The aetiology of head injury in admitted patients in Jamaica.

This cross-sectional, descriptive study identified 857 head-injured patients who were admitted to the University Hospital of the West Indies (UHWI) over a four-year period. Their median age (IQR) was 28 (16, 45) years and 629 (73.5%) were males. Median length of hospital stay (IQR) was 2 (1, 6) days. Median ICU stay in the intensive care unit (IQR) was 6 (2, 12) days for the 59 (6.9%) patients admitted there. Most patients (73.3%) were admitted with unintentional injuries resulting from road traffic accidents (48.9%), of which passengers were the most commonly affected, and from falls which occurred in 24.4%. Intentional injuries accounted for 26.7% of those admitted, consisting mainly of assaults with blunt objects in 18.0% (154/857). Penetrating injuries were less common, accounting for 67 (7.8%) injuries. Among these, there were 23 gunshot wounds of the head (2.7%). Head injury in admitted patients is mainly due to road traffic accidents, falls and interpersonal violence. Prevention and interventional strategies including education, law enforcement, physical and social engineering must focus on these aetiologies. Current measures are clearly insufficient and more effective strategies are urgently warranted.

Unnecessary admissions of head-injured patients at the University Hospital of the West Indies.

The prospectively collected data in the Jamaica National Trauma Registry operated by the Section of Surgery identified 88 patients who were admitted with head injury to the University Hospital of the West Indies over a one-year period. There were 67 males (76.1%), the mean (SD) age of the entire group being 35.02 (+/- 18.45) years. Intentional injuries occurred in 47.2%. The Injury Severity Score was greater than 15 in 19.3%, severe head injuries occurred in 19% and overall mortality was 16%. Care in the Intensive Care Unit (ICU) was extended to only half of those with the severe injuries. The Scottish Intercollegiate Guidelines Network (SIGN) method was used to assess the appropriateness of admission to hospital. Sixteen (18%) of the 88 patients were inappropriately admitted according to SIGN guidelines. Increased efficiency may result from standardization of admission criteria for head-injured patients and consistent implementation of the SIGN guidelines for admission without increased risk to patients. This may be expected to minimize unnecessary admissions and result in considerable cost savings.

Surgical and intensive care needs of head-injured patients transferred to the University Hospital of the West Indies.

A cross-sectional, descriptive study utilizing data collected in the 'Trauma Registry' of the Department of Surgery, Radiology, Anaesthesia and Intensive Care at the University Hospital of the West Indies (UHWI) was undertaken to document injury severity, surgical requirements and intensive care needs of head-injured patients transferred to the UHWI over a three-year period Of 144 patients studied, the majority (71%) were young males. Overall, injury tended to be mild Twenty-three patients (16.0%) had severe head injury and 27 patients (18.8%) were admitted to the intensive care unit. Concussion with (33%) or without (36%) skull fracture was the commonest neurological admission diagnosis. Associated non-neurological injuries in 33% were primarily fractures. Fifty-six patients (39%) required surgical intervention. Craniotomies and open reduction and internal fixation of fractures were the commonest procedures. The majority of patients (79.2%) were discharged home; 56 (39%) made a good Glasgow outcome score recovery. Seventeen patients (11.8%) died in hospital. As most of the transferred patients with head injuries in this study had only mild injury, most commonly concussions, and their prognosis was good, we recommend that appropriate educational and training programmes and transfer policies be implemented to minimize inappropriate transfers.

The aetiology of head injury in admitted patients in Jamaica / Aspectos etiológicos de la lesión cefálica en pacientes ingresados en Jamaica

This cross-sectional, descriptive study identified 857 head-injured patients who were admitted to the University Hospital of the West Indies (UHWI) over a four-year period. Their median age (IQR) was 28 (16, 45) years and 629 (73.5%) were males. Median length of hospital stay (IQR) was 2 (1, 6) days. Median ICU stay in the intensive care unit (IQR) was 6 (2, 12) days for the 59 (6.9%) patients admitted there. Most patients (73.3%) were admitted with unintentional injuries resulting from road traffic accidents (48.9%), of which passengers were the most commonly affected, and from falls which occurred in 24.4%. Intentional injuries accounted for 26.7% of those admitted, consisting mainly of assaults with blunt objects in 18.0% (154/857). Penetrating injuries were less common, accounting for 67 (7.8%) injuries. Among these, there were 23 gunshot wounds of the head (2.7%). Head injury in admitted patients is mainly due to road traffic accidents, falls and interpersonal violence. Prevention and interventional strategies including education, law enforcement, physical and social engineering must focus on these aetiologies. Current measures are clearly insufficient and more effective strategies are urgently warranted.

Este estudio transversal descriptivo identificó 857 pacientes con lesiones cefálicas, ingresados en el Hospital Universitario de West Indies (UHWI) por un periodo de cuatro años. Su edad mediana (IQR) fue 28 (16, 45) años y 629 (73.5%) eran varones. La longitud mediana de estancia hospitalaria (IQR) fue de 2 (1, 6) días. La estancia mediana en la unidad de cuidados intensivos fue de (IQR) 6 (2, 12) días para los 59 (6.9%) pacientes ingresados allí. La mayoría de los pacientes (73.3%) fueron ingresados con lesiones involuntarias a consecuencia de accidentes de tráfico (48.9%) ­ de los cuales los pasajeros fueron comúnmente los más afectados ­ y de caídas ocurridas en 24.4%. Las lesiones intencionales constituyeron el 26.7% de los casos ingresados, siendo el 18.0% (154/857) producidas principalmente por ataques con objetos contundentes. Las lesiones penetrantes fueron menos comunes, representadas por 67 (7.8%) de las lesiones. De estas, 23 fueron heridas de bala en la cabeza (2.7%). Las lesiones en la cabeza en los pacientes ingresados se debieron principalmente a accidentes de tráfico, caídas y violencia interpersonal. Las estrategias de prevención e intervención ­ incluyendo la educación, la imposición del cumplimiento de la ley, la ingeniería física y social ­ deben centrar su atención en estas etiologías. Las medidas actuales son a las claras insuficientes y se requiere con urgencia estrategias más efectivas

Surgical and intensive care needs of head-injured patients transferred to the University Hospital of the West Indies / Necesidades quirúrgicas y de cuidados intensivos de los pacientes con lesiones cefálicas transferidos al hospital universitario de west indies

A cross-sectional, descriptive study utilizing data collected in the 'Trauma Registry' of the Department of Surgery, Radiology, Anaesthesia and Intensive Care at the University Hospital of the West Indies (UHWI) was undertaken to document injury severity, surgical requirements and intensive care needs of head-injured patients transferred to the UHWI over a three-year period Of 144 patients studied, the majority (71%) were young males. Overall, injury tended to be mild Twenty-three patients (16.0%) had severe head injury and 27 patients (18.8%) were admitted to the intensive care unit. Concussion with (33%) or without (36%) skull fracture was the commonest neurological admission diagnosis. Associated non-neurological injuries in 33% were primarily fractures. Fifty-six patients (39%) required surgical intervention. Craniotomies and open reduction and internal fixation of fractures were the commonest procedures. The majority of patients (79.2%) were discharged home; 56 (39%) made a good Glasgow outcome score recovery. Seventeen patients (11.8%) died in hospital. As most of the transferred patients with head injuries in this study had only mild injury, most commonly concussions, and their prognosis was good, we recommend that appropriate educational and training programmes and transfer policies be implemented to minimize inappropriate transfers

Se llevó a cabo un estudio transversal descriptivo utilizando datos tomados del "Registro de traumas" del Departamento de Cirugía, Radiología, Anestesia y Cuidados Intensivos en el Hospital Universitario de West Indies (HUWI), a fin de documentar la severidad de la lesión, los requerimientos quirúrgicos y las necesidades de cuidado intensivo de pacientes con lesiones cefálicas transferidos al HUWI durante un período de más de tres años. De 144 pacientes estudiados, la mayor parte (71%) eran varones jóvenes. En general, las lesiones tendían a ser leves. Veintitrés pacientes (16.0%) tuvieron lesiones cefálicas severas, y 27 pacientes (18.8%) fueron ingresados a la unidad de cuidados intensivos. Concusión con fractura del cráneo (33%) o sin fractura del cráneo (36%) fue el diagnóstico neurológico más común para el ingreso. Las lesiones no neurológicas asociadas en 33% fueron principalmente fracturas. Cincuenta y seis pacientes (39%) necesitaron intervención quirúrgica. Las craniotomías así como la reducción abierta y la fijación interna de fracturas, fueron los procedimientos más comunes. La mayoría de los pacientes (79.2%) fueron dados de alta; 56 (39%) tuvo una buena recuperación según la puntuación de la escala de Glasgow para la evolución clínica. Diecisiete pacientes (11.8%) murieron en el hospital. Como que la mayor parte de los pacientes transferidos con lesiones de cabeza en este estudio tuvieron solo lesiones leves ­ por lo general concusiones ­ y puesto que su prognosis era buena, recomendamos que se implementen programas adecuados de educación y entrenamiento, así como políticas de transferencia apropiadas, a fin de minimizar las transferencias inadecuadas

Unnecessary admissions of head-injured patients at the University Hospital of the West Indies / Ingresos unnecesarios de pacientes con lesiones cefálicas en el hospital universitario de west indies

The prospectively collected data in the Jamaica National Trauma Registry operated by the Section of Surgery identified 88 patients who were admitted with head injury to the University Hospital of the West Indies over a one-year period. There were 67 males (76.1%), the mean (SD) age of the entire group being 35.02 (+/- 18.45) years. Intentional injuries occurred in 47.2%. The Injury Severity Score was greater than 15 in 19.3%, severe head injuries occurred in 19% and overall mortality was 16%. Care in the Intensive Care Unit (ICU) was extended to only half of those with the severe injuries. The Scottish Intercollegiate Guidelines Network (SIGN) method was used to assess the appropriateness of admission to hospital. Sixteen (18%) of the 88 patients were inappropriately admitted according to SIGN guidelines. Increased efficiency may result from standardization of admission criteria for head-injured patients and consistent implementation of the SIGN guidelines for admission without increased risk to patients. This may be expected to minimize unnecessary admissions and result in considerable cost savings.

En los datos recopilados prospectivamente en el Registro Nacional Jamaicano de Traumas (Jamaica National Trauma Registry), operado por la Sección de Cirugía, se identificaron 88 pacientes que habían ingresado con lesiones cefálicas al Hospital Universitario de West Indies, por un período de más de un año. Había 67 varones (76.1%), y la edad mediana (SD) del grupo en su totalidad fue 35.02 (± 18.45) años. En el 47% ocurrieron heridas intencionales. La Puntuación de Severidad de la Lesión fue mayor de 15 en 19.3%; las lesiones cefálicas severas ocurrieron en 19%, y la mortalidad general fue 16%. El cuidado en UCI se extendió sólo a la mitad de las lesiones severas. El método conocido como Scottish Intercollegiate Guidelines Network (SIGN), se usó para evaluar hasta que punto el ingreso al hospital era adecuado. Dieciséis (18%) de los 88 pacientes fueron ingresados inadecuadamente según los lineamientos de SIGN. Puede producirse un aumento de la eficiencia a partir de la estandardización de los criterios de admisión para los pacientes con lesiones cefálicas y la implementación sistemática de los lineamientos de SIGN para los ingresos, sin aumento de riesgo para los pacientes. Hay razón para esperar que esto minimice los ingresos innecesarios y traiga consigo un ahorro considerable de los costos

Tetanus: a recurring intensive care problem.

A fifteen-year retrospective study of 108 cases of tetanus admitted to the Intensive Care Unit (ICU) at the University Hospital of the West Indies is presented. Males predominated (70%), with peak incidence occurring amongst the young and the elderly. In 57% the disease was severe enough to require neuromuscular blockade and controlled ventilation. Respiratory complications occurred most commonly (80%), predominantly as a result of infection. Dysautonomia, exhibited by 55% of patients, presented the greatest difficulty in management. Mortality was high (20%), with sudden cardiac arrest being the most common cause of death. The average duration of stay in the ICU was long (27 days). As Jamaica is a Third World country with limited resources, the continued occurrence of this preventable disease represents a drain on existing intensive care funds. This must be brought to the attention of institutions responsible for planning health care programmes for developing countries.