The Need for Manual Skills in an Automated World to Obtain Timely Blood Pressures in Trauma Patients.

BACKGROUND: Obtaining the first blood pressure (BP) during adult trauma team activations was often delayed. A review of patient charts revealed that the average time to first documented BP was 6.6 minutes when using an automatic BP cuff. PURPOSE: The purpose was to determine whether taking the initial BP using a manual cuff decreases the time it takes to obtain the first BP. METHOD: The Iowa Model Revised was used as the framework for this project. INTERVENTION: An algorithm was developed, and staff were educated and validated on their ability to obtain manual BPs. A 2-month practice change pilot was launched on adult full and partial trauma team activations. RESULTS: It was determined that taking a BP manually during adult trauma resuscitations was more efficient, allowing for earlier determination of patient status. CONCLUSION: Obtaining the initial BP manually was 54% more timely and led to an evidence-based practice change.

79 is the new 70: Left digit bias in craniotomy.

BACKGROUND: Left digit bias is the psychological phenomenon in which the difference between values is perceived as larger due to the value of the first digit. For example, an 80 year old may be perceived as much older than a 79 year old. We sought to determine if left digit bias is present in craniotomy for elderly patients with traumatic brain injury. METHODS: Patients aged 69, 70, 79, and 80 with traumatic brain injury and an abbreviated injury scale severity of a minimum of 3 were included from the National Trauma Data Bank from the years 2012-2019. 38,908 patients were included. A Chi-squared Test was performed to compare the percentage of patients undergoing craniotomy. RESULTS: 79 year olds had higher craniotomy rates than 80 year olds (7.8% vs 6.4%, P < 0.001). There was no difference in craniotomy rates between 69 and 70 year olds (8.2% vs 7.8%, P < 0.2622). CONCLUSION: This study suggests the presence of left digit bias in the decision to perform a craniotomy in patients aged 79 vs 80 with traumatic brain injury.