Eero Hirvensalo

Helsinki Trauma Outcome Study 2005: Audit on Outcome in Trauma Management in Adult Patients in Southern Part of Finland

The outcome performance of the adult patients trauma care in Helsinki University Hospital was compared with a sample of English hospitals. This was a first time such an audit on trauma care was conducted in Finland. Helsinki University Hospital submitted the Trauma Audit and Research Network (TARN, UK) data of adult trauma patients during 1 year period (from 1 September 2004 to 31 August 2005). Patients younger than 16 years were excluded. The outcome performance was assessed by TARN prediction model using the TARN database as reference. There were total of 1,717 patients in Helsinki and 16,774 patients in English hospitals fulfilling the study inclusion criteria, and 1,635 (95.2% of total) eligible patients in Helsinki and 15,269 (91.0% of total) in England were used for analysis. The patients were older and the mean ISS was higher in Helsinki (mean ISS in Helsinki 14 vs. 11 in England). The standardized W statistic (a measure of survival variation from the expected mean, per 100 patients) was + 3.0 (confidence intervals + 2.3 to + 3.8) for Helsinki University Hospital and + 0.2 (confidence intervals –0.1 to 0.4) for English hospitals. These results suggest that the organization of trauma care in Helsinki University Hospital area is more effective in preventing death after trauma in adults than that covering the present sample of English hospitals.

Clinical and MRI Evaluation of Meniscal Tears Repaired with Bioabsorbable Arrows

Background and Aims: Excision of meniscal tissue has been shown to increase the risk of degenerative changes of the knee joint. Whenever possible, meniscus repair has become the procedure of choice for treatment of meniscal tears. Materials and Methods: The present retrospective study evaluated the healing results of 77 meniscal ruptures treated with the an all-inside technique (Biofix meniscus arrow). The study group consisted of 73 patients with 77 longitudinal, vertical meniscal ruptures treated at Helsinki University Hospital between the beginning of January 1997 and the end of March 2001. The patients who had not received secondary surgery for failed repair during the follow-up period were examined clinically and with MRI. Results: Fifty-one out of 77 meniscal ruptures (66%) healed clinically. In repairs performed in conjunction with ligament reconstruction the healing rate was higher (79%) than in the isolated tears (56%). The poorest results were seen in the very long vertical tears with luxation of the meniscus (38% healing rate). Conclusions: Bioabsorbable arrows offer a good alternative for treatment of meniscal ruptures, but the arrows alone do not seem to be sufficient to provide a reliable long-lasting result in the repair of very unstable meniscal ruptures.

MRI of menisci repaired with bioabsorbable arrows

ObjectiveTo analyze with conventional magnetic resonance imaging (MRI) the signal appearance of menisci repaired with bioabsorbable arrows.Design and patientsForty-four patients with 47 meniscal tears treated with bioabsorbable arrows underwent follow-up conventional MRI examination. The time interval between the surgery and MRI varied from 5 to 67 months (mean 26 months). Twenty-six patients also had concurrent repair of torn anterior cruciate ligament. The following grades were used to classify meniscal signal intensity: (a) G0; low signal intensity on all sequences and regular configuration in every plane, (b) G1; increased signal intensity within the meniscus, not extending to the meniscal surface, (c) G2; increased signal intensity linear in shape, which may or may not communicate with the capsular margin of the meniscus, without extending to the meniscal surface, and (d) G3; increased signal intensity extending to the meniscal surface.ResultsThirteen menisci (27.5%) had normal signal intensity, 13 menisci (27.5%) Grade 1 signal intensity, 9 menisci (19%) Grade 2 signal intensity and 12 menisci (26%) Grade 3 signal intensity. The time difference between operation and MRI was statistically significant between the G0 (36 months) and G3 groups (14 months; P=0.0288). There was no statistical significance in different grades between medial and lateral meniscus or between patients with operated or intact ACL. On physical examination sixteen patients reported slight symptoms, seen evenly in each group.ConclusionNo difference was seen in different grades between patients with operated or intact ACL. The highest incidence of menisci with a Grade 3 signal was seen in patients where surgery was within the last 18 months.

Triage in a Bomb Disaster with 166 Casualties

AbstractBackground:We describe the surgical response of thenHelsinki University Hospitals to a bomb disaster withn166 casualties. According to the Helsinki Area DisasternPlan, severely injured patients were transported tonseveral hospitals with emergency facilities to avoidnovertriage.Methods:The patient data were gathered fromnhospitals, health centers and other doctor visit/nappointments records. Injury Severity Scores (ISS),ncritical mortality rate and death/wounded ratio werencalculated.Results:Of the 166 injured patients, 5 diednimmediately at the bombing site. Sixty-six patientsnwere transported to the six affiliated hospitals. Thenmean ISS score for survivors was 12. Seventeen percentnof the acute survivors were critically injured (ISS>15).nThe critical mortality rate was 8%. There were no laterndeaths; the dead/wounded ratio was 4.4. Operativentreatment was performed for 38% of the patientsntreated in surgical emergency departments.Conclusion:The bombing attack in Myyrmanninshopping center led to 166 casualties, of whomn66 patients were received at six affiliated hospitals innHelsinki and Uusimaa Area. The critical mortality ratenwas low. A local disaster plan was implemented. Thensurgical response was rapid and well coordinated. Inna mass casualty disaster not all disaster victims neednto go to a trauma center.

Fatal Surgical or Procedure-Related Complications: A Finnish Registry-Based Study

IntroductionIn Finland, all healthcare personnel must be insured against causing patient injury. The Patient Insurance Centre (PIC) pays compensation in all cases of malpractice and in some cases of infection or other surgical complications. This study aimed to analyze all complaints relating to fatal surgical or other procedure-related errors in Finland during 2006–2010.Materials and methodsIn total, 126 patients fulfilled the inclusion criteria. Details of patient care and decisions made by the PIC were reviewed, and the total national number of surgical procedures for the study period was obtained from the National Hospital Discharge Registry.ResultsOf the 94 patients who underwent surgery, most fatal surgical complications involved orthopedic or gastrointestinal surgery. Non-surgical procedures with fatal complications included deliveries (Nxa0=xa010), upper gastrointestinal endoscopy or nasogastric tube insertion (Nxa0=xa08), suprapubic catheter insertion (Nxa0=xa04), lower intestinal endoscopy (Nxa0=xa05), coronary angiogram (Nxa0=xa01), pacemaker fitting (Nxa0=xa01), percutaneous drainage of a hepatic abscess (Nxa0=xa01), and chest tube insertion (Nxa0=xa02). In 42 (33.3xa0%) cases, patient injury resulted from errors made during the procedure, including 24 technical errors and 15 errors of judgment. There were 19 (15.2xa0%) cases of inappropriate pre-operative assessment, 28 (22.4xa0%) errors made in postoperative follow-up, 23 (18.4xa0%) cases of fatal infection, and 11 (8.8xa0%) fatal complications not linked to treatment errors.ConclusionFatal surgical and procedure-related complications are rare in Finland. Complications are usually the result of errors of judgment, technical errors, and infections.

International benchmarking of tertiary trauma centers: productivity and throughput approach

BackgroundCare process in tertiary trauma centers consists of a chain of care phases in different departments from the emergency department (ED) to post-operative rehabilitation. The historical evolution of healthcare systems and organizations has led to variations in trauma patient processes in different countries. The present study is aimed at revealing differences in the throughput and productivity of trauma patient processes between German (UKB) and Finnish (HUS) tertiary trauma centers. Problems related to the comparison of different healthcare systems were also identified. The share of patients discharged was used as a control measure.ResultsThe biggest differences between the hospitals were found in the use of resources in the ED and in post-operative care. Despite problems in defining comparable patients and resources, ED productivity was significantly higher in UKB. Post-operative care was, on average, 41% shorter in HUS. However, the share of patients discharged was significantly higher in UKB (96.5% vs. 68.9%). Differences were also found in the pre-operative length of stay of patients with proximal femoral fractures (UKB: 0.97 days, HUS: 1.57 days). The productivity of the operating unit was quite similar in the hospitals. In terms of ED mortality, no statistically significant differences were found.ConclusionsThe results of the present study showed significant differences in the use of resources and throughput times in trauma patient processes between Finnish and German hospitals. However, due to system-level differences between German and Finnish healthcare, the results cannot be directly transformed into development proposals for the organizations. On the other hand, in spite of certain differences regarding the healthcare systems, the demographic data of the trauma patients and medical procedures are comparable. Based on the present study, the ED process of severe trauma, pre-operative care, and operating unit processes were the most comparable parts of trauma care between the hospitals. The study also showed that the international benchmarking approach could be used to reveal bottlenecks in system-level policies and practices.