Repeat imaging increases detection of delayed pseudoaneurysms in patients with high-grade solid organ injury following abdominal trauma.

Background: Nonoperative management of abdominal trauma can be complicated by the development of delayed pseudoaneurysms. Early intervention reduces the risk of rupture and decreases mortality. The objective of this study is to determine the utility of repeat computed tomography (CT) imaging in detecting delayed pseudoaneurysms in patients with abdominal solid organ injury.

Advancing access to care: An assessment of the prehospital system in Senegal.

Background: Most low- and middle-income countries do not have a mature prehospital system limiting access to definitive care. This study sought to describe the current state of the prehospital system in Senegal and offer recommendations aimed at improving system capacity and population access to definitive care.

Methods: Structured interviews were conducted with key informants in various regions throughout the country using qualitative and quantitative techniques.

Complete major pancreatic duct disruption complicated by pancreatico-atmospheric fistula following blunt upper abdominal trauma.

Pancreatic injury post blunt abdominal trauma is exceedingly rare. When complete major pancreatic duct (MPD) disruption occurs, a disconnection between the pancreas and the duodenum can take place, ultimately leading to fistula formation. We describe a case of MPD disruption following blunt abdominal trauma, complicated by a fistula between the pancreas and an open abdomen (pancreatico-atmospheric fistula).

Fit Testing Retrofitted Full-Face Snorkel Masks as a Form of Novel Personal Protective Equipment During the COVID-19 Pandemic.

Objective: Bottlenecks in the personal protective equipment (PPE) supply chain have contributed to shortages of PPE during the COVID-19 pandemic, resulting in fractures in the functionality of healthcare systems. This study was conducted with the aim of determining the effectiveness of retrofitted commercial snorkel masks as an alternative respirator for healthcare workers during infectious disease outbreaks.Methods: A retrospective analysis was performed, analyzing qualitative and quantitative fit test results of the retrofitted Aria Ocean Reef® full-face snorkeling mask on healthcare workers at the McGill University Health Centre between April-June 2020.

Intermittent use of resuscitative endovascular balloon occlusion of the aorta in penetrating gunshot wound of the lower extremity.

The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in penetrating injuries is an emerging adjunct in the civilian trauma surgeon’s toolbox for the management of traumatic hemorrhagic shock. Furthermore, within the Canadian civilian context, little has been reported with regard to its use as an assisted damage-control measure in vascular reconstruction of the lower extremity. We report a case of penetrating gunshot injury of the lower extremity where the preoperative deployment of REBOA had a remarkable positive impact in the resuscitation phase and the intraoperative control of blood loss.

The Financial Burden of Road Traffic Injuries in Mozambique: A Hospital-Related Cost-of-Illness Study of Maputo Central Hospital.

Background: Road traffic injuries (RTIs) are increasingly being recognized for their significant economic impact. Mozambique, like other low-income countries, suffers staggering rates of road traffic collisions. To our knowledge, this is the first study to estimate direct hospital costs of RTIs using a bottom-up, micro-costing approach in the Mozambican context.

Management of Open Abdomen After Trauma Laparotomy: A Comparative Analysis of Dynamic Fascial Traction and Negative Pressure Wound Therapy Systems.

Background: Management of the post-traumatic open abdomen (OA) using negative pressure wound therapy (NPWT) alone is associated with low rates of primary fascial closure. The abdominal reapproximation anchor (ABRA) system exerts dynamic medial fascial traction and may work synergistically with NPWT to facilitate primary fascial closure.

Methods: Patients with an OA following trauma laparotomy between 2009 and 2018 were identified from a prospectively maintained institutional database.

Trauma Surveillance and Registry Development in Mozambique: Results of a 1-Year Study and the First Phase of National Implementation.

Background: Mozambique has had no policy-driven trauma system and no hospital-based trauma registries, and injury was not a public health priority. In other low-income countries, trauma system implementation and trauma registries have helped to reduce mortality from injury by up to 35%. In 2014, we introduced a trauma registry in four hospitals in Maputo serving 18,000 patients yearly.

Perioperative Mortality Rates as a Health Metric for Acute Abdominal Surgery in Low- and Middle-Income Countries: A Systematic Review and Future Recommendations.

Background: Approximately 5 billion people do not have access to safe, timely, and affordable surgical and anesthesia care, with this number disproportionately affecting those from low-middle-income countries (LMICs). Perioperative mortality rates (POMRs) have been identified by the World Health Organization as a potential health metric to monitor quality of surgical care provided. The purpose of this systematic review was to evaluate published reports of POMR and suggest recommendations for its appropriate use as a health metric.

Resuscitative endovascular balloon occlusion of the aorta (REBOA): a scoping review protocol concerning indications-advantages and challenges of implementation in traumatic non-compressible torso haemorrhage.

Introduction: Haemorrhage remains the leading cause of preventable death in trauma. Damage control measures applied to patients in extremis in order to control exsanguinating bleeding from non-compressible torso injuries use different techniques to limit blood flow from the aorta to the rest of the body. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is regaining momentum recently as an adjunct measure that can provide the same results using less invasive approaches.

Incidence and factors associated with development of heterotopic ossification after damage control laparotomy.

Introduction: The incidence of heterotopic ossification (HO) following damage control laparotomy (DCL) is unknown. Abdominal wall reconstruction may prove more challenging in patients with HO. This study examines the incidence and factors associated with HO in patients with an open abdomen following DCL.

Trauma care in Malawi: A call to action.

Injuries are a global public health concern because most are preventable yet they continue to be a major cause of death and disability, especially among children, adolescents, and young adults. This enormous loss of human potential has numerous negative social and economic consequences. Malawi has no formal system of prehospital trauma care, and there is limited access to hospital-based trauma care, orthopaedic surgery, and rehabilitation.

Defining and Measuring Decision-Making for the Management of Trauma Patients.

Background: Effective management of trauma patients is heavily dependent on sound judgment and decision-making. Yet, current methods for training and assessing these advanced cognitive skills are subjective, lack standardization, and are prone to error. This qualitative study aims to define and characterize the cognitive and interpersonal competencies required to optimally manage injured patients.

Epidural analgesia for traumatic rib fractures is associated with worse outcomes: a matched analysis.

Background: The optimal method of pain control for patients with traumatic rib fractures is unknown. The aim of this study was to determine the effect of epidural analgesia on respiratory complications and in-hospital mortality in patients with rib fractures.

Methods: Adult patients at a level I trauma center with ≥1 rib fracture from blunt trauma were included (2004-2013).

Support infrastructure available to Canadian residents completing post-graduate global health electives: current state and future directions.

Background: Global health electives offer medical trainees the opportunity to broaden their clinical horizons. Canadian universities have been encouraged by regulatory bodies to offer institutional support to medical students going abroad; however, the extent to which such support is available to residents has not been extensively studied.

Methods: We conducted a survey study of Canadian universities examining the institutional support available to post-graduate medical trainees before, during, and after global health electives.

Optimizing the assessment of pediatric injury severity in low-resource settings: Consensus generation through a modified Delphi analysis.

Introduction: Although a plethora of pediatric injury severity scoring systems is available, many of them present important challenges and limitations in the low resource setting. Our aim is to generate consensus among a group of experts regarding the optimal parameters, outcomes, and methods of estimating injury severity for pediatric trauma patients in low resource settings.

Materials And Methods: A systematic review of the literature was conducted to identify and compare existing injury scores used in pediatric patients.

Systematic review and need assessment of pediatric trauma outcome benchmarking tools for low-resource settings.

Introduction: Trauma is a leading cause of mortality and disability in children worldwide. The World Health Organization reports that 95% of all childhood injury deaths occur in Low-Middle-Income Countries (LMIC). Injury scores have been developed to facilitate risk stratification, clinical decision making, and research.

What Are the Principles That Guide Behaviors in the Operating Room?: Creating a Framework to Define and Measure Performance.

Objective: To identify the core principles that guide expert intraoperative behaviors and to use these principles to develop a universal framework that defines intraoperative performance.

Background: Surgical outcomes are associated with intraoperative cognitive skills. Yet, our understanding of factors that control intraoperative judgment and decision-making are limited.

Trauma care and referral patterns in Rwanda: implications for trauma system development.

Background: Trauma remains a leading cause of death worldwide. The development of trauma systems in low-resource settings may be of benefit. The objective of this study was to describe operative procedures performed for trauma at a tertiary care facility in Kigali, Rwanda, and to evaluate geographical variations and referral patterns of trauma care.

Systematic Review of Surgical Literature from Resource-Limited Countries: Developing Strategies for Success.

Background: Injuries and surgical diseases are leading causes of global mortality. We sought to identify successful strategies to augment surgical capacity and research endeavors in low-income countries (LIC's) based on existing peer-reviewed literature.

Methods: A systematic review of literature from or pertaining to LIC's from January 2002 to December 2011 was performed.

Acute care surgery in Rwanda: Operative epidemiology and geographic variations in access to care.

Background: Surgical management of emergent, life-threatening diseases is an important public health priority. The objectives of this study were to (1) describe acute care general surgery procedures performed at the largest referral hospital in Rwanda and (2) understand the geographic distribution of disease presentations and referral patterns.

Methods: We performed a retrospective review of prospectively collected acute care surgery cases performed at the Centre Hospitalier Universitaire de Kigali (CHUK) in Rwanda between June 1 and December 1, 2011.

Promoting quality of care in disaster response: A survey of core surgical competencies.

Background: Recent humanitarian crises have led to a call for professionalization of the humanitarian field, but core competencies for the delivery of surgical care have yet to be established. The objective of this study was to survey surgeons with experience in disaster response to identify surgical competencies required to be effective in these settings.

Methods: An online survey elucidating demographic information, scope of practice, and previous experience in global health and disaster response was transmitted to surgeons from a variety of surgical societies and nongovernmental organizations.

Using the age-adjusted Charlson comorbidity index to predict outcomes in emergency general surgery.

Background: We evaluated the role of the Charlson age-comorbidity index (CACI), a weighted comorbidity index that reflects cumulative increased likelihood of 1-year mortality, in predicting perioperative outcomes in an emergency general surgery population at a large Canadian teaching hospital.

Methods: A retrospective chart review of emergency general surgery admissions in 2010 was conducted. Patients who had surgery were identified.