Laparoscopy in the Evaluation of Blunt Abdominal Injury in Level-I and II Pediatric Trauma Centers

2022 ◽  
pp. 000313482110335
Author(s):  
Aryan Haratian ◽  
Areg Grigorian ◽  
Karan Rajalingam ◽  
Matthew Dolich ◽  
Sebastian Schubl ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Trauma Center ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Improvement Program ◽  
Blunt Abdominal Injury ◽  
Level Ii ◽  
American College Of Surgeons ◽  
Level I

Introduction An American College of Surgeons (ACS) Level-I (L-I) pediatric trauma center demonstrated successful laparoscopy without conversion to laparotomy in ∼65% of trauma cases. Prior reports have demonstrated differences in outcomes based on ACS level of trauma center. We sought to compare laparoscopy use for blunt abdominal trauma at L-I compared to Level-II (L-II) centers. Methods The Pediatric Trauma Quality Improvement Program was queried (2014-2016) for patients ≤16 years old who underwent any abdominal surgery. Bivariate analyses comparing patients undergoing abdominal surgery at ACS L-I and L-II centers were performed. Results 970 patients underwent abdominal surgery with 14% using laparoscopy. Level-I centers had an increased rate of laparoscopy (15.6% vs 9.7%, P = .019 ); however they had a lower mean Injury Severity Score (16.2 vs 18.5, P = .002) compared to L-II centers. Level-I and L-II centers had similar length of stay ventilator days, and SSIs (all P > .05). Conclusion While use of laparoscopy for pediatric trauma remains low, there was increased use at L-I compared to L-II centers with no difference in LOS or SSIs. Future studies are needed to elucidate which pediatric trauma patients benefit from laparoscopic surgery.

The Impact of American College of Surgeons Trauma Center Designation and Outcomes after Early Thoracotomy: A National Trauma Databank Analysis

2012 ◽  
Vol 78 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Marko Bukur ◽  
Bernardino Castelo Branco ◽  
Kenji Inaba ◽  
Ramon Cestero ◽  
Leslie Kobayashi ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Trauma Patients ◽  
National Trauma ◽  
Level Ii ◽  
Pressure Time ◽  
Significant Difference ◽  
American College Of Surgeons ◽  
Level I ◽  
The Impact

Trauma centers are designated by the American College of Surgeons (ACS) into four different levels based on resources, volume, and scientific and educational commitment. The purpose of this study was to evaluate the relationship between ACS center designation and outcomes after early thoracotomy for trauma. The National Trauma Databank (v. 7.0) was used to identify all patients who required early thoracotomy. Demographics, clinical data, and outcomes were extracted. Patients were categorized according to ACS trauma center designation. Multivariate logistic regression was used to evaluate the impact of ACS trauma center designation on mortality. From 2002 to 2006, 1834 (77.4%) patients were admitted to a Level I ACS verified trauma center, 474 (20.0%) to a Level II, and 59 (3.6%) to a Level III/IV facility. After adjusting for differences between the groups, there were no significant differences in mortality (overall: 53.3% for Level I, 63.1% for Level II, and 52.5% for Level III/IV, adjusted P = 0.417; or for patients arriving in cardiac arrest: 74.9% vs 87.1% vs 85.0%, P = 0.261). Subgroup analysis did not show any significant difference in survival irrespective of mechanism of injury. Glasgow Coma Scale score # 8, Injury Severity Score >16, no admission systolic blood pressure, time from admission to thoracotomy, and nonteaching hospitals were found to be independent predictors of death. For trauma patients who have sustained injuries requiring early thoracotomy, ACS trauma center designation did not significantly impact mortality. Nonteaching institutions however, were independently associated with poorer outcomes after early thoracotomy. These findings may have important implications in educational commitment of institutions. Further prospective evaluation of these findings is warranted.

Pediatric Trauma System Evaluation before and after Level II Verification

2019 ◽  
Vol 85 (11) ◽  
pp. 1281-1287
Author(s):  
Michael D. Dixon ◽  
Scott Engum
Keyword(s):  
Native American ◽  
Trauma Center ◽  
Injury Severity ◽  
Life Support ◽  
Pediatric Trauma ◽  
Trauma System ◽  
Trauma Centers ◽  
Level Ii ◽  
Level I ◽  
Pediatric Trauma Center

ACS-verified trauma centers show higher survival and improved mortality rates in states with ACS-verified Level I pediatric trauma centers. However, few significant changes are appreciated in the first two years after verification. Minimal research exists examining verification of ACS Level II pediatric trauma centers. We analyzed ACS Level II pediatric trauma verification at our institution. In 2014, Sanford Medical Center Fargo became the only Level II pediatric trauma center in North Dakota, as well as the only center between Spokane and Minneapolis. A retrospective review of the institution's pre-existing trauma database one year pre- and postverification was performed. Patients aged <18 years were included in the study ( P < 0.05). Patient number increased by 23 per cent, from 167 to 205 patients. A statistically significant increase occured in the three to six year old age group ( P = 0.0002); motorized recreational vehicle ( P = 0.028), violent ( P = 0.009), and other ( P = 0.0374) mechanism of injury categories; ambulance ( P = 0.0124), fixed wing ( P = 0.0028), and personal-owned vehicle ( P = 0.0112) modes of transportation. Decreased public injuries ( P = 0.0071) and advanced life support ambulance transportation ( P = 0.0397). The study showed a nonstatistically significant increase in mean Injury Severity Score (from 6.3 to 7) and Native American trauma (from 14 to 20 per cent). Whereas prolonged ACS Level I pediatric trauma center verification was found to benefit patients, minimal data exist on ACS Level II verification. Our findings are consistent with current Level I ACS pediatric trauma center data. Future benefits will require continued analysis because our Level II pediatric trauma center continues to mature and affect our rural and large Native American community.

Injury and Mortality Profiles in Level II and III Trauma Centers

2021 ◽  
pp. 000313482096629
Author(s):  
Ali Farhat ◽  
Areg Grigorian ◽  
Ahmed Farhat ◽  
Theresa L. Chin ◽  
Megan Donnelly ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Injury Severity ◽  
Trauma Centers ◽  
Median Length ◽  
Improvement Program ◽  
Level Ii ◽  
Risk Of Mortality ◽  
Severity Scores ◽  
American College Of Surgeons ◽  
Level I

Background While the benefit of admission to trauma centers compared to non-trauma centers is well-documented and differences in outcomes between Level-I and Level-II trauma centers are well-studied, data on the differences in outcomes between Level-II trauma centers (L2TCs) and Level-III trauma centers (L3TCs) are scarce. Objectives We sought to compare mortality risk between patients admitted to L2TCs and L3TCs, hypothesizing no difference in mortality risk for patients treated at L3TCs compared to L2TCs. Methods A retrospective analysis of the 2016 Trauma Quality Improvement Program (TQIP) database was performed. Patients aged 18+ years were divided into 2 groups, those treated at American College of Surgeons (ACS) verified L2TCs and L3TCs. Results From 74,486 patients included in this study, 74,187 (99.6%) were treated at L2TCs and 299 (.4%) at L3TCs. Both groups had similar median injury severity scores (ISSs) (10 vs 10, P < .001); however, L2TCs had a higher mean ISS (14.6 vs 11.9). There was a higher mortality rate for L2TC patients (6.0% vs 1.7%, P = .002) but no difference in associated risk of mortality between the 2 groups (OR .46, CI .14-1.50, P = .199) after adjusting predictors of mortality. L2TC patients had a longer median length of stay (5.0 vs 3.5 days, P < .001). There was no difference in other outcomes including myocardial infarction (MI) and cerebrovascular accident (CVA) ( P > .05). Discussion Patients treated at L2TCs had a longer LOS compared to L3TCs. However, after controlling for covariates, there was no difference in associated mortality risk between L2TC and L3TC patients.

Should All Severely Injured Pediatric Patients be Treated at Pediatric Level I Trauma Centers? A National Trauma Data Bank Study

2015 ◽  
Vol 81 (10) ◽  
pp. 927-931
Author(s):  
Shin Miyata ◽  
Tobias Haltmeier ◽  
Kenji Inaba ◽  
Kazuhide Matsushima ◽  
Catherine Goodhue ◽  
...  
Keyword(s):  
Trauma Center ◽  
Pediatric Patients ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Data Bank ◽  
Trauma Centers ◽  
National Trauma ◽  
Level Ii ◽  
National Trauma Data Bank ◽  
Level I

The American College of Surgeons Committee on Trauma stratification system for trauma centers presumes that increasing levels of resources will improve patient outcomes. Although some supportive data exist in adult trauma, there is a paucity of evidence demonstrating improved survival in pediatric trauma when patients are treated primarily at Level I versus Level II pediatric trauma centers. We hypothesized that there is no difference in the mortality of comparably injured pediatric patients treated at these two types of facilities. The study population consists of all severely injured pediatric patients (18 years old or younger, injury severity score > 15) registered in the National Trauma Data Bank, treated in designated pediatric trauma centers. A total of 13,803 patients were included in the analysis and were separated into two groups: Pediatric Level I trauma center (n = 9690) and Pediatric Level II trauma center (n = 4113). Although analysis of the clinical characteristics of the unmatched groups showed significant differences including mortality rate (11.7% vs 15.4%, P < 0.001), case matching technique, comparing 2956 pairs, successfully eliminated demographic differences and, when adjusted for injury severity, showed no difference in mortality between center types (10.0% vs 10.1%, P = 0.966, odds ratio of mortality = 0.996 and 95% confidence interval = 0.841–1.180). Subgroup analyses including Glasgow Coma Scale < 9, need for immediate procedures, and ICD-9 (International Classification of Diseases) code groupings indicative of serious injury also failed to demonstrate statistically significant differences in mortality between trauma center types.

scholarly journals Usefulness of Pelvic Radiographs in the Initial Trauma Evaluation with Concurrent CT: Is Additional Radiation Exposure Necessary?

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Anne K. Misiura ◽  
Autumn D. Nanassy ◽  
Jacqueline Urbine
Keyword(s):  
Trauma Center ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Additional Information ◽  
Pelvic Radiographs ◽  
Pelvic Radiograph ◽  
Digital Radiograph ◽  
Urban Level ◽  
Level I ◽  
Pediatric Trauma Center

Trauma patients in a Level I Pediatric Trauma Center may undergo CT of the abdomen and pelvis with concurrent radiograph during initial evaluation in an attempt to diagnose injury. To determine if plain digital radiograph of the pelvis adds additional information in the initial trauma evaluation when CT of the abdomen and pelvis is also performed, trauma patients who presented to an urban Level I Pediatric Trauma Center between 1 January 2010 and 7 February 2017 in whom pelvic radiograph and CT of the abdomen and pelvis were performed within 24 hours of each other were analyzed. A total of 172 trauma patients had pelvic radiograph and CT exams performed within 24 hours of each other. There were 12 cases in which the radiograph missed pelvic fractures seen on CT and 2 cases in which the radiograph suspected a fracture that was not present on subsequent CT. Furthermore, fractures in the pelvis were missed on pelvic radiographs in 12 of 35 cases identified on CT. Sensitivity of pelvic radiograph in detecting fractures seen on CT was 65.7% with a 95% confidence interval of 47.79-80.87%. Results suggest that there is no added diagnostic information gained from a pelvic radiograph when concurrent CT is also obtained, a practice which exposes the pediatric trauma patient to unnecessary radiation.

Initial Approach to the Management of Multisystem Trauma

2019 ◽  
pp. 397-401
Author(s):  
David S. Morris
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Hospital Admissions ◽  
The United States ◽  
Emergency Department Visits ◽  
Severely Injured ◽  
Level Ii ◽  
Level I ◽  
Nonfatal Injuries ◽  
Injured Patients

Nearly 200,000 people die of injury-related causes in the United States each year, and injury is the leading cause of death for all patients aged 1 to 44 years. Approximately 30 million people sustain nonfatal injuries each year, which results in about 29 million emergency department visits and 3 million hospital admissions. Management of severely injured patients, typically defined as having an Injury Severity Score greater than 15 is best managed in a level I or level II trauma center. Any physician who provides care for critically ill patients should have a basic familiarity with the fundamentals of trauma care.

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.

Inter-rater Variability Interferes with Reproducibility of Splenic Injury Grades Reported to the American College of Surgeons Committee on Trauma

2016 ◽  
Vol 82 (2) ◽  
pp. 171-174
Author(s):  
Eric J. Ferguson ◽  
Michael Walsh ◽  
Megan Brown
Keyword(s):  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Trauma Center ◽  
Ordinal Data ◽  
Injury Severity ◽  
Splenic Injury ◽  
Intraclass Correlation ◽  
American College Of Surgeons ◽  
Level I ◽  
Picture Archiving And Communication

The objective of this study was to determine reproducibility of our splenic injury grading data, previously reported to the American College of Surgeons Committee on Trauma for our most recent site visit. The institutional registry of a Level I trauma center was queried to identify adult patients presenting with blunt splenic injury between January 1, 2013 and December 31, 2013. Original CT scans were scanned into the picture archiving and communication system and subsequently reviewed by four trauma surgeons and two radiologists for clinical impressions of splenic injury grade. Grades assigned by the clinician and the grade recorded in the registry were compared for inter-rater reliability using the intraclass correlation coefficient, as a means of assessing variance of ordinal data. The intraclass correlation coefficient in our model was 0.77, which indicates that 77 per cent of the observed variance was due to true variance and 23 per cent of the variance was due to error. Variability in grading may, in some cases, underestimate injury severity and compromise the clinician's expectation of clinical outcome, both in real-time, as well as during retrospective review processes such as those used during the trauma center reverification process.

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