Trauma care audit using Srinagarind hospital's audit filter.

BACKGROUND: To audit trauma care (including the mortality rate and obstacles faced by the authors) at Srinagarind (University) Hospital using the trauma audit filter. MATERIAL AND METHOD: Conduct a prospective, descriptive, study of trauma patients who received trauma medical care at Srinagarind Hospital, Khon Kaen University, Thailand, between January and May 2006. Srinagarind Hospitals trauma audit filter was used to audit trauma care. The audit filter comprised 14 criteria (i.e., 1) emergency medical service; 2) accident and emergency out-patient service; 3) in-patient service). Any filter that generated a "Yes" response was investigated to find the reason(s). The obstacles and mortality were also recorded. RESULTS: The authors enrolled 3209 patients. The mortality rate was 0.5% (95% CI 0.3-0.8). Emergency medical service, accident and emergency out- and in-patient service were rated satisfactorily. The reported obstacles were lack of hospital beds, inappropriate locale for trauma care, financial process, admission process, and lack of equipment. CONCLUSIONS: Srinagarind Hospital's audit filter had the capability to audit trauma care. Overall trauma care at Srinagarind Hospital was satisfactory albeit improvements are needed.

Sixty-one cases of obturator hernia in Chiangrai Regional Hospital: retrospective study.

OBJECTIVE: To review the patient characteristics and clinical symptoms, intraoperative finding and management, including morbidity and mortality rate of obturator hernia cases. MATERIAL AND METHOD: A retrospective study was performed in 61 patients diagnosed as obturator hernia at Chiangrai Regional Hospital between January 2000 and December 2005. RESULTS: The incidence of obturator hernia is 61 of 2,828 cases (2.2%) of all hernias, female:male 6.6:1. The mean age was 72.85 years. The mean body weight was 35.72 Kg. Howship-Romberg's sign were positive in eight patients (13.11%). Thirty-five patients (57.38%) were Richter type hernia, left:right side 3:2. Strangulation of bowel occurred in 41 patients (67.21%) Mortality rate was 11.47%. All patients with postoperative complications and all deaths showed bowel strangulation and all were more than 70 years of age. CONCLUSION: In the present study, the authors found a high incidence of obturator hernia (2.2% of all hernias) compared with a previous report (0.05%-1.4% of all hernias). This high incident rate might relate to the specific local life style of people in Chiangrai as most patients had a habit of smoking. Chronic obstructive pulmonary disease (COPD), old age, and low body weight were possible contributing factors. Bowel strangulation and age more than 70 years old were associated with morbidity and mortality.

Outcome of in-patient trauma cases: Accident and Emergency Unit, Khon Kaen University.

OBJECTIVES: To study and report the outcome of in-patient trauma cases based on the Trauma and Injury Severity Scoring (TRISS) method and compare the outcome with the registry data from the Major Trauma Outcome Study (MTOS). MATERIAL AND METHOD: A descriptive study was performed by retrospective data collection. From 1 January 2002 to 31 December 2002, all admitted trauma patients in the Accident and Emergency Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University were included in the present study. Survival analysis was completed for all of the patients. Statistical analysis: TRISS method and W, M and Z-statistics (Z-score) on the basis of definitive outcome-based evaluation (DEF) method for comparing with MTOS data. RESULTS: The majorities of patients were men (76.85%) and mean age was 30.81 years. One hundred and ninety five patients (96.06%) sustained blunt trauma, the vast majority resulting from motor vehicle crashes. The observed survivors were 182, whereas the expected survivors were 183.582. The W, M and Z-statistics were -0.779, 0.843 and -0.493 respectively. CONCLUSION: Z-score -0.493 indicated no statistical difference between observed and expected survivors.