The Impact of Introducing a Physical Medicine and Rehabilitation Trauma Consultation Service to an Academic Level 1 Trauma Center

Abstract INTRODUCTION Severe traumatic brain injury (TBI) remains a leading cause of morbidity and mortality. There is a wide variability in treatment paradigm for patients with severe TBI. American College of Surgeons (ACS) level 1 trauma centers have access to 24 h neurosurgical coverage. In this study, we use the National Trauma Database (NTDB) to evaluate if ACS trauma center designation correlates with the management and outcomes of severe TBI in adults. METHODS Adult patients (<65 yr) with a severe isolated nonpenetrating TBI were identified in the NTDB from years 2007 to 2014. ICD-9 procedure codes were used to identify primary treatment approaches: intracranial pressure monitoring and cranial surgery. Multivariate logistic regression was used to determine the impact of ACS designation on procedures and patient outcomes. Patient and injury characteristics were included in the analysis. RESULTS A total of 54 769 TBI patients were identified. Among those, 22 316 (42%) were treated at an ACS level 1 trauma center and 31 835 (58%) were treated elsewhere. Level 1 designated patients had significantly more intracranial pressure (ICP) monitors placed (12.3% vs10.8%; P < .0001) and more cranial surgeries performed (17.7% vs 15.7%; P < .0001). A greater percentage of patients were admitted to the intensive care unit (ICU; 89.9% vs 83.9%; P < .0001) and had a longer hospital stay (16.1 vs 15.2; P < .0001) at ACS level 1 trauma centers. In a regression analysis, patients at level 1 centers were associated with a 14% and 17% increased odds of obtaining a cranial surgery or ICP monitor, respectively. Patients treated at a level 1 center were associated with a 6% decrease in odds of mortality (P = .01). CONCLUSION ACS level 1 designation did correlate with increased rates of neurosurgical intervention and ICU admissions. This translated into patient outcomes as those treated at level 1 facilities were associated with lower rates of mortality.

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Outcomes of Endovascular Management of Acute Thoracic Aorta Emergencies in an Academic Level 1 Trauma Center

Journal of Vascular Surgery ◽

10.1016/j.jvs.2015.08.006 ◽

2015 ◽

Vol 62 (4) ◽

pp. 1090

Author(s):

A.B. Echeverria ◽

B.C. Branco ◽

K.R. Goshima

Keyword(s):

Thoracic Aorta ◽

Trauma Center ◽

Endovascular Management ◽

Academic Level ◽

Level 1 ◽

Level 1 Trauma Center

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(P2-74) Does Implementation of Protocols Improve the Red Area Disposition Time of Emergency Department at a Level-1 Trauma Center?

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11005188 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s160-s160

Author(s):

R. Kumar ◽

K. Shyamla ◽

S. Bhoi ◽

T.P. Sinha ◽

S. Chauhan ◽

...

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Trauma Center ◽

Safety Issues ◽

Ed Visits ◽

Level 1 ◽

The Impact ◽

Level 1 Trauma Center ◽

Final Disposition ◽

Disposition Time

BackgroundAcute care addresses immediate resuscitation and early disposition to definitive care. Delay in final disposition from the emergency department (ED) affects outcomes in terms of morbidity and mortality. An audit was performed to assess the impact of protocols on red area disposition time.MethodsAn audit of red (resuscitation) area disposition time was performed among patients with compromised airway, breathing, and circulation. The red area disposition time was defined as the time from ED arrival to red area disposition. Pre-protocol data from nursing report books were reviewed for ED to operating room (OR), ED to intensive care unit (ICU), and overall disposition time between September 2007 and January 2008. Similar outcomes were documented after implementation of protocols during February to December 2008.ResultsIn the pre-protocol period, 992 red area patients were enrolled out of 10,000 ED visits. Out of which 527 (53.1%) were shifted to the OR and 222 (22.3%) to ICU. The average ED disposition time was 3.5 hours (range 2–5). Similarly, 1797 red area patients were enrolled in the post-protocol period out of 25,928. Of these, 453 (25.2%) patients were shifted to the OR, and 423 (23.7%) were shifted to the ICU. The average ED disposition time was 1.5 hours (range 10 minutes–3 hours).ConclusionsImplementation of protocols improves the red area disposition time of the ED. Auditing is an important tool to address patient safety issues.

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Protocol for Urgent and Emergent Cases at a Large Academic Level 1 Trauma Center

Cureus ◽

10.7759/cureus.3973 ◽

2019 ◽

Cited By ~ 2

Author(s):

Karim Ahmed ◽

Corinna Zygourakis ◽

Sammy Kalb ◽

Zach Pennington ◽

Camilo Molina ◽

...

Keyword(s):

Trauma Center ◽

Academic Level ◽

Level 1 ◽

Level 1 Trauma Center

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The Impact of Introducing a Physical Medicine and Rehabilitation Consultation Service to an Academic Burn Center

Journal of Burn Care & Research ◽

10.1093/jbcr/irz079 ◽

2019 ◽

Vol 40 (5) ◽

pp. 648-651

Author(s):

Lawrence R Robinson ◽

Matthew Godleski ◽

Sarah Rehou ◽

Marc Jeschke

Keyword(s):

Length Of Stay ◽

Acute Care ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Rehabilitation Program ◽

Trauma Patients ◽

Physical Medicine ◽

Consultation Service ◽

Physical Medicine And Rehabilitation ◽

The Impact

Abstract Prior retrospective studies suggest that physical medicine and rehabilitation (PM&R) acute care consultation improves outcome and reduces acute care length of stay (ACLOS) in trauma patients. There have not been prospective studies to evaluate this impact in burn patients. This cohort study compared outcomes before and after the introduction of a PM&R consultation service to the acute burn program, and the inpatient rehabilitation program, at a large academic hospital. The primary outcome measures were length of stay (LOS) in acute care and during subsequent inpatient rehabilitation. For the acute care phase, there were 194 patients in the preconsultation group and 114 who received a consultation. There was no difference in age, Baux score, or LOS in these patients. For the rehabilitation phase, there were 109 patients in the prephysiatrist group and 104 who received PM&R care. The LOS was significantly shorter in the latter group (24 days vs 30 days, P = .002). Functional independence measure (FIM) change, unexpected readmission, and discharge destination were not significantly different. The addition of a burn physiatrist did not influence ACLOS. However, there was a significant reduction in inpatient rehabilitation LOS.

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Successful Implementation of Proactive Rounding by a Rapid Response Team in a Tertiary, Academic, Level 1 Trauma Center Reduces Inpatient Cardiac Arrests and Facilitates Preemptive Transfer to a Higher Level of Care

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2013.07.142 ◽

2013 ◽

Vol 62 (4) ◽

pp. S114 ◽

Cited By ~ 1

Author(s):

F.W. Guirgis ◽

C. Gerdik ◽

R.L. Wears ◽

D.J. Williams ◽

J. Sabato ◽

...

Keyword(s):

Trauma Center ◽

Rapid Response Team ◽

Rapid Response ◽

Level Of Care ◽

Successful Implementation ◽

Academic Level ◽

Response Team ◽

Level 1 ◽

Level 1 Trauma Center

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B-17 The impact of a hospital-based air ambulance program on a level 1 trauma center

AeroMedical Journal ◽

10.1016/s0894-8321(87)80148-1 ◽

1987 ◽

Vol 2 (5) ◽

pp. 36

Author(s):

Kevin Fitzpatrick ◽

Joseph A. Moylan ◽

Gregory Georgiade ◽

Rita Weber

Keyword(s):

Trauma Center ◽

Air Ambulance ◽

Level 1 ◽

The Impact ◽

Level 1 Trauma Center

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Early Prognostication after Traumatic Brain Injury: Specific Validation of the IMPACT Prognostic Calculator in a Level 1 Trauma Center

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1685137 ◽

2019 ◽

Vol 80 (06) ◽

pp. 423-429

Author(s):

Anna Jung ◽

Felix Arlt ◽

Maciej Rosolowski ◽

Jürgen Meixensberger

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Trauma Center ◽

Roc Analysis ◽

Time Frame ◽

Extended Model ◽

Severe Tbi ◽

Level 1 ◽

The Impact ◽

Level 1 Trauma Center

AbstractThe present study evaluated the usefulness of the IMPACT prognostic calculator (IPC) for patients receiving acute neurointensive care at a level 1 trauma center in Germany. A total of 139 patients with traumatic brain injury (TBI) were assessed. One day after trauma, the extended model of the IPC was found to provide the most valid prediction of 6-month mortality/unfavorable outcome. Different time frames within the first day could be determined by analyzing mild, moderate, and severe TBI cohorts. The CORE + CT model at time frame Z2 (<6 h from the point of first documentation) for mild TBI exhibited the highest values in the receiver operating characteristic (ROC) analysis (area under the curve [AUC], 0.9; sensitivity, 1; specificity, 0.7). For patients with moderate head injury at time frame Z2/3 (<6–12 h from point of first documentation), the extended model fit best. For patients with severe TBI, the extended model at time frame Z6 (48–72 h from point of first documentation) best predicted 6-month mortality and unfavorable outcome (ROC analysis: AUC, 0.542/0.445; sensitivity, 0.167/0.364; specificity, 0.575/0.444). Center-specific validation demonstrated the validity of the IPC in the early phase after TBI. These findings support the usefulness of the IPC for predicting the prognosis of patients with TBI. However, further prospective validation using a larger TBI cohort is needed.

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