Morbidity and Mortality of Trauma Patients 55 and Older: A Study of Nontrauma Risk Factors.

Introduction: The American College of Surgeons (ACS) recommends that special considerations be made during triage of trauma patients aged ≥55 due to an observed increase in morbidity and mortality in this population. The geriatric population aged ≥65 represents 30% of all trauma patients. Our objective was to assess which pre-existing conditions (PECs) are associated with worse outcomes in trauma patients aged ≥55. Methods: Study population was selected from the local trauma registry (2020-22). Bi-variate analysis compared PEC status with outcomes controlling for each Injury Severity Score (ISS) category. Injury Severity Score was defined as mild (1-8), moderate (9-15), severe (16-24), and critical (≥25). Results: A total of 5,168 patients were identified (54.9% female, 56.7% age ≥75, 49.1% mild injury). Patients who had chronic renal failure (CRF) were at increased odds of mortality after adjusting for mild (adjusted odds ratio [aOR]: 2.63), moderate (aOR: 2.97), severe (aOR: 2.84), and critical (aOR: 2.62) injuries. Patients who had cirrhosis or congestive heart failure (CHF) were at increased odds of mortality after adjusting for mild (aOR: 3.03, 1.61), moderate (aOR: 3.63, 2.14), and severe (aOR: 3.46, 1.93) injuries, respectively. In addition, there was a relationship between having chronic obstructive pulmonary disease (COPD), dementia, anticoagulant therapy, or diabetes with unplanned intensive care unit (ICU) admission and development of acute kidney injury (AKI). Discussion: There is an association between certain pre-exiting conditions and worse outcomes. Early identification of these factors could provide a foundation for better interdisciplinary management, prevention of complications and associated mortality.

Emergency Surgical Treatment and Triage: Targeting Optimal Outcomes for Emergency Surgical Patients From Index Encounter Through Definitive Care.

BACKGROUND: Patients with emergency surgical conditions (ESCs) experience higher complication rates than those without emergency conditions. Our purpose was to improve time-based key performance indicators (KPIs) of care for ESC patients, including diagnostic workup, empiric stabilization, and referral to definitive care. METHODS: A rapid response program (ESTAT) was developed to screen for and coordinate optimal, timely care for a spectrum of high-risk ESCs, from the patient's index clinical encounter up to definitive care. The Mann-Whitney test assessed whether any differences in KPIs were statistically significant (P < .05) before compared to after the implementation of ESTAT. RESULTS: 98 patients were identified: 44 in ESTAT group (70% age ≥55, 57% male); 54 in control group (57% age ≥55, 44% male). There were significant decreases from time of index clinical encounter to resuscitation (5 min. vs 34 min., P < .001), to diagnostic imaging (52 min. vs 1 hr. 19 min., P = .004), and to definitive care (2 hr. 17 min. vs 3 hr. 51 min., P = .007) in the ESTAT group compared to the control group, respectively. DISCUSSION: Improving time-based KPIs for delivery of clinical services is a common goal of medical emergency response systems (MERS) in numerous specialties. Implementation of an ESTAT program provides a screening tool for at-risk patients and reduces time to stabilize, diagnose and triage to definitive surgical intervention. These time benefits may ultimately translate to reduced complication rates for ESC patients. ESTAT may also represent a patient onboarding mechanism for surgical specialty verification programs promoted by quality improvement committees of various professional societies.

The Impact of Trauma Center Patient Volume on Observed/Expected Mortality: Does Size Matter?

Relationship between trauma center patient volume (TCV) and mortality remains inconclusive. Our aim was to determine the relationship between TCVs and observed/expected (O/E) all-cause mortality. This is the first study to evaluate the relationship between trauma center (TC) volumes and O/E all-cause mortality with no exclusion. Review of prospectively collected data from 94 TCs using the National Sample Program from the National Trauma Data Bank 2013. TCs were stratified into five groups based on TCV: <701, 701 to 1200, 1201 to 1700, 1701 to 2200, and >2200 yearly patient encounters. Chi-square and coefficient of determination were used for data analysis with a statistical significance defined as P-value < 0.05. A total of 139,324 trauma patients with blunt and penetrating injuries were evaluated from the National Sample Program. Of which, 63.6 per cent were male, 70.6 per cent white, and the average age was 41 years. The data were stratified by TCV into five groups with average O/Es ranging from 0.69 to 0.86 (P > 0.05). The coefficient of determination between TCV and O/E was r = 0.14 and r2 = 0.02. When controlling for Injury Severity Score, the correlation between mechanism of injury (blunt vs penetrating) and O/E mortality was r = -0.025. The group with the lowest average volumes had statistically significantly worse outcomes than the group with next higher volumes and also worse than the group with the highest volumes (Group 5, P = 0.04). Higher TC volumes correlated with higher injury severity and lower O/E mortality.

Comparison of Outcomes for Pediatric Trauma at Different Types of Trauma Centers: The Unresolved Mystery.

In Florida, injured children can receive emergent care at one of three types of state-approved trauma centers (TCs). A Level 1 combined adult/pediatric TC (L1, A + P), a Level 2 TC with an associated pediatric hospital (L2 + PH) or a pediatric TC at a pediatric hospital (PTH). This study aims to compare the mortality outcomes between Florida L1, A + Ps, to L2 + PHs, and PTHs. A retrospective review of dataset from the Agency for Health Care Administration compared outcomes from 2013 to 2016 at all three types of TCs. Outcomes were stratified by using the observed over expected mortality (O/E). Significance defined as P < 0.05. A total of 13,428 pediatric trauma patients were treated at all three TCs (L1, A + P, L2 + PHs, or PTH). L1, A + Ps treated 6975 pediatric patients with 104 deaths [crude mortality rate (CMR) 1.49%, O/E = 0.96], L2 + PHs treated 4066 patients with 69 deaths (CMR 1.70%, O/E = 1.21), PTHs treated 2387 patients with 34 deaths (CMR 1.42%, O/E = 1.25). When O/E's at L1, A + Ps and L2 + PHs were compared, results were statistically significant (P = <0.03),but not at L1, A + P versus PTHs. This is the first study to reveal that Level 1 adult/pediatric TCs have lower mortality rates compared with Level 2 TCs with an associated pediatric hospital. Level 1,A + P TCs had similar outcomes to pediatric TCs at stand-alone pediatric hospitals.

Implementing a Novel Guideline to Prevent Hospital-Acquired Pressure Ulcers in a Trauma Population: A Patient-Safety Approach.

BACKGROUND: The development of hospital-acquired pressure ulcers (HAPUs) is a common complication associated with immobilization and prolonged hospitalization in trauma patients. Our semi-annual Trauma Quality Improvement Program report identified HAPUs as an outlier complication. We used a hospital-wide initiative to reduce the incidence of HAPUs among our trauma patient population. Our study aimed to determine whether the implemented measures would decrease HAPUs incidence rates. STUDY DESIGN: We reviewed adult trauma patients during a 3-year period. The novel care-based platform and preventive measures for reducing HAPUs included the following components: pressure-reducing beds; improved and protocolized nutritional support; mandatory 2-hour change of posture; turning clocks; early surgical intervention; spot checks by our wound care nurse; and education to patients and caregivers. Paired-sample t-test and chi-square analyses were used, with significance defined as p < 0.05. RESULTS: A total of 9,755 patients were admitted to our trauma services in the study period. Of these, HAPUs developed in 89 patients (mean age 57.9 years and 48 [54%] were female). The Injury Severity Score ranged from 1 to 75, with a mean of 20 in patients with HAPUs compared with 8 in patients without HAPUs during the same study period. The incidence of HAPUs at our institution was initially 1.36%, which decreased to 0.98% in year 2 and to 0.39% in year 3 (p = 0.002). CONCLUSIONS: The novel 7-step care-based process changes, acquisition of specialized equipment, and educational initiatives implemented were associated with a significant decrease in the incidence rates of HAPUs.

Obtención de acetoderivados a partir de fenoles polifuncionalizados, empleando como catalizador un ácido de Lewis / Obtention of acetoderivatives from polyfunctionalized phenols by using a Lewis´ acid as a catalyzer

Con el empleo de un ácido de Lewis, acetato de vanadilo (VO(AcO)2) como catalizador para la obtención de acetoderivados a partir de fenoles polifuncionalizados se puede llevar a cabo una reacción de acetilación ecológicamente tolerable, ya que se substituye la piridina o aminas tóxicas por cloroformo, alcanzándose rendimientos entre 53-98 por ciento. Se presentaron y analizaron las características espectroscópicas IR, RMN-1H y 13C de los acetoderivados obtenidos(AU)

Profilaxis de riesgo materno y perinatal. Análisis del trabajo desplegado en un período de dos años / Perinatal and maternal risk prophylaxis. Analisis of two years of work

Fueron estudiadas 284 pacientes que asistieron a la consulta de planeamiento familiar del Policlínico Comunitario Docente, Area IV, de la ciudad de Cienfuegos en un período comprendido desde agosto de 1983 hasta agosto de 1985, las que fueron evaludadas en consulta por un equipo multidisciplinario integrado por obstetras del departamento, un psicólogo, una trabajadora social y una enfermera obstétrica. Se correlacionaron grupos etáreos con métodos anticonceptivos seleccionados así como paridad y conducta seguida por el equipo, lo que demostró que hay asociación entre estas variables al aplicar la prueba chi cuadrada de independencia con una confiabilidad de un 95 porciento. En cuanto al motivo de consulta, ocupó el primer lugar la intolerancia al D.I.U. en 57 casos y 20,07 porciento, seguido de la hipertensión arterial y la multipariedad como causa o situación predominante más grave. Se demostró que en general se utilizaron poco las tabletas anticonceptivas y otras técnicas, debido a las dificultades que presentaban estas pacientes que las obligó a tomar los métodos más eficaces

Profilaxis de riesgo materno y perinatal. Análisis del trabajo desplegado en un período de dos años / Perinatal and maternal risk prophylaxis. Analisis of two years of work

Fueron estudiadas 284 pacientes que asistieron a la consulta de planeamiento familiar del Policlínico Comunitario Docente, Area IV, de la ciudad de Cienfuegos en un período comprendido desde agosto de 1983 hasta agosto de 1985, las que fueron evaludadas en consulta por un equipo multidisciplinario integrado por obstetras del departamento, un psicólogo, una trabajadora social y una enfermera obstétrica. Se correlacionaron grupos etáreos con métodos anticonceptivos seleccionados así como paridad y conducta seguida por el equipo, lo que demostró que hay asociación entre estas variables al aplicar la prueba chi cuadrada de independencia con una confiabilidad de un 95 porciento. En cuanto al motivo de consulta, ocupó el primer lugar la intolerancia al D.I.U. en 57 casos y 20,07 porciento, seguido de la hipertensión arterial y la multipariedad como causa o situación predominante más grave. Se demostró que en general se utilizaron poco las tabletas anticonceptivas y otras técnicas, debido a las dificultades que presentaban estas pacientes que las obligó a tomar los métodos más eficaces(AU)