The Impact of In-house Attending Surgeon Supervision on the Rates of Preventable and Potentially Preventable Complications and Death at the Start of the New Academic Year

2013 ◽  
Vol 79 (11) ◽  
pp. 1134-1139 ◽  
Author(s):  
Kenji Inaba ◽  
Adam Hauch ◽  
Bernardino C. Branco ◽  
Stephen Cohn ◽  
Pedro G. R. Teixeira ◽  
...  
Keyword(s):  
Los Angeles ◽  
Trauma Center ◽  
Medical Center ◽  
Trauma Patients ◽  
University Of Southern California ◽  
Academic Level ◽  
Significant Difference ◽  
Level I ◽  
The Impact ◽  
Academic Year

The purpose of this study was to examine the impact of in-house attending surgeon supervision on the rate of preventable deaths (PD) and complications (PC) at the beginning of the academic year. All trauma patients admitted to the Los Angeles County 1 University of Southern California Medical Center over an 8-year period ending in December 2009 were reviewed. Morbidity and mortality reports were used to extract all PD/PC. Patients admitted in the first 2 months (July/ August) of the academic year were compared with those admitted at the end of the year (May/June) for two distinct time periods: 2002 to 2006 (before in-house attending surgeon supervision) and 2007 to 2009 (after 24-hour/day in-house attending surgeon supervision). During 2002 to 2006, patients admitted at the beginning of the year had significantly higher rates of PC (1.1% for July/ August vs 0.6% for May/June; adjusted odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1 to 3.2; P < 0.001). There was no significant difference in mortality (6.5% for July/August vs 4.6% for May/ June; adjusted OR, 1.1; 95% CI,0.8 to 1.5; P = 0.179). During 2007 to 2009, after institution of 24-hour/day in-house attending surgeon supervision of fellows and housestaff, there was no significant difference in the rates of PC (0.7% for July/August vs 0.6% for May/June; OR, 1.1; 95% CI, 0.8 to 1.3; P = 0.870) or PD (4.6% for July/August vs 3.7% for May/June; OR, 1.3; 95% CI, 0.9 to 1.7; P = 0.250) seen at the beginning of the academic year. At an academic Level I trauma center, the institution of 24-hour/day in-house attending surgeon supervision significantly reduced the spike of preventable complications previously seen at the beginning of the academic year.

The Impact of American College of Surgeons Trauma Center Designation and Outcomes after Early Thoracotomy: A National Trauma Databank Analysis

2012 ◽  
Vol 78 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Marko Bukur ◽  
Bernardino Castelo Branco ◽  
Kenji Inaba ◽  
Ramon Cestero ◽  
Leslie Kobayashi ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Trauma Patients ◽  
National Trauma ◽  
Level Ii ◽  
Pressure Time ◽  
Significant Difference ◽  
American College Of Surgeons ◽  
Level I ◽  
The Impact

Trauma centers are designated by the American College of Surgeons (ACS) into four different levels based on resources, volume, and scientific and educational commitment. The purpose of this study was to evaluate the relationship between ACS center designation and outcomes after early thoracotomy for trauma. The National Trauma Databank (v. 7.0) was used to identify all patients who required early thoracotomy. Demographics, clinical data, and outcomes were extracted. Patients were categorized according to ACS trauma center designation. Multivariate logistic regression was used to evaluate the impact of ACS trauma center designation on mortality. From 2002 to 2006, 1834 (77.4%) patients were admitted to a Level I ACS verified trauma center, 474 (20.0%) to a Level II, and 59 (3.6%) to a Level III/IV facility. After adjusting for differences between the groups, there were no significant differences in mortality (overall: 53.3% for Level I, 63.1% for Level II, and 52.5% for Level III/IV, adjusted P = 0.417; or for patients arriving in cardiac arrest: 74.9% vs 87.1% vs 85.0%, P = 0.261). Subgroup analysis did not show any significant difference in survival irrespective of mechanism of injury. Glasgow Coma Scale score # 8, Injury Severity Score >16, no admission systolic blood pressure, time from admission to thoracotomy, and nonteaching hospitals were found to be independent predictors of death. For trauma patients who have sustained injuries requiring early thoracotomy, ACS trauma center designation did not significantly impact mortality. Nonteaching institutions however, were independently associated with poorer outcomes after early thoracotomy. These findings may have important implications in educational commitment of institutions. Further prospective evaluation of these findings is warranted.

Association of Scapular Fractures and Blunt Thoracic Aortic Injury: Fact or Fiction?

2005 ◽  
Vol 71 (1) ◽  
pp. 54-57 ◽  
Author(s):  
Carlos V.R. Brown ◽  
George Velmahos ◽  
Dennis Wang ◽  
Susan Kennedy ◽  
Demetrios Demetriades ◽  
...  
Keyword(s):  
Los Angeles ◽  
Blunt Trauma ◽  
Medical Center ◽  
Aortic Injury ◽  
Trauma Patients ◽  
Associated Injuries ◽  
Blunt Thoracic Aortic Injury ◽  
Scapular Fractures ◽  
Thoracic Aortic Injury ◽  
Level I

It is classically taught that scapular fractures (SF) are commonly associated with blunt thoracic aortic injury (BTAI). The purpose of this study was to determine the association between SF and BTAI. A 10-year retrospective review of blunt trauma admissions from two level I trauma centers located in different geographic regions, Washington Hospital Center (WHC) and Los Angeles County Medical Center and the University of Southern California (LAC/USC), was performed. Patients with SF and BTAI were identified, and records were reviewed to determine associated injuries. We identified 35,541 blunt trauma admissions (WHC: 12,971, LAC/USC: 22,570). SF and BTAI occurred in 1.1 per cent and 0.6 per cent of patients, respectively. Most of the patients with SF had associated injuries (99%). Only four patients with SF had BTAI (4/392; 1.0%). The most common injuries associated with SF were rib (43%), lower extremity (36%), and upper extremity (33%) fractures. SF is uncommon after blunt trauma. Patients with SF almost always have significant associated injuries. Although SF indicates a high amount of energy transmitted to the upper thorax, these patients rarely have BTAI. SF should not be used as an indicator of possible BTAI.

scholarly journals Impact of the COVID-19 shutdown on orthopedic trauma numbers and patterns in an academic Level I Trauma Center in Berlin, Germany

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246956
Author(s):  
Tazio Maleitzke ◽  
Matthias Pumberger ◽  
Undine A. Gerlach ◽  
Carolin Herrmann ◽  
Anna Slagman ◽  
...  
Keyword(s):  
Trauma Center ◽  
Control Period ◽  
Orthopedic Trauma ◽  
Injury Patterns ◽  
Total Patient ◽  
Academic Level ◽  
Level I ◽  
Rate Ratios ◽  
And Control ◽  
The Impact

Background The COVID-19 pandemic led to the implementation of drastic shutdown measures worldwide. While quarantine, self-isolation and shutdown laws helped to effectively contain and control the spread of SARS-CoV-2, the impact of COVID-19 shutdowns on trauma care in emergency departments (EDs) remains elusive. Methods All ED patient records from the 35-day COVID-19 shutdown (SHUTDOWN) period were retrospectively compared to a calendar-matched control period in 2019 (CTRL) as well as to a pre (PRE)- and post (POST)-shutdown period in an academic Level I Trauma Center in Berlin, Germany. Total patient and orthopedic trauma cases and contacts as well as trauma causes and injury patterns were evaluated during respective periods regarding absolute numbers, incidence rate ratios (IRRs) and risk ratios (RRs). Findings Daily total patient cases (SHUTDOWN vs. CTRL, 106.94 vs. 167.54) and orthopedic trauma cases (SHUTDOWN vs. CTRL, 30.91 vs. 52.06) decreased during the SHUTDOWN compared to the CTRL period with IRRs of 0.64 and 0.59. While absolute numbers decreased for most trauma causes during the SHUTDOWN period, we observed increased incidence proportions of household injuries and bicycle accidents with RRs of 1.31 and 1.68 respectively. An RR of 2.41 was observed for injuries due to domestic violence. We further recorded increased incidence proportions of acute and regular substance abuse during the SHUTDOWN period with RRs of 1.63 and 3.22, respectively. Conclusions While we observed a relevant decrease in total patient cases, relative proportions of specific trauma causes and injury patterns increased during the COVID-19 shutdown in Berlin, Germany. As government programs offered prompt financial aid during the pandemic to individuals and businesses, additional social support may be considered for vulnerable domestic environments.

The Impact of Intoxication on the Number of Organs Available for Transplantation after Brain Death

2009 ◽  
Vol 75 (5) ◽  
pp. 416-420
Author(s):  
Pantelis Hadjizacharia ◽  
Ali Salim ◽  
Joseph Dubose ◽  
Angela Mascarenhas ◽  
Daniel R. Margulies
Keyword(s):  
Brain Death ◽  
Retrospective Review ◽  
Trauma Center ◽  
Statistical Difference ◽  
Organ Procurement ◽  
Organ Donor ◽  
Trauma Patients ◽  
Head Injured ◽  
Level I ◽  
The Impact

A significant number of head-injured trauma patients are likely to present with a positive toxicology. The purpose of this study is to investigate whether intoxication with substances such as cocaine, amphetamine, alcohol, and opiates on admission has any influence on the number of organs that are recovered after brain death in these patients. We conducted a retrospective review of all organ donor patients admitted to a Level I trauma center over a 4-year period (2002 to 2005). Patients with positive toxicology screens on admission were compared to counterparts with negative screens with regard to the number of organs harvested. There were 90 organ donor patients during the 4-year period. There were 63 (70%) patients to negative toxicology screens. The remaining 27 (30%) were found to be intoxicated with a variety of substances, including alcohol (18%), cocaine (4%), amphetamines (9%), benzodiazepines (4%), opiates (4%), and poly-substances (10%). A comparison of total organs and individual organs donated by both intoxicated and nonintoxicated patients showed no overall statistical difference in the number or type of organs donated between the two groups. Thus, the prospect of organ procurement should not be overlooked in intoxicated patients.

The Impact of Methamphetamine Use on Trauma Patients at a Level I Trauma Center: A 10-Year Retrospective Review

2018 ◽  
Vol 84 (3) ◽  
pp. 428-432 ◽  
Author(s):  
Gregory R. Stroh ◽  
Fanglong Dong ◽  
Elizabeth Ablah ◽  
Jeanette G. Ward ◽  
James M. Haan
Keyword(s):  
Retrospective Review ◽  
Trauma Center ◽  
Traumatic Injury ◽  
Hospital Length Of Stay ◽  
Drug Screen ◽  
Trauma Patients ◽  
Urine Drug Screen ◽  
Increased Risk ◽  
Level I ◽  
The Impact

The effects of methamphetamines (MAs) on trauma patient outcomes have been evaluated, but with discordant results. The purpose of this study was to identify hospital outcomes associated with MA use after traumatic injury. Retrospective review of adult trauma patients admitted to an American College of Surgeons verified–Level I trauma center who received a urine drug screen (UDS) between January 1, 2004 and December 31, 2013. Logistic regression analysis was used to identify factors associated with mortality. Patients with a negative UDS were used as controls. Among the 2321 patients included, 75.1 per cent were male, 81.9 per cent were white, and the average age was 39. Patients were grouped by UDS results (negative, MA only, other drug plus MA, or other drug without MA). A positive drug screen result of other drug without MA demonstrated a significantly lower risk for mortality, but longer intensive care unit and hospital length of stay, as well as increased ventilator days than negative results. Results of MA only did not alter the risk of mortality. These findings suggest that patients who test positive for MAs are not at an increased risk of in-hospital mortality when compared with patients having a negative drug screen.

The Impact of Early Hormonal Therapy in Catastrophic Brain-Injured Patients and Its Effect on Organ Procurement

2012 ◽  
Vol 78 (3) ◽  
pp. 318-324 ◽  
Author(s):  
Lydia Lam ◽  
Kenji Inaba ◽  
Bernardino Castelo Branco ◽  
Bradley Putty ◽  
Ali Salim ◽  
...  
Keyword(s):  
Hormonal Therapy ◽  
Trauma Center ◽  
Organ Procurement ◽  
High Volume ◽  
Academic Level ◽  
Brain Injured ◽  
Early Use ◽  
Level I ◽  
Injured Patients ◽  
The Impact

The purpose of this study was to evaluate the impact of early hormonal therapy on organ procurement from catastrophic brain-injured patients. All catastrophic brain-injured patients admitted to a high-volume academic Level I trauma center who underwent successful organ procurement over a 3-year period (2006 to 2008) were reviewed. Patients were divided into two groups, those who received hormone therapy (HT) before brain death (BD) declaration and those who received HT after BD declaration. Thirty-two (60.4%) received HT before BD and 21 (39.6%) HTafter BD. Trauma was the most common cause of brain injury in both groups (before BD 96.9 vs after BD 90.5%, P = 0.324). There were no significant differences in demographics and clinical data. Patients receiving HT before BD were more hypotensive on admission (28.2 vs 9.5%, P = 0.048); however, they required vasopressors less frequently (62.5 vs 100.0%, P = 0.001), for a shorter duration (17.2 ± 16.3 hours vs 33.1 ± 34.9 hours, P = 0.043), and at a lower dosage. Time from admission to procurement did not differ between the two groups (109.8 ± 83.1 hours vs 125.0 ± 79.9 hours, P = 0.505). Patients receiving HT before BD had significantly more organs procured (4.5 ± 1.5 vs 3.5 ± 1.3, P = 0.023). Although catastrophic brain-injured patients receiving early hormonal therapy were more hypotensive, they required less vasopressors and had higher procurement rates. The early use of hormonal therapy may decrease the need for vasopressors and increase the salvage of potentially transplantable organs.

scholarly journals Prehospital Intervals and In-Hospital Trauma Mortality: A Retrospective Study from a Level I Trauma Center

2020 ◽  
Vol 35 (5) ◽  
pp. 508-515
Author(s):  
Hassan Al-Thani ◽  
Ahammed Mekkodathil ◽  
Attila J. Hertelendy ◽  
Tim Frazier ◽  
Gregory R. Ciottone ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Road Traffic ◽  
Trauma Patients ◽  
Golden Hour ◽  
Chest Injuries ◽  
Life Saving ◽  
Level I ◽  
Prehospital Time ◽  
The Impact

AbstractBackground:The increase in mortality and total prehospital time (TPT) seen in Qatar appear to be realistic. However, existing reports on the influence of TPT on mortality in trauma patients are conflicting. This study aimed to explore the impact of prehospital time on the in-hospital outcomes.Methods:A retrospective analysis of data on patients transferred alive by Emergency Medical Services (EMS) and admitted to Hamad Trauma Center (HTC) of Hamad General Hospital (HGH; Doha, Qatar) from June 2017 through May 2018 was conducted. This study was centered on the National Trauma Registry database. Patients were categorized based on the trauma triage activation and prehospital intervals, and comparative analysis was performed.Results:A total of 1,455 patients were included, of which nearly one-quarter of patients required urgent and life-saving care at a trauma center (T1 activations). The overall TPT was 70 minutes and the on-scene time (OST) was 24 minutes. When compared to T2 activations, T1 patients were more likely to have been involved in road traffic injuries (RTIs); experienced head and chest injuries; presented with higher Injury Severity Score (ISS: median = 22); and had prolonged OST (27 minutes) and reduced TPT (65 minutes; P = .001). Prolonged OST was found to be associated with higher mortality in T1 patients, whereas TPT was not associated.Conclusions:In-hospital mortality was independent of TPT but associated with longer OST in severely injured patients. The survival benefit may extend beyond the golden hour and may depend on the injury characteristics, prehospital, and in-hospital settings.

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.

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