Physician-Led Thoracic Trauma Management in a Specialist Emergency Care Centre.

INTRODUCTION: Falls cause 75% of trauma in patients above 65 years of age, and thoracic trauma is the second commonest injury; rib fractures are the most common thoracic injury. These patients have up to 12% mortality, with 31% developing pneumonias. There is wide variation in care. Northumbria Healthcare has a team of respiratory consultants, physiotherapists, specialist nurses and anesthetists for thoracic-trauma management on a respiratory support unit. METHODS: With Caldicott approval, basic demographics and clinical outcomes of patients admitted with thoracic trauma between 20 August-21 April were analyzed. A descriptive statistical methodology was applied. RESULTS: A total of 119 patients were identified with a mean age of 71.1 years (range 23-97). Of the 119 patients, 53 were male, 66 females. The main mechanism of injury was falls from standing (65) and falls down stairs/bed or in the bath (18). Length of stay was 7.3 days (range 1-54). In total, 85 patients had more than one co-morbidity, 26 had a full trauma assessment and 75 had pan CTs. The mean number of rib fractures was 3.6 and 31 (26%) patients had a pneumothorax and/or haemothorax. A total of 18 chest drains were inserted (all small bore) and one needle aspiration was performed. No cardiothoracic input was required. Isolated chest trauma was present only in 45 patients. All patients had a pain team review, 22 erector spinae catheters were inserted with 2 paravertebral blocks. Overall, 82 patients did not require oxygen, 1 required CPAP and 1 HFNC. 7 needed intensive care transfer. Furthermore, 20 (17%) developed pneumonias and 16 (14%) deaths occurred within 30 days-all were in those with falls from standing. There was no correlation between number of fractured ribs, length of stay and mortality. CONCLUSIONS: High level care for thoracic trauma can be performed by a physician led team. Overall, 42% pneumothoraces/haemothoraces were observed. Further large scale randomised trials are warranted for definitive outcomes.

Evaluation of the Console in Acquiring Laparoscopic Skills through Video Gaming.

STUDY OBJECTIVE: Video gaming experience and practice is known to help attain and improve laparoscopic skills. We compared the impact of Wii (Nintendo, Kyoto, Japan) and XBox (Microsoft Inc., Redmond, WA) gaming experience on laparoscopic skills. DESIGN: Observational study. SETTING: Tertiary hospital. PARTICIPANTS: Twenty-seven selected medical student volunteers with no previous laparoscopy experience. INTERVENTIONS: A selected cohort of medical students completed a questionnaire on their video gaming experience and were asked to play a game each on the Wii console and on the Xbox for 10 minutes each. They were then assessed on predefined laparoscopic skills with standardized objective scoring by 2 independent assessors. The skills tested were stacking ice cubes in set time, putting discs through strings in set time, and circle cutting. MEASUREMENTS AND MAIN RESULTS: Score was allocated for each video gaming session and for the laparoscopic session. The video gaming skills score was based on points achieved during a stipulated time period on 2 different consoles. Laparoscopy skills were assessed based on an agreed scoring matrix that involved appropriate weighting of the score based on importance of the task. The laparoscopy skills scores correlated significantly with both Xbox and Wii scores. Correlations between laparoscopic task scores were further analyzed by game console, Wii and Xbox. There was a stronger correlation between the Wii highest score and the total of the laparoscopic skills score (Spearman correlation coefficient = .734; p = .0001) compared with the correlation between the Xbox and the total laparoscopic skills score (Spearman correlation coefficient = .412; p = .033). CONCLUSION: We confirm the correlation between video gaming and laparoscopic skills. Further, we conclude that the correlation is stronger with the Wii console compared with the Xbox for psychomotor skills, perhaps due to the similarity of action between the Nintendo Wii remote and laparoscopic instruments. Thus, practicing video gaming on the Nintendo Wii console over Xbox may improve manual dexterity laparoscopic skills. However, research of larger cohort studies with different games would provide further insight into the best methods for future simulated learning.