MINISTRY OF EDUCATION MINISTRY OF DEFENCE 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: Surgery Code: 9720104 SUMMARY OF MEDICAL DOCTORAL THESIS HANOI - 2019 This research was carried out in Vietnam Military Medical University Supervisors: Nguyen Tien Binh, M.D., Ph.D., Prof 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 of .at … o’clock on … This thesis is available at: National Library ………………………… INTRODUCTION Imperativeness Bone fractures in motor organs include spinal fractures, pelvic fractures and limb fractures There are many causes of bone fractures in motor organs The structure, the rate, distribution characteristics and causes of fractures also vary depending on countries and regions There are about 16,000 people die from injuries over the world every day (Mack C et al, 2004) In Vietnam, the traffic accident rate was 27/100,000 people, 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 is timely and properly (prevention of shock, fixation of fractures, prevention of deviation and secondary injury, early transportation ), it will create good conditions for treatment at the back level to have results First aid is very important On one hand, right first aid, solid fracture fixation reduce the rate of systemic and local complications such as shock, closed fractures into open fractures, vascular and nerves lesions On the other hand, the early rescue also creates conditions for the post-treatment process to be more convenient The timely and effective first aid was extremely important to reduce the severity and mortality of injuries (Nguyen Thuy Quynh, 2013) Bone fractures are interested in researchs by domestic and foreign authors In the world, most countries have accident and injury prevention centers In Vietnam, the aspects of injury prevention, the first aid of bone fractures in motor organs has been noticed for about 10 years In order to have basic and systematic information of the epidemiological characteristics 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: To identify some epidemiological characteristics of fractures of motor organs in patients treated at 103 Military hospital in the period of 2010 - 2014 To survey the first aid status of bone fractures of motor organs in patients treated at 103 Military hospital during this time 2 Scientific significance The thesis has provided data about some epidemiological characteristics of motor fractures: results of age, gender and occupational characteristics of fractured people; characteristics of causes and time of fracture occurrence; fracture structural characteristics and fracture properties Furthermore, the thesis has provided information on the first aid status of bone fractures in motor organs: the results of the proportion of patients who were given first aid, the time from the accident to the emergency, the means of transport, the rate of fracture were provided in accordance with the principle Practical significance The results of some epidemiological characteristics and the first aid status of bone fractures in motor organs are the basis for building investment promotion plan equipment for first aid for pre-hospital routes, organizing training courses, training to improve emergency accident knowledge for grassroots health and strengthen the coordination of contracts between hospitals and pre-hospital to improve the quality of first aid Structure of the thesis The thesis consists of 111 pages: pages of problems; Chapter (Documentary Overview) 40 pages; Chapter (Subjects and research methods) 12 pages; Chapter (Research results) 27 pages; Chapter (Discussion) 27 pages; Conclusion pages and page perspectives The thesis has 29 tables, charts, figures and 126 references (39 Vietnamese documents, 97 English documents) Chapter DOCUMENTARY OVERVIEW 1.1 Overview of fractures and fracture classification Fractures are lesions that cause loss of bone continuity due to injury or pathology Bone fractures in motor organs include limb fractures, vertebral fractures, pelvic fractures and some other fractures (clavicle, shoulder blade, kneecap) There are many ways to classify fractures that are being applied clinically now The classification of fractures by cause is divided into injuries and diseases (osteitis, bone syphilis, primary bone malignancy, bone cancer metastasis, fatigue, and obstetric complications ) Classification of software vulnerability includes classification of open fractures of Gustilo and Anderson, 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, AO synthesis classification 1.2 Epidemiological of bone fractures in motor organs The bone fractures in motor organs has been studied by many authors in the world such as China, Iran, India, Brazil, America Johansen A et al studied fractures in the emergency department of the Cardiff Royal Hospital found that the fracture rate was 21.1 / 1000 people / year (male: 23.5 / 1,000 people / year; female : 18.8 / 1,000 people / year) The frequency of fractures was similar to that of the US, Australia and Norway, but higher in the UK in the 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 (Hanoi School of Public Health, 2011) Studies showed that the fracture rate had very different points, the difference was not only by age, gender, region, even by race, skin color Humerus fractures accounted for about 1-3% of the total fractures The forearm fractures accounted for about 1.2% of total fractures, the femoral fractures accounted for about 0.9% of total fractures, spinal fractures accounted for - 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 as simple 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 of emergency 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%, of which 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% (Dong Ngoc Duc et al., 2009) Among injury cases, most of them rated first aid as good and effective: 9.2% said it was very effective, 74.5% said it was effective The rate of effective and very effective first aid is quite high in Thai Nguyen (98%), Thai Binh (94%), and Dong Thap (93%) (Nguyen Thuy Quynh et al, 2003) 115 current emergency system is primarily responsible for the emergency treatment of common diseases The quantity of traffic accident victims who was transported, first-aid by the 115 Emergency System is low, only about 10-15% of the quantity of traffic accident victims to medical facilities Many cases of emergency illnesses including traffic accidents victims must be transported by means of nonprofessional facilities that are easy to cause complications or death before going to the hospital Many victims were not transported to hospitals by specialized emergency vehicles but by other means such as taxi, motorcycle taxi or even by truck because of many reasons including the lack of ambulance The main means that people use to bring victims to health facilities was motorcycles, the time to reach health facilities was less than 30 minutes (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 the hospital by available means (mostly by motorbikes) after traffic accidents in Vietnam The rate of transfer by motorbike from the field to the hospital was 84.48% (Pham Thi My Ngoc, 2013) Transporting fracture victims from the vehicle to the clinic was still 33.3% by hand There was still a large proportion of picggy back carrying Transport means, and the transport level was still limited (Dong Ngoc Duc, 2009) There were 6.9% of cases going to hospitals over 60 minutes (3 minutes - 100 minutes) (Pham Thi My Ngoc, 2013) Chapter SUBJECTS AND METHODS 2.1 Subjects 4918 patients with bone fractures of motor organs who were treated at 103 Military Hospital during years (2010-2014) * Selection criteria: - Patients with fractures of motor organs whose medical records have fully and clearly information according to the form of research medical records - Patients who were initially treated at 103 Military Hospital (underwent first aid at the accident place or the medical facility or the regional clinic after 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 fractures combined or not with other lesions (X-ray film with fractures also required) * Exclusion criteria: - Patients was hospitalized for the second and third time treatment since having fractures - Did not have all the necessary information of the patients in the form of research medical record - 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 2.2 Methods 2.2.1 Research design Cross-sectional descriptive study with continued follow-up on all fracture patients at the hospital 2.2.2 Sample size and sampling method 2.2.2.1 Sample size Used the sample size calculation (1 formula p ) for a descriptive study: n Z (1  / ) p - n: Minimum sample size needed for research - Z1-α / 2: Reliability factor With a threshold of α = 0.05 (95% confidence level), Z1-α / = 1.96 (look up the table) - p: The rate of estimating a type of motor fracture in the total number of fractures We chose this ratio as 3% (0.03) according to the Military Medical University'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 sample size was calculated at 4852 In fact, we studied 4918 fractured patients in the 103 Military Hospital for 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 until discharge, satisfying the selection criteria, exclude the above and until the minimum amount necessary for the study was met 2.2.3 Information collection method The Toolkit used to collect information for the study is a research medical record This form was based on the research contents and objectives, has been commented by experts in the specialized field and tested and revised before officially conducting research 2.2.4 Research variables The general information of patients (age, gender, address, ethnicity, religion, occupation, education level, cause of accident, type of vehicle, time of accident, status before/after first aid and hospitalization), fracture position, fracture, number of fractures, fractures characteristic: open fracture, joint fracture, vascular injury, nerve damage, trauma, first aid place, time from accident to first aid, first aid at grassroots health, first aid in emergency room, first aid provider, fixed principles and means (length, firmness), pain 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 Military Hospital 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 objectives and processed by SPSS 22.0 software Apply descriptive statistical algorithms, calculate frequency, rate, average and standard deviation, χ2 and p analyze the relationship between variables 2.2.6 Ethical issues of research - Research protocol approved by the Ethics Council in Biomedical Research of the Military Medical University - The data and information obtained are only for educational and scientific research purposes and not for any other purpose - Patients who were hospitalized due to fracture of the motor organs were given first aid at the Hospital Clinic, prepared and sent to Clinical departments for treatment and treated according to the procedure, treatment regimen of the hospital - Research files are carefully stored, kept confidential and only for research purposes Chapter RESULTS 3.1 Some epidemiological characteristics of fractures of motor organs Table 3.1 Distribution of subjects by age and sex (n=4,918) – 19 Male n % 414 12,2 Female n % 124 8,1 20 – 29 992 242 Ages 30 – 39 40 – 49 50 – 59 60 – 69 70 – 79 80 – 99 Total  ± SD (Min – Max) 29,2 667 19,6 552 16,3 461 13,6 186 5,5 76 2,2 47 1,4 3.395 69,0 36,5 ± 16,3 (1 - 97 ) 15,9 244 16,0 232 15,2 254 16,7 207 13,6 108 7,1 112 7,4 1.523 31,0 46,7 ± 20,1 (2 – 99) Total N % 538 10,9 1.234 25,1 911 18,5 784 15,9 715 14,5 393 8,0 184 3,7 159 3,2 4.918 100,0 39,7 ± 18,2 (1 – 99) p-values 0,000a 0,000a 0,003a 0,331a 0,004a 0,000a 0,000a 0,000a 0,000e a Chi-squared test e.Mann-Withney test Comments: The average age of patients was 39.7 ± 18.2 years old (from to 99) The average age of female patients was 46.7 ± 20.1 years old which is significantly higher than that of male patients (46.5 ± 20.1 years old) (p 30 1,289 26.2 Total 4,918 100.0 The above table shows that: Only 21.3% of patients with bone fractures of motor organs was given first aid immediately within the first minutes since the accident 48.8% of them was given first aid within 515 minutes; 3.7% of them was given first aid within 15 - 30 minutes, 26.2% of them was given first aid after 30 minutes Table 3.7 Distribution of type of patient transportations from the accident place to the following route (n = 4,918) Types of transportation n % Car 1,937 39.4 Motorbike 2,695 54.8 115 ambulance 79 1.6 Taxi 138 2.8 Others 69 1.4 Total 4,918 100 The above table shows that: the patients transportation from the accident place to the following route were mostly motorcycles (54.8%), automobiles (39.4%) 115 ambulance accounted for a very low rate (1.6%) Table 3.8 Distribution of first responders at the accident place (n = 480) First responders n % Non - medical staff 390 81.3 13 Medical staff 90 18.7 Total 480 100 The above table shows that: the rate of non - medical first responders is high (81.3%) The rate of medical first responders is low (18.7%) Table 3.9 Distribution of type of first aid methods by route Acciden Medical Emergenc pt place facilities y room Total First aid value (n=480) (n=1.259) (n=3.179) methods s n % n % n % n % 16 34 1,19 94 2,83 89 4,18 85 Pain relief 0.001 0 Bandages( 55 48 59 55 79 167 476 722 0.001 *) 33 70 1,19 94 2,78 87 4,32 87 Fixation 0.001 7 Antibiotic 20 18 17 s and SAT 0.0 59 152 221 0.001 (*) Note: (*) opened fracture patients (n=1,233) Patients who were given pain relief methods accounted for 34.4% at accident place, 94.6% at medical facilities and 89,0% in emergency room The difference was statistically significant with p