Perineal Injuries at a Large Urban Trauma Center: Injury Patterns and Outcomes

2009 ◽  
Vol 75 (4) ◽  
pp. 317-320 ◽  
Author(s):  
Patrizio Petrone ◽  
Kenji Inaba ◽  
Nir Wasserberg ◽  
Pedro G. R. Teixeira ◽  
Grant Sarkisyan ◽  
...  
Keyword(s):  
Los Angeles ◽  
Injury Severity ◽  
Medical Center ◽  
Vital Signs ◽  
University Of Southern California ◽  
Associated Injuries ◽  
Survival Group ◽  
Revised Trauma Score ◽  
Perineal Injuries ◽  
Trauma Score

The purpose of this study was to describe the characteristics of this unique patient population, their clinical presentations, and outcomes. The Los Angeles County and University of Southern California Medical Center Trauma Registry was used to retrospectively identify patients who sustained perineal injuries. Information included gender, age, vital signs, trauma scores, mechanisms of injury, studies performed, surgeries performed, and outcomes. Pediatric patients and injuries related to obstetric trauma were not included. Sixty-nine patients were identified between February 1, 1992 and October 31, 2005. One patient died on arrival; 85 per cent (58 of 68) were males, mean age was 30 ± 12 years, and there was a penetrating mechanism in 56 per cent. Vital signs on admission were systolic blood pressure 119 ± 33 mmHg, heart rate 94 ± 27 beats/minute, and respiratory rate 20 ± 6 breaths/min. Glasgow Coma Scale (GCS) was 13 ± 3, Revised Trauma Score (RTS) was 7.2 ± 1.5, and Injury Severity Score (ISS) was 11 ± 12. CT scan was obtained for 23 (33%) patients. Lower extremity fractures were 35 per cent and pelvic fractures 32 per cent. The most common surgery was debridement and drainage, diversion with colostomy in five patients (7%). Overall mortality was 10 per cent. Mortality group mean scores were: GCS, 6; RTS, 5.74; and ISS, 34. The survival group mean scores were: GCS, 14; RTS, 7.7; and ISS, 8. There was a statistically significant association between mortality and GCS, RTS, and ISS scores ( P < 0.001). Most patients with perineal injuries (93%) can be managed without colostomy. Associated injuries are not uncommon, particularly bony fractures. Mortality is mostly the result of exsanguination related to associated injuries.

Assessing Blood Administering Practices

1999 ◽  
Vol 123 (7) ◽  
pp. 595-598 ◽  
Author(s):  
Ira A. Shulman ◽  
Sunita Saxena ◽  
Lois Ramer
Keyword(s):  
Health Care ◽  
Los Angeles ◽  
Los Angeles County ◽  
Medical Center ◽  
Health Care Financing ◽  
Vital Signs ◽  
Data Driven ◽  
Blood Component ◽  
University Of Southern California ◽  
Health Care Financing Administration

Abstract The risk that a red blood cell unit will be associated with an ABO-incompatible transfusion is currently slightly greater than the aggregate risk of acquiring human immunodeficiency virus, human T-cell lymphotropic virus, hepatitis B virus, or hepatitis C virus by transfusion. Since the most common cause for ABO-incompatible transfusion is the failure of transfusionists to properly identify a patient or a blood component before a transfusion, transfusion services are encouraged to evaluate and monitor the processes of dispensing and administering blood. In addition, a proposal of the Health Care Financing Administration of the Department of Health and Human Services would require hospitals to use a data-driven quality assessment and performance improvement program that evaluates the dispensing and administering of blood and that ensures that each blood product and each intended recipient is positively identified before transfusion. The Los Angeles County+University of Southern California Medical Center assesses the blood dispensing and administering process as proposed by the Health Care Financing Administration. During the fourth quarter of 1997, 85 blood transfusions were assessed for compliance with the Los Angeles County+University of Southern California Medical Center policies and procedures: 55 transfusion episodes had no variance from institutional protocol and 30 had one or more variances. Of the transfusions with at least one variance, 16 had one or more variances involving the identification of the patient, the component, or the paperwork. The remaining 14 transfusions had one or more variances involving other criteria (nonidentification items). The most frequent variance was the failure to document vital signs during the first 15 minutes after a transfusion was started or after 50 mL of a component had been transfused. No variances in patient or blood component identification were noted in nursing units whose staff routinely performed self-assessment of blood administering practices. Based on these findings, a corrective action plan was implemented. Follow-up assessments (n = 63) were conducted after 3 months (during the second quarter of 1998). The compliance with the pretransfusion identification protocol improved from 81% to 95%. The most common reason for noncompliance continued to be a lack of checking vital signs. This report demonstrates the value of using a data-driven program that assesses blood administering practices.

scholarly journals Validation of the Pediatric Physiological and Anatomical Triage Score in Pediatric Patients with Burn Injuries

2019 ◽  
Vol 34 (s1) ◽  
pp. s61-s61 ◽  
Author(s):  
Chiaki Toida ◽  
Takashi Muguruma ◽  
Ichiro Takeuchi ◽  
Naoto Morimura
Keyword(s):  
Pediatric Patients ◽  
Injury Severity ◽  
Characteristic Curve ◽  
Vital Signs ◽  
Burn Injuries ◽  
Priority Ranking ◽  
Life Saving ◽  
Revised Trauma Score ◽  
Trauma Score ◽  
Accuracy Of Prediction

Introduction:Triaging plays an important role in providing suitable care to the largest number of casualties in a disaster setting. We developed the Pediatric Physiological and Anatomical Triage score (PPATS) as a new secondary triage method.Aim:This study was performed to validate the accuracy of the PPATS in pediatric patients with burn injuries.Methods:A retrospective review of pediatric patients with burn injuries younger than 15 years old registered in the Japan Trauma Databank from 2004 to 2016 was conducted. The PPATS, which was assigned scores from 0 to 22, was calculated based on vital signs, anatomical abnormalities, and need for life-saving intervention. The PPATS categorized the patients by their priority and defined the intensive care unit (ICU)-indicated patients as those with PPARSs more than 6. This study compared the accuracy of prediction of ICU-indicated patients between the PPATS and Triage Revised Trauma Score (TRTS).Results:Among 87 pediatric patients, 62 (71%) were admitted to the ICU. The median age was 3 years (interquartile range: 1 to 9 years old). The sensitivity and specificity of the PPATS were 74% and 36%, respectively. The area under the receiver-operating characteristic curve was not different between the PPTAS [0.51 (95% confidence interval: -0.51–1.48) and the TRTS [0.51 (-1.17–1.62), p=0.57]. Regression analysis showed a significant association between the PPATS and the Injury Severity Score (ISS) (r2=0.39, p<0.01). On the other hand, there is no association between the TRTS and the ISS (r2=0.00, p=0.79).Discussion:The accuracy of the PPATS was not superior to that of current secondary-triage methods. However, the PPATS had the advantage of objectively determining the triage priority ranking based on the severity of the pediatric patients with burn injuries.

Validation of the Pediatric Physiological and Anatomical Triage Score in Injured Pediatric Patients

2019 ◽  
Vol 34 (04) ◽  
pp. 363-369
Author(s):  
Takashi Muguruma ◽  
Chiaki Toida ◽  
Shintaro Furugori ◽  
Takeru Abe ◽  
Ichiro Takeuchi
Keyword(s):  
Pediatric Patients ◽  
Injury Severity ◽  
Vital Signs ◽  
Data Bank ◽  
Medical Treatments ◽  
Priority Ranking ◽  
Life Saving ◽  
Revised Trauma Score ◽  
Trauma Score ◽  
Japan Trauma Data Bank

AbstractIntroduction:Triaging plays an important role in providing suitable care to a large number of casualties in a disaster setting. A Pediatric Physiological and Anatomical Triage Score (PPATS) was developed as a new secondary triage method. This study aimed to validate the accuracy of the PPATS in identifying injured pediatric patients who are admitted at a high frequency and require immediate treatment in a disaster setting. The PPATS method was also compared with the current triage methods, such as the Triage Revised Trauma Score (TRTS).Methods:A retrospective review of pediatric patients aged ≤15 years, registered in the Japan Trauma Data Bank (JTDB) from 2012 through 2016, was conducted and PPATS was performed. The PPATS method graded patients from zero to 22, and was calculated based on vital signs, anatomical abnormalities, and the need for life-saving interventions. It categorized patients based on their priority, and the intensive care unit (ICU)-indicated patients were assigned a PPATS ≥six. The accuracy of PPATS and TRTS in predicting the outcome of ICU-indicated patients was compared.Results:Of 2,005 pediatric patients, 1,002 (50%) were admitted to the ICU. The median age of the patients was nine years (interquartile range [IQR]: 6-13 years). The sensitivity and specificity of PPATS were 78.6% and 43.7%, respectively. The area under the receiver-operating characteristic (ROC) curve (AUC) was larger for PPATS (0.61; 95% confidence interval [CI], 0.59-0.63) than for TRTS (0.57; 95% CI, 0.56-0.59; P &lt;.01). Regression analysis showed a significant correlation between PPATS and the Injury Severity Score (ISS; r2 = 0.353; P &lt;.001), predicted survival rate (r2 = 0.396; P &lt;.001), and duration of hospital stay (r2 = 0.252; P &lt;.001).Conclusion:The accuracy of PPATS for injured pediatric patients was superior to that of current secondary triage methods. The PPATS method is useful not only for identifying high-priority patients, but also for determining the priority ranking for medical treatments and evacuation.

Maintaining Low Transfusion and Angioembolization Rates in the Age of Nonoperative Management of Pediatric Blunt Splenic Injury

2014 ◽  
Vol 80 (11) ◽  
pp. 1159-1163 ◽  
Author(s):  
Vincent P. Duron ◽  
Kristopher M. Day ◽  
Shaun A. Steigman ◽  
Jeremy T. Aidlen ◽  
Francois I. Luks
Keyword(s):  
Blood Transfusion ◽  
Injury Severity ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Vital Signs ◽  
Transfusion Rate ◽  
Blunt Splenic Injury ◽  
Pediatric Hospitals ◽  
Revised Trauma Score ◽  
Trauma Score

Nonoperative management of hemodynamically stable blunt splenic injury (BSI) is the gold standard in children. Recent studies from nonpediatric surgery-specialized trauma centers have demonstrated a rise in transfusion and angioembolization associated with decreased splenectomy rates. We investigate the rate of splenectomy and nonsurgical interventions (angioembolization, blood transfusion) for BSI in a pediatric surgery-specialized trauma center. We conducted a retrospective review of children (0 to 18 years) treated between September 2001 and September 2011 at a children's hospital. Analyzed data included presenting vital signs, nadir hemoglobin, splenic injury grade, Revised Trauma Score, and Injury Severity Score (ISS). Measured outcomes included transfusion, angioembolization, and splenectomy rates. The study period was divided into three time periods to identify possible trends and compared with national averages. There were 180 patients, 91 with multiple injuries (50.6%) and 89 (49.4%) with isolated BSI. Seventy-six per cent of patients were male, average age was 12.8 years, and average ISS was 14.7. The overall splenectomy rate was 1.7 per cent (1.1% for isolated splenic injury). Our angioembolization rate was 0.6 per cent compared with 7.4 to 16 per cent nationally. Our transfusion rate was 14.4 per cent overall and 5.6 per cent for isolated splenic injury compared with 9.5 to 24.9 per cent nationally. Intervention rates remained unchanged over the study period. Splenectomy rates have remained low at our institution without an increase in angioembolization or transfusion. Children with splenic injuries treated at dedicated pediatric hospitals can be successfully managed nonoperatively without angioembolization or blood transfusion.

Development of neurosurgery in Southern California and the Los Angeles County/University of Southern California Medical Center

1993 ◽  
Vol 79 (1) ◽  
pp. 145-148
Author(s):  
John H. Schneider ◽  
Martin H. Weiss ◽  
William T. Couldwell
Keyword(s):  
Los Angeles ◽  
Los Angeles County ◽  
Southern California ◽  
Medical Center ◽  
University Of Southern California ◽  
Content Type ◽  
School Of Medicine ◽  
Integral Role ◽  
Southern California School ◽  
The University

✓ The Los Angeles County General Hospital has played an integral role in the development of medicine and neurosurgery in Southern California. From its fledgling beginnings, the University of Southern California School of Medicine has been closely affiliated with the hospital, providing the predominant source of clinicians to care for and to utilize as a teaching resource the immense and varied patient population it serves.

scholarly journals Desempenho dos ajustes do Trauma and Injury Severity Score (TRISS): revisão integrativa

2015 ◽  
Vol 49 (spe) ◽  
pp. 138-146 ◽  
Author(s):  
Cristiane de Alencar Domingues ◽  
Lilia de Souza Nogueira ◽  
Cristina Helena Costanti Settervall ◽  
Regina Marcia Cardoso de Sousa
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Revised Trauma Score ◽  
Trauma Score ◽  
Trauma And Injury

RESUMO Objetivo identificar estudos que realizaram ajustes na equação do Trauma and InjurySeverity Score (TRISS) e compararam a capacidade discriminatória da equação modificada com a original. Método Revisão integrativa de pesquisas publicadas entre 1990 e 2014 nas bases de dados LILACS, MEDLINE, PubMed e SciELO utilizando-se a palavra TRISS. Resultados foram incluídos 32 estudos na revisão. Dos 67 ajustes de equações do TRISS identificados, 35 (52,2%) resultaram em melhora na acurácia do índice para predizer a probabilidade de sobrevida de vítimas de trauma. Ajustes dos coeficientes do TRISS à população de estudo foram frequentes, mas nem sempre melhoraram a capacidade preditiva dos modelos analisados. A substituição de variáveis fisiológicas do Revised Trauma Score (RTS) e modificações do Injury Severity Score (ISS) na equação original tiveram desempenho variado. A mudança na forma de inclusão da idade na equação, assim como a inserção do gênero, comorbidades e mecanismo do trauma apresentaram tendência de melhora do desempenho do TRISS. Conclusão Diferentes propostas de ajustes no TRISS foram identificadas nesta revisão e indicaram, principalmente, fragilidades do RTS no modelo original e necessidade de alteração da forma de inclusão da idade na equação para melhora da capacidade preditiva do índice.

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