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23rd European Congress of Trauma & Emergency Surgery

Prof. Dr.

Prof.

Examining trauma in women: An epidemiological study of cases assisted by the mobile emergency care service in the greater Vitória metropolitan area, Brazil

Research

Education

Introduction: Physical trauma in women is a relevant topic in the global context, considering the growing importance of the debate on women's health. This discussion is fundamental to understanding the epidemiology and risk factors, aiming at the effective formulation of public health policies. Therefore, it is essential to study processes involved in trauma in women. Objective: To evaluate factors associated with trauma in women assisted by the Mobile Emergency Care Service, in a metropolitan region of Brazil, in the years 2020-2021. Method: Cross-sectional study carried out at the Emergency Medical Regulation Center on trauma victims treated in the Metropolitan Region of Greater Vitória-Brazil, in 2020 and 2021. Included victims of falls, traffic accidents, and assault. Univariate descriptive and analytical statistics were performed to evaluate factors associated with trauma in women. Approved by the Research Ethics Committee, opinion 4,308,858. Results: Between 2020 and 2021, 19,837 traumas were identified, 6,798 in women (34.3%), prevailing in 2020 (50.2%), from Monday to Friday (68.9%), day shift (65.7%), home origin (64.8%), in elderly women aged ≥ 60 years old (39.2%), resulting from a fall (65.1%), from their own height (74.0%), presumed moderate severity (77.0%), assisted by the Basic Support Unit - USB (89.7%), transported to the health service (77.5%), hospital destination (87.8%). Pre-hospital death rate was 0.6%. There was an association of trauma in women (p&lt;0.05) with day shift, home origin, elderly, resulting from a fall, from their own height, priority level 2 and 3, rescued by USB, transport to health service, type Ready Service and no death. Conclusion: Promoting regular physical activity, healthy eating and implementing improvements in housing are alternatives to changing the context of trauma in elderly Brazilian women, who suffer a fall from their own height, in their homes.No

Poster

Development of a novel disseminated intravascular coagulation scoring system for severe trauma patients: A secondary data analysis of J-OCTET2 study

Trauma and Emergency surgery | Miscellaneous

Introduction: The utility of the conventional JAAM disseminated intravascular coagulation (DIC) scoring system has been reported in patients with thrombotic phenotype DIC, as sepsis. However, its effectiveness in severe trauma patients with fibrinolytic coagulopathy remains controversial. Objectives: The aim of this study was to devise a scoring system for trauma induced coagulopathy (TIC) that is more accurate in predicting than the conventional JAAM DIC scores. Material &amp;Methods: We analyzed the data from the J-OCTET2 study, which was a retrospective multicenter registry study including the adult trauma patients with Injury Severity Score ≥16. We modified the cutoff value for each variable of conventional JAAM DIC scores based on a previous study, and built the new DIC scores (Table). A new DIC diagnosis was set at 4 points or more. The primary outcome was defined as in-hospital mortality. The secondary outcome was the incidence of massive transfusion (RBC ≥ 10 units within 24 hours). Patients' characteristics and outcomes were compared between the DIC and non-DIC group based on the new DIC scores. Furthermore, we evaluated the AUCs of the conventional JAAM DIC scores and the new DIC scores for in-hospital mortality. Results: We analyzed 719 severe trauma patients. In-hospital morality in the DIC group was higher than in the non-DIC group (22.5 % vs. 2.4 %, p &lt; 0.001). The frequency of the massive transfusion in DIC group was higher than that in non-DIC group. (27.6% vs. 9.4%, p &lt; 0.001). The AUC for predicting in-hospital mortality using the new DIC scores was higher than that of the conventional JAAM DIC scores (0.855 vs. 0.784, p &lt; 0.001). Conclusion: We developed a new DIC scoring system for TIC, which was more accurate than the conventional JAAM DIC scores in severe trauma patients. Further studies elucidating the cause of our result are needed in order to develop the clinical application.No

Epidemiological study about falls in Brazil: What is the path to safety?

Polytrauma

Introduction: Falls are common and preventable injuries leading to fractures, reduced functional ability, and even mortality. Objective: To assess factors related to fall types among SAMU-assisted victims in a Brazilian metropolitan area. Method: Cross-sectional study conducted at the Emergency Medical Regulation Center, Greater Vitória Metropolitan Region, Brazil, during 2020-2021. The sample included fall victims, excluding other trauma types. Univariate statistics and chi-square tests were utilized. Approved by the Research Ethics Committee, protocol 4,308,858. Results: 10,004 falls were recorded, 6,807 from standing height (68.0%), 2,999 &lt; 6m (30.0%), and 198 &gt; 6m (2.0%). Falls were more prevalent in 2020 (51.3%), Saturdays (16.3%), afternoon (39.6%) and at home (74.5%). Males (55.8%) and the elderly (46.9%) were more affected. Most cases were of moderate priority (75.2%) and, handled by the BSU (90.4%). Around 77.8% were taken to healthcare facilities, 66.7% going to hospitals, mainly public ones (85.4%). The pre-hospital fatality rate was 0.7%. Factors associated with the types of fall (p&lt;0.05): morning when falling &gt;6m, afternoon when falling &lt;6m, dawn when falling from standing height; residence when falling &lt;6m, bus terminal and public road when falling from standing height; male when falling &lt;6m and &gt;6m, female when falling from own height; children, teenagers and adults falling &lt;6m, babies, teenagers and adults &gt;6m, elderly people when falling from their own height; absolute priority for falls &lt;6m and &gt;6m, moderate and low priority for falls from own height. ASU when falling &gt;6m and BSU when falling from standing height; transport to health service for falls &lt;6m and &gt;6m; pre-hospital death for falls &gt;6m. Conclusion: A range of epidemiological factors is linked to types of falls. Implementing basic safety precautions, at home and in public spaces, can safeguard well-being, ensure individuals′; independence, and preserve their quality of life.No

Shared decision making for management of proximal femoral fracture in frail older adults with a limited life expectancy: Protocol for a national implementation study

Introduction: Palliative, nonoperative management (PNOM) is a viable alternative for frail older adults with a proximal femur fracture in the final phase of life. The shared decision making (SDM) process, involving patients and proxies, is of critical significance to align the treatment with patients&quot; preferences and needs. Objective: This protocol describes national implementation of SDM regarding PNOM versus operative treatment in selected frail older adults with a hip fracture. We aim to ensure these patients receive their optimal, patient-centered care with full awareness of both treatment options. Patients &amp; Methods: The population includes frail older adults, aged ≥70 years with an acute proximal femoral fracture, receiving nursing home care and at least one additional criterion; either malnutrition, severe mobility impairment, and/or ASA ≥4. This implementation study will be conducted as a multicenter prospective cohort study with a staged approach using data from the Dutch Hip Fracture Audit. First, we will identify barriers and facilitators for implementation and an implementation protocol will be developed. Next, is the start of implementation in 14 hospitals across the Netherlands. The protocol and developed educational documents will be enhanced during the study incorporating experiences from patients and professionals, gathered through interviews before and during the study. The final step involves expanding to national implementation. Results: The pilot implementation of phase3 started in October 2023. Conclusion: Following national implementation, patients and proxies in all hospitals will engage in structured SDM with their physicians choosing the treatment that best aligns with their medical situation and preferences for their final phase of life. In addition, the evaluation of the implementation study will clarify what the effects are of uniform SDM in this selected population with a proximal femoral fracture in daily clinical care in the Netherlands. ZonMW Grant, no further conflicts of interest

A journey to understand trauma-related fatalities: An epidemiological study in a metropolitan region of Brazil

Introduction: According to the World Health Organization, 5.8 million people die annually from trauma in the world, akin to 10% of all causes of death, and without appropriate interventions, it is predicted that the proportion will increase by 2030. Objective: Verify factors associated with deaths resulting from trauma in victims assisted by the Mobile Emergency Care Service, in a metropolitan region of Brazil. Method: A cross-sectional study was carried out at the Emergency Medical Regulation Center, Metropolitan Region of Greater Vitória-Brazil, in 2020 and 2021. The sample was composed of victims of trauma, such as traffic accidents, aggression, and falls, assisted by SAMU. Descriptive and univariate statistics and chi-square tests were performed to determine factors associated with deaths. Approved by the Research Ethics Committee, opinion 4,308,858. Results: Between 2020 and 2021, 19,837 traumas were identified, with 266 pre-hospital deaths (1.3%), prevailing in 2021 (58.3%), Saturday (18.4%), night shift ( 51.1%), male (84.6%), age group 25 to 34 years old (24.4%), resulting from aggression (55.6%), by firearm (83.8%), followed by fall (25.6%), from height (54.4%) and traffic accident (18.8%), collision type (44.0%), by motorcycle (48.0%), with presumed severity absolute (96.6%), rescued by the USA (88.0%). The following factors were associated with death (p&lt;0.05): year 2021, night shift, male gender, age groups 0 to 4 years, 15 to 24 years and 25 to 34 years, aggression by firearm, being run over, by truck and bus, fall &gt; 6 meters, absolute presumed severity, USA resource. Conclusion: Deaths from trauma are tragic and often preventable, highlighting the importance of prevention in vulnerable groups identified by the epidemiological factors of a given health region, as verified in this research.No

Epidemiological study on pedestrian accidents in a metropolitan region of Brazil: Observatory of the urgency and emergency network

Introduction: Pedestrian accidents pose a significant traffic safety concern. In Brazil, the number of pedestrians injured in traffic accidents surged from 16,654 to 18,798 (a 12.9% increase) from January 2022 to June 2023. Objective: To verify the profile and factors associated with victims of pedestrian accidents who received assistance from the Mobile Emergency Service within a metropolitan region of Brazil. Method: A cross-sectional study at the Emergency Medical Regulation Center in the Greater Vitória Metropolitan Region during 2020 and 2021 included victims of traffic accidents involving runovers, collisions, and falls from a vehicle, excluding other trauma cases. Descriptive and univariate statistical analyses and the chi-square test were employed, focusing on pedestrian runovers. Approved by the Research Ethics Committee under the number 4,308,858. Results: 7,004 accidents were recorded, 1,117 classified as pedestrian runovers (15.9%), with higher prevalence in 2021 (50.9%), on Fridays (16.7%), and during the afternoon (44.3%). Most of incidents involved cars (53.7%), and the victims were predominantly men (65.5%), within the age of 25 to 34 years (17.9%). The priority level for most cases was moderate (69.3%) and the Basic Support Unit attended 83.9% of them, 78.5% transported to health services, mainly to public hospitals (92.9%). The pre-hospital mortality was 1.8%. Several factors were associated with pedestrian runovers (p&lt;0.05), including cars, buses or trucks, female victims with a wide range of age group, incidents categorized as an absolute priority with Advanced Support Unit, and incidents resulting in fatalities. Conclusion: Pedestrian runovers cause avoidable suffering, constituting a tragic issue that affects females across various age groups. Investments in education, safe infrastructure, and stringent traffic regulations are imperative to safeguard the lives of individuals vulnerable to traffic accidentsNo

Unveiling the dynamics of critical trauma: An epidemiological study in a Brazilian metropolitan region

Introduction: Trauma is a leading preventable cause of morbidity and mortality. Understanding the epidemiological profile, focusing on critically ill trauma patients, is crucial for enhancing intervention strategies. Objective: To evaluate the profile and factors associated with trauma among critically ill patients assisted by SAMU in the Metropolitan Region of Greater Vitória, Brazil. Methods: This cross-sectional analysis at the Emergency Medical Regulation Center involved trauma victims attended by SAMU during 2020 and 2021. Descriptive and univariate statistical analyses, including the chi-square test, were conducted to distinguish critical and non-critical trauma outcomes. The Research Ethics Committee approved the study under number: 4,308,858. Results: 19,837 trauma cases were recorded, 3,858 (19.4%) identified as critical which were more prevalent in 2021 (57.7%), primarily occurring on Saturdays (16.7%), during the daytime (65.8%), 43.2% in the afternoon, and 48.7% at victims' homes. The majority involved male individuals (74.0%) aged 25 to 34 years (20.3%). Falls from one's own height (53.1%), traffic accidents (30.8%), collisions with motorcycles (52.1%), and aggression with firearms (38.5%) were the primary causative factors. Most victims were assisted by the Basic Support Unit (67.7%) and transported to hospitals (89.7%), mostly public (90.3%). The pre-hospital mortality rate was 6.7%. The factors associated with critical trauma (p&lt;0.05) are as follows: year 2021, on Wednesdays, on public roads, affecting males. Incidents involving aggression with bladed weapons and firearms, being run over by cars, trucks, or buses, falls from heights over and under 6 meters, utilization of ASU and ISU resources. Conclusion: Developing targeted public policies aimed at monitoring young adult men, particularly regarding pedestrian collisions, falls, and attacks involving bladed weapons and firearms, is essential to reduce trauma incidence and associated consequences.No

Types of trauma in a metropolitan region of Brazil: Characteristics and associated factors

Introduction: In Brazil, the Emergency Network deals with various traumas like falls, assaults, and traffic accidents, common occurrences. Optimizing response time and care quality is vital for emergency assistance. Objective: To analyze factors linked to trauma types in victims assisted by the Mobile Emergency Service in a Brazilian Metropolitan Region during 2020-2021. Method: A cross-sectional study at the Emergency Medical Regulation Center, emphasizing falls, assaults, and traffic accidents in the Greater Vitória Metropolitan Region, Brazil. Other trauma types were excluded. Qualitative variables were employed to identify factors associated with trauma types using univariate analysis and the chi-square test. Approved by the Research Ethics Committee, protocol 4,308,858. Results: 19,837 traumas were recorded, consisting of 10,004 falls (50.4%), 7,004 traffic accidents (35.3%), and 2,829 assaults (14.2%). They were more frequent on Saturdays (16.8%), in the afternoon (39.0%), at residences (51.6%), with presumed moderate severity (74.1%) in males (65.7%) and adults (65.2%). The pre-hospital mortality rate was 1.3%. Associations were found between trauma types (p=0.001): Weekdays linked to traffic accidents, while weekends with assaults; mornings correlated with falls, afternoons with traffic accidents, and nights and early mornings with assaults. Falls were more common at home, traffic accidents and assaults occurred outside home. Absolute priority connected to assaults, moderate priority to traffic accidents and falls, and low priority to falls. Assaults were associated with the ASU, while traffic accidents and falls were linked to the BSU. Males were more involved in traffic accidents and assaults, while females with falls. Age groups were connected to different trauma types, with mortality linked to assaults. Conclusion: Enhancing road and home safety, along with specific violence prevention strategies, are essential to reduce trauma.No.

Mobile emergency service observatory: Unveiling the faces of aggression in a Brazilian metropolitan region

Introduction: Aggression, a significant public health concern, leads to fatalities and adverse psychological outcomes, including depression and anxiety, affecting millions in Brazil. Objective: To verify factors associated with types of aggression among victims assisted by SAMU in Grande Vitória, Brazil. Method: A cross-sectional study at the Emergency Medical Regulation Center categorized different aggressions in the region during 2020-2021. Univariate statistical analyses and the chi-square test were applied. The study was approved by the Research Ethics Committee under number: 4,308,858. Results: The data revealed 2,829 attacks, 1,873 cases of physical assaults (66.2%), 489 cases involving firearms (17.3%), and 467 using bladed weapons (16.5%). These incidents were more frequent in 2020 (52.7%), occurring on weekdays (60.1%), during nighttime (30.9%), with 52.2% outside the home setting. Most victims were male (76.1%) within the age group of 25 to 34 years (29.1%). Non-critical injuries were observed in most of cases (62.7%). The Basic Support Unit attended 77% of cases, with 62.2% directed to health services, mainly to public hospitals (97.8%). The pre-hospital mortality rate was 5.2%. Factors associated with various types of aggression (p&lt;0.05) exhibited distinct patterns such as a higher incidence of firearm-related assaults on weekdays, and bladed weapon assaults during the weekend. Time of day was associated with types of aggression, with physical assaults occurring frequently in the morning and firearm-related incidents in the afternoon. The location of the aggression, gender, age group, injury severity, the emergency service utilized, and the ultimate outcome also displayed significant associations. Conclusion: Overcoming trauma from various forms of aggression requires ongoing care. Identifying factors associated with different types of aggression is instrumental in developing targeted public policies to safeguard community well-being in the region.No

Analyzing the landscape of motorcycle accidents: A comprehensive epidemiological study in a Brazilian metropolitan area

Introduction: Motorcycle accidents are a global challenge in urban areas, often stemming from speeding, recklessness, inadequate safety measures, non-compliance with regulations, and poor road conditions. Ineffective supervision, limited education, and substandard infrastructure exacerbate this problem. Objective: This study aims to assess the factors associated with motorcycle-related traumas and the characteristics of victims assisted by the Mobile Emergency Service (SAMU) in the Greater Vitoria area of Brazil. Method: A cross-sectional analysis was conducted at the Emergency Medical Regulation Center from January 2020 to December 2021. The study included victims involved in motorcycle accidents handled by SAMU, excluding other traffic accidents. Descriptive and univariate statistical analyses, along with the chi-square test, were employed to identify factors linked to motorcycle trauma. Ethical approval was obtained from the Research Ethics Committee (Approval number: 4,308,858). Results: Out of 7,004 traffic accidents, 62.1% (4,346 cases) were motorcycle-related, mostly occurring in 2021 (52.0%), on Fridays (18.2%), during the afternoon (42.0%), and among men (79.7%), specifically in the 25 to 34-year-old age group (35%). Collisions (59.9%) were the primary cause, with 81.8% indicating moderate severity. SAMU rescued 89.8% of victims, and 78.9% were referred to care settings, with 73.6% taken to hospitals, predominantly public hospitals (85.8%). The pre-hospital mortality rate was 0.6%. Conclusion: Motorcycle accidents persist as a critical issue in road safety, particularly affecting young adult males. This highlights the urgent need for early education initiatives and improved adherence to traffic regulations. No

Trauma in adolescents: Challenges to change a tragic journey

Introduction: Accidents and violence are the leading causes of death among teenagers worldwide. This emphasizes the need for comprehensive investigation to identify risk factors and reduce such incidents. Objective: To assess the profile and factors related to adolescent trauma in an urban region of southeastern Brazil. Method: Cross-sectional study conducted at the Emergency Medical Regulation Center from January 1,2020 to December 31,2021. The participants were adolescents attended by the Mobile Emergency Service (SAMU) in the Greater Vitória Metropolitan Region. Excluding other types of injuries and incomplete data, the information was examined using descriptive and single-variable analysis, along with a chi-square test. The study received approval from the Research Committee under number 4,308,858. Results: 19,837 trauma incidents were reported, 1,182 affecting adolescents (6.0%). Most (55.0%) occurred in 2020, predominantly on Saturdays (18.1%) during afternoons (43.9%) and involved males (71.4%). Vila Velha was the most affected municipality (25.3%). Traffic accidents (50.7%), collisions (43.1) were the leading cause, 75.0% being non-critical. BHUs handled 85.8% of cases, 73.1% transferred to care settings, 93.5% to public hospitals. Pre-hospital fatalities accounted for 1.9% of cases. The study identified associations (p&lt;0.05) between trauma and factors such as male gender, specific municipalities (Guarapari and Cariacica), incidents outside home, injuries caused by guns, requests during the night and afternoon due to traffic accidents, presumed critical severity, attended by BHUs, and referred to hospital admission. Conclusion: Understanding the factors contributing to adolescent trauma enables the development of targeted public policies for prevention initiatives such as traffic safety campaigns, focusing on young males during afternoons and Saturdays, offer potential solutions to improve the Brazilian emergency scenario. No

Deciphering the epidemiology of nighttime trauma in a Brazilian metropolitan region

Introduction: Trauma is a global challenge with the potential for significant consequences and fatalities, affecting about 60 million people annually. Nighttime poses increased risks for accidents and violence due to factors such as impaired visibility and alcohol consumption. Objective: To analyze factors associated with nighttime trauma and the characteristics of individuals assisted by the Mobile Emergency Service in a metropolitan area of Brazil. Method: A cross-sectional study at the Emergency Regulation Center in Greater Vitória during 2020-2021 encompassed trauma cases from incidents such as traffic accidents, assaults, and falls. Descriptive and univariate statistical analyses, including the chi-square test, were conducted to examine nighttime versus daytime trauma patterns. Approved by the Research Ethics Committee under number 4,308,858. Results: A total of 19,837 trauma cases were recorded, with 7,198 (36.3%) occurring at night, mainly in 2020, particularly on Saturdays, and predominantly involving males (67.6%). The most affected age group was 25-34 years (21.5%). Falls (45.3%), traffic accidents (32.3%), and aggression (22.4%) were the primary causes. A significant proportion of incidents took place at the victim's homes (54.1%), with most being non-critical (81.7%). The victims were mostly rescued by the Emergency Support Unit (88.0%) and were transferred to public hospitals (88.6%) and health services (72.8%). Pre-hospital mortality was 1.9%. There was an association with nocturnal trauma (p&lt;0.05): Saturday and Sunday, home origin, male, age groups 15 to 44 years, resulting from aggression and pre-hospital death. Conclusion: Addressing issues related to family dynamics, implementing disarmament policies, and improving public safety measures are essential in tackling nighttime trauma challenges in Brazil. These incidents often occur in homes during weekends, predominantly affecting young adult men, frequently due to knife-related assaults.No.

Perception of traffic accidents assisted by SAMU in a metropolitan region of Brazil: Implications for public health

Introduction: Traffic accidents represent a global public health concern. SAMU (Mobile Emergency Medical Service) serves a vital role in delivering pre-hospital care to those affected. Objective: To examine the factors linked to the types of traffic accidents involving SAMU-assisted victims in the Grande Vitória Metropolitan Region, Brazil. Method: A cross-sectional study was conducted at the Emergency Medical Regulation Center, focusing on traffic accident types in 2020-2021. Associations were determined using univariate statistics and chi-square tests. The study was approved by the Research Ethics Committee with the number 4,308,858. Results: During 2020-2021, 7,004 traffic accidents were recorded, comprising 3,668 collisions (52.4%), 2,219 vehicle falls (31.7%), and 1,117 pedestrian runovers (15.9%). A majority of accidents occurred in 2021 (51.9%), mainly on Saturdays (16.8%) and during the evening (42.2%). The incidents primarily involved motorcycles (62.1%), male individuals (75.8%), and adults (83.0%), with moderate severity (79.0%). BHUs provided assistance in 88.6% of cases, with 76.9% of individuals being transported to healthcare facilities, mainly hospitals (71.4%) and public institutions (86.8%). Pre-hospital fatalities accounted for 0.7% of cases. Factors associated with different types of traffic accidents (p &lt;0.05) were specific, such as the day of the week, time of day. Tuesday for crashes, Sunday for falls; evening for crashes, nighttime and early morning for falls; diverse vehicles for each accident type; gender and age associations (males and adults for collisions, females, children, adolescents, and the elderly for pedestrian strikes); varied priority levels; differing emergency response units based on the incident type (ASUs for pedestrian strikes and BHUs for collisions). Conclusion: Mitigating the impact of traffic accidents requires increased attention and accountability as they represent preventable public health tragedies. No.

Poster session 36
Research 2

Appointment

Chairs

Topic

Programme

Poster session 36Research 2

Appointment

Chairs

Topic

Programme

Poster session 36
Research 2