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Zhou M, Norton TW, Rupp K, Paxton RJ, Wang MS, Rehman NS, He J. Level One Trauma Center Proliferation May Worsen Patient Outcomes. Am Surg 2024:31348241244647. [PMID: 38581578 DOI: 10.1177/00031348241244647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
BACKGROUND From 2013 to 2020, Arizona state trauma system expanded from seven to thirteen level 1 trauma centers (L1TCs). This study utilized the state trauma registry to analyze the effect of L1TC proliferation on patient outcomes. METHODS Adult patients age≥15 in the state trauma registry from 2007-2020 were queried for demographic, injury, and outcome variables. These variables were compared across the 2 time periods: 2007-2012 as pre-proliferation (PRE) and 2013-2020 as post-proliferation (POST). Multivariate logistic regression was performed to assess independent predictors of mortality. Subgroup analyses were done for Injury Severity Score (ISS)≥15, age≥65, and trauma mechanisms. RESULTS A total of 482,896 trauma patients were included in this study. 40% were female, 29% were geriatric patients, and 8.6% sustained penetrating trauma. The median ISS was 4. Inpatient mortality overall was 2.7%. POST consisted of more female, geriatric, and blunt trauma patients (P < .001). Both periods had similar median ISS. POST had more interfacility transfers (14.5% vs 10.3%, P < .001). Inpatient, unadjusted mortality decreased by .5% in POST (P < .001). After adjusting for age, gender, ISS, and trauma mechanism, being in POST was predictive of death (OR: 1.4, CI:1.3-1.5, P < .001). This was consistent across all subgroups except for geriatric subgroup, which there was no significant correlation. DISCUSSION Despite advances in trauma care and almost doubling of L1TCs, POST had minimal reduction of unadjusted mortality and was an independent predictor of death. Results suggest increasing number of L1TCs alone may not improve mortality. Alternative approaches should be sought with future regional trauma system design and implementation.
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Affiliation(s)
- Michael Zhou
- Department of Surgery, Resident, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Taylor W Norton
- Department of Surgery, Resident, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Kelsey Rupp
- Department of Surgery, Resident, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Rebecca J Paxton
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Michele S Wang
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Nisha S Rehman
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Jack He
- Department of Surgery, Division of Trauma, Surgical Critical Care, and Acute Care Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
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Gürü M, Özensoy HS. Patterns and Outcomes of Traumatic Suicides: A Retrospective Study of 132 Patients Admitted to a Turkish Medical Center. Med Sci Monit 2024; 30:e943505. [PMID: 38414227 PMCID: PMC10910862 DOI: 10.12659/msm.943505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/24/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Patients who have attempted suicide by traumatic mechanisms and who present to the Emergency Department (ED) are important due to their severity and high mortality. This retrospective study aimed to evaluate the presentation 132 cases of attempted suicide admitted to a hospital ED in Ankara, Turkey, between September 2022 and August 2023. MATERIAL AND METHODS This retrospective study assessed data on 132 adult patients who presented at the ED of Ankara City Hospital due to attempted suicide by traumatic method during a 1-year study period. The descriptive characteristics of the cases, their chronic psychiatric diseases, and the characteristics of their injuries were analyzed based on the duration of stay in the ED and hospital as outcome measures. RESULTS Among our study population, 67% were men and 33% were women, and 52% had a previous psychiatric diagnosis. Incision was the predominant trauma mechanism (n=102, 77.3%). Patients with upper-extremity injuries had shorter stays in the ED (P=0.013), while those injured in with motor vehicle-related injuries and those falling from height stayed in the hospital longer (P=0.018). CONCLUSIONS In the traumatic suicides discussed, upper-extremity injuries with incision predominated. Upper-extremity injuries had shorter ED treatment times. Those injured by falling from heights or by motor vehicles required longer clinical care in the hospital.
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Affiliation(s)
- Meltem Gürü
- Health Care Center, Clinic of Psychiatry, Gazi University Rectorate Campus, Gazi University, Ankara, Turkey
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3
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Rogers FB, Larson NJ, Dries DJ, Olson-Bullis BA, Blondeau B. The State of the Union: Trauma System Development in the United States. J Intensive Care Med 2023:8850666231216360. [PMID: 37981752 DOI: 10.1177/08850666231216360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Injury is both a national and international epidemic that affects people of all age, race, religion, and socioeconomic class. Injury was the fourth leading cause of death in the United States (U.S.) in 2021 and results in an incalculable emotional and financial burden on our society. Despite this, when prevention fails, trauma centers allow communities to prepare to care for the traumatically injured patient. Using lessons learned from the military, trauma care has grown more sophisticated in the last 50 years. In 1966, the first civilian trauma center was established, bringing management of injury into the new age. Now, the American College of Surgeons recognizes 4 levels of trauma centers (I-IV), with select states recognizing Level V trauma centers. The introduction of trauma centers in the U.S. has been proven to reduce morbidity and mortality for the injured patient. However, despite the proven benefits of trauma centers, the U.S. lacks a single, unified, trauma system and instead operates within a "system of systems" creating vast disparities in the level of care that can be received, especially in rural and economically disadvantaged areas. In this review we present the history of trauma system development in the U.S, define the different levels of trauma centers, present evidence that trauma systems and trauma centers improve outcomes, outline the current state of trauma system development in the U.S, and briefly mention some of the current challenges and opportunities in trauma system development in the U.S. today.
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Affiliation(s)
| | | | - David J Dries
- Department of Surgery, Regions Hospital, St. Paul, MN, USA
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4
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Newgard CD, Babcock SR, Song X, Remick KE, Gausche-Hill M, Lin A, Malveau S, Mann NC, Nathens AB, Cook JNB, Jenkins PC, Burd RS, Hewes HA, Glass NE, Jensen AR, Fallat ME, Ames SG, Salvi A, McConnell KJ, Ford R, Auerbach M, Bailey J, Riddick TA, Xin H, Kuppermann N. Emergency Department Pediatric Readiness Among US Trauma Centers: A Machine Learning Analysis of Components Associated With Survival. Ann Surg 2023; 278:e580-e588. [PMID: 36538639 PMCID: PMC10149578 DOI: 10.1097/sla.0000000000005741] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE We used machine learning to identify the highest impact components of emergency department (ED) pediatric readiness for predicting in-hospital survival among children cared for in US trauma centers. BACKGROUND ED pediatric readiness is associated with improved short-term and long-term survival among injured children and part of the national verification criteria for US trauma centers. However, the components of ED pediatric readiness most predictive of survival are unknown. METHODS This was a retrospective cohort study of injured children below 18 years treated in 458 trauma centers from January 1, 2012, through December 31, 2017, matched to the 2013 National ED Pediatric Readiness Assessment and the American Hospital Association survey. We used machine learning to analyze 265 potential predictors of survival, including 152 ED readiness variables, 29 patient variables, and 84 ED-level and hospital-level variables. The primary outcome was in-hospital survival. RESULTS There were 274,756 injured children, including 4585 (1.7%) who died. Nine ED pediatric readiness components were associated with the greatest increase in survival: policy for mental health care (+8.8% change in survival), policy for patient assessment (+7.5%), specific respiratory equipment (+7.2%), policy for reduced-dose radiation imaging (+7.0%), physician competency evaluations (+4.9%), recording weight in kilograms (+3.2%), life support courses for nursing (+1.0%-2.5%), and policy on pediatric triage (+2.5%). There was a 268% improvement in survival when the 5 highest impact components were present. CONCLUSIONS ED pediatric readiness components related to specific policies, personnel, and equipment were the strongest predictors of pediatric survival and worked synergistically when combined.
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Affiliation(s)
- Craig D. Newgard
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
| | - Sean R. Babcock
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
| | - Xubo Song
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon
| | - Katherine E. Remick
- Departments of Pediatrics and Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Marianne Gausche-Hill
- Los Angeles County Emergency Medical Services, Harbor-UCLA Medical Center, Torrance, California
| | - Amber Lin
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
| | - Susan Malveau
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
| | - N. Clay Mann
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Avery B. Nathens
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Jennifer N. B. Cook
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
| | - Peter C. Jenkins
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Randall S. Burd
- Division of Trauma and Burn Surgery, Center for Surgical Care, Children’s National Hospital, Washington, District of Columbia
| | - Hilary A. Hewes
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Nina E. Glass
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Aaron R. Jensen
- Department of Surgery, University of California, San Francisco, Benioff Children’s Hospitals, San Francisco, California
| | - Mary E. Fallat
- Department of Surgery, University of Louisville School of Medicine, Norton Children’s Hospital, Louisville, Kentucky
| | - Stefanie G. Ames
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Apoorva Salvi
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
| | - K. John McConnell
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
- Center for Health Systems Effectiveness, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
| | - Rachel Ford
- Oregon Emergency Medical Services for Children Program, Oregon Health Authority, Portland, Oregon
| | - Marc Auerbach
- Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jessica Bailey
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
| | - Tyne A. Riddick
- Oregon Health & Science University-Portland State University, School of Public Health, Portland, Oregon
| | - Haichang Xin
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, University of California, Davis School of Medicine, Sacramento, California
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Kim JH. [Role of Interventional Radiologists in Trauma Centers]. J Korean Soc Radiol 2023; 84:784-791. [PMID: 37559809 PMCID: PMC10407069 DOI: 10.3348/jksr.2023.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/06/2023] [Accepted: 06/30/2023] [Indexed: 08/11/2023]
Abstract
Based on statistics available in Korea, trauma centers play a critical role in treatment of patients with trauma. Interventional radiologists in trauma centers perform various procedures, including embolization, which constitutes the basic treatment for control of hemorrhage, although interventions such as stent graft insertion may also be used. Although emergency interventional procedures have been used conventionally, rapid and effective hemorrhage control is important in patients with trauma. Therefore, it is important to accurately understand and implement the concept of damage control interventional radiology, which has gained attention in recent times, to reduce preventable trauma-induced mortality rates.
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Van Ditshuizen JC, Rojer LA, Van Lieshout EM, Bramer WM, Verhofstad MH, Sewalt CA, Den Hartog D. Evaluating associations between level of trauma care and outcomes of patients with specific severe injuries: A systematic review and meta-analysis. J Trauma Acute Care Surg 2023; 94:877-892. [PMID: 36726194 PMCID: PMC10208644 DOI: 10.1097/ta.0000000000003890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/20/2022] [Accepted: 01/01/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Trauma networks have multiple designated levels of trauma care. This classification parallels concentration of major trauma care, creating innovations and improving outcome measures. OBJECTIVES The objective of this study is to assess associations of level of trauma care with patient outcomes for populations with specific severe injuries. METHODS A systematic literature search was conducted using six electronic databases up to April 19, 2022 (PROSPERO CRD42022327576). Studies comparing fatal, nonfatal clinical, or functional outcomes across different levels of trauma care for trauma populations with specific severe injuries or injured body region (Abbreviated Injury Scale score ≥3) were included. Two independent reviewers included studies, extracted data, and assessed quality. Unadjusted and adjusted pooled effect sizes were calculated with random-effects meta-analysis comparing Level I and Level II trauma centers. RESULTS Thirty-five studies (1,100,888 patients) were included, of which 25 studies (n = 443,095) used for meta-analysis, suggesting a survival benefit for the severely injured admitted to a Level I trauma center compared with a Level II trauma center (adjusted odds ratio [OR], 1.15; 95% confidence interval [CI], 1.06-1.25). Adjusted subgroup analysis on in-hospital mortality was done for patients with traumatic brain injuries (OR, 1.23; 95% CI, 1.01-1.50) and hemodynamically unstable patients (OR, 1.09; 95% CI, 0.98-1.22). Hospital and intensive care unit length of stay resulted in an unadjusted mean difference of -1.63 (95% CI, -2.89 to -0.36) and -0.21 (95% CI, -1.04 to 0.61), respectively, discharged home resulted in an unadjusted OR of 0.92 (95% CI, 0.78-1.09). CONCLUSION Severely injured patients admitted to a Level I trauma center have a survival benefit. Nonfatal outcomes were indicative for a longer stay, more intensive care, and more frequently posthospital recovery trajectories after being admitted to top levels of trauma care. Trauma networks with designated levels of trauma care are beneficial to the multidisciplinary character of trauma care. LEVEL OF EVIDENCE Systematic review and meta-analysis; Level III.
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Jang SW, Kim HR, Jung PY, Chung JS. Multifaceted Analysis of the Environmental Factors in Severely Injured Trauma: A 30-Day Survival Analysis. Healthcare (Basel) 2023; 11:healthcare11091333. [PMID: 37174875 PMCID: PMC10177835 DOI: 10.3390/healthcare11091333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
(1) Background: Most factors that predict the in-hospital survival rate in patients with severe trauma are patient-related factors; environmental factors are not currently considered important. Predicting the severity of trauma using environmental factors could be a reliable and easy-to-use method. Therefore, the purpose of this study was to determine whether environmental factors affect the survival in patients with severe trauma. (2) Methods: Medical records of patients who activated trauma team in the single regional trauma center, from 2016 to 2020, were retrospectively analyzed. After exclusion of young patients (<19 years old), cases of mild trauma (ISS < 16), and non-preventable deaths (trauma and injury severity score <25%), a total of 1706 patients were included in the study. (3) Results: In the Cox proportional hazard regression analysis, older age, night compared with day, and high rainfall were identified as statistically significant environmental predictors of mortality due to severe trauma. The relationship between mortality and precipitation showed a linear relationship, while that between mortality and temperature showed an inverted U-shaped relationship. (4) Conclusions: Various environmental factors of trauma affect mortality in patients with severe trauma. In predicting the survival of patients with severe trauma, environmental factors are considered relatively less important, though they can be used effectively.
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Affiliation(s)
- Sung Woo Jang
- Trauma Center, National Medical Center, Seoul 04564, Republic of Korea
| | - Hae Rim Kim
- College of Natural Science, School of Statistics, University of Seoul, Seoul 02504, Republic of Korea
| | - Pil Young Jung
- Department of Traumatology, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Jae Sik Chung
- Department of Traumatology, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
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Killien EY, Grassia KL, Butler EK, Mooney SJ, Watson RS, Vavilala MS, Rivara FP. Variation in tracheostomy placement and outcomes following pediatric trauma among adult, pediatric, and combined trauma centers. J Trauma Acute Care Surg 2023; 94:615-623. [PMID: 36730091 PMCID: PMC10038845 DOI: 10.1097/ta.0000000000003848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Tracheostomy placement is much more common in adults than children following severe trauma. We evaluated whether tracheostomy rates and outcomes differ for pediatric patients treated at trauma centers that primarily care for children versus adults. METHODS We conducted a retrospective cohort study of patients younger than 18 years in the National Trauma Data Bank from 2007 to 2016 treated at a Level I/II pediatric, adult, or combined adult/pediatric trauma center, ventilated >24 hours, and who survived to discharge. We used multivariable logistic regression adjusted for age, insurance, injury mechanism and body region, and Injury Severity Score to estimate the association between the three trauma center types and tracheostomy. We used augmented inverse probability weighting to model the likelihood of tracheostomy based on the propensity for treatment at a pediatric, adult, or combined trauma center, and estimated associations between trauma center type with length of stay and postdischarge care. RESULTS Among 33,602 children, tracheostomies were performed in 4.2% of children in pediatric centers, 7.8% in combined centers (adjusted odds ratio [aOR], 1.47; 95% confidence interval [CI], 1.20-1.81), and 11.2% in adult centers (aOR, 1.81; 95% CI, 1.48-2.22). After propensity matching, the estimated average tracheostomy rate would be 62.9% higher (95% CI, 37.7-88.1%) at combined centers and 85.3% higher (56.6-113.9%) at adult centers relative to pediatric centers. Tracheostomy patients had longer hospital stay in pediatric centers than combined (-4.4 days, -7.4 to -1.3 days) or adult (-4.0 days, -7.2 to -0.9 days) centers, but fewer children required postdischarge inpatient care (70.1% pediatric vs. 81.3% combined [aOR, 2.11; 95% CI, 1.03-4.31] and 82.4% adult centers [aOR, 2.51; 95% CI, 1.31-4.83]). CONCLUSION Children treated at pediatric trauma centers have lower likelihood of tracheostomy than children treated at combined adult/pediatric or adult centers independent of patient or injury characteristics. Better understanding of optimal indications for tracheostomy is necessary to improve processes of care for children treated throughout the pediatric trauma system. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Elizabeth Y. Killien
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Kalee L. Grassia
- Department of Pediatric Critical Care Medicine, Cincinnati Children’s Hospital, Cincinnati, OH, USA
| | - Elissa K. Butler
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
- Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Stephen J. Mooney
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - R. Scott Watson
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA
| | - Monica S. Vavilala
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | - Frederick P. Rivara
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA
- Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle, WA
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Avila FR, Carter RE, McLeod CJ, Bruce CJ, Guliyeva G, Torres-Guzman RA, Maita KC, Ho OA, TerKonda SP, Forte AJ. The Role of Telemedicine in Prehospital Traumatic Hand Injury Evaluation. Diagnostics (Basel) 2023; 13:diagnostics13061165. [PMID: 36980474 PMCID: PMC10047211 DOI: 10.3390/diagnostics13061165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/11/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Unnecessary ED visits and transfers to hand clinics raise treatment costs and patient burden at trauma centers. In the present COVID-19 pandemic, needless transfers can increase patients' risk of viral exposure. Therefore, this review analyzes different aspects of the remote diagnosis and triage of traumatic hand injuries. The most common file was photography, with the most common devices being cell phone cameras. Treatment, triage, diagnosis, cost, and time outcomes were assessed, showing concordance between teleconsultation and face-to-face patient evaluations. We conclude that photography and video consultations are feasible surrogates for ED visits in patients with traumatic hand injuries. These technologies should be leveraged to decrease treatment costs and potentially decrease the time to definitive treatment after initial evaluation.
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Affiliation(s)
- Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Christopher J McLeod
- Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Charles J Bruce
- Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Gunel Guliyeva
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | | | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Olivia A Ho
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Sarvam P TerKonda
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
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10
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Gobetti JSC, Zraik MB, Afornali CB, Goveia CHM, Naufel Junior CR, Coelho GA, Nunes SGB, Simm EB. Comparative analysis of the trauma care profile before and during the COVID-19 pandemic: a cross-sectional study in a tertiary university hospital. Rev Col Bras Cir 2023; 50:e20233449. [PMID: 36921134 PMCID: PMC10519697 DOI: 10.1590/0100-6991e-20233449-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/24/2022] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES to evaluate the profile of emergency care of trauma patients at Hospital Universitário Evangélico Mackenzie (HUEM) during the period of restrictive measures due to COVID-19 (03/13/2021 to 04/05/2021), and compare to the same period at the beginning of the pandemic, in 2020, and before the pandemic, in 2019. METHODS quantitative and descriptive observational cross-sectional study. The final sample of 8,338 was analyzed in terms of date, gender, age and service responsible for providing care; the traumas were analyzed according to the etiology and conduct of the treatment and outcome. RESULTS there was a percentage increase in non-traumatic emergency care during the pandemic, and the medical clinic held a third of admissions in 2021. There was a reduction in trauma care, since in 2019 traumas were responsible for 44.9% of admissions and by 23.5% in 2021. There was a significant difference in the proportion between the attendance of men and women, and the percentage of men victims of trauma was higher than in the pre-pandemic periods. There was a reduction in absolute numbers, with statistical significance, in traffic accidents, falls from the same level, burns, general blunt trauma and sports and leisure trauma. The proportion of conservative treatments with hospital discharge reduced. There was a significant difference in the number of deaths, decreasing in 2020 but increasing in 2021. CONCLUSION there was a reduction in trauma care during the pandemic, but the profile remained the adult male victim of a traffic accident. More severe traumas were admitted, resulting in an increase in surgical treatment, hospitalizations and deaths.
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Affiliation(s)
| | - Mariam Bleibel Zraik
- - Faculdade Evangélica Mackenzie do Paraná, Curso de Medicina - Curitiba - PR - Brasil
| | | | | | - Carlos Roberto Naufel Junior
- - Faculdade Evangélica Mackenzie do Paraná, Curso de Medicina - Curitiba - PR - Brasil
- - Hospital Universitário Evangélico Mackenzie, Pronto-socorro - Curitiba - PR - Brasil
| | - Guilherme Andrade Coelho
- - Faculdade Evangélica Mackenzie do Paraná, Curso de Medicina - Curitiba - PR - Brasil
- - Hospital Universitário Evangélico Mackenzie, Pronto-socorro - Curitiba - PR - Brasil
| | - Suelen Geisemara Barcelar Nunes
- - Faculdade Evangélica Mackenzie do Paraná, Curso de Medicina - Curitiba - PR - Brasil
- - Hospital Universitário Evangélico Mackenzie, Pronto-socorro - Curitiba - PR - Brasil
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11
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Fernandes GS, Martins MC, Gomes HL. Experience of non-operative management of blunt liver trauma at Hospital das Clínicas de Uberlândia: 114 cases. Rev Col Bras Cir 2023; 50:e20233424. [PMID: 36921133 PMCID: PMC10519691 DOI: 10.1590/0100-6991e-20233424-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/04/2022] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION trauma is the leading cause of death for the age group from 1 to 49 years in Brazil. Non-Operative Management (NOM) is the gold standard in trauma centers and does not affect mortality in comparison to operative treatment. METHODS medical records were reviewed for 114 patients with blunt liver trauma treated at Hospital das Clínicas of the Federal University of Uberlândia (HC-UFU) from November 2015 to November 2020. RESULTS the most prevalent gender was masculine (74.5%). The most prevalent age group was 20 to 49 years (65.7%). The majority of admitted patients (60.5%) had an Injury Severity Score (ISS) of more than 15. On hospital admission, 30.7% had HR above 100 bpm and 30.70% had SBP below 100mmHg. NOM was implemented in 77.2% of patients, the failure rate was 11.36% and the specific failure rate, excluding complications of associated injuries that resulted in surgery, was 1.75%. One third of deaths were due to severe traumatic brain injury. CONCLUSION the failure rate of NOM in this study is similar to the literature reports for liver trauma. The failure rate, excluding complications of associated injuries, is considered low. The recognition of the epidemiological profile of patients admitted at HC-UFU allows multidisciplinary and integrated care with specialized training, as well as the development of institutional protocols, aiming to reduce morbidity and mortality related to hepatic trauma.
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Affiliation(s)
- Gabriela Souza Fernandes
- - Hospital das Clínicas da Universidade Federal de Uberlândia, Serviço de Cirurgia Geral - Uberlândia - MG - Brasil
| | - Murilo Cândido Martins
- - Hospital das Clínicas da Universidade Federal de Uberlândia, Serviço de Cirurgia Geral - Uberlândia - MG - Brasil
| | - Heitor Luiz Gomes
- - Hospital das Clínicas da Universidade Federal de Uberlândia, Serviço de Cirurgia Geral - Uberlândia - MG - Brasil
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VON-Bahten LC, Zvicker AL, Silva AADA, Salviato BZ, Teixeira HM, Ando PK, Bernardelli RS. Influence of the COVID-19 pandemic on the epidemiological profile of the initial care of victims of falls. Rev Col Bras Cir 2023; 50:e20233422. [PMID: 36921132 PMCID: PMC10519699 DOI: 10.1590/0100-6991e-20233422-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/17/2022] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVE to assess the epidemiological profile of trauma patients from fall from the same level (FSL) and fall from an elevated level (FEL) during the COVID-19 pandemic, and to compare it with data from different levels of restriction (flags) and data prior to the pandemic. METHOD a cross-sectional study with a probability sample of the medical records of patients aged 18 years or older admitted to the emergency room due to falls, from June 2020 to May 2021. Epidemiological data, such as sex, age and injuries were analyzed, as well the current level of restriction. The three restriction periods were compared between then and the proportion of admissions due to falls was compared with the period from December 2016 to February 2018. RESULTS a total of 296 admissions were evaluated, 69.9% were victims of FSL and 30.1% of FEL. The mean age was 57.6 years, and 45.6% were over 60 years old. Admissions among men predominated, and 40.2% of patients required hospitalization. During the red flag period, there were proportionally more injuries to the head and neck (p=0.016), injuries to extremities (p=0.015) and neurological trauma (p<0.001). An average of 6.1, 6.3 and 5.2 admissions per day was obtained during the yellow, orange and red flag, respectively. There was a relative increase in falls when compared to the pre-pandemic period. CONCLUSIONS there was an absolute reduction in admissions of victims of falls in midst of the most restrictive period during the pandemic. However, when compared to pre-pandemic data, there was a relative increase in falls.
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Affiliation(s)
- Luiz Carlos VON-Bahten
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
- - Universidade Federal do Paraná, Departamento de Clínica Cirúrgica - Curitiba - PR - Brasil
- - Pontifícia Universidade Católica do Paraná, Escola de Medicina e Ciências da Vida - Departamento de Clínica Cirúrgica - Curitiba - PR - Brasil
| | - Aliana Lunardi Zvicker
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
| | - Angel Adriany DA Silva
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
| | | | - Heloísa Moro Teixeira
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
| | - Paula Kaori Ando
- - Hospital Universitário Cajuru, Liga Acadêmica do Trauma (LATHUC) - Curitiba - PR - Brasil
| | - Rafaella Stradiotto Bernardelli
- - Pontifícia Universidade Católica do Paraná, Escola de Medicina e Ciências da Vida - Departamento de Bioestatística - Curitiba - PR - Brasil
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Remick K, Smith M, Newgard CD, Lin A, Hewes H, Jensen AR, Glass N, Ford R, Ames S, Cook J, Malveau S, Dai M, Auerbach M, Jenkins P, Gausche-Hill M, Fallat M, Kuppermann N, Mann NC. Impact of individual components of emergency department pediatric readiness on pediatric mortality in US trauma centers. J Trauma Acute Care Surg 2023; 94:417-424. [PMID: 36045493 PMCID: PMC9974586 DOI: 10.1097/ta.0000000000003779] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Injured children initially treated at trauma centers with high emergency department (ED) pediatric readiness have improved survival. Centers with limited resources may not be able to address all pediatric readiness deficiencies, and there currently is no evidence-based guidance for prioritizing different components of readiness. The objective of this study was to identify individual components of ED pediatric readiness associated with better-than-expected survival in US trauma centers to aid in the allocation of resources targeted at improving pediatric readiness. METHODS This cohort study of US trauma centers used the National Trauma Data Bank (2012-2017) matched to the 2013 National Pediatric Readiness Project assessment. Adult and pediatric centers treating at least 50 injured children (younger than 18 years) and recording at least one death during the 6-year study period were included. Using a standardized risk-adjustment model for trauma, we calculated the observed-to-expected mortality ratio for each trauma center. We used bivariate analyses and multivariable linear regression to assess for associations between individual components of ED pediatric readiness and better-than-expected survival. RESULTS Among 555 trauma centers, the observed-to-expected mortality ratios ranged from 0.07 to 4.17 (interquartile range, 0.93-1.14). Unadjusted analyses of 23 components of ED pediatric readiness showed that trauma centers with better-than-expected survival were more likely to have a validated pediatric triage tool, comprehensive quality improvement processes, a pediatric-specific disaster plan, and critical airway and resuscitation equipment (all p < 0.03). The multivariable analysis demonstrated that trauma centers with both a physician and a nurse pediatric emergency care coordinator had better-than-expected survival, but this association weakened after accounting for trauma center level. Child maltreatment policies were associated with lower-than-expected survival, particularly in Levels III to V trauma centers. CONCLUSION Specific components of ED pediatric readiness were associated with pediatric survival among US trauma centers. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Katherine Remick
- From the Department of Pediatrics (K.R.), Dell Medical School at the University of Texas at Austin, Austin, Texas; Department of Pediatrics (M.S., H.H., S.A., M.D., N.C.M.), University of Utah School of Medicine, Salt Lake City, Utah; Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (C.D.N., A.L., J.C., S.M.), Oregon Health & Science University, Portland, Oregon; UCSF Benioff Children's Hospitals, Department of Surgery (A.R.J.), University of California San Francisco, San Francisco, California; Department of Surgery (N.G.), Rutgers New Jersey Medical School, Newark, New Jersey; Oregon EMS for Children Program (R.F.), Oregon Health Authority, Portland, Oregon; Departments of Pediatrics (M.A.) and Emergency Medicine (M.A.), Yale University School of Medicine, New Haven, Connecticut; Indiana University School of Medicine, Department of Surgery (P.J.), Indianapolis, Indiana; Departments of Emergency Medicine (M.G.-H.) and Pediatrics (M.G.-H.), David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California; Department of Surgery (M.F.), University of Louisville School of Medicine, Louisville, Kentucky; and Departments of Emergency Medicine (N.K.) and Pediatrics (N.K.), University of California Davis School of Medicine, Sacramento, California
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Nguyen JK, Sanghavi P. Comparison of survival outcomes among older adults with major trauma after trauma center versus non-trauma center care in the United States. Health Serv Res 2023. [PMID: 36829289 DOI: 10.1111/1475-6773.14148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVE To compare level 1 and 2 trauma centers with similarly sized non-trauma centers on survival after major trauma among older adults. DATA SOURCES AND STUDY SETTING We used claims of 100% of 2012-2017 Medicare fee-for-service beneficiaries who received hospital care after major trauma. STUDY DESIGN Survival differences were estimated after applying propensity-score-based overlap weights. Subgroup analyses were performed for ambulance-transported patients and by external cause. We assessed the roles of prehospital care, hospital quality, and volume. DATA COLLECTION Data were obtained from the Centers for Medicare and Medicaid Services. PRINCIPAL FINDINGS Thirty-day mortality was higher overall at level 1 versus non-trauma centers by 2.2 (95% confidence interval [CI]: 1.8, 2.6) percentage points (pp). Thirty-day mortality was higher at level 1 versus non-trauma centers by 2.3 (95% CI: 1.9, 2.8) pp for falls and 2.3 (95% CI: 0.2, 4.4) pp for motor vehicle crashes. Differences persisted at 1 year. Level 1 and 2 trauma centers had similar outcomes. Hospital quality and volume did not explain these differences. In the ambulance-transported subgroup, after adjusting for prehospital variables, no statistically significant differences remained. CONCLUSIONS Trauma centers may not provide longer survival than similarly sized non-trauma hospitals for severely injured older adults.
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Affiliation(s)
- Jessy K Nguyen
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Prachi Sanghavi
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
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Lim NK, Kim S, Hee Yoon J, Choi KH. Association between the participation of the plastic surgery department and qualitative prognoses in severe trauma patients: A retrospective observational study. Medicine (Baltimore) 2022; 101:e32387. [PMID: 36595792 PMCID: PMC9794290 DOI: 10.1097/md.0000000000032387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Catastrophic incidents would necessitate the intervention of multiple specializations with plastic surgery (PS) as an indispensable area of expertise. In view of PS, prognostic assessment of trauma patients should be focused on the qualitative value rather than mortality because plastic surgeons rarely handled patients' vital signs in actual. Thus, we explored the association between the involvement of the PS department and qualitative prognoses for severe trauma patients. From November 2014 to December 2019, we enrolled total 529 trauma patients with an injury severity score (ISS) over 15 points. We set the prognostic factors that the rate of admission in intensive care unit (ICU), total or ICU duration of hospitalization, post-discharge progress and disability diagnosis which were regarded as qualitative prognoses. The analysis was performed with logistic regression analysis or regression analysis adjusted for age, sex, past medical history, cause of trauma, and frequency of operation. Among total of 529 patients, 290 patients in PS group and 239 patients in non-PS group were analyzed. In both groups, the under-65-year ages and male patients were significantly predominant. The rate of going home showed 2.082 times higher in PS group than non-PS group after adjusting for covariates, while there was no significant difference in diagnosis of disability. Meanwhile, overall prognoses were highly correlated with either higher ISS or lower Glasgow Coma Scale (GCS). In conclusion, higher severity generally affected to the severe trauma patient's prognoses, and the PS treatment only contributes to discharge disposition to home.
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Affiliation(s)
- Nam Kyu Lim
- Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Cheonan, Chungnam, Republic of Korea
- Department of Plastic and Reconstructive Surgery, Dankook University College of Medicine, Cheonan, Chungnam, Republic of Korea
- *Correspondence: Nam Kyu Lim, Department of Plastic and Reconstructive surgery, Dankook University College of Medicine, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam, 31116, Republic of Korea (e-mail: /)
| | - Sungyeon Kim
- Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Cheonan, Chungnam, Republic of Korea
| | - Jae Hee Yoon
- Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Cheonan, Chungnam, Republic of Korea
| | - Kyung-Hwa Choi
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Chungnam, Republic of Korea
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Lu LY, Robichaud SN, Boggs KM, Bedell BR, Cash RE, Sullivan AF, Harris NS, Camargo CA. A Geographical Analysis of Access to Trauma Centers from US National Parks in 2018. Prehosp Disaster Med 2022;:1-6. [PMID: 36263736 DOI: 10.1017/S1049023X22001431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Millions of people visit US national parks annually to engage in recreational wilderness activities, which can occasionally result in traumatic injuries that require timely, high-level care. However, no study to date has specifically examined timely access to trauma centers from national parks. This study aimed to examine the accessibility of trauma care from national parks by calculating the travel time by ground and air from each park to its nearest trauma center. Using these calculations, the percentage of parks by census region with timely access to a trauma center was determined. METHODS This was a cross-sectional study analyzing travel times by ground and air transport between national parks and their closest adult advanced trauma center (ATC) in 2018. A list of parks was compiled from the National Parks Service (NPS) website, and the location of trauma centers from the 2018 National Emergency Department Inventory (NEDI)-USA database. Ground and air transport times were calculated using Google Maps and ArcGIS, with medians and interquartile ranges reported by US census region. Percentage of parks by region with timely trauma center access-defined as access within 60 minutes of travel time-were determined based on these calculated travel times. RESULTS In 2018, 83% of national parks had access to an adult ATC within 60 minutes of air travel, while only 26% had timely access by ground. Trauma center access varied by region, with median travel times highest in the West for both air and ground transport. At a national level, national parks were unequally distributed, with the West housing the most parks of all regions. CONCLUSION While most national parks had timely access to a trauma center by air travel, significant gaps in access remain for ground, the extent of which varies greatly by region. To improve the accessibility of trauma center expertise from national parks, the study highlights the potential that increased implementation of trauma telehealth in emergency departments (EDs) may have in bridging these gaps.
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Lim NK, Park JH. The use of machine learning for investigating the role of plastic surgeons in anatomical injuries: A retrospective observational study. Medicine (Baltimore) 2022; 101:e30943. [PMID: 36221333 PMCID: PMC9542809 DOI: 10.1097/md.0000000000030943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
While plastic surgeons have been historically indispensable in the reconstruction of posttraumatic defects, their role in trauma centers worldwide has not been clearly defined. Therefore, we aimed to investigate the contribution of plastic surgeons in trauma care using machine learning from an anatomic injury viewpoint. We conducted a retrospective study reviewing the data for all trauma patients of our hospital from March 2019 to February 2021. In total, 4809 patients were classified in duplicate according to the 17 trauma-related departments while conducting the initial treatment. We evaluated several covariates, including age, sex, cause of trauma, treatment outcomes, surgical data, and severity indices, such as the Injury Severity Score and Abbreviated Injury Scale (AIS). A random forest algorithm was used to rank the relevance of 17 trauma-related departments in each category for the AIS and outcomes. Additionally, t test and chi-square test were performed to compare two groups, which were based on whether the patients had received initial treatment in the trauma bay from the plastic surgery department (PS group) or not (non-PS group), in each AIS category. The department of PS was ranked first in the face and external categories after analyzing the relevance of the 17 trauma-related departments in six categories of AIS, through the random forest algorithm. Of the 1108 patients in the face category of AIS, the PS group was not correlated with all outcomes, except for the rate of discharge to home (P < .0001). Upon re-verifying the results using random forest, we found that PS did not affect the outcomes. In the external category in AIS, there were 30 patients in the PS group and 56 patients in the non-PS group, and there was no statistically significant difference between the two groups when comparing the outcomes. PS has contributed considerably to the face and external regions among the six AIS categories; however, there was no correlation between plastic surgical treatment and the outcome of trauma patients. We investigated the plastic surgeons' role based on anatomical injury, using machine learning for the first time in the field of trauma care.
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Affiliation(s)
- Nam Kyu Lim
- Department of Plastic and Reconstructive Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea
- Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Cheonan, Republic of Korea
- *Correspondence: Nam Kyu Lim, Department of Plastic and Reconstructive surgery, Dankook University College of Medicine, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam 31116, Republic of Korea (e-mail: )
| | - Jong Hyun Park
- Department of Plastic and Reconstructive Surgery, Dankook University Hospital, Cheonan, Republic of Korea
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Rosenthal JL, Haynes SC, Bonilla B, Rominger K, Williams J, Sanders A, Orqueza Dizon RA, Grether-Jones KL, Marcin JP, Hamline MY. Enhancing the Implementation of the Virtual Pediatric Trauma Center Using Practical, Robust, Implementation and Sustainability Model: A Mixed-Methods Study. Telemed Rep 2022; 3:137-148. [PMID: 36185467 PMCID: PMC9518803 DOI: 10.1089/tmr.2022.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND This article describes factors related to adoption, implementation, and effectiveness of the Virtual Pediatric Trauma Center intervention, which uses telehealth for trauma specialist consultations for seriously injured children. We aimed at (1) measuring RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation outcomes and (2) identifying PRISM (Practical, Robust, Implementation, and Sustainability Model) contextual factors that influenced the implementation outcomes. METHODS This interim implementation evaluation of our telehealth trial used a convergent mixed-methods design. The quantitative component was a cross-sectional analysis of pediatric trauma encounters using electronic health records. The qualitative component was a thematic analysis of written and verbal feedback from providers and family advisory board meetings. We compared the quantitative and qualitative data by synthesizing them in a joint display table, organized by RE-AIM dimensions. We categorized these key findings into the PRISM domains. RESULTS During the first 10 months of this trial, 246 subjects were randomized, with 177 assigned to standard care and 69 assigned to telehealth. Four referring sites transitioned from standard care into their intervention period. PRISM contextual factors that influenced RE-AIM implementation outcomes included the following findings: Providers struggle to remember, interpret, and navigate intervention workflows; providers have preconceived ideas about the intervention purpose; the intervention mitigates parents' anxieties about the transfer process. DISCUSSION This study revealed implementation challenges that influence the overall success of this telehealth trial. Early identification of these challenges allows our team the opportunity to address them now to optimize the intervention reach, adoption, and implementation. This early action will ultimately enhance the success of our trial and the ability of our intervention to achieve broad impact.
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Affiliation(s)
- Jennifer L. Rosenthal
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Sarah C. Haynes
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Bethney Bonilla
- Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USA
| | - Katherine Rominger
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Jacob Williams
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - April Sanders
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | | | - Kendra L. Grether-Jones
- Department of Emergency Medicine, University of California Davis, Sacramento, California, USA
| | - James P. Marcin
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Michelle Y. Hamline
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
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Rahman U, Hamid M, Shan Dasti M, Nouman T, Vedovelli L, Javid A. Traumatic Brain Injuries: A Cross-Sectional Study of Traumatic Brain Injuries at a Tertiary Care Trauma Center in the Punjab, Pakistan. Disaster Med Public Health Prep 2022; 17:e89. [PMID: 35225207 DOI: 10.1017/dmp.2021.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Traumatic brain injuries (TBIs) are 1 of the most common reasons for young adult death and disability. This study sought to provide novel data for TBIs in Southern Punjab, as well as to identify any areas of service improvement to reduce the acute and long-term burden of this condition. METHODS A survey in English was created, which was then circulated to members of the emergency and neurosurgical department for a 3-wk period. RESULTS A total of 450 patients (379 male [84.2%] and 71 female [15.2%]) were included as TBI admissions or attendances with a mean age of 28.9 y. Of the total, 420 people (93.2%) had experienced a TBI following a road traffic incident (RTI), with 78.7% (n = 354) of TBIs involving motorbike users who were not wearing helmets. A total of 226 (50.1%) patients arrived by car to the hospital, and 201 (44.7%) arrived by means of provincial government-funded emergency ambulance services. CONCLUSIONS TBIs in Southern Punjab mostly affect younger males involved in RTIs while riding motorbikes. Recommendations to reduce the acute and long-term burden of TBIs in this region include formal training of all hospital and prehospital staff in the management of acute trauma cases according to international guidelines and operating provincial government emergency ambulance services in a wider geographic area.
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Bahouth H, Abramov R, Bodas M, Halberthal M, Lin S. The Feedback Form and Its Role in Improving the Quality of Trauma Care. Int J Environ Res Public Health 2022; 19:ijerph19031866. [PMID: 35162888 PMCID: PMC8835460 DOI: 10.3390/ijerph19031866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/04/2022] [Accepted: 02/05/2022] [Indexed: 12/04/2022]
Abstract
Background: One of the tasks of a level I trauma center is quality improvement of level II and level III regional hospitals and emergency medical services by means of continuous education and learning processes. One of the tools for this, which provides constant monitoring of the quality of treatment, is feedback. The purpose of the study was to evaluate the effect of feedback on the quality of trauma care. Methods: Retrospective cohort study comprising two periods of time, 2012-2013 and 2017-2018. The study group included physicians and pre-hospital staff who treated patients prior to referral to the level I center. Upon arrival when the trauma teams identified issues requiring improvement, they were asked to fill in feedback forms. Data on patients treated in the trauma shock room for whom feedback forms were filled out were also extracted. Results: A total of 662 feedback forms were completed, showing a significant improvement (p ˂ 0.0001). The majority of the medical personnel who received the most negative feedback were the pre-hospital staff. A significant increase was revealed in the number of feedbacks with reference to mismanagement of backboard spinal fixation, of the pre-hospital staff, in 2012-2013 compared to 2017-2018 (p < 0.001). Improvement in reducing the time of treatment in the field was also revealed, from 15.2 ± 8.3 min in 2012-2013 to 13.4 ± 7.9 min in 2017-2018. Conclusion: The findings show that feedback improves the treatment of injured patients. Furthermore, constantly monitoring the quality of treatment provided by the trauma team is vital for improvement.
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Affiliation(s)
- Hany Bahouth
- Trauma and Acute Care Surgery, Division of Surgery, Rambam Health Care Campus, Haifa 3109601, Israel;
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Institute of Technology, Haifa 3109601, Israel;
| | - Roi Abramov
- Department of General Surgery, Rambam Health Care Campus, Haifa 3109601, Israel;
| | - Moran Bodas
- The Israeli National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Ramat Gan 5262100, Israel;
- Department of Emergency Management and Disaster Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo 6997801, Israel
| | - Michael Halberthal
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Institute of Technology, Haifa 3109601, Israel;
- Rambam Management, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Shaul Lin
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Institute of Technology, Haifa 3109601, Israel;
- The Israeli National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Ramat Gan 5262100, Israel;
- Department of Endodontics and Dental Trauma, Rambam Health Care Campus, Haifa 3109601, Israel
- Correspondence:
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21
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Engstrom A, Moloney K, Nguyen J, Parker L, Roberts M, Moodliar R, Russo J, Wang J, Scheuer H, Zatzick D. A Pragmatic Clinical Trial Approach to Assessing and Monitoring Suicidal Ideation: Results from A National US Trauma Care System Study. Psychiatry 2021; 85:13-29. [PMID: 34932440 PMCID: PMC8916972 DOI: 10.1080/00332747.2021.1991200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Few investigations have comprehensively described methods for assessing and monitoring suicidal ideation in pragmatic clinical trials of mental health services interventions. This investigation's goal was to assess a collaborative care intervention's effectiveness in reducing suicidal ideation and describe suicide monitoring implementation in a nationwide protocol. METHOD The investigation was a secondary analysis of a stepped wedge cluster randomized trial at 25-Level I trauma centers. Injury survivors (N = 635) were randomized to control (n = 370) and intervention (n = 265) conditions and assessed at baseline hospitalization and follow-up at 3-, 6- and 12-months post-injury. The Patient Health Questionnaire (PHQ-9) item-9 was used to evaluate patients for suicidal ideation. Mixed model regression was used to assess intervention versus control group changes in PHQ-9 item-9 scores over time and associations between baseline characteristics and development of suicidal ideation longitudinally. As part of the study implementation process assessment, suicide outreach call logs were also reviewed. RESULTS Over 50% of patients endorsed suicidal ideation at ≥1 assessment. Intervention patients relative to control patients demonstrated reductions in endorsements of suicidal ideation that did not achieve statistical significance (F[3,1461] = 0.74, P = .53). The study team completed outreach phone calls, texts or voice messages to 268 patients with PHQ-9 item-9 scores ≥1 (n = 161 control, n = 107 intervention). CONCLUSIONS Suicide assessment and monitoring can be feasibly implemented in large-scale pragmatic clinical trials. Intervention patients demonstrated less suicidal ideation over time; however, these comparisons did not achieve statistical significance. Intensive pragmatic trial monitoring may mask treatment effects by providing control patients a supportive intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT02655354.
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Affiliation(s)
- Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Jefferson Nguyen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Lea Parker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Department of Psychology, Drexel University College of Arts and Sciences, Philadelphia, US
| | - Michelle Roberts
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, USA
| | - Rddhi Moodliar
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Department of Psychology, University of California, Los Angeles, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, USA
| | - Hannah Scheuer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- School of Social Work, University of Washington, Seattle, USA
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, USA
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22
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Biswas S, Bahouth H, Solomonov E, Waksman I, Halberthal M, Bala M. Preparedness for Mass Casualty Incidents: The Effectiveness of Current Training Model. Disaster Med Public Health Prep 2021;:1-9. [PMID: 34711298 DOI: 10.1017/dmp.2021.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The importance of MCI organization and training was highlighted by the events of September 11, 2001. Training focuses on the management of physical injuries caused by a single traumatic event over a well-defined, relatively short timeframe. MCI management is integrated into surgical and trauma training, with disaster management training involving the emergency services, law enforcement, and state infrastructure agencies. The COVID-19 pandemic revealed gaps in the preparedness of nation states and global partners in disaster management. The questions that arose include 'has training really prepared us for an actual emergency,' 'what changes need to be made to training to make it more effective,' and 'who else should training be extended to?' This article focuses on the importance of involving multiple sectors in mass casualty training and asks whether greater involvement of non-medical agencies and the public, in operational drills might improve preparedness for global events such as the COVID-19 pandemic.
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23
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Jain M, Mohanty CR, Doki SK, Radhakrishnan RV, Khutia S, Patra SK, Biswas M. Traumatic spine injuries in Eastern India: A retrospective observational study. Int J Crit Illn Inj Sci 2021; 11:79-85. [PMID: 34395209 PMCID: PMC8318168 DOI: 10.4103/ijciis.ijciis_95_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/05/2020] [Accepted: 10/27/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Trauma is the leading cause of hospitalization globally, and trauma-induced spinal injuries can be devastating and permanent. The objective of this study was to describe the pattern, association, and outcome in patients with traumatic spine injury (TSI). Methods: A retrospective cross-sectional study was undertaken on patients with TSI who presented to the trauma and emergency department of a level 1 trauma center in eastern India between August 15, 2018, and August 14, 2019, by including 103 patients. Information pertaining to demography, mode of injury (MOI), fracture morphology, neurological grading, and associated spinal or other regional injuries was obtained. Correlation among injury severity score (ISS), neurological damage as per American Spinal Injury Association (ASIA), and morphological patterns was determined. Results: The median age was 39 years, and the gender ratio was 5.87:1. Fall from height (43.7%) was the most common MOI. The median ISS was 21, and the percentage of patients with polytrauma was 73% (ISS > 15). The cervical region (n = 30) was the most common site of injury, and multiple vertebral involvement (n = 32) was more common than isolated involvement. Type A pattern (53.4%) was the predominant type, followed by types C and B (29.1% and 15.5%, respectively) for primary spine injury, and type A was the predominant type for secondary spinal injury. Severe neurological damage (ASIA A-C) was noticed in 69 patients. The correlation between ISS and ASIA scores (Spearman's ρ = 0.561, P < 0.001) and between morphology type and ASIA score (Pearson's χ
2= 69.7, P < 0.001) was statistically significant. In total, 53 patients were managed surgically and 24 patients were managed by conservative measures. Conclusion: Our study found a predominantly younger population, multilevel involvement, significant neurological damage, multiple associated injuries, and higher ISS among the patients of TSI. The pattern in eastern India is different from previous reports from other parts of the country.
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Affiliation(s)
- Mantu Jain
- Department of Orthopedics, AIIMS, Bhubaneswar, Odisha, India
| | | | - Sunil Kumar Doki
- Department of Orthopedics, IMS and Sum Hospital, Bhubaneswar, Odisha, India
| | | | - Susanta Khutia
- Department of Orthopedics, AIIMS, Bhubaneswar, Odisha, India
| | - Saroj Kumar Patra
- Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India
| | - Mridul Biswas
- Department of Orthopedics, AIIMS, Bhubaneswar, Odisha, India
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24
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Lee HJ, Lee M, Jang SJ. Compassion Satisfaction, Secondary Traumatic Stress, and Burnout among Nurses Working in Trauma Centers: A Cross-Sectional Study. Int J Environ Res Public Health 2021; 18:7228. [PMID: 34299686 DOI: 10.3390/ijerph18147228] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/03/2021] [Accepted: 07/04/2021] [Indexed: 12/05/2022]
Abstract
Due to the nature of their work, trauma nurses are exposed to traumatic situations and often experience burnout. We conducted a cross-sectional study examining compassion satisfaction, secondary traumatic stress, and burnout among trauma nurses to identify the predictors of burnout. Data were collected from 219 nurses in four trauma centers in South Korea from July to August 2019. We used the Traumatic Events Inventory to measure nurses’ traumatic experience and three Professional Quality of Life subscales to measure compassion satisfaction, secondary traumatic stress, and burnout. Multiple regression analysis confirmed that compassion satisfaction and secondary traumatic stress significantly predicted nurses’ burnout, with compassion satisfaction being the most potent predictor. The regression model explained 59.2% of the variance. Nurses with high job satisfaction, high compassion satisfaction, and low secondary traumatic stress tend to experience less burnout than their counterparts. Nurse managers should recognize that strategies to enhance job and compassion satisfaction and decrease secondary traumatic stress are required to decrease burnout among nurses in trauma centers.
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25
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Truong EI, Ho VP, Tseng ES, Ngana C, Curtis J, Curfman ET, Claridge JA. Is more better? Do statewide increases in trauma centers reduce injury-related mortality? J Trauma Acute Care Surg 2021; 91:171-177. [PMID: 33843835 PMCID: PMC8487036 DOI: 10.1097/ta.0000000000003178] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Trauma centers are inconsistently distributed throughout the United States. It is unclear if new trauma centers improve care and decrease mortality. We tested the hypothesis that increases in trauma centers are associated with decreases in injury-related mortality (IRM) at the state level. METHODS We used data from the American Trauma Society to geolocate every state-designated or American College of Surgeons-verified trauma center in all 50 states and the District of Columbia from 2014 to 2018. These data were merged with publicly available IRM data from the Centers for Disease Control and Prevention. We used geographic information systems methods to map and study the relationships between trauma center locations and state-level IRM over time. Regression analysis, accounting for state-level fixed effects, was used to calculate the effect of total statewide number of trauma center on IRM and year-to-year changes in statewide trauma center with the IRM (shown as deaths per additional trauma center per 100,000 population, p value). RESULTS Nationwide between 2014 and 2018, the number of trauma center increased from 2,039 to 2,153. Injury-related mortality also increased over time. There was notable interstate variation, from 1 to 284 trauma centers. Four patterns in statewide trauma center changes emerged: static (12), increased (29), decreased (5), or variable (4). Of states with trauma center increases, 26 (90%) had increased IRM between 2014 and 2017, while the remaining 3 saw a decline. Regression analysis demonstrated that having more trauma centers in a state was associated with a significantly higher IRM rate (0.38, p = 0.03); adding new trauma centers was not associated with changes in IRM (0.02, p = 0.8). CONCLUSION Having more trauma centers and increasing the number of trauma center within a state are not associated with decreases in state-level IRM. In this case, more is not better. However, more work is needed to identify the optimal number and location of trauma centers to improve IRM. LEVEL OF EVIDENCE Epidemiologic, level III; Care management, level III.
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Affiliation(s)
- Evelyn I. Truong
- Department of Surgery, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Vanessa P. Ho
- Department of Surgery, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Esther S. Tseng
- Department of Surgery, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Colette Ngana
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Jacqueline Curtis
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Eric T. Curfman
- Department of Surgery, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey A. Claridge
- Department of Surgery, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio
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26
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Lin IC, McKenny M, Elkbuli A. Broken bones, broken minds, and broken hearts: Psychotrauma resources for pediatric non-accidental trauma survivors - Editorial. Ann Med Surg (Lond) 2021; 67:102512. [PMID: 34295463 PMCID: PMC8282460 DOI: 10.1016/j.amsu.2021.102512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 11/14/2022] Open
Abstract
The PTSD Checklist for DSM-5 (PCL-5) assessment is not meant for an acute trauma and is administered to assess PTSD symptoms experienced over the past month. This screening tool is indicated for children ages 7 or above, which spans a wider age range than does the PHQ-9. It is difficult to say how widely available psycho-trauma resources are in the acute care setting at PTCs. However, the literature demonstrates the importance of immediate, adequate psychologic care for pediatric trauma cases. We hope that trauma centers moving forward, stop only healing the broken bones and start healing the broken bones, the broken minds, and comforting the broken hearts.
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Affiliation(s)
- I-Chun Lin
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenny
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
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27
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Alhomaidan HT, Rasheed Z, Alsudais MM, AlMutairi AM, Alzaben KA, AlMutairi SM, Alissa LI, Widyan AM, Alkhamiss AS, Alduraibi SK, Al Abdulmonem W. Physicians based emergency medical services for the management of burn injuries in trauma centers of the center region of Saudi Arabia: evaluation of physicians' knowledge and experience. Int J Burns Trauma 2021; 11:184-190. [PMID: 34336383 PMCID: PMC8310865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Medical services at trauma centers regularly encounter severe burn patients but prehospital care of these patients in Saudi Arabia is comparatively unexplored. This study evaluates the knowledge and experience of physicians working in trauma centers of Qassim province of Saudi Arabia for the management of patients with burn injuries. METHODS This is a cross sectional study performed on 204 physicians working in the trauma centers of Qassim province. Physicians' knowledge and experience were assessed via administration of validated questionnaires and the data were analyzed using SPSS software. RESULTS Among total studied physicians, only 35.3% and 24.0% gave the right answer to the question on the diagnosis of burn skin in depth/extent for adults and pediatric patients, respectively. Importantly, 93.6% physicians responded correctly for first aid treatment. For the parkland concept, 62.2% responded correctly, however, only 22.5% understand the colloid fluid concept. The 74% physicians knew the methods of fluid revival for mass burn injuries and about half of studied physicians showed right knowledge for intubation for breathing for mass burn injuries. Only 47.5% physicians understand the concept of electrolyte disorder. CONCLUSIONS This is the first study from the central region of Saudi Arabia that analyzed the knowledge and experience of physicians working in trauma centers for the management of patients with burn injuries. Overall data showed that ~60% physicians working in trauma centers have knowledge for handling the patients with burn injuries but the rest needed counseling, therefore proper training sessions for them are needed for management of burn patients.
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Affiliation(s)
- Homaidan T Alhomaidan
- Department of Family and Community Medicine, College of Medicine, Qassim UniversityBuraidah, Saudi Arabia
| | - Zafar Rasheed
- Department of Medical Biochemistry, College of Medicine, Qassim UniversityBuraidah, Saudi Arabia
| | - Manal M Alsudais
- Medical Intern, College of Medicine, Qassim UniversityBuraidah, Saudi Arabia
| | - Asma M AlMutairi
- Department of Internal Medicine, Prince Sultan Military Medical CityRiyadh, Saudi Arabia
| | - Khawlah A Alzaben
- Department of Ophthalmology, King Khaled Eye Specialist HospitalRiyadh, Saudi Arabia
| | - Sara M AlMutairi
- Department of Obstetrician and Gynecology, King Fahad Medical CityRiyadh, Saudi Arabia
| | - Lamees I Alissa
- Department of Obstetrician and Gynecology, Security Forces HospitalRiyadh, Saudi Arabia
| | - Adel M Widyan
- Department of Mathematics, College of Science, Qassim UniversityBuraidah, Saudi Arabia
| | - Abdullah S Alkhamiss
- Department of Pathology, College of Medicine, Qassim UniversityBuraidah, Saudi Arabia
| | - Sharifa K Alduraibi
- Department of Radiology, College of Medicine, Qassim UniversityBuraidah, Saudi Arabia
| | - Waleed Al Abdulmonem
- Department of Pathology, College of Medicine, Qassim UniversityBuraidah, Saudi Arabia
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28
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Taylor A, Huang E, Waller J, White C, Martinez-Quinones P, Robinson T. Achievement of goal anti-Xa activity with weight-based enoxaparin dosing for venous thromboembolism prophylaxis in trauma patients. Pharmacotherapy 2021; 41:508-514. [PMID: 33864688 DOI: 10.1002/phar.2526] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 11/09/2022]
Abstract
STUDY OBJECTIVE The purpose of this study was to evaluate the utility of routine anti-Xa peak monitoring for trauma patients initiated on weight-based enoxaparin for venous thromboembolism (VTE) prophylaxis and identify patient populations where monitoring is necessary. DESIGN Retrospective study. SETTING Augusta University (AU) Medical Center in Augusta, Georgia, a level 1 trauma center. PATIENTS Adult patients admitted to the trauma surgery service requiring chemical VTE prophylaxis. INTERVENTION At least three consecutive doses of enoxaparin 0.5 mg/kg subcutaneously every 12 hour for VTE prophylaxis prior to an anti-Xa peak as the initial chemical VTE prophylaxis strategy. MEASUREMENTS The primary end point was the percentage of patients who achieved goal anti-Xa peak of 0.2-0.6 unit/ml. The incidence of newly diagnosed VTE and clinically significant bleeding were assessed as secondary end points. MAIN RESULTS From January 1, 2018, through February 28, 2019, 300 patients met inclusion criteria. Anti-Xa peaks were within goal in 91% of all patients, 7.7% were below goal, and 1.3% were above goal. For patients who did not meet the goal, dose adjustments were made in 70.4% of patients. New levels were obtained in 73.7% of those patients, and all repeat levels was within goal. Clinically significant bleeding occurred in 5.3% of patients. Newly diagnosed VTE occurred in 1.7% of patients. CONCLUSIONS The use of initial weight-based enoxaparin dosing in trauma patients routinely achieved the prespecified target anti-Xa goal. In conclusion, anti-Xa levels are not necessary for routine monitoring of weight-based enoxaparin for VTE prophylaxis in trauma patients. Incidence of clinically significant bleeding and newly diagnosed VTE were similar to previous studies.
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Affiliation(s)
- Ashley Taylor
- Augusta University Medical Center, Augusta, Georgia, USA.,Department of Clinical and Administrative Pharmacy, The University of Georgia College of Pharmacy, Athens, Georgia, USA
| | - Ellen Huang
- Augusta University Medical Center, Augusta, Georgia, USA
| | | | | | | | - Tim Robinson
- Augusta University Medical Center, Augusta, Georgia, USA
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29
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Abstract
OBJECTIVE This paper demonstrates that localized and chronic stop-question-and-frisk (SQF) practices are associated with community members' utilization of emergency department (ED) resources. To explain this relationship, we explore the empirical applicability of a legal epidemiological framework, or the study of legal institutional influences on the distribution of disease and injury. DATA AND STUDY DESIGN Analyses are derived from merging data from the Philadelphia Vehicle and Pedestrians Investigation, the National Historical Geographic Information System, and the Southeastern Philadelphia Community Health database to zip code identifiers common to all datasets. Weighted multilevel negative binomial regressions measure the influence that local SQF practices have on ED use for this population. Analytic methods incorporate patient demographic covariates including household size, health insurance status, and having a doctor as a usual source of care. PRINCIPAL FINDINGS Findings reveal that both tract-level frisking and poor health are linked to more frequent use of hospital EDs, per respondent report. Despite their health care needs, however, reporting poor/fair health status is associated with a substantial decrease in the rate of emergency department visits as neighborhood frisk concentration increases (IRR = 0.923; 95% CI: 0.891, 0.957). Moreover, more sickly people in high-frisk neighborhoods live in tracts that have greater racial disparities in frisking-a pattern that accounts for the moderating role of neighborhood frisking in sick people's usage of the emergency room. CONCLUSIONS Findings indicating the robust association reported above interrogate the chronic incompatibility of local health and human service system aims. The study also provides an interdisciplinary theoretical lens through which stakeholders can make sense of these challenges and their implications.
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Affiliation(s)
- Erin M Kerrison
- School of Social Welfare, University of California, Berkeley, Berkeley, California
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30
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Killien EY, Huijsmans RLN, Vavilala MS, Schleyer AM, Robinson EF, Maine RG, Rivara FP. Association of Psychosocial Factors and Hospital Complications with Risk for Readmission After Trauma. J Surg Res 2021; 264:334-345. [PMID: 33848832 DOI: 10.1016/j.jss.2021.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/26/2021] [Accepted: 02/27/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Unplanned hospital readmissions are associated with morbidity and high cost. Existing literature on readmission after trauma has focused on how injury characteristics are associated with readmission. We aimed to evaluate how psychosocial determinants of health and complications of hospitalization combined with injury characteristics affect risk of readmission after trauma. MATERIALS AND METHODS We conducted a retrospective cohort study of adult trauma admissions from July 2015 to September 2017 to Harborview Medical Center in Seattle, Washington. We assessed patient, injury, and hospitalization characteristics and estimated associations between risk factors and unplanned 30-d readmission using multivariable generalized linear Poisson regression models. RESULTS Of 8916 discharged trauma patients, 330 (3.7%) had an unplanned 30-d readmission. Patients were most commonly readmitted with infection (41.5%). Independent risk factors for readmission among postoperative patients included public insurance (adjusted Relative Risk (aRR) 1.34, 95% CI 1.02-1.76), mental illness (aRR 1.39, 1.04-1.85), and chronic renal failure (aRR 2.17, 1.39-3.39); undergoing abdominal, thoracic, or neurosurgical procedures; experiencing an index hospitalization surgical site infection (aRR 4.74, 3.00-7.50), pulmonary embolism (aRR 3.38, 2.04-5.60), or unplanned ICU readmission (aRR 1.74, 1.16-2.62); shorter hospital stay (aRR 0.98/d, 0.97-0.99), and discharge to jail (aRR 4.68, 2.63-8.35) or a shelter (aRR 4.32, 2.58-7.21). Risk factors varied by reason for readmission. Injury severity, trauma mechanism, and body region were not independently associated with readmission risk. CONCLUSIONS Psychosocial factors and hospital complications were more strongly associated with readmission after trauma than injury characteristics. Improved social support and follow-up after discharge for high-risk patients may facilitate earlier identification of postdischarge complications.
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Affiliation(s)
- Elizabeth Y Killien
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, Washington.
| | - Roel L N Huijsmans
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; University Medical Center Utrecht, Utrecht, Netherlands
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Anneliese M Schleyer
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington; Hospital Quality and Patient Safety, Harborview Medical Center, Seattle, Washington
| | - Ellen F Robinson
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Rebecca G Maine
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, , Washington
| | - Frederick P Rivara
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington; Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle, Washington
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31
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Watson D, Benton B, Ablah E, Lightwine K, Lusk R, Okut H, Bui T, Haan JM. Demographics and Incident Location of Traumatic Injuries at a Single Level I Trauma Center. Kans J Med 2021; 14:5-11. [PMID: 33643521 PMCID: PMC7833984 DOI: 10.17161/kjm.vol1413771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/21/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Traumatic injuries are preventable and understanding determinants of injury, such as socio-economic and environmental factors, is vital. This study evaluated traumatic injuries and identified areas of high trauma incidence. Methods A retrospective review was conducted of all patients 14 years or older who were admitted with a traumatic injury to a Level I trauma center between 2016 and 2017. Descriptive analyses were presented and maps of high injury areas were generated. Results The most frequent mechanisms of injury were falls (58.3%), motor vehicle crashes (22.3%), and motorcycle crashes (5.7%). Fall patients were more likely to be female (59.6%) and were the oldest age group (72.1 ± 17.2) compared to motor vehicle and motorcycle crash patients. Severe head (22.1%, p = 0.007) and extremity (35.7%, p = 0.001) injuries were most frequent among fall patients, however, more motorcycle crash patients required mechanical ventilation (16.1%, p < 0.001) and experienced the longest intensive care unit length of stay (5.3 ± 6.8 days, p < 0.001) and mechanical ventilation days (6.6 ± 8.5, p < 0.036). Motorcycle crash patients also had the greatest number of deaths (7.5%, p < 0.001). The generated maps of all traumas suggested that most injuries occur near our hospital and are located in several of the most population-dense zip codes. Conclusion Patient demographics, injury severity, and hospital outcomes varied by mechanisms of injury. Traumatic injuries occurred near our hospital and were located in several of the most populationdense zip codes. Injury prevention efforts should target high incident areas.
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Affiliation(s)
- David Watson
- Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Blair Benton
- Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Elizabeth Ablah
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Kelly Lightwine
- Ascension Via Christi Hospital on St. Francis, Department of Trauma Services, Wichita, KS
| | - Ronda Lusk
- Ascension Via Christi Hospital on St. Francis, Department of Trauma Services, Wichita, KS
| | - Hayrettin Okut
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Thuy Bui
- Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - James M Haan
- Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS.,Ascension Via Christi Hospital on St. Francis, Department of Trauma Services, Wichita, KS
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32
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Ordoñez CA, Parra MW, Caicedo Y, Padilla N, Rodríguez-Holguín F, Serna JJ, Salcedo A, García A, Orlas C, Pino LF, Del Valle AM, Mejia D, Salamea-Molina JC, Brenner M, Hörer T. REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients. Colomb Med (Cali) 2020; 51:e4064506. [PMID: 33795901 PMCID: PMC7968426 DOI: 10.25100/cm.v51i4.4422.4506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Noncompressible torso hemorrhage is one of the leading causes of preventable death worldwide. An efficient and appropriate evaluation of the trauma patient with ongoing hemorrhage is essential to avoid the development of the lethal diamond (hypothermia, coagulopathy, hypocalcemia, and acidosis). Currently, the initial management strategies include permissive hypotension, hemostatic resuscitation, and damage control surgery. However, recent advances in technology have opened the doors to a wide variety of endovascular techniques that achieve these goals with minimal morbidity and limited access. An example of such advances has been the introduction of the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), which has received great interest among trauma surgeons around the world due to its potential and versatility in areas such as trauma, gynecology & obstetrics and gastroenterology. This article aims to describe the experience earned in the use of REBOA in noncompressible torso hemorrhage patients. Our results show that REBOA can be used as a new component in the damage control resuscitation of the severely injured trauma patient. To this end, we propose two new deployment algorithms for hemodynamically unstable noncompressible torso hemorrhage patients: one for blunt and another for penetrating trauma. We acknowledge that REBOA has its limitations, which include a steep learning curve, its inherent cost and availability. Although to reach the best outcomes with this new technology, it must be used in the right way, by the right surgeon with the right training and to the right patient.
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Affiliation(s)
- Carlos A Ordoñez
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL - USA
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Natalia Padilla
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia
| | - José Julián Serna
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia
| | - Alexander Salcedo
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia
| | - Alberto García
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Claudia Orlas
- Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, USA.,Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, USA
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Hospital Universitario del Valle, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia
| | | | - David Mejia
- Hospital Pablo Tobon Uribe, Department of Surgery, Medellin, Colombia.,Universidad de Antioquia, Department of Surgery, Medellin, Colombia
| | - Juan Carlos Salamea-Molina
- Hospital Vicente Corral Moscoso, Division of Trauma and Acute Care Surgery. Cuenca, Ecuador.,Universidad del Azuay, Escuela de Medicina. Cuenca, Ecuador
| | - Megan Brenner
- University of California, Department of Surgery Riverside University Health Systems. Riverside, CA, USA
| | - Tal Hörer
- 15 Örebro University Hospital, Faculty of Medicine, Department of Cardiothoracic and Vascular Surgery, Örebro, Sweden
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Ledrick D, Payvandi A, Murray AC, Leskovan JJ. Is There a Need for Abdominal CT Scan in Trauma Patients With a Low-Risk Mechanism of Injury and Normal Vital Signs? Cureus 2020; 12:e11628. [PMID: 33376642 PMCID: PMC7755665 DOI: 10.7759/cureus.11628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Clinically significant injuries are often missed in trauma patients with low-risk mechanisms of injury and lack of "red flags," such as abnormal vital signs. The purpose of this retrospective analysis was to evaluate the efficacy of computed axial tomography (CT) for identifying occult injuries in a high-volume trauma center. Methods Records from our institutional trauma registry were retrospectively extracted, examining encounters from January 2015 to October 2019. Those patients between the ages of 18 and 65 who were referred to the trauma team with a CT scan of the abdomen and had low-risk mechanisms of injury, a Glasgow Coma Scale (GCS) score of 15, and normal vital signs at presentation were included. Patients in the lowest trauma categorization (Level Three, Consult) met the study definition for the low-risk mechanism of injury. Demographic and clinical data were abstracted for all patients. For this analysis, patients were divided into two groups based on age (18 - 40 years or 40 - 65 years). Injuries found on CT, their clinical significance, and the likelihood of being missed without CT were determined. Results Of 2,103 blunt trauma patients that received a CT scan of the abdomen from January 2015 to October 2019, 134/2,103 (6.4%) met the inclusion criteria (mean age: 44.6 years; 72.3% male). Patients between the ages of 40 and 65 years comprised 61.2% (82/134) of the study population. Of the included patients, 17.2% (23/134) had at least one acute traumatic injury identified after CT imaging of the torso. Occult injuries found on CT included rib fracture with associated lung injuries (10/23, 43.5%), splenic laceration (4/23, 17.4%), liver laceration (3/23, 13.0%), gluteal hematoma with active bleeding (1/23, 4.3%), sternal fractures (3/23, 13.0%), and thoracic or lumbar spine fractures (2/23, 8.7%). An independent review of the medical records determined that 9.0% (12/134) of these patients had traumatic injuries that would have been missed based on clinical examination without CT. Conclusions Based on our experience, utilizing CT imaging of at least the abdomen as a routine screening measure for all trauma consults - even low-risk patients with normal vital signs - can rapidly and accurately identify clinically significant injuries that would have been otherwise missed in a notable portion of the population.
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Affiliation(s)
- David Ledrick
- Department of Emergency Medicine, Mercy St. Vincent Medical Center, Toledo, USA
| | - Alexander Payvandi
- Department of Emergency Medicine, Mercy St. Vincent Medical Center, Toledo, USA
| | - Adam C Murray
- Department of Emergency Medicine, Mercy St. Vincent Medical Center, Toledo, USA
| | - John J Leskovan
- Department of Trauma Surgery, Mercy St. Vincent Medical Center, Toledo, USA
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Dooley JH, Dennis BM, Magnotti LJ, Sharpe JP, Guillamondegui OD, Croce MA, Fischer PE. Is NBATS-2 up to the Task? Actual vs. Predicted Patient Volume Shifts With the Addition of Another Trauma Center. Am Surg 2020; 87:595-601. [PMID: 33131286 DOI: 10.1177/0003134820952383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Version 2 of the Needs-Based Assessment of Trauma Systems (NBATS) tool quantifies the impact of an additional trauma center on a region. This study applies NBATS-2 to a system where an additional trauma center was added to compare the tool's predictions to actual patient volumes. METHODS Injury data were collected from the trauma registry of the initial (legacy) center and analyzed geographically using ArcGIS. From 2012 to 2014 ("pre-"period), one Level 1 trauma center existed. From 2016 to 2018 ("post-"period), an additional Level 2 center existed. Emergency medical service (EMS) destination guidelines did not change and favored the legacy center for severely injured patients (Injury Severity Score (ISS) >15). NBATS-2 predicted volume was compared to the actual volume received at the legacy center in the post-period. RESULTS 4068 patients were identified across 14 counties. In the pre-period, 72% of the population and 90% of injuries were within a 45-minute drive of the legacy trauma center. In the post-period, 75% of the total population and 90% of injuries were within 45 minutes of either trauma center. The post-predicted volume of severely injured patients at the legacy center was 434, but the actual number was 809. For minor injuries (ISS £15), NBATS-2 predicted 581 vs. 1677 actual. CONCLUSION NBATS-2 failed to predict the post-period volume changes. Without a change in EMS destination guidelines, this finding was not surprising for severely injured patients. However, the 288% increase in volume of minor injuries was unexpected. NBATS-2 must be refined to assess the impact of local factors on patient volume.
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Affiliation(s)
| | | | | | | | | | - Martin A Croce
- 4285University of Tennessee Health Science Center, TN, USA
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Abstract
Background: Firework injuries to the hand can be devastating due to the explosive and ballistic nature of these devices. The aim of this study was to describe the injury and treatment characteristics of patients requiring surgery for firework-related hand injuries and to investigate which factors are associated with an increased utilization of health care resources. Methods: A retrospective chart review of patients undergoing surgery for firework-related hand injuries at two American College of Surgeons level I trauma centers between 2005 and 2016 was performed. Twenty cases were identified. These patients were evaluated for demographics, injury characteristics, number and types of surgical interventions, length of stay, and utilization of health care resources. Bivariate analyses were performed to investigate which factors were associated with increased consumption of health care resources. Results: Injuries ranged from digital nerve injuries to traumatic amputation. Patients underwent a median of 3 surgical operations. More than half the patients underwent flap or skin graft coverage of a soft tissue defect. The median length of hospital stay was 7 days. Factors found to be associated with an increased utilization of surgical and hospital resources included a first web space injury, thumb fracture, and traumatic amputation of any digit. Conclusions: The morbidity inflicted by firework injuries to individual patients is substantial. Patients with severe injuries undergo a median of three surgical operations and have a long duration of initial hospital stay. Knowing which factors are associated with an increased utilization of resources can help prognosticate these preventable injuries.
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Affiliation(s)
- Ricardo Ortiz
- Massachusetts General Hospital, Division of Plastic and Reconstructive Surgery, Harvard Medical School, Boston, USA
| | - Sezai Ozkan
- Massachusetts General Hospital, Department of Orthopedic Surgery, Harvard Medical School, Boston, USA
| | - Neal C. Chen
- Massachusetts General Hospital, Department of Orthopedic Surgery, Harvard Medical School, Boston, USA
| | - Kyle R. Eberlin
- Massachusetts General Hospital, Division of Plastic and Reconstructive Surgery, Harvard Medical School, Boston, USA
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Carroll AL, Garcia D, Cassells SJ, Bruce JS, Bereknyei Merrell S, Schillinger E. "Making It Work": A Preliminary Mixed Methods Study of Rural Trauma Care Access and Resources in New Mexico. Cureus 2020; 12:e11143. [PMID: 33251053 PMCID: PMC7685818 DOI: 10.7759/cureus.11143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction Patients in the rural western United States face challenges accessing trauma and surgical services and are more likely to succumb to their injuries. New Mexico, a rural and medically underresourced state, is a salient space to study these disparities. We examine how travel distance from trauma centers impacts injured patient outcomes and describe care delivery obstacles. Materials and Methods We conducted an explanatory mixed methods study by creating geospatial maps of New Mexico’s trauma data, incorporating linear regression analyses on patient outcomes as a function of estimated travel distance from trauma centers. We also conducted qualitative semi-structured interviews with trauma providers to illuminate and provide context for the geospatial findings utilizing a systematic, collaborative, iterative transcript analysis process. We constructed a conceptual framework describing rural trauma care delivery obstacles. Results Geospatial analyses revealed that most New Mexicans face long travel times to trauma centers. Comparing regression analyses using different data sources suggests that solely hospital-derived data may undercount rural trauma deaths. Interviews with 10 providers suggest that elements that may contribute to these findings include on-the-ground resource-based challenges and those related to broader healthcare systems-based issues. Our conceptual framework denotes how these elements collectively may impact rural trauma outcomes and proposes potential solutions. Conclusions In addressing rural patients’ needs, healthcare policy decision-makers should ensure that their datasets are comprehensive and inclusive. They must also take into account the particular challenges of underserved rural patients and providers who care for them by eliciting their perspectives, as presented in our conceptual framework.
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Affiliation(s)
- Anna L Carroll
- Medicine, Stanford University School of Medicine, Stanford, USA
| | - Deanna Garcia
- Computer Science, Stanford University, Stanford, USA
| | | | - Janine S Bruce
- Pediatrics, Stanford University School of Medicine, Stanford, USA
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Donovan RL, Tilston T, Frostick R, Chesser T. Outcomes of Orthopaedic Trauma Services at a UK Major Trauma Centre During a National Lockdown and Pandemic: The Need for Continuing the Provision of Services. Cureus 2020; 12:e11056. [PMID: 33224652 PMCID: PMC7676444 DOI: 10.7759/cureus.11056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim To review the trauma operating workload, theatre time and outcomes at a time of national lockdown at the beginning of the coronavirus disease 2019 (COVID-19) pandemic, comparing it with a year prior. Methods A retrospective case-control study was performed in a single Level 1 Major Trauma Centre (MTC) in the UK. Inclusion criteria were all patients undergoing operative intervention for an emergency or urgent trauma admission within our Trauma and Orthopaedics department. Data collected included anatomical area of injury, cause of injury, operative procedure, type of anaesthesia, total theatre time, complications, and mortality at 30 days. Results A total of 159 operations were performed on 142 patients in April 2019, and 110 operations on 106 patients in April 2020 (time of national lockdown). There was a 30% decrease due to reduced numbers of road traffic accidents and sport-related injuries. The number of hip fractures and those injuring themselves from less than 2m height remained the same. Operative total theatre time increased by a mean of 14 minutes, and complications and mortality were not significantly changed. The incidence of COVID in the patients tested was 8.5%, which matched the population incidence at the time. Conclusions Orthopaedic trauma services need to be provided during a national lockdown. There was no decrease in the volume of patients sustaining falls, which includes hip fractures. Mean operating time only increases by 14 minutes with the wearing of PPE. This should be part of future planning of any pandemics or national lockdowns.
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Affiliation(s)
- Richard L Donovan
- Trauma and Orthopaedic Surgery, North Bristol National Health Service (NHS) Trust, Bristol, GBR
| | - Thomas Tilston
- Trauma and Orthopaedic Surgery, North Bristol National Health Service (NHS) Trust, Bristol, GBR
| | - Rhiannon Frostick
- Trauma and Orthopaedic Surgery, North Bristol National Health Service (NHS) Trust, Bristol, GBR
| | - Tim Chesser
- Trauma and Orthopaedic Surgery, North Bristol National Health Service (NHS) Trust, Bristol, GBR
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Zeineddin A, Williams M, Nonez H, Nizam W, Olufajo OA, Ortega G, Haider A, Cornwell EE. Gunshot Injuries in American Trauma Centers: Analysis of the Lethality of Multiple Gunshot Wounds. Am Surg 2020; 87:39-44. [PMID: 32915073 DOI: 10.1177/0003134820949515] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Trauma center care and survival have been improving over the past several years. However, yearly firearm-related deaths have remained near constant at 33 000. One challenge to decreasing gunshot mortality is patients presenting with complex injury patterns from multiple gunshot wounds (GSWs) made possible by high-caliber automated weapons. Our study analyzes outcomes of trauma patients of firearms using the National Trauma Databank (NTDB). METHODS We conducted a retrospective review of the NTDB from the years 2003-2015 for patients with penetrating injuries. We separated patients into groups based on stab wounds, single GSW, and multiple GSW. We performed multivariate logistic regression analyses in which we adjusted for demographics and injury severity. RESULTS Overall, 382 376 patients presenting with penetrating injuries were analyzed. Of those 167 671 had stab, 106 538 single GSW, and 57 819 multiple GSW injuries. Crude mortality was 1.97% for stab wounds, 13.26% for single GSW, and 18.84% for multiple GSW. Adjusted odds ratio (OR) compared with 2003 demonstrates a trend toward decreased mortality for stab wounds (OR range of 0.48-0.69, P < .05 for years 2010-2015). A similar trend was demonstrated in single GSW injuries (OR 0.31-0.83, P < .01 for years 2005-2015). Conversely, multiple GSW injuries did not follow this trend (OR 0.91-1.36 with P > 0.05 for each year). CONCLUSION In contrast to significant improvement in survival in patients with a single GSW injury since 2003, multiple GSW injuries still pose a challenge to trauma care. This warrants further investigation into the efficacy of legislature, and the lack thereof, as well as future preventative measures to this type of injury.
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Affiliation(s)
- Ahmad Zeineddin
- 20814Department of Surgery, Clive O. Callender Howard-Harvard Health Sciences Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Mallory Williams
- 20814Department of Surgery, Clive O. Callender Howard-Harvard Health Sciences Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Harry Nonez
- 20814Department of Surgery, Clive O. Callender Howard-Harvard Health Sciences Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Wasay Nizam
- 20814Department of Surgery, Clive O. Callender Howard-Harvard Health Sciences Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Olubode A Olufajo
- 20814Department of Surgery, Clive O. Callender Howard-Harvard Health Sciences Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Gezzer Ortega
- 483907Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Adil Haider
- 483907Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edward E Cornwell
- 20814Department of Surgery, Clive O. Callender Howard-Harvard Health Sciences Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
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Anderson RE, Keihani S, Moses RA, Nocera AP, Selph JP, Castillejo Becerra CM, Baradaran N, Glavin K, Broghammer JA, Arya CS, Sensenig RL, Rezaee ME, Morris BJ, Majercik S, Hewitt T, Burks FN, Schwartz I, Elliott SP, Luo-Owen X, Mukherjee K, Thomsen PB, Erickson BA, Miller BD, Santucci RA, Allen L, Norwood S, Fick CN, Smith BP, Piotrowski J, Dodgion CM, DeSoucy ES, Zakaluzny S, Kim DY, Breyer BN, Okafor BU, Askari R, Lucas JW, Simhan J, Khabiri SS, Nirula R, Myers JB. Current Management of Extraperitoneal Bladder Injuries: Results from the Multi-Institutional Genito-Urinary Trauma Study (MiGUTS). J Urol 2020; 204:538-44. [PMID: 32259467 DOI: 10.1097/JU.0000000000001075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We studied the current management trends for extraperitoneal bladder injuries and evaluated the use of operative repair versus catheter drainage, and the associated complications with each approach. MATERIALS AND METHODS We prospectively collected data on bladder trauma from 20 level 1 trauma centers across the United States from 2013 to 2018. We excluded patients with intraperitoneal bladder injury and those who died within 24 hours of hospital arrival. We separated patients with extraperitoneal bladder injuries into 2 groups (catheter drainage vs operative repair) based on their initial management within the first 4 days and compared the rates of bladder injury related complications among them. Regression analyses were used to identify potential predictors of complications. RESULTS From 323 bladder injuries we included 157 patients with extraperitoneal bladder injuries. Concomitant injuries occurred in 139 (88%) patients with pelvic fracture seen in 79%. Sixty-seven patients (43%) initially underwent operative repair for their extraperitoneal bladder injuries. The 3 most common reasons for operative repair were severity of injury or bladder neck injury (40%), injury found during laparotomy (39%) and concern for pelvic hardware contamination (28%). Significant complications were identified in 23% and 19% of the catheter drainage and operative repair groups, respectively (p=0.55). The only statistically significant predictor for complications was bladder neck or urethral injury (RR 2.69, 95% 1.21-5.97, p=0.01). CONCLUSIONS In this large multi-institutional cohort, 43% of patients underwent surgical repair for initial management of extraperitoneal bladder injuries. We found no significant difference in complications between the initial management strategies of catheter drainage and operative repair. The most significant predictor for complications was concomitant urethral or bladder neck injury.
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Abstract
OBJECTIVE To examine sociodemographic predictors of trauma center (TC) transport of severely injured older adults. DATA SOURCES The data source was the Healthcare Cost and Utilization Project, New York Inpatient Database (2014). STUDY DESIGN This study was a secondary analysis of injured older adults. Key sociodemographic variables were age, gender, race/ethnicity, median household income, and primary payer. Confounding variables were injury severity, geographic location, number of chronic conditions, and injury mechanism. The outcome variable was TC transport. DATA COLLECTION/EXTRACTION METHODS The database was filtered on the following criteria: age =/> 55 years, primary diagnosis of injury (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM], 800.0-957.9, excluding poisoning, late effects, and interfacility transfers), admitted to an acute care hospital in New York. PRINCIPAL FINDINGS Records of 33 696 patients were included. Multivariate logistic regression analysis revealed that all variables were statistically significant predictors of TC transport except primary payer. Predictors of TC transport were as follows: higher injury severity (OR 2.1, CI 1.79-2.46; 3.39, CI 2.85-4.05); Asian/Pacific and Hispanic race/ethnicity (OR 2.51, CI 1.92-3.27; OR 1.1, CI 0.86-1.42), highest median household income (OR 1.24, CI 1.01-1.52), high population density (OR 1.32, CI 1.12-1.55; OR 3.2, CI 2.68-2.83), and vehicle crashes (OR 3.39, CI 2.79-4.11). Predictors of non-TC transport were as follows: older age groups (OR 0.92, CI 0.76-1.11; OR 0.79, CI 0.64-0.96; OR 0.77, CI 0.63-0.95), females (OR 0.65, CI 0.57-0.74), Black and "other" race (OR 0.75, CI 0.0.56-1.0; OR 0.96, CI 0.77-1.20), lower median household income (OR 0.76, CI 0.62-0.93; OR 0.86, CI 0.71-1.05), low population density (OR 0.96, CI 0.67-1.36; OR 0.89, CI 0.53-1.51), and number of chronic conditions (OR 0.89, CI 0.87-0.91). CONCLUSIONS Sociodemographic factors are a source of disparity for access to TCs. Further research is needed to confirm bias and test bias reduction strategies. Comprehensive education and policies are needed to reduce disparities in access to trauma care.
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Affiliation(s)
- Linda J Scheetz
- Department of Nursing, School of Health Sciences, Human Services and Nursing, Lehman College and The Graduate Center, CUNY, Bronx, New York
| | - John P Orazem
- Biostatistics, School of Health Sciences, Human Services and Nursing, Lehman College, CUNY, Bronx, New York
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Moses RA, Anderson RE, Keihani S, Hotaling JM, Nirula R, Vargo DJ, Myers JB. High grade renal trauma management: a survey of practice patterns and the perceived need for a prospective management trial. Transl Androl Urol 2019; 8:297-306. [PMID: 31555553 DOI: 10.21037/tau.2019.07.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background To evaluate the current practice patterns of practitioners managing high grade renal trauma and determine perceived need for a prospective trial on the management of renal trauma. Methods We distributed an electronic survey to members of the American Association for the Surgery of Trauma (AAST) and The Society of Genitourinary Reconstructive Surgeons (GURS). The survey evaluated demographics, interventional radiology (IR) access, and renal trauma management. Descriptive statistics were utilized to analyze participants' responses. Results A total of 253 practitioners responded (age 48.4±10.4 years). The majority were acute care/trauma surgeons (ACS/TS) (63.2%), followed by urologists (34.4%) practicing at level 1 trauma centers (80.6%) in 39 US states. Most participants were in practice >10 years (62.8%); and had completed an ACS/TS (53.8%), or trauma/reconstructive urology (25.7%) fellowship. Ninety-five percent (241/253) found value in renal preservation with 74% utilizing IR embolization in the last year. However, there was wide variation in threshold for angiography, low rates of renal repair (24%) or packing (20%) and half reported performing a nephrectomy within the prior year. More than 80% believed there was value in a prospective trial to evaluate a protocol to decrease nephrectomy rates in renal trauma management. Conclusions The majority of respondents had access to IR, reported comfort in renorrhaphy, and valued renal preservation. There was variation in thresholds for bleeding intervention, and nephrectomy was still a common management strategy. There is great interest among trauma surgeons and urologists for a prospective trial of renal trauma management aimed at decreasing nephrectomy when possible.
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Affiliation(s)
- Rachel A Moses
- Section of Urology, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Ross E Anderson
- Division of Urology, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Sorena Keihani
- Division of Urology, University of Utah Medical Center, Salt Lake City, UT, USA
| | - James M Hotaling
- Division of Urology, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Raminder Nirula
- Department of Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Daniel J Vargo
- Department of Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Jeremy B Myers
- Division of Urology, University of Utah Medical Center, Salt Lake City, UT, USA
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Abstract
PURPOSE Results of a systematic literature review to identify roles for emergency medicine (EM) pharmacists beyond traditionally reported activities and to quantify the benefits of these roles in terms of patient outcomes are reported. SUMMARY Emergency department (ED)-based clinical pharmacy is a rapidly growing practice area that has gained support in a number of countries globally, particularly over the last 5-10 years. A systematic literature search covering the period 1995-2016 was conducted to characterize emerging EM pharmacist roles and the impact on patient outcomes. Six databases were searched for research publications on pharmacist participation in patient care in a general ED or trauma center that documented interventions by ED-based pharmacists; 15 results satisfied the inclusion criteria. Six reported studies evaluated EM pharmacist involvement in the care of critically ill patients, 5 studies evaluated antimicrobial stewardship (AMS) activities via pharmacist review of positive cultures, 2 studies assessed pharmacist involvement in generating orders for nurse-administered home medications and 2 reviewed publications focused on EM pharmacist involvement in management of healthcare-associated pneumonia and dosing of phenytoin. A diverse range of positive patient outcomes was identified. The included studies were assessed to be of low quality. CONCLUSION A systematic review of the literature revealed 3 key emerging areas of practice for the EM pharmacist that are associated with positive patient outcomes. These included involvement in management of critically ill patients, AMS roles, and ordering of home medications in the ED.
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Affiliation(s)
- Cristina Roman
- Pharmacy Department and Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - Gail Edwards
- Pharmacy Department, The Alfred Hospital, Melbourne, Australia
| | - Michael Dooley
- Pharmacy Department, The Alfred Hospital, Melbourne, Australia.,Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Biswadev Mitra
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Vernon SA, Helmer SD, Ward JG, Haan JM. Computed Tomography in Trauma Patients Accepted in Transfer: Missed Injuries and Rationale for Repeat Imaging. Can we do Better? Kans J Med 2019; 12:7-10. [PMID: 30854162 PMCID: PMC6396959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Computed tomography scans often are repeated on trauma patient transfers, leading to increased radiation exposure, resource utilization, and costs. This study examined the incidence of repeated computed tomography scans (RCT) in trauma patient transfers before and after software upgrades, physician education, and encouragement to reduce RCT. METHODS The number of RCTs at an American College of Surgeons Committee on Trauma verified level 1 trauma center was measured. The trauma team was educated and encouraged to use the computed tomography scans received with transfer trauma patients as per study protocol. All available images were reviewed and reasons for a RCT when ordered were recorded and categorized. Impact of system improvements and education on subsequent RCT were evaluated. RESULTS A RCT was done on 47.2% (n = 76) of patients throughout the study period. Unacceptable image quality and possible missed diagnoses were the most commonly reported reasons for a RCT. Preventable reasons for a RCT (attending refusal to read outside films, incompatible software, and physician preference) decreased from 25.8 to 14.3% over the study periods. CONCLUSIONS The volume of unnecessary RCT can be reduced primarily through software updates and physician education, thereby decreasing radiation exposure, patient cost, and inefficiencies in hospital resource usage.
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Affiliation(s)
| | - Stephen D. Helmer
- University of Kansas School of Medicine-Wichita, Department of Surgery,Via Christi Hospital Saint Francis, Wichita, KS
| | - Jeanette G. Ward
- University of Kansas School of Medicine-Wichita, Department of Surgery,Via Christi Hospital Saint Francis, Wichita, KS,Chandler Regional Medical Center, Chandler, AZ
| | - James M. Haan
- University of Kansas School of Medicine-Wichita, Department of Surgery,Via Christi Hospital Saint Francis, Wichita, KS
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Shults RA, Jones JM, Komatsu KK, Sauber-Schatz EK. Alcohol and marijuana use among young injured drivers in Arizona, 2008-2014. Traffic Inj Prev 2019; 20:9-14. [PMID: 30681899 PMCID: PMC7042953 DOI: 10.1080/15389588.2018.1527032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/18/2018] [Accepted: 09/18/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE We examined alcohol and marijuana use among injured drivers aged 16-20 years evaluated at Arizona level 1 trauma centers during 2008-2014. METHODS Using data from the Arizona State Trauma Registry, we conducted a descriptive analysis of blood alcohol concentration (BAC) and qualitative test results (positive or negative) for delta-9-tetrahydrocannabinol (THC) by year of age, sex, race, ethnicity, injury severity, seat belt use, motorcycle helmet use, and type of vehicle driven. To explore compliance with Arizona's motorcycle helmet law requiring helmet use for riders <18 years old, we examined helmet use by age. RESULTS Data on 5,069 injured young drivers were analyzed; the annual number of injured drivers declined by 41% during the 7-year study period. Among the 76% (n = 3,849) of drivers with BAC results, 19% tested positive, indicating that at least 15% of all drivers had positive BACs. Eighty-two percent of the BAC-positive drivers had BACs ≥0.08 g/dL, the illegal threshold for drivers aged ≥21 years. Among the 49% (n = 2,476) of drivers with THC results, 30% tested positive, indicating that at least 14% of all drivers were THC-positive. American Indians and blacks had the highest proportion of THC-tested drivers with positive THC results (38%). In addition, 28% of tested American Indians had positive results for both substances, more than twice the proportion seen in all other race or ethnic groups. Crude prevalence ratios suggested that drivers who tested positive for alcohol or THC were less likely than those who tested negative to wear a helmet or seat belt, further increasing their injury risk. Helmet use among motorcyclists was lower among 16- and 17-year-old riders compared to 18- to 20-year-olds, despite Arizona's motorcycle helmet law requiring riders aged <18 years to wear a helmet. CONCLUSIONS About 1 in 4 injured drivers aged 16-20 years tested positive for alcohol, THC, or both substances. Most drivers with positive BACs were legally intoxicated (BAC ≥0.08 g/dL). All substance-using young drivers in this study were candidates for substance abuse screening and possible referral to treatment. Broader enforcement of existing laws targeting underage access to alcohol and alcohol-impaired driving could further reduce injuries among young Arizona drivers. To further reduce crash-related injuries and fatalities among all road users, the state could consider implementing a primary enforcement seat belt law and a universal motorcycle helmet law.
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Affiliation(s)
- Ruth A. Shults
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jefferson M. Jones
- Epidemic Intelligence Services, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Erin K. Sauber-Schatz
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Li H, Nyland J, Kuban K, Givens J. Physical therapy needs for patients with physical function injuries post-earthquake disasters: A systematic review of Chinese and Western literature. Physiother Res Int 2018; 23:e1714. [PMID: 29608038 DOI: 10.1002/pri.1714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/07/2017] [Accepted: 01/26/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE Over the last 500 years, the most earthquakes with 10,000 or more fatalities and the most overall fatalities have occurred in China. Physical therapists must develop a better understanding of the patient and injury types that they are likely to treat post-earthquake disasters. This systematic review of Chinese and Western literature identified the primary patients treated by physical therapists post-earthquake disasters for injuries that negatively impacted physical function, activity, and participation. METHODS Comparisons were made between reports of earthquakes in China and reports from the rest of the world combined. RESULTS Sixty-seven studies of 71,986 patients (51.8% male) at 40.6 ± 15 years of age were included. Studies were mostly prospective (n = 48, 71.6%). Reports of earthquakes in China represented more recently occurring disasters (p = .003) and more prospective research designs (p = .003). Reports from China also had a higher median fracture number (p = .004). Studies from China used manual muscle testing (p = .02), visual analogue pain scales (p = .008), Barthel index or modified Barthel index (p < .0001), and joint motion assessment (p = .007) with greater frequencies. DISCUSSION Physical therapists from China are more likely to treat patients with a fracture; however, physical therapists from both regions are likely to treat patients with general injuries representing poly-trauma to multiple body regions, traumatic brain-closed head injuries, spinal cord injuries, peripheral nerve injuries, and soft tissue injuries. IMPLICATIONS ON PHYSIOTHERAPY PRACTICE These data can help improve earthquake disaster planning, infrastructure development, and resource needs assessment effectiveness. More prospective research study designs and more recent earthquake disasters in China are likely associated with greater explicit use of valid and reliable outcome measurements such as joint motion assessment, manual muscle testing, visual analogue pain scale, and the Barthel index or modified Barthel index.
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Affiliation(s)
- Hao Li
- Department of Disaster Rehabilitation, Sichuan University, Chengdu, China.,Institute for Disaster Management and Reconstruction, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - John Nyland
- Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA
| | - Katrina Kuban
- Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA
| | - Justin Givens
- Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA
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Abstract
BACKGROUND Transfers of patients with higher acuity injuries to trauma centers have helped improve care since the enactment of Emergency Medical Treatment and Active Labor Act. However, an unintended consequence is the inappropriate transfer of patients who do not truly require handover of care. METHODS We retrospectively reviewed the records of all patients transferred to our level I trauma center for injuries distal to the ulnohumeral joint between April 1, 2013, and March 31, 2014; 213 patients were included. We examined the records for appropriateness of transfer based on whether the patient required the care of the receiving hospital's attending surgeon (appropriate transfer) or whether junior-level residents treated the patient alone (inappropriate transfer) and calculated odds ratios. We performed logistic regression to identify factors associated with appropriateness of transfer; these factors included specialist evaluation prior to transfer, age, insurance status, race, injury type, sex, shift time, distance traveled, and median income. RESULTS The risk of inappropriate transfers was 68.5% (146/213). Specialist evaluation at the referring hospital was not associated with a lower risk of inappropriate transfers (odds ratio 1.62 [95% CI: 0.48-5.34], P = .383). Only evening shift (15:01 to 23:00) was associated with inappropriate transfers. Amputations and open fractures were associated with appropriate transfers. CONCLUSION Second shift and type of injury (namely, amputations and open fractures) were significant factors to appropriateness of transfer. No significant association was found between specialist evaluation and appropriate transfers. Future studies may focus on finding reasons and aligning incentives to minimize inappropriate transfers and associated systems costs.
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Affiliation(s)
- Djuro Petkovic
- Loma Linda University, CA, USA,Djuro Petkovic, Department of Orthopedic Surgery, Loma Linda University Medical Center, 11406 Loma Linda Drive, Suite 213, Loma Linda, CA 92354, USA.
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Scott JW, Neiman PU, Najjar PA, Tsai TC, Scott KW, Shrime MG, Cutler DM, Salim A, Haider AH. Potential impact of Affordable Care Act-related insurance expansion on trauma care reimbursement. J Trauma Acute Care Surg 2017; 82:887-895. [PMID: 28431415 PMCID: PMC5468098 DOI: 10.1097/ta.0000000000001400] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nearly one quarter of trauma patients are uninsured and hospitals recoup less than 20% of inpatient costs for their care. This study examines changes to hospital reimbursement for inpatient trauma care if the full coverage expansion provisions of the Affordable Care Act (ACA) were in effect. METHODS We abstracted nonelderly adults (ages 18-64 years) admitted for trauma from the Nationwide Inpatient Sample during 2010-the last year before most major ACA coverage expansion policies. We calculated national and facility-level reimbursements and trauma-related contribution margins using Nationwide Inpatient Sample-supplied cost-to-charge ratios and published reimbursement rates for each payer type. Using US census data, we developed a probabilistic microsimulation model to determine the proportion of pre-ACA uninsured trauma patients that would be expected to gain private insurance, Medicaid, or remain uninsured after full implementation of the ACA. We then estimated the impact of these coverage changes on national and facility-level trauma reimbursement for this population. RESULTS There were 145,849 patients (representing 737,852 patients nationwide) included. National inpatient trauma costs for patients aged 18 years to 64 years totaled US $14.8 billion (95% confidence interval [CI], 12.5,17.1). Preexpansion reimbursements totaled US $13.7 billion (95% CI, 10.8-14.7), yielding a national margin of -7.9% (95% CI, -10.6 to -5.1). Postexpansion projected reimbursements totaled US $15.0 billion (95% CI, 12.7-17.3), increasing the margin by 9.3 absolute percentage points to +1.4% (95% CI, -0.3 to +3.2). Of the 263 eligible facilities, 90 (34.2%) had a positive trauma-related contribution margin in 2010, which increased to 171 (65.0%) using postexpansion projections. Those facilities with the highest proportion of uninsured and racial/ethnic minorities experienced the greatest gains. CONCLUSION Health insurance coverage expansion for uninsured trauma patients has the potential to increase national reimbursement for inpatient trauma care by over one billion dollars and nearly double the proportion of hospitals with a positive margin for trauma care. These data suggest that insurance coverage expansion has the potential to improve trauma centers' financial viability and their ability to provide care for their communities. LEVEL OF EVIDENCE Economic analysis, level II.
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Affiliation(s)
- John W Scott
- From the Department of Surgery, Center for Surgery and Public Health (J.W.S., P.N., T.C.T., A.S., A.H.H.), Brigham & Women's Hospital; Program in Global Surgery and Social Change (J.W.S., M.G.S.), Harvard Medical School, Boston; John F. Kennedy School of Government (P.U.), Harvard University, Cambridge, Massachusetts; David Geffen School of Medicine at the University of California (P.U.), Los Angeles, Los Angeles, California; Harvard Business School (P.N.); Department of Health Policy and Management (T.C.T.), Harvard T.H. Chan School of Public Health; Harvard Medical School (K.W.S.); Department Of Otolaryngology & Office of Global Surgery (M.G.S.), Massachusetts Eye & Ear Infirmary, Boston; Department of Economics (D.M.C.), Harvard University; National Bureau of Economics Research (D.M.C.); and Division of Trauma, Department of Surgery (A.S., A.H.H.), Brigham & Women's Hospital, Boston, Massachusetts
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Huang GS, Dunham CM. Mortality outcomes in trauma patients undergoing prehospital red blood cell transfusion: a systematic literature review. Int J Burns Trauma 2017; 7:17-26. [PMID: 28533934 PMCID: PMC5435648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/29/2017] [Indexed: 06/07/2023]
Abstract
The value of prehospital red blood cell (RBC) transfusion for trauma patients is controversial. The purposes of this literature review were to determine the mortality rate of trauma patients with hemodynamic instability and the benefit of prehospital RBC transfusion. A 30-year systematic literature review was performed in 2016. Eligible studies were combined for meta-analysis when tests for heterogeneity were insignificant. The synthesized mortality was 35.6% for systolic blood pressure ≤ 90 mmHg; 51.1% for ≤ 80 mmHg; and 63.9% for ≤ 70 mmHg. For patients with either hypotension or emergency trauma center transfused RBCs, the synthesized Injury Severity Score (ISS) was 27.0 and mortality was 36.2%; the ISS and mortality correlation was r = 0.766 (P = 0.0096). For civilian patients receiving prehospital RBC transfusions, the synthesized ISS was 27.5 and mortality was 39.5%. One civilian study suggested a decrement in mortality with prehospital RBC transfusion; however, patient recruitment was only one per center per year and mortality was < 10% despite an ISS of 37. The same study created a matched control subset and indicated that mortality decreased using multivariate analysis; however, neither the assessed factors nor raw mortality was presented. Civilian studies with patients undergoing prehospital RBC transfusion and a matched control subset showed that the synthesized mortality was similar for those transfused (37.5%) and not transfused (38.7%; P = 0.8933). A study of civilian helicopter patients demonstrated a similar 30-day mortality for those with and without prehospital blood product availability (22% versus 21%; P = 0.626). Mortality in a study of matched military patients was better for those receiving prehospital blood or plasma (8%) than the controls (20%; P = 0.013). However, transfused patients had a shorter prehospital time, more advanced airway procedures, and higher hospital RBC transfusion (P < 0.05). A subset with an ISS > 16 showed similar mortality with and without prehospital RBC availability (27.6% versus 32.0%; P = 0.343). Trauma patient mortality increases with the magnitude of hemodynamic instability and anatomic injury. Some literature evidence indicates no survival advantage with prehospital RBC availability. However, other data suggesting a potential benefit is confounded or likely to be biased.
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Affiliation(s)
- Gregory S Huang
- Trauma/Surgical Critical Care, St. Elizabeth Youngstown Hospital1044 Belmont Ave., Youngstown 44501, OH, USA
| | - C Michael Dunham
- Trauma/Surgical Critical Care, St. Elizabeth Youngstown Hospital1044 Belmont Ave., Youngstown 44501, OH, USA
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Jung K, Huh Y, Lee JCJ, Kim Y, Moon J, Youn SH, Kim J, Kim J, Kim H. The Applicability of Trauma and Injury Severity Score for a Blunt Trauma Population in Korea and a Proposal of New Models Using Score Predictors. Yonsei Med J 2016; 57:728-34. [PMID: 26996574 PMCID: PMC4800364 DOI: 10.3349/ymj.2016.57.3.728] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/24/2016] [Accepted: 01/25/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of this study was to verify the utility of existing Trauma and Injury Severity Score (TRISS) coefficients and to propose a new prediction model with a new set of TRISS coefficients or predictors. MATERIALS AND METHODS Of the blunt adult trauma patients who were admitted to our hospital in 2014, those eligible for Korea Trauma Data Bank entry were selected to collect the TRISS predictors. The study data were input into the TRISS formula to obtain "probability of survival" values, which were examined for consistency with actual patient survival status. For TRISS coefficients, Major Trauma Outcome Study-derived values revised in 1995 and National Trauma Data Bank-derived and National Sample Project-derived coefficients revised in 2009 were used. Additionally, using a logistic regression method, a new set of coefficients was derived from our medical center's database. Areas under the receiver operating characteristic (ROC) curve (AUC) for each prediction ability were obtained, and a pairwise comparison of ROC curves was performed. RESULTS In the statistical analysis, the AUCs (0.879-0.899) for predicting outcomes were lower than those of other countries. However, by adjusting the TRISS score using a continuous variable rather than a code for age, we were able to achieve higher AUCs [0.913 (95% confidence interval, 0.899 to 0.926)]. CONCLUSION These results support further studies that will allow a more accurate prediction of prognosis for trauma patients. Furthermore, Korean TRISS coefficients or a new prediction model suited for Korea needs to be developed using a sufficiently sized sample.
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Affiliation(s)
- Kyoungwon Jung
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
| | - Yo Huh
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - John Cook-Jong Lee
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Younghwan Kim
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Jonghwan Moon
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Seok Hwa Youn
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Jiyoung Kim
- Ajou Regional Trauma Center, Ajou University Hospital, Suwon, Korea
| | - Juryang Kim
- Ajou Regional Trauma Center, Ajou University Hospital, Suwon, Korea
| | - Hyoju Kim
- Ajou Regional Trauma Center, Ajou University Hospital, Suwon, Korea
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Stewart K, Garwe T, Bhandari N, Danford B, Albrecht R. Factors Associated with the Use of Helicopter Inter-facility Transport of Trauma Patients to Tertiary Trauma Centers within an Organized Rural Trauma System. PREHOSP EMERG CARE 2016; 20:601-8. [PMID: 26986053 DOI: 10.3109/10903127.2016.1149650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE A review of the literature yielded little information regarding factors associated with the decision to use ground (GEMS) or helicopter (HEMS) emergency medical services for trauma patients transferred inter-facility. Furthermore, studies evaluating the impact of inter-facility transport mode on mortality have reported mixed findings. Since HEMS transport is generally reserved for more severely injured patients, this introduces indication bias, which may explain the mixed findings. Our objective was to identify factors at referring non-tertiary trauma centers (NTC) influencing transport mode decision. METHODS This was a case-control study of trauma patients transferred from a Level III or IV NTC to a tertiary trauma center (TTC) within 24-hours reported to the Oklahoma State Trauma Registry between 2005 and 2012. Multivariable logistic regression was used to determine clinical and non-clinical factors associated with the decision to use HEMS. RESULTS A total of 7380 patients met the study eligibility. Of these, 2803(38%) were transported inter-facility by HEMS. Penetrating injury, prehospital EMS transport, severe torso injury, hypovolemic shock, and TBI were significant predictors (p<0.05) of HEMS use regardless of distance to a TTC. Association between HEMS use and male gender, Level IV NTC, and local ground EMS resources varied by distance from the TTC. Many HEMS transported patients had minor injuries and normal vital signs. CONCLUSIONS Our results suggest that while distance remains the most influential factor associated with HEMS use, significant differences exist in clinical and non-clinical factors between patients transported by HEMS versus GEMS. To ensure comparability of study groups, studies evaluating outcome differences between HEMS and GEMS should take factors determining transport mode into account. The findings will be used to develop propensity scores to balance baseline risk between GEMS and HEMS patients for use in subsequent studies of outcomes.
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