The relationship between timing of admission to a hospital and severity of injuries following 2005 Pakistan earthquake / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>The objective of this study was to establish the relationship between the timing of admission to a hospital and the severity of injuries following an earthquake.</p><p><b>METHODS</b>It was a retrospective chart review of injured patients admitted to a tertiary care teaching hospital following the 2005 Pakistan earthquake. Age, gender, injury severity score, type of injuries, complications, operations, hospital stay and mortality were studied and compared at different time intervals using SPSS.</p><p><b>RESULTS</b>Most injuries were musculoskeletal [145 (59%)] vs. all other injuries, including minor lacerations [103 (41%)], but the percentage of non-musculoskeletal injuries was higher within 24 h (67% vs. 53% respectively, p = 0.4). Injury severity score (25 ± 10 vs. 16 ± 9, p=0.01), multiple injuries [73% vs. 45%, p=0.05] and crush syndrome [20% vs. 03%, p = 0.02] were significantly higher in patients admitted within 24 h. More patients with head and neck injuries were admitted within 24 h (27% vs. 18%, p = 0.4). Patients admitted within 24 h had higher complication rates (67% vs. 32%, P = 0.01) as well as mean operative procedures (2.8 ± 1.9 vs. 1.9 ± 1.9, p= 0.08).</p><p><b>CONCLUSION</b>Our study showed that patients admitted to a hospital within 24 h following an earthquake had more severe injuries and higher complication rate than those admitted after 24 h.</p>

Colovesical Fistula: Should It Be Considered a Single Disease?

PURPOSE: This research was conducted to compare the management and the outcome of patients with colovesical fistulae of different aetiologies. METHODS: Retrospective data were collected from 2002 to 2012 and analyzed with SPSS ver. 17. Age, gender, aetiology, management, hospital stay, postoperative complications, and mortality were studied and compared among colovesical fistulae of different aetiologies. RESULTS: A total of 55 patients, 46 males (84%) and 9 females (16%), with a median age of 65 years (interquartile range [IQR], 48-75 years) were studied. Diverticular disease was the most common benign cause and recto-sigmoid cancer the most common malignancy. Anterior resection and bladder repair were the most frequent operations in benign cases, as was total pelvic exenteration in the malignant group. Multiple intestinal loop involvement and subsequent resection were significantly higher in those with Crohn disease than it was in patients of colovesical fistula due to all other causes collectively (60% vs. 6%, P = 0.006). Patients with malignancy had a higher postoperative complication rate than patients who did not (12 [80%] vs. 7 [32%], P = 0.0005). Pelvic collection (11, 22%) was the most frequent early complication (predominantly in the malignant group) whereas incisional hernia (8, 22%) was the most common late complication, with a predominance in the benign group. The median hospital stay was significantly prolonged in the malignant group (32 days; IQR, 17-70 days vs. 16 days; IQR, 11-25 days; P < 0.001). CONCLUSION: Despite their having similar clinical presentation, colovesical fistulae of various aetiologies differ significantly in management and outcome.

Surgical audit using possum scoring system

Objectives: The objectives of this study was, to describe the efficacy of a simple scoring system [possum] for surgical audit system

Design: This was a descriptive study

Place and Duration of Study: Surgical unit-/, Holy Family Hospital Rawalpindi Pakistan from April, 2001 to October, 2001

Patients And Methods: A total of 500 cases were studied. The physiological score was calculated at the time of admission whereas operative severity score at the time of discharge. By using logistic regression analysis the mortality and morbidity rates were predicted and the outcome measured. The O: E ratio and sensitivity and specificity calculated. Significance assessed by Chi square analysis

Results: The scoring system studied, provided the assessments for mortality and morbidity, which did not significantly differ from observed rates [p < 0.001].

Conclusion: The POSSUM score provided a reasonably effective means of achieving comparison among the two-thirds of patients who underwent surgical procedure. All the data required was readily available from the patient's routine assessment, observations and investigations in all clinical settings. POSSUM provides a good assessment of the risk of mortality and morbidity in general surgical patients. This score can be effectively applied in all surgical setups in Pakistan. We stress that POSSUM should be used as an adjunct to surgical audit