Trauma unit management and outcomes at an urban tertiary hospital in sub-Saharan Africa: a descriptive study

Background: Injuries are a neglected burden despite accounting for 9% of deaths worldwide which is 1.7 times that of hiv, tb and malaria combined. Trauma remains overlooked as research and resources are focused on infectious diseases. Ugandawith limited trauma epidemiological data has one of the highest traumatic injury rates. This study describes demographics, management and outcomes of patients admitted to mulago hospital trauma unit. Materials and methods: This study was a retrospective record review from july 2012 to december 2015. A data collected included age, time and vitals of admission plus interventions, management and outcomes after which it was analyzed. Results: 834 patient records were reviewed. The predominant age group was 18-35 and 86% of the patients were male. 54% of the patients presented during day and majority of the admission had gcs of less than 8. Antibiotics were given to 467 patients with mechanical ventilation (301) and intubation (289) as the frequent interventions done. 52% of admitted patients were discharged and 40% died. Conclusion: Most admissions’ were of youthful age and had severe head injuries (gcs<8). 56% received antibiotics with frequent interventions beig mechanical ventilation and intubation. 52% of admitted patients were discharged and 40% died. Keywords: Trauma; trauma care; emergency care; head injury.

636 Optimising Operative Capacity for Hand Trauma - An audit

Aim Assess compliance with departmental and BSSH guidelines for hand trauma. Optimise operative capacity within the department. Promote minor ops experience among the junior doctors. Method Retrospective review of the overbooked patients seen in the Hand trauma Unit (HTU) in August 2020 using the eTrauma system and time to operation using the Lorenzo patient record system. Results Overall Local Compliance rates Overall BSSH Compliance rates Main area of non-compliance was waiting time for tendon operations, with a 30% breech rate (&gt;5 days waiting time). Conclusions Interventions before re-audit: On call junior doctor to be based in HTU for the whole day- will allow for minor procedures (nail beds and skin lacerations) to be done at bedside. The above will free up capacity in the minor ops theatre for tendons.

288 Management of Lateral Third Clavicle Fractures: A Five-Year Review in a Regional Trauma Unit

Introduction Due to an increased risk of complications, lateral clavicle fractures are usually managed operatively. Unfortunately, there is no consensus on the optimal method of fixation. Method We assessed practice in our regional trauma unit by retrospectively identifying patients who underwent fixation of a lateral clavicle fracture between 1st August 2014 and 31st July 2019. Data was extracted from electronic care records and imaging systems. Results 44 patients were included, with the following demographics: mean age 26 years, 63.6% male, 65.9% high energy injury, and 68.2% Neer II fracture. The following operations were performed; hook plate fixation (HPF) = 10, locking plate fixation (LPF) = 16, coracoclavicular ligament reconstruction (CCLR) = 12, and LPF + CCLR = 6. Patients having LPF had a significantly larger post-operative coracoclavicular distance (7.6mm vs 13.5mm, p &lt; 0.01), and a trend towards incomplete acromioclavicular joint reduction (50.0% vs 89.3%, p = 0.11). There was a significantly higher re-operation rate after HPF (100% vs 23.5%, p &lt; 0.01). Conclusions In our unit there is no favoured method of fixation of lateral clavicle fractures. When LPF is used, there should be consideration of concomitant CCLR. The high rate of re-operation after HPF must be considered.

Patient Care in Emergency and Critical Care Medicine: An Interview with Dr. Robert Arntfield

Dr. Robert Arntfield is a critical care intensivist and traumatologist at London Health Sciences Center where he also acts as the medical director of the Critical Care Trauma Unit. Originally interested in emergency medicine, he then carved his pathway to enter the realm of critical care. Dr. Arntfield is a world-renowned expert in critical care ultrasonography and lectures globally on the topic. He is currently working in collaboration with multiple artificial intelligence and technology companies to advance the applications of Point-of-Care Ultrasound (POCUS). We had the opportunity to talk to Dr. Arntfield about the field of critical care medicine at LHSC, in Canadian healthcare, and the significance of the POCUS within the field.