More is Not Better: Implications of Antibiotic Practice Management Guidelines for Penetrating Trauma Hollow Viscus Injury in a Level I Trauma Center

2019 ◽  
Vol 85 (11) ◽  
pp. 530-532
Author(s):  
David T. Pointer ◽  
Alison Smith ◽  
Douglas P. Slakey ◽  
Danielle Tatum ◽  
Lili E. Schindelar ◽  
...  
Keyword(s):  
Trauma Center ◽  
Penetrating Trauma ◽  
Practice Management ◽  
Hollow Viscus ◽  
Management Guidelines ◽  
Hollow Viscus Injury ◽  
Level I

Diagnostic performance of CT and the use of GI contrast material for detection of hollow viscus injury after penetrating abdominal trauma. Experience from a level 1 Nordic trauma center

2020 ◽  
Vol 61 (10) ◽  
pp. 1309-1315
Author(s):  
Sigurveig Thorisdottir ◽  
Gudrun L Oladottir ◽  
Mari T Nummela ◽  
Seppo K Koskinen
Keyword(s):  
Abdominal Trauma ◽  
Contrast Material ◽  
Penetrating Trauma ◽  
Gunshot Wounds ◽  
Hollow Viscus ◽  
Penetrating Abdominal Trauma ◽  
Stab Wounds ◽  
Significant Difference ◽  
Hollow Viscus Injury ◽  
Local Trauma

Background Use of gastrointestinal (GI) contrast material for computed tomography (CT) diagnosis of hollow viscus injury (HVI) after penetrating abdominal trauma is still controversial. Purpose To assess the sensitivity of CT and GI contrast material use in detecting HVI after penetrating abdominal trauma. Material and Methods Retrospective analysis (2013–2016) of patients with penetrating abdominal trauma. Data from the local trauma registry, medical records, and imaging from PACS were reviewed. CT and surgical findings were compared. Results Of 636 patients with penetrating trauma, 177 (163 men, 14 women) had abdominal trauma (mean age 34 years, age range 16–88 years): 155/177 (85%) were imaged with CT on arrival; 128/155 (83%) were stab wounds and 21/155 (14%) were gunshot wounds; 47/155 (30%) had emergent surgery after CT. Two patients were imaged using oral, rectal and i.v. contrast; 23 with rectal and i.v. contrast; and 22 with i.v. contrast only. Surgery revealed HVI in 26 patients. CT had an overall sensitivity 69.2%, specificity 90.5%, PPV 90.0%, and NPV 70.4%. CT with oral and/or rectal contrast (n = 25) had sensitivity 66.7%, specificity 71.4%, PPV 85.7%, and NPV 45.5%. CT with i.v. contrast only (n = 22) had 75% sensitivity, 100% specificity, PPV 100%, and NPV 87.5%. No statistically significant difference was found between sensitivity of CT with GI contrast material and i.v. contrast only ( P = 1). Conclusion Stab wounds were the most common cause of penetrating abdominal trauma. CT had 69.2% sensitivity and 90.5% specificity in detecting HVI. CT with GI contrast had similar sensitivity as CT with i.v. contrast only.

Management of Traumatic Vascular Injuries to the Neck: A 7-Year Experience at a Level I Trauma Center

2012 ◽  
Vol 78 (3) ◽  
pp. 335-338 ◽  
Author(s):  
Jon D. Simmons ◽  
Naveed Ahmed ◽  
Kimberly A. Donnellan ◽  
Robert E. Schmieg ◽  
John M. Porter ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Trauma Center ◽  
Chart Review ◽  
Jugular Vein ◽  
Penetrating Trauma ◽  
Vascular Injuries ◽  
Mortality And Morbidity ◽  
Carotid Artery Injuries ◽  
Level I ◽  
Significant Mortality

Injury to the carotid artery results in significant mortality and morbidity. The general consensus is to repair all injuries to the common and internal carotid arteries. Ligation is usually reserved for neurologic or hemodynamic instability. We report our experience at a Level I trauma center with vascular injuries to the neck. Retrospective chart review of all patients with vascular injuries in the neck resulting from either blunt or penetrating trauma treated at a Level I trauma center between January 2000 and February 2007. Demographics and outcomes were collected from a chart review. Twenty-five patients with vascular injuries to the neck were identified. There were 13 carotid artery injuries (CAI), five internal jugular vein (IJV) injuries, and 13 external jugular vein (EJV) injuries. Of the carotid artery injuries, six (50%) underwent operative repair (4 primary repairs and 2 bypasses), five (38%) were managed nonoperatively, and one was treated using endovascular techniques. No patient had a postoperative decrease in Glasgow Coma Scale score. There were five isolated IJV injuries (3 primary repair and 2 ligations). Four of the venous injuries (all internal jugular veins) were repaired and the remaining 13 were ligated. Vascular injuries to the neck have significant mortality and morbidity. Treatment of these injuries must be individualized. All CAI in noncomatose patients should be repaired if hemodynamically stable. All IJV injuries should be repaired but may be ligated if hemodynamically unstable. All EJV injuries can be ligated without reservation regardless of neurological status.

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.

scholarly journals Insurance Status Impacts Hospital Discharge for Penetrating Trauma Survivors: One Decade of Experience From an Urban Level I Trauma Center

2021 ◽  
Vol 233 (5) ◽  
pp. e219
Author(s):  
Samantha N. Olafson ◽  
Ryan Cohen ◽  
Pak Shan P. Leung ◽  
Benjamin Moran ◽  
Afshin Parsikia ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Trauma Center ◽  
Penetrating Trauma ◽  
Trauma Survivors ◽  
Insurance Status ◽  
Urban Level ◽  
Level I

A clinical study of hollow viscus injury in the cases of abdominal trauma

2019 ◽  
Vol 9 (1) ◽  
pp. 13-16
Author(s):  
Ashok F Shelake ◽  
◽  
James Joseph Nadar ◽  
Dwarka R Dhanve ◽  
◽  
...  
Keyword(s):  
Clinical Study ◽  
Abdominal Trauma ◽  
Hollow Viscus ◽  
Hollow Viscus Injury

scholarly journals Prehospital time and mortality in polytrauma patients: a retrospective analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
E. Berkeveld ◽  
Z. Popal ◽  
P. Schober ◽  
W. P. Zuidema ◽  
F. W. Bloemers ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Emergency Medical Services ◽  
Trauma Center ◽  
Total Mortality ◽  
Medical Services ◽  
Severely Injured ◽  
Emergency Medical ◽  
Polytrauma Patients ◽  
Level I ◽  
Prehospital Time

Abstract Background The time from injury to treatment is considered as one of the major determinants for patient outcome after trauma. Previous studies already attempted to investigate the correlation between prehospital time and trauma patient outcome. However, the outcome for severely injured patients is not clear yet, as little data is available from prehospital systems with both Emergency Medical Services (EMS) and physician staffed Helicopter Emergency Medical Services (HEMS). Therefore, the aim was to investigate the association between prehospital time and mortality in polytrauma patients in a Dutch level I trauma center. Methods A retrospective study was performed using data derived from the Dutch trauma registry of the National Network for Acute Care from Amsterdam UMC location VUmc over a 2-year period. Severely injured polytrauma patients (Injury Severity Score (ISS) ≥ 16), who were treated on-scene by EMS or both EMS and HEMS and transported to our level I trauma center, were included. Patient characteristics, prehospital time, comorbidity, mechanism of injury, type of injury, HEMS assistance, prehospital Glasgow Coma Score and ISS were analyzed using logistic regression analysis. The outcome measure was in-hospital mortality. Results In total, 342 polytrauma patients were included in the analysis. The total mortality rate was 25.7% (n = 88). Similar mean prehospital times were found between the surviving and non-surviving patient groups, 45.3 min (SD 14.4) and 44.9 min (SD 13.2) respectively (p = 0.819). The confounder-adjusted analysis revealed no significant association between prehospital time and mortality (p = 0.156). Conclusion This analysis found no association between prehospital time and mortality in polytrauma patients. Future research is recommended to explore factors of influence on prehospital time and mortality.

Facial Fractures Have Similar Outcomes When Managed by Either Otolaryngology or Plastic Surgery: Encounters From a Single Level I Trauma Center

2021 ◽  
pp. 194338752110206
Author(s):  
Ashton Christian ◽  
Beatrice J. Sun ◽  
Nima Khoshab ◽  
Areg Grigorian ◽  
Christina Y. Cantwell ◽  
...  
Keyword(s):  
Plastic Surgery ◽  
Trauma Center ◽  
Demographic Data ◽  
Open Reduction Internal Fixation ◽  
Facial Fractures ◽  
Chi Square ◽  
Single Level ◽  
Baseline Characteristics ◽  
Level I ◽  
Complications And Mortality

Study Design: Retrospective cohort. Objective: Traumatic facial fractures (FFs) often require specialty consultation with Plastic Surgery (PS) or Otolaryngology (ENT); however, referral patterns are often non-standardized and institution specific. Therefore, we sought to compare management patterns and outcomes between PS and ENT, hypothesizing no difference in operative rates, complications, or mortality. Methods: We performed a retrospective analysis of patients with FFs at a single Level I trauma center from 2014 to 2017. Patients were compared by consulting service: PS vs. ENT. Chi-square and Mann-Whitney-U tests were performed. Results: Of the 755 patients with FFs, 378 were consulted by PS and 377 by ENT. There was no difference in demographic data ( P > 0.05). Patients managed by ENT received a longer mean course of antibiotics (9.4 vs 7.0 days, P = 0.008) and had a lower rate of open reduction internal fixation (ORIF) (9.8% vs. 15.3%, P = 0.017), compared to PS patients. No difference was observed in overall operative rate (15.1% vs. 19.8%), use of computed tomography (CT) imaging (99% vs. 99%), time to surgery (65 vs. 55 hours, P = 0.198), length of stay (LOS) (4 vs. 4 days), 30-day complication rate (10.6% vs. 7.1%), or mortality (4.5% vs. 2.6%) (all P > 0.05). Conclusion: Our study demonstrated similar baseline characteristics, operative rates, complications, and mortality between FFs patients who had consultation by ENT and PS. This supports the practice of allowing both ENT and PS to care for trauma FFs patients, as there appears to be similar standardized care and outcomes. Future studies are needed to evaluate the generalizability of our findings.

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.

scholarly journals Transfer Time After Acceptance to a Level I Trauma Center

2018 ◽  
Vol 2 (2) ◽  
pp. e081
Author(s):  
Ena Nielsen ◽  
David L. Skaggs ◽  
Liam R. Harris ◽  
Lindsay M. Andras
Keyword(s):  
Trauma Center ◽  
Transfer Time ◽  
Level I
Sign in / Sign up

Export Citation Format

Share Document