RESUMEN
BACKGROUND: Trauma centers (TCs) improve patient outcomes. Few investigations detail the US geographical distribution of Level 1 and 2 TCs (L1TCs, L2TCs) regarding motor vehicle collision (MVC) injuries/fatalities. OBJECTIVE: We utilized Geographic Information Systems mapping to investigate the distribution of L1TCs and L2TCs in relation to population growth, MVC injuries, and MVC fatalities at the county and regional level to identify any disparities in access to trauma care. METHODS: A cross-sectional analysis of L1TC and L2TC distribution, MVC injuries/fatalities, and population growth from 2010 to 2018. Information was gathered at the county and region level for young adults (aged 15-44), middle-aged adults (45-64), and elderly (≥65). RESULTS: A total of 263 L1TCs across 46 states and 156 counties and 357 L2TCs across 44 states and 255 counties were identified. The mean distance between L1TCs and L2TCs is 28.3 miles and 31.1 miles, respectively. Seven counties were identified as being at-risk, all in the Western and Southern US regions that experienced ≥10% increase in population size, upward trends in MVC injuries, and upward trends MVC fatalities across all age groups. CONCLUSIONS: Seven US counties containing ≤2 ACSCOT-verified and/or state-designated L1TCs or L2TCs experienced a 10% increase in population, MVC injuries, and MVC fatalities across young, middle-aged and elderly adults from 2010 to 2018. This study highlights chronic disparities in access to trauma care for MVC patients. Evaluation of state limitations regarding the distribution of L1TCs and L2TCs, frequent evaluation of local and regional trauma care needs, and strategic interventions to improve access to trauma care may improve patient outcomes for heavily burdened counties.
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Sistemas de Información Geográfica , Centros Traumatológicos , Anciano , Persona de Mediana Edad , Adulto Joven , Humanos , Crecimiento Demográfico , Estudios Transversales , Accidentes de Tránsito , Vehículos a MotorRESUMEN
BACKGROUND AND OBJECTIVES: With the rate of physician suicide increasing, more research is needed to implement adequate prevention interventions. This study aims to identify trends and patterns in physician/surgeon suicide and the key factors influencing physician suicide. We hope such information can highlight areas for targeted interventions to decrease physician suicide. METHODS: Review of Centers for Disease Control and Preventions National Violent Death Reporting System (NVDRS) for 2003 to 2017 of physician and dentists dying by suicide. Twenty-eight medical, surgical, and dental specialties were included. RESULTS: Nine hundred five reported suicides were reviewed. Physician suicides increased from 2003 to 2017. Majority surgeons' suicides were middle-aged, White males. Orthopedic surgeons had the highest prevalence of suicide among surgical fields (28.2%). Black/African American surgeons were 56% less likely [odds ratio (OR) = 0.44, 95% confidence interval (CI): 0.06-3.16] and Asian/Pacific Islander were 438% more likely (OR = 5.38, 95% CI: 2.13-13.56) to die by suicide. Surgeons were 362% more likely to have a history of a mental disorder (OR = 4.62, 95% CI: 2.71-7.85), were 139% more likely to use alcohol (OR = 2.39, 95% CI: 1.36-4.21), and were 289% more likely to have experienced civil/legal issues (OR = 3.89, 95% CI: 1.36-11.11). CONCLUSIONS: The prevalence of physician suicide increased over the 2003 to 2017 time-frame with over a third of deaths occurring from 2015 to 2017. Among surgeons, orthopedics has the highest prevalence of reported suicide.Risk factors for surgeon suicide include Asian/Pacific Islander race/ethnicity, older age, history of mental disorder, alcohol use, and civil/legal issues.
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Suicidio , Cirujanos , Causas de Muerte , Centers for Disease Control and Prevention, U.S. , Homicidio , Humanos , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Less than half of medical school professorships and decanal ranks are held by women. Our study investigates the gender-based geographical distribution and differences in lifetime peer-reviewed publications, H-index, and grant funding by the National Institutes of Health (NIH) of all allopathic medical school deans in the United States (US). METHODS: A cross-sectional cohort study utilizing data from US allopathic medical school websites, PubMed, and the NIH Research Portfolio Online Reporting Tools regarding lifetime peer-reviewed publications and quantity/monetary sum of NIH grants received by medical school deans. Descriptive statistics, independent sample T-tests, and ANOVA were performed with statistical significance defined as P < 0.05. RESULTS: Women occupied 33/157 (21.0%) dean positions overall. Compared to women, men possess higher mean number of lifetime peer-reviewed publications (112.0 vs. 55.2, P = 0.001) and H-index (43.2 vs. 25.7, P = 0.001); however, there are no differences in the mean number of NIH grants (27.5 vs. 19.1, P = 0.323) nor mean total NIH funding received ($18,931,336 vs. $14,289,529, P = 0.524). While significant differences in mean H-index between all US regions were found (P = 0.002), no significant differences exist between major US regions regarding the mean lifetime publication count (P = 0.223), NIH grants received (P = 0.200), nor total NIH funding (P = 0.824) received. CONCLUSION: A significant discrepancy in the gender distribution, lifetime peer-reviewed publications, and H-index of allopathic medical school deans exists across the US, highlighting the need for adequate support for women in academic medicine. Greater implementation of mentorship, increased institutional support, and diversity training can improve the representation of women in medical school decanal positions.
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Medicina , Facultades de Medicina , Estudios Transversales , Docentes Médicos , Femenino , Humanos , Masculino , National Institutes of Health (U.S.) , Estados UnidosRESUMEN
BACKGROUND: Motor vehicle collisions (MVCs) are a leading cause of morbidity and mortality. However, there is limited evidence examining the effects seatbelt use has on MVC-related injuries and outcomes in patients with rib fractures. We aim to assess how seatbelt use affects associated injuries and outcomes in adult MVC patients with ≥2 rib fractures. METHODS: This retrospective study utilized the American College of Surgeons (ACS) Trauma Quality Programs (TQP) Participant Use File (PUF) Database. Drivers/passengers who sustained ≥2 rib fractures following an MVC and had an AIS ≤2 for extra-thoracic body regions were analyzed. Patients were then subdivided by presence of flail chest into two cohorts, which were subdivided according to injury severity score (ISS) and seatbelt use. Logistic and linear regression was used to assess the impact of seatbelt use on outcomes. RESULTS: Among both low and intermediate ISS classifications, restrained patients in the non-flail chest cohort had decreased incidence of pneumothorax, pulmonary contusion, and liver injury (P < 0.001). After adjusting for confounders, restrained patients (versus unrestrained) had decreased odds of pneumothorax (aOR = 0.91, P = <0.001) and acute respiratory distress syndrome (aOR=0.65, P = 0.02), while having increased odds of splenic laceration (aOR = 1.18, P = 0.003) (intermediate ISS group). Compared to unrestrained patients, restrained non-flail chest patients had a significantly decreased hospital length of stay (LOS) and intensive care unit LOS (P < 0.05). CONCLUSIONS: Seatbelt use may be protective against serious injuries in patients with ≥2 rib fractures, resulting in improved outcomes. Education programs should be developed to bolster seatbelt compliance.
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Tórax Paradójico , Fracturas de las Costillas , Traumatismos Torácicos , Adulto , Tórax Paradójico/cirugía , Humanos , Puntaje de Gravedad del Traumatismo , Vehículos a Motor , Estudios Retrospectivos , Fracturas de las Costillas/complicaciones , Fracturas de las Costillas/etiología , Cinturones de Seguridad/efectos adversos , Traumatismos Torácicos/complicacionesRESUMEN
BACKGROUND: There is a lack of literature regarding the most effective timing to initiate physical therapy (PT) among traumatically injured patients. We aim to evaluate the association between early PT/mobilization versus delayed or late PT/mobilization and clinical outcomes of trauma patients. METHODS: A retrospective cohort analysis of an urban level-I trauma center from 2014 to 2019 was performed. Univariate analyses and multivariable logistic regression were performed with significance defined as P < 0.05. RESULTS: A total of 11,937 patients were analyzed. Among patients without a traumatic brain injury (TBI), late PT initiation times were associated with 60% lower odds of being discharged home without services (P < 0.05), significantly increased hospital and ICU length of stay (H-LOS, ICU-LOS) (P < 0.05), and significantly higher odds of complications (VTE, pneumonia, pressure ulcers, ARDS) (P < 0.001). Among patients with a TBI, late PT initiation time had 76% lower odds of being discharged home without services (P < 0.05) and significantly longer H-LOS and ICU-LOS (P < 0.05) however did not experience significantly higher odds of complications (P > 0.05). CONCLUSIONS: Among traumatically injured patients, early PT is associated with decreased odds of complications, shorter H-LOS and ICU-LOS, and a favorable discharge disposition to home without services. Adoption of early PT initiation/mobilization protocols and establishment of prophylactic measures against complications associated with delayed PT is critical to maximize quality of care and trauma patient outcomes. Multi-center prospective studies are needed to ascertain the impact of PT initiation times in greater detail and to minimize trauma patient morbidity.
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Lesiones Traumáticas del Encéfalo , Centros Traumatológicos , Lesiones Traumáticas del Encéfalo/complicaciones , Lesiones Traumáticas del Encéfalo/terapia , Humanos , Tiempo de Internación , Modalidades de Fisioterapia , Estudios RetrospectivosRESUMEN
BACKGROUND: Trauma Centers integrate Trauma Registrars and Performance Improvement Nurses to drive quality care. Delays in their duties could have negative impacts on outcomes and performance. We aim to investigate the impact of COVID-19 pandemic on Trauma Center operations by assessing performance of trauma registry and performance improvement processes across the United States. METHODS: A cross-sectional study was performed utilizing data from two anonymous questionnaires distributed to Trauma Center Association of America members. Descriptive statistics, Fisher's Exact Test, and multivariable logistic regression were performed with statistical significance defined as P < 0.05. RESULTS: Of 90.2% (83) of Trauma Registrars and 85.9% (67) of Performance Improvement personnel reported that their Trauma Centers have treated COVID-19 patients. Among trauma registrars, respondents did not significantly differ in the current status of completing registry cases (P> 0.05), during COVID-19 compared to prior (P> 0.05), or adjusted odds of COVID-19 delaying completion of entries (P> 0.05). Having >2 Performance Improvement Nurses was significantly associated with improved performance during the COVID-19 pandemic (P= 0.03) whereas working at a Trauma Center which treats adults-only or mixed patient population (adult and pediatric) was associated with being 1-3 months behind in closing of performance improvement cases (P= 0.02). CONCLUSIONS: The negative impact of COVID-19 on Trauma Registrars and Performance Improvement Nurses has been minimal. Adequate staffing/experience seem to mitigate delays and decreased performance. Implementation of expanded staffing, improved training, and evidenced-based revision of Trauma Center logistics may help mitigate future disruptions relating to COVID-19 and allow Trauma Centers to recover and improve their operations.
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COVID-19 , Centros Traumatológicos , Adulto , COVID-19/epidemiología , Niño , Estudios Transversales , Humanos , Pandemias , Sistema de Registros , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Recursos HumanosRESUMEN
BACKGROUND: Emergency department resuscitative thoracotomy (ED-RT) or prehospital resuscitative thoracotomy (PH-RT) is performed for trauma patients with impending or full cardiovascular collapse. This systematic review and meta-analysis analyze outcomes in patients with thoracic trauma receiving PH-RT and ED-RT. METHODS: PubMed, JAMA Network, and CINAHL electronic databases were searched to identify studies published on ED-RT or PH-RT between 2000-2020. Patients were grouped by location of procedure and type of thoracic injury (blunt versus penetrating). RESULTS: A total of 49 studies met the criteria for qualitative analysis, and 43 for quantitative analysis. 43 studies evaluated ED-RT and 5 evaluated PH-RT. Time from arrival on scene to PH-RT >5 min was associated with increased neurological complications and time from the initial encounter to PH-RT or ED-RT >10 min was associated with increased mortality. ISS ≥ 25 and absent signs of life were also associated with increased mortality. There was higher mortality in all PH-RT (93.5%) versus all ED-RT (81.8%) (P = 0.02). Among ED-RTs, a significant difference was found in mortality rate between patients with blunt (92.8%) versus penetrating (78.7%) injuries (P < 0.001). When considering only blunt or penetrating injury types, no significant difference in RT mortality rate was found between ED-RT and PH-RT (P = 0.65 and P = 0.95, respectively). CONCLUSIONS: ED-RT and PH-RT are potentially life-saving procedures for patients with penetrating thoracic injuries in extremis and with signs of life. The efficacy of this procedure is time sensitive. Moreover, there appears to be a greater mortality risk for patients with thoracic trauma receiving RT in the PH setting compared to the ED setting. More studies are needed to determine the significance of PH-RT mortality.
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Traumatismos Torácicos , Heridas no Penetrantes , Heridas Penetrantes , Servicio de Urgencia en Hospital , Humanos , Resucitación/métodos , Estudios Retrospectivos , Traumatismos Torácicos/cirugía , Toracotomía/métodos , Heridas Penetrantes/cirugíaRESUMEN
INTRODUCTION: There is a paucity of literature evaluating research-funding differences between male and female surgeons. Our study aims to evaluate possible disparities in the National Institutes of Health (NIH) grant awards by surgeon gender, type of medical degree (MD/DO), and advanced degrees among six surgery specialties: general surgeons, neurosurgeons, urologists, obstetricians/gynecologists, plastic, and orthopedic surgeons, from 2015 to 2020. METHODS: A retrospective cohort study was performed investigating the number of NIH grants received by male and female surgeon-scientists overall and within each listed specialty, 2015-2020. As a surrogate for grants submitted, the proportion of active surgeon-scientists per specialty was used. A priori level of significance was defined as P < 0.05. RESULTS: After adjusting for confounders, male surgeons had a higher mean number of NIH grants and higher grant funding than female surgeons (P < 0.001 for both). Type of medical degree (MD/DO) was not significantly associated with NIH funding. An advanced degree was associated with NIH funding among neurosurgeons only (P < 0.05). Differences in the proportion of active surgeon-scientists and proportion of NIH grants received by male and female surgeon-scientists were found only in the fields of orthopedic surgery (5.8% female surgeons and received 20.7% of grants, P = 0.003) and plastic surgery (17.2% female surgeons and received 33.3% of grants, P = 0.01). CONCLUSIONS: Male surgeons received most of the total surgical NIH grants. However, funding for female surgeons in orthopedic and plastic surgery outpaces that of their male counterparts when compared to gender proportions in their respective field. Future studies should further investigate the effects of additional applicant demographics on securing NIH grant funding.
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Distinciones y Premios , Investigación Biomédica , Especialidades Quirúrgicas , Cirujanos , Femenino , Humanos , Masculino , National Institutes of Health (U.S.) , Estudios Retrospectivos , Estados UnidosRESUMEN
INTRODUCTION: We aim to assess the trends in trauma patient volume, injury characteristics, and facility resource utilization that occurred during four surges in COVID-19 cases. METHODS: A retrospective cohort study of 92 American College of Surgeons (ACS)-verified trauma centers (TCs) in a national hospital system during 4 COVID-19 case surges was performed. Patients who were directly transported to the TC and were an activation or consultation from the emergency department (ED) were included. Trends in injury characteristics, patient demographics & outcomes, and hospital resource utilization were assessed during four COVID-19 case surges and compared to the same dates in 2019. RESULTS: The majority of TCs were within a metropolitan or micropolitan division. During the pandemic, trauma admissions decreased overall, but displayed variable trends during Surges 1-4 and across U.S. regions and TC levels. Patients requiring surgery or blood transfusion increased significantly during Surges 1-3, whereas the proportion of patients requiring plasma and/or platelets increased significantly during Surges 1-2. Patients admitted to the hospital had significantly higher Injury Severity Score (ISS) and mortality as compared to pre-pandemic during Surge 1 and 2. Patients with Medicaid or uninsured increased significantly during the pandemic. Hospital length of stay (LOS) decreased significantly during the pandemic and more trauma patients were discharged home. CONCLUSIONS: Trauma admissions decreased during Surge 1, but increased during Surge 2, 3 and 4. Penetrating injuries and firearm-related injuries increased significantly during the pandemic, patients requiring surgery or packed red blood cells (PRBCs) transfusion increased significantly during Surges 1-3. The number of patients discharged home increased during the pandemic and was accompanied by a decreased hospital length of stay (LOS).
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COVID-19 , Centros Traumatológicos , COVID-19/epidemiología , Humanos , Puntaje de Gravedad del Traumatismo , Tiempo de Internación , Prevalencia , Estudios Retrospectivos , Estados Unidos/epidemiologíaRESUMEN
Each year, traumatic injuries affect 2.6 million adults in the United States leading to significant health problems. Although many sequelae stem directly from physical manifestations of one's sustained injuries, mental health may also be affected in the form of post-traumatic stress disorder (PTSD). PTSD can lead to decreased physical recovery, social functioning, and quality of life. Several screening tools such as the Injured Trauma Survivor Screen, PTSD CheckList, Primary Care PTSD, and Clinician-Administered PTSD Scale for DSM-5 have been used for initial PTSD screening of the trauma patient. Early screening is important as it serves as the first step in delivering the appropriate mental health care to those in need. Factors that increase the likelihood of developing PTSD include younger age, nonwhite ethnicity, and lower socioeconomic status. Current data on male or female predominance of PTSD in trauma populations is inconsistent. Cognitive behavioral therapy, hypnosis, and psychoeducation have been used to treat symptoms of PTSD. This review discusses the impact PTSD has on the trauma patient and the need for universal screening in this susceptible population. Ultimately, trauma centers should implement such universal screening protocols as to avoid absence, or undertreatment of PTSD, both of which having longstanding consequences.
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Calidad de Vida , Trastornos por Estrés Postraumático/epidemiología , Adulto , Factores de Edad , Niño , Terapia Cognitivo-Conductual/organización & administración , Humanos , Hipnosis , Tamizaje Masivo/organización & administración , Servicios de Salud Mental/organización & administración , Factores de Riesgo , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicología , Trastornos por Estrés Postraumático/terapia , Centros Traumatológicos/organización & administración , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Traumatic Brain Injury (TBI) is a leading cause of mortality in the trauma population. Accurate prognosis remains a challenge. Two common Computed Tomography (CT)-based prognostic models include the Marshall Classification and the Rotterdam CT Score. This study aims to determine the utility of the Marshall and Rotterdam scores in predicting mortality for adult patients in coma with severe TBI. METHOD: Retrospective review of our Level 1 Trauma Center's registry for patients ≥ 18 years of age with blunt TBI and a Glasgow Coma Scale (GCS) of 3-5, with no other significant injuries. Admission Head CT was evaluated for the presence of extra-axial blood (SDH, EDH, SAH, IVH), intra-axial blood (contusions, diffuse axonal injury), midline shift and mass effect on basilar cisterns. Rotterdam and Marshall scores were calculated for all patients; subsequently patients were divided into two groups according to their score (< 4, ≥ 4). RESULTS: 106 patients met inclusion criteria; 75.5% were males (n = 80) and 24.5% females (n = 26). The mean age was 52. The odds ratio (OR) of dying from severe TBI for patients in coma with a Rotterdam score of ≥ 4 compared to < 4 was OR = 17 (P < 0.05). The odds of dying from severe TBI for patients in coma with a Marshall score of ≥ 4 versus < 4 was OR = 11 (P < 0.05). CONCLUSION: Higher scores in the Marshall classification and the Rotterdam system are associated with increased odds of mortality in adult patients in come from severe TBI after blunt injury. The results of our study support these scoring systems and revealed that a cutoff score of < 4 was associated with improved survival.
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Lesiones Traumáticas del Encéfalo/mortalidad , Encéfalo/diagnóstico por imagen , Escala de Coma de Glasgow/estadística & datos numéricos , Traumatismos Cerrados de la Cabeza/mortalidad , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Lesiones Traumáticas del Encéfalo/diagnóstico , Femenino , Traumatismos Cerrados de la Cabeza/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Valores de Referencia , Estudios Retrospectivos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: Thoracic injury secondary to rib fractures following motor vehicle collisions (MVCs) significantly contribute to morbidity and mortality. While obesity has reached epidemic proportions, little is known regarding how BMI impacts outcomes in MVCs. The aim of this study was to examine how BMI impacts outcomes in MVC patients with rib fractures. METHODS: The ACS-TQIP Database was utilized to evaluate adult MVC patients with ≥3 rib fractures. Patients with a non-thoracic AIS ≥3 were excluded, to focus on chest injuries. Patients were sorted according to the presence or absence of flail chest injuries and BMI into groups with a low (<15), intermediate (15-24), or severe (≥25) ISS. RESULTS: Overweight and obese patients in the non-flail cohort had decreased odds of pneumothorax in all ISS groups (P < 0.05). Overweight (P = 0.049) and obese (P = 0.011) patients in the low ISS non-flail cohort had decreased odds of splenic laceration. In the non-flail cohort, obese patients with a low and intermediate ISS had decreased odds of pulmonary contusion (P < 0.01). Obese patients in the low and intermediate ISS non-flail cohorts had increased odds of PE (P < 0.05). In both the flail and non-flail cohorts, obese patients with an intermediate ISS had decreased odds of liver laceration (P < 0.05), as well as a longer HLOS, ICU-LOS, and mechanical ventilation time (P < 0.01). CONCLUSION: Obesity affects associated injuries, complications, and hospital outcomes in a complex way after MVC related chest wall trauma. Thus, the effect of BMI should be taken into consideration when assessing and treating obese MVC trauma patients.
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Tórax Paradójico , Fracturas de las Costillas , Traumatismos Torácicos , Pared Torácica , Adulto , Índice de Masa Corporal , Tórax Paradójico/etiología , Humanos , Estudios Retrospectivos , Fracturas de las Costillas/complicaciones , Fracturas de las Costillas/epidemiología , Traumatismos Torácicos/complicaciones , Traumatismos Torácicos/epidemiologíaRESUMEN
BACKGROUND: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) was developed to prevent traumatic exsanguination. We aim to identify the outcomes in animal models with 1) partial versus complete REBOA occlusion and 2) zone 1 versus 2 placements. METHODS: The PRISMA guidelines were followed. We conducted a search of PubMed, EMBASE and Google Scholar for REBOA studies in animal trauma models using the following search terms: "REBOA trauma", "REBOA outcomes" "REBOA complications". SYRCLE's RoB Tool was utilized for the risk of bias and study quality assessment. RESULTS: Our search yielded 14 RCTs for inclusion. Eleven studies directly investigated partial REBOA versus total aortic occlusion. Overall, partial REBOA techniques were associated with similar attainment of proximal MAP but with significantly less ischemic burden. Significant mortality benefit with partial occlusion was observed in three studies. Survival time post-occlusion also was improved with zone 3 placement versus zone 1 (100% versus 33%; P < 0.01). CONCLUSIONS: There appears to be a fine balance between desired proximal arterial pressure and time of occlusion for overall survival and subsequent risk of distal ischemia. Many "partial occlusion" techniques may be superior in attaining such balance over prolonged REBOA inflation where no distal flow is allowed. Tailored zone 3 placement may offer significant mortality and morbidity advantages compared to sustained total occlusion and indiscriminate zone 1 placement strategies. As clear conclusions regarding REBOA are unlikely to be established in animal models, larger randomized investigations utilizing human subjects are needed to describe optimal REBOA technique and applicability in greater detail.
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Oclusión con Balón , Procedimientos Endovasculares , Choque Hemorrágico , Animales , Aorta/cirugía , Oclusión con Balón/métodos , Modelos Animales de Enfermedad , Procedimientos Endovasculares/métodos , Humanos , Resucitación/métodosRESUMEN
BACKGROUND: Popliteal artery injuries are the second most common arterial injuries below the inguinal ligament. We aimed to compare outcomes in patients with popliteal injuries by hospital teaching status utilizing the National Trauma Data Bank Research Data Set (NTDB-RDS) 2013-2016. METHODS: Four-year retrospective study using the NTDB-RDS, evaluating popliteal vascular injuries. Patients were divided by popliteal injury type and teaching status into; nonteaching hospital (NTH), community teaching (CTH), or University teaching (UTH). Demographics and outcome measures were compared between groups. Risk-adjusted mortality odds ratios (ORs) were calculated. Significance was defined as P < 0.05. RESULTS: 3,577,168 patients were in the NTDB-RDS, with 1120 having a popliteal injury, (incidence = 0.03%). There was no significant difference in the amputation rate between patients treated in NTHs, CTHs, or UTHs (P > 0.05). There was no significant difference in the raw mortality rate between patients treated in NTHs, CTHs, or UTHs. After adjusting for confounders; compared to NTH, the odds ratio for mortality for popliteal artery injuries in the CTH group was significantly higher (OR: 15.95, 95% CI: 1.19-213.84), and for the UTH group the mortality was also significantly higher (OR: 5.74, 95% CI: 0.45-72.95). CONCLUSIONS: The incidence of popliteal vascular injuries was 0.03% for 2013-2016. Patients with popliteal artery injuries treated at community teaching hospitals have a 16 times higher risk of mortality and at university teaching hospitals have a 5.7 times higher risk of mortality than patients treated at nonteaching hospitals.
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Hospitales Universitarios/estadística & datos numéricos , Arteria Poplítea/lesiones , Lesiones del Sistema Vascular/mortalidad , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos/epidemiología , Adulto JovenRESUMEN
BACKGROUND: As the COVID-19 pandemic continues, there is a question of whether hospitals have adequate resources to manage patients. We aim to investigate global hospital bed (HB), acute care bed (ACB), and intensive care unit (ICU) bed capacity and determine any correlation between these hospital resources and COVID-19 mortality. METHOD: Cross-sectional study utilizing data from the World Health Organization (WHO) and other official organizations regarding global HB, ACB, ICU bed capacity, and confirmed COVID-19 cases/mortality. Descriptive statistics and linear regression were performed. RESULTS: A total of 183 countries were included with a mean of 307.1 HBs, 413.9 ACBs, and 8.73 ICU beds/100,000 population. High-income regions had the highest mean number of ICU beds (12.79) and HBs (402.32) per 100,000 population whereas upper middle-income regions had the highest mean number of ACBs (424.75) per 100,000. A weakly positive significant association was discovered between the number of ICU beds/100,000 population and COVID-19 mortality. No significant associations exist between the number of HBs or ACBs per 100,000 population and COVID-19 mortality. CONCLUSIONS: Global COVID-19 mortality rates are likely affected by multiple factors, including hospital resources, personnel, and bed capacity. Higher income regions of the world have greater ICU, acute care, and hospital bed capacities. Mandatory reporting of ICU, acute care, and hospital bed capacity/occupancy and information relating to coronavirus should be implemented. Adopting a tiered critical care approach and targeting the expansion of space, staff, and supplies may serve to maximize the quality of care during resurgences and future disasters.
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COVID-19/terapia , Salud Global/estadística & datos numéricos , Recursos en Salud/estadística & datos numéricos , Capacidad de Camas en Hospitales/estadística & datos numéricos , Pandemias/prevención & control , COVID-19/mortalidad , Cuidados Críticos/economía , Cuidados Críticos/estadística & datos numéricos , Estudios Transversales , Carga Global de Enfermedades/estadística & datos numéricos , Salud Global/economía , Recursos en Salud/economía , Capacidad de Camas en Hospitales/economía , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Pandemias/estadística & datos numéricosRESUMEN
BACKGROUND: Splenectomies are widely performed, but there exists controversy regarding care for splenic injury patients. The purpose of this study is to provide a comprehensive review of the literature over the last 20 years for operative management (OM) versus nonoperative management (NOM) versus splenic artery embolization (SAE) for traumatic splenic injuries and associated outcomes. METHODS: A review of literature was performed following the PRISMA guidelines through a search of PubMed, EMBASE, Cochrane Library, JAMA Network, and SAGE journals from 2000 to 2020 regarding splenic injury in trauma patients and their management. Articles were then selected based on inclusion/exclusion criteria with GRADE criteria used on the included articles to assess quality. RESULTS: Twenty retrospective cohorts and one prospective cohort assessed patients who received OM versus NOM or SAE. Multiple studies indicated that NOM, in properly selected patients, provided better outcomes than its operative counterpart. CONCLUSION: This review provides additional evidence to support the NOM of splenic injuries for hemodynamically stable patients with benign abdomens as it accounts for consistently shorter hospital length of stay, fewer complications, and lower mortality than OM. For hemodynamically unstable patients, management continues to be intervention with surgery. More studies are needed to further investigate outcomes of post-splenectomy patients based on grade of injury, hemodynamic status, type of procedure (i.e., SAE), and failure of NOM in order to provide additional evidence and improve outcomes for this patient population.
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Traumatismos Abdominales , Embolización Terapéutica , Heridas no Penetrantes , Traumatismos Abdominales/terapia , Humanos , Puntaje de Gravedad del Traumatismo , Estudios Prospectivos , Estudios Retrospectivos , Bazo/lesiones , Resultado del Tratamiento , Heridas no Penetrantes/terapiaRESUMEN
Bilateral transverse thoracosternotomy, known colloquially as "clamshell thoracotomy," provides quick and extensive exposure to the thoracic organs. The origins of the radical incision are unclear, and its influence on historical developments in surgery has not been elaborated. Transsternal extension to bilateral thoracotomy likely occurred during World War I and was designated as Tuffier's method by 1922. Théodore Tuffier had already solidified his reputation as a trailblazing thoracic surgeon in Paris when the French army summoned him to design triage systems for trauma patients during the Great War. Following World War II, cardiac surgery grew tremendously during the 1950s, and many pioneering open-heart procedures utilized the bilateral incision for safe exposures with satisfactory results. Median sternotomy became the incision of choice for open-heart surgery by the early 1960s; however, thoracotomy remained important to the trauma surgeon's repertoire. Transsternal conversion was only briefly mentioned in trauma literature through the 1980s, although up to one-half of reported emergency thoracotomies at busy trauma centers were clamshells. The moniker clamshell thoracotomy came in 1994 when thoracic surgical oncology and lung transplantation flourished with complex operations requiring larger incisions. The twenty-first century has brought two iterations of evidence-based guidelines for emergency thoracotomy, but incision choice has not been formally discussed. Renewed conversation in recent years has advocated for the clamshell as arguably the best approach for patients in extremis. Given these trends, the tortuous history of this controversial incision deserves attention.
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Trasplante de Pulmón , Toracotomía , Urgencias Médicas , Humanos , MasculinoRESUMEN
BACKGROUND: Effective management of trauma patients is dependent on pre-hospital triage systems and proper in-hospital treatment regardless of time of admission. We aim to investigate any differences in adjusted all-cause mortality between day vs. night arrival for adult trauma patients who were transported to the hospital via ground emergency medical services (GEMS) and helicopter emergency medical services (HEMS) and to determine if care/outcomes are inferior when admitted during the night shift as compared to the day shift. METHODS: Retrospective cohort analysis of adult blunt and penetrating injury patients requiring full team trauma activation at an American College of Surgeons Committee on Trauma (ACSCOT)-verified Level 1 trauma center from 2011 to 2019. Descriptive statistical analyses, chi-square analyses, independent-sample t-tests, and Fisher's exact tests were performed. Primary measurement outcome was adjusted observed/expected (O/E) mortality ratios utilizing TRISS methodology. RESULTS: 8370 patients with blunt injuries and 1216 patients with penetrating injuries were analyzed. There were no significant differences in day vs. night O/Es overall (blunt 0.65 vs. 0.59; p = 0.46) (penetrating 0.88 vs. 0.87; p = 0.97). There also were no significant differences when stratified by GEMS (blunt 0.64 vs. 0.55; p = 0.08) (penetrating 0.88 vs. 1.10; p = 0.09) and HEMS admissions (blunt 0.76 vs. 0.75; p = 0.91) (penetrating 0.88 vs. 0.91; p = 0.85). CONCLUSIONS: At an ACSCOT-verified Level 1 Trauma Center, care/outcomes of patients admitted during the night shift were not inferior to those admitted during the day shift. Trauma Center verification by the ACSCOT and multidisciplinary collaboration may allow for consistent care despite injury type and time of day.
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Atención Posterior/organización & administración , Horario de Trabajo por Turnos , Transporte de Pacientes/métodos , Heridas y Lesiones/mortalidad , Heridas y Lesiones/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Garantía de la Calidad de Atención de Salud , Estudios Retrospectivos , Transporte de Pacientes/organización & administración , Centros Traumatológicos/organización & administración , Resultado del Tratamiento , Heridas y Lesiones/etiología , Adulto JovenRESUMEN
BACKGROUND: Emergency medicine (EM) physicians have been on the front line of the COVID-19 pandemic. This study aims to determine the impact of COVID-19 pandemic and other related factors such as resource availability and institutional support on well-being, burnout and job-satisfaction of EM physicians in the United States. METHODS: A cross-sectional survey study of EM physicians was conducted through the Emergency Medicine Practice Research Network of the ACEP. The survey focused on resource adequacy, institutional support, well-being, and burnout. A total of 890 EM physicians were invited to participate. Both descriptive and risk adjusted, and multivariate regressions were performed with a statistical significance defined as p < 0.05. RESULTS: EM physicians' response rate was 18.7% (166) from 39 states. Burnout was reported by 74.7% (124) since the start of the pandemic. Factors contributing included work-related emotional strain and anxiety, isolation from family and friends, and increased workload. Those reporting inadequate resources felt ignored by their institutions (p < 0.0001). Physicians who felt there was inadequate institutional support, were also dissatisfied with patient care resources (p = 0.001). Physicians expressing job dissatisfaction were more likely to report feelings of burnout (p = 0.001). CONCLUSION: EM physicians face greater burnout in the COVID-19 pandemic. This may be compounded by resource scarcity, psychological stress, isolation, and job dissatisfaction. Many of the survey respondents reported inadequate mental health services and resources. The findings of this study may help identify solutions to mitigate these issues.
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Agotamiento Profesional/etiología , COVID-19/psicología , Medicina de Emergencia , Satisfacción en el Trabajo , Médicos/psicología , Adulto , Anciano , Agotamiento Profesional/epidemiología , Agotamiento Profesional/psicología , Estudios Transversales , Femenino , Recursos en Salud/provisión & distribución , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Apoyo Social , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Unintentional injury remains the leading cause of death for adults worldwide. We aimed to investigate the rates and distribution of dead on arrival (DOA) patients according to emergency medical services (EMS) mode of transport (MoT), EMS transport time (TT), injury severity score (ISS), and type of injury. METHODS: This retrospective study utilized de-identified incident-based data from the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP PUF) dataset (2013-2018) to study Adult DOA patients. DOA was defined according to the data point, "arrived with no signs of life and did not recover". Patients with unknown vitals and patients with no EMS vitals at the scene (HR = 0, RR = 0, and SBP = 0) were excluded to identify DOAs who died during transport. The DOAs included for analysis were sorted into three groups based on injury severity score [low (ISS < 15), intermediate (ISS = 15-24), and severe (ISS ≥ 25)] and subdivided according to injury type (blunt vs. penetrating), EMS Mode of transport and transport times. Statistical significance was defined as p < 0.05. RESULTS: The majority of the evaluated 6030 adult DOA patients were male (73.3%) and 18-64 years of age (79.6%). Most patients sustained blunt injuries (58.2%), and the most common mechanism of injury was motor vehicle collisions (MVCs). Patients who traveled by helicopter EMS (HEMS) experienced less deaths than those traveling by ground EMS (GEMS) despite transporting more severely injured patients over longer time intervals. Median HEMS TTs were greater than their GEMS counterparts for blunt and penetrating injuries across all ISS groups but were associated with fewer deaths. CONCLUSION: Helicopter emergency medical service use with intermediate and severely injured patients with penetrating injuries is associated with a reduced number of DOAs. Future studies should prospectively investigate EMS performance to confirm the findings identified in this retrospective analysis. Additionally, other factors affecting pre-hospital EMS performance (e.g., geographic variations, weather-related characteristics, in-flight interventions/procedures) should be investigated. Finally, the results of this study highlight the need for standardized HEMS utilization triage criteria.