Is trauma in Switzerland any different? epidemiology and patterns of injury in major trauma - a 5-year review from a Swiss trauma centre.

Switzerland, the country with the highest health expenditure per capita, is lacking data on trauma care and system planning. Recently, 12 trauma centres were designated to be reassessed through a future national trauma registry by 2015. Lausanne University Hospital launched the first Swiss trauma registry in 2008, which contains the largest database on trauma activity nationwide. METHODS: Prospective analysis of data from consecutively admitted shock room patients from 1 January 2008 to 31 December 2012. Shock room admission is based on physiology and mechanism of injury, assessed by prehospital physicians. Management follows a surgeon-led multidisciplinary approach. Injuries are coded by Association for the Advancement of Automotive Medicine (AAAM) certified coders. RESULTS: Over the 5 years, 1,599 trauma patients were admitted, predominantly males with a median age of 41.4 years and median injury severity score (ISS) of 13. Rate of ISS >15 was 42%. Principal mechanisms of injury were road traffic (40.4%) and falls (34.4%), with 91.5% blunt trauma. Principal patterns were brain (64.4%), chest (59.8%) and extremity/pelvic girdle (52.9%) injuries. Severe (abbreviated injury scale [AIS] score ≥ 3) orthopaedic injuries, defined as extremity and spine injuries together, accounted for 67.1%. Overall, 29.1% underwent immediate intervention, mainly by orthopaedics (27.3%), neurosurgeons (26.3 %) and visceral surgeons (13.9%); 43.8% underwent a surgical intervention within the first 24 hours and 59.1% during their hospitalisation. In-hospital mortality for patients with ISS >15 was 26.2%. CONCLUSION: This is the first 5-year report on trauma in Switzerland. Trauma workload was similar to other European countries. Despite high levels of healthcare, mortality exceeds published rates by >50%. Regardless of the importance of a multidisciplinary approach, trauma remains a surgical disease and needs dedicated surgical resources.

Fibrous P.C. Concrete Overlay Research Green County, Iowa, December 1978

The Greene County, Iowa overlay project, completed in October 1973, was inspected on October 16 & 17, 1978 After five years of service The 33 fibrous concrete sections, four CRCP sections, two mesh reinforced and two plain concrete sections with doweled reinforcement were rated relative to each other on a scale of 0 t o 100. The rating was conducted by the original members of the Project Planning Committee, Iowa DOT, Iowa Counties, Federal Highway Administration, University of Illinois and industry representatives . In all , there were 23 representatives who rated this project . The 23 values were then averaged to provide a final rating number for each section. The highest panel rating (90) was assigned to the 5-inch thick , deformed barre in forced PCC sections ; an 86t o a 3-inch thick , 160 lbs. of fiber and 600 lbs . of cement on a partial bonded surface ; an 84 to the 4-inch CRC with elastic joints (bonded) and an 84 to a 4-inch mesh reinforce section. One of the major factors influencing performance appears t o be the thickness. In the fibrous concrete overlay, The greatest influences appears t o be the fiber content. Overlay Sections containing 160 1b/yd3 of Fiber are, in almost all cases , outperforming those c o n t a i n i n g 60 or 100. It is obvious at This time meth at the 3-inch thick fibrous concrete overlays are, in general, out performing the 2-inch thick sections. The performance of the fibrous concrete the overlay appears to be favorably influenced by: (1) The use of higher a spectra fiber (0.025 x 2.5 i n c h e s ) v e r s u s (0.010 x 0.022 x 1.0 inches) (2) The use of a lower cement c o n t e n t ( 600 versus 750 1b/yd3) However, The set less well defined and the improvements in overlay performance attributed to high aspect ratio fibers and low cement contents.

Evaluation of Dense Bridge Floor Concrete Using High Range Water Reducer, May 1983

The objectives of this research project are: (1) To determine the feasibility of proportioning, mixing, placing and finishing a dense portland cement concrete in a bridge floor using conventional mixing, placing and finishing equipment. (2) To determine the economics, longevity, maintenance performance and protective qualities of a dense portland cement concrete bridge floor when using a high rangewater reducing admixture. The purpose of a high range water reducing admixture is to produce a dense, high quality concrete at a low water-cement ratio witj adequate workability. A low water-cement ratio contributes greatly to increased strength. The normal 7 day strength of untreated concrete would be expected i n 3 days using a superplasticizer. A dense concrete also has the desirable properties of excellent durability and reduced permeability. It is felt that a higher quality, denser, higher strength portland cement concrete can be produced and placed, using conventional equipment, by the addition of a high range water reducing admixture. Such a dense concrete, w i t h a water/cement ratio of approximately 0.30 to 0.35, would be expected to be much less permeable and thus retard the intrusion of chloride. With care and attention given to obtaining the design cover over steel (2% inches clear), it i s hoped that protection for the design life of the structure will be obtained. Evaluation of this experimental concrete bridge floor included chloride content and delamination testing of the concrete floor five years after construction. A comparitive evaluation o f a control section o f concrete without the water reducing admixture was conducted. Other items o f comparison include workability during construction, strength, density, water-cement ratio and chloride penetration.