Geriatric Skiers: Active But Still at Risk, a National Trauma Data Bank Study.

BACKGROUND: Downhill skiing accounts for a large portion of geriatric sport-related trauma. We assessed the national burden of geriatric versus nongeriatric ski trauma. MATERIALS AND METHODS: Adults presenting to level 1/2 trauma centers after ski-associated injuries from 2011 to 2015 were identified from the National Trauma Data Bank by ICD-9 code. We compared demographics, injury patterns, and outcomes between geriatric (age ≥65 y) and nongeriatric adult skiers (age 18-64 y). A multiple regression analysis assessed for risk factors associated with severe injury (Injury Severity Score >15). RESULTS: We identified 3255 adult ski trauma patients, and 16.7% (543) were geriatric. Mean ages for nongeriatric versus geriatric skiers were 40.8 and 72.1 y, respectively. Geriatric skiers more often suffered head (36.7 versus 24.3%, P < 0.0001), severe head (abbreviated injury scale score >3, 49.0 versus 31.5%, P < 0.0001) and thorax injuries (22.2 versus 18.1%, P = 0.03) as compared with nongeriatric skiers. Geriatric skiers were also more often admitted to the ICU (26.5 versus 14.9%, P < 0.0001), discharged to a facility (26.7 versus 11.6%, P < 0.0001), and suffered higher mortality rates (1.3 versus 0.4%, P = 0.004). Independent risk factors for severe injury included being male (OR: 1.68, CI: 1.22-2.31), helmeted (OR: 1.41, CI: 1.07-1.85), and having comorbidities (OR: 1.37, CI: 1.05-1.80). Geriatric age was not independently associated with severe injury. CONCLUSIONS: At level 1/2 trauma centers, geriatric age in ski trauma victims was associated with unique injury patterns, higher acuity, increased rates of facility care at discharge, and higher mortality as compared with nongeriatric skiers. Our findings indicate the need for specialized care after high impact geriatric ski trauma.

Quality assessment of the literature on surgical quality improvement.

BACKGROUND: A proliferation of work on surgical quality improvement has brought about an increase in quality improvement publications. We assessed the quality of surgical quality improvement publications using the Standards of Quality Improvement Reporting Excellence (SQUIRE) guidelines. METHODS: We conducted a comprehensive review of the surgical quality improvement literature from 2008 to 2018. Articles were reviewed for concordance with 18 SQUIRE statements and 40 subheadings using a dichotomous (yes or no) scale. RESULTS: Fifty-five articles were included. No publication adhered to all 18 SQUIRE statements. On average, quality improvement publications met 11 out of 18 (61%) of the main statements and 26 out of 40 (65%) of the subheadings. Articles were concordant with introductory components, such as problem description (n = 55, 100%) and rationale (n = 52, 95%), but were less adherent to statements describing methodology, results, and discussion sections including measures (n = 7, 13%), results (n = 3, 5.5%), interpretation (n = 2, 3.6%), and conclusions (n = 2, 3.6%). Only 4 articles cited the SQUIRE guidelines (7.3%). Articles that cited SQUIRE were not more concordant to the statements than those that did not cite SQUIRE. CONCLUSION: Our analysis demonstrates that SQUIRE guidelines have not been adopted widely as a framework for the reporting of surgical quality improvement studies. Increased adherence to SQUIRE guidelines has the potential to improve the development and dissemination of surgical quality improvement projects.

A senior scholars forum can enhance the scholarship process.

BACKGROUND: The purpose of our study was to evaluate the educational value of an annual Senior Scholars Forum (SSF) of graduating Emergency Medicine resident participants and attendees. DESCRIPTION: This study was conducted at an urban academic medical center with a PGY1-4 year residency program. After completion of the 2nd annual SSF, a web-based survey instrument was sent to all resident and faculty attendees. The instrument was a 3-part tool adapted from previous studies on postgraduate scholarship. Data were analyzed using descriptive statistics. EVALUATION: Forty-two of the 44 (95%) attendees completed the survey, including 100% of the PGY4 resident presenters. Prior to the SSF, 52% of respondents did not have a full understanding of senior scholarly activities. After the SSF, 67% reported an improved understanding and 88% had a better understanding of the scope of potential scholarly projects. Sixty-four percent reported the SSF introduced them to departmental resources available for completion of their own scholarly projects, and 69% would have liked to have heard the lessons communicated earlier in residency. Most (79%) agreed the SSF demonstrated the value of communal scholarly activities. Most senior residents (67%) felt most of the department would not know about their scholarship if they had not participated in the SSF. CONCLUSIONS: Our innovative SSF enhanced the scholarship process by allowing graduating senior residents an opportunity to share their scholarly productivity with a larger audience, provided attendees critical insights into the process of scholarship, and encouraged communal learning. Because the Accreditation Council for Graduate Medical Education and Residency Review Committee require all residents to participate in scholarly activity, other training programs may benefit from a similar educational experience.