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

Background: Globally, surgical site infections (SSIs) not only complicate the surgeries but also lead to $5–10 billion excess health expenditures, along with the increased length of hospital stay. SSI rates have become a universal measure of quality in hospital-based surgical practice because they are probably the most preventable of all healthcare-associated infections. Although, many national regulatory bodies have made it mandatory to report SSI rates, the burden of SSI is still likely to be significant underestimated due to truncated SSI surveillance as well as underestimated postdischarge SSIs. A WHO survey found that in low- to middle-income countries, the incidence of SSIs ranged from 1.2 to 23.6 per 100 surgical procedures. This contrasted with rates between 1.2% and 5.2% in high-income countries. Objectives: We aimed to leverage the existing surveillance capacities at our tertiary-care hospital to estimate the incidence of SSIs in a cohort of trauma patients and to develop and validate an indigenously developed, electronic SSI surveillance system. Methods: A prospective cohort study was conducted at a 248-bed apex trauma center for 18 months. This project was a part of an ongoing multicenter study. The demographic details were recorded, and all the patients who underwent surgery (n = 770) were followed up until 90 days after discharge. The associations of occurrence of SSI and various clinico-microbiological variables were studied. Results: In total, 32 (4.2%) patients developed SSI. S. aureus (28.6%) were the predominant pathogen causing SSI, followed by E. coli (14.3%) and K. pneumoniae (14.3%). Among the patients who had SSI, higher SSI rates were associated in patients who were referred from other facilities (P = .03), had wound class-CC (P < .001), were on HBOT (P = .001), were not administered surgical antibiotics (P = .04), were not given antimicrobial coated sutures (P = .03) or advanced dressings (P = .02), had a resurgery (P < .001), had a higher duration of stay in hospital from admission to discharge (P = .002), as well as from procedure to discharge (P = .002). SSI was cured in only 16 patients (50%) by 90 days. SSI data collection, validation, and analyses are essential in developing countries like India. Thus, it is very crucial to implement a surveillance system and a system for reporting SSI rates to surgeons and conduct a robust postdischarge surveillance using trained and committed personnel to generate, apply, and report accurate SSI data.Funding: NoneDisclosures: None

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A retrospective study of pediatric oral and maxillofacial trauma seen in an urban level I trauma center

European Journal of Oral and Maxillofacial Surgery ◽

10.23736/s2532-3466.17.00115-1 ◽

2017 ◽

Vol 1 (2) ◽

Author(s):

Marisa Dailey ◽

Natasha Bhalla ◽

Malcolm B. Zola ◽

Rawle F. Philbert

Keyword(s):

Retrospective Study ◽

Trauma Center ◽

Maxillofacial Trauma ◽

Urban Level ◽

Level I

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Usefulness of Pelvic Radiographs in the Initial Trauma Evaluation with Concurrent CT: Is Additional Radiation Exposure Necessary?

International Journal of Pediatrics ◽

10.1155/2018/6260954 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Anne K. Misiura ◽

Autumn D. Nanassy ◽

Jacqueline Urbine

Keyword(s):

Trauma Center ◽

Pediatric Trauma ◽

Trauma Patients ◽

Additional Information ◽

Pelvic Radiographs ◽

Pelvic Radiograph ◽

Digital Radiograph ◽

Urban Level ◽

Level I ◽

Pediatric Trauma Center

Trauma patients in a Level I Pediatric Trauma Center may undergo CT of the abdomen and pelvis with concurrent radiograph during initial evaluation in an attempt to diagnose injury. To determine if plain digital radiograph of the pelvis adds additional information in the initial trauma evaluation when CT of the abdomen and pelvis is also performed, trauma patients who presented to an urban Level I Pediatric Trauma Center between 1 January 2010 and 7 February 2017 in whom pelvic radiograph and CT of the abdomen and pelvis were performed within 24 hours of each other were analyzed. A total of 172 trauma patients had pelvic radiograph and CT exams performed within 24 hours of each other. There were 12 cases in which the radiograph missed pelvic fractures seen on CT and 2 cases in which the radiograph suspected a fracture that was not present on subsequent CT. Furthermore, fractures in the pelvis were missed on pelvic radiographs in 12 of 35 cases identified on CT. Sensitivity of pelvic radiograph in detecting fractures seen on CT was 65.7% with a 95% confidence interval of 47.79-80.87%. Results suggest that there is no added diagnostic information gained from a pelvic radiograph when concurrent CT is also obtained, a practice which exposes the pediatric trauma patient to unnecessary radiation.

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Experiences of Older Adult Trauma Patients Discharged Home From a Level I Trauma Center

Journal of Trauma Nursing ◽

10.1097/jtn.0000000000000288 ◽

2017 ◽

Vol 24 (3) ◽

pp. 182-192

Author(s):

Nathalie Rodrigue ◽

Andréa Maria Laizner ◽

Nancy Tze ◽

Maida Sewitch

Keyword(s):

Older Adult ◽

Trauma Center ◽

Trauma Patients ◽

Level I

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Direct transport of geriatric trauma patients with pelvic fractures to a Level I trauma center within an organized trauma system: impact on two-week incidence of in-hospital complications

The American Journal of Surgery ◽

10.1016/j.amjsurg.2012.05.020 ◽

2012 ◽

Vol 204 (6) ◽

pp. 921-926 ◽

Cited By ~ 7

Author(s):

Tabitha Garwe ◽

Zachary V. Roberts ◽

Roxie M. Albrecht ◽

Ashley E. Morgan ◽

Jeremy J. Johnson ◽

...

Keyword(s):

Trauma Center ◽

Trauma System ◽

Pelvic Fractures ◽

Geriatric Trauma ◽

Trauma Patients ◽

Level I ◽

System Impact

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Deceleration thoracic aortic ruptures in trauma center level I areas: a 6-year retrospective study

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-018-01063-4 ◽

2019 ◽

Vol 45 (6) ◽

pp. 943-949 ◽

Cited By ~ 1

Author(s):

Jan Trlica ◽

Štěpánka Kučerová ◽

Eva Kočová ◽

Jaromír Kočí ◽

Petr Habal ◽

...

Keyword(s):

Retrospective Study ◽

Trauma Center ◽

Level I

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08. Missed Diagnosis of Pneumothorax During Aeromedical Transport

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00045829 ◽

1996 ◽

Vol 11 (S2) ◽

pp. S38-S38

Author(s):

SH Thomas ◽

P DeVellis ◽

T Harrison ◽

SK Wedel

Keyword(s):

Trauma Center ◽

Air Transport ◽

Trauma Patients ◽

X Ray ◽

Chest X Ray ◽

Missed Diagnosis ◽

Level I ◽

Aeromedical Transport ◽

One Year ◽

Needle Decompression

Purpose: Difficulties with physical assessment inherent to the helicopter environment have led to suggestion that aeromedical crews may be unable to identify hemo- or pneumothorax (HTX/PTX) while in-flight. This study was conducted to determine the frequency of missed HTX/PTX in trauma patients undergoing air transport.Methods: One year (1994) of an air medical service's trauma transports to a Level I trauma center were analyzed to identify patients undergoing tube thoracostomy (TT) within 2 hours of trauma center arrival. Patients who had received intra-transport needle thoracostomy were excluded. Records were reviewed to determine how HTX/PTX was diagnosed at the trauma center.Results: Only 11 patients who had not received aeromedical needle decompression underwent TT at the receiving center. Two of the 11 were trauma arrests and received TT as part of thoracotomy, without air or blood return on TT. None of the remaining 9 patients had TT on clinical suspicion alone. Four had normal physical examination and underwent TT after chest X-ray (CXR). Remaining patients had no HTX/PTX clues on exam or CXR; one had a small HTX identified on chest computed tomography and the other four received intra-operative TT because of rib fractures in the setting of multisystem trauma.

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The Impact of In-house Attending Surgeon Supervision on the Rates of Preventable and Potentially Preventable Complications and Death at the Start of the New Academic Year

The American Surgeon ◽

10.1177/000313481307901113 ◽

2013 ◽

Vol 79 (11) ◽

pp. 1134-1139 ◽

Cited By ~ 4

Author(s):

Kenji Inaba ◽

Adam Hauch ◽

Bernardino C. Branco ◽

Stephen Cohn ◽

Pedro G. R. Teixeira ◽

...

Keyword(s):

Los Angeles ◽

Trauma Center ◽

Medical Center ◽

Trauma Patients ◽

University Of Southern California ◽

Academic Level ◽

Significant Difference ◽

Level I ◽

The Impact ◽

Academic Year

The purpose of this study was to examine the impact of in-house attending surgeon supervision on the rate of preventable deaths (PD) and complications (PC) at the beginning of the academic year. All trauma patients admitted to the Los Angeles County 1 University of Southern California Medical Center over an 8-year period ending in December 2009 were reviewed. Morbidity and mortality reports were used to extract all PD/PC. Patients admitted in the first 2 months (July/ August) of the academic year were compared with those admitted at the end of the year (May/June) for two distinct time periods: 2002 to 2006 (before in-house attending surgeon supervision) and 2007 to 2009 (after 24-hour/day in-house attending surgeon supervision). During 2002 to 2006, patients admitted at the beginning of the year had significantly higher rates of PC (1.1% for July/ August vs 0.6% for May/June; adjusted odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1 to 3.2; P < 0.001). There was no significant difference in mortality (6.5% for July/August vs 4.6% for May/ June; adjusted OR, 1.1; 95% CI,0.8 to 1.5; P = 0.179). During 2007 to 2009, after institution of 24-hour/day in-house attending surgeon supervision of fellows and housestaff, there was no significant difference in the rates of PC (0.7% for July/August vs 0.6% for May/June; OR, 1.1; 95% CI, 0.8 to 1.3; P = 0.870) or PD (4.6% for July/August vs 3.7% for May/June; OR, 1.3; 95% CI, 0.9 to 1.7; P = 0.250) seen at the beginning of the academic year. At an academic Level I trauma center, the institution of 24-hour/day in-house attending surgeon supervision significantly reduced the spike of preventable complications previously seen at the beginning of the academic year.

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