Emergency Trauma Providers as Equal Partners: From “Proof of Concept” to “Outcome Parity”

2019 ◽  
Vol 85 (9) ◽  
pp. 961-964
Author(s):  
Kathryn C. Kelley ◽  
Alex Alers ◽  
Charles Bendas ◽  
Peter G. Thomas ◽  
James Cipolla ◽  
...  
Keyword(s):  
United States ◽  
Injury Severity Score ◽  
Severity Score ◽  
Functional Outcomes ◽  
Injury Severity ◽  
The United States ◽  
Patient Age ◽  
Lengths Of Stay ◽  
Patient Âgé ◽  
Surgical Critical Care

Enmeshment of emergency trauma providers (ETPs) into the United States health-care fabric resulted in the establishment of a formalized surgical critical care fellowship and certification for emergency medicine trainees. The aim of this study was to compare trauma outcomes for surgery-trained providers (STPs) and ETPs at our institution, hypothesizing patient outcome equivalency. We performed an institutional review board–exempt institutional registry review (January 1, 2004 to August 1, 2018), comparing 74 STPs and 6 ETPs. Comparator variables included all-cause mortality, all-cause morbidity, CTimaging studies per provider, time in ED (min), hospital/ICU lengths of stay, ICU admissions, and functional outcomes on discharge. Statistical comparisons included chi-square test for categorical data and analysis of covariance for continuous data (adjustments made for patient age, Injury Severity Score, and trauma mechanism; all P < 0.20). Statistical significance was set at P < 0.05, with an equivalence study design. A total of 33,577 trauma resuscitations were reviewed (32,299 STP-led and 1,278 ETP-led). Except for patient age (STP 50.2 ± 25.9 vs ETP 54.9 ± 25.3 years), Injury Severity Score (8.47 ± 8.14 vs 9.22 ± 8.40), and ICU admissions (16.1% vs 18.8%), we noted no significant intergroup differences. ETPs’ performance was equivalent to that of STPs for all primary comparator variables (mortality, morbidity, CT utilization, time in the ED, lengths of stay, and functional outcomes). Incorporation of ETPs into our trauma center resulted in outcome parity between ETPs and STPs, while simultaneously expanding the expertise and experiential diversity within our multidisciplinary team. This study provides support for further incorporation of ETPs as equal partners across the growing network of United States regional trauma centers.

scholarly journals Trauma and Injury Severity Score modification for predicting survival of trauma in one regional emergency medical center in Korea: Construction of Trauma and Injury Severity Score coefficient model

2018 ◽  
Vol 26 (4) ◽  
pp. 225-232 ◽  
Author(s):  
In Hye Kang ◽  
Kang Hyun Lee ◽  
Hyun Youk ◽  
Jeong Il Lee ◽  
Hee Young Lee ◽  
...  
Keyword(s):  
United States ◽  
Survival Rate ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Medical Center ◽  
The United States ◽  
Trauma Patients ◽  
Analysis Model ◽  
Trauma And Injury

Background: The problem that is central to trauma research is the prediction of survival rate after trauma. Trauma and Injury Severity Score is being used for predicting survival rate after trauma. Many countries have conducted a study on the classification, characteristics of variables, and the validity of the Trauma and Injury Severity Score model. However, few investigations have been made on the characteristics of coefficients or variables related to Trauma and Injury Severity Score in Korea. Objectives: There is a need for coefficient analysis of Trauma and Injury Severity Score which was created based on the United States database to be optimized for the situation in Korea. Methods: This study examined how the currently used Trauma and Injury Severity Score coefficients were developed and created for trauma patients visiting the emergency department in a hospital in Korea using the analytical method. A total of 34,340 trauma patients who were hospitalized into an emergency center from January 2012 to December 2014 for 3 years were analyzed with trauma registry established on August 2006. Results: Trauma and Injury Severity Score coefficients were transformed with the methods that were used to make the existing Trauma and Injury Severity Score coefficients using the trauma patients’ data. Regression coefficients (B) were drawn by building up a logistic regression analysis model that used variables such as Injury Severity Score, Revised Trauma Score, and age depending on survival with Trauma and Injury Severity Score. Conclusion: With regard to Trauma and Injury Severity Score established in the United States differing from Korea in injury types, it seems possible to realize significant survival rate by deriving coefficients with data in Korea and reanalyzing them.

scholarly journals Financial burden of pediatric firearm-related injury admissions in the United States

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252821
Author(s):  
Jordan S. Taylor ◽  
Sriraman Madhavan ◽  
Ryan W. Han ◽  
Julia M. Chandler ◽  
Lakshika Tenakoon ◽  
...  
Keyword(s):  
United States ◽  
Length Of Stay ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Financial Burden ◽  
The United States ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Income Quartile

Pediatric firearm-related injuries pose a significant public health problem in the United States, yet the associated financial burden has not been well described. This is the first study examining national data on the cost of initial hospitalization for pediatric firearm-related injuries. In this retrospective review, the Healthcare Cost and Utilization Project Kids’ Inpatient Database from the years 2003, 2006, 2009, and 2012 was used to identify all patients 18 years of age and under who were admitted with firearm-related injuries. We compared demographic and discharge-level data including injury severity score, hospital length of stay, income quartile, injury intent, and inflation-adjusted hospital costs across age groups (0–5, 6–9, 10–15, 16–18 years). There were approximately 4,753 pediatric firearm-related admissions each year, with a median hospitalization cost of $12,984 per patient. Annual initial hospitalization costs for pediatric firearm injuries were approximately $109 million during the study period. Pediatric firearm-related injuries predominately occured among older teenagers (74%, 16–18 years), males (89%), black individuals (55%), and those from the lowest income quartile (53%). We found significant cost variation based on patient race, income quartile, injury severity score, intent, hospital length of stay, disposition, and hospital region. Inflation-adjusted hospitalization costs have increased significantly over the study period (p < 0.001). Pediatric firearm-related injuries are a large financial burden to the United States healthcare system. There are significant variations in cost based on predictable factors like hospital length of stay and injury severity score; however, there are also substantial discrepancies based on hospital region, patient race, and income quartile that require further investigation.

scholarly journals A traumatic injury mortality prediction (TRIMP) based on a comprehensive assessment of abbreviated injury scale 2005 predot codes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Muding Wang ◽  
Guohu Zhang ◽  
Degang Cong ◽  
Yunji Zeng ◽  
Wenhui Fan ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Characteristic Curve ◽  
Traumatic Injury ◽  
The United States ◽  
Mortality Prediction ◽  
Abbreviated Injury Scale ◽  
Body Regions ◽  
Injury Mortality

AbstractAbbreviated Injury Scale (AIS)-based systems such as injury severity score (ISS), exponential injury severity score (EISS), trauma mortality prediction model (TMPM), and injury mortality prediction (IMP), classify anatomical injuries with limited accuracy. The widely accepted alternative, trauma and injury severity score (TRISS), improves the prediction rate by combining an anatomical index of ISS, physiological index (the Revised Trauma Score, RTS), and the age of patients. The study introduced the traumatic injury mortality prediction (TRIMP) with the inclusion of extra clinical information and aimed to compare the ability against the TRISS as predictors of survival. The hypothesis was that TRIMP would outperform TRISS in prediction power by incorporating clinically available data. This was a retrospective cohort study where a total of 1,198,885 injured patients hospitalized between 2012 and 2014 were subset from the National Trauma Data Bank (NTDB) in the United States. A TRIMP model was computed that uses AIS 2005 (AIS_05), physiological reserve and physiological response indicators. The results were analysed by examining the area under the receiver operating characteristic curve (AUC), the Hosmer–Lemeshow (HL) statistic, and the Akaike information criterion. TRIMP gave both significantly better discrimination (AUCTRIMP, 0.964; 95% confidence interval (CI), 0.962 to 0.966 and AUCTRISS, 0.923; 95% CI, 0.919 to 0.926) and calibration (HLTRIMP, 14.0; 95% CI, 7.7 to 18.8 and HLTRISS, 411; 95% CI, 332 to 492) than TRISS. Similar results were found in statistical comparisons among different body regions. TRIMP was superior to TRISS in terms of accurate of mortality prediction, TRIMP is a new and feasible scoring method in trauma research and should replace the TRISS.

scholarly journals Intentional fallers with complex pelvic and acetabular fractures do not have worse radiological and functional outcomes than accidental fallers

2019 ◽  
Author(s):  
Yi-Hsun Yu ◽  
Ying-Chao Chou ◽  
Yung-Heng Hsu ◽  
I-Jung Chen ◽  
Lien-Chung Wei
Keyword(s):  
Mental Disorders ◽  
Injury Severity Score ◽  
Severity Score ◽  
Functional Outcomes ◽  
Injury Severity ◽  
Adjustment Disorder ◽  
Acetabular Fractures ◽  
Loss To Follow Up ◽  
New Injury Severity Score

Abstract Intentional fallers with complex pelvic and acetabular fractures were thought to have a worse prognosis because of their mental disorders. We aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis surgeries and to compare the radiological and functional outcomes between intentional and accidental fallers.Methods Between 2014 and 2017, fallers with complex pelvic and acetabular fractures who survived from resuscitation and complete surgical treatments were enrolled and investigated.Results Forty-nine fallers who underwent osteosynthesis for pelvic and acetabular fractures were included. Sixteen patients were intentional fallers, whereas the rest of the patients fell accidently. All patients who fell intentionally had pre-existing mental disorders, and the major diagnosis was adjustment disorder. Intentional fallers presented with younger age, higher injury severity score and new injury severity score, longer intensive care unit and hospital stay, early loss to follow-up, and worse functional outcomes at the 6-month follow-up. However, the radiological and functional outcomes at the 12-month follow-up did not significantly differ between the intentional and accidental fallers.Conclusion In conclusion, the intentional fallers with complex pelvic and acetabular fractures may have worse clinical presentations initially, but their radiological and functional outcomes may become comparable to those of accidental fallers after treatments.

Disseminierte intravasale Gerinnung und Fibrinolyse in der Frühphase nach Polytrauma

1995 ◽  
Vol 15 (02) ◽  
pp. 79-86
Author(s):  
L. Lampl ◽  
M. Helm ◽  
M. Tisch ◽  
K. H. Bock ◽  
E. Seifried
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Tissue Type ◽  
Disseminierte Intravasale Gerinnung

ZusammenfassungGerinnungsstörungen nach einem Polytrauma werden eine große Bedeutung für die weitere Prognose der Patienten beigemessen. In einer prospektiv angelegten Studie wurden bei 20 polytraumatisierten Patienten Gerinnungsund Fibrinolyseparameter analysiert, um deren Veränderungen während der präklinischen Phase zu definieren. Die Blutentnahmen wurden zum frühestmöglichen Zeitpunkt am Unfallort und bei Klinikübergabe durchgeführt. Die gewonnenen Proben wurden mit Hilfe eines speziell konzipierten »Kleinlabors« noch vor Ort verarbeitet, um möglichst native Meßwerte zu erhalten. Die Patienten wurden dem Schweregrad der Verletzung entsprechend kategorisiert und hatten einen Verletzungsschweregrad nach NACA > IV und einen Injury Severity Score (ISS) > 20. Die Ergebnisse zeigen, daß bereits in der sehr frühen Phase nach Eintritt des Traumas schwerwiegende Veränderungen des Gerinnungsund Fibrinolysesystems eintreten. Die frühzeitige Thrombingenerierung führt zu einer Verbrauchskoagulopathie und reaktiven Hyperfibrinolyse. Zusätzlich erzeugt die Freisetzung von endothelständigem Tissue-type-Plasminogenaktivator eine primäre Hyperfibrinolyse. Die Veränderungen des Gerinnungsund Fibrinolysesystems in der frühen präklinischen Phase nach Polytrauma können zu schwerwiegenden klinischen Komplikationen wie Blutungen, thromboembolischen Komplikationen und zur Ausbildung von Schockorganen führen.

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