The spectrum and outcome of paediatric emergency surgical admissions - a regional hospital analysis.

BACKGROUND: Improving emergency surgical care for children requires information on the causes of admissions and the variables affecting outcome. There is a lack of such data in the South African context. METHODS: This retrospective study was conducted from January 2016 to December 2017. Data was collected on all children (< 12 years of age) requiring admission with emergency surgical conditions. Infrastructure and staffing ratios were determined prior to data collection. Information was sourced from admission and discharge books, patient files and theatre registers. Variables of age, sex, referral source, diagnosis, length of stay, surgical treatment and outcome including death were collected. RESULTS: Four hundred and thirty-five of the 1 048 children (42%) admitted were in the 0-2-year age group. Trauma (258), sepsis (564) and burns (226) were the main causes. The median hospital stay was 3 days (IQR 2-5), however, for burns patients, the median stay was 4 days (IQR 2-9). Surgery was performed on 279 (27%) admissions. Eight (0.8%) died, six of which were due to burns. Clinical status prior to death was poorly documented. A dedicated high care unit and burns isolation rooms were lacking. Surgeon/population and child/nurse ratios were respectively 1.48/100 000 and 7-12/1. CONCLUSION: This study found that the emergency paediatric surgical burden is significant. Sepsis and trauma combined are the leading cause of emergency admissions. Burns had the highest mortality. Although mortality was low, improvements of staff to patient ratios and the institution of an early warning system could reduce mortality.

Do upper leg compression garments aid performance and reduce exercise-induced muscle damage in recreational marathon runners?

Background: Despite the lack of scientific knowledge on the physiological and biomechanical effects of wearing compression garments (CGs), there has been an increase in the use of compression garments (CG) amongst endurance runners. Objectives: To compare marathon race performance, post-race pain, and mid-thigh circumference in marathon runners using upper leg CGs, with runners who did not use CGs in the same marathon race. Methods: The study was conducted on healthy, long-distance runners (n=18) participating in the Winelands Marathon race, Cape Town, South Africa. The CG group (n=10) participated in the race wearing upper leg CGs, while the control group (n=8) did not. Participants were tested on three occasions for various subjective markers of exercise-induced muscle damage (Visual analogue scale (VAS) pain rating score, and Likert scale for muscle pain), mid-thigh circumference for muscle swelling, and running performance (race pace). Results: VAS pain ratings for hamstring (p=0.04), knee flexion (p=0.02) and hip extension (p=0.04) were significantly lower than the ratings of the control group immediately post-race and two days post-race. No statistically significant differences were detected in race performance, mid-thigh circumferences or Likert scale for determination of muscle soreness. Discussion: Wearing of upper leg CGs while running a marathon race improved VAS pain ratings immediately post-race through to two days post-race. However, due to no placebo control, this beneficial effect may be psychological as opposed to a physiological effect of the CGs on muscle pain. Conclusion: The use of upper leg CGs reduced subjective muscle pain in runners in the first 48 hours post-race.