An Objective Study of the Impact of the Electronic Medical Record on Outcomes in Trauma Patients

2012 ◽  
Vol 78 (11) ◽  
pp. 1249-1254 ◽  
Author(s):  
Paul J. Schenarts ◽  
Claudia E. Goettler ◽  
Michael A. White ◽  
Brett H. Waibel
Keyword(s):  
Length Of Stay ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Injury Severity ◽  
Unit Length ◽  
Traumatic Injury ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Delay In Diagnosis ◽  
The Impact

It is commonly believed that the electronic medical record (EMR) will improve patient outcomes. However, there is scant published literature to support this claim and no studies in any surgical population. Our hypothesis was that the EMR would not improve objective outcome measures in patients with traumatic injury. Prospectively collected data from our university-based Level I trauma center was retrospectively reviewed. Demographic, injury severity as well as outcomes and complications data were compared for all patients admitted over a 20-month period before introduction of the EMR and a 20-month period after full, hospital-wide use of the EMR. Implementation of the EMR was associated with a decreased hospital length of stay, P = 0.02; intensive care unit length of stay, P = 0.001; ventilator days, P = 0.002; acute respiratory distress syndrome, P = 0.006, pneumonia, P = 0.008; myocardial infarction, P = 0.001; line infection, P = 0.03; septicemia, P = 0.000; renal failure, P = 0.000; drug complication, P = 0.001; and delay in diagnosis, P = 0.04. There was no difference in mortality, unexpected cardiac arrest, missed injury, pulmonary embolism/deep vein thrombosis, or late urinary tract infection. This is the first study to investigate the impact of the EMR in surgical patients. Although there was an improvement in some complications, the overall impact was inconsistent.

Intraabdominal Injury is Common in Blunt Trauma Patients who Sustain Spinal Cord Injury

2007 ◽  
Vol 73 (10) ◽  
pp. 1035-1038
Author(s):  
Ali Salim ◽  
Marcus Ottochian ◽  
Ryan J. Gertz ◽  
Carlos Brown ◽  
Kenji Inaba ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Length Of Stay ◽  
Blunt Trauma ◽  
Injury Severity ◽  
Unit Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Cord Injury ◽  
Intraabdominal Injury

The evaluation of the abdomen in patients with spinal cord injury (SCI) is challenging for obvious reasons. There are very little data on the incidence and complications of patients who sustain SCI with concomitant intraabdominal injury (IAI). To determine the incidence and outcomes of IAI in blunt trauma patients with SCI, a trauma registry and record review was performed between January 1998 and December 2005. Baseline demographic data, Injury Severity Score, and associated IAI were collected. Two groups were established and outcomes were analyzed based on the presence or absence of IAI. Intraabdominal and hollow viscus injures were found in 15 per cent and 6 per cent, respectively, of 292 patients with blunt SCI. The presence of intraabdominal injury varied according to the level of the SCI: 10 per cent of cervical, 23 per cent of thoracic, and 18 per cent of lumbar SCI. The overall mortality was 16 per cent. The presence of intraabdominal injury was associated with longer intensive care unit length of stay (13 versus 6 days, P < 0.01), hospital length of stay (23 versus 18 days, P < 0.05), higher complication rate (46% versus 33%, P = 0.09), and higher mortality (44% versus 11%, P < 0.01) when compared with patients with SCI without IAI. Intraabdominal injuries are common in blunt SCI. Liberal evaluation with computed tomography is necessary to identify injuries early.

Placement of Surgical Feeding Tubes Among Patients With Severe Traumatic Brain Injury Requiring Exploratory Abdominal Surgery

2020 ◽  
Vol 86 (6) ◽  
pp. 635-642
Author(s):  
Peter I. Cha ◽  
Ronald M. Jou ◽  
David A. Spain ◽  
Joseph D. Forrester
Keyword(s):  
Length Of Stay ◽  
Abdominal Surgery ◽  
Injury Severity ◽  
Unit Length ◽  
Feeding Tube ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Fascial Closure ◽  
Trauma Patients ◽  
Percutaneous Endoscopic Gastrostomy Placement

Objectives The purpose of this study was to identify trauma patients who would benefit from surgical placement of an enteral feeding tube during their index abdominal trauma operation. Methods We performed a retrospective analysis of all patients admitted to 2 level I trauma centers between January 2013 and February 2018 requiring urgent exploratory abdominal surgery. Results Six-hundred and one patients required exploratory abdominal surgery within 24 hours of admission after trauma activation. Nineteen (3% of total) patients underwent placement of a feeding tube after their initial exploratory surgery. On multivariate analysis, an intracranial Abbreviated Injury Scale ≥4 (odds ratio [OR] = 9.24, 95% CI 1.09-78.26, P = .04) and a Glasgow Coma Scale ≤8 (OR = 4.39, 95% CI 1.38-13.95, P = .01) were associated with increased odds of requiring a feeding tube. All patients who required a feeding tube had an Injury Severity Score ≥15. While not statistically significant, patients with an open surgical feeding tube compared with interventional radiology/percutaneous endoscopic gastrostomy placement had lower median intensive care unit length of stay, fewer ventilator days, and shorter median total hospital length of stay. Conclusions Trauma patients with severe intracranial injury already requiring urgent exploratory abdominal surgery may benefit from early, concomitant placement of a feeding tube during the index abdominal operation, or at fascial closure.

Risk for Contrast-Induced Nephropathy in Elderly Trauma Patients

2012 ◽  
Vol 78 (10) ◽  
pp. 1114-1117 ◽  
Author(s):  
Ryan Finigan ◽  
Jacqueline Pham ◽  
Rosemarie Mendoza ◽  
Michael Lekawa ◽  
Matthew Dolich ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Length Of Stay ◽  
Injury Severity ◽  
Unit Length ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Contrast Induced Nephropathy ◽  
History Of ◽  
Elderly Trauma Patients

The objective of this study was to determine if elderly trauma patients are at risk for contrast-induced nephropathy (CIN). A retrospective study was conducted identifying 362 patients 65 years and older in our Level I trauma center who received computerized tomography (CT) scans with intravenous contrast. CIN was defined as a 25 per cent increase in serum creatinine levels or a 0.5 mg/dL increase above baseline after CT. History of diabetes mellitus, hospital length of stay, intensive care unit length of stay, Injury Severity Score (ISS), and age were recorded. Eighteen per cent (21 of 118) of the patients had a peak in creatinine, 12 per cent (14 of 118) peaked and returned to baseline, and 6 per cent (7 of 118) peaked and stayed high. Pre-CT elevated creatinine, diabetes mellitus, increased hospital length of stay, ISS, and age show little association to CIN. The data suggest that CIN in elderly trauma patients is rare, regardless of history of diabetes mellitus, age, creatinine, high ISS, or result in higher length of stay. Therefore, there is little justification for the delay in diagnosis to assess a patient's renal susceptibility.

Propofol Infusion Syndrome: Efficacy of a Prospective Screening Protocol

2018 ◽  
Vol 84 (8) ◽  
pp. 1333-1338 ◽  
Author(s):  
Thomas J. Schroeppel ◽  
L. Paige Clement ◽  
Danielle L. Barnard ◽  
Whitney Guererro ◽  
Margaret D. Ferguson ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Unit Length ◽  
Hospital Length ◽  
Serum Lactate ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Propofol Infusion Syndrome ◽  
Positive Screen ◽  
Screening Protocol

Propofol infusion syndrome (PIS) is a potentially lethal complication of propofol marked by rhabdomyolysis, metabolic acidosis, and cardiac arrhythmias or collapse. The objective of this study was to determine the effectiveness of a prospective screening protocol to prevent PIS. All trauma patients admitted who received propofol as a continuous infusion were prospectively screened from November 1, 2013 to December 31, 2015. Variables studied included demographics, injury severity, laboratory values, infusion rates, and mortality. Serum creatine phosphokinase (CPK) and lactate were drawn daily. Propofol was stopped for a positive screen defined as an increase in CPK to greater than 5000 IU/L or lactate greater than 4 mmol/L. Positive and negative cohorts were compared. Two hundred and twenty-five patients met the inclusion criteria and 12 patients (5.3%) had propofol stopped because of elevated CPK. No differences were identified in demographics, transfusions, injury severity, hospital length of stay, or propofol dose. The positive screened group had longer intensive care unit length of stay (20 vs 13 days; P = 0.002) and increased vent days (14.5 vs 10 days; P = 0.008). Max serum osmolality (334 vs 305 mosm/kg; P = 0.049) and max serum CPK (6782 vs 1058 IU/L; P < 0.0001) were higher in the positive cohort. No cases of PIS occurred, and mortality (16.7 vs 15.5%; P = 0.999) was not different between the cohorts. The screening protocol was effective in eliminating PIS. Serial CPK evaluations provided an effective screening tool and serum lactate can be dropped from screening.

PP8 Trauma and the obesity epidemic: a systematic review of the impact of obesity on trauma mortality and morbidity

2019 ◽  
Vol 36 (10) ◽  
pp. e5.1-e5
Author(s):  
Simon Mayer ◽  
Sumitra Lahiri ◽  
Joseph Rowles
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Strong Relationship ◽  
Normal Weight ◽  
The Body ◽  
Trauma Patients ◽  
Mortality And Morbidity ◽  
The Impact

BackgroundTrauma and obesity are both current global epidemics. A simple way to measure the body habitus of patients, to identify the overweight or obese is via the internationally recognized calculation of body mass index (BMI). The primary aim of this systematic review is to assess the mortality rate of those patients with a BMI > 30 kg/m2 in relation to traumatic injury and secondly to assess the effect of those patients with BMI > 30 kg/m2 upon the length of stay in hospital with regards to traumatic injury.MethodA systematic review of the literature was conducted via an internet search of databases and hand searching of references in identified publications from 1st January 1990 to 17th February 2018. Data was extracted from identified publications to include odds ratios of mortality and total length of stay in hospital (days) for patients with a BMI >30 kg/m2 from included studies when compared to patients with a BMI <24.9 kg/m2.ResultsA total of 23 studies met the inclusion criteria. 32, 378 patients were admitted to hospital with a BMI >30 kg/m2 and recorded injury severity score (ISS). Data collated identified BMI >30 kg/m2 OR 1.66 (95% CI 0.75 – 4.2) vs BMI <24.9 kg/m2 OR 0.93 (95% CI 0.82–1.5) to suffer mortality. ISS, BMI >30 kg/m2–19.93 vs 22.3 respectively. Furthermore, those categorised as BMI >30 kg/m2 have 3.78 additional days in the hospital compared to those defined as normal weight.ConclusionThis systematic review presents a strong relationship of increased mortality and complications in trauma patients with BMI >30 kg/m2. Complications are suggestive of those who have a BMI >30 kg/m2 are more likely to suffer detrimental effects following trauma predominantly due to pre-existing unknown co-morbidities. Although, the direct relationship between obesity, trauma and mortality is not fully understood at present and requires more research.

Dabigatran Use Does Not Increase Intracranial Hemorrhage in Traumatic Geriatric Falls When Compared with Warfarin

2015 ◽  
Vol 81 (10) ◽  
pp. 1039-1042 ◽  
Author(s):  
Anthony Pozzessere ◽  
Jonathan Grotts ◽  
Stephen Kaminski
Keyword(s):  
Length Of Stay ◽  
Intracranial Hemorrhage ◽  
Injury Severity ◽  
Unit Length ◽  
Hospital Length Of Stay ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Exact Matching ◽  
Increased Risk ◽  
Community Trauma

Patients on anticoagulation are at increased risk for intracranial hemorrhage (ICH) after trauma. This is important for geriatric trauma patients, who are increasing in number, frequently fall, and often take anticoagulants. This study sought to evaluate whether prehospital use of dabigatran, a newer anticoagulant, is associated with outcome differences in geriatric trauma patients suffering falls when compared with warfarin. The registry of a Level II community trauma center was used to identify 247 patients aged 65 and older who sustained a fall while taking prehospital dabigatran or warfarin admitted between December 2010 and March 2014. Patients on warfarin were included if their International Normalized Ratio was therapeutic (2–3). About 176 of the 247 patients were then compared using coarsened exact matching. In the matched analysis, overall population means for age, Glasgow Coma Score, and Injury Severity Score were 83.5, 14.7, and 5.1, respectively. The overall rate of ICH was 12.5 per cent, with a mortality rate of 16.1 per cent for patients who sustained an ICH. There were no observed differences in ICH, hospital length of stay, intensive care unit length of stay, or mortality between patients taking prehospital warfarin or dabigatran.

Pain Assessment and Control in the Injured Elderly

2016 ◽  
Vol 82 (10) ◽  
pp. 867-871 ◽  
Author(s):  
Ara Ko ◽  
Megan Y. Harada ◽  
Eric J.T. Smith ◽  
Michael Scheipe ◽  
Rodrigo F. Alban ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Injury Severity ◽  
Unit Length ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Increased Risk ◽  
Elderly Trauma Patients

Elderly trauma patients may be at increased risk for underassessment and inadequate pain control in the emergency department (ED). We sought to characterize risk factors for oligoanalgesia in the ED in elderly trauma patients and determine whether it impacts outcomes in elderly trauma patients. We included elderly patients (age ≥55 years) with Glasgow Coma Scale scores 13 to 15 and Injury Severity Score (ISS) ≥9 admitted through the ED at a Level I trauma center. Patient characteristics and outcomes were compared between those who reported pain and received analgesics medication in the ED (MED) and those who did not (NO MED). A total of 183 elderly trauma patients were identified over a three-year study period, of whom 63 per cent had pain assessed via verbal pain score; of those who reported pain, 73 per cent received analgesics in the ED. The MED and NO MED groups were similar in gender, race, ED vitals, ISS, and hospital length of stay. However, NO MED was older, with higher head Abbreviated Injury Scale score and longer intensive care unit length of stay. Importantly, as patients aged they reported lower pain and were less likely to receive analgesics at similar ISS. Risk factors for oligoanalgesia may include advanced age and head injury.

The Impact of Anticoagulation on Trauma Outcomes

2020 ◽  
Vol 86 (7) ◽  
pp. 773-781
Author(s):  
Rosalynn K. Nguyen ◽  
James H. Rizor ◽  
Michael P. Damiani ◽  
Andrew J. Powers ◽  
Jacob T. Fagnani ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Anticoagulation Therapy ◽  
Care Facility ◽  
Data Bank ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Outcomes ◽  
The Impact

Background Increased prevalence of patients on anticoagulants and the advent of new therapies raise concern over how these patients fare if they sustain a traumatic injury. We investigated the role of prehospitalization anticoagulation therapy in trauma-related mortality and postacute disposition. Methods A retrospective analysis was performed on patients who sustained traumatic injury identified in the 2017 National Trauma Data Bank (NTDB). Patients with and without anticoagulation therapy were analyzed to identify differences in demographics, injury type, Injury Severity Score (ISS), and trauma outcomes including hospital length of stay, ER, final hospital disposition, and mortality. Logistic regression was used to correlate anticoagulation to mortality and facility discharge. Results Of the 1 000 596 patients included, 73 602 (7%) patients were on anticoagulants at the time of their trauma. Increased age was the strongest predictor for anticoagulation therapy (odds ratio 5.54, 95% CI 5.44-5.63), but being female and white were also independent predictors of anticoagulation ( P < .001). Patients on anticoagulants had a significantly longer length of stay (5.11 days; 95% CI 5.06-5.15) than those who were not (4.37 days, 95% CI 4.36-4.39), were 2.20 times more likely to die (95% CI 2.12-2.28, P < .001), and were 2.77 times more likely to be discharged to a facility (95% CI 2.73-2.81, P < .001). Anticoagulation remained a significant predictor of worse trauma outcomes even when accounting for age and ISS in multivariate analysis. Discussion Anticoagulation preceding trauma-related admission is associated with higher mortality and an increased likelihood of the need for a posthospital care facility.

Use of Damage Control and the Open Abdomen in Combat

2013 ◽  
Vol 79 (8) ◽  
pp. 747-753 ◽  
Author(s):  
Benjamin Bograd ◽  
Carlos Rodriguez ◽  
Richard Amdur ◽  
Fred Gage ◽  
Eric Elster ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Multivariate Regression ◽  
Injury Severity ◽  
Open Abdomen ◽  
Damage Control ◽  
Unit Length ◽  
Significant Risk ◽  
Hospital Length Of Stay ◽  
Study Cohort ◽  
Regression Analyses

Despite the well-documented use of damage control laparotomy (DCL) in civilian trauma, its use has not been well described in the combat setting. Therefore, we sought to document the use of DCL and to investigate its effect on patient outcome. Prospective data were collected on 1603 combat casualties injured between April 2003 and January 2009. One hundred seventy patients (11%) underwent an exploratory laparotomy (ex lap) in theater and comprised the study cohort. DCL was defined as an abbreviated ex lap resulting in an open abdomen. Patients were stratified by age, Injury Severity Score (ISS), Glasgow Coma Score (GCS), mechanism of injury, and blood product administration. Multivariate regression analyses were used to determine risks factors for intensive care unit length of stay (ICU LOS), hospital length of stay (HLOS), and the need for DCL. Mean age of the cohort was 24 ± 5 years, ISS was 21 ± 11, and 94 per cent sustained penetrating injury. Patients with DCL comprised 50.6 per cent (n = 86) of the study cohort and had significant increases in ICU admission ( P < 0.001), ICU LOS ( P < 0.001), HLOS ( P < 0.05), ventilator days ( P < 0.001), abdominal complications ( P < 0.05), but not mortality ( P = 0.65) compared with patients without DCL. When compared with the non-DCL group, patients undergoing DCL required significantly more blood products (packed red blood cells, fresh-frozen plasma, platelets, and cryoprecipitate; P < 0.001). Multivariate regression analyses revealed blood transfusion and GCS as significant risk factors for DCL ( P < 0.05). Patients undergoing DCL had increased complications and resource use but not mortality compared with patients not undergoing DCL. The need for combat DCL may be different compared with civilian use. Prospective studies to evaluate outcomes of DCL are warranted.

scholarly journals Does emergency medicine length of stay predict trauma outcomes at a Level 1 Trauma Center?

2015 ◽  
Vol 4 (5) ◽  
pp. 1 ◽  
Author(s):  
Erin Powers Kinney ◽  
Kamal Gursahani ◽  
Eric Armbrecht ◽  
Preeti Dalawari
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Hospital Capacity ◽  
Significant Difference ◽  
Level 1 ◽  
Level 1 Trauma Center

Objective: Previous studies looking at emergency department (ED) crowding and delays of care on outcome measures for certain medical and surgical patients excluded trauma patients. The objectives of this study were to assess the relationship of trauma patients’ ED length of stay (EDLOS) on hospital length of stay (HLOS) and on mortality; and to examine the association of ED and hospital capacity on EDLOS.Methods: This was a retrospective database review of Level 1 and 2 trauma patients at a single site Level 1 Trauma Center in the Midwest over a one year period. Out of a sample of 1,492, there were 1,207 patients in the analysis after exclusions. The main outcome was the difference in hospital mortality by EDLOS group (short was less than 4 hours vs. long, greater than 4 hours). HLOS was compared by EDLOS group, stratified by Trauma Injury Severity Score (TRISS) category (< 0.5, 0.51-0.89, > 0.9) to describe the association between ED and hospital capacity on EDLOS.Results: There was no significant difference in mortality by EDLOS (4.8% short and 4% long, p = .5). There was no significant difference in HLOS between EDLOS, when adjusted for TRISS. ED census did not affect EDLOS (p = .59), however; EDLOS was longer when the percentage of staffed hospital beds available was lower (p < .001).Conclusions: While hospital overcrowding did increase EDLOS, there was no association between EDLOS and mortality or HLOS in leveled trauma patients at this institution.

Sign in / Sign up

Export Citation Format

Share Document