Trauma Team Activation at a Level I Trauma Center in Southern California: Time of Day Matters

2019 ◽  
Vol 85 (10) ◽  
pp. 1142-1145
Author(s):  
Morgan Schellenberg ◽  
Kenji Inaba ◽  
Bryan E. Love ◽  
Zachary Warriner ◽  
Matthew J. Forestiere ◽  
...  
Keyword(s):  
Injury Severity ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Trauma Team ◽  
Time Of Day ◽  
Operative Intervention ◽  
Trauma Patients ◽  
Mechanism Of Injury ◽  
Trauma Team Activation ◽  
Level I

The ACS Committee on Trauma specifies prehospital criteria that trigger trauma team activation (TTA). The study aims to define the relationship between TTA and time of day, mechanism of injury, and need for operative intervention. All trauma patients presenting to LAC1USC (January 2008–July 2018) after triggering TTA were screened. Patients were excluded if time of ED arrival was undocumented. Demographics, injury data, and outcomes were analyzed. After exclusions (<1%), 54,826 patients were enrolled. The median age was 35 [IQR 23–53]. The median Injury Severity Score was 4 [1–10]. The most common mechanisms of injury were falls (n = 14,166; 31%), auto versus pedestrian collisions (n = 11,921; 26%), and motor vehicle collisions (n = 11,024; 24%). Penetrating trauma comprised 16 per cent (n = 8,686). The busiest hour for TTAs was 19:00 to 20:00, although penetrating trauma was most common between 23:00 and 01:00. Emergent surgical intervention in absolute numbers was most frequent between 20:00 and 01:00. As a proportion of the number of TTAs per hour, emergent operative intervention was most frequent between 23:00 and 06:00. In conclusion, the volume of TTAs and the triggering mechanism of injury vary significantly by time of day. The need for operative intervention is highest overnight. This information can be used to help increase hospital preparedness and allocate resources accordingly.

Nocturnal Violence: Implications for Resident Trauma Operative Experiences

2012 ◽  
Vol 78 (6) ◽  
pp. 657-663 ◽  
Author(s):  
Colyn J. Watkins ◽  
Paul L. Feingold ◽  
Barry Hashimoto ◽  
Laura S. Johnson ◽  
Christopher J. Dente
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Time Of Day ◽  
Operative Intervention ◽  
Peak Time ◽  
Trauma Patients ◽  
Time Period ◽  
Work Hour ◽  
Level I

Trauma centers face novel challenges in resource allocation in an era of cost consciousness and work-hour restrictions. Studies have shown that time of day and day of week affect trauma admission volume; however, these studies were performed in cold climates. Data from 2000 to 2010 at a Level I trauma center were reviewed. Demographic, injury severity, and injury timing from 23,827 trauma patients were analyzed along with their emergency department disposition (operating room, intensive care unit, ward) and final outcome. Nighttime arrivals (NAs) accounted for 56.6 per cent and daytime arrivals accounted for 43.4 per cent of total admissions. The increase in NAs was most pronounced during the period from midnight to 6 AM on weekends ( P < 0.05). Also, the period from midnight to 6 AM on weekends showed a significantly increased proportion of penetrating trauma ( P < 0.01). Similarly, there was an increased rate of trauma arrivals needing emergent operative intervention in the period between midnight and 6 AM on weekends when compared with any other time period ( P < 0.01). In a southern Level I trauma center, patient volume varies nonrandomly with time. Emergent operative intervention is more likely between midnight and 6 AM, the peak time for penetrating trauma. Because resident operative experience is maximized at night and on weekends, coverage during these periods should remain a priority for residency programs.

Correlation of Clinical Findings and Autopsy Results after Fatal Injury from Motor Vehicular-Related Crashes

2006 ◽  
Vol 72 (3) ◽  
pp. 282-287 ◽  
Author(s):  
Luke Y. Shen ◽  
Kendra N. Marcotte ◽  
Stephen D. Helmer ◽  
Mary H. Dudley ◽  
R. Stephen Smith
Keyword(s):  
Injury Severity ◽  
Motor Vehicle ◽  
Treatment Time ◽  
Clinical Findings ◽  
Trauma Patients ◽  
Additional Information ◽  
Total Treatment Time ◽  
Glascow Coma Scale ◽  
American College Of Surgeons ◽  
Level I

In the past, autopsy served as the gold standard to document diagnostic accuracy. Although a valuable contributor to medical education, information collected from autopsies is frequently delayed and poorly used. The purpose of this study was to determine the degree of concordance between clinical findings and autopsy results of trauma patients involved in fatal vehicular-related crashes. A 10-year retrospective review of trauma patients involved in fatal vehicular-related crashes who subsequently had an autopsy performed was conducted at an American College of Surgeons-verified Level I trauma center. The clinical record, trauma registry data, and autopsy results were reviewed. Degree of concordance was evaluated using the Goldman Type Errors Criteria. A total of 207 decedents were included (mean age, 41; 63% male; median Glascow Coma Scale score, 3; median Injury Severity Score, 37). The majority (69.6%) of decedents were injured in motor vehicle crashes. Total treatment time was <15 minutes in 29.0 per cent of cases, <6 hours in 59.4 per cent of cases, and <24 hours in 73.9 per cent of cases. Location of death was the emergency department (43.0%), the intensive care unit (49.8%), the operating room (5.4%), and the nursing floor (1.0%). There were no Goldman Class I or IV type errors, (i.e., no major or minor discrepancies, respectively, that may have altered therapy or survival of the patient). Following ATLS-based protocols results in appropriate identification of clinically significant injuries in patients involved in motor vehicular-related crashes. The routine use of autopsy results offers little additional information to a mature American College of Surgeons-verified Level I trauma program.

scholarly journals Did Amendments to the Ontario Highway Traffic Act in 2009-2010 Affect the Proportion of Alcohol-Related Motor Vehicle Collisions Seen at a Level I Trauma Centre over a 10-year Period?

CJEM ◽  
2016 ◽  
Vol 19 (2) ◽  
pp. 106-111
Author(s):  
Meghan Garnett ◽  
Tanya Charyk Stewart ◽  
Michael R Miller ◽  
Rodrick Lim ◽  
Kristine Van Aarsen ◽  
...  
Keyword(s):  
Injury Severity ◽  
Trauma Registry ◽  
Motor Vehicle ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Highway Traffic ◽  
Motor Vehicle Collisions ◽  
Vehicle Collisions ◽  
Level I ◽  
Legislative Amendments

AbstractObjectivesTo determine if changes to the Ontario Highway Traffic Act (OHTA) in 2009 and 2010 had an effect on the proportion of alcohol-related motor vehicle collisions (MVCs) presenting to a trauma centre over a 10-year period.MethodsA retrospective review of the trauma registry at a Level I trauma centre in southwestern Ontario was undertaken. The trauma registry is a database of all trauma patients with an injury severity score (ISS) ≥12 and/or who had trauma team activation. Descriptive statistics were calculated. Interrupted time series analyses with ARIMA modeling were performed on quarterly data from 2004-2013.ResultsA total of 377 drivers with a detectable serum ethanol concentration (SEC) were treated at our trauma centre over the 10-year period, representing 21% of all MVCs. The majority (330; 88%) were male. The median age was 31 years, median SEC was 35.3 mmol/L, and median ISS was 21. A total of 29 (7.7%) drinking drivers died from their injuries after arriving to hospital. There was no change in the proportion of drinking drivers after the 2009 amendment, but there was a significant decline in the average SEC of drinking drivers after changes to the law. There was no difference in the proportion of drinking drivers ≤21 years after introduction of the 2010 amendment for young and novice drivers.ConclusionsThere was a significance decline in the average SEC of all drinking drivers after the 2009 OHTA amendment, suggesting that legislative amendments may have an impact on drinking before driving behaviour.

scholarly journals Major trauma patients are not who you might think they are: a linked data study

2019 ◽  
Vol 16 ◽  
Author(s):  
Elizabeth Brown ◽  
Hideo Tohira ◽  
Paul Bailey ◽  
Daniel Fatovich ◽  
Judith Finn
Keyword(s):  
Major Trauma ◽  
Injury Severity ◽  
Motor Vehicle ◽  
High Energy ◽  
Categorical Variables ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Continuous Variables ◽  
Mechanism Of Injury ◽  
Young Males

IntroductionMajor trauma patients are often perceived as being young males injured by high energy transfer mechanisms. The aim of this study was to describe the demographics of major trauma patients who were transported to hospital by ambulance.MethodsThis is a retrospective cohort study of adult major trauma (injury severity score >15) patients transported to hospital by St John Western Australia emergency ambulance in metropolitan Perth, between 1 January 2013 and 31 December 2016. To describe the cohort, median and interquartile range (IQR) were used for continuous variables and counts and percentages for categorical variables. Differences between mechanism of injury groups were assessed using the Kruskal-Wallis test. Trauma deaths were defined as early (declared deceased within 24 hours) or late (declared deceased within 30 days). ResultsA total of 1625 patients were included. The median age was 51 years (IQR 30-75) and 1158 (71%) were male. Falls from standing were the most common mechanism of injury (n=460, 28%) followed by motor vehicle crashes (n=259, 16%). Falls from standing were responsible for the majority of early (n=45/175, 26%) and late deaths (n=69/158, 44%). A large number of early deaths also resulted from motorbike crashes (n=32/175, 18%) with a median age of 34 years (IQR 21-46, p<0.001). ConclusionMajor trauma is not only a disease of the young. More than half of the cohort was more than 51 years of age and the most common cause was a fall from standing. Pre-hospital care must evolve to address the needs of a changing trauma patient demographic.

Families’ Perception of the Value of Timed Daily “Family Rounds” in a Trauma ICU

2005 ◽  
Vol 71 (10) ◽  
pp. 886-891 ◽  
Author(s):  
Alicia J. Mangram ◽  
T. McCauley ◽  
D. Villarreal ◽  
J. Berne ◽  
D. Howard ◽  
...  
Keyword(s):  
Family Physician ◽  
Trauma Team ◽  
Time Of Day ◽  
Trauma Patients ◽  
Patient Admissions ◽  
The Family ◽  
Physician Relationship ◽  
Level I ◽  
Scheduled Time ◽  
Trauma Surgeons

Daily communications between the ICU trauma patients’ families and the trauma team are often limited due to the unpredictable nature of subsequent patient admissions and operative procedures. In order to improve the lines of family-physician communication and educate residents regarding family communication, our level I trauma center instituted daily “Family Rounds” (FR). FR occur at the same time every day, in the patient's ICU room. The purpose of this study was to determine whether families valued the scheduled daily FR, to establish whether FR improved the family-physician relationship, and to delineate strengths and weaknesses of the present structure of our FR. We mailed surveys to family members of trauma patients hospitalized in the trauma ICU for ≥3 days. A total of 55 (22%) families responded. Combining “excellent” and “good” responses, 86.5 per cent of families looked forward to having a specific time of day to meet with the trauma team, and 90 per cent liked having rounds in the ICU room with the patient. However, 36 per cent did not like having only scheduled time for FR. The majority, 75 per cent, believed that all concerns were addressed during FR, and 84.9 per cent rated their overall experience as either excellent or good. Scheduled FR appear to improve communication between trauma surgeons and patients’ families, enhance the family-physician relationship, and strengthen our surgical residency teaching program.

The Triage of Injured Patients: Mechanism of Injury, Regardless of Injury Severity, Determines Hospital Destination

2016 ◽  
Vol 82 (4) ◽  
pp. 356-361 ◽  
Author(s):  
Kristan Staudenmayer ◽  
N. Ewen Wang ◽  
Thomas G. Weiser ◽  
Paul Maggio ◽  
Robert C. Mackersie ◽  
...  
Keyword(s):  
Injury Severity ◽  
Hospital Admissions ◽  
Motor Vehicle ◽  
Health Planning ◽  
Trauma System ◽  
Penetrating Trauma ◽  
Emergency Department Visits ◽  
Three Dimensions ◽  
Mechanism Of Injury ◽  
Injured Patients

The target rate for trauma undertriage is <5 per cent, but rates are as high as 30 to 40 per cent in many trauma systems. Wehypothesized that high undertriage rates were duetothe tendencyto undertriage injured elderly patients and a growing elderly population. We conducted a retrospective analysis of all hospital visits in California using the Office of Statewide Health Planning and Development Database over a 5-year period. All hospital admissions and emergency department visits associated with injury were longitudinally linked. The primary outcome was triage pattern. Triage patterns were stratified across three dimensions: age, mechanism of injury, and access to care. A total of 60,182 severely injured patients were included in the analysis. Fall-related injuries were frequently undertriaged compared with injuries from motor vehicle collisions (MVCs) and penetrating trauma (52% vs 12% and 10%, respectively). This pattern was true for all age groups. Conversely, MVCs and penetrating traumas were associated with high rates of overtriage (>70% for both). In conclusion, in contrast to our hypothesis, we found that triage is largely determined by mechanism of injury regardless of injury severity. High rates of undertriage are largely due to the undertriage of fall-related injuries, which occurs in both younger and older adults. Patients injured after MVCs and penetrating trauma victims are brought to trauma centers regardless of injury severity, resulting in high rates of overtriage. These findings suggest an opportunity to improve trauma system performance.

scholarly journals The cost and compensability of trauma patients

2009 ◽  
Vol 33 (1) ◽  
pp. 84 ◽  
Author(s):  
Kate Curtis ◽  
Cara Dickson ◽  
Deborah Black ◽  
Thomas Nau
Keyword(s):  
Health Insurance ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Direct Costs ◽  
Trauma Centre ◽  
Third Party ◽  
Workers Compensation ◽  
Trauma Patients ◽  
Mechanism Of Injury ◽  
Insurance Cover

Injury in Australia was responsible for 400 000 hospitalisations in 2002. This study aimed to examine the direct costs of trauma patients in a Level 1 trauma centre and determine the compensability of those patients. Data on all admitted patients (206) filling trauma criteria were collected prospectively over a 3-month period (November 2006 to January 2007). A 10-question survey was completed on each patient to record mechanism of injury, third party private health insurance or workers compensation, and direct costs were also obtained. 30% of trauma admissions had an injury severity score (ISS)> 15 (n = 62; median ISS =9; range, 1?56). Median length of stay was 3 days (range, 1?126). Almost half (47%) of the patients were involved in road trauma, and 29% in falls. More than half (53.4%) were eligible for compensation (21.8% of patients had full hospital health insurance cover, 21.4% third party insurance and 9.2% workers compensation). The mechanism of injury with the highest median cost per patient was assault, followed by pedal cyclists, pedestrians then motor vehicle collisions.

scholarly journals Impact of COVID-19 pandemic on injury prevalence and pattern in the Washington, DC Metropolitan Region: a multicenter study by the American College of Surgeons Committee on Trauma, Washington, DC

2021 ◽  
Vol 6 (1) ◽  
pp. e000659
Author(s):  
Marc Chodos ◽  
Babak Sarani ◽  
Andrew Sparks ◽  
Brandon Bruns ◽  
Shailvi Gupta ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Trauma Center ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Motor Vehicle Crash ◽  
Metropolitan Region ◽  
Washington Dc ◽  
Mechanism Of Injury ◽  
The Impact

BackgroundThe COVID-19 pandemic has had far-reaching effects on healthcare systems and society with resultant impact on trauma systems worldwide. This study evaluates the impact the pandemic has had in the Washington, DC Metropolitan Region as compared with similar months in 2019.DesignA retrospective multicenter study of all adult trauma centers in the Washington, DC region was conducted using trauma registry data between January 1, 2019 and May 31, 2020. March 1, 2020 through May 31, 2020 was defined as COVID-19, and January 1, 2019 through February 28, 2020 was defined as pre-COVID-19. Variables examined include number of trauma contacts, trauma admissions, mechanism of injury, Injury Severity Score, trauma center location (urban vs. suburban), and patient demographics.ResultsThere was a 22.4% decrease in the overall incidence of trauma during COVID-19 compared with a 3.4% increase in trauma during pre-COVID-19. Blunt mechanism of injury decreased significantly during COVID-19 (77.4% vs. 84.9%, p<0.001). There was no change in the specific mechanisms of fall from standing, blunt assault, and motor vehicle crash. The proportion of trauma evaluations for penetrating trauma increased significantly during COVID-19 (22.6% vs. 15.1%, p<0.001). Firearm-related and stabbing injury mechanisms both increased significantly during COVID-19 (11.8% vs. 6.8%, p<0.001; 9.2%, 6.9%, p=0.002, respectively).Conclusions and relevanceThe overall incidence of trauma has decreased since the arrival of COVID-19. However, there has been a significant rise in penetrating trauma. Preparation for future pandemic response should include planning for an increase in trauma center resource utilization from penetrating trauma.Level of evidenceEpidemiological, level III.

scholarly journals 35. Emergency Medical Services Use of Trauma Triage Criteria to Stratify Patients by Injury Severity and Need for Emergent Intervention

1996 ◽  
Vol 11 (S2) ◽  
pp. S32-S32
Author(s):  
Robert E. O'Connor ◽  
Glen H. Tinkoff ◽  
Susan Mascioli ◽  
Ross E. Megargel
Keyword(s):  
Injury Severity ◽  
Vital Signs ◽  
Penetrating Trauma ◽  
Trauma Patients ◽  
Chi Square ◽  
Probability Of Survival ◽  
Trauma Service ◽  
Severity Scores ◽  
Serious Injury ◽  
Level I

Purpose: Prehospital triage criteria (PTC) have been used to classify patients according to risk of serious injury. This study was conducted determine whether PTC could be used to identify serious injury, the need for intensive care (ICU), or immediate operative intervention (IOI).Methods: Data for this observational study were gathered prospectively, at a level-I trauma center, from a patient cohort admitted to the trauma service from 01 February to 31 July 1995. Specific triage criteria, based on information given by EMS prior to arrival were used to categorize patients by severity. Patients classified as most serious (codes) had the following: shock, major anatomic injury or proximal penetrating trauma. Patients classified as more serious (alerts) had one of the following: abnormal vital signs, Glasgow Coma Scale <13, moderate anatomic injury, high-risk mechanism of injury, or co-morbid factors. Patients not meeting either set of criteria, but were admitted, served as controls (consults). Injury severity scores (ISS) and probability of survival (Probsurvival) were calculated for each patient. The percentage admitted to the ICU, operating room (OR), or requiring IOI, were tabulated. Statistical analysis was performed using ANOVA, Mest and chi-square.

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