Geriatric Patients on Antithrombotic Agents who Fall: Does Trauma Team Activation Improve Outcomes?

2019 ◽  
Vol 85 (7) ◽  
pp. 721-724
Author(s):  
Peter Hwang ◽  
Adrian W. Ong ◽  
Alison Muller ◽  
Amanda Mcnicholas ◽  
Anthony Martin ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Propensity Score ◽  
Geriatric Patients ◽  
Propensity Score Analysis ◽  
Trauma Team ◽  
The Elderly ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Trauma Team Activation ◽  
Injured Patients

Despite the incorporation of anticoagulant and antiplatelet (ACAP) drugs in our trauma triage criteria, it is unclear whether trauma team activation (TTA) impacts outcomes in geriatric patients on ACAP drugs sustaining falls. We hypothesized that TTA in this cohort was associated with improved outcomes. The hospital electronic database was queried to identify normotensive, awake patients aged ≥65 years on ACAP agent from 2014 to 2018 presenting to the emergency department after falls. The outcome was in-hospital mortality. The association between TTA and mortality was examined using logistic regression analysis and 1:1 propensity score matching analysis. In this study, 4540 patients on ACAP drugs were analyzed, with TTA occurring in 500 (11%). TTA occurred in younger but more severely injured patients with lower Glasgow Coma Score. Logistic regression revealed that TTA was not associated with mortality (odds ratio [95% confidence intervals], 2.04 [0.89–4.25]). The 1:1 propensity score analysis revealed similar mortality for the matched groups (non-TTA, 1.6% vs TTA, 2.2%, P = 0.64). In the elderly patients on ACAP agents, the current triage criteria resulted in the appropriate use of TTA for more severely injured patients. The lack of outcome benefit suggests that ACAP drug use as a criterion for TTA should be re-evaluated.

Opportunities for improved trauma care of the elderly – A single center analysis of 2090 severely injured patients

2012 ◽  
Vol 55 (3) ◽  
pp. 660-666 ◽  
Author(s):  
Amadéa Schönenberger ◽  
Adrian T. Billeter ◽  
Burkhardt Seifert ◽  
Valentin Neuhaus ◽  
Otmar Trentz ◽  
...  
Keyword(s):  
Trauma Care ◽  
The Elderly ◽  
Severely Injured ◽  
Single Center ◽  
Severely Injured Patients ◽  
Injured Patients

Undertriage of the elderly major trauma patient continues in major trauma centre care: a retrospective cohort review

2020 ◽  
pp. emermed-2019-208541
Author(s):  
Antonia C Hoyle ◽  
Leela C Biant ◽  
Mike Young
Keyword(s):  
Older Patients ◽  
Major Trauma ◽  
Trauma Team ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Major Trauma Centre ◽  
Trauma Triage ◽  
Injured Patients

BackgroundMajor trauma (Injury Severity Score (ISS) ≥16) in older people is increasing, but concerns persist that major trauma is not always recognised in older patients on triage. This study compared undertriage of older and younger adult major trauma patients in the major trauma centre (MTC) setting to investigate this concern.MethodsA retrospective review of Trauma Audit and Research Network data was conducted for three MTCs in the UK for 3 months in 2014. Age, ISS, injury mechanism and injured areas were examined for all severely injured patients (ISS ≥16) and appropriate major trauma triage rates measured via the surrogate markers of trauma team activation and the presence of a consultant first attender, as per standards for major trauma care set by National Confidential Enquiry into Patient Outcomes and Deaths, Royal College of Surgeons of England and the British Orthopaedic Association. Trends in older (age ≥65) and younger (ages 18–64) adult major trauma presentation, triage and reception were reviewed.ResultsOf 153 severely injured patients, 46 were aged ≥65. Older patients were significantly less likely to receive the attention of a consultant first attender or trauma team. Similar trends were also seen on subgroup analysis by mechanism of injury or number of injured body areas. Older major trauma patients exhibit a higher mortality, despite a lower median ISS (older patient ISS=20 (IQR 16–25), younger patient ISS=25 (IQR 18–29)).ConclusionOlder major trauma patients are at greater risk of undertriage, even in the MTC environment. Existing hospital trauma triage practices should be further investigated to explain and reduce undertriage of elderly trauma patients.

scholarly journals Impact of Trauma Center Care on Mortality in Gangwon Province in Korea 

2020 ◽  
Author(s):  
GYOJIN AN ◽  
Yoon-Seop Kim ◽  
Hye Sim Kim ◽  
Chan Young Kang ◽  
Sung Oh Hwang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Trauma Center ◽  
Injury Severity ◽  
Trauma Patients ◽  
Severely Injured ◽  
Trauma Centers ◽  
Severely Injured Patients ◽  
Risk Of Mortality ◽  
Injured Patients

Abstract Background: Al though controversial, there has been a consensus that compared with non-regional trauma centers, regional trauma centers have survival benefits. In a predominantly rural province with a single regional trauma center, we compared the in-hospital mortality of all trauma patients and severely injured patients between regional and non-regional trauma centers.Methods: Using data extracted from the National Emergency Department Information System in Korea, we examined all trauma patients who visited emergency departments in Gangwon province between January 2015 and December 2017. The International Classification of Disease-Based Injury Severity Score (ICISS) was used to categorize the severity of the patients. Propensity score matching was used for balancing the severity between the two groups.Results: Of 23,510 trauma patients, 2,857 and 20,653 were treated in regional and non-regional trauma centers, respectively. After propensity score matching, all patients in the non-regional trauma center group had a 6.27-fold higher risk of mortality than those in the regional trauma center group; severely injured patients—defined as those with ICISS < 0.9—in the non-regional trauma center group had a 4.90-fold higher risk of mortality than those in the regional trauma center group. ICISS cutoff values for mortality were 0.9015 and 0.8737 for the non-regional and regional trauma center groups, respectively.Conclusion: Conventional paradigms of trauma systems can be used in predominantly rural Korean provinces, because trauma care in regional trauma centers conferred better survival benefits than that in non-regional trauma centers. Additionally, severely injured patients should be transported to regional trauma centers from the trauma scene.

scholarly journals The evolution of trauma care in the Netherlands over 20 years

2019 ◽  
Vol 46 (2) ◽  
pp. 329-335 ◽  
Author(s):  
Falco Hietbrink ◽  
Roderick M. Houwert ◽  
Karlijn J. P. van Wessem ◽  
Rogier K. J. Simmermacher ◽  
Geertje A. M. Govaert ◽  
...  
Keyword(s):  
The Netherlands ◽  
Trauma Care ◽  
Trauma System ◽  
Trauma Surgeon ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
The Past ◽  
Level 1 ◽  
Trauma Surgeons ◽  
Injured Patients

Abstract Introduction In 1999 an inclusive trauma system was initiated in the Netherlands and a nationwide trauma registry, including all admitted trauma patients to every hospital, was started. The Dutch trauma system is run by trauma surgeons who treat both the truncal (visceral) and extremity injuries (fractures). Materials and Methods In this comprehensive review based on previous published studies, data over the past 20 years from the central region of the Netherlands (Utrecht) was evaluated. Results It is demonstrated that the initiation of the trauma systems and the governance by the trauma surgeons led to a region-wide mortality reduction of 50% and a mortality reduction for the most severely injured of 75% in the level 1 trauma centre. Furthermore, major improvements were found in terms of efficiency, demonstrating the quality of the current system and its constructs such as the type of surgeon. Due to the major reduction in mortality over the past few years, the emphasis of trauma care evaluation shifts towards functional outcome of severely injured patients. For the upcoming years, centralisation of severely injured patients should also aim at the balance between skills in primary resuscitation and surgical stabilization versus longitudinal surgical involvement. Conclusion Further centralisation to a limited number of level 1 trauma centres in the Netherlands is necessary to consolidate experience and knowledge for the trauma surgeon. The future trauma surgeon, as specialist for injured patients, should be able to provide the vast majority of trauma care in this system. For the remaining part, intramural, regional and national collaboration is essential

scholarly journals The impact of regionalized trauma care on the distribution of severely injured patients in the Netherlands

2021 ◽  
Author(s):  
Suzan Dijkink ◽  
Erik W. van Zwet ◽  
Pieta Krijnen ◽  
Luke P. H. Leenen ◽  
Frank W. Bloemers ◽  
...  
Keyword(s):  
The Netherlands ◽  
Trauma Care ◽  
Trauma System ◽  
Future Research ◽  
Severely Injured ◽  
Trauma Centers ◽  
Severely Injured Patients ◽  
The Right ◽  
Injured Patients ◽  
The Impact

Abstract Background Twenty years ago, an inclusive trauma system was implemented in the Netherlands. The goal of this study was to evaluate the impact of structured trauma care on the concentration of severely injured patients over time. Methods All severely injured patients (Injury Severity Score [ISS] ≥ 16) documented in the Dutch Trauma Registry (DTR) in the calendar period 2008–2018 were included for analysis. We compared severely injured patients, with and without severe neurotrauma, directly brought to trauma centers (TC) and non-trauma centers (NTC). The proportion of patients being directly transported to a trauma center was determined, as was the total Abbreviated Injury Score (AIS), and ISS. Results The documented number of severely injured patients increased from 2350 in 2008 to 4694 in 2018. During this period, on average, 70% of these patients were directly admitted to a TC (range 63–74%). Patients without severe neurotrauma had a lower chance of being brought to a TC compared to those with severe neurotrauma. Patients directly presented to a TC were more severely injured, reflected by a higher total AIS and ISS, than those directly transported to a NTC. Conclusion Since the introduction of a well-organized trauma system in the Netherlands, trauma care has become progressively centralized, with more severely injured patients being directly presented to a TC. However, still 30% of these patients is initially brought to a NTC. Future research should focus on improving pre-hospital triage to facilitate swift transfer of the right patient to the right hospital.

The (Absence of a) Role of Venous Duplex Scan in the Diagnosis of Pulmonary Embolism after Severe Trauma

2006 ◽  
Vol 72 (1) ◽  
pp. 7-10
Author(s):  
George C. Velmahos ◽  
Carlos V. Brown ◽  
Demetrios Demetriades
Keyword(s):  
Intensive Care Unit ◽  
Pulmonary Embolism ◽  
Intensive Care ◽  
Sensitivity And Specificity ◽  
Clinical Suspicion ◽  
Severely Injured ◽  
Duplex Scan ◽  
Severely Injured Patients ◽  
High Level ◽  
Injured Patients

Venous duplex scan (VDS) has been used for interim bedside diagnosis of pulmonary embolism (PE) in severely injured patients deemed to be at risk if transported out of the intensive care unit. In combination with the level of clinical suspicion for PE, VDS helps select patients for temporary treatment until definitive diagnosis is made. We evaluate the sensitivity and specificity of VDS in critically injured patients with a high level of clinical suspicion for PE. We performed a prospective observational cohort study at the surgical intensive care unit of an academic level 1 trauma center. Patients were 59 critically injured patients suspected to have PE over a 30-month period. The level of clinical suspicion for PE was classified as low or high according to preset criteria. Interventions were VDS and a PE outcome test (conventional or computed tomographic pulmonary angiography). The sensitivity and specificity of VDS to detect PE in all patients and in patients with high level of clinical suspicion was calculated against the results of the outcome test. PE was diagnosed in 21 patients (35.5%). The sensitivity and specificity of VDS was 33 per cent and 89 per cent, respectively. Among the 28 patients who had a high level of clinical suspicion for PE, the sensitivity of VDS was 23 per cent and the specificity 93 per cent. In this latter population, 1 of the 4 (25%) positive VDS was of a patient without PE and 10 of the 24 (42%) negative VDS were of patients who had PE. VDS does not accurately predict PE in severely injured patients, even in the presence of a high level of clinical suspicion.

scholarly journals Impact of Surgical Resection and Reasons for Poor Prognosis of Pelvic Osteosarcoma Based on the Bone Tumor Registry in Japan

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3320
Author(s):  
Satoshi Takenaka ◽  
Hironari Tamiya ◽  
Toru Wakamatsu ◽  
Sho Nakai ◽  
Yoshinori Imura ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Propensity Score ◽  
Surgical Resection ◽  
Bone Tumor ◽  
Poor Prognosis ◽  
Propensity Score Analysis ◽  
The Elderly ◽  
Tumor Stage ◽  
Tumor Registry ◽  
Score Analysis

Pelvic osteosarcoma has a poor prognosis compared to osteosarcomas in other locations, and the reasons for this remain unknown. Surgical resection of pelvic osteosarcoma is technically demanding and often results in dysfunction and complications. In this study, we investigated the reasons underlying the poor prognosis of pelvic osteosarcoma by comparing it to femoral osteosarcoma using data from the Bone Tumor Registry in Japan. We used propensity score analysis to determine whether surgical resection of pelvic osteosarcoma improved its prognosis. We demonstrated that pelvic osteosarcoma had a poor prognosis because it occurred more often in the elderly, often had larger tumor size, and had metastasis at presentation more often in comparison to femoral osteosarcoma. These three factors were also associated with the non-surgical treatment of pelvic osteosarcoma, which also led to a poor outcome. The overall survival rate was only comparable in pelvic osteosarcoma and femoral osteosarcoma in cases treated with surgical resection. Propensity score analysis revealed that surgical treatment improved the prognosis of pelvic osteosarcoma. As such, we propose that surgical resection should be considered based on tumor stage and patient age in order to improve the prognosis of pelvic osteosarcoma.

scholarly journals Early Versus Late Spine Surgery in Severely Injured Patients—Which Is the Appropriate Timing for Surgery?

2021 ◽  
pp. 219256822198929
Author(s):  
Arnaldo Sousa ◽  
Cláudia Rodrigues ◽  
Luís Barros ◽  
Pedro Serrano ◽  
Ricardo Rodrigues-Pinto
Keyword(s):  
Mortality Rate ◽  
Spinal Fractures ◽  
Simplified Acute Physiology Score ◽  
Neurological Injury ◽  
Spine Fractures ◽  
Severely Injured ◽  
Intubation Time ◽  
Severely Injured Patients ◽  
Level Of Evidence ◽  
Injured Patients

Study Design: Retrospective cohort study conducted at tertiary spinal trauma referral center. Objective: We aimed to determine if early definitive management of spine fractures in patients admitted to the Intensive Care Unit (ICU) shortens the intubation time and the length of stay (LOS), without increasing mortality. Methods: The medical records of all patients admitted to the ICU and submitted to surgical stabilization of spine fractures were reviewed over a 10-year period. Time to surgery, number of fractured vertebrae, degree of neurological injury, Simplified Acute Physiology Score (SAPS II), ASA score and associated trauma were evaluated. Surgeries performed on the first 72 hours after trauma were defined as “early surgeries.” Intubation time, LOS on ICU, overall LOS and mortality rate were compared between patients operated early and late. Results: Fifty patients were included, 21 with cervical fractures, 23 thoracic and 6 lumbar. Baseline characteristics did not differ between patients in both groups. Patients with early surgical stabilization had significantly shorter intubation time, ICU-LOS and overall LOS, with no differences in terms of mortality rate. After multivariate adjustments overall LOS was significantly shorter in patients operated earlier. Conclusions: Early spinal stabilization (<72 hours) of severely injured patients is beneficial and shortens the intubation time, ICU-LOS and overall LOS, with no differences in terms of mortality rate. Although some patients may require a delay in treatment due to necessary medical stabilization, every reasonable effort should be made to treat patients with unstable spinal fractures as early as possible. Level of Evidence of the Study: Level III.

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