The impact of the “Weekend Effect” on emergency exploratory laparotomy surgeries outcomes at an urban level 1 trauma center

Abstract INTRODUCTION Severe traumatic brain injury (TBI) remains a leading cause of morbidity and mortality. There is a wide variability in treatment paradigm for patients with severe TBI. American College of Surgeons (ACS) level 1 trauma centers have access to 24 h neurosurgical coverage. In this study, we use the National Trauma Database (NTDB) to evaluate if ACS trauma center designation correlates with the management and outcomes of severe TBI in adults. METHODS Adult patients (<65 yr) with a severe isolated nonpenetrating TBI were identified in the NTDB from years 2007 to 2014. ICD-9 procedure codes were used to identify primary treatment approaches: intracranial pressure monitoring and cranial surgery. Multivariate logistic regression was used to determine the impact of ACS designation on procedures and patient outcomes. Patient and injury characteristics were included in the analysis. RESULTS A total of 54 769 TBI patients were identified. Among those, 22 316 (42%) were treated at an ACS level 1 trauma center and 31 835 (58%) were treated elsewhere. Level 1 designated patients had significantly more intracranial pressure (ICP) monitors placed (12.3% vs10.8%; P < .0001) and more cranial surgeries performed (17.7% vs 15.7%; P < .0001). A greater percentage of patients were admitted to the intensive care unit (ICU; 89.9% vs 83.9%; P < .0001) and had a longer hospital stay (16.1 vs 15.2; P < .0001) at ACS level 1 trauma centers. In a regression analysis, patients at level 1 centers were associated with a 14% and 17% increased odds of obtaining a cranial surgery or ICP monitor, respectively. Patients treated at a level 1 center were associated with a 6% decrease in odds of mortality (P = .01). CONCLUSION ACS level 1 designation did correlate with increased rates of neurosurgical intervention and ICU admissions. This translated into patient outcomes as those treated at level 1 facilities were associated with lower rates of mortality.

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PC172. Comparative Trends in the Management of Peripheral Vascular Injuries at an Urban Level 1 Trauma Center: Trauma Versus Vascular Surgery

Journal of Vascular Surgery ◽

10.1016/j.jvs.2015.04.312 ◽

2015 ◽

Vol 61 (6) ◽

pp. 164S

Author(s):

Jatin Anand ◽

Anand V. Ganapathy ◽

Ahmed F. Khouqeer ◽

Eric K. Rachlin ◽

Peter I. Tsai ◽

...

Keyword(s):

Vascular Surgery ◽

Trauma Center ◽

Vascular Injuries ◽

Peripheral Vascular ◽

Urban Level ◽

Level 1 ◽

Level 1 Trauma Center

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(P2-74) Does Implementation of Protocols Improve the Red Area Disposition Time of Emergency Department at a Level-1 Trauma Center?

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11005188 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s160-s160

Author(s):

R. Kumar ◽

K. Shyamla ◽

S. Bhoi ◽

T.P. Sinha ◽

S. Chauhan ◽

...

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Trauma Center ◽

Safety Issues ◽

Ed Visits ◽

Level 1 ◽

The Impact ◽

Level 1 Trauma Center ◽

Final Disposition ◽

Disposition Time

BackgroundAcute care addresses immediate resuscitation and early disposition to definitive care. Delay in final disposition from the emergency department (ED) affects outcomes in terms of morbidity and mortality. An audit was performed to assess the impact of protocols on red area disposition time.MethodsAn audit of red (resuscitation) area disposition time was performed among patients with compromised airway, breathing, and circulation. The red area disposition time was defined as the time from ED arrival to red area disposition. Pre-protocol data from nursing report books were reviewed for ED to operating room (OR), ED to intensive care unit (ICU), and overall disposition time between September 2007 and January 2008. Similar outcomes were documented after implementation of protocols during February to December 2008.ResultsIn the pre-protocol period, 992 red area patients were enrolled out of 10,000 ED visits. Out of which 527 (53.1%) were shifted to the OR and 222 (22.3%) to ICU. The average ED disposition time was 3.5 hours (range 2–5). Similarly, 1797 red area patients were enrolled in the post-protocol period out of 25,928. Of these, 453 (25.2%) patients were shifted to the OR, and 423 (23.7%) were shifted to the ICU. The average ED disposition time was 1.5 hours (range 10 minutes–3 hours).ConclusionsImplementation of protocols improves the red area disposition time of the ED. Auditing is an important tool to address patient safety issues.

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Trends in Case-Mix-Adjusted Use of Radiology Resources at an Urban Level 1 Trauma Center

American Journal of Roentgenology ◽

10.2214/ajr.176.4.1760851 ◽

2001 ◽

Vol 176 (4) ◽

pp. 851-854 ◽

Cited By ~ 15

Author(s):

M. Bradford Henley ◽

Frederick A. Mann ◽

Sarah Holt ◽

Joseph Marotta

Keyword(s):

Trauma Center ◽

Case Mix ◽

Urban Level ◽

Level 1 ◽

Level 1 Trauma Center

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Temporal Variation in Ankle Fractures and Orthopedic Resident Program Planning in an Urban Level 1 Trauma Center

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2017.01.056 ◽

2017 ◽

Vol 56 (4) ◽

pp. 724-729 ◽

Cited By ~ 2

Author(s):

Aaron Wynkoop ◽

Osy Ndubaku ◽

Norman Walter ◽

Theresa Atkinson

Keyword(s):

Temporal Variation ◽

Trauma Center ◽

Program Planning ◽

Ankle Fractures ◽

Urban Level ◽

Level 1 ◽

Level 1 Trauma Center

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Reforming our general surgery residency program at an urban level 1 Trauma Center during the COVID-19 pandemic: Towards maintaining resident safety and wellbeing

The American Journal of Surgery ◽

10.1016/j.amjsurg.2020.06.001 ◽

2020 ◽

Vol 220 (4) ◽

pp. 847-849 ◽

Cited By ~ 6

Author(s):

Evander Meneses ◽

Mark McKenney ◽

Adel Elkbuli

Keyword(s):

General Surgery ◽

Residency Program ◽

Trauma Center ◽

General Surgery Residency ◽

Urban Level ◽

Level 1 ◽

Surgery Residency Program ◽

Level 1 Trauma Center

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How Did the COVID-19 Pandemic Affect Trauma Volume at an Urban Level I Trauma Center?

The American Surgeon ◽

10.1177/00031348211054075 ◽

2022 ◽

pp. 000313482110540

Author(s):

Alexandra Hahn ◽

Tommy Brown ◽

Brett Chapman ◽

Alan Marr ◽

Lance Stuke ◽

...

Keyword(s):

Health Care ◽

Trauma Center ◽

Penetrating Trauma ◽

Retrospective Chart Review ◽

Trauma Patients ◽

Minor Trauma ◽

Significant Difference ◽

Urban Level ◽

Level 1 ◽

Level 1 Trauma Center

Introduction The COVID-19 pandemic changed the face of health care worldwide. While the impacts from this catastrophe are still being measured, it is important to understand how this pandemic impacted existing health care systems. As such, the objective of this study was to quantify its effects on trauma volume at an urban Level 1 trauma center in one of the earliest and most significantly affected US cities. Methods A retrospective chart review of consecutive trauma patients admitted to a Level 1 trauma center from January 1, 2017 to December 31, 2020 was completed. The total trauma volume in the years prior to the pandemic (2017-2019) was compared to the volume in 2020. These data were then further stratified to compare quarterly volume across all 4 years. Results A total of 4138 trauma patients were treated in the emergency room throughout 2020 with 4124 seen during 2019, 3774 during 2018, and 3505 during 2017 in the pre-COVID-19 time period. No significant difference in the volume of minor trauma or trauma transfers was observed ( P < .05). However, there was a significant increase in the number of major traumas in 2020 as compared to prior years (38.5% vs 35.6%, P < .01) and in the volume of penetrating trauma (29.1% vs 24.0%, P < .01). Discussion During the COVID-19 outbreak, trauma remained a significant health care concern. This study found an increase in volume of penetrating trauma, specifically gunshot wounds throughout 2020. It remains important to continue to devote resources to trauma patients during the ongoing COVID-19 pandemic.

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