Association between the mode of transport and in-hospital medical complications in trauma patients: findings from a level-I trauma center in Saudi Arabia.

BACKGROUND: In Saudi Arabia, injury is the leading cause of death. Even if nonfatal, the impact of injuries on population health is enormous, as thousands of young patients suffer permanent disabilities every year. Unlike in developed countries, private transportation (PT) is a common means to transport trauma patients. Outcome differences between patients transported via PT relative to emergency medical services (EMS) has not been previously explored. OBJECTIVES: To evaluate the association between transportation mode and in-hospital complications among trauma patients. DESIGN: Retrospective. SETTING: Tertiary care center. PATIENTS AND METHODS: The study included all patients (>=16 years), who were admitted following trauma. MAIN OUTCOME MEASURES: The main outcome in the study was the occurrence of any medical complications including stroke, sepsis, myocardial infarction, pulmonary embolism, pneumonia, renal failure, acute respiratory distress syndrome, and cardiac arrest. RESULTS: The 493 patients were relatively young (over two-thirds of the sample were 45 years old or younger) and over half the population sustained injuries due traffic crashes. More than half (58%) of patients arrived via private transportation. Regression analyses revealed that in-hospital complications following injuries were significantly lower among those who arrived via PT. However, after incorporating propensity score matching, we found no difference in hospital complications (OR=0.55, 95% CI 0.25-1.17). CONCLUSION: Multiple factors may influence this unexpected finding, such as distance to health care set.tings, the belief that PT is faster or lack of knowledge of the EMS contact number. Further efforts are needed to raise awareness of the importance of using EMS to transport trauma patients to hospitals. Prevention programs to reduce traffic crashes may facilitate reduction in traumatic injuries and associated complications. LIMITATIONS: Retrospective and conducted in one center only.

Prevalence and Predictors of Gastroesophageal Reflux Disease After Laparoscopic Sleeve Gastrectomy.

BACKGROUND AND AIMS: Laparoscopic sleeve gastrectomy (LSG) might be associated with a new onset or worsening of gastroesophageal reflux disease (GERD). We aim to evaluate the prevalence of post-LSG GERD symptoms and its predictors. METHODS: We included patients who underwent primary LSG at a university hospital from 2009 to 2015. We used the GERD-Health-Related Quality of Life (GERD-HRQL) questionnaire and included questions regarding regurgitation to evaluate symptoms before and after LSG; each item was scored from 1 to 5 based on the symptom severity. RESULTS: A total of 213 patients (mean age, 36.08 ± 10.22 years; 48.36% were men) were included. The mean preoperative body mass index (BMI) was 47.84 kg/m2, mean percent total weight loss was 37.99% (95% CI, 36.64 to 39.34), mean percent excess weight loss was 84.14% (95% CI, 80.91 to 87.36), and the mean percent excess BMI loss was 84.17% (95% CI, 80.94 to 87.41). The mean heartburn score while standing increased (0.71 vs. 1.09, p < 0.01) as well as the score of heartburn requiring a diet change (0.67 vs. 1.16, p < 0.01) post-LSG. The scores for dysphagia, odynophagia, and regurgitation increased. New-onset heartburn was reported in 47.06% of our cohort. Those with high preoperative BMIs were less likely to develop new-onset or worsening symptoms of GERD (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95-0.99). More severe heartburn symptoms while standing were associated with higher risks of developing or worsening GERD symptoms (OR, 1.22; 95% CI, 1.01-1.47). None of the other variables could predict the development or worsening of the GERD symptoms. CONCLUSION: Symptoms of heartburn and regurgitation are common after LSG; however, none of the variables preoperatively could strongly predict patients who would develop new onset or experience worsening of symptoms postoperatively.