Abstracts / Injury Extra 40 (2009) 139–146144

This problem is most pronounced among junior doctors. The datasuggests that not all doctors can safely insert chest drains, and that,while on the whole, they are aware of their limitations, furthereducation, and appropriate supervision, remains important.

doi: 10.1016/j.injury.2009.03.034

Non-operative management of high grade splenic injury:Review of factors leading to high spleen slavage rate in a level 1trauma centre

Amit Rana, Kate Curtis, Mary Ling, Stuart Tan, Thomas NauTrauma Services, St George Hospital, Sydney, NSW, Australia

Introduction: The standard management of haemodynamicallystable splenic injury is aggressive non-operative management.Successful management of high grade splenic injury without anycomplications requires strict practice guidelines for non-operativemanagement. The various factors and adjunct for success of non-operative management been researched in recent years. We aim toanalyze the cumulative effect of various factors on spleen salvageand determine salvage rate in high grade splenic injury in ourinstitute.Methods: Retrospective analysis of prospectively gathered datafrom trauma registry of level 1 trauma centre at St George hospitalwas analyzed for grade 3 and 4 blunt splenic injury managed non-operatively for a period of 18 months (01/01/2007–30/06/2008).Spleen salvage rate, complications, missed associated abdominalinjuries, blood transfusion, timing of full ambulation, timing ofdeep venous thrombosis prophylaxis, role of progress CT Scan andsplenic artery embolization, Haemodynamic monitoring, numberof days of stay in the High Dependency Unit were studied.

Results: Twenty-one patients with grade 3 and 4 (AAST grading)blunt splenic injury were selected and managed non-operativelywere found to be eligible for the study. Spleen salvage rate was 95%.One patient failed due to non-compliance accounting for a failurerate of 5%. Three patients underwent therapeutic splenic arteryembolization. All the patients underwent a progress CT scan after amean of 3.4 days and the CT scan findings led to intervention in 45%of the study group. The average blood transfusion rate was 1.6 units,75% of patients who received blood transfusion had other associatedinjuries requiring blood transfusion. The incidence of deep veinthrombosis and pulmonary embolism was zero percent. Averagestay in the High Dependency Unit was 5 days. Mean time for fullambulation was 6.5 days. No associated bowel injury was missed.

Conclusion: A 95% splenic salvage rate can be achieved in grade 3and 4 blunt splenic injuries managed non-operatively withoutsignificant complications. Management by a single trauma teamensures uniform practice and contributes to a highly successfulresult.

doi: 10.1016/j.injury.2009.03.035

Outcomes of proximal femoral fractures in patients treated atAustralian level-1 trauma centres

S. Roshan-Zamir a,*, B. Gabbe b, R. Gruen a,c, S. Liew d,M. Richardson a,e

a Department of Surgery, The University of Melbourne, Australiab Department of Epidemiology and Preventive Medicine, Monash

University, Australiac Department of Surgery, The Royal Melbourne Hospital, Australiad Department of Orthopaedic Surgery, The Alfred Hospital, Australiae Department of Orthopaedic Surgery, The Royal Melbourne Hospital,

Australia

Objectives: To analyse clinical and patient-reported outcomes inpatients with hip fractures treated at Australian level-1 trauma

centres, and, to highlight differences between the ‘typical’ patient(age >60 years) and those aged �60 years.Methods: Patients with traumatic proximal femoral fracturestreated at The Royal Melbourne and Alfred hospitals between2003 and 2006 were identified via the Victorian OrthopaedicTrauma Outcomes Registry.

Patient-reported outcomes were prospectively measured at 6and 12 months post-injury using the SF-12 and a Numerical PainScale. Fracture classification was determined by reviewing allX-rays.Results: A total of 695 patients were identified with 13.8% aged�60years, and displaced subcaptial fractures (AO-31B3) occurringmost commonly.

Inpatient mortality reached 5.5% whilst mortality at 6 and 12months post-injury was 17.1% and 22.6% respectively.

Most recovery occurred within the initial 6 months post-injurywith plateau thereafter. After 12 months >30% of survivors wereyet to return to pre-injury living status and mean physical SF-12scores remained well below population norms (36.4 vs 48.9).

Several predictors of mortality and/or functional recovery wereobserved.Conclusions: Mortality is comparable to similar internationalinstitutions. The rise in mortality is greatest within the initial 6months, a period during which close medical attention isparamount.

Recovery plateaus following the initial 6 months, warranting areview to ascertain whether this represents a crucial ‘window-period’ for rehabilitation or whether appropriate care is not beingprovided beyond 6 months.

Patients aged �60 years are unique with reference topresentation, management and outcomes. Management andtreatment goals should be tailored accordingly.

doi: 10.1016/j.injury.2009.03.036

Evaluation of the trauma high dependency unit

L. Carter a,*, L. Aitken b, M. Schuetz c

a Princess Alexandra Hospital, Brisbane, Australiab Princess Alexandra Hosptial and Griffith University, Australiac Princess Alexandra Hospital and Queensland University of

Technology, Australia

Introduction: The first Trauma Service in Queensland (QLD),Australia was established at Princess Alexandra Hospital. Thisservice incorporated a dedicated 4-bed Trauma High DependencyUnit (HDU) that was opened in February 2007. The Trauma HDUprovides care for multiply injured patients in the acute (highdependency) phase of their treatment.

Aims: To evaluate the effectiveness of the Trauma HDU on patientoutcomes for the high risk multiply injured patients.Method: A pre-Trauma HDU patient group of fifty patients wasidentified utilising the QLD Trauma Registry and the Intensive CareUnit (ICU) Database. A post-Trauma HDU group included allpatients admitted to the HDU during June to November 2007.Trauma patients who had an Injury Severity Score �16 or wereadmitted to ICU were identified. Medical records were reviewedfor patient outcomes including length of stay, complications andICU readmission.Results: Preliminary results for the pre-Trauma HDU groupidentified that 30% of patients were inter hospital transfers. Fortypercent of patients nursed in the general wards experiencedrespiratory complications, 30% cardiac complications, and 40% ofpatients had coagulation abnormalities.Conclusion: High risk patients have been cared for in the TraumaHDU to facilitate closer patient observation and improve manage-ment of analgesia, oxygenation and fluid balance requirements.