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https://www.readbyqxmd.com/read/29283966/under-triage-in-trauma-does-an-organized-trauma-network-capture-the-major-trauma-victim-a-statewide-analysis
#1
Michael A Horst, Shreya Jammula, Brian W Gross, Alan D Cook, Eric H Bradburn, Juliet Altenburg, Danielle Von Nieda, Madison Morgan, Frederick B Rogers
BACKGROUND: Proper triage of critically injured trauma patients to accredited trauma centers (TCs) is essential for survival and patient outcomes. We sought to determine the percentage of patients meeting trauma criteria who received care at non-trauma centers (NTCs) within the statewide trauma system that exists in the state of Pennsylvania. We hypothesized that a substantial proportion of the trauma population would be undertriaged to NTCs with undertriage rates (UTR) decreasing with increasing severity of injury...
December 28, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29283920/does-lactate-affect-the-association-of-early-hyperglycemia-and-multiple-organ-failure-in-severely-injured-blunt-trauma-patients
#2
Justin E Richards, Thomas M Scalea, Michael A Mazzeffi, Peter Rock, Samuel M Galvagno
BACKGROUND: Early hyperglycemia is associated with multiple organ failure (MOF) after traumatic injury; however, few studies have considered the contribution of depth of clinical shock. We hypothesize that when considered simultaneously, glucose and lactate are associated with MOF in severely injured blunt trauma patients. METHODS: We performed a retrospective investigation at a single tertiary care trauma center. Inclusion criteria were patient age ≥18 years, injury severity score (ISS) >15, blunt mechanism of injury, and an intensive care unit length of stay >48 hours...
December 26, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29221606/-medical-information-system-pmsi-does-not-adequately-identify-severe-trauma
#3
A Perozziello, T Gauss, A Diop, M Frank-Soltysiak, P Rufat, M Raux, S Hamada, B Riou
BACKGROUND: Resource allocation to hospitals is highly dependent on appropriate case coding. For trauma victims, the major diagnosis-coding category (DCC) is multiple trauma (DCC26), which triggers higher funding. We hypothesized that DCC26 has limited capacity for appropriate identification of severe trauma victims. METHODS: We studied Injury Severity Score (ISS), Trauma Related Injury Severity Score (TRISS) and in-hospital mortality using data recorded in three level 1 trauma centers over a 2-year period...
December 5, 2017: Revue D'épidémiologie et de Santé Publique
https://www.readbyqxmd.com/read/29214322/road-traffic-accidents-in-children-the-what-how-and-why
#4
Yue Yen Lee, Eric Fang, Yanyi Weng, Sashikumar Ganapathy
INTRODUCTION: Road traffic accidents (RTAs) in Singapore involving children were evaluated, with particular focus on the epidemiology, surrounding circumstances and outcomes of these accidents. Key factors associated with worse prognosis were identified. We proposed some measures that may be implemented to reduce the frequency and severity of such accidents. METHODS: This was a retrospective study of RTAs involving children aged 0-16 years who presented to the Children's Emergency at KK Women's and Children's Hospital, Singapore, from January 2011 to June 2014...
December 7, 2017: Singapore Medical Journal
https://www.readbyqxmd.com/read/29194318/non-compliance-with-acs-cot-recommended-criteria-for-full-trauma-team-activation-is-associated-with-undertriage-deaths
#5
Christopher J Tignanelli, Wayne E Vander Kolk, Judy N Mikhail, Matthew J Delano, Mark R Hemmila
BACKGROUND: The appropriate triage of acutely injured patients within a trauma system is associated with improved rates of mortality and optimal resource utilization. The American College of Surgeons Committee on Trauma (ACS-COT) put forward six minimum criteria (ACS-6) for full trauma team activation (TTA). We hypothesized that ACS-COT verified trauma center compliance with these criteria is associated with low under-triage rates and improved overall mortality. METHODS: Data from a state-wide collaborative quality initiative was utilized...
November 21, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29170332/35%C3%A2-to-pan-scan-or-not-to-pan-scan-further-analysis-of-the-tarn-database-2012-2017
#6
Paul Hunt, Fiona Lecky, Omar Bouamra
BACKGROUND: A 'whole body' or 'pan-scan' computed tomography (CT) imaging approach is now becoming the standard of care during the early management of adult patients with suspected severe blunt multitrauma. A number of studies have variously reported a mortality benefit or no benefit from a pan-scan approach compared to that of carrying out body region-focused CT and/or plain radiographs or a mixture of imaging modalities. However, unanswered questions still remain due to the significant heterogeneity in practice between institutions, and the limitations of published studies...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29127439/trauma-patients-centralization-for-the-mechanism-of-trauma-old-questions-without-answers
#7
S Magnone, A Ghirardi, M Ceresoli, L Ansaloni
INTRODUCTION: Centralization of trauma patients has become the standard of care. Unfortunately, overtriage can overcome the capability of Trauma Centres. This study aims to analyse the association of different mechanisms of injury with severe or major trauma defined as Injury Severity Score (ISS) greater than 15 and an estimation of overtriage upon our Trauma Centre. METHODS: A retrospective review of our prospective database was undertaken from March 2014 to August 2016...
November 10, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28969894/targeting-resuscitation-to-normalization-of-coagulating-status-hyper-and-hypocoagulability-after-severe-injury-are-both-associated-with-increased-mortality
#8
Hunter B Moore, Ernest E Moore, Ioannis N Liras, Charles Wade, Benjamin R Huebner, Clay Cothren Burlew, Fredric M Pieracci, Angela Sauaia, Bryan A Cotton
INTRODUCTION: The prevalence and impact of hypercoagulability (hypo) in severely injured patients early after injury remains unclear. We hypothesize that the predominant phenotype of postinjury coagulopathy is hypercoagulability (hyper) and it is associated with increased mortality. MATERIAL AND METHODS: Blood samples from 141 healthy volunteers assayed with thrombelastography (TEG) were used to identify thresholds of hypo and hypercoagulability (above 95th/below the 5thpercentile) in four TEG indices...
December 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28965094/how-health-service-delivery-guides-the-allocation-of-major-trauma-patients-in-the-intensive-care-units-of-the-inclusive-hub-and-spoke-trauma-system-of-the-emilia-romagna-region-italy-a-cross-sectional-study
#9
Arturo Chieregato, Annalisa Volpi, Giovanni Gordini, Chiara Ventura, Marco Barozzi, Maria Luisa Rita Caspani, Andrea Fabbri, Anna Maria Ferrari, Enrico Ferri, Aimone Giugni, Massimiliano Marino, Costanza Martino, Mario Pizzamiglio, Maurizio Ravaldini, Emanuele Russo, Laura Trabucco, Susanna Trombetti, Rossana De Palma
OBJECTIVE: To evaluate cross-sectional patient distribution and standardised 30-day mortality in the intensive care units (ICU) of an inclusive hub and spoke trauma system. SETTING: ICUs of the Integrated System for Trauma Patient Care (SIAT) of Emilia-Romagna, an Italian region with a population of approximately 4.5 million. PARTICIPANTS: 5300 patients with an Injury Severity Score (ISS) >15 were admitted to the regional ICUs and recorded in the Regional Severe Trauma Registry between 2007 and 2012...
September 29, 2017: BMJ Open
https://www.readbyqxmd.com/read/28930946/evaluating-the-traditional-day-and-night-shift-in-an-acute-care-surgery-fellowship-is-the-swing-shift-a-better-choice
#10
Paul J Chestovich, Christopher F McNicoll, Nichole K Ingalls, Deborah A Kuhls, Douglas R Fraser, Shawna L Morrissey, John J Fildes
BACKGROUND: Fellowship trainees in Acute Care Surgery require experience in the management of complex and operative trauma cases. Trauma center staffing usually follows standard 12 or 24 hour shifts, with resident and fellow trainees following a similar schedule. Although trauma admissions can be generally unpredictable, we analyzed temporal trends of trauma patient arrival times to determine the best time frame to maximize trainee experience during each day. METHODS: We reviewed ten years (2007-2016) of trauma registry data for blunt and penetrating trauma activations...
September 20, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28894892/using-emergency-trauma-team-activations-to-measure-trauma-activity-and-injury-severity-10%C3%A2-years-of-experience-using-an-australian-major-trauma-centre-registry
#11
M M Dinh, S Roncal, K Curtis, R Ivers
OBJECTIVES: To describe the outcomes of Emergency Department trauma team activations over a 10-year period with respect to injury severity and hospital length of stay. METHODS: This was a retrospective study using trauma registry data at a single Major Trauma Centre in Australia. All trauma team activations and arrivals on pre-hospital major trauma (T1) protocol recorded in the trauma registry between June 2006 and July 2016 were included. The outcome of interest was major trauma, defined as an Injury Severity Score (ISS) >12 or length of stay >3 days or requiring urgent operative intervention or admission to the Intensive Care Unit following trauma...
September 11, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28829661/multicenter-prospective-study-of-prehospital-administration-of-analgesia-in-the-u-s-combat-theater-of-afghanistan
#12
Steven G Schauer, Alejandra G Mora, Joseph K Maddry, Vikhyat S Bebarta
BACKGROUND: Published data on prehospital medical care in combat is limited, likely due to the chaotic and unpredictable nature of care under fire and difficulty in documentation There is limited data on how often analgesic agents are administered, which drug are being used, and whether there is an association with injury patterns. METHODS: This study was a prospective, multicenter, observational study to determine which analgesic agents are being used prehospital and whether there is an association with injury patterns...
November 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28780982/validation-of-the-criteria-for-early-critical-care-resource-use-in-assessing-the-effectiveness-of-field-triage
#13
Ki Ok Ahn, Sang Chul Kim, Ju Ok Park, Sang Do Shin, Kyoung Jun Song, Ki Jeong Hong
BACKGROUND: This study aimed to validate the criteria for early critical care resource (CCR) use as an outcome predictor for seriously injured patients triaged in the field by comparing the effectiveness of the criteria for early CCR use with that of criteria defined by an Injury Severity Score (ISS) >15. METHODS: We analysed data from seriously injured trauma patients who were triaged using a field triage protocol by emergency medical service providers (EMS-ST patients)...
July 31, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28697017/risk-factors-for-deep-vein-thrombosis-and-pulmonary-embolism-after-traumatic-injury-a-competing-risks-analysis
#14
Jan-Michael Van Gent, Richard Y Calvo, Ashley L Zander, Erik J Olson, C Beth Sise, Michael J Sise, Steven R Shackford
BACKGROUND: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is typically reported as a composite measure of the quality of trauma center care. Given recent data suggesting post-injury DVT and PE are distinct clinical processes, a better understanding may result from analyzing them as independent, competing events. Using competing risks analysis, we evaluated our hypothesis that the risk factors and timing of post-injury DVT and PE are different...
July 8, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28653327/are-severely-injured-trauma-victims-in-norway-offered-advanced-pre-hospital-care-national-retrospective-observational-cohort
#15
T Wisborg, E N Ellensen, I Svege, T Dehli
BACKGROUND: Studies of severely injured patients suggest that advanced pre-hospital care and/or rapid transportation provides a survival benefit. This benefit depends on the disposition of resources to patients with the greatest need. Norway has 19 Emergency Helicopters (HEMS) staffed by anaesthesiologists on duty 24/7/365. National regulations describe indications for their use, and the use of the national emergency medical dispatch guideline is recommended. We assessed whether severely injured patients had been treated or transported by advanced resources on a national scale...
August 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28637560/despite-trauma-center-closures-trauma-system-regionalization-reduces-mortality-and-time-to-definitive-care-in-severely-injured-patients
#16
COMPARATIVE STUDY
Jack C He, David Schechtman, Debra L Allen, Jillian J Cremona, Jeffrey A Claridge
The Northern Ohio Trauma System (NOTS), consisting of multiple hospital systems, was established in 2010 to improve trauma outcomes. This study assessed its impact on mortality and time to definitive care, focusing especially on the severely injured patients. NOTS trauma registry was queried for all trauma activations from 2008 to 2013. The years between 2008-2009 and 2011-2013 were designated as pre- and post-NOTS, respectively. Data from 2010 was excluded as a transitional year. Two trauma centers (TCs) closed in 2010...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28624030/emergency-department-length-of-stay-in-critical-nonoperative-trauma
#17
Anaar Siletz, Kexin Jin, Marilyn Cohen, Catherine Lewis, Areti Tillou, Henry Magill Cryer, Ali Cheaito
BACKGROUND: Prolonged emergency department (ED) stays correlate with negative outcomes in critically ill nontrauma patients. This study sought to determine the effect of ED length of stay (LOS) on trauma patients. MATERIALS AND METHODS: Two hundred forty-one trauma patients requiring direct intensive care unit (ICU) admission were identified. Patients requiring immediate operative intervention were excluded. Odds ratios (ORs) of outcomes for patients transferred to ICU in ≤90 min were compared with patients transferred in >90 min, adjusting for Injury Severity Score (ISS)...
June 15, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28590354/optimal-timing-for-repair-of-peripheral-nerve-injuries
#18
Eugene Wang, Kenji Inaba, Saskya Byerly, Diandra Escamilla, Jayun Cho, Joseph Carey, Milan Stevanovic, Alidad Ghiassi, Demetrios Demetriades
BACKGROUND: Data regarding outcomes after peripheral nerve injuries is limited, and the optimal management strategy for an acute injury is unclear. The aim of this study was to examine timing of repair and specific factors that impact motor-sensory outcomes after peripheral nerve injury. METHODS: This was a single-center, retrospective study. Patients with traumatic peripheral nerve injury from January 2010 to June 2015 were included. Patients who died, required amputation, suffered brachial plexus injury, or had missing motor-sensory examinations were excluded...
November 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28551050/the-relationship-between-physical-and-psychological-complaints-and-quality-of-life-in-severely-injured-patients
#19
C C H M van Delft-Schreurs, M A C van Son, M A C de Jongh, K W W Lansink, J de Vries, M H J Verhofstad
PURPOSE: The purpose of this study was two-fold. The first goal was to investigate which variables were associated with the remaining physical limitations of severely injured patients after the initial rehabilitation phase. Second, we investigated whether physical limitations were attributable to the association between psychological complaints and quality of life in this patient group. METHODS: Patients who were 18 years or older and who had an injury severity score (ISS)>15 completed a set of questionnaires at one time-point after their rehabilitation phase (15-53 months after their trauma)...
May 5, 2017: Injury
https://www.readbyqxmd.com/read/28548592/intracranial-pressure-monitoring-in-severe-blunt-head-trauma-does-the-type-of-monitoring-device-matter
#20
Alberto Aiolfi, Desmond Khor, Jayun Cho, Elizabeth Benjamin, Kenji Inaba, Demetrios Demetriades
OBJECTIVE Intracranial pressure (ICP) monitoring has become the standard of care in the management of severe head trauma. Intraventricular devices (IVDs) and intraparenchymal devices (IPDs) are the 2 most commonly used techniques for ICP monitoring. Despite the widespread use of these devices, very few studies have investigated the effect of device type on outcomes. The purpose of the present study was to compare outcomes between 2 types of ICP monitoring devices in patients with isolated severe blunt head trauma...
May 26, 2017: Journal of Neurosurgery
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