TORC 2024 Abstracts
Medical Student Poster Abstracts
Comparison of Theatre Efficiency and Training Opportunities in Two Scottish Major Trauma Centres
L Brasnic, E Lindsay, JW Lim, E Tong, S Dalgleish
Background and Aim: It is now five years since the COVID-19 Pandemic and studies have shown that Orthopaedic trainees faced significant reduction in theatre time and operating opportunities (Dattani et al., 2020). The aim of this retrospective study was to evaluate theatre efficiency and surgical training opportunities in two large Major Trauma Centres (MTC) in Scotland (North and East) between 2019 and 2022.
Methods: We retrospectively reviewed all trauma theatre cases in each MTC. Training opportunities and theatre times were identified from CentricityTM Opera and compared. Involvement of three surgical grades (junior trainee, senior trainee and consultant) and theatre efficiency timepoints were analysed using the Kruskall-Wallis test in SPSS, v.27.
Results: In the North, trainee involvement as the main surgeon exhibited significant decline since 2020, with the junior trainees being affected most severely. In the East of Scotland, trainee involvement as the main surgeon increased since 2019, particularly for the senior trainees, but declined in 2022. The average knife-to-skin operating time was similar in both groups (1.31 hours in the East; 1.34 in the North). Duration of surgery, excluding hip surgery, was found to be influenced by the surgeon’s grade (p<0.001). In both centres, theatre efficiency declined in 2020 and is yet to recover. Both MTCs exhibited a vast range of time between the anaesthetic and start of the procedure, the surgical preparation time and case turnover time.
Conclusion: In both MTCs, the pandemic negatively affected theatre efficiency and there remains a huge variation between cases. Trainee involvement as main surgeon has increased since the pandemic, particularly for senior trainees, but remains suboptimal, with a more profound effect in the North of Scotland. Both centres have potential for improvement of theatre efficiency which would result in more trainee operating opportunities and significant financial savings.
Considering the use of the Nottingham Hip Fracture Score in NHS Tayside
I. Ansari, T. Dale MacLaine, J. Littlechild
Background: Patients admitted with hip fractures have almost a 10% 30-day mortality rate. With less than 50% of Scottish hip fracture patients having the ‘Big 6’ completed on admission, it is important to consider appropriate risk stratification. In England, the Nottingham Hip Fracture Score (NFHS) is used as a 30-day mortality predictor. The primary aim of this audit was to assess the use of the NHFS at NHS Tayside.
Methods: We retrospectively collected data for all hip fractures in NHS Tayside between January 2024 and June 2024 from electronic patient records for this audit. Information was collected that fit the data required to calculate a NHFS (Age, Gender, Cognition, Living in an Institution, Number of Co-Morbidities and Malignancy). 4AT was used as an alternative to mini mental state exam, to keep in-line with the Scottish Standards of Care for Hip Fracture Patients.
Results: Full data were extracted from 259 of the 324 (80%) hip fracture patients, with no 4AT recorded for 65 (20%). The mean age was 82 years (SD 10) and 167 (65%) were female. Surgical management consisted of 141 (54%) hemiarthroplasties, 57 (22%) dynamic hip screws, 43 (16%) intramedullary nails, and 18 (7%) total hip replacements. There were 117 (45%) patients who had cognitive impairment, 235 (91%) with >2 comorbidities, 58 (22%) lived in an institution and 70 (27%) had a diagnosis of malignancy recorded. The average NHFS for the whole cohort was 5.5 (SD 1.5). We noted fewer patients had died within 30-days (13 (5%)) than the mean NHFS 30-day predicted mortality of 10.4% (SD 6.5).
Conclusion: Our data suggest that it is possible to use this score in current settings. Further work should explore the validity and cut offs for 4AT in this model and improve the number of cognitive assessments performed in these patients routinely.
Audit of Consultant Led Ward Rounds in Ninewells Hospital, Trauma and Orthopaedics - One Year On
D Yashav, E Tong, E Lindsay, D Nicoll.
Background: There are a number of pressures facing our department and the impending winter is likely to complicate this further. The key to optimum patient care is regular consultant-led ward- rounds, early decision making, clear escalation plans and discharge planning. Our previous audit demonstrated that the average number of ward rounds per week was 1.91 (Range 0-5). The average admission was 23 days. We also demonstrated that consultants who had a less than average weekly ward round (1.84 Vs 1.91) had patients remaining in hospital for longer (32 days).
Aims and Standard: The aim of the second arm of this audit was to further evaluate documentation of Consultant-Led Ward Rounds within our department. The standard set was 100% of inpatients should have a Consultant-Led Ward Round documented at least twice a week.
Method: We retrospectively reviewed all trauma admissions between 1st September 2024- 27th September 2024. Documented Consultant-Led Ward Rounds were identified from the Electronic notes. We included all emergency trauma and excluded elective or day case surgery.
Results: A total of 196 patients under the care of 15 consultants were identified during the study period. 106 patients required operative intervention and 90 were admitted for non-operative management. The average admission was 7 days (range 1 day-28 days). The average number of ward rounds per week during the total study period was 1.5 (Range 0-5), which was lower than our previous audit.
Discussion: There remains significant variation between the number of Consultant-Led Ward Rounds within our department. Whilst all patients are reviewed on admission and post-operatively, overall documented reviews remain suboptimal.
Are the Two- and Three-person Log Rolls Clinically Inferior to the Four-person Technique?
A. Hollis
Introduction/ Background: Most spinal cord injuries (SCIs) occur in low-and-middle income countries (LMICs). In addition, the in-hospital death rate from spinal cord injuries in LMICs is three times greater than that of higher-earning countries. This disproportionally high morbidity and mortality has prompted the exploration of challenges that these countries may face during the management of SCIs and raises the question of whether current guidelines may be adapted to improve patient outcomes. One of the most important factors in SCI management is spinal immobilisation, which can be achieved through employing the log roll. There is limited literature surrounding the log roll and it is not known if it is possible to safely adapt the method from the gold standard four-person technique.
Aim: This study aimed to determine whether the two- and three-person log rolls are clinically inferior to the four-person. The knowledge gained from this study may inform future SCI management in understaffed environments, particularly in LMICs.
Method: Inertial measurement units (IMUs) were attached to six healthy participants’ forehead, chest, and spine. Participants were log rolled by four, three, and two handlers on a static hospital bed. The IMUs recorded the range of motion of the cervical and lumbar regions of the spine, and data were analysed to identify differences between the log roll variations.
Results: There was no statistical difference in the range of motion for the two-, three-, or four-person log rolls, in both the cervical and lumbar regions.
Discussion/ Conclusion: The findings of this study offer a valuable contribution to the literature and evidence base surrounding log rolling and suggest that the two and three-person log rolls are not clinically inferior to the four-person technique. Further research is required to confirm the results of this study and to address a range of remaining clinically relevant questions that were beyond the scope of this initial work.
Is Minimally Assisted Extrication Superior to Self-Extrication After a Motor Vehicle Collision
N.B.Kenny
Background/Aim: Motor vehicle collisions are one of the most common causes of serious injury and death across the globe. This study aimed to add to the evidence base surrounding self-extrication (self-ex) and minimally assisted extrication (min-ex) for spinal immobilisation. It is intended that this research could help to inform best practice guidelines in both developed and developing countries.
Method: Inertial measurement units were attached to six healthy participants’ forehead, chest, and spine and measured the range of motion of the cervical and lumbar regions of the spine during simulated self-ex and min-ex. Trials took place using a model car which had been constructed based on the dimensions of a hatchback common in the UK. Self-ex involved providing verbal instruction but no manual assistance to volunteers as they exited the vehicle. Under the guidance of an emergency medical consultant and following the recommendations of a locally convened mini-consensus group, min-ex involved two personnel assisting the casualty in rotating their lower body out of the footwell, and, grasping the arms to assist with balance during rising from the vehicle. Assistants were advised to help with up to a maximum of 25% of the effort required. Data were analysed to identify differences between the extrication variations.
Results: There was no statistical difference in the range of motion of the cervical or lumbar regions of the spine comparing self-ex to min-ex at group level, and individual participant analyses indicated that some showed a higher range of motion for self-exand some for min-ex.
Conclusion: This study suggests that there may be no difference in spinal motion between self- and minimally assisted extrication from motor vehicles, however further research is required to confirm the results of this study and to address a range of remaining clinically relevant questions that were beyond the scope of this initial work.
An electromyographical assessment of the impact of fatigue on the upper limb in tennis.
Z. Amjad
Introduction and Aim: In tennis, an adverse factor in an athlete’s performance is injury. Numerous studies suggest that fatigue influences muscle activity and thus performance. Application of electromyography (EMG) sensors can measure upper limb muscle activity. The collated data will address the question: Does fatigue in an athlete lead to the use of surrounding muscles to compensate for the primary muscles and thus potentially increase the rate of injury?
Methods: Seventeen participants with competitive tennis experience were recruited, and EMG sensors were placed on the dominant forearm and bicep muscles (palmaris longus, flexor carpi radialis and biceps brachii). Participants performed different tennis shots, including rally and attacking shots. A fatiguing phase then followed, where players performed up to 50 burpees or until visibly fatigued. Post-fatigue, the same shots were repeated. EMG data was analysed using the Wilcoxon Signed Rank Test to detect significant changes in muscle activity. Statistical analysis was conducted using SPSS software.
Results and Discussion: Three out of six muscle trials showed statistically significant increases in activity post-fatigue. The palmaris longus showed significant changes in both rally (Z = -2.438, p = 0.015) and attacking shots (Z = -2.059, p = 0.039), while the flexor carpi radialis showed significant changes in rally shots (Z = -2.438, p = 0.015). These findings suggest that fatigue leads to compensatory muscle activation, particularly in the forearm, which could increase injury risk during tennis playing.
Conclusion: This study demonstrates that fatigue significantly impacts muscle activity in tennis players, leading to the use of surrounding muscles to compensate. This could increase the risk of injury, highlighting the need for further study into the importance of warm-up and injury prevention.