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A 4-year review of severe pediatric trauma in eastern Ontario: a descriptive analysis.

https://arctichealth.org/en/permalink/ahliterature191929
Source
J Trauma. 2002 Jan;52(1):8-12
Publication Type
Article
Date
Jan-2002
Author
Martin H Osmond
Maureen Brennan-Barnes
Allyson L Shephard
Author Affiliation
Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada. osmond@cheo.on.ca
Source
J Trauma. 2002 Jan;52(1):8-12
Date
Jan-2002
Language
English
Publication Type
Article
Keywords
Accident prevention
Accidental Falls - prevention & control - statistics & numerical data
Accidents, Traffic - prevention & control - statistics & numerical data
Adolescent
Age Distribution
Athletic Injuries - epidemiology - etiology - prevention & control
Child
Child Abuse - prevention & control - statistics & numerical data
Child, Preschool
Craniocerebral Trauma - epidemiology - etiology - prevention & control
Female
Hospitals, Pediatric - statistics & numerical data
Humans
Infant
Infant, Newborn
Male
Ontario - epidemiology
Retrospective Studies
Sex Distribution
Time Factors
Trauma Centers - statistics & numerical data
Trauma Severity Indices
Wounds and Injuries - epidemiology - etiology - prevention & control
Abstract
The objective of this study was to describe a population of children admitted to a tertiary care pediatric hospital with severe trauma to identify key areas for injury prevention research, and programming.
Retrospective chart review conducted on all children 0-17 years admitted to the Children's Hospital of Eastern Ontario (CHEO) between April 1, 1996, and March 31, 2000, following acute trauma. Each record was reviewed and assigned an ISS using the AIS 1990 revision. All cases with an ISS > 11 were included in the study.
There were 2610 trauma cases admitted to CHEO over the study period. Of these, 237 (9.1%) had severe trauma (ISS > 11). Sixty-two percent were male. Twenty-nine percent were between the ages of 10 and 14 years, 27% between 5 and 9 years, 16% between 15 and 17 years, 15% between 1 and 4 years, and 13% less than 1 year old. The most common mechanisms of injury were due to motor vehicle traffic (39%), falls (24%), child abuse (8%), and sports (5%). Of those resulting from motor vehicle traffic, 53 (57%) were occupants, 22 (24%) were pedestrians, and 18 (19%) were cyclists. When combining traffic and nontraffic mechanisms, 26 (11% of all severe trauma cases) occurred as a result of cycling incidents. The most severe injury in 65% of patients was to the head and neck body region.
Research efforts and activities to prevent severe pediatric trauma in our region should focus on road safety, protection from head injuries, avoidance of falls, and prevention of child abuse.
PubMed ID
11791045 View in PubMed
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The 1993 Fraser N. Gurd Lecture: The view from the edge.

https://arctichealth.org/en/permalink/ahliterature217361
Source
J Trauma. 1994 Sep;37(3):379-86
Publication Type
Article
Date
Sep-1994
Author
G W Fitzgerald
Author Affiliation
Department of Surgery, Charles S. Curtis Memorial Hospital, St. Anthony, Newfoundland, Canada.
Source
J Trauma. 1994 Sep;37(3):379-86
Date
Sep-1994
Language
English
Publication Type
Article
Keywords
Canada
Delivery of Health Care
Humans
Injury Severity Score
Off-Road Motor Vehicles
Rural Population
Trauma Centers - statistics & numerical data
PubMed ID
8083897 View in PubMed
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Abdominal injuries in a low trauma volume hospital--a descriptive study from northern Sweden.

https://arctichealth.org/en/permalink/ahliterature264480
Source
Scand J Trauma Resusc Emerg Med. 2014;22:48
Publication Type
Article
Date
2014
Author
Patrik Pekkari
Per-Olof Bylund
Hans Lindgren
Mikael Öman
Source
Scand J Trauma Resusc Emerg Med. 2014;22:48
Date
2014
Language
English
Publication Type
Article
Keywords
Abdominal Injuries - diagnosis - epidemiology - therapy
Adolescent
Adult
Disease Management
Female
Follow-Up Studies
Hospital Mortality - trends
Hospitals, Low-Volume - statistics & numerical data
Humans
Incidence
Injury Severity Score
Length of Stay - trends
Male
Middle Aged
Prognosis
Retrospective Studies
Survival Rate - trends
Sweden - epidemiology
Tomography, X-Ray Computed
Trauma Centers - statistics & numerical data
Young Adult
Abstract
Abdominal injuries occur relatively infrequently during trauma, and they rarely require surgical intervention. In this era of non-operative management of abdominal injuries, surgeons are seldom exposed to these patients. Consequently, surgeons may misinterpret the mechanism of injury, underestimate symptoms and radiologic findings, and delay definite treatment. Here, we determined the incidence, diagnosis, and treatment of traumatic abdominal injuries at our hospital to provide a basis for identifying potential hazards in non-operative management of patients with these injuries in a low trauma volume hospital.
This retrospective study included prehospital and in-hospital assessments of 110 patients that received 147 abdominal injuries from an isolated abdominal trauma (n = 70 patients) or during multiple trauma (n = 40 patients). Patients were primarily treated at the University Hospital of Umeå from January 2000 to December 2009.
The median New Injury Severity Score was 9 (range: 1-57) for 147 abdominal injuries. Most patients (94%) received computed tomography (CT), but only 38% of patients with multiple trauma were diagnosed with CT
Notes
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PubMed ID
25124882 View in PubMed
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Acetabular fracture assessment in four different pelvic trauma centers: have the Judet views become superfluous?

https://arctichealth.org/en/permalink/ahliterature269564
Source
Arch Orthop Trauma Surg. 2015 Jul;135(7):913-8
Publication Type
Article
Date
Jul-2015
Author
John Clarke-Jenssen
Stein Arne Øvre
Olav Røise
Jan Erik Madsen
Source
Arch Orthop Trauma Surg. 2015 Jul;135(7):913-8
Date
Jul-2015
Language
English
Publication Type
Article
Keywords
Acetabulum - injuries - radiography
Adult
Female
Hip Fractures - radiography
Humans
Male
Norway
Observer Variation
Predictive value of tests
Reproducibility of Results
Tomography, X-Ray Computed - methods - standards
Trauma Centers - statistics & numerical data
Abstract
The present study was designed to examine whether oblique radiographs (Judet views) in addition to 2D and 3D CT scans improved the intra- and interobserver reliability when assessing acetabular fractures.
Four international orthopedic pelvic trauma centers reviewed the radiological images for 20 acetabular fracture patients. Three different image sets were made; one set containing plain radiographs including oblique (Judet) views and 2D axial CT scans. The second set contained an AP radiograph of the pelvis, without oblique views, 2D and 3D CT scans. The third set contained all the images. The image sets were evaluated in three separate sessions, for each session the raters were asked to classify the fracture according to Letournel, as well as record a number of other important radiological features concerning the fracture.
The interobserver agreement for the Letournel classification was found to be moderate for all image sets. The image set without oblique views showed the best agreement with a kappa value of 0.60. The intra- and interobserver agreement for important modifiers were found to be substantial. The addition of oblique radiographs did not seem to increase the intra- or interobserver agreement for any of the factors evaluated except for the roof arc score.
The moderate agreement found for the Letournel classification is to be expected given the complexity of the classification. The addition of oblique radiographs to the image sets does not seem to improve the reliability and thus its routine use for classification and decision making may be debated.
PubMed ID
25931251 View in PubMed
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Alcohol intake and the pattern of trauma in young adults and working aged people admitted after trauma.

https://arctichealth.org/en/permalink/ahliterature9232
Source
Alcohol Alcohol. 2005 Jul-Aug;40(4):269-73
Publication Type
Article
Author
Olli Savola
Onni Niemelä
Matti Hillbom
Author Affiliation
Department of Neurology, Oulu University Hospital, Oulu, Finland. olli.savola@oulu.fi
Source
Alcohol Alcohol. 2005 Jul-Aug;40(4):269-73
Language
English
Publication Type
Article
Keywords
Accidental Falls
Accidents
Adolescent
Adult
Age Factors
Alcohol Drinking - adverse effects - psychology
Comparative Study
Employment - statistics & numerical data
Ethanol - adverse effects - blood - poisoning
Female
Humans
Male
Middle Aged
Patient Admission
Research Support, Non-U.S. Gov't
Trauma Centers - statistics & numerical data
Violence
Wounds and Injuries - classification - epidemiology - etiology
Abstract
AIMS: To investigate the relationship of different patterns of alcohol intake to various types of trauma. METHODS: We examined the associations of alcohol consumption in a series of 385 consecutive trauma admissions (278 men, 107 women, age range 16-49 years). Patients underwent clinical examinations, structured interviews on the amount and pattern of alcohol intake, and measurements of blood alcohol concentration (BAC). RESULTS: On admission, 51% of the patients had alcohol in their blood. Binge drinking was the predominant (78%) drinking pattern of alcohol intake. Assaults, falls and biking accidents were the most frequent causes of trauma. Dependent alcohol drinking and binge drinking were found to be significantly more common among patients with head trauma than in those with other types of trauma (77% vs 59%, OR=2.38; 95% CI 1.50 to 3.77). The OR for sustaining head injury increased sharply with increasing BAC: 1-99 mg/dl (1.24; 95% CI 0.55-2.01), 100-149 mg/dl 1.64; 95% CI 0.71-3.77), 150-199 mg/dl (3.20; 95% CI 1.57-6.53) and >199 mg/dl (9.23; 95% CI 4.79-17.79). CONCLUSIONS: Binge drinking is a major risk factor for head trauma among trauma patients. Assaults, falls and biking accidents are the commonest causes for such injuries. The relative risk for head injury markedly increases with increasing blood alcohol levels. Alcohol control measures should feature in policies aiming at the prevention of trauma-related morbidity and mortality.
PubMed ID
15870091 View in PubMed
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An evaluation of Ontario trauma outcomes and the development of regional norms for Trauma and Injury Severity Score (TRISS) analysis.

https://arctichealth.org/en/permalink/ahliterature210981
Source
J Trauma. 1996 Oct;41(4):731-4
Publication Type
Article
Date
Oct-1996
Author
P L Lane
G. Doig
A. Mikrogianakis
S T Charyk
T. Stefanits
Author Affiliation
Department of Trauma Services, Victoria Hospital, London, Ontario, Canada.
Source
J Trauma. 1996 Oct;41(4):731-4
Date
Oct-1996
Language
English
Publication Type
Article
Keywords
Evaluation Studies as Topic
Humans
Injury Severity Score
Logistic Models
Ontario - epidemiology
Reference Standards
Trauma Centers - statistics & numerical data
Trauma Severity Indices
Treatment Outcome
Wounds and Injuries - epidemiology - mortality - therapy
Abstract
Outcomes analysis of patient care programs has become increasingly necessary for a variety of reasons in recent years. This has been particularly true for trauma programs. The Trauma and Injury Severity Score (TRISS) methodology was developed for this purpose in the context of the Major Trauma Outcome Study (MTOS). It provides an estimate of the probability of survival for individual patients, based on anatomic, physiologic, and etiologic factors. In addition, it allows hospitals and groups of hospitals to compare survival rates with other hospitals submitting data to the data base. However, the published coefficients for TRISS analysis have been derived from the MTOS data base. Patterns of practice, time to treatment, and other variables may be significantly different in other jurisdictions. To compare outcomes among similar hospitals within the province of Ontario, Canada, a regression analysis was performed to develop TRISS coefficients specific to the province. Data were obtained from the 12 trauma centers in the province treating the most severely injured patients (Injury Severity Score > 12). A total of 3,880 cases were eligible for TRISS analysis, over a 3-year period. Of these, 3,672 were patients with blunt trauma, and 208 were victims of penetrating injury. Standard TRISS analysis of the patients with blunt trauma revealed z scores ranging from -10.260 to +1.849, with a mean of -6.648. Four centers had negative z scores that were significant (an absolute value of > 1.96 is considered statistically significant). Using Ontario TRISS coefficients, z scores ranged from -4.125 to +2.782, with a mean of 0.000. Four scores were significant with the Ontario coefficients, only one of which had been significant using the MTOS norms. The other three z scores were all positive, indicating more deaths than would have been predicted, but they were not significant when compared to the MTOS norms. The mean was also, of course, no longer significant. The area under the receiver operating characteristic curve analysis was strongly positive, and the Hosmer-Lemeshow Goodness-of-Fit analysis indicated good calibration. The new coefficients were subsequently validated by applying them to a subsequent year's data from patient records that did not form part of the original data set. This resulted in slightly improved z scores overall, and in most of the hospitals. This use of regional norms allows comparison with outcomes of patients cared for in hospitals within the same jurisdiction that are more similar to one another than to those in the MTOS, and helps to identify unexpected outcomes and outliers.
PubMed ID
8858037 View in PubMed
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Assessment of mortality in older trauma patients sustaining injuries from falls or motor vehicle collisions treated in regional level I trauma centers.

https://arctichealth.org/en/permalink/ahliterature152378
Source
Ann Surg. 2009 Mar;249(3):488-95
Publication Type
Article
Date
Mar-2009
Author
John S Sampalis
Robin Nathanson
Julie Vaillancourt
Andreas Nikolis
Moishe Liberman
John Angelopoulos
Nickolaos Krassakopoulos
Nadia Longo
Eliofotisti Psaradellis
Author Affiliation
Department of Surgery, Surgical Research, McGill University, Montreal, Quebec, Canada. jsampalis@jssresearch.com
Source
Ann Surg. 2009 Mar;249(3):488-95
Date
Mar-2009
Language
English
Publication Type
Article
Keywords
Accidental Falls - statistics & numerical data
Accidents, Traffic - statistics & numerical data
Age Factors
Aged
Aged, 80 and over
Cohort Studies
Female
Humans
Male
Quebec - epidemiology
Retrospective Studies
Trauma Centers - statistics & numerical data
Wounds and Injuries - mortality
Abstract
To compare mortality in elderly trauma patients sustaining fall or motor vehicle collision (MVC) related injuries and who are subsequently treated at regional Level I (tertiary) trauma centers.
An increase in the mean age of the Canadian population is leading to a higher proportion of older patients injured in falls who are subsequently treated at Level 1 trauma centers in Quebec. The Level 1 centers were designed to treat younger patients injured in MVCs and violent acts. As a result, discordance may exist between the type of care supplied at these centers and the increased demand for care tailored to older trauma patients.
A retrospective cohort study comprised of 4,717 patients over the age of 65; 606 (12.8%) injured in MVCs and 4,111 (87.2%) in falls. The mean (SD) age was 79.6 (8.0) years and 67.9% were female. The mean (SD) Injury Severity Score (ISS) was 10.8 (7.4). Data were obtained from the Quebec Trauma Registry (QTR) for patients treated at 3 Level I trauma centers in the province of Quebec, Canada. The primary outcome measure in this study was mortality.
Being injured in a fall was a strong predictor for mortality, with an odds ratio of 5.11 (95% C.I. = 1.84-14.17, P = 0.002). Additionally, the adjusted mortality rate was 25.3% among fall victims, versus 7.8% for MVC patients. Female gender, older age, higher ISS and an increasing number of injuries were all associated with heightened mortality. In contrast, the number of body regions injured, experiencing complications, sustaining a hip fracture, the Revised Trauma Score, the Prehospital Index and the Charlson (comorbidity) Index had no association with mortality in the Level I centers.
Elderly patients sustaining fall-related injuries and treated at Level I trauma centers are at risk for excess mortality when compared with those injured in MVCs. Effective and efficient methods for treating this population must be determined.
PubMed ID
19247039 View in PubMed
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A booming economy means a bursting trauma system: association between hospital admission for major injury and indicators of economic activity in a large Canadian health region.

https://arctichealth.org/en/permalink/ahliterature104921
Source
Am J Surg. 2014 May;207(5):653-7; discussion 657-8
Publication Type
Article
Date
May-2014
Author
Derek J Roberts
Debanjana Das
Michelle Mercado
Christine Vis
John B Kortbeek
Andrew W Kirkpatrick
Chad G Ball
Author Affiliation
Department of Surgery, University of Calgary, Foothills Medical Centre, 1403-29th Street Northwest, Calgary, AB T2N 2T9, Canada; Department of Community Health Sciences, University of Calgary, Foothills Medical Centre, 1403-29th Street Northwest, Calgary, AB T2N 2T9, Canada.
Source
Am J Surg. 2014 May;207(5):653-7; discussion 657-8
Date
May-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Alberta - epidemiology
Economics - statistics & numerical data
Female
Gross Domestic Product - statistics & numerical data
Hospitalization - statistics & numerical data
Hospitals, High-Volume - statistics & numerical data - utilization
Humans
Injury Severity Score
Linear Models
Male
Middle Aged
Registries
Trauma Centers - statistics & numerical data - utilization
Wounds and Injuries - economics - epidemiology
Young Adult
Abstract
Injury epidemiology fluctuates with economic activity in many countries. These relationships remain unclear in Canada.
The annual risk of admission for major injury (Injury Severity Score =12) to a high-volume, level-1 Canadian trauma center was compared with indicators of economic activity over a 16-year period using linear regression.
An increased risk of injured patient admissions was associated with rising mean gross domestic product (GDP [millions of chained 2002 dollars]) (.36 person increase per 100,000 population/$1,000 increase in GDP; P = .001) and annual gasoline prices (.47 person increase per 100,000 population/cent increase in gasoline price; P = .001). Recreation-related vehicle injuries were also associated with economic affluence. The risk of trauma patient mortality with increasing mean annual GDP (P = .72) and gasoline prices (P = .32) remained unchanged.
Hospital admissions for major injury, but not trauma patient mortality, were associated with economic activity in a large Canadian health care region.
PubMed ID
24560360 View in PubMed
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The cause of infant and toddler subdural hemorrhage: a prospective study.

https://arctichealth.org/en/permalink/ahliterature5108
Source
Pediatrics. 2001 Sep;108(3):636-46
Publication Type
Article
Date
Sep-2001
Author
K W Feldman
R. Bethel
R P Shugerman
D C Grossman
M S Grady
R G Ellenbogen
Author Affiliation
Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA. kfeldman@u.washington.edu
Source
Pediatrics. 2001 Sep;108(3):636-46
Date
Sep-2001
Language
English
Publication Type
Article
Keywords
Alaska - epidemiology
Child Abuse - statistics & numerical data
Child, Preschool
Craniocerebral Trauma - epidemiology
Female
Fractures, Bone - epidemiology
Hematoma, Subdural - epidemiology
Humans
Infant
Male
Multiple Trauma - classification - epidemiology
Northwestern United States - epidemiology
Prospective Studies
Research Support, U.S. Gov't, P.H.S.
Sex Distribution
Trauma Centers - statistics & numerical data
Washington - epidemiology
Abstract
OBJECTIVE: To determine the frequency of child abuse and unintentional injury as a cause of infant and toddler subdural hemorrhage (SDH). METHODS: A prospective case series of a level I regional trauma center, regional children's hospital, and county medical examiner's office assessed consecutive children who were
PubMed ID
11533330 View in PubMed
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Changes in red cell transfusion practice among adult trauma victims.

https://arctichealth.org/en/permalink/ahliterature205907
Source
J Trauma. 1998 Apr;44(4):583-7
Publication Type
Article
Date
Apr-1998
Author
K J Farion
B A McLellan
B R Boulanger
J P Szalai
Author Affiliation
Department of Surgery, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
Source
J Trauma. 1998 Apr;44(4):583-7
Date
Apr-1998
Language
English
Publication Type
Article
Keywords
Adult
Blood Transfusion - statistics & numerical data - utilization
Erythrocyte Transfusion - statistics & numerical data - utilization
Female
Hemoglobins - analysis
Humans
Injury Severity Score
Male
Middle Aged
Multiple Trauma - mortality - therapy
Ontario
Patient Selection
Physician's Practice Patterns - statistics & numerical data - trends
Retrospective Studies
Survival Analysis
Time Factors
Trauma Centers - statistics & numerical data
Abstract
Recent attention concerning the adverse outcomes of blood transfusion has resulted in decreased blood product usage for nonemergency care. We hypothesized that there has also been a decrease in blood product use in the management of seriously injured adults.
A retrospective review of institutional database records was conducted at a regional trauma center for adults admitted during 1991, 1993, and 1995. Data was analyzed for trends in amount, type, and timing of blood product use.
A total of 1,738 patients were assessed, with 1,605 meeting inclusion. The three patient groups were similar, including injury severity (overall mean Injury Severity Score of 23.6), mechanism (88% blunt), and survival (87%). In 1991, 54% of the patients were transfused a total of 2,341 units of packed red blood cells (mean 4.67 units/pt treated) versus 42% of patients in 1995 (p
PubMed ID
9555826 View in PubMed
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60 records – page 1 of 6.