Unrestricted Access to the Intravenous Tylenol Is Associated with Shorter Length of Stay in the Retrospective Cohort of Patients Treated for the Maxillofacial Trauma in a 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.

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Experience in an Urban Level 1 Trauma Center With Tranexamic Acid in Pediatric Trauma: A Retrospective Chart Review

Journal of Intensive Care Medicine ◽

10.1177/0885066619890834 ◽

2020 ◽

pp. 088506661989083

Author(s):

Julie M. Thomson ◽

Hanh H. Huynh ◽

Holly M. Drone ◽

Jessica L. Jantzer ◽

Albert K. Tsai ◽

...

Keyword(s):

Length Of Stay ◽

Tranexamic Acid ◽

Trauma Center ◽

Surgical Intervention ◽

Statistical Significance ◽

Pediatric Trauma ◽

End Points ◽

Transfusion Requirements ◽

Level 1 ◽

Level 1 Trauma Center

Background: Evidence for tranexamic acid (TXA) in the pharmacologic management of trauma is largely derived from data in adults. Guidance on the use of TXA in pediatric patients comes from studies evaluating its use in cardiac and orthopedic surgery. There is minimal data describing TXA safety and efficacy in pediatric trauma. The purpose of this study is to describe the use of TXA in the management of pediatric trauma and to evaluate its efficacy and safety end points. Methods: This retrospective, observational analysis of pediatric trauma admissions at Hennepin County Medical Center from August 2011 to March 2019 compares patients who did and did not receive TXA. The primary end point is survival to hospital discharge. Secondary end points include surgical intervention, transfusion requirements, length of stay, thrombosis, and TXA dose administered. Results: There were 48 patients aged ≤16 years identified for inclusion using a massive transfusion protocol order. Twenty-nine (60%) patients received TXA. Baseline characteristics and results are presented as median (interquartile range) unless otherwise specified, with statistical significance defined as P < .05. Patients receiving TXA were more likely to be older, but there was no difference in injury type or Injury Severity Score at baseline. There was no difference in survival to discharge or thrombosis. Patients who did not receive TXA had numerically more frequent surgical intervention and longer length of stay, but these did not reach significance. Conclusions: TXA was utilized in 60% of pediatric trauma admissions at a single level 1 trauma center, more commonly in older patients. Although limited by observational design, we found patients receiving TXA had no difference in mortality or thrombosis.

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The Prevalence of Blood-borne Pathogens in Maxillofacial Trauma Patients at a Level 1 Trauma Center

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000006897 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Selim G. Gebran ◽

Philip J. Wasicek ◽

Yinglun Wu ◽

Joseph Lopez ◽

Ledibabari M. Ngaage ◽

...

Keyword(s):

Trauma Center ◽

Maxillofacial Trauma ◽

Trauma Patients ◽

Level 1 ◽

Level 1 Trauma Center

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A Handoff Protocol for Pediatric Trauma Patients at a Rural Level One Trauma Center Reduces Length of Stay

The American Surgeon ◽

10.1177/0003134820956339 ◽

2020 ◽

pp. 000313482095633

Author(s):

Evelyn Coile ◽

Kathryn Bailey ◽

Eric J. Clayton ◽

Tatiana R. Eversley Kelso ◽

Heather MacNew

Keyword(s):

Length Of Stay ◽

Trauma Center ◽

Pediatric Trauma ◽

Trauma Patients ◽

Before And After ◽

Ancillary Staff ◽

Trauma Triage ◽

Level 1 ◽

Trauma Surgeons ◽

Level 1 Trauma Center

Background The management of the pediatric trauma patient is variable among trauma centers. In some institutions, the trauma surgeon maintains control of the patient throughout the hospital stay, while others transfer to a pediatric specialist after the initial evaluation and resuscitation period. We hypothesized that handoff to the pediatric surgeon would decrease the length of stay by more efficient coordination with pediatric subspecialists and ancillary staff. Methods A retrospective review from October 2014 to October 2018 was conducted at our rural level 1 trauma center analyzing the length of stay across all demographics and trauma triage levels before and after institution of a handoff protocol from adult specialized trauma surgeons to pediatric surgeons within a 24-hour window. Further analysis included emergency department (ED) disposition to include the effect of handoff on the length of stay in the setting of a higher post-ED acuity, that is, disposition of monitored beds. Results 1267 patient charts were analyzed and the mean length of stay was reduced by .38 days ( t = 5.92, P < .0005) across all demographics, trauma triage levels, post-ED dispositions, and mechanisms of injury after institution of our handoff protocol. Conclusion Handoff from adult specialized trauma surgeons to pediatric surgeons within a 24-hour window at a rural level 1 trauma center significantly improved the length of stay by .38 ( t = 5.92, P < .0005) among pediatric trauma patients in all demographics, trauma triage activations levels, mechanisms of injury, and post-ED dispositions acuity levels.

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