Effect of Resident Involvement on Trauma Patient Outcomes: A Single-Institution Review

OBJECTIVE

The purpose of this study was to examine the mortality difference and other outcome measures amongst trauma patients with residents involved in the initial management versus those that were managed by attending physicians only without resident involvement.

DESIGN

Retrospective review. Chi-square, Fisher's tests were used to analyze the outcomes, diagnostics, and interventions using the presence of residents in the initial care of patients as an independent variable. Linear and logistic regression were used to estimate adjusted outcomes.

SETTING

Riverside Community Hospital, Riverside California (State-designated level I trauma center) PARTICIPANTS: Data on all trauma patients ≥18 years old that were admitted between July 1, 2018 and June 30, 2020 was collected retrospectively (total 2644 trauma patients). Trauma patients that were transferred from outside facilities were excluded from the study.

RESULTS

There was no significant difference in mortality associated with resident involvement in both unadjusted and adjusted analysis. Patients treated by residents, however, had more comorbidities (higher CCI) and were more severely injured (higher ISS). On adjusted analysis, higher ISS was independently associated with resident presence. There was also a statistically significant increase in the use of diagnostic studies and therapeutic interventions in the resident-present group.

CONCLUSIONS

Involvement of residents in the initial management of our trauma patient population was associated with no difference in overall mortality or morbidity, despite higher injury severity in the resident treated patient group.

Long-Term Outcomes of Ventral Hernia Repair: An 11-Year Follow-Up

Background: Ventral hernia repair (VHR) is one of the most common general surgery procedures; however, few studies with long-term follow-up of VHR outcomes exist.

Methods: We performed a retrospective review of VHRs performed from 2000 to 2009 at a single institution. Our primary outcome was recurrence, and secondary outcomes were reoperations and complications including seroma, hematomas, abdominal wall abscess, wound infections, and mesh infections.

Results: Our sample population (n=420; mean age 46.3±11.7 years) included 230 females (54.8%), and cases included laparoscopic (n=31; 7.5%), laparoscopic converted to open (n=7; 1.7%), and open (n=373, 90%). As compared to suture repairs, mesh repair was associated with lower rates of complications (25.7% vs 29.5%, p=0.10) and recurrence (12.8% vs 15.2%, p=0.67). Laparoscopic repairs had lower rates of complications than open repairs (25% vs 26.8%; p=0.70) but similar rates of recurrence (13.8% and 13.6%; p=0.53). After logistic regression, obesity, chronic obstructive pulmonary disease, component separation technique, and prolonged operating time (>75th percentile) were associated with increased complications.

Conclusion: Obesity is a modifiable risk factor and must be addressed in patients undergoing VHRs. Mesh repair does not increase the risk of adverse long-term outcomes and may be performed safely in patients undergoing VHR.

Post-Coital Sudden Cardiac Arrest Due to Non-Traumatic Subarachnoid Hemorrhage-A Case Report

Emergency medicine (EM) learners are taught to approach cardiac arrest algorithmically using Advanced Cardiac Life Support (ACLS) with particular emphasis on treatment. However, when treating patients in cardiac arrest it is important to maintain a broad differential of possible non-cardiac etiologies of the presenting symptoms. A patient presented to the emergency department (ED) as a post-coital cardiac arrest with prehospital return of spontaneous circulation (ROSC). Electrocardiogram (ECG) suggested a possible coronary artery occlusion. Given the circumstances of the arrest, computed tomography (CT) of the head was performed which demonstrated a large subarachnoid hemorrhage (SAH). Emergent percutaneous coronary intervention (PCI) was deferred due to the alternative explanation for the ECG changes and the patient's instability. Her condition declined, and soon after the patient expired. Patients with sudden cardiac arrest (SCA) due to SAH are unlikely to benefit from PCI, hindering a more appropriate workup and treatment.1 When faced with patients presenting with SCA and relevant risk factors, it is important to avoid anchoring bias and consider that the ischemic changes on ECG may not be due to primary cardiac causes.

Topics

Subarachnoid hemorrhage, sudden cardiac arrest, pulseless electrical activity, ECG, CT.