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Biomedical subjects

B R Selecki

Publications and source records attributed to B R Selecki.

At least 19 recordsLinked to original sources
PubMed1986

Preventable causes of death and disability from neurotrauma.

Preventable causes of death and disability have been studied retrospectively in a series of 1161 cases of neurotrauma occurring in New South Wales in 1977-78, and prospectively in 153 cases of neurotrauma occurring in country districts in South Australia in 1981-82. In the first study, it was found that at least 80 deaths could be attributed to preventable causes; chiefly, transfer to an inappropriate hospital and/or delay in instituting treatment. Apparent failures in initial management of shock and airway obstruction were evident in this study and also in the South Australian study, which identified major deficiencies in cardiorespiratory management in 7% of cases transferred from country areas. These studies confirm that there is a need for better training, at all levels, in the management of neurotrauma. They also provide powerful arguments for the concept of an integrated regional trauma service.

Australia↗
PubMed1986

Epidemiology and clinical outcomes of neurotrauma in New South Wales.

This study of 1161 neurotrauma patients in New South Wales hospitals was designed to examine the role of preventable causes of death and disability in cases of spinal injury, extradural, subdural and multiple intracranial haematomas in order to make recommendations for improvements in accident, emergency, ambulance and hospital services. Methods have been developed for standardizing diagnosis in different classes of hospital for the assessment of severity in terms of the patient's age, sex, physical signs, head and spine injuries and other injuries. Estimates have been made of the number of preventable deaths by a case control study of each category of neurotrauma under study.

Adolescent↗
PubMed1986

Experience with spinal injuries in New South Wales.

Two hundred and two patients with acute and severe spinal injuries were treated in various hospitals in New South Wales during 1977 and 1978. Of these, 132 (65%) were cervical, 60 (30%) thoracic, eight (4%) lumbar and two were inadequately recorded. A major concurrent injury to the head was present in every third patient, to the chest in every fourth patient, and to the limbs in every fifth patient. The outcomes of patients reported in this series make it one of the worst in the literature. Sixty-nine (34%) patients died in hospital; of the 133 survivors, only 22 (11%) have resumed work, the remainder being partially or totally disabled. It is estimated that another 302 patients died before arrival in hospital. In country areas, the time lags between accident and ambulance notification, and between notification and arrival at hospital, were uncertain in many cases, but periods in excess of 2 hours were recorded in 28 (14%). One-man ambulances or private vehicles were used in at least 43 cases (21%). After admission, 139 patients were transferred to other hospitals for definitive treatment, arriving after an average time of 22 h (median time 9 h); for such patients, the original hospital presumably served as a first aid station. A case control study suggests that preventable delay in transport, inappropriate treatment, and failure to correct shock may have been causative factors in 16 deaths in this series. Reduction of the time lag between accident and institution of definitive treatment will save lives, and may avoid some crippling neurological deficits.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents↗
PubMed1986

Logistics of early management of head and spinal injuries.

The logistics of early management have been studied in a series of 1161 patients with head and/or spinal injuries, who were admitted to hospital in NSW in 1977-78. Special attention has been given to three subgroups: 336 head injuries with records of impaired consciousness before first hospital admission, 355 head injuries later transferred because of deterioration, and 202 serious spinal injuries. It was found that in at least 18% of unconscious head injuries, and a similar percentage of spinal injuries, first aid and transport to hospital were provided by ambulances recorded to have only one trained staff member. In country areas, 41% of unconscious head injuries reached hospital after periods of time exceeding 1 h. For administrative as well as geographic reasons, more than 80% of initially unconscious head injuries and spinal injuries were first admitted to hospitals without neurosurgical and/or spinal services; the majority of cases in both groups, therefore, had to be transferred to other hospitals, often within 6 h of first admission. In the subgroup of cases transferred because of deterioration, mortality increased with distance from a neurosurgical unit. These findings are related to the concept of an integrated regional trauma service.

Ambulances↗
PubMed1984

Neurosurgical management of spinal conditions--an overview.

During 1977-80 the annual number of surgical procedures on the spinal canal and discs has remained in the vicinity of 1800-1900 and fusions have ranged from 682 to 810. Neurosurgical participation in spinal surgery amounted to 18-20% of all spinal procedures. Disc lesion, canal stenosis, spondylosis, congenital and developmental malformations constituted 70% of the total spinal work carried out in a major neurosurgical unit in New South Wales. The above conditions form an 'overlapping' field of surgery, the orthopaedic surgeons treating an estimated 80% of these patients. Surgical management by neurosurgeons and orthopaedic surgeons of the same clinical category of spinal patient is different. An estimated one-third of orthopaedic patients are submitted to lumbar fusion. Neurosurgeons avoid fusion in the lumbar region. The need for integrated and sound neurosurgical and orthopaedic methods of management in the overlapping fields of spinal surgery has become imperative. To the neurosurgeon, the outcome of spinal surgery in terms of relevance to the extent of chronic spinal disability in the community has probably become more important than the outcome of craniocerebral surgery in the community. More attention should be given to standards of work in spinal surgery in matters of training, research and quality assurance. A research project by members of the Department of Neurosurgery, The Prince Henry and Prince of Wales Hospitals is outlined.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Whiplash. A specialist's view.

Moderate and severe whiplash injury may cause protracted disability. The degree of discomfort and specific damage is difficult to identify and symptoms sometimes can be encouraged by the promise of an insurance settlement.

Accidents, Traffic↗
PubMed1982

Trauma to the central and peripheral nervous systems: Part I: an overview of mortality, morbidity and costs; N.S.W. 1977.

An epidemiological study of neurotrauma in New South Wales, South Australia and the Australian Capital Territory, 1977, was initiated and sponsored by the Neurosurgical Society of Australasia, conducted by its Trauma Subcommittee in collaboration with the Division of Health Services Research, Health Commission of New South Wales, funded by the Australian Brain Foundation and the Commonwealth Department of Health and supported by the Health Commissions of New South Wales and South Australia. The following communication is structured so as to present the essential findings on mortality, morbidity and costs in New South Wales in 1977 in the first part and the more specific statistical profile of surgical treatment in New South Wales, 1977, in a separate, second part. The most revealing data found by this research is that cranio-cerebral and spinal injury was the leading cause of death up to the age of 44 in New South Wales (and South Australia) and up to the age of 49 in the male population and in the country regions. It accounted for 45% of all deaths to those aged 15 to 24. Cranio-cerebral and spinal injury caused 71% of all deaths on the roads. Sixty-four per cent of those dying in road accidents never reached hospital. The figures for mortality and morbidity in the country regions were significantly worse than those in the metropolitan regions. The most important causes were identified and recommendations aimed at reducing this record were formulated.

Accidents, Traffic↗
PubMed1982

Trauma to the central and peripheral nervous systems. Part II: A statistical profile of surgical treatment New South Wales 1977.

The epidemiological aspects of the mortality, morbidity and the costs of neurotrauma in New South Wales 1977 were outlined in Part I of this report. Part II outlines the profile of surgical work in this field in New South Wales in 1977. In all, 21,973 patients were admitted to New South Wales Hospitals in 1977 for neurotraumatic conditions (85% with head, 13% with spinal and 2% with peripheral nerve injuries); and 1,513 patients required surgery (49% with head, 22% with spinal and 29% with peripheral nerve injuries). The profile of surgery for disc disease is outlined. The participation of neurosurgeons in the management of neurotrauma is assessed.

Adolescent↗
PubMed1979

Retrospective survey of neurotraumatic admissions to a teaching hospital: comparison of data on spinal injuries after 10 to 16 years.

A retrospective survey of 202 patients with spine and cord injuries who were treated in the Prince Henry Hospital and the Prince of Wales Hospital from January, 1960, to December, 1965, was published in 1968. Ten years later, 98 patients with spine and cord injuries who were admitted over a two-year period (January, 1975, to December, 1976) were similarly studied. The data of the two surveys were compared, and changes in clinical and epidemiological features were evaluated.

Adolescent↗
PubMed1979

Severe injuries to the cervical cord and spine: neurosurgical management in the acute and early stage.

The controversy of long standing in the management of cervical cord and spine injury in the acute stage ranges from an attitude of neurosurgical nihilism on the one hand, to indiscriminate, incompetent and routine "explorative" or "diagnostic" laminectomies on the other. Judicious neurosurgical management in the acute stage tends to overcome and eliminate the ill-advised extreme attitudes by careful neurological and neuroradiological diagnostic assessment. The indications and contraindications for surgical treatment are carefully weighed in each case and are based on neurosurgical criteria and experience. This communication is a summary of methods and experience evolved in the diagnostic and surgical management in the acute stage. Indications, contraindications and techniques are presented in detail.

Acute Disease↗
PubMed1978

Retrospective survey of neurotraumatic admissions to a teaching hospital: comparison of data on head injuries after 10 to 16 years.

A retrospective survey of 1100 patients with head, spine, and cord injuries who were treated in The Prince Henry Hospital, and The Prince of Wales Hospital, Sydney, from January, 1960, to December, 1965, was published in The Medical Journal of Australia during 1967 and 1968. The present series of admissions from January, 1975, to December, 1976 comprises 179 head injury patients. The epidemiological data related to head injuries and specified in the two series are compared in the available details. The pattern of change in the structure of neurosurgical services is evaluated in relation to the ever-increasing neurological trauma on the roads of New South Wales. Growing numbers of patients with serious head injuries are treated in district and country hospitals in areas where neurosurgical consultative services cannot be obtained. The standards of treatment of these patients are unknown, and cannot be evaluated. The need for planning for better standards of care in district and country hospitals is stressed. A permanent system of statistical monitoring of all neurotrauma across the State is advocated. Organization of permanent postgraduate training courses in the management of acute neurotraumatic admissions, readily available to all those treating head injuries in the country hospitals is considered as a basic and imperative requirement.

Accidents, Traffic↗
PubMed1978

Planning for better standards in the care of the neurological sequelae of trauma.

Injuries of the nervous system are common, and cause many deaths and much permanent disability. They inflict an enormous financial burden on the national economy; in Australia, adequate data are at present lacking, but a simple extrapolation from Canadian statistic suggests an estimate of more than $500,000,000 annually for the injuries resulting from road traffic accidents alone; if other causes of injury are included, the figure may reach one billion dollars. The neurosurgeon is specifically trained to undertake the management of all forms of neurological trauma; however, in Australia, and in many other countries, only a small minority of such injuries receive neurosurgical care. This is chiefly because the number of neurosurgeons at present available is small in relation to the tasks. Many cases must therefore be in the care of general or orthopaedic surgeons, especially in country centres, and it is important that these surgeons should have some basic neurosurgical training. The Neurosurgical Society of Australasia wishes to formulate a programme to ensure that opportunities for such training are available throughout Australia. This programme should also embody a national plan for research into the treatment and prevention of neurological trauma.

Accidents, Traffic↗
PubMed1978

Stenotic conditions of the lumbar spinal canal: changes in surgical techniques in the management of low back disability.

The diagnostic recognition of acquired stenotic conditions in the lumbar spinal canal occurring from the fifth to the eighth decades of life had led to a significant change in surgical techniques during the last ten years. This communication presents a comparison of surgical techniques used by the author in two consecutive series of patients operated for low back, lumbosciatic, and spondylotic caudal disability syndromes during the period 1965 to 1969 inclusive (100 patients) and 1976 and 1977 (105 patients). Interlaminar discectomy was carried out in 88%, and laminectomy with spinal nerve nerolysis in 12%, of the 1965 - 1969 series. Discectomy by interlaminar approach was carried out in only 10% of the 1976 - 1977 series; all other patients had laminectomies with or without discectomies. Early follow-up results in the recent series indicate a significant (20%) increase in the number of patients who resumed their previous occupations as compared with those in the previous series.

Aged↗