Survival Factors in Patients of High Fall – a 10-year Level-I Multi-Trauma Center Study

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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Transfer Time After Acceptance to a Level I Trauma Center

JAAOS Global Research and Reviews ◽

10.5435/jaaosglobal-d-17-00081 ◽

2018 ◽

Vol 2 (2) ◽

pp. e081

Author(s):

Ena Nielsen ◽

David L. Skaggs ◽

Liam R. Harris ◽

Lindsay M. Andras

Keyword(s):

Trauma Center ◽

Transfer Time ◽

Level I

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Analysis of Profit and Loss by Injury Severity over 20 Years at a University Level I Trauma Center

The American Surgeon ◽

10.1177/000313481608200732 ◽

2016 ◽

Vol 82 (7) ◽

pp. 644-648

Author(s):

Zachary Dietch ◽

Jeffrey S. Young ◽

Steven D. Young

Keyword(s):

Trauma Center ◽

Injury Severity ◽

Positive Margin ◽

Cost Data ◽

Hospital Charges ◽

Data Set ◽

Average Loss ◽

University Level ◽

Level I ◽

Injured Patients

We examined financial data from a University Level I Trauma Center from 1994 to 2014. We sought to investigate the hypothesis that lower injury severity correlates with increased profitability. We examined data from July 1994 to December 2014. This included hospital charges, Medicare cost data, final reimbursement, and payor source. Patients were separated into Injury Severity Score (ISS) groupings: 0 to 9, 10 to 14, 15 to 24, >24, and >14. Mean and standard deviation of mean are reported. We had complete data on 27,582 patients. Overall profit per case when subtracting costs from reimbursements was $1,932/case (total profit in unadjusted dollars = $53,475,828 or $2,673,791/year). When examined by ISS, profitability was significantly different between ISS 0 to 14 and 15 to 24, and > 24. When charge data were examined, the average loss per case was -$31,313 for the 27,582 patient data set. When using cost, and not charge data, overall trauma care had a positive margin. Severely injured patients (ISS > 14) were the most profitable, with a significantly higher profit per case than all other groupings. Only through examination of cost data can realistic determinations of trauma center profitability be made. If only charge data had been examined in this study, the overall loss from the 20-year period would have been $863,675,166 and not a profit of $53,475,828.

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