Level I trauma center internal campaign to increase safe driving by staff.

A 3-month internal campaign at our trauma center was conducted to improve employee motor vehicle safety and have employees serve as community role models. The injury-prevention coordinator and trauma program manager developed and implemented a campaign of high-visibility events. Effectiveness was evaluated through pre- and postcampaign surveys and seat belt-use observation and observation at 1 year. Although survey responses did not change, observed seat belt use increased significantly from 79% to 87%, with maintenance at 1 year (89%). No direct causal effect can be proven, but the campaign appears to have increased employee seat belt use.

Impact of elevated per cent carbohydrate-deficient transferrin at hospital admission on outcomes in trauma patients.

Chronic alcohol consumption has been linked to increased morbidity and mortality in the intensive care unit setting. The purpose of our study was to assess outcomes in trauma patients admitted to our institutional university-affiliated, Level I emergency trauma unit (ETU) with and without per cent carbohydrate-deficient transferrin (%CDT) elevations over a 12-week timeframe. Markers for alcohol consumption including %CDT, gamma glutamyl transferase, and serum osmolality were measured along with the standard trauma laboratory panel on arrival to the ETU. Intensive care unit length of stay (LOS), length of time requiring ventilator support, hospital LOS, total hospital charges as well as incidences of postoperative complications were collected on all patients with a LOS greater than or equal to 48 hours. Demographics between the groups were similar. Drinking histories were more significant in the elevated %CDT group (P = 0.0006). Patients with elevated %CDT had significantly longer ICU and hospital LOS (5.1 vs. 3.9, P = 0.01; 8.7 vs. 7.1 days, P = 0.0052) and ventilator days (2 vs. 1.5 days, P = 0.0286). Complications and hospital charges were similar between groups. Trauma patients presenting to the ETU with %CDT elevations appear to be at risk for longer ICU and hospital LOS.

Impact of an alcohol withdrawal syndrome practice guideline on surgical patient outcomes.

STUDY OBJECTIVE: To standardize treatment of alcohol withdrawal syndrome (AWS) in surgical patients using an AWS practice guideline with a symptom-triggered approach. DESIGN: Prospective interventional (pilot group) and retrospective (comparison group). SETTING: University teaching hospital. PATIENTS: Thirty-eight trauma, orthopedic, and general surgery patients identified at risk for AWS in the pilot group, and 34 patients who were managed using nonstandardized approaches. INTERVENTIONS: At-risk patients in the pilot group were assessed using the AWS Type Indicator. They received lorazepam, clonidine, or haloperidol, based on AWS Type Indicator assessment and AWS practice guideline criteria. MEASUREMENTS AND MAIN RESULTS: A standardized symptom-triggered approach to managing AWS was expected to decrease the use of benzodiazepines, avoid undertreatment of adrenergic hyperactivity and delirium, decrease the need for sitters and physical restraints, and reduce hospital length of stay. Pilot patients received a mean of 23 mg less benzodiazepine (p=0.01), 0.1 mg more clonidine (p=0.01), and 20 mg less haloperidol (p=0.06) than comparison patients. Pilot patients also required significantly fewer sitter hours (p=0.04) and hours of restraint use (p=0.09) than comparison patients. No significant differences were found between groups for length of stay (p=0.77). CONCLUSIONS: This pilot project suggests that trauma, orthopedic, and general surgery patients at risk for AWS can be safely and effectively managed with a standardized, symptom-triggered approach. Moreover, this approach decreased the amounts of benzodiazepines and haloperidol administered to patients at risk for AWS.

A feasibility pilot study on the use of text messages to track PTSD symptoms after a traumatic injury.

OBJECTIVE: Monitoring posttraumatic stress disorder (PTSD) symptoms after a traumatic injury is beneficial for patients and providers. Text messages can be used to automatically monitor symptoms and impose minimal burden to patients and providers. The present study piloted such a strategy with traumatic injury patients. METHOD: An automated daily text message was piloted to evaluate PTSD symptoms after discharge from the hospital. Twenty-nine patients who experienced a traumatic injury received 15 daily texts and were then followed up at 1-month and 3-months after discharge. RESULTS: 82.8% of the sample responded at least once and the average response rate per participant was 63.1%. Response rates were correlated with PTSD symptoms at baseline but not at any other time. Patient satisfaction with this approach was high. CONCLUSION: Text messages are a viable method to monitor PTSD symptoms after a traumatic injury. Such an approach should be evaluated on a larger scale as part of a more comprehensive early intervention for traumatic stress.

Surgical rib fixation for flail chest deformity improves liberation from mechanical ventilation.

PURPOSE: The goal of this study was to determine the impact of surgical rib fixation (SRF) in a treatment protocol for severe blunt chest trauma. MATERIALS AND METHODS: Patients with flail chest admitted between September 2009 and June 2010 to our level I trauma center who failed traditional management and underwent SRF were matched with an historical group. Outcome variables evaluated include age, injury severity score, intensive care unit length of stay (LOS), hospital LOS, ventilator days, total number of rib fractures, and total number of segmental rib fractures. RESULTS: The 2 groups were similar in age, injury severity score, intensive care unit LOS, hospital LOS, total number of rib fractures, and total segmental rib fractures. The operative group demonstrated a significant reduction in total ventilator days as compared with the nonsurgical group (4.5 [0-30] vs 16.0 [4-40]; P = .040). Patients with SRF were permanently liberated from the ventilator within a median of 1.5 days (0-8 days). CONCLUSIONS: Surgical rib fixation resulted in a significant decrease in ventilator days and may represent a novel approach to decreasing morbidity in flail chest patients when used as a rescue therapy in patients with declining pulmonary status. Larger studies are required to further identify these benefits.