scholarly journals Effect of Early Pelvic Binder Use in Emergency Management of Suspected Pelvic Trauma: A Retrospective Cohort Study

2017 ◽  
Author(s):  
Sheng-Der Hsu ◽  
Cheng-Jueng Chen ◽  
Yu-Ching Chou ◽  
Sheng-Hao Wang ◽  
De-Chuan Chan
Keyword(s):  
Cervical Spine ◽  
Emergency Management ◽  
Injury Severity ◽  
Trauma Team ◽  
High Energy ◽  
Pelvic Trauma ◽  
Pelvic Injury ◽  
Trauma Patients ◽  
Pelvic Binder ◽  
Trauma Score

Background: We aimed to evaluate the effect of early pelvic binder use in emergency management of suspected pelvic trauma, compared with the conventional stepwise approach. Methods: We enrolled trauma patients with initial stabilization using a pelvic binder for suspecting pelvic injury. Inclusion criteria were traumatic injury requiring a trauma team and at least one of the following: loss of consciousness or Glasgow coma score (GCS) < 13; systolic blood pressure < 90 mmHg; falling from ≥6 m; injury to multiple vital organs; and suspected pelvic injury. Various parameters, including gender, age, mechanism of injury, GCS, mortality, hospital stay, initial vital sign, revised trauma score, injury severity score, and outcome, were assessed and compared with historical controls. Results: A total of 204 patients with high-energy multiple-trauma from single level I trauma center in North Taiwan were enrolled in the study from August 2013 to July 2014. The two group baseline patient characteristics were all collected and compared. The trauma patients with suspected pelvic fractures initially stabilized with a pelvic binder had shorter hospital and ICU stays. The study group achieved statistically significantly improved survival and lower mean blood transfusion volume and mortality rate although they were more severe in the trauma score. Conclusions: We recommend prompt pelvic binder use for suspected pelvic injury before definitive imaging is available, as a cervical spine collar is used to protect the cervical spine from further injury prior to definitive identification and characterization of an injury.

scholarly journals Trauma resource pit stop: increasing efficiency in the evaluation of lower severity trauma patients

2021 ◽  
Vol 6 (1) ◽  
pp. e000670
Author(s):  
Imad S Dandan ◽  
Gail T Tominaga ◽  
Frank Z Zhao ◽  
Kathryn B Schaffer ◽  
Fady S Nasrallah ◽  
...  
Keyword(s):  
Injury Severity ◽  
Diagnostic Testing ◽  
Trauma Team ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Evaluation Time ◽  
Retrospective Comparison ◽  
Trauma Bay

BackgroundOvertriage of trauma patients is unavoidable and requires effective use of hospital resources. A ‘pit stop’ (PS) was added to our lowest tier trauma resource (TR) triage protocol where the patient stops in the trauma bay for immediate evaluation by the emergency department (ED) physician and trauma nursing. We hypothesized this would allow for faster diagnostic testing and disposition while decreasing cost.MethodsWe performed a before/after retrospective comparison after PS implementation. Patients not meeting trauma activation (TA) criteria but requiring trauma center evaluation were assigned as a TR for an expedited PS evaluation. A board-certified ED physician and trauma/ED nurse performed an immediate assessment in the trauma bay followed by performance of diagnostic studies. Trauma surgeons were readily available in case of upgrade to TA. We compared patient demographics, Injury Severity Score, time to physician evaluation, time to CT scan, hospital length of stay, and in-hospital mortality. Comparisons were made using 95% CI for variance and SD and unpaired t-tests for two-tailed p values, with statistical difference, p<0.05.ResultsThere were 994 TAs and 474 TRs in the first 9 months after implementation. TR’s preanalysis versus postanalysis of the TR group shows similar mean door to physician evaluation times (6.9 vs. 8.6 minutes, p=0.1084). Mean door to CT time significantly decreased (67.7 vs. 50 minutes, p<0.001). 346 (73%) TR patients were discharged from ED; 2 (0.4%) were upgraded on arrival. When admitted, TR patients were older (61.4 vs. 47.2 years, p<0.0001) and more often involved in a same-level fall (59.5% vs. 20.1%, p<0.0001). Undertriage was calculated using the Cribari matrix at 3.2%.DiscussionPS implementation allowed for faster door to CT time for trauma patients not meeting activation criteria without mobilizing trauma team resources. This approach is safe, feasible, and simultaneously decreases hospital cost while improving allocation of trauma team resources.Level of evidenceLevel II, economic/decision therapeutic/care management study.

A Contemporary Analysis of Delayed Diagnoses After Traumatic Injury

2020 ◽  
pp. 000313482095145
Author(s):  
Justin S. Hatchimonji ◽  
Catherine E. Sharoky ◽  
Elinore J. Kaufman ◽  
Lucy W. Ma ◽  
Anna E. Garcia Whitlock ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Trauma Team ◽  
Trauma Patients ◽  
Extremity Injury ◽  
Factors Associated ◽  
Common Category ◽  
Multivariable Regression Model ◽  
Multivariable Regression

Background Factors associated with delayed injury diagnosis (DID) have been examined, but incompletely researched. Methods We evaluated demographics, mechanism, and measures of mental status and injury severity among 10 years’ worth of adult trauma patients at our center for association with DID in a multivariable regression model. Descriptions of DID injuries were reviewed to highlight characteristics of these injuries. Results We included 13 509 patients, 89 (0.7%) of whom had a recognized DID. In regression analysis, ISS (OR 1.04 per point, 95% CI 1.02-1.06) and number of injuries (OR 1.08 per injury, 95% CI 1.04-1.11) were associated with DID. Operative patients had twice the odds of DID (OR 2.02, 95% CI 1.18-3.44). The most common category of DID was orthopedic extremity injury (22/89). Conclusion DID is associated with injury severity and operative intervention. This suggests that the presence of an injury requiring operation may distract the trauma team from additional injuries.

scholarly journals Use of anterolateral thigh flap for reconstruction of traumatic bilateral hemipelvectomy after major pelvic trauma: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Saleh Al-wageeh ◽  
Faisal Ahmed ◽  
Khalil Al-naggar ◽  
Mohammad Reza Askarpour ◽  
Ebrahim Al-shami
Keyword(s):  
Case Report ◽  
Cause Of Death ◽  
Axial Skeleton ◽  
High Energy ◽  
Pelvic Trauma ◽  
Anterolateral Thigh Flap ◽  
Trauma Patients ◽  
Anterolateral Thigh ◽  
Life Threatening

Abstract Background Major pelvic trauma (MPT) with traumatic hemipelvectomy (THP) is rare, but it is a catastrophic health problem caused by high-energy injury leading to separation of the lower extremity from the axial skeleton, which is associated with a high incidence of intra-abdominal and multi-systemic injuries. THP is generally performed as a lifesaving protocol to return the patient to an active life. Case report A 12-year male patient exposed to major pelvic trauma with bilateral THP survived the trauma and multiple lifesaving operations. The anterolateral thigh flap is the method used for wound reconstruction. The follow-up was ended with colostomy and cystostomy with wheelchair mobilization. To the best of our knowledge, there have been a few bilateral THP reports, and our case is the second one to be successfully treated with an anterolateral thigh flap. Conclusion MPT with THP is the primary cause of death among trauma patients. Life-threatening hemorrhage is the usual cause of death, which is a strong indication for THP to save life.

Comparison of APACHE II, trauma score, and injury severity score as predictors of outcome in critically injured trauma patients

1993 ◽  
Vol 166 (3) ◽  
pp. 244-247 ◽  
Author(s):  
Robert Rutledge ◽  
Samir Fakhry ◽  
Edmond Rutherford ◽  
Farid Muakkassa ◽  
Anthony Meyer
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Apache Ii ◽  
Trauma Patients ◽  
Predictors Of Outcome ◽  
Trauma Score

scholarly journals A comparative study of designated trauma team leaders on trauma patient survival and emergency department length-of-stay

CJEM ◽  
2007 ◽  
Vol 9 (02) ◽  
pp. 105-110 ◽  
Author(s):  
Garnet E. Cummings ◽  
Damon C. Mayes
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Injury Severity ◽  
Patient Survival ◽  
Negative Impact ◽  
Trauma Team ◽  
Regression Modeling ◽  
Outcome Variable ◽  
Trauma Patients ◽  
Trauma Severity

ABSTRACT Objectives: There is controversy over who should serve as the Trauma Team Leader (TTL) at trauma-receiving centres. This study compared survival and emergency department (ED) length-of-stay between patients cared for by 3 different groups of TTLs: surgeons, emergency physicians (EPs) on call for trauma cases and EPs on shift in the ED. Methods: We performed a retrospective cohort study involving all adult major blunt trauma patients (aged 17 and older) who were admitted to 2 level I trauma centres and who were entered into a provincial Trauma Registry between March 2000 and April 2002. The study was designed to compare the effect of TTL-type on survival and ED length-of-stay, while controlling for sex, age, and trauma severity as defined by the Injury Severity Score (ISS) and the Revised Trauma Score (RTS). Analysis was performed using linear regression modeling (for the ED lenght-of-stay outcome variable), and logistic regression modeling (for the surivial outcome variable). Results: There were 1412 patients enrolled in the study. The study population comprised 74% men and 26% women, with a mean age of 44.7 years (43.1, 46.6 and 42.8 years for surgeons, on-call EPs and on-shift EPs, respectively). The overall mean ISS was 23.2 (23.7 for surgeons, 22.9 for on-call EPs and 23.3 for on-shift EPs) and the overall average RTS was 7.6 (7.6 for surgeons, 7.6 for on-call EPs and 7.5 for on-shift EPs). The overall median ED length-of-stay was 5.3 hours (4.5, 5.3 and 5.6 hours for surgeons, on-call EPs and on-shift EPs, respectively; p = 0.07) and the overall survival was 87% (86% surgeon, 88% on-call EP, 87% on-shift EP; p = 0.08). No statistically significant relationship was found between TTL-type and ED length-of-stay (p = 0.42) or survival (p = 0.43) using multivariate modeling. Conclusion: Our results suggest that surgeons, on-call EPs, or on-shift EPs can act as the TTL without a negative impact on patient survival or ED length-of-stay.

scholarly journals Trauma recidivism in a Canadian province: a 14-year registry review

CJEM ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 473-476 ◽  
Author(s):  
Mete Erdogan ◽  
Nelofar Kureshi ◽  
Mark Asbridge ◽  
Robert S. Green
Keyword(s):  
Nova Scotia ◽  
Major Trauma ◽  
Injury Severity ◽  
Trauma Registry ◽  
Trauma Team ◽  
Population Based ◽  
Trauma Patients ◽  
Screening And Brief Intervention ◽  
Factors Associated ◽  
Trauma Recidivism

ABSTRACTObjectivesTo determine the rate of recurrent major trauma (i.e., trauma recidivism) using a provincial population-based trauma registry. We compared outcomes between recidivists and non-recidivists, and assessed factors associated with recidivism and mortality.MethodsReview of all adult (>17 years) major trauma patients in Nova Scotia (2001–2015) using data from the Nova Scotia Trauma Registry. Outcomes of interest were mortality, duration of hospital stay, and in-hospital complications. Multiple regression was used to assess factors associated with recidivism and mortality.ResultsOf 9,365 major trauma patients, 2% (150/9365) were recidivists. Mean age at initial injury was 52 ± 21.5 years; 73% were male. The mortality rate for both recidivists and non-recidivists was 31%. However, after adjusting for potential confounders the likelihood of mortality was over 3 times greater for recidivists compared to non-recidivists (OR 3.67, 95% CI 2.06–6.54). Other factors associated with mortality included age, male gender, penetrating injury, Injury Severity Score, trauma team activation (TTA) and admission to the intensive care unit. The only variables associated with recidivism were age (OR 0.98, 95% CI 0.97–1.00) and TTA (OR 0.59, 95% CI 0.34–0.96).ConclusionsThis is the first provincial investigation of major trauma recidivism in Canada. While recidivism was infrequent (2%), the adjusted odds of mortality were over three times greater for recidivists. Further research is warranted to determine the effectiveness of strategies for reducing rates of major trauma recidivism such as screening and brief intervention in cases of violence or substance abuse.

A Trauma Transfusion Pathway Decreases Coagulopathy without Increasing Blood Product Utilization

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4071-4071
Author(s):  
Leonard A. Minuk ◽  
Kathleen Eckert ◽  
Tanya Charyk Stewart ◽  
Neil Parry ◽  
Daryl Gray ◽  
...  
Keyword(s):  
Injury Severity ◽  
Blood Product ◽  
Massive Transfusion ◽  
Fixed Ratio ◽  
Trauma Team ◽  
Control Group ◽  
P Value ◽  
Trauma Patients ◽  
Severe Traumatic Injury ◽  
Mean Time

Abstract Background: Trauma patients often require massive transfusion and their resuscitation is commonly complicated by coagulopathy. Debate persists regarding optimal massive transfusion strategies, which have traditionally adopted 2 approaches: coagulation laboratory based therapy (LBT) versus fixed ratio trauma transfusion pathways (TTP). The proponents of a LBT strategy cite “rational use” and avoidance of over-transfusion. This system may not adequately address the dynamic trauma situation where a delay in coagulation results may be detrimental. A TTP more rapidly meets the needs of trauma patients but may increase blood product utilization. Objective: Retrospectively compare our preliminary early experience with a TTP compared to our previous LBT strategy. Method: Retrospective cohort study using our transfusion database comparing 14 patients who activated the TTP with 28 patients treated before the pathways introduction. Inclusion criteria included severe traumatic injury (Injury Severity Score (ISS) &gt;12), massive transfusion (defined as &gt;8 units of red blood cells (RBCs) in the first 24 hours). The TTP is activated by the trauma team and results in the immediate release of 4 units of uncrossmatched RBCs. Blood product is then issued in trauma packs (TPs). Each trauma pack contains 4 units of RBCs and 4 units of frozen plasma (FP) and every second pack contains one pool of platelets (PLTs). A dose of recombinant factor VIIa (rFVIIa) is made available after TP #3. Cryoprecipitate (CRYO) is issued only at the request of the trauma team. A CBC, INR, PTT, and fibrinogen is measured at TTP activation and after every other TP. Outcomes: Outcome variables included total blood product utilization (RBC, FP, CRYO, PLTs), time to first and second set of FP (time 0 is release of 1st RBC unit), number of RBC units issued until first and second set of FP, coagulopathy at presentation and highest INR during first 24 hours of resuscitation. Results: The results are summarized in the attached table. There was no difference in ISS between groups. The introduction of the TTP resulted in no difference in the amount of blood product utilization when compared to the pre-pathway control group. Significant differences included a much shorter time to first and second FP delivery and fewer RBC units before the first and second FP delivery. The majority of the patients were coagulopathic on presentation (defined as INR &gt; 1.4) and the TTP group achieved a significantly lower peak INR during the first 24 hours of resuscitation compared to the pre-pathway group. Conclusion: This pilot study shows that the introduction of a trauma transfusion pathway significantly improves coagulopathy and reduces time to FP administration without increasing blood product utilization. Pre-Pathway (n=28) Trauma Transfusion Pathway (n=14) P-value Mean ISS 42.0 ± 12.5 34 ± 15.1 NS Mean RBC units used 23.4 ± 14.5 23.1 ± 10.7 NS Mean FP units used 13.4 ± 9.6 16.1 ± 8.3 NS Mean PLT pools used 1.8 ± 1.5 2.7 ± 1.8 NS Mean CRYO pools used 0.46 ± 0.64 0.71 ± 0.83 NS Mean time to 1stFP (min) 89.9 ± 55.5 55.4 ± 49.2 0.02 Mean time to 2ndFP (min) 237.0 ± 206.8 103.0 ± 59.4 0.0004 Mean #RBC units to 1st set FP 10.4 ± 9.0 7.8 ± 1.6 0.02 Mean #RBC units to 2nd set FP 17.6 ± 8.8 12.9 ± 3.4 0.016 # Patients coagulopathic on initial testing (INR&gt;1.4) 12 (43%) 8 (62%) NS Mean initial INR 1.5 ± 0.55 1.7 ± 0.58 NS Mean of highest INR in first 24h 2.3 ± 1.70 1.4 ± 0.25 0.006 # Patients given rFVIIa 6 (21%) 5 (36%) NS

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