scholarly journals Accuracy of institutional orthopedic trauma databases: a retrospective chart review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Aman Chopra ◽  
Abigail C. Cortez ◽  
Ashraf El Naga ◽  
Anthony Ding ◽  
Saam Morshed
Keyword(s):  
Quality Control ◽  
Chart Review ◽  
Capture Rate ◽  
Data Entry ◽  
Retrospective Chart Review ◽  
Fracture Pattern ◽  
Control Measures ◽  
Injury Patterns ◽  
Level 1 ◽  
Level 1 Trauma Center

Abstract Introduction Academic trauma institutions rely on fracture databases as research and quality control tools. Frequently, these databases are populated by trainees, but the completeness and accuracy of such databases has not yet been evaluated. The purpose of this study is to determine the capture rate of a resident-populated database in collecting extremity fractures and to determine the accuracy of assigned Orthopaedic Trauma Association (OTA) classifications. Materials and methods A retrospective study was performed at a level 1 trauma center of all adult patients who underwent treatment for extremity fractures after an emergency department or inpatient consultation. A 20% random sample was taken from these entries and compared to a resident-populated fracture database designed to capture the same patients. For all matching records containing a resident-assigned OTA classification, relevant imaging was blindly reviewed by a trauma fellowship-trained orthopedic attending surgeon for fracture pattern classification. Resident OTA classifications were compared to this gold standard to determine overall accuracy rate. Results Three hundred eighteen (80%) out of 400 entries were captured by the resident-populated database. Two hundred thirty-one of these 318 entries contained an OTA classification. One hundred fifty-three (66%) of these 231 entries demonstrated concordance between resident and attending assigned OTA classifications. On subgroup analysis, 133 (70%) of the 190 lower extremity classifications were accurately identified as compared to just 20 (49%) of the 41 upper extremity classifications (p = 0.009). Seventy-nine (65%) of the 121 end segment fractures showed agreement versus 42 (67%) of the 63 diaphyseal injury patterns (p = 0.85). Accuracy of classification did not significantly vary by resident year of training (p = 0.142). Conclusion Trainee generated databases at academic institutions may be subject to incomplete data entry and inaccurate fracture classifications. Quality control measures should be instituted to ensure accuracy in such databases if efforts are invested with the expectation of useful information.

scholarly journals Accuracy of Institutional Orthopaedic Trauma Databases: A Retrospective Chart Review

2021 ◽  
Author(s):  
Aman Chopra ◽  
Abigail Cortez ◽  
Ashraf El Naga ◽  
Anthony Ding ◽  
Saam Morshed
Keyword(s):  
Quality Control ◽  
Chart Review ◽  
Capture Rate ◽  
Data Entry ◽  
Retrospective Chart Review ◽  
Fracture Pattern ◽  
Control Measures ◽  
Orthopaedic Trauma ◽  
Injury Patterns ◽  
Accuracy Rate

Abstract Introduction: Academic trauma institutions rely on fracture databases as research and quality control tools. Frequently, these databases are populated by trainees, but the completeness and accuracy of such databases has not yet been evaluated. The purpose of this study is to determine the capture rate of a resident-populated database in collecting extremity fractures and to determine the accuracy of assigned Orthopaedic Trauma Association (OTA) classifications.Materials and Methods: A retrospective study was performed at a level one trauma center of all adult patients who underwent treatment for extremity fractures after an emergency department or inpatient consultation. A 20% random sample was taken from these entries and compared to a resident-populated fracture database designed to capture the same patients. For all matching records containing a resident-assigned OTA classification, relevant imaging was blindly reviewed by a trauma fellowship-trained orthopaedic attending surgeon for fracture pattern classification. Resident OTA classifications were compared to this gold standard to determine overall accuracy rate.Results: 318 (80%) out of 400 entries were captured by the resident-populated database. 231 of these 318 entries contained an OTA classification. 153 (66%) of these 231 entries demonstrated concordance between resident and attending assigned OTA classifications. On subgroup analysis, 133 (70%) of the 190 lower extremity classifications were accurately identified as compared to just 20 (49%) of the 41 upper extremity classifications (p = 0.009). 79 (65%) of the 121 end segment fractures showed agreement versus 42 (67%) of the 63 diaphyseal injury patterns (p = 0.85). Accuracy of classification did not significantly vary by resident year of training (p = 0.142). Conclusion: Trainee generated databases at academic institutions may be subject to incomplete data entry and inaccurate fracture classifications. Quality control measures should be instituted to ensure accuracy in such databases if efforts are invested with the expectation of useful information.

scholarly journals Incidental Findings on CT Scans in the Emergency Department

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Ryan J. Thompson ◽  
Susan M. Wojcik ◽  
William D. Grant ◽  
Paul Y. Ko
Keyword(s):  
Incidental Findings ◽  
Chart Review ◽  
Incidental Finding ◽  
Retrospective Chart Review ◽  
Ct Scans ◽  
Urban Level ◽  
Discharged Patients ◽  
Level 1 ◽  
To Receive ◽  
Level 1 Trauma Center

Objectives. Incidental findings on computed tomography (CT) scans are common. We sought to examine rates of findings and disclosure among discharged patients who received a CT scan in the ED.Methods. Retrospective chart review (Aug-Oct 2009) of 600 patients age 18 and older discharged home from an urban Level 1 trauma center. CT reports were used to identify incidental findings and discharge paperwork was used to determine whether the patient was informed of these findings.Results. There were 682 CT scans among 600 patients: 199 Abdomen & Pelvis, 405 Head, and 78 Thorax. A total of 348 incidental findings were documented in 228/682 (33.4%) of the scans, of which 34 (9.8%) were reported to patients in discharge paperwork. Patients with 1 incidental finding were less likely to receive disclosure than patients with 2 or more (). Patients age <60 were less likely to have incidental findings (). There was no significant disclosure or incidental finding difference by gender.Conclusions. While previous research suggests that CT incidental findings are often benign, reporting to patients is recommended but this is rarely happening.

Syndesmotic Screw Removal in a Clinic Setting Is Safe and Cost-effective

2019 ◽  
Vol 13 (2) ◽  
pp. 144-151 ◽  
Author(s):  
Michelle T. Sugi ◽  
Brandon Ortega ◽  
Lane Shepherd ◽  
Charalampos Zalavras
Keyword(s):  
Operating Room ◽  
Chart Review ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Cost Effective ◽  
Level Of Evidence ◽  
Superficial Infection ◽  
Syndesmotic Screw ◽  
Level 1 ◽  
Level 1 Trauma Center

Background. There is no consensus in the literature regarding the necessity of syndesmotic screw removal, but the majority of surgeons prefer screw removal in the operating room. Purpose. The aim of this study is to analyze the safety and cost-effectiveness of syndesmotic screw removal in the clinic. Methods. A retrospective chart review was performed on all acute, traumatic ankle fractures that required syndesmotic stabilization over 5 years at a level 1 trauma center. Radiographs were evaluated for maintenance of syndesmotic reduction. Orthopaedic clinic visits and operating room costs were calculated. Results. Of 269 patients, syndesmotic screws were successfully removed in the clinic in 170 patients and retained in 99 patients. Two superficial infections (1.2%) developed following screw removal. The superficial infection rate was 3.3% (2 of 60) in patients who did not receive antibiotics compared with 0% (0 of 110) in patients who received antibiotics (P = .12). No patient lost syndesmotic reduction after screw removal. Cost savings of $13 829 per patient were achieved by syndesmotic screw removal in the clinic. Conclusion. Our study demonstrates that syndesmotic screw removal in the clinic is safe, does not result in tibiofibular diastasis, is cost-effective, and results in substantial financial savings. Level of Evidence: Level IV

Crotalidae Polyvalent Immune Fab and Cost-Effective Management of Hospital Admissions for Snakebites

2022 ◽  
pp. 000313482110545
Author(s):  
Mallory B. Bowden ◽  
Dudley B. Christie ◽  
Kelly H. Hand ◽  
Anne Montgomery
Keyword(s):  
Patient Population ◽  
Chart Review ◽  
Hospital Admissions ◽  
Treatment Protocol ◽  
Retrospective Chart Review ◽  
Cost Effective ◽  
Species Number ◽  
Level 1 ◽  
The Impact ◽  
Level 1 Trauma Center

Background Venomous snakebites are a common clinical scenario in the Southeastern United States. CroFab® (Crotalidae Polyvalent Immune Fab (Ovine), BTG, Wales, UK) antivenom is indicated in cases involving pit vipers and is known to be expensive. The treatment protocol for snakebites is based on clinically subjective measures triggering the application, or escalation of, antivenom administration. The purpose of this study is to characterize the use of CroFab at our institution and to evaluate the impact of its use regarding cost and overall outcomes. We suspect that it is often used but potentially less often needed. We hypothesized that CroFab use was associated with increased length of stay (LOS) without an observed difference in patient outcomes. Materials and Methods A retrospective chart review of snakebite patients at our level-1 trauma center from 2000 to 2016 was performed. Snakebite location, snake species, number of vials of CroFab administered, hospital LOS, intensive care unit (ICU) LOS, and complications were identified for each patient. Patients were divided into CroFab (C) and no CroFab (NC) groups. Results One hundred ninety patients with venomous snakebites were included. 53.7% of patients received CroFab. There was no difference in the complication rate of C versus NC groups, ( P = .1118). CroFab use was associated with longer hospital LOS ( P < .0001) and ICU LOS ( P < .0001). Discussion CroFab use was associated with increased LOS in our patient population. There was no difference in observed outcomes between the C and NC groups. These findings imply that CroFab is potentially over-used in our patient population.

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

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.

Facial Fractures: Demographics and Injury Patterns in a Level 1 Trauma Center

2013 ◽  
Vol 71 (9) ◽  
pp. e15-e16
Author(s):  
R. Garza ◽  
J.M. Adkinson ◽  
J.N. Gilstrap ◽  
N.F. Miller ◽  
S.M. Eid ◽  
...  
Keyword(s):  
Trauma Center ◽  
Facial Fractures ◽  
Injury Patterns ◽  
Level 1 ◽  
Level 1 Trauma Center

Completely Resistant Acinetobacter baumannii Strains

2002 ◽  
Vol 23 (8) ◽  
pp. 477-479 ◽  
Author(s):  
Siham Mahgoub ◽  
Jimi Ahmed ◽  
Aaron E. Glatt
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Control ◽  
Acinetobacter Baumannii ◽  
Broad Spectrum ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Control Measures ◽  
Teaching Hospitals ◽  
Infection Control Measures

Abstract Nosocomially acquired completely resistant Acinetobacter baumannii strains are a major clinical concern. We identified completely resistant A. baumannii in 6 (4.9%) of 122 A. baumannii isolates in a retrospective chart review at two teaching hospitals. All of these patients had received broad-spectrum antibiotics and had severe underlying comorbid illnesses, long hospitalizations, or recent surgical procedures; 3 had been in the intensive care unit. Five (83%) of the 6 patients were older than 70 years. Only one death occurred. Strict infection control measures may limit further spread.

5-Year Study of Gunshot Injury Patterns at an Urban Level 1 Trauma Center

2019 ◽  
Vol 229 (4) ◽  
pp. e219
Author(s):  
Alison A. Smith ◽  
Jennifer Avegno ◽  
Kevin Slaughter ◽  
Tyler Zeoli ◽  
Victor Nguyen ◽  
...  
Keyword(s):  
Trauma Center ◽  
Gunshot Injury ◽  
Injury Patterns ◽  
Urban Level ◽  
Level 1 ◽  
Level 1 Trauma Center

scholarly journals What to expect? Injury patterns of Electric-Scooter accidents over a period of one year - A prospective monocentric study at a Level 1 Trauma Center

2021 ◽  
Author(s):  
Andreas Harbrecht ◽  
Michael Hackl ◽  
Tim Leschinger ◽  
Stephan Uschok ◽  
Kilian Wegmann ◽  
...  
Keyword(s):  
Trauma Center ◽  
Epidemiological Data ◽  
University Hospital ◽  
Maximum Speed ◽  
Injury Patterns ◽  
New Type ◽  
Level 1 ◽  
One Year ◽  
Intensive Education ◽  
Level 1 Trauma Center

Abstract Purpose E-scooters are a new type of urban transportation utilized in Germany since June 2019, primarily in larger cities in the context of sharing offers. Such electrically operated standing scooters can be driven at a maximum speed of 20 km/h. A helmet is not mandatory. The aim of this prospective study is to document the injury patterns over the period of 1 year and compare our findings with already available data. Methods Over a period of 1 year (July 2019–July 2020), data on E-scooter-related accidents treated at a level 1 trauma center of a major German city were prospectively documented. Injury patterns were analyzed, and epidemiological data evaluated. Results Fifty-nine (35 female, 24 male) accidents were included in the observation period. Mean age of accident victims was 30.03 years (± 9.32). Alcohol influence at the time of accident was detected in 9 cases (15.25%). Many of the accident victims suffered multiple injuries. Most of the injuries were upper (50.84%) and lower extremity (47.45%) as well as craniofacial injuries (62.71%). A helmet was not worn in any of the cases. Conclusion In the year following their introduction, E-scooter-related accidents have led to an additional burden on the emergency capacities of the involved University Hospital, especially in the summer months of 2019. Protective equipment is de facto not worn. Injuries to the extremities, head, and face were most common. None of the accident victims died. This coincides with results from other major cities in national and international comparison. A more intensive education about injury consequences of unprotected E-scooter use and the discussion of a possible obligation to wear a helmet and further protection equipment for the extremities should take place.

Outcomes of second targeted therapy in metastatic renal carcinoma: A retrospective chart review in the EU.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 558-558
Author(s):  
Daniel Yick Chin Heng ◽  
Jinhee Park ◽  
James E. Signorovitch ◽  
Hongbo Yang ◽  
Jinlin Song ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Chart Review ◽  
Data Entry ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Eligibility Criteria ◽  
Kaplan Meier ◽  
The Uk ◽  
Sites Of Metastases ◽  
The Eu

558 Background: This study describes the real-world outcomes of metastatic renal cell carcinoma (mRCC) patients treated with everolimus (EVE), sorafenib (SOR), and axitinib (AXI) as 2nd targeted therapy in the UK, Germany, and France. Methods: A retrospective chart review was conducted among oncologists and urologists in the UK, Germany and France. Charts were reviewed for adult mRCC patients satisfying the following eligibility criteria: 1) experienced disease progression on 1st targeted therapy with sunitinib or pazopanib; 2) initiated 2nd targeted therapy with EVE, AXI, or SOR between 10/2012 and 6/2013. Kaplan-Meier analysis was used to estimate overall survival (OS) after initiation of 2nd targeted therapy among all patients and stratified by type of 2nd targeted therapy. Results: A total of 281 charts were reviewed, with 99, 91, and 91 mRCC patients receiving EVE, AXI, and SOR as 2nd targeted therapy, respectively. Mean age was 60.6 years old at initial mRCC diagnosis and 65.5% were male. The majority of patients used sunitinib (79.4%), with the rest using pazopanib (20.6%) as 1st targeted therapy. Median duration of 1st targeted therapy was 9.7 months. At the initiation of 2nd targeted therapy, 91.8% of patients had an ECOG score ≤ 2. The most common sites of metastases were lung (71.2%), bone (53.0%), and lymph nodes (47.0%). Median OS from the initiation of 2nd targeted therapy among all patients was 21.8 months (95% CI: 16.5-26.2). The median OS was 23.0, 23.5, and 18.7 for EVE, AXI, and SOR respectively. The majority of patients (87.5%) initiated 2nd targeted therapy on the recommended dose. Patients receiving AXI had a higher rate of dose increase (13.2%), compared to EVE (1.0%) and SOR (0.0%), while patients on EVE had a higher rate of dose decrease (12.1%), compared to AXI (5.5%) and SOR (8.8%). Conclusions: In this retrospective chart review study of several EU countries, the observed median OS was numerically comparable for EVE and AXI, but rates of dose adjustment differed by treatments. Retrospective chart reviews may be subject to selection bias and errors in data entry, and further analysis is underway to address confounding effects of unobserved patient characteristics.

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