Obesity is not associated with increased difficulty placing peripheral IVs in trauma activation patients

Introduction Diagnostic radiology interpretive errors in trauma patients can lead to missed diagnoses, compromising patient care. Due to this, our level II trauma center implemented a reread protocol of all radiographic imaging within 24 hours on our highest trauma activation level (Code T). We sought to determine the efficacy of this reread protocol in identifying missed diagnoses in Code T patients. We hypothesized that a few, but clinically relevant errors, would be identified upon reread. Methods All radiographic study findings (initial read and reread) performed for Code T admissions from July 2015 to May 2016 were queried. The reviewed radiological imaging was given one of four designations: agree with interpretation, minor (non-life threatening) nonclinically relevant error(s)—addendum/correction required or clinically relevant error(s) (major [life threatening] and minor)—addendum/correction required, and trauma surgeon notified. The results were compiled, and the number of each type of error was calculated. Results Of the 752 radiological imaging studies reviewed on the 121 Code T patients during this period, 3 (0.40%) contained minor clinically relevant errors, 11 (1.46%) contained errors that were not clinically relevant, and 738 (98.1%) agreed with the original interpretation. The three clinically relevant errors included a right mandibular fracture found on X-ray and a temporal bone fracture that crossed the clivus and bilateral rib fractures found on computerized tomography. Discussion Clinically relevant errors, although minimal, were discovered during rereads for Code T patients. Although the clinical errors were significant, none affected patient outcomes. We propose that the implementation of reread protocols should be based upon institution-specific practices.

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627 Strategies for Reducing Emergency Department Lengths of Stay for Admitted Pediatric Burn Patients

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.277 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S169-S169

Author(s):

Lisa M Shostrand ◽

Brett C Hartman ◽

Belinda Frazee ◽

Dawn Daniels ◽

Madeline Zieger

Keyword(s):

Emergency Department ◽

Gap Analysis ◽

Burn Patients ◽

Improvement Project ◽

Burn Trauma ◽

Charge Nurse ◽

Lengths Of Stay ◽

Burn Unit ◽

Set Up ◽

Trauma Activation

Abstract Introduction Various strategies to reduce emergency department (ED) lengths of stay (LOS) for admitted pediatric burn patients may be employed as a quality improvement project. Decreasing ED LOS may promote patient outcomes and reduce morbidity. Initial discussions were brought forth during trauma and burn multidisciplinary peer review rounds in March 2019 and have persisted to present day. Methods Several strategies, such as preparation of the burn unit staff within one hour of patient arrival in ED, notification to the burn unit by the burn attending of an incoming pediatric burn patient, allowing the PICU charge nurses or advisors to assist with room set up and admissions, and creating a checklist to assist PICU nurses and advisors in helping prepare for anticipating inpatient admissions. These strategies were designed and enforced in March/April 2019. In addition to these action plans, trauma activation alerts were added in December 2019 to the burn charge nurse phone for pediatric burn trauma one and trauma alerts for more expedient notifications. Finally, communication efforts between ED and burn leadership teams were conducted in June 2020 to help with additional mitigating of ED LOS, such as discussing the appropriateness of specialty consults while in the ED. Results Initial ED LOS was reduced from 209 minutes in March 1019 to 150 minutes in June 2019. Increased trends were noted in early 2020, with a peak at 244 minutes in July 2020. Additional interventions, such as trauma activation alerts and ED/Burn team communications, did not provide sustainable long-term reductions. Conclusions Recent strategies to reduce overall ED LOS trends have been beneficial, but not consistent, in sustaining downward trends. Action to perform a gap analysis to discover persistent barriers and to introduce additional structure, such as a burn trauma one algorithm, may provide stability to this metric.

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Efforts to Improve Appropriate Trauma Activation for Patients Transferred to a Level 1 Trauma Center From Outside Hospitals

The American Surgeon ◽

10.1177/0003134820919732 ◽

2020 ◽

Vol 86 (5) ◽

pp. 467-475

Author(s):

Sara Seegert ◽

Roberta E. Redfern ◽

Bethany Chapman ◽

Daniel Benson

Keyword(s):

Injury Severity ◽

Trauma Centers ◽

Activation Level ◽

American College Of Surgeons ◽

Before And After ◽

Trauma Response ◽

Level 1 ◽

Transferred Patients ◽

Trauma Activation ◽

Level 1 Trauma Center

Trauma centers monitor under- and overtriage rates to comply with American College of Surgeons Committee on Trauma verification requirements. Efforts to maintain acceptable rates are often undertaken as part of quality assurance. The purpose of this project was to improve the institutional undertriage rate by focusing on appropriately triaging patients transferred from outside hospitals (OSHs). Trauma physicians received education and pocket cards outlining injury severity score (ISS) calculation to aid in prospectively estimating ISS for patients transferred from OSHs, and activate the trauma response expected for that score. Under- and overtriage rates before and after the intervention were compared. The postintervention period saw a significant decrease in overall overtriage rate, with simultaneous trend toward lower overall undertriage rate, attributable to the significant reduction in undertriage rate of patients transferred from OSHs. Prospectively estimating ISS to assist in determining trauma activation level shows promise in managing appropriate patient triage. However, questions arose regarding the necessity for full trauma activation for transferred patients, regardless of ISS. It may be necessary to reconsider how patients transferred from OSHs are evaluated. Full trauma activation can be a financial and resource burden, and should not be taken lightly.

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Hate to Burst Your Balloon: Successful REBOA Use Takes More Than a Course

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v4i1.106 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Christina Mae Theodorou ◽

Edgardo S Salcedo ◽

Joseph J DuBose ◽

Joseph M Galante

Keyword(s):

Trauma Surgery ◽

Skills Training ◽

Balloon Occlusion ◽

Implementation Challenges ◽

Surgical Skills Training ◽

Trauma Activation ◽

Activation Criteria ◽

Level 1 Trauma Center ◽

Endovascular Balloon Occlusion ◽

Operating Room Staff

Background: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is emerging as a viable intervention for hemorrhagic shock. Training surgeons to place the device is only part of the process. We hypothesize that implementation challenges extend beyond surgical skills training and initial REBOA use should not be expected to mirror published success.Methods:All REBOA placements from January 2016-February 2017 at a level 1 trauma center were reviewed for opportunities for improvement (OFI). From September 2016-February 2017 all patients meeting highest trauma activation criteria were reviewed against our REBOA algorithm to identify patients meeting criteria for REBOA placement but not undergoing the procedure.Results:REBOA was introduced at our institution in September 2015, with first placement in January 2016. Trauma surgery, Emergency Department, and Operating Room staff underwent training. Nine patients had REBOA placed with six survivors. One patient underwent unsuccessful REBOA attempt and died. Four patients had complications from REBOA. Eight additional patients met indications but did not undergo REBOA. Conclusion:Successful REBOA use requires more than teaching surgeons indications and techniques. For a successful REBOA program, systems factors must be addressed. Systems processes must ensure equipment and procedures are standardized and familiar to all involved. Complications should be expected.

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Emergency Department Length of Stay Is an Independent Predictor of Hospital Mortality in Trauma Activation Patients

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e3182175199 ◽

2011 ◽

Vol 70 (6) ◽

pp. 1317-1325 ◽

Cited By ~ 51

Author(s):

Nathan T. Mowery ◽

Stacy D. Dougherty ◽

Amy N. Hildreth ◽

James H. Holmes ◽

Michael C. Chang ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Hospital Mortality ◽

Independent Predictor ◽

Trauma Activation

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Gunshot Injuries to the Extremity: Is Immediate General Surgery Presence Needed?

The American Surgeon ◽

10.1177/000313481808400948 ◽

2018 ◽

Vol 84 (9) ◽

pp. 1450-1454

Author(s):

Brian G. Harbrecht ◽

Keith R. Miller ◽

Amirrezat Motameni ◽

Matthew V. Benns ◽

Matthew C. Bozeman ◽

...

Keyword(s):

Blood Pressure ◽

Emergency Department ◽

Injury Severity ◽

Demographic Data ◽

Gunshot Wounds ◽

Operative Intervention ◽

General Surgeon ◽

Vascular Repair ◽

Body Regions ◽

Trauma Activation

Gunshot wounds (GSW) are becoming increasingly prevalent in urban settings. GSW to the trunk mandate full trauma activation and immediate surgeon response because of the high likelihood of operative intervention. Extremity GSW proximal to the knee/elbow also require full trauma activation based on American College of Surgeons Committee on trauma standards. However, whether isolated extremity GSW require frequent operative intervention is unclear. We evaluated GSW at our Level I trauma center from January 2012 to December 2016. Demographic data and injury patterns were abstracted from the trauma registry and charts. The number of GSW increased yearly but the age, gender, Injury Severity Score and injury pattern did not change (P = ns, not shown). There were 504 GSW that included an extremity and 194 (38%) involved multiple body regions. There were 310 GSW (62%) isolated to an extremity and 176 were proximal to the elbow/knee. If proximal GSW had an Emergency Department systolic blood pressure <90 mm Hg, 53 per cent underwent vascular repair, 12 per cent had soft tissue repair, and 29 per cent required no operation. If proximal GSW had an Emergency Department blood pressure >90 mm Hg, 57 per cent underwent orthopedic repair, 22 per cent required no surgery, and only 13 per cent required vascular repair (P < 0.01). In the absence of other criteria for full trauma activation such as shock, the need for the immediate presence of a general surgeon to perform emergency surgery for a GSW isolated to the extremity is low.

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Your Automated Implantable Cardioverter Defibrillator Is Not a Bulletproof Vest but It Might Save Your Life

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.4.42086 ◽

2019 ◽

Vol 3 (3) ◽

pp. 191-193

Author(s):

Tzlil Perahia ◽

David Kleinman ◽

Wassim Habre

Keyword(s):

Emergency Department ◽

Implantable Cardioverter Defibrillator ◽

Upper Extremity ◽

Gunshot Wounds ◽

Direct Impact ◽

Left Chest ◽

Cardioverter Defibrillator ◽

Arm Pain ◽

Trauma Activation ◽

Bulletproof Vest

A 43-year-old male was brought to the emergency department as the highest level trauma activation with complaints of chest and arm pain after sustaining gunshot wounds (GSW). Initial workup was notable for superficial GSWs to the left chest and upper extremity with direct impact to the patient’s automated implantable cardioverter defibrillator. The patient underwent replacement of the device without rewiring and was discharged home without complications.

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Trauma Activation Responsiveness: An RFID-enabled trauma flowsheet

2020 42nd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC) ◽

10.1109/embc44109.2020.9175880 ◽

2020 ◽

Author(s):

Moein Enayati ◽

Heather Heaton ◽

Rona Wang ◽

Gomathi Marisamy ◽

Nasibeh Zanjirani Farahani ◽

...

Keyword(s):

Trauma Activation

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Efficacy of anatomic and physiologic indicators versus mechanism of injury criteria for trauma activation in pediatric emergencies

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e3182782789 ◽

2012 ◽

Vol 73 (6) ◽

pp. 1471-1477 ◽

Cited By ~ 11

Author(s):

Andrew R. Krieger ◽

Hale E. Wills ◽

Mary Christine Green ◽

Ana L. Gleisner ◽

Dennis W. Vane

Keyword(s):

Mechanism Of Injury ◽

Pediatric Emergencies ◽

Injury Criteria ◽

Trauma Activation ◽

Versus Mechanism

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A Comparison of Prehospital Nonphysician and Hospital Physician Placed Tube Thoracostomy

The American Surgeon ◽

10.1177/0003134820940238 ◽

2020 ◽

Vol 86 (7) ◽

pp. 841-847

Author(s):

Kevin N. Harrell ◽

Dylan E. Brooks ◽

Preston H. Palm ◽

Jonathan T. Cowart ◽

Robert Maxwell ◽

...

Keyword(s):

Injury Severity ◽

Prehospital Care ◽

Unit Length ◽

Tube Thoracostomy ◽

Organ Injury ◽

Complication Rates ◽

Tube Malposition ◽

Chest Decompression ◽

Trauma Activation ◽

Hospital Acquired

Background Prehospital chest decompression can be a lifesaving procedure in severe chest trauma. Studies investigating prehospital chest decompression are mostly European where physicians are assigned to prehospital care units. This report is one of the first to compare demographics and outcomes in patients undergoing prehospital chest decompression by trained aeromedical nonphysician personnel to hospital chest decompression by physicians. Methods Prehospital tube thoracostomy (PTT) patients were identified from January 2014 to January 2019 and were matched in a 1:2 ratio based on age, Injury Severity Score (ISS), and chest Abbreviated Injury Score (AIS) to patients who underwent hospital tube thoracostomy (HTT) within 24 hours of admission. Results Forty-nine PTT patients were matched to 98 HTT patients. PTT patients had lower admission Glasgow Coma Scale (GCS), a higher rate of pre-chest tube needle decompression, and higher level 1 trauma activation. PTT were placed sooner (21.9 vs 157.0 minutes, P < .001). Rates of tube malposition, organ injury, tube dislodgement, empyema, and hospital-acquired pneumonia over the course of hospital admission were not significantly different between the 2 groups. PTT patients had longer intensive care unit length of stay (LOS), but similar hospital LOS, and overall mortality. Discussion This report demonstrates that PTT is performed sooner than hospital placed tubes. Complication rates associated with tube thoracostomy and patient outcomes were not statistically different between PTT and HTT groups.

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