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"Triage" AND "Trauma"

B-C Lin, R-J Chen, T-L Hwang
Background: The aim of this study was to analyse outcomes of spleen-preserving (SPDP) and spleen-sacrificing (SSDP) distal pancreatectomy in adults with severe blunt pancreatic injuries. Methods: This was an observational study of adult patients who underwent distal pancreatectomy for grade III or IV blunt pancreatic injury between 1991 and 2015. Outcomes of SPDP and SSDP were compared. Results: Fifty-one patients were included, of whom 23 underwent SPDP and 28 SSDP...
December 2018: BJS open
Oriol Yuguero, Ana Vena, Carles Forné, Jose Daniel Lacasta, Cecilia Llobet, Maria José Abadías
There are lack of indicators of quality of care in resuscitation units of emergency departments. With the aim of proposing a series of indicators to evaluate the quality of care delivered in hospital resuscitation areas, we conducted a descriptive study of 7579 admissions to the resuscitation unit of an emergency department at a Spanish hospital between 2012 and 2016. The proposed indicators were the percentage of patients attending to the emergency department admitted to the resuscitation area by level of triage, the length of stay, the percentage of patients moved to intensive care and surgery at disposition, the mortality in the area or in the emergency department within 24 hours of disposition, and the data completeness...
November 2018: Medicine (Baltimore)
Maria Lampi, Johan P E Junker, John S Tabu, Peter Berggren, Carl-Oscar Jonson, Andreas Wladis
BACKGROUND: Improved trauma management can reduce the time between injury and medical interventions, thus decreasing morbidity and mortality. Triage at the emergency department is essential to ensure prioritization and timely assessment of injured patients. The aim of the present study was to investigate how a lack of formal triage system impacts timely intervention and mortality in a sub-Saharan referral hospital. Further, the study attempts to assess potential benefits of triage towards efficient management of trauma patients in one middle income country...
November 29, 2018: BMC Emergency Medicine
Giselle Sarganas, Angelika Schaffrath Rosario, Steffen Berger, Hannelore K Neuhauser
BACKGROUND: Data are lacking to provide cutoffs for hypotension in children based on outcome studies and Pediatric Advanced Life Support (PALS) and Advanced Trauma Life Support (ATLS) definitions are based on normal populations. The goal of this study was to compare different normal population based cutoffs including 5 percentile of systolic blood pressure (P5-SBP) in children and adolescents from the German Health Examination Survey for Children and Adolescents (KiGGS), US population data (Fourth-Report) and cutoffs from PALS and ATLS guidelines...
November 27, 2018: Journal of Trauma and Acute Care Surgery
Alicia A Heelan Gladden, Erik D Peltz, Robert C McIntyre, Stephanie Vega, Regina Krell, Catherine Velopulos, Lisa Ferrigno, Franklin L Wright
BACKGROUND: Early blood product resuscitation reduces trauma patient mortality from hemorrhage. This mortality benefit depends on a system that can rapidly identify actively bleeding patients, initiate massive transfusion protocol (MTP), and mobilize resources to the bedside. We hypothesized that process improvement efforts that identify patients early and mobilize appropriate blood products to the bedside for immediate use would improve mortality. STUDY DESIGN: Pre-implementation, MTP activation was at the discretion of the trauma surgeon and only PRBCs were immediately available...
November 23, 2018: Journal of the American College of Surgeons
Bryce N Taylor, Niki Rasnake, Kelly McNutt, Catherine Lindsay McKnight, Brian J Daley
BACKGROUND: There is debate within the emergency medical services (EMS) community over the value of calling a helicopter for trauma patients within a moderate distance/<45 min, of a trauma center. Helicopter EMS (HEMS) generally have a wider scope and more advanced training than the ground EMS (GEMS). GEMS, on the other hand, have the benefit of being able to immediately initiate rapid transport to the trauma center without the delay involved with HEMS flying to the scene, landing, and assuming patient care...
December 2018: Journal of Surgical Research
Arnaud Cassignol, Thibaut Markarian, Jean Cotte, Julien Marmin, Cédric Nguyen, Mickael Cardinale, Vanessa Pauly, François Kerbaul, Eric Meaudre, Xavier Bobbia
INTRODUCTION: Several prehospital major trauma patient triage scores have been developed, the triage revised trauma score (T-RTS), Vittel criteria, Mechanism/Glasgow Coma Scale/Age/Systolic blood pressure score (MGAP) and the new trauma score (NTS). These scoring schema allow a rapid and accurate prognostic assessment of the severity of potential lesions. The aim of our study was to compare these scores with in-hospital mortality predictions in a cohort of consecutive trauma patients admitted in a Level 1 trauma center...
November 20, 2018: Prehospital Emergency Care
Yong Deok Lim, Dong Hun Lee, Byung Kook Lee, Yong Soo Cho, Goeun Choi
PURPOSE: Since January 2016, emergency medical centers in South Korea have used the Korean Triage and Acuity Scale (KTAS) as the initial triage tool for all patients, including trauma patients, who visited the emergency department (ED). This present study aimed to assess the validity of the KTAS for predicting 30-day mortality due to severe trauma. METHODS: This retrospective study included patients with severe trauma (injury severity score ≥ 16) from January 2016 to December 2017...
November 19, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Rehab Abdelwahab, Hannah Yang, Hareya Gebremedhin Teka
Introduction: An effective emergency triage system should prioritize both trauma and non-trauma patients according to level of acuity, while also addressing local disease burden and resource availability. In March 2012, an adapted version of the South African Triage Scale was introduced in the emergency centre (EC) of Ayder Comprehensive Specialized Hospital in northern Ethiopia. Methods: This quality improvement study was conducted to evaluate the implementation of nurse-led emergency triage in a large Ethiopian teaching hospital using the Donabedian model...
December 2017: African Journal of Emergency Medicine Revue Africaine de la Médecine D'urgence
Esther Mm Van Lieshout, Daan T Van Yperen, Margriet E Van Baar, Suzanne Polinder, Doeke Boersma, Anne Ymvp Cardon, Piet Ar De Rijcke, Marc Guijt, Taco Mal Klem, Koen Ww Lansink, Akkie N Ringburg, Maarten Staarink, Leon Van de Schoot, Alexander H Van der Veen, Floortje C Van Eijck, Percy V Van Eerten, Paul A Vegt, Dagmar I Vos, Marco Waleboer, Michael Hj Verhofstad, Cornelis H Van der Vlies
INTRODUCTION: The Emergency Management of Severe Burns (EMSB) referral criteria have been implemented for optimal triaging of burn patients. Admission to a burn centre is indicated for patients with severe burns or with specific characteristics like older age or comorbidities. Patients not meeting these criteria can also be treated in a hospital without burn centre. Limited information is available about the organisation of care and referral of these patients. The aims of this study are to determine the burn injury characteristics, treatment (costs), quality of life and scar quality of burn patients admitted to a hospital without dedicated burn centre...
November 15, 2018: BMJ Open
Rebecca Jeanmonod, Shellie Asher, Jamie Roper, Luis Vera, Josephine Winters, Nirali Shah, Mark Reiter, Eric Bruno, Donald Jeanmonod
OBJECTIVES: A prior single-center study demonstrated historical and exam features predicting intracranial injury (ICI) in geriatric patients with low-risk falls. We sought to prospectively validate these findings in a multicenter population. METHODS: This is a prospective observational study of patients ≥65 years presenting after a fall to three EDs. Patients were eligible if they were at baseline mental status and were not triaged to the trauma bay. Fall mechanism, head strike history, headache, loss of consciousness (LOC), anticoagulants/antiplatelet use, dementia, and signs of head trauma were recorded...
October 23, 2018: American Journal of Emergency Medicine
Rodolfo Romero Pareja, Rafael Castro Delgado, Fernando Turégano Fuentes, Israel Jhon Thissard-Vasallo, David Sanz Rosa, Pedro Arcos González
BACKGROUND: In mass casualty incidents (MCI), death usually occurs within the first few hours and thus early transfer to a trauma centre can be crucial in selected cases. However, most triage systems designed to prioritize the transfer to hospital of these patients do not assess the need for surgery, in part due to inconclusive evidence regarding the value of such an assessment. Therefore, the aim of the present study was to evaluate the capacity of a new triage system-the Prehospital Advanced Triage Method (META)-to identify victims who could benefit from urgent surgical assessment in case of MCI...
November 7, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Urs Borner, Lukas Anschuetz, Nadine Kaiser, Alexander Rieke, Patrick Dubach, Marco Caversaccio
OBJECTIVE: The clinical challenge in blunt nasal trauma in children, is to identify cases requiring specialized care among frequently encountered banalities, whilst trying to minimize the exposure to diagnostic procedures. We aim to evaluate the related diagnostic and therapeutic pathways and its outcome during follow-up. METHODS: This retrospective cohort study includes children up to 16 years presenting at the emergency department with blunt nasal trauma of our tertiary reference center...
October 31, 2018: European Archives of Oto-rhino-laryngology
N N Lam, H T X Huong, C A Tuan
A survey was conducted on 397 physicians working in Emergency and Trauma Departments of district and provincial hospitals in Vietnam. The contents of the survey were emergency care for burn and mass burn injuries. Results showed that only 39.8% of participants gave more than 50% correct answers. In the case of mass burn injuries, only 10.3% of participants gave correct answers for triage, and 71.8% of participants considered oral fluid resuscitation to be an appropriate method. In addition, intubation for suspected inhalational injury was indicated by 51...
June 30, 2018: Annals of Burns and Fire Disasters
Shao-Chun Wu, Cheng-Shyuan Rau, Spencer C H Kuo, Peng-Chen Chien, Hsiao-Yun Hsieh, Ching-Hua Hsieh
The reverse shock index (rSI) multiplied by Glasgow Coma Scale (GCS) score (rSIG), calculated by multiplying the GCS score with systolic blood pressure (SBP)/hear rate (HR), was proposed to be a reliable triage tool for identifying risk of in-hospital mortality in trauma patients. This study was designed to externally validate the accuracy of the rSIG in the prediction of mortality in our cohort of trauma patients, in comparison with those that were predicted by the Revised Trauma Score (RTS), shock index (SI), and Trauma and Injury Severity Score (TRISS)...
October 24, 2018: International Journal of Environmental Research and Public Health
Dohyun Kim, Sungmin You, Soonwon So, Jongshill Lee, Sunhyun Yook, Dong Pyo Jang, In Young Kim, Eunkyoung Park, Kyeongwon Cho, Won Chul Cha, Dong Wook Shin, Baek Hwan Cho, Hoon-Ki Park
In a mass casualty incident, the factors that determine the survival rate of injured patients are diverse, but one of the key factors is the time for triage. Additionally, the main factor that determines the time of triage is the number of medical personnel. However, when relying on a small number of medical personnel, the ability to increase survivability is limited. Therefore, developing a classification model for survival prediction that can quickly and precisely triage via wearable devices without medical personnel is important...
2018: PloS One
E Brooke Lerner, Jonathan R Studnek, Nicole Fumo, Anjishnu Banerjee, Igli Arapi, Lorin R Browne, Daniel G Ostermayer, Stacy Reynolds, Manish I Shah
BACKGROUND: Although all emergency departments (EDs) should be ready to treat children, some may have illnesses or injuries that require higher-level pediatric resources that are not available at all hospitals. There are no national guidelines for emergency medical services (EMS) providers about when to directly transport children to hospitals with higher-level pediatric resources, with the exception of severe trauma. Variability exists in EMS protocols about when children warrant transport to hospitals with higher-level pediatric care...
October 21, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Dominic Murphy, Kirsten V Smith
Evidence suggests that veterans with posttraumatic stress disorder (PTSD) have a poorer treatment response than nonveterans.  In this study, we explored heterogeneity in treatment response for 960 veterans in the United Kingdom with PTSD who had been offered a residential intervention consisting of a mixture of group sessions and individual trauma-focused cognitive behavioral therapy (TF-CBT). The primary outcome was PTSD score on the Impact of Event Scale-Revised (IES-R).  Covariates included depression, anxiety, anger, alcohol misuse, functional impairment, and sociodemographic characteristics...
October 2018: Journal of Traumatic Stress
A Sandras, C Guilbeau-Frugier, F Savall, N Telmon, C Capuani
Identifying tool mark and involved weapon in sharp force trauma is essential to understanding the circumstances of death. But accuracy and reliability of such expert testimony remains unknown, and validation studies are rare in forensic literature. That is why, we conducted an experiment in order to determine error rates and predictive values on identifying the right implement through different types of knife-inflicted trauma. Human bone cut marks were analysed through epifluorescence microscopy. The samples were examined through a randomised, blinded, controlled study by three researchers with varying degrees of experience with direct and indirect observation of cut marks (photography)...
October 18, 2018: International Journal of Legal Medicine
Priti P Parikh, Pratik Parikh, Logan Mamer, Mary C McCarthy, Joseph V Sakran
Importance: Studies show that secondary overtriage (SO) contributes significantly to the economic burden of injured patients; thus, the association of SO with use of the trauma system has been examined. However, the association of the underlying trauma system design with such overtriage has yet to be evaluated. Objectives: To evaluate whether the distribution of trauma centers in a statewide trauma system is associated with SO and to identify clinical and demographic factors that may lead to SO...
September 19, 2018: JAMA Surgery
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