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"Triage" AND "Trauma"

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 19, 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
Rym Hamed, Amel Maaref, Feten Amira, Houssem Aouni, Imen Mekki, Amina Jebali
BACKGROUND: Severe Trauma is a misleading cause of death in young people. Early assessment of prognosis is the cornerstone in the management of such patients. Several prognostic scores have been proposed during the last decade. AIM: To evaluate the prognostic performance of trauma scores in terms of mortality in severe trauma patients admitted to the emergency department. METHODS: This was a prospective, observational and prognostic study with inclusion of severe trauma patients admitted to the emergency department over a 20 months period...
March 2018: La Tunisie Médicale
Joon-Myoung Kwon, Youngnam Lee, Yeha Lee, Seungwoo Lee, Hyunho Park, Jinsik Park
AIM: Triage is important in identifying high-risk patients amongst many less urgent patients as emergency department (ED) overcrowding has become a national crisis recently. This study aims to validate that a Deep-learning-based Triage and Acuity Score (DTAS) identifies high-risk patients more accurately than existing triage and acuity scores using a large national dataset. METHODS: We conducted a retrospective observational cohort study using data from the Korean National Emergency Department Information System (NEDIS), which collected data on visits in real time from 151 EDs...
2018: PloS One
Sasank Chilamkurthy, Rohit Ghosh, Swetha Tanamala, Mustafa Biviji, Norbert G Campeau, Vasantha Kumar Venugopal, Vidur Mahajan, Pooja Rao, Prashant Warier
BACKGROUND: Non-contrast head CT scan is the current standard for initial imaging of patients with head trauma or stroke symptoms. We aimed to develop and validate a set of deep learning algorithms for automated detection of the following key findings from these scans: intracranial haemorrhage and its types (ie, intraparenchymal, intraventricular, subdural, extradural, and subarachnoid); calvarial fractures; midline shift; and mass effect. METHODS: We retrospectively collected a dataset containing 313 318 head CT scans together with their clinical reports from around 20 centres in India between Jan 1, 2011, and June 1, 2017...
October 11, 2018: Lancet
Jeffrey N Wherry, Shauna C Herrington
This study reports on the reliability and validity for two measures developed for screening of symptoms in child sexual abuse (CSA)-the Trauma Symptom Checklist for Children-Screening Form (TSCC-SF) and the Trauma Symptom Checklist for Young Children-Screening Form (TSCYC-SF). The sample of 200 children and caregivers received outpatient treatment. Internal consistencies ranged from an alpha of 0.79-0.85. Concurrent validity was demonstrated by correlations with the TSCC and TSCYC. The TSCC-SF General Trauma (GT) was only correlated Child Behavior Checklist (r = ...
October 9, 2018: Journal of Child Sexual Abuse
Kelly E Hall, Manuel Boller, Jayme Hoffberg, Maureen McMichael, Marc R Raffe, Claire R Sharp
OBJECTIVE: To report summative data from the American College of Veterinary Emergency and Critical Care Veterinary Committee on Trauma (VetCOT) registry. DESIGN: Multi-institutional veterinary trauma registry data report. SETTING: VetCOT identified veterinary trauma centers (VTCs). ANIMALS: Dogs and cats with evidence of trauma presented to VTCs with data entered in the VetCOT registry September 1, 2013-March 31, 2017...
October 7, 2018: Journal of Veterinary Emergency and Critical Care
Jared M Wohlgemut, Joseph Davies, Christopher Aylwin, Jonathan J Morrison, Elaine Cole, Nicola Batrick, Susan I Brundage, Jan O Jansen
BACKGROUND: Metrics exist to assess and validate trauma system outcomes; however, these are clinically focused and do not evaluate the appropriateness of admission patterns, relative to geography and triage category. We propose the term "functional inclusivity", defined as the number and proportion of triage-negative, and/or nonseverely injured patients, who were injured in proximity to a level II/III trauma center but admitted to a level I facility. The aim of this study was to evaluate this metric in the North West London Trauma Network...
November 2018: Journal of Surgical Research
Elizabeth R Lusczek, Cole Myers, Kimberly Popovsky, Kristine Mulier, Greg Beilman, Robert Sawyer
INTRODUCTION: Age and sex affect outcomes from trauma. Older patients tend to be under-triaged, consume more healthcare resources, and experience worse outcomes relative to younger patients. Sex has also been associated with different outcomes, with women experiencing better outcomes than men. While baseline metabolism differs with both age and sex, no study has examined how these differences affect the response to trauma. We used high-throughput metabolomics to assess metabolic differences associated with blunt trauma according to age and sex...
September 17, 2018: Injury
Lewis D Hahn, Anand M Prabhakar, Evan J Zucker
Aortic injury remains a major contributor to morbidity and mortality from acute thoracic trauma. While such injuries were once nearly uniformly fatal, the advent of cross-sectional imaging in recent years has facilitated rapid diagnosis and triage, greatly improving outcomes. In fact, cross-sectional imaging is now the diagnostic test of choice for traumatic aortic injury (TAI), specifically computed tomography angiography (CTA) in the acute setting and CTA or magnetic resonance angiography (MRA) in follow-up...
September 28, 2018: VASA. Zeitschrift Für Gefässkrankheiten
Sanjit R Konda, Ariana Lott, Kenneth A Egol
Introduction: In response to increasing health-care costs, Centers for Medicare & Medicaid Services has initiated several programs to transition from a fee-for-service model to a value-based care model. One such voluntary program is Bundled Payments for Care Improvement Advanced (BPCI Advanced) which includes all hip and femur fractures that undergo operative fixation. The purpose of this study was to analyze the current cost and resource utilization of operatively fixed (nonarthroplasty) hip and femur fracture procedure bundle patients at a single level 1 trauma center within the framework of a risk stratification tool (Score for Trauma Triage in the Geriatric and Middle-Aged [STTGMA]) to identify areas of high utilization before our hospitals transition to bundle period...
2018: Geriatric Orthopaedic Surgery & Rehabilitation
Mark P Breazzano, H Russell Day, Sarah Tanaka, Uyen Tran
OBJECTIVES: While immediate diagnosis and irrigation is standard chemical eye burn practice, it is unknown to what extent specific pH measurements influence management, given the frequent clinical availability of narrow-spectrum nitrazine pH strips. We hypothesize that exclusive broad-spectrum pH strip implementation leads to more accurate measurement and expedited ophthalmologic consultation. METHODS: At a Level 1 trauma center over 25 months, all emergent adult ophthalmology consultations for chemical burns were included in a pre-intervention (N=22) and post-intervention (N=20) study design...
September 24, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Andrew Y Powers, Mauricio B Pinto, Ashley M Aldridge, Oliver Y Tang, Jia-Shu Chen, Rebecca L Berube, Cody Doberstein, Jordan M Fox, Joseph A Carnevale, Wael F Asaad
PURPOSE: Traumatic subdural hemorrhage (SDH) is associated with high mortality, yet many patients are not managed surgically. We sought to understand what factors might be associated with SDH enlargement to contribute to the triage of these conservatively managed patients. MATERIALS AND METHODS: A consecutive series of 117 patients admitted to our institution's level 1 trauma center for SDH between January 1, 2010 and December 31, 2010 were evaluated. Volumetric measurement of SDHs was performed on initial and follow-up head computed tomography (CT) scans with recording of initial midline shift and classification by location...
September 14, 2018: Journal of Critical Care
Stephanie F Polites, Jennifer M Leonard, Amy E Glasgow, Martin D Zielinski, Donald H Jenkins, Elizabeth B Habermann
INTRODUCTION: Severely injured patients should receive definitive care at high acuity trauma centers. The purposes of this study were to determine the undertriage (UT) rate within a national sample of trauma centers and to identify characteristics of UT patients. METHODS: Severely injured adults ≥16 years were identified from the 2010-2012 NTDB. UT was defined as those who received definitive care or died at hospitals without state or ACS level I or II verification...
September 14, 2018: American Journal of Surgery
Eveline A J van Rein, Said Sadiqi, Koen W W Lansink, Rob A Lichtveld, Risco van Vliet, F Cumhur Oner, Luke P H Leenen, Mark van Heijl
PURPOSE: Severely injured patients should be treated at higher-level trauma centres, to improve chances of survival and avert life-long disabilities. Emergency medical service (EMS) providers must try to determine injury severity on-scene, using a prehospital trauma triage protocol, and decide the most appropriate type of trauma centre. The objective of this study is to investigate the role of EMS provider judgment in the prehospital triage process of trauma patients, by analysing the compliance rate to the protocol and administering a questionnaire among EMS providers...
September 20, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Jie C Nguyen, Paul H Yi, Kaitlin M Woo, Humberto G Rosas
BACKGROUND: Musculoskeletal complaints are common among children, and magnetic resonance (MR) is increasingly used to supplement the clinical assessment. The validation of a short triage protocol could reduce the number of unnecessary contrast-enhanced MR studies that sometimes also require the need for sedation. OBJECTIVE: To compare the diagnostic accuracy between fluid-sensitive sequence and contrast-enhanced MR study in the detection of musculoskeletal pathology in the pelvis and the appendicular skeleton in children older than 2 years...
September 19, 2018: Pediatric Radiology
Scott J Farber, Rami S Kantar, Eduardo D Rodriguez
As the United States continues to increase its use of Special Operations Forces worldwide, treatment of craniomaxillofacial (CMF) trauma must be adapted to meet the needs of the warfighter. The remoteness of Special Operations can result in potentially longer times until definitive treatment may be reached. A significant portion of Servicemembers incur injury to the CMF region (42%). Severe CMF trauma can result in substantial hemorrhage and airway compromise. These can be immediately life threatening and must be addressed expeditiously...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Mohammad Reza Khajehaminian, Ali Ardalan, Abbasali Keshtkar, Sayed Mohsen Hosseini Boroujeni, Amir Nejati, Omid Mahdi Ebadati Ebadati E, Abbas Rahimi Foroushani
INTRODUCTION: Mass casualty incidents impose a large burden on the emergency medical systems, hospitals and community infrastructures. The pre-hospital and hospital capacities are usually bear the burden of casualties large numbers. One of the challenging issues in mass casualty incidents is the distribution of casualties among the suitable health care facilities. OBJECTIVE: To review models and criteria affecting the distribution of casualties during the trauma-related mass causality incidents...
September 6, 2018: Injury
Jody A Vogel, W Gannon Sungar, Dowin Boatright, Jordan Ryan, Benjamin Murphy, Jesse Loar, Sabrina Adams, Jason S Haukoos
BACKGROUND: Early identification of trauma patients who need specialized healthcare resources may facilitate goal-directed resuscitation and effective secondary triage. OBJECTIVE: To estimate associations between Denver Emergency Department (ED) Trauma Organ Failure (TOF) Score and healthcare resource utilization. METHODS: Retrospective study of adult trauma patients at Denver Health Medical Center. The outcome was resource utilization including: intensive care unit (ICU) length of stay (LOS), hospital LOS, procedures, and costs...
August 30, 2018: American Journal of Emergency Medicine
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