Injured Adolescents, Not Just Large Children: Difference in Care and Outcome between Adult and Pediatric Trauma Centers

2013 ◽  
Vol 79 (3) ◽  
pp. 267-273 ◽  
Author(s):  
Kazuhide Matsushima ◽  
Eric W. Schaefer ◽  
Eugene J. Won ◽  
Pamela A. Nichols ◽  
Heidi L. Frankel
Keyword(s):  
Regression Models ◽  
Multivariable Analysis ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Complication Rates ◽  
Trauma Centers ◽  
Significant Difference ◽  
Multivariable Regression ◽  
Multivariable Regression Models ◽  
Emergent Laparotomy

Adolescent injury victims receive care at adult trauma centers (ATCs) and pediatric trauma centers (PTCs). The purpose of this study was to identify care variations and their impact on the outcome of adolescent trauma patients treated at PTC versus ATC. We queried the Pennsylvania Trauma Systems Foundation database for trauma patients between 13 and 18 years of age from 2005 to 2010. Mortality and hospital complication rates between ATC and PTC were compared in univariable and multivariable analysis. In addition, the differences in the delivery of care were also compared. Of 9033 total patients, 6027 (67%) received care at an ATC. Patients in the ATC group were older (16.7 vs 14.9 years, P < 0.001) and more severely injured (Injury Severity Score: 14.5 vs 12.2, P < 0.001). Admission diagnostic computed tomography (CT), emergent laparotomy and craniotomy, blood transfusion, and drug screening were more frequently performed at an ATC. After adjustment for potential confounders in multivariable regression models, treatment at a PTC was significantly associated with fewer CTs for transferred patients (odds ratio [OR], 0.28; P < 0.001) and with less frequent emergent laparotomy for all patients (OR, 0.65; P = 0.007). The ATC group had a significantly higher hospital mortality rate (2.9 vs 0.9%, P < 0.001) and complication rate (9.7 vs 4.8%, P < 0.001). However, these outcomes were not significantly different between PTC and ATC in multivariable regression models. In the state of Pennsylvania, there were no significant differences in risk-adjusted outcomes between PTC and ATC despite significant difference in use of CT scanning and emergent laparotomy.

Percutaneous versus Open Tracheostomy in the Pediatric Trauma Population

2010 ◽  
Vol 76 (3) ◽  
pp. 276-278 ◽  
Author(s):  
Ashish Raju ◽  
D'Andrea K. Joseph ◽  
Cheickna Diarra ◽  
Steven E. Ross
Keyword(s):  
Injury Severity ◽  
Percutaneous Tracheostomy ◽  
Pediatric Trauma ◽  
Retrospective Chart Review ◽  
Feeding Tube ◽  
Tube Placement ◽  
Trauma Patients ◽  
Complication Rates ◽  
Trauma Population ◽  
Significant Difference

The purpose of this study was to determine the safety and efficacy of percutaneous versus open tracheostomy in the pediatric trauma population. A retrospective chart review was conducted of all tracheostomies performed on trauma patients younger than 18 years for an 8-year period. There was no difference in the incidence of brain, chest, or facial injury between the open and percutaneous tracheostomy groups. However, the open group had a significantly lower age (14.2 vs. 15.5 years; P < 0.01) and higher injury severity score (26 vs. 21; P = 0.015). Mean time from injury to tracheostomy was 9.1 days (range, 0 to 16 days) and was not different between the two methods. The majority of open tracheostomies were performed in the operating room and, of percutaneous tracheostomies, at the bedside. Concomitant feeding tube placement did not affect complication rates. There was not a significant difference between complication rates between the two methods of tracheostomy (percutaneous one of 29; open three of 20). Percutaneous tracheostomy can be safely performed in the injured older child.

Impact of Age on Short-term Outcomes After Lumbar Fusion

Neurosurgery ◽  
2015 ◽  
Vol 77 (3) ◽  
pp. 347-354 ◽  
Author(s):  
Mohamad Bydon ◽  
Nicholas B. Abt ◽  
Rafael De la Garza-Ramos ◽  
Israel O. Olorundare ◽  
Kelly McGovern ◽  
...  
Keyword(s):  
Lumbar Fusion ◽  
Multivariable Analysis ◽  
The Elderly ◽  
Complication Rates ◽  
Improvement Program ◽  
Younger Patients ◽  
Age Cohorts ◽  
Significant Difference ◽  
Age Cohort ◽  
Multivariable Regression

Abstract BACKGROUND: The safety and efficacy of spinal fusion in the elderly population remains uncertain with conflicting data. OBJECTIVE: To determine if elderly patients undergoing instrumented lumbar fusion have increased 30-day complication rates compared to younger patients. METHODS: The American College of Surgeons National Surgical Quality Improvement Program was used to identify all patients undergoing instrumented posterolateral lumbar fusion between 2005 and 2011. Patients were stratified by decade cohorts as follows: &lt;65, 65 to 75, 75 to 85, and ≥85 years old. All 30-day complications were grouped as overall composite morbidity and were compared using multivariate analysis. RESULTS: A total of 1395 patients were identified and the overall 30-day complication rate was 11.47%. The complication rates were 9.04% and 14.05% for patients younger than 65 and older than 65, respectively. When stratified by decade cohorts, the complication rates were 9.04% for the &lt;65 cohort, 13.46% for the 65 to 75 cohort, 16.17% for the &gt;75 to 85 cohort, and 4.00% for the ≥85 cohort. Multivariable regression analysis revealed no statistically significant difference between the &lt;65 and ≥65 age cohorts (odds ratio = 1.26; 95% confidence interval: 0.87-2.19). After stratifying into age cohorts, multivariable analyses revealed no difference in odds of postoperative complication occurrence for any age cohort when compared with the referent group (&lt;65 years of age). CONCLUSION: Patients older than 65 years of age have significantly higher rates of complications after lumbar fusion when compared to younger patients. However, multivariable analysis revealed that age was not an independent risk factor for complication occurrence after lumbar fusion.

scholarly journals The Association between Delivery during the COVID-19 Pandemic and Immediate Postpartum Maternal Cognitive Function

2020 ◽  
Vol 9 (11) ◽  
pp. 3727
Author(s):  
Hagai Hamami ◽  
Eyal Sheiner ◽  
Tamar Wainstock ◽  
Elad Mazor ◽  
Talya Lanxner Battat ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Postpartum Period ◽  
Regression Models ◽  
Medical Center ◽  
Significant Difference ◽  
Neurocognitive Test ◽  
Multivariable Regression ◽  
Objective Tests ◽  
Multivariable Regression Models ◽  
Attention Function

Survivors of the 2003 SARS epidemic were found to have higher rates of adverse mental conditions. This study aimed to assess cognitive function in women delivering during the COVID-19 pandemic, as compared to women who delivered before the COVID-19 pandemic. A cohort study was performed during the immediate postpartum period of women delivering singletons at term. Cognitive function was assessed using an objective neurocognitive test (Symbol Digit Modalities Test SDMT90, SDMT4) and a subjective self-estimation questionnaire (Attention Function Index AFI). The exposed group was recruited during the COVID-19 outbreak in Israel (May 2020), whereas the comparison group consisted of women delivering at the same medical center before the COVID-19 pandemic (2016–2017). Multivariable regression models were constructed to control potential confounders. There were 79 parturients recruited during the COVID-19 pandemic and compared with 123 women who delivered before the COVID-19 pandemic. Women delivering during the COVID-19 pandemic scored lower in the subjective AFI test compared to the unexposed group (70.0 ± 15.4 vs. 75.1 ± 14.7, p = 0.018). However, no significant difference was found in the objective SDMT tests scores. These results remained similar in the multivariable regression models when controlling for maternal age, ethnicity and time from admission to assessment, for AFI, SDMT90 and SDMT4 scores (p = 0.014; p = 0.734; p = 0.786; respectively). While no significant difference was found in objective tests, our findings propose that the exposure to the COVID-19 pandemic is independently associated with a significant decrease in subjective maternal cognitive function during the immediate postpartum period.

scholarly journals Proctored Step by Step Training Program for GreenLight Laser Anatomic Photovaporization of the Prostate: A Single Surgeon's Experience

2021 ◽  
Vol 8 ◽  
Author(s):  
Francesco Sessa ◽  
Riccardo Campi ◽  
Stefano Granieri ◽  
Agostino Tuccio ◽  
Paolo Polverino ◽  
...  
Keyword(s):  
Training Program ◽  
Regression Models ◽  
Operative Time ◽  
Multivariable Analysis ◽  
Greenlight Laser ◽  
Surgeon Experience ◽  
Cumulative Summation ◽  
Multivariable Regression ◽  
Potential Impact ◽  
Multivariable Regression Models

Objectives: To evaluate the feasibility and safety of a proctored step-by-step training program for GreenLight laser anatomic photovaporization (aPVP) of the prostate.Methods: Data from patients undergoing aPVP between January 2019 and December 2020 operated by a single surgeon following a dedicated step-by-step proctored program were prospectively collected. The procedure was divided into five modular steps of increasing complexity. Preoperative patients' data as well as total operative time, energy delivered on the prostate and postoperative data, were recorded. Then, we assessed how the overall amount of energy delivered and the operative times varied during the training program. Surgical steps were analyzed by cumulative summation. Univariable and multivariable regression models were built to assess the predictors of the amount of energy delivered on the prostate.Results: Sixty consecutive patients were included in the analysis. Median prostate volume was 56.5 mL. The training program was succesfully completed with no intraoperative or meaningful post-operative complications. The energy delivered reached the plateau after the 40th case. At multivariable analysis, increasing surgeon experience was associated with lower amounts of energy delivered as well as lower operative times.Conclusions: A step-by-step aPVP training program can be safely performed by surgeons with prior endoscopic experience if mentored by a skilled proctor. Considering the energy delivered as an efficacy surrogate metrics (given its potential impact on persistent postoperative LUTS), 40 cases are needed to reach a plateau for aPVP proficiency. Further studies are needed to assess the safety of our step-by-step training modular program in other clinical contexts.

scholarly journals The Impact of Weather and Seasons on Falls and Physical Activity among Older Adults with Glaucoma: A Longitudinal Prospective Cohort Study

Sensors ◽  
2021 ◽  
Vol 21 (10) ◽  
pp. 3415
Author(s):  
Hursuong Vongsachang ◽  
Aleksandra Mihailovic ◽  
Jian-Yu E ◽  
David S. Friedman ◽  
Sheila K. West ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Fall Prevention ◽  
Regression Models ◽  
Activity Promotion ◽  
Injurious Fall ◽  
Multivariable Regression ◽  
Multivariable Regression Models ◽  
The Impact ◽  
The Relationship

Understanding periods of the year associated with higher risk for falling and less physical activity may guide fall prevention and activity promotion for older adults. We examined the relationship between weather and seasons on falls and physical activity in a three-year cohort of older adults with glaucoma. Participants recorded falls information via monthly calendars and participated in four one-week accelerometer trials (baseline and per study year). Across 240 participants, there were 406 falls recorded over 7569 person-months, of which 163 were injurious (40%). In separate multivariable regression models incorporating generalized estimating equations, temperature, precipitation, and seasons were not significantly associated with the odds of falling, average daily steps, or average daily active minutes. However, every 10 °C increase in average daily temperature was associated with 24% higher odds of a fall being injurious, as opposed to non-injurious (p = 0.04). The odds of an injurious fall occurring outdoors, as opposed to indoors, were greater with higher average temperatures (OR per 10 °C = 1.46, p = 0.03) and with the summer season (OR = 2.69 vs. winter, p = 0.03). Falls and physical activity should be understood as year-round issues for older adults, although the likelihood of injury and the location of fall-related injuries may change with warmer season and temperatures.

Abstract 3572: Clinical Outcomes of the “Stroke100 Club”

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Amy K Guzik ◽  
Rema Raman ◽  
Kain Ernstrom ◽  
Dawn M Meyer ◽  
Ajeet Sodhi ◽  
...  
Keyword(s):  
Regression Models ◽  
Young Patients ◽  
Older Age ◽  
Advanced Age ◽  
Stroke Severity ◽  
Old Patients ◽  
Multivariable Regression ◽  
Independent Variable ◽  
Poor Outcomes ◽  
Multivariable Regression Models

Background: Patients with advanced age or high NIHSS have poorer tPA outcomes. When combined, old age (≥80yo) and elevated NIHSS (≥20) may have an even worse outcome. Patients who are also in this “Stroke100 Club” (any combination of age and NIHSS ≥100) by other means, have not been fully assessed. We evaluated discharge destination, 90-day mRS, sICH and death in treated and untreated Stroke100 Club patients. We further compared patients with age ≥ 80 and NIHSS ≥ 20 (“80/20s”), those who reached 100 without both characteristics (“non80/20s”) and ‘controls’. Methods: The UCSD SPOTRIAS prospectively collected database was analyzed for AIS patients (with and without tPA). Multivariable regression models including the Stroke100 group as an independent variable was used. Outcomes were adjusted for baseline mRS. For comparing categorical outcomes between controls, “80/20s” and “non80/20s” subgroups, a Fisher’s exact was used. Results: The IV tPA subset included 257 patients (mean age 71, 52% male, 85% white, mean NIHSS 12). 53 were in the “Stroke100 Club” (28 80/20, 25 non80/20), with more women (68% p= 0.002), higher NIHSS (22.5 p<0.0001), older age (mean age 86.4 p<0.0001), higher pre stroke mRS (34.6% mRS 3-6 vs 7.84%, p<0.0001), more HTN (p=0.045) and more afib (p= 0.008). There were 284 non tPA patients (mean age 69.52, 54% male, 85% white, mean NIHSS 5.92). 21 were in the “Stroke100 Club” (14 80/20, 7 non80/20), with higher NIHSS (23 p<0.0001), older age (mean 86.2 p<0.0001), higher pre stroke mRS (45.5% 3-6 vs 9.5%, p= 0.0001), and more afib (p= 0.0002). Stroke100 Club 90day mRS(3-6) outcomes were worse in both tPA treated patients (OR=6.77, p= 0.0001) and nontreated patients (OR 31.57, p= 0.001). sICH rates (in tPA subjects) were not different (3.8% vs 3.4%, p> 0.99). Conclusions: There is a question of treatment outcome in patients with various permutations of stroke severity and advanced age. Our data corroborates the concern of poor outcomes for Stroke100 Club patients, but notes no increased sICH with tPA. Though outcome may be poor, withholding tPA should be discouraged as worse outcomes were not due to sICH. Young patients with severe strokes or old patients with mild strokes may have outcomes similar to the standard “80/20” Stroke100 patients, however further adjusted analysis is ongoing. In addition, further analyses are being done to compare tPA to non tPA patients.

Abstract WP341: Difference in Acute Ischemic Post Thrombolytic Stroke Outcomes in Pre Comprehensive and Post Comprehensive Status: Single Center Experience

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Vishal B Jani ◽  
Achint Patel ◽  
Jillian Schurr ◽  
Erin Shell ◽  
Julie Bey ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Secondary Outcome ◽  
Rank Test ◽  
Stroke Severity ◽  
Complication Rates ◽  
Single Center ◽  
Stroke Treatment ◽  
Significant Difference ◽  
Multivariable Regression ◽  
Iv Tpa

Background: In last decade there is a significant change in stroke care especialy with newer data for ischemic stroke treatment there is a movement to obtain comprehensive stroke center certification (CSCC) to provide enhanced complex care for stroke. This study aims to assess the single center quality matrix assessment pre and post CSC status Methods: We reviewed single center cohort of IV tPA (tissue plasminogen activator) in-between year 2010 to 2014 at sparrow health system in mid Michigan region. This cohort was dichotomized in pre CSCC and post CSCC era. Stroke quality matrics data was collected for these patients. Severity of stroke was categorized in mild-moderate vs moderate-severe based on NIH stroke scale (NIHSS) scale. Primary out come for this study was any complication, which is composite end point of in-hospital mortality, and hemorrhage and secondary outcome was hospital stay. Chi square, student’s t test and wilcoxon sum rank test was used to compare both groups. Multivariable regression models were utilized to calculate odd ratios after adjusting with stroke severity. Results: Cohort of IV tPA was identified in-between year 2010 to 2014 (332 hospitalizations off which 241 were pre CSCC and 91 were Post CSCC ). In- hospital complication was lower after receiving CSCC (9.89% vs. 21.99%; p:0.011). In multivariable regression analysis the trend for in hospital complication persisted [Adjusted Odds ratio (OR):0.43–95%confidence-Interval(CI):0.20-0.93–p:0.032] but there was no significant difference in hospital stay (Median days 5 vs. 5; P:673) Conclusion: There is a clear and persistent trend of low in-hospital complication rates after acquiring CSCC quality matrics.

scholarly journals Autonomy in the Operating Room: A Multicenter Study of Gender Disparities During Surgical Training

2021 ◽  
Vol 13 (5) ◽  
pp. 666-672
Author(s):  
Jenny X. Chen ◽  
Edward H. Chang ◽  
Francis Deng ◽  
Shari Meyerson ◽  
Brian George ◽  
...  
Keyword(s):  
Surgical Training ◽  
Gender Disparities ◽  
Training Level ◽  
Surgical Performance ◽  
Surgical Trainees ◽  
Significant Difference ◽  
Multivariable Regression ◽  
Operative Performance ◽  
And Performance ◽  
Multivariable Regression Models

ABSTRACT Background Gender disparities are prevalent in medicine, but their impact on surgical training is not well studied. Objective To quantify gender disparities in trainee intraoperative experiences and explore the variables associated with ratings of surgical autonomy and performance. Methods From September 2015 to May 2019, attending surgeons and trainees from 71 programs assessed trainee autonomy on a 4-level Zwisch scale and performance on a 5-level modified Dreyfus scale after surgical procedures. Multivariable regression models were used to examine the association of trainee gender with autonomy and performance evaluations. Results A total of 3255 trainees and attending surgeons completed 94 619 evaluations. Attendings gave lower ratings of operative autonomy to female trainees than male trainees when controlling for training level, attending, and surgical procedure (effect size B = −0.0199, P = .008). There was no difference in ratings of autonomy at the beginning of training (P = .32); the gap emerged as trainees advanced in years (B = −0.0163, P = .020). The gender difference in autonomy was largest for the most complex cases (B = −0.0502, P = .002). However, there was no difference in attending ratings of surgical performance for female trainees compared to male trainees (B = −0.0124, P = .066). Female trainees rated themselves as having less autonomy and worse performance than males when controlling for training level, attending, procedure, case complexity, and attending ratings (autonomy B = −0.0669, P &lt; .001; performance B = −0.0704, P &lt; .001). Conclusions While there was no significant difference in ratings of operative performance, a small difference between ratings of operative autonomy for female and male surgical trainees was identified.

Outcomes of Tube Thoracostomies Performed by Advanced Practice Providers vs Trauma Surgeons

2008 ◽  
Vol 17 (4) ◽  
pp. 357-363 ◽  
Author(s):  
Laura C. Bevis ◽  
Gina M. Berg-Copas ◽  
Bruce W. Thomas ◽  
Donald G. Vasquez ◽  
Ruth Wetta-Hall ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Insertion Site ◽  
Physician Assistants ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Advanced Practice ◽  
Trauma Centers ◽  
Significant Difference ◽  
Trauma Surgeons

Background The role of advanced registered nurse practitioners and physician assistants in emergency departments, trauma centers, and critical care is becoming more widely accepted. These personnel, collectively known as advanced practice providers, expand physicians’ capabilities and are being increasingly recruited to provide care and perform invasive procedures that were previously performed exclusively by physicians. Objectives To determine whether the quality of tube thoracostomies performed by advanced practice providers is comparable to that performed by trauma surgeons and to ascertain whether the complication rates attributable to tube thoracostomies differ on the basis of who performed the procedure. Methods Retrospective blinded reviews of patients’ charts and radiographs were conducted to determine differences in quality indicators, complications, and outcomes of tube thoracostomies by practitioner type: trauma surgeons vs advanced practice providers. Results Differences between practitioner type in insertion complications, complications requiring additional interventions, hospital length of stay, and morbidity were not significant. The only significant difference was a complication related to placement of the tube: when the tube extended caudad, toward the feet, from the insertion site. Interrater reliability ranged from good to very good. Conclusions Use of advanced practice providers provides consistent and quality tube thoracostomies. Employment of these practitioners may be a safe and reasonable solution for staffing trauma centers.

Preadmission Corticosteroid Therapy and the Risk of Respiratory Failure in Adults Without HIV Presenting With Pneumocystis Pneumonia

2019 ◽  
Vol 35 (12) ◽  
pp. 1465-1470 ◽  
Author(s):  
Patrick M. Wieruszewski ◽  
Erin F. Barreto ◽  
Jason N. Barreto ◽  
Hemang Yadav ◽  
Pritish K. Tosh ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Corticosteroid Therapy ◽  
Regression Models ◽  
Pneumocystis Pneumonia ◽  
Severe Respiratory Failure ◽  
Corticosteroid Administration ◽  
Multivariable Regression ◽  
Multivariable Regression Models ◽  
Reduced Risk ◽  
Hiv Negative

Background: Corticosteroid therapy is a well-recognized risk factor for Pneumocystis pneumonia (PCP); however, it has also been proposed as an adjunct to decrease inflammation and respiratory failure. Objective: To determine the association between preadmission corticosteroid use and risk of moderate-to-severe respiratory failure at the time of PCP presentation. Methods: This retrospective cohort study evaluated HIV-negative immunosuppressed adults diagnosed with PCP at Mayo Clinic from 2006 to 2016. Multivariable regression models were used to evaluate the association between preadmission corticosteroid exposure and moderate-to-severe respiratory failure at presentation. Results: Of the 323 patients included, 174 (54%) used preadmission corticosteroids with a median daily dosage of 20 (interquartile range: 10-40) mg of prednisone or equivalent. After adjustment for baseline demographics, preadmission corticosteroid therapy did not decrease respiratory failure at the time of PCP presentation (odds ratio: 1.23, 95% confidence interval: 0.73-2.09, P = .38). Additionally, after adjusting for inpatient corticosteroid administration, preadmission corticosteroid use did not impact the need for intensive care unit admission ( P = .98), mechanical ventilation ( P = .92), or 30-day mortality ( P = .11). Conclusions: Corticosteroid exposure before PCP presentation in immunosuppressed HIV-negative adults was not associated with a reduced risk of moderate-to-severe respiratory failure.

Sign in / Sign up

Export Citation Format

Share Document