Epidemiology and estimated economic impact of musculoskeletal injuries in polytrauma patients in a level one trauma centre in Singapore

INTRODUCTION@#Musculoskeletal injuries are the most common reason for surgical intervention in polytrauma patients.@*METHODS@#This is a retrospective cohort study of 560 polytrauma patients (injury severity score [ISS] >17) who suffered musculoskeletal injuries (ISS >2) from 2011 to 2015 in National University Hospital, Singapore.@*RESULTS@#560 patients (444 [79.3%] male and 116 [20.7%] female) were identified. The mean age was 44 (range 3-90) years, with 45.4% aged 21-40 years. 39.3% of the patients were foreign migrant workers. Motorcyclists were involved in 63% of road traffic accidents. The mean length of hospital stay was 18.8 (range 0-273) days and the mean duration of intensive care unit (ICU) stay was 5.7 (range 0-253) days. Patient mortality rate was 19.8%. A Glasgow Coma Scale (GCS) score <12 and need for blood transfusion were predictive of patient mortality (p < 0.05); lower limb injuries, road traffic accidents, GCS score <8 and need for transfusion were predictive of extended hospital stay (p < 0.05); and reduced GCS score, need for blood transfusion and upper limb musculoskeletal injuries were predictive of extended ICU stay. Inpatient costs were significantly higher for foreign workers and greatly exceeded the minimum insurance coverage currently required.@*CONCLUSION@#Musculoskeletal injuries in polytrauma remain a significant cause of morbidity and mortality, and occur predominantly in economically productive male patients injured in road traffic accidents and falls from height. Increasing insurance coverage for foreign workers in high-risk jobs should be evaluated.

Leucocyte Profile of Adult Nigerians as Indicator of Severity Level of Acute Musculoskeletal Trauma

Leucocytosis, marked increase in the number of white blood cells (WBC) is a known physiological response to trauma. In recent times, several studies have asserted the absence of this response in Africans. In view of this, current study investigated the existence of, and prognostic implications of post-traumatic leucocytosis amongst adult Nigerians with acute musculoskeletal (MSK) trauma. Two hundred and twenty three (223) adult male and females (MSK traumatized) and fifty apparently healthy volunteers (adults) were ethically recruited from the National Orthopaedic Hospital, Enugu, regional centre for trauma, orthopaedic, burns and plastic surgery in south-east Nigeria. Using the Leishman’s stained blood smear technique, leucocyte profiles [Neutrophil, Lymphocytes, Basophils, Eosinophils and Monocyte counts] were obtained for each participant. In all case, Age, Gender and duration of hospitalization were also obtained. Following careful analysis, study found, using one way analysis of variance (ANOVA), a statistically significant increase (p < .05) in acutely traumatized subjects; with adults of ages 20 to 49 years constituting the majority (70%). A statistically significant lymphopenia was also observed in test population, with Pearson Product Moment Correlation proving positive for higher levels of WBC counts. A negative correlation was also seen for Neutrophils and lymphocyte counts, implicating the Neutrophil-Lymphocyte Stress Factor (NLSF). We recommend the exploration of the NLSF for prognosis of Leucocytosis in Africans.

Proceso de afrontamiento y adaptación en adultos hospitalizados que experimentaron un trauma musculo ­ esquelético por accidentes de transito / Coping and adaptation process in hospitalized adults who experienced musculoskeletal trauma due to traffic accidents

Objetivo: Explorar el proceso de afrontamiento y adaptación de 11 casos de adultos que experimentaron un trauma musculo esquelético, por accidentes de tránsito, durante la estancia hospitalaria en la Clínica Universidad de la Sabana en 2015. Método: Estudio de casos que permitió describir y comparar el proceso de afrontamiento y adaptación en 11 personas. Se aplicó la Escala de medición del proceso de afrontamiento y adaptación versión abreviada en español, al ingreso y al egreso hospitalario. En esta investigación se tuvo en cuenta los principios éticos correspondientes, se obtuvo el consentimiento informado de los participantes y las autorizaciones de la Subcomisión de Investigación de la Facultad de Enfermería y Rehabilitación de la Universidad de la Sabana y de la Clínica donde se llevó a cabo el estudio. Resultado: Los hallazgos de este estudio muestran para ocho de los once casos una tendencia a mantenerse en nivel alto de afrontamiento o a pasar de nivel medio a alto desde el ingreso hasta el egreso hospitalario. Conclusión: La mayoría de los casos tuvo un proceso de afrontamiento y adaptación dirigido al problema, donde se encontró interés por resolver dudas relacionadas con la situación antes de actuar, utilización de experiencias pasadas consideradas como útiles, adopción de nuevas habilidades para afrontar las situaciones difíciles y el uso de soluciones alternativas y recursos. (AU)

Objective: To explore the process of coping and adaptation of 11 cases of adults who experienced musculoskeletal trauma by traffic accidents during the hospital stay at the Clinic Universidad de la Sabana in 2015. Method: Case studies allowed to describe and comparing the process of coping and adaptation in 11 people. It was used the Scale measurement of coping and adaptation process abridged version in Spanish, it was applied at admission and hospital discharge. This research took into account the relevant ethical principles, the informed consent process and authorization of the Subcommittee on Research of the School of Nursing and Rehabilitation Sabana University and Clinic where was obtained the study. Result: The findings of this study showed for eight of the eleven cases a tendency to keep high level of coping or move from medium to high level from admission to hospital discharge. Conclusion: Most cases had a process of coping and adaptation addressed to the problem. It was approached by participants through the clarifying questions related to the situation before acting, the use of past experiences considered useful, the adoption of new skills to cope with difficult situations and the use of alternative solutions and resources. (AU)