scholarly journals Does Care at a Trauma Center Affect Geriatric Hip Fracture Patients?

2020 ◽  
Vol 11 ◽  
pp. 215145932091186
Author(s):  
Jordan B. Pasternack ◽  
Matthew L. Ciminero ◽  
Michael Silver ◽  
Joseph Chang ◽  
Piyush Gupta ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Outcome Measures ◽  
Hip Fractures ◽  
Complication Rate ◽  
Trauma Center ◽  
Secondary Outcome ◽  
Transfusion Rate ◽  
Geriatric Hip Fracture ◽  
Level 1 ◽  
Level 1 Trauma Center

Introduction: With respect to care setting, there are mixed results in the literature with respect to the role of trauma centers in management of isolated geriatric hip fractures. During a transition from a Level 3 to a Level 1 trauma center, significant protocol changes were implemented that sought to standardize and improve the care of hip fracture patients. The objective of this study was to determine the effects of this transition on the management, efficiency, morbidity, mortality, and discharge of geriatric hip fracture patients. Methods: A retrospective chart review of geriatric hip fractures treated operatively was conducted. Two cohorts were compared: hip fractures in the year prior to (2015) and year following (2017) Level 1 Trauma designation. Primary outcome measures were length of stay (LOS), transfusion rate, complication rate, and mortality rate. Secondary outcome measures were time from emergency department (ED) arrival to medical optimization, time from medical optimization to surgery, time from ED arrival to surgery, and discharge destination. Results: There were no differences in LOS, transfusion rate, or complication rate between the two cohorts. There was a nonsignificant trend toward lower in-hospital mortality after the transition (2.24% vs 0.83%). There were no differences in time from ED arrival to medical optimization, time from medical optimization to surgery, time from ED arrival to surgery, and percentage of patients discharged home between the cohorts. Discussion: Management of operative geriatric hip fractures at our institution has remained consistent following transition to a Level 1 trauma center. There was a trend toward lower mortality after transition, but this difference was not statistically significant. We attribute the variety of findings in the literature with respect to trauma center management of hip fractures to individualized institutional trauma protocols as well as the diverse patient populations these centers serve.

Can Geriatric Hip Fractures be Managed Effectively Within a Level 1 Trauma Center?

2015 ◽  
Vol 29 (3) ◽  
pp. 160-164 ◽  
Author(s):  
Shi-Neng James Ling ◽  
Christopher Kleimeyer ◽  
Genni Lynch ◽  
Elizabeth Burmeister ◽  
Diana Kennedy ◽  
...  
Keyword(s):  
Hip Fractures ◽  
Trauma Center ◽  
Level 1 ◽  
Level 1 Trauma Center

Establishing a Geriatric Hip Fracture Program at a Level 1 Community Trauma Center

2020 ◽  
Vol 39 (3) ◽  
pp. 171-179
Author(s):  
Kristin OʼMara-Gardner ◽  
Roberta E. Redfern ◽  
Jeffrey M. Bair
Keyword(s):  
Hip Fracture ◽  
Trauma Center ◽  
Geriatric Hip Fracture ◽  
Level 1 ◽  
Community Trauma

scholarly journals Hypovitaminosis D Among Patients Admitted With Hip Fracture to a Level-1 Trauma Center in the Sunny Upper Egypt

2016 ◽  
Vol 7 (3) ◽  
pp. 148-152 ◽  
Author(s):  
Osama Farouk ◽  
Dalia G. Mahran ◽  
Hatem G. Said ◽  
Mohamed M. Alaa ◽  
Amr Atef Eisa ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Trauma Center ◽  
Hypovitaminosis D ◽  
Upper Egypt ◽  
Level 1 ◽  
Level 1 Trauma Center

scholarly journals Hip Fracture Volume Does Not Change at a New York City Level 1 Trauma Center During a Period of Social Distancing

2020 ◽  
Vol 11 ◽  
pp. 215145932097267
Author(s):  
Jonathan D. Haskel ◽  
Charles C. Lin ◽  
Daniel J. Kaplan ◽  
John F. Dankert ◽  
David Merkow ◽  
...  
Keyword(s):  
New York ◽  
Hip Fracture ◽  
Operating Room ◽  
Trauma Center ◽  
Femoral Shaft ◽  
Social Distancing ◽  
Significant Difference ◽  
Level 1 ◽  
Orthopedic Injuries ◽  
Level 1 Trauma Center

Purpose: To characterize the volume and variation in orthopedic consults and surgeries that took place during a period of social distancing and pandemic. Methods: All orthopedic consults and surgeries at an urban level 1 trauma center from 3/22/20-4/30/2020 were retrospectively reviewed (the social distancing period). Data from the same dates in 2019 were reviewed for comparison. Age, gender, Score for Trauma Triage in the Geriatric and Middle Aged (STTGMA) score and injury type were queried. Operating room data collected included: type of surgery performed, inpatient or outpatient status, and if the cases were categorized as elective, trauma or infectious cases. Results: Compared to 2019, there was a 48.3% decrease in consult volume in 2020. The 2020 population was significantly older (44.0 vs 52.6 years-old, p = 0.001) and more male (65% vs 35%, p = 0.021). There were 23 COVID positive patients, 10 of which died within the collection period. Consult distribution dramatically changed, with decreases in ankle fractures, distal radius fractures and proximal humerus fractures of 76.5%, 77.4% and 55.0%, respectively. However, there was no significant difference in volume of hip, tibial shaft and femoral shaft fractures (p > 0.05). In 2020, there was a 41.4% decrease in operating room volume, no elective cases were performed, and cases were primarily trauma related. Conclusions: During a period of pandemic and social distancing, the overall volume of orthopedic consults and surgeries significantly declined. However, hip fracture volume remained unchanged. Patients presenting with orthopedic injuries were older, and at higher risk for inpatient mortality.

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

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.

Poster 16 Utilization review from a level 1 trauma center to improve scene triage

1992 ◽  
Vol 11 (10) ◽  
pp. 80
Author(s):  
Edward T. Rupert ◽  
J. Duncan Harviel ◽  
Grace S. Rozycki ◽  
Howard R. Champion
Keyword(s):  
Trauma Center ◽  
Utilization Review ◽  
Level 1 ◽  
Level 1 Trauma Center

Room F, 10/17/2000 2: 00 PM - 4: 00 PM (PS) Clinical Research in Emergency Patients — Experience with Delayed Consent at a Level 1 Trauma Center 

2000 ◽  
Vol 93 (3A) ◽  
pp. A-480 ◽  
Author(s):  
Richard P. Dutton ◽  
Colin F. Mackenzie ◽  
Thomas M. Scalea
Keyword(s):  
Clinical Research ◽  
Trauma Center ◽  
Emergency Patients ◽  
Level 1 ◽  
Patients Experience ◽  
Level 1 Trauma Center
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