Patterns and management of musculoskeletal injuries in attempted suicide by jumping from a height: a single, regional level I trauma center experience

Abstract Background: Although it is well-recognized that other surgical specialties perform various procedures related to trauma care, there is a lack of analyses focusing on the role of plastic surgical management in trauma centers in Korea. This retrospective study was designed to investigate the scope of plastic surgery services in acute trauma care, using clinical data obtained from a single, regional, level I, trauma center.Methods: This study included patients who presented to a single, regional, level I, trauma center in March 2016. Of them, patients with acute trauma to the facial soft tissue and skeleton, soft tissue of the upper and lower limbs, trunk and perineum, and other areas requiring plastic surgical procedures were included in the analysis. Data on patients’ demographics and detailed surgical procedures were acquired from electric medical records.Results: A total of 1,544 patients underwent surgery, and 2,217 procedures were recorded during the 2-year study period. In 2016, 1,062 procedures on 690 patients, and, in 2017, 1,155 procedures on 787 patients were registered. The head and neck region was the most commonly observed anatomical area that was operated on. The facial bone requiring the largest degree of surgical intervention was the mandible, followed by the zygomatic bone, nasal bones, orbital floor, and maxilla. Microsurgical procedures, such as flap surgery and microsurgery, were performed in 121 cases. Conclusion: Plastic surgeons work alongside experts from various specialties to restore the appearance and function of a specific anatomical area. Thus, plastic surgeons are an essential part of trauma centers.Trial registration: Not applicable.

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Faculty Opinions recommendation of Improvements in early mortality and coagulopathy are sustained better in patients with blunt trauma after institution of a massive transfusion protocol in a civilian level I trauma center.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1287960.755060 ◽

2009 ◽

Author(s):

Jonathan Waters ◽

Jay S Raval

Keyword(s):

Blunt Trauma ◽

Trauma Center ◽

Massive Transfusion ◽

Early Mortality ◽

Massive Transfusion Protocol ◽

Level I ◽

Transfusion Protocol

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Prehospital time and mortality in polytrauma patients: a retrospective analysis

BMC Emergency Medicine ◽

10.1186/s12873-021-00476-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

E. Berkeveld ◽

Z. Popal ◽

P. Schober ◽

W. P. Zuidema ◽

F. W. Bloemers ◽

...

Keyword(s):

Patient Outcome ◽

Emergency Medical Services ◽

Trauma Center ◽

Total Mortality ◽

Medical Services ◽

Severely Injured ◽

Emergency Medical ◽

Polytrauma Patients ◽

Level I ◽

Prehospital Time

Abstract Background The time from injury to treatment is considered as one of the major determinants for patient outcome after trauma. Previous studies already attempted to investigate the correlation between prehospital time and trauma patient outcome. However, the outcome for severely injured patients is not clear yet, as little data is available from prehospital systems with both Emergency Medical Services (EMS) and physician staffed Helicopter Emergency Medical Services (HEMS). Therefore, the aim was to investigate the association between prehospital time and mortality in polytrauma patients in a Dutch level I trauma center. Methods A retrospective study was performed using data derived from the Dutch trauma registry of the National Network for Acute Care from Amsterdam UMC location VUmc over a 2-year period. Severely injured polytrauma patients (Injury Severity Score (ISS) ≥ 16), who were treated on-scene by EMS or both EMS and HEMS and transported to our level I trauma center, were included. Patient characteristics, prehospital time, comorbidity, mechanism of injury, type of injury, HEMS assistance, prehospital Glasgow Coma Score and ISS were analyzed using logistic regression analysis. The outcome measure was in-hospital mortality. Results In total, 342 polytrauma patients were included in the analysis. The total mortality rate was 25.7% (n = 88). Similar mean prehospital times were found between the surviving and non-surviving patient groups, 45.3 min (SD 14.4) and 44.9 min (SD 13.2) respectively (p = 0.819). The confounder-adjusted analysis revealed no significant association between prehospital time and mortality (p = 0.156). Conclusion This analysis found no association between prehospital time and mortality in polytrauma patients. Future research is recommended to explore factors of influence on prehospital time and mortality.

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Facial Fractures Have Similar Outcomes When Managed by Either Otolaryngology or Plastic Surgery: Encounters From a Single Level I Trauma Center

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/19433875211020615 ◽

2021 ◽

pp. 194338752110206

Author(s):

Ashton Christian ◽

Beatrice J. Sun ◽

Nima Khoshab ◽

Areg Grigorian ◽

Christina Y. Cantwell ◽

...

Keyword(s):

Plastic Surgery ◽

Trauma Center ◽

Demographic Data ◽

Open Reduction Internal Fixation ◽

Facial Fractures ◽

Chi Square ◽

Single Level ◽

Baseline Characteristics ◽

Level I ◽

Complications And Mortality

Study Design: Retrospective cohort. Objective: Traumatic facial fractures (FFs) often require specialty consultation with Plastic Surgery (PS) or Otolaryngology (ENT); however, referral patterns are often non-standardized and institution specific. Therefore, we sought to compare management patterns and outcomes between PS and ENT, hypothesizing no difference in operative rates, complications, or mortality. Methods: We performed a retrospective analysis of patients with FFs at a single Level I trauma center from 2014 to 2017. Patients were compared by consulting service: PS vs. ENT. Chi-square and Mann-Whitney-U tests were performed. Results: Of the 755 patients with FFs, 378 were consulted by PS and 377 by ENT. There was no difference in demographic data ( P > 0.05). Patients managed by ENT received a longer mean course of antibiotics (9.4 vs 7.0 days, P = 0.008) and had a lower rate of open reduction internal fixation (ORIF) (9.8% vs. 15.3%, P = 0.017), compared to PS patients. No difference was observed in overall operative rate (15.1% vs. 19.8%), use of computed tomography (CT) imaging (99% vs. 99%), time to surgery (65 vs. 55 hours, P = 0.198), length of stay (LOS) (4 vs. 4 days), 30-day complication rate (10.6% vs. 7.1%), or mortality (4.5% vs. 2.6%) (all P > 0.05). Conclusion: Our study demonstrated similar baseline characteristics, operative rates, complications, and mortality between FFs patients who had consultation by ENT and PS. This supports the practice of allowing both ENT and PS to care for trauma FFs patients, as there appears to be similar standardized care and outcomes. Future studies are needed to evaluate the generalizability of our findings.

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Impact of the first COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01654-8 ◽

2021 ◽

Author(s):

Carolin A. Kreis ◽

Birte Ortmann ◽

Moritz Freistuehler ◽

René Hartensuer ◽

Hugo Van Aken ◽

...

Keyword(s):

Surgical Procedures ◽

Trauma Center ◽

Control Period ◽

Open Fractures ◽

Injury Patterns ◽

Emergency Patient ◽

Emergency Operations ◽

Incidence Proportion ◽

Level I ◽

The Impact

Abstract Purpose In Dec 2019, COVID-19 was first recognized and led to a worldwide pandemic. The German government implemented a shutdown in Mar 2020, affecting outpatient and hospital care. The aim of the present article was to evaluate the impact of the COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center in Germany. Methods All emergency patients were recorded retrospectively during the shutdown and compared to a calendar-matched control period (CTRL). Total emergency patient contacts including trauma mechanisms, injury patterns and operation numbers were recorded including absolute numbers, incidence proportions and risk ratios. Results During the shutdown period, we observed a decrease of emergency patient cases (417) compared to CTRL (575), a decrease of elective cases (42 vs. 13) and of the total number of operations (397 vs. 325). Incidence proportions of emergency operations increased from 8.2 to 12.2% (shutdown) and elective surgical cases decreased (11.1 vs. 4.3%). As we observed a decrease for most trauma mechanisms and injury patterns, we found an increasing incidence proportion for severe open fractures. Household-related injuries were reported with an increasing incidence proportion from 26.8 to 47.5% (shutdown). We found an increasing tendency of trauma and injuries related to psychological disorders. Conclusion This analysis shows a decrease of total patient numbers in an emergency department of a Level I trauma center and a decrease of the total number of operations during the shutdown period. Concurrently, we observed an increase of severe open fractures and emergency operations. Furthermore, trauma mechanism changed with less traffic, work and sports-related accidents.

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