Bicycle Helmets save More than Heads: Experience from a Pediatric Level I Trauma Hospital

2017 ◽  
Vol 83 (9) ◽  
pp. 1007-1011 ◽  
Author(s):  
Patrick D. Michael ◽  
Daniel L. Davenport ◽  
John M. Draus
Keyword(s):  
Brain Injuries ◽  
Injury Severity ◽  
Demographic Data ◽  
Private Insurance ◽  
Hospital Costs ◽  
Study Cohort ◽  
Level I ◽  
Minor Injuries ◽  
Trauma Activation ◽  
Activation Criteria

We studied pediatric bicycle accident victims (age ≤ 15 years) who were treated at our pediatric Level I trauma center during a 10-year period. Demographic data, injury severity, hospital course, and hospital cost data were collected. We compared the children who were helmeted to those who were unhelmeted. Our study cohort consisted of 516 patients. Patients were mostly male (70.2%) and white (84.7%); the median age was nine years. There were 101 children in the helmet group and 415 children in the unhelmeted group. Helmeted children were more likely to have private insurance (68.3% vs 35.9%, P < 0.001). Unhelmeted children were more likely to sustain multiple injuries (40% vs 25.7%, P = 0.008), meet our trauma activation criteria (45.5% vs 16.8%, P < 0.001), and be admitted to the hospital (42.4% vs 14.9%, P < 0.001). Helmeted children were less likely to sustain brain injuries (15.8% vs 25.8%, P = 0.037), skull fractures (1% vs 10.8%, P = 0.001), and facial fractures (1% vs 6%, P = 0.040). Median hospital costs were more expensive in the unhelmeted group. Helmet usage was suboptimal. Although most children sustained relatively minor injuries, the unhelmeted children had more injuries and higher costs than those who used helmets. Injury prevention programs are warranted.

Trauma Intensive Care Unit ‘Bouncebacks': Identifying Risk Factors for Unexpected Return Admission to the Intensive Care Unit

2014 ◽  
Vol 80 (8) ◽  
pp. 778-782 ◽  
Author(s):  
A. Britton Christmas ◽  
Elizabeth Freeman ◽  
Angela Chisolm ◽  
Peter E. Fischer ◽  
Gaurav Sachdev ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Injuries ◽  
Injury Severity ◽  
Hospital Costs ◽  
Retrospective Chart Review ◽  
Trauma Patients ◽  
Respiratory Compromise ◽  
Patient Demographics ◽  
Hygiene Practices

Return transfer (RT) to the intensive care unit (ICU) negatively impacts patient outcomes, length of stay (LOS), and hospital costs. This study assesses the most common events necessitating RT in trauma patients. We performed a retrospective chart review of ICU RT from 2004 to 2008. Patient demographics, injuries and injury severity, reason for transfer, LOS, interventions, and outcomes data were collected. Overall, 158 patients required readmission to the ICU. Respiratory insufficiency/ failure (48%) was the most common reason for RT followed by cardiac (16%) and neurological (13%) events. The most commonly associated injuries were traumatic brain injuries (TBIs) (32%), rib fractures (30%), and pulmonary contusions (20%). Initial ICU LOS was 6.6 ± 8 days (range, 1 to 44 days) with 4.4 ± 7.8 ventilator days. Mean floor time before ICU RT was 5.7 ± 6.3 days (range, 0 to 33 days). Forty-nine patients (31%) required intubation and mechanical ventilation on RT. ICU RT incurred an additional ICU LOS of 8 ± 8.5 days (range, 1 to 40 days) and 5.2 ± 7.5 ventilator days. Mortality after a single RT was 10 per cent (n = 16). RT to the ICU most often occurs as a result of respiratory compromise, and patients with TBI are particularly vulnerable. Trauma pulmonary hygiene practices should be evaluated to determine strategies that could decrease RT.

Gunshot Injuries to the Extremity: Is Immediate General Surgery Presence Needed?

2018 ◽  
Vol 84 (9) ◽  
pp. 1450-1454
Author(s):  
Brian G. Harbrecht ◽  
Keith R. Miller ◽  
Amirrezat Motameni ◽  
Matthew V. Benns ◽  
Matthew C. Bozeman ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Injury Severity ◽  
Demographic Data ◽  
Gunshot Wounds ◽  
Operative Intervention ◽  
General Surgeon ◽  
Vascular Repair ◽  
Body Regions ◽  
Trauma Activation

Gunshot wounds (GSW) are becoming increasingly prevalent in urban settings. GSW to the trunk mandate full trauma activation and immediate surgeon response because of the high likelihood of operative intervention. Extremity GSW proximal to the knee/elbow also require full trauma activation based on American College of Surgeons Committee on trauma standards. However, whether isolated extremity GSW require frequent operative intervention is unclear. We evaluated GSW at our Level I trauma center from January 2012 to December 2016. Demographic data and injury patterns were abstracted from the trauma registry and charts. The number of GSW increased yearly but the age, gender, Injury Severity Score and injury pattern did not change (P = ns, not shown). There were 504 GSW that included an extremity and 194 (38%) involved multiple body regions. There were 310 GSW (62%) isolated to an extremity and 176 were proximal to the elbow/knee. If proximal GSW had an Emergency Department systolic blood pressure <90 mm Hg, 53 per cent underwent vascular repair, 12 per cent had soft tissue repair, and 29 per cent required no operation. If proximal GSW had an Emergency Department blood pressure >90 mm Hg, 57 per cent underwent orthopedic repair, 22 per cent required no surgery, and only 13 per cent required vascular repair (P < 0.01). In the absence of other criteria for full trauma activation such as shock, the need for the immediate presence of a general surgeon to perform emergency surgery for a GSW isolated to the extremity is low.

Non-accidental Trauma Injury Patterns and Outcomes: A Single Institutional Experience

2015 ◽  
Vol 81 (9) ◽  
pp. 835-838 ◽  
Author(s):  
Austin Ward ◽  
Joseph A. Iocono ◽  
Samuel Brown ◽  
Phillip Ashley ◽  
John M. Draus
Keyword(s):  
Brain Injuries ◽  
Injury Severity ◽  
Hot Spot ◽  
Demographic Data ◽  
Pediatric Trauma ◽  
Pediatric Intensive Care ◽  
Injury Patterns ◽  
Accidental Trauma ◽  
Trauma Population ◽  
Non Accidental Trauma

Non-accidental trauma (NAT) victims account for a significant percentage of our pediatric trauma population. We sought to better understand the injury patterns and outcomes of NAT victims who were treated at our level I pediatric trauma center. Trauma registry data were used to identify NAT victims between January 2008 and December 2012. Demographic data, injury severity, hospital course, and outcomes were evaluated. One hundred and eighty-eight cases of suspected NAT were identified. Children were mostly male and white. The median age was 1.1 years; the median Injury Severity Score was 9. Traumatic brain injuries, lower extremity fractures, and skull fractures were the most common injuries. Twenty-seven per cent required medical procedures; most were performed by orthopedic surgery. Twenty-four per cent required admission to the pediatric intensive care unit. The median length of stay was two days. The mortality rate was 9.6 per cent. We generated a hot spot map of our catchment area and identified areas of our state where NAT occurs at increased rates. NAT victims sustain significant morbidity and mortality. Due to the severity of injuries, pediatric trauma surgeons should be involved in the evaluation and management of these children. Much work is needed to prevent the death and disability incurred by victims of child abuse.

Comparison of Outcome Tools Used to Test Mass-Casualty Algorithms in the Pediatric Population

2021 ◽  
pp. 1-5
Author(s):  
J. Joelle Donofrio ◽  
Alaa Shaban ◽  
Amy H. Kaji ◽  
Genevieve Santillanes ◽  
Mark X. Cicero ◽  
...  
Keyword(s):  
Injury Severity ◽  
Pediatric Population ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Study Objective ◽  
Large Numbers ◽  
Triage Category ◽  
Level I ◽  
Outcome Tool ◽  
Trauma Activation

Abstract Introduction: Mass-casualty incident (MCI) algorithms are used to sort large numbers of patients rapidly into four basic categories based on severity. To date, there is no consensus on the best method to test the accuracy of an MCI algorithm in the pediatric population, nor on the agreement between different tools designed for this purpose. Study Objective: This study is to compare agreement between the Criteria Outcomes Tool (COT) to previously published outcomes tools in assessing the triage category applied to a simulated set of pediatric MCI patients. Methods: An MCI triage category (black, red, yellow, and green) was applied to patients from a pre-collected retrospective cohort of pediatric patients under 14 years of age brought in as a trauma activation to a Level I trauma center from July 2010 through November 2013 using each of the following outcome measures: COT, modified Baxt score, modified Baxt combined with mortality and/or length-of-stay (LOS), ambulatory status, mortality alone, and Injury Severity Score (ISS). Descriptive statistics were applied to determine agreement between tools. Results: A total of 247 patients were included, ranging from 25 days to 13 years of age. The outcome of mortality had 100% agreement with the COT black. The “modified Baxt positive and alive” outcome had the highest agreement with COT red (65%). All yellow outcomes had 47%-53% agreement with COT yellow. “Modified Baxt negative and <24 hours LOS” had the highest agreement with the COT green at 89%. Conclusions: Assessment of algorithms for triaging pediatric MCI patients is complicated by the lack of a gold standard outcome tool and variability between existing measures.

Does the Presence of Subdural Hemorrhage Increase the Risk of Intracranial Hemorrhage Expansion after the Initiation of Antithrombotic Medication?

2018 ◽  
Vol 84 (3) ◽  
pp. 416-421 ◽  
Author(s):  
Urmil Pandya ◽  
Jill Pattison ◽  
Chris Karas ◽  
Michael O'Mara
Keyword(s):  
Intracranial Hemorrhage ◽  
Injury Severity ◽  
Demographic Data ◽  
Clinical Indication ◽  
Subdural Hemorrhage ◽  
Trauma Patients ◽  
Inclusion Criteria ◽  
Antiplatelet Medication ◽  
Level I ◽  
Antithrombotic Medication

Patients with traumatic intracranial hemorrhage (ICH) with a clinical indication for antithrombotic medication present a clinical dilemma, burdened by the task of weighing the risks of hemorrhage expansion against the risk of thrombosis. We sought to determine the effect of subdural hemorrhage on the risk of hemorrhage expansion after administration of antithrombotic medication. Medical records of 1626 trauma patients admitted with traumatic ICH between March 1, 2008, and March 31, 2013, to a Level I trauma center were retrospectively reviewed. The pharmacy database was queried to determine which patients were administered anticoagulant or antiplatelet medication during their hospitalization, leaving a sample of 97 patients that met inclusion criteria. Patients presenting with subdural hemorrhage were compared with patients without subdural hemorrhage. Demographic data, clinically significant expansion of hematoma, postinjury day of initiation, and mortality were analyzed. A total of 97 patients met inclusion criteria with 55 patients in the subdural hemorrhage group and 42 in the other ICH group. There were no significant differences in age, gender, injury severity score, admission Glasgow coma score, or mean hospital day of antithrombotic administration between the groups. Patients with subdural hemorrhage had a significantly higher rate of ICH expansion (9.1 vs 0%, P = 0.045). There was no difference in overall hospital mortality between the two groups. Incidence of ICH expansion was higher in patients with subdural hemorrhage. It may be prudent to use special caution when administering antiplatelet or anticoagulant medication in this group of patients after injury.

Suboptimal compliance with evidence-based guidelines in patients with traumatic brain injuries

2014 ◽  
Vol 120 (3) ◽  
pp. 773-777 ◽  
Author(s):  
Shahid Shafi ◽  
Sunni A. Barnes ◽  
D Millar ◽  
Justin Sobrino ◽  
Rustam Kudyakov ◽  
...  
Keyword(s):  
Scale Score ◽  
Brain Injuries ◽  
Injury Severity ◽  
Compliance Rate ◽  
Traumatic Brain Injuries ◽  
Evidence Based ◽  
Clinical Practices ◽  
Severe Tbi ◽  
Level I ◽  
Evidence Based Guidelines

Object Evidence-based management (EBM) guidelines for severe traumatic brain injuries (TBIs) were promulgated decades ago. However, the extent of their adoption into bedside clinical practices is not known. The purpose of this study was to measure compliance with EBM guidelines for management of severe TBI and its impact on patient outcome. Methods This was a retrospective study of blunt TBI (11 Level I trauma centers, study period 2008–2009, n = 2056 patients). Inclusion criteria were an admission Glasgow Coma Scale score ≤ 8 and a CT scan showing TBI, excluding patients with nonsurvivable injuries—that is, head Abbreviated Injury Scale score of 6. The authors measured compliance with 6 nonoperative EBM processes (endotracheal intubation, resuscitation, correction of coagulopathy, intracranial pressure monitoring, maintaining cerebral perfusion pressure ≥ 50 cm H2O, and discharge to rehabilitation). Compliance rates were calculated for each center using multivariate regression to adjust for patient demographics, physiology, injury severity, and TBI severity. Results The overall compliance rate was 73%, and there was wide variation among centers. Only 3 centers achieved a compliance rate exceeding 80%. Risk-adjusted compliance was worse than average at 2 centers, better than average at 1, and the remainder were average. Multivariate analysis showed that increased adoption of EBM was associated with a reduced mortality rate (OR 0.88; 95% CI 0.81–0.96, p < 0.005). Conclusions Despite widespread dissemination of EBM guidelines, patients with severe TBI continue to receive inconsistent care. Barriers to adoption of EBM need to be identified and mitigated to improve patient outcomes.

Pediatric hospitalizations and in-patient mortality from all-terrain vehicle crashes, 2006–2016

Trauma ◽  
2019 ◽  
Vol 22 (1) ◽  
pp. 56-63
Author(s):  
Sarah B Cairo ◽  
Joshua K Burk ◽  
David H Rothstein
Keyword(s):  
Rural Areas ◽  
Demographic Data ◽  
Private Insurance ◽  
Hospital Costs ◽  
The United States ◽  
Vehicle Crashes ◽  
Targeted Interventions ◽  
The Past ◽  
West Region ◽  
National Frequency

PurposeTo evaluate trends in national frequency of hospitalizations and in-patient mortality in the United States for children injured in all-terrain vehicle crashes during the past decade.MethodsRetrospective review of the 2006, 2009, 2012, and 2016 Kids' Inpatient Databases to identify hospitalizations of patients <19 years of age for all-terrain vehicle-related injuries. External-cause-of-injury codes were used to identify patients hospitalized for injuries sustained in all-terrain vehicle crashes. Odds ratios for in-patient mortality were calculated by logistic regression incorporating multiple individual demographic and hospital variables.ResultsEstimated all-terrain vehicle-related hospitalizations ranged from 3666 in 2006 (5.2/100,000 persons <19 years of age) to 2558 in 2012 (3.3/100,000). Crude in-patient mortality was low, and varied slightly from year to year (range, 0.55–1.04%). Patients hospitalized for all-terrain vehicle-related injuries were 76.8–78.4% White and 72.1–77.2% male. Totally 61.0–64.3% had private insurance, 35.3–39.3% were from rural areas, 37.4–38.3% were in the 10–14-year age group, and patients from the West region accounted for 40.4–43.6% of patients. There were no risk factors identified as being consistently associated with mortality in this cohort. Average total charges increased from $26,996 to $67,370 over the course of the study ( p < 0.001).ConclusionsHospitalizations for all-terrain vehicle-related injuries in children have fallen in the past decade although the reasons for this change are unknown. In-patient mortality rates have stayed relatively constant and while no factors were predictive of in-patient mortality, demographic data may provide an opportunity for targeted interventions to further reduce injuries and associated hospital costs.

Trauma System Overtriage: Are We on Track?

2014 ◽  
Vol 80 (10) ◽  
pp. 960-965 ◽  
Author(s):  
Zoe Fullerton ◽  
Graham W. Donald ◽  
Henry G. Cryer ◽  
Catherine E. Lewis ◽  
Ali Cheaito ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Trauma Center ◽  
Injury Severity ◽  
Trauma System ◽  
Length Of Hospital Stay ◽  
Optimal Care ◽  
American College Of Surgeons ◽  
Level I ◽  
Trauma Activation

The American College of Surgeons (ACS) recommends trauma overtriage rate (OT) below 50 per cent to maximize efficiency while ensuring optimal care. This retrospective study was undertaken to evaluate OT rates in our Level I trauma center using the most recent criteria and guidelines. OT rates during a 12-month period were measured using six definitions based on combinations of Injury Severity Score (ISS), length of hospital stay (LOS, in days), procedures, and disposition after the emergency department. Reason for trauma activation was 55 per cent criteria, 16 per cent guidelines, 11 per cent paramedic judgment, five per cent no reason, and 13 per cent no documentation. OT rates ranged from 22.6 per cent (ISS less than 9, LOS 1 day or less, no consults) to 48.2 per cent (ISS less than 9, LOS 3 days or less, with procedures/consults) and were in compliance with ACS recommendations. Physiologic assessment criteria and anatomic injury had the lowest OT rates and contained all mortalities. Passenger space intrusion (PSI), pedestrian versus automobile (criterion and guideline), and extrication (guideline) all had consistently high rates of OT. We conclude that PSI should be reduced to a guideline, the pedestrian versus automobile criterion and guideline should be combined, and extrication could be removed from the triage scheme.

Transitioning to Thoracic Endovascular Repair: A Single Institution's Analysis of the Management of Blunt Aortic Injury

2013 ◽  
Vol 79 (8) ◽  
pp. 806-809 ◽  
Author(s):  
Clay G. Nelson ◽  
Richard E. Redlinger ◽  
Jay N. Collins ◽  
Leonard J. Weireter ◽  
L. D. Britt
Keyword(s):  
Length Of Stay ◽  
Endovascular Repair ◽  
Injury Severity ◽  
Demographic Data ◽  
Aortic Injury ◽  
Trauma Patients ◽  
Acute Complications ◽  
Aortic Injuries ◽  
Level I

Over the past 15 years, there has been a rapid transformation in the way blunt aortic injuries (BAIs) are managed shifting from open thoracotomies to thoracic endovascular repairs (TEVAR). As a result of this change, we sought to describe our experience with open and endovascular repairs through a retrospective analysis of all trauma patients admitted with BAI to our Level I trauma center from 2002 to 2011. Demographic data, type of repair, complications, length of stay (LOS) data, and mortality were identified. No difference was noted in age, sex, Injury Severity Score, or Glasgow Coma Scale score between the two groups. There were also no differences in the number of acute complications or mortality. Intensive care unit (ICU) LOS was significantly shorter in the TEVAR group (20 vs 9 days, P < 0.05). Additionally, there was a trend toward shorter hospital LOS (28 vs 18 days, P = 0.07) and ventilator length of stay (12 vs 5 days, P = 0.171). In summary, endovascular repair of BAI is safe and has no increased rate of acute complications or mortality. ICU LOS is much shorter with TEVAR, and there was a trend toward shorter ventilator and hospital LOS, all of which may result in decreased cost. Still, more needs to be learned about potential long-term complications.

Use of Damage Control and the Open Abdomen in Combat

2013 ◽  
Vol 79 (8) ◽  
pp. 747-753 ◽  
Author(s):  
Benjamin Bograd ◽  
Carlos Rodriguez ◽  
Richard Amdur ◽  
Fred Gage ◽  
Eric Elster ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Multivariate Regression ◽  
Injury Severity ◽  
Open Abdomen ◽  
Damage Control ◽  
Unit Length ◽  
Significant Risk ◽  
Hospital Length Of Stay ◽  
Study Cohort ◽  
Regression Analyses

Despite the well-documented use of damage control laparotomy (DCL) in civilian trauma, its use has not been well described in the combat setting. Therefore, we sought to document the use of DCL and to investigate its effect on patient outcome. Prospective data were collected on 1603 combat casualties injured between April 2003 and January 2009. One hundred seventy patients (11%) underwent an exploratory laparotomy (ex lap) in theater and comprised the study cohort. DCL was defined as an abbreviated ex lap resulting in an open abdomen. Patients were stratified by age, Injury Severity Score (ISS), Glasgow Coma Score (GCS), mechanism of injury, and blood product administration. Multivariate regression analyses were used to determine risks factors for intensive care unit length of stay (ICU LOS), hospital length of stay (HLOS), and the need for DCL. Mean age of the cohort was 24 ± 5 years, ISS was 21 ± 11, and 94 per cent sustained penetrating injury. Patients with DCL comprised 50.6 per cent (n = 86) of the study cohort and had significant increases in ICU admission ( P < 0.001), ICU LOS ( P < 0.001), HLOS ( P < 0.05), ventilator days ( P < 0.001), abdominal complications ( P < 0.05), but not mortality ( P = 0.65) compared with patients without DCL. When compared with the non-DCL group, patients undergoing DCL required significantly more blood products (packed red blood cells, fresh-frozen plasma, platelets, and cryoprecipitate; P < 0.001). Multivariate regression analyses revealed blood transfusion and GCS as significant risk factors for DCL ( P < 0.05). Patients undergoing DCL had increased complications and resource use but not mortality compared with patients not undergoing DCL. The need for combat DCL may be different compared with civilian use. Prospective studies to evaluate outcomes of DCL are warranted.

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