This study supports the implementation of a multimodal, multitime-based concussion evaluation process to ensure that immediate and late developing concussions are captured.

The vast majority of rugby union ('rugby') participants are community-based players; however, the majority of injury surveillance studies reported relate to the elite, professional game. A potential reason for this dearth of studies could be the perceived difficulty of using the consensus statement for injury recording at the community level. The aim of this study was to identify areas where the consensus statement could be adapted for easier and more appropriate implementation within the community setting. Design Round-table discussion Methods All community-based injury surveillance issues were discussed during a 2-day facilitated round-table meeting, by an 11-person working group consisting of researchers currently active in rugby-related injury surveillance, sports medicine and sports science issues. The outcomes from the meeting were summarised in a draft guidance document that was then subjected to an extensive iterative review prior to producing methodological recommendations. Results Each aspect of the rugby-specific consensus statement was reviewed to determine whether it was feasible to implement the standards required in the context of non-elite rugby and the resources available within in a community setting. Final recommendations are presented within a communitybased injury report form. Conclusions It is recommended that whenever possible the rugby-specific consensus statement for injury surveillance studies be used: this paper presents an adapted report form that can be used to record injury surveillance information in community rugby if suitable medical support is not available.

No abstract

Traumatic diaphragmatic hernia secondary to diaphragmatic injury is a recognized complication following trauma. It is frequently unrecognized in acute trauma, and delayed presentations with complications are not uncommon.We report the case of a 12-year-old boy presenting in respiratory distress 1 year after blunt abdominal trauma. A chest radiograph demonstrated dilated bowel loops in the left hemithorax mimicking tension pneumothorax. At emergency laparotomy, dilated sigmoid colon was found in the left hemithorax. The hernia was reduced, and a noncongenital diaphragmatic defect was repaired.Although well described in patients with congenital diaphragmatic hernia, tension gastrothorax-colothorax has not been well characterized in traumatic diaphragmatic hernia. We present the second reported pediatric case and discuss the diagnostic workup, operative approach, and postoperative course of this unusual condition.

Study Objective Tools proposed to triage acuity in suspected COVID-19 in the ED have been derived and validated in higher-income settings during early waves of the pandemic. We estimated the accuracy of seven risk-stratification tools recommended to predict severe illness in the Western Cape, South Africa. Methods An observational cohort study using routinely collected data from EDs across the Western Cape, from the 27th of August 2020 to 11th March 2022 was conducted to assess performance of the PRIEST tool, NEWS2, TEWS, the WHO algorithm, CRB-65, Quick COVID-19 Severity Index and PMEWS in suspected COVID-19. The primary outcome was death or ICU admission. Results Of 446,084 patients, 15,397 patients (3.45%, 95% CI:34% to 35.1%) experienced the primary outcome. Clinical decision-making for inpatient admission achieved a sensitivity of 0.77 (95% CI 0.76 to 0.78), specificity 0.88 (95% CI 0.87 to 0.88) and the negative predictive value (NPV) 0.99 (95% CI 0.99 to 0.99). NEWS2, PMEWS and PRIEST tool algorithm identified patients at risk of adverse outcomes at recommended cut-offs with moderate sensitivity (>0.8) and specificity ranging from 0.47 (NEWS2) to 0.65 (PRIEST tool). Use of the tools at recommended thresholds would have more than doubled admissions with only a 0.01% reduction in false negative triage. Conclusion Use of the PRIEST score, NEWS2 and PMEWS at a threshold of a point higher would achieve similar accuracy to current clinical admission decision, with possible gains in transparency and speed of decision-making.

No abstract

No abstract

No abstract