ORCID Profile
0000-0002-4392-2924
Current Organisation
University of New South Wales
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Publisher: Wiley
Date: 06-2021
DOI: 10.1111/AJR.12735
Abstract: Off‐road riding of quad bikes and motorcycles is common among children across rural and remote Australia, but is a significant source of injury and hospitalisation. An in‐depth analysis of paediatric off‐road vehicle crashes was undertaken to inform injury prevention countermeasures by characterising injury patterns and sources of injury. This is a prospective in‐depth case series. Participants are children aged 16 and under who have been hospitalised due to injury sustained from the use of an off‐road motorcycle or quad bike in New South Wales, Australia. Crash investigation techniques (medical data, structured interview, vehicle and crash site inspection) were used to ascertain details of the crash event, protective gear, injury information and contributory factors. Thirty children were recruited, 27 boys and 3 girls, ranging in age from 4 to 16 years, having crashed on off‐road motorcycles (n = 27) or quads (n = 3). Most (73.3%) were participating in unstructured social riding. A total of 67 separate injuries were observed, with overall Injury Severity Scores between 1 and 35. There were high rates of wearing helmets and motorcycle‐specific garments. The most commonly injured areas were the upper and lower extremities. The most common sources of injury were from impacting the ground, obstacles/other riders or the vehicle. This study demonstrates the patterns of riding and injury in rural paediatric off‐road vehicle riders, occurring despite high rates of helmet rotective gear use. This underscores the need for investigation into the injury mitigation and fit properties of protective gear and the inherent risks for physically and developmentally maturing children.
Publisher: Informa UK Limited
Date: 14-07-2011
DOI: 10.3109/10428194.2011.598250
Abstract: We analyzed patients with small B-cell clonal populations in a non-hospital based pathology laboratory servicing metropolitan and regional areas of New South Wales, Australia. There were 414 patients with a finding of a B-cell clone with total B-lymphocytes < 5.0 × 10(9)/L, fulfilling the criteria for monoclonal B-lymphocytosis (MBL). There were 212 males (51%) and 202 females (49%) with a mean age of 69.7 years. Patients could be clearly ided into two dominant groups: 322 (77.7%) with a typical chronic lymphocytic leukemia (CLL) phenotype, MBL[cll], and 92 (22.3%) with a "non-CLL" or lymphoma-like phenotype, MBL[nhl]. Analysis of MBL[cll] showed 168 (52.2%) males and 154 (47.8%) females with a mean age of 70.6 years. The mean clonal level (CD19/CD5+) was 2.36 × 10(9)/L and the absolute lymphocyte count (ALC) was 0.4-10.5 × 10(9)/L. The ALC was within the reference range (1.0-4.0 × 10(9)/L) in 22%. The 92 patients with MBL[nhl] were 44 (47.8%) males and 48 (52.2%) females, with a mean age of 66.7 years. The mean clonal level was 1.27 × 10(9)/L. There were 65 patients with a "lymphoma unclassifiable" clone and the remainder had a probable disease-specific diagnosis. In a large community cohort of patients, MBL can be ided into two dominant groups, MBL[cll] and the more heterogeneous MBL[nhl].
Publisher: Wiley
Date: 26-06-2017
DOI: 10.1111/JPC.13568
Abstract: Falls in infants are a common cause of injury. Compared to older children, infants under age one are likely to have distinctive causation and injury patterns, as they are pre-mobile or have limited independent mobility and falls are more directly the responsibility of the care giver. There is little known about the mechanistic factors, predictors of injury and injury patterns in this age group. We conducted a retrospective review of infants under age one who presented after a fall to a paediatric trauma centre in Sydney, Australia. Circumstances and mechanisms of the fall, injury patterns, burden of investigations and outcomes were analysed. Over a 3-year period (2011-2013), 916 infants presented following a fall. One hundred and six (11.6%) were admitted and there was one death. Head injury was the most common reason for admission (85%). While there were severe and critical head injuries (Abbreviated Injury Scale 4-5) these were infrequent (2% of presentations). All admitted cases involved a short distance fall. Patients dropped by others were three times more likely to be admitted than infants presenting following other fall types (95% CI 1.9-4.8). Compared to other mechanisms, patients who fell from furniture had significantly longer hospital stays. Fall mechanisms involving infants being dropped by adults, and falls from beds or couches carry the highest clinical burden. These mechanisms should be targets for injury prevention and inform the design of safe equipment and environments for babies.
Publisher: SAGE Publications
Date: 25-08-2020
Abstract: In end-stage ankle arthritis, little is known about the impact of concomitant knee pathology, including the impact of ipsilateral knee pain on total ankle arthroplasty (TAA) outcomes. The aim of this study was to determine the prevalence of ipsilateral preoperative knee pain in patients undergoing TAA and analyze its impact on patient-reported functional outcome measures (PROMs). A retrospective review was performed on the Vancouver End Stage Ankle Arthritis Database at a single institution. In total, 114 patients were studied, with patient demographics collected preoperatively, including the presence or absence of knee pain. Postoperative follow-up was performed at 5 years, primarily analyzing disease-specific PROMs, including the Ankle Osteoarthritis Score (AOS) and Ankle Arthritis Score (AAS). Multivariate mixed-effects linear regression models compared the scores between the groups. In total, 31 patients (27.2%) presented with concomitant ipsilateral knee pain. Despite more females in the knee pain group (64.5% vs 36.1%) there were no other significant differences at baseline between the knee pain and no knee pain groups in terms of demographics or baseline primary disease specific PROMs. At 5 years, the patients with knee pain had significantly worse AAS (37.9 ± 23.8 vs 21.2 ± 16.3, P = .004) and AOS total scores (38.1 ± 24.1 vs 21.9 ± 15.5, P = .005) compared with the no-knee pain group. Both groups improved significantly from baseline across all outcome measures however, the magnitude of improvement was less in the knee pain group. Our study demonstrated that over one-quarter of patients with end-stage ankle arthritis undergoing TAA present with ipsilateral concomitant knee pain. If present, it is associated with worse functional outcomes at the 5-year mark. Further studies are needed to evaluate if knee pain influences complications, implant failure rates, and survival. Levels of Evidence: Level III
Publisher: Massachusetts Medical Society
Date: 11-06-2009
DOI: 10.1056/NEJMC090559
Publisher: BMJ
Date: 15-08-2016
DOI: 10.1136/INJURYPREV-2016-042071
Abstract: Indoor tr oline parks are increasing as a source of injuries among children. We conducted a prospective cohort study, with semi-structured interview and medical record review, of children aged <17 years presenting to a paediatric emergency department following an injury at an indoor tr oline park. In a 6-month period in 2014, 40 such children (55% female) presented to the department. Common mechanisms were in idual jumpers falling while attempting a somersault or trick, landing awkwardly on an obstacle such as a ball or protective padding, and multiple users on a single tr oline. Most sustained soft tissue injuries (n=22, 55%) and fractured bones (n=15, 37.5%). One child sustained an unstable cervical fracture/dislocation. Unlike domestic tr olines, where the majority of injuries occur from falling off, most tr oline-park injuries occur on the tr oline surface. These differences require injury prevention strategies that engage children, carers and businesses to meet best practice design and management standards.
Publisher: American Society of Hematology
Date: 18-06-2009
Publisher: BMJ
Date: 13-07-2022
Abstract: To characterise and compare off-road motorcycle and quad bike crashes in children in New South Wales (NSW), Australia. A retrospective, cross-sectional study was performed of children aged 0-16 years, admitted to hospitals in NSW, from 2001 to 2018 following an injury sustained in an off-road motorcycle or quad bike crash, using linked hospital admissions, mortality and census data.Motorcycle and quad bike injuries were compared regarding: demographics incidence body region injured and type of injury injury severity based on the survival risk ratio length of stay and mortality. There were 6624 crashes resulting in hospitalisation 5156 involving motorcycles (77.8%) and 1468 involving quad bikes (22.2%). There were 10 fatalities (6 from motorcycles and 4 from quad bikes). The rates of injury declined over the study period for motorcycles, but not for quad bikes.Motorcycle riders were more likely than quad bike riders to have lower limb injuries (OR 1.49, p<0.001) but less likely to have head/neck (OR 0.616, p<0.001), abdominal (OR 0.778, p=0.007) and thoracic (OR 0.745, p=0.003) injuries. Quad bike crashes resulted in higher injury severity (mean International Classification Injury Severity Score 0.975 vs 0.977, p=0.03) and longer hospital stay (mean 2.42 days vs 2.09 days, p=0.01). There are significant differences between quad bike and motorcycle crashes in injury type and affected body region. While quad bike injuries in children were more severe, there were almost four times more hospitalisations from motorcycles overall. The overall larger burden of motorcycle crashes suggests a greater focus of injury prevention countermeasures for two-wheeled riders is needed.
Publisher: Informa UK Limited
Date: 17-02-2015
Publisher: American Society of Clinical Oncology (ASCO)
Date: 2021
DOI: 10.1200/JCO.20.01933
Abstract: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9% adjusted odds ratio [aOR], 0.62 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6% aOR, 0.53 95% CI, 0.36 to 0.76). Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2014
Publisher: Wiley
Date: 24-04-2022
DOI: 10.1111/CODI.16117
Abstract: The SARS‐CoV‐2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non‐delayed surgery. This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January–April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90–1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69–1.27, P = 0.672). Longer delays were not associated with poorer outcomes. One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID‐19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long‐term survival attributable to delays is likely to be due to micro‐metastatic disease.
No related grants have been discovered for Christopher Mulligan.