scholarly journals Outcomes in Trauma Population of Nonagenarians Admitted to a Surgical Service vs Non-surgical: Experience at a Level I Trauma Center

2021 ◽  
Vol 233 (5) ◽  
pp. e221-e222
Author(s):  
Charles Kung C. Hu ◽  
Daniel Jeremy Cucher
Keyword(s):  
Trauma Center ◽  
Surgical Service ◽  
Surgical Experience ◽  
Trauma Population ◽  
Level I

scholarly journals Capturing acute stress disorder in the trauma population

2018 ◽  
Vol 8 (11) ◽  
pp. 24
Author(s):  
Janelle Marie Delle ◽  
Joan E. King
Keyword(s):  
Trauma Center ◽  
Stress Disorder ◽  
Acute Stress ◽  
Acute Stress Disorder ◽  
Trauma Patients ◽  
Psychiatric Referral ◽  
Use Of Resources ◽  
Trauma Population ◽  
Level I

Acute Stress Disorder (ASD) is classified as a psychiatric diagnosis that was first introduced to the DSM-IV in 1994. It was introduced to describe acute stress reactions that precede Post-Traumatic Stress Disorder (PTSD). ASD usually occurs within the first month after the occurrence of a traumatic event. Early recognition of ASD is crucial from both an early treatment standpoint and avoidance of progressing to PTSD, especially in the trauma population, as late recognition can lead to long-term mental and physical suffering. At this time, there is no protocol for screening of ASD upon admission to a Level I trauma center in the Southeast in the Unites States. Hence, not all trauma patients are assessed for ASD. Often, acute stress is recognized several days after admission, with late referrals to the psychiatric team for psychological evaluation and treatment. This late psychiatric referral often leads to the patient’s inability to participate in physical rehabilitation due to stress and anxiety, thus increasing hospital stay and use of resources. Thus, collaborating between the primary medical team and psychiatry team is essential and facilitates the recovery process for potential acute or long-term psychiatric disorders. To determine if ASD was recognized in the trauma population at a large Level I Trauma Center in the Southeast, and if referrals to psychiatry were initiated in a timely manner, this quality improvement study was developed. The data from this study served to correlate the percentage of patients who screened positive for ASD on admission to a sub-acute trauma floor.  A standardized tool called The Stanford Acute Stress Reaction Questionnaire (SASRQ) was used to determine the frequency of ASD in this trauma population. We also ascertained if the trauma nurse practitioners (NPs) had requested a psychiatric referral without the use of the SASRQ tool.  Findings included 18 of the 50 trauma patients who had screened positive for ASD (36%). It was found that of those 18 patients who screened positive for ASD, 2 patients received a psychiatric consultation for evaluation and treatment. These findings suggest a needed focus of capturing ASD early in the admission process, using a validated screening tool, along with early psychological intervention to aid in prevention of PTSD post-discharge.

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.

scholarly journals Transfer Time After Acceptance to a Level I Trauma Center

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

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

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.

Ocular injury in orbital fractures at a level I trauma center

2017 ◽  
Vol 52 (5) ◽  
pp. 499-502 ◽  
Author(s):  
Michael Ross ◽  
Christian El-Haddad ◽  
Jean Deschênes
Keyword(s):  
Trauma Center ◽  
Ocular Injury ◽  
Orbital Fractures ◽  
Level I

An Analysis of Pediatric Gunshot Wounds Treated at a Level I Pediatric Trauma Center

2003 ◽  
Vol 54 (6) ◽  
pp. 1102-1106 ◽  
Author(s):  
Alison K. Snyder ◽  
Li Ern Chen ◽  
Robert P. Foglia ◽  
Patrick A. Dillon ◽  
Robert K. Minkes
Keyword(s):  
Trauma Center ◽  
Pediatric Trauma ◽  
Gunshot Wounds ◽  
Level I ◽  
Pediatric Trauma Center

scholarly journals Surgical Site Infections at a Level I Trauma Center in India: Data From an Indigenously Developed, e-SSI Surveillance System

2020 ◽  
Vol 41 (S1) ◽  
pp. s397-s398
Author(s):  
Ayush Lohiya ◽  
Samarth Mittal ◽  
Vivek Trikha ◽  
Surbhi Khurana ◽  
Sonal Katyal ◽  
...  
Keyword(s):  
Surveillance System ◽  
Trauma Center ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Trauma Patients ◽  
Care Hospital ◽  
Middle Income ◽  
Predominant Pathogen ◽  
Level I

Background: Globally, surgical site infections (SSIs) not only complicate the surgeries but also lead to $5–10 billion excess health expenditures, along with the increased length of hospital stay. SSI rates have become a universal measure of quality in hospital-based surgical practice because they are probably the most preventable of all healthcare-associated infections. Although, many national regulatory bodies have made it mandatory to report SSI rates, the burden of SSI is still likely to be significant underestimated due to truncated SSI surveillance as well as underestimated postdischarge SSIs. A WHO survey found that in low- to middle-income countries, the incidence of SSIs ranged from 1.2 to 23.6 per 100 surgical procedures. This contrasted with rates between 1.2% and 5.2% in high-income countries. Objectives: We aimed to leverage the existing surveillance capacities at our tertiary-care hospital to estimate the incidence of SSIs in a cohort of trauma patients and to develop and validate an indigenously developed, electronic SSI surveillance system. Methods: A prospective cohort study was conducted at a 248-bed apex trauma center for 18 months. This project was a part of an ongoing multicenter study. The demographic details were recorded, and all the patients who underwent surgery (n = 770) were followed up until 90 days after discharge. The associations of occurrence of SSI and various clinico-microbiological variables were studied. Results: In total, 32 (4.2%) patients developed SSI. S. aureus (28.6%) were the predominant pathogen causing SSI, followed by E. coli (14.3%) and K. pneumoniae (14.3%). Among the patients who had SSI, higher SSI rates were associated in patients who were referred from other facilities (P = .03), had wound class-CC (P < .001), were on HBOT (P = .001), were not administered surgical antibiotics (P = .04), were not given antimicrobial coated sutures (P = .03) or advanced dressings (P = .02), had a resurgery (P < .001), had a higher duration of stay in hospital from admission to discharge (P = .002), as well as from procedure to discharge (P = .002). SSI was cured in only 16 patients (50%) by 90 days. SSI data collection, validation, and analyses are essential in developing countries like India. Thus, it is very crucial to implement a surveillance system and a system for reporting SSI rates to surgeons and conduct a robust postdischarge surveillance using trained and committed personnel to generate, apply, and report accurate SSI data.Funding: NoneDisclosures: None

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