Epidemiology and estimated economic impact of musculoskeletal injuries in polytrauma patients in a level one trauma centre in Singapore.

Joel Yong Hao Tan; Jiong Hao Tan; Si Heng Sharon Tan; Liang Shen; Lynette Mee-ann Loo; Philip Iau; Diarmuid Paul Murphy; Gavin Kane O'neill

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Epidemiology and estimated economic impact of musculoskeletal injuries in polytrauma patients in a level one trauma centre in Singapore.

Author: Joel Yong Hao TAN ¹ ; Jiong Hao TAN ¹ ; Si Heng Sharon TAN ¹ ; Liang SHEN ² ; Lynette Mee-Ann LOO ³ ; Philip IAU ³ ; Diarmuid Paul MURPHY ¹ ; Gavin Kane O'NEILL ¹
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1. Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore.
2. Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
3. University Surgical Cluster, Division of General Surgery, National University Health System, Singapore.
Publication Type:Journal Article
Keywords: Epidemiology; length of stay; mortality; musculoskeletal trauma; polytrauma
MeSH: Humans; Male; Female; Child, Preschool; Child; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Trauma Centers; Retrospective Studies; Singapore/epidemiology*; Multiple Trauma/epidemiology*; Length of Stay
From:Singapore medical journal 2023;64(12):732-738
CountrySingapore
Language:English
Abstract: INTRODUCTION:Musculoskeletal injuries are the most common reason for surgical intervention in polytrauma patients.
METHODS:This is a retrospective cohort study of 560 polytrauma patients (injury severity score [ISS] >17) who suffered musculoskeletal injuries (ISS >2) from 2011 to 2015 in National University Hospital, Singapore.
RESULTS:560 patients (444 [79.3%] male and 116 [20.7%] female) were identified. The mean age was 44 (range 3-90) years, with 45.4% aged 21-40 years. 39.3% of the patients were foreign migrant workers. Motorcyclists were involved in 63% of road traffic accidents. The mean length of hospital stay was 18.8 (range 0-273) days and the mean duration of intensive care unit (ICU) stay was 5.7 (range 0-253) days. Patient mortality rate was 19.8%. A Glasgow Coma Scale (GCS) score <12 and need for blood transfusion were predictive of patient mortality (p < 0.05); lower limb injuries, road traffic accidents, GCS score <8 and need for transfusion were predictive of extended hospital stay (p < 0.05); and reduced GCS score, need for blood transfusion and upper limb musculoskeletal injuries were predictive of extended ICU stay. Inpatient costs were significantly higher for foreign workers and greatly exceeded the minimum insurance coverage currently required.
CONCLUSION:Musculoskeletal injuries in polytrauma remain a significant cause of morbidity and mortality, and occur predominantly in economically productive male patients injured in road traffic accidents and falls from height. Increasing insurance coverage for foreign workers in high-risk jobs should be evaluated.