P-EGS12 An observational study investigating the differences the COVID-19 Pandemic had on admissions, methods of injury in a tertiary trauma centre in a major UK City

Background During March 2020 the country was plunged into a nationwide lockdown. Despite this, there remained a steady stream of trauma admissions. COVID changed a lot about how many medical specialties worked and we wanted to explore the effects on our patient population, and compare it to the experience of other hospitals. Methods We analysed existing data on admissions to the Emergency Department that were referred to the trauma service between the 12th of March to the 24th of May; encompassing the lockdown and the two weeks either side. This data was compared to that of the year beforehand. We compared ages, sexes, mortality, methods of injury, and disposition. Results Admissions fell, 193, compared to 271 (∼3:1 M:F). Both cohorts featured more younger people, but there was a drop-off in the number of older folk post-COVID; 6 of 9 centiles of the over 60s showed a fall in admissions of at least 14%. Those admitted to the Major Trauma service (ISS 9+) remained the same. Regarding the methods of injury, the most common presentations remained road traffic accidents, stabbings and falls <1m, contributing to 71 and 72% total admissions before and after COVID respectively. However, there were fewer patients falling from heights of > 2m (OR 0.5), and fewer recorded assaults (OR 4.0). Penetrating injuries were separated into “stabbings” and “others”. There was a significant increase in non-stabbing penetrating injuries (OR 4.6), a majority of which were self-inflicted. The rate of self harm during the lockdown showed a similar increase, from featuring in 8% of total presentations to 15% of admissions (OR 1.87). The hospital restructured considerably between the sample dates such that dispositions are not possible to compare meaningfully. Rates of patients sent straight home from the ED were similar (OR 1.0). Conclusions Overall, the lockdown had a moderate impact on patient numbers and demography. The data implies that the measures did small amounts to deter people from the roads and from interacting with each other in assaults and stabbings. Older people were less likely to present traumatically. The isolation may have led to a masking of mental health issues leading to a significant increase in self harm, which may present opportunities for restructuring of services in any the event of further major lockdowns. These conclusions are limited by the data, and next steps would include gathering more detailed mortality data.

The Role of Nonophthalmologists in the Primary Evaluation of Head Injury Patients with Ocular Injuries

Purpose—Visual complaints are common in trauma cases. However, not every institution provides immediate ophthalmic consultations 24 h per day. Some patients may receive an ophthalmic consultation but without positive findings. We tried to evaluate risk factors for ocular emergencies in trauma patients. Then, the ophthalmologists could be selectively consulted. Methods—From January 2019 to December 2019, head injuries patients concurrent with suspected ocular injuries were retrospectively reviewed. All of the patients received comprehensive ophthalmic examinations by ophthalmologists. Patients with and without ocular injuries were compared. Specific ophthalmic evaluations that could be primarily performed by primary trauma surgeons were also analyzed in detail. Results—One hundred forty cases were studied. Eighty-nine (63.6%) patients had ocular lesions on computed tomography (CT) scans or needed ophthalmic medical/surgical intervention. Near 70% (69.7%, 62/89) of patients with ocular injuries were diagnosed by CT scans. There was a significantly higher proportion of penetrating injuries in patients with ocular injuries than in patients without ocular injuries (22.5% vs. 3.9%, p = 0.004). Among the patients with blunt injuries (N = 118), 69 (58.5%) patients had ocular injuries. These patients had significantly higher proportions of periorbital swelling (89.9% vs. 67.3%, p = 0.002) and diplopia (26.1% vs. 8.2%, p = 0.014) than patients without ocular injuries. Conclusions—In patients with head injuries, concomitant ocular injuries with indications for referral should always be considered. CT serves as a rapid and essential diagnostic tool for the evaluation of concomitant ocular injuries. Ophthalmologists could be selectively consulted for patients with penetrating injuries or specific ocular presentations, thus reducing the burden of ophthalmologists.

Incidence, Demographics, and Outcomes of Penetrating Trauma in Sweden During the Past Decade

Trauma injury is the sixth leading cause of death worldwide, and interpersonal violence is one of the major contributors in particular regarding injuries to the head and neck. The incidence, demographics, and outcomes of penetrating trauma reaching hospitals in Sweden are not known. We report the largest, nationwide epidemiological study of penetrating injuries in Sweden, using the Swedish Trauma Registry (SweTrau). A multi-center retrospective descriptive study of 4,776 patients was conducted with penetrating injuries in Sweden, between 2012 and 2018. Due to the increase in coverage of the SweTrau registry during the same period, we chose to analyze the average number of cases for the time intervals 2013–2015 and 2016–2018 and compare those trends to the reports of the Swedish National Council for Crime Prevention (Brå) as well. A total of 663 patients had Injury Severity Score (ISS) ≥ 15 at admission and were included in the study. Three hundred and sixty-eight (55.5%) were stab wounds (SW), 245 (37.0%) gunshot wounds (GSW), and 50 (7.5%) other traumas. A majority of the cases involved injuries to the head, neck, and face. SW increased from 145 during 2013–2015 to 184 during the second period of 2016–2018. The increase was greater for GSW from 92 to 141 during the same respective periods. This trend of increase over time was also seen in head, neck, and face injuries. The 30-day mortality was unaffected (48–47%) in GSW and trended toward lower in SW (24–21%) when comparing 2013–2015 with 2016–2018. Patients with head trauma had 45% mortality compared to 18% for non-head trauma patients. Head trauma also resulted in worse outcomes, only 13% had Glasgow outcome score (GOS) 5 compared to 27% in non-head trauma. The increasing number of cases of both SW and GSW corresponded well with reports from Brå although further studies also are needed to address deaths outside of hospitals and not registered at the SweTrau. The majority of cases had injuries to the head, neck, and face and were associated with higher mortality and poor outcomes. Further studies are needed to understand the contributing factors to these worse outcomes in Sweden and whether more targeted trauma care of these patients can improve outcomes.

Nail gun injury through the parapharyngeal space in a carpenter: a unique case report

<p class="abstract">In developing countries, head and neck penetrating injuries from construction nails are rare can be dangerous or fatal. The use of nail guns in the construction industry gained popularity during the 1990s and is now widespread. In majority of nail gun injuries, the extremities are involved, although injuries to the head and neck region have also been described with approximately 45 cases of cranium penetrating nail gun injuries published in the literature. The management of such cases includes a neurological examination, systemic physical examination, and determination of the optimal surgical method to approach and remove the foreign body. we report a case of penetrating skull base injury caused by a nail gun in a 46-year-old man that was successfully managed by a transnasal endoscopic approach. The patient recovered completely and was discharged. To prevent complications and achieve the best outcomes in such cases, careful diagnosis and assessment are necessary.</p>

A Case of Hepatic Injury Following Shrapnel Injury to the Abdomen in a Paediatric Patient

In children, trauma is the leading cause of morbidity and mortality worldwide. Trauma can be a catalyst resulting in intra-abdominal solid organ injury in this population. The case report highlights a prepubescent male who presented with a penetrating abdominal wound resulting in hepatic injury. The mechanism of injury in this case is unusual and differs from previously reported causes of penetrating abdominal trauma in children. The case demonstrates that penetrating abdominal injuries may be more likely to require surgical intervention secondary to their association with a high percentage of multiple organ injuries. Penetrating injuries in children require a high degree of vigilance to rule out visceral injury.

Accidentally lodged airgun pellet in maxilla during childhood play retrieved surgically after a decade

Non-powder firearm-related injuries to the head and neck carry the potential risk of significant morbidity and mortality. Such penetrating injuries tend to be under-reported and trivialised especially in children. Air gun pellet injury may cause damage to both soft tissue and bone. Some metals, when embedded in body tissue, can evoke a foreign body reaction or release toxins over time. It therefore becomes imperative to retrieve these pellets. We present one such case of accidental lodgement of airgun pellet in the right maxilla of a 12-year-old boy during childhood play with an airgun which went unnoticed at that time and was surgically retrieved after a decade. The patient had not suffered from any neurosensory deficit.

Traumatic Diaphragmatic Hernia: Management and Review

Traumatic diaphragmatic injury (TDI) is a fairly uncommon with incidence of 0.8 and 1.6 %, commonest fallowing blunt trauma abdomen. Right-side have higher mortality rate compared to left side and penetrating injuries. It present as occult to obvious. Laparoscopy offers diagnostic and therapeutic tool of care. Lack of awareness of the condition may delay in diagnosis, results life threatening complications. Missed hernia is a known complication of blunt trauma as acute diagnosis can be difficult to ascertain. An early diagnosis and treatment lead to better outcome. In present study CECT revealed acute diaphragmatic hernia, bilateral pleural effusion and hair line fracture of right tibia on skiagram limb. Because of uncertainty in diagnosis of acute diaphragmatic hernia or rupture surgeons faces challenges for the management, high suspicion index required to diagnose the cases. An early diagnosis and treatment lead to better outcome