Impact of the State-mandated Stay-at-home Order for the COVID-19 Pandemic on an Academic Level I Trauma Center with a Large Rural Catchment Area

The purpose of this study was to examine the impact of in-house attending surgeon supervision on the rate of preventable deaths (PD) and complications (PC) at the beginning of the academic year. All trauma patients admitted to the Los Angeles County 1 University of Southern California Medical Center over an 8-year period ending in December 2009 were reviewed. Morbidity and mortality reports were used to extract all PD/PC. Patients admitted in the first 2 months (July/ August) of the academic year were compared with those admitted at the end of the year (May/June) for two distinct time periods: 2002 to 2006 (before in-house attending surgeon supervision) and 2007 to 2009 (after 24-hour/day in-house attending surgeon supervision). During 2002 to 2006, patients admitted at the beginning of the year had significantly higher rates of PC (1.1% for July/ August vs 0.6% for May/June; adjusted odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1 to 3.2; P < 0.001). There was no significant difference in mortality (6.5% for July/August vs 4.6% for May/ June; adjusted OR, 1.1; 95% CI,0.8 to 1.5; P = 0.179). During 2007 to 2009, after institution of 24-hour/day in-house attending surgeon supervision of fellows and housestaff, there was no significant difference in the rates of PC (0.7% for July/August vs 0.6% for May/June; OR, 1.1; 95% CI, 0.8 to 1.3; P = 0.870) or PD (4.6% for July/August vs 3.7% for May/June; OR, 1.3; 95% CI, 0.9 to 1.7; P = 0.250) seen at the beginning of the academic year. At an academic Level I trauma center, the institution of 24-hour/day in-house attending surgeon supervision significantly reduced the spike of preventable complications previously seen at the beginning of the academic year.

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Influence of a Stay-At-Home Order on Trauma Volume and Injury Patterns at a Level I Trauma Center in Ohio

The American Surgeon ◽

10.1177/00031348211047488 ◽

2021 ◽

pp. 000313482110474

Author(s):

Gregory S. Huang ◽

Elisha A. Chance ◽

C. Michael Dunham

Keyword(s):

Trauma Center ◽

Drug Testing ◽

Injury Severity ◽

Census Data ◽

Retrospective Chart Review ◽

Trauma Patients ◽

Injury Patterns ◽

Trauma Service ◽

Level I ◽

At Home

Background Changes in injury patterns during the COVID pandemic have been reported in other states. The objective was to explore changes to trauma service volume and admission characteristics at a trauma center in northeast Ohio during a stay-at-home order (SAHO) and compare the 2020 data to historic trauma census data. Methods Retrospective chart review of adult trauma patients admitted to a level I trauma center in northeast Ohio. Trauma admissions from January 21 to July 21, 2020 (COVID period) were compared to date-matched cohorts of trauma admissions from 2018 to 2019 (historic period). The COVID period was further categorized as pre-SAHO, active-SAHO, and post-SAHO. Results The SAHO was associated with a reduction in trauma center admissions that increased after the SAHO ( P = .0033). Only outdoor recreational vehicle (ORV) injuries ( P = .0221) and self-inflicted hanging ( P = .0028) mechanisms were increased during the COVID period and had substantial effect sizes. Glasgow Coma Scores were lower during the COVID period ( P = .0286) with a negligible effect size. Violence-related injuries, injury severity, mortality, and admission characteristics including alcohol and drug testing and positivity were similar in the COVID and historic periods. Discussion The SAHO resulted in a temporary decrease in trauma center admissions. Although ORV and hanging mechanisms were increased, other mechanisms such as alcohol and toxicology proportions, injury severity, length of stay, and mortality were unchanged.

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Prevention of Adverse Drug Events and Cost Savings Associated with PharmD Interventions in an Academic Level I Trauma Center: An Evidence-based Approach

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2012.12.002 ◽

2013 ◽

Vol 44 (2) ◽

pp. 570

Author(s):

Benjamin Easter

Keyword(s):

Trauma Center ◽

Adverse Drug Events ◽

Cost Savings ◽

Evidence Based ◽

Academic Level ◽

Level I

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CORR Insights®: How Did the Number and Type of Injuries in Patients Presenting to a Regional Level I Trauma Center Change During the COVID-19 Pandemic with a Stay-at-home Order?

Clinical Orthopaedics and Related Research ◽

10.1097/corr.0000000000001527 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Prashant Meshram

Keyword(s):

Trauma Center ◽

Regional Level ◽

Level I ◽

At Home

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Impact of the COVID-19 shutdown on orthopedic trauma numbers and patterns in an academic Level I Trauma Center in Berlin, Germany

PLoS ONE ◽

10.1371/journal.pone.0246956 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246956

Author(s):

Tazio Maleitzke ◽

Matthias Pumberger ◽

Undine A. Gerlach ◽

Carolin Herrmann ◽

Anna Slagman ◽

...

Keyword(s):

Trauma Center ◽

Control Period ◽

Orthopedic Trauma ◽

Injury Patterns ◽

Total Patient ◽

Academic Level ◽

Level I ◽

Rate Ratios ◽

And Control ◽

The Impact

Background The COVID-19 pandemic led to the implementation of drastic shutdown measures worldwide. While quarantine, self-isolation and shutdown laws helped to effectively contain and control the spread of SARS-CoV-2, the impact of COVID-19 shutdowns on trauma care in emergency departments (EDs) remains elusive. Methods All ED patient records from the 35-day COVID-19 shutdown (SHUTDOWN) period were retrospectively compared to a calendar-matched control period in 2019 (CTRL) as well as to a pre (PRE)- and post (POST)-shutdown period in an academic Level I Trauma Center in Berlin, Germany. Total patient and orthopedic trauma cases and contacts as well as trauma causes and injury patterns were evaluated during respective periods regarding absolute numbers, incidence rate ratios (IRRs) and risk ratios (RRs). Findings Daily total patient cases (SHUTDOWN vs. CTRL, 106.94 vs. 167.54) and orthopedic trauma cases (SHUTDOWN vs. CTRL, 30.91 vs. 52.06) decreased during the SHUTDOWN compared to the CTRL period with IRRs of 0.64 and 0.59. While absolute numbers decreased for most trauma causes during the SHUTDOWN period, we observed increased incidence proportions of household injuries and bicycle accidents with RRs of 1.31 and 1.68 respectively. An RR of 2.41 was observed for injuries due to domestic violence. We further recorded increased incidence proportions of acute and regular substance abuse during the SHUTDOWN period with RRs of 1.63 and 3.22, respectively. Conclusions While we observed a relevant decrease in total patient cases, relative proportions of specific trauma causes and injury patterns increased during the COVID-19 shutdown in Berlin, Germany. As government programs offered prompt financial aid during the pandemic to individuals and businesses, additional social support may be considered for vulnerable domestic environments.

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Predictors of surgical management of high grade blunt splenic injuries in adult trauma patients: a 5-year retrospective cohort study from an academic level I trauma center

Patient Safety in Surgery ◽

10.1186/s13037-020-00257-3 ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Thomas M. P. Nijdam ◽

Roy Spijkerman ◽

Lilian Hesselink ◽

Luke P. H. Leenen ◽

Falco Hietbrink

Keyword(s):

Cohort Study ◽

Surgical Management ◽

Retrospective Cohort Study ◽

Trauma Center ◽

Retrospective Cohort ◽

Trauma Patients ◽

High Grade ◽

Academic Level ◽

Level I

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The Impact of Early Hormonal Therapy in Catastrophic Brain-Injured Patients and Its Effect on Organ Procurement

The American Surgeon ◽

10.1177/000313481207800340 ◽

2012 ◽

Vol 78 (3) ◽

pp. 318-324 ◽

Cited By ~ 3

Author(s):

Lydia Lam ◽

Kenji Inaba ◽

Bernardino Castelo Branco ◽

Bradley Putty ◽

Ali Salim ◽

...

Keyword(s):

Hormonal Therapy ◽

Trauma Center ◽

Organ Procurement ◽

High Volume ◽

Academic Level ◽

Brain Injured ◽

Early Use ◽

Level I ◽

Injured Patients ◽

The Impact

The purpose of this study was to evaluate the impact of early hormonal therapy on organ procurement from catastrophic brain-injured patients. All catastrophic brain-injured patients admitted to a high-volume academic Level I trauma center who underwent successful organ procurement over a 3-year period (2006 to 2008) were reviewed. Patients were divided into two groups, those who received hormone therapy (HT) before brain death (BD) declaration and those who received HT after BD declaration. Thirty-two (60.4%) received HT before BD and 21 (39.6%) HTafter BD. Trauma was the most common cause of brain injury in both groups (before BD 96.9 vs after BD 90.5%, P = 0.324). There were no significant differences in demographics and clinical data. Patients receiving HT before BD were more hypotensive on admission (28.2 vs 9.5%, P = 0.048); however, they required vasopressors less frequently (62.5 vs 100.0%, P = 0.001), for a shorter duration (17.2 ± 16.3 hours vs 33.1 ± 34.9 hours, P = 0.043), and at a lower dosage. Time from admission to procurement did not differ between the two groups (109.8 ± 83.1 hours vs 125.0 ± 79.9 hours, P = 0.505). Patients receiving HT before BD had significantly more organs procured (4.5 ± 1.5 vs 3.5 ± 1.3, P = 0.023). Although catastrophic brain-injured patients receiving early hormonal therapy were more hypotensive, they required less vasopressors and had higher procurement rates. The early use of hormonal therapy may decrease the need for vasopressors and increase the salvage of potentially transplantable organs.

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