scholarly journals Maxillofacial Trauma and COVID-19: A Review of the First 6 Months of the Pandemic

2021 ◽  
pp. 194338752110020
Author(s):  
Steven G. Press
Keyword(s):  
Trauma Center ◽  
Initial Phase ◽  
Medical Center ◽  
Respiratory Illness ◽  
Maxillofacial Trauma ◽  
Maxillofacial Injuries ◽  
Bivariate Statistics ◽  
First Case ◽  
Rebound Increase ◽  
The Impact

Study Design: Retrospective cohort study. Objective: The emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in late December 2019 has spread globally resulting in a pandemic of respiratory illness. The purpose of this study is to understand the impact of the first 6 months of the COVID-19 pandemic on the epidemiology of maxillofacial trauma at an urban trauma center. Methods: The study sample was derived from the population of patients who presented for evaluation and management of maxillofacial injuries at TriStar Skyline Medical Center in Nashville, Tennessee beginning March 1, 2020 and ending August 31, 2020, compared to the same period in 2019. Descriptive and bivariate statistics were calculated for study variables in each cohort with significance set at P < .05. Results: The number of subjects in the 2020 cohort (n = 212) was 4.2% higher than the 2019 cohort (n = 203). Volume decreased 24.5% during the initial phase of the pandemic with a 36.1% increase in volume occurring during the reopening phase (P = .003). Volume related to interpersonal decreased 52.4% during the initial phase of the pandemic with a rebound increase of 30% during reopening (P = .005). Conclusion: The first case of COVID-19 presented in Nashville, Tennessee in early March 2020. Over the next 6 months, periods of lockdown and reopening transpired. The volume of maxillofacial trauma decreased during the initial 3-months of the pandemic and rebounded to volumes greater than the year prior.

scholarly journals Lack of impact of nil-per-os (NPO) time on goal-directed fluid delivery in first case versus afternoon case starts: a retrospective cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
R. Ryan Field ◽  
Tuan Mai ◽  
Samouel Hanna ◽  
Brian Harrington ◽  
Michael-David Calderon ◽  
...  
Keyword(s):  
Operating Room ◽  
Medical Center ◽  
Fluid Administration ◽  
Fluid Replacement ◽  
Primary Study ◽  
Start Time ◽  
Fluid Delivery ◽  
First Case ◽  
Patient Reported ◽  
The Impact

Abstract Background Goal Directed Fluid Therapy (GDFT) represents an objective fluid replacement algorithm. The effect of provider variability remains a confounder. Overhydration worsens perioperative morbidity and mortality; therefore, the impact of the calculated NPO deficit prior to the operating room may reach harm. Methods A retrospective single-institution study analyzed patients at UC Irvine Medical Center main operating rooms from September 1, 2013 through September 1, 2015 receiving GDFT. The primary study question asked if GDFT suggested different fluid delivery after different NPO periods, while reducing inter-provider variability. We created two patient groups distinguished by 0715 surgical start time or start time after 1200. We analyzed fluid administration totals with either a 1:1 crystalloid to colloid ratio or a 3:1 ratio. We performed direct group-wise testing on total administered volume expressed as total ml, total ml/hr., and total ml/kg/hr. between the first case start (AM) and afternoon case (PM) groups. A linear regression model included all baseline covariates that differed between groups as well as plausible confounding factors for differing fluid needs. Finally, we combined all patients from both groups, and created NPO time to total administered fluid scatterplots to assess the effect of patient-reported NPO time on fluid administration. Results Whether reported by total administered volume or net fluid volume, and whether we expressed the sum as ml, ml/hr., or ml/kg/hr., the AM group received more fluid on average than the PM group in all cases. In the general linear models, for all significant independent variables evaluated, AM vs PM case start did not reach significance in both cases at p = 0.64 and p = 0.19, respectively. In scatterplots of NPO time to fluid volumes, absolute adjusted and unadjusted R2 values are < 0.01 for each plot, indicating virtually non-existent correlations between uncorrected NPO time and fluid volumes measured. Conclusions This study showed NPO periods do not influence a patient’s volume status just prior to presentation to the operating room for surgical intervention. We hope this data will influence the practice of providers routinely replacing calculated NPO period volume deficit; particularly with those presenting with later surgical case start times.

The Impact of In-house Attending Surgeon Supervision on the Rates of Preventable and Potentially Preventable Complications and Death at the Start of the New Academic Year

2013 ◽  
Vol 79 (11) ◽  
pp. 1134-1139 ◽  
Author(s):  
Kenji Inaba ◽  
Adam Hauch ◽  
Bernardino C. Branco ◽  
Stephen Cohn ◽  
Pedro G. R. Teixeira ◽  
...  
Keyword(s):  
Los Angeles ◽  
Trauma Center ◽  
Medical Center ◽  
Trauma Patients ◽  
University Of Southern California ◽  
Academic Level ◽  
Significant Difference ◽  
Level I ◽  
The Impact ◽  
Academic Year

The purpose of this study was to examine the impact of in-house attending surgeon supervision on the rate of preventable deaths (PD) and complications (PC) at the beginning of the academic year. All trauma patients admitted to the Los Angeles County 1 University of Southern California Medical Center over an 8-year period ending in December 2009 were reviewed. Morbidity and mortality reports were used to extract all PD/PC. Patients admitted in the first 2 months (July/ August) of the academic year were compared with those admitted at the end of the year (May/June) for two distinct time periods: 2002 to 2006 (before in-house attending surgeon supervision) and 2007 to 2009 (after 24-hour/day in-house attending surgeon supervision). During 2002 to 2006, patients admitted at the beginning of the year had significantly higher rates of PC (1.1% for July/ August vs 0.6% for May/June; adjusted odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1 to 3.2; P < 0.001). There was no significant difference in mortality (6.5% for July/August vs 4.6% for May/ June; adjusted OR, 1.1; 95% CI,0.8 to 1.5; P = 0.179). During 2007 to 2009, after institution of 24-hour/day in-house attending surgeon supervision of fellows and housestaff, there was no significant difference in the rates of PC (0.7% for July/August vs 0.6% for May/June; OR, 1.1; 95% CI, 0.8 to 1.3; P = 0.870) or PD (4.6% for July/August vs 3.7% for May/June; OR, 1.3; 95% CI, 0.9 to 1.7; P = 0.250) seen at the beginning of the academic year. At an academic Level I trauma center, the institution of 24-hour/day in-house attending surgeon supervision significantly reduced the spike of preventable complications previously seen at the beginning of the academic year.

scholarly journals Lack of Impact of Nil-Per-Os (NPO) Time on Goal-Directed Fluid Delivery in First Case versus Afternoon Case Starts: A Retrospective Cohort Study

2019 ◽  
Author(s):  
R Ryan Field ◽  
Tuan Mai ◽  
Samouel Hanna ◽  
Brian Harrington ◽  
Michael-David Calderon ◽  
...  
Keyword(s):  
Operating Room ◽  
Medical Center ◽  
Fluid Administration ◽  
Fluid Replacement ◽  
Primary Study ◽  
Start Time ◽  
Fluid Delivery ◽  
First Case ◽  
Patient Reported ◽  
The Impact

Abstract Background: Goal Directed Fluid Therapy(GDFT) represents an objective fluid replacement algorithm. The effect of provider variability remains a confounder. Overhydration worsens perioperative morbidity and mortality; therefore, the impact of the calculated NPO deficit prior to the operating room may reach harm. Methods: A retrospective single-institution study analyzed patients at UC Irvine Medical Center main operating rooms from September 1, 2013 through September 1, 2015 receiving GDFT. The primary study question asked if GDFT suggested different fluid delivery after different NPO periods, while reducing inter-provider variability. We created two patient groups distinguished by 0715 surgical start time or start time after 1200. We analyzed fluid administration totals with either a 1:1 crystalloid to colloid ratio or a 3:1 ratio. We performed direct group-wise testing on total administered volume expressed as total ml, total ml/hr, and total ml/kg/hr between the first case start (AM) and afternoon case (PM) groups. A linear regression model included all baseline covariates that differed between groups as well as plausible confounding factors for differing fluid needs. Finally, we combined all patients from both groups, and created NPO time to total administered fluid scatterplots to assess the effect of patient-reported NPO time on fluid administration. Results: Whether reported by total administered volume or net fluid volume, and whether we expressed the sum as ml, ml/hr, or ml/kg/hr, the AM group received more fluid on average than the PM group in all cases. In the general linear models, for all significant independent variables evaluated, AM vs PM case start did not reach significance in both cases at p=0.64 and p=0.19, respectively. In scatterplots of NPO time to fluid volumes, absolute adjusted and unadjusted R2 values are < 0.01 for each plot, indicating virtually non-existent correlations between uncorrected NPO time and fluid volumes measured. Conclusions: This study showed NPO periods do not influence a patient’s volume status just prior to presentation to the operating room for surgical intervention. We hope this data will influence the practice of providers routinely replacing calculated NPO period volume deficit; particularly with those presenting with later surgical case start times.

scholarly journals Lack of Impact of Nil-Per-Os (NPO) Time on Goal-Directed Fluid Delivery in First Case versus Afternoon Case Starts: A Retrospective Cohort Study

2019 ◽  
Author(s):  
R Ryan Field ◽  
Tuan Mai ◽  
Samouel Hanna ◽  
Brian Harrington ◽  
Michael-David Calderon ◽  
...  
Keyword(s):  
Operating Room ◽  
Medical Center ◽  
Fluid Administration ◽  
Fluid Replacement ◽  
Primary Study ◽  
Start Time ◽  
Fluid Delivery ◽  
First Case ◽  
Patient Reported ◽  
The Impact

Abstract Background: Goal Directed Fluid Therapy(GDFT) represents an objective fluid replacement algorithm. The effect of provider variability remains a confounder. Overhydration worsens perioperative morbidity and mortality; therefore, the impact of the calculated NPO deficit prior to the operating room may reach harm. Methods: A retrospective single-institution study analyzed patients at UC Irvine Medical Center main operating rooms from September 1, 2013 through September 1, 2015 receiving GDFT. The primary study question asked if GDFT suggested different fluid delivery after different NPO periods, while reducing inter-provider variability. We created two patient groups distinguished by 0715 surgical start time or start time after 1200. We analyzed fluid administration totals with either a 1:1 crystalloid to colloid ratio or a 3:1 ratio. We performed direct group-wise testing on total administered volume expressed as total ml, total ml/hr, and total ml/kg/hr between the first case start (AM) and afternoon case (PM) groups. A linear regression model included all baseline covariates that differed between groups as well as plausible confounding factors for differing fluid needs. Finally, we combined all patients from both groups, and created NPO time to total administered fluid scatterplots to assess the effect of patient-reported NPO time on fluid administration. Results: Whether reported by total administered volume or net fluid volume, and whether we expressed the sum as ml, ml/hr, or ml/kg/hr, the AM group received more fluid on average than the PM group in all cases. In the general linear models, for all significant independent variables evaluated, AM vs PM case start did not reach significance in both cases at p=0.64 and p=0.19, respectively. In scatterplots of NPO time to fluid volumes, absolute adjusted and unadjusted R2 values are < 0.01 for each plot, indicating virtually non-existent correlations between uncorrected NPO time and fluid volumes measured. Conclusions: This study showed NPO periods do not influence a patient’s volume status just prior to presentation to the operating room for surgical intervention. We hope this data will influence the practice of providers routinely replacing calculated NPO period volume deficit; particularly with those presenting with later surgical case start times.

scholarly journals Lack of Impact of Nil-Per-Os (NPO) Time on Goal-Directed Fluid Delivery in First Case versus Afternoon Case Starts: A Retrospective Cohort Study

2019 ◽  
Author(s):  
R Ryan Field ◽  
Tuan Mai ◽  
Samouel Hanna ◽  
Brian Harrington ◽  
Michael-David Calderon ◽  
...  
Keyword(s):  
Operating Room ◽  
Medical Center ◽  
Fluid Administration ◽  
Fluid Replacement ◽  
Primary Study ◽  
Start Time ◽  
Fluid Delivery ◽  
First Case ◽  
Patient Reported ◽  
The Impact

Abstract Background: Goal Directed Fluid Therapy(GDFT) represents an objective fluid replacement algorithm. The effect of provider variability remains a confounder. Overhydration worsens perioperative morbidity and mortality; therefore, the impact of the calculated NPO deficit prior to the operating room may reach harm. Methods: A retrospective single-institution study analyzed patients at UC Irvine Medical Center main operating rooms from September 1, 2013 through September 1, 2015 receiving GDFT. The primary study question asked if GDFT suggested different fluid delivery after different NPO periods, while reducing inter-provider variability. We created two patient groups distinguished by 0715 surgical start time or start time after 1200. We analyzed fluid administration totals with either a 1:1 crystalloid to colloid ratio or a 3:1 ratio. We performed direct group-wise testing on total administered volume expressed as total ml, total ml/hr, and total ml/kg/hr between the first case start (AM) and afternoon case (PM) groups. A linear regression model included all baseline covariates that differed between groups as well as plausible confounding factors for differing fluid needs. Finally, we combined all patients from both groups, and created NPO time to total administered fluid scatterplots to assess the effect of patient-reported NPO time on fluid administration. Results: Whether reported by total administered volume or net fluid volume, and whether we expressed the sum as ml, ml/hr, or ml/kg/hr, the AM group received more fluid on average than the PM group in all cases. In the general linear models, for all significant independent variables evaluated, AM vs PM case start did not reach significance in both cases at p=0.64 and p=0.19, respectively. In scatterplots of NPO time to fluid volumes, absolute adjusted and unadjusted R2 values are < 0.01 for each plot, indicating virtually non-existent correlations between uncorrected NPO time and fluid volumes measured. Conclusions: This study showed NPO periods do not influence a patient’s volume status just prior to presentation to the operating room for surgical intervention. We hope this data will influence the practice of providers routinely replacing calculated NPO period volume deficit; particularly with those presenting with later surgical case start times.

scholarly journals Burden of Maxillofacial Trauma at Level 1 Trauma Center

2014 ◽  
Vol 7 (2) ◽  
pp. 126-130 ◽  
Author(s):  
Ruchi Pathak Kaul ◽  
Sushma Sagar ◽  
Maneesh Singhal ◽  
Abhishek Kumar ◽  
Jiten Jaipuria ◽  
...  
Keyword(s):  
Trauma Center ◽  
The Body ◽  
Maxillofacial Trauma ◽  
Etiologic Factor ◽  
Mandibular Fractures ◽  
New Delhi ◽  
Maxillofacial Injuries ◽  
Concomitant Injuries ◽  
Female Ratio ◽  
Maxillofacial Fractures

There is an upward trend in facial injuries following changes in population pattern, increasing industrialization and urbanization, hence maxillofacial trauma is becoming a burden and a leading medical problem in emergency rooms worldwide. This study was performed to evaluate the pattern of maxillofacial fractures, associated injuries, and treatment used at Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India, between January 2007 and June 2010. The study provides basis for establishment of trauma as major etiology of maxillofacial injuries and planning for preventive strategies. A retrospective study of patients seen and treated at JPNATC, AIIMS, New Delhi, between January 2007 and June 2010 was performed. Data extracted from patient records included etiology, age, sex, types and sites of fractures, treatment modality, and concomitant injuries. There were 795 fractures of the maxillofacial skeleton and 86 concomitant injuries from 542 patients. Road traffic accident (RTA) (56.8%) was the most common etiologic factor, followed by falls (22.3%) and fights (18.5%). The age range was from 3 to 75 years (mean, 34.7 years) with a peak incidence in the third decade with a male-to-female ratio of 3.7:1. The most common location of maxillofacial fractures was the mandible 615 (77%) and middle third 180 (23%). With regard to mandibular fractures, the body (29.6%) was the most common site, followed by the angle (24.4%), ramus (19.5%), dentoalveolar (14.6%), symphysis (11.0%), condyle (0.8%) while in the middle third, the nasal bone (36.7%) was the most common, followed by zygomatic bone (27.8), Lefort II (14.4), Lefort I (7.8%), dentoalveolar (10.0%), and Lefort III (3.3%). Majority of the patients were treated by open reduction and internal fixation (70.6). Concomitant injuries were 84 (10.8%) with orthopedic injuries accounting for the majority (63.9%). Head injury was associated in 16.3% of cases. RTA was the major etiologic factor of maxillofacial injuries in our setting and the young adult males were the main victims. Henceforth, establishment of regionalized, efficient, and focused trauma centers in various parts of the country particularly for acute trauma should be emphasized. Also, the laws regarding the precautions such as seat belts, speed limits, and traffic rules must be observed strictly to reduce the incidence of RTA.

The Impact of an Independent Transfer Center on the Evaluation and Transport of Patients With Burn and Maxillofacial Injuries to Definitive Care at a Level 1 Trauma Center

2012 ◽  
Vol 68 (5) ◽  
pp. 484-488 ◽  
Author(s):  
Matthew Surrusco ◽  
Winnie Tong ◽  
Katherine S. Roden ◽  
Preston B. Rich ◽  
Bruce A. Cairns ◽  
...  
Keyword(s):  
Trauma Center ◽  
Maxillofacial Injuries ◽  
Level 1 ◽  
The Impact ◽  
Level 1 Trauma Center

scholarly journals Lack of Impact of Nil-Per-Os (NPO) Time on Goal-Directed Fluid Delivery in First Case versus Afternoon Case Starts: A Retrospective Cohort Study

2019 ◽  
Author(s):  
R Ryan Field ◽  
Tuan Mai ◽  
Samouel Hanna ◽  
Brian Harrington ◽  
Michael-David Calderon ◽  
...  
Keyword(s):  
Operating Room ◽  
Medical Center ◽  
Fluid Administration ◽  
Fluid Replacement ◽  
Primary Study ◽  
Start Time ◽  
Fluid Delivery ◽  
First Case ◽  
Patient Reported ◽  
The Impact

Abstract Background: Goal Directed Fluid Therapy(GDFT) represents an objective fluid replacement algorithm. The effect of provider variability remains a confounder. Overhydration worsens perioperative morbidity and mortality; therefore, the impact of the calculated NPO deficit prior to the operating room may reach harm. Methods: A retrospective single-institution study analyzed patients at UC Irvine Medical Center main operating rooms from September 1, 2013 through September 1, 2015 receiving GDFT. The primary study question asked if GDFT suggested different fluid delivery after different NPO periods, while reducing inter-provider variability. We created two patient groups distinguished by 0715 surgical start time or start time after 1200. We analyzed fluid administration totals with either a 1:1 crystalloid to colloid ratio or a 3:1 ratio. We performed direct group-wise testing on total administered volume expressed as total ml, total ml/hr, and total ml/kg/hr between the first case start (AM) and afternoon case (PM) groups. A linear regression model included all baseline covariates that differed between groups as well as plausible confounding factors for differing fluid needs. Finally, we combined all patients from both groups, and created NPO time to total administered fluid scatterplots to assess the effect of patient-reported NPO time on fluid administration. Results: Whether reported by total administered volume or net fluid volume, and whether we expressed the sum as ml, ml/hr, or ml/kg/hr, the AM group received more fluid on average than the PM group in all cases. In the general linear models, for all significant independent variables evaluated, AM vs PM case start did not reach significance in both cases at p=0.64 and p=0.19, respectively. In scatterplots of NPO time to fluid volumes, absolute adjusted and unadjusted R2 values are < 0.01 for each plot, indicating virtually non-existent correlations between uncorrected NPO time and fluid volumes measured. Conclusions: This study showed NPO periods do not influence a patient’s volume status just prior to presentation to the operating room for surgical intervention. We hope this data will influence the practice of providers routinely replacing calculated NPO period volume deficit; particularly with those presenting with later surgical case start times.

Maxillofacial Horse Trauma: A 10-Year Retrospective Study at a UK Major Trauma Center

2021 ◽  
pp. 194338752110259
Author(s):  
Rajeevan Sritharan ◽  
Christopher David Blore ◽  
Daya Singh Gahir
Keyword(s):  
Trauma Center ◽  
Major Trauma ◽  
Trauma Centre ◽  
Maxillofacial Trauma ◽  
Maxillofacial Injuries ◽  
Hard Tissue ◽  
Safety Equipment ◽  
Horse Riding ◽  
Chi Squared ◽  
Level 1

Introduction/Objecive: There are very few studies that have investigated equestrian-related maxillofacial injuries. A retrospective review was performed to investigate maxillofacial horse trauma at a Level 1 Trauma Centre at the Royal Stoke Hospital over the last 10 years between 2010 and 2020. Study Design/Methods: Search of the hospital’s major trauma database as well as ED records showed 51 patients who sustained maxillofacial injuries related to horses. Statistical analysis was performed using Chi Squared tests. Results: 41 patients were female and the remaining 10 were male. 43% of patients were female and aged 30 and under. Kicks from horses accounted for 64.4% of equine-related maxillofacial injuries. A total of 90 injuries were recorded. Hard tissue injuries which include all fractures accounted for 66.3% of injuries sustained. 70.5% patients sustained isolated maxillofacial trauma. There was an association between patients sustaining non-isolated maxillofacial trauma and hard tissue maxillofacial injuries ( P = 0.04). 65.6% of injuries were managed operatively. Patients aged 30 and under were more likely to be managed operatively ( P = 0.03). Conclusion: Equestrian related maxillofacial trauma represents a proportion of trauma workload. The safety aspect of horse riding should be considered and education in safe riding and the use of appropriate safety equipment is vital.

scholarly journals The impact of delayed surgical intervention following high velocity maxillofacial injuries

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Daniel Oren ◽  
Amiel A. Dror ◽  
Adeeb Zoabi ◽  
Adi Kasem ◽  
Lior Tzadok ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
High Velocity ◽  
Medical Center ◽  
Complication Rates ◽  
Maxillofacial Injuries ◽  
Delayed Treatment ◽  
Syrian Civil War ◽  
The Mean ◽  
The Impact

AbstractOur study compares the number of postoperative complications of Syrian patients admitted to the Galilee Medical Center (GMC) over a 5-year period (May 2013–May 2018) for treatment after initial high-velocity maxillofacial injuries sustained during the Syrian civil war. Specifically, we evaluated complication rates of patients arriving “early,” within 24 h, to the GMC versus those who arrived “late,” or 14–28 days following high-velocity maxillofacial injuries. Both groups of patients received definitive surgical treatment within 48 h of admission to our hospital with a total of 60 patients included in this study. The mean age was 26 ± 8 years (range: 9–50) and all except one were male. Postoperative complications in the early group were found to be significantly higher compared to the delayed arrival group (p = 0.006). We found that unintentionally delayed treatment may have contributed to a critical revascularization period resulting in improved healing and decreased postoperative morbidity and complications. We discuss potential mechanisms for complication rate variations, including critical vascularization periods. Our study may add to a growing body of work demonstrating the potential benefit of delayed surgical treatment for high-velocity maxillofacial injuries.

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