The association between remoteness of injury and in-hospital mortality for motor vehicle collision major trauma patients: evidence of survivor bias in an analysis of registry data.

Background: Rural Australians have a higher age adjusted rate of both hospitalisation and death from injury, and this rate increases with increasing remoteness. However, it is uncertain if this is due to an increased incidence of injury or less access to treatment. The aim of this study is to examine the association of remoteness and in-hospital mortality in Major Trauma patients admitted to the Royal Melbourne Hospital.

Case Series of Resuscitative Hysterotomy in Pregnant Trauma Patients Performed in the Emergency Department of a Level One Major Trauma Service.

Objective: To describe the demographics, injury patterns and outcomes of pregnant trauma patients following resuscitative hysterotomy performed in the emergency department.

Methods: A retrospective case series reviewing resuscitative hysterotomies performed in pregnant trauma patients in the emergency department from 1 January 1999, until 30 June 2024.

Results: Three cases of resuscitative hysterotomy were identified.

A retrospective cohort study of Medical Emergency Team events amongst adult trauma patients.

Background: The clinical associations of patient deterioration necessitating a Medical Emergency Team (MET) response have been studied in several types of hospital patient cohorts. However, there is limited information on MET events in the Australasian trauma population.

Methods: A retrospective patient cohort study was conducted through merger of the Royal Melbourne Hospital trauma and MET registries between July 1st, 2018, and December 31st, 2022.

Low falls and inpatient complications increase risk for longer length of stay in older persons admitted following trauma.

Background: Older adults make up 33% of all trauma admissions in Australia despite comprising 17% of the population with rates rising faster for older age groups compared to any other age group. A high proportion of older adults admitted to hospital following trauma are frail and have increased rates of hospital acquired complications, resulting in poorer outcomes as well as increased resource utilisation and cost to the healthcare system. Length of Stay (LOS) is an important outcome for hospitals, contributing to resource utilisation and patient flow.

Epidemiology of injured e-scooter riders at a major trauma service - the who, what, where and when?

Background: E-scooter associated injury patterns are well described, but less is known about the riders. This study describes the epidemiological characteristics of injured riders with the aim of providing information for preventative strategies.

Methods: A retrospective review of prospectively collected data on admissions (2021) and all hospital presentations (2022-2023) to the Royal Melbourne Hospital, due to injury in a rider of an e-scooter.

Evaluating the Implementation of an Occupational Therapy-Led Concussion Clinic Model Into Usual Practice: A Mixed Methods Study.

Objectives: (1) To evaluate the implementation of Australia's first occupational therapy-led concussion clinic model into usual practice by examining acceptability and fidelity among clinicians and service users, and (2) to explore the feasibility of embedding outcome measures into the service to facilitate longer-term clinic evaluation.

Setting And Participants: A large tertiary trauma hospital service in Melbourne, Australia. Participants were patients referred to the concussion clinic and occupational therapists working in the service.

Association between acute pre-injury alcohol use and 12-month health outcomes for survivors of major trauma: A registry-based study.

Introduction: Alcohol is commonly detected in patients presenting to hospital after major trauma and is a key preventable risk factor for injury. While it has been suggested that alcohol intoxication at the time of injury results in worse acute patient outcomes, there is currently limited knowledge on the impact of alcohol on health outcomes following hospital discharge. The aim of this study was to examine the relationship between acute pre-injury alcohol exposure and the self-reported health outcomes of survivors of major trauma 12-months post-injury.

Defining futile and potentially avoidable interhospital trauma transfers.

Purpose: Interhospital transfer of critically injured patients to a major trauma service reduces preventable death in major trauma. Yet some of those transferred die without intervention. These 'futile' interhospital trauma transfers (IHTs), and other potentially avoidable IHTs place enormous stress on families of trauma victims, can delay care, and incur great cost to public health resources.

Photosynthate transfer from an autotrophic orchid to conspecific heterotrophic protocorms through a common mycorrhizal network.

The minute 'dust seeds' of some terrestrial orchids preferentially germinate and develop as mycoheterotrophic protocorms near conspecific adult plants. Here we test the hypothesis that mycorrhizal mycelial connections provide a direct pathway for transfer of recent photosynthate from conspecific green orchids to achlorophyllous protocorms. Mycelial networks of Ceratobasidium cornigerum connecting green Dactylorhiza fuchsii plants with developing achlorophyllous protocorms of the same species were established on oatmeal or water agar before the shoots of green plants were exposed to CO.

Paradigms in trauma laparoscopy for anterior abdominal stab wounds: A scoping review.

Introduction: Anterior abdominal stab wounds (AASW) are a heterogeneous presentation with evolving management over time and heterogenous practice between centres. The aim of this scoping review was to identify, characterise and classify paradigms for trauma laparoscopies for AASW.

Methodology: Studies were screened from Embase, Medline, Scopus, Cochrane Library and Web of Science from 1 January 1947 until 1 January 2023.

Management of acute perianal abscess: is surgeon specialization associated with improved outcomes?

Background: Acute surgical units (ASU) are increasingly being adopted and in our system are staffed by colorectal and non-colorectal general surgeons. This study aims to evaluate whether surgeon specialization was associated with improved outcomes in perianal abscess.

Methods: Patients with perianal abscess admitted to the ASU between 2016 and 2020 were identified from a prospective database and their medical records reviewed.

Venous thromboembolism prophylaxis and related outcomes in patients with traumatic brain injury and prolonged intensive care unit stay.

Traumatic brain injury (TBI) patients with prolonged intensive care unit (ICU) stay are at risk of secondary intracranial haemorrhage (ICH) and venous thromboembolism (VTE). We aimed to study VTE prophylaxis, secondary ICH, and VTE prevalence and outcomes in this population. Retrospective observational study.

Biases in the collection of blood alcohol data for adult major trauma patients in Victoria, Australia.

Background: In-hospital alcohol testing provides an opportunity to implement prevention strategies for patients with high risk of experiencing repeated alcohol-related injuries. However, barriers to alcohol testing in emergency settings can prevent patients from being tested. In this study, we aimed to understand potential biases in current data on the completion of blood alcohol tests for major trauma patients at hospitals in Victoria, Australia.

Acute Colonic Pseudo-obstruction Following Spinal Fixation for Trauma.

Background: Acute colonic pseudo-obstruction (ACPO) is a potentially highly morbid surgical complication. The incidence of ACPO following spinal trauma is unknown, but is likely higher than after elective spinal fusion. The purpose of this study was to establish the incidence of ACPO in patients with major trauma undergoing spinal fusion for unstable thoracic and lumbar fracture, and secondly, to characterize the nature of ACPO in this group, including treatment and complications.

Drug and alcohol intoxication in major trauma: Associations, trends and outcomes over a decade.

Objectives: Drug and alcohol intoxication is common among injured patients altering trauma presentation and characteristics. However, uncertainty exists regarding the effect of intoxication on injury severity, as well as outcomes. The present study aims to provide an update on substance-use patterns and their association with traumatic presentation and outcome within a contemporary Australian context.

Prehospital tourniquet use in civilian extremity trauma: an Australian observational study.

Background: Prehospital tourniquets (PHTQ) for trauma have been shown to be safe and effective in the military environment and in some civilian settings. However, the supporting civilian data are mostly from North America with a differing case mix and trauma system and may not be applicable to the Australian environment. The aim of this study is to describe our initial experience with PHTQ from safety and efficacy viewpoints.

An algorithm for the management of traumatic abdominal wall hernia based on a 9-year review.

Background: Traumatic abdominal wall hernia (TAWH) is a rare consequence of blunt abdominal trauma, usually in the setting of multitrauma, with little consensus or guidelines for management. We present a case series of patients with traumatic herniae over a 9-year period and a suggested management algorithm.

Method: Retrospective review of all patients with TAWH from 1st January 2011 to 31st December 2019 at a Level 1 adult Major Trauma Centre.

Inorganic phosphorus nutrition in green-leaved terrestrial orchid seedlings.

Background And Aims: Many terrestrial orchids have an obligate dependence on their mycorrhizal associations for nutrient acquisition, particularly during germination and early seedling growth. Though important in plant growth and development, phosphorus (P) nutrition studies in mixotrophic orchids have been limited to only a few orchid species and their fungal symbionts. For the first time, we demonstrate the role of a range of fungi in the acquisition and transport of inorganic P to four phylogenetically distinct green-leaved terrestrial orchid species (Diuris magnifica, Disa bracteata, Pterostylis sanguinea and Microtis media subsp.

Quality of care was not compromised during the COVID-19 pandemic at a level 1 trauma centre.

Background: The COVID-19 pandemic has had a profound effect on the presentation and management of trauma at the Royal Melbourne Hospital, a level 1 adult major trauma service and a designated COVID-19 hospital. This study compares the changes in epidemiology and trauma patient access to emergency imaging and surgery during the pandemic response.

Methods: The population of interest was all trauma patients captured in the hospital's trauma registry from 16 March 2016 to 10 September 2020.

Delayed ileostomy closure increases the odds of Clostridium difficile infection.

Aim: A diverting ileostomy is typically performed to divert intestinal contents in high-risk colorectal anastomoses. Ileostomy closure is associated with high rates of postoperative Clostridium difficile infection (CDI). Risk factors for the development of CDI are unclear; however, a correlation has been observed with delayed closure.

Threat of COVID-19 impacting on a quaternary healthcare service: a retrospective cohort study of administrative data.

Objectives: The threat of a pandemic, over and above the disease itself, may have significant and broad effects on a healthcare system. We aimed to describe the impact of the SARS-CoV-2 pandemic (during a relatively low transmission period) and associated societal restrictions on presentations, admissions and outpatient visits.

Design: We compared hospital activity in 2020 with the preceding 5 years, 2015-2019, using a retrospective cohort study design.