scholarly journals Diversity in clinical management and protocols for the treatment of major bleeding trauma patients across European level I Trauma Centres

2015 ◽  
Vol 23 (1) ◽  
Author(s):  
Nadine Schäfer ◽  
◽  
Arne Driessen ◽  
Matthias Fröhlich ◽  
Ewa K. Stürmer ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Clinical Management ◽  
Trauma Patients ◽  
European Level ◽  
Trauma Centres ◽  
Level I

The ACS-TQIP palliative care guidelines at two level I trauma centres: a prospective study of patient and caregiver satisfaction

2020 ◽  
pp. bmjspcare-2020-002229
Author(s):  
Rebecca Vogel ◽  
Constance McGraw ◽  
Diane Redmond ◽  
Pamela Bourg (retired) ◽  
Chester Dreiman ◽  
...  
Keyword(s):  
Palliative Care ◽  
Patient Satisfaction ◽  
Family Satisfaction ◽  
Trauma Patients ◽  
Do Not Resuscitate ◽  
Advanced Directives ◽  
Trauma Centres ◽  
Caregiver Satisfaction ◽  
Information Giving ◽  
Level I

ObjectivesTo measure trauma patient and caregiver satisfaction before and after implementation of standardised palliative care (PC) guidelines.MethodsProspective pre–post study at two level-I trauma centres. PC satisfaction surveys were administered prior to discharge for consented trauma patients (Family Satisfaction with Advanced Cancer Scale, Patient (FAMCARE-P13) survey)≥55 years, and their caregivers (FAMCARE survey), from 1 November 2016 to 30 November 2018. Standardised PC guidelines were implemented January 2018 and included consultations, prognostication assessments, identification of proxies, review of advanced directives and do not resuscitate orders within 24 hours of admission, while advanced goals of care, formal family meetings and spiritual care support were recommended within 72 hours of admission. Generalised linear models were used to determine whether differences in patient or caregiver satisfaction existed pre versus post implementation.ResultsThere were 572 patients (299 pre; 273 post) and 595 caregivers (334 pre; 261 post) included. Overall patient satisfaction significantly increased post implementation (82.0 vs 86.0, p=0.001). After adjustment, the implementation of the guidelines was an independent predictor of higher overall patient satisfaction (least squares mean (LSM= (83.8% (95%CI 81.2%-86.5%) vs 80.3% (77.7%-82.9%), p=0.003)). Compared with preimplementation, patient satisfaction was significantly higher post implementation in the following domains: information giving (80.9 vs 85.5, p=0.001), followed by physical care (82.2 vs 86.0, p=0.002), availability of care (83.4 vs 86.8, p=0.007) and psychosocial care (84.7 vs 87.6, p=0.04). No significant differences in caregiver satisfaction were found before or after adjustment (LSMpre: 83.1% (95%CI 80.9%-85.3%) vs. post: 82.4% (80.3%-84.5%), p=0.56))ConclusionsOur data suggest that the implementation of PC guidelines significantly improved patient satisfaction following traumatic injury, while maintaining robust caregiver satisfaction.

Does Gender Matter: A Multi-Institutional Analysis of Viscoelastic Profiles for 1565 Trauma Patients With Severe Hemorrhage

2021 ◽  
pp. 000313482110335
Author(s):  
Alison Smith ◽  
Juan Duchesne ◽  
Matthew Marturano ◽  
Shaun Lawicki ◽  
Kevin Sexton ◽  
...  
Keyword(s):  
Alpha Angle ◽  
Reaction Times ◽  
Maximum Amplitude ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Survival Difference ◽  
Severe Hemorrhage ◽  
Male Patients ◽  
Level I ◽  
Clot Formation Time

Background Viscoelastic tests including thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are being used in patients with severe hemorrhage at trauma centers to guide resuscitation. Several recent studies demonstrated hypercoagulability in female trauma patients that was associated with a survival advantage. The objective of our study was to elucidate the effects of gender differences in TEG/ROTEM values on survival in trauma patients with severe hemorrhage. Methods A retrospective review of consecutive adult patients receiving massive transfusion protocol (MTP) at 7 Level I trauma centers was performed from 2013 to 2018. Data were stratified by gender and then further examined by TEG or ROTEM parameters. Results were analyzed using univariate and multi-variate analyses. Results A total of 1565 patients were included with 70.9% male gender (n = 1110/1565). Female trauma patients were older than male patients (43.5 ± .9 vs 41.1 ± .6 years, P = .01). On TEG, females had longer reaction times (6.1 ± .9 min vs 4.8 ± .2 min, P = .03), increased alpha angle (68.6 ± .8 vs 65.7 ± .4, P < .001), and higher maximum amplitude (59.8 ± .8 vs 56.3 ± .4, P < .001). On ROTEM, females had significantly longer clot time (99.2 ± 13.7 vs 75.1 ± 2.6 sec, P = .09) and clot formation time (153.6 ± 10.6 sec vs 106.9 ± 3.8 sec, P < .001). When comparing by gender, no difference for in-hospital mortality was found for patients in the TEG or ROTEM group ( P > .05). Multivariate analysis showed no survival difference for female patients (OR 1.11, 95% CI .83-1.50, P = .48). Conclusions Although a difference between male and females was found on TEG/ROTEM for certain clotting parameters, no difference in mortality was observed. Prospective multi-institutional studies are needed.

scholarly journals Surgical Site Infections at a Level I Trauma Center in India: Data From an Indigenously Developed, e-SSI Surveillance System

2020 ◽  
Vol 41 (S1) ◽  
pp. s397-s398
Author(s):  
Ayush Lohiya ◽  
Samarth Mittal ◽  
Vivek Trikha ◽  
Surbhi Khurana ◽  
Sonal Katyal ◽  
...  
Keyword(s):  
Surveillance System ◽  
Trauma Center ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Trauma Patients ◽  
Care Hospital ◽  
Middle Income ◽  
Predominant Pathogen ◽  
Level I

Background: Globally, surgical site infections (SSIs) not only complicate the surgeries but also lead to $5–10 billion excess health expenditures, along with the increased length of hospital stay. SSI rates have become a universal measure of quality in hospital-based surgical practice because they are probably the most preventable of all healthcare-associated infections. Although, many national regulatory bodies have made it mandatory to report SSI rates, the burden of SSI is still likely to be significant underestimated due to truncated SSI surveillance as well as underestimated postdischarge SSIs. A WHO survey found that in low- to middle-income countries, the incidence of SSIs ranged from 1.2 to 23.6 per 100 surgical procedures. This contrasted with rates between 1.2% and 5.2% in high-income countries. Objectives: We aimed to leverage the existing surveillance capacities at our tertiary-care hospital to estimate the incidence of SSIs in a cohort of trauma patients and to develop and validate an indigenously developed, electronic SSI surveillance system. Methods: A prospective cohort study was conducted at a 248-bed apex trauma center for 18 months. This project was a part of an ongoing multicenter study. The demographic details were recorded, and all the patients who underwent surgery (n = 770) were followed up until 90 days after discharge. The associations of occurrence of SSI and various clinico-microbiological variables were studied. Results: In total, 32 (4.2%) patients developed SSI. S. aureus (28.6%) were the predominant pathogen causing SSI, followed by E. coli (14.3%) and K. pneumoniae (14.3%). Among the patients who had SSI, higher SSI rates were associated in patients who were referred from other facilities (P = .03), had wound class-CC (P < .001), were on HBOT (P = .001), were not administered surgical antibiotics (P = .04), were not given antimicrobial coated sutures (P = .03) or advanced dressings (P = .02), had a resurgery (P < .001), had a higher duration of stay in hospital from admission to discharge (P = .002), as well as from procedure to discharge (P = .002). SSI was cured in only 16 patients (50%) by 90 days. SSI data collection, validation, and analyses are essential in developing countries like India. Thus, it is very crucial to implement a surveillance system and a system for reporting SSI rates to surgeons and conduct a robust postdischarge surveillance using trained and committed personnel to generate, apply, and report accurate SSI data.Funding: NoneDisclosures: None

scholarly journals Usefulness of Pelvic Radiographs in the Initial Trauma Evaluation with Concurrent CT: Is Additional Radiation Exposure Necessary?

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Anne K. Misiura ◽  
Autumn D. Nanassy ◽  
Jacqueline Urbine
Keyword(s):  
Trauma Center ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Additional Information ◽  
Pelvic Radiographs ◽  
Pelvic Radiograph ◽  
Digital Radiograph ◽  
Urban Level ◽  
Level I ◽  
Pediatric Trauma Center

Trauma patients in a Level I Pediatric Trauma Center may undergo CT of the abdomen and pelvis with concurrent radiograph during initial evaluation in an attempt to diagnose injury. To determine if plain digital radiograph of the pelvis adds additional information in the initial trauma evaluation when CT of the abdomen and pelvis is also performed, trauma patients who presented to an urban Level I Pediatric Trauma Center between 1 January 2010 and 7 February 2017 in whom pelvic radiograph and CT of the abdomen and pelvis were performed within 24 hours of each other were analyzed. A total of 172 trauma patients had pelvic radiograph and CT exams performed within 24 hours of each other. There were 12 cases in which the radiograph missed pelvic fractures seen on CT and 2 cases in which the radiograph suspected a fracture that was not present on subsequent CT. Furthermore, fractures in the pelvis were missed on pelvic radiographs in 12 of 35 cases identified on CT. Sensitivity of pelvic radiograph in detecting fractures seen on CT was 65.7% with a 95% confidence interval of 47.79-80.87%. Results suggest that there is no added diagnostic information gained from a pelvic radiograph when concurrent CT is also obtained, a practice which exposes the pediatric trauma patient to unnecessary radiation.

Experiences of Older Adult Trauma Patients Discharged Home From a Level I Trauma Center

2017 ◽  
Vol 24 (3) ◽  
pp. 182-192
Author(s):  
Nathalie Rodrigue ◽  
Andréa Maria Laizner ◽  
Nancy Tze ◽  
Maida Sewitch
Keyword(s):  
Older Adult ◽  
Trauma Center ◽  
Trauma Patients ◽  
Level I

Direct transport of geriatric trauma patients with pelvic fractures to a Level I trauma center within an organized trauma system: impact on two-week incidence of in-hospital complications

2012 ◽  
Vol 204 (6) ◽  
pp. 921-926 ◽  
Author(s):  
Tabitha Garwe ◽  
Zachary V. Roberts ◽  
Roxie M. Albrecht ◽  
Ashley E. Morgan ◽  
Jeremy J. Johnson ◽  
...  
Keyword(s):  
Trauma Center ◽  
Trauma System ◽  
Pelvic Fractures ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Level I ◽  
System Impact

Children and Terror Casualties Receive Preference in ICU Admissions

2012 ◽  
Vol 6 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Kobi Peleg ◽  
Michael Rozenfeld ◽  
Eran Dolev ◽  
Keyword(s):  
Traffic Accidents ◽  
Injury Severity ◽  
Road Traffic ◽  
Age Groups ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Severe Injuries ◽  
Level I ◽  
Hospital Emergency Departments ◽  
Trauma Type

ABSTRACTObjective: Trauma casualties caused by terror-related events and children injured as a result of trauma may be given preference in hospital emergency departments (EDs) due to their perceived importance. We investigated whether there are differences in the treatment and hospitalization of terror-related casualties compared to other types of injury events and between children and adults injured in terror-related events.Methods: Retrospective study of 121 608 trauma patients from the Israel Trauma Registry during the period of October 2000-December 2005. Of the 10 hospitals included in the registry, 6 were level I trauma centers and 4 were regional trauma centers. Patients who were hospitalized or died in the ED or were transferred between hospitals were included in the registry.Results: All analyses were controlled for Injury Severity Score (ISS). All patients with ISS 1-24 terror casualties had the highest frequency of intensive care unit (ICU) admissions when compared with patients after road traffic accidents (RTA) and other trauma. Among patients with terror-related casualties, children were admitted to ICU disproportionally to the severity of their injury. Logistic regression adjusted for injury severity and trauma type showed that both terror casualties and children have a higher probability of being admitted to the ICU.Conclusions: Injured children are admitted to ICU more often than other age groups. Also, terror-related casualties are more frequently admitted to the ICU compared to those from other types of injury events. These differences were not directly related to a higher proportion of severe injuries among the preferred groups.(Disaster Med Public Health Preparedness. 2012;6:14–19)

ATLS adherence in the transfer of rural trauma patients to a level I facility

Injury ◽  
2013 ◽  
Vol 44 (9) ◽  
pp. 1241-1245 ◽  
Author(s):  
Marta L. McCrum ◽  
Jessica McKee ◽  
Michael Lai ◽  
John Staples ◽  
Noah Switzer ◽  
...  
Keyword(s):  
Trauma Patients ◽  
Level I

Analysis of factors related to the development of ventilator-associated pneumonia: use of existing databases

2000 ◽  
Vol 9 (5) ◽  
pp. 344-349 ◽  
Author(s):  
JF Byers ◽  
ML Sole
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Odds Ratio ◽  
Demographic Data ◽  
Tube Feeding ◽  
Causative Organism ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Receptor Antagonists ◽  
Level I

OBJECTIVE: To investigate factors related to ventilator-associated pneumonia to assist in the development and implementation of prevention strategies. METHODS: A retrospective, descriptive design was used. Power analysis determined sample size. A consecutive sample of 120 patients admitted to the critical care units of a level I trauma center who were receiving mechanical ventilation was used. Data were obtained from clinical and financial databases. Variables included demographic data, causative organism of the pneumonia, medications, comorbid conditions, complications, duration of therapies, length of stay, and cost per case. RESULTS: The average patient was a 49-year-old man. The sample was 54.9% trauma patients, and the prevalence of ventilator-associated pneumonia was 16.7%. Significant factors included duration of intubation (r = 0.28, P = .005), mechanical ventilation (r = 0.26, P = .005), and tube feeding (r = 0.30, P = .001); trauma (phi = 0.24, P = .009); and use of histamine2 receptor antagonists (phi = -0.25, P = .006). The only variable that significantly increased the odds ratio for ventilator-associated pneumonia was trauma. The only variable that significantly decreased the odds ratio was use of histamine2 receptor antagonists. Patients in whom ventilator-associated pneumonia developed had a 16-day increase in length of stay (t = -2.68, P = .008), and a $29,369 increase in cost per case (t = -3.649, P = .000). CONCLUSIONS: These findings provide a baseline for discussions about potential changes in practice to help prevent ventilator-associated pneumonia.

Analyzing the dynamics of the deadwood carbon pool in Spain through the European Level I Monitoring Programme

2020 ◽  
Vol 463 ◽  
pp. 118020 ◽  
Author(s):  
Daniel Moreno-Fernández ◽  
Laura Hernández ◽  
Isabel Cañellas ◽  
Patricia Adame ◽  
Iciar Alberdi
Keyword(s):  
Carbon Pool ◽  
Monitoring Programme ◽  
European Level ◽  
Level I
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