An Assessment of the Impact of SARS-CoV-2 on a Level 1 Trauma Center Including Subgroup Analysis of Orthopedic Injuries and Mechanism of Injury

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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(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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P0213 / #2008: THE EPIDEMIOLOGY OF PEDIATRIC POLYTRAUMA AND ORTHOPEDIC INJURIES: 12-YEAR ANALYSIS OF A LEVEL-1 TRAUMA CENTER (2007-2019)

Pediatric Critical Care Medicine ◽

10.1097/01.pcc.0000739196.40654.0d ◽

2021 ◽

Vol 22 (Supplement 1 3S) ◽

pp. 129-129

Author(s):

M. Castelão ◽

J. Pedro ◽

G. Lopes

Keyword(s):

Trauma Center ◽

Level 1 ◽

Orthopedic Injuries ◽

Level 1 Trauma Center

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B-17 The impact of a hospital-based air ambulance program on a level 1 trauma center

AeroMedical Journal ◽

10.1016/s0894-8321(87)80148-1 ◽

1987 ◽

Vol 2 (5) ◽

pp. 36

Author(s):

Kevin Fitzpatrick ◽

Joseph A. Moylan ◽

Gregory Georgiade ◽

Rita Weber

Keyword(s):

Trauma Center ◽

Air Ambulance ◽

Level 1 ◽

The Impact ◽

Level 1 Trauma Center

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Early Prognostication after Traumatic Brain Injury: Specific Validation of the IMPACT Prognostic Calculator in a Level 1 Trauma Center

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1685137 ◽

2019 ◽

Vol 80 (06) ◽

pp. 423-429

Author(s):

Anna Jung ◽

Felix Arlt ◽

Maciej Rosolowski ◽

Jürgen Meixensberger

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Trauma Center ◽

Roc Analysis ◽

Time Frame ◽

Extended Model ◽

Severe Tbi ◽

Level 1 ◽

The Impact ◽

Level 1 Trauma Center

AbstractThe present study evaluated the usefulness of the IMPACT prognostic calculator (IPC) for patients receiving acute neurointensive care at a level 1 trauma center in Germany. A total of 139 patients with traumatic brain injury (TBI) were assessed. One day after trauma, the extended model of the IPC was found to provide the most valid prediction of 6-month mortality/unfavorable outcome. Different time frames within the first day could be determined by analyzing mild, moderate, and severe TBI cohorts. The CORE + CT model at time frame Z2 (<6 h from the point of first documentation) for mild TBI exhibited the highest values in the receiver operating characteristic (ROC) analysis (area under the curve [AUC], 0.9; sensitivity, 1; specificity, 0.7). For patients with moderate head injury at time frame Z2/3 (<6–12 h from point of first documentation), the extended model fit best. For patients with severe TBI, the extended model at time frame Z6 (48–72 h from point of first documentation) best predicted 6-month mortality and unfavorable outcome (ROC analysis: AUC, 0.542/0.445; sensitivity, 0.167/0.364; specificity, 0.575/0.444). Center-specific validation demonstrated the validity of the IPC in the early phase after TBI. These findings support the usefulness of the IPC for predicting the prognosis of patients with TBI. However, further prospective validation using a larger TBI cohort is needed.

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Ethnicity/race and service-connected disability disparities in civilian traumatic brain injury mechanism of injury and VHA health services costs in military veterans: Evidence from a Level 1 Trauma Center and VA Medical Center

Trauma ◽

10.1177/1460408620914436 ◽

2020 ◽

pp. 146040862091443

Author(s):

CE Dismuke-Greer ◽

SM Fakhry ◽

MD Horner ◽

TK Pogoda ◽

MJ Pugh ◽

...

Keyword(s):

Traumatic Brain Injury ◽

African American ◽

Brain Injury ◽

Military Service ◽

Trauma Center ◽

Mechanism Of Injury ◽

Level 1 ◽

Level 1 Trauma Center ◽

African American Race ◽

Hispanic White

Introduction The objective of this study was to examine the association of military veteran socio-demographics and service-connected disability with civilian mechanism of traumatic brain injury and long-term Veterans Health Administration (VHA) costs. Methods We conducted a 17-year retrospective longitudinal cohort study of veterans with a civilian-related traumatic brain injury from a Level 1 Trauma Center between 1999 and 2013, with VHA follow-up through 2016. We merged trauma center VHA data, and used logit to model mechanism of injury, and generalized linear model to model VHA costs. Results African American race or Hispanic ethnicity veterans had a higher unadjusted rate of civilian assault/gun as mechanism of injury (15.38%) relative to non-Hispanic White (7.19%). African American race or Hispanic veterans who were discharged from the trauma center with traumatic brain injury and followed in VHA had more than twice the odds of assault/gun (OR 2.47; 95% CI 1.16:5.26), after adjusting for sex, age, and military service-connected disability. Veterans with service-connected disability ≥50% had more than twice the odds of assault/gun (OR 2.48; 95% CI 0.97:6.31). Assault/gun was associated with significantly higher annual VHA costs post-discharge ($16,807; 95% CI 672:32,941) among non-Hispanic White veterans. Military service-connected disability ≥50% was associated with higher VHA costs among both non-Hispanic White ($44,987; 95% CI $17,159:$72,816) and African American race or Hispanic ($37,901; 95% CI $4,543:$71,258) veterans. Conclusions We found that African American race or Hispanic veterans had higher adjusted likelihood of assault/gun mechanism of traumatic brain injury, and non-Hispanic White veterans had higher adjusted annual VHA resource costs associated with assault/gun, post trauma center discharge. Veterans with higher than 50% service-connected disability had higher likelihood of assault/gun and higher adjusted annual VHA resource costs. Assault/gun prevention efforts may be indicated within the VHA, especially in minority and service-connected disability veterans. More data from Level 1 Trauma Centers are needed to assess the generalizability of these findings.

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Impact of Crystalloid to PRBC Ratio in Patients with Exsanguinating Penetrating Abdominal Injuries: The Conundrum of Resuscitation

Panamerican Journal of Trauma, Critical Care & Emergency Surgery ◽

10.5005/jp-journals-10030-1058 ◽

2013 ◽

Vol 2 (1) ◽

pp. 52-57

Author(s):

Marie Unruh ◽

Marquinn Duke ◽

Peter Meade ◽

Norman E McSwain ◽

Juan C Duchesne

Keyword(s):

Logistic Regression ◽

Trauma Center ◽

Survival Benefit ◽

High Ratio ◽

Abdominal Injuries ◽

Hemostatic Resuscitation ◽

Level 1 ◽

Overall Survival Benefit ◽

The Impact ◽

Level 1 Trauma Center

ABSTRACT Background When intraoperative hemostatic resuscitation (IHR) implements high transfusion ratios of FFP:PRBC (>1:2), there is an associated increased survival in patients with exsanguinating penetrating abdominal injuries (EPAI). The impact of crystalloids: PRBC during IHR has not been analyzed. We hypothesize that minimizing the amount of intraoperative crystalloids:PRBC in combination with high ratio FFP: PRBC will correlate with a survival benefit in patients with EPAI. Methods This was a 9-year retrospective analysis of patients with EPAI at a Level 1 Trauma Center. EPAI was defined as any patient who received >20 units of PRBC during IHR. Intraoperative ratio for FFP:PRBC was recorded, and patients were placed in three separate categories accordingly: high (>1:2), mid (1:4 - 1:2), and low ratio (<1:4) groups. Quantity of crystalloids used during each category was recorded and a ratio of crystalloids:PRBC calculated. Logistic regression model was applied to analyze impact of crystalloid:PRBC on mortality, comparing the high FFP:PRBC ratio group to the low FFP: PRBC ratio group. Results Intraoperative high ratio FFP:PRBC conveyed a 32% overall survival benefit when compared with low ratio groups. Patients that received a high ratio FFP:PRBC when compared to low ratio group, received less intraoperative crystalloids (calculated crystalloids:PRBC ratios 1:3.4 vs 1:1.1; p = 0.001). Our logistic regression demonstrated a survival benefit with a high FFP:PRBC [OR 95%;0.19 , CI (0.05-0.33), p = 0.003] and the calculated low crystalloid:PRBC [OR 95%; 0.11 CI (0.01- 0.59), p = 0.001]. Conclusion We were able to demonstrate a survival advantage in patients with EPAI that received IHR of a high ratio of FFP:PRBC and a low ratio of crystalloids:PRBC. These findings suggest that in patients with EAPI requiring massive volumes of PRBC, the ratio of intraoperative FFP:PRBC should be high and crystalloids:PRBC should be low. How to cite this article Guidry C, Unruh M, Duke M, Meade P, McSwain NE Jr, Duchesne JC. Impact of Crystalloid to PRBC Ratio in Patients with Exsanguinating Penetrating Abdominal Injuries: The Conundrum of Resuscitation. Panam J Trauma Critical Care Emerg Surg 2013;2(1):52-57.

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

Journal of Emergencies Trauma and Shock ◽

10.4103/jets.jets_8_20 ◽

2020 ◽

Vol 13 (3) ◽

pp. 232

Author(s):

Adel Elkbuli ◽

Sarah Zajd ◽

Brianna Dowd ◽

Shaikh Hai ◽

Dessy Boneva ◽

...

Keyword(s):

Trauma Center ◽

Exploratory Laparotomy ◽

Weekend Effect ◽

Urban Level ◽

Level 1 ◽

The Impact ◽

Level 1 Trauma Center

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Evisceration Versus Enucleation Following Ocular Trauma, a Retrospective Analysis at a Level One Trauma Center

Military Medicine ◽

10.1093/milmed/usz278 ◽

2019 ◽

Vol 185 (3-4) ◽

pp. 409-412 ◽

Cited By ~ 1

Author(s):

Donovan Reed ◽

Alexandra Papp ◽

Wesley Brundridge ◽

Aditya Mehta ◽

Joseph Santamaria ◽

...

Keyword(s):

Retrospective Analysis ◽

Surgical Outcomes ◽

Trauma Center ◽

Ocular Trauma ◽

Sympathetic Ophthalmia ◽

Complication Rates ◽

Mechanism Of Injury ◽

Level 1 ◽

Scleral Shell ◽

Level 1 Trauma Center

Abstract Introduction Penetrating and perforating ocular trauma is often devastating and may lead to complete visual loss in the traumatized eye and subsequent compromise of the fellow eye. Enucleation is commonly utilized for management of a non-salvageable eye following penetrating and perforating ocular injuries. Recently, the use of evisceration for non-salvageable traumatized eyes has increased. As a technically easier alternative, evisceration offers several advantages to the ocular trauma surgeon to include faster surgical times, better cosmesis and motility, and improved patient outcomes. Debate still persists concerning whether or not evisceration is a viable option in the surgical management of a non-salvageable eye following ocular trauma given the theoretical increased risk of sympathetic ophthalmia and technical difficulty in construction of the scleral shell with extensive and complex corneoscleral lacerations. A retrospective analysis at a level 1 trauma center was performed to evaluate the practicality of evisceration in ocular trauma. Materials and Methods Eyes that underwent evisceration or enucleation following ocular trauma at San Antonio Military Medical Center, a level 1 trauma center, between 01 January 2014 and 30 December 2016 were examined. Factors evaluated include mechanism of injury, defect complexity, ocular trauma score, and time from injury to surgical intervention. Surgical outcomes were assessed. Results In total, 29 eyes were examined, 15 having undergone evisceration and 14 enucleation. The average size of the scleral defect before evisceration was 20 mm in length, and 23 mm before enucleation. The mechanism of injury and characterization of the defects among the two groups were relatively similar and described. Overall comparison of the two study groups in terms of surgical outcomes and complications was also relatively similar, as demonstrated. No cases of postoperative persistent pain, sympathetic ophthalmia, infection, or hematoma were identified for either group. Conclusions The postoperative outcomes demonstrated for the evisceration group are comparable to enucleation, which is consistent with the recent literature. Defect size and complexity did not affect surgical construction of the scleral shell during evisceration. If consistently proven to be a safe and viable alternative to enucleation, evisceration can offer shorter surgical times and better cosmesis for patients. More research into the long-term complication rates and more cases of evisceration for use following ocular trauma should be assessed. Still, this analysis demonstrates that evisceration is a viable surgical alternative and perhaps superior to enucleation for the management of a non-salvageable eye following extensive ocular trauma in many cases.

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