Watching the Games: public health surveillance for the Sydney 2000 Olympic Games.

STUDY OBJECTIVE: To describe the development of the public health surveillance system for the Sydney 2000 Olympic Games; document its major findings; and discuss the implications for public health surveillance for future events. DESIGN: Planning for the system took almost three years. Its major components included increased surveillance of communicable diseases; presentations to sentinel emergency departments; medical encounters at Olympic venues; cruise ship surveillance; environmental and food safety inspections; surveillance for bioterrorism; and global epidemic intelligence. A daily report integrated data from all sources. SETTING: Sydney, Australia. Surveillance spanned the period 28 August to 4 October 2000. PARTICIPANTS: Residents of Sydney, athletes and officials, Australian and international visitors. MAIN RESULTS: No outbreaks of communicable diseases were detected. There were around 5% more presentations to Sydney emergency departments than in comparable periods in other years. Several incidents detected through surveillance, including injuries caused by broken glass, and a cluster of presentations related to the use of the drug ecstasy, prompted further action. CONCLUSIONS: Key elements in the success of public health surveillance for the Games included its careful planning, its comprehensive coverage of public health issues, and its timely reporting and communication processes. Future systems need to be flexible enough to detect the unexpected.

Traumatic thoracic aortic rupture: investigation determines outcome.

Blunt thoracic aortic rupture (TAR) initially presents with subtle signs but is usually fatal if not diagnosed and treated early. Does the diagnostic process affect outcome? The definitive test most widely promoted is thoracic (arch) aortography but is usually only available in major teaching hospitals. Thoracic computerized tomography (CT) scanning is more readily available but its role in diagnosis of TAR is unproven. A retrospective review of trauma databases and medical record indexes over a 7 year period identified 38 patients presenting with TAR at Westmead and Royal North Shore Hospitals in the period 1984-91. Thirteen patients (34%) were dead on arrival or died within 15 min of arrival at either hospital. Five patients (13%) who arrived in cardiac arrest (with suspected TAR) died after immediate thoracotomy (two in the Emergency Department and three in the operating room). Two patients (5%) died from severe head injuries and were not investigated for TAR. Eighteen patients (47%) remained alive long enough for investigation and were considered potentially salvageable. Nine of these survived. Only 13 patients had arch aortography. No patient survived without an aortogram. Five patients had a chest CT scan; aortography followed in four patients. Computerized tomography scans delayed aortography or were misinterpreted. Review of all trauma thoracic (arch) aortograms for the same period at Westmead Hospital revealed a diagnosis of TAR in 7.4%. Blind thoracotomy did not result in survival. Computerized tomography scanning of the chest was of no value in the management of this injury. Early suspicion of possible thoracic aortic rupture demands urgent arch aortography and this remains the diagnostic 'gold standard'.

Sternal fractures: associated injuries and management.

Prospective data from blunt trauma victims admitted to one hospital were analyzed to determine the significance of sternal fractures and possible associated injuries. A total of 12,618 patients were admitted over a 6 1/2 year period, of whom 2226 (17.6%) were injured while in a motor vehicle. One hundred seventy-two sternal fractures were recorded with 152 (89%) occurring in motor vehicle occupants. Vehicle occupants with sternal fractures included a greater proportion of patients over 50 years (56% vs. 11%), more females (55% vs. 34%) and more seat belt wearers (70% vs. 40%). There was no association with serious visceral chest injury (including cardiac contusion). There was an association with thoracic spine fractures (Chi-squared 5.871, df = 1, p < 0.05). Sternal fractures in motor vehicle occupants were associated with less injury overall (median ISS = 5.5) compared with those without sternal fractures (median ISS = 13). Assessment of such patients should include age and injury mechanism to reduce the rate of admission and investigation of patients whose sole injury is a sternal fracture without significant pain.

Head injury and facial injury: is there an increased risk of cervical spine injury?

A series of 8285 blunt trauma victims from one hospital were analyzed to establish the possible association of cervical spine injuries with craniocerebral and facial injuries. Patients with clinically significant head injuries were at greater risk of cervical spine injuries than those without head trauma (4.5% vs. 1.1%, significant by Chi-squared analysis). Patients with Glasgow Coma Scale scores of 8 or less were at even greater risk of cervical spine injuries (7.8%). Facial injuries were not associated with cervical spine injuries. Procedures to achieve airway control in patients with serious head injuries must reflect these findings so that protection is afforded to the cervical spine during trauma resuscitation.

Non-iatrogenic trauma to the extrahepatic biliary tract.

Between 1980 and 1991, 15 cases of non-iatrogenic extrahepatic biliary tract trauma have been managed at Westmead and the Royal Canberra Hospitals. There were seven cases of gall-bladder injury and eight bile duct injuries. Four cases resulted from penetrating trauma whereas 11 resulted from blunt trauma. Associated injuries were common. Cholecystectomy was the preferred method of management for gall-bladder injuries whereas the bile duct injuries were managed by a variety of techniques. There were three deaths in the series, mostly related to associated injuries. Bile duct injuries were associated with longer hospitalization than gallbladder injuries.