Helmet use and reduction in skull fractures in skiers and snowboarders admitted to the hospital

2011 ◽  
Vol 7 (3) ◽  
pp. 268-271 ◽  
Author(s):  
Anand I. Rughani ◽  
Chih-Ta Lin ◽  
Wiliam J. Ares ◽  
Deborah A. Cushing ◽  
Michael A. Horgan ◽  
...  
Keyword(s):  
Head Injury ◽  
Length Of Stay ◽  
Skull Fracture ◽  
Ct Scans ◽  
Spine Injury ◽  
Intracranial Injury ◽  
Helmet Use ◽  
Number Of Patients ◽  
Significant Difference ◽  
Secondary Outcomes

Object Helmet use has been associated with fewer hospital visits among injured skiers and snowboarders, but there remains no evidence that helmets alter the intracranial injury patterns. The authors hypothesized that helmet use among skiers and snowboarders reduces the incidence of head injury as defined by findings on head CT scans. Methods The authors performed a retrospective review of head-injured skiers and snowboarders at 2 Level I trauma centers in New England over a 6-year period. The primary outcome of interest was intracranial injury evident on CT scans. Secondary outcomes included the following: need for a neurosurgical procedure, presence of spine injury, need for ICU admission, length of stay, discharge location, and death. Results Of the 57 children identified who sustained a head injury while skiing or snowboarding, 33.3% were wearing a helmet at the time of injury. Of the helmeted patients, 5.3% sustained a calvarial fracture compared with 36.8% of the unhelmeted patients (p = 0.009). Although there was a favorable trend, there was no significant difference in the incidence of epidural hematoma, subdural hematoma, intraparenchymal hemorrhage, subarachnoid hemorrhage, or contusion in helmeted and unhelmeted patients. With regard to secondary outcomes, there were no significant differences between the 2 groups in percentage of patients requiring neurosurgical intervention, percentage requiring admission to an ICU, total length of stay, or percentage discharged home. There was no difference in the incidence of cervical spine injury. There was 1 death in an unhelmeted patient, and there were no deaths among helmeted patients. Conclusions Among hospitalized children who sustained a head injury while skiing or snowboarding, a significantly lower number of patients suffered a skull fracture if they were wearing helmets at the time of the injury.

scholarly journals The patient with head injury and a Glasgow coma score of 15: Is a brain CT examination indicated?

2003 ◽  
Vol 7 (3) ◽  
pp. 14-16
Author(s):  
S. L. Benade ◽  
A. T. Scher
Keyword(s):  
Head Injury ◽  
Glasgow Coma Score ◽  
Ct Scanning ◽  
Clinical History ◽  
Intracranial Injury ◽  
Brain Ct ◽  
State Hospitals ◽  
Ct Examination ◽  
Number Of Patients ◽  
The Brain

The decision as to whether to perform a CT examination of the brain in patients with a Glasgow coma score of 15 after injury is often difficult, given the limited CT scanning facilities available in state hospitals. A retrospective evaluation of 100 consecutive head-injury patients presenting with a Glasgow coma score of 15 at Tygerberg Hospital was therefore carried out. In a surprisingly high number of patients (50%) abnormal findings due to the injury were detected. Analysis of the clinical history parameters did not demonstrate a significant association with abnormal CT findings. It is therefore concluded that brain CT examination in patients with a Glasgow coma score of 15 is justified and that the Glasgow coma scale is a poor predictor of intracranial injury.

Abstract WMP118: In Safe Hands: Implementation on the Stroke Unit. Does it Improve Patient Care and Ward Efficiency?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sheila M Jala ◽  
Sarah Giaccari ◽  
Melissa Passer ◽  
Carin Bertmar ◽  
Susan Day ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Stroke Unit ◽  
Oral Intake ◽  
Improve Patient Care ◽  
Tertiary Hospital ◽  
Study Data ◽  
Acute Hospital ◽  
Staff Satisfaction ◽  
Number Of Patients ◽  
Significant Difference

The ‘In Safe Hands” (ISH) is a structured interdisciplinary bedside round developed to increase patients participation in their care in acute hospital wards. This has shown to improve quality of care by reducing communication errors and complications, enhancing a culture of safety in an acute hospital. The purpose of this study was to assess the effect of ISH on length of stay (LOS), in-hospital complications and assess whether the ISH enhances patient and staff satisfaction in a stroke unit of a tertiary hospital in Sydney, Australia. This was a longitudinal study pre and post implementation. A total of 200 patients participated in the study. Data on the length of stay, incidence rate relating to patient safety and patient and staff satisfaction surveys using Patient Experience Tracker (PET) devices were collected pre and post implementation. ISH increased the number of patients with at least 72hours in stroke unit care by 80 percent (P < 0.001). Fever and hyperglycaemia were treated in all patients following ISH implementation vs only 50% and 64% respectively of patients pre ISH implementation. Swallow screen was completed in all patients prior oral intake compared to 92% of patients of the pre ISH group (P = 0.03). There was no significant difference in the LOS and complications. All stroke patients received stroke education and there were no readmissions post implementation. There was no significant difference in the patient and staff satisfaction. In conclusion, although ISH did not improve the primary endpoints of LOS, complications and satisfaction it did improve protocol adherence.

scholarly journals Surgery Delay Increases Length of Stay in Thoracolumbar Trauma

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Lawrence Zeldin ◽  
Sean N Neifert ◽  
Robert J Rothrock ◽  
Ian T McNeill ◽  
Jonathan S Gal ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spinal Injury ◽  
Specific Effect ◽  
Spinal Trauma ◽  
Spine Injury ◽  
Complication Rates ◽  
Improvement Program ◽  
Delayed Surgery ◽  
Significant Difference ◽  
Surgery Timing

Abstract INTRODUCTION The ideal timing from admission of a thoracolumbar spinal trauma patient to the start of surgery at US trauma centers remains a hotly contested area of debate. The effect of surgical latency on patient outcomes in thoracolumbar trauma remains unclear. METHODS All 2013 to 2015 thoracolumbar spinal trauma cases from the American College of Surgeons Trauma Quality Improvement Program (TQIP) were analyzed. Patients with unsurvivable spine injury, polytraumas (serious injuries in more than one bodily region), and those discharged within 24 h were excluded. Patients were classified into 3 groups by surgery timing: less than 8 h (early, N = 1699), between 8 and 24 h (normal, N = 946), and over 24 h (delayed, N = 1601). Mortality, length of stay (LOS), and complication rates were compared between groups. Demographic variables and complication rates were compared. Multivariate logistic regression was utilized to determine the specific effect of surgery timing on outcomes. RESULTS Patients with earlier surgery presented with more severe spinal trauma (P < .0001). Patients in the normal surgical timing cohort were most likely to have altered mental status (4.97% vs 3.24%, P = .05), and less likely to suffer from UTI (4.97% vs 3.24%, P = .03). Patients in the delayed cohort were older (46.2 vs 43.7 yr, P = .0003), more likely to have a longer LOS (11.3 vs 10.6 d, P = .02), return to the ICU (2.94% vs 1.29%, P = .001), experience unplanned intubation (2.06% vs 1%, P = .01) and suffer from cardiac arrest (0.53% vs 1.19%, P = .04). Upon multivariate analysis, delayed surgery was an independent risk factor for prolonged LOS (OR: 1.21, 95% CI: 0.56-1.87, P = .0003). CONCLUSION Patients with earlier surgery possessed more severe spinal injury. When adjusting for demographics and severity, no significant difference is seen in mortality between the different surgery times; however, LOS is prolonged in patients with delayed surgery.

scholarly journals Evaluation of an Initial Specimen Diversion Device (ISDD) on Rates of Blood Culture Contamination in the Emergency Department

2021 ◽  
Vol 14 ◽  
pp. 73-76
Author(s):  
Blake Buzard ◽  
Patrick Evans ◽  
Todd Schroeder
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Blood Culture ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Total Hospital Cost ◽  
Initial Specimen ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Impact

Introduction: Blood cultures are the gold standard for identifying bloodstream infections. The Clinical and Laboratory Standards Institute recommends a blood culture contamination rate of <3%. Contamination can lead to misdiagnosis, increased length of stay and hospital costs, unnecessary testing and antibiotic use. These reasons led to the development of initial specimen diversion devices (ISDD). The purpose of this study is to evaluate the impact of an initial specimen diversion device on rates of blood culture contamination in the emergency department.  Methods: This was a retrospective, multi-site study including patients who had blood cultures drawn in an emergency department. February 2018 to April 2018, when an ISDD was not utilized, was compared with June 2019 to August 2019, a period where an ISDD was being used. The primary outcome was total blood culture contamination. Secondary outcomes were total hospital cost, hospital and intensive care unit length of stay, vancomycin days of use, vancomycin serum concentrations obtained, and repeat blood cultures obtained.  Results: A statistically significant difference was found in blood culture contamination rates in the Pre-ISDD group vs the ISDD group (7.47% vs 2.59%, p<0.001). None of the secondary endpoints showed a statistically significant difference. Conclusions: Implementation of an ISDD reduces blood culture contamination in a statistically significant manner. However, we were unable to capture any statistically significant differences in the secondary outcomes.

Oncology consults in admitted cancer patients: The ways to reduce length of stay.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13516-e13516
Author(s):  
Bohdan Baralo ◽  
Muhammad Hanif ◽  
Archen Krupadev ◽  
Sabah Iqbal ◽  
Navyamani Kagita ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Cancer Patients ◽  
Hospice Care ◽  
Medical Center ◽  
Severe Disease ◽  
Tertiary Care ◽  
Charlson Score ◽  
Primary Malignancy ◽  
Number Of Patients ◽  
Significant Difference

e13516 Background: The cancer patients, while being admitted to the hospital often have an oncologist consult (OC) through the admission. The goal of the study is to assess, whether OC impact the length of stay (LOS) and to define the group of cancer patients in whom omitting the OC can decrease LOS. Methods: We reviewed 415 admissions of cancer patients from 1/1/2018 to 11/30/2020 to the both campuses of Mercy Catholic Medical Center. We included patients who are 18 years or older with confirmed malignancy. We excluded COVID positive, patients who died during admission, were transferred to tertiary care institutions, or were recommended hospice care, but decided to continue treatment despite poor prognosis. Patient with hematologic disorders were excluded as well. The LOS of stay in cancer patients with and without OC will be compared using two tailed unpaired t-test and Mann-Whitney test ( < 20 admissions in each group, or one of the groups had a largely skewed data). Sub-analysis will be done accounting for Charlson score, spread of the disease and reason of admission (cancer vs non-cancer related). Statistical software Prism 9 will be used for analysis. Results: 290 admissions were selected using inclusion and exclusion criteria. Throughout all admission 234 admission had OC and mean LOS was 4.86 day compare to 4.23 in 56 patients, who did not have OC. Patients with non-cancer related (non-CR) admissions who had Charlson score ≤6 and no OC had shorter LOS (13 admission with median LOS 3 days) compared to those who had OC (11 admissions with LOS 7days), p 0.0462. Also, patient with non-CR admission and localized cancer tend have shorter LOS when no OC involved (15 admission with median LOS 6 days) compare to OC (16 admissions with median LOS 2.5 days), p 0.0365. No other significant difference in LOS were observed (Table). Conclusions: The cancer patients admitted for the reasons not related to their primary malignancy and who have either localized disease or Charlson score < 6 have shorter length of stay when OC not done. The limitation of the current study is the small number of patients in analysis subgroups, as well as fact that patients who had OC may have more severe disease during admission, despite the fact that patient had same extend of disease and comorbidities. Study with larger number of admissions may be necessary to confirm findings of this study.[Table: see text]

scholarly journals Head injury from falls in children younger than 6 years of age

2015 ◽  
Vol 100 (11) ◽  
pp. 1032-1037 ◽  
Author(s):  
P Burrows ◽  
L Trefan ◽  
R Houston ◽  
J Hughes ◽  
G Pearson ◽  
...  
Keyword(s):  
Head Injury ◽  
Ct Scan ◽  
Skull Fracture ◽  
Cross Sectional Study ◽  
Skull Fractures ◽  
Sectional Study ◽  
Intracranial Injury ◽  
Cross Sectional ◽  
Serious Injury ◽  
The Relationship

The risk of serious head injury (HI) from a fall in a young child is ill defined. The relationship between the object fallen from and prevalence of intracranial injury (ICI) or skull fracture is described.MethodCross-sectional study of HIs from falls in children (<6 years) admitted to UK hospitals, analysed according to the object fallen from and associated Glasgow Coma Score (GCS) or alert, voice, pain, unresponsive (AVPU) and CT scan results.ResultsOf 1775 cases ascertained (median age 18 months, 54.7% boys), 87% (1552) had a GCS=15/AVPU=alert. 19.3% (342) had a CT scan: 32% (110/342) were abnormal; equivalent to 5.9% of the overall population, 16.9% (58) had isolated skull fractures and 13.7% (47) had ICI (49% (23/47) had an associated skull fracture). The prevalence of ICI increased with neurological compromise; however, 12% of children with a GCS=15/AVPU=alert had ICI. When compared to falls from standing, falls from a person's arms (233 children (mean age 1 year)) had a significant relative OR for a skull fracture/ICI of 6.94 (95% CI 3.54 to 13.6), falls from a building (eg, window or attic) (mean age 3 years) OR 6.84 (95% CI 2.65 to 17.6) and from an infant or child product (mean age 21 months) OR 2.75 (95% CI 1.36 to 5.65).ConclusionsMost HIs from a fall in these children admitted to hospital were minor. Infants, dropped from a carer's arms, those who fell from infant products, a window, wall or from an attic had the greatest chance of ICI or skull fracture. These data inform prevention and the assessment of the likelihood of serious injury when the object fallen from is known.

Spinal injury patterns among skiers and snowboarders

2011 ◽  
Vol 31 (5) ◽  
pp. E8 ◽  
Author(s):  
Molly E. Hubbard ◽  
Ryan P. Jewell ◽  
Travis M. Dumont ◽  
Anand I. Rughani
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Head Injury ◽  
Spinal Cord Injuries ◽  
Skull Fracture ◽  
Closed Head Injury ◽  
Spine Injury ◽  
Cervical Spine Trauma ◽  
Spine Trauma ◽  
Injury Patterns

Object Skiing and snowboarding injuries have increased with the popularity of these sports. Spinal cord injuries (SCIs) are a rare but serious event, and a major cause of morbidity and mortality for skiers and snowboarders. The purpose of this study is to characterize the patterns of SCI in skiers and snowboarders. Methods The authors queried the Nationwide Inpatient Sample for the years 2000–2008 for all patients admitted with skiing or snowboarding as the mechanism of injury, yielding a total of 8634 patients. The injury patterns were characterized by the ICD-9 diagnostic and procedure codes. The codes were searched for those pertaining to vertebral and skull fracture; spinal cord, chest, abdominal, pelvic, and vessel injuries; and fractures and dislocations of the upper and lower extremity. Statistical analysis was performed with ANOVA and Student t-test. Results Patients were predominantly male (71%) skiers (61%), with the average age of the skiers being older than that of snowboarders (39.5 vs 23.5 years). The average length of stay for patients suffering from spine trauma was 3.8 days and was increased to 8.9 days in those with SCI. Among hospitalized patients, SCI was seen in 0.98% of individuals and was equally likely to occur in snowboarders and skiers (1.07% vs 0.93%, p < 0.509). Cervical spine trauma was associated with the highest likelihood of SCI (19.6% vs. 10.9% of thoracic and 6% of lumbar injuries, p < 0.0001). Patients who were injured skiing were more likely to sustain a cervical spine injury, whereas those injured snowboarding had higher frequencies of injury to the lumbar spine. The most common injury seen in tandem with spine injury was closed head injury, and it was seen in 13.4% of patients. Conversely, a spine injury was seen in 12.9% of patients with a head injury. Isolated spine fractures were seen in 4.6% of patients. Conclusions Skiers and snowboarders evaluated at the hospital are equally likely to sustain spine injuries. Additionally, participants in both sports have an increased incidence of SCI with cervical spine trauma.

scholarly journals Comparison of inhaled methoxyflurane versus procedural sedation for manipulation and reduction of acute shoulder and elbow dislocation in the emergency department

2021 ◽  
pp. 201010582199349
Author(s):  
Shu Fang Ho ◽  
Sameera Ganti ◽  
Eunizar Omar ◽  
Sherman Wei Qiang Lian ◽  
Hui Cheng Tan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Shoulder Dislocation ◽  
Elbow Dislocation ◽  
Procedural Sedation ◽  
Median Length ◽  
Procedural Sedation And Analgesia ◽  
Significant Difference ◽  
Sedation And Analgesia ◽  
Secondary Outcomes

Introduction: This paper compares the usage of inhaled methoxyflurane versus traditional procedural sedation and analgesia for manipulation and reduction of acute shoulder dislocation and acute elbow dislocation in the emergency department. Methods: This was a retrospective observational study of patients who presented with either acute shoulder dislocation or acute elbow dislocation to an adult tertiary emergency department between 1 April 2018 and 30 September 2019 and underwent manipulation and reduction with either methoxyflurane or procedural sedation and analgesia. Primary outcomes of patients’ length of stay in the emergency department and secondary outcomes of duration of procedure and success of reduction on first attempt for inhaled methoxyflurane were compared against those of procedural sedation and analgesia. Results: A total of 192 patients were included in this study; 74 patients underwent reduction with methoxyflurane while 118 patients (85 acute shoulder dislocation and 33 acute elbow dislocation) underwent reduction with procedural sedation and analgesia. The median length of stay in the emergency department was significantly shorter ( P<0.001) for the methoxyflurane group (99 minutes, interquartile range (IQR) 136.8 minutes) versus the procedural sedation and analgesia group (246.5 minutes, IQR 163 minutes). The median duration of procedure in the emergency department was also significantly shorter ( P<0.001) for the methoxyflurane group (16 minutes, IQR 17 minutes) versus the procedural sedation and analgesia group (32 minutes, IQR 40.3 minutes). There was no significant difference in reduction on first attempt between the two groups. Conclusion: The use of inhaled methoxyflurane in the manipulation and reduction of acute shoulder dislocation and acute elbow dislocation was associated with a shorter patient length of stay and a shorter duration of procedure, while no significant difference was observed in the success of reduction on first attempt when compared to procedural sedation and analgesia.

scholarly journals The impact of helmet use on neurosurgical care and outcomes after pediatric all-terrain vehicle and dirt bike crashes: a 10-year single-center experience

2021 ◽  
pp. 1-9
Author(s):  
Jackson H. Allen ◽  
Aaron M. Yengo-Kahn ◽  
Kelly L. Vittetoe ◽  
Amber Greeno ◽  
Muhammad Owais Abdul Ghani ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pediatric Patients ◽  
Absolute Risk ◽  
Skull Fracture ◽  
Pediatric Trauma ◽  
Neurosurgical Procedures ◽  
Intracranial Injury ◽  
Helmet Use ◽  
The Impact

OBJECTIVE All-terrain vehicle (ATV) and dirt bike crashes frequently result in traumatic brain injury. The authors performed a retrospective study to evaluate the role of helmets in the neurosurgical outcomes of pediatric patients involved in ATV and dirt bike crashes who were treated at their institution during the last decade. METHODS The authors analyzed data on all pediatric patients involved in ATV or dirt bike crashes who were evaluated at a single regional level I pediatric trauma center between 2010 and 2019. Patients were excluded if the crash occurred in a competition (n = 70) or if helmet status could not be determined (n = 18). Multivariable logistic regression was used to analyze the association of helmet status with the primary outcomes of 1) neurosurgical consultation, 2) intracranial injury (including skull fracture), and 3) moderate or severe traumatic brain injury (MSTBI) and to control for literature-based, potentially confounding variables. RESULTS In total, 680 patients were included (230 [34%] helmeted patients and 450 [66%] unhelmeted patients). Helmeted patients were more frequently male (81% vs 66%). Drivers were more frequently helmeted (44.3%) than passengers (10.5%, p < 0.001). Head imaging was performed to evaluate 70.9% of unhelmeted patients and 48.3% of helmeted patients (p < 0.001). MSTBI (8.0% vs 1.7%, p = 0.001) and neurosurgical consultation (26.2% vs 9.1%, p < 0.001) were more frequent among unhelmeted patients. Neurosurgical injuries, including intracranial hemorrhage (16% vs 4%, p < 0.001) and skull fracture (18% vs 4%, p < 0.001), were more common in unhelmeted patients. Neurosurgical procedures were required by 2.7% of unhelmeted patients. One helmeted patient (0.4%) required placement of an intracranial pressure monitor, and no other helmeted patients required neurosurgical procedures. After adjustment for age, sex, driver status, vehicle type, and injury mechanism, helmet use significantly reduced the odds of neurosurgical consultation (OR 0.250, 95% CI 0.140–0.447, p < 0.001), intracranial injury (OR 0.172, 95% CI 0.087–0.337, p < 0.001), and MSTBI (OR 0.244, 95% CI 0.079–0.758, p = 0.015). The unadjusted absolute risk reduction provided by helmet use equated to a number-needed-to-helmet of 6 riders to prevent 1 neurosurgical consultation, 4 riders to prevent 1 intracranial injury, and 16 riders to prevent 1 MSTBI. CONCLUSIONS Helmet use remains problematically low among young ATV and dirt bike riders, especially passengers. Expanding helmet use among these children could significantly reduce the rates of intracranial injury and MSTBI, as well as the subsequent need for neurosurgical procedures. Promoting helmet use among recreational ATV and dirt bike riders must remain a priority for neurosurgeons, public health officials, and injury prevention professionals.

Serious Head Injury in Infants: Accident or Abuse?

PEDIATRICS ◽  
1985 ◽  
Vol 75 (2) ◽  
pp. 340-342 ◽  
Author(s):  
M. Elaine Billmire ◽  
Patricia A. Myers
Keyword(s):  
Child Abuse ◽  
Head Injury ◽  
Medical Records ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Head Injuries ◽  
Skull Fracture ◽  
Intracranial Injury ◽  
Vehicle Accident ◽  
History Of

The medical records and computed tomography (CT) scans of all children less than 1 year of age admitted to the hospital with head injury over a 2-year period were reviewed. Sixty-four percent of all head injuries, excluding uncomplicated skull fracture, and 95% of serious intracranial injuries were the result of child abuse. The occurrence of intracranial injury in infants, in the absence of a history of significant accidental trauma, such as a motor vehicle accident, constitutes grounds for an official child abuse investigation.

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