Browsing by Subject "Trauma Centers"

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    Assessment of the Wisconsin Criteria at a Level I Trauma Center.
    (The Journal of craniofacial surgery, 2022-09) Gray, Megan C; Kollu, Tejas; Uppal, Priya A; Hanos, Christina; Heiman, Adee; Ricci, Joseph A; Patel, Ashit

    Abstract

    The Wisconsin Criteria was developed for physicians evaluating facial trauma to determine the likelihood of facial fractures. Subsequent studies have not consistently validated these criteria. This study seeks to validate the Wisconsin Criteria and determine its utility in predicting operative facial fractures.Retrospective chart review of the trauma database registry at a Level I Trauma Center was conducted from September 2011 to May 2019. Adult patients who had a complete facial examination by otolaryngology or plastic surgery as well as a head computed tomography scan completed, were included. Fisher exact test was utilized for statistical analysis ( P < 0.05) and positive predictive value, and negative predictive value (NPV) were calculated with a 95% confidence interval.After screening, 546 patients met eligibility, 448 had at least 1 finding of the Wisconsin Criteria, and 472 patients had facial fractures. The sensitivity of the Wisconsin Criteria for determining the presence of a facial fracture was 86.23%, the specificity was 44.59%, and the NPV was 33.67% ( P < .0001). Malocclusion was the criterion most specific in determining if a facial fracture was present (98.65%), and Glasgow Coma Score < 14 was the least specific (67.57%).The Wisconsin Criteria did aid in the identification of facial fractures in trauma patients with a comparable sensitivity, higher specificity, and much lower NPV than originally described. Further investigation should be done to validate the criteria in other large trauma centers.
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    Impact of US hospital center and interhospital transfer on spinal cord injury management: An analysis of the National Trauma Data Bank.
    (The journal of trauma and acute care surgery, 2021-06) Williamson, Theresa; Hodges, Sarah; Yang, Lexie Zidanyue; Lee, Hui-Jie; Gabr, Mostafa; Ugiliweneza, Beatrice; Boakye, Maxwell; Shaffrey, Christopher I; Goodwin, C Rory; Karikari, Isaac O; Lad, Shivanand; Abd-El-Barr, Muhammad

    Background

    Traumatic spinal cord injury (SCI) is a serious public health problem. Outcomes are determined by severity of immediate injury, mitigation of secondary downstream effects, and rehabilitation. This study aimed to understand how the center type a patient presents to and whether they are transferred influence management and outcome.

    Methods

    The National Trauma Data Bank was used to identify patients with SCI. The primary objective was to determine association between center type, transfer, and surgical intervention. A secondary objective was to determine association between center type, transfer, and surgical timing. Multivariable logistic regression models were fit on surgical intervention and timing of the surgery as binary variables, adjusting for relevant clinical and demographic variables.

    Results

    There were 11,744 incidents of SCI identified. A total of 2,883 patients were transferred to a Level I center and 4,766 presented directly to a level I center. Level I center refers to level I trauma center. Those who were admitted directly to level I centers had a higher odd of receiving a surgery (odds ratio, 1.703; 95% confidence interval, 1.47-1.97; p < 0.001), but there was no significant difference in terms of timing of surgery. Patients transferred into a level I center were also more likely to undergo surgery than those at a level II/III/IV center, although this was not significant (odds ratio, 1.213; 95% confidence interval, 0.099-1.48; p = 0.059).

    Conclusion

    Patients with traumatic SCI admitted to level I trauma centers were more likely to have surgery, particularly if they were directly admitted to a level I center. This study provides insights into a large US sample and sheds light on opportunities for improving pre hospital care pathways for patients with traumatic SCI, to provide the timely and appropriate care and achieve the best possible outcomes.

    Level of evidence

    Care management, Level IV.
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    Learning from 2523 trauma deaths in India- opportunities to prevent in-hospital deaths.
    (BMC health services research, 2017-02-16) Roy, Nobhojit; Kizhakke Veetil, Deepa; Khajanchi, Monty Uttam; Kumar, Vineet; Solomon, Harris; Kamble, Jyoti; Basak, Debojit; Tomson, Göran; von Schreeb, Johan
    A systematic analysis of trauma deaths is a step towards trauma quality improvement in Indian hospitals. This study estimates the magnitude of preventable trauma deaths in five Indian hospitals, and uses a peer-review process to identify opportunities for improvement (OFI) in trauma care delivery.All trauma deaths that occurred within 30 days of hospitalization in five urban university hospitals in India were retrospectively abstracted for demography, mechanism of injury, transfer status, injury description by clinical, investigation and operative findings. Using mixed methods, they were quantitatively stratified by the standardized Injury Severity Score (ISS) into mild (1-8), moderate (9-15), severe (16-25), profound (26-75) ISS categories, and by time to death within 24 h, 7, or 30 days. Using peer-review and Delphi methods, we defined optimal trauma care within the Indian context and evaluated each death for preventability, using the following categories: Preventable (P), Potentially preventable (PP), Non-preventable (NP) and Non-preventable but care could have been improved (NPI).During the 18 month study period, there were 11,671 trauma admissions and 2523 deaths within 30 days (21.6%). The overall proportion of preventable deaths was 58%, among 2057 eligible deaths. In patients with a mild ISS score, 71% of deaths were preventable. In the moderate category, 56% were preventable, and 60% in the severe group and 44% in the profound group were preventable. Traumatic brain injury and burns accounted for the majority of non-preventable deaths. The important areas for improvement in the preventable deaths subset, inadequacies in airway management (14.3%) and resuscitation with hemorrhage control (16.3%). System-related issues included lack of protocols, lack of adherence to protocols, pre-hospital delays and delays in imaging.Fifty-eight percent of all trauma deaths were classified as preventable. Two-thirds of the deaths with injury severity scores of less than 16 were preventable. This large subgroup of Indian urban trauma patients could possibly be saved by urgent attention and corrective action. Low-cost interventions such as airway management, fluid resuscitation, hemorrhage control and surgical decision-making protocols, were identified as OFI. Establishment of clinical protocols and timely processes of trauma care delivery are the next steps towards improving care.
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    Trauma Center Efficacy: Certification Status and its Effect on Traffic Fatalities at Varying Radii
    (2013-04-15) Van Dusen, Robert
    The goal of the paper is to better inform policy makers on the optimal placement of trauma center facilities. I examine the effect of Californian trauma centers vs. standard emergency departments on traffic fatalities for 2002 to 2008. Hospital addresses are geocoded and compared to the geographic coordinates of fatal car accidents provided through USDOT in order to create a dependent fatality density variable for every hospital at different radii. Demographic controls for different radii are constructed using ArcGIS to serve as a model for traffic fatalities.