Early Psychiatric Consultation Is Associated With Decreased Cost and Length of Stay in the Patient Population at a Level I Trauma Center

We assessed the effectiveness of the implementation of an institutional massive transfusion protocol (MTP) for resuscitation with a 1:1:1 transfusion ratio of packed red blood cell (PRBC), fresh frozen plasma, and platelet units. In a Level I trauma center database, all trauma admissions (2004–2012) that received massive transfusions (≥10 units PRBCs in the first 24 hours) were reviewed retrospectively. Demographic data, transfusion ratios, and outcomes were compared before (PRE) and after (POST) MTP implementation in May 2008. Age, sex, and mechanism of injury were similar between 239 PRE and 208 POST trauma patients requiring massive transfusion. Transfusion ratios of fresh frozen plasma:PRBC and platelet:PRBC increased after MTP implementation. Among survivors, MTP implementation shortened hospital length of stay from 31 to 26 days (P = 0.04) and intensive care unit length of stay from 31 to 26 days (P = 0.02). Linear regression identified treatment after (versus before) implementation of MTP as an independent predictor of decreased ventilator days after adjusting for age, Glasgow Coma Scale, and chest Abbreviated Injury Score (P < 0.0001). Modest improvement in ratios likely does not account for all significant improvements in outcomes. Implementing a standardized protocol likely impacts automation, efficiency, and/or timeliness of product delivery.

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Mass Casualty following Unprecedented Tornadic Events in the Southeast: Natural Disaster Outcomes at a Level I Trauma Center

The American Surgeon ◽

10.1177/000313481207800716 ◽

2012 ◽

Vol 78 (7) ◽

pp. 770-773 ◽

Cited By ~ 4

Author(s):

Elizabeth H. Hartmann ◽

Nathan Creel ◽

Jacob Lepard ◽

Robert A. Maxwell

Keyword(s):

Soft Tissue ◽

Length Of Stay ◽

Emergency Preparedness ◽

Trauma Center ◽

Average Length ◽

Mass Casualty ◽

Incident Command ◽

Trauma Service ◽

Large Patient ◽

Level I

On April 27, 2011, an EF4 (enhanced Fujita scale) tornado struck a 48-mile path across northwest Georgia and southeast Tennessee. Traumatic injuries sustained during this tornado and others in one of the largest tornado outbreaks in history presented to the regional Level I trauma center, Erlanger Health System, in Chattanooga, TN. Patients were triaged per mass casualty protocols through an incident command center and triage officer. Medical staffing was increased to anticipate a large patient load. Records of patients admitted as a result of tornado-related injury were retrospectively reviewed and characterized by the injury patterns, demographics, procedures performed, length of stay, and complications. One hundred four adult patients were treated in the emergency department; of these, 28 (27%) patients required admission to the trauma service. Of those admitted, 16 (57%) were male with an age range of 21 to 87 years old and an average length of stay of 10.9 ± 11.8 days. Eleven (39%) patients required intensive care unit admissions. The most common injuries seen were those of soft tissue, bony fractures, and the chest. Interventions included tube thoracostomies, exploratory laparotomies, orthopedic fixations, soft tissue reconstructions, and craniotomy. All 28 patients admitted survived to discharge. Nineteen (68%) patients were discharged home, six (21%) went to a rehabilitation hospital, and three (11%) were transferred to skilled nursing facilities. Emergency preparedness and organization are key elements in effectively treating victims of natural disasters. Those victims who survive the initial tornadic event and present to a Level I trauma center have low mortality. Like in our experience, triage protocols need to be implemented to quickly and effectively manage mass injuries.

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Sturgeons versus Surgeons: Leaping Fish Injuries at a Level I Trauma Center

The American Surgeon ◽

10.1177/000313480907500306 ◽

2009 ◽

Vol 75 (3) ◽

pp. 220-222

Author(s):

Jason P. Wilson ◽

George Burgess ◽

Robert D. Winfield ◽

Lawrence Lottenberg

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Trauma Center ◽

Public Awareness ◽

Closed Head Injury ◽

Facial Trauma ◽

Closed Head ◽

Secondary Injuries ◽

Level I

We have recently noted an increase in patients injured by an unusual mechanism and source: leaping sturgeon. We present our experience with eight cases of sturgeon related injuries. Between January 2006 and June 2007, there were eight patients evaluated at our Level I trauma center for sturgeon related injuries. Injuries included isolated fractures, liver lacerations, severe facial trauma, and a closed head injury. The overall length of stay was 6 days (range 0-20) and 50 per cent of patients required an intensive care unit stay. For comparative purposes, injuries were classified as primary sturgeon injuries (injuries where the sturgeon directly impacted the patient) and secondary sturgeon injuries (injuries related to the sturgeon but not resultant from direct impact). There were five primary injuries and three secondary injuries in our series. Patients with secondary injuries had a longer length of stay (12 days vs 3 days) and a higher intensive care unit utilization (100 % vs 20%) when compared with patients having primary injuries. This is the first report of sturgeon-related injuries in the medical literature. These peculiar insults seem to have increased in recent years. Public awareness and proper boat safety are vital in reducing the number and severity of these incidents.

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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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Impact of the first COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01654-8 ◽

2021 ◽

Author(s):

Carolin A. Kreis ◽

Birte Ortmann ◽

Moritz Freistuehler ◽

René Hartensuer ◽

Hugo Van Aken ◽

...

Keyword(s):

Surgical Procedures ◽

Trauma Center ◽

Control Period ◽

Open Fractures ◽

Injury Patterns ◽

Emergency Patient ◽

Emergency Operations ◽

Incidence Proportion ◽

Level I ◽

The Impact

Abstract Purpose In Dec 2019, COVID-19 was first recognized and led to a worldwide pandemic. The German government implemented a shutdown in Mar 2020, affecting outpatient and hospital care. The aim of the present article was to evaluate the impact of the COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center in Germany. Methods All emergency patients were recorded retrospectively during the shutdown and compared to a calendar-matched control period (CTRL). Total emergency patient contacts including trauma mechanisms, injury patterns and operation numbers were recorded including absolute numbers, incidence proportions and risk ratios. Results During the shutdown period, we observed a decrease of emergency patient cases (417) compared to CTRL (575), a decrease of elective cases (42 vs. 13) and of the total number of operations (397 vs. 325). Incidence proportions of emergency operations increased from 8.2 to 12.2% (shutdown) and elective surgical cases decreased (11.1 vs. 4.3%). As we observed a decrease for most trauma mechanisms and injury patterns, we found an increasing incidence proportion for severe open fractures. Household-related injuries were reported with an increasing incidence proportion from 26.8 to 47.5% (shutdown). We found an increasing tendency of trauma and injuries related to psychological disorders. Conclusion This analysis shows a decrease of total patient numbers in an emergency department of a Level I trauma center and a decrease of the total number of operations during the shutdown period. Concurrently, we observed an increase of severe open fractures and emergency operations. Furthermore, trauma mechanism changed with less traffic, work and sports-related accidents.

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