Optimal Trauma Activation Criteria for "Found Down" Patients.

INTRODUCTION: Patients who are found down (FD) with unknown mechanism of injury pose a triage dilemma. At the study institution, this population with any "suspicion of trauma" criteria were previously triaged as a trauma team activation (TTA) but due to high rates of mis-triage was modified to "signs of trauma." The purpose of this study is to compare injured and uninjured FD patients to identify patient characteristics and outcomes, and to evaluate triage accuracy of signs of trauma. METHODS: A single-center retrospective review was conducted on adult patients who were FD between 1/2019 and 4/2021. Based on injury severity score (ISS), FD patients were categorized as injured or uninjured and these groups were compared. Sensitivity and specificity were calculated for signs and suspicion of trauma as triage criteria, where suspicion of trauma included altered mental status, confusion, seizures, intoxication, or dementia. Signs of trauma were defined as abrasions, lacerations, ecchymosis, contusions, hematomas, deformity, pain, and crepitus. RESULTS: 415 FD patients were identified with 273 (65.8%) sustaining injury and 142 (34.2%) uninjured. There were no differences in age, gender, Glasgow Coma Scale (GCS) score, or vital signs. Signs of trauma had high sensitivity (96.0%) and moderate specificity (82.4%) for injury, whereas suspicion of trauma had low sensitivity (2.2%) and specificity (37.3%). CONCLUSION: Injured and uninjured FD trauma patients had similar characteristics on arrival including GCS and vitals, emphasizing the challenge of identifying patients with injury requiring trauma evaluation. Signs of trauma represent a valuable indicator of injury in the FD population.

Help a mother out: The impact of acute care surgeon response in postpartum hemorrhage.

INTRODUCTION: A Code White (CW) activation is a hospital-wide alert for postpartum hemorrhage (PPH) and acute care surgeons (ACS) were added to the response team to assist in resuscitation. A multidisciplinary training program was also implemented. This study aimed to evaluate the impact of ACS involvement and training on maternal outcomes. METHODS: A retrospective review was performed on all CW activations from 1/1/2015-8/31/2022. Three groups-pre-ACS response, ACS response, and ACS response â€‹+ â€‹training (R&T)-were compared. RESULTS: 218 patients had CW activations. ACS response increased MTP activations (50.0%vs76.5%vs76.2%, p â€‹= â€‹0.014) and TXA administration (50.0%vs96.5%vs93.3%, p â€‹< â€‹0.0001). The ACS R&T had the highest ACS presence (53.6%vs72.9%vs96.2%, p â€‹< â€‹0.0001), shortest operation (99 vs 67 vs 53min, p â€‹= â€‹0.002), lowest crystalloid use (2000 vs 1110 vs 800 â€‹ml, p â€‹= â€‹0.003), and lowest transfusion requirements. Mortality decreased from 17.9% in pre-ACS to 2.4% in ACS response and 0% in ACS R&T (p â€‹< â€‹0.0001). CONCLUSION: ACS assistance in CW activations and multidisciplinary PPH education led to the prevention of maternal mortality. ACS are a valuable resource in this unique population.

To observe or not to observe: Evaluation of the modified brain injury guideline management of small volume intracranial hemorrhage.

INTRODUCTION: Patients with small volume intracranial hemorrhage (ICH) are categorized as modified Brain Injury Guidelines (mBIG) 1 and are managed with a 6-h emergency department (ED) observation period. The current study aimed to describe the mBIG 1 patient population and determine the utility of the ED observation period. METHODS: A retrospective analysis was performed on trauma patients with small volume ICH. Exclusion criteria were Glasgow Coma Scale (GCS) < 13 and penetrating injuries. RESULTS: 359 patients were identified over the 8-year study period. The most common ICH was SDH (52.7%) followed by SAH (50.1%). Two patients (0.56%) had neurologic deterioration, but neither had radiographic progression. Overall, 14.3% of the cohort had radiographic progression; none required neurosurgical intervention. Four patients (1.1%) had readmission related to TBI from the index admission. CONCLUSION: There were no patients with small volume ICH that required neurosurgical intervention despite a small subset of patients having radiographic or clinical deterioration. Patients who meet the mBIG 1 criteria may be managed safely without an ED observation period.