Non-Trauma Service Admissions: Should We Care?

2020 ◽  
Vol 86 (1) ◽  
pp. 15-20
Author(s):  
Brandon J. Fumanti ◽  
Lisa Szydziak ◽  
Michael D. Grossman
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Care Process ◽  
Similar Proportion ◽  
Process Of Care ◽  
Discharge Disposition ◽  
Trauma Service ◽  
Appropriateness Of Care ◽  
Severity Scores ◽  
Injured Patients

The American College of Surgeons Committee on Trauma requires that trauma centers with greater than 10 per cent injured patients admitted to non-trauma services (NTSs) have processes to review these for appropriateness of care. We previously described an algorithm to determine the appropriateness of NTS admissions. Our objective was to determine if the outcome and process of care was similar between TS- and NTS-admitted patients. We conducted a retrospective analysis of our trauma registry. NTS-appropriate patients by algorithm were included. Differences between patients admitted to a TS and an NTS were compared. Nine hundred forty-one patients met the algorithm criteria as appropriate for the NTS; 694 were admitted to TS and 247 to NTS. Contact with TS was the most common association with admission to TS. NTS patients were older and had similar Injury Severity Scores, and a similar proportion had three or greater pre-existing comorbidities. NTS-admitted patients had similar risk for mortality and complications, but longer length of stay, and were less likely to have a desirable discharge disposition. Minimally injured elderly patients constitute most of NTS and a large proportion of TS admissions. NTS admission seems appropriate with respect to mortality and complications. Differences in the care process may have accounted for longer length of stay and differences in disposition destination.

Impact of Acute Care General Surgery Coverage by Trauma Surgeons on the Trauma Patient

2008 ◽  
Vol 74 (6) ◽  
pp. 494-502 ◽  
Author(s):  
Paul J. Schenarts ◽  
Sachin V. Phade ◽  
Claudia E. Goettler ◽  
Brett H. Waibel ◽  
Steven C. Agle ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Trauma Patient ◽  
Acute Care ◽  
General Surgery ◽  
Injury Severity ◽  
Trauma Patients ◽  
Trauma Service ◽  
Severity Scores ◽  
Trauma Surgeons ◽  
The Impact

Although acute care general surgery (ACS) coverage by trauma surgeons may help re-invigorate the field of trauma surgery, introducing additional responsibilities to an already overburdened system may negatively impact the trauma patient. Our purpose was to determine the impact on the trauma patient of a progressive integration of ACS coverage into a trauma service. Data from a university, Level I trauma registry was retrospectively reviewed to compare demographics, injury severity, complications, and outcomes over a 6-year period. During this study period, the trauma service treated only trauma patients for 32 months, then added ACS coverage 2 days per week for 32 months, and then expanded to 4 days per week coverage for 9 months. Trauma patients admitted during periods of ACS coverage were not different with respect to gender, mechanism of injury, Revised Trauma Score, or Glasgow Coma Score; however, they were slightly older and had slightly higher injury severity scores. As ACS coverage progressively increased, trauma patients had an increase in ventilator days ( P < 0.0001), intensive care unit length of stay ( P < 0.0001), and hospital length of stay ( P < 0.0001). Occurrences of neurologic, pulmonary, gastrointestinal, and infectious complications were similar during all three time periods, whereas cardiac and renal complications progressively increased after ACS coverage was added. Mortality remained unchanged after ACS integration.

scholarly journals A retrospective cohort study of 27,049 polytraumatized patients age 60 and above: identifying changes over 16 years

2021 ◽  
Author(s):  
Y. Kalbas ◽  
M. Lempert ◽  
F. Ziegenhain ◽  
J. Scherer ◽  
V. Neuhaus ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Descriptive Analysis ◽  
Patient Characteristics ◽  
Severe Trauma ◽  
Diagnostic Tools ◽  
Trauma Patients ◽  
Treatment Algorithms ◽  
Injured Patients ◽  
Over Time

Abstract Purpose The number of severely injured patients exceeding the age of 60 has shown a steep increase within the last decades. These patients present with numerous co-morbidities, polypharmacy, and increased frailty requiring an adjusted treatment approach. In this study, we establish an overview of changes we observed in demographics of older severe trauma patients from 2002 to 2017. Methods A descriptive analysis of the data from the TraumaRegister DGU® (TR-DGU) was performed. Patients admitted to a level one trauma center in Germany, Austria and Switzerland between 2002 and 2017, aged 60 years or older and with an injury severity score (ISS) over 15 were included. Patients were stratified into subgroups based on the admission: 2002–2005 (1), 2006–2009 (2), 2010–2013 (3) and 2014–2017 (4). Trauma and patient characteristics, diagnostics, treatment and outcome were compared. Results In total 27,049 patients with an average age of 73.9 years met the inclusion criteria. The majority were males (64%), and the mean ISS was 27.4. The proportion of patients 60 years or older [(23% (1) to 40% (4)] rose considerably over time. Trauma mechanisms changed over time and more specifically low falls (< 3 m) rose from 17.6% (1) to 40.1% (4). Altered injury patterns were also identified. Length-of-stay decreased from 28.9 (1) to 19.5 days (4) and the length-of-stay on ICU decreased from 17.1 (1) to 12.7 days (4). Mortality decreased from 40.5% (1) to 31.8% (4). Conclusion Length of stay and mortality decreased despite an increase in patient age. We ascribe this observation mainly to increased use of diagnostic tools, improved treatment algorithms, and the implementation of specialized trauma centers for older patients allowing interdisciplinary care.

scholarly journals Improving length of stay on a trauma service

2021 ◽  
Vol 6 (1) ◽  
pp. e000744
Author(s):  
Walter L Biffl ◽  
Ning Lu ◽  
Peter R Schultz ◽  
Jiayan Wang ◽  
Matthew R Castelo ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Care Management ◽  
Injury Severity ◽  
Trauma Registry ◽  
Elective Surgery ◽  
Level Of Evidence ◽  
Trauma Service ◽  
Specific Factors ◽  
A Prospective Study ◽  
Study Type

BackgroundReducing length of stay (LOS) is a major healthcare initiative. While LOS is closely linked to the diagnosis and procedure in elective surgery, many additional factors influence LOS on a trauma service. We hypothesized that more standardized patient management would lead to decreased LOS.MethodsRetrospective analysis of Trauma Registry data compared LOS before (PRE) and after (POST) implementation of standardized processes on a trauma service. Patients were subdivided by age (over and under 65 years). Data were compared using unpaired t-test, χ2 test and analysis of variance tests, where appropriate.Results1613 PRE and 1590 POST patients were compared. Although age and Injury Severity Score were similar, median LOS decreased by 1 day for the group overall (p<0.0001), and for subgroups over and under the age of 65 years (p<0.0001). Older patients were discharged home 13% more often in POST, compared with 4% more for younger patients.ConclusionsImproved standardization of processes on a trauma service reduced LOS in patients of all ages. A prospective study may identify specific factors associated with prolonged LOS, to allow further improvement.Level of evidenceIII.Study typeTherapeutic/Care management.

Trauma Attending Physician Continuity: Does it Make a Difference?

2010 ◽  
Vol 76 (1) ◽  
pp. 48-54
Author(s):  
David G. Jacobs ◽  
Jennifer L. Sarafin ◽  
Karen E. Head ◽  
A Britt Christmas ◽  
Toan Huynh ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Standard Of Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Trauma Service ◽  
Retrospective Comparison ◽  
Scale Scores ◽  
Attending Physician

Continuity of care is important in achieving optimal outcomes in trauma patients, but the optimal length of the trauma attending (TA) rotation is unknown. We hypothesize that longer TA rotations provide greater continuity, and therefore improve outcomes. We did a retrospective comparison of trauma patient outcomes from two consecutive 6-month periods during which we transitioned from a 1-month TA rotation to a 1-week TA rotation. The Wilcoxon rank sum test, and the χ2 were used for statistical analysis. Over the 12-month study period 1924 patients were admitted to the Trauma Service. The two groups were similar with regard to age, gender, injury mechanism, Injury Severity Score and Glasgow Coma Scale scores, and Abbreviated Injury Scores for the chest, abdomen, and extremities. Although mortality, patient charges, and violations of the standard of care were similar between the two groups, overall morbidity was lower (18.6% vs 23.2%), and hospital length of stay higher (9.07 days vs 8.41 days) in the 1-week TA group compared with the 1-month TA group. A one-week TA rotation was associated with a longer hospital length of stay, but improved morbidity. Longer TA rotations do not necessarily provide improved continuity or improved outcomes.

“Shift Work” Improves Survival and Reduces Intensive Care Unit Use in Seriously Injured Patients

2007 ◽  
Vol 73 (2) ◽  
pp. 185-191
Author(s):  
Luke Y. Shen ◽  
Stephen D. Helmer ◽  
Jennifer Huang ◽  
Gerayu Niyakorn ◽  
R. Stephen Smith
Keyword(s):  
Intensive Care Unit ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Shift Work ◽  
Continuity Of Care ◽  
Injury Severity ◽  
Severely Injured ◽  
Trauma Service ◽  
Injured Patients

We assessed whether a trauma service model with an emphasis on continuity of care by using “shift work” will improve trauma outcomes and cost. This was a case-control cohort study that took place at a university-affiliated Level I trauma center. All patients (n = 4283) evaluated for traumatic injuries between May 1, 2002 and April 30, 2004 were included. During Period I (May 1, 2002 to April 30, 2003), a rotating off-service team provided initial management between 5:00 PM and 7:00 AM. The “day team” provided all other care and was responsible for continuity of care. In Period II (May 1, 2003 to April 30, 2004), a dedicated trauma service consisting of two resident teams evaluated all injured patients. Variables included hospital and intensive care unit length of stay (LOS), mechanical ventilation requirements, hospital mortality, and hospital care costs. Demographics and injury mechanism for both periods were similar, but Injury Severity Score (ISS) in Period II was greater (ISS, 8.2% vs 7.2%, P < 0.0001; ISS > 15, 18.5% vs 15.4%). In the more severely injured (ISS > 15), patients in Period II had shorter hospital LOS (8.6 vs 9.7 days, P = 0.98), a shorter ICU LOS (5.5 vs 7.7 days, P = 0.039), shorter mechanical ventilator requirements (5.5 vs 7.7 days, P = 0.32), improved hospital mortality rate (19.9% vs 26.8%, P = 0.029), and decreased hospital costs ($19,146 vs $21,274, P = 0.36). On multivariate analysis, factors affecting mortality and LOS included age, initial vital signs, injury type, and ISS. Overall, the two trauma service models resulted in similar outcomes. Although multivariate analysis revealed that treatment period did not affect mortality, our study revealed improved patient survival and reduction in LOS and cost for the severely injured in Period II.

A report of two years of pre-hospital blood transfusions by Thames Valley Air Ambulance

Trauma ◽  
2017 ◽  
Vol 20 (3) ◽  
pp. 221-224 ◽  
Author(s):  
James E Raitt ◽  
Edward Norris-Cervetto ◽  
Oliver Hawksley
Keyword(s):  
Injury Severity ◽  
Blood Transfusions ◽  
Hospital Inpatient ◽  
Blood Products ◽  
Air Ambulance ◽  
Traumatic Cardiac Arrest ◽  
Severity Scores ◽  
Injured Patients ◽  
Age Range ◽  
Retrospective Database

Introduction Thames Valley Air Ambulance have carried two units of red blood cells on board both the aircraft and rapid response car since 2014. Methods A retrospective database narrative review of patients receiving blood was carried out. Results Data were analysed for 63 patients, the age range was 13 years to 89 years and 74.6% were male. Blunt trauma was the mechanism of injury in 84%. Overall, 16% of patients died at scene, 32% died either in the Emergency Department or as a hospital inpatient and 52% survived to discharge. There were no survivors from traumatic cardiac arrest who received blood products. Injury Severity Scores (ISS) ranged from 4 to 75, and 95% of the patients for whom data were available had an Injury Severity Scores greater than 15. Discussion Patients who received pre-hospital blood transfusions were overwhelmingly those with high Injury Severity Scores and the majority who survived to hospital received additional blood products on arrival. This suggests that our pre-hospital blood transfusions were correctly targeted to severely injured patients who had a need for blood transfusion in hospital.

scholarly journals How Translators Affect the Experience and Healthcare of Primary Spanish-Speaking Patients in the Trauma Department

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Catherin Morocho ◽  
Tasha N. S. Joplin ◽  
Kevin Lopez ◽  
Damaris Ortiz ◽  
Craig J. Goergen ◽  
...  
Keyword(s):  
Injury Severity ◽  
Healthcare Team ◽  
Trauma Patients ◽  
Structured Interviews ◽  
Spanish Speaking ◽  
Trauma Registries ◽  
Academic Level ◽  
Trauma Service ◽  
Severity Scores ◽  
Trauma Bay

Background and Objective:  The trauma bay is a fast-paced environment where comprehension of medical jargon is difficult even for native English-speaking patients. For Spanish-speaking patients, the presence, and use of the translating tools in hospitals may change the course and/or quality of their care, especially in a trauma setting. Our objective was to gather information and perspectives of Spanish-speaking patients in the trauma bay and subsequent hospitalization. This pilot study determined if there were constant themes.  Methods: In this pilot qualitative study, we successfully recruited three adult primary Spanish-speaking patients admitted to the trauma service for at least twenty-four hours in July 2021 at an urban academic level I trauma center. Spanish only in-person semi-structured interviews were used to gather patient’s perspectives, with data supplemented from electronic health records and trauma registries. The interview was transcribed in Spanish, translated to English, coded, and analyzed using thematic analysis.     Results: Although recruitment occurred at both hospitals, this study includes only three patients admitted at IU Health Methodist. All three were males aged 22-37 years from Latin America. Blunt injuries occurred in two with injury severity scores (ISS) ranging from 5-11 while the third had penetrating injuries with an ISS of 10. Several themes have emerged. All patients felt they did not have autonomy or empowerment in their care. It was found that the healthcare team decided who received a translator. Two of the patients had a lack of understanding in their traumatic injuries. One patient relied on his partner for translating, even though a translator was provided.  Conclusions: These results suggest that Spanish-speaking trauma patients lack autonomy, empowerment, and understanding their medical conditions. Further interviews need to be conducted in order to strengthen the perspective of a Spanish-speaking trauma patient’s care.  

Defining the Contribution of Renal Dysfunction to Outcome after Traumatic Injury

2007 ◽  
Vol 73 (8) ◽  
pp. 836-840 ◽  
Author(s):  
Brian G. Harbrecht ◽  
Matthew R. Rosengart ◽  
Mazen S. Zenati ◽  
Raquel M. Forsythe ◽  
Andrew B. Peitzman
Keyword(s):  
Length Of Stay ◽  
Renal Impairment ◽  
Serum Creatinine ◽  
Renal Dysfunction ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Elevated Serum ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Injured Patients

Renal failure is frequently considered an ominous development after injury, but its impact on outcome is poorly understood. Renal dysfunction or failure can be defined in many ways, such as elevated serum creatinine or the need for dialysis. The best method to characterize renal dysfunction however, is not known. To determine which definition of renal dysfunction correlates best with outcome, we retrospectively analyzed all injured patients from 1994 to 2000 who had an Injury Severity Score ≥14 and a hospital length of stay >2 days for the development of renal impairment. One hundred sixty-seven patients (4%) developed a serum creatinine ≥2.0 mg/dL and 49 patients required dialysis. Patients with renal dysfunction were older, suffered from more comorbid medical problems, were more seriously injured, and were more likely to have been in shock. A serum creatinine ≥2.0 mg/dL, the maximum creatinine level, and need for dialysis, were highly correlated with death, and the total number of dialysis treatments was not. All measures of renal dysfunction correlated relatively poorly with length of stay. These data demonstrate that the simple measure of serum creatinine ≥2.0 mg/dL is associated with a significantly increased likelihood of death in injured patients and is a stronger predictor than other common indicators of renal impairment.

scholarly journals Alcohol use in severely injured trauma patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Antti Riuttanen ◽  
Saara J. Jäntti ◽  
Ville M. Mattila
Keyword(s):  
Alcohol Use ◽  
Length Of Stay ◽  
Injury Severity ◽  
Relative Proportion ◽  
University Hospital ◽  
Trauma Patients ◽  
Severely Injured ◽  
New Injury Severity Score ◽  
Severity Scores ◽  
Medical Histories

Abstract Alcohol is a major risk factor for several types of injuries, and it is associated with almost all types and mechanisms of injury. The focus of the study was to evaluate alcohol use in severely injured trauma patients with New Injury Severity Score (NISS) of 16 or over, and to compare mortality, injury severity scores and mechanisms and patterns of injury between patients with positive and negative blood alcohol levels (BAL). Medical histories of all severely injured trauma patients (n = 347 patients) enrolled prospectively in Trauma Register of Tampere University Hospital (TAUH) between January 2016 to December 2017 were evaluated for alcohol/substance use, injury mechanism, mortality and length of stay in Intensive Care Unit (ICU). A total of 252 of 347 patients (72.6%) were tested for alcohol with either direct blood test (50.1%, 174/347), breathalyser (11.2%, 39/347), or both (11.2%, 39/347). After untested patients were excluded, 53.5% of adult patients (18–64 years), 20.5% of elderly patients (above 65 years) and 13.3% of paediatric patients (0–17 years) tested BAL positive. The mean measured BAL for the study population was 1.9 g/L. The incidence of injuries was elevated in the early evenings and the relative proportion of BAL positive patients was highest (67.7%) during the night. Injury severity scores (ISS or NISS) and length of stay in ICU were not adversely affected by alcohol use. Mortality was higher in patients with negative BAL (18.2% vs. 7.7%, p = 0.0019). Falls from stairs, and assaults were more common in patients with positive BAL (15.4% vs. 5.4% and 8.7% vs. 2.7%, p < 0.006, respectively). There were no notable differences in injury patterns between the two groups. Alcohol use among severely injured trauma patients is common. Injury mechanisms between patients with positive and negative BAL have differences, but alcohol use will not increase mortality or prolong length of stay in ICU. This study supports the previously reported findings that BAL is not a suitable marker to assess patient mortality in trauma setting.

Incidence and Outcomes of Critical Illness-Related Corticosteroid Insufficiency in Trauma Patients

2011 ◽  
Vol 77 (5) ◽  
pp. 579-585
Author(s):  
Mark L. Walker ◽  
Phillip S. Owen ◽  
Candace Sampson ◽  
Janene Marshall ◽  
Teresa Pounds ◽  
...  
Keyword(s):  
Critical Illness ◽  
Injury Severity ◽  
Strong Predictor ◽  
Trauma Patients ◽  
Mortality And Morbidity ◽  
Clinical Criteria ◽  
Severity Scores ◽  
Prolonged Duration ◽  
Injured Patients ◽  
Corticosteroid Insufficiency

The spectrum of critical illness-related corticosteroid insufficiency (CIRCI) in trauma is not fully defined. This study describes our trauma experience with hydrocortisone-treated patients experiencing CIRCI. We conducted a 5-year retrospective analysis from a Level II trauma center using biochemical and clinical criteria for adrenal insufficiency. Seventy patients met the inclusion criteria for CIRCI. There was a 34 per cent mortality rate despite therapy. Nonsurvivors were older with larger admission base deficits and experienced higher rates of sepsis, bacteremia, and pneumonia. Nonsurvivors had prolonged vent days (mean 53 ± 64 days) when compared with survivors (mean 30 ± 22 days; P = 0.029). Renal replacement therapy was a strong predictor of mortality. Spinal cord-injured patients had high Injury Severity Scores (mean 34 ± 18), elevated baseline Cortisol levels (mean 56 ± 84 vs 18 ± 14; P = 0.004), and required prolonged duration of steroid therapy (30 ± 52 vs 15 ± 15 days; P = 0.080) when compared with the nonspinal cord-injured group. Our data suggest that CIRCI in trauma is associated with significant mortality and morbidity even when patients are treated appropriately.

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