Burden of Chest trauma, Perspective of Nepal and SAARC (South Asia) Region Way forward for rib fixation surgery in the region

Transcription

1 Burden of Chest trauma, Perspective of Nepal and SAARC (South Asia) Region Way forward for rib fixation surgery in the region Dr. Ram Prasad Shrestha, MD, MS, FICS, FCSS Dr. Tej Dawadi, MS Date: March 19 th, 2016

2 The South Asia The South Asian Association for Regional Cooperation (SAARC), a contiguous block of countries Established in 1985 Initially seven countries Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan and Sri Lanka. In 2006 extended by including Afghanistan as an eighth member. China and Myanmar have also applied for the status of full members of SAARC

3 Population of The South Asia Country Population 1 Bangladesh 152,518 2 Bhutan 697,000 3 India 1,210,193,422 4 Maldives 396,334 5 Nepal 26,620,080 6 Pakistan 180,440,000 7 Sri Lanka 20,277,597 8 Afghanistan 29,159,000 Total 1,626,000,000

4 Injury related mortality in south Asia Pattern of injury Frequency (%) RTA 18 Self inflicted 15 Fires 11 Falls 7 Violence 7 drowning 6 poisoning 6 War 1 Other unintentional 29 Source: WHO, Geneva, Global Burden of Disease Study (2004 update)

5 Road traffic death in SA Country Estimated road traffic death rate / 100,000 pop. Bangladesh 12.6 Bhutan 14.4 India 16.8 Maldives 18.3 Nepal 15.1 Sri Lanka 13.5

6 Spectrum of Chest trauma in Nepal and SA

7 TRAUMA / CHEST TRAUMA Trauma : * 3 rd leading cause of death * 9% of total mortality Jha N, Agrawal CS. Epidemiological study of road traffic accident: A study from eastern Nepal. WHO Regional Health Forum. 2004; 8:15 22

8 Chest Trauma 15% of surgical trauma cases 1 Common in males * 80 : 20% 2 * 73 : 27% 3 1) Spectrum of surgical trauma and associated head injuries at a university hospital in eastern NepalA Bajracharya, A Agrawal, BR Yam, CS Agrawal, and Owen Lewis. J Neurosci Rural Pract Jan-Jun; 1(1): ) Analysis of Blunt Chest Trauma Cases Requiring Admission in a Tertiary Care Level Hospital of Nepal. Robin Man Karmacharya, Hemanta Batajoo, Sumita Pradhan, Yagya Ratna Shakya, Bibhushan Shrestha. International Journal of Health Sciences and Research (IJHSR) 3) Profile of thoracic injury at College of Medical Sciences Teaching Hospital D Chapagain,1 D Jayapal Reddy,2 S Shah,3 K G Shrestha.3 Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1

9 Topographical variation TRAUMA / CHEST TRAUMA Mode of injury 1. Terai: RTA 1 2. Hill: Fall from height 2 1) Profile of thoracic injury at College of Medical Sciences Teaching Hospital D Chapagain,1 D Jayapal Reddy,2 S Shah,3 K G Shrestha.3 Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1, ) Analysis of Blunt Chest Trauma Cases Requiring Admission in a Tertiary Care Level Hospital of Nepal. Robin Man Karmacharya, Hemanta Batajoo, Sumita Pradhan, Yagya Ratna Shakya, Bibhushan Shrestha. International Journal of Health Sciences and Research (IJHSR)

10 Eastern Nepal experience, a study in parameters 1848 patients frequency Hemothorax 16.2% Pneumothorax 8.1% # Rib alone 51.1% # Rib with Hemothorax 5.8% Flail chest 3.4% Title: Spectrum of surgical trauma and associated head injuries at a university hospital in eastern Nepal Author: A Bajracharya, A Agrawal, BR Yam, CS Agrawal, and Owen Lewis. Published: J Neurosci Rural Pract Jan-Jun; 1(1): 2 8.

11 Experience in Mid Terai region of Nepal: a study in 100 thoracic injury cases parameters Rib # 83% Hemothorax 57% Pneumothorax 33% Flail chest 9% Frequency Title: Profile of thoracic injury at College of Medical Sciences Teaching Hospital, Bharatpur, Chitawan,Nepal Author: D Chapagain,1. D Jayapal Reddy, 2. S Shah, 3. K G Shrestha. Published : Journal of College of Medical Sciences-Nepal, 2013, Vol-9,No-1, 30-39

12 Spectrum of chest trauma Title: Analysis of Blunt Chest Trauma Cases Requiring Admission in a Tertiary Care Level Hospital of Nepal. Author: Robin Man Karmacharya, Hemanta Batajoo, Sumita Pradhan, Yagya Ratna Shakya, Bibhushan Shrestha. Published: International Journal of Health Sciences and Research (IJHSR)

13 Experience from Central India A study of Total # of trauma patient patients 1,408 total # of Chest injury 402 (29%) Parameter frequency Multiple rib # 52.2% Two Rib # 15.1% Single rib # 9.9% Pneumo / Hemothorax 12.4% Flail chest 7.7% Title: Pattern of chest injuries in fatal vehicular accidents in central india (at PGIMS, Rohtak) Author: Dr. P Murkey, Dr. N Nagrale, Dr. B Tirpude, Dr. P Wankhade, Dr. S Patond The Internet Journal of Surgery Volume 18 Number 1.

14 Experience from India: University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India Total 105 patients of chest injuries Parameters frequency Fracture ribs 46.6% Pneumothorax 46.6% Haemothorax 42% Subcutaneous emphysema 42% Hemo-pneumothorax 34.2% Flail Chest 13.3% Title: Experiences with chest trauma: Where do we stand today Author: M. Mohta, P. Kumar, A. Mohta*, R. Bhardwaj, A. Tyagi, A. K. Sethi Published: Indian J Crit Care Med January-March 2006 Vol 10 Issue 1

15 A Pakistan experience Total chest trauma cases 143 Blunt Injury 87.4 % Penetrating injury 12.6% Rib # 74% Mgt. Thoracostomy 45% Ventilator support 11.8% Title: Thoracic trauma: presentation and management outcome. Author: Saaiq M, Shah SA Coll Physians Surg Pak.2008 Apr;18(4): doi: /JCPSP

16 A Taiwan experience A prospective study of 1333 patients admitted to the Department of Thoracic surgery 6% of all trauma comprises Thoracic Trauma 36.3% requiring ICU treatment But accounts for up to 50% of trauma related death 1.5% is the flail chest rate Factors associated with ICU admission in patients with traumatic thoracic injury Journal of International Medical research: : 1310 Author: Frank Cheau-Feng Lin et al

17 Commonalities Chest trauma are in increasing trend In Hill areas causative factors are fall RTA are in plain and urban areas Male preponderance Prevalence are seen from years of age

18 Current status in management Supportive care Analgesics Pain O2 + Ventilators Respiratory support Tube Thoracostomy Thoracotomy Surgery

19 The management of Pain Oral analgesics- NSAIDS, IV analgesics Inter-coastal Nerve root block Epidurals analgesia

20 Interventional treatment ICU admitted 46% - significantly correlated with mortality (p<0.05) Ventilator support 11% Tube thoracostomy 45% Thoracotomy 4% Flail chest - 9% - only O2 3% - ventilator with IPPV 6% Title: Profile of thoracic injury at College of Medical Sciences Teaching Hospital Author: D Chapagain,1 D Jayapal Reddy,2 S Shah,3 K G Shrestha.3 Published: Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1

21 Rib fixation surgery Around AD, wiring used to be done at TUTH, Nepal Left out due to wire breakage and migration problems

22 At MMTH Rib Fixation surgery The initial experience Case 1- Kanchhi Tamang

23 Case 1- Kanchhi Tamang

24 Case 2- Saraswoti Neupane

25 The team

26 FUTURE OF RIB SURGERY IN NEPAL (and in South Asia) Number of patients with chest trauma are growing Till now, by and large, non-surgical management Long hospital stay and ventilator dependency High Morbidity and Mortality rate Initial experience in MMTH ( in south asia) is highly encouraging Recent meet of SAARC Surgical care society in Dhaka and personal discussion (Dr. Shrestha) with the regional surgeons found to be encouraged and excited in adopting the technology in the region It is a needed and viable option of treatment in Nepal and in the region

27 Consideration for technology transfer in the region 3 Aspects to be considered: Expertise Implants and instruments Cost of Surgery Workshop Seminar Training Availability Marketing Manufacturing From own pocket Insurance Subsidy

28 RPS