The correlation between full moon and admission volume for penetrating injuries at a major trauma centre in South Africa

BACKGROUND

The possible effect of full moon on admission volume of trauma centres is a well-mentioned phenomenon that has been perpetuated worldwide. We aimed to review the correlation between full moon and admission volume and to interrogate any possible relationship on admission for penetrating trauma.

METHODS

A retrospective study from 2012 to 2018 at Pietermaritzburg Metropolitan Trauma Service (PMTS), South Africa.

RESULTS

A total of 8 722 patients were admitted. Eighty-three per cent (7 242/8 722) were male and the mean age was 29 years. The total number of days during the study period was 1 953, 66 of which were 'full moon' (FM) days and 1 887 were 'non-full moon' (NFM) days. There was no significant difference between gender or age distribution. The mean number of admissions per day on FM days compared with NFM days was not significant (4.1 vs 4.5, p = 0.583). A total of 3 332 patients with penetrating trauma were admitted. This constituted 42% (113/271) of admission on FM days and 38% (3 219) on NFM days, which is not statistically significant (p = 0.229). Subgroup analysis did not demonstrate any significant difference between the number of stab wounds - 28% (77/113) vs 25% (2 124/3 219) - or gunshot wounds - 13% (16/113) vs 12% (990/3 219) - between FM and NFM days.

CONCLUSION

The correlation between full moon and trauma admission is unfound in our setting. The perpetuating notion that 'it must be full moon tonight' is likely to be an urban myth with no scientific evidence for such a claim.

The correlation between full moon and admission volume for penetrating injuries at a major trauma centre in South Africa

ABSTRACT BACKGROUND: The possible effect of full moon on admission volume of trauma centres is a well-mentioned phenomenon that has been perpetuated worldwide. We aimed to review the correlation between full moon and admission volume and to interrogate any possible relationship on admission for penetrating trauma METHODS: A retrospective study from 2012 to 2018 at Pietermaritzburg Metropolitan Trauma Service (PMTS), South Africa RESULTS: A total of 8 722 patients were admitted. Eighty-three per cent (7 242/8 722) were male and the mean age was 29 years. The total number of days during the study period was 1 953, 66 of which were 'full moon' (FM) days and 1 887 were 'non-full moon' (NFM) days. There was no significant difference between gender or age distribution. The mean number of admissions per day on FM days compared with NFM days was not significant (4.1 vs 4.5, p = 0.583). A total of 3 332 patients with penetrating trauma were admitted. This constituted 42% (113/271) of admission on FM days and 38% (3 219) on NFM days, which is not statistically significant (p = 0.229). Subgroup analysis did not demonstrate any significant difference between the number of stab wounds - 28% (77/113) vs 25% (2 124/3 219) - or gunshot wounds - 13% (16/113) vs 12% (990/3 219) - between FM and NFM days CONCLUSION: The correlation between full moon and trauma admission is unfound in our setting. The perpetuating notion that 'it must be full moon tonight' is likely to be an urban myth with no scientific evidence for such a claim Keywords: emergency medicine, trauma, epidemiology, full moon, lunar cycle

Blunt and Penetrating Liver Trauma have Similar Outcomes in the Modern Era

BACKGROUND

The trend in liver trauma management has progressively become increasingly conservative. However, a vast majority of literature focuses heavily on the management of blunt trauma. This study reviews the management of hepatic trauma at a major trauma center in a developing world setting, in order to compare blunt and penetrating liver trauma and to define current management algorithms and protocols.

METHODS

All patients who sustained liver trauma between 2012 to 2018 were identified in the Hybrid Electronic Medical Registry and extracted for further analysis.

RESULTS

A total of 808 patients with hepatic trauma were managed by our trauma center. There were 658 males and 150 females. The mean age was 30 years (standard deviation 13.3). A total of 68 patients died (8.2%) and a total of 290 (35%) patients required intensive care unit admission. The mean presenting shock index was 0.806 (standard deviation 0.67-1.0), the median Injury Severity Score was 18 (interquartile range 10-25) and the mean Revised Trauma Score was 12 (standard deviation 11-12). There were 367 penetrating and 441 blunt liver injuries. The age distribution was similar in both groups. There were significantly less females in the penetrating group. The shock index and the Injury Severity Score on presentation were significantly worse in the blunt group, respectively: 0.891 (standard deviation 0.31) versus 0.845 (standard deviation 0.69) (p < 0.001) and score 21 (interquartile range 13-27) versus 16 (interquartile range 9-20) (p < 0.01). The opposite applied to the Revised Trauma Score of 11.75 (standard deviation 0.74) versus 11.19 (standard deviation 1.3) (p < 0.001). There were significantly more associated intra-abdominal injuries in the penetrating group than the blunt group, in particular that of hollow organs, and 84% of patients with a penetrating injury underwent a laparotomy while only 33% of the blunt injuries underwent a laparotomy. The mortality rate was comparable between both groups.

CONCLUSION

Hepatic trauma is still associated with a high morbidity rate, although there have been dramatic improvements in mortality rates over the last three decades. The mortality rates for blunt and penetrating liver trauma are now similar. Non-operative management is feasible for over two-thirds of blunt injuries and for just under 20% of penetrating injuries.

[Palliative sedation, the sympathetic alternative for euthanasia?]

Palliative sedation is given to relieve refractory discomfort (pain, shortness of breath, agitation) during the phase when life expectancy is estimated to be a week or less. It is a medical intervention which, although not expressly meant to shorten life, may well do so. There is an inherent uncertainty here which is the cause of considerable ethical unease. Figures show that in a limited number of cases palliative sedation is actually applied with the intention to hasten death. It may well be impossible to rid ourselves ofthis uncertainty conclusively.

[Letters of condolence to the relatives of patients]

Most people who die in the Netherlands receive medical care during the final stage of their life. Since the 19th century, when a sombre prognosis was often the only medical intervention available, sophisticated diagnostic procedures and curative victories have forced elementary bedside manners into retreat. However, modern medicine is rediscovering its boundaries; the inevitability of death and the human tragedy of dying. The renewed interest in letters of condolence from doctors to the family of their deceased patients is an example of this. These letters provide the physician with an opportunity for worthy and effective behaviour under trying circumstances.

[Percutaneous endoscopic gastrostomy catheter: a trap without escape?]

Three patients, a 76-year old man with Parkinson's disease and two women aged 81 and 80 years, both of whom had experienced a stroke, were transferred from a hospital to a nursing home following the insertion of a percutaneous endoscopic gastrostomy (PEG) catheter. The worldwide accepted indication for the insertion of a PEG catheter is: the existence of serious swallowing disorders which are expected to last for more than 2-4 weeks and are mostly connected with a neurological disorder with an uncertain prognosis. However, this procedure may lead to a fairly common adverse effect, although never acknowledged as such: the unintended prolonging of a patient's suffering. This was also the case for the patients described. Eventually in the case of the first two patients, who were completely passive and incontinent for both urine and faeces, the catheter was removed once it had been established (in discussions with those responsible for treatment and the family) that it no longer fulfilled its purpose as a medical treatment. The patients died under adequate sedation. In the case of the third patient, those responsible for the treatment were unsure about the unfavourable prognosis and the absence of a quality of life; she later died from an untreated pneumonia. In order to reduce the frequency with which these serious consequences occur, it is suggested that the insertion of a PEG catheter should be characterised as a medical procedure the purpose of which should be clearly stated. Whether or not this purpose has been attained can be evaluated at given points in time so that the treatment can either be continued, or withdrawn.