Missed injuries during the initial assessment in a cohort of 1124 level-1 trauma patients

Injury ◽  
2012 ◽  
Vol 43 (9) ◽  
pp. 1517-1521 ◽  
Author(s):  
G.F. Giannakopoulos ◽  
T.P. Saltzherr ◽  
L.F.M. Beenen ◽  
J.B. Reitsma ◽  
F.W. Bloemers ◽  
...  
Keyword(s):  
Initial Assessment ◽  
Trauma Patients ◽  
Missed Injuries ◽  
Level 1

scholarly journals (P2-91) EMS Trauma Triage: Does the Red-Blue Criteria Enable Overtriage?

2011 ◽  
Vol 26 (S1) ◽  
pp. s166-s166
Author(s):  
D.M. Higgins ◽  
R.E. Thaxton
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Initial Assessment ◽  
Trauma Patients ◽  
Minor Trauma ◽  
Trauma Severity ◽  
Physician Assessment ◽  
Assessment Skills ◽  
Trauma Triage ◽  
Level 1

IntroductionWith the current need for effective trauma center utilization, understanding how current trauma triage criteria may promote overtriage will enable both field and hospital teams to provide the most appropriate patient care. It is hypothesized that current Southwest Texas trauma criteria promote overtriage by prehospital emergency medical services (EMS) of patients in favor of a Level 1 trauma facility when compared to physician assessment and Injury Severity Score (ISS).MethodsThis prospective, observational study at a Southwest Texas military Level 1 trauma center compared adult trauma patients' prehospital status noted by EMS personnel with the triage criteria documented by the treating emergency physician. The patients were divided into four groups: Prehospital Criteria Met or Not Met; Arrival Criteria Met or Not Met. Each patient's ISS and mechanism of injury were also collected and compared to initial assessment for predictive value. Descriptive statistics were used.ResultsThe study enrolled 278 adult trauma patients. EMS reported Level 1 trauma status similar to physician assessment (60.1% vs. 59.7%, respectively). The rates patients met Level 1 trauma status corresponded with trauma severity when compared to the ISS. Assessment between EMS and physicians for ISSs were similar among the four groups. Comparisons using multivariate analysis of the four groups found similar ISSs, except for the Prehospital Criteria Met/Arrival Criteria Not Met group. Seventy-five percent of these patients were assigned an ISS in the Minor (ISS < 9) category (p = 0.013).ConclusionTrauma triage criteria assessment skills were similar between EMS personnel and emergency physicians except for identifying minor trauma patients. While the criteria generally led to overtriage, EMS crews appear to overtriage minor trauma patients at a much higher rate.

scholarly journals P043: Trauma team leaders in Canada: A national survey

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S78
Author(s):  
V. Belhumeur ◽  
C. Malo ◽  
A. Nadeau ◽  
S. Hegg ◽  
A. Gagné ◽  
...  
Keyword(s):  
Prehospital Care ◽  
Injured Patient ◽  
Trauma Team ◽  
Initial Assessment ◽  
Trauma Patients ◽  
Lack Of Information ◽  
Level 1 ◽  
Patient Prognosis ◽  
Activation Criteria ◽  
Early Trauma

Introduction: It was demonstrated that the early trauma team activation (TTA) could improve younger trauma patients outcomes and mortality rates. However, the link between older patient prognosis improvement and the activation / effectiveness of the Trauma team (TT) is still unclear. There is also a lack of information about the exact and optimal structure of TTs and their activation criteria, which may differ across centers. The main objective of this study is to provide a description of the current TT available in level 1 and 2 centres across Canada. Methods: In 2017, a survey using a modified Dillman technique was sent to 210 health professionals scattered across all Canadian trauma care facilities. The survey included questions regarding 1) the presence and the composition of a TT, 2) the established TT activation criteria, and finally 3) the initial patient care. Results: A total of 107 (57%) completed surveys were received. Among them, only 22 (11.7%) were from level 1 or 2 centres and were therefore considered for analyses. Seventeen respondents had a TT in their centre, and they all shared their TT activation criteria (1 to 27 different indications). Most frequently mentioned criteria were: suspected injuries (58.8%), judgment of the emergency physician (41.2%), systolic blood pressure (47.1%), Glasgow Coma score (35.3%) and respiratory rate (28%). In presence of a prehospital care warning trauma, the initial assessment of a severely injured patient is exclusively completed by a member of the TT for only 35.1% of the respondents. For 11.8% of respondents, TT coordinates airway management. For 64.7% of participants, the TT leader is the dedicated care provider to accompany patients until final orientation. Conclusion: These results suggest a great variability across Canada regarding the roles assumed by the TT, but also regarding the activation criteria leading them to take action.

Acute Traumatic Cervical Facet Fractures

2018 ◽  
Vol 1 (2) ◽  
pp. 5
Author(s):  
Shankar Gopinat
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Early Surgery ◽  
Initial Assessment ◽  
Trauma Patients ◽  
Spinal Stability ◽  
Fracture Patterns ◽  
Spine Ct ◽  
Cervical Facet

Acute cervical facet fractures are increasingly being detected due to the use of cervical spine CT imaging in the initial assessment of trauma patients. For displaced cervical facet fractures with dislocations and subluxations, early surgery can decompress the spinal cord and stabilize the spine. For patients with non-displaced cervical facet fractures, the challenge in managing these patients is the determination of spinal stability. Although many of the patients with non-displaced cervical facet fractures can be managed with a cervical collar, the imaging needs to be analyzed carefully since certain fracture patterns may be better managed with early surgical stabilization.

Pathologic Fibrinolysis is More Common in a Rural Trauma Setting

2020 ◽  
pp. 000313482097372
Author(s):  
James M. Bardes ◽  
Daniel J. Grabo ◽  
Sijin Wen ◽  
Alison Wilson
Keyword(s):  
Trauma Team ◽  
Rural Environment ◽  
Trauma Patients ◽  
Future Studies ◽  
Factors Influencing ◽  
American College Of Surgeons ◽  
Level 1 ◽  
Transferred Patients ◽  
Prehospital Time ◽  
Level 1 Trauma Center

Introduction Fibrinolysis (lysis) has been extensively studied in trauma patients. Many studies on the distribution of lysis phenotype have been conducted in setting with short prehospital time. This study aimed to evaluate the distribution of lysis phenotypes in a population with prolonged prehospital times in a rural environment. Methods A retrospective study was performed at an American College of Surgeons-verified level 1 trauma center, serving a large rural population. Full trauma team activations from January 1, 2017 to August 31, 2018 were evaluated, and all patients with an ISS>15 analyzed. Thromboelastography was routinely performed on all participants on arrival. Lysis phenotypes were classified based on LY30 results: shutdown (≤.8%), physiologic (.9-2.9%), and hyper (>2.9%). Results 259 patients were evaluated, 134 (52%) presented direct from the scene. For scene patients, lysis distribution was 24% physiologic, 49% shutdown, and 27% hyper. Transferred patients demonstrated a reduction in physiologic lysis to 14% ( P = .03), shutdown present in 66%, and hyper in 20%. Empiric prehospital tranexamic acid was given to 18 patients, physiologic lysis was present in 6%, shutdown 72%, and hyper 22%; this increase was not statistically significant ( P = .5). Conclusion Fibrinolysis phenotypes are not consistent across all trauma populations. This study showed rural trauma patients had a significantly increased rate of pathologic lysis. This was consistent for scene and transfer patients who received care at another facility prior to arrival for definitive care. Future studies to evaluate the factors influencing these differences are warranted.

scholarly journals Identifying trauma patients with benefit from direct transportation to Level-1 trauma centers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charlie A. Sewalt ◽  
Benjamin Y. Gravesteijn ◽  
Daan Nieboer ◽  
Ewout W. Steyerberg ◽  
Dennis Den Hartog ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Trauma Center ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Absolute Benefit ◽  
Predicted Probability ◽  
Prehospital Triage ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Level 2

Abstract Background Prehospital triage protocols typically try to select patients with Injury Severity Score (ISS) above 15 for direct transportation to a Level-1 trauma center. However, ISS does not necessarily discriminate between patients who benefit from immediate care at Level-1 trauma centers. The aim of this study was to assess which patients benefit from direct transportation to Level-1 trauma centers. Methods We used the American National Trauma Data Bank (NTDB), a retrospective observational cohort. All adult patients (ISS > 3) between 2015 and 2016 were included. Patients who were self-presenting or had isolated limb injury were excluded. We used logistic regression to assess the association of direct transportation to Level-1 trauma centers with in-hospital mortality adjusted for clinically relevant confounders. We used this model to define benefit as predicted probability of mortality associated with transportation to a non-Level-1 trauma center minus predicted probability associated with transportation to a Level-1 trauma center. We used a threshold of 1% as absolute benefit. Potential interaction terms with transportation to Level-1 trauma centers were included in a penalized logistic regression model to study which patients benefit. Results We included 388,845 trauma patients from 232 Level-1 centers and 429 Level-2/3 centers. A small beneficial effect was found for direct transportation to Level-1 trauma centers (adjusted Odds Ratio: 0.96, 95% Confidence Interval: 0.92–0.99) which disappeared when comparing Level-1 and 2 versus Level-3 trauma centers. In the risk approach, predicted benefit ranged between 0 and 1%. When allowing for interactions, 7% of the patients (n = 27,753) had more than 1% absolute benefit from direct transportation to Level-1 trauma centers. These patients had higher AIS Head and Thorax scores, lower GCS and lower SBP. A quarter of the patients with ISS > 15 were predicted to benefit from transportation to Level-1 centers (n = 26,522, 22%). Conclusions Benefit of transportation to a Level-1 trauma centers is quite heterogeneous across patients and the difference between Level-1 and Level-2 trauma centers is small. In particular, patients with head injury and signs of shock may benefit from care in a Level-1 trauma center. Future prehospital triage models should incorporate more complete risk profiles.

Clinical and economic effects of selective radiological evaluation of high-energy trauma patients: a prospective experience of a level 1 busy trauma centre

2014 ◽  
Vol 32 (7) ◽  
pp. 535-538 ◽  
Author(s):  
Shahram Paydar ◽  
Armin Ahmadi ◽  
Behnam Dalfardi ◽  
Alireza Shakibafard ◽  
Hamidreza Abbasi ◽  
...  
Keyword(s):  
High Energy ◽  
Trauma Centre ◽  
Economic Effects ◽  
Trauma Patients ◽  
Radiological Evaluation ◽  
High Energy Trauma ◽  
Level 1

scholarly journals Does emergency medicine length of stay predict trauma outcomes at a Level 1 Trauma Center?

2015 ◽  
Vol 4 (5) ◽  
pp. 1 ◽  
Author(s):  
Erin Powers Kinney ◽  
Kamal Gursahani ◽  
Eric Armbrecht ◽  
Preeti Dalawari
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Hospital Capacity ◽  
Significant Difference ◽  
Level 1 ◽  
Level 1 Trauma Center

Objective: Previous studies looking at emergency department (ED) crowding and delays of care on outcome measures for certain medical and surgical patients excluded trauma patients. The objectives of this study were to assess the relationship of trauma patients’ ED length of stay (EDLOS) on hospital length of stay (HLOS) and on mortality; and to examine the association of ED and hospital capacity on EDLOS.Methods: This was a retrospective database review of Level 1 and 2 trauma patients at a single site Level 1 Trauma Center in the Midwest over a one year period. Out of a sample of 1,492, there were 1,207 patients in the analysis after exclusions. The main outcome was the difference in hospital mortality by EDLOS group (short was less than 4 hours vs. long, greater than 4 hours). HLOS was compared by EDLOS group, stratified by Trauma Injury Severity Score (TRISS) category (< 0.5, 0.51-0.89, > 0.9) to describe the association between ED and hospital capacity on EDLOS.Results: There was no significant difference in mortality by EDLOS (4.8% short and 4% long, p = .5). There was no significant difference in HLOS between EDLOS, when adjusted for TRISS. ED census did not affect EDLOS (p = .59), however; EDLOS was longer when the percentage of staffed hospital beds available was lower (p < .001).Conclusions: While hospital overcrowding did increase EDLOS, there was no association between EDLOS and mortality or HLOS in leveled trauma patients at this institution.

scholarly journals Impact of Implementation of Sequential Trauma Education Programs (STEPs) Course on Missed Injuries in Emergency Polytrauma Patients, Ismailia, Egypt

2021 ◽  
Author(s):  
Adel Hamed Elbaih ◽  
Maged El-Setouhy ◽  
Jon Mark Hirshon ◽  
Hazem Mohamed El-Hariri ◽  
Mohamed El-Shinawi
Keyword(s):  
Low Income ◽  
Life Support ◽  
University Hospital ◽  
Low Income Countries ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Education Programs ◽  
Missed Injuries ◽  
Polytrauma Patients ◽  
Trauma Education

Abstract IntroductionTrauma deaths account for 8% of all deaths in Egypt. Patients with multiple injuries are at high risk but may be saved with a good triage system and a well-trained trauma team in dedicated institutions. The incidence of missed injuries in the Emergency Department (ED) of Suez Canal University Hospital (SCUH) was found to be 9.0% after applying Advanced Trauma Life Support (ATLS) guidelines. However, this rate is still high compared with many trauma centers.AimImprove the quality of management of polytrauma patients by decreasing the incidence of missed injuries by implementing the Sequential Trauma Education Programs (STEPs) course in the ED at SCUH.MethodsThis interventional training study was conducted in the SCUH ED that adheres to CONSORT guidelines. The study was conducted during the 1-month precourse and for 6 months after the implementation of the STEPs course for ED physicians. Overall, 458 polytrauma patients were randomly selected, of which 45 were found to have missed injuries after applying the inclusion and exclusion criteria. We assessed the clinical relevance of these cases for missed injuries before and after the STEPs course.ResultsOverall, 45 patients were found to have missed injuries, of which 15 (12%) were pre-STEPs and 30 (9%) were post-STEPs course. The STEPs course significantly increased adherence to vital data recording, but the reduction of missed injuries (3.0%) was not statistically significant in relation to demographic and trauma findings. However, the decrease in missed injuries in the post-STEPs course group was an essential clinically significant finding.ConclusionSTEPs course implementation decreased the incidence of missed injuries in polytrauma patients. Thus, the STEPs course can be considered at the same level of other advanced trauma courses as a training skills program or possibly better in dealing with trauma patients. Repetition of this course by physicians should be mandatory to prevent more missed injuries. Therefore, the validation of STEPs course certification should be completed at least every 2 years to help decrease the number of missed injuries, especially in low-income countries and low-resource settings.Trial RegistrationProject manager for the Pan African Clinical Trial Registry (www.pactr.org) database has been accepted with the date of approval:18/11/2020. Current Controlled Trials number for the registry is PACTR202011853914203. Please note that the article state Retrospectively registered that my study adheres to CONSORT guidelines.

scholarly journals Mortality Rate of Trauma Patients with ESI Triage Level 1–2 Who Underwent Computerized Tomography-PANSCAN versus Conventional Computerized Tomography Scan

2021 ◽  
Vol Volume 13 ◽  
pp. 457-463
Author(s):  
Sorravit Savatmongkorngul ◽  
Chaiyaporn Yuksen ◽  
Wapee Maspol ◽  
Pungkava Sricharoen ◽  
Sirote Wongwaisayawan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Computerized Tomography ◽  
Trauma Patients ◽  
Level 1 ◽  
Triage Level ◽  
Tomography Scan

scholarly journals Epidemiology of Blood Stream Infections at a Level-1 Trauma Care Center of India

2014 ◽  
Vol 6 (01) ◽  
pp. 022-027 ◽  
Author(s):  
Purva Mathur ◽  
Prince Varghese ◽  
Vibhor Tak ◽  
Jacinta Gunjiyal ◽  
Sanjeev Lalwani ◽  
...  
Keyword(s):  
Pathogenic Bacteria ◽  
Care Center ◽  
Subsequent Development ◽  
Bloodstream Infections ◽  
Blood Stream ◽  
Common Source ◽  
Trauma Patients ◽  
Major Life ◽  
High Prevalence ◽  
Level 1

ABSTRACT Purpose: Bloodstream infections (BSIs) are one of the major life-threatening infections in hospitals. They are responsible for prolonged hospital stays, high healthcare costs, and significant mortality. The epidemiology of BSIs varies between hospitals necessitating analysis of local trends. Few studies are available on trauma patients, who are predisposed due to the presence of multiple invasive devices. Materials and Methods: A prospective surveillance of all BSIs was done at a level 1 trauma center from April, 2011 to March, 2012. All patients admitted to the different trauma intensive care units (ICUs) were monitored daily by attending physicians for subsequent development of nosocomial BSI. An episode of BSI was identified when patients presented with one or more of the following signs/symptoms, that is, fever, hypothermia, chills, or hypotension and at least one or more blood culture samples demonstrated growth of pathogenic bacteria. BSIs were further divided into primary and secondary BSIs as per the definitions of Center for Disease Control and Prevention. All patients developing nosocomial BSIs were followed till their final outcome. Results: A total of 296 episodes of nosocomial BSIs were observed in 240 patients. A source of BSI was identified in 155 (52%) episodes. Ventilator-associated pneumonia was the most common source of secondary BSI. The most common organism was Acinetobacter sp. (21.5%). Candida sp. accounted for 12% of all blood stream organisms. A high prevalence of antimicrobial resistance was observed in Gram-negative and-positive pathogens. Conclusions: Trauma patients had a high prevalence of BSIs. Since secondary bacteremia was more common, a targeted approach to prevention of individual infections would help in reducing the burden of BSIs.

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