Analysis of Risk Factors with Hospital Mortality in Pedestrian Injured Patients; A Dataset Analysis of a Level-I Trauma Center in Southern Iran

We examined financial data from a University Level I Trauma Center from 1994 to 2014. We sought to investigate the hypothesis that lower injury severity correlates with increased profitability. We examined data from July 1994 to December 2014. This included hospital charges, Medicare cost data, final reimbursement, and payor source. Patients were separated into Injury Severity Score (ISS) groupings: 0 to 9, 10 to 14, 15 to 24, >24, and >14. Mean and standard deviation of mean are reported. We had complete data on 27,582 patients. Overall profit per case when subtracting costs from reimbursements was $1,932/case (total profit in unadjusted dollars = $53,475,828 or $2,673,791/year). When examined by ISS, profitability was significantly different between ISS 0 to 14 and 15 to 24, and > 24. When charge data were examined, the average loss per case was -$31,313 for the 27,582 patient data set. When using cost, and not charge data, overall trauma care had a positive margin. Severely injured patients (ISS > 14) were the most profitable, with a significantly higher profit per case than all other groupings. Only through examination of cost data can realistic determinations of trauma center profitability be made. If only charge data had been examined in this study, the overall loss from the 20-year period would have been $863,675,166 and not a profit of $53,475,828.

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Initial Approach to the Management of Multisystem Trauma

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0062 ◽

2019 ◽

pp. 397-401

Author(s):

David S. Morris

Keyword(s):

Trauma Center ◽

Injury Severity ◽

Hospital Admissions ◽

The United States ◽

Emergency Department Visits ◽

Severely Injured ◽

Level Ii ◽

Level I ◽

Nonfatal Injuries ◽

Injured Patients

Nearly 200,000 people die of injury-related causes in the United States each year, and injury is the leading cause of death for all patients aged 1 to 44 years. Approximately 30 million people sustain nonfatal injuries each year, which results in about 29 million emergency department visits and 3 million hospital admissions. Management of severely injured patients, typically defined as having an Injury Severity Score greater than 15 is best managed in a level I or level II trauma center. Any physician who provides care for critically ill patients should have a basic familiarity with the fundamentals of trauma care.

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Resuscitation of Hypotensive Head-Injured Patients: Is Hypertonic Saline the Answer?

The American Surgeon ◽

10.1177/000313480807400316 ◽

2008 ◽

Vol 74 (3) ◽

pp. 253-259

Author(s):

Jose L. Pascual ◽

Eileen Maloney-Wilensky ◽

Patrick M. Reilly ◽

Corinna Sicoutris ◽

Michael K. Keutmann ◽

...

Keyword(s):

Brain Tissue ◽

Hypertonic Saline ◽

Trauma Center ◽

Tissue Oxygenation ◽

Perfusion Pressure ◽

Inclusion Criteria ◽

Brain Tissue Oxygenation ◽

Head Injured ◽

Level I ◽

Injured Patients

Hypertonic saline (HTS) may decrease intracranial pressure (ICP) in severe traumatic brain injury (STBI) and effectively resuscitates hypotensive patients. No data exist on institutional standardization of HTS for hypotensive patients with STBI. It remains unclear how HTS affects brain tissue oxygenation (PbtO2) in STBI. We hypothesized HTS could be safely standardized in patients with STBI and would lower ICP while improving cerebral perfusion pressure (CPP) and PbtO2. Under institutional guidelines in a Level I trauma center, 12 hypotensive STBI intensive care unit subjects received HTS. Inclusion criteria included mean arterial pressure (MAP) ≤ 90 mmHg, Glasgow Coma Scale (GCS) ≤ 8, ICP ≥ 20 mmHg, and serum [Na+] < 155 mEq/L. All patients underwent ICP monitoring. Hemodynamics, CPP, ICP, and PbtO2 data were collected before and hourly for 6 hours after HTS infusion. Guideline criteria compliance was greater than 95 per cent. No major complications occurred. Mean ICP levels dropped by 45 per cent (P < 0.01) and this drop persisted for 6 hours. CPP levels increased by 20 per cent (P < 0.05). PbtO2 remained persistently elevated for all time points after HTS infusion. Institutional use of HTS in STBI can be safely implemented in a center caring for neurotrauma patients. HTS infusion in hypotensive STBI reduces ICP and raises CPP. Brain tissue oxygenation tends to improve after HTS infusion.

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Progressive Neurologic Deficit in Spinal Injured Patients at a Level I Trauma Center

Journal of Orthopaedic Trauma ◽

10.1097/00005131-199004020-00028 ◽

1990 ◽

Vol 4 (2) ◽

pp. 212

Author(s):

Paul A. Anderson ◽

M. Bradford Henley

Keyword(s):

Trauma Center ◽

Neurologic Deficit ◽

Level I ◽

Injured Patients

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Epidemiology and Outcome Determinants of Pedestrian Injuries in a Level I Trauma Center in Southern Iran; A Cross-Sectional Study

Bulletin of Emergency and Trauma ◽

10.18869/acadpub.beat.5.4.508 ◽

2017 ◽

Vol 5 (4) ◽

pp. 273-279 ◽

Cited By ~ 1

Author(s):

Haleh Ghaem ◽

◽

Maryam Soltani ◽

Mahnaz Yadollahi ◽

Tanaz Valad Beigi ◽

...

Keyword(s):

Trauma Center ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Southern Iran ◽

Pedestrian Injuries ◽

Level I

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Predictable Risk Factors of Upper-Extremity Deep Venous Thrombosis in a Level I Trauma Center

International Journal of General Medicine ◽

10.2147/ijgm.s311669 ◽

2021 ◽

Vol Volume 14 ◽

pp. 2637-2644

Author(s):

Scarlett Tohme ◽

Aparna Vancheswaran ◽

Kyle Mobbs ◽

Jessica Kydd ◽

Nisha Lakhi

Keyword(s):

Risk Factors ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Upper Extremity ◽

Trauma Center ◽

Level I

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Risk Factors for Urinary Tract Infection or Pneumonia After Admission for Traumatic Subdural Hematoma at a Level I Trauma Center: Large Single-Institution Series

World Neurosurgery ◽

10.1016/j.wneu.2019.10.192 ◽

2020 ◽

Vol 134 ◽

pp. e754-e760

Author(s):

Tammy B. Pham ◽

Shanmukha Srinivas ◽

Joel R. Martin ◽

Michael G. Brandel ◽

Arvin R. Wali ◽

...

Keyword(s):

Risk Factors ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Subdural Hematoma ◽

Trauma Center ◽

Single Institution ◽

Level I

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Blood Transfusions in Trauma: Six-Year Analysis of the Transfusion Practices at a Level I Trauma Center

The American Surgeon ◽

10.1177/000313480807401015 ◽

2008 ◽

Vol 74 (10) ◽

pp. 953-957 ◽

Cited By ~ 4

Author(s):

Pedro G.R. Teixeira ◽

Didem Oncel ◽

Demetrios Demetriades ◽

Kenji Inaba ◽

Ira Shulman ◽

...

Keyword(s):

Trauma Center ◽

Injury Severity ◽

Negative Impact ◽

Fresh Frozen Plasma ◽

Blood Transfusions ◽

Trauma Patients ◽

Packed Red Blood Cells ◽

Fresh Frozen ◽

Level I ◽

Injured Patients

The objective of this study was to analyze the transfusion practices in trauma patients in one institution. A retrospective analysis of the Trauma Registry linked with the Blood Bank Database of a Level 1 trauma center was conducted. Over 6 years, 17 per cent of the 25,599 trauma patients received blood transfusions. The overall mortality in transfused patients was 20 per cent and remained the same during the study period. There was no change in the proportion of patients receiving transfusions throughout the years, however there was a significant 23.5 per cent reduction in the mean number of packed red blood cells (PRBC) units transfused (P < 0.001 for trend). This reduction in PRBC used remained true and even more evident in the group of more severely injured patients (Injury Severity Score ≥ 16), with a 27.9 per cent decrease in mean units of PRBC (P < 0.001 for trend). The highest reduction in PRBC transfusion was seen in blunt trauma patients (34.6%, P < 0.001). During the study period there was a concurrent increase in mean units of fresh frozen plasma used (60.7%, P < 0.001) and no change in the use of platelets and cryoprecipitate. In conclusion, transfusions of PRBC were significantly reduced over time in trauma patients without any evident negative impact on mortality.

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Age and traumatic brain injury as prognostic factors for late-phase mortality in patients defined as polytrauma according to the New Berlin Definition: experiences from a level I trauma center

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03626-w ◽

2020 ◽

Author(s):

V. Weihs ◽

V. Heel ◽

M. Dedeyan ◽

N. W. Lang ◽

S. Frenzel ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Prognostic Factors ◽

Trauma Center ◽

Late Phase ◽

Severely Injured ◽

Severely Injured Patients ◽

Berlin Definition ◽

Severe Tbi ◽

Level I ◽

Injured Patients

Abstract Background The rationale of this study was to identify independent prognostic factors influencing the late-phase survival of polytraumatized patients defined according to the New Berlin Definition. Methods Retrospective data analysis on 173 consecutively polytraumatized patients treated at a level I trauma center between January 2012 and December 2015. Patients were classified into two groups: severely injured patients (ISS > 16) and polytraumatized patients (patients who met the diagnostic criteria for the New Berlin Definition). Results Polytraumatized patients showed significantly lower late-phase and overall survival rates. The presence of traumatic brain injury (TBI) and age > 55 years had a significant influence on the late-phase survival in polytraumatized patients but not in severely injured patients. Despite the percentage of severe TBI being nearly identical in both groups, severe TBI was identified as main cause of death in polytraumatized patients. Furthermore, severe TBI remains the main cause of death in polytraumatized patients > 55 years of age, whereas younger polytraumatized patients (< 55 years of age) tend to die more often due to the acute trauma. Conclusion Our results suggest that age beyond 55 years and concomitant (severe) TBI remain as most important influencing risk factor for the late-phase survival of polytraumatized patients but not in severely injured patients. Level of evidence Prognostic study, level III.

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