The correlation between full moon and admission volume for penetrating injuries at a major trauma centre in South Africa.

BACKGROUND: The possible effect of full moon on admission volume of trauma centres is a well-mentioned phenomenon that has been perpetuated worldwide. We aimed to review the correlation between full moon and admission volume and to interrogate any possible relationship on admission for penetrating trauma. METHODS: A retrospective study from 2012 to 2018 at Pietermaritzburg Metropolitan Trauma Service (PMTS), South Africa. RESULTS: A total of 8 722 patients were admitted. Eighty-three per cent (7 242/8 722) were male and the mean age was 29 years. The total number of days during the study period was 1 953, 66 of which were 'full moon' (FM) days and 1 887 were 'non-full moon' (NFM) days. There was no significant difference between gender or age distribution. The mean number of admissions per day on FM days compared with NFM days was not significant (4.1 vs 4.5, p = 0.583). A total of 3 332 patients with penetrating trauma were admitted. This constituted 42% (113/271) of admission on FM days and 38% (3 219) on NFM days, which is not statistically significant (p = 0.229). Subgroup analysis did not demonstrate any significant difference between the number of stab wounds - 28% (77/113) vs 25% (2 124/3 219) - or gunshot wounds - 13% (16/113) vs 12% (990/3 219) - between FM and NFM days. CONCLUSION: The correlation between full moon and trauma admission is unfound in our setting. The perpetuating notion that 'it must be full moon tonight' is likely to be an urban myth with no scientific evidence for such a claim.

The Hybrid Electronic Medical Registry Allows Benchmarking of Quality of Trauma Care: A Five-Year Temporal Overview of the Trauma Burden at a Major Trauma Centre in South Africa.

INTRODUCTION: This study is a five-year follow-up of previously published review of the trauma workload at our institution. It aims to provide evidence about the quality of trauma care delivered by a major academic trauma service in South Africa to provide a temporal analysis of trauma trends in the city of Pietermaritzburg. MATERIALS AND METHODS: All trauma patients admitted by the Pietermaritzburg Metropolitan Trauma Service (PMTS) for the period December 2012-April 2018 were retrieved from the Hybrid Electronic Medical Registry (HEMR) for analysis. RESULTS: Over the five-year period, a total of 8722 trauma patients were admitted to Grey's Hospital. There were 7242 (83.0%) males. The average age was 29.66 years. A total of 1719 (19.7%) patients less than 19 years of age, 377 (4.3%) older than 60 years of age and 1480 (17.0%) female patients were admitted following trauma. Table 3 breaks down the mechanism of trauma. A total of 5027 patients sustained blunt trauma (57.6%), and 3334 (38.5%) sustained penetrating trauma. A total of 4808 patients sustained intentional trauma implying that 55.1% of all trauma was secondary to grievous bodily harm or assault either in the form of a stab wound or GSW or of an assault. There was a total of 2232 road traffic-related incidents, of which 37.9% (845) were pedestrian victims. The mortality rate for all trauma admissions was 4.5% (396). Of these 396 deaths, 64 (16.2%) were classified at the morbidity and mortality conference as being avoidable. CONCLUSIONS: The HEMR has allowed us to track the burden of trauma presenting to our institution over a five-year period. This confirms previous studies over shorter time periods from our institution. The pattern of trauma has remained consistent, and the previously described high levels show no sign of decreasing. Interventions to try and reduce this burden are urgently required.

Desflurane analgesia for vaginal delivery.

The use of subanaesthetic concentration of inhalational anaesthetic for vaginal delivery offers many advantages to the mother and newborn. Desflurane, with the characteristics of rapid onset and minimal metabolism, may provide better analgesia and safety for labour pain control. Eighty healthy parturients were randomly assigned to receive either desflurane 1.0-4.5% and oxygen (n = 40) or nitrous oxide 30-60% in oxygen (n = 40). Analgesia was assessed using a score from 0 (no relief) to 4+ (excellent analgesia), amnesia for the delivery, blood loss were recorded. Neonates were evaluated by Apgar scores and neurologic and adaptive capacity scores (NACS). Data were analyzed for statistical significance using Student's t-test or Chi-square when appropriate. Analgesia scores were similar for both groups with more amnesia in desflurane group (23% vs 0% P < 0.05). Blood loss did not differ significantly, 364 ml for the desflurane group and 335 ml for the nitrous oxide group. There were no significant differences for neonatal Apgar score at 1 min or at 5 min or the NACS at 2 hr or 24 hr between the two groups. We conclude that desflurane in subanaesthetic doses is safe and effective inhalation agent for normal delivery but might be associated with amnesia.

Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old.

Over a ten-year period, fifty-one congenitally dislocated hips in forty-one patients, whose ages ranged from twelve to thirty-six months, required open reduction. Supplemental procedures such as derotational osteotomy, pericapsular (Pemberton) osteotomy, and femoral shortening were performed as necessary. All of the patients have been followed for at least two years (average, 6.1 years). No patient had a significant limp, Trendelenburg gait, or avascular necrosis. Using Severin's classification of radiographic evaluation, twenty-nine hips (57 per cent) were rate as excellent and eighteen hips (35 per cent), as good. In our experience, open reduction of the hip together with correction of acetabular and femoral deformities affords the patient in the one to three-year-old age range an excellent chance of obtaining an anatomically satisfactory hip.

Arteriography in club foot.

Arteriography was done on fourteen children with nineteen typical, severe, untreated club feet. The age range of the patients was from 1.3 to 13.5 years (average, 6.3 years). Only three feet were found to have normal arterial anatomy. In the remaining sixteen feet the posterior tibial artery was the dominant structure; the anterior tibial artery was hypoplastic and ended at the ankle, so that no dorsalis pedis artery was present. After operative correction of the feet, no change was noted in the arteriograms of three patients. The importance of protecting the posterior tibial artery during operative correction is emphasized.

Posterior iliopsoas muscle transfer in myelodysplasia.

A Sharrard posterior iliopsoas muscle-transfer procedure was done in forty-two hips of twenty-four children with myelodysplasia. Folow-up ranged from twenty-nine months to approximately ten years. An over-all success rate of 50 per cent was achieved which included all hips operated on for potential and existing instability. The success rate for surgery in hips with an existing instability was 29.6 per cent. Factors predisposing to a poor result were: age more than five years old, dysplastic acetabulum (index more than 30 degrees), prior hip surgery, and inequality of limb length. This operation is recommended primarily for hips not previously operated on in children less than five years old who have a normal acetabular index. If the child is more than five years old or if acetabular dysplasia exists, reconstruction of the acetabulum should precede or accompany the tendon transfer for best results. Iliopsoas muscle transfer is unlikely to be successful if used as a salvage procedure.