The Effect of a 6am-9am Dedicated Orthopaedic Trauma Room on Hip Fracture Outcomes in a Community Level II Trauma Center

Nearly 200,000 people die of injury-related causes in the United States each year, and injury is the leading cause of death for all patients aged 1 to 44 years. Approximately 30 million people sustain nonfatal injuries each year, which results in about 29 million emergency department visits and 3 million hospital admissions. Management of severely injured patients, typically defined as having an Injury Severity Score greater than 15 is best managed in a level I or level II trauma center. Any physician who provides care for critically ill patients should have a basic familiarity with the fundamentals of trauma care.

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Cracking Chests without a Scratch: A Review of Emergency Department Thoracotomy Outcomes and Injuries to Providers at a Level II Trauma Center

The American Surgeon ◽

10.1177/000313481708300917 ◽

2017 ◽

Vol 83 (9) ◽

pp. 384-385

Author(s):

Sarah S. Fox ◽

Tasha Martin ◽

Zachary F. Williams ◽

William W. Hope

Keyword(s):

Emergency Department ◽

Trauma Center ◽

Emergency Department Thoracotomy ◽

Level Ii

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Pediatric Trauma Deaths: A Three-Part Analysis from a Nonacademic Trauma Center

The American Surgeon ◽

10.1177/000313480607200311 ◽

2006 ◽

Vol 72 (3) ◽

pp. 249-259

Author(s):

Mary O. Aaland ◽

Thein Hlaing

Keyword(s):

Mortality Rate ◽

Trauma Center ◽

Pediatric Trauma ◽

Trauma System ◽

Time Frame ◽

Level Ii ◽

Liver Injuries ◽

Depth Analysis ◽

Trauma Mortality ◽

Trauma Deaths

A three-part analysis was undertaken to assess pediatric trauma mortality in a nonacademic Level II trauma center at Parkview Hospital in Fort Wayne, Indiana. Part I was a comparison of Parkview trauma registry data collected from 1999 through 2003 with those of pediatric and adult trauma centers in Pennsylvania. The same methodology used in Pennsylvania was used for the initial evaluation of pediatric deaths from trauma in our trauma center. Part II was a formal in-depth analysis of all individual pediatric deaths as well as surgical cases with head, spleen, and liver injuries from the same time frame. Part III proposes a new methodology to calculate a risk-adjusted mortality rate based on the TRISS model for the evaluation of a trauma system. The use of specific mortality and surgical intervention rates was not an accurate reflection of trauma center outcome. The proposed risk-adjusted mortality rate calculation is perhaps an effective outcome measure to assess patient care in a trauma system.

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Does Care at a Trauma Center Affect Geriatric Hip Fracture Patients?

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320911865 ◽

2020 ◽

Vol 11 ◽

pp. 215145932091186

Author(s):

Jordan B. Pasternack ◽

Matthew L. Ciminero ◽

Michael Silver ◽

Joseph Chang ◽

Piyush Gupta ◽

...

Keyword(s):

Hip Fracture ◽

Outcome Measures ◽

Hip Fractures ◽

Complication Rate ◽

Trauma Center ◽

Secondary Outcome ◽

Transfusion Rate ◽

Geriatric Hip Fracture ◽

Level 1 ◽

Level 1 Trauma Center

Introduction: With respect to care setting, there are mixed results in the literature with respect to the role of trauma centers in management of isolated geriatric hip fractures. During a transition from a Level 3 to a Level 1 trauma center, significant protocol changes were implemented that sought to standardize and improve the care of hip fracture patients. The objective of this study was to determine the effects of this transition on the management, efficiency, morbidity, mortality, and discharge of geriatric hip fracture patients. Methods: A retrospective chart review of geriatric hip fractures treated operatively was conducted. Two cohorts were compared: hip fractures in the year prior to (2015) and year following (2017) Level 1 Trauma designation. Primary outcome measures were length of stay (LOS), transfusion rate, complication rate, and mortality rate. Secondary outcome measures were time from emergency department (ED) arrival to medical optimization, time from medical optimization to surgery, time from ED arrival to surgery, and discharge destination. Results: There were no differences in LOS, transfusion rate, or complication rate between the two cohorts. There was a nonsignificant trend toward lower in-hospital mortality after the transition (2.24% vs 0.83%). There were no differences in time from ED arrival to medical optimization, time from medical optimization to surgery, time from ED arrival to surgery, and percentage of patients discharged home between the cohorts. Discussion: Management of operative geriatric hip fractures at our institution has remained consistent following transition to a Level 1 trauma center. There was a trend toward lower mortality after transition, but this difference was not statistically significant. We attribute the variety of findings in the literature with respect to trauma center management of hip fractures to individualized institutional trauma protocols as well as the diverse patient populations these centers serve.

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