Tracking pressure injuries as adverse events: National use of the Global Trigger Tool over a 4-year period.

AIM: To examine the frequency, preventability, and consequences of hospital acquired pressure injuries in acute care hospitals over a 4-year period. METHOD: A retrospective record review was performed using the Swedish version of the Global Trigger Tool (GTT). A total of 64 917 hospital admissions were reviewed. Data were collected between 2013 and 2016 from all 63 Swedish acute care hospitals. RESULTS: The prevalence of pressure injuries (category 2-4) was 1%. Older patients, "satellite patients", and patients with acute admissions had more pressure injuries. Most pressure injuries (91%) were determined to be preventable. The mean extended length of hospital stay was 15.8 days for patients who developed pressure injuries during hospitalization. CONCLUSION: The GTT provides a useful and complementary national perspective on hospital acquired pressure injuries across hospitals, informing health care providers on safety priorities to reduce patient harm. Clinical leaders can use information on the preventability and the consequences of pressure injuries, as well as evidence-based arguments for improving the health care organization.

The value of ultrasonography in the preoperative diagnostic evaluation of patients with recurrent anterior shoulder dislocation: a prospective study of 44 patients.

The purpose of this study was to investigate the value of ultrasonography in the pre-operative assessment of patients with recurrent post-traumatic, anterior shoulder instability. Forty-four consecutive patients, 44 men and 12 women, with unilateral, post-traumatic, recurrent instability of the shoulder were included in the study. One experienced radiologist examined all patients, using a 5.0 or 7.5 MHz linear-array transducer, with the arm in different positions, one of which was used to provoke apprehension of the shoulder. Special attention was paid to the evaluation of the joint capsule, the anterior labrum, especially in terms of the presence of a Bankart lesion. All patients were subsequently treated surgically. After a diagnostic arthroscopy either an open or arthroscopic stabilisation of the shoulder was performed. Ultrasonography disclosed an unstable anterior labrum (equivalent to a Bankart lesion) in 36 shoulders; the lesion was verified in all 36 shoulders during arthroscopy. In three shoulders, arthroscopy disclosed an injured labrum, which had healed in an anterio-medial position on the scapular neck. In these three shoulders, ultrasonography failed to show any lesion. In five shoulders no Bankart lesion was found at arthroscopy. All these patients had increased shoulder laxity, and ultrasonography did not show any Bankart lesion. Furthermore a judgement of the joint capsule was not possible either. A bony Bankart lesion was found in four shoulders, using both arthroscopy and ultrasonography. The sensitivity of the ultrasonographic evaluation was 92%, and the specificity 100%. The positive predictive value was 100%, and the negative predictive value 63%. Ultrasonography showed a high correlation with the arthroscopic findings, with a high sensitivity and specificity. Therefore, we conclude that US can give important pre-operative information in patients with recurrent, unilateral, post-traumatic, anterior shoulder instability.

Longitudinal Split of the Peroneus Brevis Tendon and Lateral Ankle Instability: Treatment of Concomitant Lesions.

OBJECTIVE: To describe the clinical picture, pathophysiology, and treatment of concomitant lesions of the peroneus brevis tendon and lateral ligament injuries to the ankle. BACKGROUND: In some cases, chronic lateral ankle instability is associated with a longitudinal partial tear in the peroneus brevis tendon. Patients who suffer from this lesion usually have atypical posterolateral ankle pain combined with signs of recurrent ligament instability ("giving way"). The tendon injury is often overlooked because it is combined with the ligament injury, and the injury mechanisms are similar. DESCRIPTION: Tears or laxity in the superior peroneal retinaculum allow the anterior part of the injured peroneus brevis tendon to ride over the sharp posterior edge of the fibula, leading to a longitudinal tear in the tendon. This combined injury should be suspected in patients with recurrent giving way of the ankle joint and retromalleolar pain. The diagnosis can be established using either ultrasonography or magnetic resonance imaging. DIFFERENTIAL DIAGNOSIS: Ligament injury, tenosynovitis, peroneus longus tendon lesion, os peroneum fracture, distal peroneus brevis tendon tear, or anomalous peroneus tertius tendon. TREATMENT: The tendon injury and the ligament insufficiency should be repaired at the same time. CONCLUSIONS: We recommend reconstruction of the superior peroneal retinaculum, combined with repair of the tendon, using side-to-side sutures and anatomical reconstruction of the lateral ankle ligaments.