scholarly journals Rehabilitation Needs, Service Provision, and Costs in the First Year Following Traumatic Injuries: Protocol for a Prospective Cohort Study

10.2196/25980 ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. e25980
Author(s):  
Helene Lundgaard Soberg ◽  
Håkon Øgreid Moksnes ◽  
Audny Anke ◽  
Olav Røise ◽  
Cecilie Røe ◽  
...  
Keyword(s):  
Health Care ◽  
Service Provision ◽  
Major Trauma ◽  
Injury Severity ◽  
University Hospital ◽  
First Year ◽  
Traumatic Injuries ◽  
Geographical Regions ◽  
Rehabilitation Needs

Background Traumatic injuries, defined as physical injuries with sudden onset, are a major public health problem worldwide. There is a paucity of knowledge regarding rehabilitation needs and service provision for patients with moderate and major trauma, even if rehabilitation research on a spectrum of specific injuries is available. Objective This study aims to describe the prevalence of rehabilitation needs, the provided services, and functional outcomes across all age groups, levels of injury severity, and geographical regions in the first year after trauma. Direct and indirect costs of rehabilitation provision will also be assessed. The overarching aim is to better understand where to target future efforts. Methods This is a population-based prospective follow-up study. It encompasses patients of all ages with moderate and severe acute traumatic injury (New Injury Severity Score >9) admitted to the regional trauma centers in southeastern and northern Norway over a 1-year period (2020). Sociodemographic and injury data will be collected. Upon hospital discharge, rehabilitation physicians estimate rehabilitation needs. Rehabilitation needs are assessed by the Rehabilitation Complexity Scale Extended–Trauma (RCS E–Trauma; specialized inpatient rehabilitation), Needs and Provision Complexity Scale (NPCS; community-based rehabilitation and health care service delivery), and Family Needs Questionnaire–Pediatric Version (FNQ-P). Patients, family caregivers, or both will complete questionnaires at 6- and 12-month follow-ups, which are supplemented by telephone interviews. Data on functioning and disability, mental health, health-related quality of life measured by the EuroQol Questionnaire (EQ-5D), and needs and provision of rehabilitation and health care services are collected by validated outcome measures. Unmet needs are represented by the discrepancies between the estimates of the RCS E–Trauma and NPCS at the time of a patient’s discharge and the rehabilitation services the patient has actually received. Formal service provision (including admission to inpatient- or outpatient-based rehabilitation), informal care, and associated costs will be collected. Results The project was funded in December 2018 and approved by the Regional Committee for Medical and Health Research Ethics in October 2019. Inclusion of patients began at Oslo University Hospital on January 1, 2020, and at the University Hospital of North Norway on February 1, 2020. As of February 2021, we have enrolled 612 patients, and for 286 patients the 6-month follow-up has been completed. Papers will be drafted for publication throughout 2021 and 2022. Conclusions This study will improve our understanding of existing service provision, the gaps between needs and services, and the associated costs for treating patients with moderate and major trauma. This may guide the improvement of rehabilitation and health care resource planning and allocation. International Registered Report Identifier (IRRID) DERR1-10.2196/25980

scholarly journals Rehabilitation Needs, Service Provision, and Costs in the First Year Following Traumatic Injuries: Protocol for a Prospective Cohort Study (Preprint)

2020 ◽  
Author(s):  
Helene Lundgaard Soberg ◽  
Håkon Øgreid Moksnes ◽  
Audny Anke ◽  
Olav Røise ◽  
Cecilie Røe ◽  
...  
Keyword(s):  
Health Care ◽  
Service Provision ◽  
Major Trauma ◽  
Injury Severity ◽  
University Hospital ◽  
First Year ◽  
Traumatic Injuries ◽  
Geographical Regions ◽  
Rehabilitation Needs

BACKGROUND Traumatic injuries, defined as physical injuries with sudden onset, are a major public health problem worldwide. There is a paucity of knowledge regarding rehabilitation needs and service provision for patients with moderate and major trauma, even if rehabilitation research on a spectrum of specific injuries is available. OBJECTIVE This study aims to describe the prevalence of rehabilitation needs, the provided services, and functional outcomes across all age groups, levels of injury severity, and geographical regions in the first year after trauma. Direct and indirect costs of rehabilitation provision will also be assessed. The overarching aim is to better understand where to target future efforts. METHODS This is a population-based prospective follow-up study. It encompasses patients of all ages with moderate and severe acute traumatic injury (New Injury Severity Score >9) admitted to the regional trauma centers in southeastern and northern Norway over a 1-year period (2020). Sociodemographic and injury data will be collected. Upon hospital discharge, rehabilitation physicians estimate rehabilitation needs. Rehabilitation needs are assessed by the Rehabilitation Complexity Scale Extended–Trauma (RCS E–Trauma; specialized inpatient rehabilitation), Needs and Provision Complexity Scale (NPCS; community-based rehabilitation and health care service delivery), and Family Needs Questionnaire–Pediatric Version (FNQ-P). Patients, family caregivers, or both will complete questionnaires at 6- and 12-month follow-ups, which are supplemented by telephone interviews. Data on functioning and disability, mental health, health-related quality of life measured by the EuroQol Questionnaire (EQ-5D), and needs and provision of rehabilitation and health care services are collected by validated outcome measures. Unmet needs are represented by the discrepancies between the estimates of the RCS E–Trauma and NPCS at the time of a patient’s discharge and the rehabilitation services the patient has actually received. Formal service provision (including admission to inpatient- or outpatient-based rehabilitation), informal care, and associated costs will be collected. RESULTS The project was funded in December 2018 and approved by the Regional Committee for Medical and Health Research Ethics in October 2019. Inclusion of patients began at Oslo University Hospital on January 1, 2020, and at the University Hospital of North Norway on February 1, 2020. As of February 2021, we have enrolled 612 patients, and for 286 patients the 6-month follow-up has been completed. Papers will be drafted for publication throughout 2021 and 2022. CONCLUSIONS This study will improve our understanding of existing service provision, the gaps between needs and services, and the associated costs for treating patients with moderate and major trauma. This may guide the improvement of rehabilitation and health care resource planning and allocation. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/25980

scholarly journals Continuity of nursing care in Finnish primary health care settings: A 15-year follow-up

2018 ◽  
Vol 7 (1) ◽  
pp. 11 ◽  
Author(s):  
Risto Raivio ◽  
Eija Paavilainen ◽  
Kari J. Mattila
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Continuity Of Care ◽  
Nursing Care ◽  
Health Centre ◽  
University Hospital ◽  
Primary Health ◽  
Patient Reported ◽  
Health Centres

Objective: Continuity is an essential part of high-quality nursing care. This study is the first systematic follow-up of Finnish primary health care patients assessing continuity of health centre nursing staff. The aim was to ascertain how longitudinal interpersonal continuity of care is related to patients’ characteristics, their consultation experiences, and how continuity had changed over the 15-year study period.Methods: A questionnaire survey was conducted among patients attending the health centres in the Tampere University Hospital catchment area from 1998 to 2013. A total of 157,549 patients responded out of 363,464 in almost 60 health centres. We analysed the opinions of patients (n = 47,470) who had visited a nurse during the survey weeks. Opinions on the continuity of care were assessed with the question: “When visiting the health centre, do you usually see the same nurse”, the alternatives being “yes” or “no”. A binary logistic regression model was used.Results: Almost two thirds of the respondents had met the same nurse when visiting their health care centre. Longitudinal interpersonal continuity of care decreased by 15 percentage (67%-52%) during the study years. Continuity was connected to patient-related items such as a visit in the preceding 12 months (OR 1.32, 95% CI 1.17-1.49) and non-urgency of the visit (OR 1.44, 95% CI 1.27-1.63). The most prominent factor contributing to the sense of continuity of care was how attentively nurses had listened to their patients’ problems and shown an interest in them and a willingness to answer their questions (OR 1.31, 95% CI 1.120-1.43).Conclusions: In the past 15 years patient-reported longitudinal interpersonal continuity of nursing care has declined. However continuity of care proved to enhance the experienced quality of primary health care. Continuity was best realized in nursing care when nurses had listened to their patients’ problems, showed interest toward them and a willingness to answer their questions.

COSTS OF HEALTH CARE AND SOCIAL SERVICES DURING THE FIRST YEAR AFTER ISCHEMIC STROKE

1999 ◽  
Vol 15 (3) ◽  
pp. 573-584 ◽  
Author(s):  
Vibeke Porsdal ◽  
Gudrun Boysen
Keyword(s):  
Health Care ◽  
Social Services ◽  
Resource Use ◽  
University Hospital ◽  
Outpatient Rehabilitation ◽  
First Year ◽  
Total Cost ◽  
Home Help ◽  
Scale Scores ◽  
Degree Of Disability

Objectives: Knowledge of resource use and costs can be useful when evaluating existing services or planning new services. This study investigates the use of health care and social services during the first year after a stroke. Total costs are calculated, costs are compared across subgroups of patients, and resource items of major importance for the total costs are identified.Methods: The study is based on a database comprising data on all stroke patients admitted to a university hospital in Copenhagen, Denmark, over a 1-year period, 1994–95. Patients were followed for 1 year after the stroke, and data on resource use during and after hospitalization were collected prospectively at interviews. This paper focuses on a subset of 385 patients who were admitted because of cerebral infarct or unspecified stroke.Results: The mean cost, based on all patients, of health care and social services during the first year was 142,900 DKK (US $25,500). The hospital care until the first discharge, including acute care and rehabilitation, cost 101,600 Danish krones (DKK) (US $18,100), i.e., 71% of the total cost. Major resource items after discharge were nursing homes, readmissions, outpatient rehabilitation, and home help. The cost during the first year varied with a number of factors, with the most important being survival and degree of disability. Patients who survived the acute phase and who had severe disability (Barthel Activities of Daily Living [ADL] Index: 0–9) 7–10 days after admission had a total cost during the first year that was five times as high as patients with no disability (Barthel ADL Index: 20).Conclusion: Costs of health care and social services during the first year after a stroke vary considerably. Disability as measured with the Barthel ADL Index is a stronger predictor of costs than Scandinavian Stroke Scale scores and other clinical and demographic variables.

scholarly journals Use of health care services 6 months following major trauma

2007 ◽  
Vol 31 (4) ◽  
pp. 628 ◽  
Author(s):  
Belinda J Gabbe ◽  
Ann M Sutherland ◽  
Owen D Williamson ◽  
Peter A Cameron
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Service Use ◽  
Major Trauma ◽  
Injury Severity ◽  
Care Service ◽  
Health Care Service ◽  
Trauma Patients ◽  
Care Services ◽  
Use Of Health Care

To establish the use of health care services 6 months following major trauma, 243 blunt major trauma patients were recruited during their acute hospital stay and followed up by telephone interview at 6 months post-injury. Data collected at 6 months included health care service usage and their level of disability according to the Glasgow Outcome Scale ? Extended (GOSE). Ninety-four percent of patients were living in the community at 6 months, and most (69%) reported continued use of health care services. Of those with ongoing disability, non-compensable patients were significantly more likely (OR 3.7; 95% CI, 1.6?8.6) to have ceased health care service use than compensable patients, independent of injury severity.

Determining optimal follow up for patients with anal cancer following chemoradiation.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 689-689
Author(s):  
Marissa Frazer ◽  
George Q Yang ◽  
Seth Felder ◽  
Julian Sanchez ◽  
Sophie Dessureault ◽  
...  
Keyword(s):  
Health Care ◽  
Anal Carcinoma ◽  
High Volume ◽  
Disease Recurrence ◽  
First Year ◽  
High Volume Center ◽  
High Control ◽  
Cancer Network

689 Background: U.S. health care is increasingly defined by over expenditure and inefficiency. Optimizing patient follow-up is critical especially in cancers treated with high control rates. The objective of this study was to assess time to disease recurrence or toxicity in a cohort of patients with anal carcinoma in order to optimize patient care. Methods: 140 patients diagnosed with biopsy-proven, non-metastatic anal carcinoma, treated with chemoradiation utilizing IMRT, were identified from an institutional database at our high volume center. After IRB approval, a retrospective study was conducted that evaluated local recurrence (LR), distant metastasis (DM), overall survival (OS), and late ≥ grade three toxicity (LG3T) based on National Cancer Institute Common Terminology for Adverse Events version 4. Patients were followed post-treatment every three months for two years, every six months in years 3-5 then yearly thereafter with imaging per National Comprehensive Cancer Network recommendations. Results: Median age and follow up is 58 years and 27 months, respectively. Patients were staged based on AJCC 8th edition and 24 patients were stage I (17%), 55 stage II (39%) and 61 stage III (44%). The median radiation dose was 54 Gy (range: 40-62.5), and 11% of patients required a radiation break. The two year LC, DMFS, and OS were 93%, 94% and 89% and 5-year LC, DMFS, OS were 92%, 87% and 85% respectively. In total, there were 29 disease or treatment related events: LR occurred in nine patients, DM in 11 patients, and LG3T in nine patients. Overall, 62% of events occurred within year one and 77 % within two years. Stratified by event type, at two years 79% of LR, 64% of DM and 89% LG3T were identified. At the remaining follow-up points after 2 years there was an event incidence rate of 1.4%. Conclusions: The majority of recurrences/toxicities in patients diagnosed with non-metastatic anal carcinoma after chemoradiation occur within the first year, with 77% of any event occurring before year two. The data from individual time points suggest a reduction in follow-up during years 3-5 may provide adequate surveillance. Considering revisions of the current follow-up recommendations could maximize health care resources while also improving patient quality of life.

Management of renal injury in a UK major trauma centre

Trauma ◽  
2018 ◽  
Vol 22 (1) ◽  
pp. 26-31
Author(s):  
Robert Torrance ◽  
Abigail Kwok ◽  
David Mathews ◽  
Matthew Elliot ◽  
Andrew Baird ◽  
...  
Keyword(s):  
Renal Injury ◽  
Major Trauma ◽  
Trauma Centre ◽  
University Hospital ◽  
Research Network ◽  
Renal Trauma ◽  
High Grade ◽  
Major Trauma Centre ◽  
Renal Injuries

Introduction This study reviews the type, severity, management and follow-up of renal trauma presenting to a major trauma centre in the northwest of England in the four years following inception of the major trauma centre. Given the recent introduction of major trauma centres nationally, research is needed within every specialty to ensure that the centralisation of services benefits all patients affected by these changes. Methods Patients presenting to Aintree University Hospital with renal trauma between June 2012 and June 2016 were identified using the Trauma Audit and Research Network (TARN) database. The data gathered retrospectively for each patient included mechanism of injury, injury severity score, American Association for the Surgery of Trauma (AAST) grading, management of injury, and follow-up. Results Out of a total of 2595 trauma patients, 33 renal injuries were identified. The 31 patients who received imaging were classified according to AAST grading, with 8 Grade I (25.8%), 4 Grade II (12.9%), 8 Grade III (25.8%), 4 Grade IV (12.9%), and 7 Grade V (22.6%) injuries. Twenty-five out of the 30 surviving patients received conservative treatment, three patients received angioembolisation (AE), one patient received a laparotomy with renal suturing, and one patient required a nephrectomy. Of these 30 surviving patients, seven received urology follow-up in clinic (23%). Conclusion The findings appear to support the growing trend towards the conservative management of high-grade renal injuries, and provide further evidence for the value of AE in renal trauma. The success of AE in this study appears to support the centralisation of services in renal trauma; however, the low nephrectomy rate could be interpreted as suggestive of the opposite. The study revealed that improvements to follow-up are needed, and that further research should seek to inform the optimal radiological follow-up of high-grade renal injury.

scholarly journals Risk of cervical intraepithelial neoplasia grade 3 or higher (CIN3+) among women with HPV-test in 1990–1992, a 30-year follow-up study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Marit Østlyngen Riibe ◽  
Sveinung Wergeland Sørbye ◽  
Gunnar Skov Simonsen ◽  
Arnfinn Sundsfjord ◽  
Josef Ekgren ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
University Hospital ◽  
First Year ◽  
Hpv 16 ◽  
Study Objective ◽  
Negative Test ◽  
Hpv Status ◽  
Hpv Test

Abstract Background/objective Having a 30-year follow-up of a cohort of women tested for HPV is a unique opportunity to further study long-term risk of CIN3+. The study objective was to compare HPV status at baseline with the risk of CIN3+ in the follow-up period of 30 years. Methods All women (n = 642) referred to the HPV outpatient clinic at the University Hospital of North Norway (UNN) in 1990–1992, with an HPV test at baseline, were included in a prospective cohort. HPV-testing was performed by two different HPV-DNA tests, and genotypes 6, 11, 16, 18, 31 and 33 were identified. High-risk (HR) HPV genotypes (16, 18, 31 and 33) were classified as HPV positive, whereas low-risk (LR) genotypes (6 and 11) in addition to absent HPV were classified as HPV negative. A single cohort in which women were classified for their HPV status underwent follow-up prospectively to the last time-point of observation of 30 years. Results During follow-up, 148 (148/642) cases of CIN3+ were detected, of whom 70.3% (104/148) were HPV positive and 29.7% (44/148) were HPV negative at baseline. The proportions of women who developed CIN3+ following a positive and a negative test were 46.6% (104/223) and 10.5% (44/419), respectively. Most cases of CIN3+ were seen shortly after the baseline HPV test, with 112 cases of CIN3+ diagnosed within the first year. In total, 48.6% (72/148) with HPV 16 and 57.6% (19/33) with HPV 33 developed CIN3+. Within the first year, CIN3+ was detected in 37.8% (56/148) with HPV 16, and 51.5% (17/33) with HPV 33. The long-term risk of CIN3+ was significantly lower than the short-term risk, and mainly associated with HPV 16. Overall, eight cases of cervical cancer were detected. Five were HPV positive, harboured HPV 16 at baseline and developed cervical cancer after 3, 4, 5, 11 and 24 years of follow-up. Conclusion and consequences HPV status at baseline is predictive for the subsequent risk of developing CIN3+. Women with a positive HPV test in 1990–1992 had a significantly higher risk of CIN3+ during 30 years of follow-up than those with a negative test. HPV 16 was associated with the greatest long-term risk of cervical cancer. All patients with a positive HPV test at baseline should be followed up until negative. Trial registration ISRCTN, ISRCTN10836802. Registered 14 December 2020 - Retrospectively registered.

scholarly journals More Than 10% of NPM1-Mutated AML Relapses Occur after 5 Years from Complete Remission

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2802-2802
Author(s):  
Sarah Bertoli ◽  
Suzanne Tavitian ◽  
Emilie Berard ◽  
Noemie Gadaud ◽  
Audrey Sarry ◽  
...  
Keyword(s):  
Complete Remission ◽  
Conflicts Of Interest ◽  
University Hospital ◽  
First Year ◽  
Wild Type ◽  
The Third ◽  
Mutational Status ◽  
Second Year ◽  
Wbc Count

Abstract The majority of relapses in acute myeloid leukemia (AML) patients occur in the first or second year following complete remission. In routine, AML patients are followed during five years because few relapses can occur after three or five years. These late or very late relapses remain poorly described, particularly at the molecular level, with only few consistent series in the literature. (Medeiros B et al., Leuk Lymphoma 2007; Verma D et al., Leuk Lymphoma 2010; Watts J et al., Leuk Res 2014). We retrospectively studied all AML relapses occurring after complete remission (CR) obtained with one or two induction cycles between 2000 and 2012 in Toulouse University Hospital, France. Our analyses focused on late relapses (LR, >3 years from CR) and very late relapses (VLR, >5 years from CR) in comparison to early relapses (ER, ≤3 years from CR). Between 2000 and 2012, out of 636 CR patients, 346 had morphological relapses (54.4%). The median time to relapse was 0.9 years (range, 0.1-11.9 years; interquartile range [IQR], 0.5-1.5 years). There were 198 relapses during the first year (57.2%), 82 during the second year (23.7%), 24 during the third year (6.9%) whereas 42 relapses occurred after 3 years (12.1%) and 16 after 5 years (4.6%). Characteristics at diagnosis, i.e., age, AML status, WBC count, karyotype, FLT3-ITD mutation, CEBPA mutation and induction regimen did not differ between ER and LR or VLR. However, NPM1 mutations were more frequent in LR (NPM1m at diagnosis in relapses >3 years: 46% vs. 28% in relapses <3 years, P=.0532), and in VLR (NPM1m at diagnosis in relapses >5 years: 67% vs. 27% % in relapses <5 years, P=.0070). Allogeneic stem cell transplantation (alloSCT) was more frequently performed in the LR group (24% vs. 14%, P=.0369) and in VLR group (31% vs. 14%, P=.0748). Second CR (CR2) rate and median overall survival from relapse date (OS2) were better in LR and VLR than in ER (CR2ER: 26%, CR2LR: 43%, CR2VLR: 50%; P=.0154; OS2ER: 4.6 months, OS2LR: 10.8 months, OS2VLR: 11.6 months; P=.0024). Among the 142 CR1 patients with NPM1m, 67 relapsed (47.2%). In patients with NPM1m, relapses occurred during the first year in 39 (58.2% of NPM1m relapses), during the second year in 14 (20.9%) and during the third year in 2 (3%) whereas 12 relapses occurred after 3 years (17.9%), 8 occurred after 5 years (11.9%) and 3 after 8 years (4.5%). In NPM1-wild type patients, LR and VLR were significantly less frequent (<3 years: 91.9%; >3 years: 8.1%; >5 years: 2.5%; >8 years: 0.6%; P=.0317, .0037 and .0783 respectively). NPM1m relapses represented one half of LR (48%) and two thirds of VLR (67%). Among them, genotype was NPM1m/FLT3-wild type in most patients (75% in LR and 88% in VLR patients). In LR and VLR, NPM1 mutational status had no impact on CR2 and OS2: CR2LR/NPM1m: 42% vs. CR2LR/NPM1-WT: 38% (P=.8702); CR2VLR/NPM1m: 50%vs. CR2LR/NPM1-WT: 50% (P=1.0000); OS2LR/NPM1m: 7.4 months vs. OS2LR/NPM1-WT: 19.4 months (P=.2019); OS2VLR/NPM1m: 7.8 months vs. OS2VLR/NPM1-WT: 29.8 months (P=.0917). Our data show that LR and VLR are not infrequent in AML patients with NPM1 mutations. Although this finding needs to be validated in updated multicentric cohorts with a very long follow-up, it strongly suggests that AML patients with NPM1 mutations should benefit from a prolonged follow-up beyond 5 years from CR. Table Table. Disclosures No relevant conflicts of interest to declare.

scholarly journals Healthcare resource utilization and costs of outpatient follow-up after liver transplantation in a university hospital in São Paulo, Brazil: cost description study

2014 ◽  
Vol 133 (3) ◽  
pp. 171-178 ◽  
Author(s):  
Patricia Coelho de Soárez ◽  
Amanda Nazareth Lara ◽  
Ana Marli Christovam Sartori ◽  
Edson Abdala ◽  
Luciana Bertocco de Paiva Haddad ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Healthcare Resource Utilization ◽  
Sao Paulo ◽  
University Hospital ◽  
First Year ◽  
São Paulo ◽  
Cost Component ◽  
Accounting Information System ◽  
Main Driver

CONTEXT AND OBJECTIVE:Data on the costs of outpatient follow-up after liver transplantation are scarce in Brazil. The purpose of the present study was to estimate the direct medical costs of the outpatient follow-up after liver transplantation, from the first outpatient visit after transplantation to five years after transplantation.DESIGN AND SETTING:Cost description study conducted in a university hospital in São Paulo, Brazil.METHODS:Cost data were available for 20 adults who underwent liver transplantation due to acute liver failure (ALF) from 2005 to 2009. The data were retrospectively retrieved from medical records and the hospital accounting information system from December 2010 to January 2011.RESULTS:Mean cost per patient/year was R$ 13,569 (US$ 5,824). The first year of follow-up was the most expensive (R$ 32,546 or US$ 13,968), and medication was the main driver of total costs, accounting for 85% of the total costs over the five-year period and 71.9% of the first-year total costs. In the second year after transplantation, the mean total costs were about half of the amount of the first-year costs (R$ 15,165 or US$ 6,509). Medication was the largest contributor to the costs followed by hospitalization, over the five-year period. In the fourth year, the costs of diagnostic tests exceeded the hospitalization costs.CONCLUSION:This analysis provides significant insight into the costs of outpatient follow-up after liver transplantation due to ALF and the participation of each cost component in the Brazilian setting.

scholarly journals Patterns of moderate and severe injury in children after the introduction of major trauma networks

2018 ◽  
Vol 104 (4) ◽  
pp. 366-371 ◽  
Author(s):  
Samantha Jones ◽  
Sarah Tyson ◽  
Michael Young ◽  
Matthew Gittins ◽  
Naomi Davis
Keyword(s):  
Major Trauma ◽  
Injury Severity ◽  
Research Network ◽  
After School ◽  
Trauma Network ◽  
Body Parts ◽  
Severe Injuries ◽  
Traumatic Injuries ◽  
Trauma Networks ◽  
Outcomes For Children

ObjectiveTo describe the demographics, mechanisms, presentation, injury patterns and outcomes for children with traumatic injuries.SettingData collected from the UK’s Trauma and Audit Research Network.Design and patientsThe demographics, mechanisms of injury and outcomes were described for children with moderate and severe injuries admitted to the Major Trauma Network in England between 2012 and 2017.ResultsData regarding 9851 children were collected. Most (69%) were male. The median age was 6.4 (SD 5.2) years, but infants aged 0.1 year (36.5 days) were the most frequently injured of all ages (0–15 years); 447 (36.0%) of injuries in infants aged <1 year were from suspected child abuse. Most injuries occurred in the home, from falls <2 m, after school hours, at weekends and during the summer. The majority of injuries were of moderate severity (median Injury Severity Score 9.0, SD 8.7). The limbs and pelvis, followed by the head, were the most frequently and most severely injured body parts. Ninety-two per cent were discharged home and 72.8% made a ‘good recovery’ according to the Glasgow Outcome Scale. 3.1% of children died, their median age was 7.0 years (SD 5.8), but infants were the most commonly fatally injured group.ConclusionsA common age of injury and mortality was infants aged <1 year. Accident prevention strategies need to focus on the prevention of non-accidental injuries in infants. Trauma services need to be organised to accommodate peak presentation times, which are after school, weekends and the summer.

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