scholarly journals Management of intertrochanteric femoral fractures at Level 1 trauma center in Leningrad Region

2021 ◽  
pp. 68-76
Author(s):  
B. A. Maiorov ◽  
A. E. Tulchinskii ◽  
I. G. Belenkii ◽  
G. D. Sergeev ◽  
I. M. Barsukova ◽  
...  
Keyword(s):  
Trauma Center ◽  
Femoral Fractures ◽  
Multidisciplinary Teams ◽  
Leningrad Region ◽  
Post Surgery ◽  
Fracture Management ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Hospital Group ◽  
Group 1

Relevance. An in-house Protocol for proximal femoral fracture management was developed at Vsevolozhsk Clinical Interdistrict Hospital of Leningrad Region.Intention To demonstrate possible practical application of preliminary federal clinical guidelines at Level 1 trauma center in Leningrad Region including comparative analysis of its efficacy when treating intertrochanteric femoral fractures.Methodology. Post-surgery outcomes were retrospectively assessed in 86 patients of Vsevolozhsk Clinical Interdistrict Hospital (Group 1, per Protocol) and 28 patients of Tosno Clinical Interdistrict Hospital (Group 2, w/o Protocol) with intertrochanteric femoral fractures (31A by Arbeitsgemeinschaft für Osteosynthesefragen classification and S72.1 by ICD-10).Results and Discussion. There were no significant differences in patients’ age, methods of anesthesia and osteosynthesis between the groups. Group 1 demonstrated statistically significant decrease in preoperative bed-days, time to sitting up in bed after surgery, ambulation with walkers and duration of hospitalization. Group 1 patients needed less assistance from other health-care professionals, less intensive therapy and blood transfusions.Conclusion. Adoption of in-house protocols, optimization of supply and staffing as well as involvement of multidisciplinary teams will improve management of proximal femoral fractures.

scholarly journals Chronic hyponatremia in patients with proximal femoral fractures after low energy trauma: A retrospective study in a level-1 trauma center

Bone Reports ◽  
2020 ◽  
Vol 12 ◽  
pp. 100234
Author(s):  
Daniel Bernd Hoffmann ◽  
Christian Popescu ◽  
Marina Komrakova ◽  
Lena Welte ◽  
Dominik Saul ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Trauma Center ◽  
Femoral Fractures ◽  
Low Energy ◽  
Proximal Femoral Fractures ◽  
Chronic Hyponatremia ◽  
Level 1 ◽  
Level 1 Trauma Center

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.

Poster 16 Utilization review from a level 1 trauma center to improve scene triage

1992 ◽  
Vol 11 (10) ◽  
pp. 80
Author(s):  
Edward T. Rupert ◽  
J. Duncan Harviel ◽  
Grace S. Rozycki ◽  
Howard R. Champion
Keyword(s):  
Trauma Center ◽  
Utilization Review ◽  
Level 1 ◽  
Level 1 Trauma Center

Changing Characteristics of Facial Fractures Treated at a Regional, Level 1 Trauma Center, From 2005 to 2010

2012 ◽  
Vol 68 (5) ◽  
pp. 461-466 ◽  
Author(s):  
Katherine S. Roden ◽  
Winnie Tong ◽  
Matthew Surrusco ◽  
William W. Shockley ◽  
John A. Van Aalst ◽  
...  
Keyword(s):  
Trauma Center ◽  
Regional Level ◽  
Facial Fractures ◽  
Level 1 ◽  
Level 1 Trauma Center

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.

scholarly journals Staying at the Cutting Edge: Partnership With a Level 1 Trauma Center Improves Clinical Currency and Wartime Readiness for Military Surgeons

2016 ◽  
Vol 181 (5) ◽  
pp. 459-462 ◽  
Author(s):  
Vilas Saldanha ◽  
Fia Yi ◽  
Jeffrey D. Lewis ◽  
Nichole K. Ingalls
Keyword(s):  
Trauma Center ◽  
Cutting Edge ◽  
Level 1 ◽  
Level 1 Trauma Center
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