Contemporary management of isolated free fluid on computed tomography scan in blunt abdominal trauma-experience from a Level 1 trauma centre in New Zealand.

AIMS: The management of patients with blunt abdominal trauma (BAT) who have isolated free fluid (IFF) with no solid organ injury (SOI) on computed tomography (CT) remains controversial. This study aims to determine if the volume of free fluid (FF) is a predictor of the need for operative management of traumatic intra-abdominal injuries, by reviewing the local cumulative experience with IFF at a major trauma centre in New Zealand. METHODS: A retrospective study was undertaken over nine years at a Level 1 trauma centre in New Zealand. Patients aged over 15 years who sustained BAT and had IFF with no SOI demonstrated on CT were included. All CT scans and patient notes were reviewed. The volume of free fluid was classified by the local interpreting radiologist on the CT report. RESULTS: Eighty-two out of 1,177 BAT patients (7%) had IFF with no SOI on CT. Thirty-eight percent were males, with a median age of 31 years. Nineteen (23%) underwent immediate operative management (OM) at the time of presentation. The remaining 63 patients had a trial of non-operative management (NOM), 10 (16%) of which were unsuccessful and required an operation. Overall, 29 patients (35%) required operative management. Eighty-nine percent of the OM group and 90% who failed NOM had positive operative findings, giving an overall true positive of 32%. CONCLUSIONS: The presence of IFF in itself is not an absolute indication for operative exploration and many patients with trace IFF can be managed non-operatively. Small amounts of IFF should be regarded with suspicion, and moderate or large amounts of fluid are likely to require operative exploration. Further work must make use of clinical scoring systems and laparoscopy or laparotomy to assess patients at high risk of surgically remediable intra-abdominal injury post BAT.

Blood alcohol screening and outcomes in trauma team activation patients at a level 1 trauma centre in New Zealand.

OBJECTIVE: A causal relationship between alcohol consumption and injury exists and the prevalence of harmful alcohol intakes in New Zealand adults is high. The present study investigates compliance to blood alcohol (BA) screening policy and the epidemiological profile and hospital-related outcomes of trauma team activation (TTA) patients with positive BA at a New Zealand level 1 trauma centre. METHODS: A retrospective review of Midland Trauma Registry hospitalisation data between January 2012 and December 2019 was conducted. Eligible patients (n = 2168) were ≥15 years who received TTA at Waikato Hospital. BA screening rates, demographic and event information, injury severity and hospital-related outcomes were examined. RESULTS: The average BA screening rate was 94.0% (95% confidence interval 92.9-95.0%) and 17.9% of screened patients were BA+ . BA+ patients were younger than BA- (34.7 and 40.5 years, P < 0.0001). More males than females (20.6 and 12.4%, P < 0.0001), Maori (30.8%) compared to non-Maori (<16.0%) and unemployed/beneficiaries (33.4%) compared to employed patients (15.5%) were BA+ . Road transport crashes accounted for the highest proportion (45.2%) but, in comparison there were higher odds of BA+ from interpersonal violence (odds ratio 4.48, P < 0.0001). No difference between BA+ and BA- was observed in survival rate, injury severity scores, length of intensive care and total hospital stay. CONCLUSION: Between 2012 and 2019, Waikato Hospital demonstrated high compliance to BA screening policy for TTA patients. Appropriate alcohol awareness initiatives that focus on road safety and interpersonal violence are required to reduce the preventable prevalence and burden of alcohol-related trauma in the Waikato region.

Do the 'Eyes' have it? How good are surgeons at identifying appendicitis macroscopically? A retrospective study in NewZealand.

AIMS: The management of a macroscopically normal appendix during diagnostic laparoscopy depends on the accuracy of surgeons' intra-operative assessments. This study aims to determine the accuracy of this assessment and identify factors affecting it. METHODS: We reviewed appendicectomies on adult patients at Waikato District Health Board in 2017. The primary outcome was the agreement between the operative assessment and the gold standard histopathologic assessment. Secondary outcomes were predictors of this agreement. RESULTS: 420 patients were included. Among 74 appendixes assessed as normal by surgeons, 16 (21.6%) had appendicitis on histology. Surgeons assessed 346 appendixes as inflamed; however, 22 (6.3%) were revealed to be histologically normal. Only 2 of the 14 appendiceal neoplasms on histology were identified at the time of laparoscopy. Overall, there was disagreement in 9.1% of cases. This yielded a kappa of 0.69, indicating moderate inter-rater reliability. An inflamed appendix was significantly more likely to be falsely assessed as normal by non-trainee registrars, in female patients and in patients with a pre-operative ultrasound. A pre-operative computerised tomography scan (CT) decreased the odds of false negative operative diagnoses, but it increased the odds of false positives. CONCLUSIONS: Macroscopic assessment of the appendix lacks accuracy and may be challenging in certain groups of operators and patients.

Smoking in film in New Zealand: measuring risk exposure.

BACKGROUND: Smoking in film is a risk factor for smoking uptake in adolescence. This study aimed to quantify exposure to smoking in film received by New Zealand audiences, and evaluate potential interventions to reduce the quantity and impact of this exposure. METHODS: The ten highest-grossing films in New Zealand for 2003 were each analysed independently by two viewers for smoking, smoking references and related imagery. Potential interventions were explored by reviewing relevant New Zealand legislation, and scientific literature. RESULTS: Seven of the ten films contained at least one tobacco reference, similar to larger film samples. The majority of the 38 tobacco references involved characters smoking, most of whom were male. Smoking was associated with positive character traits, notably rebellion (which may appeal to adolescents). There appeared to be a low threshold for including smoking in film. Legislative or censorship approaches to smoking in film are currently unlikely to succeed. Anti-smoking advertising before films has promise, but experimental research is required to demonstrate cost effectiveness. CONCLUSION: Smoking in film warrants concern from public health advocates. In New Zealand, pre-film anti-smoking advertising appears to be the most promising immediate policy response.