The e-scooter pandemic at a UK Major Trauma Centre: A cost-based cohort analysis of injury presentation and treatment.

OBJECTIVES: The aim of the study was to describe injuries related to electric scooter at a Major-Trauma-Centre in the UK, We reviewed data from January 2020-December 2020. METHODS: All patient-records mentioning electric-scooter at a major-MTC. Records were reviewed, and data were stratified according to two groups: electric scooter riders and other road users. A predefined survey was completed in all cases where 'e-scooter or electric scooter' was present. This contained variables such as patient demographics, mechanism of injury (including head and body protection), acuity, intoxication, treatment facility and clinical utilisation. Among incidents involving electric scooters, summary statistics on continuous and categorical variables of interest were reported. Healthcare modelling utilising time driven activity-based costing and Patient-Level-Activity-Costing used to conduct a post hoc analysis of health provider costs. RESULTS: 202 e-scooter injuries were identified. Riders were more likely to be young males aged 18-35, a minority of reported cases being associated with the influence of alcohol or drugs (7.4%). They fall independently involving no other party (87%); sustaining both minor and major injuries; with a significant proportion requiring urgent and emergent surgery 23.7% (n = 40) with 60.1% (n = 121) requiring further secondary care follow-up; whilst 16% require immediate admission with a mean LOS of 5.9 days, including 8-ITU admissions. The overall mortality rate was 0.5% (n = 1), and cost per patient was £1482.46/patient, reducing to £927.25/patient if immediate surgery (<12 h s) was not required. CONCLUSION: Due to an emphasis on social distancing, changes in UK law, e-scooters injuries have increased. Most injuries are reported in riders, and are minor, however the mean health episode cost was over £1000.00/patient due to the minority of serious injuries. Research on interventions to prevent e-scooter injuries including protective clothing like helmet wearing is needed to address this growing area of concern, and unnecessary costly healthcare utilisation.

Diagnostic challenge of the non-specific presentation of adult intussusception.

The following report will discuss the diagnosis and management of non-specific abdominal pain in a 77-year-old woman who presented to a district general hospital in South London. CT imaging demonstrated ileo-colic intussusception with free air and fluid indicating perforation. The images of the specimen clearly show the ileal tumour within the intussusception. Thus, the patient underwent an emergency right hemicolectomy and formation of a double-barrelled ileostomy. Histology subsequently confirmed this was secondary to a colonic adenocarcinoma. This case report is unique as it highlights that intussusception in adults is very difficult to accurately diagnose based on clinical features (due to non-specific findings) and even with radiology can be challenging. This is also the first documented case of the site of perforation not being directly involved with the site of intussusception. The perforation site was in fact distal to the intussusception. At the time of surgery, it was noted that the patient had significantly faecal loading up to her rectum. The resulting closed loop was the cause of her perforation.

A closed loop obstruction caused by entrapment of the fallopian tube and herniation through the broad ligament.

A 49-year-old female presented with one week history of severe abdominal pain, vomiting and constipation. Pertinent past surgical history consisted of caesarean section, laparoscopic right fallopian tube cystectomy and myomectomy. There was also recent left mastectomy and adjuvant chemotherapy for breast carcinoma. Clinical examination established a tensely distended abdomen with scanty bowel sounds but no clinical peritonism. Blood tests showed severe acute kidney injury and raised inflammatory markers. Computed tomography without intravenous contrast demonstrated small bowel obstruction of uncertain aetiology but with likely calibre change in the pelvis. At operation, the left fallopian tube had wrapped itself around ischemic bowel. A left salpingo-oophorectomy was performed to release the bowel. On closer inspection, an internal hernia caused by a defect in the broad ligament was diagnosed. This case report describes a differential of atypical small bowel obstruction to be considered when faced with a female acute abdomen.

Laparoscopically assisted repair of vaginal evisceration after hysterectomy.

Vaginal evisceration is a rare condition most commonly associated with previous vaginal surgery. It usually presents with vaginal bleeding, lower abdominal pain and a protruding mass, and requires immediate assessment and surgical management to salvage the prolapsed bowel. Any delay in the treatment may result in bowel ischaemia and perforation which is associated with higher morbidity and mortality. We report a case of spontaneous vaginal evisceration during defaecation in a 56-year-old postmenopausal women 11 months post hysterectomy. This case highlights the benefits of a combined laparoscopic and transvaginal approach in the successful management of this surgical emergency.

Gallbladder volvulus: a case of mimicry.

Torsion of the gallbladder resulting in a volvulus is a rare clinical finding that poses a diagnostic challenge preoperatively to both surgeons and radiologists. It is thought to occur secondary to a redundant mesentery where rotation of the gallbladder occurs along the axis of the cystic duct and cystic artery. Gallbladder volvulus commonly presents as acute cholecystitis and is rarely diagnosed preoperatively. An early emergency laparoscopic cholecystectomy is the preferred treatment. Early consideration of this diagnosis enables prompt surgical intervention and quick postoperative recovery periods.

Dr Thomas Aitchison Latta (c1796-1833): pioneer of intravenous fluid replacement in the treatment of cholera.

In 1832 pandemic cholera travelled across Europe with devastating mortality. Before this, doctors had speculated on the benefits of intravenous therapy but none had tried. Only in 1832 did Thomas Latta perform intravenous infusions. This treatment disappeared after Latta's death. This was mainly due to general medical scepticism, lack of biochemical and physiological knowledge and poor patient selection. Finally, there were no further pandemics comparable with that of 1832 to provide the catalyst to accelerate medical development in this field.

Acute gallbladder torsion: an unexpected intraoperative finding.

Gallbladder torsion is an uncommon clinical entity and a difficult condition to diagnose preoperatively. Since its first description in 1898 by Wendel there have been over 500 documented cases in the literature. It is known to occur when there is rotation of the gallbladder along the axis of the cystic duct and vascular pedicle. Except for isolated cases reported in childhood, this disease is more frequently encountered in the elderly with 85% of the cases reported between the ages of 60 and 80 years. There is a female preponderance with a female to male ratio of 3:1. Gallbladder torsion typically presents as an acute abdomen requiring emergency surgery but preoperative diagnosis of gallbladder torsion is difficult and most cases are found as a surprise at surgery.We report a case of acute gallbladder torsion in an elderly lady and review the clinical aspect of the disease.