Search

Background: In response to the coronavirus pandemic, lockdown restrictions and a ban on alcohol sales were introduced in South Africa. Objectives. To investigate the impact of lockdown measures on the number of patients who visited a tertiary urban trauma centre. Methods. The period of investigation was from 1 February to 30 June 2020 and was segmented into three intervals: pre-lockdown (February and March 2020), hard lockdown (April and May 2020) and immediately post lockdown (June 2020). The electronic HECTIS health record registry was interrogated for the total number of patients that were seen per month. These were further categorised according to mechanism of injury (stab, gunshot, blunt assault and road traffic injuries). Penetrating (stab and gunshot) and blunt assault victims were collectively grouped as violent trauma. Results. The mean total number of patients seen decreased by 53% during the hard lockdown period. There was a moderate reduction (15%) in patients with gunshot injuries seen during the hard lockdown phase, but there was an 80% increase in the post-lockdown period. The proportion of patients injured in road traffic collisions pre lockdown, hard lockdown and immediate post lockdown was 16.4%, 8.9% and 11.1%, respectively. Patients injured in road traffic collisions decreased by 74% during the hard lockdown period and maintained a reduction of 32% during the immediate post-lockdown period. The mean total number of patients who visited the trauma unit returned to pre-lockdown levels in June. Conclusions. There was an overall trend of reduced number of patients who visited the trauma unit during the hard lockdown period; however, these numbers returned to pre-lockdown levels during the immediate post-lockdown period. The number of road traffic injury admissions remained reduced during all three phases of lockdown, while the number of gunshot victims increased substantially during the post-lockdown period.

Background: In response to the coronavirus pandemic, lockdown restrictions and a ban on alcohol sales were introduced in South Africa. Objectives. To investigate the impact of lockdown measures on the number of patients who visited a tertiary urban trauma centre. Methods. The period of investigation was from 1 February to 30 June 2020 and was segmented into three intervals: pre-lockdown (February and March 2020), hard lockdown (April and May 2020) and immediately post lockdown (June 2020). The electronic HECTIS health record registry was interrogated for the total number of patients that were seen per month. These were further categorised according to mechanism of injury (stab, gunshot, blunt assault and road traffic injuries). Penetrating (stab and gunshot) and blunt assault victims were collectively grouped as violent trauma. Results. The mean total number of patients seen decreased by 53% during the hard lockdown period. There was a moderate reduction (15%) in patients with gunshot injuries seen during the hard lockdown phase, but there was an 80% increase in the post-lockdown period. The proportion of patients injured in road traffic collisions pre lockdown, hard lockdown and immediate post lockdown was 16.4%, 8.9% and 11.1%, respectively. Patients injured in road traffic collisions decreased by 74% during the hard lockdown period and maintained a reduction of 32% during the immediate post-lockdown period. The mean total number of patients who visited the trauma unit returned to pre-lockdown levels in June. Conclusions. There was an overall trend of reduced number of patients who visited the trauma unit during the hard lockdown period; however, these numbers returned to pre-lockdown levels during the immediate post-lockdown period. The number of road traffic injury admissions remained reduced during all three phases of lockdown, while the number of gunshot victims increased substantially during the post-lockdown period.

Background: Hospital-acquired infections (HAIs) are a major cause of morbidity and mortality. Surgical site infection (SSI) rates are reported to range from 2.5% to 41%. HAI increases the risk of death by 2 - 11%, and three-quarters of these deaths are directly attributable to SSIs., Objectives: To determine the incidence of HAI and to identify risk factors amenable to modification with a resultant reduction in infection rates., Methods: An analysis of HAIs was performed between January and April 2018 in the trauma centre surgical wards at Groote Schuur Hospital, Cape Town, South Africa., Results: There were 769 admissions during the study period. Twenty-two patients (0.03%) developed an HAI. The majority were men, and the mean age was 32 years (range 18 - 57). The mean length of hospital stay (LoS) was 9 days, higher than the mean LoS for the hospital of 6 days. Fourteen patients underwent emergency surgery, 3 patients underwent abbreviated damage control surgery, and 9 patients were admitted to the critical care unit. Most patients with nosocomial sepsis were treated with appropriate culture-based antibiotics (82%). Four patients were treated with amoxicillin/clavulanic acid presumptively prior to culture and sensitivity results, after which antibiotic therapy was tailored. All but 1 patient received antibiotics., Conclusions: A combination of measures is required to prevent trauma-related infections. By determining the incidence of nosocomial infections in our trauma patients, uniform policies to reduce infection rates further could be determined. Our low incidence of infection may be explained by established preventive care bundles already in place.

Background: This study evaluated factors influencing mortality in a large cohort of patients who sustained pancreatic injuries and underwent DCS., Methods: A prospective database of consecutive patients with pancreatic injuries treated at a Level 1 academic trauma centre was reviewed to identify those who underwent DCS between 1995 and 2014., Results: Seventy-nine (71 men, median age: 26 years, range 16-73 years, gunshot wounds = 62, blunt = 14, stab = 3) patients with pancreatic injuries (35 proximal, 44 distal) had DCS. Fifty-nine (74.7 %) patients had AAST grade 3, 4 or 5 pancreatic injuries. The 79 patients had a total of 327 associated injuries (mean: 3 per patient, range 0-6) and underwent a total of 187 (range 1-7) operations. Vascular injuries (60/327, 18.3 %) occurred in 41 patients. Twenty-seven (34.2 %) patients died without having a second operation. The remaining 52 patients had two or more laparotomies (range 2-7). Overall 28 (35 %) patients underwent a pancreatic resection either during DCS (n = 18) or subsequently as a secondary procedure (n = 10) including a Whipple (n = 6) when stable. Overall 43 (54.4 %) patients died. Mortality was related to associated vascular injuries overall (p < 0.01), major visceral venous injuries (p < 0.01) and combined vascular and total number of associated organs injured (p < 0.04)., Conclusions: Despite the magnitude of their combined injuries and the degree of physiological insult, DCS salvaged 45 % of critically injured patients who later underwent definitive pancreatic surgery. Mortality correlated with associated vascular injuries overall, major visceral venous injuries and the combination of vascular plus the total number of associated organs injured.

Objective: To report the surgical management and outcome of iliac vessel (IV) injuries in a civilian trauma centre with a high incidence of penetrating trauma., Design, Patients and Methods: A retrospective record review of patients with IV injuries treated between January 2000 and December 2009., Results: Sixty nine patients, 59 with gunshot wounds, sustained 108 iliac vessel injuries. Mean revised trauma and injury severity scores was 7.06 and 28.4, respectively. Twenty nine patients required damage control laparotomy. Common or external iliac arteries were repaired by primary repair (10), temporary shunt with delayed graft (6), interposition graft (5) or ligation if limb non-viable (3). Forty-seven patients had injuries to the common or external iliac vein, 42 were ligated. Mortality was 25% and 6 survivors required amputation., Conclusions: In a stable patient a primary arterial repair is preferred but a temporary shunt can be a life and limb saving option in the unstable patient. Ligating the common or external iliac veins is associated with a low incidence of prolonged leg swelling., (Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: The role of nonoperative management for penetrating kidney injuries is unknown. Therefore, we review the management and outcome of penetrating kidney injuries at a center with a high incidence of penetrating trauma., Materials and Methods: Data from all patients presenting with hematuria and/or kidney injury discovered on imaging or at surgery admitted to the trauma center at Groote Schuur Hospital in Cape Town, South Africa during a 19-month period (January 2007 to July 2008) were prospectively collected and reviewed. These data were analyzed for demographics, injury mechanism, perioperative management, nephrectomy rate and nonoperative success. Patients presenting with hematuria and with an acute abdomen underwent a single shot excretory urogram. Those presenting with hematuria without an indication for laparotomy underwent computerized tomography with contrast material., Results: A total of 92 patients presented with hematuria following penetrating abdominal trauma. There were 75 (80.4%) proven renal injuries. Of the patients 84 were men and the median age was 26 years (range 14 to 51). There were 50 stab wounds and 42 gunshot renal injuries. Imaging modalities included computerized tomography in 60 cases and single shot excretory urography in 18. There were 9 patients brought directly to the operating room without further imaging. A total of 47 patients with 49 proven renal injuries were treated nonoperatively. In this group 4 patients presented with delayed hematuria, of whom 1 had a normal angiogram and 3 underwent successful angioembolization of arteriovenous fistula (2) and false aneurysm (1). All nonoperatively managed renal injuries were successfully treated without surgery. There were 18 nephrectomies performed for uncontrollable bleeding (11), hilar injuries (2) and shattered kidney (3). Post-nephrectomy complications included 1 infected renal bed hematoma requiring percutaneous drainage. Of the injuries found at laparotomy 12 were not explored, 2 were drained and 5 were treated with renorrhaphy., Conclusions: Penetrating trauma is associated with a high nephrectomy rate (24.3%). However, a high nonoperative success rate (100%) is achievable with minimal morbidity (9%)., (Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: The surgical management and outcome of abdominal vena cava (AVC) injuries is presented. STUDY DESIGN, PATIENTS AND METHODS: A retrospective record review of patients with AVC injuries treated in the Trauma Unit at Groote Schuur Hospital between January 1999 and December 2003 was undertaken. Demographic data, mechanism of injury, surgical management, associated injuries, duration of hospital stay, complications and mortality were extracted from patient records. Patients with acute peritonitis and/or shock underwent emergency laparotomy., Results: Forty-eight patients with AVC injuries were identified. Gunshot wounds accounted for 45 (94%) injuries. The mean weighted revised trauma score, injury severity score (ISS) and penetrating abdominal trauma index (PATI) were 6.3, 24 and 42, respectively. The AVC injury was infrarenal and suprarenal in 41 and seven patients, respectively. Thirty injuries were ligated. There were 15 deaths (31%). Significant differences between survivors and non-survivors included ISS, preoperative hypotension and blood transfusion requirements, whereas site of injury, PATI, and surgical management did not., Conclusion: Abdominal vena cava injuries are associated with a high mortality. Ligation of the AVC in critically ill patients is a feasible and life-saving option.