PubMed Health⌕ Search

Biomedical subjects

Belinda J Gabbe

Publications and source records attributed to Belinda J Gabbe.

At least 19 recordsLinked to original sources
PubMed2007

Ladders revisited.

OBJECTIVE: To describe the epidemiology of falls from ladders in a state-wide population. DESIGN AND SETTING: Retrospective review of data from the the Victorian State Trauma Registry and the Victorian Emergency Minimum Dataset on patients presenting to public hospital emergency departments (EDs) with injuries due to a fall while climbing a ladder, from 1 July 2001 to 30 June 2005. MAIN OUTCOME MEASURES: Overall trends in the incidence of ladder-related ED presentations, and in cases of major trauma, trends according to age, and trends according to activity at the time of the fall. RESULTS: 4553 patients presented to EDs after falls from ladders in Victoria during the study period; 160 patients had injuries classified as major trauma. There has been a significant rise in the number of presentations to EDs following falls from ladders in Victoria, with a marked increase in the number of cases involving patients aged over 50 years and those climbing ladders outside of paid working conditions. Deaths occurred predominantly in the elderly after falls from heights above 1 metre. CONCLUSIONS: Despite knowledge of the dangers of falls from ladders, there has been a significant increase in the number of patients presenting to hospitals after ladder falls. Middle-aged to elderly patients undertaking unpaid work account for this increase. A targeted public health initiative is required to curb this trend.

Accidental Falls↗
PubMed2006

Assessing outcomes in paediatric trauma populations.

INTRODUCTION: Assessing outcomes in the paediatric trauma population is important. Identifying suitable instruments can be problematic. This article highlights the commonly used outcome measures for assessing functional status and health related quality of life in paediatric trauma patients. Child specific characteristics which impact upon instrument development and selection are reviewed. METHODS: An electronic database search was conducted to identify suitable English language measures used for outcome assessment in paediatric trauma patients from 1966 to present. RESULTS: Nine suitable instruments were identified, the child health questionnaire (CHQ), Glasgow outcome scale (GOS), paediatric overall performance category (POPC), PedsQL 4.0 generic core scales, paediatric evaluation of disability inventory (PEDI), functional independence measure (FIM), WeeFIM and an unnamed paediatric trauma specific measure [Gofin R, Hass T, Adler B, The development of disability scales for childhood and adolescent injuries. J Clin Epidemiol 1995;48:977-84]. Each instrument was found to have advantages and disadvantages for assessing outcomes in a paediatric trauma population. CONCLUSION: The PedsQL 4.0 generic core scale could be feasible for administration as a routine outcome measure for paediatric trauma groups. For very young children an additional measure such as that proposed by Gofin et al. [Gofin R, Hass T, Adler B, The development of disability scales for childhood and adolescent injuries. J Clin Epidemiol 1995;48:977-84] may be indicated. Future use of these instruments in the paediatric population would benefit from further psychometric evaluation.

Adolescent↗
PubMed2006

The importance of quality of survival as an outcome measure for an integrated trauma system.

Risk-adjusted survival rates have been the principle mode of comparison between trauma systems. In mature trauma systems, it is possible that there will be further improvements in survival but these are likely to be small. In the future, the largest gains will come from quality of life and improved function of the survivors. The issues related to measuring quality of survival for trauma systems are reviewed, including feasibility, ethical considerations, risk adjustment of outcomes of survivors, and challenges for selection of instruments and administration. In addition, the preliminary experiences of measuring outcomes in survivors through the Victorian State Trauma Registry are discussed. Although function and quality of life have been identified as important factors to measure in trauma populations, a standardised protocol has not been established. The experience in Victoria suggests that monitoring of population-based outcomes in survivors is feasible and may create the basis for benchmarking the level of morbidity in survivors.

Australia↗
PubMed2006

Measuring quality in trauma care.

For use in quality measurement, a quality indicator (QI) must satisfy a number of criteria: there needs to be an established link with outcome; the indicator needs to measure what is considered current accepted practice; the targeted population requires precise definition; an appropriate risk adjustment strategy must be employed; the indicator should be feasible for collection; and, the measure must apply to a sufficient number of people so as to provide a measure of system-wide quality. This article discusses the use of QIs in the care of trauma patients. A series of QIs were originally promulgated by the American College of Surgeons Committee on Trauma (ACSCOT) and have been investigated for their utility in measuring quality in trauma systems by a number of US based studies. While some have advocated the implementation of several specific indicators, others have recommended discontinued use of a range of proposed QIs. This review highlights the difficulties of meeting these ideal indicator requirements in trauma care and proposes that the development of alternative indicators may provide more useful measures of quality care.

Humans↗
PubMed2006

Is there an association between self-reported warm-up behaviour and golf related injury in female golfers?

Golfing injuries have been shown to occur frequently, and injury countermeasures have been suggested to help reduce injury risk. Performing an appropriate warm-up is thought to reduce injury risk, however there is a lack of evidence to support this notion. Therefore this study aimed to investigate the relationships between warm-up participation and injury in a cohort of female golfers. A total of 522 golfers participating in the Victorian Women's Pennant Competition completed the study. Over one-third (35.2%) of the golfers reported having sustained a golfing injury within the previous 12 months, with the lower back the most commonly injured region. Most golfers reported not warming-up prior to play or practice. Golfers who reported not warming-up on a regular basis were more likely to have reported a golfing injury in the previous 12 months than those reporting frequent warm-up participation (OR=45.2; 95% CI: 13.5, 151.7). Less skilled golfers were also less likely to report sustaining a golfing injury than more skilled golfers (OR=0.2; 95% CI: 0.1, 0.5). This study is one of the few to establish an association between warm-up participation and injury. Further prospective studies are warranted to determine whether warm-up reduces injury risk for golf participation.

Adolescent↗
PubMed2006

Why are older Australian football players at greater risk of hamstring injury?

INTRODUCTION: Increasing age is a commonly identified predictor of hamstring injury but is not modifiable to reduce injury risk. Why increasing age is a risk factor for hamstring injuries in athletes has not been studied to date. This study aimed to identify potentially modifiable age-related changes that predict hamstring injury in a population of Australian football players. METHODS: One hundred and one young (< or =20 years), and 73 older (> or =25 years), Australian football players, without a history of hamstring injury in the past 12 months were studied prospectively. Players underwent screening of anthropometric, flexibility and lower extremity range of movement tests during the pre-season period and were followed-up for a full season with respect to injury and match participation. Comparisons of the age groups were performed to identify differences related to age. Logistic regression analysis was undertaken to determine whether the observed differences were predictors of hamstring injury. RESULTS: There were significant differences between the age groups with respect to body weight, body mass index, hip flexor flexibility, hip internal rotation and ankle dorsiflexion range of movement. Body weight and hip flexor flexibility were significant independent predictors of hamstring injury in players aged > or =25 years. None of the observed differences were predictors of injury in the younger age group. CONCLUSIONS: There are age-related changes that are potentially modifiable to reduce injury risk in older athletes and these factors should be considered in the development of hamstring injury prevention programs for this high risk group.

Adolescent↗
PubMed2006

Routine follow up of major trauma patients from trauma registries: What are the outcomes?

BACKGROUND: Routine measurement of outcomes other than mortality in trauma is needed to monitor trauma care, benchmark trauma hospitals and systems, and to guide resource provision. Trauma registries are ideally placed to capture morbidity outcomes such as functional loss, disability, and handicap. This study aimed to provide a broad description of the 6-month outcomes of major trauma patients captured by a population-based trauma registry, establish the follow-up rate of registry patients, and determine any biases associated with loss to follow up. METHODS: The Victorian State Trauma Registry (VSTR) is a population-based registry in Victoria, Australia. Major trauma patients captured by the VSTR with a date of injury from October 1, 2003 to September 30, 2004 were followed up at 6 months postinjury by telephone to collect information about their living status, functional levels, and return to work. RESULTS: Of the 1,102 eligible patients, 67% were successfully followed up at 6 months postinjury. Eighteen patients had died since discharge. Patients lost to follow up were less severely injured (p = 0.004) and younger (p = 0.010) at baseline than those followed up. The vast majority of major trauma patients are independent with respect to locomotion (78%), feeding (93%), and expression (93%) by 6 months postinjury. Of those working before injury, 60% had returned to work. CONCLUSIONS: The findings show that follow up of registry patients is feasible, results in few biases in the follow-up population, and reports similar findings to individual studies of trauma populations.

Adolescent↗
PubMed2006

A comparison of self-reported and independently observed disability in an orthopedic trauma population.

BACKGROUND: Although outcome measures that assess disability after isolated orthopedic injuries have been found to be valid and responsive to change, the reliability of self-reported disability has not been studied in these patients. The purpose of this study was to compare self-reported and independently observed disability in patients with isolated orthopedic injuries. METHODS: Items were selected from the Short Musculoskeletal Functional Assessment (SMFA) and Disabilities of the Arm, Shoulder, and Hand (DASH) outcome assessment instruments. Participants had either an isolated upper (n = 61) or lower extremity (n = 55) injury or were noninjured controls (n = 40). Participants completed the SMFA and DASH before being videotaped completing items selected from the outcome assessment instruments. Observers reviewed the video and rated participants' levels of disability in performing the items. RESULTS: Observers consistently rated the disability levels for the items lower than the participants. Overall, agreement in levels of disability between observers and participants varied greatly across the different items (quadratic weighted kappa; range, 0.00-0.82). CONCLUSION: The results emphasize that patients and observers differ in their assessment of an individual's level of disability in performing items related to activities of daily living. Therefore, caution should be used when data collected by a proxy observer is used to substitute self-reported data.

Activities of Daily Living↗
PubMed2006

Outcomes of patients with orthopaedic trauma admitted to level 1 trauma centres.

BACKGROUND: Although orthopaedic trauma results in significant disability and substantial financial cost, there is a paucity of large cohort studies that collectively describe the functional outcomes of a variety of these injuries. The current study aimed to investigate the outcomes of patients admitted with a range of orthopaedic injuries to adult Level 1 trauma centres. METHODS: Patients were recruited from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), which included all patients with orthopaedic trauma admitted to the two adult Level 1 trauma centres in Victoria (Australia). Patients were categorised into three groups; isolated orthopaedic injuries, multiple orthopaedic injuries and orthopaedic and other injuries. Demographic and injury data were collected from the medical record and hospital/trauma databases, and functional outcome instruments were given at 6 months post-injury. RESULTS: Of the 1303 patients recruited for VOTOR over a 12-month period, 1181 patients were eligible for the study and a response rate of 75.6% was obtained at 6 months post-injury. Patients reported ongoing pain (moderate-severe: 37.2%), disability (79.5%) and inability to return to work (35.2%). Poorer outcomes were evident in patients with orthopaedic and other injuries than those with single or multiple orthopaedic injuries alone. CONCLUSION: A large percentage of patients have ongoing pain and disability and a reduced capacity to return to work 6 months after orthopaedic trauma. Further research into the long-term outcomes of patients with orthopaedic injuries is required to identify patient subgroups and specific injuries and procedures that result in high morbidity.

Adolescent↗
PubMed2005

Models developed by three techniques did not achieve acceptable prediction of binary trauma outcomes.

BACKGROUND AND OBJECTIVES: To develop prediction models for outcomes following trauma that met prespecified performance criteria. To compare three methods of developing prediction models: logistic regression, classification trees, and artificial neural networks. METHODS: Models were developed using a 1996-2001 dataset from a major trauma center in Victoria, Australia. Developed models were subjected to external validation using the first year of data collection, 2001-2002, from a state-wide trauma registry for Victoria. Different authors developed models for each method. All authors were blinded to the validation dataset when developing models. RESULTS: Prediction models were developed for an intensive care unit stay following trauma (prevalence 23%) using information collected at the scene of the injury. None of the three methods gave a model that satisfied the performance criteria of sensitivity >80%, positive predictive value >50% in the validation dataset. Prediction models were also developed for death (prevalence 2.9%) using hospital-collected information. The performance criteria of sensitivity >95%, specificity >20% in the validation dataset were not satisfied by any model. CONCLUSION: No statistical method of model development was optimal. Prespecified performance criteria provide useful guides to interpreting the performance of developed models.

Adult↗
PubMed2005

Outcome instruments for the assessment of the upper extremity following trauma: a review.

Orthopaedic injuries are common among trauma patients and can result in long-term problems. Considerable data are available regarding functional outcomes following lower extremity trauma. There is, however, a paucity of data available for upper extremity trauma patients. Whilst currently available instruments appear to assess outcomes of relevance in trauma populations, the reliability, validity and responsiveness of these instruments have not been evaluated in the upper extremity trauma population. This paper reviews instruments designed for patient self-evaluation of musculoskeletal disorders of the upper extremity, and instruments used in an orthopaedic trauma population to assess functional recovery following injury. The Musculoskeletal Functional Assessment (MFA), Short Musculoskeletal Functional Assessment (SMFA), Disabilities of the Arm, Shoulder, and Hand (DASH), American Shoulder and Elbow Surgeons Shoulder Scale (ASES-s), American Shoulder and Elbow Surgeons Elbow Scale (ASES-e), Patient Rated Elbow Evaluation (PREE), and the Patient Rated Wrist Evaluation (PRWE) were reviewed. Until research is published outlining the evaluation of assessment instruments in upper extremity orthopaedic populations, authors will need to conduct their own validation studies before investigating outcomes in specific trauma populations.

Arm Injuries↗
PubMed2005

Is paramedic judgement useful in prehospital trauma triage?

Precise prehospital trauma triage criteria are critical for ensuring patients with severe injuries are transported to trauma centres. Most prehospital trauma triage criteria adopt a combination of physiological, anatomic and mechanism of injury components, but this approach still fails to identify a number of patients with severe injuries and often burdens trauma centres with patients suffering minor injuries. Paramedic judgement has been identified as an alternative method for the triage of trauma patients. This study critically reviewed the literature regarding the ability of paramedics to predict injury severity, and found there is no clear evidence supporting paramedic judgement as an accurate triage method. However, the studies were limited due to significant data losses, variable definitions of major trauma, differences across EMS and trauma care systems, variable paramedic experience levels and incomparable methods of data collection. The role of paramedic judgement in identifying patients with severe blunt anatomic injuries requires further investigation.

Allied Health Personnel↗
PubMed2005

Children's misadventures with golfing equipment.

The purpose of this study was to identify and describe injuries sustained by children less than 15 years of age associated with golfing equipment resulting in presentation to an emergency department. These findings can then be used to highlight potential injury prevention strategies. Retrospective analysis of data from the Victorian Emergency Minimum Dataset was performed. Golf-related injury cases were identified for the period April 1997 - December 2002. Cases where the text description of the injury event included the word "golf" were extracted for analysis. Text narratives of all cases were reviewed and cases occurring during golf play or practice or at a golf course were excluded from the analysis. There were 309 presentations to an emergency department for treatment of an injury caused by golfing equipment in children less than 15 years of age. The majority of presentations were male (71.5%) and children aged 5-9 years presented most commonly (53.1%). Head injuries were the most common reason for presentation (84.4%), with open wounds being the most common type of injury (68.5%). Being struck by an object (96.8%) was the most frequent cause of injury. Whilst relatively uncommon, golf equipment injuries to children could be prevented by attention to community safety and awareness of correct storage of golfing equipment. In addition, education of children regarding the safe handling and use of golf equipment could be useful. This could help reduce the number of emergency department visits and hospital admissions, thereby contributing to the reduction of costs associated with injury.

Accidents↗
PubMed2005

Does the presence of an upper extremity injury affect outcomes after major trauma?

BACKGROUND: There is a paucity of information about the impact of upper extremity (UE) injuries on patient outcomes, particularly after major trauma. METHODS: Data were obtained from a statewide trauma registry. Cases were defined as major trauma cases (Injury Severity Score > 15) with (UE group) and without (no-UE group) an associated upper extremity injury. Multivariate analysis was performed to identify independent predictors of outcome. RESULTS: Major trauma patients with UE injury were 1.5 times (p = 0.011) more likely than the no-UE group to have a length of stay greater than 7 days. After adjusting for age, mechanism of injury, and Injury Severity Score, UE injury was not an independent predictor of discharge destination. CONCLUSION: In major trauma patients, the presence of an upper extremity injury is a significant predictor of length of stay, indicating a greater complexity and cost of care associated with this group of major trauma patients.

Accidental Falls↗
PubMed2005

Prehospital prediction of intensive care unit stay and mortality in blunt trauma patients.

BACKGROUND: The success of a trauma system relies on transfer of patients from the field to the most appropriate hospital for definitive care. However, no consensus has been reached regarding the best criteria or triage tool for identifying patients injured seriously enough to warrant transfer to a trauma center. METHODS: Predictors of mortality and intensive care unit stay were identified and prediction models developed in a design data set. The performance of these models was evaluated in a test data set and compared with current trauma triage guidelines, derived from the American College of Surgeons model. RESULTS: The newly developed prediction models performed comparably with the current trauma triage guidelines. CONCLUSION: Although the performance of newly developed triage models was promising, their performance did not exceed that of the current trauma triage guidelines. In particular, the anatomic injury criteria appeared to be the key component of the current trauma triage guidelines.

Decision Support Techniques↗
PubMed2005

The trauma registry as a statewide quality improvement tool.

BACKGROUND: Trauma registries have been developed to describe the pattern of trauma and trauma workload, provide data for research, and to demonstrate changes in patient outcomes. Quality improvement using trauma registries at a system-wide level has been difficult to achieve. In Victoria, Australia, a statewide trauma system and trauma registry has been established to monitor and feedback the process of management and outcomes of major trauma patients across all healthcare providers. METHODS: The development and implementation of the Victorian State Trauma Registry (VSTR), including its role as a quality monitoring tool and results from the first 2 years of operation, are provided. RESULTS: More than 80% of major trauma patients are being managed at major trauma services and standardized death rates are comparable with international standards. Quality indicators identify some areas for improvement. CONCLUSION: VSTR data indicate that the statewide trauma system is working well and provides a method for ongoing monitoring and trauma care feedback.

Adolescent↗
PubMed2005

Predictors of mortality, length of stay and discharge destination in blunt trauma.

BACKGROUND: The present study explored a range of variables to identify predictors of mortality and morbidity and to develop prediction models based on these variables. METHODS: Tools for predicting mortality, hospital length of stay and a patient's destination post-hospital discharge were developed using logistic regression in one dataset (design) and evaluated for prediction performance in a separate dataset (validation). The performance of the mortality model was compared to the trauma and injury severity score (TRISS) and a severity characterization of trauma (ASCOT). RESULTS: The profile of variables contributing to the final prediction models developed from the design dataset varied across the different outcomes of interest although age, injury severity score, development of complications and triage category were common predictors of all three outcomes. The performance of the new mortality prediction model was superior to both TRISS and ASCOT in the validation dataset. Overall, the new models did not meet the prespecified performance criteria. CONCLUSIONS: The present study identified key predictors of mortality and morbidity (length of hospital stay and discharge destination). The newly developed mortality model out-performed published trauma scoring methods. However, further development and trial of the new prediction models is required before implementation as definitive audit and benchmarking tools could be recommended.

Adult↗