Ruben Peralta

The therapeutic challenges of degloving soft-tissue injuries.

Background: Degloving soft-tissue injuries are serious and debilitating conditions. Deciding on the most appropriate treatment is often difficult. However, their impact on patients’ outcomes is frequently underestimated. Objectives: We aimed to study the incidence, clinical presentation, management and outcome of degloving soft-tissue injuries. Materials and Methods: We conducted a narrative traditional review using the key words; degloving injury and soft-tissue injuries through search engines PubMed, Science Direct, and Scopus. Results: There are several therapeutic options for treating degloving soft-tissue injuries; however, no evidence-based guidelines have been published on how to manage degloving soft-tissue injuries, although numerous articles outline the management of such injuries. Conclusion: Degloving soft-tissue injuries are underreported and potentially devastating. They require early recognition, and early management. A multidisciplinary approach is usually needed to ensure the effective rehabilitation of these patients.

Blunt splenic trauma: Assessment, management and outcomes

BACKGROUNDnThe approach for diagnosis and management of blunt splenic injury (BSI) has been considerably shifted towards non-operative management (NOM). We aimed to review the current practice for the evaluation, diagnosis and management of BSI.nnnMETHODSnA traditional narrative literature review was carried out using PubMed, MEDLINE and Google scholar search engines. We used the keywords Traumatic Splenic injury, Blunt splenic trauma, management between December 1954 and November 2014.nnnRESULTSnMost of the current guidelines support the NOM or minimally approaches in hemodynamically stable patients. Improvement in the diagnostic modalities guide the surgeons to decide the timely management pathway Though, there is an increasing shift from operative management (OM) to NOM of BSI; NOM of high grade injury is associated with a greater rate of failure, prolonged hospital stay, risk of delayed hemorrhage and transfusion-associated infections. Some cases with high grade BSI could be successfully treated conservatively, if clinically feasible, while some patients with lower grade injury might end-up with delayed splenic rupture. Therefore, the selection of treatment modalities for BSI should be governed by patient clinical presentation, surgeons experience in addition to radiographic findings.nnnCONCLUSIONnAbout one-fourth of the blunt abdominal trauma accounted for BSI. A high index of clinical suspicion along with radiological diagnosis helps to identify and characterize splenic injuries with high accuracy and is useful for timely decision-making to choose between OM or NOM. Careful selection of NOM is associated with high success rate with a lower rate of morbidity and mortality.

Traumatic injury among females: does gender matter?

BackgroundTrauma remains one of the leading causes of morbidity and mortality worldwide. Generally, the incidence of traumatic injuries is disproportionately high in males. However, trauma in females is underreported.AimTo study the epidemiology and outcome of different mechanisms and types of traumatic injuries in women.MethodsWe conducted a traditional narrative review using PubMed, MEDLINE and EMBASE, searching for English-language publications for gender-specific trauma between January 1993 and January 2013 using key words “trauma”, “gender”, “female” and “women”.ResultsAmong 1150 retrieved articles, 71 articles were relevant over 20 years. Although it is an important public health problem, traumatic injuries among females remain under-reported.ConclusionThere is a need for further research and evaluation of the exact burden of traumatic injuries among females together with the implementation of effective community based preventive programs.

Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital

BackgroundNecrotizing fasciitis (NF) is a fatal aggressive infectious disease. We aimed to assess the major contributing factors of mortality in NF patients.MethodsA retrospective study was conducted at a single surgical intensive care unit between 2000 and 2013. Patients were categorized into 2 groups based on their in-hospital outcome (survivors versus non-survivors).ResultsDuring a14-year period, 331 NF patients were admitted with a mean age of 50.8 ± 15.4 years and 74 % of them were males Non-survivors (26 %) were 14.5 years older (p = 0.001) and had lower frequency of pain (p = 0.01) and fever (p = 0.001) than survivors (74 %) at hospital presentation. Diabetes mellitus, hypertension, and coronary artery disease were more prevalent among non-survivors (p = 0.001). The 2 groups were comparable for the site of infection; except for sacral region that was more involved in non-survivors (p = 0.005). On admission, non-survivors had lower hemoglobin levels (p = 0.001), platelet count (p = 0.02), blood glucose levels (p = 0.07) and had higher serum creatinine (p = 0.001). Non-survivors had greater median LRINEC (Laboratory Risk Indicator for NECrotizing fasciitis score) and Sequential Organ Failure Assessment (SOFA) scores (p = 0.001). Polybacterial and monobacterial gram negative infections were more evident in non-survivors group. Monobacterial pseudomonas (p = 0.01) and proteus infections (p = 0.005) were reported more among non-survivors. The overall mortality was 26 % and the major causes of death were bacteremia, septic shock and multiorgan failure. Multivariate analysis showed that age and SOFA score were independent predictors of mortality in the entire study population.ConclusionThe mortality rate is quite high as one quarter of NF patients died during hospitalization. The present study highlights the clinical and laboratory characteristics and predictors of mortality in NF patients.

Epidemiology of occupational injuries by nationality in Qatar: Evidence for focused occupational safety programmes

INTRODUCTIONnOccupational injuries are the second leading cause of trauma admission in Qatar. Given the wide diversity of the countrys migrant worker populations at risk, this study aimed to analyse and describe the epidemiology of these injuries based on the workers nationality residing in Qatar.nnnMETHODSnA retrospective analysis of trauma registry data on occupational-related injuries was conducted. The analysis included all patients [aged ≥18 years] admitted to the Level I Hamad Trauma Center, from January 1, 2010 to December 31, 2013.nnnRESULTSnOut of 6555 trauma admissions, 2015 (30.7%) patients had occupational injury. The admitted Case Fatality Rate (CFR) was 4.3 per 100 occupational injury related trauma admissions. Overall non-fatal occupational injury rate was 37.34 per 100,000 workers, whereas fatal injury rate was 1.58 per 100,000 workers. Most of the workers experiencing occupational injuries were from Nepal (28%), India (20%) and Bangladesh (9%). Fatal occupational injuries were predominately among Indians (20%), Nepalese (19%), and Filipinos/Bangladeshis (both 8%). Filipinos had the highest admitted CFR at 8.2 deaths per 100 trauma admissions with the next highest being Indians and Indonesians (4.2 per 100 trauma admissions). During the study period, the incidence of severe occupational injuries decreased despite a simultaneous increase in the worker population within Qatar. Almost one in four occupational injuries was a major trauma (ISS≥16). Nepalese and Indian workers represented 29% and 18% of all major trauma cases.nnnCONCLUSIONSnNon-fatal occupational injuries appear to follow a pattern distinct from fatal ones. High-risk worker populations as defined by those with high admitted CFRs, experiencing the most severe or fatal injuries, must be the focus of targeted risk factor analysis and occupational safety interventions.

Underutilization of occupant restraint systems in motor vehicle injury crashes: a quantitative analysis from Qatar

ABSTRACT Introduction: Restraint systems (seat belts and airbags) are important tools that improve vehicle occupant safety during motor vehicle crashes (MVCs). We aimed to identify the pattern and impact of the utilization of passenger restraint systems on the outcomes of MVC victims in Qatar. Methods: A retrospective study was conducted for all admitted patients who sustained MVC-related injuries between March 2011 and March 2014 inclusive. Results: Out of 2,730 road traffic injury cases, 1,830 (67%) sustained MVC-related injuries, of whom 88% were young males, 70% were expatriates, and 53% were drivers. The use of seat belts and airbags was documented in 26 and 2.5% of cases, respectively. Unrestrained passengers had greater injury severity scores, longer hospital stays, and higher rates of pneumonia and mortality compared to restrained passengers (P = .001 for all). There were 311 (17%) ejected cases. Seat belt use was significantly lower and the mortality rate was 3-fold higher in the ejected group compared to the nonejected group (P = .001). The overall mortality was 8.3%. On multivariate regression analysis, predictors of not using a seat belt were being a front seat passenger, driver, or Qatari national and young age. Unrestrained males had a 3-fold increase in mortality in comparison to unrestrained females. The risk of severe injury (relative risk [RR] = 1.82, 95% confidence interval [CI], 1.49–2.26, P = .001) and death (RR = 4.13, 95% CI, 2.31–7.38, P = .001) was significantly greater among unrestrained passengers. Conclusion: The nonuse of seat belts is associated with worse outcomes during MVCs in Qatar. Our study highlights the lower rate of seat belt compliance in young car occupants that results in more severe injuries, longer hospital stays, and higher mortality rates. Therefore, we recommend more effective seat belt awareness and education campaigns, the enforcement of current seat belt laws, their extension to all vehicle occupants, and the adoption of proven interventions that will assure sustained behavioral changes toward improvements in seat belt use in Qatar.

Trauma resuscitation requiring massive transfusion: a descriptive analysis of the role of ratio and time

ObjectiveWe aimed to evaluate whether early administration of high plasma to red blood cells ratios influences outcomes in injured patients who received massive transfusion protocol (MTP).MethodsA retrospective analysis was conducted at the only level 1 national trauma center in Qatar for all adult patients(≥18xa0years old) who received MTP (≥10 units) of packed red blood cell (PRBC) during the initial 24xa0h post traumatic injury. Data were analyzed with respect to FFB:PRBC ratio [(highu2009≥u20091:1.5) (HMTP) vs. (lowu2009<u20091:1.5) (LMTP)] given at the first 4xa0h post-injury and also between (>4 and 24xa0h). Mortality, multiorgan failure (MOF) and infectious complications were studied as well.ResultsDuring the study period, a total of 4864 trauma patients were admitted to the hospital, 1.6 % (nu2009=u200977) of them met the inclusion criteria. Both groups were comparable with respect to initial pH, international normalized ratio, injury severity score, revised trauma score and development of infectious complications. However, HMTP was associated with lower crude mortality (41.9 vs. 78.3 %, pu2009=u20090.001) and lower rate of MOF (48.4 vs. 87.0 %, pu2009=u20090.001). The number of deaths was 3 times higher in LMTP in comparison to HMTP within the first 30xa0days (36 vs. 13 cases). The majority of deaths occurred within the first 24xa0h (80.5 % in LMTP and 69 % in HMTP) and particularly within the first 6xa0h (55 vs. 46 %).ConclusionsAggressive attainment of high FFP/PRBC ratios as early as 4xa0h post-injury can substantially improve outcomes in trauma patients.

Compartmental anatomical classification of traumatic abdominal injuries from the academic point of view and its potential clinical implication

BackgroundThe mechanism and outcome of traumatic abdominal injury (TAI) varies worldwide. Moreover, data comparing TAIs in each abdominal compartment are lacking. We aimed to assess from the academic point of view, TAI based on its anatomical compartments.Patients & methodsWe conducted a retrospective study for TAI patients between 2008 and 2011 in Qatar. Patients were categorized according to the involved anatomical compartment (C): intrathoracic (ITC), retroperitoneal (RPC), true abdomen (TAC), and pelvic abdomen (PAC) group. Chi Square test, One-Way ANOVA and multivariate regression analysis were appropriately performed.ResultsOf 6,888 patients admitted to the trauma unit, 1,036 (15%) had TAI that were grouped as ITC (65%), RPC (15%), TAC (13%), and PAC (7%). The mean age was lowest in ITC (29u2009±u200913) and highest in TAC (34u2009±u200911) group, (Pu2009=u20090.001). Motor vehicle crash was the main mechanism of injury in all groups except for PAC, in which fall dominated. Vast majority of expatriates had PAC and TAC injuries. The main abdominal injuries included liver (35%; ITC), spleen (32%; ITC) and kidneys (18%; RPC). Extra-abdominal injuries involved the head in RPC and ITC, lung in ITC and RPC and extremities in PAC. Mean ISS was higher in RPC and ITC. Abdominal AIS was higher in TAC injuries. Overall hospital mortality was 10%: RPC (15%), TAC (11%), ITC (9.4%) and PAC (1.5%). Concurrent traumatic brain injury (OR 5.3; Pu2009=u20090.001) and need for blood transfusion (OR 3.03; Pu2009=u20090.003) were the main independent predictors of mortality.ConclusionIn addition to its academic value, the anatomical approach of TAI would be a complementary tool for better understanding and prediction of the pattern and outcome of TAI. This would be possible if further research find accurate, early diagnostic tool for this anatomical classification.

Epidemiology, Causes and Prevention of Car Rollover Crashes with Ejection

Rollover crashes (ROCs) are responsible for almost a third of all highway vehicle occupant fatalities. Although ROCs are common and serious mechanism of injury, ROCs are under-reported. To analyze the causes, mechanism, impact and prevention of ROCs, we reviewed the literature between 1984 and 2013. By utilizing the search engines PubMed, MEDLINE and EMBASE by using key words ROCs Ejection and vehicle the initial search yielded 241 abstracts, of which 58 articles were relevant. Most of the articles were either retrospective or experimental studies funded by automobile companies. All vehicles are susceptible to rollovers to certain extents. Despite continuing innovation in vehicles′ safety, human factor is pivotal in prevention of ROCs. Distracted driving, speeding and drinking escalate the chances of rollover crashes. Wearing a seatbelt greatly improves the chances of surviving a ROC.

Traffic-related pedestrian injuries amongst expatriate workers in Qatar: a need for cross-cultural injury prevention programme

Qatar is a rapidly developing country in which expatriate workers constitute the majority of population. Also, Qatar is an example of right-sided road driving convention (RDC) country. The aim of our study is to analyse the traffic-related pedestrian injuries (TRPI) amongst expatriates in relation to RDC. A retrospective analysis of prospectively collected data of TRPI patients who were admitted to the only Level I trauma centre in Qatar between 2009 and 2011 was performed. Demographics, country of origin, time of injury, injury severity score (ISS), RDC, morbidity and mortality were analysed. Of the 4997 injured patients, 601 (12%) were pedestrians. Of these, 92% were expatriates. The mean age was 31.8 ± 17 and 64% of them were 18–45 years old. Mean ISS was higher in those who were injured on weekends (15.4 ± 10) in comparison to working days (13.5 ± 10) (p = 0.04). The overall mortality was 15%. Sixty-seven percent of those who died were from left RDC countries. Expatriate workers, originally from left RDC countries are disproportionately affected by TRPI. This group of injured patients requires focused injury prevention programmes that are culture and language appropriate.