A Research of Emergency Service Admission Due To Home Accidents Before and During The Covid-19 (Sars-Cov-2) Pandemic In Ankara (Turkey)

Home accidents can cause serious injuries, disabilities, and deaths. Approximately 40 million people were treated in hospitals annually because of injuries occurring in homes, and these injuries were responsible for approximately 76% of preventable deaths. The aims of this study are to compare the home accidents in the one-year period during the pandemic and the home accidents in the one-year period before the pandemic, and to reveal how the home accidents are affected in which part of the home and in which types of injuries. A retrospective study was made of the records of patients injured in home accidents between pre-pandemic and pandemic one-year periods. The patients were classified according to age groups, gender, season, day and time of the home accident, accident type, part of the home, trauma localization and type, and severity of injuries. While 46.5% of the 581 injured patients were before the pandemic, 53.5% were in the pandemic period. The injuries increased as the number of households staying at home increased compared to the pre-pandemic period. Likewise, there was a significant increase in the number of falls from balconies and windows during the pandemic period. It is still not possible to make a definite prediction about the course of the pandemic. In this context, it is of great importance to provide information on prevention from home accidents, especially in television programs and distance education activities.Copyright © 2023, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.

Co-Occurring Physical Health Challenges in Neurodivergent Children and Young People: A Topical Review and Recommendation

Background: Neurodivergence has been established as associated with a significant number of co-occurring physical conditions, particularly for autistic individuals who are at risk for increased pain, hypermobility (including Ehlers-Danlos Syndrome) and gastrointestinal problems. However, data, so far, has been focused on adults and generally limited to discussions of condition prevalence alone. Method(s): The following article will present a topical review of the literature considering evidence for increased physical health concerns within neurodivergent populations, particularly autistic individuals, with a focus on the impact that these physical health concerns may have in an educational setting. Results and discussion: The impact of physical health concerns within neurodivergent populations in an educational setting may be concerning. Such populations may face a range of challenges in obtaining appropriate support for physical conditions. We discuss a number of said challenges including;communication challenges, misattributing physical health symptoms as a part of neurodivergence, and a history of not being believed, which limits symptomatic reporting. We further consider the potential impact these physical health concerns may have on scholastic and social development, such as impacts for attainment and attendance. Furthermore, we provide recommendations for teachers, parents/carers and other allied professionals in young people's lives, on supporting young neurodivergent people with physical health concerns.Copyright © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Investigation of the effect of COVID-19 on upper extremity trauma

Aim: Our study aims to evaluate the upper extremity trauma that admitted to our hospital from April 11, 2020, to June 1, 2020, the days when the restrictions were applied in Turkey, and to investigate the effect of COVID-19 on upper extremity trauma by comparing with the data of a year ago between the same dates. Material(s) and Method(s): Demographic information, trauma details, and region, and the treatment method of patients with any upper extremity trauma who were over the age of 18 and admitted to the hospital between April 11, 2019, and June 1, 2019 (2019-Before Restrictions) and between April 11, 2020, and June 1, 2020 (2020-Lockdown) were examined retrospectively. Result(s): In 2019-Before Restrictions, 218 patients and in the 2020-Lockdown, 163 patients were admitted to the hospital due to upper extremity trauma. The number of hospital admissions with upper extremity trauma during the 2020-Lockdown was 25.22% less than that of those in 2019-Before Restrictions, (p<0.05). While the number of patients admitted to the hospital due to fractures in the upper extremity during 2019-Before Restrictions, was 89 (Open Fracture=32, Closed Fracture=57), this number was observed to decrease to 48 (Open Fracture=11, Closed Fracture=37) in the 2020-Lockdown (p<0.05). Discussion(s): It was determined that there was a decrease in upper extremity trauma during 2020-Lockdown compared to the same dates of the previous year. It is possible to state that quarantine practices applied to prevent the spread of COVID-19 affect the decrease in upper extremity trauma.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Management of Maxillofacial Trauma Emergency Department Presentations in an Evolving Pandemic. Did COVID-19 Change Our Practice?

Aim: Trauma encompasses a significant proportion of referrals to Oral Maxillofacial Surgery (OMFS). COVID-19 called for clinicians globally to tailor practice and follow-up patterns. Multiple government-imposed lock downs saw changes in patterns of emergency department (ED) attendances nationally. The aim of this audit was to examine the impact of COVID-19 on Maxillofacial trauma presentations, admissions, and existing practice in University Hospital of Wales (UHW). Method: Data was collected using an electronic patient database Team Talk. Patients filtered by pathology (Soft tissue trauma, fractures) and location (ED). Annual data collected for 2019, 2020 and 2021, to compare pre-pandemic (2019), evolving pandemic (2020) and established pandemic (2021) figures. Results: Trauma made up 74%, 73% and 78% of total OMFS referrals (2019, 2020, 2021). There was an 83% decrease in the number of trauma referrals between 2019 and 2020, despite UHW becoming a major trauma centre. No correlation identified between trauma presentations and lockdown events (2020) but lifting of restrictions (September 2021) showed an increase in presentations. 16.8%, 16.4% and 16.2% (2019, 2020 and 2021, respectively) of ED referrals were offered follow up follow up. Percentage of follow up appointments used for removal of sutures (ROS) decreased by 30% (2019-2020). Conclusions: 1) Overall decrease of trauma presentations during the COVID-19 pandemic, but trauma still comprised >70% of all OMFS referrals from ED. 2) Pandemic pressures did not change follow-up, discharge, or admission decisions for ED referrals. 3) Change to absorbable sutures can be taken forward to reduce percentage of follow up clinic appointments required for ROS.

Comparing Autopsy Thoracic Injury Patterns between In-Hospital CPR Patients Receiving LUCAS Device vs Manual Chest Compressions

Background: Current research comparing CPR-associated injuries between those receiving LUCAS device and manual CPR has primarily focused on patients who suffered out-of-hospital cardiac arrest. During the SARS-CoV-2 pandemic, more hospitals leveraged mechanical CPR devices to provide distant yet high quality chest compressions for in-hospital cardiac arrest (IHCA) patients. We sought to investigate autopsy thoracic injury patterns in in-hospital non-traumatic cardiac arrests, comparing traditional manual compressions with the mechanical LUCAS device compressions. Design: Autopsies were screened for a history of in-hospital cardiopulmonary resuscitation in the absence of prior traumatic injuries at a single, large quaternary care center from 1/1/2018 to 06/30/2021. 20 received LUCAS compressions and 40 received manual compressions. Student's T-Tests were used to compare means for continuous variables, while chi-squared and Fischer's exact tests were used for categorical variables. An alpha of 0.05 was chosen as the threshold for statistical significance. Results: A statistically significant decrease in the rate of sternal fractures and rate of multiple sternal fractures during mechanical CPR was found. A statistically significant increase in other soft tissue injuries, such as pleural wall or lung injuries was seen in mechanical CPR cases, while an increased rate of bilateral rib fractures was noted in manual compression cases. Conversely, no difference in the number or laterality of rib fractures were noted. There was no significant difference in age, biological sex, or rate of scoliosis or kyphosis between cohorts. Results are listed in table 1. (Table Presented) Little research has looked at the injury patterns of mechanical CPR in the IHCA patient population. These results point to a potential difference in thoracic injury patterns from manual compressions when compared to LUCAS device compressions. The statistically significant decrease in sternal fractures with mechanical compressions is noteworthy. Conversely, the increase in other soft tissue injury demands further examination. The decrease in bilateral rib fractures with LUCAS use suggests that placement of the device may play a role in the epidemiology of rib injuries, but not in the number of ribs injured. Further research should examine rib injuries in more detail, and quantify additional comorbidities in both survivors and non-survivors of cardiac arrest.

A Better Way to Manage Paediatric Maxillofacial Trauma;A Retrospective Study Examining the Presentation of Maxillofacial Soft Tissue Injuries and Management over 3-year period at a Regional Children's Hospital

Introduction: Maxillofacial treatment is evolving with changing paediatric lifestyles and clinical limitations, including COVID-19. The aim of this study is to assess trends in the presentation of maxillofacial soft tissue injuries and subsequent management within a regional paediatric hospital. Methods: Retrospective study over a 3-year period (from 2019-2021 between January and April). Inclusion of all paediatric patients seen on the emergency department by OMFS team. Results: Between 2019 and 2021, the total number of patients dropped by over half. The average age dropped from 5.9 in 2019 to 3.8 in 2021. Males were more commonly seen. Extraoral injuries increased by 21%. Intraoral injuries reduced by 8%. Less complicated communicating injuries and associated dental trauma were seen in 2021. Lip lacerations accounted for most injuries. In 2020, there was 21% reduction in conservative management of injuries. Wound closure under LA increased by 12% in 2020. There has been an overall increase in wound closure under GA by 5% between 2019 and 2020. Falls accounted for most injuries, however, there has been an increase in dog bite injuries by 5% in 2021. Conclusions: The average age has dropped between 2019-2021 and hence treatment options remain limited. Age, cooperation, and severity of injury are important factors. The number of overall lacerations has decreased but a greater proportion required formal closure under general anaesthesia. It is vital OMFS surgeons are aware of the changes in presentation and current trends in management. This will help to better equip surgical teams for the changing landscape of paediatric maxillofacial trauma.

Soft tissue trauma clinic - an advanced practice physiotherapist-led pilot

Keywords: Soft tissue trauma, Advanced Practice Physiotherapist, Fracture Clinic Purpose: A large amount of patients were identified in Fracture Clinic with soft tissue trauma who did not necessarily need to see a doctor. We proposed that we could reduced the demands on doctors in Fracture Clinic and the foot-fall through the hospital, whilst improving patient outcomes and patient satisfaction by having these patients seen instead in an advanced practice physiotherapist-led STTC. Aims of the pilot: 1. Reduce the number of patients in Fracture Clinic requiring medical review 2. Standardise pathways of care 3. Provide patients with earlier specialised physiotherapy management 4. Maintain or improve outcomes and patient satisfaction Methods: A quality improvement approach was used with an Action Research Methodology. Results: Less patients with Soft tissue trauma required medical review. Reduced patient foot-fall through the hospital (59% of patients discharged at first contact compared to 35% of patients in Fracture Clinic). Management pathways for patients with soft tissue trauma were standardised. Patients received early specialist physiotherapy management. Also reduced number of referrals to physiotherapy and a reduced average number of subsequent physiotherapy follow-up appointments. We received outstanding patient satisfaction (95% rated extremely likely to recommend the service to friends and family;97/100 achieved on the VSQ-9 satisfaction questionnaire) Conclusion(s): The Soft Tissue Trauma Clinic utilises expert clinicians who provide a highly effective and cost-efficient service that reduces demand on Fracture Clinic whilst delivering excellent patient outcomes and satisfaction. Depending on funding, we are hoping the service can be made substantive, and then expanded to be included in the Trust's Trauma management pathway. Impact: We’ve demonstrated that patients with Soft tissue trauma can be successfully managed without needing to see a doctor in Fracture Clinic. Adopting an APP led-soft tissue trauma clinic could aid the post-COVID Orthopaedic Recovery Plan by releasing a Registrar from Fracture clinic to do other activities, such as elective orthopaedic clinics or additional theatre lists. We were able to reduce the footfall through the hospital. More patients were discharged at first contact in the STTC with fewer requiring additional follow-up appointments because patients were seeing the right person at the right time. 59% of patients were appropriately discharge at their first attendance in the STTC compared to 35% in Fracture clinic. We managed to agree with the Orthopaedic team Standardised care pathways for patients with STT. In line with the NHS Long-term plan, if we can standardise care pathways we can:- Reduced unwarranted variation which in-turn will reduce variations in outcomes and inequalities. - We can ensure an evidenced base and best practice model is followed as suggested by the ‘GIRFT’ as opposed to research literature and anecdotal evidence that suggests a lot of variation in patient management by current fracture clinic services. We were able to provide patients with earlier specialist physiotherapy management. We know the earlier we can provide suitable management advice we are more likely to improve a patient's function and their return to work, reduce patient anxiety, and reduce long-term pain and disability. We also reduced the length of a patient's rehabilitation and need for further physiotherapy. Funding acknowledgements: Not funded

A rare cause of paediatric wrist pain unmasked by minor trauma

Introduction: A 10 year-old girl was referred to paediatric rheumatology with a six-month history of a painful, swollen left wrist associated with functional limitation and disturbed sleep. She initially had a minor fall, X-rays at the time showed no bony abnormalities. Objectives: Blood tests were normal including inflammatory markers and autoimmune screen. Wrist MRI showed significant synovial thickening and avascular necrosis of the left lunate (figure 1). Methods: Our patient received non-steroidal anti-inflammatories and physiotherapy, but a year later continued to have chronic regional pain with allodynia and hyperalgesia. Despite this, she remains upbeat and continues to live a normal childhood and has coped well with the recent increase in computer usage and typing associated with remote-schooling as a consequence of closures during the COVID-19 pandemic. Results: Kienböck disease;an eponym for avascular necrosis of the lunate bone, is of unknown aetiology and incidence[1]. The proposed trigger is trauma in those with a susceptibility due to natural skeletal and vascular variations[2]. It is the commonest cause of adult aseptic osteonecrosis of the upper extremity, usually in dominant hands of men aged 20-40[3]. Paediatric Kienböck is rare;presenting as pain, stiffness, swelling and reduced power often after an innocuous fall. Diagnostically this is challenging because the mechanism suggests a soft-tissue injury whereas the chronicity mimics Juvenile Idiopathic Arthritis. Radiographic severity is defined by Lichtman classification and used to guide non-curative surgical or conservative management[4]. This aims to relieve pressure on the lunate bone and restore perfusion. Anti-inflammatory medications are offered prior to surgical jointlevelling to reduce pain, swelling and deformity[5]. Conclusion: We emphasise that clinicians consider this rare, destructive pathology in their differential diagnosis for paediatric chronic wrist pain and swelling, especially in those presenting weeks after a seemingly innocuous hand trauma.

Lessons learnt from managing orthopaedic trauma during the first wave of the CIVID-19 pandemic at a uk district general hospital

Background: The Coronavirus disease (COVID-19) pandemic has contributed to over 900,000 deaths worldwide. Hospitals responded by expanding services to accommodate the forecasted rise in COVID-19- related admissions. We describe the effects these changes had on management of orthopaedic trauma and patient outcomes at a district general hospital in Southern England. Method: Data were extrapolated retrospectively from two separate sixweek periods in 2019 and 2020 (1st April - 13th May) using electronic records of patients referred to the orthopaedic team. Soft tissue injuries were included where a confirmed diagnosis was made with radiological evidence. Patients were excluded if no orthopaedic intervention was required. Data were compared between the two time periods. Results: There were fewer attendances to hospital in 2020 compared with 2019 (178 vs 328), but time from presentation to surgery significantly increased in 2020 (2.94 days vs 4.91 days, p=0.009). There were fewer operative complications in 2020 (36/145 vs 11/88, p<0.001). However, ordinal logistic regression analysis found a significantly greater complication severity in 2020 including death (p=0.039). Complication severity was unrelated to COVID-19 status. Conclusions: Restructuring of orthopaedic services in response to the COVID-19 pandemic has been associated with significant delays to surgery and higher post-operative complication severity. Our results demonstrate the need for fast-track emergency operative orthopaedic services in UK district general hospitals whilst the COVID-19 pandemic continues.