Publications by authors named "Husham Abdelrahman"

66 Publications

The Patterns and Impact of Off-Working Hours, Weekends and Seasonal Admissions of Patients with Major Trauma in a Level 1 Trauma Center.

Int J Environ Res Public Health 2021 08 12;18(16). Epub 2021 Aug 12.

Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha P.O. Box 3050, Qatar.

Background: The trauma incidence follows specific patterns in different societies and is expected to increase over the weekend and nighttime. We aimed to explore and analyze the incidence, pattern, and severity of trauma at different times (working hours vs. out off-working hours, weekdays vs. weekends and season).

Methods: A retrospective analysis was conducted at a level 1 trauma facility in Qatar. All injured patients admitted between June 2017 and May 2018 were included. The data were analyzed to determine whether outcomes and care parameters of these patients differed between regular working hours and off-working hours, weekdays vs. weekends, and between season intervals.

Results: During the study period, 2477 patients were admitted. A total of 816 (32.9%) patients presented during working hours and 1500 (60.6%) during off-working hours. Off-working hours presentations differed significantly with the injury severity score (ISS) (  <  0.001), ICU length of stay (  =  0.001), blood transfusions ( = 0.001), intubations ( = 0.001), mortality rate (9.7% vs. 0.7%; < 0.001), and disposition to rehabilitation centers. Weekend presentations were significantly associated with a higher ISS ( = 0.01), Priority 1 trauma activation (19.1% vs. 14.7%; = 0005), and need for intubation (21% vs. 16%; = 0.002). The length of stay (ICU and hospital), mortality, and disposition to rehabilitation centers and other clinical parameters did not show any significant differences. No significant seasonal variation was observed in terms of admissions at the trauma center.

Conclusions: The off-working hours admission showed an apparent demographic effect in involved mechanisms, injury severity, and trauma activations, while outcomes, especially the mortality rate, were significantly different during nights but not during the weekends. The only observed seasonal effect was a decrease in the number of admissions during the summer break.
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http://dx.doi.org/10.3390/ijerph18168542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8393594PMC
August 2021

Adrenal Gland Trauma: An Observational Descriptive Analysis from a Level 1-Trauma Center.

J Emerg Trauma Shock 2021 Apr-Jun;14(2):92-97. Epub 2021 Apr 27.

Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.

Introduction: We aimed to describe the presentation, classification, and outcome of traumatic adrenal injury in a single Level-1 trauma center.

Methods: A retrospective study was conducted to include all patients identified to have adrenal trauma from 2011 to 2014. Data were retrieved from charts and electronic medical records for all patients with adrenal trauma with a 3-year follow-up for mortality.

Results: A total of 116 patients who were admitted with adrenal injury (12.9% of abdominal trauma and 20% of total solid organ injury admissions) were included in the study, 104 were males and 12 were females. In our population, 86% of adrenal injuries involved the right adrenal gland, 14% in the left, and 12% had bilateral injuries. The majority of associated injuries were rib fractures accounting for 42%, while 37% had associated lung injuries, and 35% had head injuries. As per the American Association for the Surgery of Trauma classification, 46% of adrenal traumas were grade one. Of all adrenal trauma, 25 patients were operated (21%), whereas the majority were admitted to the intensive care unit or surgical ward. Surgical interventions were indicated for associated injury to the bowel, spleen, diaphragm, mesentery, kidneys, or inferior vena cava. One patient underwent angioembolization of the adrenal vessels due to contrast leak. The mortality rate was 14.6%, and no further mortality was reported during a 3-year follow-up. On multivariable analysis, admission systolic blood pressure, Glasgow Coma Scale, and injury severity score were predictors of hospital mortality.

Conclusions: Adrenal injury is not rare and often unilateral with right-sided predominance. Associated injuries influence the clinical findings, management, and outcome. Surgical interventions are rarely required except for few cases of active bleeding. Long-term outcome postadrenal injury is still not well studied.
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http://dx.doi.org/10.4103/JETS.JETS_63_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8312916PMC
April 2021

Clinical characteristics, injury pattern and management of pediatric pelvic fracture: An observational retrospective study from a level I trauma center.

BMC Musculoskelet Disord 2021 Jul 16;22(1):626. Epub 2021 Jul 16.

Clinical Research, Trauma & Vascular Surgery, Department of Surgery, Hamad General Hospital, HMC, Doha, Qatar.

Background: Pediatric pelvic fractures (PPF) are uncommon among children requiring hospitalization after blunt trauma. The present study explored our experience for the prevalence, patients demographics, clinical characteristics, injury pattern and management of pediatric pelvic fractures in a level I trauma center.

Methods: This is a retrospective review of prospectively collected data obtained from trauma registry database for all pediatrics trauma patients of age ≤18 years. Data were analyzed according to different aspects relevant to the clinical applications such as Torode classification for pelvic ring fracture (Type I-IV), open versus closed triradiate cartilage, and surgical versus non-surgical management.

Results: During the study period (3 and half years), a total of 119 PPF cases were admitted at the trauma center (11% of total pediatric admissions); the majority had pelvic ring fractures (91.6%) and 8.4% had an acetabular fracture. The mean age of patients was 11.5 ± 5.7, and the majority were males (78.2%). One hundred and four fractures were classified as type I (5.8%), type II (13.5%), type III (68.3%) and type IV (12.5%). Patients in the surgical group were more likely to have higher pelvis AIS (p = 0.001), type IV fractures, acetabular fractures and closed triradiate cartilage as compared to the conservative group. Type III fractures and open triradiate cartilage were significantly higher in the conservative group (p < 0.05). Patients with closed triradiate cartilage frequently sustained spine, head injuries, acetabular fracture and had higher mean ISS and pelvis AIS (p < 0.01) than the open group. However, the rate of in-hospital complications and mortality were comparable among different groups. The overall mortality rate was 2.5%.

Conclusion: PPF are uncommon and mainly caused by high-impact trauma associated with multisystem injuries. The majority of PPF are stable, despite the underlying high-energy mechanism. Management of PPF depends on the severity of fracture as patients with higher grade fractures require surgical intervention. Furthermore, larger prospective study is needed to understand the age-related pattern and management of PPF.
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http://dx.doi.org/10.1186/s12891-021-04448-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8285877PMC
July 2021

The use of Indocyanine green fluorescent in patients with abdominal trauma for better intraoperative decision-making and less bowel anastomosis leak: case series.

J Surg Case Rep 2021 Jun 16;2021(6):rjab235. Epub 2021 Jun 16.

Trauma Surgery Section, Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar.

Despite technological advances in the management of blunt abdominal trauma, the rate of bowel anastomotic leakage (AL) remains high. The etiology of AL is multifactorial, but insufficient blood perfusion is considered to play a substantial role in the pathogenesis. In recent years, angiography with Indocyanine green (ICG), a fluorescent dye, has been introduced in the clinical practice to assess organ perfusion in several conditions. Given the scarcity of publications describing the use of ICG in trauma patients as a potentially useful strategy that may facilitate intraoperative decisions and limit the extent of bowel resection, we presented the utility of intraoperative ICG fluorescent in abdominal trauma patients in a level 1 trauma center. The use of ICG fluoroscopy in patients with abdominal trauma is feasible and useful; however, large prospective studies in trauma patients are warranted.
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http://dx.doi.org/10.1093/jscr/rjab235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8208799PMC
June 2021

Patterns and Effects of Admission Hyperglycemia and Inflammatory Response in Trauma Patients: A Prospective Clinical Study.

World J Surg 2021 09 11;45(9):2670-2681. Epub 2021 Jun 11.

Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.

Background: The constellation of the initial hyperglycemia, proinflammatory cytokines and severity of injury among trauma patients is understudied. We aimed to evaluate the patterns and effects of on-admission hyperglycemia and inflammatory response in a level 1 trauma center. We hypothesized that higher initial readings of blood glucose and cytokines are associated with severe injuries and worse in-hospital outcomes in trauma patients.

Methods: A prospective, observational study was conducted for adult trauma patients who were admitted and tested for on-admission blood glucose, hemoglobin A1c, interleukin (IL)-6, IL-18 and hs-CRP. Patients were categorized into four groups [non-diabetic normoglycemic, diabetic normoglycemic, diabetic hyperglycemic (DH) and stress-induced hyperglycemic (SIH)]. The inflammatory markers were measured on three time points (admission, 24 h and 48 h). Generalized estimating equations (GEE) were used to account for the correlation for the inflammatory markers. Pearson's correlation test and logistic regression analysis were also performed.

Results: During the study period, 250 adult trauma patients were enrolled. Almost 13% of patients presented with hyperglycemia (50% had SIH and 50% had DH). Patients with SIH were younger, had significantly higher Injury Severity Score (ISS), higher IL-6 readings, prolonged hospital length of stay and higher mortality. The SIH group had lower Revised Trauma Score (p = 0.005), lower Trauma Injury Severity Score (p = 0.01) and lower GCS (p = 0.001). Patients with hyperglycemia had higher in-hospital mortality than the normoglycemia group (12.5% vs 3.7%; p = 0.02). A significant correlation was identified between the initial blood glucose level and serum lactate, IL-6, ISS and hospital length of stay. Overall rate of change in slope 88.54 (95% CI:-143.39-33.68) points was found more in hyperglycemia than normoglycemia group (p = 0.002) for IL-6 values, whereas there was no statistical significant change in slopes of age, gender and their interaction. The initial IL-6 levels correlated with ISS (r = 0.40, p = 0.001). On-admission hyperglycemia had an adjusted odds ratio 2.42 (95% CI: 1.076-5.447, p = 0.03) for severe injury (ISS > 12) after adjusting for age, shock index and blood transfusion.

Conclusions: In trauma patients, on-admission hyperglycemia correlates well with the initial serum IL-6 level and is associated with more severe injuries. Therefore, it could be a simple marker of injury severity and useful tool for patient triage and risk assessment.

Trial Registration: This study was registered at the ClinicalTrials.gov (Identifier: NCT02999386), retrospectively Registered on December 21, 2016. https://clinicaltrials.gov/ct2/show/NCT02999386 .
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http://dx.doi.org/10.1007/s00268-021-06190-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8321976PMC
September 2021

Patterns, Management, and Outcome of Traumatic Femur Fracture: Exploring the Experience of the Only Level 1 Trauma Center in Qatar.

Int J Environ Res Public Health 2021 05 31;18(11). Epub 2021 May 31.

Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar.

Background: Femur is the most fractured long bone in the body that often necessitates surgical fixation; however, data on the impact of the mechanism of injury (MOI), age, and timing of intervention are lacking in our region of the Arab Middle East. We aimed to describe the patterns, management, and outcome of traumatic femoral shaft fractures.

Methods: A retrospective descriptive observational study was conducted for all trauma patients admitted with femoral shaft fractures between January 2012 and December 2015 at the only level 1 trauma center and tertiary hospital in the country. Data were analyzed and compared according to the time to intervention (intramedullary nailing; IMN), MOI, and age groups. Main outcomes included in-hospital complications and mortality.

Results: A total of 605 hospitalized cases with femur fractures were reviewed. The mean age was 30.7 ± 16.2 years. The majority of fractures were unilateral (96.7%) and 91% were closed fractures. Three-fourths of fractures were treated by reamed intramedullary nailing (rIMN), antegrade in 80%. The pyriform fossa nails were used in 71.6% while trochanteric entry nails were used in 28.4%. Forty-five (8.9%) fractures were treated with an external fixator, 37 (6.1%) had conservative management. Traffic-related injuries occurred more in patients aged 14-30 years, whereas fall-related injuries were significantly higher in patients aged 31-59. Thirty-one patients (7.8%) had rIMN in less than 6 h post-injury, 106 (25.5%) had rIMN after 6-12 h and 267 (66.8%) had rIMN after more than 12 h. The implant type, duration of surgery, DVT prophylaxis, in-hospital complications, and mortality were comparable among the three treatment groups.

Conclusions: In our center, the frequency of femoral fracture was 11%, and it mainly affected severely injured young males due to traffic-related collisions or falls. Further multicenter studies are needed to set a consensus for an appropriate management of femur fracture based on the MOI, location, and timing of injury.
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http://dx.doi.org/10.3390/ijerph18115916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8198965PMC
May 2021

Utility of Angioembolization in Patients with Abdominal and Pelvic Traumatic Bleeding: Descriptive Observational Analysis from a Level 1 Trauma Center.

Ther Clin Risk Manag 2021 19;17:333-343. Epub 2021 Apr 19.

Department of Surgery, Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar.

Background: Massive bleeding is a major preventable cause of early death in trauma. It often requires surgical and/or endovascular intervention. We aimed to describe the utilization of angioembolization in patients with abdominal and pelvic traumatic bleeding at a level 1 trauma center.

Methods: We conducted a retrospective analysis for all trauma patients who underwent angioembolization post-traumatic bleeding between January 2012 and April 2018. Patients' data and details of injuries, angiography procedures and outcomes were extracted from the Qatar national trauma registry.

Results: A total of 175 trauma patients underwent angioembolization during the study period (103 for solid organ injury, 51 for pelvic injury and 21 for other injuries). The majority were young males. The main cause of injury was blunt trauma in 95.4% of the patients. The most common indication of angioembolization was evident active bleeding on the initial CT scan (contrast pool or blushes). Blood transfusion was needed in two-third of patients. The hepatic injury cases had higher ISS, higher shock index and more blood transfusion. Absorbable particles (Gelfoam) were the most commonly used embolic material. The overall technical and clinical success rate was 93.7% and 95%, respectively, with low rebleeding and complication rates. The hospital and ICU length of stay were 13 and 6 days, respectively. The median injury to intervention time was 320 min while hospital arrival to intervention time was 274 min. The median follow-up time was 215 days. The overall cohort mortality was 15%.

Conclusion: Angioembolization is an effective intervention to stop bleeding and support nonoperative management for both solid organ injuries and pelvic trauma. It has a high success rate with a careful selection and proper implementation.
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http://dx.doi.org/10.2147/TCRM.S303518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064722PMC
April 2021

Complications following chest tube insertion pre-and post-implementation of guidelines in patients with chest trauma: A retrospective, observational study.

Int J Crit Illn Inj Sci 2020 Oct-Dec;10(4):189-194. Epub 2020 Dec 29.

Department of Trauma Surgery, Hamad General Hospital, Doha, Qatar.

Background: The need to evacuate the chest after a penetrating wound was first recognized in the 18 century. Most thoracic injuries are treated with tube thoracostomy (TT) which refers to the insertion of a TT into the pleural cavity to drain air, blood, pus, or other fluids. However, TT has been challenged in the trauma care due to insertional, positional, or infective complications.

Methods: A retrospective study of all trauma patients who had TT insertion from 2008 to 2014 was conducted based on the trauma registry data to describe patient characteristics, injury characteristics, management, and outcomes. The complication incidences per TT before (2008) and after (2009-2014) the implementation of standard protocol were compared.

Results: During the study period, 804 patients were managed with 1004 TT procedures. The mean age was 34 years, and majority (91%) was males. Motor vehicle crash (43%) was the main mechanism of injury. Mean injury severity score was 22. The rib fractures (68%) were more frequent followed by pneumothorax (49%). Nearly 72% of patients received antibiotic coverage before insertion. The complications developed per TT reduced over the years from 2008 to 2014 (12.6% to 4.4%). The average complication per TT after the protocol implementation (2009-2014) reduced by 7% when compared to the duration before implementation (2008).

Conclusions: The present study shows that standardized management of trauma patients who undergo TT results in a reduction in complications, helps improve patient flow, and ensures the proper management of resources in our high-volume trauma center.
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http://dx.doi.org/10.4103/IJCIIS.IJCIIS_98_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033205PMC
December 2020

Clinical implications of serum myoglobin in trauma patients: A retrospective study from a level 1 trauma center.

Int J Crit Illn Inj Sci 2020 Oct-Dec;10(4):170-176. Epub 2020 Dec 29.

Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.

Background: We aimed to study the clinical implication of high serum myoglobin levels in trauma patients.

Methods: A retrospective analysis was conducted on data from trauma patients who were admitted to a level 1 trauma center between January 2012 and December 2015. A receiver operating characteristic (ROC) curve analysis was performed for the optimum myoglobin cutoff plotted against hospital length of stay of >1 week. Patients were divided into two groups (Group 1; low vs. Group 2; high myoglobin), and a comparative analysis was performed.

Results: There were 898 patients who met the inclusion criteria with a mean age of 35.9 ± 14.6 years. Based on ROC, the myoglobin optimum cutoff was 1000 ng/ml (64% of patients were in Group 1 and 36% in Group 2). The mean myoglobin level was 328 ng/ml in patients with the Injury Severity Score (ISS) <15 versus 1202 ng/ml in patients with ISS ≥15 ( < 0.001). Patients in Group 2 had higher ISS (22.2 ± 10 vs. 18.8 ± 10), more musculoskeletal injuries (18.3% vs. 4.2%), more blood transfusion (74% vs. 39%), intubation (57% vs. 46.5%), and sepsis (12% vs. 7.3%). The length of hospital stays was significantly higher in Group 2, but mortality was comparable. High myoglobin levels had a crude odd ratio 2.41; 95% confidence interval (1.470-3.184) for a longer hospital stay with a positive predictive value of 89% and a specificity of 77%.

Conclusions: One-third of the admitted trauma patients have elevated serum myoglobin level, which is associated with the prolonged hospital stay. The discriminatory power of myoglobin value of 1000 in trauma is fair, and further prospective assessments are needed.
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http://dx.doi.org/10.4103/IJCIIS.IJCIIS_71_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033204PMC
December 2020

Platelet to Lymphocyte Ratio Associated with Prolonged Hospital Length of Stay Postpeptic Ulcer Perforation Repair: An Observational Descriptive Analysis.

Biomed Res Int 2021 9;2021:6680414. Epub 2021 Mar 9.

Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar.

Background: The predictive role of platelet to lymphocyte ratio (P/LR) in patients with perforated peptic ulcer (PPU) is not well-studied. We aimed to investigate the association between the P/LR ratio and the hospital length of stay (HLOS) for surgically treated PPU.

Method: This is a retrospective observational study for surgically treated adult cases of PPU at Hamad Medical Corporation during the period from January 2012 to August 2017. Patients were categorized into two groups based on their HLOS (I week). The receiver operating characteristic (ROC) curve was plotted to determine the cutoff value for lymphocyte count, neutrophil to lymphocyte ratio, and P/LR ratio for predicting the prolonged hospitalization.

Results: One hundred and fifty-two patients were included in the study. The majority were young males. The mean age was 38.3 ± 12.7 years. Perforated duodenal ulcer (139 patients) exceeded perforated gastric ulcer (13 patients). The HLOS > 1 week was observed in 14.5% of cases. Older age ( = 0.01), higher preoperative WBC ( = 0.03), lower lymphocyte count ( = 0.01), and higher P/LR ratio ( = 0.005) were evident in the HLOS > 1 week group. The optimal cutoff value of P/LR was 311.2 with AUC 0.702 and negative predictive value of 93% for the prediction of prolonged hospitalization. Two patients died with a mean P/LR ratio of 640.8 ± 135.5 vs. 336.6 ± 258.9 in the survivors.

Conclusion: High preoperative P/LR value predicts prolonged HLOS in patients with repaired perforated peptic ulcer. Further larger multicenter studies are needed to support the study findings.
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http://dx.doi.org/10.1155/2021/6680414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969085PMC
May 2021

Prediction of in-hospital mortality in patients on mechanical ventilation post traumatic brain injury: machine learning approach.

BMC Med Inform Decis Mak 2020 12 14;20(1):336. Epub 2020 Dec 14.

Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar.

Background: The study aimed to introduce a machine learning model that predicts in-hospital mortality in patients on mechanical ventilation (MV) following moderate to severe traumatic brain injury (TBI).

Methods: A retrospective analysis was conducted for all adult patients who sustained TBI and were hospitalized at the trauma center from January 2014 to February 2019 with an abbreviated injury severity score for head region (HAIS) ≥ 3. We used the demographic characteristics, injuries and CT findings as predictors. Logistic regression (LR) and Artificial neural networks (ANN) were used to predict the in-hospital mortality. Accuracy, area under the receiver operating characteristics curve (AUROC), precision, negative predictive value (NPV), sensitivity, specificity and F-score were used to compare the models` performance.

Results: Across the study duration; 785 patients met the inclusion criteria (581 survived and 204 deceased). The two models (LR and ANN) achieved good performance with an accuracy over 80% and AUROC over 87%. However, when taking the other performance measures into account, LR achieved higher overall performance than the ANN with an accuracy and AUROC of 87% and 90.5%, respectively compared to 80.9% and 87.5%, respectively. Venous thromboembolism prophylaxis, severity of TBI as measured by abbreviated injury score, TBI diagnosis, the need for blood transfusion, heart rate upon admission to the emergency room and patient age were found to be the significant predictors of in-hospital mortality for TBI patients on MV.

Conclusions: Machine learning based LR achieved good predictive performance for the prognosis in mechanically ventilated TBI patients. This study presents an opportunity to integrate machine learning methods in the trauma registry to provide instant clinical decision-making support.
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http://dx.doi.org/10.1186/s12911-020-01363-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737377PMC
December 2020

Maturation process and international accreditation of trauma system in a rapidly developing country.

PLoS One 2020 10;15(12):e0243658. Epub 2020 Dec 10.

Trauma Surgery, Hamad General Hospital, Doha, Qatar.

Background: As trauma systems mature, they are expected to improve patient care, reduce in-hospital complications and optimize outcomes. Qatar has a single trauma center, at the Hamad General Hospital, which serves as the hub for the trauma system that was verified as a level 1 trauma system by the Accreditation Canada International Distinction program in 2014. We hypothesized that this international accreditation was a major step, in the maturation process of the Qatar trauma system, that has positively impacted patient care, reduced complications and improved outcomes of trauma patients in such a rapidly developing country.

Methods: A retrospective analysis of data was conducted for all trauma patients who were admitted between 2010 and 2018. Data were obtained from the level 1 trauma center registry at Hamad Medical Corporation. Patients were divided into Group 1- pre-accreditation (admitted from January 2010 to October 2014) and Group 2- post-accreditation (admitted from November 2014 to December 2018). Patients' characteristics and in-hospital outcomes were analyzed and compared. Data included patients' demographics; injury types, mechanism and injury severity scores, interventions, hospital stay, complications and mortality (pre-hospital and in-hospital). Time series analysis for mortality was performed using expert modeler.

Results: Data from a total of 15,864 patients was collected and analyzed. Group 2 patients had more severe injuries in comparison to Group 1 (p<0.05). However, Group 2, had a lower complication rate (ventilator associated pneumonia (VAP)) and a shorter mean hospital length of stay (p<0.05). The overall mortality was 8%. In Group 2; the pre-hospital mortality was higher (52% vs. 41%, p = 0.001), while in-hospital mortality was lower (48% vs. 59%) compared to Group 1 (p = 0.001).

Conclusions: The international recognition and accreditation of the trauma center in 2014 was the key factor in the maturation of the trauma system that improved the in-hospital outcomes. Accreditation also brought other benefits including a reduction in VAP and hospital length of stay. However, further studies are required to explore the maturation process of all individual components of the trauma system including the prehospital setting.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243658PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728290PMC
January 2021

Patterns, management, and outcomes of traumatic pelvic fracture: insights from a multicenter study.

J Orthop Surg Res 2020 Jul 9;15(1):249. Epub 2020 Jul 9.

Trauma & Vascular Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar.

Background: Traumatic pelvic fracture (TPF) is a significant injury that results from high energy impact and has a high morbidity and mortality.

Purpose: We aimed to describe the epidemiology, incidence, patterns, management, and outcomes of TPF in multinational level 1 trauma centers.

Methods: We conducted a retrospective analysis of all patients with TPF between 2010 and 2016 at two trauma centers in Qatar and Germany.

Results: A total of 2112 patients presented with traumatic pelvic injuries, of which 1814 (85.9%) sustained TPF, males dominated (76.5%) with a mean age of 41 ± 21 years. In unstable pelvic fracture, the frequent mechanism of injury was motor vehicle crash (41%) followed by falls (35%) and pedestrian hit by vehicle (24%). Apart from both extremities, the chest (37.3%) was the most commonly associated injured region. The mean injury severity score (ISS) of 16.5 ± 13.3. Hemodynamic instability was observed in 44%. Blood transfusion was needed in one third while massive transfusion and intensive care admission were required in a tenth and a quarter of cases, respectively. Tile classification was possible in 1228 patients (type A in 60%, B in 30%, and C in 10%). Patients with type C fractures had higher rates of associated injuries, higher ISS, greater pelvis abbreviated injury score (AIS), massive transfusion protocol activation, prolonged hospital stay, complications, and mortality (p value < 0.001). Two-thirds of patients were managed conservatively while a third needed surgical fixation. The median length of hospital and intensive care stays were 15 and 5 days, respectively. The overall mortality rate was 4.7% (86 patients).

Conclusion: TPF is a common injury among polytrauma patients. It needs a careful, systematic management approach to address the associated complexities and the polytrauma nature.
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http://dx.doi.org/10.1186/s13018-020-01772-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344030PMC
July 2020

Using trauma registry data to predict prolonged mechanical ventilation in patients with traumatic brain injury: Machine learning approach.

PLoS One 2020 8;15(7):e0235231. Epub 2020 Jul 8.

Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar.

Objectives: We aimed to build a machine learning predictive model to predict the risk of prolonged mechanical ventilation (PMV) for patients with Traumatic Brain Injury (TBI).

Methods: This study included TBI patients who were hospitalized in a level 1 trauma center between January 2014 and February 2019. Data were analyzed for all adult patients who received mechanical ventilation following TBI with abbreviated injury severity (AIS) score for the head region of ≥ 3. This study designed three sets of machine learning models: set A defined PMV to be greater than 7 days, set B (PMV > 10 days) and set C (PMV >14 days) to determine the optimal model for deployment. Patients' demographics, injury characteristics and CT findings were used as predictors. Logistic regression (LR), Artificial neural networks (ANN) Support vector machines (SVM), Random Forest (RF) and C.5 Decision Tree (C.5 DT) were used to predict the PMV.

Results: The number of eligible patients that were included in the study were 674, 643 and 622 patients in sets A, B and C respectively. In set A, LR achieved the optimal performance with accuracy 0.75 and Area under the curve (AUC) 0.83. SVM achieved the optimal performance among other models in sets B with accuracy/AUC of 0.79/0.84 respectively. ANNs achieved the optimal performance in set C with accuracy/AUC of 0.76/0.72 respectively. Machine learning models in set B demonstrated more stable performance with higher prediction success and discrimination power.

Conclusion: This study not only provides evidence that machine learning methods outperform the traditional multivariate analytical methods, but also provides a perspective to reach a consensual definition of PMV.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235231PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343348PMC
September 2020

Prediction of in-hospital mortality in patients with post traumatic brain injury using National Trauma Registry and Machine Learning Approach.

Scand J Trauma Resusc Emerg Med 2020 May 27;28(1):44. Epub 2020 May 27.

Department of Surgery, Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar.

Background: The use of machine learning techniques to predict diseases outcomes has grown significantly in the last decade. Several studies prove that the machine learning predictive techniques outperform the classical multivariate techniques. We aimed to build a machine learning predictive model to predict the in-hospital mortality for patients who sustained Traumatic Brain Injury (TBI).

Methods: Adult patients with TBI who were hospitalized in the level 1 trauma center in the period from January 2014 to February 2019 were included in this study. Patients' demographics, injury characteristics and CT findings were used as predictors. The predictive performance of Artificial Neural Networks (ANN) and Support Vector Machines (SVM) was evaluated in terms of accuracy, Area Under the Curve (AUC), sensitivity, precision, Negative Predictive Value (NPV), specificity and F-score.

Results: A total of 1620 eligible patients were included in the study (1417 survival and 203 non-survivals). Both models achieved accuracy over 91% and AUC over 93%. SVM achieved the optimal performance with accuracy 95.6% and AUC 96%.

Conclusions: for prediction of mortality in patients with TBI, SVM outperformed the well-known classical models that utilized the conventional multivariate analytical techniques.
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http://dx.doi.org/10.1186/s13049-020-00738-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251921PMC
May 2020

Clinical Presentation and Surgical Treatment of Retrosternal Goiter: A Case Series Study.

Qatar Med J 2020 4;2020(1):13. Epub 2020 May 4.

Clinical Research, Trauma & Vascular Surgery Section, Hamad General Hospital (HGH), Doha, Qatar.

The retrosternal goiter (RSG) is a slow-growing mass often benign in nature; thyroidectomy remains the preferred standard curative treatment. This study aimed to explore the local experience of RSG with respect to the clinical presentation, classifications, management, and outcomes. A retrospective chart review was conducted to include all cases diagnosed with RSG and underwent thyroidectomy between January 1998 and December 2013. A total of 1210 patients underwent thyroidectomy; of which 30 (2.5%) patients were diagnosed to have RSG. The commonly reported symptoms were dyspnea (40%), pain and discomfort (30%), dysphagia (26.7%), and hoarseness (20%). Thirteen patients (43.3%) were completely asymptomatic. The fine-needle aspiration cytology was performed in 22 (73.3%) patients, of whom the majority was benign (77.3%). The grading classification showed that grade 1 is the most frequent (73.3%). Total bilateral thyroidectomy was the most prevailing procedure in 57% cases followed by partial thyroidectomy. All patients underwent retrosternal thyroidectomy through a cervical incision except for one case. Postoperative histopathology showed frequent benign multinodular goiter (83.3%), followed by papillary thyroid cancer (10%) and thyroiditis (6.7%). The most common complication after thyroidectomy was tracheomalacia (13.4%), transient hypocalcemia (10%), and hypoparathyroidism (6.7%). There was no intraoperative or perioperative mortality. RSG is a rare entity often presented with pressure symptoms, mostly involving anterior mediastinum and had a challenging surgical procedure. A large multicenter study is needed to include more cases in order to have a consensus on the definition and classification system for such important clinical goiter presentation.
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http://dx.doi.org/10.5339/qmj.2020.13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7198470PMC
May 2020

Traumatic Kidney Injury: An Observational Descriptive Study.

Urol Int 2020 17;104(1-2):148-155. Epub 2019 Dec 17.

Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar.

Background: Trauma is a major cause of death and disability worldwide. Renal injuries account for 8-10% of abdominal trauma. We aimed to describe the incidence, presentation, and management of traumatic kidney injury in our institution.

Methods: This is a retrospective analysis of all patients admitted with traumatic kidney injury at a level 1 trauma center between January 2014 and December 2017.

Results: During a period of 3 years, a total of 152 patients with blunt renal trauma were admitted to a level 1 trauma center; 91% of these were males, with a mean age of 32.8 ± 13.7 years. Motor vehicle crashes accounted for 68% of cases, followed by fall from height (23%). Seventy-one percent of patients had associated chest injuries, 38% had pelvis injuries, and 32% had head injury. Associated abdominal injuries included the liver (35%) and spleen (26%). The mean abdominal abbreviated injury scale was 2.8 ± 1.0; and for those with severe renal injury, it was 3.9 ± 0.9. The mean injury severity score was 24.9 ± 13.7 (31.8 ± 14.2 with renal vs. 21.9 ± 12.9 without renal injury, p = 0.004). Most of the patients were treated conservatively (93%), including severe renal injuries (grades IV and V), and 7% had surgical exploration, mainly those with severe injuries (grades IV and V). The mortality rate was 11%.

Conclusions: High-grade renal injuries in hemodynamically stable patients can be managed conservatively. A multidisciplinary approach coordinated by trauma, urology, and radiology services facilitates the care of these patients in our trauma center.
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http://dx.doi.org/10.1159/000504895DOI Listing
February 2021

The FASILA Score: A Novel Bio-Clinical Score to Predict Massive Blood Transfusion in Patients with Abdominal Trauma.

World J Surg 2020 04;44(4):1126-1136

Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.

Background: Early identification of patients who may need massive blood transfusion remains a major challenge in trauma care. This study proposed a novel and easy-to-calculate prediction score using clinical and point of care laboratory findings in patients with abdominal trauma (AT).

Methods: Patients with AT admitted to a trauma center in Qatar between 2014 and 2017 were retrospectively analyzed. The FASILA score was proposed and calculated using focused assessment with sonography in trauma (0 = negative, 1 = positive), Shock Index (SI) (0 = 0.50-0.69, 1 = 0.70-0.79, 2 = 0.80-0.89, and 3 ≥ 0.90), and initial serum lactate (0 ≤ 2.0, 1 = 2.0-4.0, and 2 ≥ 4.0 mmol/l). Outcome variables included mortality, laparotomy, and massive blood transfusion (MT). FASILA was compared to other prediction scores using receiver operating characteristics and areas under the curves. Bootstrap procedure was employed for internal validation.

Results: In 1199 patients with a mean age of 31 ± 13.5 years, MT, MT protocol (MTP) activation, exploratory laparotomy (ExLap), and hospital mortality were related linearly with the FASILA score, Injury Severity Score, and total length of hospital stay. Initial hemoglobin, Revised Trauma Score (RTS), and Trauma Injury Severity Score (TRISS) were inversely proportional. FASILA scores correlated significantly with the Assessment of Blood Consumption (ABC) (r = 0.65), Revised Assessment of Bleeding and Transfusion (RABT) (r = 0.63), SI (r = 0.72), RTS (r = - 0.34), and Glasgow Coma Scale (r = - 0.32) and outperformed other predictive systems (RABT, ABC, and SI) in predicting MT, MTP, ExLap, and mortality.

Conclusions: The novel FASILA score performs well in patients with abdominal trauma and offers advantages over other scores.
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http://dx.doi.org/10.1007/s00268-019-05289-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223809PMC
April 2020

Shock index in patients with traumatic solid organ injury as a predictor of massive blood transfusion protocol activation.

Inj Epidemiol 2019 7;6:41. Epub 2019 Oct 7.

Department of Surgery, Trauma & Vascular Surgery, HGH, Doha, Qatar.

Purpose: We aimed to assess the utility of shock index (SI) to predict the need for massive transfusion protocol (MTP) in patients with solid organ injury (SOI) in a Level 1 Trauma center.

Methods: We conducted a retrospective analysis for patients with SOI between 2011 and 2014. Patients were categorized according to on-admission SI into low (< 0.8) and high SI (≥0.8) group.

Results: A total of 4500 patients were admitted with trauma, of them 572 sustained SOIs (289 patients had SI ≥0.8). In comparison to low SI, patients with high SI were younger, had higher injury severity scores (ISS) and lower Trauma and Injury Severity Score (TRISS); ( < 0.001). The proportion of exploratory laparotomy (EXLap), blood transfusion (BT), MTP activation, sepsis and hospital mortality were significantly higher in patients with high SI. Serum lactate ( = 0.34), hematocrit ( = - 0.34), ABC score ( = 0.62), ISS ( = 0.35), and amount of transfused blood ( = 0.22) were significantly correlated with SI. On multivariable regression analysis using 9 relevant variables (age, sex, ISS, ED GCS, serum lactate, hematocrit, Abdomen AIS and Focused assessment with sonography in trauma (FAST) and SI), SI ≥ 0.8 was an independent predictor of BT (OR 2.80; 95%CI 1.56-4.95) and MTP (OR 2.81;95% CI 1.09-7.21) .

Conclusions: In patients with SOI, SI is a simple bedside predictor for BT and MTP activation. Further prospective studies are needed to support our findings.
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http://dx.doi.org/10.1186/s40621-019-0218-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6778976PMC
October 2019

Evolution of The Qatar Trauma System: The Journey from Inception to Verification.

J Emerg Trauma Shock 2019 Jul-Sep;12(3):209-217

Department of Surgery, Universidad Nacional Pedro Henriquez Urena, School of Medicine, Santo Domingo, Dominican Republic.

Traumatic injuries accounted for substantial burden of morbidity and mortality (M and M) worldwide. Despite better socioeconomic conditions and living standards, the incidence of trauma is rising in the Eastern Mediterranean Region (EMR). Road traffic injuries are the leading cause of the high fatality rate in young economically productive adults in our region. The provision of trauma care at high-volume, accredited trauma center by a team of dedicated full-time professional health-care providers has been shown to improve the quality of care and the outcomes for trauma victims. With persistent hard work and effective leadership, in Qatar, the Trauma Section has evolved into a well-reputed and internationally recognized Center of Excellence in Trauma Care, Hamad Level 1 Trauma Center. In 2014, Qatar Trauma System was accredited with Trauma Distinction Award by the Accreditation Canada International, for high-quality trauma care of severely injured patients; first in the Middle East. The Hamad Trauma Center is committed to the advancement of trauma care in different aspects right from the immediate prehospital care to the subsequent hospital-based care, involving diagnosis, treatment, support, rehabilitation, and community reintegration of the patients and injury prevention. Our trauma system has gradually embedded with a structured and matured research unit with dedicated clinicians and academic researchers. The trauma team embodies the 21-century paradigm of translational research and injury prevention by going well beyond the bedside, out into the populations that need it most. The trauma system's future vision relies on the evidence-based health-care service and better outcomes; state-of-the-art infrastructure and multidimensional collaborations with health care and governmental services to minimize the burden of M and M caused by traumatic injury in the State of Qatar and to fulfill the population health enhancement strategy.
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http://dx.doi.org/10.4103/JETS.JETS_56_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735200PMC
September 2019

Traumatic sternal injury in patients with rib fracture: A single-center experience.

Int J Crit Illn Inj Sci 2019 Apr-Jun;9(2):75-81

Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.

Purpose: We aimed to assess the pattern and impact of sternal injury with rib fracture in a Level 1 trauma center.

Patients And Methods: We conducted a retrospective review of trauma registry data to identify patients who presented with sternal fracture between 2010 and 2017. Data were analyzed and compared in patients with and without rib fracture.

Results: We identified 212 patients with traumatic sternal injury, of them 119 (56%) had associated rib fractures. In comparison to those who had no rib fracture, patients with rib fractures were older (40.1 ± 13.6 vs. 37.8 ± 14.5), were frequently involved in traffic accidents (75% vs. 71%), had higher chest abbreviated injury scale (AIS 2.8 ± 0.6 vs. 2.2 ± 0.5) and Injury Severity Score ( ISS 17.5 ± 8.6 vs. 13.3 ± 9.6), were more likely to be intubated (33% vs. 19%), required chest tube insertion (13.4% vs. 4.3%), and received blood transfusion (29% vs. 17%). Rates of spine fracture, head injury, and solid organ injury were comparable in the two groups. Manubrium, clavicular and scapular fractures, lung contusion, hemothorax, and pneumothorax were significantly more evident in those who had rib fractures. Hospital length of stay was prolonged in patients with rib fractures ( = 0.008). The overall mortality was higher but not statistically significant in patients with rib fractures (5.0% vs. 3.2%).

Conclusions: Sternal fractures are rare, and detection of associated injuries requires a high index of suspicion. Combined sternal and rib fractures are more evident in relatively older patients after chest trauma. This combination has certain clinical implications that necessitate further prospective studies.
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http://dx.doi.org/10.4103/IJCIIS.IJCIIS_67_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625325PMC
July 2019

Bicycle-related traumatic injury hospitalizations: six years descriptive analysis in Qatar.

J Inj Violence Res 2019 Jul 7;11(2):233-242. Epub 2019 Jul 7.

Department of Surgery, Trauma Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.

Background: Bicycle riding is a widely practiced mode of transportation, commuting, competition, fitness and recreation. We aimed to describe the incidence, risk factors and outcomes of Bicycle-Related Traumatic Injury (BRTI) in a Middle Eastern country.

Methods: Data were extracted from a prospectively collected trauma registry over a period of six years (2010- 2015) from the national trauma center. Demographics and clinical characteristics of patients, and outcomes were analyzed.

Results: There were 150 patients with a mean age of 27.2±16.6 years, 98% were males, 86.6% were hit by a car and 8.7% died. The average annual incidence of BRTIs was 1.3 per 100,000 populations. The mean Glasgow Coma Score (GCS) and injury severity score (ISS) were12.7±4.0 and 13.6±9.8; respectively. Almost one-third of cases had an ISS of 9-15. The most commonly injured region was the head (47%) followed by a lower extremity (30%), chest (25%), upper extremity (21.3%), spine (20.7%), abdomen (18.7%) and (7%) pelvis.

Conclusions: BRTI is relatively uncommon in Qatar; however, it is characterized by a distinct epidemiology with a considerable mortality. Young male nationals, recreational cyclists and expatriate young commuter cyclists comprise the majority of victims and should be the focus of primary prevention efforts. Complementary prevention should aim at enforcing helmet laws to reduce fatal head injuries, and educating motorists of safer practices around cyclists.
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http://dx.doi.org/10.5249/jivr.v11i2.1162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6646826PMC
July 2019

Prognostic Role of Shock Index in Traumatic Pelvic Fracture: A Retrospective Analysis.

J Surg Res 2019 11 3;243:410-418. Epub 2019 Jul 3.

Department of Surgery, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar.

Background: We aimed to validate the utility of shock index (SI) in predicting the need of blood transfusion and outcomes in patients with traumatic pelvic fracture (TPF).

Materials And Methods: We conducted a retrospective analysis for patients who sustained TPF between 2012 and 2016 in a level 1 trauma center. Patients were categorized into patients with low versus high SI based on the cutoff obtained from the receiver operating characteristic curves to predict mortality.

Results: A total of 966 patients sustained TPF (28.5% had SI ≥ 0.9 based on receiver operating characteristic curves) with a median age of 33 (IQR 25-47) y. Type B and C pelvic fractures significantly had higher SI. The frequency of blood transfusion use was greater in patients with high SI (P = 0.001). SI correlated significantly with Injury Severity Score (r = 0.32), Revised Trauma Score (r = -0.40), and transfused blood units (r = 0.35). Patients with high SI had prolonged hospital length of stay and higher mortality (P = 0.001). SI ≥ 0.9 showed high sensitivity and negative predictive value to identify the need of massive blood transfusion (77% and 86%, respectively) and mortality (73.5% and 98.1%, respectively). For hospital mortality, high SI had a sensitivity of 73.5%, specificity 74%, negative predictive value 98%, and negative likelihood ratio of 0.36. After adjustment for age, sex, Injury Severity Score, Glasgow Coma Scale, pelvis Abbreviated Injury Scale, blood transfusion, and Tile classification, the multivariate analysis models showed that high SI was an independent predictor of blood transfusion (odd ratio 5.6) and mortality (odd ratio 3.63).

Conclusions: SI is a potentially useful instant tool for the prediction of massive transfusion and mortality in patients with TPF. Further prospective studies are warranted to support our findings.
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http://dx.doi.org/10.1016/j.jss.2019.05.062DOI Listing
November 2019

Prehospital administration of tranexamic acid in trauma patients: A 1:1 matched comparative study from a level 1 trauma center.

Am J Emerg Med 2020 02 30;38(2):266-271. Epub 2019 Apr 30.

Department of Surgery, Trauma Surgery, HGH, Doha, Qatar.

Purpose: The purpose of this study was to test the efficacy of prehospital administration of tranexamic acid (TXA) to injured patients on mortality, thromboembolic events and need for blood transfusion in a level 1 trauma center.

Methods: We conducted a retrospective study comparing adult trauma patients receiving or not receiving prehospital TXA between January 2017 and September 2018. Patients not receiving TXA but transfused within 4 h of admission were 1:1 matched to TXA-treated patients for age, sex, injury severity score, head abbreviated injury score, prehospital heart rate and systolic blood pressure.

Results: In total 204 patients were included (102 TXA and 102 control), with a mean age of 31 years. On admission, shock index (p = 0.03) and serum lactate (p = 0.001) were greater in the control group, whereas the initial base deficit, hemoglobin levels and EMS time were comparable in both groups. The odd ratio (OR) for shock index ≥0.9 after TXA administration was 0.44 (95% CI 0.23-0.84). The median amount of blood transfusion was greater in the control group [eight units (range 1-40) vs three (range 0-40), p = 0.01] as well as the use of massive blood transfusion [OR 0.35 (95% CI 0.19-0.67)]. In the TXA group, VTE was higher [OR 2.0 (95% CI 0.37-11.40)]; whereas the overall mortality was lower [OR 0.78 (95% CI 0.42-1.45)] without reaching statistical significance.

Conclusions: Prehospital TXA administration is associated with less in-hospital blood transfusion and massive transfusion protocol (MTP). There is no significant increase in the thromboembolic events and mortality, however, further evaluation in larger clinical trials is needed.
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http://dx.doi.org/10.1016/j.ajem.2019.04.051DOI Listing
February 2020

Clinical Presentation and Management of Pelvic Morel-Lavallee Injury in Obese Patients.

J Emerg Trauma Shock 2019 Jan-Mar;12(1):40-47

Department of Surgery, Trauma Surgery, HGH, Doha, Qatar.

Introduction: Morel-Lavallee lesion (MLL) is an infrequent or underreported serious consequence of closed degloving injuries. We aimed to describe the clinical presentation and management of pelvic MLL in obese patients.

Materials And Methods: A retrospective analysis was conducted for pelvic trauma patients with a diagnosis of MLL between 2010 and 2012. Patients' demographics, presentations, management, and outcomes were analyzed and compared based on the body mass index (BMI) and injury severity.

Results: Of 580 patients with pelvic region injuries, 183 (31.5%) had MLL with a mean age of 30.1 ± 12.2 years. The majority (75.4%) of MLL patients had a BMI ≥30 and 44% patients had pelvic fracture. Based on the initial clinical examination, MLL was diagnosed in 84% of patients and clinically missed in 16% of patients. Nonoperative management (NOM) was performed in 93.4% of patients, while primary surgical intervention was indicated in 6.6% of patients. Failed NOM was observed in seven cases, of them five were obese. The overall mortality in MLL patients was 12.6% and the frequency of deaths was nonsignificantly higher in Grade I obese patients. Multivariate analysis showed that injury severity score (odds ratio [OR]: 1.25, 95% confidence interval [CI]: 1.05-1.50) and Glasgow coma scale (OR: 0.72, 95% CI: 0.56-0.92) were the predictors of mortality in patients with MLL irrespective of BMI.

Conclusions: One-third of pelvic region injuries have MLL and three-quarter of them are obese. This significant association of obesity and MLL needs further prospective evaluation.
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http://dx.doi.org/10.4103/JETS.JETS_37_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6496989PMC
May 2019

Review of Existing Scoring Systems for Massive Blood Transfusion in Trauma Patients: Where Do We Stand?

Shock 2019 09;52(3):288-299

Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.

Background: Uncontrolled bleeding is the main cause of the potential preventable death in trauma patients. Accordingly, we reviewed all the existing scores for massive transfusion posttraumatic hemorrhage and summarized their characteristics, thus making it easier for the reader to have a global view of these scores-how they were created, their accuracy and to which population they apply.

Methods: A narrative review with a systematic search method to retrieve the journal articles on the predictive scores or models for massive transfusion was carried out. A literature search using PubMed, SCOPUS, and Google scholar was performed using relevant keywords in different combinations. The keywords used were "massive transfusion," "score," "model," "trauma," and "hemorrhage" in different combinations. The search was limited for full-text articles published in English language, human species and for the duration from January 1, 1998 to November 30, 2018.

Results: The database search yielded 295 articles. The search was then restricted to the inclusion criteria which retrieved 241 articles. Duplicates were removed and full-texts were assessed for the eligibility to include in the review which resulted in inclusion of 24 articles. These articles identified 24 scoring systems including modified or revised scores. Different models and scores for identifying patients requiring massive transfusion in military and civilian settings have been described. Many of these scorings were complex with difficult calculation, while some were simple and easy to remember.

Conclusions: The current prevailing practice that is best described as institutional or provider centered should be supplemented with score-based protocol with auditing and monitoring tools to refine it. This review summarizes the current scoring models in predicting the need for MT in civilian and military trauma. Several questions remain open; i.e., do we need to develop new score, merge scores, modify scores, or adopt existing score for certain trauma setting?
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http://dx.doi.org/10.1097/SHK.0000000000001359DOI Listing
September 2019

Blunt liver trauma: a descriptive analysis from a level I trauma center.

BMC Surg 2018 Jun 19;18(1):42. Epub 2018 Jun 19.

Department of surgery, Trauma Surgery section, Hamad General Hospital (HGH), Doha, Qatar.

Background: We aimed to review liver injury experience in a level 1 trauma center; namely clinical presentation, grading, management approach and clinical outcomes.

Methods: It is a retrospective analysis to include all blunt liver injury patients who were admitted at the Level 1 trauma center over a 3-year period. Data were compared and analyzed based on the liver injury grades and management approaches.

Results: Blunt liver injury accounted for 38% of the total blunt abdominal trauma cases with a mean age of 31 ± 13 years. Liver injury grade II (44.7%) was most common followed by grade I (28.8%), grade III (19.1%), grade IV (7.0%) and grade V (0.4%). Blood transfusion was more frequently required in patients with grade IV (p = 0.04). Out of 257 patients with blunt liver trauma, 198 were initially treated conservatively, that was successful in 192 (97%), whereas it failed in 6 (3%) patients due to delayed bleeding from hepatic hematoma, associated splenic rupture and small bowel injury which mandate surgical intervention. Fifty-nine patients (23%) underwent emergent surgery in terms of packing, resection debridement, left lobe hepatectomy and splenectomy. Hepatic complications included biloma, pseudoaneurysm and massive liver necrosis. Subanalysis of data using the World Society of Emergency Surgery (WSES) classification revealed 19 patients were categorized as a WSES grade IV who needed surgical intervention without having an initial computerized tomography scanning. The overall mortality was 7.8% which was comparable among the conservative and operative group.

Conclusions: In our center, low grade liver injury in young males prevails. NOM is successful even for high graded injuries. All conservatively treated patients with high-grade liver injuries should be closely monitored for signs of failure of the non-operative management. Introducing the new WSES classification makes clear how is important the hemodynamic status of the patients despite the lesion. However, further larger prospective and multicenter studies are needed to support our findings.
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http://dx.doi.org/10.1186/s12893-018-0369-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6006727PMC
June 2018

Blunt traumatic injury during pregnancy: a descriptive analysis from a level 1 trauma center.

Eur J Trauma Emerg Surg 2019 Jun 27;45(3):393-401. Epub 2018 Mar 27.

Department of Surgery, Trauma Surgery, Hamad General Hospital, P.O Box 3050, Doha, Qatar.

Purpose: The precise incidence of trauma in pregnancy is not well-known, but trauma is estimated to complicate nearly 1 in 12 pregnancies and it is the leading non-obstetrical cause of maternal death.

Methods: A retrospective study of all pregnant women presented to national level 1 trauma center from July 2013 to June 2015 was conducted. Descriptive and inferential statistics applied for data analysis.

Results: Across the study period, a total of 95 pregnant women were presented to the trauma center. The average incidence rate of traumatic injuries was 250 per 1000 women of childbearing age presented to the Hamad Trauma Center. The mean age of patients was 30.4 ± SD 5.6 years, with age ranging from 20 to 42 years. The mean gestational age at the time of injury was 24.7 ± 8.7 weeks which ranged from 5 to 37 weeks. The majority (47.7%) was in the third trimester of the pregnancy. In addition, the large majority of injuries was due to MVCs (74.7%) followed by falls (15.8%).

Conclusions: Trauma during pregnancy is not an uncommon event particularly in the traffic-related crashes. As it is a complex condition for trauma surgeons and obstetrician, an appropriate management protocol and multidisciplinary team are needed to improve the outcome and save lives of both the mother and fetus.
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http://dx.doi.org/10.1007/s00068-018-0948-1DOI Listing
June 2019

Home-related falls: An underestimated mechanism of injury.

J Family Community Med 2018 Jan-Apr;25(1):48-51

Department of Surgery, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar.

Background: The home is a leading location for falls, but the epidemiology and outcome of falls at home (FH) have not been adequately described. Our aim was to evaluate FH, particularly in the bathroom.

Materials And Methods: We conducted a retrospective analysis of patients with a history of FH admitted to the Level I trauma center in Qatar. Patients were divided into Group 1: <60 years and Group 2: 60 year or older, and their data were analyzed and compared.

Results: A total of 98 patients with FH in the bathroom with a mean age of 51 ± 18 years, mostly males (73.5%) were identified over 3 years. One out of every 50 trauma patients admitted was a victim of a fall in the bathroom. Group 2 had significantly more females and sustained a single-site injury. Group 1 had more involvement of alcohol ( = 0.02) and sustained more multiple injuries (44% vs. 23%; = 0.02). The mean Injury Severity Score and length of hospital stay was comparable among the two groups. Head, abdomen, and facial injuries were significantly higher in Group 1 whereas lower extremity injuries and mortality were significantly higher in Group 2.

Conclusion: FH, particularly in the bathroom, is an underrecognized mechanism of injury with a unique dichotomous epidemiology based on age. This needs increased public awareness and primary prevention programs for high-risk populations.
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http://dx.doi.org/10.4103/jfcm.JFCM_148_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774043PMC
February 2018
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