Characteristics and Outcomes Associated With Emergent Rectal Foreign Body Management: A Retrospective Cohort Analysis.

Background Bedside management and outcomes of rectal foreign bodies remain challenging due to the presentation and complexity of the inserted objects. Injuries, such as perforation of the colon and rectum, are among the most commonly reported complications. However, prior studies are unclear regarding the setting in which the complication rates may be minimized. This study aimed to assess whether there was a statistically significant difference among the various extraction methods with regard to complications in the emergency department and operating room. Materials and methods This was a retrospective study of all cases of rectal foreign bodies that were removed in the emergency department at a large county hospital between 1/1/2010 and 12/31/2020. Patients included in this study were adults who were evaluated and treated in the emergency department. Results A total of 78 patients were included in the final analysis. More than half (51.3%, n=40) of the patients were successfully treated in the emergency department. Compared with the emergency department, patients in the operating room were more likely to undergo exploratory laparotomy and colectomy (0% vs. 31.6%, p<0.0001), undergo general anesthesia (84.2% vs. 0%, p<0.0001), have higher complication rates (21% vs. 0%, p=0.0021), and have a longer hospital length of stay (median=1 vs. 0, p<0.0001). Conclusion This study revealed a >50% success rate of rectal foreign body removal in the emergency department without any reported complications. To improve the success rate of bedside retrieval and decrease complications, physicians need to be vigilant, communicative, and compassionate about their evaluations and clinical methodology.

Comparison of emergency airway management techniques in the performance of emergent Cricothyrotomy.

INTRODUCTION: Emergent cricothyrotomy (EC) is a rare and lifesaving procedure to secure a difficult airway when other methods have failed. Many techniques have been discussed in the literature. This study aimed to identify major techniques used to perform EC in a regional trauma center and evaluate outcomes associated with the techniques. METHODS: Patients who underwent EC at Arrowhead Regional Medical Center between 1-1-2009 and 1-1-2019 were reviewed for eligibility for this study. Patients' data were extracted from the trauma database. Chi-square tests were conducted to assess the difference on variables between the techniques. RESULTS: A total of 51 (0.17%) of these patients required EC and were included in the database. The two most prevalent techniques were the scalpel-bougie-tube (SBT) and the surgical cricothyrotomy technique (SCT). More than half (n = 27, 52.9%) of the cohort received the SBT. There was no statistically significant difference between the two techniques with regards to demographic variables, including age (p = 0.7528), injury severity score (ISS, p = 0.896), gender (p = 0.3709), and race (p = 0.8935). However, the SCT group had a statistically higher Glasgow Coma Scale (GCS) than the SBT group (p = 0.0036). There was no statistically significant difference in mortality or complications between these two groups (p = 0.2172 for mortality). DISCUSSION: Two techniques of EC were identified as preferred techniques. Both procedures were successful in securing an emergency airway, noting a difference in the time to completion of the two techniques. Given the rarity of the procedure, practitioners may choose the method based on their training and the availability of appropriate instruments.

Variation in Trauma Team Response Fees in United States Trauma Centers: An Additional Undisclosed Variable Cost in Trauma Care.

BACKGROUND: The rising costs associated with trauma care in the United States is an important topic in today's healthcare environment. Factors such as innovations in technology, increasing governmental and organizational regulations, and the specialization of care have led to increasing costs to the patient. A component of trauma cost is the one-time trauma team response fee (TTRF). The determination process of the TTRF's dollar amount is elusive as no apparent standardized process exists and the literature is scant regarding this aspect of trauma care. METHODS: A nationwide cross-sectional convenience sample was conducted using SurveyMonkey. Surveys were sent to 525 trauma centers in the continental United States, including Alaska and Hawaii, between October 8, 2019 and March 11, 2020. Additionally, hospital medical directors and trauma medical directors were queried on their knowledge of their facility's TTRF amount. RESULTS: Only 46 out of 525 trauma centers, or 8.8% of those surveyed shared their scheduled fees. Comparisons of TTRFs among different trauma centers, activation levels, and geographical locations were not statistically significant. CONCLUSIONS: Understanding the true costs of trauma care and fees for patients in the United States remains elusive due to inadequate data and low response rates. Trauma centers struggle to maintain financial viability as regulatory agencies and the public push for transparency of TTRFs. Collaboration between trauma centers and regulatory agencies is needed to ensure a balance between providing quality trauma care with justified associated charges and financial sustainability.

Emergent needle thoracostomy in prehospital trauma patients: a review of procedural execution through computed tomography scans.

BACKGROUND: Traumatic tension pneumothoraces (TPT) are among the most serious causes of death in traumatic injuries, requiring immediate treatment with a needle thoracostomy (NT). Improperly placed NT insertion into the pleural cavity may fail to treat a life-threatening TPT. This study aimed to assess the accuracy of prehospital NT placements by paramedics in adult trauma patients. METHODS: A retrospective chart review was performed on 84 consecutive trauma patients who had received NT by prehospital personnel. The primary outcome was the accuracy of NT placement by prehospital personnel. Comparisons of various variables were conducted between those who survived and those who died, and proper versus improper needle insertion separately. RESULTS: Proper NT placement into the pleural cavity was noted in 27.4% of adult trauma patients. In addition, more than 19% of the procedures performed by the prehospital providers appeared to have not been medically indicated. DISCUSSION: Long-term strategies may be needed to improve the capabilities and performance of prehospital providers' capabilities in this delicate life-saving procedure. LEVEL OF EVIDENCE: IV.

Impact of Obesity on Mortality in Adult Trauma Patients.

Introduction Trauma is a major cause of morbidity and mortality amongst all populations in the United States. With the widespread increase of obesity in the United States, studies have been conducted to compare different body mass index (BMI) groups and their clinical outcomes for traumatic injuries. The goal of this study was to retrospectively compare mortality between adult trauma patients with a high BMI to those with a lower BMI as well as investigate whether the mechanism of trauma had an effect on the outcome. Methods This study was a retrospective review of all adult trauma patients presented to the emergency department at Arrowhead Regional Medical Center (ARMC) between January 2014 and October 2019. The outcome was all-cause mortality. Patients were grouped according to BMI and mechanisms of injury, including blunt trauma, low velocity penetrating trauma, and high velocity penetrating trauma. Patients were also stratified by injury severity scores (ISS). Results Among the 9642 patients assessed in this study, majority (88%) of patients sustained blunt trauma. The number of patients among the three different BMI groups was appropriately equal with 34.4% of normal BMI, 34.6% overweight, and 31.1% obese. The overall mortality of all patients studied was 2.6% (n=248). There was no statistically significant difference in mortality among the three different BMI groups for blunt trauma, penetrating trauma, and subgroup analyses stratified by ISS score (ISS<16 or ISS ≥ 16). Conclusion Our study found no statistically significant differences in mortality among the three BMI groups in regard to mortality, even when stratified by ISS, or mechanism of injury, and traumatic velocities.

The Impact of Quality Improvement Measures in the Management of Asthma Patients in Juvenile Detention Facilities.

Asthma is a serious chronic lung disease with a significant economic burden. The population of the San Bernardino County Juvenile Detention and Assessment Centers have higher odds of asthma as compared to the general population. Research has shown that a significant number of patients with a prior history of asthma were misdiagnosed. A protocol using objective testing, along with the detailed patient's history, was successfully implemented to verify the diagnosis and guide more effective medical care. After the implementation of those steps, the prevalence of asthma was found to be lower with the new protocol, from 18.1% in the pre-protocol period to 11.2% in the post-protocol period. This decrease resulted in an associated reduction in both direct and indirect healthcare costs and more efficient medical care.

San Bernardino County Youth Opioid Response: Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder.

Opioid use disorder (OUD) and related overdose deaths have become a crisis of epidemic proportions in the United States. In 2018, over 10 million people age 12 years or older misused opioids.Substance use is also correlated with increased physical and mental health disorders, and developmental challenges among youths. Medication-assisted treatment (MAT) has been reported to reduce mortality, opioid use, and human immunodeficiency virus and hepatitis C virus transmission while increasing treatment retention in adults. The San Bernardino County Youth Opioid Response (SBCYOR) program was formed to explore best practices for youths at risk of opioid use disorders and/or overdose. SBCYOR is a coalition of professionals in healthcare, behavioral health, public education, law enforcement, emergency medical services (EMS) agencies, and juvenile detention centers throughout San Bernardino County, California. SBCYOR focuses on high-risk and addicted individuals between the ages of 12 to 24 years in San Bernardino County's correctional system. It utilizes a strategy of collaboration, prevention, risk mitigation, medication, psychological treatment, and community outreach. This study aimed to evaluate the implementation and progress of SBCYOR.

BWGS: A R package for genomic selection and its application to a wheat breeding programme.

We developed an integrated R library called BWGS to enable easy computation of Genomic Estimates of Breeding values (GEBV) for genomic selection. BWGS, for BreedWheat Genomic selection, was developed in the framework of a cooperative private-public partnership project called Breedwheat (https://breedwheat.fr) and relies on existing R-libraries, all freely available from CRAN servers. The two main functions enable to run 1) replicated random cross validations within a training set of genotyped and phenotyped lines and 2) GEBV prediction, for a set of genotyped-only lines. Options are available for 1) missing data imputation, 2) markers and training set selection and 3) genomic prediction with 15 different methods, either parametric or semi-parametric. The usefulness and efficiency of BWGS are illustrated using a population of wheat lines from a real breeding programme. Adjusted yield data from historical trials (highly unbalanced design) were used for testing the options of BWGS. On the whole, 760 candidate lines with adjusted phenotypes and genotypes for 47 839 robust SNP were used. With a simple desktop computer, we obtained results which compared with previously published results on wheat genomic selection. As predicted by the theory, factors that are most influencing predictive ability, for a given trait of moderate heritability, are the size of the training population and a minimum number of markers for capturing every QTL information. Missing data up to 40%, if randomly distributed, do not degrade predictive ability once imputed, and up to 80% randomly distributed missing data are still acceptable once imputed with Expectation-Maximization method of package rrBLUP. It is worth noticing that selecting markers that are most associated to the trait do improve predictive ability, compared with the whole set of markers, but only when marker selection is made on the whole population. When marker selection is made only on the sampled training set, this advantage nearly disappeared, since it was clearly due to overfitting. Few differences are observed between the 15 prediction models with this dataset. Although non-parametric methods that are supposed to capture non-additive effects have slightly better predictive accuracy, differences remain small. Finally, the GEBV from the 15 prediction models are all highly correlated to each other. These results are encouraging for an efficient use of genomic selection in applied breeding programmes and BWGS is a simple and powerful toolbox to apply in breeding programmes or training activities.