3 Damage control surgery in a regional trauma centre – defining the population: a pilot study

IntroductionTrauma has a major disease burden, by causing physiological disruption.1 Damage Control Surgery (DCS) minimises physiological disruption.2 3 The demographics of patients who undergo DCS surgery within our institution are unknown. This study aims to characterise our DCS cohort and potential for prospective study.MethodsOur hospital has a DCS protocol.4 This ensures the appropriate patients are safely and promptly transferred to a prepared operating theatre. All ORSOS data were captured from Nov 2017 – Sep 2019. Data was reviewed, and demographics analysed.ResultsThe DCS protocol was put on stand-by 42 times and activated in 21. Patient data was held for 38 cases, 30 male and 8 female, median age 37 years.Median Injury Severity Score was 29, with patients sustaining injuries from a range of mechanisms, figure 1. Median inpatient stay was 12 days, with a 29% 30-day mortality.Abstract 3 Figure 1Together this shows that despite prompt surgical intervention, a young patient cohort carries a significant mortality.ConclusionsWe have established the demographics of those who trigger DCS protocol use in a regional trauma centre. The resultant database enables prospective data collection for future DCS patients. Such data will afford our region a greater understanding of the DCS population.ReferencesPolinder S, Haagsma JA, Toet H, van Beeck EF. Epidemiological burden of minor, major and fatal trauma in a national injury pyramid. British journal of surgery 2012 Jan;99(S1):114–20.Schreiber MA. Damage control surgery. Critical Care Clinics 2004 Jan 1;20(1):101–18.Rotondo MF, Schwab CW, McGonigal MD, Fruchterman TM, Kauder DR, Latenser BA, Angood PA. ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury. The Journal of Trauma 1993 Sep;35(3):375–82.Moor P, Droog S, Adams S. Damage Control Surgery (Online). Peninsula Trauma Network. University Hospital Plymouth. 2016 Feb [2019 December]. Available from: https://www.plymouthhospitals.nhs.uk/download.cfm?doc=docm93jijm4n3410.pdf&ver=4326

The Rose-Colored Glasses of Geriatric Fall Patients: Inconsistencies Between Knowledge of Risk Factors for and Actual Causes of Falls

Background: Falls are the leading cause of fatal injury, and most common cause of non-fatal trauma, among older adults. We sought to elicit older patient’s perspectives on fall risks for the general population as well as contributions to any personal falls to identify opportunities to improve fall education. Methods: Ten patients with a history of falls from inpatient trauma and outpatient geriatric services were interviewed. Transcripts were analyzed independently by five individuals using triangulation and constant comparison (NVivo11, QSR International) to compare fall risks to fall causes. Results: All patients reported that either they (9/10 participants) or someone they knew (8/10) had fallen. Despite this, only two personally worried about falling. Patient perceptions of fall risks fell into seven major themes: physiologic decline (8/10); underestimating limitations (7/10); environmental hazards (7/10), lack of awareness/rushing (4/10), misuse/lack of walking aids (3/10); positional transitions (2/10), and improper footwear (1/10). In contrast, the most commonly reported causes of personal falls were lack of awareness/rushing (7/10), environmental hazards (3/10), misuse/lack of walking aids (2/10), improper footwear (2/10), physiologic decline (2/10), underestimating limitations (1/10) and positional transitions (1/10). In general tended to attribute their own falls to their surroundings and were less likely to attribute physical or psychological limitations. Conclusion: Despite participants identifying falls as a serious problem, they were unlikely to worry about falling themselves. Participants were able to identify common fall risks. However, when speaking about personal experience, they were more likely to blame environmental hazards or rushing, and minimized the role of physiologic decline and personal limitations.

A Review through Dialogue: Ruthann Knechel Johansen’s “Listening in the Silence, Seeing in the Dark: Reconstructing Life after Brain Injury”

As educators, we never know what stories our students may be carrying with them. This book holds insights and treasures for anyone who has been witness to or experienced the hard fight back from a near fatal trauma and the resulting loss of identity. As educators, researchers, and parents it is important to understand the difficult struggle of returning to life after suffering from a traumatic brain injury. This book is a beautiful and heart-wrenching testament to that struggle, and the ripple-effect through family, friends, and community when circumstance changes an individual’s life in an instant. Ruthann Knechel Johansen has opened up many spaces which allow for contemplation, examination, and ultimately a dialogue in response to her son’s car accident and subsequent coma and traumatic brain injury.