Living on a Prayer: Religious Affiliation and Trauma Outcomes

2012 ◽  
Vol 78 (1) ◽  
pp. 66-68 ◽  
Author(s):  
Amal Khoury ◽  
Tolulope A. Oyetunji ◽  
Oluwaseyi Bolorunduro ◽  
Leia Harbour ◽  
Edward E. Cornwell ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Length Of Stay ◽  
Injury Severity ◽  
Religious Affiliation ◽  
Length Of Hospital Stay ◽  
Bivariate Analysis ◽  
Trauma Outcomes ◽  
All Cause Mortality ◽  
Urban Level ◽  
Level I

Research has shown that religious affiliation is associated with reduced all cause mortality. The aim of this study was to determine if religious affiliation predicts trauma-specific mortality and length of stay. Patients admitted to our urban Level I trauma center in 2008 were examined; the main study categorization was based on endorsement of a specific religious affiliation during a standard intake procedure. Bivariate and multivariate analysis was performed with in-hospital mortality and length of stay as the outcomes of interest, adjusting for demographic and injury severity characteristics. A total of 2303 patients were included in the study. Forty-six per cent endorsed a religious affiliation. Patients with a religious affiliation were more likely to be female, Hispanic, and older than those who reported no affiliation ( P < 0.001). There was no difference in length of hospital stay. On bivariate analysis those without religious affiliation were more likely to die ( P = 0.01), but this difference disappeared after adjusting for covariates. Although we could not identify a statistical association between religious affiliation and mortality on multivariate analysis, there was an association with injury severity suggesting religious patients were less severely injured.

Early FAST Examinations during Resuscitation May Compromise Trauma Outcomes

2018 ◽  
Vol 84 (10) ◽  
pp. 1705-1709
Author(s):  
John Kleinman ◽  
Kenji Inaba ◽  
Emily Pott ◽  
Kazuhide Matsushima ◽  
Demetrios Demetriades ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Central Line ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Outcomes ◽  
Primary Survey ◽  
Icu Length Of Stay ◽  
Level I ◽  
Review 2014

Focused assessment with Sonography for trauma (FAST) examination is essential to trauma triage. We sought to determine whether FASTs completed early in sequencing portend worse outcomes. A two-year review (2014–2015) of all trauma activations at our Level I trauma center was performed. Patients were matched at baseline and FAST times were compared. Outcomes included resuscitation time (RESUS-h), ventilation days (d), hospital length of stay (HLOS-d), ICU length of stay (LOS-d), survival (%), nosocomial infection rate (%), and venous thromboembolism complication rate (%). ED interventions included transfusions, crystalloid, antibiotics, central line placement, intubation, thoracostomy, thoracotomy, pelvic X-ray, and binder. One thousand, three hundred and twelve patients were included for analysis (mean age = 38 ± 19 years, mean Injury Severity Score = 12 ± 11, 21% penetrating). Compared with FASTs completed after the primary survey, early FASTs led to significantly more ventilation days ( P < 0.01), longer ICU length of stay ( P < 0.01), and a greater incidence of nosocomial infections ( P = 0.03). In the ED, early FASTs led to significantly more intubations ( P < 0.01) and transfusions ( P < 0.01) compared with late FASTs. FASTs completed before primary survey portend worse outcomes, with more ED interventions and equivocal results. FAST as a true adjunct to primary survey is recommended.

Decreased Length of Stay After Laparoscopic Diaphragm Repair for Isolated Diaphragm Injury After Penetrating Trauma

2020 ◽  
Vol 86 (5) ◽  
pp. 493-498
Author(s):  
Haris H. Chaudhry ◽  
Areg Grigorian ◽  
Michael E. Lekawa ◽  
Matthew O. Dolich ◽  
Ninh T. Nguyen ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Length Of Stay ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Bivariate Analysis ◽  
Trauma Patients ◽  
Improvement Program ◽  
Chi Square ◽  
Diaphragm Injury ◽  
Diaphragmatic Repair

Background Isolated diaphragm injury (IDI) occurs in up to 30% of penetrating left thoracoabdominal injuries. Laparoscopic abdominal procedures have demonstrated improved outcome including decreased postoperative pain and length of stay (LOS) compared to open surgery. However, there is a paucity of data on this topic for penetrating IDI. The aim of this study was to examine the prevalence and outcome of laparoscopic diaphragmatic repair versus open diaphragmatic repair (LDR vs ODR) of IDI. Methods The Trauma Quality Improvement Program (2010-2016) was queried for patients with IDI who underwent ODR versus LDR. A bivariate analysis using Pearson chi-square and Mann-Whitney test was performed to determine LOS among the two groups. Results From 2039 diaphragm injuries, 368 patients had IDI; 281 patients (76.4%) underwent ODR and 87 (23.6%) underwent LDR. Compared to LDR, the ODR patients were older (median, 31 vs 25 years, P < .001) and had a higher injury severity score (mean, 11.2 vs 9.6, P = .03) but had similar rates of intensive care unit LOS, unplanned return to the operating room, ventilator days, and complications ( P > .05). Patients undergoing ODR had a longer LOS (5 vs 4 days, P = .01), compared to LDR. There were no deaths in either group. Conclusions Trauma patients presenting with IDI undergoing ODR had a longer hospital LOS compared to patients undergoing LDR with no difference in complications or mortality. Therefore, we recommend when possible an LDR should be employed to decrease hospital LOS. Further research is needed to examine other benefits of laparoscopy such as postoperative pain, incisional hernia, and wound-related complications.

scholarly journals Tocilizumab shortens time on mechanical ventilation and length of hospital stay in patients with severe COVID-19: a retrospective cohort study.

2020 ◽  
Author(s):  
Johannes Eimer ◽  
Jan Vesterbacka ◽  
Anna-Karin Svensson ◽  
Bertil Stojanovic ◽  
Charlotta Wagrell ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Propensity Score ◽  
Ventilatory Support ◽  
Length Of Hospital Stay ◽  
Matched Cohort ◽  
All Cause Mortality ◽  
Secondary Endpoints ◽  
The Impact

Background: Hyperinflammation is a key feature of the pathogenesis of COVID-19 with a central role of the interleukin-6 pathway. We aimed to study the impact of the IL-6 receptor antagonist tocilizumab on the outcome of patients admitted to the intensive care unit (ICU) with acute respiratory distress syndrome (ARDS) related to COVID-19. Methods: Eighty-seven patients with confirmed SARS-CoV-2 infection and moderate to severe ARDS were included (n tocilizumab = 29, n controls = 58). A matched cohort was created using a propensity score. The primary endpoint was 30-day all-cause mortality, secondary endpoints included ventilation-free days and length of stay. Results: No difference was found in 30-day all-cause mortality in patients treated with tocilizumab compared to controls (17.2% vs. 32.8%, p = 0.2; HR = 0.52 [0.19 - 1.39], p = 0.19). Ventilator-free days were 19.0 (IQR 12.5 - 20.0) versus 9 (IQR 0.0 - 18.5; p = 0.04), respectively. A higher rate of freedom from mechanical ventilation at 30 days was achieved in patients receiving tocilizumab (HR 2.83 [1.48 - 5.40], p < 0.002). Median length of stay in ICU and total length of stay were reduced by 8 and 9.5 days in patients treated with tocilizumab. Similar results were obtained in the analysis of the propensity score matched cohort. Conclusions: Treatment of critically ill patients with ARDS due to COVID-19 with tocilizumab was not associated with reduced 30-day all-cause mortality, but shorter duration on ventilatory support as well as shorter overall length of stay in hospital and in ICU.

Abdominal Hollow Viscus Injuries are Associated with Spine and Neurologic Infections after Penetrating Spinal Cord Injuries

2014 ◽  
Vol 80 (10) ◽  
pp. 966-969 ◽  
Author(s):  
Alexander C. Schwed ◽  
David S. Plurad ◽  
Scott Bricker ◽  
Angela Neville ◽  
Fred Bongard ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Multivariate Analysis ◽  
Injury Severity ◽  
Spinal Cord Injuries ◽  
Infectious Complications ◽  
Injury Patterns ◽  
Hollow Viscus ◽  
Increased Risk ◽  
Level I ◽  
The Impact

Penetrating spinal cord injuries are rare but potentially devastating injuries that are associated with significant morbidity. The objective of this study was to assess the impact of abdominal hollow viscus injuries (HVIs) on neurologic and spinal infectious complications in patients sustaining penetrating spinal cord injuries. We performed a 13-year retrospective review of a Level I trauma center database. Variables analyzed included demographics, injury patterns and severity, spine operations, and outcomes. Spine and neurologic infections (SNIs) were defined as para-spinal or spinal abscess, osteomyelitis, and meningitis. Multivariate analysis was performed to identify factors associated with SNI. Of 137 patients, there were 126 males (92%) with a mean age of 27 ± 10 years. Eight patients (6%) underwent operative stabilization of their spine. Fifteen patients (11%) developed SNI. There was a higher incidence of SNI among patients with abdominal HVI compared with those without (eight [26%] vs six [6%], P < 0.001). On multivariate analysis, after controlling for injury severity, solid abdominal injury and HVI, vascular injury, and spine operation, abdominal HVIs were independently associated with an increased risk for SNI (odds ratio, 6.88; 95% confidence interval, 2.14 to 22.09; P = 0.001). Further studies are required to determine the optimal management strategy to prevent and successfully treat these infections.

Common Denominators in Death from Pediatric Back-Over Trauma

2011 ◽  
Vol 77 (10) ◽  
pp. 1420-1422 ◽  
Author(s):  
Rebecca Stark ◽  
Steven Lee ◽  
Angela Neville ◽  
Brant Putnah ◽  
Scott Bricker
Keyword(s):  
Family Member ◽  
Head Trauma ◽  
Injury Severity ◽  
Pediatric Population ◽  
Female Gender ◽  
Blunt Head Trauma ◽  
Revised Trauma Score ◽  
Urban Level ◽  
Level I ◽  
Trauma Injury

Low-speed “back-over” injuries comprise a small number of pediatric automobile versus pedestrian (AVP) trauma, however these injuries tend to be more severe and have a higher rate of mortality. The objective of this study was to determine environmental, mechanistic, and demographic factors common in pediatric back-over injuries resulting in death. Patients were identified from the trauma registry of an urban Level I trauma center over a 15-year period. Charts for all pediatric AVP injuries in ages 4 years and younger were reviewed. Mortalities due to back-over injuries were identified. For the study period reviewed (1995–2010) we identified 535 cases of auto versus pedestrian injury in children less than 4-years-old. Of these, 31 (5.79%) were mortalities. Among those 31 mortalities, six (19.3%) were identified as resulting from back-over trauma. Mean age was significantly lower in back-over injuries as compared with non back-over AVP trauma (1.33 ± 0.23 years, vs 3.5 ± 1.0 years, P = 0.001). We noted a trend toward female gender (67%) and Hispanic ethnicity (67%). All sustained massive blunt head trauma as the cause of death. There were no significant differences in Injury Severity Score or Revised Trauma Score in the back-over group. Environmental analysis revealed that cars were the perpetrating vehicle 50 per cent of the time, and sport utility vehicles, vans, or trucks 50 per cent of the time. In all cases, the accidents occurred in the patient's own driveway and by either a family member (67%) or acquaintance (33%). These data suggest that key characteristics of back-over trauma resulting in mortality include very young age, massive head trauma, injury occurring in the patient's own driveway, and with a family member or acquaintance behind the wheel. This may help identify points of injury prevention to decrease the number of victims of back-over trauma in the pediatric population.

Effects of a More Restrictive Transfusion Trigger in Trauma Patients

2019 ◽  
Vol 85 (4) ◽  
pp. 409-413 ◽  
Author(s):  
Mary Garland-Kledzik ◽  
Michaela Gaffley ◽  
David Crouse ◽  
Collin Conrad ◽  
Preston Miller ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Trauma Patients ◽  
Transfusion Trigger ◽  
Transfusion Threshold ◽  
Trauma Service ◽  
Transfusion Requirements ◽  
Organ System Failure ◽  
Urban Level ◽  
Level I

Since the Transfusion Requirements in Critical Care trial, studies have shown that acutely ill patients can drift as a low as 5 g/dL. This study reviews a transfusion trigger change to 6.5 g/dL, which we hypothesize will conserve resources and improve quality of care. This is a retrospective chart review at an urban Level I trauma center from January through December 2015 after our trauma service changed the transfusion trigger from 7 to 6.5 g/dL. Outcomes in patients before (TT7) and after (TT6.5) the change in transfusion threshold were then compared. One hundred thirty-one discrete patients were included in this trial, with 285 instances of a hemoglobin of 7 g/dL or less and 178 transfusions. Seventy-two patients were before the change in threshold and 59 after. There was no change in length of hospital stay, ICU stay, ventilator days, mortality, and organ system failure after change in the transfusion threshold. After initiation of a more conservative threshold, 72 units of blood were saved. Decreased transfusion threshold was associated with no worse outcomes associated with decreased resource utilization.

Hyperglycemia and Infections in Pediatric Trauma Patients

2008 ◽  
Vol 74 (3) ◽  
pp. 195-198 ◽  
Author(s):  
David W. Tuggle ◽  
M. Ann Kuhn ◽  
Susan K. Jones ◽  
Jennifer J. Garza ◽  
Sean Skinner
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Head Injuries ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Severely Injured ◽  
Exact Test ◽  
Glucose Levels ◽  
Increased Risk ◽  
Level I

Hyperglycemia has been associated with poor outcome in children with head injuries and burns. However, there has not been a correlation noted between hyperglycemia and infections in severely injured children. The trauma registry of a Level I trauma center was queried for injured children <13 years admitted between July 1, 1999 and August 31, 2003. The records of severely injured children [Injury Severity Score (ISS) > 15] were examined for survival, age, weight, ISS, infection, length of stay (LOS), and maximum glucose levels within the first 24 hours of injury (D1G). Statistical analysis was performed using a t test, Fisher's exact test, a Mann-Whitney Rank Sum test, or Kendall's Tau where appropriate. Eight hundred and eighty eight children under 13 years of age were admitted. One hundred and nine had an ISS > 15, and 57 survived to discharge with measured D1G. Patients excluded were those who died in less than 72 hours or had an LOS less than 72 hours. The survivors were divided into high glucose (≥130 mg/dL; n = 48) and normal glucose (<130 mg/dL; n = 9). There was no difference between the groups with respect to age, weight, incidence of head injury, and ISS. An elevated D1G correlated with an increased risk of infection (P = 0.05) and an increased LOS (P = 0.01). These data suggest that severely injured children are often hyperglycemic in the first 24 hours after injury. Hyperglycemia in this study population correlated with an increased incidence of infection and increased length of stay. This suggests that strict control of hyperglycemia in injured children may be beneficial.

The Price of Always Saying Yes: A Cost Analysis of Secondary Overtriage to an Urban Level I Trauma Center

2018 ◽  
Vol 84 (8) ◽  
pp. 1368-1375 ◽  
Author(s):  
Marko Bukur ◽  
Candace Teurel ◽  
Joseph Catino ◽  
Stanley Kurek
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Tissue Injury ◽  
Spinal Injury ◽  
Financial Burden ◽  
Trauma System ◽  
Soft Tissue Injury ◽  
Cost Savings ◽  
Urban Level ◽  
Level I

Level I trauma centers serve as a community resource, with most centers using an inclusive transfer policy that may result in overtriage. The financial burden this imparts on an urban trauma system has not been well examined. We sought to examine the incidence of secondary overtriage (SOT) at an urban Level I trauma center. This was a retrospective study from an urban Level I trauma center examining patients admitted as trauma transfers (TT) from 2010 to 2014. SOT was defined as patients not meeting the “Orange Book” transfer criteria and who had a length of stay of <48 hours. Average ED and transport charges were calculated for total transfer charges. A total of 2397 TT were treated. The number of TT increased over the study interval. The mean age of TT was 59.7 years (SD ± 26.4 years); patients were predominantly male (59.2%), white (83.2%), with at least one comorbidity (71.5%). Blunt trauma accounted for 96.8 per cent of admissions with a median Injury Severity Score of nine (IQR: 5–16). Predominant injuries were isolated closed head trauma (61.4%), skin/soft tissue injury (18.9%), and spinal injury (17.6%). SOT was 48.2 per cent and increased yearly (P < 0.001). The median trauma center charge for SOT was ($27,072; IQR: $20,089–34,087), whereas ED charges were ($40,440; IQR: $26,150–65,125), resulting in a total cost of $67,512/patient. A liberal TT policy results in a high SOT rate adding significant unnecessary costs to the health-care system. Efforts to establish transfer guidelines may allow for significant cost savings without compromising care.

The Dangers of Equivocal FAST in Trauma Resuscitation

2017 ◽  
Vol 83 (10) ◽  
pp. 1127-1131 ◽  
Author(s):  
John Kleinman ◽  
Aaron Strumwasser ◽  
David Rosen ◽  
Jeremy Hardin ◽  
Kenji Inaba ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
False Negative ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Abdominal Sonography ◽  
Trauma Outcomes ◽  
Level I ◽  
The Right

Equivocal focused abdominal sonography for trauma (FAST) examinations confound decision-making for trauma surgeons. We sought to determine whether the equivocal FAST (defined as any nonconcordant result) has a deleterious effect on trauma outcomes. A 2-year review (2014–2015) of all trauma activations at our Level I trauma center was performed. Patients were matched at baseline and FAST results were compared. Outcomes included resuscitation time (h), ventilation days (d), hospital length of stay (HLOS-d), ICU length-of-stay, and survival (%). In addition, skill level of the sonographer was stratified by novice (postgraduate year (PGY) years 1–3) or expert skill levels (PGY-4/fellow or attending). A total of 1,027 patients were included. Compared with concordant FAST examinations, equivocal FASTs were associated with increased HLOS (14.1 vs 10.6, P = 0.05), higher mortality (9.8 vs 3.7%, P = 0.02), decreased positive predictive value in the right upper quadrant (RUQ) (55 vs 79%, P = 0.02) and left upper quadrant (LUQ) (50 vs 83%, P < 0.01) and significantly decreased specificity in the thoracic (83 vs 98%), RUQ (80 vs 98%), LUQ (86 vs 99%), and pelvic (88 vs 98%) windows (P < 0.01 for all). A trend of greater positive predictive value in the thoracic window (100 vs 81%, P = 0.09) among PGY-4/fellow and attending providers compared with PGY levels 1–3 was observed. Equivocal FASTs portend worse outcomes than concordant FASTs because of high false-negative rates, specifically in the thoracic region and the upper quadrants. Lower thresholds for intervention are recommended.

You Cannot Go Home: Routine Concussion Evaluation is not Enough

2015 ◽  
Vol 81 (4) ◽  
pp. 395-403 ◽  
Author(s):  
Jennifer L. Hartwell ◽  
M. Chance Spalding ◽  
Brian Fletcher ◽  
M. Shay O'Mara ◽  
Chris Karas
Keyword(s):  
Ct Scan ◽  
Injury Severity ◽  
Neurocognitive Deficits ◽  
Inclusion Criteria ◽  
Neurocognitive Evaluation ◽  
Urban Level ◽  
Level I ◽  
Discharge Criteria ◽  
Head Computed Tomography

Traditional care of mild traumatic brain injury (MTBI) is to discharge patients from the emergency department (ED) if they have a Glasgow Coma Score (GCS) of 15 and a normal head computed tomography (CT) scan. However, this does not address short-term neurocognitive deficits. Our hypothesis is that a notable percentage of patients will need outpatient neurocognitive therapy despite a reassuring initial presentation. This is a retrospective review of patients with MTBI at an urban Level I trauma center. Inclusion criteria were a diagnosis of MTBI in patients 14 years old or older, GCS 15, negative head CT scan, a completed neurocognitive evaluation, blunt mechanism, and no confounding psychiatric comorbidities. Six thousand thirty-two patients were admitted over 18 months. Three hundred ninety-five patients met inclusion criteria. Average age was 38 years (range, 14 to 93 years), 64 per cent were male, and mean Injury Severity Score (ISS) was 8.1. Forty-one per cent were cleared for discharge without follow-up. Twenty-seven per cent required ongoing neurocognitive therapy. Three per cent were deemed unsafe for discharge home. Of the patients cleared for discharge, 88 per cent had positive/questionable loss of consciousness (LOC), whereas 81 per cent who required additional therapy had positive/questionable LOC ( P = 0.20). Age, gender, ISS, and alcohol use were compared between the groups and not found to be statistically different rendering them poor predictors for appropriate discharge from the ED. A surprisingly high percentage (27%) of patients who would have met traditional ED discharge criteria were found to have persistent deficits after neurocognitive testing and were referred for ongoing therapy. We provide evidence to suggest that we should take pause before discharging patients with MTBI without a cognitive evaluation.

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