Nghiên cứu một số đặc điểm dịch tễ học và thực trạng cấp cứu ban đầu ở bệnh nhân gãy xương cơ quan vận động điều trị tại bệnh viện quân y 103 tt tiếng anh

AND TRAININGVIETNAM MILITARY MEDICAL UNIVERSITY NGUYEN HUU CHIEN RESEARCH ON EPIDEMIOLOGICAL CHARACTERISTICS AND THE FIRST AID STATUS OF BONE FRACTURES OF MOTOR ORGANS IN PATIENTS TREATE

AND TRAINING

VIETNAM MILITARY MEDICAL UNIVERSITY

NGUYEN HUU CHIEN

RESEARCH ON EPIDEMIOLOGICAL CHARACTERISTICS AND THE FIRST AID STATUS OF BONE FRACTURES OF MOTOR ORGANS IN PATIENTS TREATED AT 103

MILITARY HOSPITAL

Speciality: SurgeryCode: 9720104

SUMMARY OF MEDICAL DOCTORAL THESIS

HANOI - 2019

This research was carried out in Vietnam Military Medical University

Supervisors:

1 Nguyen Tien Binh, M.D., Ph.D., Prof

2 Pham Dang Ninh, M.D., Ph.D., Assoc.Prof

Reviewer 1: Nguyen Van Thach, M.D., Ph.D., Assoc.Prof

Reviewer 2: Nghiem Đinh Phan, M.D., Ph.D., Assoc.Prof

Reviewer 3: Nguyen Thai Son, M.D., Ph.D., Assoc.Prof

This thesis was defended in doctoral examination council

INTRODUCTION

1 Imperativeness

Bone fractures in motor organs include spinal fractures, pelvic fracturesand limb fractures There are many causes of bone fractures in motor organs.The structure, the rate, distribution characteristics and causes of fracturesalso vary depending on countries and regions

There are about 16,000 people die from injuries over the worldevery day(Mack C et al, 2004) In Vietnam, the traffic accident rate was 27/100,000people, higher than the global rate of 19/100,000 people (Ta Van Tram,2006) Bone fracture is a severe surgical emergency, but if the first aid istimely and properly (prevention of shock, fixation of fractures, prevention ofdeviation and secondary injury, early transportation ), it will create goodconditions for treatment at the back level to have results First aid is veryimportant On one hand, right first aid, solid fracture fixation reduce the rate

of systemic and local complications such as shock, closed fractures into openfractures, vascular and nerves lesions On the other hand, the early rescuealso creates conditions for the post-treatment process to be moreconvenient The timely and effective first aid was extremely important toreduce the severity and mortality of injuries (Nguyen Thuy Quynh, 2013).Bone fractures are interested in researchs by domestic and foreignauthors In the world, most countries have accident and injury preventioncenters In Vietnam, the aspects of injury prevention, the first aid of bonefractures in motor organs has been noticed for about 10 years

In order to have basic and systematic information of the epidemiologicalcharacteristics and the first aid status of bone fractures in motor organs, this

reseach: “Research on epidemiological characteristics and the first aid status of bone fractures in motor organs in patients treated at 103 Military hospital” was perfomed with the following objectives:

1 To identify some epidemiological characteristics of fractures ofmotor organs in patients treated at 103 Military hospital in the period of

2010 - 2014

2 To survey the first aid status of bone fractures of motor organs inpatients treated at 103 Military hospital during this time

2 Scientific significance

The thesis has provided data about some epidemiologicalcharacteristics of motor fractures: results of age, gender and occupationalcharacteristics of fractured people; characteristics of causes and time offracture occurrence; fracture structural characteristics and fractureproperties

Furthermore, the thesis has provided information on the first aid status

of bone fractures in motor organs: the results of the proportion of patientswho were given first aid, the time from the accident to the emergency,the means of transport, the rate of fracture were provided in accordancewith the principle

3 Practical significance

The results of some epidemiological characteristics and the first aidstatus of bone fractures in motor organs are the basis for buildinginvestment promotion plan equipment for first aid for pre-hospital routes,organizing training courses, training to improve emergency accidentknowledge for grassroots health and strengthen the coordination ofcontracts between hospitals and pre-hospital to improve the quality offirst aid

4 Structure of the thesis

The thesis consists of 111 pages: 2 pages of problems; Chapter 1(Documentary Overview) 40 pages; Chapter 2 (Subjects and researchmethods) 12 pages; Chapter 3 (Research results) 27 pages; Chapter 4(Discussion) 27 pages; Conclusion 2 pages and 1 page perspectives.The thesis has 29 tables, 6 charts, 3 figures and 126 references (39Vietnamese documents, 97 English documents)

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Chapter 1 DOCUMENTARY OVERVIEW

1.1 Overview of fractures and fracture classification

Fractures are lesions that cause loss of bone continuity due to injury orpathology Bone fractures in motor organs include limb fractures, vertebralfractures, pelvic fractures and some other fractures (clavicle, shoulder blade,kneecap)

There are many ways to classify fractures that are being applied clinicallynow The classification of fractures by cause is divided into injuries anddiseases (osteitis, bone syphilis, primary bone malignancy, bone cancermetastasis, fatigue, and obstetric complications ) Classification of softwarevulnerability includes classification of open fractures of Gustilo andAnderson, classification of software vulnerability of Oestern and Tscherne.Classification of bone lesions by mechanism of trauma, fracture position,morphology and properties, according to Quinquist and Hansen, AOsynthesis classification

1.2 Epidemiological of bone fractures in motor organs

The bone fractures in motor organs has been studied by many authors inthe world such as China, Iran, India, Brazil, America Johansen A et al.studied fractures in the emergency department of the Cardiff Royal Hospitalfound that the fracture rate was 21.1 / 1000 people / year (male: 23.5 / 1,000people / year; female : 18.8 / 1,000 people / year) The frequency of fractureswas similar to that of the US, Australia and Norway, but higher in the UK inthe 1960s (9 / 1,000 people / year) (Johansen A et al, 1997) In Vietnam,bone fractures in motor organs are the leading cause of death and disability.The burden of disability in both sexes was 2.7 million YLD in 2008 (HanoiSchool of Public Health, 2011)

Studies showed that the fracture rate had very different points, thedifference was not only by age, gender, region, even by race, skin color.Humerus fractures accounted for about 1-3% of the total fractures Theforearm fractures accounted for about 1.2% of total fractures, the femoralfractures accounted for about 0.9% of total fractures, spinal fracturesaccounted for 3 - 4% of the total fractures

1.3 The status of first aid and diagnosis of factures in Vietnam

The emergency situation of transporting patients in different countries

in the world is very diverse in form, types of participating forces, levels

of training and service access time

There are many methods of transporting patients to hospitals such assimple vehicles (rudimentary vehicles, trailers ), motor vehicles(motorcycles, cars, small buses ) and modern, high-speed vehicles (plane).Countries have been focused on training the first responders in the field ofemergency techniques and transport of trauma patients such as Ghana,Keyna, South Africa, Sri Lanka, Brazil, Colombia, Ecuador, Mexico,Panama, Peru The rate of non-first aid fracture victims was 82.14%, ofwhich upper and lower limb fractures accounted for 32.61% and 43.48%.The rate of fracture victims fixed by bandages or splints is 8.93% (DongNgoc Duc et al., 2009) Among injury cases, most of them rated first aid asgood and effective: 9.2% said it was very effective, 74.5% said it waseffective The rate of effective and very effective first aid is quite high inThai Nguyen (98%), Thai Binh (94%), and Dong Thap (93%) (NguyenThuy Quynh et al, 2003) 115 current emergency system is primarilyresponsible for the emergency treatment of common diseases The quantity

of traffic accident victims who was transported, first-aid by the 115Emergency System is low, only about 10-15% of the quantity of trafficaccident victims to medical facilities Many cases of emergency illnessesincluding traffic accidents victims must be transported by means of non-professional facilities that are easy to cause complications or death beforegoing to the hospital Many victims were not transported to hospitals byspecialized emergency vehicles but by other means such as taxi, motorcycletaxi or even by truck because of many reasons including the lack ofambulance The main means that people use to bring victims to healthfacilities was motorcycles, the time to reach health facilities was less than 30minutes (58.6%) and 30 to 60 minutes (30.4%) (Nguyen Thuy Quynh et al,2003) Most of the victims were often picked up by around people to thehospital by available means (mostly by motorbikes) after traffic accidents inVietnam The rate of transfer by motorbike from the field to the hospital was84.48% (Pham Thi My Ngoc, 2013) Transporting fracture victims from thevehicle to the clinic was still 33.3% by hand There was still a largeproportion of picggy back carrying Transport means, and the transport level

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was still limited (Dong Ngoc Duc, 2009) There were 6.9% of cases going tohospitals over 60 minutes (3 minutes - 100 minutes) (Pham Thi My Ngoc,2013).

Chapter 2 SUBJECTS AND METHODS

2.1 Subjects

4918 patients with bone fractures of motor organs who were treated at

103 Military Hospital during 5 years (2010-2014)

* Selection criteria:

- Patients with fractures of motor organs whose medical records havefully and clearly information according to the form of research medicalrecords

- Patients who were initially treated at 103 Military Hospital (underwentfirst aid at the accident place or the medical facility or the regional clinicafter undergoing fractures), and never been treated at any other hospital

- Patients were diagnosed with arm, forearm, metacarpal-phalange,femoral, tibia, fibula, metatarsal-phalange, vertebral and pelvic fracturescombined or not with other lesions (X-ray film with fractures also required)

- Patient suffered a fracture due to another condition

- Patients with traumatic brain injury

- Patients suffered a fracture but they died before going to the hospital

- n: Minimum sample size needed for research.

- Z1-α / 2: Reliability factor With a threshold of α = 0.05 (95%confidence level), Z1-α / 2 = 1.96 (look up the table)

- p: The rate of estimating a type of motor fracture in the total number offractures We chose this ratio as 3% (0.03) according to the Military MedicalUniversity's orthopedic injury in 2006 and according to Nguyen Tien Binh

in 2009

- ε: Relatively acceptable errors In this study we choose ε = 16% (0.16).Replacing the above parameters into the formula, the theoretical samplesize was calculated at 4852 In fact, we studied 4918 fractured patients in the

103 Military Hospital for 5 years (2010- 2014)

2.2.2.2 Sampling method

Applying convenient and standardized sampling methods: Introduced all

patients with motor organs fractures to the 103 Military Hospital Clinic then

allocated to treat at the Department of Orthopedic Trauma, Neurosurgery, Surgical field, Emergency Resuscitation of 103 Military Hospital untildischarge, satisfying the selection criteria, exclude the above and until theminimum amount necessary for the study was met

2.2.3 Information collection method

The Toolkit used to collect information for the study is a researchmedical record This form was based on the research contents andobjectives, has been commented by experts in the specialized field and testedand revised before officially conducting research

2 )

2 / 1 (

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reduction, bandage wound, washing wounds, antibiotics and time of use,injection of SAT and injection site, time from accident to hospital admission,X-ray examination, diagnosis of grassroots health, clinics of 103 MilitaryHospital and treated department, CT scanner / MRI.

2.2.5 Data processing methods

The data of the research records that were entered into the computer

by Excel software, were analyzed according to the research objectivesand processed by SPSS 22.0 software

Apply descriptive statistical algorithms, calculate frequency, rate,average and standard deviation, χ2 and p analyze the relationshipbetween variables

2.2.6 Ethical issues of research

- Research protocol approved by the Ethics Council in BiomedicalResearch of the Military Medical University

- The data and information obtained are only for educational andscientific research purposes and not for any other purpose

- Patients who were hospitalized due to fracture of the motor organswere given first aid at the Hospital Clinic, prepared and sent to Clinicaldepartments for treatment and treated according to the procedure,treatment regimen of the hospital

- Research files are carefully stored, kept confidential and only forresearch purposes

Chapter 3 RESULTS 3.1 Some epidemiological characteristics of fractures of motor organs

Table 3.1 Distribution of subjects by age and sex (n=4,918)

Ages n Male % n Female % N Total % p-values

46,7 ± 20,1(2 – 99)

39,7 ± 18,2(1 – 99)

0,000e

a Chi-squared test e.Mann-Withney test

Comments: The average age of patients was 39.7 ± 18.2 years old(from 1 to 99) The average age of female patients was 46.7 ± 20.1 yearsold which is significantly higher than that of male patients (46.5 ± 20.1years old) (p <0.01)

Patients from 20 to 29 accounted for the highest rate of 25.1% , andthe patients from 30 to 39 accounted for 18.5% The elderly and retiredgroup accounted for 15,9% The ages of 50 onwards, the rate of fracturestended to decrease

Table 3.2 Distribution of subjects by occupation (n = 4,918)

Table 3.3 Distribution of subjects by type of accident (n= 4,918)

Type of accident Male Female Total

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<0.01) With other types of accidents, female patients accounted for52.4% higher than that of men (40.7%)(p <0.01).

The quantity of fractures tended to increase during the study periodfrom 2010 to 2014

Traffic accidential fractures were occured usually at the beginningand end of the lunar year (February, March, September and December).Traffic accidents were occured usually in the evening, about 14-18 hours(30.9%) Occupational accidents fractures were occured usually in themorning (5 - 11 hours)

Among fracture cases, the rate of closed fracture was 74.9%, it washigher than that of opened fracture (25.1%)

The lower limb fractures accounted for the highest rate of 54.2%; Theupper limb fractures accounted for the lower rate of 26.5%, the incidence

of limb fractures was 2.8% of the total Other types of fracturesaccounted for a low rate (spinal fractures 11.1%, pelvis fractures 3.0%)

Table 3.4 Distribution of patients by number of fractured bones (n=4,918)

Number of fractured

bones

Number of patients

Propotion (%)

The combined lesions of common limb fractures were articular, majorvascular and nerve injuries The rate of upper limb injuries ranged from29.7% to 34.3%, of lower limb injuries ranged from 26.1% to 32.7%.The rate of upper limb fractures with shock was 5.1%; the rate oflower limb fractures with shock was 6.2%; The rate of fracture withshock was 24.6%

Table 3.5 Distribution of patients by site and type of fracture

Opened fracture (n=1,233)

Closed fracture (n=3,685)

Total (n=4,918) p-

1 9Tibia, fibula 505 40.

Closed fracture of femur ranked second (28.9%), opened femurfracture accounted for 13.1% Fracture of the hand and finger boneaccounted for 20.7%, ranked the third among the most common types ofbone fracture Opened forearm bone fracture accounted for 13.6%.Opened fracture of the foot and toe bone accounted for 10%

3.2 The first aid status of bone fractures in motor organs in patients

Table 3.5.Distribution of patients under went first aid by accident place and by first aid place (n = 4,918)

Accident

place

Accident places

(n=480)

Medical facilities

(n=1,259)

Emergency rooms