Abstracts / Injury Extra 40 (2009) 139–146 143

manage. Staff believed that patient anger, frustration and painwere the main contributors to difficult or aggressive behaviours.Notably, very few staff believed mood-related difficulties (e.g.,depression, post traumatic stress), which are common in thissetting, were related to the occurrence of challenging behaviours.Curiously, staff reported a moderate to high level of confidence inmanaging difficult behaviours in their workplace, despite report-ing limited effectiveness of systematic behavioural managementpolicies and practices in their workplace.Discussion: These preliminary findings suggest a high frequency ofdifficult and aggressive behaviours in acute trauma settings. Sincestaff did not perceive available behavioural management policiesand practices to be effective, their confidence in their ability tomanage challenging behaviours may stem from reliance on theirpersonal resources.

doi: 10.1016/j.injury.2009.03.031

All terrain vehicle accidents (ATV’s) requiring hospitaladmission—A 13-year state major trauma centre experience

M. Burrell a,*, J. Neilson b, M. Mort b

a Trauma Program Manager, Royal Perth Hospital, Australiab Trauma Research Nurse, Royal Perth Hospital, Australia

ATVs are unlicensed 3 or 4 wheeled motorised vehicles designedprimarily for farm use. The popularity of these vehicles forrecreational purposes has seen a dramatic increase in the numberof presentations to Royal Perth Hospital (RPH) with ATV-relatedtrauma since August 1994.Aim: To describe the nature of ATV-related injuries ofpatients that presented to RPH from August 1994 to December2007.Method: Patients who were admitted to RPH following ATV-relatedtrauma were identified on the Trauma Registry and data relating tothe trauma incident was examined.Results: Over the time period 172 patients were admitted with anATV-related injury, with the majority of injuries sustained by15–34 year old males. The primary mechanisms of injury eitherinvolved a fall from the vehicle or a collision. The majority ofincidents occurred in off-road areas and in the non-metropolitanregions (70%). Helmets were not worn by 26% of patients. Thecommonest injuries were fractures of the limbs and spine. Themedian ISS was 9 (1–43). The average LOS was 7.1 days, and 75% ofpatients were discharged home.Conclusion: RPH is a State Major Trauma Centre, and as suchhas a responsibility in terms of community education and injuryprevention. It is important that the public be made aware of thedangers associated with ATV use. Trauma Registries play animportant role in the identification of target groups and can beused to monitor the impact of any prevention program.

doi: 10.1016/j.injury.2009.03.032

Outcome of follow-up CT in blunt hepatic injury managed non-operatively

Timothy Cooper a, Scott D’Amours a,b, Bin Jalaludin a,c,Minh Truong d

a University of New South Wales, Sydney, New South Wales, Australiab Department of Trauma, Liverpool Hospital, Sydney, New South

Wales, Australiac Centre for Research, Evidence Management and Surveillance,

Liverpool, Australiad Department of Radiology, Liverpool Hospital, Sydney, New South

Wales, Australia

Aim: Computed tomography (CT) scanning is invaluable indelineating the nature and extent of liver injury. However, the

role of routine follow-up CT scanning in the nonoperativemanagement of blunt hepatic injury is unclear. The aim of thisstudy was to review the usefulness of routine CT imaging inpatients managed nonoperatively following initial assessment.Methods: Prospectively collected registry data from a singleinstitution was reviewed for demographic, admission, complica-tion and discharge information. Additionally, patient charts andoutpatient notes were reviewed retrospectively for physiologicalparameters prior to CT scanning and initial transfusion require-ments. CT scans and reports were retrospectively reviewed by ahospital radiologist for injury grade and follow-up scans graded asimproved, unchanged or worsened.Results: Over 13 years, 29 020 patients were admitted with injury.297 had blunt liver injury, 113 (38%) met inclusion criteria (age>15, non-operative management, survival 24 h post injury). Therewere 19 grade I, 35 grade II, 24 grade III (27.9%), 34 grade IV (10.1%)and 1 grade V (3.1%) injuries. 70 patients had 104 follow-up CTscans. On review, 51 (49.0%) scans demonstrated improvement, 47(45.2%) no change and 6 (5.8%) appeared worse. Three abnorm-alities (2 bilomas, 1 haematobilia) were detected on follow-up CT.One patient underwent CT guided drainage although no fluid wasaspirated. The remaining 43 patients were managed withoutfollow-up CT imaging. In this group, two patients were suspectedto have rebleeding, but symptoms resolved without intervention inboth cases.Conclusions: In adults with blunt hepatic trauma successfullymanaged non-operatively, routine repeat CT imaging revealed lowrates of worsening injury. In both the patients who underwentfollow-up imaging and those managed successfully withoutadditional CT scans, no patient developed a substantial complica-tion that required intervention. Follow-up CT imaging did notaffect management or outcome.

doi: 10.1016/j.injury.2009.03.033

Safe placement of chest drains—An audit of knowledge amonghospital medical practitioners

D. Weber a,b

a Department of General Surgery, Royal Perth Hospital, Australiab General Surgery Trainee, Royal Australasian College of Surgeons,

Australia

Aim: Chest drain insertion is an invasive procedure that hasapplication in various medical specialties. Appropriate training isrequired in order for the procedure to be performed safely andeffectively. This audit attempts to define current doctors’ under-standing of the procedure.Methods: 71 medical practitioners working at Royal Perth Hospitalwere surveyed. Their seniority and experience with chest drainswas recorded. Participants were asked to mark a safe site forinsertion of a non-emergency chest drain on a photograph. Theimage used was reproduced from a recent procedural video onchest drain insertion in the New England Journal of Medicine. Theiranswer was compared to a subsequent frame of the video, whichdemonstrated the ‘‘Triangle of Safety’’. Finally, the participantswere asked whether or not they were confident in their answer,and whether or not they would request assistance from a moreexperienced colleague.Results: The majority (58%) of participants selected a point forinsertion outside the ‘‘Triangle of Safety’’, most commonlyidentifying a site too inferior. A significant learning curve appearedto affect doctors during their early postgraduate years. Employ-ment history in ‘‘Trauma Surgery’’ and ‘‘Intensive Care’’ signifi-cantly improved practitioners’ answers.Conclusions: Significant inexperience regarding chest drain inser-tion is demonstrated among medical practitioners at our hospital.