Predictors of Inappropriate Helicopter Transport

2020 ◽  
pp. 000313482095142
Author(s):  
Christopher Brown ◽  
Wajeeh Irfan ◽  
Jonathan E. Schoen ◽  
Alan B. Marr ◽  
Lance E. Stuke ◽  
...  
Keyword(s):  
Injury Severity ◽  
Univariate Analysis ◽  
Hospital Length ◽  
T Test ◽  
Hospital Length Of Stay ◽  
P Value ◽  
Binary Logistic Regression Analysis ◽  
Student’S T ◽  
Chi Square Analysis ◽  
Student’S T Test

Background Helicopter transport (HT) is an efficient, but costly, means for injured patients to receive life-saving, definitive trauma care. Identifying the characteristics of inappropriate HT presents an opportunity to improve the utilization of this finite medical resource. Methods Trauma registry records of all HT for a 3-year period (2016-2018) to an urban Level I trauma center were reviewed. HT was defined as inappropriate for patients who were discharged home from the emergency department or had a hospital length of stay <1 day, and who were discharged alive. Chi-square analysis and Student’s t-test were used for univariate analysis. Predictors with a P value of less than .15 were subject to binary logistic regression analysis. A P value ≤.05 was considered significant. Results There were 713 patients who received HT during the study period. One-hundred and forty-eight (20.8%) patients met the criteria as an inappropriate HT. In univariate analysis, Glasgow Coma Scale >8, Shock Index <0.9, and fall mechanism were found to be significantly associated with inappropriate HT. Age >55 was found to be associated with an appropriate HT. The average Injury Severity Score of the inappropriate HT group was 3.86 (±3.85) compared with 16.80 (±11.23) ( P = .0001, Student’s t-test). Discussion Our findings suggest that there are evidence-based predictors of patients receiving inappropriate HT. Triage of HT using these predictors has the potential to decrease unnecessary deployments and reduce health care costs.

scholarly journals Biaya dan Outcome Hemodialisis di Rumah Sakit Kelas B dan C

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Firda Tania ◽  
Hasbullah Thabrany
Keyword(s):  
Weight Loss ◽  
T Test ◽  
P Value ◽  
Intermediate Outcome ◽  
Student’S T ◽  
Base Group ◽  
Eq Vas ◽  
Student’S T Test

 Gagal Ginjal Kronis (GGK) merupakan kondisi yang semakin meningkat kejadiannya di Indone­sia, menghabiskan banyak dana publik Jaminan Kesehatan Nasional (JKN). Dalam program JKN, hemodi­alisis (HD) untuk penanganan GGK dijamin tetapi perleu keseimbangan antara biaya dan outcome. Sejak 2014, BPJS menanggung hampir seluruh biaya HD di Indonesia dengan besaran tarif Casemix Base Group (CBG) yang berbeda menurut kelas Rumah Sakit (RS). Tujaun dari penelitian ini adalah untuk mengetahui perbedaan biaya Hemodialisis pada Rumah Sakit Kelas B dan Kelas C.Studi evaluasi ekonomi ini dilakukan di dua RS dengan kelas berbeda: kelas B (RS B) dan kelas C (RS C) dengan perbedaan kepemilikan. Kepemilikan RS B adalah pemerintah daerah sedangkan RS C dimiliki oleh yayasan swasta. Outcome HD diukur dengan suatu survey ke pasien HD. Analisis outcome dilakukan dengan penilaian kualitas hidup (instrumen EQ-5D) dengan Indeks EQ, EQ VAS, intermediate outcome berupa rerata Intra Dialytic Weight Loss (IDWL), dan rerata Hb. Perbedaan rerata nilai hasil diuji dengan Student’s t-test. Responden dipilih dari pasien GGK yang menjalani HD di kedua RS selama Feb­ruari-April 2016. Analisis biaya menurut perspektif pasien, meliputi biaya langsung medis, biaya langsung non medis, dan biaya tidak langsung. Biaya sebenarnya yang dikeluarkan oleh RS dikumpulkan dari doku­men RS. Studi kualitatif tambahan dilakukan dengan wawancara mendalam kepada informan kunci di RS yang bertanggung jawab atas unit HD. Pada penelitian ini, total responden sebanyak adalah 100 orang (di RS B 76 orang & di RS C 24 orang). Menurut perspektif pasien, biaya langsung medis HD selama sebulan di RS B Rp 5.215.331 dan di RS C Rp 7.781.744. Besaran tarif CBG untuk RS kelas B adalah Rp 962.800 dan kelas C adalah Rp 893.300. Menurut perspektif RS, tidak terdapat perbedaan biaya operasional HD antar kelas RS. Biaya langsung non medis HD selama sebulan di RS B Rp 566.260 dan di RS C Rp 334.500. Biaya tidak langsung HD selama sebulan di RS B Rp 165.530 dan di RS C Rp 45.830. Rerata total biaya HD selama sebulan di RS B Rp 6.149.285 dan di RS C Rp 8.162.077. Pada intermediate outcome didapatkan bahwa rerata Hb pada RS B sebesar 10,26 g% berbeda secara signifikan dengan RS C (8,21 g%), p= 0,000. Rerata IDWL pada RS B (0,0403) tidak berbeda secara signifikan dengan RS C (0,0438), p= 0.188. Rerata EQ Indeks sebesar 0,7178 dan EQ VAS sebesar 64,74 di RS B tidak berbeda secara signifikan dengan rerata EQ Indeks sebesar 0,7208 dan EQ VAS sebesar 64,79 di RS C, dengan p value secara berurutan p=0,94 dan p= 0,986

Ready for the Frontline: Is Early Thoracoscopic Decortication the New Standard of Care for Advanced Pneumonia with Empyema?

2006 ◽  
Vol 72 (8) ◽  
pp. 688-693 ◽  
Author(s):  
Adam M. Suchar ◽  
Amer H. Zureikat ◽  
Loretto Glynn ◽  
Mindy B. Statter ◽  
Jongin Lee ◽  
...  
Keyword(s):  
Pleural Fluid ◽  
Surgical Outcome ◽  
Standard Of Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
P Value ◽  
X Rays ◽  
Necrotizing Pneumonia ◽  
Significant Difference ◽  
Student’S T

Video-assisted thoracoscopic decortication (VATD) has been established as an effective and potentially less morbid alternative to open thoracotomy for the management of empyema. However, the timing and role of VATD for advanced pneumonia with empyema is still controversial. In assessing surgical outcome, the authors reviewed their VATD experience in children with empyema or empyema with necrotizing pneumonia. The charts of 42 children who underwent VATD at our institution between July 2001 and July 2005 were retrospectively reviewed for surgical outcome. For purposes of analysis, patients were cohorted into four classes with increasing severity of pneumonia: 1 (-) intraoperative pleural fluid cultures, (-) necrotizing pneumonia, 18 (43%); 2 (+) pleural fluid cultures, (-) necrotizing pneumonia, 10 (24%); 3 (-) pleural fluid cultures, (+) necrotizing pneumonia, 6 (14%); 4 (+) pleural fluid cultures, (+) necrotizing pneumonia, 8 (19%). A P value of <0.05 via Student's t test or Fischer's exact analysis was considered an indicator of significant difference in the comparison of group outcomes. VATD was successfully completed in all 42 patients with no mortality and without significant morbidity (82% had less than 20 cc blood loss). There was found to be no significant difference (p = NS) in time to surgical discharge (removal of chest tube) among all groups. Hospital length of stay postsurgery was found to be significantly increased between 1 and 4 (6 days vs 9 days; P = 0.038). 14/14 (100%) of children with necrotizing pneumonia were found to have evidence of lung parenchymal preservation with improved aeration on follow-up CT scan and/or chest x-rays. The authors conclude that early VATD in children with advanced pneumonia with empyema is indicated to avoid unnecessarily lengthy hospitalization and prolonged intravenous antibiotic therapy. Furthermore, early VATD can be safely performed in various stages of advanced pneumonia with empyema, promoting lung salvage, and accelerating clinical recovery.

Is the Face an Air Bag for the Brain and Torso?—The Potential Protective Effects of Severe Midface Fractures

2018 ◽  
Vol 84 (8) ◽  
pp. 1299-1302
Author(s):  
Hannah E. Woriax ◽  
Mark E. Hamill ◽  
Carol M. Gilbert ◽  
Christopher M. Reed ◽  
Emily R. Faulks ◽  
...  
Keyword(s):  
Brain Injuries ◽  
Injury Severity ◽  
Univariate Analysis ◽  
Penetrating Trauma ◽  
Hospital Length ◽  
Wilcoxon Test ◽  
Hospital Length Of Stay ◽  
Protective Effects ◽  
Exact Test ◽  
Midface Fractures

We investigated the patterns of injury associated with major midface trauma. Our hypothesis is that midface injuries are associated with a decrease in certain traumatic brain injuries as well as major torso injuries. The registry of our Level I trauma center was queried for all adult patients treated over 25 years from 1989 to 2013. Patients with midface fractures were identified based on the ICD-9 code. Associated injuries were defined based both on individual ICD-9 codes as well as the Barell Injury Matrix. Injury etiology was defined based on e-codes. Univariate analysis was performed using chi-squared test, Fisher's exact test, and Wilcoxon test. A total of 29,152 patients were identified. Excluding pediatric patients, those with exclusively penetrating trauma, and patients with incomplete data, 20,971 patients were included for subsequent analysis. Midface fractures were identified in 752 patients. Patients with Le Fort fractures were more likely to be male, have a higher Injury Severity Score, a lower arrival Glasgow Coma Scale, and more likely to require intensive care unit admission and mechanical ventilation, with a longer hospital length of stay. Patients with midface fractures had significantly fewer subdural hematomas, subarachnoid hemorrhages, spine fractures, and were less likely to have associated abdominal and pelvic injuries. Patients with midface fractures were more likely to require facial reconstruction procedures and craniotomy. Patients presenting with midface fractures after blunt trauma have a distinctly different pattern of injuries. One potential mechanism for this is a deceleration effect, where midface impact and resulting fractures dissipate some of the energy.

scholarly journals Outcomes of Total versus Partial Colectomy in Fulminant Clostridium Difficile Colitis. A Propensity Matched Analysis.

2021 ◽  
Author(s):  
Nasim Ahmed ◽  
YenHong Kuo
Keyword(s):  
Clostridium Difficile ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
P Value ◽  
Improvement Program ◽  
Discharge Disposition ◽  
Significant Difference ◽  
Partial Colectomy

Abstract BackgroundThe Total Abdominal Colectomy (TAC) is the recommended procedure for Fulminant Clostridium Difficile Colitis (FCDC), however, occasionally, FCDC is also treated with partial colectomies. The purpose of the study was to identify the outcomes of partial colectomy in FCDC cases.MethodThe National Surgical Quality Improvement Program (NSQIP) database was accessed and eligible patients from 2012 through 2016 were reviewed. Patients 18 years and older who were diagnosed with FCDC and who underwent colectomies were included in the study. Patients’ demography, clinical characteristics, comorbidities, mortality, morbidities, length of hospital stay and discharge disposition were compared between the group who underwent partial colectomy and the group who underwent TAC. Univariate analysis followed by propensity matching were performed. A p value of <0.05 is considered as statistically significant. ResultsOut of 491 patients who qualified for the study, 93 (18.94%) patients underwent partial colectomy. The pair matched analysis showed no significant difference in patients’ characteristics and comorbidities in the two groups. There was no significant difference found in mortality between the two groups (30.1% vs. 30.15, P>0.99). There were no differences found in the median [95% CI] hospital length of stay [LOS] (23 days [19-31] vs. 21 [17-25], P=0.30), post-operative complications (P>0.05), and discharged disposition to home (43.1% vs. 33.8%) or transfer to rehab (21.55 vs. 12.3%, P=0.357) between the TAC and partial colectomy groups.Conclusion The overall 30 days mortality remains very high in FCDC. Partial colectomy did not increase risk of mortality or morbidities and LOS.

scholarly journals Trauma resource pit stop: increasing efficiency in the evaluation of lower severity trauma patients

2021 ◽  
Vol 6 (1) ◽  
pp. e000670
Author(s):  
Imad S Dandan ◽  
Gail T Tominaga ◽  
Frank Z Zhao ◽  
Kathryn B Schaffer ◽  
Fady S Nasrallah ◽  
...  
Keyword(s):  
Injury Severity ◽  
Diagnostic Testing ◽  
Trauma Team ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Evaluation Time ◽  
Retrospective Comparison ◽  
Trauma Bay

BackgroundOvertriage of trauma patients is unavoidable and requires effective use of hospital resources. A ‘pit stop’ (PS) was added to our lowest tier trauma resource (TR) triage protocol where the patient stops in the trauma bay for immediate evaluation by the emergency department (ED) physician and trauma nursing. We hypothesized this would allow for faster diagnostic testing and disposition while decreasing cost.MethodsWe performed a before/after retrospective comparison after PS implementation. Patients not meeting trauma activation (TA) criteria but requiring trauma center evaluation were assigned as a TR for an expedited PS evaluation. A board-certified ED physician and trauma/ED nurse performed an immediate assessment in the trauma bay followed by performance of diagnostic studies. Trauma surgeons were readily available in case of upgrade to TA. We compared patient demographics, Injury Severity Score, time to physician evaluation, time to CT scan, hospital length of stay, and in-hospital mortality. Comparisons were made using 95% CI for variance and SD and unpaired t-tests for two-tailed p values, with statistical difference, p<0.05.ResultsThere were 994 TAs and 474 TRs in the first 9 months after implementation. TR’s preanalysis versus postanalysis of the TR group shows similar mean door to physician evaluation times (6.9 vs. 8.6 minutes, p=0.1084). Mean door to CT time significantly decreased (67.7 vs. 50 minutes, p<0.001). 346 (73%) TR patients were discharged from ED; 2 (0.4%) were upgraded on arrival. When admitted, TR patients were older (61.4 vs. 47.2 years, p<0.0001) and more often involved in a same-level fall (59.5% vs. 20.1%, p<0.0001). Undertriage was calculated using the Cribari matrix at 3.2%.DiscussionPS implementation allowed for faster door to CT time for trauma patients not meeting activation criteria without mobilizing trauma team resources. This approach is safe, feasible, and simultaneously decreases hospital cost while improving allocation of trauma team resources.Level of evidenceLevel II, economic/decision therapeutic/care management study.

30-Day Outcomes for Total Ankle Arthroplasty in Patients With Anemia

2021 ◽  
pp. 107110072110175
Author(s):  
Jordan R. Pollock ◽  
Matt K. Doan ◽  
M. Lane Moore ◽  
Jeffrey D. Hassebrock ◽  
Justin L. Makovicka ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Univariate Analysis ◽  
Hospital Length ◽  
Total Ankle Arthroplasty ◽  
Hospital Length Of Stay ◽  
Preoperative Anemia ◽  
Improvement Project ◽  
Average Hospital ◽  
Ankle Arthroplasty ◽  
Reoperation Rates

Background: While anemia has been associated with poor surgical outcomes in total knee arthroplasty and total hip arthroplasty, the effects of anemia on total ankle arthroplasty remain unknown. This study examines how preoperative anemia affects postoperative outcomes in total ankle arthroplasty. Methods: A retrospective analysis was performed using the American College of Surgeons National Surgery Quality Improvement Project database from 2011 to 2018 for total ankle arthroplasty procedures. Hematocrit (HCT) levels were used to determine preoperative anemia. Results: Of the 1028 patients included in this study, 114 patients were found to be anemic. Univariate analysis demonstrated anemia was significantly associated with an increased average hospital length of stay (2.2 vs 1.8 days, P < .008), increased rate of 30-day readmission (3.5% vs 1.1%, P = .036), increased 30-day reoperation (2.6% vs 0.4%, P = .007), extended length of stay (64% vs 49.9%, P = .004), wound complication (1.75% vs 0.11%, P = .002), and surgical site infection (2.6% vs 0.6%, P = .017). Multivariate logistic regression analysis found anemia to be significantly associated with extended hospital length of stay (odds ratio [OR], 1.62; 95% CI, 1.07-2.45; P = .023) and increased reoperation rates (OR, 5.47; 95% CI, 1.15-26.00; P = .033). Anemia was not found to be a predictor of increased readmission rates (OR, 3.13; 95% CI, 0.93-10.56; P = .066) or postoperative complications (OR, 1.27; 95% CI, 0.35-4.56; P = .71). Conclusion: This study found increasing severity of anemia to be associated with extended hospital length of stay and increased reoperation rates. Providers and patients should be aware of the increased risks of total ankle arthroplasty with preoperative anemia. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Does emergency medicine length of stay predict trauma outcomes at a Level 1 Trauma Center?

2015 ◽  
Vol 4 (5) ◽  
pp. 1 ◽  
Author(s):  
Erin Powers Kinney ◽  
Kamal Gursahani ◽  
Eric Armbrecht ◽  
Preeti Dalawari
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Hospital Capacity ◽  
Significant Difference ◽  
Level 1 ◽  
Level 1 Trauma Center

Objective: Previous studies looking at emergency department (ED) crowding and delays of care on outcome measures for certain medical and surgical patients excluded trauma patients. The objectives of this study were to assess the relationship of trauma patients’ ED length of stay (EDLOS) on hospital length of stay (HLOS) and on mortality; and to examine the association of ED and hospital capacity on EDLOS.Methods: This was a retrospective database review of Level 1 and 2 trauma patients at a single site Level 1 Trauma Center in the Midwest over a one year period. Out of a sample of 1,492, there were 1,207 patients in the analysis after exclusions. The main outcome was the difference in hospital mortality by EDLOS group (short was less than 4 hours vs. long, greater than 4 hours). HLOS was compared by EDLOS group, stratified by Trauma Injury Severity Score (TRISS) category (< 0.5, 0.51-0.89, > 0.9) to describe the association between ED and hospital capacity on EDLOS.Results: There was no significant difference in mortality by EDLOS (4.8% short and 4% long, p = .5). There was no significant difference in HLOS between EDLOS, when adjusted for TRISS. ED census did not affect EDLOS (p = .59), however; EDLOS was longer when the percentage of staffed hospital beds available was lower (p < .001).Conclusions: While hospital overcrowding did increase EDLOS, there was no association between EDLOS and mortality or HLOS in leveled trauma patients at this institution.

scholarly journals Nurses' leadership styles in the icu: association with personal and professional profile and workload

2009 ◽  
Vol 17 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Alexandre Pazetto Balsanelli ◽  
Isabel Cristina Kowal Olm Cunha ◽  
Iveth Yamaguchi Whitaker
Keyword(s):  
Leadership Styles ◽  
Leadership Style ◽  
T Test ◽  
Descriptive Statistics ◽  
Nursing Workload ◽  
Comparison Test ◽  
Multiple Comparison Test ◽  
Professional Profile ◽  
Student’S T ◽  
Student’S T Test

This study aims to explore the association between nurses' leadership styles and personal and professional nursing profile and workload. The sample consisted of seven nurses and seven nursing technicians who were grouped into pairs. At the end of three months, nurses were queried regarding what leadership style would be adopted when the nursing technician under their evaluation delivered care to patients admitted to the ICU. Relevant data was analyzed by applying descriptive statistics, Tukey's multiple comparison test and Student's t-test (p< 0.05). Nursing workload reached 80.1% on average. The personal and professional profile variables did not show any relation with the leadership styles chosen by nurses (p>0.05). The determine, persuade, and share leadership styles prevailed. However, whenever the nursing workload peaked, the determine and persuade styles were used (p<0.05).

scholarly journals Intravesical prostaglandin e2 effectiveness in the prevention of urinary retention after transvaginal reconstruction of the pubo-cervical fascia and short arm sling according to Lahodny: a prospective randomized clinical trial

2010 ◽  
Vol 14 (1) ◽  
pp. 15 ◽  
Author(s):  
G. QUADRI ◽  
N. NATALE ◽  
C. SPREAFICO ◽  
C. BELLONI ◽  
D. BARISANI ◽  
...  
Keyword(s):  
Prostaglandin E2 ◽  
Urinary Retention ◽  
Study Groups ◽  
T Test ◽  
Control Group ◽  
Fisher Exact Test ◽  
Test Results ◽  
Exact Test ◽  
Student’S T ◽  
Student’S T Test

Intravesical prostaglandin E2 is effective in the recovery of spontaneous voiding after transvaginal reconstruction of the pubocervical fascia and short arm sling according to Lahodny. The aim of the study was to compare the effects of intravesical prostaglandin E2 in the prevention of urinary retention after transvaginal reconstruction of the pubocervical fascia and short arm sling according to Lahodny. STUDY DESIGN: From November 1996 to June 1999 fifty women underwent the Lahodny procedure for moderate/severe cystocele and stress urinary incontinence. Women were randomly assigned to 1 of the 2 study groups: intravesical prostaglandin E2 versus controls. Data obtained were analyzed with the Student t test and the Fisher exact test. RESULTS: Two patients of the treatment group had to be excluded from the study, one because of the wrong measurement of the post-voidal residual volume and another due to a fastidious burning sensation which appeared immediately after prostaglandin instillation and required the suspension of the treatment. No other side effects such as nausea, vomiting, diarrhea or hyperthermia were observed. Patients who underwent the prostaglandin E2 treatment showed a recovery of spontaneous voiding after 7.9&plusmn;6.7 days, whereas this interval was significantly longer in the control group, being 12.9&plusmn;9.7 days (p=0.04, Two tailed Unpaired Student's T test). CONCLUSION: The effectiveness and the low associated morbidity mark the treatment with intravesical prostaglandin E2 useful in the recovery of normal voiding after transvaginal pubocervical fascia reconstruction and short arm sling with the procedure according to Lahodny.

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