scholarly journals 316. Application of New Consensus Definition Identifies High Numbers of Fracture Related Infections with Negative Cultures

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S230-S230
Author(s):  
Kaitlyn E Weinert-Stein ◽  
Julia C Slater ◽  
Henry C Sagi ◽  
Margaret Powers-Fletcher ◽  
Federico Palacio
Keyword(s):  
Diagnostic Criteria ◽  
Trauma Surgery ◽  
Diagnostic Error ◽  
Consensus Definition ◽  
Orthopedic Surgeon ◽  
Common Location ◽  
Standardize Laboratory ◽  
Sizable Proportion ◽  
Level I ◽  
Culture Positive

Abstract Background Fracture related infection (FRI) is a severe complication in trauma surgery but defining the full impact of these infections has been challenging with the lack of clear diagnostic criteria. This is particularly problematic for culture-negative FRI (CNFRI), which lack pathogen identification to guide antimicrobial therapy. However, new consensus definition and criteria for the diagnosis of FRI (Table) may help reduce the risk of diagnostic error. The purpose of this study was to determine the proportion and clinical characteristics of CNFRI cases at a level I trauma hospital using the new diagnostic criteria. Methods Laboratory reports were used to identify all patients with at least one specimen submitted for microbiology culture by an orthopedic surgeon at our trauma I level hospital in Cincinnati, Ohio during a three-year study period. This cohort was refined by an electronic medical record (EMR) review to select patients that met the diagnostic criteria for suspected/confirmed FRI. The specimen details and results of the cultures were recorded for the first orthopedic surgeon collection for each suspected FRI case. Clinical data, including fracture characteristics, surgical treatment, antibiotic utilization, and patient outcomes were also extracted from the EMR for each case. Results A total of 246 patients were identified with at least one culture specimen; 35.8% (n = 88) of these were deemed suspected/confirmed FRI based on consensus guidelines. The cultures for the first orthopedic surgery collection on these FRI were negative for 35% (n = 31). The most common location for CNFRI were proximal lower extremity fractures (52%), a distribution different from that of culture positive (Figure). Culture positive FRI were predominated by Staphylococcus aureus (39%) followed by gram negative rods (23%). Conclusion This retrospective cohort study identified a sizable proportion of CNFRI at our trauma center using the recently published consensus definition. While further analysis is necessary to determine the exact impact of these new criteria, this suggests that clearer definitions may facilitate improved recognition of CNFRI. Because of the relatively high rates of CNFRI, efforts to standardize laboratory diagnostic processes and case management will be required. Disclosures Henry C. Sagi, MD, FACS, Conexxions (Board Member)GLW trauma (Consultant)GLW trauma (Shareholder)Stryker (Consultant)

Military Orthopedic Surgeons Are Not Just Traumatologists

2021 ◽  
Author(s):  
Camille Choufani ◽  
Olivier Barbier ◽  
Laurent Mathieu ◽  
Nicolas de L’Escalopier
Keyword(s):  
Orthopedic Surgery ◽  
Descriptive Analysis ◽  
Trauma Surgery ◽  
Armed Forces ◽  
Trauma Surgeon ◽  
Reconstruction Surgery ◽  
Orthopedic Surgeon ◽  
Orthopedic Surgeons ◽  
French Military ◽  
Military Patients

ABSTRACT Introduction Each French military orthopedic surgeon is both an orthopedic surgeon and a trauma surgeon. Their mission is to support the armed forces in France and on deployment. The aim of this study was to describe the type of orthopedic surgery performed for the armed forces in France. Our hypothesis was that scheduled surgery was more common than trauma surgery. Methods We conducted a retrospective descriptive analysis of the surgical activity for military patients in the orthopedic surgery departments of the four French military platform hospitals. All surgical procedures performed during 2020 were collected. We divided the procedures into the following categories: heavy and light trauma, posttraumatic reconstruction surgery, sports surgery, degenerative surgery, and specialized surgery. Our primary endpoint was the number of procedures performed per category. Results A total of 827 individuals underwent surgery, 91 of whom (11%) were medical returnees from deployment. The surgeries performed for the remaining 736 soldiers present in metropolitan France (89%) consisted of 181 (24.6%) trauma procedures (of which 86.7% were light trauma) and 555 (75.4%) scheduled surgery procedures (of which 60.8% were sports surgery). Among the medical returnees, there were 71 traumatology procedures (78%, of which 87.3% were light traumatology) and 20 procedures corresponding to surgery usually carried out on a scheduled basis (22%, of which 95% were sports surgery). Conclusion Military orthopedic surgeons are not just traumatologists; their activity for the armed forces is varied and mainly consists of so-called programmed interventions.

scholarly journals Novel coronavirus and trauma surgery: successful infection control from a level I trauma centre

2020 ◽  
Vol 46 (4) ◽  
pp. 737-741
Author(s):  
Péter Jávor ◽  
Endre Varga ◽  
Károly Fekete ◽  
Ferenc Tóth ◽  
Petra Hartmann
Keyword(s):  
Infection Control ◽  
Trauma Surgery ◽  
Trauma Centre ◽  
Successful Infection ◽  
Level I ◽  
Novel Coronavirus

WED 094 Diagnostic error rates in diagnosing idiopathic intracranial hypertension

2018 ◽  
Vol 89 (10) ◽  
pp. A10.1-A10
Author(s):  
Scotton Sangeeta ◽  
Liczkowski Anthony ◽  
Mollan Susan P ◽  
Sinclair Alexandra J
Keyword(s):  
Intracranial Hypertension ◽  
Diagnostic Criteria ◽  
Lumbar Puncture ◽  
Error Rate ◽  
Idiopathic Intracranial Hypertension ◽  
Final Diagnosis ◽  
Diagnostic Error ◽  
Error Rates ◽  
Tertiary Centre ◽  
Error Taxonomy

ObjectiveTo quantify the rate of diagnostic error amongst patients with IIH. Additionally to identify factors contributing to diagnostic error.MethodsSequential patients referred with a diagnosis of IIH to the Birmingham tertiary neuro-ophthalmology IIH clinic were prospectively included (October 2013- February 2017) A diagnostic error taxonomy tool was applied to cases referred as ‘definite’ or ‘possible’ IIH. Discrepancy between referred and final diagnosis were recorded. Results212 patients were referred, (96.2% female), 138/212 (65%) with definite IIH and 74/212 (35%) with possible IIH. Of those diagnosed with definite IIH 25% were not IIH and out of those diagnosed with possible IIH 57% were not IIH. Reasons for diagnostic error included incorrectly identifying papilloedema where in fact pseudopapilloedema existed and diagnosing IIH following an isolated lumbar puncture (LP) pressure >25 cmCSF (but in the absence of other diagnostic criteria for IIH). Misdiagnosis lead to 43% receiving unnecessary acetazolamide (or other diuretics) and 14% having multiple LPs.ConclusionsWe noted a high diagnostic error rate amongst IIH patients referred to a tertiary centre for ongoing management. Where there is doubt about the presence of true papilloedema early specialist review may reduce unnecessary treatment and LP’s.

How often is multiple sclerosis mistaken for a psychiatric disorder?

1988 ◽  
Vol 18 (3) ◽  
pp. 733-736 ◽  
Author(s):  
K. Skegg ◽  
P. A. Corwin ◽  
D. C. G. Skegg
Keyword(s):  
Multiple Sclerosis ◽  
Psychiatric Disorder ◽  
Diagnostic Criteria ◽  
Diagnostic Error ◽  
Physical Symptoms ◽  
The Other ◽  
Psychiatric Diagnoses ◽  
Psychiatric Disturbance ◽  
Psychiatric Assessment ◽  
Early Symptoms

SynopsisIn a defined population of 112000, an attempt was made to discover every patient with multiple sclerosis. Using strict diagnostic criteria, 91 patients were identified. A search of psychiatric records for the same population revealed that 15 (16%) of these patients were referred to psychiatrists between the onset of their symptoms and the diagnosis of multiple sclerosis. Ten (11 %) were seen with symptoms attributable to multiple sclerosis. These symptoms were recognized as neurological in only two cases, while the other eight patients received a variety of psychiatric diagnoses.Possible reasons for diagnostic error included the subjective nature of many early symptoms, histrionic behaviour, and psychiatric disturbance which drew attention away from physical symptoms. The results underline the caution needed when patients with physical symptoms are referred for psychiatric assessment.

scholarly journals Are trauma research programs in academic and non-academic centers measured by equal standards? A survey of 137 level I trauma centers in the United States

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Robert M. Madayag ◽  
Erica Sercy ◽  
Gina M. Berg ◽  
Kaysie L. Banton ◽  
Matthew Carrick ◽  
...  
Keyword(s):  
General Surgery ◽  
Trauma Surgery ◽  
The United States ◽  
Full Time ◽  
Trauma Centers ◽  
Patient Volume ◽  
Non Profit ◽  
Trauma Research ◽  
Research Programs ◽  
Level I

Abstract Background American College of Surgeons level I trauma center verification requires an active research program. This study investigated differences in the research programs of academic and non-academic trauma centers. Methods A 28-question survey was administered to ACS-verified level I trauma centers in 11/12/2020–1/7/2021. The survey included questions on center characteristics (patient volume, staff size), peer-reviewed publications, staff and resources dedicated to research, and funding sources. Results The survey had a 31% response rate: 137 invitations were successfully delivered via email, and 42 centers completed at least part of the survey. Responding level I trauma centers included 36 (86%) self-identified academic and 6 (14%) self-identified non-academic centers. Academic and non-academic centers reported similar annual trauma patient volume (2190 vs. 2450), number of beds (545 vs. 440), and years of ACS verification (20 vs. 14), respectively. Academic centers had more full-time trauma surgeons (median 8 vs 6 for non-academic centers) and general surgery residents (median 30 vs 7) than non-academic centers. Non-academic centers more frequently ranked trauma surgery (100% vs. 36% academic), basic science (50% vs. 6% academic), neurosurgery (50% vs. 14% academic), and nursing (33% vs. 0% academic) in the top three types of studies conducted. Academic centers were more likely to report non-profit status (86% academic, 50% non-academic) and utilized research funding from external governmental or non-profit grants more often (76% vs 17%). Conclusions Survey results suggest that academic centers may have more physician, resident, and financial resources available to dedicate to trauma research, which may make fulfillment of ACS level I research requirements easier. Structural and institutional changes at non-academic centers, such as expansion of general surgery resident programs and increased pursuit of external grant funding, may help ensure that academic and non-academic sites are equally equipped to fulfill ACS research criteria.

scholarly journals Comprehensive Review of Neurophysiologic Basis and Diagnostic Interventions in Managing Chronic Spinal Pain

2009 ◽  
Vol 4;12 (4;7) ◽  
pp. E71-E121
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Diagnostic Criteria ◽  
Sacroiliac Joint ◽  
Facet Joint ◽  
Spinal Pain ◽  
Level Of Evidence ◽  
Nerve Blocks ◽  
Interventional Techniques ◽  
Level Ii ◽  
Level I ◽  
Chronic Spinal Pain

Background: Understanding the neurophysiological basis of chronic spinal pain and diagnostic interventional techniques is crucial in the proper diagnosis and management of chronic spinal pain.Central to the understanding of the structural basis of chronic spinal pain is the provision of physical diagnosis and validation of patient symptomatology. It has been shown that history, physical examination, imaging, and nerve conduction studies in non-radicular or discogenic pain are unable to diagnose the precise cause in 85% of the patients. In contrast, controlled diagnostic blocks have been shown to determine the cause of pain in as many as 85% of the patients. Objective: To provide evidence-based clinical practice guidelines for diagnostic interventional techniques. Design: Best evidence synthesis. Methods: Strength of evidence was assessed by the U.S. Preventive Services Task Force (USPSTF) criteria utilizing 5 levels of evidence ranging from Level I to III with 3 subcategories in Level II. Diagnostic Criteria: Diagnostic criteria established by systematic reviews were utilized with controlled diagnostic blocks. Diagnostic criteria included at least 80% pain relief with controlled local anesthetic blocks with the ability to perform multiple maneuvers which were painful prior to the diagnostic blocks for facet joint and sacroiliac joint blocks, whereas for provocation discography, the criteria included concordant pain upon stimulation of the target disc with 2 adjacent discs producing no pain at all. Results: The indicated level of evidence for diagnostic lumbar, cervical, and thoracic facet joint nerve blocks is Level I or II-1. The indicated evidence is Level II-2 for lumbar and cervical discography, whereas it is Level II-3 for thoracic provocation discography. The evidence for diagnostic sacroiliac joint nerve blocks is Level II-2. Level of evidence for selective nerve root blocks for diagnostic purposes is Level II-3. Limitations: Limitations of this guideline preparation include a continued paucity of literature and conflicts in preparation of systematic reviews and guidelines. Conclusion: These guidelines include the evaluation of evidence for diagnostic interventional procedures in managing chronic spinal pain and recommendations. However, these guidelines do not constitute inflexible treatment recommendations. These guidelines also do not represent a “standard of care.” Key words: Diagnostic interventional techniques, chronic spinal pain, facet joint interventions, epidural procedures, provocation discography, sacroiliac joint blocks, post lumbar surgery syndrome, spinal stenosis, provocation discography

Assessment of Psychiatric Symptoms at a Level I Trauma Center Surgery Follow-up Clinic: A Preliminary Report

2013 ◽  
Vol 79 (5) ◽  
pp. 492-494 ◽  
Author(s):  
Erich J. Conrad ◽  
Tonya C. Hansel ◽  
Nicholas G. Pejic ◽  
Joseph Constans
Keyword(s):  
Community Violence ◽  
Psychiatric Symptoms ◽  
Trauma Surgery ◽  
Trauma Centers ◽  
Psychiatric Consultation ◽  
Surgical Services ◽  
Patient Health ◽  
Disorder Identification ◽  
Level I

At Level I trauma centers, psychiatric consultation is readily available to inpatient surgical services. This study sought to characterize the psychiatric symptoms present in the surgical follow-up clinic. Patients aged 18 years and older were assessed over one month for symptoms of posttraumatic stress disorder (PTSD) with the Short PTSD Rating Interview (SPRINT), depression with the Patient Health Questionnaire (PHQ-9), alcohol abuse with the Alcohol Use Disorder Identification Test (AUDIT), and the presence of violence using the MacArthur Community Violence Instrument (MCVIa [victimization] MCVIb [perpetration]). Twenty-five individuals participated. Using the SPRINT, 13 (52.0%) met the cutoff for PTSD. For PHQ-9 depression, 11 (44%) were in the moderate to severe range. For AUDIT, five (20.0%) likely had an alcohol problem. Using the MCVI, 15 (60.0%) reported victimization and 12 (48.0%) reported perpetration. Elevated levels of psychiatric symptoms were found in the trauma surgery follow-up clinic. Psychiatric care embedded in this setting may be warranted.

Wiser with Age? Increased Per-Surgeon Elderly Patient Volume is Associated with Lower Postinjury Complications

2018 ◽  
Vol 84 (6) ◽  
pp. 1027-1032 ◽  
Author(s):  
Elizabeth Warnack ◽  
Joshua Simon ◽  
Quoc Dang ◽  
Joseph Catino ◽  
Marko Bukur
Keyword(s):  
Elderly Patient ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Trauma Surgery ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Patient Volume ◽  
Clinical Complications ◽  
Volume Group ◽  
Level I

We hypothesize that higher elderly patient volume per trauma surgeon is associated with fewer clinical complications. This is a retrospective cohort study which included elderly patients admitted to trauma surgery service within a five-year period, from 2009 to 2013, at two Level I trauma centers in Florida. Trauma surgeons were stratified into three groups depending on patient volume. Primary outcomes were postinjury complications and in-hospital mortality, and secondary outcomes were hospital length of stay (LOS), intensive care unit LOS, and ventilator days. A total of 2379 elderly patients were included in this study. Elderly patient volume per surgeon did not significantly differ based on years in practice after fellowship (P = 0.88). The higher volume group had lower incidence of complications (15% complication rate, P = 0.02), compared with the average and low-volume group (18.1 and 21%, respectively), and had significantly lower rates of acute respiratory failure (P = 0.04) and acute renal failure (P = 0.004). In-hospital mortality was not affected by volume. Hospital LOS was decreased in the higher volume group (mean LOS 7.4 days, P < 0.001). There appears to be a relationship between elderly patient volume and outcome, independent of surgeon years of experience.

scholarly journals Effects of the first lockdown of the COVID-19 pandemic on the trauma surgery clinic of a German Level I Trauma Center

2021 ◽  
Author(s):  
Dirk Wähnert ◽  
Christian Colcuc ◽  
Georg Beyer ◽  
Markus Kache ◽  
Adrian Komadinic ◽  
...  
Keyword(s):  
Trauma Center ◽  
Operating Time ◽  
Trauma Surgery ◽  
Working Hours ◽  
Intermediate Care ◽  
Trauma Centers ◽  
Level I ◽  
Hospital Days ◽  
Second Wave ◽  
Pandemic Wave

Abstract Purpose The effects of the first pandemic wave on a German Level I Trauma Center should be evaluated to find ways to redistribute structural, personnel, and financial resources in a targeted manner in preparation for the assumed second pandemic wave. Methods We examined the repercussions of the first wave of the pandemic on the trauma surgery clinic of a Level I Trauma Center and compared the data with data from 58 other trauma clinics. The results could aid in orientating the distribution of structural, financial, and human resources (HR) during the second wave. The period between March 16 and April 30, 2020 was compared with the data over the same period during 2019. Information was collected from the HR department, central revenue management, and internal documentation. Results The proportion of trauma surgical patients in the emergency room decreased by 22%. The number of polytrauma cases increased by 53%. Hospital days of trauma surgery patients in the intensive and intermediate care wards increased by 90%. The number of operations decreased by 15%, although the operating time outside of normal working hours increased by 44%. Clinics with more than 600 beds recorded a decrease in cases and emergencies by 8 and 9%, respectively, while the Trauma Center showed an increase of 19 and 12%. The results reflect the importance of level I trauma centers in the lockdown phase. Conclusion To reduce the risk of an increased burden on the healthcare infrastructure, it suggests the care of trauma and COVID-19 patients should be separated locally, when possible.

scholarly journals Intraoperative vasopressor use during emergency surgery on injured meth users

2020 ◽  
Vol 5 (1) ◽  
pp. e000553
Author(s):  
Alexandra Marie Edwards ◽  
Eric Gregory Johnson ◽  
Andrew C. Bernard
Keyword(s):  
Intraoperative Complications ◽  
Trauma Surgery ◽  
Hemodynamic Instability ◽  
Urine Drug Screen ◽  
Cardiac Events ◽  
Level Of Evidence ◽  
Level I ◽  
Anesthetic Complications ◽  
Vasopressor Use ◽  
Emergent Surgery

BackgroundMethamphetamine is a growing drug of abuse in America. Patients with recent methamphetamine use pose potential complications to general anesthesia due to changes in hemodynamics and arrhythmias. Limited data exists on the incidence of intraoperative complications on methamphetamine-intoxicated patients requiring urgent or emergent trauma surgery. This study aims to describe intraoperative complications observed in methamphetamine and amphetamine-intoxicated patients requiring emergent surgery.MethodsUsing the Trauma Registry at our ACS-verified level I trauma center, we completed a single-center, descriptive, retrospective cohort review between July 1, 2012 and June 30, 2016, of adult patients requiring emergent surgery with a positive urine-drug screen for methamphetamines or amphetamines. The objective was to evaluate vasopressor utilization during surgical operation.ResultsA total of 92 patients were identified with a positive UDS for amphetamine and/or methamphetamine who went to the operating room within 24 hours of admission. Thirty-two (34%) patients received one or more (≥1) doses of vasopressor, while 60 patients (66%) received no vasopressor. Changes in mean arterial pressure (MAP) were noted in 64%, while only 3% experienced an EKG change. A binomial logistic regression showed age, base deficit and change in MAP to be predictive of vasopressor use (p<0.002). No intraoperative cardiac events or anesthetic complications were seen.DiscussionHemodynamic instability in the amphetamine and methamphetamine-intoxicated population may be more directly related to degree of resuscitation required, than the presence of a positive UDS.Level of evidenceIV

Sign in / Sign up

Export Citation Format

Share Document