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Medicina
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Trauma care
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Trauma care

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: closed (31 August 2020) | Viewed by 16646

Special Issue Editors

Dr. Gerard O’Reilly

E-Mail Website
Guest Editor
1. Emergency and Trauma Centre, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
2. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia
3. National Trauma Research Institute, Alfred Health, Melbourne, VIC 3004, Australia
Interests: epidemiology; emergency medicine; trauma capacity development; trauma care systems; emergency care registry development
Prof. Dr. Biswadev Mitra

E-Mail Website
Co-Guest Editor
1. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia
2. Alfred Health, Melbourne, VIC 3004, Australia
Interests: trauma; emergency medicine; neurosciences; resuscitation; transfusion medicine; pre-hospital care

Special Issue Information

Dear Colleagues,

Approximately five million people die from injuries every year, and many more are disabled. In the few countries with well-developed integrated trauma care systems, there has been a reduction in death and disability over time. But, in most countries, the systems for the care of the injured are not well developed. This is particularly the case in the many less-resourced settings, where the burden of injury is growing in the absence of a sustainable capacity to deliver safe and effective care.

In May 2019, the 72nd annual World Health Assembly adopted a resolution on emergency and trauma care aimed at helping countries ensure timely care for injured persons. Globally, there will hopefully now be a spike in the development, evaluation, and implementation of the tools, resources, and systems necessary for the improved delivery of emergency care to injured persons, anywhere. Now is the time to focus attention on what works—and what does not work—in a variety of global contexts, so as to improve the capacity and effectiveness of established and emerging trauma care systems, from the site of injury, via whatever prehospital emergency care service exists, to the facility-level emergency care of the injured patient.

Prof. Gerard O’Reilly
Prof. Biswadev Mitra
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • trauma
  • injury
  • emergency
  • registries
  • quality improvement
  • health systems
  • global health

Published Papers (5 papers)

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Research

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6 pages, 253 KiB  
Article
Analysis of Road Traffic Accidents in Turkey between 2013 and 2017
by Ali Kemal Erenler and Burak Gümüş
Medicina 2019, 55(10), 679; https://doi.org/10.3390/medicina55100679 - 09 Oct 2019
Cited by 11 | Viewed by 2568
Abstract
Background and objectives: Road traffic accident (RTAs) is one of the top ten leading causes of death worldwide and its incidence is higher in developing countries. In this study, our aim was to determine the characteristics of RTAs in Turkey and make recommendations [...] Read more.
Background and objectives: Road traffic accident (RTAs) is one of the top ten leading causes of death worldwide and its incidence is higher in developing countries. In this study, our aim was to determine the characteristics of RTAs in Turkey and make recommendations to reduce mortality and morbidity related to RTAs. Material and Methods: We obtained our data, which cover the years 2013 to 2017, from the database accessible at the official website of the Turkish Statistical Institute, which permits the use of its data for research purposes. The chi-square test was used for statistical analysis, and the percentage distribution and odds ratios were calculated. Results: In the study period, a total of 697,957 RTAs occurred in Turkey. A total of 1,168,121 individuals have been wounded and 3534 of them have lost their lives. The majority of RTAs occurred on weekends and in summer months. Male individuals are more likely to be exposed to death and injuries related to accidents. When the vehicle type is considered, motorcycle drivers are under more risk for RTAs. RTAs are more likely to occur in rural areas. Conclusion: Male individuals and motorcyclists are under a great risk for RTAs. Strict laws are mandatory in order to reduce morbidity and mortality related to RTAs. Additionally, educational efforts must focus on two-wheelers and tractor drivers, particularly in developing countries. Full article
(This article belongs to the Special Issue Trauma care)
9 pages, 1167 KiB  
Article
Temporary Fixation of Reduction with Fabric Adhesive Bandage in the Surgical Treatment of Pediatric Supracondylar Humerus Fractures
by Ozan Turhal, Mustafa Kınaş, Zekeriya Okan Karaduman, Yalçın Turhan, Onur Kaya and Cemal Güler
Medicina 2019, 55(8), 450; https://doi.org/10.3390/medicina55080450 - 07 Aug 2019
Cited by 2 | Viewed by 2840
Abstract
Background and objectives: Supracondylar humerus fractures are common in children and can be surgically treated. However, the general surgical procedures involving reduction and fixation might lead to reduction loss, failure to direct the Kirschner (K)-wire toward the desired position, prolonged surgery, or chondral [...] Read more.
Background and objectives: Supracondylar humerus fractures are common in children and can be surgically treated. However, the general surgical procedures involving reduction and fixation might lead to reduction loss, failure to direct the Kirschner (K)-wire toward the desired position, prolonged surgery, or chondral damage. This study aimed to show that temporary fixation of closed reduction with a fabric adhesive bandage in pediatric supracondylar humerus fractures could maintain reduction so that surgical treatment can be easily performed by a single physician. Materials and Methods: Forty-six patients with Gartland type 3 supracondylar humerus fractures who underwent surgical treatment between May 2017 and June 2018 were retrospectively evaluated. Fluoroscopy-guided reduction and fixation were performed from the distal third of the forearm to the proximal third of the humerus using a fabric adhesive bandage. Two crossed pins were applied on the fracture line by first inserting a lateral-entry K-wire and then inserting another K-wire close to the anterior aspect of the medial epicondyle and diverging from the ulnar nerve tunnel. A tourniquet was not applied in any patient and no patients required open reduction. Results: The study included 32 boys (69.6%) and 14 girls (30.4%) (mean age, 7.1; range, 2–16 years). The mean hospital stay and follow-up duration were 4.3 ± 3.9 days and 48.1 ± 14.3 weeks, respectively. Heterotopic ossification was detected in one patient, and ulnar nerve neuropraxia was detected in another patient. Functional (according to Flynn criteria) and cosmetic outcomes were excellent in 95.6%, moderate in 2.2%, and poor in 2.2% of patients. The mean duration of fixation of the closed reduction with a fabric adhesive bandage was 8.1 ± 3.9 min, and the mean duration of pinning was 7.9 ± 1.4 min. Conclusions: Temporary preoperative fixation of supracondylar humerus fractures that require surgical treatment with a fabric adhesive bandage may be significantly convenient in practice. Full article
(This article belongs to the Special Issue Trauma care)
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Review

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17 pages, 684 KiB  
Review
Early Identification of Acute Traumatic Coagulopathy Using Clinical Prediction Tools: A Systematic Review
by Sophie Thorn, Helge Güting, Marc Maegele, Russell L. Gruen and Biswadev Mitra
Medicina 2019, 55(10), 653; https://doi.org/10.3390/medicina55100653 - 28 Sep 2019
Cited by 14 | Viewed by 4199
Abstract
Background and objectives: Prompt identification of patients with acute traumatic coagulopathy (ATC) is necessary to expedite appropriate treatment. An early clinical prediction tool that does not require laboratory testing is a convenient way to estimate risk. Prediction models have been developed, but none [...] Read more.
Background and objectives: Prompt identification of patients with acute traumatic coagulopathy (ATC) is necessary to expedite appropriate treatment. An early clinical prediction tool that does not require laboratory testing is a convenient way to estimate risk. Prediction models have been developed, but none are in widespread use. This systematic review aimed to identify and assess accuracy of prediction tools for ATC. Materials and Methods: A search of OVID Medline and Embase was performed for articles published between January 1998 and February 2018. We searched for prognostic and predictive studies of coagulopathy in adult trauma patients. Studies that described stand-alone predictive or associated factors were excluded. Studies describing prediction of laboratory-diagnosed ATC were extracted. Performance of these tools was described. Results: Six studies were identified describing four different ATC prediction tools. The COAST score uses five prehospital variables (blood pressure, temperature, chest decompression, vehicular entrapment and abdominal injury) and performed with 60% sensitivity and 96% specificity to identify an International Normalised Ratio (INR) of >1.5 on an Australian single centre cohort. TICCS predicted an INR of >1.3 in a small Belgian cohort with 100% sensitivity and 96% specificity based on admissions to resuscitation rooms, blood pressure and injury distribution but performed with an Area under the Receiver Operating Characteristic (AUROC) curve of 0.700 on a German trauma registry validation. Prediction of Acute Coagulopathy of Trauma (PACT) was developed in USA using six weighted variables (shock index, age, mechanism of injury, Glasgow Coma Scale, cardiopulmonary resuscitation, intubation) and predicted an INR of >1.5 with 73.1% sensitivity and 73.8% specificity. The Bayesian network model is an artificial intelligence system that predicted a prothrombin time ratio of >1.2 based on 14 clinical variables with 90% sensitivity and 92% specificity. Conclusions: The search for ATC prediction models yielded four scoring systems. While there is some potential to be implemented effectively in clinical practice, none have been sufficiently externally validated to demonstrate associations with patient outcomes. These tools remain useful for research purposes to identify populations at risk of ATC. Full article
(This article belongs to the Special Issue Trauma care)
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19 pages, 1235 KiB  
Review
Geographical Variance in the Use of Tranexamic Acid for Major Trauma Patients
by Kieran Walsh, Francis O’Keeffe and Biswadev Mitra
Medicina 2019, 55(9), 561; https://doi.org/10.3390/medicina55090561 - 02 Sep 2019
Cited by 6 | Viewed by 3631
Abstract
Background and Objectives: The CRASH-2 trial is the largest randomised control trial examining tranexamic acid (TXA) for injured patients. Since its publication, debate has arisen around whether results could be applied to mature trauma systems in developed nations, with global opinion divided. [...] Read more.
Background and Objectives: The CRASH-2 trial is the largest randomised control trial examining tranexamic acid (TXA) for injured patients. Since its publication, debate has arisen around whether results could be applied to mature trauma systems in developed nations, with global opinion divided. The aim of this study was to determine if, among trauma patients in or at significant risk of major haemorrhages, there is an association of geographic region with the proportion of patients that received tranexamic acid. Materials and Methods: We conducted a systematic review of the literature. Potentially eligible papers were first screened via title and abstract screening. A full copy of the remaining papers was then obtained and screened for final inclusion. The Newcastle–Ottawa Scale for non-randomised control trials was used for quality assessment of the final studies included. A meta-analysis was conducted using a random-effects model, reporting variation in use sub-grouped by geographical location. Results: There were 727 papers identified through database searching and 23 manuscripts met the criteria for final inclusion in this review. There was a statistically significant variation in the use of TXA for included patients. Europe and Oceania had higher usage rates of TXA compared to other continents. Use of TXA in Asia and Africa was significantly less than other continents and varied use was observed in North America. Conclusions: A large geographical variance in the use of TXA for trauma patients in or at significant risk of major haemorrhage currently exists. The populations in Asia and Africa, where the results of CRASH-2 could be most readily generalised to, reported low rates of use. The reason why remains unclear and further research is required to standardise the use of TXA for trauma resuscitation. Full article
(This article belongs to the Special Issue Trauma care)
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14 pages, 1284 KiB  
Review
What Is the Clinical Evidence Supporting Trauma Team Training (TTT): A Systematic Review and Meta-Analysis
by Michael Noonan, Alexander Olaussen, Joseph Mathew, Biswadev Mitra, De Villiers Smit and Mark Fitzgerald
Medicina 2019, 55(9), 551; https://doi.org/10.3390/medicina55090551 - 30 Aug 2019
Cited by 10 | Viewed by 2861
Abstract
Background and Objectives: Major trauma centres manage severely injured patients using multi-disciplinary teams but the evidence-base that targeted Trauma Team Training (TTT) improves patients’ outcomes is unclear. This systematic review aimed to identify the association between the implementation of TTT programs and patient [...] Read more.
Background and Objectives: Major trauma centres manage severely injured patients using multi-disciplinary teams but the evidence-base that targeted Trauma Team Training (TTT) improves patients’ outcomes is unclear. This systematic review aimed to identify the association between the implementation of TTT programs and patient outcomes. Materials and Methods: We searched OVID Medline, PubMed and The Cochrane Library (CENTRAL) from the date of the database commencement until 10 of April 2019 for a combination of Medical Subject Headings (MeSH) terms and keywords relating to TTT and clinical outcomes. Reference lists of appraised studies were also screened for relevant articles. We extracted data on the study setting, type and details about the learners, as well as clinical outcomes of mortality and/or time to critical interventions. A meta-analysis of the association between TTT and mortality was conducted using a random effects model. Results: The search yielded 1136 unique records and abstracts, of which 18 full texts were reviewed. Nine studies met final inclusion, of which seven were included in a meta-analysis of the primary outcome. There were no randomised controlled trials. TTT was not associated with mortality (Pooled overall odds ratio (OR) 0.83; 95% Confidence Interval; 0.64–1.09). TTT was associated with improvements in time to operating theatre and time to first computerized tomography (CT) scanning. Conclusions: Despite few publications related to TTT, its introduction was associated with improvements in time to critical interventions. Whether such improvements can translate to improvements in patient outcomes remains unknown. Further research focusing on the translation of standardised trauma team reception “actions” into TTT is required to assess the association between TTT and patient outcome. Full article
(This article belongs to the Special Issue Trauma care)
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