Results of the Spanish National Polytrauma Registry. Where are we and where are we heading?

INTRODUCTION

In 2017, the Spanish National Polytrauma Registry (SNPR) was initiated in Spain with the goal to improve the quality of severe trauma management and evaluate the use of resources and treatment strategies. The objective of this study is to present the data obtained with the SNPR since its inception.

METHODS

We conducted an observational study with prospective data collection from the SNPR. The trauma patients included were over 14 years of age, with ISS ≥ 15 or penetrating mechanism of injury, from a total of 17 tertiary hospitals in Spain.

RESULTS

From 1/1/17 to 1/1/22, 2069 trauma patients were registered. The majority were men (76.4%), with a mean age of 45 years, mean ISS 22.8, and mortality 10.2%. The most common mechanism of injury was blunt trauma (80%), the most frequent being motorcycle accident (23%). Penetrating trauma was presented in 12% of patients, stab wounds being the most common (84%). On hospital arrival, 16% of patients were hemodynamically unstable. The massive transfusion protocol was activated in 14% of patients, and 53% underwent surgery. Median hospital stay was 11 days, while 73.4% of patients required intensive care unit (ICU) admission, with a median ICU stay of 5 days.

CONCLUSIONS

Trauma patients registered in the SNPR are predominantly middle-aged males who experience blunt trauma with a high incidence of thoracic injuries. Early addressed detection and treatment of these kind of injuries would probably improve the quality of trauma care in our environment.

Preliminary trends over ten years of persistent organic pollutants in air - Comparison of two sets of data in the same countries

In two series of ambient air measurement campaigns to support the implementation of the global monitoring plan (GMP) component of the Stockholm Convention on Persistent Organic Pollutants (POPs), passive air samplers (PAS) using polyurethane foams were implemented by the United Nations Environment Programme (UNEP). With the same laboratories responsible for the chemical analyses of the different groups of POPs, a total of 423 PUFs were analyzed for organochlorine pesticides (OCPs) including hexachlorobenzene (HCB) and polychlorinated biphenyls (PCB); 242 for dioxin-like POPs. For trend analysis, to compare amounts of POPs in the PUFs during the first phase in 2010/2011 and the second phase from 2017 to 2019, only results were assessed that were generated in the same country and for the same POP in both campaigns. Finally, there were 194 PUFs available for OCPs (GMP1 = 67 and GMP2 = 127), 297 for PCB (GMP1 = 103, GMP2 = 194), 158 for polychlorinated dibenzodioxins and polychlorinated dibenzofurans (PCDD, PCDF) (GMP1 = 39, GMP2 = 119), and 153 for dl-PCB (GMP1 = 34, GMP2 = 119). Indicator PCB and dioxin-like POPs were quantified in all countries at all times; decreases of about 30% based on median values were determined. A 50% increase was found for HCB. By scale, DDT remained with the highest values, although more than 60% decrease was found; mainly due to smaller values in the Pacific Islands region. Our assessment showed that on relative scale - per PUF - trend analysis was achieved and that such approach should be undertaken at regular intervals, not necessarily on an annual basis.

Quality of life following hip fractures: results from the Norwegian hip fracture register

BACKGROUND

Patient-reported health-related quality of life is an important outcome measure when assessing the quality of hip fracture surgery. The frequently used EQ-5D index score has unfortunately important limitations. One alternative can be to assess the distribution of each of the five dimensions of the patients' descriptive health profile. The objective of this paper was to investigate health-related quality of life (HRQoL) after hip fractures.

METHODS

Data from hip fracture operations from 2005 through 2012 were obtained from The Norwegian Hip Fracture Register. Patient reported HRQoL, (EQ-5D-3L) was collected from patients preoperatively and at four and twelve months postoperatively n = 10325. At each follow-up the distribution of the EQ-5D-3L and mean pain VAS was calculated.

RESULTS

Generally, a higher proportion of patients reported problems in all 5 dimensions of the EQ-5D-3L at all follow-ups compared to preoperative. Also a high proportion of patients with no preoperative problems reported problems after surgery; At 4 and 12 months follow-ups 71 % and 58 % of the patients reported walking problems, and 65 % and 59 % of the patients reported pain respectively. Patients with femoral neck fractures and the youngest patients (age < 70 years) reported least problems both preoperatively and at all follow-ups.

CONCLUSIONS

A hip fracture has a dramatic impact on the patients' HRQoL, and the deterioration in HRQoL sustained also one year after the fracture. Separate use of the descriptive profile of the EQ-5D is informative when assessing quality of life after hip fracture surgery.