The Critical Intervention Screen: A Novel Tool to Determine the Use of Lights and Sirens during the Transport of Trauma Patients.

Objective: EMS use of lights and sirens has long been employed in EMS systems, despite an increased risk of motor vehicle collisions associated with their use. The specific aims of this study were to assess the current use of lights and sirens during the transport of trauma patients in a busy metropolitan area and to subsequently develop a novel tool, the Critical Intervention Screen, to aid EMS professionals tasked with making transport decisions in the presence of acute injury.Methods: This single-center, retrospective study included all patients transported to an academic Level One trauma center by ground ambulance from the scene of presumed or known injury. A subset of patients was identified as being most likely to benefit from shorter transport times if they received one of the following critical interventions within 20 minutes of emergency department arrival: intubation, thoracotomy, chest tube, blood products, central line, arterial line, REBOA, disposition to an operating room, or death. Stepwise logistic regression was employed for the development of the Critical Intervention Screen, with a subset of data retained for internal validation.Results: 1296 patients were available for analysis. Overall, 217 patients (16.7%) received a critical intervention, and 112 patients (8.6%) of those patients received a critical intervention within 20 minutes of emergency department arrival. At baseline, EMS use of lights and sirens was 91.1% sensitive and 80.3% specific for receiving a critical intervention. Stepwise logistic regression demonstrated that the need for assisted ventilation, GCS Motor < 6, and penetrating trauma to the trunk were the most predictive prehospital data for receiving at least one critical intervention. The Critical Intervention Screen, defined as having at least one of these risk factors in the prehospital setting, modestly increased sensitivity and specificity (96.4% and 87.9%, respectively) predicting the need for a critical intervention.Conclusion: These findings indicate that EMS are able to correctly identify high-acuity trauma patients, but at times employ L&S during the transport of patients with a low likelihood of receiving a time-sensitive intervention upon emergency department arrival. Therefore, the Critical Intervention Screen has the potential to reduce the use of lights and sirens and improve EMS safety.

Trauma Registry Data Collection Practices and the Impact of Hospital Data Dictionaries: A National Survey.

BACKGROUND: Trauma programs are required to collect a uniform set of trauma variables and submit data to regional, state, and or national registries. Programs may also collect unique data elements to support hospital-specific initiatives. OBJECTIVE: This study explored what additional data elements are being collected by U.S. trauma programs and the impact of having a hospital-specific data dictionary. METHODS: An anonymous, cross-sectional survey exploring what additional data are being collected, and the impact of having a hospital-specific data dictionary, was distributed by the Society of Trauma Nurses, Trauma System News, and the American College of Surgeons. The survey was open from July 2020 to September, 2020. RESULTS: There were 693 respondents from approximately 368 Level I/II trauma programs. The estimated trauma center response rate was 59.4% (n = 368/620). Level I programs had a higher response rate than Level II programs (66.9% and 53.4%, respectively).In our sample, 85.5% of responding centers collect additional data. The most common additional data collected at Level I/II programs concerned quality improvement initiatives (70.3% and 66.1%, respectively). Other commonly collected data pertained to deaths (60.6%) and complications (50.3%).Only 43% of responding centers (n = 161/368) have a hospital-specific data dictionary. Hospitals that collect additional data were more likely to have such a resource compared with those that do not (n = 147/315, 46.7% vs. n = 14/53, 26.4%, p = .01). CONCLUSION: Most trauma programs collect data outside required fields. Fewer than half define these data in a data dictionary. Centers should consider establishing a data dictionary to define data collected.

How Do Hospital-Specific Data Dictionaries Impact Competency Level With Data Collection: A National Survey.

BACKGROUND: Trauma registry staff are tasked with high-quality data collection to support program requirements. Hospital-specific data dictionaries are increasingly used to ensure accurate data collection, yet it is unknown how such a resource impacts a trauma registry team's competency with data collection. OBJECTIVE: This study sought to explore whether having a hospital-specific data dictionary affected trauma service team members' self-reported competency level with abstracting required and nonrequired data elements. METHODS: This study used an anonymous, cross-sectional survey distributed (July 2020 to September 2020) by the Society of Trauma Nurses, the American College of Surgeons, and the Trauma System News outlets to trauma registrars, trauma nurse coordinators, clinical quality specialists, program managers, program directors, and trauma research personnel. A 26-question survey was designed using a visual sliding scale from 0 to 100 to measure self-reported competence and associated variables. RESULTS: A total of 881 respondents completed the survey from at least 495 centers. Six hundred ninety-six (79.0%) respondents were from Level I or Level II programs. Several factors were associated with team members feeling highly competent in collecting data for various reporting requirements, including the level of trauma center verification, tenure working in trauma services, and the presence of a hospital-specific data dictionary. CONCLUSION: Trauma centers should consider establishing a hospital-specific data dictionary as they are associated with higher registry staff competence working with trauma registry data.

A novel system for intensive Diadema antillarum propagation as a step towards population enhancement.

The long-spined sea urchin Diadema antillarum was once an abundant reef grazing herbivore throughout the Caribbean. During the early 1980s, D. antillarum populations were reduced by > 93% due to an undescribed disease. This event resulted in a lack of functional reef herbivory and contributed to ongoing ecological shifts from hard coral towards macroalgae dominated reefs. Limited natural recovery has increased interest in a range of strategies for augmenting herbivory. An area of focus has been developing scalable ex situ methods for rearing D. antillarum from gametes. The ultimate use of such a tool would be exploring hatchery origin restocking strategies. Intensive ex situ aquaculture is a potentially viable, yet difficult, method for producing D. antillarum at scales necessary to facilitate restocking. Here we describe a purpose-built, novel recirculating aquaculture system and the broodstock management and larval culture process that has produced multiple D. antillarum cohorts, and which has the potential for practical application in a dedicated hatchery setting. Adult animals held in captivity can be induced to spawn year-round, with some evidence for annual and lunar periodicity. Fecundity and fertilization rates are both consistently very high, yet challenges persist in both late stage larval development and early post-settlement survival. Initial success was realized with production of 100 juvenile D. antillarum from ~ 1200 competent larvae. While the system we describe requires a significant level of investment and technical expertise, this work advances D. antillarum culture efforts in potential future hatchery settings and improves the viability of scalable ex situ production for population enhancement.

Labral calcification in end-stage osteoarthritis of the hip correlates with pain and clinical function.

The acetabular labrum of the hip (ALH) is recognized as a clinically important structure, but knowledge about the pathophysiology of this fibrocartilage is scarce. In this prospective study we determined the prevalence of ALH calcification in patients with end-stage osteoarthritis (OA) and analyzed the relationship of cartilage calcification (CC) with hip pain and clinical function. Cohort of 80 patients (70.2 ± 7.6years) with primary OA scheduled for total hip replacement. Harris Hip Score (HHS) was recorded preoperatively. Total ALH and femoral head (FH) were sampled intraoperatively. CC of the ALH and FH was analyzed by high-resolution digital contact radiography. Histological degeneration of the ALH (Krenn-Score) and FH (OARSI-Score) was determined. Multivariate linear regression model and partial correlation analyses were performed. The prevalence of cartilage calcification both in the ALH and FH was 100%, while the amount of CC in the ALH was 1.55 times higher than in the FH (p < 0.001). There was a significant inverse regression between the amount of calcification of both the ALH and the FH and preoperative HHS (ßALH = -2.1, p = 0.04), (ßFH = -2.9, p = 0.005), but pain was influenced only by ALH calcification (ßALH = -2.7, p = 0.008). Age-adjusted, there was a significant correlation between cartilage calcification and histological degeneration (ALH:rs = 0.53, p < 0.001/FH: rs = 0.30, p = 0.007). Fibrocartilage and articular cartilage calcification are inseparable pathological findings in end-stage osteoarthritis of the hip. Fibrocartilage calcification is associated with poor and painful hip function. CLINICAL SIGNIFICANCE: ALH fibrocartilage appears to be particularly prone to calcification, which may explain higher pain levels in individuals with a high degree of ALH calcification independent of age and histological degeneration. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1248-1255, 2018.