scholarly journals Impact of Establishing A Level-1 Trauma Center For Lower Extremity Trauma: A 4-Year Experience

2021 ◽  
Author(s):  
Min Ji Kim ◽  
Kyung Min Yang ◽  
Hyung Min Hahn ◽  
Hyoseob Lim ◽  
Il Jae Lee
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
External Fixator ◽  
Trauma Center ◽  
Emergency Operation ◽  
Trauma Patients ◽  
Soft Tissue Reconstruction ◽  
Primary Amputation ◽  
Level 1 ◽  
Level 1 Trauma Center

Abstract Purpose: A multidisciplinary approach is essential for trauma patients’ treatment, particularly for cases with open lower extremity fractures, which are considered major traumas requiring a comprehensive approach. Recently, the social demand for severe-trauma centers has increased. This study analyzed the clinical impact of establishing a trauma center for the treatment of open lower extremity fractures.Methods: A retrospective chart review was conducted for trauma patients admitted to our hospital. Patients were classified into two groups: before (January 2014–December 2015, 178 patients) and after establishment of a Level-1 trauma center (January 2017–December 2018, 125 patients). We included patients with open fracture below the knee level and Gustilo type II/III, but excluded those with life-threatening trauma that affected the treatment choice.Results: Total 273 patient were included in this study, initial infection was significantly more common and external fixator application significantly less in post-center establishment group. The time to emergency operation decreased significantly from 13.89 ± 17.48 to 11.65 ± 19.33 hours post-center setup. By multivariate analysis, the decreased primary amputation and increased limb salvage was attributed to establishment of the trauma center. Conclusion: With the establishment of the Level-1 trauma center, limbs of patients with open lower extremity fractures could be salvaged, and the need for primary amputation was decreased. Early control of initial open wound infection and minimizing external fixator use allowed early soft tissue reconstruction. The existence of the center ensured a shorter interval to emergency operation and facilitated interdepartmental cooperation, which promoted active limb salvage and contributed to patients’ quality of life.

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.

scholarly journals Does emergency medicine length of stay predict trauma outcomes at a Level 1 Trauma Center?

2015 ◽  
Vol 4 (5) ◽  
pp. 1 ◽  
Author(s):  
Erin Powers Kinney ◽  
Kamal Gursahani ◽  
Eric Armbrecht ◽  
Preeti Dalawari
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Hospital Capacity ◽  
Significant Difference ◽  
Level 1 ◽  
Level 1 Trauma Center

Objective: Previous studies looking at emergency department (ED) crowding and delays of care on outcome measures for certain medical and surgical patients excluded trauma patients. The objectives of this study were to assess the relationship of trauma patients’ ED length of stay (EDLOS) on hospital length of stay (HLOS) and on mortality; and to examine the association of ED and hospital capacity on EDLOS.Methods: This was a retrospective database review of Level 1 and 2 trauma patients at a single site Level 1 Trauma Center in the Midwest over a one year period. Out of a sample of 1,492, there were 1,207 patients in the analysis after exclusions. The main outcome was the difference in hospital mortality by EDLOS group (short was less than 4 hours vs. long, greater than 4 hours). HLOS was compared by EDLOS group, stratified by Trauma Injury Severity Score (TRISS) category (< 0.5, 0.51-0.89, > 0.9) to describe the association between ED and hospital capacity on EDLOS.Results: There was no significant difference in mortality by EDLOS (4.8% short and 4% long, p = .5). There was no significant difference in HLOS between EDLOS, when adjusted for TRISS. ED census did not affect EDLOS (p = .59), however; EDLOS was longer when the percentage of staffed hospital beds available was lower (p < .001).Conclusions: While hospital overcrowding did increase EDLOS, there was no association between EDLOS and mortality or HLOS in leveled trauma patients at this institution.

Delays in Transfer of Elderly Less-injured Trauma Patients Can Have Deadly Consequences

2014 ◽  
Vol 80 (11) ◽  
pp. 1132-1135 ◽  
Author(s):  
Peter E. Fischer ◽  
Paul D. Colavita ◽  
Gregory P. Fleming ◽  
Toan T. Huynh ◽  
A. Britton Christmas ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Trauma Patients ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Local Trauma ◽  
Level 1 ◽  
Poor Outcomes ◽  
Injured Patients ◽  
Level 1 Trauma Center

Transfer of severely injured patients to regional trauma centers is often expedited; however, transfer of less-injured, older patients may not evoke the same urgency. We examined referring hospitals’ length of stay (LOS) and compared the subsequent outcomes in less-injured transfer patients (TP) with patients presenting directly (DP) to the trauma center. We reviewed the medical records of less-injured (Injury Severity Score [ISS] 9 or less), older (age older than 60 years) patients transferred to a regional Level 1 trauma center to determine the referring facility LOS, demographics, and injury information. Outcomes of the TP were then compared with similarly injured DP using local trauma registry data. In 2011, there were 1657 transfers; the referring facility LOS averaged greater than 3 hours. In the less-injured patients (ISS 9 or less), the average referring facility LOS was 3 hours 20 minutes compared with 2 hours 24 minutes in more severely injured patients (ISS 25 or greater, P < 0.05). The mortality was significantly lower in the DP patients (5.8% TP vs 2.6% DP, P = 0.035). Delays in transfer of less-injured, older trauma patients can result in poor outcomes including increased mortality. Geographic challenges do not allow for every patient to be transported directly to a trauma center. As a result, we propose further outreach efforts to identify potential causes for delay and to promote compliance with regional referral guidelines.

scholarly journals Being Prepared for the Next Conflict Part II: Case Analysis of a Military Level 1 Trauma Center

2020 ◽  
Vol 185 (7-8) ◽  
pp. e1235-e1239
Author(s):  
Thomas T Wood ◽  
Haydn J Roberts ◽  
Daniel J Stinner
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Trauma Center ◽  
Free Flaps ◽  
Soft Tissue Coverage ◽  
Combat Casualty ◽  
Civilian Trauma ◽  
Low Volume ◽  
Level 1 ◽  
Level 1 Trauma Center

Abstract Introduction Combat-related injuries have declined substantially in recent years as we have transitioned to a low-volume combat casualty flow era. Surgeons must remain actively committed to training for the next engagement to maintain life and limb-saving skills. Soft tissue coverage procedures were imperative to the management of complex lower extremity trauma that occurred during recent conflicts. The purpose of this study was to evaluate advanced soft tissue coverage procedures performed on the lower extremity over the previous decade on military and civilian trauma patients at a Department of Defense Level 1 trauma center to provide data that can be used to guide future training efforts. Materials and Methods The electronic surgical record system was searched for cases that utilized advanced soft tissue coverage (rotational and free flaps) to the lower extremity. The date of treatment, indication, procedure performed, and military/civilian patient designation were recorded. The data was categorized between military and civilian cases, rotational versus free flap, and indication and then charted over time. It was assessed as moving averages over a 12-month period. Statistically distinct periods were then identified. Results From January 2006 to March 2015, 132 advanced soft tissue coverage procedures were performed on the lower extremity (100 military, 32 civilian). Military soft tissue coverage data demonstrated peaks in 2007 and late 2011 to late 2012, averaging 6.5 (3.5–9.6) and 4.5 (3.2–5.8) per quarter, respectively. There were two low periods, from 2008 to mid-2010 and from mid-2012 to the end of the study, averaging 1.1 (0.6–1.6) and 1.8 (1.1–2.6) cases per quarter, respectively. Civilian procedures averaged 0.9 per quarter (0.5–1.2) throughout the study, but notably were equal to the number of military procedures by the last quarter of 2013 at 2.0 (1.2–2.8 civilian, 0.8–3.1 military). Conclusions This data supports prior identified trends in military cases correlating increased number of procedures with increased combat activity related to the conflicts in Iraq and Afghanistan in 2007 and 2011, respectively. The data showed relative stability in the numbers of civilian procedures with a slight uptrend beginning in mid-2012. A comparison after mid-2012 shows military procedures declining and civilian procedures increasing to eventually become equivalent at the end of the data collection. These trends follow previously reported data on tibia fracture fixation procedures and lower extremity amputations for the same time periods. These data demonstrate the importance of the civilian trauma mission for maintaining surgical skills relevant to limb salvage, such as rotational and free flaps, during a low-volume combat casualty flow era.

The Prevalence of Blood-borne Pathogens in Maxillofacial Trauma Patients at a Level 1 Trauma Center

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Selim G. Gebran ◽  
Philip J. Wasicek ◽  
Yinglun Wu ◽  
Joseph Lopez ◽  
Ledibabari M. Ngaage ◽  
...  
Keyword(s):  
Trauma Center ◽  
Maxillofacial Trauma ◽  
Trauma Patients ◽  
Level 1 ◽  
Level 1 Trauma Center

Lower Extremity Trauma in Vehicular Front-Seat Occupants: Patients Admitted to a Level 1 Trauma Center

1994 ◽  
Author(s):  
Patricia C. Dischinger ◽  
Andrew R. Burgess ◽  
Brad M. Cushing ◽  
Timothy D. O'Quinn ◽  
Carl B. Schmidhauser ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Trauma Center ◽  
Front Seat ◽  
Lower Extremity Trauma ◽  
Extremity Trauma ◽  
Level 1 ◽  
Level 1 Trauma Center

Abstract No. 57: 5-Year Experience of Retrievable IVC Filter Use in Trauma Patients at a Level 1 Trauma Center

2009 ◽  
Vol 20 (2) ◽  
pp. S24
Author(s):  
S. Al-Humayyd ◽  
C. Dey ◽  
B. Kalmovitch ◽  
Z. Jiwan ◽  
T. Razek ◽  
...  
Keyword(s):  
Trauma Center ◽  
Trauma Patients ◽  
Ivc Filter ◽  
Level 1 ◽  
Level 1 Trauma Center

scholarly journals Management of high-grade renal traumas with collecting system injuries

2021 ◽  
Vol 15 (11) ◽  
Author(s):  
Jennifer A. Locke ◽  
Sarah Neu ◽  
Roshan Navaratnam ◽  
Andrea Phillips ◽  
Avery B. Nathens ◽  
...  
Keyword(s):  
Trauma Center ◽  
American Association ◽  
Trauma Patients ◽  
High Grade ◽  
Asymptomatic Patients ◽  
Urinary Extravasation ◽  
Prospective Trials ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Collecting System

Introduction: Approximately 50% of all high-grade renal traumas (HGRT, American Association for the Surgery of Trauma [AAST] grade 4/5) have associated collecting system injuries. Although most of these collecting system injuries will heal spontaneously, approximately 20–30% of these injuries are managed with ureteric stents. The objective of the study was to review the management of HGRT with collecting system injuries in a level 1 trauma center. Methods: This was a single-center, retrospective cohort study of trauma patients with HGRT and collecting system injuries from 1998–2019. Results: We identified 147 patients with HGRT. Of the 105 patients who had trauma computed tomography (CT) imaging within 24 hours, 46 were found to have collecting system injuries. Seven of these patients underwent intervention based on initial CT findings; the remaining 39 patients with urinary extravasation were conservatively managed. Of the 37 patients who underwent reimaging, 22 (59%) demonstrated a stable or resolving collection and 15 (41%) demonstrated continued urinary extravasation. Resolution of extravasation on subsequent imaging was observed in 10 of those patients, while five patients (14%) required intervention (four stents, one percutaneous drain) for symptoms/signs of urinary extravasation. Conclusions: In this study, most patients with HGRT and collecting system injuries did not require intervention unless the patient became symptomatic. The majority of collecting system injuries resolved with no intervention. This study underscores the need for future prospective trials to investigate the necessity of intervening in HGRT collecting system injuries and, secondarily, the need for routine reimaging in these asymptomatic patients.

scholarly journals Utility Of Angioembolization In Patients with Abdominal and Pelvic Traumatic Bleeding: Descriptive Observational Analysis From A Level 1 Trauma Center

2020 ◽  
Author(s):  
Hassan Al-Thani ◽  
Husham Abdelrahman ◽  
Ali Barah ◽  
Mohammad Asim ◽  
Ayman El-Menyar
Keyword(s):  
Blood Transfusion ◽  
Success Rate ◽  
Trauma Center ◽  
Clinical Success Rate ◽  
Trauma Patients ◽  
Solid Organ ◽  
Complication Rates ◽  
Traumatic Bleeding ◽  
Level 1 ◽  
Level 1 Trauma Center

Abstract Background: Massive bleeding is a major preventable cause of early death in trauma. It often requires surgical or endovascular intervention. We aimed to describe the utilization of angioembolization in patients with abdominal and pelvic traumatic bleeding at a level 1 trauma center.Methods: We conducted a retrospective analysis for all trauma patients who underwent angioembolization post-traumatic bleeding between January 2012 and April 2018. Patients’s data and details of injuries, angiography procedures and outcomes were extracted from the Qatar national trauma registry.Results: A total of 175 trauma patients underwent angioembolization during the study period (103 for solid organ injury , 51 for pelvic injury and 21 for other injuries). The majority were young males. The main cause of injury was blunt trauma in 95.4% of patients. The most common indication of angioembolization was evident active bleeding on the initial CT scan (contrast pool or blushes). Blood transfusion was needed in two-third of patients. The hepatic injury cases had higher ISS, higher shock Index and more blood transfusion Absorbable particles (Gelfoam) was the most commonly used embolic material. The overall technical and clinical success rate was 93.7% and 95% respectively with low rebleeding and complication rates. The hospital and ICU length of stay were13 and 6 days respectively. The median injury to intervention time was 320 min while hospital arrival to intervention time was 274 min. The median follow-up time was 215 days. The overall cohort mortality was 15%. Conclusion: Angioembolization is an effective intervention to stop bleeding and support nonoperative management for both solid organ injuries and pelvic trauma. It has a high success rate with a careful selection and proper implementation.

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