Retrospective review of injury severity, interventions and outcomes among helicopter and nonhelicopter transport patients at a Level 1 urban trauma centre

BackgroundE-bike usage is increasingly popular and concerns about e-bike-related injuries and safety have risen as more injured e-bikers attend the emergency department (ED). Traumatic brain injury (TBI) is the main cause of severe morbidity and mortality in bicycle-related accidents. This study compares the frequency and severity of TBI after an accident with an e-bike or classic bicycle among patients treated in the ED.MethodsThis was a prospective cohort study of patients with bicycle-related injuries attending the ED of a level 1 trauma centre in the Netherlands between June 2016 and May 2017. The primary outcomes were frequency and severity of TBI (defined by the Abbreviated Injury Scale head score ≥1). Injury Severity Score, surgical intervention, hospitalisation and 30-day mortality were secondary outcomes. Independent risk factors for TBI were identified with multiple logistic regression.ResultsWe included 834 patients, of whom there were 379 e-bike and 455 classic bicycle users. The frequency of TBI was not significantly different between the e-bike and classic bicycle group (respectively, n=56, 15% vs n=73, 16%; p=0.61). After adjusting for age, gender, velocity, anticoagulation use and alcohol intoxication the OR for TBI with an e-bike compared with classic bicycle was 0.90 (95% CI 0.56 to 1.45). Independent of type of bicycle, TBI was more likely if velocity was 26–45 km/hour, OR 8.14 (95% CI 2.36 to 28.08), the patient was highly alcohol intoxicated, OR 7.02 (95% CI 2.88 to 17.08) or used anticoagulants, OR 2.18 (95% CI 1.20 to 3.97). TBI severity was similar in both groups (p=0.65): eight e-bike and seven classic bicycle accident victims had serious TBI.ConclusionThe frequency and severity of TBI among patients treated for bicycle-related injuries at our ED was similar for e-bike and classic bicycle users. Velocity, alcohol intoxication and anticoagulant use were the main determinants of the risk of head injury regardless of type of bicycle used.

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Injury coding in a national trauma registry: a one-year validation audit in a level 1 trauma centre

BMC Emergency Medicine ◽

10.1186/s12873-019-0276-8 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Anna Bågenholm ◽

Ina Lundberg ◽

Bjørn Straume ◽

Rune Sundset ◽

Kristian Bartnes ◽

...

Keyword(s):

Injury Severity ◽

Trauma Registry ◽

Improve Patient Safety ◽

Head Injuries ◽

Trauma Team ◽

Trauma Centre ◽

Registry Data ◽

Reference Standard ◽

National Trauma ◽

Level 1

Abstract Background Hospitals must improve patient safety and quality continuously. Clinical quality registries can drive such improvement. Trauma registries code injuries according to the Abbreviated Injury Scale (AIS) and benchmark outcomes based on the Injury Severity Score (ISS) and New ISS (NISS). The primary aim of this study was to validate the injury codes and severities registered in a national trauma registry. Secondarily, we aimed to examine causes for missing and discordant codes, to guide improvement of registry data quality. Methods We conducted an audit and established an expert coder group injury reference standard for patients met with trauma team activation in 2015 in a Level 1 trauma centre. Injuries were coded according to the AIS. The audit included review of all data in the electronic health records (EHR), and new interpretation of all images in the picture archiving system. Validated injury codes were compared with the codes registered in the registry. The expert coder group’s interpretations of reasons for discrepancies were categorised and registered. Inter-rater agreement between registry data and the reference standard was tested with Bland–Altman analysis. Results We validated injury data from 144 patients (male sex 79.2%) with median age 31 (inter quartile range 19–49) years. The total number of registered AIS codes was 582 in the registry and 766 in the reference standard. All injuries were concordantly coded in 62 (43.1%) patients. Most non-registered codes (n = 166 in 71 (49.3%) patients) were AIS 1, and information in the EHR overlooked by registrars was the dominating cause. Discordant coding of head injuries and extremity fractures were the most common causes for 157 discordant AIS codes in 74 (51.4%) patients. Median ISS (9) and NISS (12) for the total population did not differ between the registry and the reference standard. Conclusions Concordance between the codes registered in the trauma registry and the reference standard was moderate, influencing individual patients’ injury codes validity and ISS/NISS reliability. Nevertheless, aggregated median group ISS/NISS reliability was acceptable.

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A profile of adult patients with major burns admitted to a Level 1 Trauma Centre and their functional outcomes at discharge: A retrospective review

South African Journal of Physiotherapy ◽

10.4102/sajp.v77i1.1543 ◽

2021 ◽

Vol 77 (1) ◽

Author(s):

Irene K. Angelou ◽

Heleen van Aswegen ◽

Moira Wilson ◽

Regina Grobler

Keyword(s):

Retrospective Review ◽

Functional Outcomes ◽

Trauma Centre ◽

Adult Patients ◽

Level 1

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Trends in Hospitalization Associated with TBI in an Urban Level 1 Trauma Centre

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100018503 ◽

2014 ◽

Vol 41 (4) ◽

pp. 466-475 ◽

Cited By ~ 3

Author(s):

Elaine de Guise ◽

Joanne LeBlanc ◽

Jehane Dagher ◽

Simon Tinawi ◽

Julie Lamoureux ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Injury Severity ◽

Health Centre ◽

Trauma Centre ◽

Ageing Population ◽

Risk Of Falls ◽

Urban Level ◽

Level 1 ◽

The Impact

Objective:Traumatic brain injury (TBI) is the single largest cause of death and disability following injury worldwide. The aim of this study was to determine the demographic, clinical, medical and accident related trends for patients with TBI hospitalized in an urban level 1 Trauma Centre.Methods:Data were retrospectively collected on individuals (n = 5,642) who were admitted to the Traumatic Brain Injury Program of the McGill University Health Centre - Montreal General Hospital from 2000 to 2011.Results:Regression analysis showed a significant upward trend in the yearly number of cases as well as an upward trending by year in the proportion of TBI cases aged 70-years-old or more. The Injury Severity Scale scores were positively associated with year indicating a slight increase in injury severity over the years and there was an increase in patient psychological, social and medical premorbid complexity. In addition, the Extended Glasgow Outcome Scale score tended to become more severe over the years. There was a slight decrease in the proportion of discharges home and in the proportion of deaths.Conclusions:These results will help to understand the impact of TBI in an urban Canadian level 1 Trauma Centre. This information should be used to develop public prevention strategies and to educate the community about the risk of TBI especially the risk of falls in the ageing population. These findings can also provide information to help health policy makers plan for future resources.

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A profile of adult patients with major burns admitted to a Level 1 Trauma Centre and their functional outcomes at discharge: A retrospective review

South African Journal of Physiotherapy ◽

10.4102/sajp.v78i1.1543 ◽

2022 ◽

Vol 78 (1) ◽

Author(s):

Irene K. Angelou ◽

Heleen Van Aswegen ◽

Moira Wilson ◽

Regina Grobler

Keyword(s):

Muscle Strength ◽

Physical Function ◽

Injury Severity ◽

Clinical Course ◽

Data Extraction ◽

Total Body Surface Area ◽

Trauma Centre ◽

Independent Function ◽

Wound Debridement ◽

Level 1

Background: Patients with major burns suffer with pain, which impacts their physical function during hospitalisation.Objectives: To describe the demographics, burn characteristics, clinical course, physical function, complications developed after major burns and to establish predictors of non-independent physical function at hospital discharge.Method: Records of all consecutive adult burn admissions to a Level 1 Trauma Centre between 2015 and 2017 were screened retrospectively against our study criteria, using the Trauma Bank Data Registry. Anonymised data from included records were captured on specifically designed data extraction forms. Descriptive statistics were used to summarise findings. A regression analysis was undertaken to establish predictors of non-independent function at discharge.Results: Males represented 87.7% (n = 64) of included records (n = 73). Median age was 38 (interquartile range [IQR]: 22). Thermal burns were most reported (n = 47, 64.4%), followed by median total body surface area (TBSA) 31% and head and arms were most affected (60.3% and 71.2%). Injury severity was high with median intensive care unit (ICU) length of stay (LOS) of 17 (IQR: 34) and hospital LOS 44 (IQR: 31) days. Wound debridement was mostly performed (n = 27, 36.9%) with limb oedema as a common complication (n = 15, 21.7%). Muscle strength and functional performance improved throughout LOS. None of the variables identified were predictors of non-independent function at hospital discharge.Conclusion: Adults with major burns were predominantly male, in mid-life and sustained thermal injury with a high injury severity. Decreased range of motion (ROM) of affected areas, ‘fair’ muscle strength and independent function were recorded for most patients at hospital discharge.Clinical implications: These findings contribute to the limited body of evidence on the profile, clinical course and outcomes of South African adult burn patients.

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The management and outcome of paediatric splenic injuries in the Netherlands

World Journal of Emergency Surgery ◽

10.1186/s13017-021-00353-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Maike Grootenhaar ◽

Dominique Lamers ◽

Karin Kamphuis-van Ulzen ◽

Ivo de Blaauw ◽

Edward C. Tan

Keyword(s):

The Netherlands ◽

Hospital Stay ◽

Operative Management ◽

Trauma Centre ◽

Management Approach ◽

Haemodynamic Instability ◽

Low Grade ◽

High Grade ◽

Level 1 ◽

Non Operative Management

Abstract Background Non-operative management (NOM) is generally accepted as a treatment method of traumatic paediatric splenic rupture. However, considerable variations in management exist. This study analyses local trends in aetiology and management of paediatric splenic injuries and evaluates the implementation of the guidelines proposed by the American Paediatric Surgical Association (APSA) in a level 1 trauma centre. Methods The charts of paediatric patients with blunt splenic injury (BSI) who were admitted or transferred to a level 1 trauma centre between 2003 and 2020 were retrospectively assessed. Information pertaining to demographics, mechanism of injury, injury description, associated injuries, intervention and outcomes were analysed and compared to international literature. Results There were 130 patients with BSI identified (63.1% male), with a mean age of 11.3 ± 4.0 and a mean Injury Severity Score (ISS) of 21.6 ± 13.7. Bicycle accidents were the most common trauma mechanism (23.1%). Sixty-four percent were multi-trauma patients, 25% received blood transfusions, and 31% were haemodynamically unstable. Mean injury grade was 3.0, with 30% of patients having a high-grade injury. In total, 75% of patients underwent NOM with a 100% efficacy rate. Total splenectomy rate was 6.2%. Four patients died due to brain damage. Patients with a high-grade BSI (grades IV–V) had a significantly higher ISS and longer bedrest and more often presented with an active blush on computed tomography (CT) scans than patients with a low-grade BSI (grades I–III). Non-operative management was mainly the choice of treatment in both groups (76.6% and 79.5%, respectively). Haemodynamic instability was a predictor for operative management (OM) (p = 0.001). Predictors for a longer length of stay (LOS) included concomitant injuries, haemodynamic instability and OM (all p < 0.02). Interobserver agreement in the grading of BSI is moderate, with a Cohens Kappa coefficient of 0.493. Conclusion Non-operative management has proven to be a realistic management approach in both low- and high-grade splenic injuries. Consideration for operative management should be based on haemodynamic instability. Compared to the anticipated length of bedrest and hospital stay outlined in the APSA guidelines, the Netherlands can reduce the length of bedrest and hospital stay through their non-operative management. Level of evidence Therapeutic study, level III

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Development and temporal external validation of a simple risk score tool for prediction of outcomes after severe head injury based on admission characteristics from level-1 trauma centre of India using retrospectively collected data

BMJ Open ◽

10.1136/bmjopen-2020-040778 ◽

2021 ◽

Vol 11 (1) ◽

pp. e040778

Author(s):

Vineet Kumar Kamal ◽

Ravindra Mohan Pandey ◽

Deepak Agrawal

Keyword(s):

Hospital Mortality ◽

External Validation ◽

Trauma Centre ◽

Unfavourable Outcome ◽

Motor Score ◽

Validation Data ◽

Data Set ◽

Development Data ◽

Level 1 ◽

Pupillary Reactivity

ObjectiveTo develop and validate a simple risk scores chart to estimate the probability of poor outcomes in patients with severe head injury (HI).DesignRetrospective.SettingLevel-1, government-funded trauma centre, India.ParticipantsPatients with severe HI admitted to the neurosurgery intensive care unit during 19 May 2010–31 December 2011 (n=946) for the model development and further, data from same centre with same inclusion criteria from 1 January 2012 to 31 July 2012 (n=284) for the external validation of the model.Outcome(s)In-hospital mortality and unfavourable outcome at 6 months.ResultsA total of 39.5% and 70.7% had in-hospital mortality and unfavourable outcome, respectively, in the development data set. The multivariable logistic regression analysis of routinely collected admission characteristics revealed that for in-hospital mortality, age (51–60, >60 years), motor score (1, 2, 4), pupillary reactivity (none), presence of hypotension, basal cistern effaced, traumatic subarachnoid haemorrhage/intraventricular haematoma and for unfavourable outcome, age (41–50, 51–60, >60 years), motor score (1–4), pupillary reactivity (none, one), unequal limb movement, presence of hypotension were the independent predictors as its 95% confidence interval (CI) of odds ratio (OR)_did not contain one. The discriminative ability (area under the receiver operating characteristic curve (95% CI)) of the score chart for in-hospital mortality and 6 months outcome was excellent in the development data set (0.890 (0.867 to 912) and 0.894 (0.869 to 0.918), respectively), internal validation data set using bootstrap resampling method (0.889 (0.867 to 909) and 0.893 (0.867 to 0.915), respectively) and external validation data set (0.871 (0.825 to 916) and 0.887 (0.842 to 0.932), respectively). Calibration showed good agreement between observed outcome rates and predicted risks in development and external validation data set (p>0.05).ConclusionFor clinical decision making, we can use of these score charts in predicting outcomes in new patients with severe HI in India and similar settings.

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Clinical and economic effects of selective radiological evaluation of high-energy trauma patients: a prospective experience of a level 1 busy trauma centre

Emergency Medicine Journal ◽

10.1136/emermed-2014-204083 ◽

2014 ◽

Vol 32 (7) ◽

pp. 535-538 ◽

Cited By ~ 2

Author(s):

Shahram Paydar ◽

Armin Ahmadi ◽

Behnam Dalfardi ◽

Alireza Shakibafard ◽

Hamidreza Abbasi ◽

...

Keyword(s):

High Energy ◽

Trauma Centre ◽

Economic Effects ◽

Trauma Patients ◽

Radiological Evaluation ◽

High Energy Trauma ◽

Level 1

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Efforts to Improve Appropriate Trauma Activation for Patients Transferred to a Level 1 Trauma Center From Outside Hospitals

The American Surgeon ◽

10.1177/0003134820919732 ◽

2020 ◽

Vol 86 (5) ◽

pp. 467-475

Author(s):

Sara Seegert ◽

Roberta E. Redfern ◽

Bethany Chapman ◽

Daniel Benson

Keyword(s):

Injury Severity ◽

Trauma Centers ◽

Activation Level ◽

American College Of Surgeons ◽

Before And After ◽

Trauma Response ◽

Level 1 ◽

Transferred Patients ◽

Trauma Activation ◽

Level 1 Trauma Center

Trauma centers monitor under- and overtriage rates to comply with American College of Surgeons Committee on Trauma verification requirements. Efforts to maintain acceptable rates are often undertaken as part of quality assurance. The purpose of this project was to improve the institutional undertriage rate by focusing on appropriately triaging patients transferred from outside hospitals (OSHs). Trauma physicians received education and pocket cards outlining injury severity score (ISS) calculation to aid in prospectively estimating ISS for patients transferred from OSHs, and activate the trauma response expected for that score. Under- and overtriage rates before and after the intervention were compared. The postintervention period saw a significant decrease in overall overtriage rate, with simultaneous trend toward lower overall undertriage rate, attributable to the significant reduction in undertriage rate of patients transferred from OSHs. Prospectively estimating ISS to assist in determining trauma activation level shows promise in managing appropriate patient triage. However, questions arose regarding the necessity for full trauma activation for transferred patients, regardless of ISS. It may be necessary to reconsider how patients transferred from OSHs are evaluated. Full trauma activation can be a financial and resource burden, and should not be taken lightly.

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