PURPOSE: Road traffic accidents (RTA), assaults, falls, and sports-related injuries are the leading causes of maxillofacial trauma. Due to quite different geographical environment and fast urbanization, the use of various protective equipment is restricted in India. Thus, compared to other countries, there might be a significant difference in the pattern and frequency of associated injuries among subjects with maxillofacial trauma. The present study was conducted to identify the causes and pattern of various maxillofacial fractures and the frequency of other related injuries among subjects with maxillofacial trauma. METHODS: This is a cross-sectional retrospective study recording 2617 subjects with maxillofacial trauma from October 2017 to October 2022. The patient demographics, causes of trauma, types of maxillofacial injury, and associated soft and hard tissue injuries were recorded. The types of maxillofacial and associated injuries were diagnosed from details of clinical examinations and the interpretation of various radiographs available in the file. The associated injuries were divided into head injury, other bony injuries, and soft tissue and vital structure injuries. Descriptive statistics and the test of proportion were used. A p value < 0.05 was considered as a level of significance. RESULTS: The maxillofacial injuries were significantly common in patients aged 16 - 45 years (66.7%) than in patients aged ≤ 15 and > 46 years (33.3%) (p < 0.001). The RTA was the most common cause of maxillofacial injury (n = 2139, 81.7%), followed by fall (n = 206, 7.9%), other causes of injury (n = 178, 6.8%), and assaults (n = 94, 3.6%). The maxillofacial injury by 2-wheel vehicle accidents was significantly higher than that by 4-wheel vehicle and other vehicle accidents (p < 0.001). There was a significant correlation between alcohol and RTA (p < 0.001). The head injury (n = 931, 61.1%) was the most common associated injury, followed by soft tissue and vital structures injuries (n = 328, 21.5%) and other bone injuries (n = 264, 17.3%). DISCUSSION Head injury was the most common associated injury followed by soft tissue and vital structures and bone injuries among subjects with maxillofacial trauma. Clavicle fracture and injury to the lower extremities were the most common hard and soft tissue-associated injuries.
Humans ; Maxillofacial Injuries/etiology* ; Retrospective Studies ; Adult ; India/epidemiology* ; Male ; Female ; Cross-Sectional Studies ; Middle Aged ; Adolescent ; Young Adult ; Tertiary Care Centers ; Accidents, Traffic/statistics & numerical data* ; Child ; Aged ; Multiple Trauma/epidemiology* ; Child, Preschool

PURPOSE: Polytrauma is still a challenge for health care organizations. Today, the search for factors to reduce lethality continues. This study aims to describe the causes of death associated with polytrauma in 1 year. METHODS: This retrospective study analyzed autopsy data of trauma deaths in Moscow for the whole of 2017. We identified victims with polytrauma, taking into account the Berlin definition as the main inclusion criteria with penetrating and blunt trauma. Each forensic report had information about the pre-hospital and hospital stages of treatment and autopsy data. The exclusion criteria for this study were: isolated injury, forensic reports not related to the examination of entire corpses, and autopsy studies of children (<18 years old). Statistical analysis was performed according to basic principles, including a comparison of groups using the Chi-squared test with Bonferroni comparison test and Fisher's exact test. The critical level of significance (p value) in testing statistical hypotheses in this study was taken as 0.05. RESULTS: We analyzed 2337 forensic medical examinations of victims who died of trauma in Moscow in 2017, of which 41.5% (n = 969) were polytrauma deaths. Most of the victims (65.4%, n = 634) died on the scene, and only 30.0% were admitted to the hospital. The most frequent cause of death was bleeding (72.0%, n = 698), followed by traumatic brain injury (43.8%, n = 424). They accounted for the first peak (78.4%, p = 0.005) of deaths, occurring in the first hours. Then these causes of death in the first peak go down in a few hours, and the second peak of mortality appears in 3 - 7 days (p = 0.001). CONCLUSIONS This is the largest full-year autopsy study of polytrauma victims. Our data show that the main cause of polytrauma death is massive bleeding, with a lethality peak in the first hours after injury. The time distribution of polytrauma deaths has a bimodal pattern - the second period of polytrauma deaths occurs in 3 - 7 days.
Humans ; Retrospective Studies ; Male ; Female ; Moscow/epidemiology* ; Autopsy ; Multiple Trauma/mortality* ; Adult ; Adolescent ; Middle Aged ; Child ; Child, Preschool ; Cause of Death ; Young Adult ; Infant ; Aged ; Aged, 80 and over

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.
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

PURPOSE: The mortality rate for severely injured patients with the injury severity score (ISS) ≥16 has decreased in Germany. There is robust evidence that mortality is influenced not only by the acute trauma itself but also by physical health, age and sex. The aim of this study was to identify other possible influences on the mortality of severely injured patients. METHODS: In a matched-pair analysis of data from Trauma Register DGU®, non-surviving patients from Germany between 2009 and 2014 with an ISS≥16 were compared with surviving matching partners. Matching was performed on the basis of age, sex, physical health, injury pattern, trauma mechanism, conscious state at the scene of the accident based on the Glasgow coma scale, and the presence of shock on arrival at the emergency room. RESULTS: We matched two homogeneous groups, each of which consisted of 657 patients (535 male, average age 37 years). There was no significant difference in the vital parameters at the scene of the accident, the length of the pre-hospital phase, the type of transport (ground or air), pre-hospital fluid management and amounts, ISS, initial care level, the length of the emergency room stay, the care received at night or from on-call personnel during the weekend, the use of abdominal sonographic imaging, the type of X-ray imaging used, and the percentage of patients who developed sepsis. We found a significant difference in the new injury severity score, the frequency of multi-organ failure, hemoglobine at admission, base excess and international normalized ratio in the emergency room, the type of accident (fall or road traffic accident), the pre-hospital intubation rate, reanimation, in-hospital fluid management, the frequency of transfusion, tomography (whole-body computed tomography), and the necessity of emergency intervention. CONCLUSION Previously postulated factors such as the level of care and the length of the emergency room stay did not appear to have a significant influence in this study. Further studies should be conducted to analyse the identified factors with a view to optimising the treatment of severely injured patients. Our study shows that there are significant factors that can predict or influence the mortality of severely injured patients.
Accidents ; classification ; Adult ; Age Factors ; Blood Transfusion ; Data Analysis ; Emergency Medical Services ; Female ; Fluid Therapy ; Germany ; epidemiology ; Hemoglobins ; Humans ; International Normalized Ratio ; Intubation ; statistics & numerical data ; Male ; Matched-Pair Analysis ; Multiple Organ Failure ; Registries ; Sex Factors ; Survival Rate ; Trauma Severity Indices ; Wounds and Injuries ; mortality

PURPOSE: To explore the epidemiological and clinical profile of patients admitted to the trauma and emergency department (TED) of a tertiary care hospital due to tropical cyclone Fani and highlight the challenges faced by the hospital in this natural disaster. METHODS: A retrospective study was conducted in the TED in the affected zone. Data of all victims affected by the cyclone Fani on May 3, 2019 were obtained from disaster records and medical case sheets. All patients except death on admission were included. Clinical variables included anatomical sites and severity of injuries which was assessed by revised trauma score (RTS) and injury severity score (ISS). Trauma injury severity score (TRISS) was also calculated. RESULTS: Of 75 patients, 74 were included and the other one was brought dead and thus excluded. The age, median ± interquartile range (IQ), was 41.0 (27.7-53.0) years. The male to female ratio was 2:1. Most of the wounded were transported by the police control room vans on day 1: first 10 h, 50.0%; 10-24 h, 20.3%. The median ± IQ range of RTS, ISS and TRISS were 20 (14-28), 7.84 (7.841-7.841), and 97.4 (91.6-98.9), respectively. Simple external injury was the dominant injury type. Polytrauma (ISS >15) was seen in 67% cases and spine injury in 14% cases (7% cervical and 7% thoracolumbar). Injury causes included sharp flying objects (broken pieces of glasses and asbestos) in 31% cases, followed by fall of trees in 20.3%. Twenty-four patients were discharged after primary treatment, 30 admitted to the indoor-trauma ward or intensive care unit and 20 deferred or transferred to another center. There was no in-house mortality. Challenges were related to electricity failure, mobile network breakdown, infrastructure collapse, and delay in expertise repair from outside due to airport/railway closure. CONCLUSION In cyclonic storm like Fani, sharp flying objects, fall of trees/poles and collapsing walls constitute the common mode of injuries causing harm to more than one body regions. Polytrauma was seen in the majority of patients though external injury was the commonest. The affected hospital had the uphill task of treating hospitalized patients as well as disaster victims.
Adolescent ; Adult ; Child ; Cyclonic Storms ; Disaster Planning ; Disaster Victims ; statistics & numerical data ; Emergency Service, Hospital ; Female ; Humans ; Male ; Middle Aged ; Multiple Trauma ; epidemiology ; etiology ; Retrospective Studies ; Tertiary Care Centers ; Trauma Centers ; Trauma Severity Indices ; Young Adult

OBJECTIVE: A massive transfusion (MT) of 10 or more units of packed red blood cells (PRCs) focuses on the summation volumes over 24 hours. This traditional concept promotes survivor bias and fails to identify the “massively” transfused patient. The critical administration threshold (≥3 units of PRCs per hour, CAT+) has been proposed as a new definition of MT that includes the volume and rate of blood transfusion. This study examined the CAT in predicting mortality in adult patients with severe trauma, compared to MT. METHODS: Retrospective data of adult major trauma patients (age≥15 years, Injury Severity Score [ISS]≥16) from a regional trauma center collected between May 2016 and June 2017 were used to identify the factors associated with trauma-related death. Univariate associations were calculated, and multiple logistic regression analysis was performed to determine the parameters associated with in-hospital mortality. RESULTS: A total of 540 patients were analyzed. The median ISS was 22, and the hospital mortality rate was 30.9% (n=92). Forty-two (7.8%) and 23 (4.3%) patients were CAT+ and traditional MT+, respectively. Severe brain injury, CAT+, acidosis, and elderly age were significant variables in multivariate analysis. CAT+ was associated with a fourfold increased risk of death (odds ratio, 4.427; 95% confidence interval, 1.040–18.849), but MT+ was not associated (odds, 1.837; 95% confidence interval, 0.376–8.979). CONCLUSION: The new concept of CAT for transfusion was a more useful validation concept of mortality in adult severe trauma patients on admission than traditional MT. Encompassing both the rate and volume of transfusion, CAT is a more sensitive tool than common MT definitions.
Acidosis ; Adult* ; Aged ; Animals ; Bias (Epidemiology) ; Blood Transfusion ; Brain Injuries ; Cats ; Erythrocytes ; Hospital Mortality ; Humans ; Injury Severity Score ; Logistic Models ; Mortality* ; Multiple Trauma ; Multivariate Analysis ; Retrospective Studies ; Survivors ; Trauma Centers

PURPOSETo accurately assess the mechanism, type and severity of injury in Iranian multiple trauma patients of a trauma center.

METHODSPatients with multiple traumas referring to the emergency department of Hasheminejad University Hospital in Mashhad, Iran, entered this cross sectional study from March 2013 to December 2013. All the patients with injury severity score (ISS) > 9 were included in this study. Data analysis was performed by SPSS software (Version 11.5) and P values less than 0.05 were considered as significant differences.

RESULTSAmong the 6306 hospitalized trauma patients during this period, 148 had ISS>9. The male female ratio was 80%. The mean age of the patients was (33.5 ± 19.3) years. And 71% of the patients were younger than 44 years old. There were 19 (13%) deaths from which 68.5% were older than 44 years old. The mean transfer time from the injury scene to hospital was (55 ± 26) minutes. The most frequent mechanisms of injury were motorcycle crashes and falling from height, which together included 66.2% of all the injuries. A total of 84% of hospital deaths occurred after the first 24 h of hospitalization. Head and neck were the most common body injured areas with a prevalence of 111 cases (75%).

CONCLUSIONMotorcycle crashes have high frequency in Iran. Since most victims are young males, injury prevention strategies should be considered to reduce the burden of injuries.

Accidents, Traffic ; statistics & numerical data ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Cross-Sectional Studies ; Female ; Hospital Mortality ; Humans ; Infant ; Injury Severity Score ; Male ; Middle Aged ; Multiple Trauma ; epidemiology ; mortality ; Trauma Centers ; Young Adult

OBJECTIVES: This study aimed to assess the relationship between musculoskeletal symptoms and non-fatal injuries in construction workers. METHODS: This was a cross-sectional study involving 1,836 male construction workers in petrochemical plants in Korea. For this study, a structured self-reported questionnaire(KOSHA CODE H-30-2003) was used. Musculoskeletal symptoms were defined as symptoms that affect the operation of the musculoskeletal system, for longer than one week or a frequency of more than once per month. To evaluate the association between musculoskeletal symptoms and non-fatal occupatioanl injuries, multiple logistic-regressions were used after adjusting for age, exercise, smoking status, alcohol consumption, work time, work duration, and income. RESULTS: A total of 140 workers were involved in non-fatal injuries cases, representing 7.6% prevalence. After adjusting for confounding variables, the logistic regression analyses indicated the group with musculoskeletal symptoms(OR 1.73 95% CI:1.21~2.47) and intensity criteria of musculoskeletal symptoms as related to 'moderate' criteria(OR 1.82 95% CI:1.18~2.81) or 'severe' criteria(OR 2.57 95% CI:1.43~4.63). This identified group was more likely to experience non-fatal occupational injuries. However, a 'mild' criteria(OR 1.00 95% CI:0.51~1.99) was not associated with non-fatal occupational injuries. CONCLUSIONS: The results indicated a possible association between musculoskeletal symptoms and non-fatal injuries. Hence, strengthening of laws and regulations, effective ergonomic programs and training is necessary to prevent musculoskeletal symptoms.
Alcohol Drinking ; Confounding Factors (Epidemiology) ; Cross-Sectional Studies ; Humans ; Jurisprudence ; Korea ; Logistic Models ; Male ; Multiple Trauma ; Musculoskeletal System ; Occupational Injuries ; Prevalence ; Smoke ; Smoking ; Social Control, Formal

OBJECTIVETo provide the experience on medical rescue and care for any giant earthquake by analysing the patients treated by the Chinese Medical Rescue Team in the Barakott earthquake of Pakistan.

METHODSOn October 8, 2005, a giant earthquake (7.8 Richter scale) earthquake occurred in the northwest Pakistan. We belonged to the Chinese Medical Rescue Team and worked in the earthquake-affected town---Barakott from October 28, 2005 to November 17, 2005. The patients were classified into upper respiratory tract infection, diarrhea, trauma and other diseases. All the data of patients who were injured during the earthquake were analysed. The difference was analyzed by X(2) test.

RESULTSOf the 2 194 patients treated by the Chinese Medical Rescue Team, trauma patients only accounted for 29%, diarrhea patients for 4%, upper respiratory infection patients for 14%, and other types of diseases for 52%. Among the 630 trauma patients, 426 patients were injured during the earthquake. Of the 426 patients, 291 (68%) patients were found having open wounds, 85 (20%) patients mainly complained of soft tissue pain without any wound or fracture, and 76 (18%) patients had fractures with or without open wound. The most frequent site of wound was lower extremity. Head injury in children was 30%, obviously higher than that in the adults. Wound infection was common among the injured patients, with the rates of 72%, 64% and 78% in male, female adult patients and children, respectively.

CONCLUSIONSPrevalence of common diseases, trauma, wound infection and fracture are main problems presented at late stage of the giant earthquake. Great attention should be paid to head and lower extremity injuries.

Adolescent ; Adult ; Aged ; Craniocerebral Trauma ; epidemiology ; Earthquakes ; Female ; Fractures, Bone ; epidemiology ; Humans ; Lower Extremity ; injuries ; Male ; Middle Aged ; Multiple Trauma ; epidemiology ; Pakistan ; epidemiology ; Retrospective Studies ; Survivors ; Upper Extremity ; injuries ; Wounds and Injuries ; epidemiology ; Young Adult

OBJECTIVETo investigate the impact of age and gender on multiple organ dysfunction syndrome (MODS) after multiple injuries and the possible mechanism.

METHODSThe clinical data of 78 patients with multiple injuries admitted in the ICU in our hospital from Jan. 2004 to Jan. 2007 were reviewed for age, gender, ISS, incidence of MODS, sepsis and mortality, days in ICU, and duration of ventilation. The plasma levels of TNF-alpha and IL-6 were examined by ELISA in the first two weeks after the injury, and the results were analyzed in relation to the demographic and clinical data.

RESULTSWith similar ISS scores, the male patients were more likely to develop into MODS than the female patients (P<0.05), and age produced a marginal effect on the incidence of MODS (P=0.06). Compared with patients without MODS, those with MODS had a significantly different pattern of plasma TNF-alpha and IL-6 alterations. In the initial week following the injury, the male patients showed significantly higher plasma IL-6 levels than the female patients with the same ISS scores (P=0.04), but the level alteration in the initial two weeks showed no significant difference between the male and female patients (P=0.14).

CONCLUSIONGender plays an important role in the occurrence of MODS following multiple injuries, but the effect of age on MODS seems only marginal and need to be further investigated.

Adolescent ; Adult ; Age Factors ; Aged ; China ; epidemiology ; Cytokines ; blood ; Female ; Humans ; Interleukin-6 ; blood ; Male ; Middle Aged ; Multiple Organ Failure ; blood ; epidemiology ; etiology ; Multiple Trauma ; blood ; complications ; Sex Factors ; Tumor Necrosis Factor-alpha ; blood ; Young Adult