scholarly journals Success Of An Expedited Emergency Department Triage Evaluation System For Geriatric Trauma Patients Not Meeting Trauma Activation Criteria

2019 ◽  
Vol Volume 11 ◽  
pp. 241-247 ◽  
Author(s):  
Forrest B Fernandez ◽  
Adrian Ong ◽  
Anthony P Martin ◽  
C William Schwab ◽  
Tom Wasser ◽  
...  
Keyword(s):  
Emergency Department ◽  
Evaluation System ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Emergency Department Triage ◽  
Trauma Activation ◽  
Activation Criteria

Old and Undertriaged: A Lethal Combination

2012 ◽  
Vol 78 (6) ◽  
pp. 711-715 ◽  
Author(s):  
Amelia Rogers ◽  
Frederick Rogers ◽  
Eric Bradburn ◽  
Margaret Krasne ◽  
John Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Elderly Patients ◽  
Trauma Patient ◽  
Trauma Team ◽  
Geriatric Trauma ◽  
Emergency Department Physician ◽  
Risk Of Death ◽  
Trauma Service ◽  
Trauma Activation

The geriatric trauma patient poses unique challenges to the trauma surgeon due to occult injuries and occult hypoperfusion. We hypothesized that those elderly patients with significant injuries, who were not initially evaluated via trauma activation, would suffer worse outcomes. All cases of elderly (age ≥ 65) admitted to the trauma service from the years 2000 to 2010 were included. Our trauma activation system encompasses anatomic, physiologic, and mechanism of injury criteria. We defined patients as undertriaged (UT) if they had an ISS > 15 and did not undergo a trauma team activation, but had a regular workup by an emergency department physician and trauma team consultation. Factors that contributed to being UT in the emergency department were investigated by univariate and multivariate analysis. A total of 4534 elderly patients constitute this analysis, of which 15.1 per cent were UT. The UT patients were more likely to die, when adjusted for Revised Trauma Score, Glasgow Coma score, the occurrence of $1 complication, and whether the patient was on Coumadin. UT has a high risk of death in elderly patients. Trauma triage guidelines need to be better tailored to identify the high-risk geriatric trauma patient.

Evaluation of Prehospital and Emergency Department Systolic Blood Pressure as a Predictor of In-Hospital Mortality

2009 ◽  
Vol 75 (10) ◽  
pp. 1009-1014 ◽  
Author(s):  
Fariborz Lalezarzadeh ◽  
Paul Wisniewski ◽  
Katie Huynh ◽  
Maria Loza ◽  
Dev Gnanadev
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Trauma Registry ◽  
Strong Predictor ◽  
Trauma Patients ◽  
Risk Of Mortality ◽  
Blood Pressures ◽  
Activation Criterion ◽  
Trauma Activation

Hypotension is a trauma activation criterion validated by multiple studies. However, field systolic blood pressures (SBP) are still met with skepticism. How significant is the role of prehospital (PH) and emergency department (ED) SBP in the patient's overall condition? A review of the trauma registry over a 5-year period was conducted. PH SBPs were stratified into four categories: severe (SBP 80 mmHg or less), moderate (81-100 mmHg), mild hypotension (101-120 mmHg), and normotension (greater than 120 mmHg). These four groups were further subcategorized into the patients who were hypotensive, SBP 90 mmHg or less in the ED, versus those that were not (SBP greater than 90 mmHg). Data for 6964 patients were analyzed. Patients with PH SBP of 80 mmHg or less compared with patients who had PH SBP of greater than 80 mmHg had higher mortality (OR, 9; 95% CI, 6.45-12.84). Patients with both PH SBP 80 mmHg or less and ED SBP 90 mmHg or less had the highest risk of mortality (50%) and highest need for emergent operative intervention (54%). PH and ED hypotension is a strong predictor of in-hospital mortality and need for emergent surgical intervention in trauma patients. Field or ED blood pressures should serve as a significant marker of the patient's condition.

scholarly journals The Impact of Age and Receipt Antihypertensives to Systolic Blood Pressure and Shock Index at Injury Scene and in the Emergency Department to Predict Massive Transfusion in Trauma Patients

2020 ◽  
Author(s):  
Se Jin Park ◽  
Mi Jin Lee ◽  
Changho Kim ◽  
Haewon Jung ◽  
Seong Hun Kim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Systolic Blood Pressure ◽  
Massive Transfusion ◽  
Geriatric Trauma ◽  
Red Blood Cell Transfusion ◽  
Trauma Patients ◽  
Shock Index ◽  
Cutoff Value ◽  
The Impact

Abstract Background : Systolic blood pressure (SBP) and shock index (SI) are accurate indicators of hemodynamic instability and the need for transfusion in trauma patients. We aimed to determine whether the utility and cutoff point for SBP and SI are affected by age or antihypertensives. Methods : This was a retrospective observational study of a level 1 trauma center between January 2017 and December 2018. We analyzed the utility and cutoff points of SBP and SI for predicting massive transfusion (MT) and 30-day mortality according to patients’ age and whether they were taking antihypertensives. Results : We analyzed 4681 trauma cases. There were 1949 patients aged 65 years or older (41.6%), and 1375 (29.4%) hypertensive patients. MT was given to 137 patients (2.9%). The 30-day mortality rate was 6.3% (n = 294). In geriatric trauma patients taking antihypertensives, prehospital SBP less than 110 mmHg was the cutoff value for predicting MT in multivariate logistic regression analyses; packed red blood cell transfusion volume decreased abruptly based on prehospital SBP of 110 mmHg. Emergency Department SI greater than 1.0 was the cutoff value for the prediction of MT in patients who were older than 65 years who were not taking antihypertensives. Conclusions : The triage of trauma patients is based on the identification of clinical features that are readily identifiable by first responders. However, age and medications may also affect accurate evaluation. In initial trauma management, we must apply SBP and SI differently depending on age, whether a patient is taking antihypertensives, and the time at which the indicators are measured.

Location of Injury and Other Factors Associated With Increased Survival Among Severely Injured Geriatric Trauma Patients

2021 ◽  
pp. 000313482110505
Author(s):  
Paige C. Newman ◽  
Tawnya M. Vernon ◽  
Kellie E. Bresz ◽  
Jennifer A. T. Schwartz
Keyword(s):  
Geriatric Patients ◽  
Injury Severity ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Severely Injured ◽  
Retrospective Case ◽  
Benzodiazepine Use ◽  
Trauma Outcome ◽  
Trauma Injury ◽  
Trauma Activation

Background Patients with a Trauma Injury Severity Score (TRISS) < .5 are termed “unexpected survivors.” There is scarce information published on this subset of geriatric patients whose survival is an anomaly. Methods This is a retrospective case-control study examining all geriatric patients (age ≥65) not expected to survive (TRISS<.5) in the Pennsylvania Trauma Outcome Study (PTOS) database from 2013 to 2017. Primary outcome was survival to discharge. We selected 10 clinically important variables for logistic regression analysis as possible factors that may improve survival. Results 1336 patients were included, 395 (29.6%) were unexpected survivors. Factors that improved survival odds are the following: Place of injury: street/highway (AOR:0.51; 95% CI: .36-.73, P < .001) and residential institution (AOR:0.46; 95% CI: .21-.98, P = .043); and presence of Benzodiazepines (AOR:0.49; 95% CI: .31-.77, P = .002) or ethanol (AOR:0.57; 95% CI: .34-.97, P = .040). Factors that decreased survival odds are the following: Hypotension (AOR: 8.59; 95% CI: 4.33-17.01, P < .001) and hypothermia (AOR: 1.58; 95% CI: 1.10-2.28, P = .014). Gender, race/ethnicity, blood transfusion in first 24 hours, shift of presentation to Emergency Department, place of injury (farm, industrial, recreational, or public building), use of Tetrahydrocannabinol, amphetamines or opioids, and level of trauma activation did not impact survival. Discussion Location of injury (street/highway and residential institution) and ethanol or benzodiazepine use led to a significant increased survival in severely injured geriatric patients. Hypotension and hypothermia led to decreased survival. Future studies should determine possible reasons these factors lead to survival (and identify additional factors) to focus efforts in these areas to improve outcomes in geriatric trauma.

Radiographic Reread Protocols to Identify Clinically Relevant Errors in Initial Trauma Evaluations

2021 ◽  
pp. 000313482199867
Author(s):  
Madison E. Morgan ◽  
Catherine T. Brown ◽  
Tawnya M. Vernon ◽  
Brian W. Gross ◽  
Daniel Wu ◽  
...  
Keyword(s):  
Trauma Patients ◽  
Radiological Imaging ◽  
Major Life ◽  
Temporal Bone Fracture ◽  
Level Ii ◽  
Activation Level ◽  
Life Threatening ◽  
Trauma Activation ◽  
Original Interpretation ◽  
Missed Diagnoses

Introduction Diagnostic radiology interpretive errors in trauma patients can lead to missed diagnoses, compromising patient care. Due to this, our level II trauma center implemented a reread protocol of all radiographic imaging within 24 hours on our highest trauma activation level (Code T). We sought to determine the efficacy of this reread protocol in identifying missed diagnoses in Code T patients. We hypothesized that a few, but clinically relevant errors, would be identified upon reread. Methods All radiographic study findings (initial read and reread) performed for Code T admissions from July 2015 to May 2016 were queried. The reviewed radiological imaging was given one of four designations: agree with interpretation, minor (non-life threatening) nonclinically relevant error(s)—addendum/correction required or clinically relevant error(s) (major [life threatening] and minor)—addendum/correction required, and trauma surgeon notified. The results were compiled, and the number of each type of error was calculated. Results Of the 752 radiological imaging studies reviewed on the 121 Code T patients during this period, 3 (0.40%) contained minor clinically relevant errors, 11 (1.46%) contained errors that were not clinically relevant, and 738 (98.1%) agreed with the original interpretation. The three clinically relevant errors included a right mandibular fracture found on X-ray and a temporal bone fracture that crossed the clivus and bilateral rib fractures found on computerized tomography. Discussion Clinically relevant errors, although minimal, were discovered during rereads for Code T patients. Although the clinical errors were significant, none affected patient outcomes. We propose that the implementation of reread protocols should be based upon institution-specific practices.

Impact of 24/7 Onsite Emergency Radiology Staff Coverage on Emergency Department Workflow

2021 ◽  
pp. 084653712110238
Author(s):  
Francesco Macri ◽  
Bonnie T. Niu ◽  
Shannon Erdelyi ◽  
John R. Mayo ◽  
Faisal Khosa ◽  
...  
Keyword(s):  
Emergency Department ◽  
Major Trauma ◽  
Patient Flow ◽  
Interrupted Time Series ◽  
Trauma Patients ◽  
Linear Regression Models ◽  
High Acuity ◽  
Time Series Approach ◽  
Comparison Series ◽  
The Impact

Purpose: Assess the impact of 24/7/365 emergency trauma radiology (ETR) coverage on Emergency Department (ED) patient flow in an urban, quaternary-care teaching hospital. Methods: Patient ED visit and imaging information were extracted from the hospital patient care information system for 2008 to 2018. An interrupted time-series approach with a comparison group was used to study the impact of 24/7/365 ETR on average monthly ED length of stay (ED-LOS) and Emergency Physician to disposition time (EP-DISP). Linear regression models were fit with abrupt and permanent interrupts for 24/7/365 ETR, a coefficient for comparison series and a SARIMA error term; subgroup analyses were performed by patient arrival time, imaging type and chief complaint. Results: During the study period, there were 949,029 ED visits and 739,796 diagnostic tests. Following implementation of 24/7/365 coverage, we found a significant decrease in EP-DISP time for patients requiring only radiographs (-29 min;95%CI:-52,-6) and a significant increase in EP-DISP time for major trauma patients (46 min;95%CI:13,79). No significant change in patient throughput was observed during evening hours for any patient subgroup. For overnight patients, there was a reduction in EP-DISP for patients with symptoms consistent with stroke (-78 min;95%CI:-131,-24) and for high acuity patients who required imaging (-33 min;95%CI:-57,-10). Changes in ED-LOS followed a similar pattern. Conclusions: At our institution, 24/7/365 in-house ETR staff radiology coverage was associated with improved ED flow for patients requiring only radiographs and for overnight stroke and high acuity patients. Major trauma patients spent more time in the ED, perhaps reflecting the required multidisciplinary management.

627 Strategies for Reducing Emergency Department Lengths of Stay for Admitted Pediatric Burn Patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S169-S169
Author(s):  
Lisa M Shostrand ◽  
Brett C Hartman ◽  
Belinda Frazee ◽  
Dawn Daniels ◽  
Madeline Zieger
Keyword(s):  
Emergency Department ◽  
Gap Analysis ◽  
Burn Patients ◽  
Improvement Project ◽  
Burn Trauma ◽  
Charge Nurse ◽  
Lengths Of Stay ◽  
Burn Unit ◽  
Set Up ◽  
Trauma Activation

Abstract Introduction Various strategies to reduce emergency department (ED) lengths of stay (LOS) for admitted pediatric burn patients may be employed as a quality improvement project. Decreasing ED LOS may promote patient outcomes and reduce morbidity. Initial discussions were brought forth during trauma and burn multidisciplinary peer review rounds in March 2019 and have persisted to present day. Methods Several strategies, such as preparation of the burn unit staff within one hour of patient arrival in ED, notification to the burn unit by the burn attending of an incoming pediatric burn patient, allowing the PICU charge nurses or advisors to assist with room set up and admissions, and creating a checklist to assist PICU nurses and advisors in helping prepare for anticipating inpatient admissions. These strategies were designed and enforced in March/April 2019. In addition to these action plans, trauma activation alerts were added in December 2019 to the burn charge nurse phone for pediatric burn trauma one and trauma alerts for more expedient notifications. Finally, communication efforts between ED and burn leadership teams were conducted in June 2020 to help with additional mitigating of ED LOS, such as discussing the appropriateness of specialty consults while in the ED. Results Initial ED LOS was reduced from 209 minutes in March 1019 to 150 minutes in June 2019. Increased trends were noted in early 2020, with a peak at 244 minutes in July 2020. Additional interventions, such as trauma activation alerts and ED/Burn team communications, did not provide sustainable long-term reductions. Conclusions Recent strategies to reduce overall ED LOS trends have been beneficial, but not consistent, in sustaining downward trends. Action to perform a gap analysis to discover persistent barriers and to introduce additional structure, such as a burn trauma one algorithm, may provide stability to this metric.

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