The Impact of the Tertiary Survey in an Established Trauma Program

2020 ◽  
pp. 000313482095144
Author(s):  
Brendan P. Mitchell ◽  
Kelly Stumpff ◽  
Stepheny Berry ◽  
James Howard ◽  
Ashley Bennett ◽  
...  
Keyword(s):  
Trauma Care ◽  
Trauma Registry ◽  
Trauma Patients ◽  
Advanced Practice ◽  
Completion Rates ◽  
Resident Physicians ◽  
Tertiary Survey ◽  
Secondary Injuries ◽  
The Impact ◽  
Modern Era

Introduction The trauma tertiary survey (TTS) was first described in 1990 and is recognized as an essential practice in trauma care. The TTS remains effective in detecting secondary injuries in the modern era. Methods Trauma patients discharged between August 1, 2016, and December 31, 2016, were identified in our trauma registry. Collected data include TTS completion rates, detection of injuries, type of provider, and timing. TTS documentation was qualitatively evaluated. Results Out of 407 patients, 264 patients (65%) received a TTS. Injury detection rate was 1.1.%. Average time to TTS was 41 hours. TTS were completed by resident physicians (46%) and advanced practice providers (APPs; 46%). TTS documentation was more complete for APPs than for resident physicians. Conclusion TTS remains an integral component of modern trauma care. Ongoing education on the significance of TTS and the importance of thorough documentation is essential. Provision of real-time feedback to providers is also critical for improving current practices.

Dispatch, Prehospital time, Interventions and Outcomes in a Norwegian Trauma population – assessing initial trauma management in urban and rural areas. The DIONT-project: a national registry-based research protocol (Preprint)

2021 ◽  
Author(s):  
Inger Nilsbakken ◽  
Stephen Sollid ◽  
Torben Wisborg ◽  
Elisabeth Jeppesen
Keyword(s):  
Statistical Methods ◽  
Rural Areas ◽  
Trauma Registry ◽  
Trauma System ◽  
Trauma Patients ◽  
Trauma Management ◽  
Trauma Systems ◽  
Urban And Rural Areas ◽  
Prehospital Time ◽  
The Impact

BACKGROUND Time is considered an essential determinant in the initial care of trauma patients. In Norway, the particular time indicator response time (i.e. time from dispatch center call to ambulance arrival at scene) is a controversial national quality indicator. However, no national requirements for response times have been established. There is an ongoing debate regarding the optimal configuration of the Norwegian trauma system. Recent centralization of trauma services and closure of emergency hospitals have increased distances for prehospital transports, predominantly for rural trauma patients. The impact of trauma system configuration on early trauma management in urban and rural areas is inadequately described. OBJECTIVE The project will assess the injured patient´s initial pathway through the trauma system and explore differences between central and rural areas in a Norwegian trauma cohort. This field is unexplored at a national level and existing evidence for an optimal organization of trauma care is still inconclusive regarding the impact of prehospital time. METHODS Three quantitative registry-based retrospective cohort studies are planned. The studies based on data from the Norwegian Trauma Registry (NTR) (Study 1, 2 and 3) and local Emergency Medical Communications Center (EMCC) data (Study 2). All injured adult patients admitted to a Norwegian hospital and registered in the NTR in the period 1st of January 2015 to 31st of December 2020 will be included in the analysis. Trauma registry data will be analyzed using descriptive statistical methods and relevant statistical methods to compare prehospital time in rural and central areas including regression analyses and adjusting for confounders. RESULTS The project received funding autumn 2020 and is approved by the Oslo University Hospital data protection officer, case number 18/02592. Registry data including approximately 40.000 trauma patients will be extracted during the first quarter of 2022 and analysis will begin immediately thereafter. Results are expected to be ready for publication from the third quarter of 2022. CONCLUSIONS : Findings from the study will contribute to new knowledge regarding existing quality indicators and with an increasing centralization of hospitals and residents, the study will contribute to further development of the Norwegian trauma system. A high generalizability to other trauma systems is expected, given the similarities between demographical changes and trauma systems in many high-income countries.

The Effect of Anticoagulation and Antiplatelet Use in Trauma Patients on Mortality and Length of Stay

2021 ◽  
pp. 000313482198904
Author(s):  
Nisha Narula ◽  
Savas Tsikis ◽  
Sayuri P. Jinadasa ◽  
Charles S. Parsons ◽  
Charles H. Cook ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Trauma Registry ◽  
Multivariable Analysis ◽  
Trauma Patients ◽  
Inclusion Criteria ◽  
Hemorrhage Control ◽  
Discharge Outcomes ◽  
Control Procedures ◽  
The Impact

Background Though many trauma patients are on anticoagulation or antiplatelet therapy (AAT), there are few generalizable data on the risks for these patients. The purpose of this study was to analyze the impact of anticoagulation (AC) and antiplatelet (AP) therapy on mortality and length of stay (LOS) in general trauma patients. Methods A retrospective review was performed of patients in the institutional trauma registry during 2019 to determine AAT use on admission and discharge. Outcomes were compared using standard statistics. Results Of 2261 patients who met the inclusion criteria, 2 were excluded due to an incomplete medication reconciliation, resulting in 2259 patients. Patients on AAT had a higher mortality (4.5% vs 2.1%). On multivariable analysis, preadmission AC (odds ratio OR, 3.325, P = .001), age (OR 1.040, P < .001), and injury severity score ((ISS) 1.094, P < .001) were associated with mortality. Anticoagulation use was also associated with longer LOS on multivariable analysis (OR: 1.626, P = .005). Antiplatelet use was not associated with higher mortality or longer LOS. More patients on AAT were unable to be discharged home. However, patients on AAT did not have a greater blood transfusion requirement or need more hemorrhage control procedures. Lastly, 23.7% of patients on preadmission AAT were not discharged on any AAT. Discussion These data demonstrate that patients on AC, but not AP, have greater mortality and longer hospital LOS. This may provide guidance for those being newly started on AAT. Further work to determine which patients benefit most from restarting AAT would lead to improvement in the care of trauma patients.

scholarly journals Profile of trauma mortality and trauma care resources at rural emergency departments and urban trauma centres in Quebec: a population-based, retrospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028512 ◽  
Author(s):  
Richard Fleet ◽  
François Lauzier ◽  
Fatoumata Korinka Tounkara ◽  
Stéphane Turcotte ◽  
Julien Poitras ◽  
...  
Keyword(s):  
Cohort Study ◽  
Outcome Measures ◽  
Trauma Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Trauma Registry ◽  
Mortality Rates ◽  
Secondary Outcome ◽  
Trauma Patients ◽  
Trauma Centres

ObjectivesAs Canada’s second largest province, the geography of Quebec poses unique challenges for trauma management. Our primary objective was to compare mortality rates between trauma patients treated at rural emergency departments (EDs) and urban trauma centres in Quebec. As a secondary objective, we compared the availability of trauma care resources and services between these two settings.DesignRetrospective cohort study.Setting26 rural EDs and 33 level 1 and 2 urban trauma centres in Quebec, Canada.Participants79 957 trauma cases collected from Quebec’s trauma registry.Primary and secondary outcome measuresOur primary outcome measure was mortality (prehospital, ED, in-hospital). Secondary outcome measures were the availability of trauma-related services and staff specialties at rural and urban facilities. Multivariable generalised linear mixed models were used to determine the relationship between the primary facility and mortality.ResultsOverall, 7215 (9.0%) trauma patients were treated in a rural ED and 72 742 (91.0%) received treatment at an urban centre. Mortality rates were higher in rural EDs compared with urban trauma centres (13.3% vs 7.9%, p<0.001). After controlling for available potential confounders, the odds of prehospital or ED mortality were over three times greater for patients treated in a rural ED (OR 3.44, 95% CI 1.88 to 6.28). Trauma care setting (rural vs urban) was not associated with in-hospital mortality. Nearly all of the specialised services evaluated were more present at urban trauma centres.ConclusionsTrauma patients treated in rural EDs had a higher mortality rate and were more likely to die prehospital or in the ED compared with patients treated at an urban trauma centre. Our results were limited by a lack of accurate prehospital times in the trauma registry.

Use of Payer as a Proxy for Health Insurance Status on Admission Results in Misclassification of Insurance Status among Pediatric Trauma Patients

2016 ◽  
Vol 82 (2) ◽  
pp. 146-151 ◽  
Author(s):  
Elizabeth A. Carter ◽  
Lauren J. Waterhouse ◽  
Roy Xiao ◽  
Randall S. Burd
Keyword(s):  
Emergency Department ◽  
Health Insurance ◽  
Confidence Interval ◽  
Trauma Registry ◽  
Pediatric Trauma ◽  
Insurance Status ◽  
Trauma Patients ◽  
Patient Medical Record ◽  
Health Insurance Status ◽  
The Impact

The purpose of this study was to quantify health insurance misclassification among children treated at a pediatric trauma center and to determine factors associated with misclassification. Demographic, medical, and financial information were collected for patients at our institution between 2008 and 2010. Two health insurance variables were created: true (insurance on hospital admission) and payer (source of payment). Multivariable logistic regression was used to determine which factors were independently associated with health insurance misclassification. The two values of health insurance status were abstracted from the hospital financial database, the trauma registry, and the patient medical record. Among 3630 patients, 123 (3.4%) had incorrect health insurance designation. Misclassification was highest in patients who died: 13.9 per cent among all deaths and 30.8 per cent among emergency department deaths. The adjusted odds of misclassification were 6.7 (95% confidence interval: 1.7, 26.6) among patients who died and 16.1 (95% confidence interval: 3.2, 80.77) among patients who died in the emergency department. Using payer as a proxy for health insurance results in misclassification. Approaches are needed to accurately ascertain true health insurance status when studying the impact of insurance on treatment outcomes.

scholarly journals Pediatric Orthopedic Trauma Care During the COVID-19 Pandemic: A Survey of the Pediatric Orthopedic Society of North America

2021 ◽  
pp. 155633162110560
Author(s):  
Mitchell A. Johnson ◽  
Theodore J. Ganley ◽  
Lindsay Crawford ◽  
Ishaan Swarup
Keyword(s):  
North America ◽  
Trauma Care ◽  
Care Delivery ◽  
Trauma Surgery ◽  
Trauma Patients ◽  
Orthopedic Trauma ◽  
Fracture Management ◽  
Pediatric Orthopedic ◽  
The Impact

Background: The COVID-19 pandemic has dramatically altered the practice of pediatric orthopedic trauma surgery in both outpatient and inpatient settings. While significant declines in patient volume have been noted, the impact on surgeon decision-making is unclear. Purpose: We sought to investigate changes in pediatric orthopedic trauma care delivery as a result of COVID-19 and determine their implications for future orthopedic practice. Methods: An electronic survey was distributed to all members (N = 1515) of the Pediatric Orthopedic Society of North America (POSNA) in March to April 2021; only members who provided care for pediatric orthopedic trauma patients were asked to complete it. The survey included questions on hospital trauma call, inpatient care, outpatient clinic practice, and 3 unique fracture case scenarios. Results: A total of 147 pediatric orthopedic surgeons completed the survey, for a 9.7% response rate, with 134 (91%) taking trauma call at a hospital as part of their practice. Respondents reported significant differences across institutions regarding COVID-19 testing, hospital rounding, and employee COVID-19 screening. Changes in outpatient fracture management were observed, including a decreased number of follow-up visits for nondisplaced clavicle fractures, distal radius buckle fractures, and toddler’s fractures. Of respondents who changed their fracture follow-up schedules due to COVID-19, over 75% indicated that they would continue these outpatient treatment schedules after the pandemic. Conclusions: This survey found changes in pediatric orthopedic trauma care as a result of the COVID-19 pandemic. The use of telemedicine and abbreviated follow-up practices for common fracture types are likely to persist following the resolution of the COVID-19 pandemic.

FORMATION OF HUMAN CAPITAL IN THE DIGITAL TRANSFORMATION PARADIGM

2020 ◽  
Vol 2 (5) ◽  
pp. 115-119
Author(s):  
M. V. SAVINA ◽  
◽  
A. A. STEPANOV ◽  
I.A. STEPANOV ◽  
◽  
...  
Keyword(s):  
Human Capital ◽  
Digital Age ◽  
Digital Transformation ◽  
Educational Process ◽  
Knowledge And Skills ◽  
Main Components ◽  
The Impact ◽  
Modern Era

The article highlights the problems of the impact of "digitalization" of society on the formation and transformation of human capital, and above all, the development of new competencies, knowledge and skills. The main components of human capital in the modern era, the features of the formal and informal educational process are clarified and disclosed. The necessity of minimizing the precariat class is proved. The main directions of qualitative improvement of human capital adequate to the challenges of the digital age and globalization are defined.

Authors’ response to AAEM on the impact of advanced practice provider staffing in emergency departments

2021 ◽  
Author(s):  
Jesse M. Pines ◽  
Amer Z. Aldeen ◽  
John Bedolla ◽  
Maura Polansky ◽  
Tamara S. Ritsema ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Advanced Practice ◽  
The Impact

scholarly journals The impact of regionalized trauma care on the distribution of severely injured patients in the Netherlands

2021 ◽  
Author(s):  
Suzan Dijkink ◽  
Erik W. van Zwet ◽  
Pieta Krijnen ◽  
Luke P. H. Leenen ◽  
Frank W. Bloemers ◽  
...  
Keyword(s):  
The Netherlands ◽  
Trauma Care ◽  
Trauma System ◽  
Future Research ◽  
Severely Injured ◽  
Trauma Centers ◽  
Severely Injured Patients ◽  
The Right ◽  
Injured Patients ◽  
The Impact

Abstract Background Twenty years ago, an inclusive trauma system was implemented in the Netherlands. The goal of this study was to evaluate the impact of structured trauma care on the concentration of severely injured patients over time. Methods All severely injured patients (Injury Severity Score [ISS] ≥ 16) documented in the Dutch Trauma Registry (DTR) in the calendar period 2008–2018 were included for analysis. We compared severely injured patients, with and without severe neurotrauma, directly brought to trauma centers (TC) and non-trauma centers (NTC). The proportion of patients being directly transported to a trauma center was determined, as was the total Abbreviated Injury Score (AIS), and ISS. Results The documented number of severely injured patients increased from 2350 in 2008 to 4694 in 2018. During this period, on average, 70% of these patients were directly admitted to a TC (range 63–74%). Patients without severe neurotrauma had a lower chance of being brought to a TC compared to those with severe neurotrauma. Patients directly presented to a TC were more severely injured, reflected by a higher total AIS and ISS, than those directly transported to a NTC. Conclusion Since the introduction of a well-organized trauma system in the Netherlands, trauma care has become progressively centralized, with more severely injured patients being directly presented to a TC. However, still 30% of these patients is initially brought to a NTC. Future research should focus on improving pre-hospital triage to facilitate swift transfer of the right patient to the right hospital.

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