"Trauma-the forgotten pandemic?"

Global annual deaths from Trauma are greater than any other single cause in the global working population, and, more than all contagious diseases added together including COVID-19. The number of people injured, either temporarily or permanently, is greater than any other medical condition. This problem affects Low and Middle Income Countries (LMICs) disproportionately. The numbers are so great as to cause "zone out" and present a human rights issue. This is a particular issue as Trauma presently receives less than 1% of global healthcare funding. This article will highlight and discuss many of the issues and raise some uncomfortable arguments showing that improvement is needed, necessary and achievable.

Mechanical prophylaxis, early mobilisation and risk stratification: as effective as drugs for low risk patients undergoing primary joint replacement. Results in 13,384 patients.

INTRODUCTION: Current NICE Guidelines state that all patients undergoing total hip and knee arthroplasty should be given both mechanical and chemical prophylaxis. At our institution, a targeted thromboprophylaxis policy has been in place since October 1999. The aim of this study was to calculate our venous thromboembolism rates and compare these to published rates in the literature. METHODS: All patients are pre-operatively assessed for their VTE risk. Patients are stratified into high or low risk: all patients received mechanical thromboprophylaxis and the higher risk patients now receive chemical and mechanical thromboprophylaxis post op. Patients are reviewed at 2, 6 and 52 weeks and with annual postal questionnaires and clinical and radiological review at 5 and 10yrs. RESULTS: 13,384 primary THA and TKAs were entered into the database. The overall rate of clinically apparent DVT and overall PE rates of 0.48% and 0.42% respectively. 86.16% of our patients were low risk, of these 23.3% of patients were on Aspirin/Clopidogrel with mechanical thromboprophylaxis and 76.7% of patients had mechanical prophylaxis alone. There was no statistical difference between the DVT or PE rates in the low risk groups. CONCLUSION: Our results show that use of early mobilisation and mechanical prophylaxis within an Enhanced Recovery Programme results in comparable VTE rates to chemical prophylaxis for all, which is reflected in the literature. Our results question the need for chemical thromboprophylaxis or extended use of mechanical thromboprophylaxis in "lower risk" patients if a risk stratification policy is used in the context of modern surgical approaches.