EXTENSIVE EPIDEMIOLOGICAL STUDY OF TRAUMATIC PNEUMOTHORAX IN SAUDI ARABIA’S POPULATION

2021 ◽  
pp. 32-34
Author(s):  
NASSER ALRASHIDI
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Demographic Data ◽  
Demographic Characteristics ◽  
Local Health ◽  
Common Cause ◽  
Traumatic Pneumothorax ◽  
Level 1 ◽  
Level 1 Trauma Center

Objectives: Traumatic pneumothorax is one of the causes of trauma mortality and morbidity. It is a problem for developing countries as many accidents can be avoided and there are few epidemiological data to support programs injury prevention. The main objective of the current study was to determine demographic characteristics, patterns, and severity of the injury, thoracic, and extra-thoracic related injuries in a Level 1 trauma center, Riyadh, Saudi Arabia (SA). Methods: This retrospective observational study used the King Abdulaziz Medical City Trauma Center’s trauma registry to review the data of traumatic pneumothorax patients admitted to the hospital from January 2001 to December 2018. Demographic characteristics, admission date and time, type and mechanism of injury, involved body area, and severity rates were analyzed. Results: A total of 708 patients of whom 92.3% were males. Blunt trauma (75.8%) is the most common cause of injury. Motor Vehicle Accidents (MVA) were the most common cause (57%) of traumatic pneumothorax. Rib fractures (36.5%), lung contusions (31.5%), and hemothorax (23.5%) were the most common clinical forms of chest injury associated with traumatic pneumothorax. On the other hand, the head injury (34.8%) was the most common extra thoracic part associated. The mean Injury Severity Score in the current study was found to be 20.1. Conclusion: This study showed the trends of traumatic pneumothorax injuries in a Level 1 trauma center, Riyadh, SA, showing MVA are the leading cause of traumatic pneumothorax in our region. These demographic data will be crucial for local health-care systems to be optimally resourced.

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 (A138) Duration of Emergency Department Stay and Injury Profile of Homeless Patients in a Level-1 Trauma Center

2011 ◽  
Vol 26 (S1) ◽  
pp. s39-s39
Author(s):  
S. Chauhan ◽  
S. Bhoi ◽  
D.T. Sinha ◽  
M. Rodha ◽  
L. Alexender ◽  
...  
Keyword(s):  
Emergency Department ◽  
Head Injury ◽  
Trauma Center ◽  
Injury Severity ◽  
Road Traffic ◽  
Road Traffic Crash ◽  
Emergency Department Stay ◽  
Level 1 ◽  
Gcs Score ◽  
Level 1 Trauma Center

Background and ObjectiveImmediate resuscitation and early disposition to definitive care improves outcomes. Homeless patients are neglected in emergency department (ED). The duration of ED stay and profile of injury of homeless patients at a Level-1 Trauma center were measured.MethodsThe study was performed from October 2008 to September 2009. Homeless patients were defined as patients who had no attendant and did not have any shelter. Duration of ED stay was noted from the ED arrival time to entry time at the definitive care (intensive care unit/ward). Clinical and demographic details were recorded. Subjects who had: (1) an attendant; (2) were discharged from the ED; or (3) expired in the ED were excluded.ResultsForty-one homeless patients were admitted. The mode of injury was road traffic crash in 73.2%; assault in 7.3%; fall from height in 7.3%; and in 12.2%, the mode of injury unknown. The average Injury Severity Score (ISS) was 6.76, with a maximum of 34 and minimum of 1. A total of 24 subjects (59%) had a Glasgow Coma Scale (GCS) score of ≤ 8 (severe head injury), 10 patients (24%) had GCS score 9–12 (moderate head injury), and seven subjects (17%) had GCS score 13–15 (minor head injury). Breath alcohol test was positive in 13%. The average duration of ED stay was 35 (3–173) hours in the homeless group and 12 (0.5–18) hours for patients with an attendant. Twenty-one subjects were admitted to neurosurgery (51.2%) with an average ED stay of 22.4 hours, five to surgery (12.20%) with average ED stay of 56.6 hours, and 15 to orthopedics (36.6%) with average ED stay of 45.3 hours.ConclusionsThe emergency department stay of homeless patients was 35 hours. Orthopedic trauma subjects had a prolonged disposal time. This addresses serious patient safety concerns and immediate remedial measures.

External retrospective validation of Brain Injury Guidelines criteria and modified guidelines for improved care value in the management of patients with low-risk neurotrauma

2020 ◽  
Vol 133 (6) ◽  
pp. 1880-1885 ◽  
Author(s):  
Miner Ross ◽  
Priscilla S. Pang ◽  
Ahmed M. Raslan ◽  
Nathan R. Selden ◽  
Justin S. Cetas
Keyword(s):  
Brain Injury ◽  
Trauma Center ◽  
Injury Severity ◽  
Radiographic Progression ◽  
Medical Intervention ◽  
Neurosurgical Procedures ◽  
Radiographic Findings ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Neurosurgical Intervention

OBJECTIVEConventional management of patients with neurotrauma frequently consists of routine, repeat head CT at preordained intervals with ICU-level monitoring, regardless of injury severity. The Brain Injury Guidelines (BIG) are a classification tool for stratifying patients into injury severity and risk-of-progression categories based on presenting clinical and radiographic findings. In the present study, the authors aimed to validate BIG criteria at a single level 1 trauma center.METHODSPatients were classified according to BIG criteria and evaluated for subsequent radiographic progression or development of neurological decline. A 2-year retrospective cohort review of consecutive patients with neurotrauma (n = 590) was undertaken. The authors then developed a modified BIG algorithm for use at their institution and followed its implementation prospectively over 555 consecutive patients.RESULTSIn the retrospective analysis, no patient in the BIG 1 category (n = 88, 14.9%) demonstrated progression or neurological decline, and 7.5% of BIG 2 patients (n = 107, 18.1%) demonstrated mild radiographic progression without any decline or need for additional neurosurgical or medical intervention, whereas 15.4% of BIG 3 patients (n = 395, 66.9%) underwent additional neurosurgical procedures. In the prospective analysis, no BIG 1 (n = 105, 18.9%) or BIG 2 (n = 48, 8.6%) patients demonstrated a clinical decline or required any further neurosurgical intervention. By contrast, 12.9% of BIG 3 patients (n = 402, 72%) required immediate neurosurgical intervention, and a further 2.0% required delayed intervention based on clinical and/or radiographic evidence of injury progression.CONCLUSIONSApplication of the BIG criteria in a single large level 1 trauma center reliably sorted patients into appropriate risk categories that accurately guided ongoing management.

Age and gender differences in substance screening may underestimate injury severity: a study of 9793 patients at level 1 trauma center from 2006 to 2010

2014 ◽  
Vol 188 (1) ◽  
pp. 190-197 ◽  
Author(s):  
Georgia M. Beasley ◽  
Truls Østbye ◽  
Lawrence H. Muhlbaier ◽  
Carolyn Foley ◽  
John Scarborough ◽  
...  
Keyword(s):  
Gender Differences ◽  
Trauma Center ◽  
Injury Severity ◽  
Age And Gender ◽  
Age And Gender Differences ◽  
Level 1 ◽  
And Gender ◽  
Level 1 Trauma Center

Emergency Medical Service Transport Time and Trauma Outcomes at an Urban Level 1 Trauma Center: Evaluation of Prehospital Emergency Medical Service Response

2021 ◽  
pp. 000313482098882
Author(s):  
Adel Elkbuli ◽  
Brianna Dowd ◽  
Carol Sanchez ◽  
Saamia Shaikh ◽  
Mason Sutherland ◽  
...  
Keyword(s):  
Emergency Medical Service ◽  
Trauma Center ◽  
Medical Service ◽  
Injury Severity ◽  
Future Research ◽  
Trauma Patients ◽  
Transport Time ◽  
Emergency Medical ◽  
Level 1 ◽  
Level 1 Trauma Center

Background The use of helicopter emergency medical services (HEMS) for trauma patients has been debated since its introduction. We aim to compare outcomes for trauma patients transported by ground EMS (GEMS) vs. HEMS using raw and adjusted mortality in a level 1 trauma center. Methods A 6-year retrospective cohort study utilizing our level 1 trauma center registry for patients transferred by GEMS or HEMS was performed. Demographics and outcome measures were compared. Raw and adjusted mortality was evaluated. Adjusted mortality was determined incorporating confounders, including patient demographics, comorbid conditions, mechanism of injury, injury severity score (ISS), Glasgow Coma Scale score, and EMS transport time. Chi-square, multivariable logistic regression, and independent sample T-test were utilized with significance, defined as P < .05. Results Of 12 633 patients, 10 656 were transported via GEMS and 1977 with HEMS. Mean age was 55 for GEMS and 40 for HEMS ( P < .001). Mean ISS was 9.29 and 11.73 for GEMS and HEMS ( P < .001). Mean Revised Trauma Score was higher (less severe) for GEMS vs. HEMS (7.6 vs. 7.12, P < .001). Mean transport times for GEMS and HEMS was 39.45 vs. 47.29 minutes ( P = .02). Raw mortality was 2.55% (307/10 656) for GEMS and 6.78% (134/1977) for HEMS. Adjusted mortality revealed a 16.6% increased mortality for GEMS compared to HEMS (adjusted odds ratio = 1.166, 95% CI: .815-1.668). Conclusions Air-lifted trauma patients were younger, more severely injured, and more hemodynamically unstable and required longer transport time but experienced lower adjusted mortality. Future research is needed to investigate whether reducing transport times and augmenting the advanced care already implemented by HEMS crews can improve outcomes.

scholarly journals The Relationship between Hospital Volume and In-Hospital Mortality of Severely Injured Patients in Dutch Level-1 Trauma Centers

2021 ◽  
Vol 10 (8) ◽  
pp. 1700
Author(s):  
Charlie Sewalt ◽  
Esmee Venema ◽  
Erik van Zwet ◽  
Jan van Ditshuizen ◽  
Stephanie Schuit ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Trauma Center ◽  
Hospital Volume ◽  
Injury Severity ◽  
Severely Injured ◽  
Trauma Centers ◽  
Severely Injured Patients ◽  
Level 1 ◽  
Injured Patients ◽  
Level 1 Trauma Center

Centralization of trauma centers leads to a higher hospital volume of severely injured patients (Injury Severity Score (ISS) > 15), but the effect of volume on outcome remains unclear. The aim of this study was to determine the association between hospital volume of severely injured patients and in-hospital mortality in Dutch Level-1 trauma centers. A retrospective observational cohort study was performed using the Dutch trauma registry. All severely injured adults (ISS > 15) admitted to a Level-1 trauma center between 2015 and 2018 were included. The effect of hospital volume on in-hospital mortality was analyzed with random effects logistic regression models with a random intercept for Level-1 trauma center, adjusted for important demographic and injury characteristics. A total of 11,917 severely injured patients from 13 Dutch Level-1 trauma centers was included in this study. Hospital volume varied from 120 to 410 severely injured patients per year. Observed mortality rates varied between 12% and 24% per center. After case-mix correction, no statistically significant differences between low- and high-volume centers were demonstrated (adjusted odds ratio 0.97 per 50 extra patients per year, 95% Confidence Interval 0.90–1.04, p = 0.44). The variation in hospital volume of the included Level-1 trauma centers was not associated with the outcome of severely injured patients. Our results suggest that well-organized trauma centers with a similar organization of care could potentially achieve comparable outcomes.

scholarly journals Results of delayed follow-up imaging in traumatic brain injury

2016 ◽  
Vol 124 (3) ◽  
pp. 703-709 ◽  
Author(s):  
Adam Ross Befeler ◽  
William Gordon ◽  
Nickalus Khan ◽  
Julius Fernandez ◽  
Michael Scott Muhlbauer ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Trauma Center ◽  
Demographic Data ◽  
Data Types ◽  
Surgical Interventions ◽  
Imaging Results ◽  
Level 1 ◽  
Level 1 Trauma Center

OBJECT There is a paucity of scientific evidence available about the benefits of outpatient follow-up imaging for traumatic brain injury patients. In this study, 1 year of consecutive patients at a Level 1 trauma center were analyzed to determine if there is any benefit to routinely obtaining CT of the head at the outpatient follow-up visit. METHODS This single-institution retrospective review was performed on all patients with a traumatic brain injury seen at a Level 1 trauma center in 2013. Demographic data, types of injuries, surgical interventions, radiographic imaging in inpatient and outpatient settings, and outcomes were assessed through a review of the institution’s trauma registry, patient charts, and imaging. RESULTS Five hundred twenty-five patients were seen for traumatic brain injury in 2013 at Regional One Health in Memphis, Tennessee. One hundred eighty-five patients (35%) presented for outpatient follow-up, all with CT scans of the head. Seven of these patients (4%) showed worsening of their intracranial injuries on outpatient imaging studies; however, surgical intervention was recommended for only 3 of these patients (2%). All patients requiring an intervention had neurological deterioration prior to their follow-up appointment. CONCLUSIONS These experiences suggest that outpatient follow-up imaging for traumatic brain injury should be done selectively, as it was not helpful for patients who did not exhibit worsening of neurological signs or symptoms. Furthermore, routine outpatient imaging results in unnecessary resource utilization and radiation exposure.

scholarly journals Females Fall More From Heights But Males Survive Less Among A Geriatric Population: Insights From An American Level 1 Trauma Center

2019 ◽  
Author(s):  
Ayman El-Menyar ◽  
Elizabeth Tilley ◽  
Hassan Al-Thani ◽  
Rifat Latifi
Keyword(s):  
Older Adults ◽  
Trauma Center ◽  
Injury Severity ◽  
Age Groups ◽  
Trauma Patients ◽  
Chi Square ◽  
Geriatric Population ◽  
Fall Injury ◽  
Level 1 ◽  
Level 1 Trauma Center

Abstract Background Approximately one third of subjects ≥65 year old and half of subjects ≥80 years old sustain a fall injury each year. We aimed to study the outcomes of fall from a height (FFH) among older adults. We hypothesized that in an elderly population, fall-related injury and mortality are the same in both genders.Methods A retrospective analysis was conducted between January 2012 and December 2016 in patients who sustained fall injury at age of at least 60 years and were admitted into a Level 1 Trauma center. Patients were divided into 3 groups: Gp-I: 60-69, Gp-II: 70-79 and Gp-III: ≥80 years old. Data were analyzed and compared using Chi-square, one-way analysis of variance (ANOVA) and logistic regression analysis tests.Results Forty-three percent (3665/8528) of adult trauma patients had FFH and 59.5% (2181) were ≥ 60 years old and 52% were women. The risk of fall increased with age with an Odd ratio (OR) 1.52 for age 70-79 and an OR 3.40 for ≥80. Females fell 1.2 times more (age-adjusted OR 1.24; 95% CI 1.05-1.45) and 47% of ≥80 years old suffered FFH. Two-thirds of FFH occurred at a height ≤1 meter. Injury severity (ISS, NISS and GCS) were worse in Gp-II, lower extremities max Abbreviated Injury score (max AIS) was higher in Gp-III. Overall mortality was 8.7% (Gp-I 3.6% vs. 11.3% in Gp-II and 14% in Gp- III). Males showed higher mortality than females in the entire age groups (Gp-I: 4.6% vs 1%, Gp-II: 12.9% vs 4.2% and Gp-III: 17.3% vs 6.9% respectively). On multivariate analysis, shock index (OR 3.80; 95% CI 1.27-11.33) and male gender (OR 2.70; 95% CI 1.69-4.16) were independent predictors of mortality.Conclusions Fall from a height is more common in older adult female patients, but male patients have worse outcomes. Preventive measures for falls at home still are needed for the older adults of both genders.

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