Extreme Interventions for Trauma Patients in Extremis: Variations among Trauma Centers

2017 ◽  
Vol 83 (10) ◽  
pp. 1033-1039
Author(s):  
Galinos Barmparas ◽  
Ara Ko ◽  
Navpreet K. Dhillon ◽  
James M. Tatum ◽  
Mark Choi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Trauma Patient ◽  
National Level ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Inclusion Criteria ◽  
Emergency Department Thoracotomy ◽  
National Trauma ◽  
High Level ◽  
Trauma Surgeons

Although guidelines for the performance of an emergency department thoracotomy (EDT) are available, high level evidence remains scarce potentially leading to variation in decisions and practices among trauma surgeons. The National Trauma Databank was queried for all subjects who died in the emergency department (ED) between 2007 and 2011. Trauma centers were divided into four quartiles based on the rate of EDTamong ED deaths. A total of 31,623 subjects admitted to 729 trauma centers met inclusion criteria. Most of of these centers (n = 328, 53%) never performed an EDT during the study period. Very few outlier centers (1.1%) performed this procedure in 50.0 per cent or more of all patients who died in the ED. Trauma centers in the highest quartiles in performing EDT were more likely to intervene with both surgical and nonsurgical procedures in patients who died in the ED, independent of the performance of an EDT. There are significant variations among trauma centers in the management of trauma patients who expire in the ED. Further research at a national level toward standardizing the management of the trauma patient in extremis and the decision to perform an EDT is necessary, given the extremely low survival associated with this procedure.

scholarly journals Level 1 Trauma Centers and OEF/OIF Emergency Departments: Comparison of Trauma Patient Populations

2020 ◽  
Vol 185 (9-10) ◽  
pp. e1569-e1575
Author(s):  
Shelia C Savell ◽  
Alexis Blessing ◽  
Nicole M Shults ◽  
Alejandra G Mora ◽  
Kimberly L Medellin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Trauma Patient ◽  
Emergency Departments ◽  
Trauma Center ◽  
San Antonio ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Level 1 ◽  
Hospital Days ◽  
Level 1 Trauma Center

Abstract Introduction Brooke Army Medical Center (BAMC), the largest military hospital and the only level 1 trauma center in the DoD, cares for active duty, retired uniformed services personnel, and beneficiaries. In addition, BAMC works in collaboration with the Southwest Texas Regional Advisory Council (STRAC) and University Hospital (UH), San Antonio’s other level 1 trauma center, to provide trauma care to residents of the city and 22 counties in southwest Texas from San Antonio to Mexico (26,000 square mile area). Civilian-military partnerships are shown to benefit the training of military medical personnel; however, to date, there are no published reports specific to military personnel experiences within emergency care. The purpose of the current study was to describe and compare the emergency department trauma patient populations of two level 1 trauma centers in one metropolitan city (BAMC and UH) as well as determine if DoD level 1 trauma cases were representative of patients treated in OEF/OIF emergency department settings. Materials and Methods We obtained a nonhuman subjects research determination for de-identified data from the US Air Force 59th Medical Wing and the University of Texas Health Science Center at San Antonio Institutional Review Boards. Data on emergency department patients treated between the years 2015 and 2017 were obtained from the two level 1 trauma centers (BAMC and UH, located in San Antonio, Texas); data included injury descriptors, ICU and hospital days, and department procedures. Results Two-proportion Z-tests indicated that trauma patients were similar across trauma centers on injury type, injury severity, and discharge status; yet trauma patients differed significantly in terms of mechanism of injury and regions of injury. BAMC received significantly greater proportions of patients injured from falls, firearms and with facial and head injuries than UH, which received significantly greater proportion of patients with thorax and abdominal injuries. In addition, a significantly greater proportion of patients spent more than 2 days in the ICU and greater than two total hospital days at BAMC than in UH. In comparison to military emergency departments in combat zones, BAMC had significantly lower rates of blood product administration and endotracheal intubations. Conclusions The trauma patients treated at a military level 1 trauma center were similar to those treated in the civilian level 1 trauma center in the same city, indicating the effectiveness of the only DoD Level 1 trauma center to provide experience comparable to that provided in civilian trauma centers. However, further research is needed to determine if the exposure rates to specific procedures are adequate to meet predeployment readiness requirements.

Predictors of Trauma High Resource Consumers in a Mature Trauma System

2020 ◽  
Vol 86 (5) ◽  
pp. 486-492
Author(s):  
Madison E. Morgan ◽  
Eric H. Bradburn ◽  
Tawnya M. Vernon ◽  
Brian Gross ◽  
Shreya Jammula ◽  
...  
Keyword(s):  
Gunshot Wound ◽  
Lower Extremities ◽  
Hospital Length Of Stay ◽  
Major Surgery ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Inclusion Criteria ◽  
Adult Age ◽  
Adjusted Analysis ◽  
High Resource

Background Extended hospital length of stay (LOS) is widely associated with significant healthcare costs. Since LOS is a known surrogate for cost, we sought to evaluate outliers. We hypothesized that particular characteristics are likely predictive of trauma high resource consumers (THRC) and can be used to more effectively manage care of this population. Methods The Pennsylvania Trauma Outcome Study database was retrospectively queried from 2003-2017 for all adult (age ≥15) trauma patients admitted to accredited trauma centers in Pennsylvania. THRC were defined as patients with hospital LOS two standard deviations above the population mean or ≥22 days (p<0.05). Patient demographics, comorbid conditions and clinical variables were compared between THRC and non-THRC to identify potential predictor variables. A multilevel mixed-effects logistic regression model controlling for age, gender, injury severity, admission Glasgow coma score, systolic blood pressure, and injury year assessed the adjusted impact of clinical factors in predicting THRC status. The National Trauma Data Bank (NTDB) was retrospectively queried from 2014-2016 for all adult (age ≥15) trauma patients admitted to state-accredited trauma centers and likewise were assessed for factors associated with THRC. Results A total of 465,601 patients met inclusion criteria [THRC: 16,818 (3.6%); non-THRC 448,783 (96.4%)]. Compared to non-THRC counterparts, THRC patients were significantly more severely injured (median ISS: 9 vs. 22, p<0.001). In adjusted analysis, gunshot wound (GSW) to the abdomen, undergoing major surgery and reintubation along with injury to the spine, upper or lower extremities were significantly associated with THRC. From the NTDB, 2 323 945 patients met inclusion criteria. In adjusted analysis, GSW to the abdomen was significantly associated with THRC. Penetrating injury overall was associated with decreased risk of being a THRC in the NTDB dataset. Those who had either GSW to abdomen, surgery, or reintubation required significantly longer LOS (p<0.001). Conclusions Reintubation, major surgery, gunshot wound to abdomen, along with injury to the spine, upper or lower extremities are all strongly predictive of THRC. Understanding the profile of the THRC will allow clinicians and case management to proactively put processes in place to streamline care and potentially reduce costs and LOS.

The National Trauma Data Bank story for emergency department thoracotomy: How old is too old?

Surgery ◽  
2018 ◽  
Vol 163 (3) ◽  
pp. 515-521 ◽  
Author(s):  
Lindsay A. Gil ◽  
Michael J. Anstadt ◽  
Anai N. Kothari ◽  
Michael J. Javorski ◽  
Richard P. Gonzalez ◽  
...  
Keyword(s):  
Emergency Department ◽  
Data Bank ◽  
Emergency Department Thoracotomy ◽  
National Trauma ◽  
National Trauma Data Bank

scholarly journals Tranexamic Acid (TXA) in Trauma Patients: Barriers to Use among Trauma Surgeons and Emergency Physicians

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Abdulaziz Alburaih
Keyword(s):  
Tranexamic Acid ◽  
Massive Transfusion ◽  
Positive Impact ◽  
National Level ◽  
Trauma Patients ◽  
Emergency Physicians ◽  
Major Barrier ◽  
Massive Transfusion Protocol ◽  
Trauma Surgeons ◽  
Transfusion Protocol

Objective.Tranexamic Acid (TXA) is currently the only drug with prospective clinical evidence supporting its use in bleeding trauma patients. We sought to better understand the barriers preventing its use and elicit suggestions to further its use in trauma patients in the state of Maryland.Methods. This is a cross-sectional study.Results. The overall response rate was 38%. Half of all participants reported being familiar with the CRASH-2 trial and MATTERs study. Half reported being aware of TXA as part of their institution’s massive transfusion protocol. The majority of participants felt that TXA would have a significant positive impact on the survival of trauma patients. A majority also felt that the use of TXA would increase if its administration was the responsibility of both trauma surgeons and emergency physicians.Conclusion. Only half of responders reported being aware of TXA as being part of their institution’s massive transfusion protocol. Lack of awareness of the clinical data supporting its use is a major barrier. However, most trauma providers and emergency physicians do have a favorable view of TXA and support its incorporation into massive transfusion protocols. We believe that more studies of this kind on both state and national level are needed.

Analysis of radiation exposure among pediatric trauma patients at national trauma centers

2013 ◽  
Vol 74 (3) ◽  
pp. 907-911 ◽  
Author(s):  
Anupam B. Kharbanda ◽  
Andrew Flood ◽  
Karen Blumberg ◽  
Nathan S. Kreykes
Keyword(s):  
Radiation Exposure ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Trauma Centers ◽  
National Trauma

scholarly journals Outcomes of emergency department thoracotomy in a tertiary care Canadian trauma centre

CJEM ◽  
2015 ◽  
Vol 17 (4) ◽  
pp. 353-358 ◽  
Author(s):  
Julian J Owen ◽  
Niv Sne ◽  
Angela Coates ◽  
Peter K Channan
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Survival Rates ◽  
Penetrating Trauma ◽  
Trauma Centre ◽  
Trauma Patients ◽  
National Guidelines ◽  
Emergency Department Thoracotomy ◽  
Life Saving ◽  
Record Review

AbstractObjectiveEmergency department thoracotomy (EDT) is a rare and potentially life-saving intervention performed for trauma patients in extremis. EDT is rare at Canadian trauma centres because of our infrequent occurrence of penetrating trauma. This study was undertaken to evaluate outcomes at a Canadian level 1 trauma facility and compare survival to large published datasets. Also, we evaluated the appropriateness of an EDT performed at our centre based on published national guidelines.MethodsRetrospective medical record review of all patients undergoing an EDT during their resuscitation in the emergency department. Records were identified using our trauma registry, and all charts were manually reviewed. The primary outcome was survival to hospital discharge.ResultsOver a 20-year period, 58 EDTs were performed with 6 (10.3%) survivors. Patients undergoing an EDT secondary to penetrating trauma had the highest survival (5 of 24 patients or 20.8% survival) compared to patients undergoing an EDT for blunt trauma (1 of 34 patients or 2.9% survival). Patients undergoing an EDT who had not suffered cardiac arrest represented the group with the highest survival rate (3 of 6 patients or 50% survival). The majority of EDTs (79.3%) were indicated, and no patient undergoing an EDT survived if it was performed outside of published guidelines.ConclusionsSurvival following an EDT in our small, regional trauma centre is consistent with survival rates from larger published datasets. An EDT should continue to be performed under accepted clinical indications.

scholarly journals Do Transferred Patients Increase the Risk of Venous Thromboembolism in Trauma Centers?

2017 ◽  
Vol 83 (11) ◽  
pp. 1241-1245
Author(s):  
Brian K. Yorkgitis ◽  
Olubode A. Olufajo ◽  
David Metcalfe ◽  
Gally Reznor ◽  
Joaquim M. Havens ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Risk Factor ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Vte Prophylaxis ◽  
National Trauma ◽  
Level I ◽  
Transferred Patients

Trauma patients often require initial stabilization followed by transfer for ongoing trauma care. Thus, the administration of VTE prophylaxis is often delayed until admission to the receiving hospital. It is unclear if transfer status is a risk factor for VTE. The National Trauma Database v6.2 was used to identify patients admitted to Level I and II trauma centers. Exclusions included patients on anticoagulation, <18 years, known VTE before trauma, or pregnant. Patients transferred were compared with nontransferred patients. Analysis included 736,374 patients with 189,166 (25.69%) transferred patients within 24 hours of injury. Using weighted measures, VTE was identified in 11,619 (1.50%) patients. The VTE rate was significantly higher in the transferred group compared with the nontransferred group (1.73% vs 1.42%, P = 0.002) including deep venous thrombosis (1.39% vs 1.14%, P = 0.004) and pulmonary embolism (0.45% vs 0.39%, P = 0.003). Multivariable analyses adjusting for patient-level risk factors demonstrated that transfer was associated with a higher likelihood of VTE (aOR 1.18; 95% CI: 1.09–1.28, P ≤ 0.001), pulmonary embolism (aOR 1.21; 95% CI: 1.11–1.33, P ≤ 0.001), and deep venous thrombosis (aOR 1.17; 95% CI: 1.07–1.28, P = 0.0004). Transfer status of trauma patients is a risk factor for VTE. Accepting a transferred patient results in an increased VTE risk and may not be reflective of the quality of care at the receiving facility.

Sign in / Sign up

Export Citation Format

Share Document