Trauma research in Vietnam question

[Avenue Q]

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[Sessamoid]

1) What is the primary injury/disease that is seen in pediatric orthopedics? Here it is primarilly motorbike related accidents, and bowed limbs due to rickets.

Wow, I'd have to say that rickets is not something we see commonly here, or like ever. It's only a textbook disease to almost every physician in the United States. I've never actually seen a case. The only cases we're likely to see are from recent immigrants from third world countries. Most common pediatric ortho injury I see on a regular basis is probably skateboard and scooter accidents involving the hand, wrist, and forearm.

2) What is the frequency that children require surgery for broken bones (due to traffic related accidents)?

Depends on the nature of the fracture. In general, management of pediatric fractures is conservative (casting/immobilization) when possible to avoid problems inhibiting bone growth from surgical hardware. I can't give you a percentage, but I'd guess the vast majority of pediatric fractures in this country are treated conservatively (i.e. non-surgical).

3) What is the average length of stay for pediatric traumas? What is the general discharge criteria?

This question is too broad and would require nearly a textbook or at least several long chapters to explore in full detail. Is there a particular case that you're curious about? The rule in the US is get them home when possible. It's more comfortable and familiar, and if we're not doing anything for them in the hospital, then we're wasting their time and money.

 

[Avenue Q]

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[Echinoidea]

Yeah, even through my un-experienced eyes seeing rickets was a shocker. It seems like It's the majority of non-trauma surgery. Just goes to show you what happens when the average income in a country is a dollar a day, and most people live only on rice.

about 1/2 of the kids in this hospital are there because they have been involved in a motorbike related accident - either being on the motorbike, getting hit by one as a pedestrian, or being hit while they were on a bicycle. Its a major public health issue here.

In terms of the lenght of stay - your answer is exactly what I was thinking. These kids seem way too "okay" to be inpatient. I cannot imagine them staying overnight in a hospital in the US. In this particular hospital the average lenght of stay is 9 days, which seems very very long. I tried bringing this up to some of the doctors, and asked how long most kids were staying, and they were not very clear, mentioning a need to oberseve them. But like I said, most of the kids didn't seem very sick. For example, there was one 1-year-old whose surgery I observed on Thursday. He had a deformity of the foot (his big toe was separated very far down) and it was repaired in a fairly quick surgery. Today (Tuesday) he was still in the hospital, walking around on his bandaged foot, with no IV, eating fine, seemingly very happy and healthy. Through my limited experience in pediatric departments in the states, it's hard to imagine this kid there.

Thanks a ton for your comments 🙂

This doesn't really relate to your question, but when you apply, you're going to be an adcom's dream come true. You have got the ultimate pre-med experience. Good luck and enjoy your time in Asia. I'm sure its an awesome experience.

 

[FoughtFyr]

In terms of the lenght of stay - your answer is exactly what I was thinking. These kids seem way too "okay" to be inpatient. I cannot imagine them staying overnight in a hospital in the US. In this particular hospital the average lenght of stay is 9 days, which seems very very long. I tried bringing this up to some of the doctors, and asked how long most kids were staying, and they were not very clear, mentioning a need to oberseve them. But like I said, most of the kids didn't seem very sick. For example, there was one 1-year-old whose surgery I observed on Thursday. He had a deformity of the foot (his big toe was separated very far down) and it was repaired in a fairly quick surgery. Today (Tuesday) he was still in the hospital, walking around on his bandaged foot, with no IV, eating fine, seemingly very happy and healthy. Through my limited experience in pediatric departments in the states, it's hard to imagine this kid there.

Thanks a ton for your comments 🙂

I would look at the goals of the inpatient stay. I spent some time in South Africa and have a good friend who did volunteer surgery in Venezuela. In both places, we kept children inpatient for seemingly long stays because a. poor water qulaity and poor hygiene led to unbelievable wound infections. b. poor nutrition at home leading to poor healing and c. loss to follow-up if a long trip back to the city would be required of the family. In South Africa, if the families lived in the city and were "of means", stays were similar to the U.S. If they lived rural, the stays were closer to what you describe.

Just a thought,

- H

 

[dlung]

If you're interested in the Medical College of Ohio, this would be a GREAT 'in'... the EM program at St. Vincent Mercy Medical Center (our affiliate) sends a team to Saigon (+/- rural areas) every year. I would not hesitate to contact the program -- I'm certain one of the faculty would be more than happy to correspond with you about Vietnam. Dr. Plewa might be someone you want to ask for specifically as he's gone for many years now and is one of the two major research faculty at the program. As a personal note, he's been a great mentor, and is definitely one of my faculty role-models.

Terry Moore is the contact for the program.
[email protected]

 

[beyond all hope]

Almost never. Like most things in pediatrics, the patient is either fine or extremely sick. 99% of pediatric trauma (and when I say trauma I'm talking about anything, from a fall off the bed to a fall off a cliff) is minor, maybe a broken bone or two, splint and send home for later followup with ortho.
Even car and motorcycle accidents tend to follow this rule: either okay or really screwed, rarely anywhere in between.

The few patients that need to stay overnight are either multisystem casualties, require surgery or have an extremely dangerous mechanism of injury such that observation is required. The exception to that is patients with poor home-care, victims of abuse, or those with serious comorbidities (immune compromise from cancer, etc).

Of those patients, the average length of stay would be so variable that it's not worth commenting on. Once the chest tubes are out and the Halo is off, we try to get them out as soon as possible.

 

[Avenue Q]

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