Mobility Practices following Traumatic Solid Organ Injury: An Australia and New Zealand Benchmarking Survey
Presenter: Cecile Lejoly, Physiotherapist, Queensland Health
Authors List
Lejoly, C., Princess Alexandra Hospital, Brisbane, Australia
Lockwood, D., Princess Alexandra Hospital, Brisbane, Australia
Jennings, F., Princess Alexandra Hospital, Brisbane, Australia
Hackett, C., Princess Alexandra Hospital, Brisbane, Australia
Cassar, T., Princess Alexandra Hospital, Brisbane, Australia
Agli, A., Princess Alexandra Hospital, Brisbane, Australia
Mackay, C., Princess Alexandra Hospital & The University of Queensland, Brisbane, Australia
Introduction
The management of solid organ injuries has shifted towards non-operative approaches in hemodynamically stable patients. Historically prolonged bed rest was used to minimise the risk of bleeding, however emerging evidence supports earlier mobilisation (Teichman et al. 2018). We hypothesized that mobility practices vary with less restrictive practices in higher level of trauma centres.
Aims
To describe and compare usual mobility practices following traumatic kidney, liver and spleen injury across Australia and New Zealand, encompassing all injury grades and management strategies, across trauma and non-trauma centres.
Methodology
We conducted an international cross-sectional survey of clinicians across trauma and non-trauma centres in Australia and New Zealand.
Results
53 clinicians from 32 workplaces responded; 44% percent worked in Level 1 trauma centres, 76% had ≥10 years of clinical experience and half were physiotherapists. Angioembolisation was available at 83% of workplaces. For conservatively managed injuries, mobility was largely unrestricted for lower-grade injuries but varied with higher-grade. Across all trauma centres, bed rest increased from 20% to 44% for liver, 20% to 40% for splenic and 22% to 53% for kidney injuries (garde 3-5). Level 1 Trauma centres showed similar patterns (16-39% liver, 11-33% spleen, 22%-56% kidney). Following surgery, most reported unrestricted mobility, particularly in Level 1 centres. Following angioembolisation, unrestricted mobility decreased with increasing injury grade (grade 3: 57–66%, grade 4: 41–53%, grade 5: 30–48%) across trauma centres. Surgeons reported more progressive mobilisation than physiotherapists and nurses. Key facilitators were staff availability to mobilise (59%) and monitor patients (57%) while barriers were other injuries (89%) and awaiting medical clearance (75%).
Conclusions
Mobility practices following traumatic solid organ injury vary substantially across Australia and New Zealand, particularly with increasing injury grade, trauma-centre level and clinician profession, highlighting a lack of consensus.
References:
Teichman, A., Scantling, D., McCracken, B., & Eakins, J. (2018). Early mobilization of patients with non-operative liver and spleen injuries is safe and cost effective. European Journal of Trauma and Emergency Surgery, 44(6), 883-887.
Lejoly, C., Princess Alexandra Hospital, Brisbane, Australia
Lockwood, D., Princess Alexandra Hospital, Brisbane, Australia
Jennings, F., Princess Alexandra Hospital, Brisbane, Australia
Hackett, C., Princess Alexandra Hospital, Brisbane, Australia
Cassar, T., Princess Alexandra Hospital, Brisbane, Australia
Agli, A., Princess Alexandra Hospital, Brisbane, Australia
Mackay, C., Princess Alexandra Hospital & The University of Queensland, Brisbane, Australia
Introduction
The management of solid organ injuries has shifted towards non-operative approaches in hemodynamically stable patients. Historically prolonged bed rest was used to minimise the risk of bleeding, however emerging evidence supports earlier mobilisation (Teichman et al. 2018). We hypothesized that mobility practices vary with less restrictive practices in higher level of trauma centres.
Aims
To describe and compare usual mobility practices following traumatic kidney, liver and spleen injury across Australia and New Zealand, encompassing all injury grades and management strategies, across trauma and non-trauma centres.
Methodology
We conducted an international cross-sectional survey of clinicians across trauma and non-trauma centres in Australia and New Zealand.
Results
53 clinicians from 32 workplaces responded; 44% percent worked in Level 1 trauma centres, 76% had ≥10 years of clinical experience and half were physiotherapists. Angioembolisation was available at 83% of workplaces. For conservatively managed injuries, mobility was largely unrestricted for lower-grade injuries but varied with higher-grade. Across all trauma centres, bed rest increased from 20% to 44% for liver, 20% to 40% for splenic and 22% to 53% for kidney injuries (garde 3-5). Level 1 Trauma centres showed similar patterns (16-39% liver, 11-33% spleen, 22%-56% kidney). Following surgery, most reported unrestricted mobility, particularly in Level 1 centres. Following angioembolisation, unrestricted mobility decreased with increasing injury grade (grade 3: 57–66%, grade 4: 41–53%, grade 5: 30–48%) across trauma centres. Surgeons reported more progressive mobilisation than physiotherapists and nurses. Key facilitators were staff availability to mobilise (59%) and monitor patients (57%) while barriers were other injuries (89%) and awaiting medical clearance (75%).
Conclusions
Mobility practices following traumatic solid organ injury vary substantially across Australia and New Zealand, particularly with increasing injury grade, trauma-centre level and clinician profession, highlighting a lack of consensus.
References:
Teichman, A., Scantling, D., McCracken, B., & Eakins, J. (2018). Early mobilization of patients with non-operative liver and spleen injuries is safe and cost effective. European Journal of Trauma and Emergency Surgery, 44(6), 883-887.
