scholarly journals Initial Trauma Database in a University Hospital in Malaysia

2019 ◽  
pp. 19
Author(s):  
Affirul Chairil Ariffin ◽  
Mohamed Hajhamad ◽  
Firdaus Hayati ◽  
Nornazirah Azizan ◽  
Zamri Zuhdi ◽  
...  
Keyword(s):  
Injury Severity ◽  
Motor Vehicle ◽  
Hospital Length ◽  
University Hospital ◽  
Hospital Length Of Stay ◽  
Permanent Disability ◽  
Major Health Problem ◽  
Average Hospital ◽  
Trauma Centres ◽  
Trauma Service

Trauma is a major health problem in Malaysia. An understanding of the trauma epidemiology is important in developing a reliable trauma service. The aim of this study is to understand the pattern of trauma in our institution and to highlight the need for a dedicated trauma service. In this database, 142 cases were included. Majority were males (127, 89.4%). Most common injury types are motor vehicle accidents (87.3%) followed by falls (7.7%), and stabs (3.5%). Most Injury Severity Score (ISS) falls under moderate score with 38.7%. Mean Abbreviated Injury Score (AIS) was 3 with most involving the chest and 90% of the patients have injuries involving at least 2 regions. Average hospital length of stay (LOS) was 11.4 days ±11.5 SD; with most patients (71.8%) were discharged without permanent disability. The mortality rate was 9.2% with all having ISS>16. ISS found to be strongly related to longer hospital stay and worse outcome (0.59, p < 0.0001, 0.4, p < 0.0001). This data is equivalent to the compared registries from 4 different trauma centres. However, steps need to be taken to improve this database. In conclusion, this university hospital receives a reasonable load of trauma cases yearly which is equivalent with other trauma centres. The increasing trauma cases will benefit from an implementation of a dedicated trauma service. This trauma database needs more depth in its elements and better data handling to ensure a quality and complete registry.

scholarly journals Pediatric Farm Injuries

2019 ◽  
Vol 10 (4) ◽  
pp. 92-95
Author(s):  
Clint Rathje ◽  
Ashley Venegas ◽  
Stephen D. Helmer ◽  
Rachel M. Drake ◽  
Jeanette G. Ward ◽  
...  
Keyword(s):  
Fall Prevention ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Soft Tissue Injuries ◽  
Hospital Length ◽  
Safety Training ◽  
Hospital Length Of Stay ◽  
Permanent Disability ◽  
Farm Injuries ◽  
Animal Handling

Introduction. Agriculture is an industry where family members oftenlive and work on the same premises. This study evaluated injury patternsand outcomes in children from farm-related accidents. Methods. A 10-year retrospective review of farm-accident relatedinjuries was conducted of patients 17 years and younger. Data collectedincluded demographics, injury mechanism, accident details, injuryseverity and patterns, treatments required, hospitalization details, anddischarge disposition. Results. Sixty-five patients were included; 58.5% were male and themean age was 9.7 years. Median Injury Severity Score and GlasgowComa Scale were 5 and 15, respectively. Accident mechanisms includedanimal-related (43.1%), fall (21.5%), and motor vehicle (21.5%).Soft tissue injuries, concussions and upper extremity fractures werethe most common injuries observed (58.5%, 29.2%, and 26.2%,respectively). Twenty-six patients (40%) required surgical intervention.Mean hospital length of stay was 3.4 ± 4.7 days. The majority ofpatients were discharged to home (n = 62, 95.4%) and two patientssuffered permanent disability. Conclusion. Overall, outcomes for this population were favorable,but additional measures to increase safety, such as fall prevention,animal handling, and driver safety training should be advocated.KS J Med 2017;10(4):92-95.

Trauma Attending Physician Continuity: Does it Make a Difference?

2010 ◽  
Vol 76 (1) ◽  
pp. 48-54
Author(s):  
David G. Jacobs ◽  
Jennifer L. Sarafin ◽  
Karen E. Head ◽  
A Britt Christmas ◽  
Toan Huynh ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Standard Of Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Trauma Service ◽  
Retrospective Comparison ◽  
Scale Scores ◽  
Attending Physician

Continuity of care is important in achieving optimal outcomes in trauma patients, but the optimal length of the trauma attending (TA) rotation is unknown. We hypothesize that longer TA rotations provide greater continuity, and therefore improve outcomes. We did a retrospective comparison of trauma patient outcomes from two consecutive 6-month periods during which we transitioned from a 1-month TA rotation to a 1-week TA rotation. The Wilcoxon rank sum test, and the χ2 were used for statistical analysis. Over the 12-month study period 1924 patients were admitted to the Trauma Service. The two groups were similar with regard to age, gender, injury mechanism, Injury Severity Score and Glasgow Coma Scale scores, and Abbreviated Injury Scores for the chest, abdomen, and extremities. Although mortality, patient charges, and violations of the standard of care were similar between the two groups, overall morbidity was lower (18.6% vs 23.2%), and hospital length of stay higher (9.07 days vs 8.41 days) in the 1-week TA group compared with the 1-month TA group. A one-week TA rotation was associated with a longer hospital length of stay, but improved morbidity. Longer TA rotations do not necessarily provide improved continuity or improved outcomes.

In the Wake of Hurricane Isabel: A Prospective Study of Postevent Trauma and Injury Control Strategies

2005 ◽  
Vol 71 (3) ◽  
pp. 194-197 ◽  
Author(s):  
E.B. Gagnon ◽  
M.B. Aboutanos ◽  
A.K. Malhotra ◽  
D. Dompkowski ◽  
T.M. Duane ◽  
...  
Keyword(s):  
Injury Severity ◽  
Control Strategies ◽  
Recovery Phase ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Average Hospital ◽  
Urban City ◽  
Upper And Lower Extremities ◽  
Hurricane Isabel ◽  
A Prospective Study

Preventing hurricane-related injuries (HRI) has historically centered on the pre-event and event phases of the disaster. To date, no study has focused on injuries occurring during the postevent phase. We examined HRI that occurred after Hurricane Isabel struck a U.S. urban city. HRI presenting 1 week prior to the hurricane were collected from emergency department electronic records. HRI that presented to our level 1 trauma center were prospectively collected for 1 week after the hurricane. Nine hundred seventy-eight patients with possible HRI were identified. Fifty-one patients with trauma directly attributed to the hurricane were used for analysis. The number of HRI occurring before, during, and after the hurricane were 7 (14%), 3 (6%), and 41 (80%), respectively. The majority of HRI (37%) occurred on posthurricane day 1. Head, chest, upper and lower extremities accounted for 9 (18%), 8 (16%), 13 (26%), and 14 (28%) of HRI. More than one third of HRI patients were admitted to the hospital, and 12 (24%) underwent an operation. The average hospital length of stay was 4.7 days. Of our trauma alerts, 75 per cent had an Injury Severity Score (ISS) >8, and 20 per cent had an ISS >15. Tree-related injuries (TRI) accounted for 59 per cent of HRI. Males, ages 50–60, had the highest incidence of injury (63%). Significant injuries occur in the wake of a hurricane. Optimization of disaster preparation must include prevention strategies targeted to the postevent recovery phase of disasters.

scholarly journals Hearing hoofbeats? Think head and neck trauma: a 10-year NTDB analysis of equestrian-related trauma in the USA

2021 ◽  
Vol 6 (1) ◽  
pp. e000728
Author(s):  
Kevin Mutore ◽  
Jiyun Lim ◽  
Demba Fofana ◽  
Annelyn Torres-Reveron ◽  
Jeffrey J Skubic
Keyword(s):  
Retrospective Study ◽  
Head And Neck ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Data Bank ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Level Of Evidence ◽  
Discharge Disposition ◽  
The Usa

ObjectiveThere is a paucity of evidence about traumatic injuries and their sequelae sustained due to equestrian injuries nationally.MethodsRetrospective study analyzing National Trauma Data Bank data from 2007 to 2016. Variables collected included age, sex, race, payer status, Injury Severity Score (ISS), hospital length of stay, Glasgow Coma Scale, systolic blood pressure (SBP) at presentation, discharge disposition, and mortality. Patient data were analyzed by anatomic region.ResultsThe most frequent type of injury was in the thorax, but head and neck injuries produced the highest mortality. Increased ISS and an SBP of less than 90 mm Hg were also significant predictors of mortality.ConclusionsThe risk of hospital admission from equestrian injuries is higher than football, motor vehicle racing, and skiing. Preventive measures and campaigns should be instituted to highlight safety practices and the use of personal protective equipment while on horseback either for sports, leisure, or work.Level of evidenceLevel IV. Retrospective study.

Advancing the Use of Laparoscopy in Trauma: Repair of Intraperitoneal Bladder Injuries

2019 ◽  
Vol 85 (12) ◽  
pp. 1402-1404 ◽  
Author(s):  
Michael R. Arnold ◽  
Caroline D. Lu ◽  
Bradley W. Thomas ◽  
Gaurav Sachdev ◽  
Kyle W. Cunningham ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Bladder Rupture ◽  
Trauma Patients ◽  
Average Hospital ◽  
Early Return ◽  
Significant Difference ◽  
Intraperitoneal Bladder Rupture

Traumatic intraperitoneal bladder rupture (IBR) requires surgical repair. Traditionally performed via laparotomy, experience with laparoscopic bladder repair (LBR) after blunt trauma is limited. Benefits of laparoscopy include decreased length of stay (LOS), less pain, early return to work, fewer adhesions, and lower risk of incisional hernia. The aim of this series is to demonstrate the potential superiority of LBR in select trauma patients. This is a retrospective review performed of all IBR patients from 2008 to 2016. Demographics, clinical management, outcomes, and follow-up were compared between LBR and open bladder repair (OBR) patients. Twenty patients underwent OBR, and seven underwent LBR. There was no significant difference in gender, age, or Injury Severity Score. There were no deaths or reoperations in either group. Average hospital length of stay and ICU days were similar between groups. There was one patient with UTI and one with readmission in each group. There were two incisional hernias and two bowel obstructions in the OBR group, with one patient requiring operative intervention. No such complications occurred in the LBR group. LBR for traumatic IBR can be safely performed in select patients, even in those with multiple extra-abdominal injuries.

Late Operative Rib Fixation is Inferior to Nonoperative Management

2020 ◽  
Vol 86 (8) ◽  
pp. 944-949
Author(s):  
Kevin N. Harrell ◽  
Robert J. Jean ◽  
S. Dave Bhattacharya ◽  
Darren J. Hunt ◽  
Donald E. Barker ◽  
...  
Keyword(s):  
Injury Severity ◽  
Hospital Length ◽  
Outcome Data ◽  
Rib Fractures ◽  
Hospital Length Of Stay ◽  
Average Hospital ◽  
Rib Fixation ◽  
Level I ◽  
Short Time ◽  
Early Fixation

Background Operative rib fixation (ORF) of traumatic rib fractures has been shown to decrease hospital length of stay (LOS), ventilator days, and mortality. ORF performed within 1 day of admission has been shown to have favorable outcomes compared to later ORF. This report examines the ORF experience over 10 years at a level I trauma center. Methods ORF patients from January 2007-January 2018 were matched to nonoperative controls in a 1:2 ratio based on age, injury severity score (ISS), chest Abbreviated Injury Score (AIS), and head AIS. Patient demographic, injury, and outcome data were collected from the trauma registry and medical records. Hospital day of ORF was identified for each ORF patient. Hospital LOS, ICU LOS, ventilator days, and mortality were compared against matched nonoperative controls. Results Ninety-five ORF patients were matched to 190 nonoperative patients. ORF patients had a higher number of rib fractures (9.6 vs 6.4, P < .001). ORF patients with short time to operation (0-2 days) had a shorter average hospital stay than those with delayed operations (11.8 vs 12.6 vs 13.4 vs 19.6 days, P = .003). ORF patients with operations performed 3-4 days and >6 days after admission also had statistically significant longer ICU LOS and ventilator days. Patient mortality was higher when ORF was performed after 6 days. Discussion Early ORF may improve pulmonary function, patient outcomes, and decrease LOS. Shifting practice toward early fixation may help further solidify the benefits of this procedure in the treatment of blunt chest trauma.

scholarly journals Impacts of injury severity on long-term outcomes following motor vehicle crashes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kevin K. C. Hung ◽  
◽  
Annette Kifley ◽  
Katherine Brown ◽  
Jagnoor Jagnoor ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Health Outcomes ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Severe Injury ◽  
Post Injury ◽  
Severe Injuries

Abstract Background There is growing evidence that a range of pre-injury, injury related and post-injury factors influence social and health outcomes across the injury severity spectrum. This paper documents health related outcomes for people with mild, moderate and severe injury after motor vehicle crash (MVC) injuries in New South Wales, Australia. Methods This inception cohort study followed 2019 people injured in MVCs, for 6 and 12 months post-injury. We categorised moderate injury as hospital length-of-stay (LOS) of 2–6 days and Injury Severity Score (ISS) of 4–11, while severe injury as LOS ≥7 days or ISS ≥ 12. We examined differences in paid work status, 12-Item Short Form Survey (SF12), EQ-5D and World Health Organisation Disability Assessment Schedule II (WHODAS) outcomes longitudinally from baseline to 12 months between levels of injury severity using linear mixed models for repeated measures. We first considered minimally sufficient adjustment factors (age, sex, crash role, perceived danger in crash, pre-injury health, pre-injury EQ-5D, recruitment source), and then more extensive adjustments including post-injury factors. The presence of mediating pathways for SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) via post-injury factors was evaluated. Results Based on hospital length of stay (LOS), 25 and 10% of participants sustained moderate and severe injuries, respectively, while 43 and 4% had these injuries based on ISS. Twelve months post-injury LOS ≥7 days versus ≤1 day was associated with an estimated 9 units lower mean SF12 PCS using a minimally sufficient adjustment model, and LOS ≥ 7 days was associated with a 3 units lower mean SF12 MCS score. Mediation analyses (LOS ≥ 7 days vs ≤1 day) found for SF12 MCS outcomes, effects of injury severity were small and mostly indirect (direct effect − 0.03, indirect effect − 0.22). Whereas for SF12 PCS outcomes the effect of having a more severe injury rather than mild were both direct and indirect (direct effect − 0.50, indirect effect − 0.38). Conclusions Individuals with severe injuries (those with LOS ≥ 7 days and ISS 12+) had poorer recovery 12 months after the injury. In addition, post-injury mediators have an important role in influencing long-term health outcomes. Trial registration Australia New Zealand Clinical trial registry identification number - ACTRN12613000889752.

Checklist-styled Daily Sign-out Rounds Improve Hospital Throughput in a Major Trauma Center

2014 ◽  
Vol 80 (5) ◽  
pp. 434-440 ◽  
Author(s):  
John C. Lee ◽  
Michael Horst ◽  
Amelia Rogers ◽  
Frederick B. Rogers ◽  
Daniel Wu ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Major Trauma ◽  
Injury Severity ◽  
Clinical Care ◽  
Hospital Length ◽  
Organ System ◽  
Hospital Length Of Stay ◽  
Admission Diagnosis ◽  
Trauma Service

The checklist concept has received much attention as a result of its ability to improve patient care by minimizing complications. We hypothesized daily sign-out rounds using a checklist, by improving team communication and consistency of clinical care, could lead to expedited throughput for patients at a major trauma center. A retrospective study examined patients admitted to a mature trauma center. Two time periods, PRE (September 2008 to January 2009) and POST (September 2009 to January 2010), were selected to match for seasonal variation in admission diagnosis. An organ system-based checklist was used during daily sign-out for all admitted trauma patients in the POST period. We examined discharge status, complications and rates, and intensive care unit (ICU) and overall hospital length of stay for differences. There were similar numbers of patients (824 PRE vs 798 POST) admitted in these two cohorts. We found no statistical differences in the incidence of complications or mortality rate. We did discover statistically significant differences in the median ICU days (2 PRE vs 1 POST, P = 0.007) as well as median hospital length of stay (2 days, interquartile differences Q1 to Q3 PRE [1 to 5] and POST [1 to 4] P = 0.000). These trends remained valid even among the severely injured (Injury Severity Score 16 or greater) with a hospital length of stay of 5 (PRE) versus 3 days (POST; P = 0.021). A simple, organ system-based checklist can be successfully adopted for daily sign-out round on a busy, multiprovider trauma service. We were able to expedite trauma patient throughput in both ICU and overall hospital stays with a trend toward decreasing mortality. This improved throughput may potentially translate into a cost saving for the hospital.

scholarly journals Trauma resource pit stop: increasing efficiency in the evaluation of lower severity trauma patients

2021 ◽  
Vol 6 (1) ◽  
pp. e000670
Author(s):  
Imad S Dandan ◽  
Gail T Tominaga ◽  
Frank Z Zhao ◽  
Kathryn B Schaffer ◽  
Fady S Nasrallah ◽  
...  
Keyword(s):  
Injury Severity ◽  
Diagnostic Testing ◽  
Trauma Team ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Evaluation Time ◽  
Retrospective Comparison ◽  
Trauma Bay

BackgroundOvertriage of trauma patients is unavoidable and requires effective use of hospital resources. A ‘pit stop’ (PS) was added to our lowest tier trauma resource (TR) triage protocol where the patient stops in the trauma bay for immediate evaluation by the emergency department (ED) physician and trauma nursing. We hypothesized this would allow for faster diagnostic testing and disposition while decreasing cost.MethodsWe performed a before/after retrospective comparison after PS implementation. Patients not meeting trauma activation (TA) criteria but requiring trauma center evaluation were assigned as a TR for an expedited PS evaluation. A board-certified ED physician and trauma/ED nurse performed an immediate assessment in the trauma bay followed by performance of diagnostic studies. Trauma surgeons were readily available in case of upgrade to TA. We compared patient demographics, Injury Severity Score, time to physician evaluation, time to CT scan, hospital length of stay, and in-hospital mortality. Comparisons were made using 95% CI for variance and SD and unpaired t-tests for two-tailed p values, with statistical difference, p<0.05.ResultsThere were 994 TAs and 474 TRs in the first 9 months after implementation. TR’s preanalysis versus postanalysis of the TR group shows similar mean door to physician evaluation times (6.9 vs. 8.6 minutes, p=0.1084). Mean door to CT time significantly decreased (67.7 vs. 50 minutes, p<0.001). 346 (73%) TR patients were discharged from ED; 2 (0.4%) were upgraded on arrival. When admitted, TR patients were older (61.4 vs. 47.2 years, p<0.0001) and more often involved in a same-level fall (59.5% vs. 20.1%, p<0.0001). Undertriage was calculated using the Cribari matrix at 3.2%.DiscussionPS implementation allowed for faster door to CT time for trauma patients not meeting activation criteria without mobilizing trauma team resources. This approach is safe, feasible, and simultaneously decreases hospital cost while improving allocation of trauma team resources.Level of evidenceLevel II, economic/decision therapeutic/care management study.

30-Day Outcomes for Total Ankle Arthroplasty in Patients With Anemia

2021 ◽  
pp. 107110072110175
Author(s):  
Jordan R. Pollock ◽  
Matt K. Doan ◽  
M. Lane Moore ◽  
Jeffrey D. Hassebrock ◽  
Justin L. Makovicka ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Univariate Analysis ◽  
Hospital Length ◽  
Total Ankle Arthroplasty ◽  
Hospital Length Of Stay ◽  
Preoperative Anemia ◽  
Improvement Project ◽  
Average Hospital ◽  
Ankle Arthroplasty ◽  
Reoperation Rates

Background: While anemia has been associated with poor surgical outcomes in total knee arthroplasty and total hip arthroplasty, the effects of anemia on total ankle arthroplasty remain unknown. This study examines how preoperative anemia affects postoperative outcomes in total ankle arthroplasty. Methods: A retrospective analysis was performed using the American College of Surgeons National Surgery Quality Improvement Project database from 2011 to 2018 for total ankle arthroplasty procedures. Hematocrit (HCT) levels were used to determine preoperative anemia. Results: Of the 1028 patients included in this study, 114 patients were found to be anemic. Univariate analysis demonstrated anemia was significantly associated with an increased average hospital length of stay (2.2 vs 1.8 days, P < .008), increased rate of 30-day readmission (3.5% vs 1.1%, P = .036), increased 30-day reoperation (2.6% vs 0.4%, P = .007), extended length of stay (64% vs 49.9%, P = .004), wound complication (1.75% vs 0.11%, P = .002), and surgical site infection (2.6% vs 0.6%, P = .017). Multivariate logistic regression analysis found anemia to be significantly associated with extended hospital length of stay (odds ratio [OR], 1.62; 95% CI, 1.07-2.45; P = .023) and increased reoperation rates (OR, 5.47; 95% CI, 1.15-26.00; P = .033). Anemia was not found to be a predictor of increased readmission rates (OR, 3.13; 95% CI, 0.93-10.56; P = .066) or postoperative complications (OR, 1.27; 95% CI, 0.35-4.56; P = .71). Conclusion: This study found increasing severity of anemia to be associated with extended hospital length of stay and increased reoperation rates. Providers and patients should be aware of the increased risks of total ankle arthroplasty with preoperative anemia. Level of Evidence: Level III, retrospective comparative study.

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