Planning for the Next Pandemic: Trauma Injuries Require Pre-COVID-19 Levels of High-Intensity Resources.

As hospital systems plan for health care utilization surges and stress, understanding the necessary resources of a trauma system is essential for planning capacity. We aimed to describe trends in high-intensity resource utilization (operating room [OR] usage and intensive care unit [ICU] admissions) for trauma care during the initial months of the COVID-19 pandemic. Trauma registry data (2019 pre-COVID-19 and 2020 COVID-19) were collected retrospectively from 4 level I trauma centers. Direct emergency department (ED) disposition to the OR or ICU was used as a proxy for high-intensity resource utilization. No change in the incidence of direct ED to ICU or ED to OR utilization was observed (2019: 24%, 2020 23%; P = .62 and 2019: 11%, 2020 10%; P = .71, respectively). These results suggest the need for continued access to ICU space and OR theaters for traumatic injury during national health emergencies, even when levels of trauma appear to be decreasing.

Mapping Injury Prevention With Microsoft Excel.

BACKGROUND: Level I trauma centers must conduct injury prevention activities within their communities, despite limited resources available to them. To direct resources where they are most needed, injury prevention personnel at our trauma center use a novel method employing standard computer software. Although this method can be applied toward any injury population and prevention program, the example of targeting elderly falls prevention with A Matter of Balance classes is provided. OBJECTIVE: To share an innovative, yet efficient, technique to direct injury prevention efforts using Microsoft Excel map charts. METHODS: Using fictitious trauma registry data, an elderly falls rate is computed for each zip code. The top falls areas are then compared visually with areas where A Matter of Balance classes were conducted using Microsoft Excel map charts. RESULTS: Disparate areas of outreach, as well as areas where resources are inefficiently utilized, present in a manner that is easily recognized and communicated. CONCLUSION: Microsoft Excel map charts provide an effective and efficient means of displaying areas of greatest need, assessing disparities between those needs and outreach efforts that were conducted, and communicating with leadership.

Adding to the story, did penetrating trauma really increase? changes in trauma patterns during the COVID-19 pandemic: A multi-institutional, multi-region investigation.

BACKGROUND: Results from single-region studies suggest that stay at home orders (SAHOs) had unforeseen consequences on the volume and patterns of traumatic injury during the initial months of the Coronavirus disease 2019 (COVID-19). The aim of this study was to describe, using a multi-regional approach, the effects of COVID-19 SAHOs on trauma volume and patterns of traumatic injury in the US. METHODS: A retrospective cohort study was performed at four verified Level I trauma centers spanning three geographical regions across the United States (US). The study period spanned from April 1, 2020 - July 31, 2020 including a month-matched 2019 cohort. Patients were categorized into pre-COVID-19 (PCOV19) and first COVID-19 surge (FCOV19S) cohorts. Patient demographic, injury, and outcome data were collected via Trauma Registry queries. Univariate and multivariate analyses were performed. RESULTS: A total 5,616 patients presented to participating study centers during the PCOV19 (2,916) and FCOV19S (2,700) study periods.  Blunt injury volume decreased (p = 0.006) due to a significant reduction in the number of motor vehicle collisions (MVCs) (p = 0.003). Penetrating trauma experienced a significant increase, 8% (246/2916) in 2019 to 11% (285/2,700) in 2020 (p = 0.007), which was associated with study site (p = 0.002), not SAHOs. Finally, study site was significantly associated with changes in nearly all injury mechanisms, whereas SAHOs accounted for observed decreases in calculated weekly averages of blunt injuries (p < 0.02) and MVCs (p = 0.003). CONCLUSION: Results of this study suggest that COVID-19 and initial SAHOs had variable consequences on patterns of traumatic injury, and that region-specific shifts in traumatic injury ensued during initial SAHOs. These results suggest that other factors, potentially socioeconomic or cultural, confound trauma volumes and types arising from SAHOs. Future analyses must consider how regional changes may be obscured with pooled cohorts, and focus on characterizing community-level changes to aid municipal preparation for future similar events.

Functional Reach and Gait Speed Improvement in A Matter of Balance Participants.

BACKGROUND: Falls among older adults are the most common cause of hospital admissions. A Matter of Balance may reduce these falls by improving balance, flexibility, gait speed, and agility. OBJECTIVE: The study aimed to measure functional reach and gait speed among adults older than 65 years following A Matter of Balance. It was hypothesized that functional reach scores would increase and gait speed scores would decrease. METHODS: This was an interventional study with the primary outcomes of functional reach (measured by the Functional Reach test) and gait speed (measured by the Timed Up and Go test). A one-tailed paired t test was used to compare pre- and postprogram functional reach mean differences. A one-tailed Wilcoxon signed-rank test was used for comparing median differences of pre- and postprogram gait speed. Characteristics of participants who improved scores were compared with those who did not improve, using two-tailed independent-samples t tests and two-tailed Pearson's χ2. Effect sizes were computed for tests significant beyond p < .05. RESULTS: Mean functional reach increased by 0.6 inches (SD = 2.21, p = .002; d = 0.2). Median gait speed decreased by 1.25 s (interquartile range = 2.39, p < .001; r = .76). Improvement was not attributable to differences of age, sex, health status, preexisting conditions, or delivery site. CONCLUSIONS: Following A Matter of Balance, functional reach and gait speed improved. Adults older than 65 years should be encouraged to participate in the program, as it may reduce their fall risk.

Improving Blunt Chest Wall Injury Outcomes: Introducing the PIC Score.

BACKGROUND: To improve care for nonintubated blunt chest wall injury patients, our Level I trauma center developed a treatment protocol and a pulmonary evaluation tool named "PIC Protocol" and "PIC Score," emphasizing continual assessment of pain, incentive spirometry, and cough ability. OBJECTIVE: The primary objective was to reduce unplanned intensive care unit admissions for blunt chest wall injury patients using the PIC Protocol and the PIC Score. Additional outcomes included intensive care unit length of stay, ventilator days, length of hospital stay, inhospital mortality, and discharge destination. METHODS: This was a retrospective cohort study comparing outcomes of rib fracture patients treated at our facility 2 years prior to (control group) and 2 years following PIC Protocol use (PIC group). The protocol included admission screening, a power plan order set, the PIC Score patient assessment tool, in-room communication board, and patient education brochure. Outcomes were compared using independent-samples t tests for continuous variables and Pearson's χ2 for categorical variables with α set to p < .05. RESULTS: There were 1,036 patients in the study (control = 501; PIC = 535). Demographics and injury severity were similar between groups. Unanticipated escalations of care for acute pulmonary distress were reduced from 3% (15/501) in the control group to 0.37% (2/535) in the PIC group and were predicted by a preceding fall in the PIC Score of 3 points over the previous 8-hr shift, marking pulmonary decline by an acutely falling PIC Score. CONCLUSIONS: The PIC Protocol and the PIC Score are easy-to-use, cost-effective tools for guiding care of blunt chest wall injury patients.

Prioritizing Injury Prevention: Cause of Injury Text Analysis.

BACKGROUND: Motor vehicle (MVCs) and motorcycle crashes (MCCs) continue to be among the most prevalent mechanisms of trauma injury and mortality. We sought to identify specific populations and factors associated with MVCs and MCCs for local injury prevention efforts. A novel, yet easily performed, research method was utilized-a qualitative content analysis of text narratives describing each patient's cause of injury. OBJECTIVE: To determine target populations for local MVC and MCC injury prevention. METHODS: A retrospective descriptive analysis was performed using registry data from a Level I trauma center. The registry was queried for all trauma patients presenting with MVC or MCC injuries between June 8, 2014, and June 7, 2019. Cases were then reviewed via their respective text narratives of injury causation. Common themes were identified, coded by independent raters, and assessed for interrater reliability using Cohen's κ. Frequencies and proportions are reported for each preventable factor and patient characteristic. RESULTS: There were a total of 2,861 cases studied, of which 2,330 (81.4%) were MVC and 531 (18.6%) were MCC. Demographics varied by mechanism of injury. Driver drug or alcohol use was involved in 97 (3.4%), protective devices were not used in 776 (27.1%), distracted driving was involved in 30 (1%), excessive speeding was involved in 152 (5.3%), and driver sleeping/syncope/medical condition was present in 113 (3.9%) cases. CONCLUSIONS: Content analysis of cause of injury text narratives can detect target populations and preventable factors to direct injury prevention efforts specific to the local population.