Injury-International Journal of the Care of the Injured最新文献

{"title":"Recovery after neurologic injury in operative acetabular and pelvic fractures: Defining the natural history of foot drop","authors":"","doi":"10.1016/j.injury.2024.111974","DOIUrl":"10.1016/j.injury.2024.111974","url":null,"abstract":"<div><h3>Introduction</h3><div>Dorsiflexion weakness, or footdrop, is a well-described sequela of high-energy acetabular and pelvic trauma, but little data exists describing the factors related to neurologic recovery and the timeline therein. An improved understanding of these factors would facilitate prognostication, patient education, and treatment decision-making. The aim of this study was to compare neurologic recovery between acetabular and pelvic fractures, delineate factors associated with recovery, and determine the expected timeline of recovery.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted at a level 1 tertiary referral center from 2000 to 2021 using CPT codes and keyword search functions to identify adult patients with neurologic injury in the setting of operative acetabular and/or pelvic ring trauma. Patients were included if they had documented, graded weakness not clearly explained by a concomitant injury (extremity or spine) following a pelvic/acetabular injury. Patients were followed to a minimum of 6 months follow-up or to neurologic recovery. Primary outcomes were the presence of motor recovery and time to initial and maximum recovery. The contributions of injury type and initial neurologic status were analyzed using logistic regression for impact on neurologic recovery.</div></div><div><h3>Results</h3><div>We identified 121 patients with neurologic injury and resultant footdrop in the setting of an operative pelvic ring or acetabular fracture. From this cohort, 58 patients (47.9 %) demonstrated some degree of neurologic recovery in follow-up. There was no difference in recovery when comparing injury type (pelvis vs. acetabulum). Any motor function (including flicker) at time of initial evaluation was predictive of recovery (OR 6.18, [2.00 – 19.14]; <em>p</em> = 0.002). Initial neurologic function also correlated with more rapid recovery in comparison to patients with initial absent neurologic function both in time to initial recovery (56 days vs 107 days; <em>p</em> = 0.016) and time to maximum recovery (153 days vs 241 days; <em>p</em> = 0.027).</div></div><div><h3>Conclusions</h3><div>These results highlight the relatively poor prognosis for neurologic recovery in operative pelvic and acetabular injuries. Any initial neurologic function is predictive of likelihood of neurologic recovery and correlates with a more expedient neurologic recovery. Ultimately, this enables providers to better educate patients and facilitates decisions regarding further intervention.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of orthogeriatric co-management with prescription frequencies of anti-osteoporotic drugs in patients with fragility fractures: An observational study with health insurance data","authors":"","doi":"10.1016/j.injury.2024.111971","DOIUrl":"10.1016/j.injury.2024.111971","url":null,"abstract":"<div><h3>Background</h3><div>Geriatricians are increasingly involved in the treatment of fragility fractures. In Germany, hospitals that meet specific standards for orthogeriatric co-management (OGCM) are additionally certified as 'geriatric trauma centers.' One responsibility of OGCM is the appropriate management of osteoporosis through medication. We aimed to analyse the association between prescription frequencies of anti-osteoporotic drugs in hospitals with certified OGCM, those with non-certified OGCM, and those with no OGCM at all.</div></div><div><h3>Methods</h3><div>Claims data from nearly 200,000 patients aged 80 and older with an incident index fracture of the humerus, forearm, hip, pelvis, or spine, were obtained from a German health insurance. Hospitals were categorized into three groups: no OGCM, with OGCM, and with certified OGCM. The outcomes were new prescriptions for specific anti-osteoporotic drugs and vitamin D within 180 days after the index fracture. Crude incidences and adjusted incidence rate ratios (IRR) were calculated.</div></div><div><h3>Results</h3><div>Prescription rates of specific anti-osteoporotic drugs and vitamin D increased from hospitals with no OGCM to hospitals with OGCM and were highest in hospitals with certified OGCM. This pattern was observed across all fracture types, age groups, and both men and women, except for forearm fractures. For example, in hip fractures, the IRR for prescriptions of specific anti-osteoporotic drugs in hospitals with certified OGCM compared to those with no OGCM was 2.17 (95 % CI: 1.90–2.48).</div></div><div><h3>Conclusion</h3><div>OGCM, especially when coupled with certification as a 'Geriatric Trauma Center,' is associated with higher prescription rates of specific anti-osteoporotic drugs and vitamin D after fragility fractures in Germany.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fracture patterns in bicycle accidents: A descriptive national cohort study of fractures sustained in bicycle accidents in the Swedish Fracture Register 2015–2022","authors":"","doi":"10.1016/j.injury.2024.111960","DOIUrl":"10.1016/j.injury.2024.111960","url":null,"abstract":"<div><h3>Introduction</h3><div>Bicycle accidents account for the majority of traffic-related accidents in Sweden. Despite the widespread everyday use of bicycles, little is known about the fracture panorama resulting from bicycle accidents. This study analysed the fracture patterns of bicycle accidents in Sweden in regard to fracture type, sex, age, and type of bicycle.</div></div><div><h3>Material and methods</h3><div>We retrieved data from the Swedish Fracture Register on all fractures caused by bicycle accidents between 2015 and 2022. The study population was comprised of both children and adults who had sustained one or more fractures in a bicycle accident as registered in the Swedish Fracture Register.</div></div><div><h3>Results</h3><div>We included 33,384 fractures (25,960 in adults and 7424 in children) in 30,815 patients, with a dominance of fractures in men. The mean age at fracture was 41.6 years (SD 23). The majority of fractures (62.7 %, <em>n</em> = 20,932) were sustained via a low energy mechanism. Overall, the most commonly fractured body parts were the forearm (35.2 %, <em>n</em> = 11,747), the hand (15.6 %, <em>n</em> = 5,196) and the clavicle (13.7 %, <em>n</em> = 4,558). In children, fractures of the forearm (56.8 %, <em>n</em> = 4,215) clearly dominated, followed by the hand (11.7 %, <em>n</em> = 868), and the humerus (11.0 %, <em>n</em> = 816). In adults, the top 3 fracture locations were the forearm (29.0 %, <em>n</em> = 7,532), the hand (16.7 %, <em>n</em> = 4,328), and the clavicle (15.7 %, <em>n</em> = 4,086). Mountain bikes and road bikes showed a fracture panorama that was very similar with a predominance of fractures to the clavicle. Fractures were more common during the warm season.</div></div><div><h3>Conclusion</h3><div>The main finding is that bicyclists predominantly sustained fractures of the upper limb via low energy mechanisms. The fracture panorama differed by age, sex, and type of bicycle.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic factors of falls in hospitalized adults and elderly: An epidemiological and clinical analysis","authors":"","doi":"10.1016/j.injury.2024.111966","DOIUrl":"10.1016/j.injury.2024.111966","url":null,"abstract":"<div><h3>Background</h3><div>Falls are known to cause injuries ranging from minor to severe, resulting in local or systemic lesions. Addressing prognostic factors associated with falls is crucial for preventing this adverse event through the implementation of patient care protocols. This study aimed to explore the epidemiological, clinical, and pharmacological prognostic factors influencing falls in adult and elderly patients, assessing the timing and impact of these factors using survival curve analysis.</div></div><div><h3>Methods</h3><div>A retrospective observational cohort study included 176 hospitalized patients experiencing falls, categorized into adults (&lt;60 years) and elderly (≥60 years). Binomial tests and logistic regression assessed variable associations, while Kaplan-Meier curves and Cox proportional hazards models analyzed survival.</div></div><div><h3>Results</h3><div>Overall, 25.9 % of adults and 33.3 % of the elderly experienced some form of injury (minor or moderate). Patients were alone during the fall in 77.6 % of cases for those under 60, compared to 50 % for those 60 and older (<em>p</em> &lt; 0.001). Falls from own height were the most common, occurring in 46.6 % of patients under 60 years and 66.7 % of elderly patients (<em>p</em> = 0.011). Among adults under 60, factors such as past alcohol history (<em>p</em> = 0.0276), falling alone (<em>p</em> = 0.0002), benzodiazepine use (<em>p</em> = 0.0001), antiarrhythmic/antihypertensive medication (<em>p</em> = 0.0005), and antipsychotics (<em>p</em> = 0.0001) were significantly associated with falls. In the elderly, significant factors included falling from one's own height (<em>p</em> = 0.0112), muscle weakness (<em>p</em> = 0.0183), gait disorders (<em>p</em> = 0.0443), vasodilators (<em>p</em> = 0.0107), antihistamines (<em>p</em> = 0.0003), and hypoglycemic agents (<em>p</em> = 0.0041). Survival curve analysis indicated women under 60 had a worse prognosis for falls compared to elderly women (<em>p</em> = 0.038). For the elderly, opioid use (<em>p</em> = 0.045) and muscle weakness (<em>p</em> = 0.037) represented poor prognostic factors compared to adults under 60. In Cox regression, only female sex in patients under 60 showed a higher risk (HR=1.47) compared to women over 60 (<em>p</em> = 0.0014). Although not significant in multivariate analysis, muscle weakness (<em>p</em> = 0.066) and opioid use (<em>p</em> = 0.0545) had proportional hazards of 1.37 and 1.12, respectively.</div></div><div><h3>Conclusion</h3><div>Female sex indicated poorer prognosis in &lt;60 s, while opioids and muscle weakness were concerning for the elderly. These findings emphasize the need for tailored care protocols to stratify patient fall risk and prognosis during hospitalization and develop effective preventive strategies in healthcare<strong>.</strong></div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comprehensive review of current trends in e-scooter associated injuries, associated outcomes, and effective interventions: Towards establishing sustainable prevention interventions","authors":"","doi":"10.1016/j.injury.2024.111967","DOIUrl":"10.1016/j.injury.2024.111967","url":null,"abstract":"<div><h3>Introduction</h3><div>This review aims to provide a comprehensive overview of electric-scooter (E-Scooter) injuries by evaluating the incidence, common mechanisms of injury, clinical outcomes, associated costs, and effective interventions for injury prevention.</div></div><div><h3>Methods</h3><div>A literature search using PubMed, Google Scholar, EMBASE, and ProQuest was performed to identify relevant articles published between July 10, 2014, and July 10, 2024. Outcomes of interest included epidemiologic trends of E-Scooter injuries, common mechanisms of injury, associated risk factors, clinical outcomes, and interventions to decrease E-Scooter injuries.</div></div><div><h3>Results</h3><div>A total of 41 articles were included in this study, with 39 evaluating the epidemiologic trends of e-scooter injuries, 22 the most common mechanisms of injury, 21 assessed intoxication, 15 assessed helmet usage, 33 determined patient's clinical outcomes, and 3 assessed effective interventions for decreasing the incidence of e-scooter injuries. Falls were the most common mechanism of injury; however, collisions with motor vehicles caused more severe injuries. Additionally, studies showed that up to 74 % of all E-Scooter injuries included alcohol intoxication, and over 80 % did not use a helmet leading to severe head injuries.</div></div><div><h3>Conclusion</h3><div>The incidence of E-Scooter related injuries rose significantly in recent years. These injuries typically result from falls and MVAs and are compounded by factors including limited helmet usage and riding while intoxicated. These contribute to the poorer clinical outcomes seen with E-Scooter injuries. However, there remains a significant paucity of literature focused on the outcomes of policies and interventions designed to reduce these injuries. Further investigation must address these gaps and discrepancies to inform future policies.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142531802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No difference in early outcomes comparing intramedullary versus extramedullary fibular fixation in operative ankle fractures","authors":"","doi":"10.1016/j.injury.2024.111973","DOIUrl":"10.1016/j.injury.2024.111973","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;The purpose of this study was to compare postoperative complications and outcomes of minimally invasive intramedullary fixation (IMF) versus plate fixation (PF) in the treatment of distal fibular fractures.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and methods&lt;/h3&gt;&lt;div&gt;A retrospective review was performed from identifying all consecutive ankle fracture patients aged ≥18-years-old surgically managed between August 2017 to September 2022 at a tertiary care center with minimum 6 months clinical follow-up. Patients were grouped into those receiving intramedullary versus extramedullary fibular fixation. The primary outcomes were relevant demographic factors (diabetes, osteoporosis, charlson comorbidity index [CCI]), surgical time, complication rates, reoperation rates. Secondary outcomes included time to definitive fracture fixation, fracture characteristics (AO/OTA and Lauge-Hansen classification), syndesmotic instability requiring fixation and discharge disposition.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Forty-one IMF patients (average age 55.3 ± 18.1yrs) and 162 PF patients (47.7 ± 17.4yrs) were identified and included in this study. Within the IMF group, 25 patients received IM nailing and 16 patients received percutaneous screw fixation. A greater proportion of IMF patients had diabetes (39 % vs 22 %, p &lt; 0.001), osteoporosis (22 % vs 3 %, p &lt; 0.001), and moderate or severe CCI (41 % vs 23 %, p = 0.017). Surgical time was significantly reduced when using IMF technique (80.4 ± 43.1 min vs 99.1 ± 43.1 min, p = 0.012). Overall complication rates or time to complication did not differ significantly between groups (p = 0.578 and p = 0.082, respectively); however, when sub-stratified, IMF patients trended towards experiencing fewer wound related complications versus PF patients (5 % vs 9 %, p = 0.291). No IMF patients experienced deep or superficial infections and only 2 (5 %) patients experienced wound dehiscence. Reoperation rates(15 % vs 10 %, p = 0.267) and time to fracture union (2.7 ± 2.2 mos vs 3.1 ± 2.0 mos, p = 0.301) did not differ significantly. At final follow-up (IMF: 15.0 ± 12.2 mos vs PF: 28.5 ± 19.5 mos), Olerud and Molander ankle score was significantly higher in IMF compared to PF (87.1 ± 14.2 vs 76.2 ± 22.6, p = 0.002).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Patients in the IMF group at baseline had several comorbid medical conditions that put them at high risk for wound related complications, however, postoperatively they demonstrated higher functional scores and similar complication rates compared to the PF group. It is important to note, however, while we expected a higher rate of wound issues with the PF group, there were no significant differences in infection rates. Either IMF and PF is reliable for fixation and outcomes, and thus with proper soft tissue, biologically friendly technique, either IMF or PF is a reliable choice in the fixation of fibula fractures.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Level of evidence&lt;/h3&gt;&lt;","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142532200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparison between nail-plate constructs and the plate-on-plate technique in the treatment of proximal femoral peri-implant fracture","authors":"","doi":"10.1016/j.injury.2024.111972","DOIUrl":"10.1016/j.injury.2024.111972","url":null,"abstract":"<div><h3>Study design</h3><div>A single-centre, retrospective cohort study.</div></div><div><h3>Objectives</h3><div>To compare the clinical outcomes between nail-plate constructs and the plate-on-plate technique in the treatment of proximal femoral peri-implant fracture (PFPIF).</div></div><div><h3>Methods</h3><div>Thirty-seven patients with PFPIF treated at our hospital were included. All patients underwent at least 1-year follow-up. Imaging studies and medical records, including walking ability, complications, and functional outcomes 1 year after surgery, were thoroughly reviewed.</div></div><div><h3>Results</h3><div>Twenty patients were treated with nail-plate constructs. Seventeen patients were treated with the plate-on-plate technique. The average surgical times in the plate-on-plate technique and nail-plate construct groups were 119.4 ± 23.4 min and 246.3 ± 48.0 min, respectively. The average blood losses in the plate-on-plate technique and nail-plate construct groups were 124.7 ± 41.6 mL and 434.3 ± 170.8 mL, respectively. The plate-on-plate technique group had a significantly shorter surgical time and less blood loss than the nail-plate construct group. No statistically significant differences were found in union time, ambulation status, 36-item Short Form Health Survey score, and complication rate between the two groups.</div></div><div><h3>Conclusion</h3><div>The plate-on-plate technique can be considered an alternative option to reduce operation time and blood loss in the treatment of PFPIF, especially for older patients and those who are less capable of sustaining long-term operation and anaesthetic exposure.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"VTE rates and risk factors in major trauma patients","authors":"","doi":"10.1016/j.injury.2024.111964","DOIUrl":"10.1016/j.injury.2024.111964","url":null,"abstract":"<div><h3>Background</h3><div>Venous thromboembolism (VTE) is a common and in some instances life-threatening complication following severe traumatic injury. Owing to a lack of high-quality evidence in VTE risk prediction and prevention in this cohort, major trauma patients receive variable VTE preventative care. The aim of this systematic review was to determine the reported rates of VTE in major trauma patients, and associated risk factors.</div></div><div><h3>Methods</h3><div>A comprehensive database search was conducted using EBSCO/MEDLINE, EMBASE, CINAHL, Cochrane and Scopus to identify studies published between 1990 and 2023. Original Studies quantifying the occurrence of and/or evaluating risk factors for VTE, PE and DVT in a defined population were eligible for inclusion. Five reviewers screened, appraised, and extracted data from the selected studies.</div></div><div><h3>Results</h3><div>A total of 22 studies fulfilled the inclusion criteria. Most studies were conducted in Northern America (72 %), followed by Asia (18 %), and Europe (9 %). Of the 22 studies, 17 were retrospective, 4 were prospective and 1 was the control arm of an RCT. The reported rates in included studies ranged from 0.39 % to 32 % (VTE), 0.59 % to 57.60 % (DVT) and 0.35 % to 24.0 % (PE). Operative procedure was the most consistently reported associated variable for DVT followed by <em>delays to prophylaxis</em> and pelvic injury. Lower extremity injury was the most frequently reported associated variable for PE followed by male sex and increased age. Age was the most frequently reported variable for both DVT and PE.</div></div><div><h3>Conclusion</h3><div>There exists significant variation in the reported rates of VTE in major trauma patients globally. Operative procedure, delays to prophylaxis and pelvic injury were the most consistently reported associated variables for DVT. Lower extremity injury followed by male sex and increased age were the most frequently reported associated variables for PE. Although studies indicate possible differences in risk factors for DVT and PE, heterogeneity in study characteristics and outcome reporting impedes any meaningful conclusions. Reconciliation of VTE rates in major trauma patients is necessary when comparing populations.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conceptualising the quality experience for independent medical examinations: A narrative review","authors":"","doi":"10.1016/j.injury.2024.111965","DOIUrl":"10.1016/j.injury.2024.111965","url":null,"abstract":"<div><h3>Background</h3><div>An independent medical examination is a unique healthcare assessment conducted by an expert health professional with the aim of providing impartial advice to key stakeholders in workers’ compensation schemes regarding a worker's injury or illness. A range of dedicated guidelines provide for best practice at local and national levels, but concerns exist regarding the quality of these encounters for all involved.</div></div><div><h3>Methods</h3><div>A narrative review was conducted to explore quality principles underpinning practices and reporting of independent medical examinations. Quality was defined by dimensions outlined by the World Health Organization (effectiveness, safety, people-centredness, timeliness, equity, integration of care, efficiency). Academic (databases: Medline, CINAHL, Embase) and grey literature (advanced Google search) published in English was searched with no date limits. Results were synthesised according to the components of independent medical examinations (independent medical examiner approval and selection, independent medical examinations, reporting) and then mapped to quality dimensions.</div></div><div><h3>Results</h3><div>The quality dimensions of effectiveness, safety, person-centredness, timeliness, equity, and efficiency were partly addressed in existing independent medical examination practices, most commonly within the examination itself. However, there were prominent gaps in person-centredness and integration of care across all stages of the examination and reporting process. Opportunities for strengthening quality practices included: inviting community members with lived experience of workplace injury to serve on boards responsible for appointing independent medical examiners; explicitly encouraging questions and perspectives from injured works during examinations; holistic reporting that accurately captures injured workers’ experiences; consultations with usual treating teams prior to report finalisation and submission; and providing verbal summaries and/or reports directly to injured workers.</div></div><div><h3>Conclusion</h3><div>Although some quality principles were evident in existing independent medical examination practices described in the literature, unlike the acute and community healthcare sectors, the notion of quality was not universally applied in this context. To promote evidence-based practice, foster positive cultural shifts, and enhance experiences of injured workers and independent medical examiners, formally embedding a comprehensive quality experience in independent medical examination programs is recommended.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-energy blunt pelvic ring injuries and pre-hospital pelvic binder applications – A retrospective assessment based on a prospective registry","authors":"","doi":"10.1016/j.injury.2024.111958","DOIUrl":"10.1016/j.injury.2024.111958","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Application of a pelvic binder in the pre-hospital settings is a crucial step of high-energy blunt pelvic ring injury (PRI) management protocols. The aim of this retrospective cohort study was to evaluate the percentage of pre-hospital pelvic binder's applications in high-energy blunt type B or C PRI patients managed at a single level I trauma center, and to assess its impact on the medical resource requirements and patients' outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The institutional &lt;em&gt;Severely Injured Patients’ Registry&lt;/em&gt; was screened for patients meeting the following inclusion criteria: (1) high-energy blunt PRI; (2) admission between 2014.01.01 and 2022.12.31; (3) age ≥16 years; and (4) available computed tomography of the pelvis. Exclusion criteria were: (1) death before admission; (2) low-energy injury; (3) penetrating, blast and electrical injuries; and (4) secondary transfers. Study variables, including pre-hospital application of a pelvic binder and demographic, clinical, management and outcome data were extracted from the registry. Additionally, AO/OTA classifications were determined.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A consecutive series of 262 patients was included into the final analysis. Of these, 58.8 % received a pre-hospital pelvic binder (PPB), increasing from type A (45.1 %) to type B (57.8 %) and type C (73.7 %). Pre-hospital hemodynamic instability was a major factor triggering the use of PPB in high-energy blunt type B PRI patients with PPB in 76.9 % of the cases with hemodynamic instability vs. 51.3 % of the cases without hemodynamic instability (&lt;em&gt;p&lt;/em&gt; = 0.009). This difference was not statistically significant for high-energy blunt type C PRI patients (82.8 % vs. 64.3 %, &lt;em&gt;p&lt;/em&gt; = 0.200). The presence of a physician on the trauma site contributed to the increased percentage of PRI managed with PPB from 43.5 % to 67.3 % in type B PRI (&lt;em&gt;p&lt;/em&gt; = 0.011), and from 50 % to 77.1 % in type C PRI (&lt;em&gt;p&lt;/em&gt; = 0.257).&lt;/div&gt;&lt;div&gt;This study showed an increased need for packed red blood cells (PRBC) transfusions in subgroups treated with PPB and no statistically significant differences in term of intensive care unit (ICU) and total hospital length of stay and complications between high-energy blunt type B or C PRI patients with or without PPB.&lt;/div&gt;&lt;div&gt;Comparison of mortality rates in patients with and without PPB showed a trend towards lower mortality rates with PPB in patients with AIS extremity participating in at least 50 % of the total ISS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;In the ideal pre-hospital scenario, every high-energy blunt type B or C PRI patient should be managed with a PPB. Continuous pre-hospital team training and information is crucial to achieve this goal. The preparation of Emergency Department and ICU who admit a patient with PPB should include a sufficient number of PRBC ready for transfusion. Mortality rates did not seem to be affected by PPB, exce","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}