National Analysis of Outcomes for Adult Trauma Patients With Isolated Severe Blunt Traumatic Brain Injury Following Venous Thromboembolism Prophylaxis.

INTRODUCTION: We aim to evaluate the association of early versus late venous thromboembolism (VTE) prophylaxis on in-hospital mortality among patients with severe blunt isolated traumatic brain injuries. METHODS: Data from the American College of Surgeons Trauma Quality Program Participant Use File for 2017-2021 were analyzed. The target population included adult trauma patients with severe isolated traumatic brain injury (TBI). VTE prophylaxis types (low molecular weight heparin and unfractionated heparin) and their administration timing were analyzed in relation to in-hospital complications and mortality. RESULTS: The study comprised 3609 patients, predominantly Caucasian males, with an average age of 48.5 y. Early VTE prophylaxis recipients were younger (P < 0.01) and more likely to receive unfractionated heparin (P < 0.01). VTE prophylaxis later than 24 h was associated with a higher average injury severity score and longer intensive care unit stays (P < 0.01). Logistic regression revealed that VTE prophylaxis later than 24 h was associated with significant reduction of in-hospital mortality by 38% (odds ratio 0.62, 95% confidence interval 0.40-0.94, P = 0.02). Additionally, low molecular weight heparin use was associated with decreased mortality odds by 30% (odds ratio 0.70, 95% confidence interval 0.55-0.89, P < 0.01). CONCLUSIONS: VTE prophylaxis later than 24 h is associated with a reduced risk of in-hospital mortality in patients with severe isolated blunt TBI, as opposed to VTE prophylaxis within 24 h. These findings suggest the need for timely and appropriate VTE prophylaxis in TBI care, highlighting the critical need for a comprehensive assessment and further research concerning the safety and effectiveness of VTE prophylaxis in these patient populations.

Age Effects in Facial Fracture Trauma: Disparities in Multisystem Injuries in Non-Fall-Related Trauma.

Background and objective Facial fractures represent a growing concern among an aging population prone to falls. In light of this, this study aimed to investigate differential facial fracture patterns and outcomes based on age effects. Determining the differences between the severity and type of facial fractures in populations of different ages will help guide clinical decision-making when managing patients with facial fractures. Methods This was a single-center study involving trauma registry data, from July 1, 2016, to January 31, 2022. The inclusion criteria were based on the International Classification of Diseases (ICD-10) diagnosis of facial fracture. A linear regression was performed to ascertain the effects of predictor variables on the likelihood that a facial fracture trauma patient would experience various age effects on injury location, mortality, and morbidity. Results A total of 1575 patients were included in the analysis. A significant regression equation was found (F(47,1476)=42.46, p<0.01), with an R2 of 0.57. Older facial fracture trauma patients were more likely to be female (ß=3.13, p<0.01) with fractures to their zygoma (ß=2.57, p=0.02). Higher Abbreviated Injury Scale (AIS) facial region scores (ß=2.21, p=0.03), longer hospital length of stay (ß=0.07, p=0.02), and in-hospital mortality (ß=10.47, p<0.01) were also associated with older age. Older age was additionally associated with a higher level of several morbidity markers. Younger facial fracture trauma patients were more likely to be African American (ß=-5.46, p<0.01) or other, non-Caucasian race (ß=-8.66, p<0.01) and to have mandible fracture patterns (ß=-3.63, p<0.01). The younger patients were more likely to be fully activated (ß=-3.10, p<0.01) with a higher shock index ratio (SIR) (ß=-7.36, p<0.01). Injury mechanisms in younger facial fracture patients were more likely to be assault (ß=-12.43, p<0.01), four-wheeler/ATV accident (ß=-24.80, p<0.01), gunshot (ß=-15.18, p<0.01), moped accident (ß=-13.50, p<0.01), motorcycle accident (ß=-12.31, p<0.01), motor vehicle accident (ß=-16.52, p<.01), or pedestrian being struck by a motor vehicle (ß=-10.69, p=0.02). Conclusions Based on our findings, age effects impact facial fracture patterns and outcomes. Younger patients are more likely to experience multisystem injuries via non-fall trauma. On the other hand, older patients are more likely to experience more severe primary facial injuries. Older patients are also at a higher risk of fall-related trauma. Disparities also exist between genders and races, with male and non-Caucasian patients being at a higher risk of injury from facial fractures at a younger age. With an aging population, the prevalence of falls is likely to increase. Thus, facial fractures represent a growing healthcare burden and warrant future investments related to care and treatment.

In-Hospital Mortality After Massive Transfusion and Motorcycle Trauma May Predict Highest Injury Severity in a Rural Level I Trauma System.

The leading cause of preventable traumatic death is uncontrolled bleeding. This study aimed to better identify those most likely to experience in-hospital mortality with increasing injury severity scoring (ISS). This is a single-center study of Trauma Registry data, from July 3, 2016, to February 24, 2022. The inclusion criteria were based upon age (≥18 years) and in-hospital mortality. 546 patients (mean age 58) were included in the analysis. There were several significant associations with increasing ISS among those who experienced in-hospital mortality, which included a rising shock index ratio, activation of the massive transfusion protocol, and, most notably, motorcycle trauma. This research reiterates the importance of the "Stop the Bleed" campaign as vital for training laypersons in the life-saving technique for hemorrhage control.

Predicting Complicated Mild Traumatic Brain Injury in Adolescent Trauma to Enhance Clinical Decisions in Imaging.

BACKGROUND: The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury algorithm is used to identify children at low risk of clinically significant traumatic brain injuries to reduce computed tomography (CT) exposure. Adapting PECARN rules based on population-specific risk stratification has been suggested to improve diagnostic accuracy. OBJECTIVE: This study sought to identify center-specific patient variables, beyond PECARN rules, that may enhance the identification of patients requiring neuroimaging. METHODS: This single-center, retrospective cohort study was conducted from July 1, 2016, to July 1, 2020, in a Southwestern U.S. Level II pediatric trauma center. The inclusion criteria were adolescents (10-15 years), Glasgow Coma Scale (13-15), with a confirmed mechanical blow to the head. Patients without a head CT were excluded. Logistic regression was performed to identify additional complicated mild traumatic brain injury predictor variables beyond the PECARN. RESULTS: There were 136 patients studied; 21 (15%) presented with a complicated mild traumatic brain injury. Relative to motorcycle collision or all-terrain vehicle trauma (odds ratio [OR] 211.75, 95% confidence interval, CI [4.51, 9931.41], p < .001), an unspecified mechanism (OR 42.0, 95% CI [1.30, 1350.97], p = .03) and consult activation (OR 17.44, 95% CI [1.75, 173.31], p = .01) were significantly associated with complicated mild traumatic brain injury. CONCLUSIONS: We identified additional factors associated with complex mild traumatic brain injury, including motorcycle collision and all-terrain vehicle trauma, unspecified mechanism, and consult activation that are not in the PECARN imaging decision rule. Adding these variables may aid in determining the need for appropriate CT scanning.

Increased Penetrating Trauma and Trauma Severity During the COVID-19 Lockdown.

The COVID-19 mandated lockdown created unintended outcomes in traumatic injury patterns and psychosocial behaviors compared to previous years during the same timeframe. The aim of this research is to describe a population of trauma patients during the past 5 years to determine particular trends in trauma patterns and trauma severity. A retrospective cohort study on all adult (≥18 years) trauma patients admitted to this ACS verified Level I trauma center in South Carolina, inclusive years 2017 to 2021. A total of 3281 adult trauma patients were included during the lockdown period across 5 years. There was an increase in penetrating injuries in 2020 compared to 2019 (9% vs 4%, P < .01). The psychosocial impacts of government-mandated lockdowns may lead to increased alcohol consumption leading to a higher degree of injury severity and morbidity markers in the trauma population.

Predicting Early Versus Late In-Hospital Mortality in the Trauma Population.

This study aimed to evaluate non-survivors who were admitted to a level I trauma center but later died, in terms of predicting who would expire early vs late. This is a single-center study of Trauma Registry data, from July 3, 2016, to February 24, 2022. The inclusion criteria were based upon age (≥18 years) and in-hospital mortality. 546 patients (mean age 58) were included in the analysis. Trauma patients who may experience an earlier death were those with increasing injury severity scores, activation of massive transfusion protocol, comorbid advanced directive limiting care, COPD, personality disorder, and ED death location. Patients were more likely to experience later in-hospital mortality, including those with increasing ICU stays, and comorbid dementia.

In-Hospital Mortality after Massive Transfusion and Motorcycle Trauma may Predict Highest Injury Severity in a Rural Level I Trauma System.

The leading cause of preventable traumatic death is uncontrolled bleeding. This study aimed to better identify those most likely to experience in-hospital mortality with increasing injury severity scoring (ISS). This is a single-center study of Trauma Registry data, from July 3, 2016, to February 24, 2022. The inclusion criteria were based upon age (≥18 years) and in-hospital mortality. 546 patients (mean age 58) were included in the analysis. There were several significant associations with increasing ISS among those who experienced in-hospital mortality, which included a rising shock index ratio, activation of the massive transfusion protocol, and, most notably, motorcycle trauma. This research reiterates the importance of the "Stop the Bleed" campaign as vital for training laypersons in the life-saving technique for hemorrhage control.

Can Pre-Hospital Medical Management Predict In-Hospital Mortality in Trauma?

The current literature demonstrates an association between both size and presence of TBI and its effects on mortality; however, it does not readily address the morbidity and associated functional outcomes of those who survive. We hypothesize that the likelihood of discharge to home decreases with advancement of age in the presence of TBI. This is a single-center study of trauma registry data, inclusive years July 1, 2016, to October 31, 2021. The inclusion criteria was based upon age (≥40 years), and ICD10 diagnosis of a TBI. Disposition to home without services was the dependent variable. 2031 patients were included in the analysis. We hypothesized correctly that the likelihood of discharge to home decreases (by 6%) with advancement of age (per year) in the presence of intracranial hemorrhage.

Outcome of Trauma in Elderly Patients With Pre-existing Chronic Kidney Disease.

This research aims to evaluate the specific effects of end-stage renal disease on acutely injured trauma patients. This is a single-center study of Trauma Registry data, inclusive years July 1, 2016 to February 28, 2021. Patients were grouped by pre-existing comorbidity of chronic kidney disease (CKD) and those without. Overall, 7261 elderly trauma patients were included in the analysis; stratified groups identified 197 with CKD (3%) and 7064 without (97%). The Injury Severity Scores (ISSs) between the two groups were not significantly different. Elderly trauma patients with CKD typically stayed in the ICU and hospital longer with discharge to hospice, rehab, experienced an in-hospital mortality, and most likely experienced an in-hospital complication. For CKD and non-CKD cohorts, ISSs were similar. However, outcomes for the CKD cohort in the trauma setting were significantly worse, particularly in elderly patients with fall trauma and lower extremity fractures.

Under-triage of Elderly Trauma Patients With Comorbid Conditions.

This study aims at identifying the under-triage patients to improve the quality of care among those transferred into a level I trauma system. This is a single-center study of Trauma Registry data, inclusive years, from July 1, 2016 to January 31, 2021. Patients were grouped based upon under-triage, over-triage, and OK triage. The under-triage group was more likely to be older, partially activated, blunt, fall trauma patients with a higher GCS, higher ISS, and significant injuries found to the head/neck who experienced a longer length of stay at the referring facility and higher morbidity outcomes with diagnosed comorbidities of dementia and hypertension. There are distinct differences in under and over-triage groups within this trauma system, which gives insight into future education and outreach among interfacility transfers.

Timing and Associated Outcomes of Chemical Prophylaxis Against Venous Thromboembolism in the Elderly Trauma Population.

This study aims to assess chemical VTE prophylactic type and timing and associated outcomes within the elderly trauma population. This is a single center study of Trauma Registry data, inclusive years July 1, 2016, to February 28, 2021. The patients were grouped based upon discharge disposition. 7261 elderly trauma patients were included in the analysis. Late administration of VTE prophylaxis was associated with a discharge disposition to hospice. Administration of unfractionated heparin was most associated with in-hospital mortality. Xa inhibitors had the least impact on morbidity and mortality, with most likely associations in discharge to rehab or a skilled nursing facility. LMWH associated with a discharge to a rehab facility. The timing of administration and type of VTE prophylaxis may significantly affect the morbidity and mortality outcomes in elderly trauma.

Changes in Injury Patterns Associated With Elevated Blood Alcohol Level.

INTRODUCTION: This study aims to improve public health outreach in a high-risk population. METHODS: This is a single center study of Trauma Registry data, inclusive years January 1, 2016 to March 30, 2021. The study population was stratified into two groups: ETOH ≥ 80 mg/dL and ETOH <80 mg/dL. A total of 1141 were included. RESULTS: Those above the legal drinking limit had a significantly higher mean ETOH (231 mg/dL; P <.01) and were typically younger men that arrived by ground ambulance. The significant injury patterns of those above the legal limit included full activation and consults who fell from stairs and fell from other or unknown. A higher proportion of intoxicated fall trauma patients above the legal limit were diagnosed with a concussion. CONCLUSIONS: Excess alcohol consumption, particularly during a pandemic year, may lead to a higher incidence of fall from stairs trauma in men who are more likely to be diagnosed with a concussion.

COVID-19 Resilience for Survival: Occurrence of Domestic Violence During Lockdown at a Rural American College of Surgeons Verified Level One Trauma Center.

Background As the early peak phase in the coronavirus outbreak has intensified, stay-at-home mandates requiring identified individuals as nonessential were advised to remain home to prevent community transmission of the disease. Further mandates escalated isolated environments such as school closures, social distancing, travel restrictions, closure of public gathering spaces, and business closures. As citizens were forced to stay home during the pandemic, the crisis created intensifying stressors and isolation, which fostered an environment for increased domestic violence.  Methods A retrospective review of all emergency department (ED) patients that presented to an American College of Surgeons (ACS) verified rural level one trauma center with associated diagnostic coding for assault was conducted during the Coronavirus 2019 (COVID-19) lockdown, integral dates March 16, 2020 to April 30, 2020. In particular the identification of proportional assaults that presented to the ED after school closures (March 16, 2020) was compared to the previous year (March 16, 2019 to April 30, 2019). The data collected included patient characteristics, grouping by mechanism, grouping by a specific mechanism, and domestic violence perpetrators.  Results A statistically significant (p = 0.01) increase in assaults was found during the COVID-19 lockdown, particularly during the period after school closures.  Conclusions Although overall trauma volume was reduced during the COVID-19 stay-at-home mandates, a significant increase in domestic violence assaults was observed. Largely the assaults were perpetrated against white men by partners and unspecified nonfamily members, which were predominantly penetrating injuries.

Trauma Trends During the Initial Peak of the COVID-19 Pandemic in the Midst of Lockdown: Experiences From a Rural Trauma Center.

Background  As the early peak phase in the coronavirus outbreak has intensified, stay at home mandates were advised requiring individuals to remain home to prevent community transmission of the disease. Further mandates escalated isolated environments such as school closures, social distancing, travel restrictions, closure of public gathering spaces, and business closures. As citizens were forced to stay home during the pandemic, the crisis created unique trends in trauma referrals, which consisted of atypical trends in injuries related to trauma.  Methods  A retrospective review of all trauma registry patients presenting to a rural American College of Surgeons (ACS) verified Level I trauma center with associated trauma activation before and during the Coronavirus 2019 (COVID-19) pandemic, integral dates January 1, 2020, to May 1, 2020. A comparison was made regarding trauma trends based on the previous year (January 1, 2019, to May 1, 2019). The data collected included patient characteristics, grouping by trauma activation, injury type, injury severity score (ISS), alcohol screen, drug screen, and mode of injury.  Results   A statistically significant increase was found largely among males (p = 0.02) with positive alcohol screens (p < 0.001). The statistically significant mode of injury among this trauma population included falling, jumping, pushed (p = 0.02); self-harm-jump (p = 0.01); assault (p = 0.03); and assault with sharp object (p = 0.036).  Conclusions  Although overall trauma volume was reduced preceding and during the COVID-19 stay at home mandates, a significant increase in specific trauma trends were observed, such as falls, jumps, and pushed; self-harm-jumps; assaults; and assaults with sharp objects. Largely, the trauma trends were among men with higher levels of alcohol than previously reported.