Pelvic Fracture Risk Assessment on Admission

2008 ◽  
Vol 74 (8) ◽  
pp. 761-766 ◽  
Author(s):  
Om P. Sharma ◽  
Michael F. Oswanski ◽  
Jamal Rabbi ◽  
Gregory M. Georgiadis ◽  
Sherry K. Lauer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Trauma Center ◽  
Open Fractures ◽  
Open Book ◽  
Injury Score ◽  
Severity Scores ◽  
Level I ◽  
Initial Blood ◽  
Initial Blood Pressure ◽  
Abbreviated Injury Score

Patients with pelvic fractures (PF) have high incidences of associated injuries and mortality. To identify patients with PF at the highest risk for mortality on admission to a Level I trauma center, investigators analyzed 566 PF in 12,128 patients (1996 to 2005). PF were categorized on arrival as high risk (HR) or low risk (LR) by initial blood pressure, examination, radiographs, and CT. HR PF included open fractures, open-book injuries, PF 4 or greater abbreviated injury score, and hypotension (89 mmHg or less systolic blood pressure); all other cases were categorized as LR PF. Patients with PF had 6 per cent (35 of 566) mortality compared with 3 per cent (300 of 11,529) without PF. Mortality was 24 per cent (25 of 103) in HR PF, including 11 per cent (one of nine) of open fractures, 25 per cent (12 of 49) of open-book injuries, 23 per cent (14 of 62) of 4 or greater abbreviated injury score, and 33 per cent (20 of 60) of hypotensive patients compared with 3 per cent (13 of 454) of LR PF. Compared with LR PF, patients with HR PF were younger (43.5 vs 53.8 years) with higher injury severity scores (28.7 vs 11.9) and longer hospital stays (10.6 vs 7.4 days). PF mortality remains high despite treatment in a Level I trauma center. Trauma mechanism, initial blood pressure, pelvic radiography, and CT can be used to predict a patient's mortality risk.

An Appraisal of Trauma in the Elderly

2007 ◽  
Vol 73 (4) ◽  
pp. 354-358 ◽  
Author(s):  
Om P. Sharma ◽  
Michael F. Oswanski ◽  
Vijay Sharma ◽  
Kathryn Stringfellow ◽  
Shekhar S. Raj
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Adult Survivors ◽  
The Elderly ◽  
Linear Increase ◽  
P Value ◽  
Injury Score ◽  
Lengths Of Stay ◽  
Severity Scores ◽  
Abbreviated Injury Score

To review the trends of trauma in the elderly experienced at our trauma center compared with other Level I trauma centers. This was a retrospective trauma registry analysis (1996–2003) of 2783 blunt trauma in elderly (BTE) and 4568 adult (BTA) patients in a Level 1 trauma center. Falls and motor vehicular crashes were the most common mechanisms noted in 47 per cent and 31 per cent (84% and 13% in BTE, 25% and 42% in BTA). BTE were sicker, with higher Injury Severity Scores (ISS), lengths of stay, and mortality (5% vs 2%, P value < 0.05). ISS was 5.2-fold higher in nonsurvivors to survivors in BTA and 2.4-fold in BTE. Elevation in ISS resulted in higher linear increase in mortality in BTE ( vs BTA) at any ISS level. Mortality in patients with ISS ≥ 25 was 43.5 per cent vs 23.8 per cent. ISS ≥ 50 had 31 per cent adult survivors but no elderly survivors. Among isolated injuries, head trauma in the elderly carried the highest mortality, at 12 per cent (19% in patients with an Abbreviated Injury Score ≥3). Abdominal injuries were the most lethal (18.3% and 41.2% in patients with an Abbreviated Injury Score ≥3) in multiple trauma victims (41% vs 18% in isolated trauma). There was 4.4-fold increased mortality in the presence of thoracic trauma. Combined head, chest, and abdominal trauma carried the worst prognosis. Thirty-four per cent of BTE and 88 per cent of BTA patients were discharged home. Elderly patients need more aggressive therapy, as they are sicker with higher mortality.

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.

Prehospital Extrication Techniques: Neurological Outcomes Associated with the Rapid Extrication Method and the Kendrick Extrication Device

2018 ◽  
Vol 84 (2) ◽  
pp. 248-253
Author(s):  
Adam Misasi ◽  
Jeanette G. Ward ◽  
Fanglong Dong ◽  
Elizabeth Ablah ◽  
Chad Maurer ◽  
...  
Keyword(s):  
Injury Severity ◽  
Motor Vehicle ◽  
Motor Vehicle Crash ◽  
Motor Vehicle Collision ◽  
Injury Score ◽  
Emergency Medical Service Personnel ◽  
Neurological Outcomes ◽  
Vehicle Collision ◽  
Level I ◽  
Abbreviated Injury Score

Most emergency medical service personnel rely on one of two techniques to extricate motor vehicle crash victims; the Rapid Extrication Maneuver (REM) or the Kendrick Extrication Device (KED). The purpose of this study was to compare pre- and postextrication neurological outcomes between these two techniques. A retrospective review was conducted of all adult patients with a vertebral column injury resulting from motor vehicle collision and admitted to a Level I trauma center between January 1, 2003 and December 31, 2010. Standardized pre- and postextrication neurological examinations were reviewed for all patients. More than half of patients (N = 81) were extricated using the KED (53.1%, n = 43) and 46.9 per cent (n = 38) were extricated with the REM. Except for the thoracic Abbreviated Injury Score, no differences between groups emerged related to the Glasgow Coma Scale score, Injury Severity Score or Abbreviated Injury Score. There were no pre- and postextrication changes for motor to all extremities and sensation to all extremities using either method. The results of this study suggest that the REM and the KED are equivalent in protecting the patient from neurologic injury after motor vehicle collision.

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