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1.
J Med Syst ; 45(12): 108, 2021 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-34755231

RESUMO

Despite improved outcomes at pediatric trauma centers (PTC), 90% of injured children are not treated at PTCs. Telemedicine may play a role in ensuring patients are transferred to the appropriate level of care. We aimed to determine the level of interest in trauma telemedicine with our PTC among referring facilities. A survey was conducted with the trauma program directors of 45 hospitals in Utah, which consisted of four multiple choice questions designed to determine interest in pediatric trauma telemedicine support, projected frequency of use, anticipated uses of telemedicine, and perceived barriers to implementation. Forty-one directors (91%) responded. 88% of directors were interested in developing a pediatric trauma telemedicine network. 20% estimated their center would use telemedicine more than once a week, 17% once a week, 24% once a month, and 37% a few times a year. The most frequently cited uses of a telemedicine program were triage/transfer decisions and provider support. Inadequate volume and insufficient funding were the most common perceived barriers. These data show there is a strong interest amongst hospitals in our state in pediatric trauma telemedicine. Inadequate volume to warrant a program and insufficient facility funding remain concerns for development of a program.


Assuntos
Telemedicina , Criança , Humanos , Centros de Traumatologia , Triagem
2.
J Trauma Nurs ; 28(6): 341-349, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34766927

RESUMO

BACKGROUND: Hemorrhage is a leading cause of early mortality following trauma. A massive transfusion protocol (MTP) to guide resuscitation while bleeding is definitively controlled may improve outcomes. Prompts to initiate massive transfusion (MT) include shock index (SI) and the Assessment of Blood Consumption (ABC) score. OBJECTIVE: To compare SI with the ABC score for association with transfusion requirement, need for emergency hemorrhage interventions, and early mortality. METHODS: A retrospective cohort analysis of trauma MTP activations at our Level I trauma center was conducted from January 1, 2012, to December 31, 2016. The study data were obtained from the Trauma Registry and the blood bank. An SI cutoff of 1.0 was chosen for comparison with the positive ABC score. RESULTS: The study cohort included 146 patients. Shock index ≥ 1 had significant association with MT requirement (p = .002) whereas a positive ABC score did not (p = .65). More patients with SI ≥ 1 required bleeding control interventions (67% surgery, 47% interventional radiology) than patients having a positive ABC score (49% surgery, 29% interventional radiology). For geriatric patients who received MT, 65% had SI ≥ 1 but only 30% had a positive ABC score. Three-hour mortality following emergency department arrival was similar (60% SI ≥ 1, 62% positive ABC score). CONCLUSION: Shock index ≥ 1 outperformed a positive ABC score for association with MT requirement. Shock index is a simple tool registered nurses can independently utilize to anticipate MT.


Assuntos
Transfusão de Sangue , Ferimentos e Lesões , Idoso , Serviço Hospitalar de Emergência , Hemorragia/diagnóstico , Hemorragia/terapia , Humanos , Estudos Retrospectivos , Centros de Traumatologia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia
3.
J Trauma Nurs ; 28(6): 363-366, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34766931

RESUMO

BACKGROUND: As the population ages, it is predicted that approximately 40% of all patients who experience fall-related trauma will be 65 years of age and older. Most injuries in older adults are caused by falls that are the result of multiple contributing factors including home hazards, comorbidities, frailty, and medications. A variety of medications have been associated with falls, specifically those with sedating and anticholinergic effects. The drug burden index can be used to quantify sedating and anticholinergic drug burden, with higher scores being associated with reduced psychomotor function. OBJECTIVE: Assess the medication-associated fall risk on admission and discharge for older patients admitted to a trauma nurse practitioner service. METHODS: Retrospective, observational study of patients managed by trauma nurse practitioners at a Level 1 trauma center between January 1, 2018, and December 31, 2019. Patients were included if they were at least 65 years of age, the primary diagnosis for the admission was fall-related trauma, and length of stay was at least 7 days. RESULTS: A total of 172 patients were included in the study. The drug burden index was significantly higher at discharge than admission (M = 1.4, SD = 0.9 vs. M = 1.9, SD = 0.9) as was the total number of medications (M = 11.0, SD = 5.2 vs. M = 15.1, SD = 5.8). CONCLUSIONS: Medication-related fall risk was increased during admission due to fall-related trauma. Patients were discharged with a higher sedating and anticholinergic burden than on admission, which increases risk for future falls.


Assuntos
Acidentes por Quedas , Fragilidade , Idoso , Hospitalização , Humanos , Estudos Retrospectivos , Fatores de Risco , Centros de Traumatologia
4.
J Trauma Nurs ; 28(6): 378-385, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34766932

RESUMO

BACKGROUND: Optimal outcomes have been reported for children treated at pediatric trauma centers; however, most children are treated at nonpediatric trauma centers or nonpediatric general hospitals. Hospitals that are not verified or designated pediatric trauma centers may lack the training and level of comfort and skill when treating severely injured children. OBJECTIVE: This study focused on identifying common pediatric guidelines for standardization across all trauma centers to inform a pediatric trauma toolkit. METHODS: A needs assessment survey was developed highlighting the guidelines from an expert committee review. The purpose of the survey was to prioritize needed items for the development of a pediatric trauma toolkit. Professional trauma organizations distributed the survey to their respective memberships to ensure good representation of people who care for traumatically injured children and work in trauma centers. Deidentified survey results were analyzed with frequencies and descriptive statistics provided. Data were compared by hospital trauma verification level using a chi-square test. The value of p < .05 was considered statistically significant. RESULTS: A total of 303 people responded to the survey. The majority of respondents reported a high value in the creation of a pediatric trauma toolkit for the guidelines that were included. There was variability in the reported access to the guidelines, indicating a significant need for the toolkit development and dissemination. CONCLUSION: As expected, Level III centers reported the largest gaps in access to standardized pediatric guidelines and demonstrated high levels of interest and need.


Assuntos
Hospitais com Alto Volume de Atendimentos , Centros de Traumatologia , Criança , Hospitais Pediátricos , Humanos , Determinação de Necessidades de Cuidados de Saúde
5.
J Trauma Nurs ; 28(6): 395-400, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34766934

RESUMO

BACKGROUND: Faced with a global pandemic at the beginning of 2020, the American College of Surgeons Committee on Trauma (ACS-COT) canceled in-person site visits. Late in 2020, the focus shifted to recovery and returning to a "new normal," and the ACS transitioned to virtual visits. OBJECTIVE: This article provides insight from a health system perspective on how we developed a virtual platform, prepared our system and staff, organized our teams, and lessons learned during virtual ACS visits. METHODS: The Northwell Health Trauma Institute, a member of the largest health system in New York State, oversees seven centers ranging from Level I to Level III, including two pediatric centers. Preparations for virtual visits began with standardizing processes to ensure a smooth transition for our centers. We utilized the ACS virtual agenda as a framework. The methods we used will be divided into categories, including technology, personnel, and preparations. RESULTS: Having multiple sites engage in the virtual visit enabled us to gain insight as we completed each visit. We standardized processes and created a team site for uploading documents. As a result, we established best practices. CONCLUSION: Shifting focus from an in-person visit to a virtual visit provided us with an opportunity to assess our preparations and to determine the most effective and efficient ways to navigate this new process. Having multiple sites allowed us to critique our process and make changes as we proceeded with subsequent sites.


Assuntos
Comitês Consultivos , Cirurgiões , Criança , Humanos , New York , Centros de Traumatologia , Estados Unidos
6.
Acta Biomed ; 92(5): e2021390, 2021 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-34738560

RESUMO

BACKGROUND AND AIM: Children displaced distal radius fractures (DRFs) are commonly treated by reduction. Yet, their excellent remodeling ability provides good clinical-radiographic outcomes even in case of non-anatomical reduction. The reduction under analgesia or sedation involves hospitalizations, greater risks, and higher hospital costs. The aim of this preliminary study is to demonstrate the accountability and conveniency of non-anatomical reduction. METHODS: The study involved all 0-8 years-old children who were affected by a closed overriding DRF from February 2017 to December 2018 and were managed non-operatively by a long arm cast without reduction, analgesia, or sedation treatments. We retrospectively evaluated their clinical-radiographic outcomes and healing time. The costs of no-reduction treatments were compared with those of the two main approaches to DRFs, that is: closed reduction under sedation and application of a long arm cast; closed reduction under anesthesia, percutaneous pinning, and application of a long arm cast. The comparison was based on the Diagnosis Related Group system. RESULTS: We treated 11 children with an average initial radial shortening of 5±3 mm and average initial sagittal and coronal angulations of 4.0° and 3.5°, respectively. Average casting duration was 40 days. All patients achieved a full range of wrist motion without deformities. The procedure was respectively 7 times less expensive than closed reduction in emergency room under sedation and application of a long arm cast, and 64 times less expensive than closed reduction in the operating room under anesthesia, percutaneous pinning, and application of a long arm cast. CONCLUSIONS: In children aged 0-8 years, non-operative treatment of closed overriding DRFs with a long arm cast without reduction is a simple and cost-effective procedure with both clinical and radiographic medium-term excellent outcomes.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Rádio , Criança , Pré-Escolar , Fixação de Fratura , Humanos , Lactente , Recém-Nascido , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/terapia , Estudos Retrospectivos , Centros de Traumatologia , Resultado do Tratamento
7.
J Pak Med Assoc ; 71(Suppl 5)(8): S26-S31, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34634011

RESUMO

OBJECTIVE: A retrospective cohort study was performed at a UK major trauma centre to identify whether timing of surgical fixation of closed unstable ankle fracture affected the rate of major wound complications. Methods: Consecutive cases of unstable ankle fractures treated with open reduction internal fixation (ORIF) between March 2014 to December 2016 were included in this retrospective cohort study. Data were collected from 2018 onwards allowing a minimum follow-up of 2 years. Patients under the age of 18, polytrauma, open fractures and those requiring external fixation were excluded. Timing of ORIF were categorised into early (within 24 hours of injury) and delayed (after 24 hours of injury). Primary outcome was major soft tissue complications (defined as deep wound infections or wound breakdown that required further surgery). Secondary outcomes included fixation failure, and symptomatic metal work requiring removal. RESULTS: A total of 235 consecutive cases were included. There were 108(46%) patients in the early fixation group, and 127(54%) patients in the delayed fixation group. Seven major wound complications were identified. Five of which were in the early group, and 2 in the late group. There was no statistically significant difference in the major wound complication rates between the early and delayed surgery groups (p = 1.000). CONCLUSIONS: No significant difference was observed in the rate of major soft tissue complications between early and delayed fixation for isolated unstable ankle fractures.


Assuntos
Fraturas do Tornozelo , Tornozelo , Fraturas do Tornozelo/epidemiologia , Fraturas do Tornozelo/cirurgia , Fixação de Fratura/efeitos adversos , Fixação Interna de Fraturas , Humanos , Estudos Retrospectivos , Centros de Traumatologia , Reino Unido/epidemiologia
8.
WMJ ; 120(3): 174-177, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34710296

RESUMO

INTRODUCTION: Trauma is the number 1 cause of death among children. Shorter distance to definitive trauma care has been correlated with better clinical outcomes. There are only a small number of pediatric trauma centers (PTC) designated by the American College of Surgeons, and the resources available to treat injured children at non-PTCs are limited. To guide resource allocation and advocacy efforts for pediatric trauma care in Wisconsin, we determined the precise distance to trauma centers for all children living in the state. METHODS: The 2010 US Census data was used to determine ZIP-centroid geolocation. The Wisconsin Department of Health Services trauma classification database was used to identify trauma facilities in Wisconsin. SAS routines invoking the Google Maps application programming interface were used to calculate the driving distance to each of the trauma facilities. We quantified the percentage of children living within 30- and 60-minute driving distances of level I-IV trauma centers. RESULTS: Just 31.3% of Wisconsin children live within a 30-minute drive of a level I PTC; 32.7% live within 30 minutes of a level II center; 81.3% within 30 minutes of a level III center; and 74.6% within 30 minutes of a level IV center. CONCLUSION: Two-thirds of children in Wisconsin live beyond a 30-minute driving distance of a level I PTC, but most children live within 30 minutes of level III and IV trauma centers. As the closest hospitals for most children, smaller trauma centers should be adequately resourced to provide pediatric trauma care.


Assuntos
Centros de Traumatologia , Ferimentos e Lesões , Criança , Humanos , Wisconsin/epidemiologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia
9.
WMJ ; 120(3): 178-182, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34710297

RESUMO

BACKGROUND: Most studies of deaths from traumatic injury are from urban trauma centers. In contrast, rural areas have higher incidence of traumatic fatal injuries than urban areas. The objective of this research was to describe trends of injuries and mortality from a trauma center serving a largely rural population and compare results with reports from the National Trauma Data Bank (NTDB). METHODS: We conducted a retrospective study of patients admitted to a rural Wisconsin level II trauma center from 2000 through 2018. Details on injuries and deaths prior to discharge were obtained from the trauma registry. Event counts and fatality ratios were described by year, sex, age, mechanism of injury, and injury severity score (ISS). Trends were analyzed across 2000-2005, 2006-2011, and 2012-2018 calendar year eras. RESULTS: During 2000-2018, there were 17,334 injury events among 16,495 patients included in the trauma registry. Across the 3 eras, the proportion of injuries related to falls increased (35.6%, 40.6%, and 51.5%, respectively), and the proportion from on-road motor vehicle events decreased (37.0 %, 32.8, and 22.5%, respectively), similar to the trends from 3 corresponding NTDB reports for 2004, 2010, and 2016. There was a statistically significant decreasing trend (P < 0.001) in overall fatality ratios across the 3 eras, 5.3% (95% CI, 4.7%-6.0%), 4.1% (95% CI, 3.7%-4.6%), and 3.9 (95% CI, 3.4%-4.4%), respectively. The fatality ratios point estimates were similar to overall fatality ratios from the NTDB reports (4.7%, 4.0%, 4.3%, respectively). The median patient age increased significantly from 42, 45, and 55 years across the 3 eras (test for trend P < 0.0001). CONCLUSION: Long-term trends of traumatic injuries and mortality were generally similar to national trends, particularly in the shift to older patients and in the increasing proportion of injury events due to falls. Further research on traumatic injuries and deaths in rural populations is needed, particularly regarding immediate deaths at the scene and longer-term deaths after discharge.


Assuntos
Centros de Traumatologia , Ferimentos e Lesões , Adulto , Humanos , Escala de Gravidade do Ferimento , Pessoa de Meia-Idade , Alta do Paciente , Estudos Retrospectivos , População Rural , Ferimentos e Lesões/epidemiologia
10.
BMC Musculoskelet Disord ; 22(1): 866, 2021 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-34635079

RESUMO

BACKGROUND: To investigate the incidence of osseous wrist and hand injuries on whole-body computed tomographies (WBCT) at an urban maximum-care trauma center, to report the number of missed cases in primary radiology reports, and to develop an algorithm for improved detection of these injuries. METHODS: Retrospective analysis reviewing all WBCT for a period of 8 months for osseous wrist and hand injuries. (1) Reconstruction of hands/wrists in three planes (thickness 1-2 mm) and analysis by a blinded musculoskeletal radiologist. (2) Scanning of primary radiology reports and comparison to the re-evaluation. (3) Calculation of the diagnostic accuracy of WBCT during primary reporting. (4) Search for factors potentially influencing the incidence (trauma mechanism, associated injuries, Glasgow Coma Scale, artifacts). (5) Development of an algorithm to improve the detection rate. RESULTS: Five hundred six WBCT were included between 01/2020 and 08/2020. 59 (11.7%) WBCT showed 92 osseous wrist or hand injuries. Distal intra-articular radius fractures occurred most frequently (n = 24, 26.1%); 22 patients (37.3%) showed multiple injuries. The sensitivity of WBCT in the detection of wrist and hand fractures during primary evaluation was low with 4 positive cases identified correctly (6.8%; 95% CI 1.9 to 16.5), while the specificity was 100% (95% CI 99.2 to 100.0). Forty-three cases (72.9%) were detected on additional imaging after clinical reassessment. Twelve injuries remained undetected (20.3%). Motorcycle accidents were more common in positive cases (22.0% vs. 10.1%, p = 0.006). 98% of positive cases showed additional fractures of the upper and/or lower extremities, whereas 37% of the patients without osseous wrist and hand injuries suffered such fractures (p < 0.001). The remaining investigated factors did not seem to influence the occurrence. CONCLUSION: Osseous wrist and hand injuries are present in 11.7% on WBCT after polytrauma. 93.2% of injuries were missed primarily, resulting in a very low sensitivity of WBCT during primary reporting. Motorcycle accidents might predispose for these injuries, and they often cause additional fractures of the extremities. Clinical re-evaluation of patients and secondary re-evaluation of WBCT with preparation of dedicated multiplanar reformations are essential in polytrauma cases to detect osseous injuries of wrist and hand reliably. TRIAL REGISTRATION: The study was registered prospectively on November 17th, 2020, at the German register for clinical trials (DRKS-ID: DRKS00023589 ).


Assuntos
Traumatismos da Mão , Punho , Traumatismos da Mão/diagnóstico por imagem , Traumatismos da Mão/epidemiologia , Humanos , Incidência , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Centros de Traumatologia
11.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(5): 838-842, 2021 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-34650282

RESUMO

OBJECTIVE: To compare and analyze the difference between the injuries of recreational skiers in public ski resorts and those of skiing athletes in official competitions, and to explore the suggestions of medical insurance for these two types of skiers. METHODS: The injury data of recreational skiers in Chongli District, Zhangjiakou City, Hebei Province during 2018-2019 and 2019-2020 snow seasons, and the injury data of skiers in two official international skiing competitions during 2019-2020 snow season and domestic test events in Chongli District of 2021 Winter Olympic Games were analyzed retrospectively, and the similarities and differences were compared. RESULTS: A total of 1 187 injuries occurred to recreational skiers in the two public ski resorts during the 2018-2019 snow season, with an injury rate of 0.3%.There were 1 277 injury sites in total, and the most frequent injury sites were head and neck (230 cases, 18.0%), followed by knee joint (204 cases, 16.0%) and lower extremity (131 cases, 10.3%). Thirty-one skiers were injured in the two official international skiing competitions in the 2019-2020 and 2020-2021 snow season, and in the domestic test competitions in the 2021 Winter Olympic Games, and the injury rates were 11.5%, 17.2% and 12.0%, respectively. There were 37 injury sites in total, among which 11 (29.7%) were in the head and neck, followed by 6 (16.2%) in the knee joint and 5 (13.6%) in the chest, rib and abdomen. CONCLUSION: In order to better guarantee the safety of skiers and timely provide corresponding medical help, safety facilities and technical guidance should be added to the snow resort for leisure skiing, and medical stations should be set up in the snow resort. As the formal ski racing for skiing athletes during the game has 30 to 80 times higher injury ratesthan recreational skiers, and compared with the recreational skiing, head and neck injury rate is higher, and the damage is much heavier, more complete first aid facilities and experienced medical workers are, needed so the field should be equipped with the circuit inside the quantities, track fixed outside the clinic, surrounding referral hospitals set up trauma centers to provide athletes with more timely medical care.


Assuntos
Traumatismos em Atletas , Esqui , Traumatismos em Atletas/epidemiologia , Humanos , Extremidade Inferior , Estudos Retrospectivos , Centros de Traumatologia
12.
Artigo em Inglês | MEDLINE | ID: mdl-34639579

RESUMO

Safety policy for e-scooters in the United States tends to vary by municipality, and the effects of safety interventions have not been well studied. We reviewed medical records at a large, urban tertiary care and trauma center in Atlanta, Georgia with the goal of identifying trends in e-scooter injury and the effects of Atlanta's nighttime ban on e-scooter rentals on injuries treated in the emergency department (ED). Records from all ED visits occurring between June 2018 through August 2020 were reviewed. To account for ambiguity in medical records, confidence levels of either "certain" or "possible" were assigned using a set of predefined criteria to categorize patient injuries as being associated with an e-scooter. A total of 380 patients categorized as having certain e-scooter related injuries were identified. The average age of these patients was 31 years old, 65% were male, 41% had head injuries, 20% of injuries were associated with the built environment, and approximately 20% were admitted to the hospital. Approximately 19% of patients with injuries associated with e-scooters noted to be clinically intoxicated or have a serum ethanol level exceeding 80 mg/dL. The implementation of a nighttime rental ban on e-scooter rentals reduced the proportion of patients with e-scooter injuries with times of arrival during the hours of the ban from 32% to 22%, however this effect was not significant (p = 0.16). More research is needed to understand how e-scooter use patterns are affected by the nighttime rental ban.


Assuntos
Traumatismos Craniocerebrais , Centros de Traumatologia , Adulto , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Estudos Retrospectivos , Centros de Atenção Terciária , Estados Unidos/epidemiologia
13.
Scand J Trauma Resusc Emerg Med ; 29(1): 156, 2021 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-34717723

RESUMO

BACKGROUND: In a terror attack mass casualty incident (TerrorMASCAL), compared to a "normal" MASCAL, there is a dynamic course that can extend over several hours. The injury patterns are penetrating and perforating injuries. This article addresses the provision of material and personnel for the care of special injuries of severely injured persons that may occur in the context of a TerrorMASCAL. METHODS: To answer the research question about the preparation of hospitals for the care of severely injured persons in a TerrorMASCAL, a survey of trauma surgery departments in Bavaria (Germany) was conducted using a questionnaire, which was prepared in three defined steps based on an expert consensus. The survey is divided into a general, neurosurgical, thoracic, vascular and trauma surgery section. In the specialized sections, the questions relate to the implementation of and material and personnel requirements for special interventions that are required, particularly for injury patterns following gunshot and explosion injuries, such as trepanation, thoracotomy and balloon occlusion of the aorta. RESULTS: In the general section, it was noted that only a few clinics have an automated system to notify off-duty staff. When evaluating the data from the neurosurgical section, the following could be established with regard to the performance of trepanation: the regional trauma centers do not perform trepanation but nevertheless have the required material and personnel available. A similar result was recorded for local trauma centers. In the thoracic surgery section, it could be determined that almost all trauma centers that do not perform thoracotomy have the required material available. This group of trauma centers also stated that they have staff who can perform thoracotomy independently. The retrograde endovascular aortic occlusion procedure is possible in 88% of supraregional, 64% of regional and 10% of local trauma centers. Pelvic clamps and external fixators are available at all trauma centers. CONCLUSION: The results of the survey show potential for optimization both in the area of framework conditions and in the care of patients. Consistent and specific training measures, for example, could improve the nationwide performance of these special interventions. Likewise, it must be discussed whether the abovementioned special procedures should be reserved for higher-level trauma centers.


Assuntos
Incidentes com Feridos em Massa , Terrorismo , Explosões , Alemanha/epidemiologia , Hospitais , Humanos , Centros de Traumatologia
14.
J Trauma Acute Care Surg ; 91(5): 829-833, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34695059

RESUMO

BACKGROUND: Trauma care is associated with unplanned readmissions, which may occur at facilities other than the index treatment facility. This "fragmentation of care" may be associated with adverse outcomes. We evaluated a statewide database that includes readmissions to analyze the incidence and impact of FC. METHODS: The California Office of Statewide Health Planning and Development patient discharge data set was evaluated for calendar years 2016 to 2018. Patients 15 years or older diagnosed with blunt abdominal solid organ injury during the index admission were identified. Readmissions were evaluated postdischarge at 1, 3, and 6 months. Patients readmitted within 6 months to a facility other than the index admission facility (fragmented care [FC]) were compared with those readmitted to their index admission facility (non-FC). Logistic regression modeling was used to evaluate risk of FC. RESULTS: Of the total 1,580 patients, there were 752 FC (47.6%) and 828 (52.4%) non-FC. Readmissions representing FC at months 1, 3, and 6 were 40.3%, 49.3%, and 53.4%, respectively. At index admission, the groups were demographically and clinically similar, with similar rates of abdominal operations and complications. Non-FC patients had a higher rate of abdominal reoperation at readmission (5.8% non-FC vs. 2.9% FC, p = 0.006). In an adjusted model, multiple readmissions (odds ratio [OR] 1.11, p = 0.014), readmission >30 days after index facility discharge (OR, 1.98; p < 0.001), and discharge to a nonmedical facility (OR, 2.46; p < 0.0001) were associated with increased odds of FC. Operative intervention at index admission was associated with lower odds of FC (OR, 0.77; p = 0.039). However, FC was not independently associated with demographic or insurance characteristics. CONCLUSION: The rate of FC among patients with blunt abdominal injury is high. The risk of FC is mitigated when patients are managed operatively during the index admission. Trauma systems should implement measures to ensure that these patients are followed postdischarge. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III; Care management, level IV.


Assuntos
Traumatismos Abdominais/cirurgia , Assistência ao Convalescente/organização & administração , Readmissão do Paciente/estatística & dados numéricos , Centros de Traumatologia/organização & administração , Ferimentos não Penetrantes/cirurgia , Adulto , Assistência ao Convalescente/normas , Assistência ao Convalescente/estatística & dados numéricos , Idoso , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/normas , Alta do Paciente/estatística & dados numéricos , Melhoria de Qualidade/organização & administração , Melhoria de Qualidade/normas , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Centros de Traumatologia/normas , Centros de Traumatologia/estatística & dados numéricos , Estados Unidos
15.
J Trauma Acute Care Surg ; 91(5): 856-860, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34695062

RESUMO

BACKGROUND: The pediatric age-adjusted shock index (SIPA) accurately identifies severely injured children following trauma without accounting for neurological status. Understanding how the presence of traumatic brain injury (TBI) affects the generalizability of SIPA as a bedside triage tool is important given high rates of TBI in the pediatric trauma population. We hypothesized that SIPA combined with TBI (SIPAB+) would more accurately identify severely injured children. METHODS: Patients (1-18 years old) in the American College of Surgeons Pediatric Trauma Quality Improvement Program database (2014-2017) with an elevated SIPA upon arrival to a pediatric trauma center were included. Pediatric age-adjusted shock index combined with TBI was defined as elevated SIPA with Glasgow Coma Scale score of ≤8. Pediatric age-adjusted shock index without TBI (SIPAB-) was defined as elevated SIPA with Glasgow Coma Scale score of >9. Patients were stratified into SIPAB+ and SIPAB-. A subanalysis of patients with isolated brain injury and those with brain injury and multisystem injuries was also performed. Data were compared through univariate models and three separate logistic regression models. RESULTS: Overall, 25,068 had an elevated SIPA, with 12.3% classified as SIPAB+ and the remainder SIPAB-. Patients classified as SIPAB+ received more blood transfusions within 4 hours of injury and had higher mortality rates. On logistic regression, SIPAB+ patients had significantly higher odds of early blood transfusion and a combination of both. Mortality and early blood transfusion were also higher in SIPAB+ patients on subanalysis for patients with isolated TBI and those with multisystem injuries. CONCLUSION: The use of SIPAB+ as a bedside triage tool accurately identifies traumatically injured children at high risk for early blood transfusion and/or death while incorporating the presence of neurological injury. This is true for patients with isolated TBI and those with multisystem injury, indicating its utility in predicting outcomes for TBI patients with elevated SIPA regardless of presence of concomitant injuries. Incorporation of this as a triage tool should be considered to better predict resources in this population. LEVEL OF EVIDENCE: Prognostic, level III.


Assuntos
Lesões Encefálicas Traumáticas/epidemiologia , Choque Hemorrágico/diagnóstico , Triagem/métodos , Adolescente , Fatores Etários , Transfusão de Sangue/estatística & dados numéricos , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/terapia , Criança , Pré-Escolar , Feminino , Escala de Coma de Glasgow , Humanos , Lactente , Escala de Gravidade do Ferimento , Masculino , Prognóstico , Sistema de Registros/estatística & dados numéricos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Choque Hemorrágico/etiologia , Choque Hemorrágico/mortalidade , Choque Hemorrágico/terapia , Centros de Traumatologia/estatística & dados numéricos , Triagem/estatística & dados numéricos
16.
Isr Med Assoc J ; 23(10): 639-645, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34672446

RESUMO

BACKGROUND: Extra peritoneal packing (EPP) is a quick and highly effective method to control pelvic hemorrhage. OBJECTIVES: To determine whether EPP can be as safely and efficiently performed in the emergency department (ED) as in the operating room (OR). METHODS: Retrospective study of 29 patients who underwent EPP in the ED or OR in two trauma centers in Israel 2008-2018. RESULTS: Our study included 29 patients, 13 in the ED-EPP group and 16 in the OR-EPP group. The mean injury severity score (ISS) was 34.9 ± 11.8. Following EPP, hemodynamic stability was successfully achieved in 25 of 29 patients (86.2%). A raise in the mean arterial pressure (MAP) with a median of 25 mmHg (mean 30.0 ± 27.5, P < 0.001) was documented. All patients who did not achieve hemodynamic stability after EPP had multiple sources of bleeding or fatal head injury and eventually succumbed. Patients who underwent EPP in the ED showed higher change in MAP (P = 0.0458). The overall mortality rate was 27.5% (8/29) with no difference between the OR and ED-EPP. No differences were found between ED and OR-EPP in the amount of transfused blood products, surgical site infections, and length of stay in the hospital. However, patients who underwent ED-EPP were more prone to develop deep vein thrombosis (DVT): 50% (5/10) vs. 9% (1/11) in ED and OR-EPP groups respectively (P = 0.038). CONCLUSIONS: EPP is equally effective when performed in the ED or OR with similar surgical site infection rates but higher incidence of DVT.


Assuntos
Exsanguinação , Fraturas Ósseas , Hemostasia Cirúrgica , Pelve , Complicações Pós-Operatórias , Infecção da Ferida Cirúrgica , Trombose Venosa , Determinação da Pressão Arterial/métodos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Exsanguinação/diagnóstico , Exsanguinação/etiologia , Exsanguinação/mortalidade , Exsanguinação/cirurgia , Feminino , Fraturas Ósseas/complicações , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/cirurgia , Hemostasia Cirúrgica/efeitos adversos , Hemostasia Cirúrgica/instrumentação , Hemostasia Cirúrgica/métodos , Humanos , Escala de Gravidade do Ferimento , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pelve/diagnóstico por imagem , Pelve/lesões , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Centros de Traumatologia/estatística & dados numéricos , Trombose Venosa/diagnóstico , Trombose Venosa/etiologia
17.
Orthopade ; 50(11): 910-915, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34622324

RESUMO

BACKGROUND: The reintegration into the social and professional environment and the achievement of the best possible quality of life after multiple injuries can often only be achieved after a lengthy rehabilitation process and belongs in the hands of experienced doctors, therapists, and rehabilitation managers. REHABILITATION PHASES: Rehabilitation after serious accidents must be differentiated from "normal" orthopedic rehabilitation after elective surgery. The challenges of trauma rehabilitation require coordinated rehabilitation phases. This is the only way to avoid the so-called "rehab hole" between discharge from the acute clinic and the start of post-acute rehabilitation. A 6-phase model is described. After acute treatment (phase A) and any necessary early rehabilitation (phase B), phase C of post-acute rehabilitation places special demands on the rehabilitation facility. Phase D of the follow-up rehabilitation is established. The further rehabilitation (phase E) provides measures specifically tailored to the consequences of the accident, such as pain rehabilitation or activity-oriented procedures. Long-term follow-up care for previously severely injured patients is necessary (phase F). PROSPECTS: An integration of trauma rehabilitation centers into the existing trauma network remains the goal to improve the outcome after polytrauma.


Assuntos
Traumatismo Múltiplo , Ortopedia , Humanos , Traumatismo Múltiplo/cirurgia , Manejo da Dor , Qualidade de Vida , Centros de Traumatologia
18.
S Afr J Surg ; 59(3): 94-96, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34515424

RESUMO

BACKGROUND: The possible effect of full moon on admission volume of trauma centres is a well-mentioned phenomenon that has been perpetuated worldwide. We aimed to review the correlation between full moon and admission volume and to interrogate any possible relationship on admission for penetrating trauma. METHODS: A retrospective study from 2012 to 2018 at Pietermaritzburg Metropolitan Trauma Service (PMTS), South Africa. RESULTS: A total of 8 722 patients were admitted. Eighty-three per cent (7 242/8 722) were male and the mean age was 29 years. The total number of days during the study period was 1 953, 66 of which were 'full moon' (FM) days and 1 887 were 'non-full moon' (NFM) days. There was no significant difference between gender or age distribution. The mean number of admissions per day on FM days compared with NFM days was not significant (4.1 vs 4.5, p = 0.583). A total of 3 332 patients with penetrating trauma were admitted. This constituted 42% (113/271) of admission on FM days and 38% (3 219) on NFM days, which is not statistically significant (p = 0.229). Subgroup analysis did not demonstrate any significant difference between the number of stab wounds - 28% (77/113) vs 25% (2 124/3 219) - or gunshot wounds - 13% (16/113) vs 12% (990/3 219) - between FM and NFM days. CONCLUSION: The correlation between full moon and trauma admission is unfound in our setting. The perpetuating notion that 'it must be full moon tonight' is likely to be an urban myth with no scientific evidence for such a claim.


Assuntos
Ferimentos por Arma de Fogo , Ferimentos Penetrantes , Ferimentos Perfurantes , Adulto , Humanos , Masculino , Lua , Estudos Retrospectivos , África do Sul/epidemiologia , Centros de Traumatologia
19.
S Afr J Surg ; 59(3): 127a-127d, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34515431

RESUMO

BACKGROUND: South African data on paediatric patients with renal trauma that are usually managed conservatively is scarce. This study aimed to review a 7-year experience of paediatric renal trauma and management. METHODS: A retrospective review of all paediatric admissions with renal injury was conducted in the Department of Paediatric Surgery, University of the Witwatersrand, between 1 January 2012 and 31 December 2018. Data from medical records reviewed included patient age, gender, mechanism of injury, severity of injury, management and length of hospital stay. RESULTS: Thirty-one patients with renal injuries were identified, of which 30 had complete data. Of these cases, 26/30 (87%) sustained blunt renal injuries and 4/30 (13%) were penetrating. The median age at presentation was 6 years, and 60% were females. Three patients had isolated renal injuries, and 23 had concomitant injuries including hepatic (9), thoracic (8), splenic (5), head (4), facial (3) and ureteric (1). Twenty-three patients were managed non-operatively. Two required renal exploration with resultant nephrectomies and one haemodynamically unstable patient died preoperatively. Four patients required operative intervention for concomitant injuries with no renal exploration. Two patients required ureteric stenting. The median length of hospital stay was 7 days (Range: 4-11 days, IQR 7 days). CONCLUSION: Renal injuries in haemodynamically stable patients should be managed non-operatively. A 93% renal preservation rate was achieved in this cohort of patients with nephrectomy performed only in haemodynamically unstable patients with Grade V injuries, in keeping with international norms.


Assuntos
Centros de Traumatologia , Ferimentos não Penetrantes , Criança , Feminino , Humanos , Escala de Gravidade do Ferimento , Rim/diagnóstico por imagem , Rim/lesões , Rim/cirurgia , Estudos Retrospectivos , África do Sul/epidemiologia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgia
20.
Swiss Med Wkly ; 151(35-36)2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34495599

RESUMO

BACKGROUND: Rapid access to a trauma centre for severely injured road accident victims, conceptualised as the Golden Hour, links access time to definitive treatment within 1 hour of trauma with reduced risks of morbidity and mortality. Access times have not been studied in Switzerland. The aim of this work was to model the transport time by ambulance of seriously injured road traffic accident victims to one of the 12 trauma centres in Switzerland and to investigate whether this time influenced mortality. METHODS: Isochronous travel curves in 10-minute increments were modelled around each of the 12 Swiss trauma centres to assess travel times at the Swiss national level, based on the shortest travel time from the location of a serious road accident to the nearest trauma centre. We used the national database of the Federal Roads Office, which provided the geolocation of these accidents occurring between 2011 and 2017. The association between mortality and transport time to the nearest trauma centre was then analysed. RESULTS: The current distribution of trauma centres allowed access time within the Golden Hour for accidents occurring on the Swiss plateau, but the time was more prolonged in the Alps or the Jura. An association existed between mortality and prehospital transport time from the site of an accident to the nearest trauma centre. For each additional 10-minute isochrone, an average increase of 0.4% in mortality was observed. CONCLUSION: This work showed an adequate distribution of trauma centres in Switzerland and suggests a positive relationship between transport time to the nearest trauma centre and mortality. The numerous confounding factors not systematically collected in publicly available databases limit the robustness of our results. This study confirms the importance of having a national trauma registry to allow quality analyses to guide public health decisions.


Assuntos
Centros de Traumatologia , Ferimentos e Lesões , Acidentes de Trânsito , Bases de Dados Factuais , Humanos , Sistema de Registros , Suíça/epidemiologia
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