Quantifying the Risk of Spinal Injury in Motor Vehicle Collisions According to Ambulatory Status: A Prospective Analytical Study.

BACKGROUND: The association between ambulation at the scene of a motor vehicle collision (MVC) and spinal injury has never been quantified. OBJECTIVE: To evaluate the association between ambulation and spinal injury in patients involved in a MVC. METHODS: Prospective analytical-observational cohort study. Inclusion: patients sustaining traumatic injury in a MVC. Exclusion: < 18 years old, pregnancy. PRIMARY OUTCOME: spinal injury defined as injury to the cervical, thoracic, or lumbar spinal cord, bones, or ligaments. Secondary outcome: Injury resulting in neurological deficit, need for surgery, or death. A generalized linear model was used to evaluate the association between outcome and predictor variables. Risk ratios [RR] were reported with a point estimate and 95% confidence interval (CI). A two-tailed alpha of < 0.05 was the threshold for statistical significance. RESULTS: There were 704 patients analyzed. Nonambulatory patients were 2.29 times more likely to sustain a spinal injury, compared to ambulatory patients (RR 2.29, 95% CI 1.34-3.91). Patients ≥ 65 years of age were 3.27 times more likely to sustain a spinal injury (RR 3.27, 95% CI 1.66-6.45). Patients with a Glasgow Coma Scale score ≤ 8 were 4.93 times more likely to sustain a spinal injury (RR 4.93, 95% CI 1.86-13.10). CONCLUSION: In this prospective analytical-observational study evaluating the association between ambulatory status and spinal injury in patients involved in MVCs, we observed that those patients who were nonambulatory were more than two times as likely to have a spinal injury compared to those patients who were ambulatory at the scene.

Race-related Healthcare Disparities Among California Workers: Public Health Considerations for Immigration Reform.

BACKGROUND: Healthcare disparities are prevalent in medicine and identifying them will provide healthcare professionals, administrators, and policy makers needed information to address this public health concern. OBJECTIVE: To evaluate racial and ethnic disparities in the rates of hospital admission and death among California workers. METHODS: We performed an analysis of hospital and emergency department (ED) data from the Office of Statewide Health Planning and Development (OSHPD). Data was collected from California licensed acute care hospitals from 2008-2010. INCLUSION CRITERIA: patients >15 years of age whose expected source of payment was worker's compensation. EXCLUSION CRITERIA: patients <15 years; had missing data for age, sex, race, or injury; or were injured by a suicide attempt, poisoning, or complication of medical procedure. Multivariate logistic regression was used to evaluate the relationship of race/ethnicity and admission/death rates. RESULTS: There were 393,298 patients discharged from the ED and 23,343 patients admitted from ED had workers compensation as their expected sources of payment and 150,277 met our inclusion criteria. The annual rate of ED treated injuries was 209/100,000 for Caucasians 343/100,000 for Hispanics, 258/100,000 for blacks and 97/100,000 for Asians. Compared to Caucasians, admission odds ratios (OR) were 1.15 (95% CI 1.07-1.25) for Hispanics, 1.08 (95% CI 0.87-1.33) for blacks, and 0.78 (95% CI 0.63-0.97) for Asians. CONCLUSION: We observed race and ethnicity related healthcare disparities among the occupationally injured in California, with Hispanics having the highest odds of admission and annual incidence of ED treated injuries. No difference in mortality rates was observed.

A retrospective analysis of ethnic and gender differences in alcohol consumption among emergency department patients: a cross-sectional study.

BACKGROUND: Previous studies of alcohol use have recognized several trends in consumption patterns among gender and age yet few have examined ethnic differences. This study examines the intra- and inter-ethnic differences in alcohol consumption among a population of patients seen in the emergency department. METHODS: This is a cross-sectional study conducted in the emergency department in a large urban setting. Information on drinking behavior and ethnicity was collected using the Computerized Alcohol Screening and Brief Intervention (CASI) tool. We explored differences in drinking patterns using a multivariate multinomial logistic regression model. RESULTS: We analyzed the drinking habits of 2,444 patients surveyed between November 2012 and May 2014. The results indicate that when compared to non-Hispanic whites, Asians have the lowest odds of drinking within normal limits or excessively, followed by other Latinos, and Mexicans. Age and gender consistently showed statistically significant associations with alcohol-use. The odds of drinking within normal limits or excessively are inversely associated with age and were lower among females. The predicted probabilities show a marked gender-specific difference in alcohol use both between and within ethnic/racial groups. They also highlight an age-related convergence in alcohol use between men and women within ethnic groups. DISCUSSION: The results of this study show intra-racial/ethnic variability associated with sex and education. The highlighted differences within and between ethnic groups reinforce the need to use refined categories when examining alcohol use among minorities. CONCLUSION: The results of this study confirm some alcohol consumption trends among ethnic minorities observed in literature. It provides empirical evidence of the marked gender differences and highlights an age-related convergence for gender-specific alcohol use. Health-care personnel should be aware of these differences when screening and counseling.

A Case Report of Aortic Dissection Involving the Aortic Root, Left Common Carotid Artery, and Iliac Arteries.

Acute aortic dissection is a life-threatening event caused by separation of the aortic layers that requires prompt management and surgical consultation. We present the case of a 53-year-old male who developed acute, severe chest pain radiating to his back at a community hospital and was transferred to a tertiary center for definitive surgical management. The patient's aortic dissection was diagnosed via computed tomography angiography. He was started on rate-control and blood pressure medications, and was admitted emergently to the operating room. Emergency physicians should obtain immediate surgical consultation, promptly start medications for rate and blood pressure control, and administer analgesia in order to stabilize their patient and decrease the shear forces that would further propagate an aortic dissection. Topics: Aortic dissection, cardiothoracic surgery, vascular surgery, hypertensive emergency, aorta.

Prospective randomized crossover study of simulation vs. didactics for teaching medical students the assessment and management of critically ill patients.

BACKGROUND: Simulation (SIM) allows medical students to manage high-risk/low-frequency cases in an environment without patient risk. However, evidence for the efficacy of SIM-based training remains limited. OBJECTIVE: To compare SIM-based training to traditional didactic lecture (LEC) for teaching medical students to assess and manage critically ill patients with myocardial infarction (MI) and anaphylaxis. METHODS: Prospective, randomized, non-blinded crossover study of 28 fourth-year medical students. Students were oriented to the human patient simulator, then randomized to SIM or LEC between August and December 2007. The SIM group learned to manage MI using SIM training and the LEC group learned via PowerPoint lecture. All subjects' assessment and management skills were then evaluated during a simulation session of MI. During a second instruction session, the students crossed over and were taught anaphylaxis using the opposite modality and similar assessments were conducted. Completion of critical actions for each case were scored, converted to percentages, and analyzed via signed rank test. RESULTS: Of 28 subjects, 27 performed better when trained with SIM compared with LEC (p < 0.0001). Mean scores were 93% (95% confidence interval [CI] 91-95%) of critical actions completed for SIM and 71% (95% CI 66-76%) for LEC. Absolute increase for simulation was 22% (95% CI 18-26%). For three domains common to MI and anaphylaxis, simulation scores were higher for history (27%, 95% CI 21-38%), physical examination (26%, 95% CI 20-33%), and management (16%, 95% CI 11-21%). CONCLUSION: SIM training is superior to didactic lecture for teaching fourth-year medical students to assess and manage simulated critically ill MI and anaphylaxis patients.

Jefferson Fracture and the Classification System for Atlas Fractures, A Case Report.

The Jefferson fracture classification system describes fractures of the atlas (first cervical vertebra or C1). Jefferson fractures with potential tears in the transverse ligament can cause cervical spine instability and can result in neurologic injury if not appropriately diagnosed and managed. We present the case of a 54-year-old man who fell head first with cervical spine tenderness and upper extremity paresthesias. The patient's Jefferson fracture was diagnosed via computed tomography. The patient was then treated non-operatively for his Jefferson fracture, and he had an unremarkable hospitalization. Emergency physicians should obtain surgical consultation and consider the possibility of ligamentous injury in patients suffering injury to the cervical spine. Topics: Trauma, orthopedics, neurosurgery, cervical fracture, Jefferson fracture.

Supporting the Quadruple Aim Using Simulation and Human Factors During COVID-19 Care.

The health care sector has made radical changes to hospital operations and care delivery in response to the coronavirus disease (COVID-19) pandemic. This article examines pragmatic applications of simulation and human factors to support the Quadruple Aim of health system performance during the COVID-19 era. First, patient safety is enhanced through development and testing of new technologies, equipment, and protocols using laboratory-based and in situ simulation. Second, population health is strengthened through virtual platforms that deliver telehealth and remote simulation that ensure readiness for personnel to deploy to new clinical units. Third, prevention of lost revenue occurs through usability testing of equipment and computer-based simulations to predict system performance and resilience. Finally, simulation supports health worker wellness and satisfaction by identifying optimal work conditions that maximize productivity while protecting staff through preparedness training. Leveraging simulation and human factors will support a resilient and sustainable response to the pandemic in a transformed health care landscape.

Telesimulation: An Innovative Tool for Health Professions Education.

Telesimulation is a new and innovative concept and process that has been used to provide education, training, and assessment in health-related fields such as medicine. This new area of simulation, and its terminology, has its origins within the past decade. The face validity and ability to provide the benefits of simulation education to learners at off-site locations has allowed the wide and rapid adoption of telesimulation in the field of medical education. Telesimulation has been implemented in areas such as pediatric resuscitation, surgery, emergency medicine, ultrasound-guided regional anesthesia in anesthesiology, nursing, and neurosurgery. However, its rapid expansion and current use has outgrown its recent description less than a decade ago. To date, there is no unifying definition of telesimulation that encompasses all the areas where it has been used while simultaneously allowing for growth and expansion in this field of study. This article has two main objectives. The first objective is to provide a comprehensive and unifying definition of telesimulation that encompasses all the areas where it has been used while allowing for growth and expansion in the field of study. The secondary objective is to describe the utility of telesimulation for emergency medicine educators in the context of the current evidence to serve as a background and framework that educators may use when considering creating educational programs that incorporate telecommunication and simulation resources. This article is complementary to the large group presentation where this new comprehensive and unifying definition was introduced to the simulation community at the International Meeting on Simulation in Healthcare in January 2016.

Simulation in medical school education: review for emergency medicine.

Medical education is rapidly evolving. With the paradigm shift to small-group didactic sessions and focus on clinically oriented case-based scenarios, simulation training has provided educators a novel way to deliver medical education in the 21st century. The field continues to expand in scope and practice and is being incorporated into medical school clerkship education, and specifically in emergency medicine (EM). The use of medical simulation in graduate medical education is well documented. Our aim in this article is to perform a retrospective review of the current literature, studying simulation use in EM medical student clerkships. Studies have demonstrated the effectiveness of simulation in teaching basic science, clinical knowledge, procedural skills, teamwork, and communication skills. As simulation becomes increasingly prevalent in medical school curricula, more studies are needed to assess whether simulation training improves patient-related outcomes.