An Analysis of Patients Dead on Arrival in the American College of Surgeons Trauma Quality Program Participant Use File Data Set

2021 ◽  
pp. 000313482110110
Author(s):  
Adel Elkbuli ◽  
Scott Rowe ◽  
Shahm Raslan ◽  
Aleeza Ali ◽  
Brad Boserup ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Patient Outcomes ◽  
Motor Vehicle ◽  
Trauma Patients ◽  
Data Set ◽  
Program Participant ◽  
Quality Program ◽  
Field Triage ◽  
American College Of Surgeons ◽  
Mode Of Transportation

Background Trauma patient care begins on-scene as field triage and mode of transportation are determinants of patient outcomes. This study evaluates the US national patterns of dead on arrival (DOA) among the trauma population. Methods A cross-sectional review of the American College of Surgeons (ACS) Trauma Quality Program Participant Use File (TQP-PUF) data set (2013-2017) was performed. Trauma patients reported as DOA were stratified by ISS into low (<15), intermediate (15-24), or high (≥25) severity. Each group was then subdivided by patient demographics, mechanism, type of injury, and mode of transportation. Results Of the 4 336 816 injury cases in the TQP-PUF data set, 33 199 were DOA (.77%). 77.1% (25 604/33 199) of DOAs were male. In the low-ISS group, .36% (13 272/3 639 811) were DOA; in the intermediate-ISS group, 1.2% (4868/421 994) were DOA; and in the high-ISS group, 5.5% (15 059/275 011) were DOA. Motor vehicle collisions (MVCs) (11 262) and firearms (8894) were the most common injury types, equating to 60.7% of DOAs. Falls accounted for 9.1% of all DOAs. The most common DOA age-group was 18-64 years, followed by ≥65 years. Conclusion DOA trauma patients are predominately adult men suffering fatal blunt force injuries most frequently via MVC. DOAs are caused by all ranges of injury severity. We recommend further development of prevention programs thereby reducing the prevalence of common traumatic injuries, notably MVC, falls, and firearms to improve survival. Future studies should also investigate the access to and distribution of trauma centers and the role of helicopter, ground, and police transport modalities and transport time on and reducing DOAs and improving trauma patient outcomes.

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 Decreased adult trauma admission volumes and changing injury patterns during the COVID-19 pandemic at 85 trauma centers in a multistate healthcare system

2021 ◽  
Vol 6 (1) ◽  
pp. e000642
Author(s):  
Gina M Berg ◽  
Ransom J Wyse ◽  
Jennifer L Morse ◽  
John Chipko ◽  
Jeneva M Garland ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Trauma Network ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Injury Patterns ◽  
Level Of Evidence ◽  
Trauma Population ◽  
Absolute Decrease

BackgroundReports indicate social distancing guidelines and other effects of the COVID-19 pandemic impacted trauma patient volumes and injury patterns. This report is the first analysis of a large trauma network describing the extent of these impacts. The objective of this study was to describe the effects of the COVID-19 pandemic on patient volumes, demographics, injury characteristics, and outcomes.MethodsFor this descriptive, multicenter study from a large, multistate hospital network, data were collected from the system-wide centralized trauma registry and retrospectively reviewed to retrieve patient information including volume, demographics, and outcomes. For comparison, patient data from January through May of 2020 and January through May of 2019 were extracted.ResultsA total of 12 395 trauma patients (56% men, 79% white, mean age 59 years) from 85 trauma centers were included. The first 5 months of 2020 revealed a substantial decrease in volume, which began in February and continued into June. Further analysis revealed an absolute decrease of 32.5% in patient volume in April 2020 compared with April 2019 (4997 from 7398; p<0.0001). Motor vehicle collisions decreased 49.7% (628 from 1249). There was a statistically significant increase in injury severity score (9.0 vs. 8.3; p<0.001). As a proportion of the total trauma population, blunt injuries decreased 3.1% (87.3 from 90.5) and penetrating injuries increased 2.7% (10.0 from 7.3; p<0.001). A significant increase was found in the proportion of patients who did not survive to discharge (3.6% vs. 2.8%; p=0.010; absolute decrease: 181 from 207).DiscussionEarly phases of the COVID-19 pandemic were associated with a 32.5% decrease in trauma patient volumes and altered injury patterns at 85 trauma centers in a multistate system. This preliminary observational study describes the initial impact of the COVID-19 pandemic and warrants further investigation.Level of evidenceLevel II (therapeutic/care management).

scholarly journals The Rare Requirement of On-scene Extremity Amputations in the Entrapped Trauma Patient

2016 ◽  
Vol 5 (2) ◽  
pp. 93-100 ◽  
Author(s):  
Tanya L Zakrison ◽  
Nicholas Namias ◽  
Marc M Grossman ◽  
David V Shatz ◽  
Fahim Habib ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Trauma Center ◽  
Motor Vehicle ◽  
Trauma Patients ◽  
Trauma Surgeon ◽  
Surgical Interventions ◽  
Golden Hour ◽  
Life Threatening ◽  
Rapid Transport ◽  
Extremity Injuries

ABSTRACT Objectives Entrapment of trauma patients in motor vehicle and other accidents is common. Frequently, Emergency Medical Services (EMS) personnel and firefighters are able to free the patient and initiate rapid transport to trauma centers. In rare circumstances, severe torso and extremity injuries combined with major entrapment may require complex rescue operations. These trauma patients spend the “Golden Hour” at the scene under difficult conditions. The objective of this review is to evaluate the role of the trauma surgeon leading the care at the scene of critically injured and entrapped trauma patients with possible need for surgical interventions. Materials and methods A 10-year review of all trauma surgeon to scene activations between 2005 and 2014 at the Ryder Trauma Center, an urban ACS Level 1 trauma center, was performed. An analysis of the trauma registry, individual cases, and surgical interventions was conducted. Results The University of Miami/Jackson Memorial Hospital (UM/JMH) Ryder Trauma Center and Miami Dade Fire Rescue have an established program in place for trauma surgeon to scene activations. During the study period, the on-call trauma surgeon was activated six times and traveled to the scene by air rescue helicopter four times, by ground in 1 case and in 1 case the patient expired before takeoff. One patient required on-scene amputation of an entrapped non-salvageable upper extremity. Two patients required on-scene amputation of bilateral lower mangled, entrapped extremities. One patient required a localized limb preserving surgical procedure to free him from entrapment. The incidence was 0.016% of 36,872 trauma alert activated patients evaluated at Ryder Trauma Center during the study period. Hemorrhagic shock, associated injuries, and long scene times were present in all patients. The survival of treated patients was 80%. Conclusion The need for on-scene amputations of nonsalvable extremities in entrapped trauma patients is rare. Experienced trauma surgeons should evaluate these patients and decide which interventions are necessary. All efforts should be made to salvage the limb. However, if the entrapped extremity appears nonsalvageable and the patient is in profound life-threatening shock requiring rapid transport, field amputation may be required. Policies, safety training and gear, supply kits, and partnerships with EMS are needed. How to cite this article Pust GD, Grossman MM, Shatz DV, Habib F, Pizano L, Zakrison TL, Marttos A, Ruiz G, Ginzburg E, Namias N. The Rare Requirement of On-scene Extremity Amputations in the Entrapped Trauma Patient. Panam J Trauma Crit Care Emerg Surg 2016;5(2):93-100.

Pathologic Fibrinolysis is More Common in a Rural Trauma Setting

2020 ◽  
pp. 000313482097372
Author(s):  
James M. Bardes ◽  
Daniel J. Grabo ◽  
Sijin Wen ◽  
Alison Wilson
Keyword(s):  
Trauma Team ◽  
Rural Environment ◽  
Trauma Patients ◽  
Future Studies ◽  
Factors Influencing ◽  
American College Of Surgeons ◽  
Level 1 ◽  
Transferred Patients ◽  
Prehospital Time ◽  
Level 1 Trauma Center

Introduction Fibrinolysis (lysis) has been extensively studied in trauma patients. Many studies on the distribution of lysis phenotype have been conducted in setting with short prehospital time. This study aimed to evaluate the distribution of lysis phenotypes in a population with prolonged prehospital times in a rural environment. Methods A retrospective study was performed at an American College of Surgeons-verified level 1 trauma center, serving a large rural population. Full trauma team activations from January 1, 2017 to August 31, 2018 were evaluated, and all patients with an ISS>15 analyzed. Thromboelastography was routinely performed on all participants on arrival. Lysis phenotypes were classified based on LY30 results: shutdown (≤.8%), physiologic (.9-2.9%), and hyper (>2.9%). Results 259 patients were evaluated, 134 (52%) presented direct from the scene. For scene patients, lysis distribution was 24% physiologic, 49% shutdown, and 27% hyper. Transferred patients demonstrated a reduction in physiologic lysis to 14% ( P = .03), shutdown present in 66%, and hyper in 20%. Empiric prehospital tranexamic acid was given to 18 patients, physiologic lysis was present in 6%, shutdown 72%, and hyper 22%; this increase was not statistically significant ( P = .5). Conclusion Fibrinolysis phenotypes are not consistent across all trauma populations. This study showed rural trauma patients had a significantly increased rate of pathologic lysis. This was consistent for scene and transfer patients who received care at another facility prior to arrival for definitive care. Future studies to evaluate the factors influencing these differences are warranted.

Association between Mode of Transportation and Survival in Adult Trauma Patients with Blunt Injuries: Matched Cohort Study between Police and Ground Ambulance Transport

2021 ◽  
pp. 1-9
Author(s):  
Fouad A. Sakr ◽  
Rana H. Bachir ◽  
Mazen J. El Sayed
Keyword(s):  
Cohort Study ◽  
Survival Rate ◽  
Blunt Trauma ◽  
Survival Rates ◽  
Trauma Patients ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Blunt Injuries ◽  
Ground Ambulance ◽  
Mode Of Transportation

Abstract Introduction: Early police transport (PT) of penetrating trauma patients has the potential to improve survival rates for trauma patients. There are no well-established guidelines for the transport of blunt trauma patients by PT currently. Study Objective: This study examines the association between the survival rate of blunt trauma patients and the transport modality (police versus ground ambulance). Methods: A retrospective, matched cohort study was conducted using the National Trauma Data Bank (NTDB). All blunt trauma patients transported by police to trauma centers were identified and matched (one-to-four) to patients transported by ground Emergency Medical Services (EMS) for analysis. Descriptive analysis was carried out. This was followed by comparing all patients’ characteristics and their survival rates in terms of the mode of transportation. Results: Out of the 2,469 patients with blunt injuries, EMS transported 1,846 patients and police transported 623 patients. Most patients were 16-64 years of age (86.2%) with a male predominance (82.5%). Fall (38.4%) was the most common mechanism of injury with majority of injuries involving the head and neck body part (64.8%). Fractures were the most common nature of injury (62.1%). The overall survival rate of adult blunt trauma patients was similar for both methods of transportation (99.2%; P = 1.000). Conclusion: In this study, adult blunt trauma patients transported by police had similar outcomes to those transported by EMS. As such, PT in trauma should be encouraged and protocolized to improve resource utilization and outcomes further.

scholarly journals Making your geriatric and palliative programs a strength: TQIP guideline implementation and the VRC perspective

2021 ◽  
Vol 6 (1) ◽  
pp. e000677
Author(s):  
Vanessa P Ho ◽  
Sasha D Adams ◽  
Kathleen M O'Connell ◽  
Christine S Cocanour ◽  
Saman Arbabi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Best Practice ◽  
Guideline Implementation ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Best Practice Guidelines ◽  
American College Of Surgeons ◽  
Specialized Care ◽  
The Usa

BackgroundOlder patients compose approximately 30% of trauma patients treated in the USA but make up nearly 50% of deaths from trauma. To help standardize and elevate care of these patients, the American College of Surgeons (ACS) Trauma Quality Improvement Program’s best practice guidelines for geriatric trauma management was published in 2013 and that for palliative care was published in 2017. Here, we discuss how palliative care and geriatrics quality metrics can be tracked and used for performance improvement and leveraged as a strength for trauma verification.MethodsWe discuss the viewpoint of the ACS Verification, Review, and Consultation and three case studies, with practical tips and takeaways, of how these measures have been implemented at different institutions.ResultsWe describe the use of (1) targeted educational initiatives, (2) development of a consultation tool based on institutional resources, and (3) application of a nurse-led frailty screen.DiscussionSpecialized care and attention to these vulnerable populations is recommended, but the implementation of these programs can take many shapes.Level of evidence V

Field Triage Protocol in Elderly Trauma Patients: What Level of Care?

2012 ◽  
Vol 215 (5) ◽  
pp. 740 ◽  
Author(s):  
Jean-Pierre Tourtier ◽  
Charles Pierret ◽  
Sylvain Vico ◽  
Daniel Jost ◽  
Laurent Domanski
Keyword(s):  
Level Of Care ◽  
Trauma Patients ◽  
Field Triage ◽  
Triage Protocol ◽  
Elderly Trauma Patients

Does the American College of Surgeons NSQIP-Pediatric Accurately Represent Overall Patient Outcomes?

2015 ◽  
Vol 221 (4) ◽  
pp. 828-836 ◽  
Author(s):  
Erica R. Gross ◽  
Melissa Christensen ◽  
Jessica A. Schultz ◽  
Laura D. Cassidy ◽  
Yvonne Anderson ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
American College Of Surgeons
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