Peer review report 1 on “Management of traumatic popliteal vascular injuries in a level I trauma center: A 6-year experience/case controlled study”

2016 ◽  
Vol 25 ◽  
pp. 113
Keyword(s):  
Peer Review ◽  
Trauma Center ◽  
Controlled Study ◽  
Vascular Injuries ◽  
Level I

Management of Traumatic Vascular Injuries to the Neck: A 7-Year Experience at a Level I Trauma Center

2012 ◽  
Vol 78 (3) ◽  
pp. 335-338 ◽  
Author(s):  
Jon D. Simmons ◽  
Naveed Ahmed ◽  
Kimberly A. Donnellan ◽  
Robert E. Schmieg ◽  
John M. Porter ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Trauma Center ◽  
Chart Review ◽  
Jugular Vein ◽  
Penetrating Trauma ◽  
Vascular Injuries ◽  
Mortality And Morbidity ◽  
Carotid Artery Injuries ◽  
Level I ◽  
Significant Mortality

Injury to the carotid artery results in significant mortality and morbidity. The general consensus is to repair all injuries to the common and internal carotid arteries. Ligation is usually reserved for neurologic or hemodynamic instability. We report our experience at a Level I trauma center with vascular injuries to the neck. Retrospective chart review of all patients with vascular injuries in the neck resulting from either blunt or penetrating trauma treated at a Level I trauma center between January 2000 and February 2007. Demographics and outcomes were collected from a chart review. Twenty-five patients with vascular injuries to the neck were identified. There were 13 carotid artery injuries (CAI), five internal jugular vein (IJV) injuries, and 13 external jugular vein (EJV) injuries. Of the carotid artery injuries, six (50%) underwent operative repair (4 primary repairs and 2 bypasses), five (38%) were managed nonoperatively, and one was treated using endovascular techniques. No patient had a postoperative decrease in Glasgow Coma Scale score. There were five isolated IJV injuries (3 primary repair and 2 ligations). Four of the venous injuries (all internal jugular veins) were repaired and the remaining 13 were ligated. Vascular injuries to the neck have significant mortality and morbidity. Treatment of these injuries must be individualized. All CAI in noncomatose patients should be repaired if hemodynamically stable. All IJV injuries should be repaired but may be ligated if hemodynamically unstable. All EJV injuries can be ligated without reservation regardless of neurological status.

Level I Verification Is Associated with a Decreased Mortality Rate after Major Torso Vascular Injuries

2011 ◽  
Vol 77 (1) ◽  
pp. 32-37 ◽  
Author(s):  
Scott Norwood ◽  
Alan D. Cook ◽  
John D. Berne
Keyword(s):  
Mortality Rate ◽  
Trauma Center ◽  
Mortality Rates ◽  
Population Based ◽  
Entire Group ◽  
Vascular Injuries ◽  
Thoracic Injuries ◽  
Level Ii ◽  
Level I ◽  
Community Trauma

Major torso vascular injuries (MTVIs) are frequently fatal. Our purpose was to determine whether the American College of Surgeons’ (ACS) trauma center level of verification was associated with reduced mortality rates in a rural population-based community trauma center. Patients with blunt and penetrating MTVIs were retrospectively reviewed. Mortality rates were compared between Level II and Level I verification time periods. The primary outcome measured was death from MTVIs. Two hundred seventy-four patients (blunt, 167 [61%]; penetrating, 107 [39%]) representing 1.5 per cent of all trauma admissions were studied. Mortality decreased from 41 of 80 (51%) (Level II) to 60 of 194 (31%) (Level I) ( P = 0.002) for the entire group. Mortality reduction occurred primarily in the subgroup with blunt and penetrating thoracic injuries (Level II, 24 of 33 [73%] vs Level I, 25 of 82 [30%]; P < 0.001). A significant reduction was not observed in patients with major abdominal vascular injuries (Level II, 17 of 47 [36%] vs Level I, 35 of 112 [31%]; P = 0.581). Level I status was associated with an overall decreased mortality rate from MTVIs despite low patient numbers. The commitment of hospital resources that are required to achieve Level I ACS verification in a community hospital improves survival, particularly in patients with blunt and penetrating thoracic injuries.

A Trauma Outreach Program Provided by a Level I Trauma Center Is an Effective Way to Initiate Peer Review at Referring Hospitals and Foster Process Improvements

2010 ◽  
Vol 68 (4) ◽  
pp. 778-782 ◽  
Author(s):  
Matthew C. Byrnes ◽  
Eric Irwin ◽  
Leslie Becker ◽  
Melissa Thorson ◽  
Greg Beilman ◽  
...  
Keyword(s):  
Peer Review ◽  
Trauma Center ◽  
Outreach Program ◽  
Process Improvements ◽  
Level I

CT Angiography Effectively Evaluates Extremity Vascular Trauma

2008 ◽  
Vol 74 (2) ◽  
pp. 103-107 ◽  
Author(s):  
Peter D. Peng ◽  
David A. Spain ◽  
Monika Tataria ◽  
Jeffrey C. Hellinger ◽  
Geoffrey D. Rubin ◽  
...  
Keyword(s):  
Trauma Center ◽  
Imaging Modality ◽  
Arterial Injury ◽  
Computed Tomographic Angiography ◽  
Vascular Trauma ◽  
Vascular Imaging ◽  
Vascular Injuries ◽  
Peripheral Vascular ◽  
Diagnostic Modality ◽  
Level I

Traditionally, conventional arteriography is the diagnostic modality of choice to evaluate for arterial injury. Recent technological advances have resulted in multidetector, fine resolution computed tomographic angiography (CTA). This study examines CTA for evaluation of extremity vascular trauma compared with conventional arteriography. Our hypothesis is that CTA provides accurate and timely diagnosis of peripheral vascular injuries and challenges the gold standard of arteriogram. Traumatic extremity injuries over a 5-year period were identified using a Level I trauma center registry and radiology database. Information collected included patient demographics, mechanism, imaging modality, vascular injuries, management, and follow-up. Two thousand two hundred and fifty-one patients were identified with extremity trauma. Twenty-four patients were taken directly to the operating room for evaluation and management of vascular injuries. Fifty-two underwent vascular imaging. Fourteen patients had conventional arteriograms with 13 abnormal studies: 7 were managed operatively, 2 embolized, and 4 observed. Thirty-eight patients underwent CTA with 17 abnormal scans: 9 were managed operatively, 3 embolized, and 5 observed. There were no false negatives or missed injuries. CTA provides accurate peripheral vascular imaging while additionally offering advantages of noninvasiveness and immediate availability. Secondary to these advantages, CTA has supplanted arteriography for initial radio-graphic evaluation of peripheral vascular injuries at our Level I trauma center. This study supports CTA as an effective alternative to conventional arteriography in assessing extremity vascular trauma.

scholarly journals Management of traumatic popliteal vascular injuries in a level I trauma center: A 6-year experience

2015 ◽  
Vol 18 ◽  
pp. 136-141 ◽  
Author(s):  
Jason D. Sciarretta ◽  
Francisco Igor B. Macedo ◽  
Christian A. Otero ◽  
Jose N. Figueroa ◽  
Louis R. Pizano ◽  
...  
Keyword(s):  
Trauma Center ◽  
Vascular Injuries ◽  
Level I

scholarly journals Prehospital time and mortality in polytrauma patients: a retrospective analysis

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.

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

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.

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

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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