scholarly journals Influence of a Stay-At-Home Order on Trauma Volume and Injury Patterns at a Level I Trauma Center in Ohio

2021 ◽  
pp. 000313482110474
Author(s):  
Gregory S. Huang ◽  
Elisha A. Chance ◽  
C. Michael Dunham
Keyword(s):  
Trauma Center ◽  
Drug Testing ◽  
Injury Severity ◽  
Census Data ◽  
Retrospective Chart Review ◽  
Trauma Patients ◽  
Injury Patterns ◽  
Trauma Service ◽  
Level I ◽  
At Home

Background Changes in injury patterns during the COVID pandemic have been reported in other states. The objective was to explore changes to trauma service volume and admission characteristics at a trauma center in northeast Ohio during a stay-at-home order (SAHO) and compare the 2020 data to historic trauma census data. Methods Retrospective chart review of adult trauma patients admitted to a level I trauma center in northeast Ohio. Trauma admissions from January 21 to July 21, 2020 (COVID period) were compared to date-matched cohorts of trauma admissions from 2018 to 2019 (historic period). The COVID period was further categorized as pre-SAHO, active-SAHO, and post-SAHO. Results The SAHO was associated with a reduction in trauma center admissions that increased after the SAHO ( P = .0033). Only outdoor recreational vehicle (ORV) injuries ( P = .0221) and self-inflicted hanging ( P = .0028) mechanisms were increased during the COVID period and had substantial effect sizes. Glasgow Coma Scores were lower during the COVID period ( P = .0286) with a negligible effect size. Violence-related injuries, injury severity, mortality, and admission characteristics including alcohol and drug testing and positivity were similar in the COVID and historic periods. Discussion The SAHO resulted in a temporary decrease in trauma center admissions. Although ORV and hanging mechanisms were increased, other mechanisms such as alcohol and toxicology proportions, injury severity, length of stay, and mortality were unchanged.

Is Helicopter Evacuation Effective in Rural Trauma Transport?

2012 ◽  
Vol 78 (7) ◽  
pp. 794-797 ◽  
Author(s):  
Melanie K. Rose ◽  
G. R. Cummings ◽  
Charles B. Rodning ◽  
Sid B. Brevard ◽  
Richard P. Gonzalez
Keyword(s):  
Rural Areas ◽  
Trauma Center ◽  
Injury Severity ◽  
Patient Survival ◽  
Retrospective Chart Review ◽  
Trauma Patients ◽  
Severely Injured ◽  
Transport Services ◽  
Ground Ambulance ◽  
Level I

Helicopter transport for trauma remains controversial because its appropriate utilization and efficacy with regard to improved survival is unproven. The purpose of this study was to assess rural trauma helicopter transport utilization and effect on patient survival. A retrospective chart review over a 2-year period (2007–2008) was performed of all rural helicopter and ground ambulance trauma patient transports to an urban Level I trauma center. Data was collected with regard to patient mortality and Injury Severity Score (ISS). Miles to the Level I trauma center were calculated from the point where helicopter or ground ambulance transport services initiated contact with the patient to the Level I trauma center. During the 2-year period, 1443 rural trauma patients were transported by ground ambulance and 1028 rural trauma patients were transported by helicopter. Of the patients with ISS of 0 to 10, 471 patients were transported by helicopter and 1039 transported by ground. There were 465 (99%) survivors with ISS 0 to 10 transported by helicopter with an average transport distance of 34.6 miles versus 1034 (99.5%) survivors with ISS 0 to 10 who were transported by ground an average of 41.0 miles. Four hundred and twenty-one patients with ISS 11 to 30 were transported by helicopter an average of 33.3 miles with 367 (87%) survivors versus a 95 per cent survival in 352 patients with ISS 11 to 30 who were transported by ground an average of 39.9 miles. One hundred and thirty-six patients with ISS >30 were transported by helicopter an average of 32.8 miles with 78 (57%) survivors versus a 69 per cent survival in 52 patients with ISS > 30 who were transported by ground an average of 33.0 miles. Helicopter transport does not seem to improve survival in severely injured (ISS > 30) patients. Helicopter transport does not improve survival and is associated with shorter travel distances in less severely injured (ISS < 10) patients in rural areas. This data questions effective helicopter utilization for trauma patients in rural areas. Further study with regard to helicopter transport effect on patient survival and cost-effective utilization is warranted.

An Overview of Amish Mortalities at a Level I Trauma Center

2021 ◽  
pp. 000313482110472
Author(s):  
Madison E. Morgan ◽  
Catherine Ting Brown ◽  
Larissa Whitney ◽  
Kelly Bonneville ◽  
Lindsey L. Perea
Keyword(s):  
Trauma Center ◽  
Chart Review ◽  
Trauma Registry ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Trauma Patients ◽  
Injury Patterns ◽  
Level Of Evidence ◽  
Trauma Mortality ◽  
Level I

Background The Amish population is a unique subset of patients that may require a specialized approach due to their lifestyle differences compared to the general population. With this reasoning, Amish mortalities may differ from typical trauma mortality patterns. We sought to provide an overview of Amish mortalities and hypothesized that there would be differences in injury patterns between mortalities and survivors. Methods All Amish trauma patients who presented and were captured by the trauma registry at our Level I trauma center over 20 years (1/2000-2004/2020) were analyzed. A retrospective chart review was subsequently performed. Patients who died were of interest to this study. Demographic and clinical variables were analyzed for the mortalities. Mortalities were then compared to Amish patients who survived. Results There were 1827 Amish trauma patients during the study period and, of these, 32 (1.75%) were mortalities. The top 3 mechanisms of injury leading to mortality were falls (34.4%), pedestrian struck (21.9%), and farming accidents (15.6%). Pediatric (age ≤ 14y) (25%) and geriatric (age ≥ 65y) (28.1%) had the highest percentage of mortalities. Mortalities in the Amish population were significantly older (mean age: 39 years vs 27 years, P = .003) and had significantly higher ISS (mean ISS: 29 vs 10, P < .001) compared to Amish patients who survived. Discussion The majority of mortalities occurred in the pediatric and geriatric age groups and were falls. Further intervention and outreach in the Amish population should be done to highlight this particular cause of mortality. Level of Evidence Level III, epidemiological.

Blood Transfusions in Trauma: Six-Year Analysis of the Transfusion Practices at a Level I Trauma Center

2008 ◽  
Vol 74 (10) ◽  
pp. 953-957 ◽  
Author(s):  
Pedro G.R. Teixeira ◽  
Didem Oncel ◽  
Demetrios Demetriades ◽  
Kenji Inaba ◽  
Ira Shulman ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Negative Impact ◽  
Fresh Frozen Plasma ◽  
Blood Transfusions ◽  
Trauma Patients ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Level I ◽  
Injured Patients

The objective of this study was to analyze the transfusion practices in trauma patients in one institution. A retrospective analysis of the Trauma Registry linked with the Blood Bank Database of a Level 1 trauma center was conducted. Over 6 years, 17 per cent of the 25,599 trauma patients received blood transfusions. The overall mortality in transfused patients was 20 per cent and remained the same during the study period. There was no change in the proportion of patients receiving transfusions throughout the years, however there was a significant 23.5 per cent reduction in the mean number of packed red blood cells (PRBC) units transfused (P < 0.001 for trend). This reduction in PRBC used remained true and even more evident in the group of more severely injured patients (Injury Severity Score ≥ 16), with a 27.9 per cent decrease in mean units of PRBC (P < 0.001 for trend). The highest reduction in PRBC transfusion was seen in blunt trauma patients (34.6%, P < 0.001). During the study period there was a concurrent increase in mean units of fresh frozen plasma used (60.7%, P < 0.001) and no change in the use of platelets and cryoprecipitate. In conclusion, transfusions of PRBC were significantly reduced over time in trauma patients without any evident negative impact on mortality.

333 Undertriage in Trauma: Differences in Outcome Among Trauma Patients With Delayed Trauma Service Activation at a Level I Trauma Center

2011 ◽  
Vol 58 (4) ◽  
pp. S289-S290
Author(s):  
C. Rogen ◽  
T. Shiuh ◽  
P. Veneri ◽  
B. Campbell ◽  
C.J. Hoon ◽  
...  
Keyword(s):  
Trauma Center ◽  
Trauma Patients ◽  
Trauma Service ◽  
Level I

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 G60 Trauma Center: A Future Consideration?

2017 ◽  
Vol 83 (6) ◽  
pp. 547-553 ◽  
Author(s):  
Marko Bukur ◽  
Joshua Simon ◽  
Joseph Catino ◽  
Margaret Crawford ◽  
Ivan Puente ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Trauma Center ◽  
Injury Severity ◽  
Head Injuries ◽  
Major Complication ◽  
The Elderly ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Failure To Rescue ◽  
Level I

With a considerably increasing elderly population, we sought to determine whether the volume of elderly trauma patients treated impacted outcomes at two different Level I trauma centers. This is a retrospective review of all elderly patients (>60 years) at two state-verified Level I trauma centers over the past five years. The elderly trauma center (ETC) saw a greater proportion (52%) of elderly patients than the reference trauma center (30%, TC). Demographic and clinical characteristics were abstracted and stratified into ETC and TC groups for comparison. Primary outcomes were overall postinjury complication and mortality rates, as well as death after major complication (failure to rescue). ETC patients were older (78.6 vs 70.5), more likely to be admitted with severe head injuries (head abbreviated injury score ≥ 3, 50.0% vs 32%), had a greater overall injury burden (injury severity score > 16 41.4% vs 21.1%), and required intensive care unit admission (81.3% vs 64%) than the TC group. Need for operative intervention, mechanism of injury, and comorbidities were similar between the two groups. Overall complications were higher in trauma patients admitted to the TC (21.9% vs 14.3%), as well as failure to rescue (4.0% vs 1.8%). Adjusting for confounding factors, ETC had significantly lower chance of developing a postinjury complication (adjusted odds ratios [AOR] = 0.4, 95% confidence interval [CI] = [0.3, 0.5]), failure to rescue (AOR = 0.3, 95% CI = [0.1, 0.5]), and overall mortality (AOR = 0.3, 95% CI = [0.2, 0.4]). Improved outcomes were demonstrated in the Level I center treating a higher proportion of elderly patients. Exact etiology of these benefits should be determined for quality improvement in care of the injured geriatric patient.

Effects of a More Restrictive Transfusion Trigger in Trauma Patients

2019 ◽  
Vol 85 (4) ◽  
pp. 409-413 ◽  
Author(s):  
Mary Garland-Kledzik ◽  
Michaela Gaffley ◽  
David Crouse ◽  
Collin Conrad ◽  
Preston Miller ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Trauma Patients ◽  
Transfusion Trigger ◽  
Transfusion Threshold ◽  
Trauma Service ◽  
Transfusion Requirements ◽  
Organ System Failure ◽  
Urban Level ◽  
Level I

Since the Transfusion Requirements in Critical Care trial, studies have shown that acutely ill patients can drift as a low as 5 g/dL. This study reviews a transfusion trigger change to 6.5 g/dL, which we hypothesize will conserve resources and improve quality of care. This is a retrospective chart review at an urban Level I trauma center from January through December 2015 after our trauma service changed the transfusion trigger from 7 to 6.5 g/dL. Outcomes in patients before (TT7) and after (TT6.5) the change in transfusion threshold were then compared. One hundred thirty-one discrete patients were included in this trial, with 285 instances of a hemoglobin of 7 g/dL or less and 178 transfusions. Seventy-two patients were before the change in threshold and 59 after. There was no change in length of hospital stay, ICU stay, ventilator days, mortality, and organ system failure after change in the transfusion threshold. After initiation of a more conservative threshold, 72 units of blood were saved. Decreased transfusion threshold was associated with no worse outcomes associated with decreased resource utilization.

Elevated Blood Alcohol Level May be Protective of Trauma Patient Mortality

2009 ◽  
Vol 75 (10) ◽  
pp. 950-953 ◽  
Author(s):  
Arezou Yaghoubian ◽  
Amy Kaji ◽  
Brant Putnam ◽  
Nicholas De Virgilio ◽  
Christian De Virgilio
Keyword(s):  
Blunt Trauma ◽  
Trauma Center ◽  
Injury Severity ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Blood Alcohol Level ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
Confounding Variables ◽  
Level I

To determine whether a positive blood alcohol level (BAL) affects morbidity and mortality at a Level I trauma center, a retrospective review of trauma patients 18 years of age and older was performed. There were 7985 trauma patients and 8 per cent (645) had a positive BAL. BAL(+) patients had lower Injury Severity Score (ISS) (8 vs 11, P < 0.01), lower rate of penetrating injury (9 vs 25%, P < 0.01), and were older (38 vs 32 years, P = 0.01). Overall there were 559 deaths (7%); (1% mortality in BAL(+) patients and 7% in BAL(-) patients; P < 0.0001). There were 352 (4.4%) complications with similar rates among BAL(-) and (+) patients. On univariate analysis, a positive BAL was inversely associated with death (OR, 0.17) as was blunt trauma (OR, 0.29), whereas older age (OR 1.009) and increased ISS (OR 1.13) were associated with death. On multivariable analysis, after adjusting for age, ISS, and mechanism of injury, a positive BAL remained protective against death (OR 0.35) as did blunt trauma (OR 0.2). Age (OR 1.04) and increased ISS (OR 1.19) were associated with mortality. In conclusion, a positive BAL was associated with a decreased mortality risk in trauma patients, which persisted after adjusting for multiple confounding variables.

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.

scholarly journals 35. Emergency Medical Services Use of Trauma Triage Criteria to Stratify Patients by Injury Severity and Need for Emergent Intervention

1996 ◽  
Vol 11 (S2) ◽  
pp. S32-S32
Author(s):  
Robert E. O'Connor ◽  
Glen H. Tinkoff ◽  
Susan Mascioli ◽  
Ross E. Megargel
Keyword(s):  
Injury Severity ◽  
Vital Signs ◽  
Penetrating Trauma ◽  
Trauma Patients ◽  
Chi Square ◽  
Probability Of Survival ◽  
Trauma Service ◽  
Severity Scores ◽  
Serious Injury ◽  
Level I

Purpose: Prehospital triage criteria (PTC) have been used to classify patients according to risk of serious injury. This study was conducted determine whether PTC could be used to identify serious injury, the need for intensive care (ICU), or immediate operative intervention (IOI).Methods: Data for this observational study were gathered prospectively, at a level-I trauma center, from a patient cohort admitted to the trauma service from 01 February to 31 July 1995. Specific triage criteria, based on information given by EMS prior to arrival were used to categorize patients by severity. Patients classified as most serious (codes) had the following: shock, major anatomic injury or proximal penetrating trauma. Patients classified as more serious (alerts) had one of the following: abnormal vital signs, Glasgow Coma Scale <13, moderate anatomic injury, high-risk mechanism of injury, or co-morbid factors. Patients not meeting either set of criteria, but were admitted, served as controls (consults). Injury severity scores (ISS) and probability of survival (Probsurvival) were calculated for each patient. The percentage admitted to the ICU, operating room (OR), or requiring IOI, were tabulated. Statistical analysis was performed using ANOVA, Mest and chi-square.

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