Examining Violence Against Women at a Regional Level 1 Trauma Center During the COVID-19 Pandemic

Introduction There is a growing concern that certain public health restrictions imposed to prevent the spread of coronavirus disease 2019 (COVID-19) could result in more violence against women (VAW). We sought to determine if the rates and types of VAW changed during the COVID-19 pandemic at our level 1 trauma center (L1TC). Methods We performed a retrospective review of female patients who presented to our L1TC because of violence from 2019 through 2020. Patients were grouped into a pre-COVID or COVID period. The primary aim of this study was to compare rates of VAW between groups. Secondary aims sought to evaluate for any difference in traumatic mechanism between periods and to determine if a temporal relationship existed between COVID-19 and VAW rates. Results There was no difference in rates of VAW between the pre-COVID and COVID period (3.1% vs 3.6%, P = .6); however, rates of penetrating trauma were greater during the COVID period (38.2% vs 10.3%, P = .01). After controlling for patient age and race, the odds of penetrating trauma increased during the pandemic (OR 5.8, 95% CI 1.6-28.5, P < .01). From February 2020 through October 2020, there was a direct relationship between rates of COVID-19 and VAW ( r2 .78, P < .01). Conclusion Rates of VAW were unchanged between the pre-COVID and COVID periods, yet the odds of penetrating VAW were 5 times greater during the pandemic. Moving forward, trauma surgeons must remain vigilant for signs of violence and ensure that support services are available during future crises.

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Changing Characteristics of Facial Fractures Treated at a Regional, Level 1 Trauma Center, From 2005 to 2010

Annals of Plastic Surgery ◽

10.1097/sap.0b013e31823b69dd ◽

2012 ◽

Vol 68 (5) ◽

pp. 461-466 ◽

Cited By ~ 21

Author(s):

Katherine S. Roden ◽

Winnie Tong ◽

Matthew Surrusco ◽

William W. Shockley ◽

John A. Van Aalst ◽

...

Keyword(s):

Trauma Center ◽

Regional Level ◽

Facial Fractures ◽

Level 1 ◽

Level 1 Trauma Center

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How Did the COVID-19 Pandemic Affect Trauma Volume at an Urban Level I Trauma Center?

The American Surgeon ◽

10.1177/00031348211054075 ◽

2022 ◽

pp. 000313482110540

Author(s):

Alexandra Hahn ◽

Tommy Brown ◽

Brett Chapman ◽

Alan Marr ◽

Lance Stuke ◽

...

Keyword(s):

Health Care ◽

Trauma Center ◽

Penetrating Trauma ◽

Retrospective Chart Review ◽

Trauma Patients ◽

Minor Trauma ◽

Significant Difference ◽

Urban Level ◽

Level 1 ◽

Level 1 Trauma Center

Introduction The COVID-19 pandemic changed the face of health care worldwide. While the impacts from this catastrophe are still being measured, it is important to understand how this pandemic impacted existing health care systems. As such, the objective of this study was to quantify its effects on trauma volume at an urban Level 1 trauma center in one of the earliest and most significantly affected US cities. Methods A retrospective chart review of consecutive trauma patients admitted to a Level 1 trauma center from January 1, 2017 to December 31, 2020 was completed. The total trauma volume in the years prior to the pandemic (2017-2019) was compared to the volume in 2020. These data were then further stratified to compare quarterly volume across all 4 years. Results A total of 4138 trauma patients were treated in the emergency room throughout 2020 with 4124 seen during 2019, 3774 during 2018, and 3505 during 2017 in the pre-COVID-19 time period. No significant difference in the volume of minor trauma or trauma transfers was observed ( P < .05). However, there was a significant increase in the number of major traumas in 2020 as compared to prior years (38.5% vs 35.6%, P < .01) and in the volume of penetrating trauma (29.1% vs 24.0%, P < .01). Discussion During the COVID-19 outbreak, trauma remained a significant health care concern. This study found an increase in volume of penetrating trauma, specifically gunshot wounds throughout 2020. It remains important to continue to devote resources to trauma patients during the ongoing COVID-19 pandemic.

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Treatment of penetrating trauma of the extremities: ten years’ experience at a dutch level 1 trauma center

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/1757-7241-21-2 ◽

2013 ◽

Vol 21 (1) ◽

pp. 2 ◽

Cited By ~ 14

Author(s):

Oscar JF Van Waes ◽

Esther MM Van Lieshout ◽

Wouter Hogendoorn ◽

Jens A Halm ◽

Jefrey Vermeulen

Keyword(s):

Trauma Center ◽

Penetrating Trauma ◽

Level 1 ◽

Level 1 Trauma Center

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A Handoff Protocol for Pediatric Trauma Patients at a Rural Level One Trauma Center Reduces Length of Stay

The American Surgeon ◽

10.1177/0003134820956339 ◽

2020 ◽

pp. 000313482095633

Author(s):

Evelyn Coile ◽

Kathryn Bailey ◽

Eric J. Clayton ◽

Tatiana R. Eversley Kelso ◽

Heather MacNew

Keyword(s):

Length Of Stay ◽

Trauma Center ◽

Pediatric Trauma ◽

Trauma Patients ◽

Before And After ◽

Ancillary Staff ◽

Trauma Triage ◽

Level 1 ◽

Trauma Surgeons ◽

Level 1 Trauma Center

Background The management of the pediatric trauma patient is variable among trauma centers. In some institutions, the trauma surgeon maintains control of the patient throughout the hospital stay, while others transfer to a pediatric specialist after the initial evaluation and resuscitation period. We hypothesized that handoff to the pediatric surgeon would decrease the length of stay by more efficient coordination with pediatric subspecialists and ancillary staff. Methods A retrospective review from October 2014 to October 2018 was conducted at our rural level 1 trauma center analyzing the length of stay across all demographics and trauma triage levels before and after institution of a handoff protocol from adult specialized trauma surgeons to pediatric surgeons within a 24-hour window. Further analysis included emergency department (ED) disposition to include the effect of handoff on the length of stay in the setting of a higher post-ED acuity, that is, disposition of monitored beds. Results 1267 patient charts were analyzed and the mean length of stay was reduced by .38 days ( t = 5.92, P < .0005) across all demographics, trauma triage levels, post-ED dispositions, and mechanisms of injury after institution of our handoff protocol. Conclusion Handoff from adult specialized trauma surgeons to pediatric surgeons within a 24-hour window at a rural level 1 trauma center significantly improved the length of stay by .38 ( t = 5.92, P < .0005) among pediatric trauma patients in all demographics, trauma triage activations levels, mechanisms of injury, and post-ED dispositions acuity levels.

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PD31-02 UROLOGIC CONSULTATION IMPROVES RENAL SALVAGE RATES AT A REGIONAL LEVEL 1 TRAUMA CENTER

The Journal of Urology ◽

10.1097/ju.0000000000002032.02 ◽

2021 ◽

Vol 206 (Supplement 3) ◽

Author(s):

Joseph Kim ◽

Nicholas Ottaiano ◽

Francisco Brito ◽

Bradley Spieler ◽

Crawford Dixon ◽

...

Keyword(s):

Trauma Center ◽

Regional Level ◽

Level 1 ◽

Level 1 Trauma Center

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Prevalence of Pediatric Periorbital Trauma at a US-Mexico Border Level 1 Trauma Center, 10 Year Retrospective Review

FACE ◽

10.1177/27325016211055220 ◽

2021 ◽

pp. 273250162110552

Author(s):

James R. Skidmore ◽

Kyle Kener ◽

Jose Castro Garcia

Keyword(s):

Trauma Center ◽

Motor Vehicle ◽

Penetrating Trauma ◽

Common Mechanism ◽

Anatomical Location ◽

The Face ◽

Mexico Border ◽

Level 1 ◽

Level 1 Trauma Center ◽

Us Mexico Border

Introduction: Due to its location in the middle third of the face, the periorbital area is exposed to external forces that may cause blunt and/or penetrating trauma. This anatomical location houses important structures for vision, cosmesis, and upper and lower facial skeletal stability. Trauma in this area puts the patient at risk for injuries to important structures, that, when damaged at early age, may have permanent debilitating consequences. Methods: After obtaining IRB approval, we evaluated ER admissions at a Level 1 Trauma Center located in the US-Mexico border over a 10-year-period. Inclusion criteria included patients younger than 18 years old with diagnosis of trauma to the face involving the periorbital region. Results: From January 2009 to December 2018, 1192 pediatric patients were admitted to the Level 1 Trauma Center with trauma that involved the periorbital area amongst other injuries. Mean age was 8, STD 5.2. 61.4% were male patients. The most common mechanism of injury was fall (365) followed by blunt trauma (305) and motor vehicle accident (MVA) (108). 29.4% of patients required admission, and 18.8% required a surgical intervention. Conclusion: Periorbital trauma in the pediatric population may bring lifelong consequences due to deformity, dysfunction, or loss of the structures that are contained within this anatomical area. Further studies are warranted to assess risk factors and to provide prevention measures to avoid trauma and complications due to injury to these important structures.

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Faculty Opinions recommendation of [CONFERENCE POSTER]: Outcomes of endoscopic realignment of blunt posterior urethral injuries at a Level 1 trauma center.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.11414968.12436067 ◽

2011 ◽

Author(s):

Sanjay Kulkarni

Keyword(s):

Trauma Center ◽

Level 1 ◽

Level 1 Trauma Center ◽

Urethral Injuries

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Identifying trauma patients with benefit from direct transportation to Level-1 trauma centers

BMC Emergency Medicine ◽

10.1186/s12873-021-00487-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Charlie A. Sewalt ◽

Benjamin Y. Gravesteijn ◽

Daan Nieboer ◽

Ewout W. Steyerberg ◽

Dennis Den Hartog ◽

...

Keyword(s):

Logistic Regression ◽

Trauma Center ◽

Trauma Patients ◽

Trauma Centers ◽

Absolute Benefit ◽

Predicted Probability ◽

Prehospital Triage ◽

Level 1 ◽

Level 1 Trauma Center ◽

Level 2

Abstract Background Prehospital triage protocols typically try to select patients with Injury Severity Score (ISS) above 15 for direct transportation to a Level-1 trauma center. However, ISS does not necessarily discriminate between patients who benefit from immediate care at Level-1 trauma centers. The aim of this study was to assess which patients benefit from direct transportation to Level-1 trauma centers. Methods We used the American National Trauma Data Bank (NTDB), a retrospective observational cohort. All adult patients (ISS > 3) between 2015 and 2016 were included. Patients who were self-presenting or had isolated limb injury were excluded. We used logistic regression to assess the association of direct transportation to Level-1 trauma centers with in-hospital mortality adjusted for clinically relevant confounders. We used this model to define benefit as predicted probability of mortality associated with transportation to a non-Level-1 trauma center minus predicted probability associated with transportation to a Level-1 trauma center. We used a threshold of 1% as absolute benefit. Potential interaction terms with transportation to Level-1 trauma centers were included in a penalized logistic regression model to study which patients benefit. Results We included 388,845 trauma patients from 232 Level-1 centers and 429 Level-2/3 centers. A small beneficial effect was found for direct transportation to Level-1 trauma centers (adjusted Odds Ratio: 0.96, 95% Confidence Interval: 0.92–0.99) which disappeared when comparing Level-1 and 2 versus Level-3 trauma centers. In the risk approach, predicted benefit ranged between 0 and 1%. When allowing for interactions, 7% of the patients (n = 27,753) had more than 1% absolute benefit from direct transportation to Level-1 trauma centers. These patients had higher AIS Head and Thorax scores, lower GCS and lower SBP. A quarter of the patients with ISS > 15 were predicted to benefit from transportation to Level-1 centers (n = 26,522, 22%). Conclusions Benefit of transportation to a Level-1 trauma centers is quite heterogeneous across patients and the difference between Level-1 and Level-2 trauma centers is small. In particular, patients with head injury and signs of shock may benefit from care in a Level-1 trauma center. Future prehospital triage models should incorporate more complete risk profiles.

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