad technical and non-technical competencies to provide holistic, inclusive and compassionate care. Here we describe the philosophy of the surgical approach and define the necessary skills for trauma, both surgical and other, to improve outcome of severely injured patients. As surgery is an essential part of trauma care, surgeons play an important role for the optimal treatment of trauma patients throughout and after their hospital stay, including the intensive care unit (ICU). However, in most European countries, it might not be obvious to either the general public, patients or even the physicians that the surgeon must assume this responsibility in the ICU to optimize outcomes. The aim of this paper is to define key elements in terms of trauma systems, trauma-specific surgical skills and active critical care involvement, to organize and optimize trauma care in Europe.
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Affiliation(s)
- Falco Hietbrink
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Shahin Mohseni
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital and School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
| | - Diego Mariani
- Department of General Surgery, ASST Ovest Milanese, Milan, Italy
| | - Päl Aksel Naess
- Department of Traumatology, Oslo University Hospital Ulleval, Oslo, Norway
| | | | - Alan Biloslavo
- General Surgery Department, Cattinara University Hospital, Trieste, Italy
| | - Gary A Bass
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, USA
| | - Susan I Brundage
- Department of Surgery, R Adams Cowley Shock Trauma Center, Baltimore, USA
| | | | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
- Department of Surgery, Universidad Nacional Pedro Henriquez Urena, Santo Domingo, Dominican Republic
- Hamad Injury Prevention Program, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Luke P H Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tina Gaarder
- Department of Traumatology, Oslo University Hospital Ulleval, Oslo, Norway
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14
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Wahlen BM, Peralta R, Al‐Thani H, El‐Menyar A. Friend or foe—The
Pfizer‐BioNTech
(
BNT162b2
) vaccination: A case report of reversible acute acalculous cholecystitis. Clin Case Rep 2022; 10:e6078. [PMID: 35846906 PMCID: PMC9280744 DOI: 10.1002/ccr3.6078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/20/2022] [Accepted: 07/02/2022] [Indexed: 12/24/2022] Open
Abstract
We described a rare case of vaccine‐induced acalculous cholecystitis (ACC). A 52‐year‐old female developed ACC after 8 h of receiving a 3rd dose of the Pfizer‐BioNTech COVID‐19 vaccination. The symptoms subsided completely with conservative treatment for 12 days, and the ultrasound and laboratory findings went back to normal.
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Affiliation(s)
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery Hamad Medical Corporation (HMC) Doha Qatar
- Department of Surgery, School of Medicine Universidad Nacional Pedro Henríquez Ureña Santo Domingo Dominican Republic
| | - Hassan Al‐Thani
- Department of Surgery, Trauma and Vascular Surgery Hamad Medical Corporation (HMC) Doha Qatar
| | - Ayman El‐Menyar
- Department of Surgery, Trauma and Vascular Surgery Clinical Research Hamad Medical Corporation (HMC) Doha Qatar
- Clinical Medicine Weill Cornell Medical College Doha Qatar
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15
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Consunji RJ, Mekkodathil A, El-Menyar A, Mehmood A, Sathian B, Hyder AA, Hirani N, Abeid A, Al-Thani H, Peralta R. Direct Healthcare Costs of Moderate and Severe Work-Related Injuries: Estimates from the National Trauma Center of Qatar. IJERPH 2022; 19:ijerph19031609. [PMID: 35162635 PMCID: PMC8835368 DOI: 10.3390/ijerph19031609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022]
Abstract
Work-related injuries (WRIs) are recognized as a leading cause of admission to the national trauma center of Qatar. A retrospective analysis of trauma registry data and electronic medical records was conducted on a cohort of all WRI patients who were admitted to the Hamad Trauma Center (HTC), in Doha, Qatar, between 2011 and 2017. A total of 3757 WRI patients were treated at the HTC over the 7-year study period. The overall cost for treatment was 124,671,431 USD (18 million USD per year), with a median cost of 19,071 USD. There was a strong positive correlation between the overall cost and hospital-stay cost (r2 = 0.949, p = 0.00001) and between the overall cost and procedure cost (r2 = 0.852, p = 0.00001). Motor vehicle crash (MVC) victims who wore seatbelts had significantly lower injury severity, hospital stay and median total costs. A comparison of patients by quartiles of the costs incurred showed that the proportions of MVC victims, pedestrian injuries and mortality were significantly higher in the fourth quartile when compared to other quartiles (p < 0.05). These findings suggest that investments in the primary prevention of work-related injuries from falls and MVCs, through proven interventions, should be priorities for occupational safety and health in Qatar.
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Affiliation(s)
- Rafael J. Consunji
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (A.M.); (A.E.-M.); (N.H.); (A.A.); (H.A.-T.); (R.P.)
- Correspondence:
| | - Ahammed Mekkodathil
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (A.M.); (A.E.-M.); (N.H.); (A.A.); (H.A.-T.); (R.P.)
| | - Ayman El-Menyar
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (A.M.); (A.E.-M.); (N.H.); (A.A.); (H.A.-T.); (R.P.)
| | - Amber Mehmood
- College of Public Health, University of South Florida, Tampa, FL 33612, USA;
| | - Brijesh Sathian
- Geriatrics and Long-Term Care Department, Rumailah Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
| | - Adnan A. Hyder
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA;
| | - Nazia Hirani
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (A.M.); (A.E.-M.); (N.H.); (A.A.); (H.A.-T.); (R.P.)
| | - Aisha Abeid
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (A.M.); (A.E.-M.); (N.H.); (A.A.); (H.A.-T.); (R.P.)
| | - Hassan Al-Thani
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (A.M.); (A.E.-M.); (N.H.); (A.A.); (H.A.-T.); (R.P.)
| | - Ruben Peralta
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (A.M.); (A.E.-M.); (N.H.); (A.A.); (H.A.-T.); (R.P.)
- Department of Surgery, Universidad Nacional Pedro Henriquez Urena, Santo Domingo 1423, Dominican Republic
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16
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El-Menyar A, Asim M, Bahey AAA, Chughtai T, Alyafai A, Abdelrahman H, Rizoli S, Peralta R, Al-Thani H. Beta blocker use in traumatic brain injury based on the high-sensitive troponin status (BBTBBT): methodology and protocol implementation of a double-blind randomized controlled clinical trial. Trials 2021; 22:890. [PMID: 34876207 PMCID: PMC8650244 DOI: 10.1186/s13063-021-05872-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 11/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background Beta-adrenergic receptor blockers (BB) play an important role in the protection of organs that are susceptible for secondary injury due to stress-induced adrenergic surge. However, the use of BB in traumatic brain injury (TBI) patients is not yet the standard of care which necessitates clear scientific evidence to be used. The BBTBBT study aims to determine whether early administration of propranolol based on the high-sensitive troponin T(HsTnT) status will improve the outcome of TBI patients. We hypothesized that early propranolol use is effective in reducing 10- and 30-day mortality in TBI patients. Secondary outcomes will include correlation between serum biomarkers (troponin, epinephrine, cytokines, enolase, S100 calcium binding protein B) and the severity of injury and the impact of BB use on the duration of hospital stay and functional status at a 3-month period. Methods The BBTBBT study is a prospective, randomized, double-blinded, placebo-controlled three-arm trial of BB use in mild-to-severe TBI patients based on the HsTnT status. All enrolled patients will be tested for HsTnT at the first 4 and 6 h post-injury. Patients with positive HsTnT will receive BB if there is no contraindication (group 1). Patients with negative HsTnT will be randomized to receive either propranolol (group 2) or placebo (group 3). The time widow for receiving the study treatment is the first 24 h post-injury. Discussion Early BB use may reduce the catecholamine storm and subsequently the cascade of immune and inflammatory changes associated with TBI. HsTnT could be a useful fast diagnostic and prognostic tool in TBI patients. This study will be of great clinical interest to improve survival and functional outcomes of TBI patients. Trial registration ClinicalTrials.gov NCT04508244. Registered on 7 August 2020. Recruitment started on 29 December 2020 and is ongoing. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05872-8.
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Affiliation(s)
- Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery Section, Hamad General Hospital (HGH), PO Box 3050, Doha, Qatar. .,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
| | - Mohammad Asim
- Clinical Research, Trauma & Vascular Surgery Section, Hamad General Hospital (HGH), PO Box 3050, Doha, Qatar
| | | | - Talat Chughtai
- Department of Surgery, Trauma Surgery Section, HGH, Doha, Qatar.,Department of Surgery, Qatar University, Doha, Qatar
| | | | | | - Sandro Rizoli
- Department of Surgery, Trauma Surgery Section, HGH, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery Section, HGH, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery Section, HGH, Doha, Qatar
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17
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Mahmood I, Ahmed K, Mustafa F, Ahmed Z, Nabir S, Strandvik G, El-Menyar A, Peralta R, Rizoli S, Al-Thani H. Conservative management of Occult Hemothorax in trauma patients requiring assisted ventilation: An observational descriptive study. Journal of Emergency Medicine, Trauma and Acute Care 2021. [DOI: 10.5339/jemtac.2021.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: Traumatic hemothorax is a common consequence of blunt chest trauma. A hemothorax that is missed by initial chest X-ray, but diagnosed by computed tomography (CT), is known as an occult hemothorax. The present study aims at investigating the clinical outcomes of conservative management of occult hemothorax in mechanically ventilated trauma patients. Methods: A retrospective study of all adult blunt chest trauma patients with occult hemothorax requiring mechanical ventilation in a level 1 trauma center was conducted (2010- 2017). Data were obtained from the trauma registry and electronic medical records. Patients were categorized into (a) successful conservative treatment group, and (b) tube thoracostomy group. Results: During the study period, 78 blunt chest trauma patients who had occult hemothorax required mechanical ventilation. Occult hemothorax was managed conservatively in 69% of the patients, while 31% underwent tube thoracostomy. The main indication for tube thoracostomy was the progression of hemothorax on follow-up chest radiographs. Comparison between groups showed that pulmonary contusions (59% vs. 83%), bilateral hemothorax (26% vs. 58%) and chest infections (9% vs. 29%) were lower in conservatively treated group (p < 0.05). Length of stays in ICU and hospital were also lower (p < 0.05). Longer duration of mechanical ventilation and maximum PEEP were significantly associated with tube thoracostomy. Overall mortality was 12% and was comparable between groups. Conclusion: Mechanically ventilated patients with occult hemothorax following blunt chest trauma can be managed conservatively without tube thoracostomy. Tube thoracostomy can be restricted to patients who had evidence of progression of hemothorax on follow-up or developed respiratory compromise.
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Affiliation(s)
- Ismail Mahmood
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar E-mail:
| | - Khalid Ahmed
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar E-mail:
| | - Fuad Mustafa
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar E-mail:
| | - Zahoor Ahmed
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Syed Nabir
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Gustav Strandvik
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar E-mail:
| | - Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar E-mail:
| | - Sandro Rizoli
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar E-mail:
| | - Hassan Al-Thani
- Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
- Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar E-mail:
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18
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El-Menyar A, Asim M, Mir F, Hakim S, Kanbar A, Siddiqui T, Younis B, Ahmed K, Mahmood I, Atique S, Al Jogol H, Taha I, Mustafa F, Alabdallat M, Abdelrahman H, Peralta R, Al-Thani H. Patterns and Effects of Admission Hyperglycemia and Inflammatory Response in Trauma Patients: A Prospective Clinical Study. World J Surg 2021; 45:2670-2681. [PMID: 34117510 PMCID: PMC8321976 DOI: 10.1007/s00268-021-06190-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 11/26/2022]
Abstract
Background The constellation of the initial hyperglycemia, proinflammatory cytokines and severity of injury among trauma patients is understudied. We aimed to evaluate the patterns and effects of on-admission hyperglycemia and inflammatory response in a level 1 trauma center. We hypothesized that higher initial readings of blood glucose and cytokines are associated with severe injuries and worse in-hospital outcomes in trauma patients. Methods A prospective, observational study was conducted for adult trauma patients who were admitted and tested for on-admission blood glucose, hemoglobin A1c, interleukin (IL)-6, IL-18 and hs-CRP. Patients were categorized into four groups [non-diabetic normoglycemic, diabetic normoglycemic, diabetic hyperglycemic (DH) and stress-induced hyperglycemic (SIH)]. The inflammatory markers were measured on three time points (admission, 24 h and 48 h). Generalized estimating equations (GEE) were used to account for the correlation for the inflammatory markers. Pearson’s correlation test and logistic regression analysis were also performed. Results During the study period, 250 adult trauma patients were enrolled. Almost 13% of patients presented with hyperglycemia (50% had SIH and 50% had DH). Patients with SIH were younger, had significantly higher Injury Severity Score (ISS), higher IL-6 readings, prolonged hospital length of stay and higher mortality. The SIH group had lower Revised Trauma Score (p = 0.005), lower Trauma Injury Severity Score (p = 0.01) and lower GCS (p = 0.001). Patients with hyperglycemia had higher in-hospital mortality than the normoglycemia group (12.5% vs 3.7%; p = 0.02). A significant correlation was identified between the initial blood glucose level and serum lactate, IL-6, ISS and hospital length of stay. Overall rate of change in slope 88.54 (95% CI:-143.39–33.68) points was found more in hyperglycemia than normoglycemia group (p = 0.002) for IL-6 values, whereas there was no statistical significant change in slopes of age, gender and their interaction. The initial IL-6 levels correlated with ISS (r = 0.40, p = 0.001). On-admission hyperglycemia had an adjusted odds ratio 2.42 (95% CI: 1.076–5.447, p = 0.03) for severe injury (ISS > 12) after adjusting for age, shock index and blood transfusion. Conclusions In trauma patients, on-admission hyperglycemia correlates well with the initial serum IL-6 level and is associated with more severe injuries. Therefore, it could be a simple marker of injury severity and useful tool for patient triage and risk assessment. Trial registration This study was registered at the ClinicalTrials.gov (Identifier: NCT02999386), retrospectively Registered on December 21, 2016. https://clinicaltrials.gov/ct2/show/NCT02999386. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-021-06190-5.
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Affiliation(s)
- Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
- Trauma & Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.
| | - Mohammad Asim
- Trauma & Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Fayaz Mir
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | - Suhail Hakim
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahad Kanbar
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Tariq Siddiqui
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Basil Younis
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Khalid Ahmed
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ismail Mahmood
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Sajid Atique
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hisham Al Jogol
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ibrahim Taha
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Fuad Mustafa
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | | | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
- Department of Surgery, Universidad Nacional Pedro Henriquez Urena, Santo Domingo, Dominican Republic
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
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19
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Ahmed K, Abdelrahman H, El-Menyar A, Saqr M, Silva AD, Alkahky SM, Al Qahtani J, Mekkodathil A, Al-Thani H, Peralta R. Clinical implications of serum myoglobin in trauma patients: A retrospective study from a level 1 trauma center. Int J Crit Illn Inj Sci 2020; 10:170-176. [PMID: 33850824 PMCID: PMC8033204 DOI: 10.4103/ijciis.ijciis_71_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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/14/2020] [Accepted: 04/11/2020] [Indexed: 11/28/2022] Open
Abstract
Background: We aimed to study the clinical implication of high serum myoglobin levels in trauma patients. Methods: A retrospective analysis was conducted on data from trauma patients who were admitted to a level 1 trauma center between January 2012 and December 2015. A receiver operating characteristic (ROC) curve analysis was performed for the optimum myoglobin cutoff plotted against hospital length of stay of >1 week. Patients were divided into two groups (Group 1; low vs. Group 2; high myoglobin), and a comparative analysis was performed. Results: There were 898 patients who met the inclusion criteria with a mean age of 35.9 ± 14.6 years. Based on ROC, the myoglobin optimum cutoff was 1000 ng/ml (64% of patients were in Group 1 and 36% in Group 2). The mean myoglobin level was 328 ng/ml in patients with the Injury Severity Score (ISS) <15 versus 1202 ng/ml in patients with ISS ≥15 (P < 0.001). Patients in Group 2 had higher ISS (22.2 ± 10 vs. 18.8 ± 10), more musculoskeletal injuries (18.3% vs. 4.2%), more blood transfusion (74% vs. 39%), intubation (57% vs. 46.5%), and sepsis (12% vs. 7.3%). The length of hospital stays was significantly higher in Group 2, but mortality was comparable. High myoglobin levels had a crude odd ratio 2.41; 95% confidence interval (1.470–3.184) for a longer hospital stay with a positive predictive value of 89% and a specificity of 77%. Conclusions: One-third of the admitted trauma patients have elevated serum myoglobin level, which is associated with the prolonged hospital stay. The discriminatory power of myoglobin value of 1000 in trauma is fair, and further prospective assessments are needed.
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Affiliation(s)
- Khalid Ahmed
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Clinical Research in Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar.,Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Mahmoud Saqr
- Department of Emergency, Hamad General Hospital, Doha, Qatar
| | - Ashwin D Silva
- Department of Emergency, Hamad General Hospital, Doha, Qatar
| | | | | | - Ahammed Mekkodathil
- Department of Clinical Research in Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- 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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20
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Consunji RJ, Mehmood A, Hirani N, El-Menyar A, Abeid A, Hyder AA, Al-Thani H, Peralta R. Occupational Safety and Work-Related Injury Control Efforts in Qatar: Lessons Learned from a Rapidly Developing Economy. Int J Environ Res Public Health 2020; 17:ijerph17186906. [PMID: 32967300 PMCID: PMC7559236 DOI: 10.3390/ijerph17186906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 01/25/2023]
Abstract
Work-related injury (WRI) control is an integral part of occupational safety. In rapidly developing Gulf countries such as Qatar with a predominantly expatriate workforce, WRI control is a complex issue often seen in conjunction with the implementation of labour laws and labour rights. We aimed to implement a public health approach to facilitate efforts to achieve long-term WRI control in Qatar. A range of initiatives helped to gain visibility and momentum for this important public health problem, including identifying and engaging with key stakeholders, workers’ surveys, steps to establish a unified injury database, and the implementation of a WRI identification tool in the electronic medical records. A contemporaneous improved enforcement of existent occupational safety regulations through heightened worksite inspections and efforts to improve living conditions for migrant workers also took place. WRIs are not only a Qatar-specific problem; the same issues are faced by neighbouring Gulf countries and other rapidly developing economies with large expatriate worker populations. These strategies are also useful starting points for similar countries interested in nurturing a safe, healthy and productive workforce.
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Affiliation(s)
- Rafael J. Consunji
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar; (N.H.); (A.E.-M.); (A.A.); (H.A.-T.); (R.P.)
- Correspondence: ; Tel.: +974-6612-9987 or +974-4439-3699
| | - Amber Mehmood
- International Injury Research Unit, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Nazia Hirani
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar; (N.H.); (A.E.-M.); (A.A.); (H.A.-T.); (R.P.)
| | - Ayman El-Menyar
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar; (N.H.); (A.E.-M.); (A.A.); (H.A.-T.); (R.P.)
| | - Aisha Abeid
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar; (N.H.); (A.E.-M.); (A.A.); (H.A.-T.); (R.P.)
| | - Adnan A. Hyder
- Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA;
| | - Hassan Al-Thani
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar; (N.H.); (A.E.-M.); (A.A.); (H.A.-T.); (R.P.)
| | - Ruben Peralta
- Hamad Injury Prevention Program, Hamad Trauma Centre, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar; (N.H.); (A.E.-M.); (A.A.); (H.A.-T.); (R.P.)
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21
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Pfeifer R, Kalbas Y, Coimbra R, Leenen L, Komadina R, Hildebrand F, Halvachizadeh S, Akhtar M, Peralta R, Fattori L, Mariani D, Hasler RM, Lefering R, Marzi I, Pitance F, Osterhoff G, Volpin G, Weil Y, Wendt K, Pape HC. Indications and interventions of damage control orthopedic surgeries: an expert opinion survey. Eur J Trauma Emerg Surg 2020; 47:2081-2092. [PMID: 32458046 DOI: 10.1007/s00068-020-01386-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/02/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The objectives of this study were to gather an expert opinion survey and to evaluate the suitability of summarized indications and interventions for DCO. BACKGROUND The indications to perform temporary surgery in musculoskeletal injuries may vary during the hospitalization and have not been defined. We performed a literature review and an expert opinion survey about the indications for damage control orthopaedics (DCO). METHODS Part I: A literature review was performed on the basis of the PubMed library search. Publications were screened for damage control interventions in the following anatomic regions: "Spine", "Pelvis", "Extremities" and "Soft Tissues". A standardized questionnaire was developed including a list of damage control interventions and associated indications. Part II: Development of the expert opinion survey: experienced trauma and orthopaedic surgeons participated in the consensus process. RESULTS Part I: A total of 646 references were obtained on the basis of the MeSH terms search. 74 manuscripts were included. Part II: Twelve experts in the field of polytrauma management met at three consensus meetings. We identified 12 interventions and 79 indications for DCO. In spinal trauma, percutaneous interventions were determined beneficial. Traction was considered harmful. For isolated injuries, a new terminology should be used: "MusculoSkeletal Temporary Surgery". CONCLUSION This review demonstrates a detailed description of the management consensus for abbreviated musculoskeletal surgeries. It was consented that early fixation is crucial for all major fractures, and certain indications for DCO were dropped. Authors propose a distinct terminology to separate local (MuST surgery) versus systemic (polytrauma: DCO) scenarios.
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Affiliation(s)
- Roman Pfeifer
- Department of Trauma, University of Zurich, UniversitätsSpital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Yannik Kalbas
- Department of Trauma, University of Zurich, UniversitätsSpital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Raul Coimbra
- Riverside University Health System and Loma Linda University, Riverside, CA, USA
| | - Luke Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Radko Komadina
- Department of Traumatology, General and Teaching Hospital Celje, Medical Faculty Ljubljana University, 3000, Celje, Slovenia
| | - Frank Hildebrand
- Department of Trauma, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Sascha Halvachizadeh
- Department of Trauma, University of Zurich, UniversitätsSpital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Meraj Akhtar
- Department of Trauma, University of Zurich, UniversitätsSpital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ruben Peralta
- Surgical Department (Hamad General Hospital), Hamad Medical Corporation, HMC, Doha, Qatar
| | - Luka Fattori
- Department of Surgery, San Gerardo Hospital, University of Milan Bicocca, G.B. Pergolesi 33, Monza, Italy
| | - Diego Mariani
- Department of Emergency General Surgery, Legnano Hospital, ASST Ovest Milanese, Legnano, MI, Italy
| | - Rebecca Maria Hasler
- Department of Trauma, University of Zurich, UniversitätsSpital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Rolf Lefering
- IFOM, Institute for Research in Operative Medicine, Faculty of Health, University Witten/Herdecke, Ostmerheimer Straße 200, 51109, Cologne, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - François Pitance
- Anesthesiology and Intensive Care Unit, CHR De La Citadelle, Liege, Belgium
| | - Georg Osterhoff
- Department of Orthopaedics, Trauma, and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Gershon Volpin
- Department of Orthopedic Surgery, EMMS Hospital, Nazareth, Affiliated to Galilee Medical Faculty Zfat, Bar Ilan University, Ramat Gan, Israel
| | - Yoram Weil
- Orthopaedic Trauma Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Klaus Wendt
- Department of Trauma Surgery, University Medical Center Groningen (UMCG), Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Hans-Christoph Pape
- Department of Trauma, University of Zurich, UniversitätsSpital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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22
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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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23
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Consunji R, Malik S, El-Menyar A, Mollazehi M, Al-Thani H, Peralta R. Pediatric road traffic injuries in Qatar: Evidence for a developmental stage approach to road safety. Qatar Med J 2020; 2020:3. [PMID: 32166071 PMCID: PMC7052426 DOI: 10.5339/qmj.2020.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/27/2019] [Accepted: 08/28/2019] [Indexed: 11/03/2022] Open
Abstract
Road traffic injuries are the leading cause of death in Qatar but their epidemiology in children has not been fully described. This paper will describe the epidemiology of pediatric road traffic injuries (pRTIs) in Qatar, in order to understand the relationships among risk factors, mechanisms of injury, use of safety equipment, and according to child developmental stages. The primary sample for this study was drawn from all pRTIs (0-18 years) from January 2010 to December 2012-motor vehicle occupants, passengers and drivers, pedestrians, cyclists, motorcyclists, and all-terrain vehicle (ATV) drivers and passengers-seen at the trauma registry of the Hamad Trauma Center, the national Level I Trauma Referral Center of Qatar. During those two years, the Trauma Center attended to 4864 patients, 443 (9.1%) of whom were pRTIs, 83% were male, and 71% were non-Qatari. Only 1.2% of injured passengers and drivers were restrained. All fatalities were passengers or drivers; the overall mortality rate was 3.4%. The motor vehicle crash (MVC) mortality rate was 6.2%, with the longest mean length of hospital stay 10.5 days and highest Intensive Care Unit (ICU) admission rate 35.7%. Older adolescents (15-18 years) comprised 56.4% of total MVC mortality. One-in-four (25%) pedestrian victims was Qatari. They had the lowest mean Injury Severity Score (9.6); 73% were nine years or younger. ATV victims had a 27% ICU admission rate; 48.4% were 10-14 years old. Older adolescents made up only 17% of the pediatric population of Qatar, yet 40% of pRTI victims and 80% of pRTI deaths. Forty-two percent of injured older adolescents were drivers, with half (21%) of those underage. There are clear and distinct age and mechanism-specific patterns of pRTIs among children in Qatar that must be used to guide road safety policy and program formulation for underage pedestrians and drivers. Proven interventions that increase seatbelt and child restraint use and graduated driver licensing must be considered.
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Affiliation(s)
- Rafael Consunji
- Hamad Injury Prevention Program, Hamad Trauma Center, Hamad Medical Corporation, Doha, Qatar
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24
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Salerni G, Peralta R, Bertaina C, Gorosito M, Fernández-Bussy R. Dermoscopy of idiopathic facial aseptic granuloma. Clin Exp Dermatol 2020; 45:605-606. [PMID: 31919863 DOI: 10.1111/ced.14174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2020] [Indexed: 01/17/2023]
Affiliation(s)
- G Salerni
- Dermatology Department, Hospital Provincial del Centenario de Rosario, Universidad Nacional de Rosario, Rosario, Argentina.,Diagnóstico Médico Oroño, Rosario, Argentina
| | - R Peralta
- Dermatology Department, School of Medicine, Instituto de Investigaciones Médicas 'A. Lanari', University of Buenos Aires, Argentina
| | - C Bertaina
- Dermatology Department, Hospital Provincial del Centenario de Rosario, Universidad Nacional de Rosario, Rosario, Argentina
| | - M Gorosito
- Pathology Department, Universidad Nacional de Rosario, Argentina
| | - R Fernández-Bussy
- Dermatology Department, Hospital Provincial del Centenario de Rosario, Universidad Nacional de Rosario, Rosario, Argentina
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25
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Khoschnau S, Jabbour G, Al-Hassani A, El-Menyar A, Abdelrahman H, Afifi I, Momin UZ, Peralta R, Al-Thani H. Traumatic Kidney Injury: An Observational Descriptive Study. Urol Int 2019; 104:148-155. [PMID: 31846981 DOI: 10.1159/000504895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/09/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Trauma is a major cause of death and disability worldwide. Renal injuries account for 8-10% of abdominal trauma. We aimed to describe the incidence, presentation, and management of traumatic kidney injury in our institution. METHODS This is a retrospective analysis of all patients admitted with traumatic kidney injury at a level 1 trauma center between January 2014 and December 2017. RESULTS During a period of 3 years, a total of 152 patients with blunt renal trauma were admitted to a level 1 trauma center; 91% of these were males, with a mean age of 32.8 ± 13.7 years. Motor vehicle crashes accounted for 68% of cases, followed by fall from height (23%). Seventy-one percent of patients had associated chest injuries, 38% had pelvis injuries, and 32% had head injury. Associated abdominal injuries included the liver (35%) and spleen (26%). The mean abdominal abbreviated injury scale was 2.8 ± 1.0; and for those with severe renal injury, it was 3.9 ± 0.9. The mean injury severity score was 24.9 ± 13.7 (31.8 ± 14.2 with renal vs. 21.9 ± 12.9 without renal injury, p = 0.004). Most of the patients were treated conservatively (93%), including severe renal injuries (grades IV and V), and 7% had surgical exploration, mainly those with severe injuries (grades IV and V). The mortality rate was 11%. CONCLUSIONS High-grade renal injuries in hemodynamically stable patients can be managed conservatively. A multidisciplinary approach coordinated by trauma, urology, and radiology services facilitates the care of these patients in our trauma center.
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Affiliation(s)
| | - Gaby Jabbour
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Ammar Al-Hassani
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma and Vascular Surgery Section, Hamad General Hospital (HGH), Doha, Qatar, .,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar,
| | | | - Ibrahim Afifi
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Umais Ziad Momin
- Department of Radiology, Hamad General Hospital (HGH), Doha, Qatar
| | - Ruben Peralta
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Hassan Al-Thani
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
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26
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Ahmed K, Peralta R, El-Menyar A, Ahmed HM, Al-Thani H. Utility of On-Admission Elevated Serum Myoglobin in Trauma Patients. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.1405] [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: 11/25/2022]
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27
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El-Menyar A, Peralta R, Al-Thani H. Simple Bedside Index for Prediction of Massive Transfusion and Mortality in Traumatic Pelvic Fractures. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.676] [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: 11/26/2022]
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28
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Consunji R, Malik S, Allen KA, Mehmood A, Tariq T, Hyder AA, Al-Thani H, Peralta R. A rapid market survey on the availability of car seats in Qatar: Implications for child passenger safety. Qatar Med J 2019; 2019:8. [PMID: 31453138 PMCID: PMC6698618 DOI: 10.5339/qmj.2019.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/22/2019] [Accepted: 07/03/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction: Despite the high income level in Arabian Gulf countries, people in the region need to improve their use of child restraint systems (CRSs) to reduce the incidence of preventable injuries to child automobile passengers. Anecdotal reports have attributed the resistance to using CRSs to the expense and unavailability of the systems, prompting car seat giveaway programs. Previous studies have not assessed the adoption of CRS. This study reports the results of a rapid market survey (RMS) to understand the availability, characteristics, and affordability of CRSs in Qatar and recommend future child restraint policies and legislation. Methods: The RMS identified all retail outlets that sell CRSs in Qatar and collected standard data on each restraint system: brand, model number, age/weight limits, compliance with standards, availability, and language of the owner's manual. A previously utilized metric for child safety devices was used to measure affordability. Results: The RMS showed a sufficient number (83) and variety (five types) of car seat models at 15 retail outlets, selling at a wide price range of $14–$1,399. All the car seats complied with the European standard. Only 2% showed a manufacturing or expiry date. A user manual was available for 71% of the seats and in different languages, but only 28% appeared in Arabic. The median CRS price was equivalent to the wages for less than one day of work. Conclusion: The RMS demonstrates the availability, variety, and affordability of CRSs in Qatar. Unavailability and expense cannot be cited as barriers to use CRS, and the market is prepared for legislation requiring car seats for children in Qatar. Areas for improvement include requiring user manuals for all seats, especially in Arabic; requiring that all car seats comply with globally accepted safety standards, especially for expiry/manufacturing dates, given the harsh local climate; and encouraging further varieties of CRSs in the local market.
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Affiliation(s)
- Rafael Consunji
- Hamad Injury Prevention Program, Hamad Trauma Center, Hamad Medical Corporation, Doha, Qatar
| | - Shahnaz Malik
- Hamad Injury Prevention Program, Hamad Trauma Center, Hamad Medical Corporation, Doha, Qatar
| | - Katharine A Allen
- Johns Hopkins International Injury Research Unit, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Amber Mehmood
- Johns Hopkins International Injury Research Unit, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Tooba Tariq
- Western Michigan University Homer Stryker M.D. School of Medicine
| | - Adnan A Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Hassan Al-Thani
- Hamad Injury Prevention Program, Hamad Trauma Center, Hamad Medical Corporation, Doha, Qatar
| | - Ruben Peralta
- Hamad Injury Prevention Program, Hamad Trauma Center, Hamad Medical Corporation, Doha, Qatar.,Department of Surgery, Universidad Nacional Pedro Henriquez Urena, Santo Domingo, Dominican Republic
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29
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Mitra B, El-Menyar A, Mercier E, Liew S, Varma D, Fitzgerald MC, Al-Hilli S, Peralta R, Al-Thani H, Cameron PA. Clinical clearance of the thoracic and lumbar spine: a pilot study. ANZ J Surg 2019; 89:718-722. [PMID: 31083786 DOI: 10.1111/ans.15253] [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: 02/07/2019] [Revised: 03/21/2019] [Accepted: 03/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients who are awake with normal mental and neurologic status, it has been suggested that the thoracolumbar (TL) spine may be cleared by clinical examination, irrespective of the mechanism of injury. The aim of this pilot study was to test the feasibility and accuracy of a clinical decision tool focused towards clearance of the TL spine during assessment of patients in the emergency department after trauma. METHODS A prospective interventional study was conducted at two major trauma centres. The intervention of a clinical decision tool for assessment of the TL spine was applied prospectively to all patients with subsequent imaging results acting as the comparator. The primary outcome variable was fracture of the thoracic or lumbar vertebra(e). The clinical decision tool was assessed using sensitivity and specificity for detecting a TL fracture and reported with 95% confidence intervals (CIs). RESULTS There were 188 cases included for analysis that all underwent imaging of the thoracic and/or lumbar vertebrae. There were 34 (18%) patients diagnosed with fractures of the thoracic and/or lumbar vertebrae. In this pilot study, sensitivity of the clinical decision tool was 100% (95% CI 87.3-100%) and specificity was 37.0% (95% CI 29.5-45.2%) for the detection of a thoracic or lumbar vertebral fracture. CONCLUSIONS Feasibility of clinical clearance of the TL spine in two major trauma centres was demonstrated in a clinical study setting. Evaluation of this clinical decision tool in patients following blunt trauma, particularly in reducing imaging rates, is indicated using a larger prospective study.
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Affiliation(s)
- Biswadev Mitra
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Ayman El-Menyar
- Department of Surgery, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha, Qatar.,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Eric Mercier
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices, Université Laval, Québec, Canada.,Département de Médecine Familiale et Médecine d'Urgence, Faculté de Médecine, Université Laval, Québec, Canada.,Centre de Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval, Québec, Canada
| | - Susan Liew
- Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Dinesh Varma
- Department of Radiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Mark C Fitzgerald
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Shatha Al-Hilli
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha, Qatar.,Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Peter A Cameron
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
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30
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El-Menyar A, Sathian B, Wahlen BM, Abdelrahman H, Peralta R, Al-Thani H, Rizoli S. Prehospital administration of tranexamic acid in trauma patients: A 1:1 matched comparative study from a level 1 trauma center. Am J Emerg Med 2019; 38:266-271. [PMID: 31060862 DOI: 10.1016/j.ajem.2019.04.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 04/28/2019] [Accepted: 04/29/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The purpose of this study was to test the efficacy of prehospital administration of tranexamic acid (TXA) to injured patients on mortality, thromboembolic events and need for blood transfusion in a level 1 trauma center. METHODS We conducted a retrospective study comparing adult trauma patients receiving or not receiving prehospital TXA between January 2017 and September 2018. Patients not receiving TXA but transfused within 4 h of admission were 1:1 matched to TXA-treated patients for age, sex, injury severity score, head abbreviated injury score, prehospital heart rate and systolic blood pressure. RESULTS In total 204 patients were included (102 TXA and 102 control), with a mean age of 31 years. On admission, shock index (p = 0.03) and serum lactate (p = 0.001) were greater in the control group, whereas the initial base deficit, hemoglobin levels and EMS time were comparable in both groups. The odd ratio (OR) for shock index ≥0.9 after TXA administration was 0.44 (95% CI 0.23-0.84). The median amount of blood transfusion was greater in the control group [eight units (range 1-40) vs three (range 0-40), p = 0.01] as well as the use of massive blood transfusion [OR 0.35 (95% CI 0.19-0.67)]. In the TXA group, VTE was higher [OR 2.0 (95% CI 0.37-11.40)]; whereas the overall mortality was lower [OR 0.78 (95% CI 0.42-1.45)] without reaching statistical significance. CONCLUSIONS Prehospital TXA administration is associated with less in-hospital blood transfusion and massive transfusion protocol (MTP). There is no significant increase in the thromboembolic events and mortality, however, further evaluation in larger clinical trials is needed.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital (HGH), Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
| | - Brijesh Sathian
- Department of Surgery, Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | | | | | - Ruben Peralta
- Department of Surgery, Trauma Surgery, HGH, Doha, Qatar; Department of Surgery, Universidad Nacional Pedro Henriquez Urena, Santo Domingo, Dominican Republic
| | | | - Sandro Rizoli
- Department of Surgery, Trauma Surgery, HGH, Doha, Qatar
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31
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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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Consunji R, Mekkodathil A, Abeid A, El-Menyar A, Al-Thani H, Sekayan T, Peralta R. Applying the five-pillar matrix to the decade of action for road safety in Qatar: identifying gaps and priorities. Trauma Surg Acute Care Open 2018; 3:e000233. [PMID: 30623026 PMCID: PMC6307580 DOI: 10.1136/tsaco-2018-000233] [Citation(s) in RCA: 3] [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] [Indexed: 12/02/2022] Open
Abstract
Introduction Road traffic injuries (RTIs) are the leading cause of preventable death in Qatar; consequently, the country has participated in the Decade of Action for Road Safety (DoARS) coordinated by the United Nations Road Safety Collaboration (UNRSC). Its goal is to reduce the number of road traffic deaths and injuries by 50% by 2020, by implementing road safety activities, in the areas of road safety management, safer roads, safer vehicles, safer road users and postcrash response, the five pillars. This study will evaluate the initiatives and programs implemented in Qatar, during the initial period of the DoARS. Methods A retrospective process evaluation of the compliance of national road safety activities in Qatar, with global indicators for the DoARS set by the UNRSC was conducted. A web-based online and electronic media search, in both official languages of Qatar: Arabic and English, for data and information on completed or ongoing road safety initiatives and activities implemented in Qatar, from January 1, 2011 to December 31, 2016, was supplemented by personal consultation with relevant stakeholders in the road safety field. Results There was complete compliance for Pillars 1 (Road Safety Management) and 2 (Safer Roads), whereas Pillars 4 (Safer Road Users) and 5 (Postcrash Response) met most of the DoARS indicators, and Pillar 3 (Safer Vehicles) complied with none. Conclusion Qatar must continue to implement its present road safety activities within the Action Plan for the DoARS to achieve its goals by 2020. It must, however, implement more new efforts to require safer vehicles and make road users safer, especially those at the highest risk, that is, young drivers, occupants and workers. Level of Evidence Level IV.
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Affiliation(s)
- Rafael Consunji
- Hamad Injury Prevention Program, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar.,Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Ahammed Mekkodathil
- Clinical Research Unit, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Aisha Abeid
- Hamad Injury Prevention Program, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research Unit, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Tsoler Sekayan
- Hamad Injury Prevention Program, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Hamad Injury Prevention Program, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar.,Trauma Surgery Section, Hamad Trauma Center, Hamad General Hospital, Doha, Qatar.,Surgery, Universidad Nacional Pedro Henriquez Urena (UNPHU), Santo Domingo, D.N., Dominican Republic
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Mahmood I, Mustafa F, Younis B, Ahmed K, El-Menyar A, Asim M, Al-Hassani A, Peralta R, Al-Thani H. Postoperative complications of intestinal anastomosis after blunt abdominal trauma. Eur J Trauma Emerg Surg 2018; 46:599-606. [PMID: 30251153 DOI: 10.1007/s00068-018-1013-9] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/19/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Intestinal disruption following blunt abdominal trauma (BAT) continues to be associated with significant morbidity and mortality despite the advances in resuscitation and management. We aim to analyze the management and postoperative outcomes of intestinal injuries secondary to blunt abdominal trauma. METHOD We retrospectively reviewed all adult patients with intestinal injuries who underwent laparotomy for BAT between December 2008 and September 2015 at Level I trauma center. Data included demographics, mechanism of injury, site (small and large intestine), type of repair, (enterorrhaphy and resection with anastomosis), type of anastomosis (hand-sewn or stapled anastomoses), need for damage control laparotomy, postoperative complications, and mortality. Data were analyzed and compared for postoperative complications. RESULTS A total of 160 patients with bowel injuries were included with mean age of 33 years, and 95.6% were males. Injuries involving small bowel, colon, and combined small and large bowel were found in 57.5%, 33.1%, and 9.4%, respectively, with only two duodenal and one rectal injury cases. There were 46.3% patients underwent debridement and primary closure, while 53.8% required resection with anastomosis. Anastomoses were side-to-side stapled in 79.1%, hand-sewn in 14.0%, and combination in 7.0% of patients. The overall postoperative complications (17.5%) in terms of wound infection (n = 16), intra-abdominal abscess (n = 13), and anastomotic leak (n = 13). There were two deaths occurred because of bowel injury complications. Need for blood transfusion, high serum lactate, number of re-laparotomies, and mortality were significantly associated with postoperative complications. On multivariate regression analysis, serum lactate (OR 1.27; 95% CI 1.01-1.60; p = 0.04) was found to be the independent predictor of postoperative complications. CONCLUSION Repair of traumatic blunt bowel injury remains a surgical challenge.
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Affiliation(s)
- Ismail Mahmood
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Fuad Mustafa
- 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
| | - Ayman El-Menyar
- Clinical research, Trauma and Vascular Surgery Section, Hamad General Hospital, PO Box 3050, Doha, Qatar. .,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
| | - Mohammad Asim
- Clinical research, Trauma and Vascular Surgery Section, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Ammar Al-Hassani
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
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Mehmood A, Maung Z, Consunji RJ, El-Menyar A, Peralta R, Al-Thani H, Hyder AA. Work related injuries in Qatar: a framework for prevention and control. J Occup Med Toxicol 2018; 13:29. [PMID: 30202423 PMCID: PMC6126035 DOI: 10.1186/s12995-018-0211-z] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/20/2018] [Indexed: 11/10/2022] Open
Abstract
Work related injuries (WRIs) are a growing public health concern that remains under-recognized, inadequately addressed and largely unmeasured in low and middle-income countries (LMIC’s). However, even in high-income countries, such as those in Gulf Cooperating Council (GCC) like Qatar, there are challenges in assuring the health and safety of its labor population. Countries in the GCC have been rapidly developing as a result of the economic boom from the petrochemical industry during the early seventies. Economic prosperity has propelled the migration of workers from less developed countries to make up for the human resource deficiency to develop its infrastructure, service and hospitality industries. Although these countries have gradually made huge gains in health, economy and human development index, including improvements in life expectancy, education, and standard of living, there remains a high incidence of work-related injuries especially in jobs in the construction and petrochemical sector. Currently, there is scarcity of literature on work-related injuries, especially empirical studies documenting the burden, characteristics and risk factors of work injuries and the work injured population, which includes large numbers of migrant workers in many GCC countries. This paper will focus on the current understanding of WRIs in those countries and identify the gaps in current approaches to workplace injury prevention, outlining current status of WRI prevention efforts in Qatar, and propose a framework of concerted action by multi-sectoral engagement.
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Affiliation(s)
- Amber Mehmood
- 1Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Zaw Maung
- 1Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Rafael J Consunji
- HMC Injury Prevention Program, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Trauma Surgery Section, Hamad General Hospital, Hamad Medical Corporation, and Weill Cornell Medical College, Doha, Qatar.,Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ayman El-Menyar
- Trauma Surgery Section, Hamad General Hospital, Hamad Medical Corporation, and Weill Cornell Medical College, Doha, Qatar.,8Weill Cornell Medical College, Doha, Qatar
| | - Ruben Peralta
- 4Universidad Nacional Pedro Henriquez Urena (UNPHU), Santo Domingo, Dominican Republic.,Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Adnan A Hyder
- 1Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA.,Johns Hopkins Berman Institute of Bioethics, Baltimore, MD USA.,7George Washington University Milken Institute School of Public Health, Washington, DC USA
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36
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Afifi I, Abayazeed S, El-Menyar A, Abdelrahman H, Peralta R, Al-Thani H. Blunt liver trauma: a descriptive analysis from a level I trauma center. BMC Surg 2018; 18:42. [PMID: 29914487 PMCID: PMC6006727 DOI: 10.1186/s12893-018-0369-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 01/05/2018] [Accepted: 05/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background We aimed to review liver injury experience in a level 1 trauma center; namely clinical presentation, grading, management approach and clinical outcomes. Methods It is a retrospective analysis to include all blunt liver injury patients who were admitted at the Level 1 trauma center over a 3-year period. Data were compared and analyzed based on the liver injury grades and management approaches. Results Blunt liver injury accounted for 38% of the total blunt abdominal trauma cases with a mean age of 31 ± 13 years. Liver injury grade II (44.7%) was most common followed by grade I (28.8%), grade III (19.1%), grade IV (7.0%) and grade V (0.4%). Blood transfusion was more frequently required in patients with grade IV (p = 0.04). Out of 257 patients with blunt liver trauma, 198 were initially treated conservatively, that was successful in 192 (97%), whereas it failed in 6 (3%) patients due to delayed bleeding from hepatic hematoma, associated splenic rupture and small bowel injury which mandate surgical intervention. Fifty-nine patients (23%) underwent emergent surgery in terms of packing, resection debridement, left lobe hepatectomy and splenectomy. Hepatic complications included biloma, pseudoaneurysm and massive liver necrosis. Subanalysis of data using the World Society of Emergency Surgery (WSES) classification revealed 19 patients were categorized as a WSES grade IV who needed surgical intervention without having an initial computerized tomography scanning. The overall mortality was 7.8% which was comparable among the conservative and operative group. Conclusions In our center, low grade liver injury in young males prevails. NOM is successful even for high graded injuries. All conservatively treated patients with high-grade liver injuries should be closely monitored for signs of failure of the non-operative management. Introducing the new WSES classification makes clear how is important the hemodynamic status of the patients despite the lesion. However, further larger prospective and multicenter studies are needed to support our findings.
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Affiliation(s)
- Ibrahim Afifi
- Department of surgery, Trauma Surgery section, Hamad General Hospital (HGH), Doha, Qatar
| | | | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery, HGH, Doha, Qatar. .,Clinical Medicine, Weill Cornell Medical College, PO Box 3050, Doha, Qatar.
| | - Husham Abdelrahman
- Department of surgery, Trauma Surgery section, Hamad General Hospital (HGH), Doha, Qatar
| | - Ruben Peralta
- Department of surgery, Trauma Surgery section, 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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Wahlen BM, El-Menyar A, Peralta R, Al-Thani H. World Academic Council of Emergency Medicine Experience Document: Implementation of Point-of-Care Thromboelastography at an Academic Emergency and Trauma Center. J Emerg Trauma Shock 2018; 11:265-270. [PMID: 30568368 PMCID: PMC6262651 DOI: 10.4103/jets.jets_134_17] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: We aimed to discuss the initial experience of the implementation of point-of-care thromboelastography (POC-TEG) at the Level 1 Trauma Center of an academic health institution in Qatar. Materials and Methods: A TEG protocol was developed and tailored to our hospital requirements and patient population, after an exhausting review of the literature and international published protocols, including a synthesis of a preexisting TEG protocol from our heart hospital. To successfully achieve the incorporation of point-of-care testing (POCT) in our clinical practice, a multidisciplinary organizational and education approach is required. The education and training of the physicians in this POCT modality during the first 3 months period has been described in detail. Results: A TEG protocol has been developed and implemented according to hospital standards. Ten physicians from the department of trauma surgery have been trained over a 3-month period to perform the daily quality control as well as the patient samples in order to provide a 24/7 service. In patients with major trauma, brain injury, bleeding, sepsis, and coagulopathy are the most important determinants of the clinical course and outcomes. Viscoelastic whole-blood assays have already proved their values in cardiac as well as liver surgery. Therefore, this POCT-directed approach would be considered as a part of the goal-directed management in severe polytrauma patients. Conclusions: Our experience shows that implementation of POC-TEG program is feasible and it is a promising tool in the management of major trauma patients with a potential compromised coagulation. However, further prospective research projects and well-trained personnel still warranted.
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Affiliation(s)
- Bianca M Wahlen
- Department of Anesthesia and Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.,Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
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Al-Thani H, Jabbour G, El-Menyar A, Abdelrahman H, Peralta R, Zarour A. Descriptive Analysis of Right and Left-sided Traumatic Diaphragmatic Injuries; Case Series from a Single Institution. Bull Emerg Trauma 2018; 6:16-25. [PMID: 29379805 DOI: 10.29252/beat-060103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Hassan Al-Thani
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Gaby Jabbour
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Husham Abdelrahman
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahmad Zarour
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
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El-Menyar A, Consunji R, Mekkodathil A, Peralta R, Al-Thani H. Alcohol Screening in a National Referral Hospital: An Observational Study from Qatar. Med Sci Monit 2017; 23:6082-6088. [PMID: 29275423 PMCID: PMC5749138 DOI: 10.12659/msm.905201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Alcohol consumption is a high-risk factor for several medical disorders and traffic accidents and poses a burden on outpatient clinics and emergency units. We aimed to assess the pattern of alcohol screening among patients in a multicultural setting in a national referral hospital in an Arab Middle-Eastern country. Material/Methods A retrospective analysis was conducted for patients who were screened with blood alcohol concentration (BAC) in the Emergency Department (ED) in the period from January 2009 to December 2012. BAC positive and negative patients were compared, and BAC positive patients were classified into mmol/L (Group 1: BAC 0.1–10.8 (less intoxicated); Group 2: BAC 10.9–21.7 (intoxicated), and Group 3: >21.7 mmol/L (intoxicated at CNS depression level). Results A total of 9417 patient visits were screened for BAC during the study period (an average of 4.87 per 1000 ED visits); 38% of these tested positive. Most screened persons were males (97%) with a mean age of 37.5±11.6 years. There was a steady increase in BAC screening initially (3.18 per 1000 ED visits in 2009 and 7.47 in 2012). However, the proportion of BAC-positives per total screened decreased steadily over the years, from 50% in 2008 to 33% in 2012. There were more BAC positives (92% vs. 81%, p<0.05) in patients seeking medical vs. non-medical assessment. Among BAC positives, Group 3 patients had higher HLOS (p=0.001), but the ICU-LOS was comparable. Conclusions Despite the absence of a clinical protocol for alcohol screening, this study shows that alcohol consumption has a serious impact in ED visits and hospitalizations, even in a country that partially prohibits alcohol drinking. Implementing a protocol for the screening of alcohol misuse among select hospitalized patients should be considered in the ED.
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Affiliation(s)
- Ayman El-Menyar
- Clinical Research, Trauma 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
| | | | - Ruben Peralta
- 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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Alani M, Mahmood S, El-Menyar A, Atique S, Al-Thani H, Peralta R. An unusual case of transpelvic impalement injury: A case-report. Int J Surg Case Rep 2017; 41:26-29. [PMID: 29031173 PMCID: PMC5645491 DOI: 10.1016/j.ijscr.2017.08.068] [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] [Received: 08/06/2017] [Revised: 08/16/2017] [Accepted: 08/16/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Impalement injury is a rare type of mechanical injury following forceful insertion of projecting object into the body. Careful planning for removal of the impaling object is essential to decrease the blood loss and preserve the function of the injured organ. PRESENTATION OF CASE A 27 year-old male fell from 4m height over a U shaped projecting up metallic bar. The bar penetrated the left side of the pelvis and traversed through the left iliac bone causing a comminuted fracture in the supra-acetabular region extending to the left psoas muscle, injuring the viscera and causing fracture of the right femur. Exploratory laparotomy was performed and the metallic bar was pulled out from the sigmoid colon through the inlet of the injury. Intramedullary nailing was performed for femur fracture. The patient developed infection (Methicillin-sensitive Staphylococcus aureus and Escherichia coli) during the post-operative course that was successfully managed with antibiotic therapy. Finally the patient was sent home after a week in a good health condition. DISCUSSION Two surgical teams worked in sequence to fix the injuries starting with the trauma team followed by the orthopedic surgeons. CONCLUSION Impalement injury is a serious injury that needs a multidisciplinary team with a coordinated approach to achieve a favorable outcome.
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Affiliation(s)
- Mushrek Alani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Saeed Mahmood
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar; Clinical Research, Trauma Section, Hamad General Hospital, Doha, Qatar.
| | - Sajid Atique
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- 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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Jabbour G, Al-Hassani A, El-Menyar A, Abdelrahman H, Peralta R, Ellabib M, Al-Jogol H, Asim M, Al-Thani H. Clinical and Radiological Presentations and Management of Blunt Splenic Trauma: A Single Tertiary Hospital Experience. Med Sci Monit 2017; 23:3383-3392. [PMID: 28700540 PMCID: PMC5519223 DOI: 10.12659/msm.902438] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Splenic injury is the leading cause of major bleeding after blunt abdominal trauma. We examined the clinical and radiological presentations, management, and outcome of blunt splenic injuries (BSI) in our institution. Material/Methods A retrospective study of BSI patients between 2011 and 2014 was conducted. We analyzed and compared management and outcome of different splenic injury grades in trauma patients. Results A total of 191 BSI patients were identified with a mean (SD) age of 26.9 years (13.1); 164 (85.9%) were males. Traffic-related accident was the main mechanism of injury. Splenic contusion and hematoma (77.2%) was the most frequent finding on initial computerized tomography (CT) scans, followed by shattered spleen (11.1%), blush (11.1%), and devascularization (0.6%). Repeated CT scan revealed 3 patients with pseudoaneurysm who underwent angioembolization. Nearly a quarter of patients were managed surgically. Non-operative management failed in 1 patient who underwent splenectomy. Patients with grade V injury presented with higher mean ISS and abdominal AIS, required frequent blood transfusion, and were more likely to be FAST-positive (p=0.001). The majority of low-grade (I–III) splenic injuries were treated conservatively, while patients with high-grade (IV and V) BSI frequently required splenectomy (p=0.001). Adults were more likely to have grade I, II, and V BSI, blood transfusion, and prolonged ICU stay as compared to pediatric BSI patients. The overall mortality rate was 7.9%, which is mainly association with traumatic brain injury and hemorrhagic shock; half of the deaths occurred within the first day after injury. Conclusions Most BSI patients had grade I–III injuries that were successfully treated non-operatively, with a low failure rate. The severity of injury and presence of associated lesions should be carefully considered in developing the management plan. Thorough clinical assessment and CT scan evaluation are crucial for appropriate management of BSI.
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Affiliation(s)
- Gaby Jabbour
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar.,Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | | | - Ruben Peralta
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Hisham Al-Jogol
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Asim
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
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El-Menyar A, Abdelrahman H, Al-Hassani A, Peralta R, AbdelAziz H, Latifi R, Al-Thani H. Single Versus Multiple Solid Organ Injuries Following Blunt Abdominal Trauma. World J Surg 2017; 41:2689-2696. [DOI: 10.1007/s00268-017-4087-3] [Citation(s) in RCA: 9] [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] [Indexed: 12/19/2022]
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Irfan FB, Consunji R, El-Menyar A, George P, Peralta R, Al-Thani H, Thomas SH, Alinier G, Shuaib A, Al-Suwaidi J, Singh R, Castren M, Cameron PA, Djarv T. Cardiopulmonary resuscitation of out-of-hospital traumatic cardiac arrest in Qatar: A nationwide population-based study. Int J Cardiol 2017; 240:438-443. [PMID: 28395982 DOI: 10.1016/j.ijcard.2017.03.134] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/28/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Traumatic cardiac arrest studies have reported improved survival rates recently, ranging from 1.7-7.5%. This population-based nationwide study aims to describe the epidemiology, interventions and outcomes, and determine predictors of survival from out-of-hospital traumatic cardiac arrest (OHTCA) in Qatar. METHODS An observational retrospective population-based study was conducted on OHTCA patients in Qatar, from January 2010 to December 2015. Traumatic cardiac arrest was redefined to include out-of-hospital traumatic cardiac arrest (OHTCA) and in-hospital traumatic cardiac arrest (IHTCA). RESULTS A total of 410 OHTCA patients were included in the 6-year study period. The mean annual crude incidence rate of OHTCA was 4.0 per 100,000 population, in Qatar. OHTCA mostly occurred in males with a median age of 33. There was a preponderance of blunt injuries (94.3%) and head injuries (66.3%). Overall, the survival rate was 2.4%. Shockable rhythm, prehospital external hemorrhage control, in-hospital blood transfusion, and surgery were associated with higher odds of survival. Adrenaline (Epinephrine) lowered the odds of survival. CONCLUSION The incidence of OHTCA was less than expected, with a low rate of survival. Thoracotomy was not associated with improved survival while Adrenaline administration lowered survival in OHTCA patients with majority blunt injuries. Interventions to enable early prehospital control of hemorrhage, blood transfusion, thoracostomy and surgery improved survival.
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Affiliation(s)
- Furqan B Irfan
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden; Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Rafael Consunji
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Ayman El-Menyar
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Pooja George
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Ruben Peralta
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Hassan Al-Thani
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Stephen Hodges Thomas
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Guillaume Alinier
- Hamad Medical Corporation Ambulance Service, Medical City, Doha, Qatar; School of Health and Social Work, Paramedic Division, University of Hertfordshire, Hatfield AL10 9AB, HERTS, UK.
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Jassim Al-Suwaidi
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Rajvir Singh
- Cardiology Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Maaret Castren
- Helsinki University, Department of Emergency Medicine and Services, Helsinki University Hospital, Haartmaninkatu 4, 00029 HUS, Finland.
| | - Peter A Cameron
- The Alfred Hospital, Emergency and Trauma Centre, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia.
| | - Therese Djarv
- Department of Medicine Solna, 171 00, Karolinska Institutet, Sweden.
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Al-Aieb A, Peralta R, Ellabib M, El-Menyar A, Al-Thani H. Traumatic tension pneumocephalus: Two case reports. Int J Surg Case Rep 2017; 31:145-149. [PMID: 28152490 PMCID: PMC5288330 DOI: 10.1016/j.ijscr.2017.01.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Received: 11/03/2016] [Revised: 01/16/2017] [Accepted: 01/16/2017] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Traumatic pneumocephalus rarely evolves into tension pneumocephalus. It can be devastating if not recognized and treated promptly. CASE PRESENTATION We presented two cases of post-traumatic tension pneumocephalus. A 30- year old male pedestrian hit by a car presented with right frontal bone fracture extending to right frontal sinuses. He developed pneumocephalus involving all ventricles and subdural space and extending down to foramen magnum with tight basal cistern. The patient was managed conservatively. During the hospital course, he developed cerebrospinal fluid leak from the facial fractures and meningitis. After complete recovery, the patient was discharged home in a good health condition. The second case was a 43- year old lady driver who involved in a motor vehicle crash and presented with comminuted fracture of the right frontal bone, right parietal extra-axial hemorrhage. She developed pnemocephalus involving the bilateral frontal lobes, mainly on the left side with extension to the left lateral ventricle. Pneumocephalus was also noted in the pre-pontine cistern. The patient had rhinorrhea during the hospital course. The patient underwent wound debridement, intracranial pressure monitoring, and repair of her globe and advancement flap for right facial injury. CONCLUSIONS These are two rare cases with posttraumatic tension pneumocephalus treated conservatively with a favorable outcome. Early diagnosis of tension pneumocephalus is a crucial step to facilitate early recovery; however, the associated injuries need attention as they could influence the hospital course.
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Affiliation(s)
- Abubaker Al-Aieb
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Mohammad Ellabib
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
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Awadalla M, Tallon L, Peralta R, El-Menyar A, Al-Thani H, Consunji R. 868 The disproportionate risk of young drivers for road traffic injury and fatality in Qatar: evidence for policy. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Consunji R, Mehmood A, Irfan F, Abdelhamid R, Peralta R, El-Menyar A, Allen KA, Malik S, Al-Thani H, Hyder A. 916 A five-year time trend analysis of road traffic injuries [RTIS] and deaths among infants and toddlers in Qatar. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.916] [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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Mehmood A, Consunji R, Peralta R, Abdelhamid R, El-Menyar A, Allen KA, Malik S, Thomas S, Al-Thani H, Hyder A. 992 Time trends in work-related injuries in qatar: an analysis of hospital trauma registry data. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.992] [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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Consunji R, Mehmood A, Irfan F, Abdelhamid R, Peralta R, El-Menyar A, Allen KA, Malik S, Al-Thani H, Hyder A. 770 An evaluation of the utility of various data sources for occupational injury surveillance. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.770] [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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Consunji R, Allen KA, Peralta R, Abdelhamid R, Malik S, Mehmood A, Hyder AA. 922 Child restraint use in the state of Qatar: findings from an observational study. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.922] [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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Hyder AA, Mehmood A, Peralta R, Consunji R, Allen K. 39 Child and adolescent injuries in the Arab Gulf: understanding the burden and risk factors. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.39] [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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