Browsing by Subject "trauma management"

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  • Laaksonen, Topi; Stenroos, Antti; Puhakka, Jani; Kosola, Jussi; Kautiainen, Hannu; Rämö, Lasse; Nietosvaara, Yrjänä (2021)
    Introduction Distal radius is the most common site of fracture in children, comprising 23%-31% of all paediatric fractures. Approximately one-fifth of these fractures are displaced. Completely displaced distal metaphyseal radius fractures in children have traditionally been treated with closed reduction. Recent evidence suggests that correcting the shortening in over-riding distal metaphyseal radius fractures is not necessary in prepubertal children. To date, no published randomised controlled trial (RCT) has compared treatment of these fractures in children by casting the fracture in bayonet position to reduction and pin fixation. Methods and analysis We will conduct an RCT to compare the outcomes of casting the fracture in bayonet position in children under 11 years of age to reduction and percutaneous pin fixation. 60 patients will be randomly assigned to casting or surgery groups. We have two primary outcomes. The first is ratio (injured side/non-injured side) in the total active forearm rotation and the second is ratio (injured side/non-injured side) in total active range of motion of the wrist in the flexion-extension plane at 6 months. The secondary outcomes will include axial radiographic alignment, passive extension of the wrists, grip strength and length of forearms and hands, patient-reported outcome QuickDASH and pain questionnaire PedsQL. Patients not willing to participate in the RCT will be asked to participate in a prospective cohort. Patients not eligible for randomisation will be asked to participate in a non-eligible cohort. These cohorts are included to enhance the external validity of the results of the RCT. Our null hypothesis is that the results of the primary outcome measures in the casting group are non-inferior to surgery group. Ethics and dissemination The institutional review board of the Helsinki and Uusimaa Hospital District has approved the protocol. We will disseminate the findings through peer-reviewed publications. Trial registration number NCT04323410. Protocol V.1.1, 29 September 2020.
  • Rosqvist, Eerika; Ylönen, Marika; Torkki, Paulus; Repo, Jussi P; Paloneva, Juha (2021)
    Objectives This study investigated the costs of 2-hour multiprofessional in situ hospital trauma team simulation training and its effects on teams’ non-technical skills using the T-NOTECHS instrument.Background Simulation is a feasible and effective teaching and learning method. Calculating the costs of simulated trauma team training in medical emergency situations can yield valuable information for improving its overall cost-effectiveness.Design A prospective cohort study.Setting Trauma resuscitation room in Central Finland Hospital, Finland.Participants 475 medical professionals in 81 consecutive, simulated trauma teams.Primary and secondary outcome measures Team simulation training costs in 2017 and 2018 were analysed in the following two phases: (1) start-up costs and (2) costs of education. Primary outcome measures were training costs per participant and training costs per team. Secondary outcome measures were non-technical skills, which were measured on a 5–25-point scale using the T-NOTECHS instrument.Results The annual mean total costs of trauma team simulation training were €58 000 for 40 training sessions and 238 professionals. Mean cost per participant was €203. Mean cost per team was €1220. The annual costs of simulation training markedly decreased when at least 70–80 teams participated in the training. Mean change in T-NOTECHS score after simulation training was +2.86 points (95% CI 1.97 to 3.75;+14.5%).Conclusions The greater the number of teams trained per year, the lower the costs per trauma team. In this study, we developed an activity-based costing method to calculate the costs of trauma team simulation training to help stakeholders make decisions about whether to initiate or increase existing trauma team simulation training or to obtain these services elsewhere.Data are available upon reasonable request. Technical appendix and statistical code and data set available from the corresponding author at eerika.rosqvist@ksshp.fi.