Tubular vs Profile Plate in Peroneal or Bimalleolar Fractures: is There a Real Difference in Skin Complication? A Retrospective Study in Three Level I Trauma Center

Abstract Introduction Current classifications of complete knee dislocations do not capture the extent of the complex concomitant ligamentous and bony injuries, which may have an impact on future outcomes. The purpose of this retrospective study was to evaluate the epidemiology of complete knee dislocations as well as to present an updated classification system based on the author’s experience at a Level-I trauma center. Materials and methods Only patients with complete loss of contact of the articulating bones and ≥ 18 years of age who admitted in our level-I trauma center between 2002 and 2019 were included. Patients were identified using a retrospective systematical query in the Hospital Information System (HIS) using the International Statistical Classification of Diseases and Related Health Problems Version10 (ICD-10) codes of the German Diagnosis Related Groups (G-DRG). Results Final data included 80 patients, with the majority of patients being male (n = 64; 80.0%). Mean age was 34.9 years (range: 18–70 years). External protective fixation was applied in 32 patients (40.0%). Reconstruction of the posterior cruciate ligament and the anterior cruciate ligament were performed in 56.3% (n = 45) and 55.0% (n = 44) of cases, respectively. The lateral collateral ligament complex was surgically addressed in 47.5% (n = 38), while the medial collateral ligament complex was reconstructed in 40% (n = 32). Surgery of the lateral meniscus and the medial meniscus was needed in 31.1% (n = 25) and 30.0% (n = 24). Neurovascular surgery occurred in 13.8% (n = 11). From the characteristic injury-patterns the authors of this study present a new classification system that ranks the injuries from Grade-A to Grade-D according to their severity. Conclusion This retrospective study demonstrates that the historically used classification systems for dislocations of the knee are insufficient for these severe injuries. Concomitant ligamentous, neurovascular, bony, and meniscal injuries were frequent, and required several staged procedures. Consequently, an updated classification system is proposed.

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Changes and significance of serum troponin in trauma patients: A retrospective study in a level I trauma center

World Journal of Emergency Medicine ◽

10.5847/wjem.j.1920-8642.2022.016 ◽

2022 ◽

Vol 13 (0) ◽

Author(s):

Li-wen Dou

Keyword(s):

Retrospective Study ◽

Trauma Center ◽

Trauma Patients ◽

Level I

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Trauma System Overtriage: Are We on Track?

The American Surgeon ◽

10.1177/000313481408001011 ◽

2014 ◽

Vol 80 (10) ◽

pp. 960-965 ◽

Cited By ~ 1

Author(s):

Zoe Fullerton ◽

Graham W. Donald ◽

Henry G. Cryer ◽

Catherine E. Lewis ◽

Ali Cheaito ◽

...

Keyword(s):

Emergency Department ◽

Retrospective Study ◽

Trauma Center ◽

Injury Severity ◽

Trauma System ◽

Length Of Hospital Stay ◽

Optimal Care ◽

American College Of Surgeons ◽

Level I ◽

Trauma Activation

The American College of Surgeons (ACS) recommends trauma overtriage rate (OT) below 50 per cent to maximize efficiency while ensuring optimal care. This retrospective study was undertaken to evaluate OT rates in our Level I trauma center using the most recent criteria and guidelines. OT rates during a 12-month period were measured using six definitions based on combinations of Injury Severity Score (ISS), length of hospital stay (LOS, in days), procedures, and disposition after the emergency department. Reason for trauma activation was 55 per cent criteria, 16 per cent guidelines, 11 per cent paramedic judgment, five per cent no reason, and 13 per cent no documentation. OT rates ranged from 22.6 per cent (ISS less than 9, LOS 1 day or less, no consults) to 48.2 per cent (ISS less than 9, LOS 3 days or less, with procedures/consults) and were in compliance with ACS recommendations. Physiologic assessment criteria and anatomic injury had the lowest OT rates and contained all mortalities. Passenger space intrusion (PSI), pedestrian versus automobile (criterion and guideline), and extrication (guideline) all had consistently high rates of OT. We conclude that PSI should be reduced to a guideline, the pedestrian versus automobile criterion and guideline should be combined, and extrication could be removed from the triage scheme.

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Faculty Opinions recommendation of Improvements in early mortality and coagulopathy are sustained better in patients with blunt trauma after institution of a massive transfusion protocol in a civilian level I trauma center.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1287960.755060 ◽

2009 ◽

Author(s):

Jonathan Waters ◽

Jay S Raval

Keyword(s):

Blunt Trauma ◽

Trauma Center ◽

Massive Transfusion ◽

Early Mortality ◽

Massive Transfusion Protocol ◽

Level I ◽

Transfusion Protocol

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Prehospital time and mortality in polytrauma patients: a retrospective analysis

BMC Emergency Medicine ◽

10.1186/s12873-021-00476-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

E. Berkeveld ◽

Z. Popal ◽

P. Schober ◽

W. P. Zuidema ◽

F. W. Bloemers ◽

...

Keyword(s):

Patient Outcome ◽

Emergency Medical Services ◽

Trauma Center ◽

Total Mortality ◽

Medical Services ◽

Severely Injured ◽

Emergency Medical ◽

Polytrauma Patients ◽

Level I ◽

Prehospital Time

Abstract Background The time from injury to treatment is considered as one of the major determinants for patient outcome after trauma. Previous studies already attempted to investigate the correlation between prehospital time and trauma patient outcome. However, the outcome for severely injured patients is not clear yet, as little data is available from prehospital systems with both Emergency Medical Services (EMS) and physician staffed Helicopter Emergency Medical Services (HEMS). Therefore, the aim was to investigate the association between prehospital time and mortality in polytrauma patients in a Dutch level I trauma center. Methods A retrospective study was performed using data derived from the Dutch trauma registry of the National Network for Acute Care from Amsterdam UMC location VUmc over a 2-year period. Severely injured polytrauma patients (Injury Severity Score (ISS) ≥ 16), who were treated on-scene by EMS or both EMS and HEMS and transported to our level I trauma center, were included. Patient characteristics, prehospital time, comorbidity, mechanism of injury, type of injury, HEMS assistance, prehospital Glasgow Coma Score and ISS were analyzed using logistic regression analysis. The outcome measure was in-hospital mortality. Results In total, 342 polytrauma patients were included in the analysis. The total mortality rate was 25.7% (n = 88). Similar mean prehospital times were found between the surviving and non-surviving patient groups, 45.3 min (SD 14.4) and 44.9 min (SD 13.2) respectively (p = 0.819). The confounder-adjusted analysis revealed no significant association between prehospital time and mortality (p = 0.156). Conclusion This analysis found no association between prehospital time and mortality in polytrauma patients. Future research is recommended to explore factors of influence on prehospital time and mortality.

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Facial Fractures Have Similar Outcomes When Managed by Either Otolaryngology or Plastic Surgery: Encounters From a Single Level I Trauma Center

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/19433875211020615 ◽

2021 ◽

pp. 194338752110206

Author(s):

Ashton Christian ◽

Beatrice J. Sun ◽

Nima Khoshab ◽

Areg Grigorian ◽

Christina Y. Cantwell ◽

...

Keyword(s):

Plastic Surgery ◽

Trauma Center ◽

Demographic Data ◽

Open Reduction Internal Fixation ◽

Facial Fractures ◽

Chi Square ◽

Single Level ◽

Baseline Characteristics ◽

Level I ◽

Complications And Mortality

Study Design: Retrospective cohort. Objective: Traumatic facial fractures (FFs) often require specialty consultation with Plastic Surgery (PS) or Otolaryngology (ENT); however, referral patterns are often non-standardized and institution specific. Therefore, we sought to compare management patterns and outcomes between PS and ENT, hypothesizing no difference in operative rates, complications, or mortality. Methods: We performed a retrospective analysis of patients with FFs at a single Level I trauma center from 2014 to 2017. Patients were compared by consulting service: PS vs. ENT. Chi-square and Mann-Whitney-U tests were performed. Results: Of the 755 patients with FFs, 378 were consulted by PS and 377 by ENT. There was no difference in demographic data ( P > 0.05). Patients managed by ENT received a longer mean course of antibiotics (9.4 vs 7.0 days, P = 0.008) and had a lower rate of open reduction internal fixation (ORIF) (9.8% vs. 15.3%, P = 0.017), compared to PS patients. No difference was observed in overall operative rate (15.1% vs. 19.8%), use of computed tomography (CT) imaging (99% vs. 99%), time to surgery (65 vs. 55 hours, P = 0.198), length of stay (LOS) (4 vs. 4 days), 30-day complication rate (10.6% vs. 7.1%), or mortality (4.5% vs. 2.6%) (all P > 0.05). Conclusion: Our study demonstrated similar baseline characteristics, operative rates, complications, and mortality between FFs patients who had consultation by ENT and PS. This supports the practice of allowing both ENT and PS to care for trauma FFs patients, as there appears to be similar standardized care and outcomes. Future studies are needed to evaluate the generalizability of our findings.

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